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Bora ST, Buldukoğlu K, Bailey DE. Effectiveness of an Uncertainty Management Psychoeducation Program for Schizophrenia Caregivers: A Randomized Controlled Trial. J Am Psychiatr Nurses Assoc 2024; 30:590-602. [PMID: 36475415 DOI: 10.1177/10783903221141890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The inconsistent course of schizophrenia causes a long-term experience of uncertainty for individuals and their families. In Turkey, no studies yet exist that have attempted to address this constant uncertainty that is experienced by caregivers of schizophrenic patients. AIMS To evaluate the effects of the Uncertainty Management Psychoeducation Program on reducing uncertainty and intolerance to uncertainty, improving psychological well-being, and coping styles in caregivers of patients with schizophrenia. METHOD Single-blinded randomized controlled trial. Caregivers of schizophrenia inpatients were recruited from the psychiatry clinic of a university-affiliated hospital. Data were collected between April 2019 and August 2020. Eligible individuals were randomly allocated to one of the two groups: intervention or control. The intervention group had five individual psychoeducation sessions: "Recognizing Uncertainty," "Cognitively Reframing Uncertainty," "Solving Uncertainty-Related Issues," "Dealing with Uncertainty Using Communication Skills," and the "Closing Session." Participants in the control group received the usual care. Uncertainty, intolerance to uncertainty, psychological well-being, and stress coping strategies were measured at two points: at baseline and immediately following the intervention. Hypotheses were tested using the Mann-Whitney U and Wilcoxon tests. RESULTS A total of 54 participants were recruited. The intervention group's ratings for "seeking social support" and "optimistic approach" were higher than the control group's ratings. Significant within-group changes in terms of "uncertainty" and "optimistic approach" were reported for the intervention group in the post-intervention. In the control group, significant changes were seen in terms of "uncertainty" and "psychological well-being" over time. CONCLUSION The Uncertainty Management Psychoeducation Program was found to be effective in reducing the level of uncertainty, increasing their optimistic approach, and seeking social support of caregivers of schizophrenic patients.
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Affiliation(s)
| | | | - Donald Etheridge Bailey
- Donald Etheridge Bailey Jr., PhD, RN, FAAN, Duke University School of Nursing, Durham, NC, USA
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2
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Carney LM, Schnur JB, Morgan O, Hyun C, Magin ZE, Martin L, Montgomery GH. Psychosocial interventions to improve sexual functioning in women with cancer: a systematic review of randomized controlled trials. Sex Med Rev 2024; 12:142-153. [PMID: 38185918 PMCID: PMC10986159 DOI: 10.1093/sxmrev/qead052] [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: 06/12/2023] [Revised: 11/01/2023] [Accepted: 11/15/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Many women with cancer struggle with sexual side effects during and after treatment. Although preliminary evidence indicates that psychosocial interventions may be efficacious in improving sexual functioning for women with cancer, no systematic review has summarized the state of the science in this area. OBJECTIVES The primary goal of this review was to narratively synthesize the results of randomized controlled trials (RCTs) testing the efficacy of psychosocial interventions to address sexual dysfunction in women with cancer. A secondary goal was to describe the diversity of the included samples (ie, racial/ethnic and sexual minority). METHODS Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic review was conducted examining RCTs of psychosocial interventions to improve sexual functioning for women with cancer. Articles were identified using MEDLINE, Embase, PsycINFO, and Cochrane CENTRAL. Two reviewers independently assessed each article for inclusion, with a third to resolve discrepancies. RESULTS Seventeen studies were included in the review, 12 of which provided sufficient information to calculate effect sizes. Ten of the 12 studies primarily aimed to improve sexual functioning, all of which demonstrated positive effects on at least 1 outcome of sexual functioning. In the 2 RCTs of psychosocial interventions in which sexual function was a secondary aim, effects were negligible (ds = -0.04 and -0.15). Commonalities among the studies with large effect sizes were that they included education, mindfulness/acceptance, and communication/relationship skills as intervention components. Of note, there was an overall lack of sample diversity across studies, and most studies failed to report the race/ethnicity or sexual orientation of the participants. CONCLUSION Results support interventions targeting sexual functioning outcomes for women with cancer and suggest that multimodal interventions including education, mindfulness/acceptance, and communication/relationship skills may be most effective. Future research should also focus on examining the efficacy and potential adaptations of extant sexual functioning interventions for underrepresented groups.
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Affiliation(s)
- Lauren M Carney
- Center for Behavioral Oncology, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Julie B Schnur
- Center for Behavioral Oncology, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Orly Morgan
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, FL 33101, United States
| | - Christine Hyun
- Center for Behavioral Oncology, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Zachary E Magin
- Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269, United States
| | - Lily Martin
- Levy Library, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Guy H Montgomery
- Center for Behavioral Oncology, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
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Khajoei R, Azadeh P, ZohariAnboohi S, Ilkhani M, Nabavi FH. Breast cancer survivorship needs: a qualitative study. BMC Cancer 2024; 24:96. [PMID: 38233789 PMCID: PMC10795302 DOI: 10.1186/s12885-024-11834-5] [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: 09/16/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Breast cancer rates and the number of breast cancer survivors have been increasing among women in Iran. Effective responses from healthcare depend on appropriately identifying survivors' needs. This study investigated the experience and needs of breast cancer survivors in different dimensions. METHODS In this qualitative content analysis, semi-structured in-depth interviews were conducted from April 2023 to July 2023. Data saturation was achieved after interviewing 16 breast cancer survivors (BCSs) and four oncologists using purposive sampling. Survivors were asked to narrate their experiences about their needs during the survivorship. Data were analyzed with an inductive approach in order to extract the themes. RESULTS Twenty interviews were conducted. The analysis focused on four central themes: (1) financial toxicity (healthcare costs, unplanned retirement, and insurance coverage of services); (2) family support (emotional support, Physical support); (3) informational needs (management of side effects, management of uncertainty, and balanced diet); and (4) psychological and physical issues (pain, fatigue, hot flashes, and fear of cancer recurrence). CONCLUSIONS This study provides valuable information for designing survivorship care plans. Identifying the survivorship needs of breast cancer survivors is the first and most important step, leading to optimal healthcare delivery and improving quality of life. It is recommended to check the financial capability of patients and take necessary measures for patients with financial problems. Additionally, support sources should be assessed and appropriate. Psychological interventions should be considered for patients without a support source. Consultation groups can be used to meet the information needs of patients. For patients with physical problems, self-care recommendations may also be useful in addition to doctors' orders.
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Affiliation(s)
- Rahimeh Khajoei
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, IR, Iran
| | - Payam Azadeh
- Radiation Oncology Department, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sima ZohariAnboohi
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, IR, Iran
| | - Mahnaz Ilkhani
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, IR, Iran.
| | - Fatemah Heshmati Nabavi
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Cho HM, Choi EJ, Choi HJ, Cho EJ. Concept analysis of uncertainty in people with mental disabilities. Arch Psychiatr Nurs 2023; 45:44-53. [PMID: 37544701 DOI: 10.1016/j.apnu.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 04/08/2023] [Accepted: 04/30/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE This concept analysis clarified "uncertainty in people with mental disabilities". METHODS The research was conducted using Walker & Avant's conceptual analysis methodology. RESULTS Uncertainty in people with mental disabilities showed the defining attributes of "ambiguity," "unpredictability," "distrust," and "lack of insight into illness," of which "distrust" and "lack of insight" were unique to people with mental disabilities. Accordingly, it was defined as a state in which it is difficult to determine the treatment's timing because (1) the disease process is often too ambiguous to make a decision; (2) abnormal behavior can recur at any time while the patients are under treatment and in recovery; and (3) patients struggle to accept the illness, tend to distrust healthcare professionals and family, and show lack of knowledge, making them miss their treatment's timing and even making the expectation for recovery vague. CONCLUSION The attributes of uncertainty in people with mental disabilities identified in this study confirmed that mental health professionals should proactively intervene to treat patients at an appropriate time and continuously manage them to prevent recurrence. PRACTICE IMPLICATION The study findings can be utilized in mental health research and in developing interventions to reduce uncertainty in people with mental disabilities, helping them recover and integrate into the community.
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Affiliation(s)
- Hyun-Mee Cho
- Department of Nursing, Kaya University, 208 Samgye-ro, Gimhae, Gyungnam, South Korea
| | - Eun Joung Choi
- College of Nursing, Kosin University, 262 Gamcheon-ro, Seo-gu, Busan, South Korea.
| | - Hyun-Ju Choi
- Department of Nursing, Kaya University, 208 Samgye-ro, Gimhae, Gyungnam, South Korea
| | - Eun-Ju Cho
- College of Nursing, Kosin University, 262 Gamcheon-ro, Seo-gu, Busan, South Korea
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Rahimi H, Pirmoradi M, Lavasani FF, Farahani H. The effectiveness of group intervention focused on intolerance of uncertainty on psychological distress and quality of life in multiple sclerosis patients. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:29. [PMID: 37034881 PMCID: PMC10079199 DOI: 10.4103/jehp.jehp_521_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/01/2022] [Indexed: 06/19/2023]
Abstract
AIM AND BACKGROUND Multiple sclerosis (MS) is a long-course incurable disease as well as an unknown prognosis causing patients to experience a variety of psychological outcomes. Meanwhile, inability to control the disease-related uncertainty leads to the use of maladaptive coping strategies, causing more psychological distress. This study investigated the effectiveness of intervention focused on the intolerance of uncertainty on psychological distress and quality of life in MS patients. MATERIALS AND METHODS This research adopted a true experimental design. All phases of the study were conducted online due to the COVID-19 pandemic during 2021 in Tehran. The statistical population of the study was purposefully selected from among MS patients and was randomly assigned to three groups of 20: IU intervention and two control groups (cognitive behavioral therapy (CBT) and treatment as usual (TAU) groups). The study included pre-test, post-test, and follow-up stages. The outcome measures of the study included the Depression Anxiety Stress Scale (DASS-21) as well as Multiple Sclerosis Quality of Life-54 (MSQoL-54). Mixed analysis of variance was used to analyze the data. RESULTS The results showed that IU intervention compared to CBT, is more effective on psychological distress (depression P = 0.006, anxiety P = 0.01, and stress P = 0.01) and quality of life (P = 0.001) in MS patients. Nonetheless, IU-focused intervention is more effective than TAU on psychological distress (depression P = 0.0001, anxiety P = 0.0001, stress P = 0.0001) as well as quality of life (P = 0.0001) in these patients. CONCLUSIONS IU-based intervention can reduce psychological distress and improve quality of life of MS patients. Accepting uncertainty can reduce the anxiety and stress of MS patients which can increase the quality of life of these patients.
