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Bradley N, Dowrick C, Lloyd-Williams M. Explaining how and why social support groups in hospice day services benefit palliative care patients, for whom, and in what circumstances. Palliat Care Soc Pract 2023; 17:26323524231214549. [PMID: 38044931 PMCID: PMC10693225 DOI: 10.1177/26323524231214549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/27/2023] [Indexed: 12/05/2023] Open
Abstract
Background Palliative care aims to provide holistic support for people with life-limiting illness, responding to psychological, social and spiritual needs, as well as to clinical and physical. In the United Kingdom, hospice day services (including day care, group interventions, group activities, and social events for palliative care outpatients) aim to provide opportunities for patients to gain social support, which is thought to improve their quality of life. Objectives This research explored social support within hospice day services, to explain in detail how and why social support obtained within a hospice day service could be beneficial to palliative care patients. Design Qualitative research using observations of hospice day services and interviews with service providers. Methods Data collection involved nineteen interviews with hospice service providers (n = 19) and researcher observations of hospice day services. The findings detail how patient and hospice context interact to produce mechanisms that lead to outcomes beyond the hospice day service. Results Practical, clinical and social aspects of the hospice day service are important for patients feeling welcome and safe in the setting. The opportunity to connect with other people and work towards personal goals can boost self-confidence for patients who have lost access to meaningful activity. New friendships between patients encourages reciprocal support and feelings of belonging. It is beneficial to have permission to speak freely about topics deemed inappropriate elsewhere, because honest communication is helpful in accepting and adapting to their circumstances. Conclusion Hospice day services facilitate group settings for reciprocal social support. This research proposes an initial programme theory that can be further developed and tested. It explains how and why, in some contexts, social support increases personal and practical resources to cope with illness and death, leading to changes outside of the hospice (to mood, interpersonal interactions and behaviour) that could improve quality of life.
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Affiliation(s)
- Natasha Bradley
- School of Nursing and Midwifery, Queen’s University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT7 1NN, UK
- Centre for Health & Clinical Research, University of the West of England (UWE), Bristol BS16 1DD, UK
| | - Christopher Dowrick
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Mari Lloyd-Williams
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
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Breaking New Ground in Palliative Care: Examining the Impact of Al Ain – Palliative Care Outreach Program on Patients With Advanced Cancer in the United Arab Emirates. Cureus 2023; 15:e36756. [PMID: 36992813 PMCID: PMC10042392 DOI: 10.7759/cureus.36756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 03/29/2023] Open
Abstract
Introduction This study aimed to evaluate the effectiveness of the Palliative Outreach Program in improving the quality of palliative care for patients with advanced cancer in a Tertiary Hospital in the Al Ain region of the United Arab Emirates (UAE). Methods & Material One hundred patients who met the inclusion criteria were included in the study and administered the patient version of the Consumer Quality (CQ) Index Palliative Care Instrument to assess their perception of the quality of care they received. The demographics, diagnosis, and questionnaire responses were analyzed to determine the effectiveness of the Palliative Outreach Program. Results A total of one hundred patients met the criteria for the study. Most patients were above 50, female, female, Non-Emiratis, and had high school certificates. The top three cancer diagnoses were breast (22%), lung (15%), and head & neck (13%). The patients reported high levels of support from their caregivers regarding physical, psychological, and spiritual well-being, as well as information and expertise. The mean scores for most variables were favorable, except for information (mean = 2.9540, SD= 0.25082) and general appreciation (mean = 6.7150, sd = 0.82344). Overall, the patients rated the care they received positively, with high mean scores for physical/psychological well-being (mean = 3.4950, SD = 0.28668), autonomy (mean = 3.7667, SD= 0.28623), privacy (mean = 3.6490, SD = 0.23159), and spiritual well-being (mean =3.7500, SD = 0.54356). The patients would recommend their caregivers to others in similar situations. Discussion The findings demonstrate that the Palliative Outreach Program effectively improves the quality of palliative care for patients with advanced cancer in the UAE. The CQ Index Palliative Care Instrument proved a novel method for assessing palliative care quality from patients' perspectives. However, there is room for improvement in providing more favorable information and general appreciation outcomes. Caregivers should focus on all areas to enhance their physical/psychological well-being, autonomy, privacy, spiritual well-being, expertise, and general appreciation of their patients. Conclusion In conclusion, the Palliative Outreach Program is an effective intervention to improve the quality of palliative care for patients with advanced cancer in the UAE. The patients reported high levels of support from their caregivers in all aspects of care, except for information and general appreciation. These findings provide valuable insights into the effectiveness of palliative care interventions and highlight the need for continued efforts to improve the quality of care for patients with advanced cancer.
