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Katapodi MC, Ellis KR, Schmidt F, Nikolaidis C, Northouse LL. Predictors and interdependence of family support in a random sample of long-term young breast cancer survivors and their biological relatives. Cancer Med 2018; 7:4980-4992. [PMID: 30187678 PMCID: PMC6198202 DOI: 10.1002/cam4.1766] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 08/07/2018] [Accepted: 08/09/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Women diagnosed with breast cancer younger than 45 years (young breast cancer survivors-YBCS) and their biological relatives face significant stressors. Although family support is an important coping resource, little is known about YBCS' and relatives' support and whether it is interdependent. The study described family support in YBCS and their biological relatives; identified demographic, clinical, and psychosocial predictors of support; and determined the interdependence of support in YBCS-relatives family units. METHODS Data were collected from a random sample of YBCS and their first- or second-degree female relatives. Actor-partner interdependence models (APIM) explored predictors and interdependence of YBCS' and relatives' family support in dyads (YBCS and relative) and triads (YBCS and two relatives). RESULTS Among n = 310 YBCS and n = 431 first- or second-degree relatives, family support was higher in triads compared to dyads. APIMs identified actor effects in dyads, and actor and partner effects in triads. Across all family units, YBCS' higher self-efficacy was associated with higher YBCS support (actor effect) and relative support (partner effect); YBCS' prior diagnosis of depression was associated with lower YBCS and relative support (actor and partner effect); cost-related lack of access to care was associated with lower support among YBCS (actor effect) and relatives (actor and partner effect). CONCLUSIONS Family support was interdependent and was affected by self-efficacy, depression, and access to care. Interventions should include YBCS and relatives, enhance self-efficacy and access to care.
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Affiliation(s)
- Maria C. Katapodi
- Nursing ScienceFaculty of MedicineUniversity of BaselBaselSwitzerland
- School of NursingUniversity of MichiganAnn ArborMichigan
| | | | - Franziska Schmidt
- Institute of Higher Education and Research in Healthcare ‐ IUFRSUniversity Hospital Vaudois ‐ CHUVUniversity of Lausanne ‐ UNILLausanneSwitzerland
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Esplen MJ, Leszcz M, Hunter J, Wong J, Leung YW, Toner B, Messner S, Glendon G, Stuckless N, Butler C. A randomized controlled trial of a supportive expressive group intervention for women with a family history of breast cancer. Psychooncology 2018; 27:2645-2653. [PMID: 29952047 DOI: 10.1002/pon.4822] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 06/11/2018] [Accepted: 06/14/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Women with a family history of breast cancer (BC) often overestimate their BC risk. Heightened psychological distress may interfere with risk comprehension and screening adherence. The primary purpose of this study was to test the efficacy of a 12-week manual-based supportive-expressive (SE) group intervention for this population. METHODS Using a randomized control trial design, this study compared two interventions: a standard risk-counseling arm (RC) compared with that plus SE group intervention. The primary study outcome was BC anxiety. Secondary outcomes included psychosocial functioning, risk comprehension, BC knowledge, and screening behaviors. RESULTS A total of 161 women with a family history of BC were randomized into SE (N = 108) or RC (N = 53). Participants in both study arms significantly improved on measures of BC anxiety, psychosocial functioning, risk comprehension, and BC knowledge, with no statistical difference between study arms. Benefits were sustained at 1 year. BC screening rates were high in both arms at baseline and follow-up. CONCLUSIONS SE group therapy as an added intervention to the risk counseling was well-received, however, did not demonstrate superiority to RC alone. Future studies on treatment matching are needed to further our understanding of interventions that can support women with a family history of BC to work through residual issues, including loss and grief.
