Ineffective self-management of lymphedema in mastectomized women: concept analysis

Associate Editor (Peer review process): Camila Takao Lopes (https://orcid.org/0000-0002-6243-6497) Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

Conflicts of interest: The authors have nothing to declare.

Databases	Search Strategies
Virtual Health Library	(lymphedema) AND (mastectomy) OR (breast cancer) AND (nursing) AND (self management) OR (self care)
PubMed	((lymphedema) OR (lymphoedema)) AND (breast cancer)) OR (extended radical mastectomies)) OR (mastectomy)) OR (breast removal)) OR (breast cancer surgery)) ) ) OR (axillary lymphedema)) AND (self care)
Web of Science (SciELO index)	((lymphedema) OR (lymphoedema)) AND (mastectomy) OR (breast cancer) AND (self management))
Cinahl	((lymphedema) OR (lymphoedema)) AND ((breast cancer) OR (mastectomy) OR (breast removal)) AND ((self care) OR (self management))
Scopus	(lymphedema) AND (mastectomy) AND ( self-care) OR (self-management) AND (breast cancer)

Years	Countries	Authors	Study Titles	Journals	Designs	LE
2020	Brazil	Paiva et al.⁽⁴⁾	Nursing care from the perspective of the world in the life of women who experience lymphedema resulting from breast cancer treatment.	Anna Nery School Journal of Nursing	Qualitative phenomenological approach**	6
2012	China	Huang HP, Zhou JR, Zeng Q⁽⁵⁾	Risk Factors Associated with Lymphedema among Postmenopausal Breast Cancer Survivors after Radical Mastectomy and Axillary Dissection in China.	Breast Care	Descriptive**	6
2018	Mexico	De la Borbolla Martínez GD, Martínez MEH, Raygoza NP⁽¹⁴⁾	Nursing intervention in women who developed lymphedema after undergoing a modified radical mastectomy: A pre-experimental study	Ecancer Medical Science	Prospective longitudinal**	4
2022	China	Li et al⁽¹⁵⁾	Illness perceptions and adherence to breast cancer-related lymphedema risk management behaviours among breast cancer survivors.	European Journal of Oncology Nursing	Transversal**	6
2020	Türkiye	Cal A, Bahar Z, Gorken I⁽¹⁶⁾	Effects of Health Belief Model based nursing interventions offered at home visits on lymphedema prevention in women with breast cancer: A randomised controlled trial.	Journal of Clinical Nursing	Randomized controlled**	2
2020	Türkiye	Aydin A, Gursoy A⁽¹⁷⁾	Lymphedema Information and Prevention Practices of Women After Breast Cancer Surgery.	Florence Nightingale Journal of Nursing	Descriptive**	6
2017	Brazil	Bonisson et al^.(18)	Lymphedema in women undergoing breast cancer surgery	Revista Rene	Transversal**	6
2012	Türkiye	Sisman H, Sahin B, Duman BB, Tanriverdi G⁽¹⁹⁾	Nurse-assisted education and exercise decrease the prevalence and morbidity of lymphedema following breast cancer surgery.	Journal of the Balkan Union of Oncology	Transversal*	6
2009	USA	Swenson KK, Nissen MJ, Leach JW, Post-White J⁽²⁰⁾	Case-control study to evaluate predictors of lymphedema after breast cancer surgery.	Oncology Nursing Forum	Case control**	4
2007	USA	Meneses KD, McNees MP⁽²¹⁾	Upper extremity lymphedema after treatment for breast cancer: a review of the literature.	Ostomy Wound Manage	Literature review	7
2011	USA	Ridner SH, Dietrich MS, Kidd N⁽²²⁾	Breast cancer treatment-related lymphedema self-care: Education, practices, symptoms, and quality of life	Support Care Cancer	Transversal**	6
