Anger expression, partner support, and quality of life in cancer patients

Feasibility study of a self-guided internet-based intervention for family caregivers of patients with cancer (OAse)

Despite high levels of distress, family caregivers of patients with cancer rarely seek psychosocial support and Internet-based interventions (IBIs) are a promising approach to reduce some access barriers. Therefore, we developed a self-guided IBI for family caregivers of patients with cancer (OAse), which, in addition to patients' spouses, also addresses other family members (e.g., adult children, parents). This study aimed to determine the feasibility of OAse (recruitment, dropout, adherence, participant satisfaction). Secondary outcomes were caregivers’ self-efficacy, emotional state, and supportive care needs. N = 41 family caregivers participated in the study (female: 65%), mostly spouses (71%), followed by children (20%), parents (7%), and friends (2%). Recruitment (47%), retention (68%), and adherence rates (76% completed at least 4 of 6 lessons) support the feasibility of OAse. Overall, the results showed a high degree of overall participant satisfaction (96%). There were no significant pre-post differences in secondary outcome criteria, but a trend toward improvement in managing difficult interactions/emotions (p = .06) and depression/anxiety (p = .06). Although the efficacy of the intervention remains to be investigated, our results suggest that OAse can be well implemented in caregivers’ daily lives and has the potential to improve family caregivers’ coping strategies.

Harmonious personality and work-family conflicts: The multiple mediating roles of social support and self-control

This study aimed to examine the multiple mediating roles of social support and self-control in the relationship between harmonious personality and work-family conflict. A total of 143 Chinese adults (137 male, 95.8%; aged 30.25 ± 7.85 years) participated in this longitudinal study. Data were collected at three time points, at intervals of 1 month. Self-report questionnaires measuring social demographics and harmonious personality (Time 1), self-control and social support (Time 2), and work-family conflict (Time 3) were administered. Self-control and work-family conflict were negatively correlated. The relationship between harmony and work-family conflict was mediated by self-control and social support. Possible paths were self-control and multiple mediation by social support and self-control. Our results confirmed the multiple mediating roles of social support and self-control in the relationship between harmonious personality and work-family conflict. To achieve a better work-family balance, it is important not only to establish a harmonious interpersonal perspective and to enhance the social support from employers, colleagues, and family but also to ensure adequate self-control resources.

Impact of caregivers' negative response to cancer on long-term survivors' quality of life

Cancer survivors' quality of life (QoL) is consistently shown to be positively impacted by social support from family and friends, including informal caregivers. In contrast, a loved one's negative response to cancer can diminish survivors' QoL, and these negative responses can be more impactful than supportive behaviors. Nonetheless, negative caregiver response has not been extensively researched, and few studies have explored the potential interaction of negative caregiver response and perceived social support on survivors' QoL. Therefore, we examined direct effects of perceived negative caregiver response, and the potential moderating role of social support, on QoL in a population-based sample of cancer survivors (N = 7543) using generalized linear models. Findings indicate that survivors who rated their caregiver's response to their cancer diagnosis more negatively reported worse physical and mental health, even up to 10 years after their initial cancer diagnosis. Perceived social support was not significantly associated with physical health, but it was positively associated with mental health. However, social support was not shown to moderate the relationship between negative caregiver response and mental health. Findings suggest that positive support from others within a survivor's social network may not be enough to attenuate the negative effects of their primary caregiver's unsupportive behaviors. Accordingly, cancer survivorship research and practice must consider the critical role that negative caregiver responses have on survivors' QoL and develop strategies that focus on the survivor-caregiver dynamic.

Hostility in cancer patients as an underexplored facet of distress

OBJECTIVE

In the present study, we aimed to assess hostility and to examine its association with formal psychiatric diagnosis, coping, cancer worries, and quality of life in cancer patients.

METHODS

The World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) to make an ICD-10 (International Classification of Disease) psychiatric diagnosis was applied to 516 cancer outpatients. The patients also completed the Brief Symptom Inventory-53 to assess hostility (BSI-HOS), and the Mini-Mental Adjustment to cancer scale (Mini-MAC). A subset of patients completed the Cancer Worries Inventory (CWI), the Openness Scale, and the Quality of Life Index.

