Resilience as a predictor for emotional response to the diagnosis and surgery in breast cancer patients

Modification of Commonly Used Outcome Tools to Quantify the Patient Pain Distress Index Following Acute and Chronic Orthopedic Trauma

INTRODUCTION

Patient-reported outcome measures (PROMs) are an important component of evaluating patient health and are increasingly utilized in orthopedics. However, their use remains inconsistent among orthopedic subspecialties, with only 21% of orthopedic trauma surgeons reporting regular use of PROMs in their practice. While tools for quantifying patient distress in response to pain have been developed, they are often difficult to apply due to extensive questioning and the need for prospective implementation. The purpose of this study was to propose a novel retrospective technique to measure the Pain Distress Index (PDI) using two common PROMs: the visual analog scale (VAS) and the short musculoskeletal functional assessment (SMFA).

METHODS

A total of 797 patients who underwent operative repair of a tibial plateau fracture or revision of long bone nonunion were included. To quantify PDI, a linear trend line was calculated from a scatter plot of SMFA Bothersome Index (BI) vs. VAS pain scores at three months postoperatively. Reported SMFA BI was compared to predicted SMFA BI, and patients were stratified into three cohorts: "limited," "adequate," and "excellent" PDI.

RESULTS

In both cohorts, SMFA Function Index scores at 6 and 12 months postoperatively differed significantly among the limited, adequate, and excellent PDI levels (p < 0.0005, p < 0.0005). Worse PDI (indicating greater distress from pain) was associated with poorer SMFA Function Index scores.

CONCLUSIONS

The combination of SMFA BI and VAS scores may serve as a useful tool to quantify PDI without requiring an additional questionnaire. "Limited" PDI was associated with poorer functional outcomes at 6 and 12 months postoperatively. This method may help predict which patients are at risk for worse functional outcomes and could serve as a retrospective proxy for resilience in future research.

Does Resilience Change in Patients Undergoing Shoulder Surgery? A Retrospective Comparative Study Utilizing the Brief Resilience Scale

BACKGROUND

Resilience refers to the ability to adapt or recover from stress. There is increasing appreciation that it plays an important role in wholistic patient-centered care and may affect patient outcomes, including those of orthopaedic surgery. Despite being a focus of the current orthopaedic evidence, there is no strong understanding yet of whether resilience is a stable patient quality or a dynamic one that may be modified perioperatively to improve patient-reported outcome scores.

QUESTIONS/PURPOSES

(1) Does resilience change postoperatively? (2) How do outcome measures change postoperatively in relation to resilience grouping? (3) For patients who do have resilience instability (change in resilience of ≥ 1 SD between any two follow-up points), how were patient-level factors, surgical characteristics, and outcome measures associated with instability?

METHODS

In this single-surgeon, retrospective, comparative study, we identified all patients who underwent shoulder surgery between March 2021 and March 2023 from the medical records of one US military teaching hospital, resulting in 144 initial patients. Data on resilience (measured by the Brief Resilience Scale) and outcomes (assessed using the Numeric Rating Scale [NRS] and the Single Assessment Numeric Evaluation [SANE]) were collected for all patients and maintained in a longitudinal outcomes score database. Patients younger than 18 years of age (1% [1 of 144]) who underwent surgery for fracture, acute tendon rupture (8% [11 of 144]), or revision surgery (3% [4 of 144]); had concomitant shoulder conditions (such as, instability or rotator cuff tear) (1% [2 of 144]); or had incomplete follow-up data (4% [5 of 144]) were excluded, leaving 84% (121 of 144) of the original sample size for analysis. Among the patients, 12% (15 of 121) were women, the mean age was 41 ± 15 years, and the most common indication for surgery was instability (40% [48 of 121]) followed by rotator cuff repair (29% [35 of 121]). Based on their preoperative Brief Resilience Scale and its deviation from the mean, patients were stratified into low (> 1 SD below mean), intermediate (within 1 SD above and below mean), and high (> 1 SD above mean) resilience groups. Preoperatively, 19% (23 of 121) of patients were classified as low resilience, 62% (75 of 121) as intermediate resilience, and 19% (23 of 121) as high resilience. The mean ± SD preoperative Brief Resilience Scale score was 25 ± 4. The Brief Resilience Scale is a six-item scale with a calculated summary score ranging from 6 to 30. A higher score is suggestive of greater perceived resilience. There were no differences in the preoperative Brief Resilience Scale score with regard to age, gender, type of surgery performed, or outcome measures. Patient resilience was followed during the postoperative period for a minimum of 6 months, and instability in the scale was evaluated. Instability in resilience was defined as change in Brief Resilience Scale score by > 1 SD from one follow-up time point to another. Perioperative NRS and SANE outcomes, in addition to demographic data, were utilized to evaluate the relationship between resilience and patient-level factors.

RESULTS

Brief Resilience Scale groups across all time points remained consistent with no change in grouping or crossover in groups except for patients with low resilience who had an increase in mean ± SD Brief Resilience Scale score by the final follow-up (18 ± 3 versus 20 ± 4; p < 0.05). Regardless of resilience group, there was a decrease in mean ± SD NRS (4.4 ± 2.2 versus 2.4 ± 2.3; p < 0.001) and an improvement in mean ± SD SANE (46 ± 19 versus 69 ± 21; p < 0.001) scores during the postoperative period. At the 1- to 2-month follow-up and the 6- to 10-month follow-up visits, patients with high resilience were more likely to have lower NRS scores than patients with intermediate resilience (1.8 ± 1.0 versus 3.8 ± 2.3; p = 0.003) and low resilience (1.5 ± 1.8 versus 3.3 ± 2.4; p < 0.001), respectively. No relationship was observed between resilience groups and SANE scores, surgical category, and percentage of patients meeting the minimum clinically important difference (MCID) of the NRS or the SANE. Regarding resilience instability, 46% (56 of 121) of patients were categorized as having a Brief Resilience Scale change of ≥ 1 SD from baseline during the postoperative period. Gender (r = 0.03; p = 0.21), age (p = 0.81), and surgical category (r = 0.01; p = 0.88) were not associated with the likelihood of resilience instability. Individuals whose resilience increased had a lower starting Brief Resilience Scale score than those whose resilience stayed the same (22 ± 4 versus 25 ± 4, respectively; p < 0.001) or those whose resilience decreased (22 ± 4 versus 26 ± 3, respectively; p < 0.001).

CONCLUSION

When evaluated by resilience group, the trait appears static; however, at the individual level, resilience appears dynamic and complex. Patients with high resilience may have less postoperative pain. Identification of patients with low resilience may indicate patients who experience more dynamic change in this psychometric property.

LEVEL OF EVIDENCE

Level III, therapeutic study.

Relationship between social support and self-care ability among patients with breast cancer during rehabilitation: The multiple mediating roles of resilience and depression

AIMS

To identify the multiple mediating effects of resilience and depression between social support and self-care ability among patients with breast cancer during rehabilitation to provide reference for developing and implementing targeted interventions.

DESIGN

A cross-sectional study reported according to the STROBE checklist.

METHODS

A convenience sample of 320 patients with breast cancer during rehabilitation was recruited from one hospital in China. Data were collected from April to August 2022 using a self-report questionnaire, including the demographic and clinical information, Appraisal of Self-Care Agency Scale-Revised, Multidimensional Scale of Perceived Social Support, Connor-Davidson Resilience Scale-10 item, and Patient Health Questionnaire-9. The mediation analysis was conducted using the SPSS Process macro.

RESULTS

Self-care ability was positively associated with social support (β = .229) and resilience (β = .290), and negatively associated with depression (β = -.208). The relationship between social support and self-care ability was mediated by resilience and depression, respectively, and together in serial. The multiple mediating effects accounted for 34.0% of the total effect of social support on self-care ability.

CONCLUSION

Our findings identify resilience and depression as multiple mediators between social support and self-care ability and highlight the important roles of social support, resilience and depression in improving self-care ability.

RELEVANCE TO CLINICAL PRACTICE

Healthcare providers should pay great attention to the underlying mechanisms of how social support affects patients' self-care ability during breast cancer rehabilitation. Integrated intervention programmes targeted at enhancing social support, building resilience and alleviating depression might be beneficial to the improvement of self-care ability.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

REPORTING METHOD

The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies was applied to report the results.