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Affiliation(s)
- Hani Rahimi
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Pirmoradi
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Fathali Lavasani
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
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Jassim GA, Doherty S, Whitford DL, Khashan AS. Psychological interventions for women with non-metastatic breast cancer. Cochrane Database Syst Rev 2023; 1:CD008729. [PMID: 36628983 PMCID: PMC9832339 DOI: 10.1002/14651858.cd008729.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Breast cancer is the most common cancer affecting women worldwide. It is a distressing diagnosis and, as a result, considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer. Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life. As a consequence, multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer. This review is an update of a Cochrane Review first published in 2015. OBJECTIVES To assess the effect of psychological interventions on psychological morbidities and quality of life among women with non-metastatic breast cancer. SEARCH METHODS: We searched the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov up to 16 March 2021. We also scanned the reference lists of relevant articles. SELECTION CRITERIA Randomised controlled trials that assessed the effectiveness of psychological interventions for women with non-metastatic breast cancer. DATA COLLECTION AND ANALYSIS Two review authors independently appraised, extracted data from eligible trials, and assessed risk of bias and certainty of the evidence using the GRADE approach. Any disagreement was resolved by discussion. Extracted data included information about participants, methods, the intervention and outcomes. MAIN RESULTS We included 60 randomised controlled trials comprising 7998 participants. The most frequent reasons for exclusion were non-randomised trials and the inclusion of women with metastatic disease. The updated review included 7998 randomised women; the original review included 3940 women. A wide range of interventions was evaluated. Most interventions were cognitive- or mindfulness-based, supportive-expressive, and educational. The interventions were mainly delivered face-to-face (56 studies) and in groups (50 studies) rather than individually (10 studies). Most intervention sessions were delivered on a weekly basis with an average duration of 14 hours. Follow-up time ranged from two weeks to 24 months. Pooled standardised mean differences (SMD) from baseline indicated that the intervention may reduce depression (SMD -0.27, 95% confidence interval (CI) -0.52 to -0.02; P = 0.04; 27 studies, 3321 participants, I2 = 91%, low-certainty evidence); anxiety (SMD -0.43, 95% CI -0.68 to -0.17; P = 0.0009; 22 studies, 2702 participants, I2 = 89%, low-certainty evidence); mood disturbance in the intervention group (SMD -0.18, 95% CI -0.31 to -0.04; P = 0.009; 13 studies, 2276 participants, I2 = 56%, low-certainty evidence); and stress (SMD -0.34, 95% (CI) -0.55 to -0.12; P = 0.002; 8 studies, 564 participants, I2 = 31%, low-certainty evidence). The intervention is likely to improve quality of life in the intervention group (SMD 0.78, 95% (CI) 0.32 to 1.24; P = 0.0008; 20 studies, 1747 participants, I2 = 95%, low-certainty evidence). Adverse events were not reported in any of the included studies. AUTHORS' CONCLUSIONS Based on the available evidence, psychological intervention may have produced favourable effects on psychological outcomes, in particular depression, anxiety, mood disturbance and stress. There was also an improvement in quality of life in the psychological intervention group compared to control group. Overall, there was substantial variation across the studies in the range of psychological interventions used, control conditions, measures of the same outcome and timing of follow-up.
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Affiliation(s)
- Ghufran A Jassim
- Department of Family & Community Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain (RCSI Bahrain), Busaiteen, Bahrain
| | - Sally Doherty
- Psychiatry, Royal College of Surgeons in Ireland- Medical University of Bahrain (RCSI Bahrain), Busaiteen, Bahrain
| | | | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland
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Simpson J, Zarotti N, Varey S, Anestis E, Holland C, Murray C, Eccles FJ. 'It's a double whammy': A qualitative study of illness uncertainty in individuals with Parkinson's disease in the context of COVID-19. Chronic Illn 2022; 18:860-873. [PMID: 34524910 PMCID: PMC9643113 DOI: 10.1177/17423953211043101] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The purpose of this study was to explore the experiences of individuals with Parkinson's through the theoretical lens of illness uncertainty during the first UK full lockdown period (March-June 2020) put in place due outbreak of the COVID-19 pandemic. METHODS Individual semi-structured interviews were carried out via telephone in May 2020 with 10 individuals with Parkinson's (six men and four women) recruited from Parkinson's UK. Interviews were recorded and transcribed verbatim, and thematic analysis was adopted to analyse the resulting data. RESULTS Four overarching themes emerged from the interview data: (1) COVID-19 amplifying existing fears and difficulties around the uncertainty of Parkinson's; (2) practical and psychological efforts to manage uncertainty; (3) benefit-finding as a way of acknowledging the positives of lockdown; (4) risk and future management in the context of uncertainty. DISCUSSION Participants reported a range of implicit and explicit strategies to cope with the 'double whammy' of uncertainty caused by having Parkinson's during a global pandemic. While these were generally successful in maintaining well-being, it is important that such successful accounts are used to help inform novel strategies and interventions targeting individuals who might need additional support.
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Affiliation(s)
- Jane Simpson
- 83563Division of Health Research, 151268Faculty of Health and Medicine, Lancaster University, UK
| | - Nicolò Zarotti
- 83563Division of Health Research, 151268Faculty of Health and Medicine, Lancaster University, UK
| | - Sandra Varey
- 83563Division of Health Research, 151268Faculty of Health and Medicine, Lancaster University, UK
| | - Eleftherios Anestis
- 83563Division of Health Research, 151268Faculty of Health and Medicine, Lancaster University, UK
| | - Carol Holland
- 83563Division of Health Research, 151268Faculty of Health and Medicine, Lancaster University, UK
| | - Craig Murray
- 83563Division of Health Research, 151268Faculty of Health and Medicine, Lancaster University, UK
| | - Fiona Jr Eccles
- 83563Division of Health Research, 151268Faculty of Health and Medicine, Lancaster University, UK
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Miller C, Jerosch-Herold C, Cross J. Brachial plexus injury: living with uncertainty. Disabil Rehabil 2022:1-7. [PMID: 35722825 DOI: 10.1080/09638288.2022.2080287] [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: 11/03/2022]
Abstract
PURPOSE A traumatic brachial plexus injury (BPI) has life-changing consequences for patients and their families. Despite advancements in treatments final outcome is unpredictable depending on factors including time to treatment, injury severity, neural regeneration, and available interventions. The final outcome may not be seen for up to four years. This study aimed to explore the impact of uncertainty on people with a traumatic BPI. METHODS Secondary qualitative analysis was conducted on data from a study exploring outcomes important to patients with a traumatic BPI. Data from semi-structured interviews with adult traumatic BPI patients (n = 13) were analyzed using reflexive thematic analysis. RESULTS Three major themes were identified in the qualitative data: (i) "I don't know what happened to me," focused on uncertainty in diagnosis. (ii) "I went to work one day… and then it all changed" centered around uncertainty in the future. (iii) Coping with uncertainty. CONCLUSION The results illustrate that people with a traumatic BPI face uncertainty regarding diagnosis, prognosis, and surrounding their roles in the future. Individuals respond to uncertainty in different ways and this needs to be understood by health care professionals. IMPLICATIONS FOR REHABILITATIONHealth professionals should consider uncertainty in all their contacts with people who have experienced a traumatic brachial plexus injury.People with a traumatic brachial plexus injury experience uncertainty in different ways therefore education and information given may be optimized if tailored to the individual rather than generic.Increasing awareness of the injury and its presentation in non-specialist acute care clinicians may accelerate diagnosis and reduce initial uncertainty.Acknowledging the presence of uncertainty is important during the shared decision-making in brachial plexus injuries.
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Affiliation(s)
- Caroline Miller
- School of Health Sciences, University of East Anglia, Norwich, UK.,Therapy Services, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, Birmingham, UK
| | | | - Jane Cross
- School of Health Sciences, University of East Anglia, Norwich, UK
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Simons G, Falahee M. Fear of the Unknown: Can We Help Individuals With a Systemic Autoimmune Rheumatic Disease Deal With Uncertainty? J Rheumatol 2022; 49:977-979. [PMID: 35649548 DOI: 10.3899/jrheum.220502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Unfortunately, not much is certain in systemic autoimmune rheumatic diseases (SARDs). People with a SARD such as systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) are dealing with a chronic, inflammatory, and often unpredictable autoimmune condition that might cause them to experience illness-related uncertainty.1,2.
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Affiliation(s)
- Gwenda Simons
- G. Simons, Research Fellow, PhD, M. Falahee, Lecturer, PhD, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. G. Simons, Rheumatology Research Group, Institute of Inflammation and Ageing (IIA), Queen Elizabeth Hospital, University of Birmingham, Birmingham, B15 2WB, UK.
| | - Marie Falahee
- G. Simons, Research Fellow, PhD, M. Falahee, Lecturer, PhD, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. G. Simons, Rheumatology Research Group, Institute of Inflammation and Ageing (IIA), Queen Elizabeth Hospital, University of Birmingham, Birmingham, B15 2WB, UK.
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Factors affecting the quality of life of gastric cancer survivors. Support Care Cancer 2022; 30:3215-3224. [PMID: 34973098 PMCID: PMC8857153 DOI: 10.1007/s00520-021-06683-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 11/03/2021] [Indexed: 12/30/2022]
Abstract
Background The number of gastric cancer survivors has been increasing, and such survivors experience various changes in their lives post-recovery. Adapting to these changes requires appropriate interventions that can improve their quality of life (QoL). This study was conducted to investigate the factors affecting the QoL of gastric cancer survivors and provide basic data for effective intervention. Methods Data were collected between September 8 and September 29, 2017, from the Gastric Cancer Center at a tertiary hospital. Questionnaire surveys were conducted using the EORTC QLQ-C30/STO22, Self-Efficacy-Scale, Multidimensional Scale of Perceived Social Support, and Quality of Life-Cancer Survivors Questionnaire on gastric cancer survivors who were followed up for 3 years after gastrectomy. Data were analyzed using descriptive statistics, t test, ANOVA, Pearson’s correlation coefficient, and multiple regression analysis. Results A total of 136 gastric cancer survivors completed the questionnaire survey. There were significant positive correlations of QoL with self-efficacy, functional status, and social support (r = .35, p < .001; r = .53, p < .001; r = .26, p < .001, respectively). There were significant negative correlations of QoL with general symptoms (r = − .39, p < .001) and gastric cancer-specific symptoms (r = − .51, p < .001). The regression model explained 48.3% of the QoL, and the affecting factors were gastric cancer-specific symptoms (β = − .397, p < .001), religious belief (β = .299, p < .001), functional status (β = .251, p = .003), and self-efficacy (β = .191, p = .004). Conclusion This study confirmed that gastric cancer-specific symptoms, spiritual well-being, self-efficacy, and functional status affect the QoL of gastric cancer survivors. Hence, these factors should be considered in the interventions to improve the QoL of gastric cancer survivors.
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Sleep health in young women with breast cancer: a narrative review. Support Care Cancer 2022; 30:6419-6428. [PMID: 35288784 DOI: 10.1007/s00520-022-06953-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/03/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this narrative review was to synthesize the evidence on sleep health in young women with breast cancer and provide recommendations for clinical practice and research. METHODS Multiple databases were searched (OVID Medline, OVID PsycINFO, OVID Embase, and Scopus) using the search terms "breast neoplasm", "young women", "sleep", "sleep disturbance", "sleep problems", "sleep deficiency", and "insomnia". There were 467 titles and abstracts screened, and 82 full-text papers were reviewed, yielding 11 research publications for inclusion. RESULTS Sleep problems are prevalent among young women with breast cancer and are associated with vasomotor symptoms of menopause and psychological symptom distress. The evidence, however, is weak due to methodological and design aspects of the studies. CONCLUSIONS Poor sleep health in women with breast cancer is a clinically relevant problem that persists after treatment. As sleep is multidimensional and multifactorial, future research should evaluate sleep with objective sleep measures as well as self-reports; consider longitudinal designs; include factors that potentially contribute to poor sleep quality, such as physical and psychological symptom distress, family stressors, and competing life demands for this age group; and explore the perspective of this younger population of survivors on sleep. For clinical practice, survivorship visits should incorporate sleep assessment for all breast cancer survivors, especially younger women.
