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McPherson CJ, Devereaux A. A dyadic examination of patients' and caregivers' attachment orientations and mutually supportive care in cancer caregiving. Psychooncology 2024; 33:e6256. [PMID: 38047747 DOI: 10.1002/pon.6256] [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: 02/20/2023] [Revised: 11/09/2023] [Accepted: 11/11/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE Families play a pivotal role in supporting one another during cancer. Research suggests that supportive care interactions between patients and their caregivers can have a positive effect on the physical health and well-being of both members of the dyad. However, few studies have investigated how patient and caregiver personality characteristics intersect with their perceptions of supportive exchanges. Adopting an attachment theory perspective, our aim was to examine the dyadic effects of patient and caregiver attachment orientations on mutually supportive care. METHODS Patients (n = 103) receiving cancer care and their caregivers (n = 99) completed a survey that comprised measures of attachment orientations (Experiences in Close Relationships Modified scale), and mutually supportive care (Shared Care Inventory, SCI-3): communication, decision-making and reciprocity. RESULTS Actor-Partner Interdependence Models (APIMs) were used to examine the association between participants' attachment orientations on their own (actor effects) SCI-3 outcomes and those of the other person within the dyad (partner effects). Across the APIMs, the tendency was for an inverse relationship between attachment (anxious and avoidant orientations) and mutually supportive care. Inspection of the effects and dyadic patterns supported actor and couple models. CONCLUSIONS Using a dyadic approach, it was possible to study both intrapersonal and interpersonal effects. Our findings point to interdependence within the cancer caregiving relationship and underscore the importance of considering how individual and relational ways of responding influence support. Attachment theory provides a framework for explaining the observed relationships and a basis for therapeutic intervention.
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Affiliation(s)
| | - Alanna Devereaux
- Faculty of Health and Human Services, Vancouver Island University, Nanaimo, British Columbia, Canada
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2
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Zhou J, Chen X, Wang Z, Lin C, Zhao J, Loke AY, Li Q. Mutual communication processes within Chinese colorectal cancer patient-spousal caregiver dyads: A qualitative study of taking gender into account. Eur J Oncol Nurs 2023; 67:102427. [PMID: 37879197 DOI: 10.1016/j.ejon.2023.102427] [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: 07/22/2023] [Revised: 09/23/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE Mutual communication within cancer couples is a complex process. More research is needed to explore the complex process of mutual communication and its nuances presented by various factors in different culture contexts. Gender, a factor embedded in marital relationships, is an important consideration. We thus aim to explore the mutual communication process within Chinese colorectal cancer couples and take gender into account. METHODS A qualitative study was conducted by interviewing 20 colorectal cancer patients and 15 spousal caregivers. Inductive thematic analysis was used to analyze the transcripts. RESULTS Three themes (mutual communication and support interaction, communication quality, and foundation of mutual communication and collaboration) were developed. Gender was found to have specific impact on emotional disclosure and communication challenges. A preliminary framework of "smile" was constructed to demonstrate the relationship among the three themes and the relationships between the three themes and dyads' psychosocial adaptation to colorectal cancer. CONCLUSIONS Study findings demonstrate complex mutual communication processes within colorectal cancer couples and the impact of gender. The findings will contribute to developing more effective colorectal cancer couple-based mutual communication interventions. Health practitioners are suggested to improve mutual communication within colorectal cancer couples in three aspects: relational topics, emotional disclosure and communication skills. Guiding couples to deal with each theme and the relationship among the themes simultaneously is helpful for them to return and smile to their normal life.
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Affiliation(s)
- Junrui Zhou
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, China
| | - Xuan Chen
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, China
| | - Zhiming Wang
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, China
| | - Chunyan Lin
- Affiliated Hospital, Jiangnan University, Wuxi, Jiangsu Province, China
| | - Jie Zhao
- Affiliated Hospital, Jiangnan University, Wuxi, Jiangsu Province, China
| | - Alice Yuen Loke
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon Hong Kong, China
| | - Qiuping Li
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, China; Affiliated Hospital, Jiangnan University, Wuxi, Jiangsu Province, China.