Characteristics of positive and negative effects on the quality of life of breast cancer patients

BACKGROUND

Postoperative and ongoing treatment of breast cancer is traumatic to women with breast cancer and may lead to positive and negative psychological diseases, which can affect the prognosis of patients with breast cancer. Positive affect (PA) and negative affect (NA) significantly impact the prognosis of postoperative breast cancer patients. However, the effects of specific emotions on patient prognosis and the relationships between them are still unclear.

METHODS

A case-control study was conducted to investigate the characteristics of PA and NA and their effects on Quality of Life (QoL) in breast cancer patients. 442 postoperative breast cancer patients and 444 healthy women were recruited from November to December 2021. For the observation group, participants were eligible if they (1) were aged between 16 and 80 years and (2) had a confirmed pathological diagnosis of breast cancer and (3) possessed the ability to read text, voluntarily agreed to participate, provided informed consent, and cooperated with the study procedures. The control group consisted of individuals without breast cancer who met all other criteria, as stated above. Patients were excluded from the study if they (1) had severe comorbid conditions causing functional impairment or life-threatening risks or (2) suffered from mental disorders or were unconscious at the time of the study. For the control group, individuals with a pathological diagnosis of breast cancer were also excluded. All other exclusion criteria were consistent with those for the observation group. The demographic information and clinicopathological information of the participants were collected. The Positive Affect and Negative Affect Scale (PANAS) is a scale containing 20 emotional scores related to emotion and is used to assess the level of positive and negative affect. The Quality of Life Questionnaire Core 30 (QLQ-C30) was used to assess the quality of life of cancer patients in 15 domains. SPSS 24.0 was used to analyze and process the data. Independent-sample t-tests, one-way ANOVA and Pearson correlation analysis, were used to analyze PA and NA in different treatment phases. Polynomial regression and response surface analysis were conducted to assess the relationships among PA, NA, and QoL. The results were considered statistically significant at P < 0.05.

RESULTS

Compared with healthy women, breast cancer patients had lower scores on "alert" and "distressed" but higher scores on "inspired," "scared," and "afraid." There were no significant differences in the relationships between PA and NA between patients and healthy women (P > 0.05). During the initial treatment phase, the highest proportion of patients had an NA greater than the PA (PA < NA). In the rehabilitation phase, the highest proportion of patients had PA greater than or equal to the NA (PA ≥ NA). The relationship between PA and QoL was an inverted U-shaped curve (P < 0.05), whereas the relationship between NA and QoL was a positive U-shaped curve (P < 0.05). There was an interaction effect between PA and NA (P < 0.001). The relationships among PA, NA, and QoL varied across treatment phases. In the initial treatment phase, the presence of both positive and negative affect improved QoL. In the endocrine therapy phase, excessive positive effects decrease QoL. During the rehabilitation phase, QoL improved as positive affect increased relative to negative affect.

CONCLUSION

There are significant differences in the distributions of positive and negative effects in breast cancer patients at different treatment phases. The impact of PA and NA on QoL varies by treatment phase. Our findings have important implications for tailoring emotional interventions for breast cancer patients at different stages of treatment.

The role of resilience and coping strategies as predictors of well-being in breast cancer patients

PURPOSE

This study investigated the role of resilience and coping strategies on breast cancer patients' well-being using a structural equation model. To achieve this objective, a model previously developed by Mayordomo's group was partially replicated using a longitudinal study design in an oncological sample.

METHODS

The study was a longitudinal observational survey. Patients with breast cancer were recruited (N = 166). Resilience was measured with the Mexican Resilience Measurement Scale, coping strategies with the Forms of Coping and Dimensions Scale and perception of the psychological well-being with a short-form of Ryff's Scales of Psychological Well-Being at the start and end of adjuvant chemotherapy (T1 and T2 respectively).

RESULTS

The results showed stability in the variables over time and revealed differences with respect to Mayordomo's model. The best predictor of well-being at T2 was well-being at T1. In addition, the model indicated that resilience had a direct impact on well-being through problem-focused coping. Indeed, resilience and problem-focused coping best explained well-being at T2.

CONCLUSIONS

Both at the start and end of adjuvant chemotherapy for breast cancer, problem-focused coping positively predicted resilience, which in turn was a positive predictor of well-being. On the other hand, emotion-focused coping showed no association with resilience or well-being. As part of the multidisciplinary cancer team, oncology nurses have a key role to play in promoting resilience and problem-focused coping as an important goal of psychosocial interventions in breast cancer patients.

Subjective well-being among Iranian breast cancer patients: Exploring the influential role of psychological capital

PURPOSE

Breast cancer is a prevalent and emotionally challenging condition that profoundly affects women worldwide. Effectively managing the mental and emotional dimensions of this disease is crucial for the holistic well-being of patients. Psychological capital (PsyCap) has emerged as a pivotal psychological construct with the potential to effectively address these challenges. This study aims to explore the influential role of PsyCap and its constructs on the subjective well-being (SWB) of Iranian breast cancer patients.

METHODS

A total of 173 breast cancer patients participated in this study, selected through a random sampling approach. Face-to-face interview data on socio-demographics, PsyCap, and SWB were collected using a structured questionnaire. The analytical procedures encompassed independent sample t-tests, ANOVA tests, Pearson correlation tests, and stepwise multiple regression.

RESULTS

The findings revealed that the majority of participants fell within the 41-50 age group (38.7%), with an average age of 46.50 ± 11.76 years, and 35.8% had tumor growth in the upper left lobe. The average PsyCap score was 107.93 ± 1.52 (out of a possible score of 144), whereas SWB scored 196.51 ± 1.90 (out of 291). Notably, PsyCap showed a positive correlation with SWB (r = 0.119), accounting for approximately 8% of the variance in SWB. The final regression model showed the substantial predictive roles of PsyCap (1.667), self-efficacy (-3.692), age (-2.977), and education (-3.939) in shaping SWB.

CONCLUSIONS

Focusing on understanding and addressing factors like PsyCap, self-efficacy, and educational support could improve SWB, offering a potential avenue for comprehensive and individualized psychosocial care for women with breast cancer.

The Impact of Newly Diagnosed Early Breast Cancer on Psychological Resilience, Distress Levels, and the Perception of Health

Confronting a breast cancer diagnosis, along with complex and challenging treatment procedures, is an extremely stressful experience. Psychological resilience is the ability to maintain or restore normal functioning while facing adversity. We aimed to explore the impact of an early breast cancer diagnosis on psychological resilience, distress, and perception of health. A cross-sectional study was conducted, including 50 patients newly diagnosed with early breast cancer and 67 healthy women with screening mammograms graded 1 or 2 using a Breast Imaging Reporting and Data System. The levels of distress, perception of health, and psychological resilience were assessed using the depression, anxiety, and stress scale, the SF 36-Item Health Survey 1.0, and the Connor-Davidson RISC-25 scale. Differences between variables were examined using the t-test and chi-square test for interval and categorial variables. The surveys were conducted within four weeks of a breast cancer diagnosis. Patients with breast cancer reported a deterioration of their health relative to the previous year and significantly higher levels of psychological resilience, while there was no significant difference between the groups in levels of stress, anxiety, or depression. The process of diagnosis with early breast cancer may activate psychological dynamic processes which are involved in the effective adaptation to acute stress, leading to higher resilience levels in breast cancer patients compared to healthy controls.

Resilience Improves Patient-Reported Outcomes After Orthopaedic Trauma

OBJECTIVES

To analyze the relationship between patient resilience and patient-reported outcomes after orthopaedic trauma.

METHODS

DESIGN

Retrospective analysis of prospectively collected data.

SETTING

Single Level 1 Trauma Center.

PATIENT SELECTION CRITERIA

Patients were selected based on completion of the Patient-Reported Outcomes Measurement Information System (PROMIS) and Brief Resilience Scale (BRS) surveys 6 months after undergoing operative fracture fixation following orthopaedic trauma. Patients were excluded if they did not complete all PROMIS and BRS surveys.

OUTCOME MEASURES AND COMPARISONS

Resilience, measured by the BRS, was analyzed for its effect on patient-reported outcomes, measured by PROMIS Global Physical Health, Physical Function, Pain Interference, Global Mental Health, Depression, and Anxiety. Variables collected were demographics (age, gender, race, body mass index), injury severity score, and postoperative complications (nonunion, infection). All variables were analyzed with univariate for effect on all PROMIS scores. Variables with significance were included in multivariate analysis. Patients were then separated into high resilience (BRS >4.3) and low resilience (BRS <3.0) groups for additional analysis.

