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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 L, Zhong HY, Xiao T, Xiao RH, Yang J, Li YL, Yao Q, Chen XJ. Association between self-disclosure and benefit finding of Chinese cancer patients caregivers: the mediation effect of coping styles. Support Care Cancer 2023; 31:684. [PMID: 37945919 DOI: 10.1007/s00520-023-08158-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To examine the relationship between self-disclosure, coping styles, and benefit finding (BF) among caregivers of cancer patients. The study also aimed to identify the factors influencing BF and the impact of coping styles on the relationship between self-disclosure and BF. METHODS Convenience sampling was used to select 300 caregivers of cancer patients aged greater than 18 years from October 2022 to April 2023 in Chengdu, China. The demographic and clinical characteristics questionnaire, the Benefit Finding Scale (BFS), the Distress Disclosure Index Scale (DDI), and the Simple Coping Style Scale (SCSQ) for caregivers were included in this study. Descriptive statistics, t-tests, one-way analysis of variance, Pearson's correlation analyses, and multiple linear regression models were used. The effect of mediation was tested by the PROCESS macro (Model 4) for SPSS 26.0 by Hayes using 5000 bootstrap samples. RESULTS There were 292 valid questionnaires (effective response rate 97.33%). The total scores of BF, self-disclosure, negative coping style, and positive coping style of caregivers were 67.77 ± 14.78, 38.23 ± 8.59, 19.68 ± 5.98, and 9.88 ± 4.18, respectively; Pearson's correlation analysis showed that BF was positively correlated with self-disclosure, positive coping, and negatively correlated with negative coping; multiple linear regression analysis showed that self-disclosure, positive coping, and negative coping were influential factors of BF. The results revealed that the effect of self-disclosure on BF was partly mediated by coping styles. It also confirmed that the mediation effect accounted for 54.03% of the total effect. CONCLUSION The BF of caregivers is at a moderate level. Self-disclosure may influence BF partly because of coping styles.
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Affiliation(s)
- Li Li
- School of Nursing, Chengdu Medical College, No. 601, Tianhui Rd, Rongdu St, Chengdu, 610083, Sichuan, China
| | - Hong-Yue Zhong
- School of Nursing, Chengdu Medical College, No. 601, Tianhui Rd, Rongdu St, Chengdu, 610083, Sichuan, China
| | - Tian Xiao
- School of Nursing, Chengdu Medical College, No. 601, Tianhui Rd, Rongdu St, Chengdu, 610083, Sichuan, China
| | - Rui-Han Xiao
- School of Nursing, Chengdu Medical College, No. 601, Tianhui Rd, Rongdu St, Chengdu, 610083, Sichuan, China
| | - Jin Yang
- School of Nursing, Chengdu Medical College, No. 601, Tianhui Rd, Rongdu St, Chengdu, 610083, Sichuan, China
| | - Yan-Li Li
- Department of Nursing, The First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Qian Yao
- School of Nursing, Chengdu Medical College, No. 601, Tianhui Rd, Rongdu St, Chengdu, 610083, Sichuan, China
| | - Xiao-Ju Chen
- School of Nursing, Chengdu Medical College, No. 601, Tianhui Rd, Rongdu St, Chengdu, 610083, Sichuan, China.
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Zhang C, Xu S, Wen X, Liu M. The effect of expressive writing on Chinese cancer patients: A systematic review and meta-analysis of randomized control trails. Clin Psychol Psychother 2023; 30:1357-1368. [PMID: 37345260 DOI: 10.1002/cpp.2878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/11/2023] [Accepted: 06/08/2023] [Indexed: 06/23/2023]
Abstract
Cancer patients in China encounter distinctive challenges stemming from cultural disparities and variations in the healthcare systems. This meta-analysis aimed to provide a synthesis of the expressive writing (EW) interventions delivered to Chinese cancer patients and assess the pooled effect of EW on their well-being. The review adheres to the latest PRISMA 2020 guidelines to ensure transparency and rigour. Randomized control trials (RCTs) published before 1 April 2023, and meeting the inclusion criteria were included. Keywords searching was performed in both English and Chinese electronic databases. Ten RCTs were identified and included in the analysis. The results showed that EW usually encompassed four to six writing sessions; the most common writing themes were 'emotional expression', 'cognitive appraisal', 'benefit finding', 'coping strategies' and 'looking to the future'. The meta-analysis suggested that EW had a substantial impact on reducing anxiety levels (Hedges' g = -1.22, 95% CI [-1.54, -0.90], I2 = 0.00%). It is worth noting that although the results of these studies could not be statistically synthesized, their individual findings suggest that EW may be beneficial in reducing anxiety, self-perceived burden and depressive symptoms, as well as increasing self-efficacy in Chinese cancer patients. In conclusion, this review highlights the importance and effectiveness of Ewin alleviating anxiety among Chinese cancer patients and underscores the potential benefits of incorporating EW into comprehensive care programmes for cancer patients in China. More RCTs are needed to explore the broader impact of EW in China.