RESULTS

By analyzing the distribution of the responses 25% of the patients had moderate and 11% high levels of hostility, with about 20% being BSI-HOS "cases." Hostility was higher in patients with a formal ICD-10 psychiatric diagnosis (mainly major depression, other depressive disorders, anxiety disorders) than patients without ICD-10 diagnosis. However, about 25% of ICD-10-non cases also had moderate-to-high hostility levels. Hostility was associated with Mini-MAC hopelessness and anxious preoccupation, poorer quality of life, worries (mainly problems sin interpersonal relationships), and inability to openly discuss these problems within the family.

CONCLUSIONS

Hostility and its components should be considered as dimensions to be more carefully explored in screening for distress in cancer clinical settings for its implications in negatively impacting on quality of life, coping and relationships with the family, and possibly the health care system.

The relationship between anger regulation, mood, pain, and pain-related disability in women treated for breast cancer

OBJECTIVE

Anger, depressive symptoms, and anxiety are known reactions to cancer and suggested to modulate pain experience. We examined the association between anger regulation, mood, and pain in 952 breast cancer patients followed for 3 years.

METHODS

Preoperatively, the patients completed questionnaires about depressive symptoms (BDI), state anxiety (STAI), anger regulation (STAXI-2), and pains in the surgical and other areas. Experimental pain sensitivity was tested. In the follow-up, BDI and STAI were assessed at 1 and at 6 months and at 1, 2, and 3 years after surgery. Pain in the surgical area was evaluated during the first 7 days and at 1 and 3 years after surgery. Pain-related disability was assessed at 3 years after surgery. Latent profile analyses were performed to identify mood profiles, and regression analyses to find independent predictors for mood and pain variables.

RESULTS

Anger inhibition and pain had associations with ongoing depressive symptoms and anxiety. Pain-related disability was associated with high anxiety at a hazard ratio (HR) of 2.24 (95% CI, 1.17-4.27), with older age (HR 1.07, 95% CI, 1.01-1.13), and with pain in the surgical area (HR 3.04, 95% CI, 2.41-3.85), but not with anger variables. Any relationship between anger regulation and pain intensity disappeared after controlling for age and mood.

CONCLUSIONS

Different forms of pain are important to recognize and treat to support breast cancer patients' psychological well-being. Anger inhibition could be a target for psychotherapeutic intervention, to help with ongoing mood symptoms. The relationship between anger regulation and pain is not straightforward.

Visual Cancer Communication on Social Media: An Examination of Content and Effects of #Melanomasucks

BACKGROUND

Instagram is increasingly becoming a platform on which visual communication of cancer takes place, but few studies have investigated the content and effects. In particular, a paucity of research has evaluated the effects of visual communication of cancer on participative engagement outcomes.

OBJECTIVE

The objective of our study was to investigate cancer-related beliefs and emotions shared on Instagram and to examine their effects on participative engagement outcomes including likes, comments, and social support.

METHODS

This study analyzed the content of 441 posts of #melanomasucks on Instagram and assessed the effects of the content characteristics on outcomes, including the number of likes and comments and types of social support using group least absolute shrinkage and selection operator logistic regression.

RESULTS

Posts about controlling melanoma were most frequent (271/441, 61.5%), followed by 240 (54.4%) posts about outcomes of having melanoma. Ninety posts (20.4%) were about the causes of melanoma. A greater number of posts expressed positive (159/441, 36.1%) than negative emotions (100/441, 22.7%). Eighty posts (18.1%) expressed hope, making it the most frequently expressed emotion; 49 posts expressed fear (11.1%), 46 were humorous (10.4%), and 46 showed sadness (10.4%). Posts about self behavior as a cause of melanoma decreased likes (P<.001) and social support comments (P=.048). Posts about physical consequences of melanoma decreased likes (P=.02) but increased comments (P<.001) and emotional social support (P<.001); posts about melanoma treatment experience increased comments (P=.03) and emotional social support (P<.001). None of the expressions of positive emotions increased likes, comments, or social support. Expression of anger increased the number of likes (P<.001) but those about fear (P<.001) and joy (P=.006) decreased the number of likes. Posts about fear (P=.003) and sadness (P=.003) increased emotional social support. Posts showing images of melanoma or its treatment on the face or body parts made up 21.8% (96/441) of total posts. Inclusion of images increased the number of comments (P=.001).