RESULTS

A total of 99 patients were included in the analysis. Most patients were male (53%) with an average age of 47 years. Postoperative BRS scores significantly correlated with PROMIS Global Physical Health, Pain Interference, Physical Function, Global Mental Health, Depression, and Anxiety ( P ≤ 0.001 for all scores) at 6 months after injury on both univariate and multivariate analyses. The high resilience group had significantly higher PROMIS Global Physical Health, Physical Function, and Global Mental Health scores and significantly lower PROMIS Pain Interference, Depression, and Anxiety scores ( P ≤ 0.001 for all scores).

CONCLUSIONS

Resilience in orthopaedic trauma has a positive association with patient outcomes at 6 months postoperatively. Patients with higher resilience report higher scores in all PROMIS categories regardless of injury severity. Future studies directed at increasing resilience may improve outcomes in patients who experience orthopaedic trauma.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Increased patient resilience scores are related to positive postoperative outcomes in rotator cuff repairs

HYPOTHESIS

We sought to determine whether patients' preoperative resilience scores predict postoperative outcomes in arthroscopic rotator cuff repair surgery.

METHODS

Patients were prospectively enrolled and underwent data collection preoperatively and at 3, 6, 12, and 24 months postoperatively. Data collected included demographic characteristics and the Brief Resilience Scale (BRS) score, visual analog scale score, Veterans RAND 12-Item Health Survey scores (mental component [VR-12M] and physical component [VR-12P]), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, Single Assessment Numeric Evaluation score, and Simple Shoulder Test (SST) score.

RESULTS

In total, 131 patients had complete 1- or 2-year postoperative outcome measures. Female patients comprised 56.5% of our sample, and the average age was 57.6 years. Between the low, normal, and high resilience groups, there were significant differences in the VR-12M scores at 0, 12, and 24 months postoperatively (P < .01 for all). The VR-12P scores at 12 months were 44.2, 47.4, and 49.8 in the low, normal, and high resilience groups, respectively, showing a trend upward, but this failed to reach the level of significance (P = .08). The SST scores of the low, normal, and high resilience groups at 12 months were 69.1, 79.9, and 85.1, respectively, again showing a trend upward, but this failed to reach the level of significance (P = .07). The SST scores at 0 and 24 months did not differ between groups. There were no significant differences in American Shoulder and Elbow Surgeons, visual analog scale, and Single Assessment Numeric Evaluation scores at 0, 12, or 24 months postoperatively. We found a significant positive correlation between the BRS score and SST score at 12 months (R = 0.18), VR-12M score at 12 months (R = 0.38), VR-12M score at 24 months (R = 0.31), and VR-12P score at 12 months (R = 0.21).

CONCLUSIONS

Our study provides evidence that BRS scores in patients undergoing arthroscopic rotator cuff repair are related to postoperative outcomes, measured through the VR-12M and SST scores at 2-year follow-up.

Subjective Well-Being in Cancer Patients: The Roles of Social Support, Purpose in Life, Resilience, and Informativeness

The aim of this research was to determine the relationship between subjective well-being (life satisfaction, positive and negative experiences, and prosperity) and various psychosocial factors (social support received from family members and partners, purpose in life, resilience and information) in cancer patients and to examine the possibility of predicting components of subjective well-being based on these mentioned factors in cancer patients. A total of 338 adult cancer patients from Croatia participated in the study (41.1% male and 58.9% female). To measure the constructs, the Diener Subjective Well-Being Scale, the Social Support Scale at work and in the family, the Purpose in Life Scale, the Short Resilience Scale, and the EORTC-QLQ information questionnaire were used. Results showed a high level of life satisfaction and prosperity, as well as more frequent positive compared to negative experiences. A medium to high level of social support received from family members and from the partner was determined. High levels of purpose in life and medium levels of resilience and information were found. A high correlation was found among the components of the construct of subjective well-being, and a low to medium correlation among the predictors. Positive associations were found between the criteria of life satisfaction and prosperity with psychosocial factors. Negative associations were established between the positive/negative experience variables and the factors. Furthermore, the purpose in life was determined as an important predictor of all three components of subjective well-being, social support (both sources) as important for predicting life satisfaction, resilience for experiencing positive and negative experiences, and social family support for predicting the prosperity of cancer patients.

Childhood Adversity, Resilience, and Paranoia During the COVID-19 Outbreak. The Mediating Role of Irrational Beliefs and Affective Disturbance

Childhood adversity (CA) and resilience may impact on paranoia, but mechanisms underlying these associations are largely unknown. In this study, we investigated two potential candidates: irrational beliefs and affective disturbance. Moreover, we investigated the potential moderating role of COVID-19 perceived stress in these associations. A community sample (N = 419, m age = 27.32 years, SD = 8.98; 88.10% females) completed self-report measures. Results indicated that paranoia was significantly associated with CA and resilience (p < .05), and both irrational beliefs and affective disturbance (i.e., depressive and anxiety symptoms) mediated the associations between CA and paranoia. Moreover, depressive and anxiety symptoms partially explained the mediating role of irrational beliefs. These predictive models explained up to 23.52% of variance in paranoia (F(3,415) = 42.536, p < .001). Findings on resilience and paranoia replicated these results, and COVID-19 perceived stress moderated the association between resilience and ideas of persecution. Overall, these findings underscore the importance of irrational beliefs, depressive and anxiety symptoms in high CA or low resilience individuals experiencing paranoia.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10942-023-00511-4.

Associating Outcomes After Hip Arthroscopy With Patient Resilience

Background

Higher patient resilience has been shown to be associated with improved patient-reported outcome measures (PROMs) at 6 months after hip arthroscopy.

Purpose

To examine the relationship between patient resilience and PROMs at minimum 2 years after hip arthroscopy.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

Included were 89 patients (mean age, 36.9 years; mean follow-up, 4.6 years). Patient demographics, surgical details, and preoperative International Hip Outcome Tool-12 (iHOT-12) and visual analog scale (VAS) pain scores were collected retrospectively. Postoperative variables were collected via a survey and included the Brief Resilience Scale (BRS), Patient Activation Measure-13 (PAM-13), Pain Self-efficacy Questionnaire-2 (PSEQ-2), VAS satisfaction, and postoperative iHOT-12, and VAS pain scores. Based on the number of standard deviations from the mean BRS score, patients were stratified as having low resilience (LR; n = 18), normal resilience (NR; n = 48), and high resilience (HR; n = 23). Differences in PROMs were compared between the groups, and a multivariate regression analysis was performed to assess the relationship between pre- to postoperative change (Δ) in PROMs and patient resilience.

Results

There were significantly more smokers in the LR group compared with the NR and HR groups (P = .033). Compared with the NR and HR groups, patients in the LR group had significantly more labral repairs (P = .006), significantly worse postoperative iHOT-12, VAS pain, VAS satisfaction, PAM-13, and PSEQ-2 scores (P < .001 for all), and significantly lower ΔVAS pain and ΔiHOT-12 scores (P = .01 and .032, respectively). Regression analysis showed significant associations between ΔVAS pain and NR (β = -22.50 [95% CI, -38.81 to -6.19]; P = .008) as well as HR (β = -28.31 [95% CI, -46.96 to -9.67; P = .004) and between ΔiHOT-12 and NR (β = 18.94 [95% CI, 6.33 to 31.55]; P = .004) as well as HR (β = 20.63 [95% CI, 6.21 to 35.05]; P = .006). Male sex was a significant predictor of ΔiHOT-12 (β = -15.05 [95% CI, -25.42 to -4.69]; P = .006).

Conclusion

The study results indicate that lower postoperative resilience scores were associated with significantly worse PROM scores, including pain and satisfaction, at 2 years after hip arthroscopy.

Threat Appraisal, Resilience, and Health Behaviors in Recovered COVID-19 Patients: The Serial Mediation of Coping and Meaning-Making

Research indicates that both cognitive appraisal and personal resources can noticeably influence health behaviors, as individuals modify their health convictions and practices on the basis of threat appraisal, personality, and meaning. The aim of the current study was to investigate whether coping strategies and meaning-making can serially mediate the relationship of threat appraisal and resilience with health behaviors in recovered COVID-19 patients. Self-report measures of threat appraisal, resilience, coping, meaning-making, and health behaviors were completed by 266 participants (aged 17 to 78, 51.5% female) who had recovered from COVID-19. The serial mediation analysis showed that the relationship of threat appraisal and resilience with health behaviors was mediated by problem-focused coping, meaning-focused coping, and meaning-making, but not by emotion-focused coping. These results suggest that associations among threat perception, resilience, and health behavior depend to some extent on the interplay of coping and meaning-making, which reveals their unique role in the process of recovery from COVID-19, with potential implications for health interventions.

