A structural equation model of posttraumatic growth after prostate cancer

A Systematic Review of the Association between Psychological Resilience and Improved Psychosocial Outcomes in Prostate Cancer Patients. Could Resilience Training Have a Potential Role?

PURPOSE

A high incidence of psychosocial problems in prostate cancer patients has been reported including anxiety, depression and distress. These can add to the patients' disease burden and have been associated with unfavorable cancer treatment outcomes. Interventions designed to address them have found limited success, but psychological resilience (PR) training has never been formally tested. The measurement of PR in prostate cancer patients has been described and has been associated with more favorable psychosocial outcomes in these patients but it has never been systematically reviewed. The aim of this study was to conduct the first systematic review of those studies that have measured it using standardized scales and to determine the potential for resilience training to help overcome the significant psychosocial problems faced by prostate cancer patients.

MATERIALS AND METHODS

We searched the literature to identify articles that measured PR among prostate cancer patients.

RESULTS

Of 384 articles identified by the search criteria, there were 19 studies suitable for inclusion regarding 5,417 patients. The most commonly-used scale was the original Connor-Davidson Resilience Scale, or an abbreviated version of it. Possible scores range from 0 to 100, mean scores from these studies ranged from 72.9 to 87.1 (standard deviations varied between 13.2 and 16.3). PR was consistently associated with improved psychological outcomes including depression, anxiety and distress, although these were measured with a wide variety of methods making it difficult to quantify the effects. There was also evidence of PR mediating the physical effects of prostate cancer and treatment including urinary symptoms, fatigue and insomnia.

CONCLUSIONS

As resilience training has been successful in other cancer settings, it seems likely that it could improve the significant adverse psychosocial outcomes that have been reported in prostate cancer patients and trials designed to objectively test it should be encouraged.

Effects of Post Traumatic Growth on Successful Aging in Breast Cancer Survivors in South Korea: The Mediating Effect of Resilience and Intolerance of Uncertainty

This study aimed to identify post-traumatic growth and successful aging and the mediating effects of resilience and intolerance of uncertainty in breast cancer survivors. This study employed a descriptive survey approach. Data were collected from 143 breast cancer survivors between 27 January and 10 December 2021, at a cancer center in Gyeongsangnam-do, South Korea. SPSS/WIN 25.0 and PROCESS Macro version 3.5 were used for data analysis. Descriptive statistics were analyzed with SPSS. PROCESS was used to conduct a mediation analysis and the significance of the mediating effect was evaluated using 95% confidence intervals. Successful aging was significantly associated with post-traumatic growth, resilience, and the intolerance of uncertainty. The impact of post-traumatic growth on successful aging was mediated by resilience in breast cancer survivors. Resilience should be considered when developing nursing interventions to enhance post-traumatic growth and promote successful aging in breast cancer survivors.

Rumination and threat-biased interpretation mediate posttraumatic stress and growth responses to military stressors

We examined the role of rumination and threat-biased interpretation in stress and growth responses to military stressors. Two online surveys were completed by 183 (survey 1) and 393 (survey 2) currently serving or retired military personnel. The surveys measured exposure to potential military stressors (exposure to combat, witnessing the consequences of war, and perceived moral injury), posttraumatic stress symptomatology (PTSS), posttraumatic growth (PTG), and personal wellbeing, with survey 1 including measures of rumination, and survey 2 including a measure of threat-biased interpretation. Path analyses revealed that indirect paths from both witnessing the consequences of war and experiencing betrayal to PTSS were mediated by intrusive rumination and threat-biased interpretation, and that indirect paths from both betrayal and transgressions by others to PTG were mediated by deliberate rumination and threat-biased interpretation. The results reveal the idiosyncratic nature of military stressors, their differential involvement with cognitions that underpin rumination about past events and interpretation of current events, and their relevance to posttraumatic stress and growth in military personnel.