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Bradley N, Dowrick C, Lloyd-Williams M. Feasibility of Patient Reported Outcome Measures in Psychosocial Palliative Care: Observational Cohort Study of Hospice Day Care and Social Support Groups. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13258. [PMID: 36293835 PMCID: PMC9603547 DOI: 10.3390/ijerph192013258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/08/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
Palliative care patients can be at risk of social isolation or loneliness. Interventions that can provide effective social support, and particularly emotional support, could facilitate healthy coping that bolsters quality of life and reduces depression in palliative care patients. This is an observational cohort study which recruited thirty patients (n = 30) from the day services of four independent hospices in England. Participants completed patient reported outcome measures in perceived social support, loneliness, and depression, at up to three time points. Age range was 56-91 years, males and females were equally represented, and the sample was 93% white British. In participants that provided two or more timepoints, perceived social support increased, and loneliness and depression decreased. Largest changes with the least variation between participants was in emotional support (p = 0.165) and loneliness (p = 0.104). These results suggest that the psychosocial patient reported outcome measures used (MOS-SS, UCLA, BEDS) could be sensitive to change aligned with the goals of this intervention in palliative care. Participants in this study were observed to derive psychosocial benefit from attending the hospice day service.
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Affiliation(s)
- Natasha Bradley
- Centre for Health & Clinical Research, University of the West of England, Bristol BS16 1DD, UK
| | - Christopher Dowrick
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool L69 3BX, UK
| | - Mari Lloyd-Williams
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool L69 3BX, UK
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Emotion Regulation Flexibility and Electronic Patient-Reported Outcomes: A Framework for Understanding Symptoms and Affect Dynamics in Pediatric Psycho-Oncology. Cancers (Basel) 2022; 14:cancers14163874. [PMID: 36010870 PMCID: PMC9405711 DOI: 10.3390/cancers14163874] [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: 04/29/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 11/25/2022] Open
Abstract
Simple Summary The individual’s ability to conceive and regulate the broad spectrum of their human emotions is closely linked to their mental health. The implications of a serious disease such as cancer represent an extraordinary burden to these internal coping mechanisms, especially in the case of young patients. Regarding their well-being and support, it is therefore of particular interest for caregivers to be able to follow the dynamics of the patient’s emotional world and perceptions. Technical progress enables new possibilities for data collection through tools for digital patient self-reports while simultaneously creating new challenges. Within the scope of this article, we provide an overview of the literature on this topic, outlining the current strengths and weaknesses and possible perspectives on digital aids, especially in terms of capturing the flexibility, fluctuations and early detection of symptom changes. Abstract Emotion dysregulation is regarded as a driving mechanism for the development of mental health problems and psychopathology. The role of emotion regulation (ER) in the management of cancer distress and quality of life (QoL) has recently been recognized in psycho-oncology. The latest technological advances afford ways to assess ER, affective experiences and QoL in child, adolescent and young adult (CAYA) cancer patients through electronic patient-reported outcomes (ePRO) in their daily environment in real-time. Such tools facilitate ways to study the dynamics of affect and the flexibility of ER. However, technological advancement is not risk-free. We critically review the literature on ePRO in cancer existing models of ER in pediatric psycho-oncology and analyze strength, weaknesses, opportunities and threats of ePRO with a focus on CAYA cancer research and care. Supported by personal study-based experiences, this narrative review serves as a foundation to propose a novel methodological and metatheoretical framework based on: (a) an extended notion of ER, which includes its dynamic, adaptive and flexible nature and focuses on processes and conditions rather than fixed categorical strategies; (b) ePRO as a means to measure emotion regulation flexibility and affect dynamics; (c) identifying early warning signals for symptom change via ePRO and building forecasting models using dynamical systems theory.