CONCLUSIONS

To our knowledge, this is the first investigation of the content and effects of user-generated visual cancer communication on social media. The findings show where the self-expressive and social engagement functions of #melanomasucks converge and diverge, providing implications for extending research on the commonsense model of illness and for developing conceptual frameworks explaining participative engagement on social media.

Self-Confidence and Quality of Life in Women Undergoing Treatment for Breast Cancer

Introduction: Quality of life is an important topic in the study of chronic diseases, especially cancer which can have a major effect on patient self-confidence. This study was conducted to determine quality of life and its relationship with self-confidence in women undergoing treatment for breast cancer. Methods: This cross-sectional, descriptive, analytical study was conducted in 2016 on 166 women with breast cancer undergoing treatment at Ghazi, Al-Zahra, International and/or Shams hospitals in Tabriz. The subjects were selected through convenience sampling. A personal-demographic questionnaire, the Cancer Quality of Life Questionnaire (QLQ-C30), and the Rosenberg Self-Esteem Scale (RSES) were completed for each patient. The data obtained were analyzed using independent t-tests, one-way ANOVA, multivariate linear regression and Pearson’s correlation coefficients. Findings: The mean total score of quality of life was 59.1±17.4, ranging from 0 to 100. The highest mean score was obtained in the cognitive subscale (74.9±23.8) and the lowest in the emotional subscale (51.4±21.1). The mean score for self-confidence was 0.3 with a standard deviation of 0.1, ranging from -1 to +1. There was a significant positive relationship between self-confidence and quality of life, except in three symptom subscales for diarrhea, constipation and loss of appetite (P<0.05). Self-confidence, disease duration, lifestyle, marital satisfaction and caregiver status were among the predictors of quality of life. Discussion: Given the significant relationship between quality of life and self-confidence, health care providers may need to pay special attention to women undergoing treatment for breast cancer and perform timely measures to maintain their belief in themselves.

FORECAST - A cloud-based personalized intelligent virtual coaching platform for the well-being of cancer patients

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The challenges of cancer patients and the benefits of coaching are presented.

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Evidence of impact of coaching on the well being of cancer patients is presented.

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A cloud-based personalized intelligent virtual coaching platform for the well-being of cancer patients is proposed.

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Technology acceptance of the platform is presented, based on validation trials.

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Future work is discussed.

Well-being of cancer patients and survivors is a challenge worldwide, considering the often chronic nature of the disease. Today, a large number of initiatives, products and services are available that aim to provide strategies to face the challenge of well-being in cancer patients; nevertheless the proposed solutions are often non-sustainable, costly, unavailable to those in need, and less well-received by patients. These challenges were considered in designing FORECAST, a cloud-based personalized intelligent virtual coaching platform for improving the well-being of cancer patients. Personalized coaching for cancer patients focuses on physical, mental, and emotional concerns, which FORECAST is able to identify. Cancer patients can benefit from coaching that addresses their emotional problems, helps them focus on their goals, and supports them in coping with their disease-related stressors. Personalized coaching in FORECAST offers support, encouragement, motivation, confidence, and hope and is a valuable tool for the wellbeing of a patient.

Brief Training on Patient Anger Increases Oncology Providers' Self-Efficacy in Communicating With Angry Patients

CONTEXT

Anger is a common reaction to pain and life-limiting and life-threatening illness, is linked to higher levels of pain, and may disrupt communication with medical providers. Anger is understudied compared with other emotions in mental health and health care contexts, and many providers have limited formal training in addressing anger.

OBJECTIVES

The objective of this study was to assess if a brief provider training program is a feasible method for increasing providers' self-efficacy in responding to patient anger.

METHODS

Providers working in stem cell transplant and oncology units attending a brief training session on responding to patient anger. The program was informed by cognitive behavioral models of anger and included didactics, discussion, and experiential training on communication and stress management.

RESULTS

Provider-rated self-efficacy was significantly higher for nine of 10 skill outcomes (P < .005) including acknowledging patient anger, discussing anger, considering solutions, and using relaxation to manage their own distress. All skill increases were large in magnitude (Cohen's d = 1.18-2.22).

CONCLUSION

Providers found the program to be useful for increasing their confidence in addressing patient anger. Discussion, didactics, and experiential exercises can support provider awareness of anger, shape adaptive communication, and foster stress management skills.