Protecting healthcare workers' mental health against COVID-19-related stress: The effects of stress mindset and psychological resilience

Healthcare workers have been on the frontline of the battle against COVID-19 disease. However, this has taken a toll on them, resulting in elevated stress and poor mental health. We argue that healthcare workers' stress mindset and resilience could mitigate negative outcomes of COVID-19-related stress by helping them view this stressful situation in a more positive light and appraise it as a challenge rather than a threat. Accordingly, we hypothesized that both a stress-is-enhancing mindset about COVID-19-related stress and resilience would improve healthcare workers' appraisal of their personal resources and increase their challenge appraisals, positively contributing to their mental health. We collected data from 160 healthcare workers and performed structural equation modeling for hypothesis testing. The results indicate that both a stress-is-enhancing mindset about COVID-19-related stress and psychological resilience are indirectly related to better mental well-being and lower health-related anxiety through challenge appraisals. This study contributes to research in mental health by suggesting that protecting and promoting healthcare workers' mental health is possible by empowering them through increasing personal resources such as a positive mindset about stressful situations and resilience.

Personality Traits and Coping Strategies Relevant to Posttraumatic Growth in Patients with Cancer and Survivors: A Systematic Literature Review

The possibility of positive psychological changes after cancer, namely, posttraumatic growth, is a growing field of research. Identifying personality traits and coping strategies related to posttraumatic growth may help find vulnerable individuals as well as promote helpful coping strategies to help more patients make positive changes at an early stage. The aim of this systematic literature review is to provide an overview of the quantitative data on coping strategies and personality traits associated with posttraumatic growth in patients with cancer and cancer survivors as well as the methods used in included studies. A systematic literature search was conducted using five databases (PubMed, PubPsych, PsycInfo, Web of Science, and PSYNDEXplus). The 70 reports of included studies assessed posttraumatic growth using questionnaires in a sample of patients with cancer or survivors. In addition, associations with a personality trait or coping strategy had to be examined cross-sectionally or longitudinally. All 1698 articles were screened for titles and abstracts by two authors, after which disputed articles were reviewed by a third author. Afterwards, articles were screened for full texts. Most studies had a cross-sectional design and used a sample of patients with breast cancer. Coping strategies have been researched more than personality factors. The personality traits of resilience, hardiness, dispositional positive affectivity, and dispositional gratitude seem to be related to posttraumatic growth, while the Big Five personality traits (openness to experience, conscientiousness, extraversion, agreeableness, neuroticism) have been less researched and/or seem to be unrelated. The use of social support, religious coping, positive reframing, and reflection during illness as coping strategies seems to be related to posttraumatic growth. The findings can be used for the development of interventions. Future studies should investigate associations longitudinally.

Post-traumatic growth experience of first-line emergency nurses infected with COVID-19 during the epidemic period-A qualitative study in Shanghai, China

Background

In March 2022, Shanghai, China, was hit by a severe wave of SARS-CoV-2 transmission caused by the Omicron variant strain. The medical staff was greatly infected during this period, which posed a traumatic event for them. Meanwhile, they also experience post-traumatic growth under introspection and positive change. However, the psychological coping and growth after infection with COVID-19 among medical staff have rarely been investigated.

Objectives

To explore the process and influencing factors of post-traumatic growth among emergency nurses infected with coronavirus disease (COVID-19) so as to provide a new perspective and theoretical basis for psychological rehabilitation or intervention for medical staff who experienced traumatic events.

Methods

The study used a qualitative design based on the phenomenological approach. A purposive sampling method was used to explore the subjective feelings and post-traumatic growth among 13 first-line emergency nurses infected with COVID-19 in Shanghai, China. Semi-structured face-to-face interviews were conducted in June 2022. A Seven-step Colaizzi process was used for data analysis.

Results

Themes were described and extracted from the experience and insights at different stages during the fight against the virus. Three main themes, i.e., stress period, adjustment period, and growth period, as well as several sub-themes, were identified.