2019	Brazil	Marchito LO, Fabro EAN, Maccedo FO, Costa RM, Lou MBA⁽²³⁾	Prevention and Care of Lymphedema after Breast Cancer: Understanding and Adherence to Physiotherapeutic Guidelines	Rev. bras. cancerol	Qualitative descriptive**	6
2022	Brazil	Assis MR, Maraglia PH, Brandão MAG, Peixoto MAP ⁽²⁴⁾	Metacognition as an educational technology in self-care learning: the case of prevention of post-surgical lymphedema of breast cancer	Esc. Anna Nery Rev. Enferm	Reflection based on philosophical and theoretical reasoning	7
2021	Australia	Koelmeyer et al.⁽²⁵⁾	Prospective surveillance model in the home for breast cancer-related lymphoedema: a feasibility study.	Breast cancer research and treatment	Group Intervention Study**	3
2018	Canada	Shallwani SM, Towers A⁽²⁶⁾	Self-Management Strategies for Malignant Lymphedema: A Case Report with 1-Year and 4-Year Follow-Up Data.	Physiotherapy Canada	Case report**	7
2020	UK	Board J⁽²⁷⁾	Lymphoedema education for a Breast Cancer Support Group: an overview of the programme and its delivery.	Journal of Lymphoedema	Article**	6
2021	Australia	Koelmeyer LA, Sherman KA, Boyages J, Dean CM⁽²⁸⁾	Understanding home monitoring and self-management in breast cancer-related lymphoedema: a qualitative study.	Journal of Lymphoedema	Qualitative**	6
2013	UK	Jeffs E, Wiseman T⁽²⁹⁾	Randomised controlled trial to determine the benefit of daily home-based exercise in addition to self-care in the management of breast cancer-related lymphoedema: a feasibility study	Support Care Cancer	Randomized Controlled Clinical Trial**	2
2011	China	Chung CW, Hwang EK, Hwang SW ⁽³⁰⁾	Details of Lymphedema, Upper Limb Morbidity, and Self-Management in Women after Breast Cancer Treatment.	Korean Journal of Women Health Nursing	Transversal**	6
2021	Türkiye	Deveci Z, Karayurt O, Eyigor S⁽³¹⁾	Self-care practices, patient education in women with breast cancer-related lymphedema.	Turkish Journal of Physical Medicine & Rehabilitation	Transversal**	6
2008	Türkiye	Armer et al.⁽³²⁾	The health deviation of post-breast cancer lymphedema: symptom assessment and impact on self-care agency.	Self-Care, Dependent-Care & Nursing	Prospective longitudinal**	4
2019	Denmark	Ammitzbøll et al.⁽³³⁾	Progressive resistance training to prevent arm lymphedema in the first year after breast cancer surgery: Results of a randomized controlled trial.	Cancer	Randomized clinical trial**	2
2019	Türkiye	Temur K, Kapucu S⁽³⁴⁾	The effectiveness of lymphedema self-management in the prevention of breast cancer-related lymphedema and quality of life: A randomized controlled trial.	European Journal of Oncology Nursing	Randomized clinical trial**	2
2016	USA	Ridner et al.⁽³⁵⁾	Breast cancer survivors’ perspectives of critical lymphedema self-care support needs.	Supportive Care in Cancer	Qualitative descriptive**	6
2016	UK	Jeffs et al.⁽³⁶⁾	Exploring patient perception of success and benefit in self-management of breast cancer-related arm lymphoedema.	European Journal of Oncology Nursing	Qualitative**	6
2012	USA	Fife et al.⁽³⁷⁾	A randomized controlled trial comparing two types of pneumatic compression for breast cancer-related lymphedema treatment in the home	Supportive Care in Cancer	Randomized clinical trial**	2
2017	USA	Ostby PL, Armer JM, Smith K, Stewart BR⁽³⁸⁾	Patient Perceptions of Barriers to Self-Management of Breast Cancer–Related Lymphedema	Western Journal of Nursing Research	Qualitative**	6