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Sambucini D, Ciacchella C, Pellicano GR, Zingaretti G, Pierro L, Aceto P, Lai C. Psychosocial treatment on psychological symptoms, adherence, and physiological function on transplanted patients: A systematic review and metanalysis. J Psychosom Res 2022; 154:110717. [PMID: 35032913 DOI: 10.1016/j.jpsychores.2022.110717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/31/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Transplantation represents an important source of hope for the candidates and produces an intense emotional effect. Psychosocial interventions can be helpful in all transplantation stages to better manage this extraordinarily stressful situation. Aim of the work is to verify the effects of the psychosocial interventions on recipients on psychological symptoms, medical adherence and transplanted solid organ functioning. METHODS This work adhered to PRISMA, STROBE, Cochrane and New Castle Ottawa bias scales and it is registered in PROSPERO. Inserting "Transplant" and "Psychological intervention" as key words in PubMed, Psycinfo, Cochrane database resulted 977 studies from 2001 to 2021. A systematic review and metanalyses were processed on nineteen randomized controlled trials and observative prospective cohort studies. The difference between pre- and post- psychosocial intervention assessment on the psychological variables, medical adherence, and organ functioning outcome was processed. RESULTS Main findings showed that the psychosocial interventions were effective on depression (0.62; CI: 0.32-0.92) and anxiety on kidney recipients (0.49; CI: 0.17-0.81), and on anxiety on heart recipients, mainly when administrated after the surgery (0.68; CI: 0.30-1.06). Moreover, the findings showed a lack of studies on the effectiveness of the psychosocial intervention on organ functioning. CONCLUSION The work highlighted the effectiveness of the psychosocial interventions on psychological outcome, particularly after the surgery and the need to address the research on the evaluation of the effectiveness of the psychosocial interventions on the organ functioning. The findings suggest to integrate the transplantation procedures with psychosocial interventions considering the different needs of recipients in relation to the specific transplanted organ.
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Affiliation(s)
- Daniela Sambucini
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University, Rome, Italy
| | - Chiara Ciacchella
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University, Rome, Italy
| | - Gaia Romana Pellicano
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University, Rome, Italy
| | - Giorgia Zingaretti
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University, Rome, Italy
| | - Laura Pierro
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University, Rome, Italy
| | - Paola Aceto
- Department of Emergency, anesthesiological and reanimation sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics, University of Sacred Heart, Rome, Italy
| | - Carlo Lai
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University, Rome, Italy.
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Park SY, Lim JW. Cognitive behavioral therapy for reducing fear of cancer recurrence (FCR) among breast cancer survivors: a systematic review of the literature. BMC Cancer 2022; 22:217. [PMID: 35227244 PMCID: PMC8883021 DOI: 10.1186/s12885-021-08909-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 09/21/2021] [Indexed: 11/12/2022] Open
Abstract
Background Fear of cancer recurrence (FCR) has been addressed as a cause of emotional distress among breast cancer survivors (BCSs). This study aimed to systematically review the evidence on randomized controlled trials (RCTs) of cognitive behavioral therapy (CBT) designed to reduce FCR among BCSs. Methods A systematic review of published original research articles meeting the inclusion criteria was conducted. Five electronic databases, including the Cochrane Library, CINAHL, PubMed, PsycINFO, and Web of Science, were independently searched to identify relevant articles. The Consolidated Standards of Reporting Trials (CONSORT) 2010 checklist was used to evaluate the quality of the eligible studies. Results Through a database search and a manual review process, seventeen quantitative studies with an RCT study design were included in the current systematic review. The interventions varied greatly in length and intensity, but the study designs and methodologies were similar. RCTs with face-to-face interventions of at least 1 month seemed to be more effective in reducing FCR outcomes and complying with than the CONSORT 2010 criteria than those with a brief online or telephone format of interventions; nevertheless, most RCT interventions appeared to be effective. Conclusions These findings highlight the importance of conducting well-designed CBT interventions to reduce FCR in BCSs with diverse populations at multiple sites, thereby improving the quality of research in this area. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08909-y.
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Affiliation(s)
- So-Young Park
- Ewha Institute for Age Integration Research, Ewha Womans University, 52 Ewhayeodae-gil, Sedaemun-gu, Seoul, 03760, Republic of Korea
| | - Jung-Won Lim
- College of Social Welfare, Kangnam University, 40 Kangnam-Ro, Giheung-Gu, Yongin-Si, Gyeonggi-Do, 16979, Republic of Korea.
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Psychosocial protective interventions associated with a better quality of life and psychological wellbeing for African American/Black female breast cancer survivors: an integrative review. Support Care Cancer 2022; 30:1093-1114. [PMID: 34417643 PMCID: PMC8787847 DOI: 10.1007/s00520-021-06425-0] [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: 03/16/2021] [Accepted: 07/08/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE This integrative review provides an overview of current psychosocial interventions and qualitative studies exploring African American Breast Cancer Survivors (AABCS)' psychosocial wellbeing. METHODS We conducted a search of five databases: PubMed, Academic Search Ultimate, CINAHL, PsycINFO, and Web of Science. Peer-reviewed articles written in English and published from 2011 to May 26, 2021 were included. We critically appraised intervention studies and qualitative studies using established frameworks. RESULTS Of the 633 unique studies identified, seven interventions and twenty-one qualitative studies were included. Analysis of the interventions revealed the importance of alleviating structural barriers and facilitating peer support for AABCS. Analysis of the qualitative studies revealed seven themes: (1) spirituality/religion, (2) social support, (3) cultural perceptions of BC, (4) lack of representation, (5) negative impacts of treatment, (6) healthcare system experience, and (7) barriers to psychosocial care. CONCLUSIONS This review highlights the dearth of psychosocial interventions created specifically for AABCS. The qualitative literature in this review elucidates the unique psychosocial challenges that AABCS experience, providing rich data to inform the creation of future culturally competent interventions in this population. IMPLICATIONS FOR CANCER SURVIVORS This review found spirituality and social support to be protective factors for AABCS' psychosocial wellbeing. Further research using rigorous methodologies is needed to further evaluate how to most effectively alleviate structural barriers that AABCS face in obtaining long-term support.
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Massazza A, Kienzler H, Al-Mitwalli S, Tamimi N, Giacaman R. The association between uncertainty and mental health: a scoping review of the quantitative literature. J Ment Health 2022; 32:480-491. [PMID: 35014927 DOI: 10.1080/09638237.2021.2022620] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The current moment is characterised by deep-rooted uncertainties, such as climate change and COVID-19. Uncertainty has been reported to be associated with negative mental health outcomes, such as stress and anxiety. However, no comprehensive review on the association between uncertainty and mental health exists. AIM The aim of the current scoping review was to systematically explore and describe the literature on the link between uncertainty and mental health. METHODS A scoping review was undertaken following guidelines by Arksey and O'Malley (2005). RESULTS One hundred and one papers addressing the association between uncertainty and mental health were identified. Most were cross-sectional studies (67%) conducted in the fields of medicine or nursing (59%), in high-income countries, among adult populations (74%), and in medical settings. Substantial heterogeneity was identified in the measurements of uncertainty and mental health. Most studies (79%) reported a positive association between uncertainty and mental health problems. CONCLUSIONS Research is needed in more diverse contexts and populations. More robust designs are required to provide insight into the directionality and strength of the association between uncertainty and mental health. Few studies reported how individuals coped with uncertainty. Future studies should address the identified gaps and investigate interventions to address uncertainty and its determinants.
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Affiliation(s)
- Alessandro Massazza
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Department of Global Health and Social Medicine, King's College London, London, UK
| | - Hanna Kienzler
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Suzan Al-Mitwalli
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Nancy Tamimi
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Rita Giacaman
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
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16
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Wei L, Yang X, Sun S, Yu Y, Xie J, Zhao J, Wang X, Zhu L, Yao J. Fear-focused Self-compassion Therapy for young breast cancer patients' fear of cancer recurrence: Study protocol of a randomized controlled trial. Front Psychiatry 2022; 13:941459. [PMID: 36213912 PMCID: PMC9537371 DOI: 10.3389/fpsyt.2022.941459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In China, there are a growing number of young women being diagnosed with breast cancer. Fear of Cancer Recurrence (FCR) has become one of the major psychological concerns reported by young breast cancer patients. Yet, there is a lack of psychological intervention tailored for reducing FCR for Chinese young breast cancer patients. In the current study, the Fear-focused Self-compassion Therapy is developed to help Chinese young breast cancer patients to manage FCR. The therapy was developed based on FCR development theories and self-compassion related therapy. The primary objective is to evaluate the short-term and long-term effectiveness of Fear-focused Self-compassion Therapy. The secondary objective is to examine the underlying mechanisms of therapy in reducing FCR in young breast cancer patients. METHODS The Fear-focused Self-compassion Therapy consists of 8-week face to face group sessions. This study will be a randomized controlled trial with 160 Chinese young female breast cancer patients with severe FCR. Participants will be randomized to the therapy group or a usual care control group (1:1). Measurements will be completed at baseline, immediately completing intervention, 3, 6, and 12 months later. Primary outcomes are FCR severity, and secondary outcomes include symptoms of depression and anxiety, satisfaction with therapy, and cost-effectiveness of the therapy. DISCUSSION If successful, this study will provide an effective psychological intervention to treat FCR for young breast cancer patients in China, and illuminate the underlying mechanisms of the Fear-focused Self-compassion Therapy in reducing FCR. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: NCT04965428. Registered 23rd July 2021, https://clinicaltrials.gov/ct2/show/NCT04965428?cond=fear+of+cancer+recurrence&draw=2&rank=1.
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Affiliation(s)
- Liuyu Wei
- School of Psychology, Shaanxi Normal University, Xi'an, China
| | - Xiaomin Yang
- Shaanxi Provincial Cancer Hospital, Xi'an, China
| | - Shasha Sun
- School of Psychology, Shaanxi Normal University, Xi'an, China
| | - Yunlei Yu
- School of Psychology, Shaanxi Normal University, Xi'an, China
| | - Juan Xie
- Shaanxi Provincial Cancer Hospital, Xi'an, China
| | - Jiang Zhao
- Shaanxi Provincial Cancer Hospital, Xi'an, China
| | - Xiao Wang
- Shaanxi Provincial Cancer Hospital, Xi'an, China
| | - Lei Zhu
- School of Psychology, Shaanxi Normal University, Xi'an, China
| | - Juntao Yao
- Shaanxi Provincial Cancer Hospital, Xi'an, China
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17
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Pradhan P, Sharpe L, Menzies RE. Towards a Stepped Care Model for Managing Fear of Cancer Recurrence or Progression in Cancer Survivors. Cancer Manag Res 2021; 13:8953-8965. [PMID: 34880676 PMCID: PMC8645945 DOI: 10.2147/cmar.s294114] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/07/2021] [Indexed: 01/08/2023] Open
Abstract
Background Fear of cancer recurrence or progression (FCR) is common amongst cancer survivors and an important minority develop clinically significant levels of FCR. However, it is unclear how current clinical services might best support the growing numbers of cancer survivors. Purpose The aim of this study is to develop recommendations for future research in the management of FCR and propose a model of care to help manage FCR in the growing population of cancer survivors. Methods This is a narrative review and synthesis of empirical research relevant to managing FCR. We reviewed meta-analyses, systematic reviews and individual studies that had investigated interventions for FCR. Results A recent, well-conducted meta-analysis confirmed a range of moderately effective treatments for FCR. However, many survivors continued to experience clinical levels of FCR after treatment, indicating a clear need to improve the gold standard treatments. Accessibility of interventions is arguably a greater concern. The majority of FCR treatments require face-to-face therapy, with highly skilled psycho-oncologists to produce moderate changes in FCR. With increasing numbers of cancer survivors, we need to consider how to meet the unmet need of cancer survivors in relation to FCR. Although there have been attempts to develop minimal interventions, these are not yet sufficiently well supported to warrant implementation. Attempts to help clinicians to provide information which might prevent the development of clinically significant FCR have shown some early promise, but research is needed to confirm efficacy. Conclusion The next decade of research needs to focus on developing preventative approaches for FCR, and minimal interventions for those with mild-to-moderate symptoms. When evidence-based approaches to prevent FCR or manage moderate levels of FCR are available, stepped care approaches that could meet the needs of survivors could be implemented. However, we also need to improve existing interventions for severe FCR.