Conclusion

First-line emergency nurses infected with COVID-19 are a sensitive group that should be given more attention. Investigating how they achieve psychological adjustment and growth in the case of severe trauma can provide valuable references for nursing management and education in the future. Society, hospital and nursing managers should pay more attention to the PTG of nurses and establish supportive PTG strategies, which will benefit the retention rate and career development of nurses.

Stress and coping experience in Nurse Residency Programs for new graduate nurses: A qualitative meta-synthesis

Objectives

To determine the stress experience and coping styles of new nurses during Nurse Residency Programs (NRPs) by identifying, appraising, and synthesizing data from the qualitative studies.

Design

A systematic review and meta-synthesis of qualitative studies.

Review methods

Eleven databases were systematically searched for relevant publications in March 2022. All qualitative and mixed-method studies in English and Chinese that explored the stress and coping experience during NRPs of new graduate nurses were included. The qualitative meta-synthesis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Two independent reviewers selected the studies and assessed the quality of each study. Meta-synthesis was performed to integrate the results.

Results

A total of 13 studies revealed 13 sub-themes and three descriptive themes: multi-dimensional stressors, somatic and emotional responses, coping resources and coping methods.

Conclusion

New nurses faced a lot of physical and emotional stress during NRPs, which had a negative impact on their physical and mental health. NRPs are a critical period for the career growth of new nurses. Effective management strategies must be implemented to improve nurse capacity, meet their needs, improve self-efficacy, and build organizational support, as this can improve the quality of clinical nursing and keep the enthusiasm and stability of the nursing team.

Grief and growth among Chinese parents who lost their only child: the role of positive and negative experiences of social support from different sources

BACKGROUND

In China, bereaved parents who have lost their only child are known as Shidu parents, and they tend to present high levels of prolonged grief reactions. To date, a widespread focus has been placed on positive social support, while potential negative experiences have been relatively neglected. Additionally, the role of social support from different sources (i.e. close family members [partner, siblings, grandchildren], peers, and others [relatives, friends, colleagues]) has not been examined thoroughly.

OBJECTIVE

The present study investigated whether social support from different sources has a differential impact on postloss adaptation (i.e. prolonged grief and growth). The loss-orientated and restoration-orientated coping strategies of the dual process model were also tested for their mediating roles.

METHODS

A total of 277 Chinese Shidu parents were recruited to complete a series of questionnaires including social support from different sources, prolonged grief symptoms, posttraumatic growth, and dual process coping strategies. Correlation analyses, paired sample t tests and structural equation modelling were conducted.

RESULTS

More positive support were related to less prolonged grief symptoms and more posttraumatic growth, while more negative support was only related to more prolonged grief. Positive support from close family members and others was significantly related to prolonged grief/growth, and negative support from these sources was significantly positively associated with prolonged grief. Positive or negative support from people who shared a similar experience was unrelated to prolonged grief/growth. Positive and negative support were related to prolonged grief and growth through loss-oriented coping strategies.

CONCLUSION

Overall, the present study indicated that positive and negative support experiences from different sources functioned differently in the recovery of Chinese Shidu parents and that loss-oriented coping played a mediating role. These findings highlight the importance of differentiating social support by traits in coping with grief and the crucial mediating role of loss-oriented coping.

HIGHLIGHTS

More positive support correlated with less prolonged grief and more growth, while more negative support correlated with more prolonged grief.Support from family members and friends was more potent than that from peers.Social Support correlated with prolonged grief/growth through loss-oriented coping.