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3
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Zhou J, Wang Z, Chen X, Li Q. Gender Differences in Psychosocial Outcomes and Coping Strategies of Patients with Colorectal Cancer: A Systematic Review. Healthcare (Basel) 2023; 11:2591. [PMID: 37761788 PMCID: PMC10530630 DOI: 10.3390/healthcare11182591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Gender is an important factor impacting cancer experience. This review mainly aimed to summarize colorectal cancer (CRC) patients' gender differences in psychosocial outcomes and coping strategies. (2) Methods: Relevant studies were searched for in four electronic databases from 2007 to July 2023. And manual searching was performed on the included studies' reference lists to identify additional eligible studies. (3) Results: A total of 37 eligible articles were included in this review. These studies were conducted in 19 countries, and they targeted CRC patients at various treatment stages. Significant results showed that female patients tended to have more psychological distress, complex social functioning, and less sexual distress and to choose more positive coping strategies than male patients. But there was no gender difference in psychosocial outcomes and/or coping strategies in some studies, which implied that gender similarity also existed. (4) Conclusions: The findings support the fact that there are both gender differences and similarities in CRC patients' psychosocial outcomes and coping strategies. A perspective beyond the simple masculine-feminine binary improved our in-depth understanding of gender tendency. Importantly, taking gender tendency into account is critical for medical staff to provide more personalized support and communication interventions.
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Affiliation(s)
| | | | | | - Qiuping Li
- Wuxi School of Medicine, Jiangnan University, Wuxi 214122, China; (J.Z.); (Z.W.); (X.C.)
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4
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Chen X, Xu X, Wang T, Qiu C, Li M. Couple communication quality and family resilience among Chinese gynecologic cancer patients and their spouses: a dyadic study. Support Care Cancer 2023; 31:271. [PMID: 37060357 DOI: 10.1007/s00520-023-07727-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/03/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE The purpose of this study was to explore the couple communication process for gynecologic cancer (GC) patients and their spouses. Particular attention was given to examining the relationship between couple communication quality and family resilience for GC dyads. METHODS In this cross-sectional study, 354 dyads were recruited from a gynecology ward of a public hospital in China. The patients and their spouses completed the Couples' Communication Quality Scale and the Family Hardiness Index. This study used the actor-partner interdependence model (APIM) to examine the effect of couple communication quality on family resilience in distinguishable GC dyads. RESULTS Both GC patients and their spouses reported a moderate level of couple communication quality and family resilience, but spouses reported better couple communication and family resilience than patients. With the exception of perceived response, for which only a patient actor effect was observed, the factors of couple communication quality had significant actor effects on family resilience for both patients and spouses. Additionally, four significant partner effects were found: spouse self-disclosure, stress coping, and productive action positively predicted patients' family resilience, while patient normalcy crafting positively predicted spouses' family resilience. CONCLUSION This study not only highlights the need for couple-based communication strategies for developing family resilience but also identifies differences in the experiences of patients and their partners, which provides a direction for future intervention research. Through the development of interventions at a dyadic level, spouses can be encouraged to actively engage in communication, which may promote mutual family resilience in a larger sense.
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Affiliation(s)
- Xiaoxin Chen
- School of Nursing and Rehabilitation, Shandong University, Jinan, 250012, China
| | - Xiaoxiang Xu
- School of Nursing and Rehabilitation, Shandong University, Jinan, 250012, China
| | - Tianyi Wang
- School of Nursing and Rehabilitation, Shandong University, Jinan, 250012, China
| | - Chengmiao Qiu
- School of Nursing and Rehabilitation, Shandong University, Jinan, 250012, China
| | - Min Li
- Department of Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, 250012, China.
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5
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Zhou J, Chen X, Wang Z, Li Q. Couple-Based Communication Interventions for Cancer Patient-Spousal Caregiver Dyads' Psychosocial Adaptation to Cancer: A Systematic Review. Healthcare (Basel) 2023; 11:healthcare11020236. [PMID: 36673604 PMCID: PMC9858755 DOI: 10.3390/healthcare11020236] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/07/2023] [Accepted: 01/10/2023] [Indexed: 01/14/2023] Open
Abstract
(1) Background: Effective communication among couples in which one has been diagnosed with cancer is critical to improve their psychosocial adaptation to cancer. The objective of this review was to explore the characteristics and measurement outcomes of existing couple-based communication interventions in the cancer context. (2) Methods: Eight electronic databases were searched from database initiation to August 2022 to identify eligible articles. Hand searching was also performed on the included articles' reference lists and authors. (3) Results: A total of 14 intervention studies were eligible to be included in this review. Cancer couples with distress or communication problems before intervention were more likely to benefit from the couple-based communication interventions. Positive outcomes were reported, including an improvement in relationship functioning (including mutual communication, intimacy, and relationship satisfaction) and individual functioning (including a decline of anxiety, depression and cancer-related concerns, and an increase in psychological adjustment and quality of life). (4) Conclusions: These findings supported the importance of improving mutual communication behaviors to promote cancer patient-spousal caregiver dyads' psychosocial adaptation to cancer. While most included studies were conducted in western countries and the sample size was relatively small, more research is warranted to develop more efficacious couple-based communication interventions.