Short article: Anger and quality of life in patients co-infected with HIV and hepatitis C virus: a cross-sectional study (ANRS CO13-HEPAVIH)

OBJECTIVE

The aim of this study is to document the relationship between anger dimensions (state, trait, expression, and control) and quality of life (QoL) in patients co-infected with HIV and hepatitis C virus (HCV).

PATIENTS AND METHODS

This is a cross-sectional study nested in the ANRS CO13-HEPAVIH French national cohort. Anger and QoL were assessed using self-administered questionnaires in 536 HIV-HCV-co-infected patients. Correlations between anger scores (STAXI-2 scale) and QoL scores (WHOQOL-HIV BREF scale) were assessed using Spearman's coefficients. Multiple linear regression models were then used to test the relationship between the different dimensions of anger and QoL after adjustment for statistically significant psychosocial, sociobehavioral, and clinical characteristics.

RESULTS

Patients with excessive alcohol use or history of injecting drug use had higher levels of anger. All dimensions of anger were significantly correlated with impaired QoL for all six dimensions of the WHOQOL-HIV BREF scale. Greater internal experience of anger and impaired anger control were confirmed as independent correlates of impaired QoL related to psychological health, social relationships, and patients' beliefs after adjustment for depressive symptoms, functional impact of fatigue, socioeconomic status, and HIV-related characteristics.

CONCLUSION

Anger issues need close monitoring in HIV-HCV-co-infected patients, especially in patients with addictive behaviors. Screening for problems in anger management and implementing individualized psychotherapeutic strategies may help improve QoL in this population.

PERSONALITY TRAITS, ANGER AND PSYCHIATRIC SYMPTOMS RELATED TO QUALITY OF LIFE IN PATIENTS WITH NEWLY DIAGNOSED DIGESTIVE SYSTEM CANCER

BACKGROUND

The presence of psychiatric symptoms, anger, and personality characteristics are factors that affect the quality of life of newly diagnosed digestive system cancer patients.

OBJECTIVE

This study aims to identify which stable characteristics of the individual's personality interfere with quality of life, even when reactive emotional characteristics of falling ill are controlled.

METHODS

A cross-sectional study was performed at the Oncology Clinic ( Hospital das Clínicas ), Marília/SP, Brazil, in which 50 adult patients with digestive system cancer and diagnosed less than 6 months answered the State-Trait Anger Expression Inventory, Temperament and Character Inventory, Hospital Anxiety and Depression Scale and WHOQOL-BREF. Multiple regression was performed to verify if quality of life was related to stable characteristics of the subject's personality (anger trait, temperament and character) after controlling to the transient emotional aspects (anger state, psychiatric symptoms).

RESULTS

The quality of life psychological health score was higher in presence of self-directedness character and reward dependence temperament and quality of life environment score was higher in presence of self-directedness character and lower in presence of harm avoidance temperament.

CONCLUSION

The psychological well-being and the adaptive needs to the environment that favoring a better quality of life were reinforced mainly by the self-directedness character; which means that patients more autonomous cope better with the disease. On the other hand, the harm avoidance temperament (meaning the patient has fear of aversive situations) impaired the adaptive capacity to deal with the changes of the day-to-day imposed by the disease. Understanding these personality traits is important to the health professionals drive the patient to more successful treatment.

Anger Proneness and Prognostic Pessimism in Men With Prostate Cancer

Aim:

Anger is a common reaction to cancer diagnosis which may impact patients’ perceptions of their prognosis and goals of care. This study tested the hypothesis that men with prostate cancer who are anger prone are pessimistic regarding their cancer prognosis.

Methods:

Two hundred and twelve men with a history of prostate cancer completed measures of personality traits, their prostate cancer prognosis, and their perception of their doctor’s assessment of their prognosis. Anger proneness was operationally defined by the presence of high levels (ie, above the medians) of neuroticism and disagreeableness.

Results:

One in 4 men with prostate cancer disagreed with their doctor about prognosis. Anger-prone participants endorsed more pessimistic perceptions of prognosis ( P = .041). This significant association was maintained after accounting for potential confounders.

Conclusion:

Greater attention paid to patient anger regulation style and pessimistic perceptions will improve discussions about prognosis and goals of care among men with prostate cancer. Given recent calls for wider distress screening and earlier palliative care intervention in cancer settings, providers have an unprecedented opportunity to assess and respond to anger in the clinical setting. Communication could be improved through empathic statements that convey realistic optimism when appropriate, a commitment to the patient–provider relationship and a willingness to explore and address patient needs.