Influence of perceived trauma on the cognitive processing model of posttraumatic growth among university students

This study examined whether perceiving an event as a trauma influenced a cognitive processing model explaining posttraumatic growth (PTG). A cross-sectional questionnaire survey was conducted with 311 university students from eight universities in Japan. The participants provided information about the most stressful event they had experienced and completed the expanded version of the PTG Inventory, Core Belief Inventory, Event Related Rumination Inventory, and Cognitive and Emotional Processing from Disclosure Inventory. A multi-group structural equation modeling was conducted by dividing the participants into two groups depending on whether they identified the most stressful event as a trauma. The model with no constraint showed a good fit. The model with partial constraint showed a better fit than the models with no constraint or full constraint. The difference of the model was seen as a covariance between the Event Related Rumination Inventory and the Cognitive and Emotional Processing from Disclosure Inventory. The results demonstrated configural invariance and partial metric invariance. This indicated that PTG would be recognized irrespective of whether the event was perceived as a trauma. This study also indicated that different factors out of the model could be associated with the ruminative process and disclosure process. The importance of focusing on the process of PTG, regardless of an individual's perception of the event, was emphasized, especially for factors related to rumination and disclosure.

A Systematic Literature Review and Head-to-Head Comparison of Social Support and Social Constraint in Relation to the Psychological Functioning of Cancer Survivors

BACKGROUND

Quality of life is a multidimensional concept that includes perceptions of one's physical, psychological, social, and spiritual functioning, all of which are theorized to be interdependent. The focus of this study is social functioning, which itself is a multidimensional concept that includes social support and social constraint among other things. In cancer survivors, social support receives most of the research attention, but social constraint may have a stronger influence on quality of life.

PURPOSE

This systematic literature review evaluates which aspect of social functioning-social support or social constraint-has a stronger relationship with the psychological functioning of cancer survivors.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed in the identification and review of 32 independent records. Multiple measures of social support and social constraint were used across studies, with most having adequate psychometric properties. Psychological outcomes were divided into (a) general distress, (b) cancer-specific distress, (c) general well-being, and (d) cancer-specific well-being.

RESULTS

For general and cancer-specific distress, social constraint exhibited a larger association with distress than social support. Similarly, for general well-being, most studies reported a stronger association with social constraint than social support. For cancer-specific well-being, the opposite was true such that associations were stronger for social support than social constraint.

CONCLUSIONS

Results highlight the importance of considering social constraint when examining quality-of-life outcomes like psychological distress and well-being. Findings support social constraint as a target in interventions to reduce cancer survivors' distress, while social support could be considered in attempts to promote cancer-specific well-being.

Roles of Reexamination of Core Beliefs and Rumination in Posttraumatic Growth Among Parents of Children With Cancer: Comparisons With Parents of Children With Chronic Disease

BACKGROUND

Studies have indicated that the impact of a traumatic experience can be negative and can provide the opportunity to experience psychological growth, known as posttraumatic growth (PTG).

OBJECTIVE

To evaluate the role of cognitive processing in PTG among parents of childhood cancer survivors (CCSs) based on the PTG theoretical model. We compared the model between parents of SCC and parents of children with chronic disease (CCDs) to determine how the role of cognitive processing in PTG is different depending on the children's illness.

METHODS

Final sample consisted of 78 parents of CCSs and 44 parents of CCDs. The survey included standardized measurements assessing reexamination of core beliefs, intrusive and deliberate rumination, posttraumatic stress symptoms, and PTG. The hypothetical relationships among the variables were tested by covariance structure analysis.

RESULTS

Posttraumatic growth among parents of CCSs had significantly strong association with reexamination of core beliefs, but not with deliberate rumination. Reexamination of core beliefs was significantly more likely to foster PTG among parents of CCSs, whereas deliberate rumination was significantly more likely to be associated with PTG among parents of CCDs.

CONCLUSIONS

For parents of CCSs, reexamination of core beliefs had a greater impact on PTG than deliberate rumination. Our results suggest that support should focus on the process of reexamining core beliefs in facilitating PTG among parents of CCSs.

IMPLICATIONS FOR PRACTICE

Nurses should provide parents of CCSs with reassurance regarding their experiences of the reexamination of core beliefs, which will likely lead to PTG.

