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Abu-Odah H, Su JJ, Wang M, Sheffield D, Molassiotis A. Systematic review and meta-analysis of the effectiveness of expressive writing disclosure on cancer and palliative care patients' health-related outcomes. Support Care Cancer 2023; 32:70. [PMID: 38157056 DOI: 10.1007/s00520-023-08255-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES This review aimed to synthesize the available evidence on the effectiveness of expressive writing (EW) on health outcomes of patients with cancer. METHODS A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Six databases were searched from 1986 to 9 July 2022. The searches were updated on 3 October 2023. Methodological quality was assessed using the Cochrane Risk of Bias tool for randomized controlled trials (RCTs) and ROBINS-I tool for non-RCTs Mixed Methods Appraisal Tool. Narrative synthesis of outcomes was performed where meta-analysis was not appropriate. RESULTS Thirty-four studies with 4316 participants were identified, including 31 RCTs and three non-RCTs. Twenty-one studies focused on women with breast cancer; the remainder recruited people with various cancer types. There was a significant improvement in fatigue (SMD = - 0.3, 95% CI - 0.55 to - 0.66, P = .002), passive mood (MD = - 3.26, 95% CI = - 5.83 to - 0.69, P = 0.001), and the physical dimension of quality of life (MD = 3.21, 95% CI 0.18 to 6.25, P = 0.04) but not for anxiety, depression, and global quality of life among patients who participated in EW when compared with control groups. CONCLUSION Findings showed some benefits of EW for people with cancer, but not necessarily in anxiety or depression. Heterogeneity in the delivery of interventions and their content, and shortcomings in the methodologies used highlight the need for stronger evidence in the field through high-quality trials and consistencies in the protocol, focusing on outcomes that this review highlighted as potential outcome targets.
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Affiliation(s)
- Hammoda Abu-Odah
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Jing Jing Su
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Mian Wang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - David Sheffield
- School of Psychology, University of Derby, Derby, DE22 1GB, UK
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Li C, Fu J, Lai J, Sun L, Zhou C, Li W, Jian B, Deng S, Zhang Y, Guo Z, Liu Y, Zhou Y, Xie S, Hou M, Wang R, Chen Q, Wu Y. Construction of an Emotional Lexicon of Patients With Breast Cancer: Development and Sentiment Analysis. J Med Internet Res 2023; 25:e44897. [PMID: 37698914 PMCID: PMC10523220 DOI: 10.2196/44897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND The innovative method of sentiment analysis based on an emotional lexicon shows prominent advantages in capturing emotional information, such as individual attitudes, experiences, and needs, which provides a new perspective and method for emotion recognition and management for patients with breast cancer (BC). However, at present, sentiment analysis in the field of BC is limited, and there is no emotional lexicon for this field. Therefore, it is necessary to construct an emotional lexicon that conforms to the characteristics of patients with BC so as to provide a new tool for accurate identification and analysis of the patients' emotions and a new method for their personalized emotion management. OBJECTIVE This study aimed to construct an emotional lexicon of patients with BC. METHODS Emotional words were obtained by merging the words in 2 general sentiment lexicons, the Chinese Linguistic Inquiry and Word Count (C-LIWC) and HowNet, and the words in text corpora acquired from patients with BC via Weibo, semistructured interviews, and expressive writing. The lexicon was constructed using manual annotation and classification under the guidance of Russell's valence-arousal space. Ekman's basic emotional categories, Lazarus' cognitive appraisal theory of emotion, and a qualitative text analysis based on the text corpora of patients with BC were combined to determine the fine-grained emotional categories of the lexicon we constructed. Precision, recall, and the F1-score were used to evaluate the lexicon's performance. RESULTS The text corpora collected from patients in different stages of BC included 150 written materials, 17 interviews, and 6689 original posts and comments from Weibo, with a total of 1,923,593 Chinese characters. The emotional lexicon of patients with BC contained 9357 words and covered 8 fine-grained emotional categories: joy, anger, sadness, fear, disgust, surprise, somatic symptoms, and BC terminology. Experimental results showed that precision, recall, and the F1-score of positive emotional words were 98.42%, 99.73%, and 99.07%, respectively, and those of negative emotional words were 99.73%, 98.38%, and 99.05%, respectively, which all significantly outperformed the C-LIWC and HowNet. CONCLUSIONS The emotional lexicon with fine-grained emotional categories conforms to the characteristics of patients with BC. Its performance related to identifying and classifying domain-specific emotional words in BC is better compared to the C-LIWC and HowNet. This lexicon not only provides a new tool for sentiment analysis in the field of BC but also provides a new perspective for recognizing the specific emotional state and needs of patients with BC and formulating tailored emotional management plans.