2022	Türkiye	Brown et al.⁽³⁹⁾	Prescription and adherence to lymphedema self-care modalities among women with breast cancer-related lymphedema	Supportive Care in Cancer	Randomized clinical trial**	2
2022	Türkiye	Cansız G, Arıkan Dönmez A, Kapucu S, Borman P⁽⁴⁰⁾	The effect of a self-management Prescription and adherence to lymphedema self-care modalities among women with breast cancer-related lymphedema education program on lymphedema, lymphedema-related symptoms, patient compliance, daily living activities and patient activation in patients with breast cancer-related lymphedema: A quasi-experimental study.	European Journal of Oncology Nursing	Experimental control group**	4
2019	Canada	Bolette et al.⁽⁴¹⁾	Self-Measured Arm Circumference in Women With Breast Cancer Is Reliable and Valid.	Physical Therapy	Transversal**	6
2021	Iran	Noura et al.⁽⁴²⁾	Effect of Self-care Training on Upper Limb Function and Pain After Breast Cancer Surgery.	Med Surg Nurs J.	Experimental**	3
2015	Australia	Sherman KA, Miller SM, Roussi P, Taylor A⁽⁴³⁾	Factors predicting adherence to risk management behaviors of women at increased risk for developing lymphedema	Support Care Cancer	Prospective longitudinal*	4
2015	USA	Brown et al.⁽⁴⁴⁾	Association Between Lymphedema Self-Care Adherence and Lymphedema Outcomes Among Women with Breast Cancer-Related Lymphedema	American Journal of Physical Medicine & Rehabilitation	Randomized clinical trial**	2
2005	USA	Fu MR⁽⁴⁵⁾	Breast cancer survivors’ intentions of managing lymphedema	Cancer Nursing	Cross-sectional qualitative**	6
2015	Australia	Alcorso et al.⁽⁴⁶⁾	Psychosocial factors associated with adherence for self-management behaviors in women with breast cancer-related lymphedema.	Support Care Cancer	Transversal*	6
2015	Sweden	Karlsson K, Biguet G, Johansson K, Nilsson-Wikmar L⁽⁴⁷⁾	Perceptions of lymphoedema treatment in patients with breast cancer - a patient perspective.	Scandinavian Journal of Caring Sciences	Qualitative, phenomenographic method**	6
2011	USA	Armer JM, Brooks CW, Stewart BR⁽⁴⁸⁾	Limitations of self-care in reducing the risk of lymphedema: supportive-educative systems	Nursing Science Quarterly	Secondary analysis of qualitative data**	6
2013	Ireland	McGrath T⁽⁴⁹⁾	Irish insights into the lived experience of breast cancer related lymphoedema: implications for occupation focused practice.	World Federation of Occupational Therapists Bulletin	Longitudinal qualitative research**	6
2016	Australia	Alcorso et al.⁽⁵⁰⁾	Perceived barriers to adherence to breast cancer-related lymphoedema self-management.	Journal of Lymphoedema	Descriptive quantitative**	6
2014	Brazil	Hamaji et al.⁽⁵¹⁾	Care to mastectomy with axillary lymphadenectomy, lymphedema prevention: an integrative review	Journal of Nursing UFPE	Integrative review**	6
2016	USA	Maree JE, Beckmann D⁽⁵²⁾	Just live with it”: Having to live with breast cancer related lymphedema.	Health SA Gesondheid	Exploratory qualitative**	6
2012	South Africa	Wanchai A, Stewart BR, Armer JM⁽⁵³⁾	Experiences and management of breast cancer-related lymphoedema: a comparison between South Africa and the United States of America	International Nursing Review	Qualitative**	6
2023	Türkiye	Deveci Z, Karaywurt O, Bilik O, Eyigör S⁽⁵⁴⁾	Development of the Breast Cancer Related Lymphedema Self-Care Scale	Clinical Nursing Research	Descriptive**	6