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Affiliation(s)
- Poorva Pradhan
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Louise Sharpe
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Rachel E Menzies
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, 2006, Australia
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18
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Guan T, Qan'ir Y, Song L. Systematic review of illness uncertainty management interventions for cancer patients and their family caregivers. Support Care Cancer 2021; 29:4623-4640. [PMID: 33495851 PMCID: PMC8236440 DOI: 10.1007/s00520-020-05931-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/02/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Illness uncertainty pervades individuals' experiences of cancer across the illness trajectory and is associated with poor psychological adjustment. This review systematically examined the characteristics and outcomes of interventions promoting illness uncertainty management among cancer patients and/or their family caregivers. METHODS PubMed, Scopus, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and Cochrane Database of Systematic Reviews were systematically searched for relevant literature. We included randomized controlled trials (RCTs) and quasi-experimental studies focusing on interventions for uncertainty management in cancer patients and/or their family caregivers. RESULTS Our database searches yielded 26 studies. Twenty interventions were only offered to cancer patients, who were mostly elder, female, and White. All interventions included informational support. Other intervention components included emotional support, appraisal support, and instrumental support. Most interventions were delivered in person and via telephone (n = 8) or exclusively in person (n = 7). Overall, 18 studies identified positive intervention effects on illness uncertainty outcomes. CONCLUSION This systematic review foregrounds the promising potential of several interventions-and especially multi-component interventions-to promote uncertainty management among cancer patients and their family caregivers. To further improve these interventions' effectiveness and expand their potential impact, future uncertainty management interventions should be tested among more diverse populations using rigorous methodologies.
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Affiliation(s)
- Ting Guan
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yousef Qan'ir
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lixin Song
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Thompson T, Pérez M, Yan Y, Kreuter MW, Margenthaler JA, Colditz GA, Jeffe DB. Randomized controlled trial of a breast cancer Survivor Stories intervention for African American women. Soc Sci Med 2021; 270:113663. [PMID: 33454539 DOI: 10.1016/j.socscimed.2020.113663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/08/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
RATIONALE Video-based interventions hold promise for improving quality of life (QoL) among African American breast cancer patients. OBJECTIVE An interactive, cancer-communication intervention using African American breast cancer survivors' narratives was tested in a randomized controlled trial to determine whether viewing survivor stories improved newly diagnosed African American breast cancer patients' QoL. METHOD Participants were 228 African American women with non-metastatic breast cancer interviewed five times over two years; 120 controls received standard medical care, and 108 intervention-arm participants also received a tablet-computer with survivor stories three times in 12 months. Growth curve models were used to analyze differences between arms in change in eight RAND 36-Item Health Survey subscales, depressive symptoms, and concerns about recurrence. Additional models explored the effects of intervention usage and other intervention-related variables on QoL among patients in the intervention arm. RESULTS Models showed no effect of study arm on QoL, depressive symptoms, or concerns about recurrence. Longer use of the intervention was associated with an increase in concerns about recurrence and decline in three QoL subscales: emotional wellbeing, energy/fatigue, and role limitations due to physical health. CONCLUSION Although no significant impact of the intervention on QoL was observed when comparing the two study arms, in the intervention arm longer intervention use was associated with declines in three QoL subscales and increased concerns about recurrence. Women with improving QoL may have interacted with the tablet less because they felt less in need of information; it is also possible that encouraging patients to compare themselves to survivors who had already recovered from breast cancer led some patients to report lower QoL. Future work is warranted to examine whether adding different stories to this cancer-communication intervention or using stories in conjunction with additional health promotion strategies (e.g., patient navigation) might improve QoL for African American breast cancer patients.
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Affiliation(s)
- Tess Thompson
- Brown School of Social Work, Washington University in St. Louis, USA.
| | - Maria Pérez
- Washington University School of Medicine, USA
| | - Yan Yan
- Washington University School of Medicine, USA
| | - Matthew W Kreuter
- Brown School of Social Work, Washington University in St. Louis, USA
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20
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Zhang Y, Kwekkeboom KL. A Feasibility Study of an Uncertainty Management Intervention for Patient-Partner Dyads Experiencing Breast Cancer. Oncol Nurs Forum 2020; 47:595-608. [PMID: 32830807 DOI: 10.1188/20.onf.595-608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine the feasibility, acceptability, and effects of a dyad-based uncertainty management intervention for breast cancer, including tailored information and coping skills training. SAMPLE & SETTING 16 patient-partner dyads experiencing breast cancer were enrolled from a midwestern comprehensive cancer center. METHODS & VARIABLES A single-group pre-/post-test design was used, and descriptive statistics and Cohen's d were calculated. Measures were completed before the intervention and during each treatment cycle. Feasibility, acceptability, fidelity, uptake, and outcome variables (uncertainty, dyadic coping, family functioning) were included. RESULTS 16 dyads were enrolled during a 13-month period; 15 dyads completed the training for the study, and 13 dyads completed all study activities. Overall, participants reported satisfaction with the intervention. Small to medium effect sizes were observed across the outcomes. IMPLICATIONS FOR NURSING This study highlights the need for nurses to help couples manage uncertainty related to new cancer treatment. Tailored interventions can allow nurses to use their time efficiently by focusing on individuals' actual needs.
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21
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Hall DL, Park ER, Cheung T, Davis RB, Yeh GY. A Pilot Mind-Body Resiliency Intervention Targeting Fear of Recurrence among Cancer Survivors. J Psychosom Res 2020; 137:110215. [PMID: 32818720 PMCID: PMC7873146 DOI: 10.1016/j.jpsychores.2020.110215] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/13/2020] [Accepted: 08/08/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Interventions for fear of recurrence (FOR) of cancer have nominal effects, perhaps due to limited integration of empirically supported skills. This pilot trial tested the acceptability and feasibility of a multimodal, mind-body resiliency intervention targeting FOR among survivors of various cancers. METHODS Early stage cancer survivors 3-30 months post-treatment were recruited to participate in an eight-session in-person mind-body resiliency group intervention that taught relaxation skills, cognitive-behavioral techniques, healthy lifestyle behaviors, mindfulness meditation, and positive psychology skills all targeted for FOR. Primary outcomes were feasibility (enrollment rate, session attendance, survey completion, skills practice) and acceptability (enjoyableness, convenience, helpfulness, relevance). Patient-reported outcomes (FOR, uncertainty intolerance, cancer-related uncertainty, perceived stress, resiliency, positive affect, and coping skills) were collected at baseline, post-intervention, +1 month, and +3 months. Exit interviews assessed survivors' reported benefits. RESULTS Participants (N = 4 groups, 23 survivors, enrollment response rate = 58%) included survivors of seven common cancer types who were on average 12 months post-treatment. Attendance was high (M = 6.1 sessions), and 96% of survivors completed all surveys. Sustained increases in relaxation skills practice 3+ days/week were reported (baseline = 16%, post-intervention = 76%, +3 months = 71%). Most sessions (87%) were rated as highly or very highly acceptable. Moderate-to-large (d = 0.87) improvements in FOR severity were observed post-intervention (p < .01) and across assessments (p < .01), with similar changes observed in other patient-reported outcomes. Exit interviews revealed behavioral, cognitive, emotional, and existential benefits. CONCLUSIONS The targeted mind-body resiliency intervention shows promising acceptability, feasibility, and favorable changes in FOR and coping skills practice. Further adaptation and testing in a randomized trial are warranted. ClinicalTrials.govRegistration Number: NCT03695406.
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Affiliation(s)
- Daniel L Hall
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States of America.
| | - Elyse R Park
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States of America
| | - Tina Cheung
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, United States of America
| | - Roger B Davis
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, United States of America; Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Gloria Y Yeh
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, United States of America
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22
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Kim SH, Choe YH, Han AR, Yeon GJ, Lee GH, Lee BG, Cho YU, Park S, Lee MH. Design of a randomized controlled trial of a partnership-based, needs-tailored self-management support intervention for post-treatment breast cancer survivors. BMC Cancer 2020; 20:367. [PMID: 32357926 PMCID: PMC7193410 DOI: 10.1186/s12885-020-06861-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-management is becoming essential for breast cancer survivors, but evidence about the effectiveness of self-management support (SMS) intervention is lacking. To address this issue, we developed a theory-based SMS intervention, the 'EMPOWER', aimed at empowering breast cancer survivors. Here we describe the rationale of the intervention and its development. METHODS The conceptual framework of this study is the Chronic Care Model, which posits that SMS can influence patient-provider relationships and ultimately improve health outcomes. We will conduct a multi-center, 2-armed randomized controlled trial to assess the effectiveness of EMPOWER among post-treatment breast cancer survivors in South Korea. The trial will include 94 women who completed primary breast cancer treatment within the last 6 months. Participants will be randomly assigned to the intervention group or the wait-list control group (1:1). The intervention group will receive a 7-week partnership-based and needs-tailored SMS intervention via telephone counseling. The primary outcome is empowerment. The secondary outcomes include self-efficacy for post-treatment self-management behaviors, mental adjustment, psychological distress, and health-related quality of life (HRQOL). Data will be collected by self-reported questionnaire at baseline, post-intervention, and 3-month follow-up. DISCUSSION We believe that the EMPOWER intervention could improve HRQOL of post-treatment breast cancer survivors by enhancing their empowerment. If found successful, it could aid clinicians engaged in the long-term care of breast cancer survivors. TRIAL REGISTRATION Clinical Research Information Service, KCT0004794. Registered 5 March 2020.