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Schmauch NU, Rego F, Castro L, Sacarlal J, Rego G. Coping Strategies Used by Patients After Diagnosis Disclosure in the Transition to Palliative Care: A Cross-Sectional Study. J Palliat Care 2022; 37:570-578. [PMID: 35821581 DOI: 10.1177/08258597221113724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The objectives of this study were to identify the coping strategies used by cancer and non-cancer patients with palliative needs, and to verify if there were differences in the coping strategies adopted between sociodemographic groups. METHODS This is a cross-sectional study carried out from September to November 2019, at Maputo Central Hospital, in the units of Medicine, Surgery, Orthopedics, Gynecology and Obstetrics. Eligible patients (n = 94) were included in the study and answered a self-completion scale adapted from the Coping Strategies Inventory by Folkman and Lazarus together with a sociodemographic questionnaire. RESULTS Our study demonstrates that the most used coping strategies were Social Support, followed by Planful Problem Solving, Escape-Avoidance, and Positive Reappraisal strategies. In addition, significant differences were observed between religious beliefs, with Christians resorting more to coping strategies related to Social Support, Accepting Responsibility and Escape-Avoidance than Evangelicals, and between different levels of education, with greater resort to Social Support, Accepting Responsibility, Planful Problem Solving, and Positive Reappraisal in patients with high education. CONCLUSIONS The results indicate that most of the respondents in this study used more adaptive coping strategies, such as Social Support and Positive Reappraisal, and less avoidant strategies, such as Distancing and Confrontation. There is a need to reinforce positive strategies from health professionals to increase satisfaction, autonomy, and promote patient's quality of life.
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Affiliation(s)
- Natália Ubisse Schmauch
- Faculty of Medicine, University of Porto, Porto, Portugal.,Pain Unit at Maputo Central Hospital, Maputo Central Hospital, Maputo, Mozambique
| | - Francisca Rego
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luísa Castro
- Center for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal.,Health Information and Decision Sciences Department - MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jahit Sacarlal
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
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Han W, Peng X, Qu D, Yang Y, Li K. Heavy shackles: The experience of symptom distress and coping behaviors of Chinese patients with chronic obstructive pulmonary disease. Nurs Health Sci 2020; 22:1177-1185. [PMID: 33118687 DOI: 10.1111/nhs.12790] [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: 05/21/2020] [Revised: 10/14/2020] [Accepted: 10/26/2020] [Indexed: 11/27/2022]
Abstract
People with chronic obstructive pulmonary disease exhibit various symptoms, some of which can negatively affect their daily lives. Thus, they may adopt coping behaviors to improve their condition. This qualitative descriptive study investigated symptom distress and coping behaviors among 19 Chinese patients with chronic obstructive pulmonary disease using individual, semi-structured, face-to-face interviews. We identified the following three themes for the patients' symptom distress: distressing symptoms, inescapable imprisonment, and no choice other than being a burden to the family. The various coping behaviors of the patients were categorized into the following three themes: struggle during the medical treatment process, careful maintenance of daily life, and coping with negative emotions. Although all patients experienced physical and psychological distress, they displayed a strong desire to improve their lives and health. By recognizing the patients' symptom distress and coping behaviors, tailored interventions could be developed to improve the quality of their lives.