Pathways to post-traumatic growth in Korean female cancer patients: the mediation effects of coping strategies and resilience

ABSTRACTBackground: Cancer is a life-threatening disease in Korean women. Female cancer patients in Korea have reported poor physical functioning and psychological distress after diagnosis. However, some patients experience post-traumatic growth (PTG), which includes positive feelings and changes.Objective: The main purpose of this study was to examine the relationships between PTG and its associated factors in Korean female cancer patients to understand how female cancer patients achieve PTG while experiencing cancer diagnosis and treatment. This study aimed to improve the quality of life of many Korean female patients with cancer.Methods: This study investigated the structural model of the paths from the disruption of core beliefs (CBD), coping strategies, and resilience to PTG in a sample of female cancer patients. In total, 164 middle-aged women diagnosed with cancer were included in the final sample.Results: First, it was determined that the proposed structural model was substantial and had high fit indices. Second, problem-solving was positively associated by the CBD routes. Third, it was also favorably expected that problem-solving would lead to resilience and resilience would lead to PTG. These findings are important for developing future interventions for Korean female cancer patients and can be considered as an important variable to improve their PTG.

Self-care behaviors mediates the relationship between resilience and quality of life in breast cancer patients

Previous studies have shown that resilience could play an important role in enhancing the quality of life in women with breast cancer; however, the mediating role of self-care behaviors have not been studied. This study aims to explore the mediating role of self-care behaviors in the relationship between resilience and quality of life in breast cancer patients. A sample of 195 women with breast cancer (aged from 21 to 60 years; M = 45.32 ± 8.2) from three hospitals in Tehran, Iran completed online questionnaires measuring resilience, self-care and quality of life. The results of structural equation modeling showed that resilience (β = 0.546, p < .01) and self-care behaviors (β = 0.621, p < .01) positively predicted the quality of life in breast cancer patients. The bootstrapping analysis showed that self-care behaviors acted as a partial mediator between resilience and quality of life. The present study brings to light an underlying mechanism of the relationship between resilience and quality of life via the mediating variable of self-care behaviors for patients with breast cancer.

Resilience as a Factor Influencing Psychological Distress Experience in Patients with Neuro-Oncological Disease

Cancer causes psychological distress. Approximately one-third of all patients with cancer suffer from distress requiring psycho-oncological treatment. Examining factors contributing to their distress can inform approaches to counteracting them. Among such factors, resilience is considered to be a psychological adaptive capacity resulting from complex genetic, epigenetic, psychological, and environmental influences. For that reason, we investigated resilience as a factor of psychological distress experience among patients with neuro-oncological disease. To assess distress among patients with neuro-oncological diseases, we performed electronic psycho-oncological screening in the Department of Neurosurgery at Tübingen University Hospital (n = 100) following tumor surgery (T₀) using the Resilience Scale 13, the Hornheider Screening Instrument, the Patient Health Questionnaire-2, the Generalized Anxiety Disorder Scale-2, and the Distress Thermometer, all administered on tablets. Follow-up was done 6 months after (T₁). The distress of patients with neuro-oncological disease decreased significantly after 6 months (p < 0.01). Most patients (87%) showed moderate to high resilience. Although significant correlations with distress are measurable at the T₀ time point (ρ = -0.318 **, p < 0.01), no significant correlations were observed at T₁. Thus, resilience seems to significantly impact distress in the acute phase of the neuro-oncological disease. For clinical practice, our findings suggest that resilience-focused screening can provide useful information about patients at risk of experiencing distress.

Self-efficacy and positive coping mediate the relationship between social support and resilience in patients undergoing lung cancer treatment: A cross-sectional study

Background

The prognosis of patients undergoing lung cancer treatment might be influenced by mental health status. Resilience is one of the important predictors to reflect the mental health status. It has been shown that patients with higher levels of social support, self-care self-efficacy, and positive coping have greater resilience. This study aimed to determine the mediating role of self-efficacy and positive coping in the relationship between social support and psychological resilience in patients with lung cancer.

Method

This is a cross-sectional study that was conducted in in the oncology departments and thoracic surgical wards of four tertiary hospitals in Hunan Province, China, between November 2016 and November 2017. Three hundred and three patients who were undergoing treatment for lung cancer volunteered their participation in the study. Participants completed questionnaires, including the Chinese version of the Perceived Social Support Seale Scale, the Chinese version of Strategies Used by People to Promote Health Scale, and the Chinese version of the Connor-Davidson Resilience Scale.

Results

Mediation analysis indicated that self-care self-efficacy and social support partially mediate the effect of social support on resilience. Direct paths from social support to self-efficacy, self-efficacy to positive coping, positive coping to psychological resilience, self-efficacy to psychological resilience, and social support to psychological resilience were significant (p &lt; 0.001). The indirect paths from social support to self-efficacy and self-efficacy to psychological resilience were also significant. The chain mediation from social support to self-efficacy, self-efficacy to positive coping, and positive coping to resilience were significant.

Conclusion

Self-efficacy and positive coping play an important role in the relationship between social support and resilience in patients receiving cancer treatment. Social support not only directly influenced psychological resilience but also indirectly influenced psychological resilience through self-efficacy and positive coping.

The effects of trait resilience and rumination on psychological adaptation to breast cancer

This cross-sectional study examined the effect of trait resilience and specific types of rumination on positive psychological adaptation post-diagnosis among 201 breast cancer patients. They completed self-reported measures describing trait resilience, rumination, posttraumatic growth, and health-related quality of life. Hierarchical analysis showed that trait resilience significantly predicted higher quality of life and posttraumatic growth after controlling for demographic and clinical variables. Additionally, “intrusion” and “brooding” subtypes of rumination negatively predicted quality of life, with “instrumentality” positively predicting quality of life and posttraumatic growth, suggesting the importance of trait resilience and multidimensional rumination for positive psychological changes among breast cancer survivors.

Positive personal resources and psychological distress during the COVID-19 pandemic: resilience, optimism, hope, courage, trait mindfulness, and self-efficacy in breast cancer patients and survivors

Purpose

This study aims to understand the association between positive personal resources (i.e., optimism, hope, courage, trait mindfulness, and self-efficacy), resilience, and psychological distress (i.e., anxiety, depression, stress) in women with breast cancer and breast cancer survivors during the COVID-19 pandemic. We hypothesized that personal positive resources can directly influence resilience, which in turn prevented psychological distress.

Methods

The research sample consisted of 409 Italian women (49% patients, 51% survivors) who were administered a questionnaire to assess positive resources, resiliency, and distress. structural equation model (SEM) analysis was carried out to confirm the hypothetical-theoretical model.

Results

Personal positive resources had a direct positive effect on resilience, which prevented from distress. These results were observed across cancer patients and survivors, and regardless the level of direct exposure to COVID-19.

Conclusions

In both patients and survivors, the relationships between positive personal resources, resilience, and psychological distress is strong enough to be not influenced by the level of exposure to COVID-19 and despite COVID-19 pandemic caused the disruption of active treatment plans and delays in routine check-ups.

Implications for cancer survivors

Implications of this study suggest the urgency to screen positive resources and to identify women with lower resilience and a potentially higher susceptibility to develop psychological distress. For these women, our findings suggest the implementation of psychological interventions that build resilience.

Spiritual and Emotional Experience With a Diagnosis of Breast Cancer: A Scoping Review

BACKGROUND

The breast cancer diagnosis causes a high level of suffering and distress in patients who experience difficulties in coping. There is a need to improve knowledge of emotional and spiritual coping in response to the stressful situation of women who must face this diagnosis.

OBJECTIVES

The aims of this study were to map women's spiritual and emotional coping experiences reported after a breast cancer diagnosis and examine the proposed interventions and suggestions for clinical practice.

METHODS

A scoping review was performed by searching the Scientific Electronic Library Online, Scopus, Cumulative Index to Nursing and Allied Health Literature, Latin American & Caribbean Health Sciences Literature, Medical Literature Analyses and Retrieval System Online, Spanish Bibliographic Index of Health Sciences, PSYCINFO, and Google Scholar databases using Medical Subject Headings terms. Additional pertinent studies were identified by reviewing the bibliographies of the included studies. Twenty articles were included according to the recommendations for scoping reviews.