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Affiliation(s)
- Soo Hyun Kim
- Department of Nursing, Inha University, 100 Inha-ro, Michuhol-gu, Incheon, 22212, South Korea.
| | - Yu Hyeon Choe
- Department of Nursing, Inha University, 100 Inha-ro, Michuhol-gu, Incheon, 22212, South Korea
| | - Ah Reum Han
- Department of Nursing, Inha University, 100 Inha-ro, Michuhol-gu, Incheon, 22212, South Korea
| | - Gwui Jeong Yeon
- Department of Nursing, Inha University, 100 Inha-ro, Michuhol-gu, Incheon, 22212, South Korea
| | - Gyeong Hee Lee
- Department of Nursing, Inha University, 100 Inha-ro, Michuhol-gu, Incheon, 22212, South Korea
| | - Bo Gyeong Lee
- College of Nursing, The Research Institute of Nursing Science, Daegu Catholic University, Daegu, South Korea
| | - Young Up Cho
- Department of Surgery, Ilsan Women's & Children's Hospital, Cha University, Goyang, South Korea
| | - Seho Park
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Moon Hee Lee
- Division of Hematology-Oncology, College of Medicine, Inha University, Incheon, South Korea
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Steineck A, Wiener L, Mack JW, Shah NN, Summers C, Rosenberg AR. Psychosocial care for children receiving chimeric antigen receptor (CAR) T-cell therapy. Pediatr Blood Cancer 2020; 67:e28249. [PMID: 32159278 PMCID: PMC8396063 DOI: 10.1002/pbc.28249] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/21/2020] [Accepted: 02/22/2020] [Indexed: 12/11/2022]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy has transformed the treatment of relapsed/refractory B-cell acute lymphoblastic leukemia (ALL). However, this new paradigm has introduced unique considerations specific to the patients receiving CAR T-cell therapy, including prognostic uncertainty, symptom management, and psychosocial support. With increasing availability, there is a growing need for evidence-based recommendations that address the specific psychosocial needs of the children who receive CAR T-cell therapy and their families. To guide and standardize the psychosocial care offered for patients receiving CAR T-cell therapy, we propose the following recommendations for addressing psychosocial support.
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Affiliation(s)
- Angela Steineck
- Cancer and Blood Disorders Center, Seattle Children’s Hospital, Seattle, Washington, USA, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA, Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington, USA, Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA,Correspondence to: Angela Steineck, MD, Seattle Children’s Research Institute, 4800 Sand Point Way NE, MB 8.501 PO Box 5371, Seattle, WA 98145, Tel: 206-987-2106, Fax: 206-987-3946,
| | - Lori Wiener
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jennifer W. Mack
- Dana Farber Cancer Institute, Boston, MA, USA, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Nirali N. Shah
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Corinne Summers
- Cancer and Blood Disorders Center, Seattle Children’s Hospital, Seattle, Washington, USA, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Abby R. Rosenberg
- Cancer and Blood Disorders Center, Seattle Children’s Hospital, Seattle, Washington, USA, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA, Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington, USA, Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
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24
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Diabetic Foot Ulcer Patients' Uncertainty Regarding Their Prognosis: A Q-Methodological Study. J Wound Ostomy Continence Nurs 2020; 46:531-538. [PMID: 31738306 DOI: 10.1097/won.0000000000000597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this qualitative study was to identify the subjective patient perspectives toward the uncertainty regarding diabetic foot ulcer (DFU) prognosis. DESIGN Q-methodology, which is a qualitative method for analyzing subjective viewpoints, was used. SUBJECTS AND SETTING Forty patients with DFUs who were admitted to the diabetic wound center of a university hospital in Seoul, South Korea. METHODS Data were collected on the subjective viewpoint of patients regarding their DFU prognosis uncertainty and analyzed by the software program PQMethod 2.35 using a principal component analysis and varimax rotation. RESULTS This study revealed 4 factors characterizing patient subjective experience related to DFU prognosis: confusion from a lack of knowledge, concerns about a negative future, overdependence on information, and expectations for a positive outlook about favorable results. CONCLUSION The findings of this study suggest various intervention methods for patients with DFU facing uncertainty about their prognosis based on the 4 viewpoints identified. The identification of the factor causing uncertainty and integration of all uncertainty factors are expected to be used as the basis for reducing patients' uncertainty and helping nurses care for patients more effectively.
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Abstract
BACKGROUND Young adults with congenital heart disease (CHD) are at risk for chronic illness uncertainty in 4 domains: ambiguity about the state of their illness; lack of information about the disease, its treatment, and comorbidities; complexity of the healthcare system and relationship with healthcare providers; and unpredictability of the illness course and outcome. Chronic uncertainty has been associated with posttraumatic stress symptoms (PTSS) and posttraumatic stress disorder (PTSD). OBJECTIVE The aims of this study were to explore how young adults with CHD experience uncertainty and to describe the relationship between PTSS and the appraisal and management process. METHODS An exploratory, mixed methods design was used. Data were collected in person and via Skype from 25 participants (19-35 years old), who were diagnosed with CHD during childhood and able to read and write English. In-depth interviews and the University of California at Los Angeles Posttraumatic Stress Disorder Reaction Index were used to collect data. Qualitative data were analyzed using the constant comparative method. RESULTS The 4 domains of uncertainty were evident in the narratives. The PTSD mean (SD) score was 31.3 (7.7). Six participants met criteria for PTSD. Narrative analysis revealed a relationship between severity of PTSS and the appraisal and management of uncertainty. Participants with PTSD used management strategies that included avoidance, reexperiencing, and hyperarousal. CONCLUSIONS Young adults with CHD may be at risk for the development of long-term psychological stress and PTSD in the setting of chronic uncertainty. Regular monitoring to identify PTSS/PTSD may be a means to promote treatment adherence and participation in healthcare.
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Johns SA, Stutz PV, Talib TL, Cohee AA, Beck-Coon KA, Brown LF, Wilhelm LR, Monahan PO, LaPradd ML, Champion VL, Miller KD, Giesler RB. Acceptance and commitment therapy for breast cancer survivors with fear of cancer recurrence: A 3-arm pilot randomized controlled trial. Cancer 2019; 126:211-218. [PMID: 31539169 DOI: 10.1002/cncr.32518] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/07/2019] [Accepted: 08/23/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Fear of cancer recurrence (FCR) has a profound negative impact on quality of life (QOL) for many cancer survivors. Breast cancer survivors (BCS) are particularly vulnerable, with up to 70% reporting clinically significant FCR. To the authors' knowledge, evidence-based interventions for managing FCR are limited. Acceptance and commitment therapy (ACT) promotes psychological flexibility in managing life's stressors. The current study examined the feasibility and preliminary efficacy of group-based ACT for FCR in BCS. METHODS Post-treatment BCS (91 patients with stage I-III disease) with clinical FCR randomly were assigned to ACT (6 weekly 2-hour group sessions), survivorship education (SE; 6 weekly 2-hour group sessions), or enhanced usual care (EUC; one 30-minute group coaching session with survivorship readings). FCR severity (primary outcome) and avoidant coping, anxiety, post-traumatic stress, depression, QOL, and other FCR-related variables (secondary outcomes) were assessed at baseline (T1), after the intervention (T2), 1 month after the intervention (T3), and 6 months after the intervention (T4) using intent-to-treat analysis. RESULTS Satisfactory recruitment (43.8%) and retention (94.5%) rates demonstrated feasibility. Although each arm demonstrated within-group reductions in FCR severity over time, only ACT produced significant reductions at each time point compared with baseline, with between-group differences at T4 substantially favoring ACT over SE (Cohen d for effect sizes, 0.80; P < .001) and EUC (Cohen d, 0.61; P < .01). For 10 of 12 secondary outcomes, only ACT produced significant within-group reductions across all time points. By T4, significant moderate to large between-group comparisons favored ACT over SE and EUC with regard to avoidant coping, anxiety, depression, QOL, and FCR-related psychological distress. CONCLUSIONS Group-based ACT is a feasible and promising treatment for FCR and associated outcomes in BCS that warrants testing in larger, fully powered trials.
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Affiliation(s)
- Shelley A Johns
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.,Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana
| | - Patrick V Stutz
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Tasneem L Talib
- Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana
| | - Andrea A Cohee
- Indiana University School of Nursing, Indianapolis, Indiana
| | - Kathleen A Beck-Coon
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University School of Nursing, Indianapolis, Indiana
| | - Linda F Brown
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Laura R Wilhelm
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Charleston, West Virginia
| | - Patrick O Monahan
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Michelle L LaPradd
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Kathy D Miller
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.,Research and Clinical Trials, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - R Brian Giesler
- Department of Psychology, Butler University, Indianapolis, Indiana
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Tauber NM, O'Toole MS, Dinkel A, Galica J, Humphris G, Lebel S, Maheu C, Ozakinci G, Prins J, Sharpe L, Smith AB, Thewes B, Simard S, Zachariae R. Effect of Psychological Intervention on Fear of Cancer Recurrence: A Systematic Review and Meta-Analysis. J Clin Oncol 2019; 37:2899-2915. [PMID: 31532725 PMCID: PMC6823887 DOI: 10.1200/jco.19.00572] [Citation(s) in RCA: 182] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Fear of cancer recurrence (FCR) is a significantly distressing problem that affects a substantial number of patients with and survivors of cancer; however, the overall efficacy of available psychological interventions on FCR remains unknown. We therefore evaluated this in the present systematic review and meta-analysis. METHODS We searched key electronic databases to identify trials that evaluated the effect of psychological interventions on FCR among patients with and survivors of cancer. Controlled trials were subjected to meta-analysis, and the moderating influence of study characteristics on the effect were examined. Overall quality of evidence was evaluated using the GRADE system. Open trials were narratively reviewed to explore ongoing developments in the field (PROSPERO registration no.: CRD42017076514). RESULTS A total of 23 controlled trials (21 randomized controlled trials) and nine open trials were included. Small effects (Hedges’s g) were found both at postintervention (g = 0.33; 95% CI, 0.20 to 0.46; P < .001) and at follow-up (g = 0.28; 95% CI, 0.17 to 0.40; P < .001). Effects at postintervention of contemporary cognitive behavioral therapies (CBTs; g = 0.42) were larger than those of traditional CBTs (g = 0.24; β = .22; 95% CI, .04 to .41; P = .018). At follow-up, larger effects were associated with shorter time to follow-up (β = −.01; 95% CI, −.01 to −.00; P = .027) and group-based formats (β = .18; 95% CI, .01 to .36; P = .041). A GRADE evaluation indicated evidence of moderate strength for effects of psychological intervention for FCR. CONCLUSION Psychological interventions for FCR revealed a small but robust effect at postintervention, which was largely maintained at follow-up. Larger postintervention effects were found for contemporary CBTs that were focused on processes of cognition—for example, worry, rumination, and attentional bias—rather than the content, and aimed to change the way in which the individual relates to his or her inner experiences. Future trials could investigate how to further optimize and tailor interventions to individual patients’ FCR presentation.