Defining attributes	Identification of studies	n (%)
Edema and/or swelling in the arm	Aydin A, Gursoy A⁽¹⁷⁾ Swenson KK, Nissen MJ, Leach JW, Post-White J⁽²⁰⁾ Ridner SH, Dietrich MS, Kidd N⁽²²⁾ Shallwani SM, Towers A⁽²⁶⁾ Jeffs E, Wiseman T⁽²⁹⁾ Armer et al⁽³²⁾ Ammitzbøll et al.⁽³³⁾ Temur K, Kapucu S⁽³⁴⁾ Ridner et al.⁽³⁵⁾ Maree JE, Beckmann D⁽⁵²⁾ Deveci Z, Karaywurt O, Bilik O, Eyigör S⁽⁵⁴⁾	11 (25.6)
Feeling of weight in the arm	Assis MR, Maraglia PH, Brandão MAG, Peixoto MAP⁽²⁴⁾; Jeffs E, Wiseman T⁽²⁹⁾ Armer et al.⁽³²⁾ Ammitzbøll et al.⁽³³⁾ Cansız G, Arıkan Dönmez A, Kapucu S, Borman P⁽⁴⁰⁾ Deveci Z, Karaywurt O, Bilik O, Eyigör S⁽⁵⁴⁾	6 (14.0)
Pain	Jeffs E, Wiseman T⁽²⁹⁾ Ammitzbøll et al.⁽³³⁾ Cansız G, Arıkan Dönmez A, Kapucu S, Borman P⁽⁴⁰⁾ Maree JE, Beckmann D⁽⁵²⁾ Deveci Z, Karaywurt O, Bilik O, Eyigör S ⁽⁵⁴⁾	5 (11.6)
Low adherence to self-care modalities in lymphedema	Brown et al.⁽³⁹⁾ Alcorso et al.⁽⁴⁶⁾ Armer JM, Brooks CW, Stewart BR⁽⁴⁸⁾ Alcorso et al.⁽⁵⁰⁾	4 (9.30)
Difference in arm circumference	Cal A, Bahar Z, Gorken I⁽¹⁶⁾ Sisman H, Sahin B, Duman BB, Tanriverdi G⁽¹⁹⁾ Wanchai A, Stewart BR, Armer JM⁽⁵³⁾	3 (6.97)
Numbness	Armer et al.⁽³²⁾ Ammitzbøll et al.⁽³³⁾ Cansız G, Arıkan Dönmez A, Kapucu S, Borman P⁽⁴⁰⁾	3 (6.97)
Decrease in limb function	Li et al⁽¹⁵⁾ Cansız G, Arıkan Dönmez A, Kapucu S, Borman P⁽⁴⁰⁾ Deveci Z, Karaywurt O, Bilik O, Eyigör S⁽⁵⁴⁾	3 (6.97)
Decrease in arm range	Assis MR, Maraglia PH, Brandão MAG, Peixoto MAP⁽²⁴⁾ Maree JE, Beckmann D⁽⁵²⁾ Deveci Z, Karaywurt O, Bilik O, Eyigör S⁽⁵⁴⁾	3 (6.97)