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6
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Harju E, Rantanen A, Helminen M, Kaunonen M, Isotalo T, Åstedt-Kurki P. The marital relationship and health-related quality of life of prostate cancer patients and their spouses: A prospective, longitudinal study. Int J Nurs Pract 2022; 28:e13093. [PMID: 35971274 PMCID: PMC10078317 DOI: 10.1111/ijn.13093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 06/18/2022] [Accepted: 07/23/2022] [Indexed: 12/24/2022]
Abstract
AIMS This study aims to measure any changes in the marital relationship during the first year after a diagnosis of prostate cancer, identify the demographic characteristics that influenced such changes, and measure changes related to health-related quality of life (HRQoL). BACKGROUND Knowledge is limited on the impact of a diagnosis of prostate cancer on the marital relationship and HRQoL of patients and their spouses. DESIGN A 1-year longitudinal study. METHODS Data were collected from five Finnish hospitals between October 2013 and January 2017. Of the 350 recruited couples (N = 700), 179 patients and 166 spouses completed the Marital Questionnaire and the RAND 36-Item Health Survey 1 year after diagnosis. RESULTS No major changes were found in the marital relationship during the follow-up period. The spouses reported statistically significant changes in their marital relationships, but the patients did not. Furthermore, changes in the marital relationship were not associated with the patients' HRQoL. Among spouses, emotional well-being was associated with changes in the marital relationship. CONCLUSION The marital relationship was relevant in terms of the spouses' HRQoL during the first year after a diagnosis of prostate cancer. Nurses and other healthcare providers should assess counselling and support provided to spouses individually.
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Affiliation(s)
- Eeva Harju
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Surgery, Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland
| | - Anja Rantanen
- Faculty of Social Sciences, Nursing Science, Tampere University, Tampere, Finland
| | - Mika Helminen
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland.,Tays Research Services, Tampere University Hospital, Tampere, Finland
| | - Marja Kaunonen
- Faculty of Social Sciences, Nursing Science, Tampere University, Tampere, Finland.,Department of General Administration, Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland
| | - Taina Isotalo
- Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland
| | - Päivi Åstedt-Kurki
- Faculty of Social Sciences, Nursing Science, Tampere University, Tampere, Finland.,Department of General Administration, Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland
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7
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Green A, Winter N, DiGiacomo M, Oliffe JL, Ralph N, Dunn J, Chambers SK. Experiences of female partners of prostate cancer survivors: A systematic review and thematic synthesis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1213-1232. [PMID: 34761456 DOI: 10.1111/hsc.13644] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
The purpose of this systematic review and synthesis of studies reporting qualitative data was to understand the gendered experiences of female partners of prostate cancer survivors to inform psychosocial support for women. We searched Medline, PsycINFO, EMBASE, AMED, CINAHL, Cochrane Database of Systematic Reviews, and Sociological Abstracts for articles on 15 and 16 April 2019, and again on 30 November 2020. English language articles published in peer-reviewed journals were included if they reported solely on findings describing the perspectives of the female partners. Extracted data were analysed using line-by-line coding, organisation of codes into descriptive themes, and development of analytical themes. A theoretical framework was then selected to organise the relationships between issues that were found to be central to the experiences of female partners. Of 4839 articles screened, 14 met inclusion criteria, reporting 13 studies with a total sample of 359 female partners. Ussher and Sandoval's theory to describe the gendered positionings of cancer caregivers accommodated the thematic findings. The overarching theme reflected the substantive psychosocial impact of prostate cancer on female partners. Women's experiences were influenced by self-positioning (as part of a couple; provider of support to their male partner; resilient; and guided by faith and spirituality), being positioned by their partners' response (manager of male partner's psychological distress or strengthened by male partner's positive response) and by their broader contexts (family members and social networks; clinicians and the health system; and cultural values and customs). Findings highlight the need to avoid reductionist approaches to gender. Greater consideration of 'contextualised femininities', or conceptualising the influence of gender roles, relations, and identities within the wider life course contexts of female partners is required in the design and delivery of psychosocial support services.