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Affiliation(s)
- Nina M Tauber
- Aarhus University, Aarhus, Denmark.,International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada
| | | | - Andreas Dinkel
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,Technical University of Munich, Munich, Germany
| | - Jacqueline Galica
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,Queen's University, Kingston, Ontario, Canada
| | - Gerry Humphris
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,University of St Andrews, St Andrews, United Kingdom
| | - Sophie Lebel
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Christine Maheu
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,McGill University, Montréal, Québec, Canada
| | - Gozde Ozakinci
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,University of St Andrews, St Andrews, United Kingdom
| | - Judith Prins
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Louise Sharpe
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,University of Sydney, Sydney, NSW, Australia
| | - Allan Ben Smith
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,Ingham Institute for Applied Medical Research and University of New South Wales, Sydney, NSW, Australia
| | - Belinda Thewes
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,University of Sydney, Sydney, NSW, Australia
| | - Sébastien Simard
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,Université du Québec à Chicoutimi, Saguenay, Québec, Canada
| | - Robert Zachariae
- Aarhus University, Aarhus, Denmark.,International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,Aarhus University Hospital, Aarhus, Denmark
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Ruiz-Pérez I, Rodríguez-Gómez M, Pastor-Moreno G, Escribá-Agüir V, Petrova D. Effectiveness of interventions to improve cancer treatment and follow-up care in socially disadvantaged groups. Psychooncology 2019; 28:665-674. [PMID: 30695816 DOI: 10.1002/pon.5011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/14/2019] [Accepted: 01/23/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To identify and characterize the interventions that aimed to improve cancer treatment and follow-up care in socially disadvantaged groups. To summarize the state of the art for clinicians and researchers. METHODS We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies were randomized controlled trials and quasi-experimental studies with a control group (usual care or enhanced usual care) conducted in Organization for Economic Co-operation and Development (OECD) member countries and published until 2016. RESULTS Thirty-one interventions were identified, the majority of which were conducted in the United States in patients with breast cancer. Most interventions aimed to decrease social inequalities based on ethnicity/race and/or socioeconomic level, with fewer interventions targeting inequalities based on geographical area. The most frequently assessed outcomes were quality of life (n = 20) and psychosocial factors (n = 20), followed by treatment adherence or satisfaction (n = 12,), knowledge (n = 11), pain management (n = 10), and lifestyle habits (n = 3). CONCLUSIONS The impact of interventions designed to improve cancer treatment and follow-up care in socially disadvantages groups is multifactorial. Multicomponent-intervention approaches and cultural adaptations are common, and their effectiveness should be evaluated in the populations of interest. More interventions are needed from outside the Unite States and in patients with cancers other than breast cancer, targeting gender or geographical inequalities and addressing key outcomes such as treatment adherence or symptom management.
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Affiliation(s)
- Isabel Ruiz-Pérez
- Andalusian School of Public Health, Granada, Spain.,Centro de Investigacion Biomedica en Red de Epidemiologia y Salud Publica, Madrid, Spain.,Instituto de Investigación Biosanitaria (ibs. GRANADA), Granada, Spain
| | | | - Guadalupe Pastor-Moreno
- Andalusian School of Public Health, Granada, Spain.,Centro de Investigacion Biomedica en Red de Epidemiologia y Salud Publica, Madrid, Spain
| | - Vicenta Escribá-Agüir
- Department of Nursing, University of Valencia, Valencia, Spain.,Fundación para el fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
| | - Dafina Petrova
- Andalusian School of Public Health, Granada, Spain.,Centro de Investigacion Biomedica en Red de Epidemiologia y Salud Publica, Madrid, Spain.,Instituto de Investigación Biosanitaria (ibs. GRANADA), Granada, Spain
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Hall DL, Luberto CM, Philpotts LL, Song R, Park ER, Yeh GY. Mind-body interventions for fear of cancer recurrence: A systematic review and meta-analysis. Psychooncology 2018; 27:2546-2558. [PMID: 29744965 PMCID: PMC6488231 DOI: 10.1002/pon.4757] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/21/2018] [Accepted: 04/19/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Fear of cancer recurrence (FCR) is a common existential concern and source of distress among adults with a cancer history. Multiple randomized controlled trials (RCTs) have examined mind-body approaches to mitigating FCR. We summarized characteristics of these trials and calculated their pooled effects on decreasing FCR. METHODS Six electronic databases were systematically searched from inception to May 2017, using a strategy that included multiple terms for RCTs, cancer, mind-body medicine, and FCR. Data extraction and reporting followed Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Pooled effect sizes on self-report measures of FCR were computed by using random-effects models. RESULTS Nineteen RCTs (pooled N = 2806) were included. Most studies (53%) were published since 2015 and targeted a single cancer type (84%; mostly breast). Intervention sessions (median = 6, mode = 4) tended to last 120 minutes and occur across 1.5 months. Delivery was predominantly in-person (63%) to either groups (42%) or individuals (42%). Most interventions incorporated multiple mind-body components (53%), commonly cognitive-behavioral skills (58%), or meditative practices (53%). Small-to-medium pooled effect sizes were observed postintervention (Hedges' g = -0.36, 95% CI = -0.49, -0.23, P < .001) and at follow-up assessments (median = 8 months, P < .001). Potential modifiers (control group design, group/individual delivery, use of cognitive-behavioral or mindfulness skills, number of mind-body components, cancer treatment status, and number of sessions) did not reach statistical significance. CONCLUSIONS Mind-body interventions are efficacious for reducing FCR, with small-to-medium effect sizes that persist after intervention delivery ends. Recommendations include testing effects among survivors of various cancers and exploring the optimal integration of mind-body practices for managing fundamental uncertainties and fears during cancer survivorship.
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Affiliation(s)
- Daniel L. Hall
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | | | - Rhayun Song
- College of Nursing, Chungnam National University, South Korea
| | - Elyse R. Park
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA, USA
| | - Gloria Y. Yeh
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Choi M, Lee J, Oh EG, Chu SH, Sohn YH, Park CG. Factors Associated With Uncertainty in Illness Among People With Parkinson's Disease. Clin Nurs Res 2018; 29:469-478. [PMID: 30019611 DOI: 10.1177/1054773818788492] [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] [Indexed: 01/29/2023]
Abstract
People with Parkinson's disease (PD) reported to experience uncertainty because of gradually progressive disease characteristics with no cure, and variably manifesting and unpredictable symptoms. This study was designed to identify illness-related variables influencing uncertainty in PD patients and to analyze direct and indirect paths between these variables. Data were collected from 206 participants using a structured questionnaire. Path analysis revealed the direct and/or indirect effects of economic status, disease severity, social support, and resilience on uncertainty in people with PD. Disease severity, social support, and resilience were shown to have significant direct effects on uncertainty. Economic status and disease severity had indirect effects on uncertainty, which were mediated by social support. Disease severity and social support also had indirect effects on uncertainty, which were mediated by resilience. Therefore, the efforts of health care professionals should be directed not only toward managing PD symptoms, but also toward facilitating social support and resilience.
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Affiliation(s)
- MoonKi Choi
- Department of Nursing, Bucheon University, South Korea
| | - JuHee Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
| | - Eui Geum Oh
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
| | - Sang Hui Chu
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
| | - Young H Sohn
- College of Medicine, Yonsei University, Seoul, South Korea
| | - Chang Gi Park
- College of Nursing, The University of Illinois at Chicago, USA
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Kuang K. Reconceptualizing uncertainty in illness: commonalities, variations, and the multidimensional nature of uncertainty. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/23808985.2018.1492354] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Kai Kuang
- Department of Communication Studies, Bloomsburg University of Pennsylvania, Bloomsburg, PA, USA
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Kim SH, Kim K, Mayer DK. Self-Management Intervention for Adult Cancer Survivors After Treatment: A Systematic Review and Meta-Analysis. Oncol Nurs Forum 2018; 44:719-728. [PMID: 29052663 DOI: 10.1188/17.onf.719-728] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION This study aims to evaluate the effects of self-management interventions (SMIs) for cancer survivors who completed primary treatment.
. LITERATURE SEARCH Using PubMed, EMBASE, CINAHL®, PsycINFO®, and Cochrane Central Register of Controlled Trails (CENTRAL), the authors conducted a systematic search of randomized, controlled trials published in English from database conception through June 2016.
. DATA EVALUATION The meta-analysis was conducted with Cochrane Review Manager, version 5.3, and R program, version 3.3.1.
. SYNTHESIS 12 studies were systematically reviewed for self-management content, mode of delivery, session composition, and type of self-management skills used. Then, a meta-analysis of nine randomized, controlled trials involving 2,804 participants was conducted comparing SMIs with usual care, attention control, and a waitlist group. Qualitative synthesis showed that (a) the major study population was comprised of breast cancer survivors; (b) SMIs focused on medical/behavioral and emotional management; (c) the most common mode of delivery was web-based; and (d) the most frequently evaluated outcomes were depression, self-efficacy, and health-related quality of life (HRQOL). Quantitative results demonstrated a significant medium effect on HRQOL and a large effect on fatigue of borderline significance. The effects on anxiety, depression, and self-efficacy were not statistically significant.
. CONCLUSIONS SMIs had a significant medium effect on HRQOL for cancer survivors post-treatment, but the findings should be interpreted with caution because of substantial heterogeneity. In addition, the small number of studies limits conclusions.
. IMPLICATIONS FOR NURSING SMI as a nursing intervention for improving HRQOL of cancer survivors can be recommended, but more research should be undertaken to determine the most effective SMI format in terms of type, mode of delivery, and session composition.
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Abstract
Mishel's uncertainty in illness theory provides a conceptual framework to explain how uncertainty is generated and how it affects psychological adjustment to the cancer experience. Since 1981, when it was created, researchers have used the theory to develop and test uncertainty management interventions in multiple populations of patients with cancer. This article reviews the theory's concepts and propositions, summarizes supporting evidence, and discusses extension of the theory, clinical implications, and future directions for research.
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The Effect of Uncertainty Management Program on Quality of Life Among Vietnamese Women at 3 Weeks Postmastectomy. Cancer Nurs 2018; 42:261-270. [PMID: 29746263 DOI: 10.1097/ncc.0000000000000597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND In Vietnam, breast cancer is a top contributor to cancer-related deaths in women. Evidence shows that, after mastectomy, women in Vietnam have a lower quality of life than women in other countries. In addition, high uncertainty is a predictor of low quality of life postmastectomy. Therefore, if nurses can manage uncertainty, the quality of life postmastectomy can improve. OBJECTIVE This study examined the effect of the Uncertainty Management Program (UMP) on quality of life at 3 weeks postmastectomy in Vietnamese women. METHODS This research was a quasi-experimental study using a "posttest only with control group" design. There were 115 subjects assigned to either the experimental group (n = 57), who participated in the UMP and routine care, or the control group (n = 58), who received only routine care. Participants were assessed 2 times postmastectomy using the modified Quality of Life Index Scale-Vietnamese version. RESULTS The experimental group exhibited low uncertainty before discharge and significantly higher quality of life than the control group at 1 and 3 weeks postmastectomy, respectively (P < .05). Women's physical well-being, psychological well-being, body image concerns, and social concerns were significantly increased with UMP. CONCLUSION The UMP was considered as a promising program that might benefit the QoL of women with breast cancer 3 weeks postmastectomy. IMPLICATIONS FOR PRACTICE The UMP appears feasible to apply for women with breast cancer to improve their QoL postmastectomy in various settings. Nurses can flexibility instruct women in their holistic care attention both in the hospital and at home.
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36
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An Integrative Review of Psychosocial Concerns Among Young African American Breast Cancer Survivors. Cancer Nurs 2018; 41:139-155. [DOI: 10.1097/ncc.0000000000000477] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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LaNoue MD, Gerolamo AM, Powell R, Nord G, Doty AMB, Rising KL. Development and preliminary validation of a scale to measure patient uncertainty: The “Uncertainty Scale”. J Health Psychol 2018; 25:1248-1258. [DOI: 10.1177/1359105317752827] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Research suggests that patient uncertainty related to experiencing symptoms may drive decisions to seek care. The only validated measure of patient uncertainty assesses uncertainty related to defined illness. In prior work, we engaged patients to describe uncertainty related to symptoms and used findings to develop the ‘U-Scale’ scale. In this work, we present results from preliminary scale reliability and validity testing. Psychometric testing demonstrated content validity, high internal consistency, and evidence for concurrent validity. Next steps include administration in diverse populations for continued refinement and validation, and exploration of the potential contribution of uncertainty to healthcare utilization.