Lack of observation of signs and symptoms and risk factors	Huang HP, Zhou JR, Zeng Q⁽⁵⁾ Ostby PL, Armer JM, Smith K, Stewart BR⁽³⁸⁾	2 (4.65)
Disuse of the affected limb with edema	Chung CW, Hwang EK, Hwang SW⁽³⁰⁾ Deveci Z, Karaywurt O, Bilik O, Eyigör S⁽⁵⁴⁾	2 (4.65)
Changes in arm edema volume	Koelmeyer LA, Sherman KA, Boyages J, Dean CM⁽²⁸⁾ Fife et al.⁽³⁷⁾	2 (4.65)
Lack of lymphedema management	Ridner et al.⁽³⁵⁾ Cansız G, Arıkan Dönmez A, Kapucu S, Borman P⁽⁴⁰⁾	2 (4.65)
Lack of self-management of lymphedema symptoms	Noura et al.⁽⁴²⁾ Karlsson K, Biguet G, Johansson K, Nilsson-Wikmar L⁽⁴⁷⁾	2 (4.65)
Barriers and burdens to self-care	Brown et al.⁽⁴⁴⁾ Alcorso et al.⁽⁴⁶⁾	2 (4.65)
Lack of knowledge about risk factors	Bonisson et al^.(18)	1 (2.32)
Weight gain	Meneses KD, McNees MP⁽²¹⁾	1 (2.32)
Arm injury	Meneses KD, McNees MP⁽²¹⁾	1 (2.32)
Lack of self-management to control and/or reduce lymphedema	Board J⁽²⁷⁾	1 (2.32)
Lack of effective monitoring of lymphedema symptoms	Sherman KA, Miller SM, Roussi P, Taylor A⁽⁴³⁾	1 (2.32)
Lack of self-care activities with the affected limb	Fu MR⁽⁴⁵⁾	1 (2.32)
P Everyday problems when wearing compression clothing (e.g.: increase in body temperature)	Karlsson K, Biguet G, Johansson K, Nilsson-Wikmar L⁽⁴⁷⁾	1 (2.32)
Absence of aesthetics in the affected limb	Paiva et al.⁽⁴⁾	1 (2.32)
Lack of care to minimize lymphedema	Hamaji et al.⁽⁵¹⁾	1 (2.32)
Change in skin texture	Assis MR, Maraglia PH, Brandão MAG, Peixoto MAP⁽²⁴⁾	1 (2.32)
Fatigue	Ammitzbøll et al.⁽³³⁾	1 (2.32)
Absence of commitment to self-care guidelines	McGrath T⁽⁴⁹⁾	1 (2.32)