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Affiliation(s)
- Mary Jane Esplen
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Princess Margaret Cancer Centre, Director, de Souza Institute, University Health Network, Toronto, Canada
| | - Molyn Leszcz
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto, Canada
| | - Jonathan Hunter
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto, Canada
| | - Jiahui Wong
- Department of Psychiatry, Faculty of Medicine, University of Toronto, de Souza Institute, University Health Network, Toronto, Canada
| | - Yvonne W Leung
- de Souza Institute, University Health Network, Toronto, Canada
| | - Brenda Toner
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Gord Glendon
- Ontario Cancer Genetics Network, Lunenfeld-Tanenbaum Research Institute, University Health Network, Toronto, Canada
| | - Noreen Stuckless
- York University, Toronto, Canada.,University of Toronto, Toronto, Canada
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3
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Meadows R, Padamsee TJ, Paskett ED. Distinctive psychological and social experiences of women choosing prophylactic oophorectomy for cancer prevention. Health Care Women Int 2018; 39:595-616. [PMID: 29319429 DOI: 10.1080/07399332.2018.1424855] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Women known to have significantly elevated ovarian cancer risk due to genetic mutations or family history can reduce this risk by surgically removing both ovaries and fallopian tubes (RRBSO, risk-reducing bilateral salpingo-oophorectomy). We used interpretive phenomenological analysis (IPA) to explore the psychosocial experiences of women who chose RRBSO for cancer prevention. We extended the traditional use of IPA to compare the experiences of women who chose RRBSO for cancer prevention to those of women who underwent similar gynecologic surgery for benign indications. The analysis resulted in three superordinate themes describing women's psychosocial experiences related to RRBSO: (a) psychological facets of cancer risk (b) social support and (c) shared medical decision making. Findings illustrate that women choosing RRBSO for cancer prevention experience heightened psychosocial challenges before and after surgery compared to women undergoing surgery for benign indication. Furthermore, they may need distinct types of information and support from healthcare providers.
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Affiliation(s)
- Rachel Meadows
- a Division of Epidemiology, College of Public Health, Comprehensive Cancer Center , the Ohio State University , Columbus , Ohio , USA
| | - Tasleem J Padamsee
- b Division of Health Services Management and Policy, College of Public Health, Comprehensive Cancer Center , The Ohio State University , Columbus , Ohio , USA
| | - Electra D Paskett
- c Department of Internal Medicine, Division of Epidemiology, College of Medicine, College of Public Health, Comprehensive Cancer Center , The Ohio State University , Columbus , Ohio , USA
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Castejón V, Rovira T, Sumalla EC, Darder E, Iglesias S, Ochoa C, Blanco I. [Cultural scale adaptation and validation of the Spanish version of the BRCA Self-Concept Scale in women carriers at high risk for hereditary breast and ovarian cancer]. Med Clin (Barc) 2016; 146:148-54. [PMID: 26654557 DOI: 10.1016/j.medcli.2015.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/27/2015] [Accepted: 09/03/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Having an inherited predisposition to cancer may have a psychological impact, and one goal of genetic counseling is to promote psychological adjustment to the new situation. Thus, in the genetic context, validated measures of adjustment are required. Given that self-concept is a good indicator of adjustment to the disease or to the risk for it, and a relevant variable in oncology, the goal of the study is to culturally adapt and validate the BRCA Self-Concept Scale. MATERIAL AND METHOD One hundred and sixty-five BRCA carriers' women answered to the questionnaire, previously adapted through a process of forward/back-translation, and to the Cancer Worry Scale (CWS) as a measure of convergent validity. Theoretical structure of BRCA Self-Concept Scale was assessed by expert judges, and submitted to a confirmatory factor analysis (CFA). Cronbach's α was calculated for each subscale (Stigma, Vulnerability and Control), and correlations with CWS were performed. RESULTS Expert judges' structure and CFA do not support the original structure of the questionnaire. The respecificity model (with items 10 and 13 loading on Vulnerability factor) show a better fit: comparative fit index 0.973; Tucker-Lewis index 0.968; root mean square error of approximation 0.067. The Cronbach's α is 0.83 for Stigma, 0.84 for Vulnerability, and 0.61 for Control. Evidence of convergent validity with CWS has been obtained (Spearman's rho 0.631 for Stigma, 0.683 for Vulnerability, and -0.363 for Control; P<.001). CONCLUSIONS Results support the validity of the modified Spanish BRCA Self-Concept Scale, which is a potentially useful measure for the study of psychological adjustment to high risk for hereditary breast and ovarian cancer.