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Affiliation(s)
- Wenwen Han
- School of Nursing, Jilin University, Changchun, China.,The First Hospital of Jilin University, Changchun, China
| | - Xin Peng
- School of Nursing, Jilin University, Changchun, China
| | - Danhua Qu
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, China
| | - Yuhang Yang
- School of Nursing, Jilin University, Changchun, China.,The First Hospital of Jilin University, Changchun, China
| | - Kun Li
- School of Nursing, Jilin University, Changchun, China
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Mediating effect of interpersonal coping on meaning in spirituality and quality of life and the influences of depression and anxiety thereon in cancer patients. Palliat Support Care 2020; 17:388-395. [PMID: 30394253 DOI: 10.1017/s1478951518000731] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This study aimed to investigate associations among spirituality, coping strategies, quality of life (QOL), and the effects of depression and anxiety thereon in cancer patients. METHOD In total, 237 cancer patients referred to a psycho-oncology clinic at a university hospital in Korea were enrolled. After identifying predictors of patient QOL in a stepwise regression model, we developed a hypothetical path model wherein interpersonal coping was considered as a mediating variable between spirituality (meaning/peace) and QOL and wherein depression and anxiety affected each of these three variables. RESULT The direct effect of spirituality (meaning/peace) on QOL was 36.7%. In an indirect model, interpersonal coping significantly mediated the relationship between spirituality (meaning/peace) and QOL. Depression exerted the largest negative effect on spirituality (meaning/peace), interpersonal coping, and QOL. Anxiety had negative effects on spirituality (meaning/peace) and QOL, but a positive effect on interpersonal coping. SIGNIFICANCE OF RESULTS Interpersonal coping strategies work as a partial mediator of the relationship between meaning/peace subscales of spirituality and QOL. Effective management of depression may help in achieving better outcomes associated therewith. Greater attention and efforts to improve social connectedness and meaning of life in spiritual well-being may improve the QOL of cancer patients.
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Greer JA, Applebaum AJ, Jacobsen JC, Temel JS, Jackson VA. Understanding and Addressing the Role of Coping in Palliative Care for Patients With Advanced Cancer. J Clin Oncol 2020; 38:915-925. [PMID: 32023161 DOI: 10.1200/jco.19.00013] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Advanced cancer, with its considerable physical symptoms and psychosocial burdens, represents an existential threat and major stressor to patients and their caregivers. In response to such stress, patients and their caregivers use a variety of strategies to manage the disease and related symptoms, such as problem-focused, emotion-focused, meaning-focused, and spiritual/religious coping. The use of such coping strategies is associated with multiple outcomes, including quality of life, symptoms of depression and anxiety, illness understanding, and end-of-life care. Accumulating data demonstrate that early palliative care, integrated with oncology care, not only improves these key outcomes but also enhances coping in patients with advanced cancer. In addition, trials of home-based palliative care interventions have shown promise for improving the ways that patients and family caregivers cope together and manage problems as a dyad. In this article, we describe the nature and correlates of coping in this population, highlight the role of palliative care to promote effective coping strategies in patients and caregivers, and review evidence supporting the beneficial effects of palliative care on patient coping as well as the mechanisms by which improved coping is associated with better outcomes. We conclude with a discussion of the limitations of the state of science, future directions, and best practices on the basis of available evidence.
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Affiliation(s)
- Joseph A Greer
- Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | | | - Juliet C Jacobsen
- Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Jennifer S Temel
- Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Vicki A Jackson
- Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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He Y, Jian H, Yan M, Zhu J, Li G, Lou VWQ, Chen J. Coping, mood and health-related quality of life: a cross-sectional study in Chinese patients with advanced lung cancer. BMJ Open 2019; 9:e023672. [PMID: 31061015 PMCID: PMC6501988 DOI: 10.1136/bmjopen-2018-023672] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES The ways patients cope with advanced cancer can influence their health-related quality of life (HRQoL). This study aims to examine the mediating role of positive and negative mood in the relationship between coping and HRQoL in patients with advanced lung cancer. METHODS A consecutive sample of 261 patients (mean age: 59.99±9.53) diagnosed with stage III or IV lung cancer was recruited from the inpatient unit in a hospital that specialises in chest-related disease in Shanghai, China. Participants completed measurements including Medical Coping Modes Questionnaire, Positive and Negative Affect Schedule, and 5-level EuroQol 5-dimension instrument. RESULTS Although the total effects of confrontation on HRQoL were not significant, competing indirect effects via mood were identified: (1) positive indirect effects through positive mood were found for confrontation on mobility, usual activities, pain/discomfort and overall utility index (indirect effect=0.01, 95% CI 0.003 to 0.03); (2) negative indirect effects through negative mood were found for confrontation on mobility, pain/discomfort, anxiety/depression and overall utility index (indirect effect=-0.01, 95% CI -0.03 to -0.001). Resigned acceptance was negatively associated with HRQoL, and indirect effects via mood were identified: (1) negative indirect effects through positive mood were found for resigned acceptance on mobility, self-care, usual activities, pain/discomfort and overall utility index (indirect effect=-0.01, 95% CI -0.03 to -0.003); (2) negative indirect effects through negative mood were found for resigned acceptance on domains of HRQoL and overall utility index (indirect effect=-0.04, 95% CI -0.06 to -0.02). CONCLUSIONS Confronting advanced lung cancer can fuel ambivalent emotional experiences. Nevertheless, accepting the illness in a resigned way can be maladaptive for health outcomes. The findings suggest interventions that facilitate adaptive coping, reduce negative mood and enhance positive mood, as this could help to improve or maintain HRQoL in patients with advanced lung cancer.