The association between psychological functioning and social support and social constraint after cancer diagnosis: a 30-day daily diary study

This study evaluated one positive and one negative aspect of social functioning (social support and social constraint, respectively) to increase understanding of its relation to psychological functioning (distress and wellbeing) after cancer diagnosis. Participants in this longitudinal study were recently diagnosed, predominately late stage, first primary cancer survivors (n = 48). Data collection involved a 30-day period of daily assessment. Data were analyzed using multilevel linear models. As in prior studies, none of the variables changed significantly over time (ps = .07 to .99). Based on the intraclass correlation coefficient, 51 to 75% of the variance in the daily assessment data are attributable to between-person differences. There was a positive relationship between social constraint and both general and cancer-specific distress (ps < .05) and between social support and cancer-specific wellbeing (ps < .001). In prospective models, higher than average general distress predicted higher social support the next day (p = .004) and higher than average cancer-specific wellbeing predicted more social constraint the next day (p = .01). The findings lend some support to the interdependence of social functioning and psychological functioning after cancer diagnosis.

The factor structure of the posttraumatic growth inventory in cancer patients in Turkey

Posttraumatic growth is a positive psychological change that occurs as a result of tackling vital crises. Although cancer is perceived as a fatal disease, the individual's struggle with many negative conditions during diagnosis and treatment can provide positive change and development. The aim of this study was to examine the factor structure of the posttraumatic growth inventory (PTGI) in Turkish cancer patients. This study included 265 cancer patients receiving treatment at the chemotherapy unit of two university hospitals located in northern Turkey. Percentages, frequencies, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to analyse the data, and Cronbach's α measured internal consistency. EFA yielded a five-factor structure: Spiritual and existential change, change in perception of life and selfness, relating to others, personal strength and new possibilities. Fit indices for CFA were root mean square error of approximation (RMSEA), 0.06; non-normed fit index (NNFI), 0.92; comparative fit index (CFI), 0.90; root mean residuals (RMR), 0.06; and goodness-of-fit index (GFI), 0.90. The overall Cronbach's α of the scale was 0.93. PTGI was determined as a reliable and valid tool for Turkish cancer patients. PTGI, which has a determined validity and reliability rate, can be used by healthcare professionals working with oncology patients to evaluate the positive psychological growth and changes in cancer patients and determine their adoption rate.

"One stroke, with twenty-two people": exploring prostate cancer survivors' participation in dragon boating

Purpose: This study qualitatively explores prostate cancer survivors' experience in joining a dragon boating team and its possible impact on their wellbeing.Design: Qualitative data analysis.Sample: Eleven prostate cancer survivors from a dragon boat team.Methods: Semi-structured interviews and thematic analysis.Findings: The findings support physical benefits of dragon boating, however, the positive impact on the men's psychosocial wellbeing was more salient. Participation in dragon boating was important for establishing a social support system and positively reframing their cancer experience.Practice Implications: Dragon boating is a novel health promotion strategy for men with PC. Seeking to replicate the positive characteristics of dragon boating in the design of future physical activity interventions should be explored.

Cancer-related masculinity threat in young adults with testicular cancer: the moderating role of benefit finding

Background and Objectives: Perceiving benefit from a health-related stressor such as cancer has been associated with better psychological adjustment in various cancer populations; however, it has not been studied in the context of young adulthood or gender-related cancer threat. This study investigated the role of benefit finding in psychological adjustment among young adults with testicular cancer, and whether BF moderates cancer-related masculine threat.Design: This study utilizes a cross-sectional design with a diverse sample of young adult testicular cancer survivors.Methods: Men with a history of testicular cancer (N = 171; M age = 25.2, SD = 3.32) completed questionnaires of benefit finding, cancer-related masculine threat, and indicators of psychological adjustment.Results: Multiple regression analysis revealed that cancer-related masculine threat was associated with worse adjustment across indicators and that benefit finding was related to higher positive affect and lower depressive symptoms. Benefit finding attenuated the potentially adverse effect of cancer-related masculine threat on negative affect and depressive symptoms such that cancer-related masculine threat demonstrated a stronger association with negative affect and depressive symptoms for people with relatively low BF.Conclusions: For young adult men with testicular cancer, finding benefit appears to promote well-being in the face of masculine cancer threat.