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Affiliation(s)
- Chaixiu Li
- Nanfang Hospital, Southern Medical University, Guangzhou, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Jiaqi Fu
- Nanfang Hospital, Southern Medical University, Guangzhou, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Jie Lai
- Nanfang Hospital, Southern Medical University, Guangzhou, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Lijun Sun
- China Electronic Product Reliability and Environmental Testing Institute, Guangzhou, China
| | - Chunlan Zhou
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wenji Li
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Biao Jian
- China Electronic Product Reliability and Environmental Testing Institute, Guangzhou, China
| | - Shisi Deng
- Nanfang Hospital, Southern Medical University, Guangzhou, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Yujie Zhang
- Nanfang Hospital, Southern Medical University, Guangzhou, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Zihan Guo
- Nanfang Hospital, Southern Medical University, Guangzhou, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Yusheng Liu
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanni Zhou
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shihui Xie
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Mingyue Hou
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ru Wang
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qinjie Chen
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanni Wu
- Nanfang Hospital, Southern Medical University, Guangzhou, China
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Wu Y, Yang D, Jian B, Li C, Liu L, Li W, Li X, Zhou C. Can emotional expressivity and writing content predict beneficial effects of expressive writing among breast cancer patients receiving chemotherapy? A secondary analysis of randomized controlled trial data from China. Psychol Med 2023; 53:1527-1541. [PMID: 34425924 DOI: 10.1017/s0033291721003111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND To explore whether emotional expressivity and the patterns of language use could predict benefits from expressive writing (EW) of breast cancer (BC) patients in a culture that strongly discourages emotional disclosure. METHODS Data were obtained from a recent trial in which we compared the health outcomes between a prolonged EW group (12 sessions) and a standard EW group (four sessions) (n = 56 per group) of BC patients receiving chemotherapy. The Chinese texts were tokenized using the THU Lexical Analyser for Chinese. Then, LIWC2015 was used to quantify positive and negative affect word use. RESULTS Our first hypothesis that BC patients with higher levels of emotional expressivity tended to use higher levels of positive and negative affect words in texts was not supported (r = 0.067, p = 0.549 and r = 0.065, p = 0.559, respectively). The level of emotional expressivity has a significant effect on the quality of life (QOL), and those who used more positive or fewer negative affective words in texts had a better QOL (all p < 0.05). However, no significant difference was identified in physical and psychological well-being (all p > 0.05). Furthermore, the patterns of affective word use during EW did not mediate the effects of emotional expressivity on health outcomes (all p > 0.05). CONCLUSIONS Our findings suggest that the level of emotional expressivity and the pattern of affective word use could be factors that may moderate the effects of EW on QOL, which may help clinicians identify the individuals most likely to benefit from such writing exercises in China.
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Affiliation(s)
- Yanni Wu
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | | | - Biao Jian
- China Electronic Product Reliability and Environmental Testing Research Institute, Guangzhou, Guangdong, PR China
| | - Chaixiu Li
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Liping Liu
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Wenji Li
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Xiaojin Li
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Chunlan Zhou
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
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Li C, Ure C, Zheng W, Zheng C, Liu J, Zhou C, Jian B, Sun L, Li W, Xie L, Mai Y, Zhao H, Liu Y, Lai J, Fu J, Wu Y. Listening to voices from multiple sources: A qualitative text analysis of the emotional experiences of women living with breast cancer in China. Front Public Health 2023; 11:1114139. [PMID: 36817918 PMCID: PMC9935709 DOI: 10.3389/fpubh.2023.1114139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/13/2023] [Indexed: 02/05/2023] Open
Abstract
Background Receiving a breast cancer diagnosis and treatment is both a physical and emotional journey. Previous studies using single-source data have revealed common and culture-specific emotional experiences of patients living with breast cancer. However, few studies have combined such data from multiple sources. Thus, using a variety of data sources, the current study sought to explore the emotional experiences of women in China newly diagnosed, post-operative, or undergoing chemotherapy. We posited that even though women living with breast cancer in China have multiple channels through which they can express these emotional experiences, little variance would be found in their emotional expressivity and the themes they want to express due to cultural inhibitions. Methods Text data from female patients newly diagnosed, post-operative, or undergoing chemotherapy were collected between June 2021 and January 2022 via a Python web crawler, semi-structured interviews, and an expressive writing intervention. Data were transcribed and subjected to thematic analysis. Reporting followed the consolidated criteria for reporting qualitative studies (COREQ) guidelines. Results Analyses were based on 5,675 Weibo posts and comments published by 448 posters and 1,842 commenters, transcription texts from 17 semi-structured interviews, and 150 expressive writing texts. From this total collection of 461,348 Chinese characters, three major themes emerged: (i) conflicting emotions after diagnosis; (ii) long-term suffering and treatment concerns; and (iii) benefit finding and cognitive reappraisal. Conclusions Despite gathering information from various sources, we found that distress from body-image disturbances, gender role loss and conflict, and changes in sexuality and fertility, were consistent among this sample of female Chinese patients with breast cancer. However, when women engaged actively in benefit finding and cognitive reappraisal with strong social support, patients were able to find ways to adapt and reported post-traumatic growth. Strong social support was an important facilitator in this growth. These study findings emphasize that healthcare professionals ought to increase cultural sensitivity, provide multiple channels to encourage patients to express their emotions, and incorporate screening for patients' emotional distress at all diagnostic and treatment phases as part of routine nursing care.
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Affiliation(s)
- Chaixiu Li
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China,School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Cathy Ure
- Directorate of Allied and Public Health, School of Health and Society, University of Salford, Salford, Manchester, United Kingdom
| | - Wanting Zheng
- Vascular Thyroid Breast Surgery Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Chunrao Zheng
- Department of General Surgery, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Jianhong Liu
- Office of Retirement Work, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Chunlan Zhou
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Biao Jian
- Software Quality Engineering Center, China Electronic Product Reliability and Environmental Testing Research Institute, Guangzhou, Guangdong, China
| | - Lijun Sun
- Reliability and Environmental Test Engineering Center, China Electronic Product Reliability and Environmental Testing Research Institute, Guangzhou, Guangdong, China
| | - Wenji Li
- Department of Breast Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Lijun Xie
- Vascular Thyroid Breast Surgery Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Yuchang Mai
- Department of General Surgery, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Huihui Zhao
- Department of Breast Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yusheng Liu
- Department of Breast Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jie Lai
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China,School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Jiaqi Fu
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China,School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Yanni Wu
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China,*Correspondence: Yanni Wu ✉
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