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Ustjanauskas AE, Quinn GP, Pan TM, Rivera M, Vázquez-Otero C, Ung D, Roetzheim RG, Laronga C, Johnson K, Norton M, Carrizosa C, Muñoz D, Goldenstein M, Nuhaily S, Wells KJ. Facilitators of Survivorship Care Among Underserved Breast Cancer Survivors: a Qualitative Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:756-763. [PMID: 27385123 PMCID: PMC5219875 DOI: 10.1007/s13187-016-1064-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Research investigating facilitators of survivorship care among underserved breast cancer survivors (BCS) is sparse. This study aimed to explore facilitators of survivorship care among underserved BCS within the first 5 years following chemotherapy, radiation, or surgery for breast cancer. In-depth interviews were conducted, using a semi-structured interview guide, with underserved BCS exploring survivorship care experiences. Content analysis of the verbatim transcripts was applied, and results were summarized according to themes related to facilitators of breast cancer survivorship care. Interviews were conducted with 25 BCS. Eight main themes were identified: coordination of care; positive perceptions of health care providers; communication between patient and health care providers; financial and insurance facilitators; information, classes, and programs provided; assistance provided by organizations and health care professionals; transportation facilitators; and job flexibility. This study provides a comprehensive look at facilitators of survivorship care among underserved BCS. BCS endorsed several facilitators of their survivorship care, mainly at the interpersonal, organizational, and societal level. This study adds to the research literature on catalysts of care among underserved BCS. Results from this study are currently being used to inform a patient navigation intervention to facilitate care among this population.
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Affiliation(s)
- Amy E Ustjanauskas
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Ct., Suite 103, San Diego, CA, 92120-4913, USA
- UC San Diego Moores Cancer Center, 3855 Health Sciences Drive, La Jolla, CA, 92093-1503, USA
| | - Gwendolyn P Quinn
- Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
- University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL, 33612, USA
| | - Tonya M Pan
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Ct., Suite 103, San Diego, CA, 92120-4913, USA
- UC San Diego Moores Cancer Center, 3855 Health Sciences Drive, La Jolla, CA, 92093-1503, USA
| | - Maria Rivera
- Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
- University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL, 33612, USA
| | | | - Danielle Ung
- University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL, 33612, USA
| | - Richard G Roetzheim
- Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
- University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL, 33612, USA
| | - Christine Laronga
- Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
- University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL, 33612, USA
| | - Kenneth Johnson
- South County Oncology and Hematology, 769 Medical Center Ct., Suite 202, Chula Vista, CA, 91911-6602, USA
| | - Marilyn Norton
- South County Oncology and Hematology, 769 Medical Center Ct., Suite 202, Chula Vista, CA, 91911-6602, USA
| | - Claudia Carrizosa
- SDSU Research Foundation, 6363 Alvarado Court, Suite 250, San Diego, CA, 92120-4913, USA
| | - Dariana Muñoz
- SDSU Research Foundation, 6363 Alvarado Court, Suite 250, San Diego, CA, 92120-4913, USA
| | - Marissa Goldenstein
- Department of Psychology, San Diego State University, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120-4913, USA
| | | | - Kristen J Wells
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Ct., Suite 103, San Diego, CA, 92120-4913, USA.
- UC San Diego Moores Cancer Center, 3855 Health Sciences Drive, La Jolla, CA, 92093-1503, USA.
- Department of Psychology, San Diego State University, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120-4913, USA.
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Giesler JM, Keller B, Repke T, Leonhart R, Weis J, Muckelbauer R, Rieckmann N, Müller-Nordhorn J, Lucius-Hoene G, Holmberg C. Effect of a Website That Presents Patients' Experiences on Self-Efficacy and Patient Competence of Colorectal Cancer Patients: Web-Based Randomized Controlled Trial. J Med Internet Res 2017; 19:e334. [PMID: 29030329 PMCID: PMC5660297 DOI: 10.2196/jmir.7639] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/29/2017] [Accepted: 07/14/2017] [Indexed: 12/19/2022] Open
Abstract
Background Patients often seek other patients’ experiences with the disease. The Internet provides a wide range of opportunities to share and learn about other people’s health and illness experiences via blogs or patient-initiated online discussion groups. There also exists a range of medical information devices that include experiential patient information. However, there are serious concerns about the use of such experiential information because narratives of others may be powerful and pervasive tools that may hinder informed decision making. The international research network DIPEx (Database of Individual Patients’ Experiences) aims to provide scientifically based online information on people’s experiences with health and illness to fulfill patients’ needs for experiential information, while ensuring that the presented information includes a wide variety of possible experiences. Objective The aim is to evaluate the colorectal cancer module of the German DIPEx website krankheitserfahrungen.de with regard to self-efficacy for coping with cancer and patient competence. Methods In 2015, a Web-based randomized controlled trial was conducted using a two-group between-subjects design and repeated measures. The study sample consisted of individuals who had been diagnosed with colorectal cancer within the past 3 years or who had metastasis or recurrent disease. Outcome measures included self-efficacy for coping with cancer and patient competence. Participants were randomly assigned to either an intervention group that had immediate access to the colorectal cancer module for 2 weeks or to a waiting list control group. Outcome criteria were measured at baseline before randomization and at 2 weeks and 6 weeks Results The study randomized 212 persons. On average, participants were 54 (SD 11.1) years old, 58.8% (124/211) were female, and 73.6% (156/212) had read or heard stories of other patients online before entering the study, thus excluding any influence of the colorectal cancer module on krankheitserfahrungen.de. No intervention effects were found at 2 and 6 weeks after baseline. Conclusions The results of this study do not support the hypothesis that the website studied may increase self-efficacy for coping with cancer or patient competencies such as self-regulation or managing emotional distress. Possible explanations may involve characteristics of the website itself, its use by participants, or methodological reasons. Future studies aimed at evaluating potential effects of websites providing patient experiences on the basis of methodological principles such as those of DIPEx might profit from extending the range of outcome measures, from including additional measures of website usage behavior and users’ motivation, and from expanding concepts, such as patient competency to include items that more directly reflect patients’ perceived effects of using such a website. Trial Registration Clinicaltrials.gov NCT02157454; https://clinicaltrials.gov/ct2/show/NCT02157454 (Archived by WebCite at http://www.webcitation.org/6syrvwXxi)
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Affiliation(s)
- Jürgen M Giesler
- Section of Health Services Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bettina Keller
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tim Repke
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Hasso-Plattner-Institute, Potsdam, Germany
| | - Rainer Leonhart
- Department of Psychology, University of Freiburg, Freiburg, Germany
| | - Joachim Weis
- Clinic for Oncological Rehabilitation, UKF Reha, Department of Psycho-Oncology, University Clinic Center, Freiburg, Germany
| | - Rebecca Muckelbauer
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nina Rieckmann
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jacqueline Müller-Nordhorn
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | - Christine Holmberg
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Shilling V, Starkings R, Jenkins V, Fallowfield L. The pervasive nature of uncertainty-a qualitative study of patients with advanced cancer and their informal caregivers. J Cancer Surviv 2017; 11:590-603. [PMID: 28721677 PMCID: PMC5602354 DOI: 10.1007/s11764-017-0628-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/28/2017] [Indexed: 11/12/2022]
Abstract
PURPOSE The aim of this study was to explore the impact of extended cancer survival on broader aspects of life and wellbeing such as occupational, financial and family life for patients with advanced cancer and their nominated informal caregivers. METHODS In-depth qualitative interviews were transcribed verbatim. A thematic framework was developed from an initial process of open coding and tested iteratively as new data were collected. RESULTS Twenty-four patient-caregiver dyads with advanced ovarian (9), melanoma (9) or lung cancer (6). Patients were aged 39-84 (median 62 years) and caregivers 19-85 (median 54 years). Caregivers were the partners/spouses (15), children (5), siblings (2) and friends (2) of patients. One particular theme, 'uncertainty', encompassed many issues such as planning for the future, providing for one's family, employment and finances. Uncertainties were related to the timescale and trajectory of the disease and lack of control or ability to make plans. There were marked age effects. Accounts from within the same dyad often differed and patients and caregivers rarely discussed concerns with each other. CONCLUSIONS Both patients and their informal caregivers were challenged by the uncertainties around living with advanced cancer and the lack of a defined trajectory. This impacted many diverse areas of life. Although distressing, dyads seldom discussed these concerns with each other. IMPLICATIONS FOR CANCER SURVIVORS Uncertainty is a recurrent issue for cancer survivors and their families impacting broad aspects of their lives and their ability to move forward; however, patients and caregivers in this study rarely discussed these concerns together. Uncertainty should be discussed periodically, together, and healthcare professionals could facilitate these discussions. The use of one or more 'trigger questions' in clinic appointments may provide an opportunity to start these dialogues.
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Affiliation(s)
- Valerie Shilling
- Sussex Health Outcomes Research and Education in Cancer, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9QG, UK.
| | - Rachel Starkings
- Sussex Health Outcomes Research and Education in Cancer, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9QG, UK
| | - Valerie Jenkins
- Sussex Health Outcomes Research and Education in Cancer, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9QG, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9QG, UK
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Dhawale T, Steuten LM, Deeg HJ. Uncertainty of Physicians and Patients in Medical Decision Making. Biol Blood Marrow Transplant 2017; 23:865-869. [DOI: 10.1016/j.bbmt.2017.03.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 03/08/2017] [Indexed: 12/25/2022]
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Fairchild AJ, Heiney SP, Baruth M, Tavakoli A, Parker Hayne PD, McDaniel HL. Mediators of Social Connection in a Group Teleconference Intervention. Res Theory Nurs Pract 2017; 31:121-136. [PMID: 28482993 DOI: 10.1891/1541-6577.31.2.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Social connection has a positive influence on cancer survivorship and has been targeted in intervention work. We examined whether the formation of social connection is influenced by fear, fatalism, and isolation. METHODS We conducted a mediation analysis on data from an intervention study with African American breast cancer survivors to investigate whether fear, fatalism, and isolation conveyed effects on social connection. RESULTS Although results indicated that there were no significant mediated effects of the intervention through these variables, we garnered information about action and conceptual theories underlying the program that inform future work. IMPLICATIONS FOR PRACTICE Our insights can be considered in future interventions conducted for African American women with breast cancer during and following treatment.
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Bailey DE, Hendrix CC, Steinhauser KE, Stechuchak KM, Porter LS, Hudson J, Olsen MK, Muir A, Lowman S, DiMartini A, Salonen LW, Tulsky JA. Randomized trial of an uncertainty self-management telephone intervention for patients awaiting liver transplant. PATIENT EDUCATION AND COUNSELING 2017; 100:509-517. [PMID: 28277289 PMCID: PMC5350046 DOI: 10.1016/j.pec.2016.10.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 10/13/2016] [Accepted: 10/18/2016] [Indexed: 05/14/2023]
Abstract
OBJECTIVE We tested an uncertainty self-management telephone intervention (SMI) with patients awaiting liver transplant and their caregivers. METHODS Participants were recruited from four transplant centers and completed questionnaires at baseline, 10, and 12 weeks from baseline (generally two and four weeks after intervention delivery, respectively). Dyads were randomized to either SMI (n=56) or liver disease education (LDE; n=59), both of which involved six weekly telephone sessions. SMI participants were taught coping skills and uncertainty management strategies while LDE participants learned about liver function and how to stay healthy. Outcomes included illness uncertainty, uncertainty management, depression, anxiety, self-efficacy, and quality of life. General linear models were used to test for group differences. RESULTS No differences were found between the SMI and LDE groups for study outcomes. CONCLUSION This trial offers insight regarding design for future interventions that may allow greater flexibility in length of delivery beyond our study's 12-week timeframe. PRACTICE IMPLICATIONS Our study was designed for the time constraints of today's clinical practice setting. This trial is a beginning point to address the unmet needs of these patients and their caregivers as they wait for transplants that could save their lives.