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Affiliation(s)
- Vanessa Castejón
- Programa de Cáncer Hereditario Institut d'Investigació Biomèdica de Bellvitge, Unidad de Consejo Genético, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat, Barcelona, España; Grupo de Investigación en Estrés y Salud, Departamento de Psicología Básica, Evolutiva y de la Educación, Facultad de Psicología, Universidad Autónoma de Barcelona, Bellaterra, Barcelona, España
| | - Tatiana Rovira
- Grupo de Investigación en Estrés y Salud, Departamento de Psicología Básica, Evolutiva y de la Educación, Facultad de Psicología, Universidad Autónoma de Barcelona, Bellaterra, Barcelona, España
| | - Enric C Sumalla
- Programa de Cáncer Hereditario Institut d'Investigació Biomèdica de Bellvitge, Unidad de Consejo Genético, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat, Barcelona, España
| | - Esther Darder
- Programa de Cáncer Hereditario, Institut Català d'Oncologia-Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Unidad de Consejo Genético, Hospital Universitario Dr. Josep Trueta, Girona, España
| | - Silvia Iglesias
- Programa de Cáncer Hereditario Institut d'Investigació Biomèdica de Bellvitge, Unidad de Consejo Genético, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat, Barcelona, España
| | - Cristian Ochoa
- Unidad de Psico-Oncología, Hospital Duran i Reynals, L'Hospitalet de Llobregat, Barcelona, España; Departamento de Psiquiatría y Psicobiología Clínica, Universidad de Barcelona, Barcelona, España
| | - Ignacio Blanco
- Programa de Cáncer Hereditario Institut d'Investigació Biomèdica de Bellvitge, Unidad de Consejo Genético, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat, Barcelona, España; Programa de Asesoramiento y Genética Clínica, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, España.
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Hamilton RJ, Innella NA, Bounds DT. Living With Genetic Vulnerability: a Life Course Perspective. J Genet Couns 2015; 25:49-61. [PMID: 26323596 DOI: 10.1007/s10897-015-9877-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 08/11/2015] [Indexed: 01/01/2023]
Abstract
This is the second article of a two part series about utilizing the life course perspective (LCP) in genetic counseling. Secondary data analysis was conducted on a grounded theory, longitudinal study which provided a wide focus on living with hereditary breast and ovarian cancer (HBOC) risk. The aim of this analysis was to explore the longitudinal data for both the temporal and social context of living with BRCA mutation genetic test results. Sixteen women from two previous studies were interviewed on multiple occasions over an 8 year time period. The LCP was used to direct a thematic analysis of the data. Families experience the consequences of knowing they carry a BRCA1 or BRCA2 gene mutation long after the initial diagnosis. These women's experiences across time reflect the concepts of the LCP and show how life is changed when families know they live with a genetic vulnerability to an adult-onset and potentially life-threatening disease. Different emphases on concepts from the LCP were evident across the different age groups. For example, the group of 40-50 year old women emphasized the concept of linked lives, those in their 30's focused on human agency and women in their 20's were more focused on timing of events. This study helps give direction to healthcare providers counseling women living with a BRCA mutation.
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Affiliation(s)
- Rebekah J Hamilton
- Department of Women, Children & Family Nursing, Rush University College of Nursing, 2624 Newcastle Dr., Carrollton, TX, 75007, USA.
| | - Nancy A Innella
- Department of Women, Children & Family Nursing, Rush University College of Nursing, 2624 Newcastle Dr., Carrollton, TX, 75007, USA
| | - Dawn T Bounds
- Department of Women, Children & Family Nursing, Rush University College of Nursing, 2624 Newcastle Dr., Carrollton, TX, 75007, USA
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[Personal resources in inpatient psychotherapy - Relationships and development]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2015; 61:139-55. [PMID: 26175170 DOI: 10.13109/zptm.2015.61.2.139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We examined how personal resources develop during inpatient psychodynamic psychotherapy, their relationship to symptom development, Operationalized Psychodynamic Diagnosis (OPD-2), and sociodemographic aspects. METHODS 483 patients were examined using self-assessment questionnaires (Brief Symptom Inventory (BSI), Hospital Anxiety and Depression Scale (HADS), Inventory of Interpersonal Problems (IIP), Questionnaire of Actual Resource Realization (RES)) as well as the expert ratings Global Assessment of Functioning Scale (GAF), Impairment Score (IS), OPD-2, and the Heidelberg Structural Change Scale (HSCS), both at the beginning and the end of treatment. RESULTS There was a marked improvement in the realization of personal resources during inpatient psychotherapy, which showed significant correlations to the improvement of symptoms. The extent of improvement of resources correlated with the duration of psychotherapy and the assessment of the psychodynamic therapy foci on the HSCS. CONCLUSIONS The results show that personal resources are activated when successfully working on the psychodynamic foci in psychodynamic inpatient treatment, and that this corresponds to an improvement of symptoms.