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Affiliation(s)
- Anna Green
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Natalie Winter
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Michelle DiGiacomo
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - John L Oliffe
- School of Nursing, University of British Columbia, Vancouver, Canada
- Department of Nursing, University of Melbourne, Victoria, Australia
| | - Nicholas Ralph
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- Division of Research and Innovation, University of Southern Queensland, Springfield, Queensland, Australia
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Jeff Dunn
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- Division of Research and Innovation, University of Southern Queensland, Springfield, Queensland, Australia
- Cancer Council Queensland, Brisbane, Queensland, Australia
- Prostate Cancer Foundation of Australia, Sydney, New South Wales, Australia
| | - Suzanne K Chambers
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia
- Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
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8
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Hasson-Ohayon I, Goldzweig G, Braun M, Hagedoorn M. Beyond "being open about it": A systematic review on cancer related communication within couples. Clin Psychol Rev 2022; 96:102176. [PMID: 35700574 DOI: 10.1016/j.cpr.2022.102176] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 04/26/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022]
Abstract
Extensive literature addresses the correlates of communication behaviors within couples in the specific stressful context of oncology. This literature focused mainly on the concepts of disclosure, concealment, holding back and protective buffering to gain more insight into the potential benefits of open communication on the psychological and relational wellbeing of the patient, the spouse and the dyad. The current systematic review aims to present this literature, summarize research findings and suggest empirical, theoretical and clinical implications. Methods: The search method applied in this review was in line with the PRISMA guidelines. Key words related to couples' communication and oncology were used to identify relevant studies according to title and abstract fields from 1.1.2000 until 31.1.22. Results: Out of 3277 papers, a total of 55 articles were identified as relevant for this review. These quantitative studies used cross-sectional and longitudinal designs. Overall, integrating findings from different studies showed that while avoiding communication is negatively associated with psychological and relational wellbeing, the benefits of disclosure seems to be dependent on different factors including the partner's responsiveness, contextual factors and personal characteristics. The existing literature is limited in providing data regarding the nature of adequate or helpful partner responses, the best timing, and the specific topics that are recommended to be disclosed such as specific fears. Most importantly, it is limited in heterogeneity of constructs of communication that were studied, scales that were used and diverse mediators and moderators that were examined. Accordingly, an effort to reach consensus of definition and assessment of communicative behavior is recommended for future studies, and addressing responsiveness to communicative initiations seems to be important for clinical practice.
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Affiliation(s)
| | | | | | - Mariët Hagedoorn
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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9
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Xie F, You Y, Huang J, Guan C, Chen Z, Fang M, Yao F, Han J. Association between physical activity and digestive-system cancer: An updated systematic review and meta-analysis. JOURNAL OF SPORT AND HEALTH SCIENCE 2021; 10:4-13. [PMID: 33010525 PMCID: PMC7856558 DOI: 10.1016/j.jshs.2020.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/22/2020] [Accepted: 07/17/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND Physical activity (PA) may have an impact on digestive-system cancer (DSC) by improving insulin sensitivity and anticancer immune function and by reducing the exposure of the digestive tract to carcinogens by stimulating gastrointestinal motility, thus reducing transit time. The current study aimed to determine the effect of PA on different types of DSC via a systematic review and meta-analysis. METHODS In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched for relevant studies in PubMed, Embase, Web of Science, Cochrane Library, and China National Knowledge Infrastructure. Using a random effects model, the relationship between PA and different types of DSC was analyzed. RESULTS The data used for meta-analysis were derived from 161 risk estimates in 47 studies involving 5,797,768 participants and 55,162 