RESULTS

Study findings regarding emotional and spiritual coping with the diagnosis and proposed interventions were synthesized. A thematic list of interventions and recommendations for clinical practice is also provided.

CONCLUSIONS

The studies demonstrated that women with breast cancer are challenged by their emotions and experiences. The review highlights the importance of spiritual coping for redefining women's meaning in life. In clinical practice, caring for women's inherent needs when they are coping with a diagnosis is important to establish integral care.

IMPLICATIONS FOR PRACTICE

Nurses can evaluate coping strategies, offer support for adaptation to the disease, provide qualified listening, help women in their search for significance while coping with cancer, and help them identify ways to overcome this stressful situation. Similarly, they can encourage patients to find spiritual comfort and emotional support.

The Interplay Between Trait Resilience and Coping Self-efficacy in Patients with Breast Cancer: An International Study

The role of self-efficacy to cope with breast cancer as a mediator and/or moderator in the relationship of trait resilience to quality of life and psychological symptoms was examined in this study. Data from the BOUNCE Project ( https://www.bounce-project.eu/ ) were used. Women diagnosed with and in treatment for breast cancer (N = 484), from four countries, participated in the study. Trait resilience and coping self-efficacy were assessed at baseline (soon after the beginning of systemic treatment), and outcomes (quality of life, psychological symptoms) 3 months later. Hierarchical regression, mediation, moderation, and conditional (moderated) mediation and moderation analyses were performed to examine the study hypotheses. Coping self-efficacy mediated the impact of trait resilience. In addition, higher levels of resilience in combination with higher levels of coping self-efficacy were associated with better outcomes. Country of origin had no impact on these results. Overall, it seems that coping self-efficacy is a key factor that should be taken into account for research and intervention efforts in cancer.

Worst Pain Severity Profiles of Oncology Patients Are Associated With Significant Stress and Multiple Co-Occurring Symptoms

Little is known about the associations between pain, stress, and co-occurring symptoms in oncology patients. Purpose was to identify subgroups of patients with distinct worst pain profiles and evaluate for differences among the subgroups in demographic and clinical characteristics, as well as stress and symptom scores. Oncology outpatients (n = 1305) completed questionnaires prior to their second or third chemotherapy cycle. Worst pain intensity was assessed 6 times over 2 chemotherapy cycles using a 0 to 10 numeric rating scale. The 371 patients (28.4%) who had ≤1 occurrence of pain over the 6 assessments were classified as the None class. For the remaining 934 patients whose data were entered into the latent profile analysis, 3 distinct worst pain profiles were identified (ie Mild [12.5%], Moderate [28.6%], Severe [30.5%]). Compared to None class, Severe class had fewer years of education and a lower annual income; were less likely to be employed and married; less likely to exercise on a regular basis, had a higher comorbidity burden, and a worse functional status. Compared to None class, Severe class reported higher levels of general, disease-specific, and cumulative life stress and lower levels of resilience, as well as higher levels of depressive symptoms, anxiety, fatigue, sleep disturbance, and cognitive dysfunction. This study is the first to identify distinct worst pain profiles in a large sample of oncology patients receiving chemotherapy and associated risk factors. PERSPECTIVE: Unrelieved pain remains a significant problem for oncology patients receiving chemotherapy. High levels of stress and co-occurring symptoms contribute to a more severe pain profile in these patients.

Resilience across the Transition to Cancer Survivorship

Resilience is highly relevant in the context of cancer, and understanding how survivors adapt and potentially thrive following their diagnosis and treatment may provide insights into better supports and interventions to promote healthier survivorship. In this paper, we characterize two different ways to conceptualize and study resilience in cancer survivorship, as a trait and as a process. We focus specifically on the transition from active treatment to post-treatment survivorship. We present data from 225 cancer patients transitioning from active treatment (baseline assessment) to early survivorship (6-month follow-up). Results demonstrate that resilience assessed as a trait at baseline was unrelated to changes in survivors' mental or physical wellbeing at follow-up, but did predict a decline in social satisfaction and spiritual wellbeing over time. However, when resilience is conceptualized as a dynamic process, the sample showed substantial resilience on multiple aspects of wellbeing. We suggest that different ways of conceptualizing resilience--as a trait versus as a dynamic process--may lead to very different conclusions and discuss future research directions for cancer survivors and for science of resilience.

Age- and gender-related differences in the evolution of psychological and cognitive status after the lockdown for the COVID-19 outbreak: a follow-up study

OBJECTIVE

Individuals experienced psychological symptoms in response to quarantine for the COVID-19 pandemic. Therefore, we aimed to investigate the possible effect of age and gender on the evolution of mental health status after the quarantine in the Italian population and the baseline predictors of post-traumatic stress symptoms.

METHODS

An online follow-up questionnaire including an assessment of depression, anxiety, anger, post-traumatic stress, subjective cognitive failures, resilience, and coping style was completed by participants 2 months after the end of the quarantine (n = 758).

RESULTS

Individuals experienced psychological symptoms also 2 months after the end of the quarantine. No decrease in depression and anxiety scores emerged, but younger individuals and females experienced more severe symptoms. Anger symptoms decreased in young adults, whereas they increased in older adults. Moreover, individuals reported more cognitive failures at follow-up. No changes were observed in resilience, whereas participants reported adopting fewer coping strategies at follow-up. Finally, post-traumatic stress symptoms 2 months after the end of the lockdown were associated with more severe psychological symptoms and more fear of getting infected at baseline.

CONCLUSIONS

Our findings demonstrate that the long-term psychological impact and the cognitive consequences of quarantine differ according to age and gender. The identification of more vulnerable groups allows the implementation of interventions to reduce psychological symptoms and the risk for cognitive impairment.

Psychiatric symptoms mediate the effect of resilience on health-related quality of life in patients with breast cancer: Longitudinal examination

OBJECTIVE

Patients with breast cancer receiving neoadjuvant chemotherapy are at increased risk of poor health-related quality of life (HRQOL). This study examined clinical caseness on depression and anxiety mediate the relationship between resilience and HRQOL in patients with breast cancer.

METHODS

A total of 193 patients with breast cancer undergoing neoadjuvant chemotherapy completed questionnaires including the Connor-Davidson Resilience Scale, Hospital Anxiety and Depression Scale (HADS), and Functional Assessment of Cancer Therapy-Breast before the first session (T0), before the start of the last session (T1), and 6 months after the end (T2) of chemotherapy. Mediation analyses using a bootstrapping method was performed.

RESULTS

The indirect effect (IE) through T1 depression was significant (IE through depression = 0.043, 95% confidence interval [CI] [0.002-0.090]), while IE through T1 anxiety was not significant (IE through anxiety = 0.037, 95% CI [-0.010-0.097]) in the association between T0 resilience and T2 HRQOL.

CONCLUSIONS

Clinical caseness on HADS depression subscale during chemotherapy was a mediating factor of the relationship between resilience before chemotherapy and HRQOL after chemotherapy in patients with breast cancer receiving neoadjuvant chemotherapy. Depression during chemotherapy in patients with breast cancer may be a target symptom of screening and intervention to maintain the HRQOL after chemotherapy. Also, patients with low resilience are more likely to develop depression during chemotherapy, and clinicians should carefully monitor whether depression occurs in these patients with low resilience.

Late Presentation at Primary Diagnosis of Breast Cancer: Patients' Personality Characteristics and Attitudes

Introduction

Breast cancer (BC) is the most common cancer in women worldwide. Despite screening and information efforts, about 10% of patients present with tumor size T3 or T4 at primary diagnosis. Late presentation is associated with more advanced tumor stage and consecutively with worse survival rates.

Objective

This study aimed to evaluate whether patients with a late presentation at primary BC diagnosis differ in their personality from those with early diagnosis.

Methods

In this bicentric, observational study, personality traits, positive and negative affectivity, anxiety, spirituality, illness beliefs, and sociodemographic characteristics were assessed in BC patients who presented with T-stages 3 or 4 (late presenters) and T-stages 1 or 2 (controls) at initial diagnosis.

Results

Forty patients (20 controls, 20 late presenters) were interviewed. "Late presenters" perceived their disease as long lasting and had significantly more "positive affectivity" in the current trait. Although no significant associations were found, there was a trend for late presenters to have higher education levels, less spiritual longing, less accurate explanation of their illness, less anxiety in the trait scale, and more conscientiousness than the controls.