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Affiliation(s)
- Donald E Bailey
- Duke University School of Nursing, Durham NC, USA; Duke Center for the Study of Aging and Human Development, Durham, USA.
| | - Cristina C Hendrix
- Duke University School of Nursing, Durham NC, USA; Durham Veterans Affairs Medical Center Geriatric Research, Education, and Clinical Center, Durham, USA; Duke Center for the Study of Aging and Human Development, Durham, USA.
| | - Karen E Steinhauser
- Division of General Medicine, Department of Medicine, Duke University School of Medicine, Durham, USA; Duke Palliative Care, Duke University Health System, Durham, USA; Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, USA.
| | - Karen M Stechuchak
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, USA.
| | - Laura S Porter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, USA.
| | - Julie Hudson
- Duke Transplant Center, Duke University School of Medicine, Durham, USA.
| | - Maren K Olsen
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, USA; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, USA.
| | - Andrew Muir
- Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, Durham, USA.
| | - Sarah Lowman
- Duke Palliative Care, Duke University Health System, Durham, USA.
| | - Andrea DiMartini
- University of Pittsburgh Medical Center, Departments of Psychiatry and Surgery, Starzl Transplant Institute Pittsburgh, USA.
| | - Laurel Williams Salonen
- Organ Transplantation Program, The University of Nebraska Medical Center, 983285 Nebraska Medical Center, Omaha, USA.
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, USA; Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, USA; Center for Palliative Care, Harvard Medical School, Boston, USA.
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Dawson G, Madsen L, Dains J. Interventions to Manage Uncertainty and Fear of Recurrence in Female Breast Cancer Survivors: A Review of the Literature. Clin J Oncol Nurs 2016; 20:E155-E161. [DOI: 10.1188/16.cjon.e155-e161] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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An evaluation of the effectiveness of 'Time to Adjust' a group-based cognitive-behavioural-therapy (CBT) programme for patients recovering from cancer. Ir J Psychol Med 2016; 33:235-246. [PMID: 30115158 DOI: 10.1017/ipm.2016.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES 'Time to Adjust' (TTA) is a 6-week group-based cognitive-behavioural-therapy programme for patients recovering from cancer. The TTA intervention is designed to facilitate patient's adjustment to life after cancer by enhancing existing coping skills, developing new coping skills and drawing on peer support within the context of group delivery of the programme. The study aims to explore patient psychological adjustment and to identify features of the intervention that patients find most beneficial. METHODS This retrospective repeated measures design study represents a clinical evaluation of a group-based intervention routinely delivered by the Cancer Psychology Service at University Hospital Limerick. TTA was open to patients with a cancer diagnosis who had completed their surgery, radiotherapy and chemotherapy treatment by the programme start date. Patients self-referred and suitability for the programme was assessed by pre-programme clinical interview. Pre- and post-intervention data from 59 participants was collected using self-report measures of stress and coping. A brief end-of-programme questionnaire provided descriptive feedback on patients' experience of the programme. RESULTS Findings revealed favourable trends in the psychological adjustment of patients. Self-reported depression, anxiety and negative adjustment was lower post-TTA. CONCLUSIONS This study indicates that TTA supports patients' psychological recovery from cancer with multiple components of the programme facilitating psychological adjustment. Findings support the delivery of group-based therapeutic interventions for this patient group. Future research could use in-depth post-intervention interviews for a richer understanding of the programme benefits. Longer-term follow-up in could examine the degree to which benefits are maintained over time.
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A pilot randomized controlled trial testing a minimal intervention to prepare breast cancer survivors for recovery. Cancer Nurs 2016; 38:E48-56. [PMID: 24831043 DOI: 10.1097/ncc.0000000000000152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Interventions addressing cancer survivors' posttreatment concerns can be time-intensive and require specialized staff. Research is needed to identify feasible minimal intervention strategies to improve survivors' quality of life after treatment. OBJECTIVES The objective of this study was to evaluate the feasibility and short-term impact of a minimal clinic intervention on breast cancer survivors' quality of life, unmet needs, distress, and cancer worry. INTERVENTIONS/METHODS In this randomized controlled pilot trial, we enrolled breast cancer survivors at the end of treatment and administered baseline surveys. Participants were randomized to study arm (4-week video plus educational booklet intervention group and usual care group) and completed follow-up surveys at 10 weeks. Linear regression was used to examine intervention effects on quality of life outcomes controlling for clinical and demographic factors. Open-ended questions were used to examine program satisfaction and obtain feedback to improve the intervention. RESULTS We enrolled 92 survivors in the trial. Participants rated the intervention highly and reported feeling less isolated and having more realistic expectations about their recovery after completing the program. Despite positive qualitative findings, no significant intervention effects were observed for quality of life, unmet needs, distress, or cancer worry in unadjusted or adjusted analyses. CONCLUSIONS Future research is needed to define optimal intervention elements to prepare breast cancer survivors for the posttreatment period. IMPLICATIONS FOR PRACTICE Effective survivorship interventions may require more intensive components such as clinical input and longer follow-up periods.
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Uncertainty and Personal Growth Through Positive Coping Strategies Among Chinese Parents of Children With Acute Leukemia. Cancer Nurs 2016; 39:205-12. [DOI: 10.1097/ncc.0000000000000279] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Turkman YE, Kennedy HP, Harris LN, Knobf MT. "An addendum to breast cancer": the triple negative experience. Support Care Cancer 2016; 24:3715-21. [PMID: 27037812 DOI: 10.1007/s00520-016-3184-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 03/21/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE The triple negative breast cancer (TNBC) subtype, known to be aggressive with high recurrence and mortality rates, disproportionately affects African-Americans, young women, and BRCA1 carriers. TNBC does not respond to hormonal or biologic agents, limiting treatment options. The unique characteristics of the disease and the populations disproportionately affected indicate a need to examine the responses of this group. No known studies describe the psychosocial experiences of women with TNBC. The purpose of this study is to begin to fill that gap and to explore participants' psychosocial needs. METHOD An interpretive descriptive qualitative approach was used with in-depth interviews. A purposive sample of adult women with TNBC was recruited. Dominant themes were extracted through iterative and constant comparative analysis. RESULTS Of the 22 participants, nearly half were women of color, and the majority was under the age of 60 years and within 5 years of diagnosis. The central theme was a perception of TNBC as "an addendum" to breast cancer. There were four subthemes: TNBC is Different: "Bottom line, it's not good"; Feeling Insecure: "Flying without a net"; Decision-Making and Understanding: "A steep learning curve"; and Looking Back: "Coulda, shoulda, woulda." Participants expressed a need for support in managing intense uncertainty with a TNBC diagnosis and in decision-making. CONCLUSIONS Women with all subtypes of breast cancer have typically been studied together. This is the first study on the psychosocial needs specifically of women with TNBC. The findings suggest that women with TNBC may have unique experiences and unmet psychosocial needs.
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Affiliation(s)
- Yasemin E Turkman
- University of Virginia School of Nursing, 202 Lancaster Way, Charlottesville, VA, 22903, USA.
| | | | - Lyndsay N Harris
- Division of Hematology/Oncology, Department of Medicine, Case Western University Medical School, Cleveland, OH, 44106, USA
| | - M Tish Knobf
- Yale School of Nursing in West Haven, West Haven, CT, USA
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Piredda M, Migliozzi A, Biagioli V, Carassiti M, De Marinis MG. Written Information Improves Patient Knowledge About Implanted Ports. Clin J Oncol Nurs 2016; 20:E28-33. [PMID: 26991720 DOI: 10.1188/16.cjon.e28-e33] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Implanted ports are frequently used for patients with cancer who require IV chemotherapy. In addition to verbal communication with healthcare providers, patients with cancer may benefit from written information. OBJECTIVES This pre/post study evaluated the effectiveness of an informational booklet by improving knowledge about ports and assessed the history, need, and preferences for information. METHODS Patients with cancer who had an implanted port for at least six months were provided with an informational booklet about ports. Knowledge about ports was tested before (T0) and after (T1) patients read the booklet. Information needs and preferred sources of information were also assessed at T0. Patients reported their opinions of the booklet at T1. FINDINGS The sample included 129 patients; 49% were male, with a mean age of 59 years. Most patients want to receive as much information as possible, preferably before the port is implanted. However, 43% of patients reported they had received little information about ports. After reading the booklet, patients' knowledge, which was measured with a validated seven-item instrument, improved from T0 to T1 (p < 0.001, effect size = 0.689). Oncology nurses, by providing written and verbal information, can increase patients' knowledge about implanted ports and their confidence in caring for their ports.
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Mehrabi E, Hajian S, Simbar M, Hoshyari M, Zayeri F. The Lived Experience of Iranian Women Confronting Breast Cancer Diagnosis. J Caring Sci 2016; 5:43-55. [PMID: 26989665 PMCID: PMC4794544 DOI: 10.15171/jcs.2016.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 09/17/2015] [Indexed: 02/01/2023] Open
Abstract
Introduction: The populations who survive from
breast cancer are growing; nevertheless, they mostly encounter with many cancer
related problems in their life, especially after early diagnosis and have to
deal with these problems. Except for the disease entity, several socio-cultural
factors may affect confronting this challenge among patients and the way they
deal with. Present study was carried out to prepare clear understanding of
Iranian women's lived experiences confronting breast cancer diagnosis and coping
ways they applied to deal with it. Methods: This study was carried out by using
qualitative phenomenological design. Data gathering was done through purposive
sampling using semi-structured, in-depth interviews with 18 women who survived
from breast cancer. The transcribed interviews were analyzed using Van Manen’s
thematic analysis approach. Results: Two main themes were emerged from the
interviews including "emotional turbulence" and "threat control". The first,
comprised three sub themes including uncertainty, perceived worries, and living
with fears. The second included risk control, recurrence control, immediate
seeking help, seeking support and resource to spirituality. Conclusion: Emotional response was the immediate
reflection to cancer diagnosis. However, during post-treatment period a variety
of emotions were not uncommon findings, patients' perceptions have been changing
along the time and problem-focused coping strategies have replaced. Although
women may experience a degree of improvement and adjustment with illness, the
emotional problems are not necessarily resolved, they may continue and gradually
engender positive outcomes.
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Affiliation(s)
- Esmat Mehrabi
- Department of Midwifery, Faculty of Nursing & Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sepideh Hajian
- Department of Nursing, Department of Midwifery And Reproductive Health, Faculty of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoomeh Simbar
- Department of Nursing, Department of Midwifery And Reproductive Health, Faculty of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hoshyari
- Department of Radiation Oncology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Zayeri
- Department of Biostatistics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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