cases. We assessed the pooled associations between high vs. low PA levels and the risk of DSC (risk ratio (RR) = 0.82, 95% confidence interval (95%CI): 0.79-0.85), colon cancer (RR = 0.81, 95%CI: 0.76-0.87), rectal cancer (RR = 0.88, 95%CI: 0.80-0.98), colorectal cancer (RR = 0.77, 95%CI: 0.69-0.85), gallbladder cancer (RR = 0.79, 95%CI: 0.64-0.98), gastric cancer (RR = 0.83, 95%CI: 0.76-0.91), liver cancer (RR = 0.73, 0.60-0.89), oropharyngeal cancer (RR = 0.79, 95%CI: 0.72-0.87), and pancreatic cancer (RR = 0.85, 95%CI: 0.78-0.93). The findings were comparable between case-control studies (RR = 0.73, 95%CI: 0.68-0.78) and prospective cohort studies (RR = 0.88, 95%CI: 0.80-0.91). The meta-analysis of 9 studies reporting low, moderate, and high PA levels, with 17 risk estimates, showed that compared to low PA, moderate PA may also reduce the risk of DSC (RR = 0.89, 95%CI: 0.80-1.00), while compared to moderate PA, high PA seemed to slightly increase the risk of DSC, although the results were not statistically significant (RR = 1.11, 95%CI: 0.94-1.32). In addition, limited evidence from 5 studies suggested that meeting the international PA guidelines might not significantly reduce the risk of DSC (RR = 0.96, 95%CI: 0.91-1.02). CONCLUSION Compared to previous research, this systematic review has provided more comprehensive information about the inverse relationship between PA and DSC risk. The updated evidence from the current meta-analysis indicates that a moderate-to-high PA level is a common protective factor that can significantly lower the overall risk of DSC. However, the reduction rate for specific cancers may vary. In addition, limited evidence suggests that meeting the international PA guidelines might not significantly reduce the risk of DSC. Thus, future studies must be conducted to determine the optimal dosage, frequency, intensity, and duration of PA required to reduce DSC risk effectively.
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Affiliation(s)
- Fangfang Xie
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Yanli You
- Department of Traditional Chinese Medicine, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Jihan Huang
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Chong Guan
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Ziji Chen
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Min Fang
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Fei Yao
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
| | - Jia Han
- Department of Physiotherapy and Sport Rehabilitation, Shanghai University of Sport, Shanghai 200438, China.
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10
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Mah K, Shapiro GK, Hales S, Rydall A, Malfitano C, An E, Nissim R, Li M, Zimmermann C, Rodin G. The impact of attachment security on death preparation in advanced cancer: The role of couple communication. Psychooncology 2020; 29:833-840. [PMID: 32043679 DOI: 10.1002/pon.5354] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 01/29/2020] [Accepted: 02/05/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Attachment security protects psychological well-being in patients with advanced cancer, but its effect on death preparation in this population has not been demonstrated. We examined the relationship of attachment security to death preparation in advanced cancer and tested whether couple communication mediates this relationship and whether gender and age moderate this mediating effect, using longitudinal data from a psychotherapy trial. METHODS Patients with advanced cancer who lived with a partner (Nbaseline = 289) completed measures of attachment security (attachment avoidance, attachment anxiety), couple communication, and death preparation (preparation for end of life, life completion) and attendant health involvement (relationship with healthcare provider). A moderated mediation model was evaluated at each time period (baseline, 3 months, and 6 months). RESULTS Couple communication mediated the relationship of attachment security to preparation for end of life and life completion (b's = -.06 to -.10). Anxiety × Gender effects on baseline couple communication (P's = .016) indicated that women with greater attachment anxiety reported worse communication than their male counterparts. Couple-communication × Gender × Age effects on baseline preparation for end of life (P = .007-.020) suggested that women showed better preparation with better couple communication. Younger patients reported less preparation than older patients, especially with poorer communication, but their preparation increased with better communication, especially in younger men. CONCLUSIONS Attachment security supports death preparation in advanced cancer partly through better couple communication. Couple-based psychotherapeutic interventions, especially for younger individuals and women with attachment anxiety, may facilitate constructive conversations and death preparation.