Antecedents	Identification of studies	n (%)
Related to patients
Lack of family and/or social support	Ridner et al.⁽³⁵⁾ Jeffs et al.⁽³⁶⁾ Alcorso et al.⁽⁵⁰⁾ Deveci Z, Karaywurt O, Bilik O, Eyigör S⁽⁵⁴⁾	4 (9.30)
Education level	Bonisson et al^.(18) Deveci Z, Karayurt O, Eyigor S⁽³¹⁾	3 (6.97)
Family income	Bonisson et al^.(18) Alcorso et al.⁽⁵⁰⁾	2 (4.65)
Daily time spent on self-care	Ridner SH, Dietrich MS, Kidd N⁽²²⁾ Alcorso et al.⁽⁵⁰⁾	2 (4.65)
Physical discomfort	Fu MR⁽⁴⁵⁾ Wanchai A, Stewart BR, Armer JM⁽⁵³⁾	2 (4.65)
Using clothing to disguise swelling	Paiva et al.⁽⁴⁾ Alcorso et al.⁽⁵⁰⁾	2 (4.65)
Pain	McGrath T⁽⁴⁹⁾ Wanchai A, Stewart BR, Armer JM⁽⁵³⁾	2 (4.65)
Physical limitations	Alcorso et al.⁽⁵⁰⁾ Maree JE, Beckmann D⁽⁵²⁾	2 (4.65)
Lack of self-measurement on the arm	Bolette et al.⁽⁴¹⁾	1 (2.32)
Overweight	Swenson KK, Nissen MJ, Leach JW, Post-White J⁽²⁰⁾	1 (2.32)
Concern	Board J⁽²⁷⁾	1 (2.32)
Psychic suffering	Alcorso et al.⁽⁴⁶⁾	1 (2.32)
Negative experience with compression sleeves	Karlsson K, Biguet G, Johansson K, Nilsson-Wikmar L⁽⁴⁷⁾	1 (2.32)
Psychic and cognitive limitations	Armer JM, Brooks CW, Stewart BR⁽⁴⁸⁾	1 (2.32)
Sensation of muscle shortening	McGrath T⁽⁴⁹⁾	1 (2.32)
Advanced age	Deveci Z, Karayurt O, Eyigor S⁽³¹⁾	1 (2.32)
Chronic diseases	Deveci Z, Karayurt O, Eyigor S⁽³¹⁾	1 (2.32)
Lack of emotional support	Ammitzbøll et al.⁽³³⁾	1 (2.32)
Related to adherence to self-care
Difficulty in using accessible technologies and techniques	Ridner SH, Dietrich MS, Kidd N⁽²²⁾ Assis MR, Maraglia PH, Brandão MAG, Peixoto MAP⁽²⁴⁾ Koelmeyer et al.⁽²⁵⁾ Shallwani SM, Towers A⁽²⁶⁾ Jeffs E, Wiseman T⁽²⁹⁾ Deveci Z, Karayurt O, Eyigor S⁽³¹⁾ Jeffs et al.⁽³⁶⁾ Fu MR⁽⁴⁵⁾ Hamaji et al.⁽⁵¹⁾	9 (20.9)
Self-care deficit	Armer et al.⁽³²⁾ Fife et al.⁽³⁷⁾ Ostby PL, Armer JM, Smith K, Stewart BR⁽³⁸⁾; Brown et al.⁽³⁹⁾ Sherman KA, Miller SM, Roussi P, Taylor A⁽⁴³⁾ Alcorso et al.⁽⁴⁶⁾ Hamaji et al.⁽⁵¹⁾ Deveci Z, Karaywurt O, Bilik O, Eyigör S⁽⁵⁴⁾	8 (18.6)
Cost of treatment	Alcorso et al.⁽⁵⁰⁾ Maree JE, Beckmann D⁽⁵²⁾	2 (4.65)
Lack of resources for self-care activities	Ridner et al.⁽³⁵⁾	1 (2.32)
Difficulties integrating physical exercise and drainage into the daily routine	Temur K, Kapucu S⁽³⁴⁾	1 (2.32)
Related to knowledge and educational practices
Lack of knowledge about self-care	Ridner SH, Dietrich MS, Kidd N⁽²²⁾ Marchito LO, Fabro EAN, Maccedo FO, Costa RM, Lou MBA⁽²³⁾ Koelmeyer LA, Sherman KA, Boyages J, Dean CM⁽²⁸⁾ Ostby PL, Armer JM, Smith K, Stewart BR⁽³⁸⁾ Noura et al.⁽⁴²⁾ Hamaji et al.⁽⁵¹⁾	6 (14.0)
Nursing education and/or intervention	De la Borbolla Martínez GD, Martínez MEH, Raygoza NP⁽¹⁴⁾ Cal A, Bahar Z, Gorken I⁽¹⁶⁾ Aydin A, Gursoy A⁽¹⁷⁾ Sisman H, Sahin B, Duman BB, Tanriverdi G⁽¹⁹⁾ Huang HP, Zhou JR, Zeng Q⁽⁵⁾	5 (11.6)
Limitation in knowledge about lymphedema	Ridner et al.⁽³⁵⁾ Karlsson K, Biguet G, Johansson K, Nilsson-Wikmar L⁽⁴⁷⁾ Armer JM, Brooks CW, Stewart BR⁽⁴⁸⁾ Alcorso et al.⁽⁵⁰⁾	4 (9.30)
Knowledge about lymphedema management	Meneses KD, McNees MP⁽²¹⁾ Sherman KA, Miller SM, Roussi P, Taylor A⁽⁴³⁾	2 (4.65)
Lack of self-care training	Noura et al.⁽⁴⁴⁾	1 (2.32)