Cognitive processing following acquired disability for para sport athletes: a serial mediation model

Purpose: To understand the cognitive processing that occurs in relation to a disabling life event among para sport athletes, as well as the role of para sport participation in shaping these cognitions, and subsequent perceptions of posttraumatic growth or distress.Methods: Participants were 75 para sport athletes with acquired disability. Serial multiple mediation analysis was conducted to identify the various pathways through which posttraumatic growth or distress is experienced.Results: Findings suggested that a disabling event initiated challenges to one's core beliefs which influenced subsequent perceptions of posttraumatic growth and distress through cognitive processing at two separate time frames. Moreover, the utility of deliberate rumination (at both time points) was evident in experiencing posttraumatic growth, while intrusive rumination only appeared beneficial if it prompted deliberate ruminations.Conclusions: As several unique paths to posttraumatic growth were found, results suggest that a multitude of paths to growth may be possible. Para sport participation may have utility in facilitating deliberate ruminations and subsequent posttraumatic growth for those unable to deliberately ruminate in the immediate disability aftermath.Implications for rehabilitationAs challenges to core beliefs triggered ruminative thoughts that ultimately facilitated PTG, practitioners are encouraged to explicitly ask patients about how the adverse event might have influenced patients' self-perceptions and views about the meaning of life. Such questions may be revisited from injury onset throughout recovery and rehabilitation.Rehabilitation specialists should inform patients that intrusive ruminations may be salient in the post-trauma aftermath, but that such rumination may be facilitative if it gives way to more deliberate forms of rumination.Attempts to understand the meaning of a traumatic event may be instrumental in alleviating distress.Health practitioners should encourage individuals suffering physically disabling events to engage in activities such as para sport, given its potential to facilitate deliberate rumination and subsequent posttraumatic growth.

An Item-Level Analysis of the Posttraumatic Stress Disorder Checklist and the Posttraumatic Growth Inventory and Its Associations With Challenge to Core Beliefs and Rumination

Background: Previous studies have found that rumination and challenge to core beliefs may have a predictive effect on Posttraumatic Stress Disorder (PTSD) and Posttraumatic Growth (PTG) among different samples. In addition, there is some evidence that these variables have different effects on PTSD and PTG, although the latter construct has been the target of a larger body of research and theoretical models. The main objective of the current study is to examine the effect of challenge to core beliefs, intrusive rumination, and deliberate rumination on PTSD and PTG, through an item-level analyses.

Methods: The sample was composed of 205 Portuguese women who had been given a breast cancer diagnosis (M = 54.32, SD = 10.05), and who completed the following self-administered questionnaires: the Posttraumatic Stress Disorder Checklist (PCL-C); the Posttraumatic Growth Inventory (PTGI); the Core Beliefs Inventory; and the Event Related Rumination Inventory. Two multivariate multiple regression analyses, using each item of the PCL-C and the PTGI as dependent variables, were conducted.

Results: The results demonstrated that challenges to core beliefs predict 17 of the 21 PTGI items and 12 of the 17 PCL-C items. All but one item of the PCL-C are predicted by intrusive rumination, while the variance of only 4 items of the PTGI are explained by deliberate rumination.

Conclusion: These findings indicate that women with breast cancer who tend to display higher levels of intrusive rumination are more likely to report PTSD symptoms, and that an examination of one’s core beliefs is predictor of both positive and negative outcomes. In spite of the proven effect of challenge to core beliefs on both variables, this study suggests that this effect has only a minor influence on PTSD, in addition to confirming its major impact on PTG.