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Affiliation(s)
- Chen Zhang
- Department of Social Work and Social Policy, School of Sociology and Population Studies, Renmin University of China, Beijing, China
| | - Shuo Xu
- Department of Social Work and Social Policy, School of Sociology and Population Studies, Renmin University of China, Beijing, China
| | - Xinyue Wen
- Department of Social Work and Social Policy, School of Sociology and Population Studies, Renmin University of China, Beijing, China
| | - Mowen Liu
- Department of Social Work and Social Policy, School of Sociology and Population Studies, Renmin University of China, Beijing, China
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Mizuno M, Chiba I, Mukohara T, Kondo M, Maruo K, Ohigashi T, Naruo M, Asano Y, Onishi T, Tanabe H, Muta R, Mishima S, Okano S, Yuda M, Hosono A, Ueda Y, Bando H, Itagaki H, Ferrans CE, Akimoto T. Effectiveness of an online support program to help female cancer patients manage their health and illness: Protocol for a randomized controlled trial. Contemp Clin Trials Commun 2022; 30:101035. [PMID: 36387994 PMCID: PMC9661427 DOI: 10.1016/j.conctc.2022.101035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/17/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
Background The aim of the trial is to evaluate the effectiveness of interventions provided by online support program apps, adopting health-related quality of life (HR-QOL) scores as indicators. Methods The design is as an open, randomized, parallel-group trial with longitudinal data collection. The subjects will be female cancer patients receiving treatment in a Japanese National Cancer Hospital. Patients assigned to the experimental group will use three apps: an app for them to monitor their own health (monitoring app), an app to assess their understanding of their diagnosis and treatment and their readiness to receive treatment (confirmation app), and an app to address mental health issues (writing app); patients assigned to the control group will use only the monitoring app. At baseline (before patients undergo cancer treatment) and three other times during the study, evaluation indicators will be obtained from three different standardized HR-QOL scales that are incorporated in the monitoring app. The study hypothesis is that at 6 months after patients’ baseline health monitoring, patients in the experimental group will have improved HR-QOL as compared with patients in the control group. Conclusion This study is based on self-regulation theory, so it is important that the online support program works in an efficient way with respect to patients finding and setting their own health-related goals and adapting their behaviors to achieve those goals. Verifying the effectiveness of the combination of the three apps will show that it is a scientifically valid approach to maintaining or improving the HR-QOL of cancer patients.
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Effects of Structured Expressive Writing on Quality of Life and Perceived Self-Care Self-Efficacy of Breast Cancer Patients Undergoing Chemotherapy in Central China: A Randomized Controlled Trial. Healthcare (Basel) 2022; 10:healthcare10091762. [PMID: 36141374 PMCID: PMC9498690 DOI: 10.3390/healthcare10091762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/25/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
Expressive writing is a supportive psychological intervention allowing an individual to disclose and express their deepest thoughts and feelings related to personal traumatic experiences through writing. Previous studies suggested that expressive writing could promote the physical and mental health of cancer patients. The current study was conducted to evaluate the effect of expressive writing based on the theory of cognitive adaptation (TCA) on the quality of life and self-care self-efficacy in patients with breast cancer undergoing chemotherapy. A sample of 82 Chinese women receiving chemotherapy for breast cancer was randomly assigned to an experimental group (four 20 min writing activities focusing on emotional disclosure) or a control group (no writing activities). The quality of life (QoL) and self-care self-efficacy were assessed at baseline, 2 weeks, 4 weeks, and 6 weeks after the intervention, respectively. The sociodemographic characteristics, QoL, and self-care self-efficacy at baseline were comparable between the two groups. Repeated-measures ANOVA revealed significant effects of the time×group (F = 3.65, p < 0.05) on the QoL and significant effects of time (F = 4.77, p <0.05) on self-care self-efficacy. Compared with the control group, the QoL in the intervention group showed a significant and temporary increase at 2 weeks after the intervention (mean difference = −7.56, p < 0.05). As a low-cost and easily delivered psychological intervention, expressive writing is recommended to reduce stress when there is a lack of available emotional support.