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Heiniger L, Butow PN, Charles M, Price MA. Intuition versus cognition: a qualitative exploration of how women understand and manage their increased breast cancer risk. J Behav Med 2015; 38:727-39. [PMID: 25820809 DOI: 10.1007/s10865-015-9632-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 03/18/2015] [Indexed: 01/05/2023]
Abstract
Risk comprehension in individuals at increased familial risk of cancer is suboptimal and little is known about how risk is understood and managed by at-risk individuals who do not undergo genetic testing. We qualitatively studied these issues in 36 unaffected women from high-risk breast cancer families, including both women who had and had not undergone genetic testing. Data were collected through semi-structured interviews and data analysis was guided by Grounded Theory. Risk comprehension and risk management were largely influenced by the individual's experience of coming from a high-risk family, with both tested and untested women relying heavily on their intuition. Although women's cognitive understanding of their risk appeared generally accurate, this objective risk information was considered of secondary value. The findings could be used to guide the development and delivery of information about risk and risk management to genetically tested and untested individuals at increased risk of hereditary cancer.
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Affiliation(s)
- Louise Heiniger
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, The University of Sydney, Sydney, NSW, Australia. .,Psycho-Oncology Cooperative Research Group (PoCoG), The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia.
| | - Phyllis N Butow
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, The University of Sydney, Sydney, NSW, Australia.,Psycho-Oncology Cooperative Research Group (PoCoG), The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia
| | - Margaret Charles
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | | | - Melanie A Price
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, The University of Sydney, Sydney, NSW, Australia.,Psycho-Oncology Cooperative Research Group (PoCoG), The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia
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Heiniger L, Price MA, Charles M, Butow PN. Facilitators and Challenges in Psychosocial Adaptation to Being at Increased Familial Risk of Breast Cancer. J Genet Couns 2015; 24:890-907. [PMID: 25735441 DOI: 10.1007/s10897-015-9824-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 01/21/2015] [Indexed: 11/30/2022]
Abstract
Little is known about the process of psychosocial adaptation to familial risk in tested and untested individuals at increased familial risk of cancer. This paper presents findings from a qualitative study of 36 women participating in the Kathleen Cuningham Consortium for Research into Familial Breast cancer (kConFab) Psychosocial study. Facilitators and challenges in psychosocial adaptation were identified through semi-structured interviews. The women, who were either tested (carriers or non-carriers of breast cancer susceptibility mutations) or untested (ineligible for testing or eligible but delayed or declined testing), described personal, support network and healthcare characteristics that impacted on the adaptation process. Challenges in one domain could be overcome by facilitators in other domains and key differences relating to whether women had undergone testing, or not, were identified. Tested and untested women with an increased familial risk of breast cancer may benefit from support tailored to their mutation testing status in order to enhance adaptation.
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Affiliation(s)
- Louise Heiniger
- Psycho-Oncology Cooperative Research Group (PoCoG), University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), NSW, 2006, Sydney, Australia. .,School of Psychology, University of Sydney, NSW, 2006, Sydney, Australia.
| | - Melanie A Price
- Psycho-Oncology Cooperative Research Group (PoCoG), University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), NSW, 2006, Sydney, Australia.,School of Psychology, University of Sydney, NSW, 2006, Sydney, Australia
| | - Margaret Charles
- School of Psychology, University of Sydney, NSW, 2006, Sydney, Australia
| | - Phyllis N Butow
- Psycho-Oncology Cooperative Research Group (PoCoG), University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), NSW, 2006, Sydney, Australia.,School of Psychology, University of Sydney, NSW, 2006, Sydney, Australia
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9
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“Naked Genes” as Health Psychological Innovation: A Challenge for Research and Intervention. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.sbspro.2014.12.607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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10
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Grubs RE, Parker LS, Hamilton R. Subtle Psychosocial Sequelae of Genetic Test Results. CURRENT GENETIC MEDICINE REPORTS 2014. [DOI: 10.1007/s40142-014-0053-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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12
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Abstract
Women with pathogenic BRCA genetic mutations face high risks for cancer development. Estimates vary among mutation carriers, with lifetime risks ranging from 41% to 90% for breast cancer and 8% to 62% for ovarian cancer. Cancer risk management options for BRCA mutation positive (BRCA+) women have life-altering implications. This qualitative, phenomenological study explored the experience of cancer risk management decision making for women who are unaffected carriers of a BRCA mutation (previvors). Fifteen previvors recruited from Facing Our Risk of Cancer Empowered (FORCE), an online informational and support group, were interviewed. Findings consisted of four major themes: the early previvor experience, intense emotional upheaval; the decisional journey, navigating a personal plan for survival; lack of knowledge and experience among health care providers; and support is essential. Findings highlight the different decisional perspectives of previvors based on age and individual factors and the need for increased competence among health care providers.