From core belief challenge to posttraumatic growth in para sport athletes: moderated mediation by needs satisfaction and deliberate rumination

Purpose: To examine how deliberate rumination and psychological need satisfaction interact to facilitate posttraumatic growth for para sport athletes with acquired disability. Methods: Utilizing a sample of 70 para sport athletes, the hypothesized mediating role of deliberate rumination was examined via a simple mediation model. The interaction between needs satisfaction and deliberate rumination and their effect on posttraumatic growth was examined utilizing a moderated mediation procedure. Results: Disruption to one's core beliefs was significantly associated with posttraumatic growth. This relationship, was in part, explained by the deliberate rumination engaged in soon after the trauma. Needs satisfaction, while a significant predictor of posttraumatic growth, did not moderate the indirect effect. Conclusions: Although deliberate rumination at both timeframes and needs satisfaction were independently associated with posttraumatic growth, they did not interact in the hypothesized manner to influence posttraumatic growth. There remains a need to better understand how the experience of posttraumatic growth is achieved amongst individuals with acquired disability, and the role that para sport may play in this process. Implications for rehabilitation The disruption to one's core beliefs caused by acquiring a physical disability is not only a natural experience but also a necessary antecedent to posttraumatic growth. As such, rehabilitation practitioners ought to normalize these types of challenges when working with individuals with acquired disability. Practitioners may help to facilitate growth outcomes by encouraging individuals to deliberately ruminate about their acquired disability. That is, practitioners can help those with acquired disability to seek meaning and understanding about their disability or the precipitating event. For those who struggle to deliberately ruminate in the immediate disability aftermath, practitioners may encourage para sport participation to potentially prompt constructive cognitive processing. Individuals with acquired disabilities would also be well served by rehabilitation practitioners and para sport organizations that provide opportunities for basic psychological needs satisfaction. Specifically, individuals with acquired disabilities should be given the opportunity to demonstrate physical competence, make meaningful relationships, and feel a sense of volitional control over their rehabilitation or para sport participation. For example, practitioners and para sport organizations could establish mentorship programs wherein individuals with more recent disabilities can be mentored by those with greater disability experience.

A Model to Predict Psychological- and Health-Related Adjustment in Men with Prostate Cancer: The Role of Post Traumatic Growth, Physical Post Traumatic Growth, Resilience and Mindfulness

Background: Post traumatic growth (PTG) can be defined as positive change following a traumatic event. The current conceptualization of PTG encompasses five main dimensions, however, there is no dimension which accounts for the distinct effect of a physical trauma on PTG. The purpose of the present research was to test the role of PTG, physical post traumatic growth (PPTG), resilience and mindfulness in predicting psychological and health related adjustment.

Method: Ethical approval was obtained from relevant institutional ethics committees. Participants (N = 241), who were at least 1 year post prostate cancer treatment, were invited to complete a battery of questionnaires either through an online survey or a paper and pencil package received in the post The sample ranged in age from 44 to 88 years (M = 64.02, SD = 7.76). Data were analysis using confirmatory factor analysis and structural equation modeling.

Results: The physical post traumatic growth inventory (P-PTGI) was used to evaluate the role of PPTG in predicting adjustment using structural equation modeling. P-PTGI predicted lower distress and improvement of quality of life, whereas conversely, the traditional PTG measure was linked with poor adjustment. The relationship between resilience and adjustment was found to be mediated by P-PTGI.

Conclusion: Findings suggest the central role of PTG in the prostate cancer survivorship experience is enhanced by the inclusion of PPTG. Adjusting to a physical trauma such as illness (internal transgressor) is unlike a trauma with an external transgressor as the physical trauma creates an entirely different framework for adjustment. The current study demonstrates the impact of PPTG on adjustment. This significantly adds to the theory of the development of PTG by highlighting the interplay of resilience with PTG, PPTG, and adjustment.

Benefit finding and diurnal cortisol after prostate cancer: The mediating role of positive affect

OBJECTIVE

Benefit finding (BF) has exhibited a salutary effect on psychological adjustment to cancer. However, few studies have examined its relationship with physiology or have examined BF in men with cancer. This study investigated whether BF is associated with hypothalamic-pituitary-adrenal axis activity (ie, diurnal salivary cortisol) in men treated for prostate cancer. Positive affect (PA) is proposed as a potential pathway linking BF to diurnal salivary cortisol.