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Wang L, Guo Y, Liu Y, Yan X, Ding R. The effects of a mobile phone-based psychological intervention program on stress, anxiety and self-efficacy among undergraduate nursing students during clinical practice: A randomized controlled trial. J Prof Nurs 2022; 42:219-224. [DOI: 10.1016/j.profnurs.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 10/16/2022]
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Ji L, Wang J, Zhu B, Qiao X, Jin Y, Si H, Wang W, Bian Y, Wang C. Expressive suppression and rumination mediate the relationship between frailty and depression among older medical inpatients. Geriatr Nurs 2021; 43:293-298. [PMID: 34974398 DOI: 10.1016/j.gerinurse.2021.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Frailty is common among older medical inpatients and has been found to be an independent risk factor for depression. However, few studies have explored the underlying mechanisms of the frailty-depression relationship. The present study was aimed to examine emotional regulation strategies as mediators in the frailty-depression relationship based on the process model of emotional regulation. METHODS Older medical inpatients (N=684) completed questionnaires and tests on frailty, emotional regulation strategies, and depressive symptoms. RESULTS Structural equation models showed that expressive suppression and rumination, but not cognitive reappraisal, mediated the relationship between frailty and depressive symptoms (RMSEA = 0.059, CFI = 0.963, TLI = 0.957). CONCLUSIONS Frail older medical inpatients habitually use expressive suppression and rumination in their daily lives, which may lead to more psychological disturbance. Interventions targeting expressive suppression and rumination might be effective in reducing the detrimental effect of frailty on psychological well-being among older medical inpatients.
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Affiliation(s)
- Lili Ji
- School of Nursing, Peking University, 100191 Beijing, China; School of Nursing, Weifang Medical University, 261042 Weifang, China
| | - Jinrong Wang
- Affiliated Hospital of Weifang Medical University, 261031 Weifang, China
| | - Baoqi Zhu
- Affiliated Hospital of Weifang Medical University, 261031 Weifang, China
| | - Xiaoxia Qiao
- School of Nursing, Peking University, 100191 Beijing, China
| | - Yaru Jin
- School of Nursing, Peking University, 100191 Beijing, China
| | - Huaxin Si
- School of Nursing, Peking University, 100191 Beijing, China
| | - Wenyu Wang
- School of Nursing, Peking University, 100191 Beijing, China
| | - Yanhui Bian
- School of Nursing, Peking University, 100191 Beijing, China
| | - Cuili Wang
- School of Nursing, Peking University, 100191 Beijing, China.
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Qian J, Sun S, Zhou X, Wu M, Yu X. Effects of an expressive writing intervention in Chinese women undergoing pregnancy termination for fetal abnormality: A randomized controlled trial. Midwifery 2021; 103:103104. [PMID: 34348194 DOI: 10.1016/j.midw.2021.103104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/02/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To explore the efficacy of an expressive writing intervention on promoting psychological well-being of women who have had a diagnosis of fetal abnormality. DESIGN AND SETTING An open, randomized controlled trial with parallel group design was conducted at a tertiary hospital in China. 100 women were randomly assigned into either the expressive writing (EW) intervention group or the control group, and 80 women eventually took part in all the phases of the study. Psychological variables including post-traumatic growth (PTG), post-traumatic stress disorder (PTSD) and resilience were assessed at baseline, immediately after the intervention and 1-month follow-up. PARTICIPANTS Women who have had a diagnosis of fetal abnormalities and decided to terminate pregnancies. INTERVENTION Women in the intervention group were asked to write three 15 min essays in regard to their experiences with the fetal abnormalities. FINDINGS The intervention group had significantly higher level of PTG (p = 0.003) and lower level of PTSD symptoms (p = 0.023) immediately after the intervention, as compared with the control group. In 1-month follow-up, intervention participants demonstrated significant improvement in PTG (p = 0.014) but insignificant reduction for PTSD symptoms. No significant effects were observed in both groups in terms of changes over time in resilience. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE EW is efficacious for improving women's PTG and easing their symptoms of PTSD to some extent. Medical staff should pay more attention to this population's psychological status. In the future, EW interventions need to be conducted in larger samples with more severe symptoms of PTSD to validate its effectiveness. The efficacy of longer and more frequent writing interventions should also be investigated.
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Affiliation(s)
- Jialu Qian
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Department of Obstetrics and Gynecology, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shiwen Sun
- Department of Obstetrics and Gynecology, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaoli Zhou
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Department of Obstetrics and Gynecology, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Mengwei Wu
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Department of Obstetrics and Gynecology, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaoyan Yu
- Department of Obstetrics and Gynecology, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
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