Conclusion

As patients with late presentation for BC differ in specific psychological and sociodemographic characteristics from patients with early BC, the findings of this pilot project warrant additional investigations to identify further specific characteristics and motivations. Identifying patients at risk for late presentation and encouraging them to accept an earlier diagnosis could help to improve their therapy and, finally, their outcome.

Changes in depressive symptoms among family caregivers of patients with cancer after bereavement and their association with resilience: A prospective cohort study

Objectives

To elucidate changes in depressive symptoms after bereavement and the impact of pre‐loss resilience on such changes and on the extent of complicated grief and posttraumatic growth.

Methods

Prospective cohort surveys were provided to family caregivers of patients with cancer in four palliative care units (PCUs) before and after bereavement. Pre‐loss Connor–Davidson Resilience Scale scores, pre‐ and post‐loss Patient Health Questionnaire‐9 scores, post‐loss Brief Grief Questionnaire scores, and the expanded Posttraumatic Growth Inventory scores were determined.

Results

Out of 186 bereaved family caregivers, 71 (38.2%) responses were analyzed, among which 47% pre‐loss and 15% post‐loss responses suggested to be a high risk for major depressive disorder (MDD). Approximately 90% of family caregivers at a high risk for post‐loss MDD were already at a high risk for pre‐loss MDD. Even after adjustment of the background variables as covariates, the interaction effect between family caregivers' pre‐loss depressive symptoms and resilience on post‐loss depressive symptoms was observed (F = 7.29; p < 0.01). Moreover, pre‐loss resilience was not associated with other bereavement outcome measures.

Conclusions

Among family caregivers of patients with cancer in PCUs, 47% and 15% had high risk for MDD before and after bereavement, respectively. Moreover, pre‐loss resilience mitigated post‐loss depressive symptoms among family caregivers who had high risk for MDD before bereavement. However, considering the study's small sample size, further research is needed.

Resilience: an essential element in head and neck cancer survivorship and quality of life

PURPOSE

Individuals with head and neck cancer (HNCa) face myriad biopsychosocial challenges. Even after treatment completion, these challenges may cause continued disablement and diminished quality of life (QoL). Resilience may serve to minimize the disabling impact of HNCa and, in turn, maximize QoL. The purpose of this study was to formally assess resilience in HNCa survivors and explore its relationship with QoL.

METHODS

A cross-sectional descriptive study was conducted. Forty HNCa survivors completed three validated, self-report questionnaires pertaining to the collection of resilience and QoL data. Descriptive and correlational analyses were performed.

RESULTS

Resilience was identified in HNCa survivors and a positive correlation was found between resilience and QoL.

CONCLUSIONS

Data suggest that resilience may buffer the influence of HNCa on QoL. Thus, screening for reduced levels of resilience may proactively facilitate identification of those who are most vulnerable to the psychosocial impact of HNCa. Interventions that foster resilience may ameliorate the challenges of HNCa and maximize QoL.

Resilience and coping strategies in relation to mental health outcomes in people with cancer

Considering the importance of psychological variables on health-related processes, this study investigated the role of resilience and coping strategies in relation to health. The aim of this research was to explore the underlying association between these aspects for the better understanding of the effect of psychosocial variables on mental health in cancer. This information could lead to the design of adapted psychological interventions in cancer. Participants with different diagnosis of cancer were recruited (N = 170). They came from the Spanish Association Against Cancer of Biscay. Resilience was measured with the 10 items Connor-Davidson Resilience Scale, coping with the Cognitive Emotion Regulation Questionnaire and mental health was measured as a global indicator through the SF-12 and the GHQ-12. A structural equation model (SEM) was conducted to test the effects between the constructs. Results showed that resilience and coping were significantly associated. Results reflected an absence of significant correlation between adaptive and disadaptive coping strategies. Resilience was the factor that most correlated with health outcomes (β = –.45, p < .001). However, disadaptive coping strategies did not correlate with resilience or mental health indicators. Findings in this study underscore the positive contribution of high levels of resilience and an adaptive coping on participants´ level of health. Disadaptive coping strategies did not reflect any positive relation with resilience or health indicators. Thus, promoting resilience and adaptive coping could be a significant goal for psychosocial and educational interventions in people with cancer.

Psychological Resilience and Health-Related Quality of Life in 418 Swedish Women with Primary Breast Cancer: Results from a Prospective Longitudinal Study

Simple Summary

Psychological resilience is an important psychological mechanism that enables a person to successfully handle significant adversities, e.g., a cancer diagnosis. Despite improved prognosis, breast cancer is associated with emotional distress across the trajectory of the disease. This study aimed to investigate psychological resilience and health-related quality of life in Swedish women with breast cancer at diagnosis and one year later. The resilience score declined in the cohort and was associated with health-related quality of life at both time points. Assessment of psychological resilience in breast cancer care might enable the identification of patients in need of intensified rehabilitation to improve their health-related quality of life.

Abstract

Psychological resilience is considered a major protective psychological mechanism that enables a person to successfully handle significant adversities, e.g., a cancer diagnosis. Higher levels of resilience have been associated with higher levels of health-related quality of life (HRQoL) in breast cancer (BC) patients, but research examining the longitudinal process of resilience is limited. The aim of this population-based longitudinal study was to investigate resilience and HRQoL from diagnosis to one year later in 418 Swedish women with primary BC. Resilience was measured with the Connor–Davidson Resilience Scale 25, and HRQoL was measured with the Short Form Health Survey. The participants responded to questions regarding demographic and study-specific variables. Clinicopathological variables were collected from the Swedish National Quality Register for Breast Cancer. The mean score for resilience was 70.6 (standard deviation, SD = 13.0) at diagnosis and 68.9 (SD = 14.0) one year later, p < 0.001. The level of trust in the treatment and financial situation demonstrated the greatest association with the change in resilience levels. No oncological treatment modality was associated with a change in resilience levels. HRQoL decreased over time in the cohort. Resilience was positively associated with HRQoL at one year post diagnosis, which demonstrates that resilience is an important factor in maintaining HRQoL.

Resiliency influences postoperative outcomes following rotator cuff repair

BACKGROUND

The purpose of this retrospective review was to assess the effects of resiliency on postoperative outcome scores and complications following rotator cuff repair (RCR).

METHODS

In 2014, 49 consecutive patients underwent arthroscopic RCR for either a partial- or full-thickness tear performed by a single surgeon at a multi-location, single center. In these patients, the following scores were monitored: American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test (SST), and Life Orientation Test-Revised (LOT-R). Data collected at 4 years postoperatively were statistically analyzed by 1-way analysis of variance tests, Pearson correlations, and multivariate tests of between-subjects effects (multivariate analysis of covariance).

RESULTS

There was a statistically significant difference between cohorts and their scores of resiliency and optimism measured by the LOT-R (function portion of ASES score [ASESf], P = .048; pain portion of ASES score [ASESp], P = .003; and SST score, P = .009) as illustrated by a 1-way analysis of variance. A multivariate analysis of covariance found that LOT-R scores exhibited a significant impact on outcome scores (ASESf score, P = .043; ASESp score, P = .002; and SST score, P = .007). Correlational analysis indicated that LOT-R scores directly correlated with higher ASESp (P = .003), ASESf (P = .029), and SST (P = .018) scores. Regression line analysis provided a positive coefficient of determination value for all outcome scores.

CONCLUSION

The premise of this study was to look at mental resilience as a potential indicator of long-term outcome scores following RCR. The results of statistical analysis indicated that outcome scores are significantly different based on the degree of optimism; high levels of optimism impact and correlate to higher outcome scores. This study provides a basis for future studies of psychological resilience in the field of orthopedic surgery.

Factors affecting medical healthcare-seeking behaviours of female patients according to their stage of being diagnosed with breast cancer

OBJECTIVE

The aim of study was to determine factors affecting the medical healthcare-seeking behaviours of female patients according to their stage of being diagnosed with breast cancer.

METHODS

This descriptive and correlational study was carried out with 150 women. The data were collected by a survey form, the Body Perception Scale, the Rosenberg Self-Esteem Scale and the Social Appearance Anxiety Scale.

RESULTS

About 54% of the women were diagnosed with early-stage breast cancer, 68.7% had high self-esteem, and 80% had positive body perceptions, while their social appearance anxiety levels were moderate. The patients with breast cancer at the 4th stage had a high body perception score of 174.00 ± 23.34. Self-esteem was the highest in the patients with stage 2B breast cancer with a value of 0.61 ± 0.91. The highest social anxiety mean score was found in the patients with stage 2A breast cancer as 31.65 ± 12.50. There was no statistically significant difference in the women's sociodemographic characteristics, health and breast cancer history, self-esteem, body perception and social appearance anxiety based on their stages of cancer (p > 0.05).