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Affiliation(s)
- Yaping He
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
- Center for Health Technology Assessment, Shanghai Jiao Tong University China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Hong Jian
- Department of Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Meiqiong Yan
- Department of Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jingfen Zhu
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
- Center for Health Technology Assessment, Shanghai Jiao Tong University China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Guohong Li
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
- Center for Health Technology Assessment, Shanghai Jiao Tong University China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Vivian W Q Lou
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
| | - Jieling Chen
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
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Vas S, Povey R, Clark-Carter D. 'I would describe myself as a deformed troll': Using interpretative phenomenological analysis to explore body image struggles among palliative care patients. Palliat Med 2019; 33:232-240. [PMID: 30415599 DOI: 10.1177/0269216318811723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Illness adjustment is a widely studied area in the palliative care context. However, research focussing on how altered body image can affect men and women in palliative care is limited and unclear. Aim: To explore the links between palliative care patients’ affected sense of self, altered body image and terminal illness adjustment. Design: Semi-structured interviews were conducted, and the Interpretative Phenomenological Analysis approach was used to analyse patients’ experiences. Setting/participants: English-speaking, adult palliative care outpatients were interviewed at a local community hospice in the United Kingdom. The mean age was 55 years (ranging from 35–65 years). Results: Analysis of accounts indicated three superordinate themes: (1) ‘Not being me’: self-discrepancy, (2) existing in the landscape of loss, (3) living and thriving in the landscape of loss. The most disturbing issues, such as appearance-focussed struggles and low body-confidence, were stemming from participants’ frustration over their lack of control and their attachment to their former self-image. Conclusions: The patients’ insights demonstrated that body image distress was prevalent among all respondents regardless of gender or diagnosis. A spiral model is described showing how discrepancy-based processing (i.e. ‘not being me’) and rigid attachment to former self can have harmful consequences on palliative patients’ abilities to cope. In order to facilitate adjustment to a self-identity crisis resulting from a terminal diagnosis, it is necessary for professionals to recognise and address body image changes among palliative care outpatients.