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Affiliation(s)
- Kenneth Mah
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Gilla K Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Global Institute of Psychosocial, Palliative, and End-of-Life Care (GIPPEC), University of Toronto and Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Anne Rydall
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Carmine Malfitano
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Ekaterina An
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Rinat Nissim
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Madeline Li
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Global Institute of Psychosocial, Palliative, and End-of-Life Care (GIPPEC), University of Toronto and Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Global Institute of Psychosocial, Palliative, and End-of-Life Care (GIPPEC), University of Toronto and Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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11
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Lim JW, Shon EJ. The Dyadic Effects of Family Cohesion and Communication on Health-Related Quality of Life: The Moderating Role of Sex. Cancer Nurs 2019; 41:156-165. [PMID: 28114262 PMCID: PMC5519452 DOI: 10.1097/ncc.0000000000000468] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Spouses' ability to care for survivors can be particularly challenging because patients and spouses are interdependent and mutually influence one another. Family functioning such as family cohesion and communication may play a primary role in improving the health-related quality of life (HRQOL) of couples, given that cancer can influence family dynamics. OBJECTIVE The aims of this study were to investigate the mediating effect of family communication on the relationship between family cohesion and HRQOL and examine the moderating effect of sex on this relationship among cancer survivor-spouse dyads. METHODS A total of 91 cancer survivors with a diagnosis of breast, colorectal, or prostate cancer and their spouses were recruited from the University Hospital Registry in Cleveland, Ohio. The dyadic data were analyzed using structural equation modeling with the actor-partner interdependence mediation model. RESULTS Findings demonstrated that the spouses' own perceived family communication mediated the associations between their own family cohesion and physical HRQOL and between the survivors' family cohesion and physical HRQOL. The spouse actor effects between family communication and HRQOL significantly differed by sex. CONCLUSIONS Enhancing family cohesion and communication within the family can improve the spouses' HRQOL. Findings regarding sex differences serve as a rationale for gender-based approaches to improving HRQOL in survivorship care in the family context. IMPLICATIONS FOR PRACTICE Couple- and/or family-based interventions should be designed to enhance family cohesion and improve family communication skills for effective adjustments within couples and families. Supportive care within the family context can be promoted to address the diverse challenges of survivorship care.
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Affiliation(s)
- Jung-Won Lim
- Author Affiliations: College of Social Welfare, Kangnam University, Yongin, Gyeonggi, Korea (Dr Lim); and Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH (Ms Shon)
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Harju E, Rantanen A, Helminen M, Kaunonen M, Isotalo T, Åstedt-Kurki P. Health-related quality of life in patients with prostate cancer and their spouses: Results from a longitudinal study. Eur J Oncol Nurs 2018; 37:51-55. [PMID: 30473051 DOI: 10.1016/j.ejon.2018.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/26/2018] [Accepted: 11/01/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to explore changes in HRQoL (health-related quality of life) and identify the associated factors in patients with prostate cancer and their spouses during the year following their diagnosis of prostate cancer. METHODS The longitudinal study design consisted of 179 patients and 166 spouses, using discretionary sampling, at five Finnish central hospitals. Participants completed a self-reported RAND-36-Item Health Survey at three time-points: time of diagnosis and 6 and 12 months later. Changes in HRQoL were analysed using descriptive statistics and non-parametric tests. Linear mixed-effects models were used to identify the factors associated with the changes in HRQoL in the patients and their spouses. RESULTS On average, the HRQoL of patients with prostate cancer changed in physical functioning (p = 0.015), emotional well-being (p = 0.029) and general health (p = 0.038) were statistically significant over the 12-month study period. In spouses, statistically significant changes in HRQoL were not observed. Interaction between the age of participants and changes in HRQoL were statistically significant. CONCLUSIONS Findings in this study suggest that interventions aimed at improving the HRQoL of patients should support a few different dimensions of HRQoL for the patients themselves than for their spouses. Nurses should pay more attention to elderly couples.
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Affiliation(s)
- Eeva Harju
- Faculty of Social Sciences, Nursing Science, University of Tampere, Arvo, FI-33014, Finland.
| | - Anja Rantanen
- Faculty of Social Sciences, Nursing Science, University of Tampere, Arvo, FI-33014, Finland.
| | - Mika Helminen
- Faculty of Social Sciences, University of Tampere, Arvo, FI-33014, Finland; Science Centre, Pirkanmaa Hospital District, PO Box 2000, FI-33521, Tampere University Hospital, Finland.
| | - Marja Kaunonen
- Faculty of Social Sciences, Nursing Science, University of Tampere, Arvo, FI-33014, Finland; Department of General Administration, Pirkanmaa Hospital District, PO Box 2000, FI-33521, Tampere University Hospital, Finland.
| | - Taina Isotalo
- Department of Surgery, Päijät-Häme Central Hospital, Keskussairaalankatu 7, FI-15850, Lahti, Finland.
| | - Päivi Åstedt-Kurki
- Faculty of Social Sciences, Nursing Science, University of Tampere, Arvo, FI-33014, Finland; Department of General Administration, Pirkanmaa Hospital District, PO Box 2000, FI-33521, Tampere University Hospital, Finland.