Couples coping with cancer: exploration of theoretical frameworks from dyadic studies

OBJECTIVE

A diagnosis of cancer and subsequent treatment are distressing not only for the person directly affected, but also for their intimate partner. The aim of this review is to (a) identify the main theoretical frameworks underpinning research addressing dyadic coping among couples affected by cancer, (b) summarise the evidence supporting the concepts described in these theoretical frameworks, and (c) examine the similarities and differences between these theoretical perspectives.

METHODS

A literature search was undertaken to identify descriptive studies published between 1990 and 2013 (English and French) that examined the interdependence of patients' and partners' coping, and the impact of coping on psychosocial outcomes. Data were extracted using a standardised form and reviewed by three of the authors.

RESULTS

Twenty-three peer-reviewed manuscripts were identified, from which seven theoretical perspectives were derived: Relationship-Focused Coping, Transactional Model of Stress and Coping, Systemic-Transactional Model (STM) of dyadic coping, Collaborative Coping, Relationship Intimacy model, Communication models, and Coping Congruence. Although these theoretical perspectives emphasised different aspects of coping, a number of conceptual commonalities were noted.

CONCLUSION

This review identified key theoretical frameworks of dyadic coping used in cancer. Evidence indicates that responses within the couple that inhibit open communication between partner and patient are likely to have an adverse impact on psychosocial outcomes. Models that incorporate the interdependence of emotional responses and coping behaviours within couples have an emerging evidence base in psycho-oncology and may have greatest validity and clinical utility in this setting.

Adjustment process in Iranian men to their wives' breast cancer

Women's breast cancer causes various problems in both spouses' family life as well as enormous stress for their husbands. This grounded theory study aimed to define ways in which men adjust to their wives' breast cancer and to present an appropriate model in this respect. Twenty-six individuals (22 husbands, 2 patients and 2 physicians) were selected through purposive and theoretical sampling. The data were collected through in-depth individual interviews. Strauss and Corbin's method was used for data analysis. Data analysis revealed that Iranian men's adjustment to their wives' breast cancer occurs during the following three stages: the first stage turbulence after confrontation with the disease that contains categories 'internal unrest', 'concerns about disease management' and 'sensing the beginning of disorganization in family life'; the second stage disorganisation of family life that contains 'disturbance of family life', 'attempt to get rid of tension' and 'resistance against family life disorganisation'; and the third stage struggle to reorder family life consisting of 'support to the wife', 'revision in communications with relatives' and 'seeking external support' categories. Iranian men struggled for constant organisation of family life after their wives' disease. Health providers should take measures to support the men by facilitating their adjustment to their wives' disease.

Living with Advanced Breast Cancer among Ghanaian Women: Emotional and Psychosocial Experiences

The purpose of this study was to explore the emotional and psychosocial experiences of Ghanaian women living with advanced breast cancer in the Kumasi metropolis. The study employed a qualitative exploratory descriptive design. Purposive sampling approach was used and data was saturated with 10 participants aged between 32 and 65 years. All interviews were audio-taped and transcribed. Data was analyzed concurrently based on the techniques of content analysis. Anonymity and confidentiality were ensured. Women experienced emotional reactions such as sadness, fear, and anxiety. Pain was severe and led to suicidal ideations. Women experienced lost hopes regarding their marriage, parenting, and work. They received support from their families, spouses, colleagues, health professionals, and spiritual leaders. Women coped by accepting the disease and surrendering to God and having the will to live. Five major themes described were emotional reactions, pain, lost hope, support, and coping. It was recommended that health care providers involved in breast cancer management should be trained to enhance effective and holistic care of women and their families. Also, patients with advanced disease should be given effective pain management and a multidisciplinary palliative care team should be instituted to care for the women.

"An arena for sharing": exploring the joint involvement of patients and their relatives in a cancer rehabilitation intervention study

BACKGROUND

Despite an increasing focus on cancer rehabilitation programs, there is limited knowledge about the experiences of residential rehabilitation focusing on both the patients and their relatives.

OBJECTIVE

The aim of this study was to explore the experienced benefits of the joint involvement of patients and their relatives in a 5-day residential cancer rehabilitation course, provided as part of a larger intervention study in Denmark.