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Affiliation(s)
- Szilvia Vas
- Centre for Health Psychology and School of Life Sciences and Education, Staffordshire University, UK
| | - Rachel Povey
- Centre for Health Psychology and School of Life Sciences and Education, Staffordshire University, UK
| | - David Clark-Carter
- Centre for Health Psychology and School of Life Sciences and Education, Staffordshire University, UK
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11
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Lehto RH, Miller SEL, Flanigan M, Wyatt G. Mental health in patients with advanced cancer at the end of life: evaluation of evidence and future directions. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/23809000.2018.1483192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Rebecca H Lehto
- Michigan State University College of Nursing, East Lansing, MI, USA
| | - Sara EL Miller
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Megan Flanigan
- Michigan State University College of Nursing, East Lansing, MI, USA
| | - Gwen Wyatt
- Michigan State University College of Nursing, East Lansing, MI, USA
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12
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Liao YC, Liao WY, Sun JL, Ko JC, Yu CJ. Psychological distress and coping strategies among women with incurable lung cancer: a qualitative study. Support Care Cancer 2017; 26:989-996. [PMID: 29019055 DOI: 10.1007/s00520-017-3919-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 10/02/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Limited research has focused on women with lung cancer (LC) although they are recognized as the most vulnerable to psychological distress. This study explored in-depth the psychological distress experienced by women with incurable LC and analyzed the coping strategies with which they manage that distress. METHODS A qualitative methodology with in-depth interviews was employed for 34 women with advanced or recurrent LC. An inductive data-driven thematic analysis was applied to analyze transcripts. RESULTS Psychological distress was an iterative process for the women. Four themes were identified: shock regarding the diagnosis, distress regarding cancer treatment and its side effects, the facing of a recurrent or progressive disease, and persistent struggle with the life-limiting disease. Various coping strategies applied by the women to manage psychological distress were grouped into four themes: relying upon social support, focusing on positive thoughts, avoidance-based strategies, and religious faith and acceptance. CONCLUSIONS Women with incurable LC experienced substantial iterative psychological distress throughout the illness, regardless of length of illness at time of interview. They applied multiple forms of coping. The findings enrich the limited existing literature on this understudied population and provide direction for the future development of interventions to improve their psychological well-being.
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Affiliation(s)
- Yu-Chien Liao
- Department of Nursing, Yuanpei University of Medical Technology, 306, Yuanpei Street, Hsinchu, 30015, Taiwan.
| | - Wei-Yu Liao
- Department of Internal Medicine, College of Medicine, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan
| | - Jia-Ling Sun
- Department of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Jen-Chung Ko
- Department of Internal Medicine, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, College of Medicine, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan
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13
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Ratcliff CG, Milbury K, Chandwani KD, Chaoul A, Perkins G, Nagarathna R, Haddad R, Nagendra HR, Raghuram NV, Spelman A, Arun B, Wei Q, Cohen L. Examining Mediators and Moderators of Yoga for Women With Breast Cancer Undergoing Radiotherapy. Integr Cancer Ther 2016; 15:250-62. [PMID: 26867802 PMCID: PMC4972683 DOI: 10.1177/1534735415624141] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Hypothesis. This study examines moderators and mediators of a yoga intervention targeting quality-of-life (QOL) outcomes in women with breast cancer receiving radiotherapy.Methods. Women undergoing 6 weeks of radiotherapy were randomized to a yoga (YG; n = 53) or stretching (ST; n = 56) intervention or a waitlist control group (WL; n = 54). Depressive symptoms and sleep disturbances were measured at baseline. Mediator (posttraumatic stress symptoms, benefit finding, and cortisol slope) and outcome (36-item Short Form [SF]-36 mental and physical component scales [MCS and PCS]) variables were assessed at baseline, end-of-treatment, and 1-, 3-, and 6-months posttreatment. Results. Baseline depressive symptoms (P = .03) and sleep disturbances (P < .01) moderated the Group × Time effect on MCS, but not PCS. Women with high baseline depressive symptoms in YG reported marginally higher 3-month MCS than their counterparts in WL (P = .11). Women with high baseline sleep disturbances in YG reported higher 3-months MCS than their counterparts in WL (P < .01) and higher 6-month MCS than their counterparts in ST (P = .01). YG led to greater benefit finding than ST and WL across the follow-up (P = .01). Three-month benefit finding partially mediated the effect of YG on 6-month PCS. Posttraumatic stress symptoms and cortisol slope did not mediate treatment effect on QOL. Conclusion. Yoga may provide the greatest mental-health–related QOL benefits for those experiencing pre-radiotherapy sleep disturbance and depressive symptoms. Yoga may improve physical-health–related QOL by increasing ability to find benefit in the cancer experience.
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Affiliation(s)
- Chelsea G Ratcliff
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA Baylor College of Medicine, Houston, TX, USA VA South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA
| | - Kathrin Milbury
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Alejandro Chaoul
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - George Perkins
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Robin Haddad
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - N V Raghuram
- Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, India
| | - Amy Spelman
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Banu Arun
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qi Wei
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lorenzo Cohen
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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