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Harju E, Rantanen A, Helminen M, Kaunonen M, Isotalo T, Åstedt‐Kurki P. Marital relationship and health‐related quality of life of patients with prostate cancer and their spouses: A longitudinal clinical study. J Clin Nurs 2018. [DOI: 10.1111/jocn.14343] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Eeva Harju
- Faculty of Social Sciences Nursing Science University of Tampere Tampere Finland
| | - Anja Rantanen
- Faculty of Social Sciences Nursing Science University of Tampere Tampere Finland
| | - Mika Helminen
- Faculty of Social Sciences University of Tampere Tampere Finland
- Science Centre Pirkanmaa Hospital District Tampere University Hospital Tampere Finland
| | - Marja Kaunonen
- Faculty of Social Sciences Nursing Science University of Tampere Tampere Finland
- Department of General Administration Pirkanmaa Hospital District Tampere University Hospital Tampere Finland
| | - Taina Isotalo
- Department of Surgery Päijät‐Häme Central Hospital Lahti Finland
| | - Päivi Åstedt‐Kurki
- Faculty of Social Sciences Nursing Science University of Tampere Tampere Finland
- Department of General Administration Pirkanmaa Hospital District Tampere University Hospital Tampere Finland
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Katz A, Dizon DS. Sexuality After Cancer: A Model for Male Survivors. J Sex Med 2016; 13:70-8. [PMID: 26755089 DOI: 10.1016/j.jsxm.2015.11.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 11/19/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION For men with cancer, sexual dysfunction is a common issue and has a negative impact on quality of life, regardless of whether he has a partner. In general, sexuality encompasses much more than intercourse; it involves body image, identity, romantic and sexual attraction, and sexual thoughts and fantasies. AIM Acknowledging that cancer affects multiple physical and psychosocial domains in patients, the authors propose that such changes also inform sexual function for the male survivor. METHODS An in-depth review of the literature describing alterations to sexual functioning in men with cancer was undertaken. Based on this and the clinical expertise of the authors, a new model was created and is presented. RESULTS This biopsychosocial model is intended to expand the understanding of male sexuality beyond a purely biomedical model that addresses dysfunction as distinct from the context of a man's life and sexual identity. CONCLUSION Most data on sexual dysfunction in men with cancer are derived from those with a history of prostate cancer, although other data suggest that men with other types of malignancies are similarly affected. Unfortunately, male sexuality is often reduced to aspects of erection and performance. Acknowledging that cancer affects multiple physical and psychosocial domains in patients, the authors propose that such changes also inform sexual function for the male survivor. This biopsychosocial model might form the basis for interventions for sexual problems after cancer that includes a man and his partner as a complex whole.
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Affiliation(s)
- Anne Katz
- Manitoba Prostate Centre, CancerCare Manitoba, Winnipeg, MB, Canada.
| | - Don S Dizon
- Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Boston, MA, USA
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When cancer cannot be cured: A qualitative study on relationship changes in couples facing advanced melanoma. Palliat Support Care 2016; 14:652-663. [PMID: 26975832 DOI: 10.1017/s1478951516000055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of this qualitative study was to gain a deeper understanding about couples' relationship changes over time (the first six months) after one partner is diagnosed with an incurable advanced melanoma (stage III or IV). METHOD In semistructured interviews, eight patients and their partners were asked separately about potential changes in their relationship since diagnosis. The same questions were asked again six months later, but focusing on relationship changes over the preceding six months. Some 32 audiotaped interviews were analyzed applying qualitative content analysis. RESULTS At baseline (t1), relationship changes were mostly reported in terms of caring, closeness/distance regulation, and communication patterns. While changes in caregiving and distance/closeness regulation remained main issues at six months follow-up (t2), greater appreciation of the relationship and limitations in terms of planning spare time also emerged as major issues. Unexpectedly, 50% of patients and partners reported actively hiding their negative emotions and sorrows from their counterparts to spare them worry. Furthermore, qualitative content analysis revealed relationship changes even in those patients and partners who primarily reported no changes over the course of the disease. SIGNIFICANCE OF RESULTS Our findings revealed a differentiated and complex picture about relationship changes over time, which also might aid in the development of support programs for couples dealing with advanced cancer, focusing on the aspects of caring, closeness/distance regulation, and communication patterns.
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