Consequences	Identification of studies	n (%)
Decrease in quality of life	Cal A, Bahar Z, Gorken I⁽¹⁶⁾ Ridner SH, Dietrich MS, Kidd N⁽²²⁾ Assis MR, Maraglia PH, Brandão MAG, Peixoto MAP⁽²⁴⁾ Koelmeyer LA, Sherman KA, Boyages J, Dean CM⁽²⁸⁾ Ostby PL, Armer JM, Smith K, Stewart BR⁽³⁸⁾; Cansız G, Arıkan Dönmez A, Kapucu S, Borman P⁽⁴⁰⁾ Sherman KA, Miller SM, Roussi P, Taylor A⁽⁴³⁾ Alcorso et al.⁽⁴⁶⁾ Karlsson K, Biguet G, Johansson K, Nilsson-Wikmar L⁽⁴⁷⁾	9(20.93)
Interference with daily and work activities	Swenson KK, Nissen MJ, Leach JW, Post-White J⁽²⁰⁾ Assis MR, Maraglia PH, Brandão MAG, Peixoto MAP⁽²⁴⁾ Cansız G, Arıkan Dönmez A, Kapucu S, Borman P⁽⁴⁰⁾ Fu MR⁽⁴⁵⁾ Alcorso et al.⁽⁴⁶⁾ Maree JE, nBeckmann D⁽⁵²⁾ Deveci Z, Karaywurt O, Bilik O, Eyigör S⁽⁵⁴⁾	7(16.27)
Psychic suffering	Koelmeyer LA, Sherman KA, Boyages J, Dean CM⁽²⁸⁾ Jeffs et al.⁽³⁶⁾ Sherman KA, Miller SM, Roussi P, Taylor A⁽⁴³⁾ Fu MR⁽⁴⁵⁾ Alcorso et al.⁽⁴⁶⁾ Karlsson K, Biguet G, Johansson K, Nilsson-Wikmar L⁽⁴⁷⁾	6(13.95)
Pain	Paiva et al.⁽⁴⁾ Temur K, Kapucu S⁽³⁴⁾ Jeffs et al.⁽³⁶⁾ Fife et al.⁽³⁷⁾ Noura et al.⁽⁴²⁾ Deveci Z, Karaywurt O, Bilik O, Eyigör S⁽⁵⁴⁾	6(13.95)
Concern about appearance and/or aesthetics	Jeffs et al.⁽³⁶⁾ Fife et al.⁽³⁷⁾ Alcorso et al.⁽⁴⁶⁾	3(6.97)
Muscle weakness	Temur K, Kapucu S⁽³⁴⁾ Jeffs et al.⁽³⁶⁾ Noura et al.⁽⁴²⁾	3(6.97)
Embarrassment and/or shame	Paiva et al.⁽⁴⁾ Karlsson K, Biguet G, Johansson K, Nilsson-Wikmar L⁽⁴⁷⁾ Hamaji et al.⁽⁵¹⁾	3(6.97)
Concern about the future	Cal A, Bahar Z, Gorken I⁽¹⁶⁾ Karlsson K, Biguet G, Johansson K, Nilsson-Wikmar L⁽⁴⁷⁾	2(4.65)
Dysfunction in the affected limb	Jeffs et al.⁽³⁶⁾ Noura et al.⁽⁴²⁾	2(4.65)
Loss of self-esteem	Paiva et al.⁽⁴⁾ Hamaji et al.⁽⁵¹⁾	2(4.65)
Feeling of heaviness	Fife et al.⁽³⁷⁾ Deveci Z, Karaywurt O, Bilik O, Eyigör S⁽⁵⁴⁾	2(4.65)
Skin infections	Noura et al.⁽⁴²⁾ Deveci Z, Karaywurt O, Bilik O, Eyigör S⁽⁵⁴⁾	2(4.65)
Swelling progress	Fife et al.⁽³⁷⁾ Deveci Z, Karaywurt O, Bilik O, Eyigör S⁽⁵⁴⁾	2(4.65)
Lack of visible positive results	Ridner SH, Dietrich MS, Kidd N⁽²²⁾	1(2.32)
Difficulty choosing what to wear	Temur K, Kapucu S⁽³⁴⁾	1(2.32)
Sexual problems	Temur K, Kapucu S⁽³⁴⁾	1(2.32)
Unsuccessful management	Ostby PL, Armer JM, Smith K, Stewart BR⁽³⁸⁾	1(2.32)
Occupational distress	McGrath T⁽⁴⁹⁾	1(2.32)
Feeling of guilt	Karlsson K, Biguet G, Johansson K, Nilsson-Wikmar L⁽⁴⁷⁾	1(2.32)

[1] Corresponding author: Juliana Maria Barbosa Bertho de Oliveira Email: jmbertho3001@gmail.com

Brasil

Brasil

Ineffective self-management of lymphedema in mastectomized women: concept analysis

Abstract

Objective

Methods

Results

Conclusion