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Davis C, Rust C, Choi S. A pilot randomized study of skills training for African American cancer survivors. SOCIAL WORK IN PUBLIC HEALTH 2014; 29:549-560. [PMID: 25144697 DOI: 10.1080/19371918.2014.892865] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 02/06/2014] [Indexed: 06/03/2023]
Abstract
This study tested the efficacy of a psychosocial group intervention for African American breast cancer survivors based on the Cancer Survival Toolbox with the specific aim of decreasing distress and improving aspects of psychosocial functioning and quality of life. This pilot study utilized a randomized, repeated measures, experimental design. The study sample (N = 71) consisted of an intervention group (n = 23) of cancer survival skills training for 6 weeks and a control group (n = 48). The study could not confirm that cancer skills training in a psychoeducational group setting had a positive effect on decreasing stress or improving aspects of psychosocial functioning and quality of life.
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Affiliation(s)
- Cindy Davis
- a College of Social Work, University of Tennessee , Nashville , Tennessee , USA
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den Heijer M, Gopie JP, Tibben A. Risk factors for psychological distress in women at risk for hereditary/familial breast cancer: a systematic review. BREAST CANCER MANAGEMENT 2013. [DOI: 10.2217/bmt.12.70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Some women at risk for hereditary breast cancer are at increased risk of psychological distress. In order to correctly identify vulnerable women at an early stage for whom referral to a specialized psychologist or social worker may be considered, it is important that healthcare workers involved in the care of high-risk women have knowledge about risk factors that should be addressed during counseling. The aim of the current review is to investigate current knowledge on personal and social risk factors associated with psychological maladjustment in women at risk for hereditary breast cancer. The risk factors described in the current review may be used to develop appropriate interventions with respect to, for example, self-concept, risk appraisal, coping, family communication, social support and the partner relationship.
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Affiliation(s)
- Mariska den Heijer
- Department of Medical Psychology & Psychotherapy, Erasmus Medical Centre, Rotterdam, The Netherlands
- Department of Clinical Genetics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jessica Premdee Gopie
- Centre of Human & Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Aad Tibben
- Department of Clinical Genetics, Erasmus Medical Centre, Rotterdam, The Netherlands
- Centre of Human & Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Medical Psychology & Psychotherapy, Erasmus Medical Centre, Rotterdam, The Netherlands.
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Vos J, van Asperen CJ, Oosterwijk JC, Menko FH, Collee MJ, Gomez Garcia E, Tibben A. The counselees' self-reported request for psychological help in genetic counseling for hereditary breast/ovarian cancer: not only psychopathology matters. Psychooncology 2012; 22:902-10. [PMID: 22740372 DOI: 10.1002/pon.3081] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 02/03/2012] [Accepted: 03/19/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Several studies have shown that counselees do not experience psychopathological levels of distress after DNA test result disclosure. However, it has not systematically been studied whether the absence of psychopathology also means that counselees do not want to receive help. Their self-reported request for help may be related not only with psychopathology/distress but also with other psychological needs (e.g., surgery decisions), genetics-specific needs (e.g., feeling vulnerable/stigmatized), and existential concerns (e.g., meaning in life). METHODS Questionnaires were filled in by Dutch cancer patients, before and after disclosure of BRCA1/2 test results for hereditary breast/ovarian cancer: pathogenic mutation results (n = 30), uninformative results (n = 202), or unclassified variants (n = 16). Newly developed questions measured request for help, psychopathology was estimated with factor analyses on distress/psychopathology instruments, and several validated questionnaires measured other needs/concerns. RESULTS One-third of all counselees who reported a request for psychological help had actually received help. The level of psychopathology correlated between 0.34 and 0.44 with this self-reported need-for-help. Other needs, genetics-specific distress, and existential concerns correlated strongly/moderately with the counselees' self-reported need-for-help. Examples of other needs were intention to undergo surgery, inaccuracy of their interpretation, the impact of cancer, and family communication difficulties. Genetics-specific distress was for instance feeling vulnerable to develop cancer, stigma, and lack of mastery. Existential concerns were, among others, lack of purpose in life, low self-acceptance, and an unfulfilled wish for certainty. CONCLUSIONS The request for help is related to multiple factors. Referral to psychosocial professionals may be improved by not only discussing psychopathology during genetic-counseling sessions but also by other needs and existential concerns. Questions about other needs and existential issues may be added to psychological screening instruments.
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Affiliation(s)
- Joël Vos
- Department of Clinical Genetics, Center for Human and Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
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