METHODS

Ethnographic fieldwork, consisting of participant observations and informal conversations, was conducted with 20 individuals (10 patients and 10 relatives). In-depth interviews were conducted in the participants' homes 1 month after the rehabilitation course. Data were analyzed by a constant comparative method.

RESULTS

Residential rehabilitation course was identified to serve as an "arena for sharing," underpinned by 3 dimensions of sharing: sharing cancer experiences, sharing strategies, and sharing mutual care.

CONCLUSION

Sharing in residential rehabilitation is experienced as useful for cancer patients and their relatives, to validate cancer-related strategies and strengthen mutual understanding within relationships.

IMPLICATIONS FOR PRACTICE

The results can guide the development of cancer rehabilitation to involve patients and their relatives and provide opportunity for sharing and empowerment on individual as well as couple and group levels.

Impact of patient smoking behavior on empathic helping by family caregivers in lung cancer

PURPOSE/OBJECTIVES

To test the impact of patient smoking behavior on family caregiver judgments of responsibility, emotions, empathic responses, and helping behavior.

DESIGN

Structural equation modeling.

SETTING

Five oncology outpatient settings in Canada.

SAMPLE

304 dyads consisting of patients with lung cancer and their primary caregivers.

METHODS

Self-report questionnaires, abstracted medical record data, confirmatory factor analysis, and structural equation modeling.

MAIN RESEARCH VARIABLES

Smoking history, judgments of responsibility for controlling the disease, anger, pride, empathic responses, and helping behaviors.

FINDINGS

The impact of patient smoking behavior on caregiver help was mediated by caregiver judgments of responsibility, affective reactions of anger and pride, and empathic responses by caregivers.

CONCLUSIONS

When patients continued to engage in smoking behavior, despite a diagnosis of lung cancer, caregivers tended to ascribe more responsibility and feel more anger and less pride in the patients' efforts to manage the disease, therefore placing caregivers at risk for less empathy and helping behavior.

IMPLICATIONS FOR NURSING

Caregiver blame and anger must be assessed, particularly when the patient with lung cancer continues to smoke. If caregiver judgments of blame and anger are evident, then an attribution approach is indicated involving a dialogue between the caregiver and the patient, with the aim of enhancing the caregiver's understanding of how negative attributions and linked emotions impact his or her ability to engage in empathic helping behaviors.

Inter-relationships between the economic and emotional consequences of colorectal cancer for patients and their families: a qualitative study

Background

While the evidence-base concerning the economic impact of cancer for patients and their families/carers has grown in recent years, there is little known about how emotional responses to cancer influence this economic impact. We investigated the economic costs of cancer in the context of patients’ emotions and how these both shaped the patient and family burden.

Methods

Health professionals from six hospitals invited patients diagnosed with colorectal cancer (ICD10 C18-C20) within the previous year to take part in the study. Semi-structured face-to-face interviews were conducted with patients and, where available, a family member. Interviews covered medical and non-medical costs incurred as a result of cancer and the impact of these on the lives of the patient and their family. Interviews were audio-recorded. Recordings were transcribed verbatim and these data were analysed qualitatively using thematic content analysis.

Results

Twenty-two patients with colorectal cancer (17 colon and 5 rectal; 14 women and 8 men) were interviewed; 6 were accompanied by a family member. Important cancer-related financial outlays included: travel and parking associated with hospital appointments; costs of procedures; increased household bills; and new clothing. Cancer impacted on employed individuals’ ability to work and depressed their income. The opportunity cost of informal care for carers/family members, especially immediately post-diagnosis, was a strong theme. All patients spoke of the emotional burden of colorectal cancer and described how this burden could lead to further costs for themselves and their families by limiting work and hindering their ability to efficiently manage their expenses. Some patients also spoke of how economic and emotional burdens could interact with each other. Support from employers, family/carers and the state/health services and patients’ own attitudes influenced this inter-relationship.

Conclusions

The economic impact of colorectal cancer on patients and their families is complex. This study suggests that the economic costs and the emotional impact of cancer are often related and can exacerbate each other, but that various factors can meditate this inter-relationship.

The patient-physician relationship in patients with breast cancer: influence on changes in quality of life after rehabilitation

PURPOSE

The objective of this study was to examine whether aspects of the patient-physician relationship for breast cancer patients have an influence on the change in health-related quality of life (HRQOL) after inpatient rehabilitation.