METHODS

A sample of 66 men treated for localized prostate cancer within the prior 2 years completed questionnaires and collected salivary cortisol 3 times per day over 3 consecutive days. Hierarchical linear modeling was used for estimating the effects of BF and PA on cortisol responses as measured by diurnal slope and area under the curve (AUCg). Confidence intervals for indirect effects were estimated using the Monte Carlo method for mediation testing.

RESULTS

BF was significantly associated with diurnal cortisol slope, controlling for body mass index and age (B = -.12, P = .03), such that greater BF was associated with steeper cortisol slope. Analyses revealed that PA mediated the effect of BF on cortisol slope (Monte Carlo estimation 95% CI = -0.087, -0.001); negative affect did not mediate this relationship. BF was not significantly associated with AUCg.

CONCLUSIONS

Deriving more benefit from one's experience with prostate cancer is associated with a healthier diurnal cortisol rhythm. Through its potential to enhance PA, the relationship of BF and physiological processes underscores the health relevant value of BF in prostate cancer survivors.

The mediating role of resilience in the relationship between social support and posttraumatic growth among colorectal cancer survivors with permanent intestinal ostomies: A structural equation model analysis

PURPOSE

Information on posttraumatic growth (PTG) among colorectal cancer (CRC) survivors with permanent intestinal ostomies is limited. The aim of this cross-sectional study was to investigate the occurrence of PTG among CRC survivors with permanent intestinal ostomies and its association with perceived social support and resilience.

METHODS

This study was conducted with 164 CRC survivors with permanent intestinal ostomies at least one month after surgery. Participants completed questionnaires assessing socio-demographic and clinical characteristics, perceived social support, resilience and PTG.

RESULTS

The mean total score on the Post Traumatic Growth Inventory was 66.74 (SD = 13.99). Perceived social support (r = 0.450) and resilience (r = 0.545) were significantly positively correlated with PTG. Structural equation modeling analysis showed that resilience mediated the relationship between perceived social support and PTG in which the indirect effect of perceived social support on PTG through resilience was 0.203 (P < 0.001).

CONCLUSIONS

Moderate to high PTG was found in CRC survivors with permanent intestinal ostomies. The most important implication of this study was that improving social support and resilience might be scientific intervention strategies for promoting PTG among CRC survivors.

Association of Posttraumatic Growth and Illness-Related Burden With Psychosocial Factors of Patient, Family, and Provider in Pediatric Cancer Survivors

Research has indicated that childhood cancer may lead to posttraumatic growth (PTG), given cancer's association with posttraumatic stress. PTG may be associated with family/home and health care dynamics, as well as parental resilience, distress, and coping. This cross-sectional study investigated the associations of psychosocial factors of the patient, family, and health care team with PTG and illness-related burden (IRB) in childhood cancer survivors. The sample comprised 61 children and adolescents (7-18 years of age), their parents, and their nurses. Respondents completed their assessment an average of 1.73 years after the end of treatment for the child's disease, which was either leukemia, a solid tumor, or lymphoma. Regression analyses showed that PTG was positively associated with the patients' posttraumatic stress symptoms. It was also positively associated with the parents' religious coping, and with measures of stronger family and oncologist relationships (R² = .32). IRB was positively associated with patient-reported posttraumatic stress symptoms, negatively associated with the nurse's trust in the family, and positively associated with parent-reported mental distress, lower family socioeconomic status, and female gender (R² = .53). There was no significant association with parenting style or parent-reported posttraumatic stress symptoms in the child. The findings suggested that the young cancer patient's psychosocial and resource milieu (e.g., financial) may be instrumental in PTG and IRB. Psychosocial interventions with high-risk families and their health care teams could increase growth and reduce burden.