CONCLUSION

Nurses' identification of risky individuals in early diagnosis, information for the individual / family and society by planning trainings and raising awareness will contribute positively to the patients' medical health-seeking behaviours.

Resilience correlates with patient reported outcomes after reverse total shoulder arthroplasty

BACKGROUND

Personal and social factors may account for much of the variation in patient reported outcome scores, yet little evidence exists on how psychological properties affect patient outcomes following reverse total shoulder arthroplasty (rTSA). The objective of this study is to determine if resilience, characterised by the ability to return to a healthy level of function after experiencing stress, correlates with patient reported outcome scores after rTSA.

HYPOTHESIS

Resilience score will correlate positively with patient reported outcomes after rTSA.

METHODS

Seventy-three patients were identified that had undergone primary rTSA with minimum 2-year follow-up (4.7±1.8). These patients completed a phone survey that included the Brief Resilience Scale (BRS), a measure of general resilience in all aspects of life, along with American Shoulder and Elbow Surgeon (ASES), Penn, and Single Assessment Numerical Evaluation (SANE) scores. Mean outcome scores were calculated to identify any correlation between resilience and clinical outcomes.

RESULTS

The mean BRS score was 23.8±4.8 (range 12.0-30.0), with 41 patients classified as normal resilience (NR), 17 patients as low resilience (LR), and 15 as high resilience (HR). Postoperative BRS scores correlated with ASES (r=0.31, p=0.008), Penn (r=0.25, p=0.03), and SANE score (r=0.32, p=0.007). The mean ASES score was 14.0 points lower in the LR group (77.0 points), compared to the HR group (91.0 points; p=0.04). Similarly, the LR group had a mean SANE score that was 18.6 points lower than the HR group (73.4 and 91.9 points, respectively; p=0.021).

DISCUSSION

The observation that greater general life resilience correlates with lower pain intensity, lesser magnitude of limitations, and perception of greater normality of the shoulder after reverse total shoulder arthroplasty emphasises the importance of addressing personal and social health opportunities along with the physical in musculoskeletal care. Resilience may be a useful predictor of outcomes following rTSA.

LEVEL OF EVIDENCE

III.

Higher Levels of Stress Are Associated With a Significant Symptom Burden in Oncology Outpatients Receiving Chemotherapy

CONTEXT

A cancer diagnosis and associated treatments, as well as the uncertainty of the disease course, are stressful experiences for most patients. However, little information is available on the relationship between stress and symptom burden.

OBJECTIVES

The study purpose was to evaluate for differences in the severity of fatigue, lack of energy, sleep disturbance, and cognitive function, among three groups of patients with distinct stress profiles.

METHODS

Patients receiving chemotherapy (n = 957) completed measures of general, cancer-specific, and cumulative life stress and symptom inventories. Latent profile analysis was used to identify subgroups of patients with distinct stress profiles.

RESULTS

Three distinct subgroups of patients were identified (i.e., stressed [39.3%], normative [54.3%], resilient [5.7%]). For cognitive function, significant differences were found among the latent classes (stressed < normative < resilient). For both sleep disturbance and morning and evening fatigue, compared to the normative and resilient classes, the stressed class reported higher severity scores. Compared to the normative and resilient classes, the stressed class reported low levels of morning energy. Compared to the normative class, the stressed class reported lower levels of evening energy.

CONCLUSIONS

Consistent with our a priori hypothesis, patients in the stressed class had the highest symptom severity scores for all four symptoms and all these scores were above the clinically meaningful cutoffs for the various instruments.

Breast Cancer and Resilience: The Controversial Role of Perceived Emotional Intelligence

Cancer is a chronic disease that causes the most deaths in the world, being a public health problem nowadays. Even though breast cancer affects the daily lives of patients, many women become resilient after the disease, decreasing the impact of the diagnosis. Based on a positive psychology approach, the concept of co-vitality arises understood as a set of socio-emotional competencies that enhance psychological adaptation. In this sense, emotional intelligence is one of the main protective factors associated with resilience. However, it is not always as beneficial as it seems, and can lead to collateral effects on psychological adjustment. Given this controversy, this study aims to find the specific processes through which the dimensions of Perceived Emotional Intelligence (PEI) (Emotional Attention, Emotional Clarity, and Mood Repair) can act as a risk or protective factor in the development of resilience. The total sample was 167 women (Age: M = 43.26; SD = 12.43), 46.7% were breast cancer survivors, and 53.3% were healthy controls. The selection of women with breast cancer carries out randomly, recruited through the Oncology Units. The sample completed measures of resilience and PEI, through Resilience Scale (Wagnild and Young, 1993) and TMMS-24 (Salovey et al., 1995). The results showed that breast cancer survivors showed higher age and greater levels of resilience and mood repair than healthy women. The mediation analysis revealed that breast cancer survival and PEI predicted 28% of the variance of resilience. The direct effects showed that emotional clarity and mood repair increased resilience levels. Although breast cancer did not predict resilience directly, it does through mood repair by an indirect process. Besides, the analysis showed that emotional attention played a role in vulnerability, decreasing mood repair, and resilience. These research support theories that point to a possible dark side of PEI, thus, a great level of emotional attention makes dark the positive effect of mood repair and personal growth if a clear perception of emotions does not complement it. These results provide empirical support concerning the need to work complementary each dimension of PEI to avoid unwanted effects on intrapersonal adjustment.

Psychological Resilience and Health-Related Quality of Life in Swedish Women with Newly Diagnosed Breast Cancer

Purpose

Psychological resilience appears to be an important influencing factor in various aspects of health-related quality of life (HRQoL) in a context of adversity, eg, being informed of a cancer diagnosis. The purpose was to investigate psychological resilience and HRQoL in Swedish women with newly diagnosed breast cancer in relation to demographic and clinicopathological characteristics.

Methods

A population-based cross-sectional study was conducted including 517 women with breast cancer in the South Swedish Health Care Region. Participants were enrolled at the time of consultation for the diagnosis. Psychological resilience was assessed with the Connor-Davidson Resilience Scale 25 (CD-RISC25), and HRQoL was assessed with the Short Form Health Survey. The participants responded to questions regarding demographic variables. Clinicopathological data were collected from the Swedish National Quality Register for Breast Cancer.

Results

The mean score for psychological resilience was 70.6, identifying 15% of included patients with a score lower than 58 (-1 standard deviation). The study cohort had significantly lower mean scores for several aspects of HRQoL compared with Swedish normative data. Regression analyses demonstrated that psychological resilience was significantly associated with all domains of HRQoL after adjustment for demographic and clinicopathological factors.

Conclusion

Higher levels of psychological resilience were significantly related to higher levels of HRQoL in Swedish women with newly diagnosed breast cancer and no modifying factor was identified. The assessment of psychological resilience at the time of breast cancer diagnosis might allow for early identification of women in need of more intense psychosocial support. Future studies are needed to identify a clinically relevant threshold of the CD-RISC25.

Resilience in women with breast cancer: A systematic review

PURPOSE

Resilience refers to a dynamic process that promotes a successful adaptation to cancer-related adversity. The aim of this systematic review was to identify the biopsychosocial factors involved in the resilience of women with breast cancer and to integrate evidence on the interventions that can contribute to significantly enhancing it.

METHOD

Three databases were searched. In all, 923 articles were identified and, of these, 39 peer-reviewed articles were included.

RESULTS

Resilience was associated with multiple clinical, sociodemographic, social, psychological and physiological variables, with psychological factors being the most important contributors to the development of resilience. Some protective factors were identified, such as social support, several dimensions of quality of life (QOL) and adaptive coping strategies. Psychological distress was the variable most frequently linked to reductions in resilience, finding a bidirectional relationship between them. Resilience-promoting interventions were found to be effective in improving participants' psychological well-being.

CONCLUSION

Resilience is a relevant factor related with several sociodemographic, clinical, psychosocial and physiological variables in women with breast cancer. However, limitations such as the wide variability of instruments used together with the heterogeneity and small size of the samples restrict the generalizability of our conclusions.