METHODS

N = 329 breast cancer patients undergoing inpatient rehabilitation in Germany were surveyed using questionnaires at the beginning of rehabilitation, end of rehabilitation, and 6 months after rehabilitation. Multiple imputations and multilevel models of change were used in the data analyses.

RESULTS

Even after comprehensive adjustment for sociodemographic, medical, psychological variables, and center effects, aspects of the physician-patient relationship were statistically and clinically relevant predictors of HRQOL after rehabilitation. Satisfaction with physician's care appears to have a rather short-term effect, but the effect of promoting patient participation can still be partially determined 6 months after rehabilitation. Other important predictors of HRQOL improvement are optimism, higher level of education, higher income, living with a partner, and the ability to work.

CONCLUSIONS

By taking into consideration the patient's communication and participation needs, physicians can contribute to an improved HRQOL after rehabilitation. The high predictive power of socioeconomic factors shows that rehabilitation care can be more effective if it accounts for the specific situation of socially disadvantaged individuals.

Life experiences of women with breast cancer in south western Turkey: a qualitative study

PURPOSE

This qualitative study explores the experience of women living with breast cancer.

METHODS

The study was conducted among eight women with ongoing breast cancer chemotherapy treatment, which occurred in an ambulatory unit. The data were collected using semi-structured and in-depth individual interviews. All interviews were tape-recorded, and the results were obtained by analysing the content of the recorded data.

RESULTS

Three major themes related to the experiences of women living with breast cancer were identified. They are as follows: (1) needs (the need for spouse and family support, the need to worship, and the need to receive and share information), (2) living with losses (loss of the breast and of one's hair), and (3) changes (changes in one's normal life, change in self-perception, changes in the perception of the value of health, and a greater appreciation for life).

CONCLUSIONS

This study was conducted to increase awareness concerning women's perceptions of their care and various needs during breast cancer treatment. The results of this study challenge health care providers and educators to be more aware of the difficulties that women face when living with breast cancer.

Improving quality of life through rehabilitation in palliative care: case report

OBJECTIVE

Occupational and physical therapists can have a significant impact on the quality of life of terminally ill cancer patients. In the critical care setting, rehabilitation is often overlooked. However, occupational and physical therapists work with critically-ill patients to create realistic and meaningful goals for improving comfort, mobility, socialization skills, and ability to care for oneself regardless of disease state and medical status. The following case report describes rehabilitation intervention with a young woman diagnosed with osteosarcoma and leukemia during the final stage of her life.

METHOD

This case report highlights the use of patient-centered goals and the importance of close collaboration between the patient, occupational therapist, and physical therapists to achieve a higher quality of life.

RESULTS

A collaborative effort by the occupational and physical therapists yielded positive outcomes as defined by the patient, patient family, and the medical staff in the critical care setting.

SIGNIFICANCE OF RESULTS

Palliative care patients may benefit from occupational therapy (OT) and physical therapy (PT) intervention. Rehabilitation specialists are skilled at working with patients to set realistic and meaningful functional goals. Further study on rehabilitation treatment to improve quality of life among patients in palliative care is needed.

Integrative Oncology for the Whole Person: A Multidimensional Approach to Cancer Care

Today, more than ever before, millions of people are seeking an approach to medicine and health care that is more comprehensive, more holistic and integrative, and more compassionate and sensitive to their needs as a whole person. This is particularly true for those dealing with cancer. Changing patient demographics, heightened consumer demand for complementary and alternative medicine (CAM) products and services, advances in medical science and technology, expanding access to the Internet and health information, and other factors have contributed to a wave of transformation that is unprecedented in its impact on the entire health care system. These trends have fueled the emerging fields of integrative medicine and oncology, which are growing rapidly. As these fields continue to evolve, they will move beyond the present integrative model to a broader vision of whole-person, multidimensional care that will more fully and coherently address and embrace all dimensions of the human experience. This article describes 6 major driving forces behind the wave of transformation presently under way in medicine and health care. It provides a brief, historical overview of integrative medicine and oncology and summarizes the present status of these emerging fields. It discusses the future of integrative medicine and oncology, including a multidimensional approach to care, and highlights 5 key elements that underlie this approach. Finally, it describes The Seven Levels of Healing — a model of multidimensional care—and concludes with a discussion of 3 important challenges and opportunities for medicine and health care that lie on the horizon.