Role of resilience and emotional control in relation to mental health in people with cancer

This study explored the relationship between emotional control, resilience, and mental health in cancer. Patients with cancer were recruited (n = 170). Courtauld Scale of Emotional Control, Connor-Davidson Resilience Scale, and the General Health Questionnaire were selected. Assuming the absence of interaction among the variables, they were analyzed separately. Four groups resulted, finding statistically significant differences (F(4, 165) = 18.03; p < 0.001). High resilience and low emotional control seem to be protective attributes, and high emotional control has demonstrated to be a risk factor for mental health. Considering differences in cancer-related psychological variables could derive in personalized psychotherapeutic interventions.

Resilience as a Predictor of Patient Satisfaction With Nonopioid Pain Management and Patient-Reported Outcome Measures After Knee Arthroscopy

PURPOSE

The purpose of this study was to evaluate the Brief Resilience Score (BRS) as a predictor for patient satisfaction with nonopioid pain management and patient-reported outcome measures (PROMs) after arthroscopic partial meniscectomy or chondroplasty.

METHODS

One hundred seventy-five patients undergoing arthroscopic partial meniscectomy and/or chondroplasty were recruited from a single clinic and were preoperatively stratified into low-to-normal resilience or high resilience groups as measured by the BRS. Satisfaction with nonopioid pain control was assessed at a 2-week follow-up visit using the Hospital Consumer Assessment of Healthcare Provider and Systems questionnaire, and various PROMs were measured at 3 and 6 months postoperatively. Statistical analysis was performed to assess for differences in satisfaction with pain control or PROMs between resilience groups.

RESULTS

Analysis revealed no statistically significant differences between the low-to-normal resilience group and the high resilience group with regard to satisfaction with nonopioid pain control or PROMs assessed at 3- or 6-month follow-ups. Outcome measures [visual analog scale pain, Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain, KOOS Activities of Daily Living, KOOS Quality of Life, Single Assessment Numerical Evaluation (SANE) Knee, and Veterans Rand 12-Item Health Survey Physical and Mental Component Scores] all followed expected trajectories after surgery, without a statistically significant difference between resilience groups.

CONCLUSION

This study provides evidence that preoperative resilience score, as measured by the BRS, does not correlate with postoperative patient-reported functional outcome or satisfaction with a nonopioid pain regimen after knee arthroscopy.

LEVEL OF EVIDENCE

II.

The Resilient Athlete: Lessons Learned in the Military

Resilience, the capacity to recover from a setback or adversity, is a concept that has received considerable recent attention. An individual's resilience predicts their life trajectory following stressful events and this has increasingly been shown in a wide variety of applications. Our understanding of the degree to which we can modify our resilience, and the optimal means to do so, remains in its infancy. The US military has embraced extensive efforts to quantify and build resilience in service members in an effort to preserve the fighting force. We specifically look at the understanding of resilience as it relates to the athletes in terms of competition and return from injury. This article explores the concept of resilience, the efforts to build resilience, lessons learned from the military and applications of the resilience concept to surgical and trauma patients.

Distinct Stress Profiles Among Oncology Patients Undergoing Chemotherapy

CONTEXT

Cancer and its treatment are inherently stressful and stress impacts important patient outcomes. Patients vary considerably in their response to stress. Understanding this variability requires a patient-centered multidimensional approach.

OBJECTIVES

The objectives of this study were to identify and characterize patient subgroups with distinct multidimensional stress profiles (stress appraisal, exposure, and adaptation) during cancer treatment.

METHODS

Among 957 patients undergoing chemotherapy for breast, gastrointestinal, gynecological, or lung cancer, latent profile analysis was performed to identify patient subgroups using concurrent evaluations of global (Perceived Stress Scale) and cancer-specific (Impact of Events Scale-Revised) stress, lifetime stress exposure (Life Stressor Checklist-Revised), and resilience (Connor-Davidson Resilience Scale-10).

RESULTS

Three latent classes were identified: "Normative" (54.3%; intermediate global stress and resilience, lower cancer-related stress, lowest life stress); "Stressed" (39.9%; highest global and cancer-specific stress scores, lowest resilience, most life stress); and "Resilient" (5.7%; lowest global stress, cancer-specific stress comparable to Normative class, highest resilience, intermediate life stress). Characteristics that distinguished the Stressed from the Normative class included the following: younger age, female gender, lower socioeconomic status, unmarried/partnered, living alone, poorer functional status, and higher comorbidity burden. Compared to Stressed patients, Resilient patients were more likely to be partnered, to not live alone, and had a higher functional status. No demographic or clinical characteristics differentiated Normative from Resilient patients. Exposure to specific life stressors differed significantly among the classes.

CONCLUSION

A subset of patients warrants intensive psychosocial intervention to reduce stress and improve adaptation to cancer. Intervention efforts may be informed by further study of Resilient patients.

Psychometric properties of the Connor-Davidson Resilience Scale in women with breast cancer

The aim was to analyse the psychometric properties of the 10-item version of the Connor-Davidson Resilience Scale (CD-RISC 10©) in breast cancer patients. Method: A sample of 169 Spanish women who had undergone surgery for breast cancer completed the CD-RISC 10©, along with questionnaires assessing life satisfaction, emotional intelligence, self-esteem, and positive and negative affect. Results: Confirmatory Factor Analysis supported a single-factor structure with adequate fit indices. Reliability was analysed by calculating McDonald’s omega coefficient, which yielded a value of .83. Validity evidence based on relationships with other variables was provided by positive and significant correlations between scores on the CD-RISC 10© and scores on emotional intelligence (clarity and repair), life satisfaction, self-esteem and positive affect, and by a negative and significant correlation with negative affect. The majority of these correlations were above |.50|. Conclusions: The CD-RISC 10© has satisfactory psychometric properties and is a suitable tool for measuring resilience in patients with cancer. The instrument is quick and easy to apply and may be used in both clinical and research contexts.

Positive psychological changes after breast cancer diagnosis and treatment: The role of trait resilience and coping styles

Purpose: This study aimed to examine the relationships among trait resilience, coping styles, and perceived positive psychological changes in women's lives after breast cancer diagnosis and treatment.Design: The study adopted a cross-sectional design.Sample/Method: A total of 201 participants diagnosed with stage I-IV breast cancer were recruited. The average time since diagnosis was 39.14 months. Four rating scales were used to assess the participants' trait resilience, coping styles, perceived growth, and health-related quality of life. These are the Connor-Davidson Resilience Scale (CD-RISC), the Mini-Mental Adaptation to Cancer Scale (Mini-MAC), the Chinese Posttraumatic Growth Inventory (PTGI), and the Functional Assessment of Cancer Therapy Scale-Breast (FACT-B).Findings: Hierarchical analysis showed that trait resilience significantly predicted high levels of perceived growth and health-related quality of life. This effect was moderated by Positive-Acceptance coping. The study also found that Negative-Affect coping had a direct effect on lowering health-related quality of life but had no influence on perceived growth.Conclusions: These findings highlight the facilitating effect of trait resilience and Positive-Acceptance coping on the psychological well-being and perceived growth among breast cancer outpatients.Implications: Trait resilience may be a protective, even facilitating factor of cancer adaptation. The knowledge that trait resilience offers a way to enhance wellness after cancer diagnosis and treatments may be useful in a clinical setting.

An intervention based on protective factors to improve resilience for breast cancer patients: Study protocol for a randomized controlled trial

AIM

To present a study protocol for evaluating the feasibility and effectiveness of an individual face-to-face intervention based on protective factors to improve resilience among breast cancer patients.

BACKGROUND

Research involving the effectiveness of universal interventions to improve resilience for breast cancer patients has seldom been reported and there is an urgent need to find a more acceptable, cost-effective method of providing emotional support. Through health education and psychological interventions, increasing protective factors could promote recovery to the original condition and improve resilience.

DESIGN

A randomized controlled trial of an individual face-to-face intervention.

METHODS

A total of 160 adults diagnosed with confirmed breast cancer will be recruited. The patients will be randomly assigned to the control group (N = 80) or the intervention group (N = 80). An intervention focusing on protective factors will be implemented in the intervention group. A survey of the patients from the two groups will be conducted at baseline, 1, 3, 6, and 12 months. The primary outcome is resilience, measured by the 14-item Resilience Scale. Secondary outcomes include self-efficacy, optimism, perceived social support, and mastery. The Chinese versions of the General Self-Efficacy Scale, revised Life Orientation Test, Multidimensional Scale of Perceived Social Support, and Self-Mastery Scale will be used to measure the four protective factors.

IMPACT

One-to-one and face-to-face interventions have many potential advantages for inpatients, including convenience, accessibility and individuality. Once its effectiveness is confirmed, the intervention will be implemented broadly and make support available for a large number of patients.