The effects of mortality reminders on posttraumatic growth and finding benefits among patients with life-threatening illness and their caregivers

Individuals confronted with a life-threatening illness often report posttraumatic growth (PTG) or finding benefits in disease. These positive evaluations of personal strength, perceptions of improved personal relations and new possibilities may represent a defensive response (cf Janus-face model). Three studies investigated the effects of mortality reminders on reports of PTG or benefit findings among people living with life-threatening illness or their caregivers. 80 people living with HIV (Study 1), 164 breast cancer survivors (Study 2) and 50 family caregivers for a patient with Huntington Disease (Study 3) were randomly assigned to the experimental (mortality reminders) or control conditions. Across three studies, those exposed to mortality reminders reported lower PTG or benefit finding, compared to the controls. These effects were moderated by time elapsed since diagnosis: mortality reminders led to lower PTG/benefit finding among those who received the diagnosis more recently. The results provide an insight into the defensive character of PTG/finding benefits in illness and changes in the function of these beliefs over time elapsing since diagnosis.     

Manifestations of anxiety and coping strategies in patients with metastatic lung cancer and their family caregivers: a qualitative study

Objective: Advanced non-small cell lung cancer (NSCLC) is common, deadly, and associated with impairing anxiety for patients and caregivers who often co-experience similar symptoms that can vary together over time. We aimed to discover themes as to how NSCLC patients and caregivers express and cope with anxiety.

Design: Semi-structured interviews of patient-caregiver dyads (N?=?21), coded using NVivo Software.

Main Outcome Measures: Open-ended questions on anxiety mutuality, giving or receiving care, communication, and the most difficult aspects of having or caring for someone with Stage IV NSCLC.

Results: Analyses revealed that patients and caregivers were linked psychologically, co-experiencing symptoms of distress or coping, rising and falling together. Shared patient and caregiver themes emerged of cognitive, behavioural and physiological manifestations of anxiety and coping mechanisms.

Conclusions: Patient and caregiver expressions of anxiety and coping methods mapped onto the cognitive-behavioural model, implying potential use of cognitive behavioural therapy (CBT) to address these issues. This expands understanding of symptoms and coping strategies in NSCLC, explores patient-caregiver interaction, and confirms the need for future clinical intervention. Future research should focus on development and dissemination of CBT-based dyadic interventions addressing anxiety in NSCLC patients and caregivers.     

Psychological support needs of patients with head and neck cancer and their caregivers: A qualitative study

Objective: The aim of this study was to explore the psychological support needs of patients with head and neck cancer (HNC) and their caregivers. The appropriate timing, length, format and content of sessions were also investigated.

Design: Eighty-three patients with HNC and 73 of their caregivers completed questionnaires at diagnosis. Follow-up questionnaires were mailed to patients six months later.

Main outcome measures: Free text-comments to open-ended questions in the questionnaires were analysed using an inductive thematic approach with coding and theme development directed by the content of responses. This was used to determine psychological support needs both at diagnosis and at six month follow-up.

Results: Patients described ‘just being there’, empathy, maintaining normality and practical support as helpful from family/friends. They desired information, honesty, positivity and empathy from clinical staff. Formal psychological support was desired by approximately 40% of patients and caregivers, particularly early after diagnosis and during treatment. Most participants desired face to face sessions, providing individualised information and coping strategies.

Conclusion: The results of this study suggest that psychological interventions for patients with HNC and their caregivers should be delivered early after diagnosis in face to face sessions, presenting honest and factual information about the disease and coping strategies.     

Communicating BRCA1/2 genetic test results within the family: A qualitative analysis

Genetic testing for BRCA1/2 mutations associated with hereditary breast and ovarian cancer reveals significant risk information about one's chances of developing cancer. It is important to study communication processes in families where members are undergoing genetic testing because the information received is crucial not just to the individual concerned but also to other members of the biological family. This study investigates family communication of BRCA1/2 test results from both the informants’ and recipients’ perspectives. A total of 10 female patients and 22 of their relatives were interviewed. Patients’ and their relatives described feelings of responsibility for sharing genetic information within the family to enable others to reduce their risks of developing cancer. However, there were limits to an individuals’ responsibility once key family members had been informed, who then had to take responsibility for continuing dissemination of information. Whilst there was an implicit responsibility to inform the family of a mutation, information was edited or withheld in the best interest of relatives, dependent upon their perceived emotional readiness, resilience and current life stage and circumstances. The pre-existing family culture and the impact previous cancer diagnoses had upon the family also influenced the process of communication. Findings are discussed in relation to extant literature and implications for clinical practice are considered.     

Experiences of mandated reporting among family therapists: a qualitative analysis

Mandated reporting of child abuse by Family Therapists (FTs) has been examined by the authors in two previous studies. The first study found that mandated reporting issues negatively affected FTs abilities to maintain a systemic focus. The second study surveyed types and frequencies of negative experiences of FTs with mandated reporting. A 46-item questionnaire was administered to 101 FTs. Results were significant for four of the items. The respondents also provided 116 comments related to mandated reporting experiences. This study provides a qualitative analysis of the written comments of the respondents regarding their xexperiences with mandated reporting of child abuse.     

Finding benefit in breast cancer: Relations with personality,coping, and concurrent well-being

Cancer patients experience positive as well as adverse consequences from cancer diagnosis and treatment. The work reported here was part of an effort to characterize the experiences of benefit finding in breast cancer patients. A sample of 230 early-stage breast cancer patients completed a set of benefit finding items in the year post-surgery. This measure was then related to measures of concurrent coping, several aspects of psychosocial well-being, demographic variables, and several other personality traits. Benefit finding related positively to trait optimism, and to positive reframing and religious activity as coping reactions. Benefit finding related inversely to emotional distress, but was relatively unrelated to other measures of well-being.     

The burden of filial piety: A qualitative study on caregiving motivations amongst family caregivers of patients with cancer in Singapore

Objective. This study explores (1) the motivations and challenges facing family caregiving for cancer in Singapore and (2) suggests a possible framework to guide culturally sensitive future work on caregivers.

Design. Twenty caregivers of patients being treated for cancer at a public hospital in Singapore were interviewed. A semi-structured interview format and inductive thematic analysis were used to analyse the data. Caregivers were asked about their motivations for caregiving and the challenges they faced.

Results. Caregivers’ motivations grouped into three categories: personal value and fulfilment, giving care because of societal expectations such as filial piety, and practical need. Challenges were grouped into interpersonal challenges, disclosure and finding balance. Caregivers with different primary motivations varied in their responses to these challenges. More autonomous caregivers cited learning points and reprioritised more effectively than less autonomous caregivers, who reported more internal conflict and less control over their situation.

Conclusions. In Singapore and Asia, sociocultural values of family caregiving are not uniformly experienced as positive, and may be burdensome for caregivers who give care primarily for extrinsic motivations. As family caregiving needs increase, targeted psychosocial support for caregivers with less autonomous behavioural orientations may pre-empt caregiver burnout and burden.     

Coping strategies and quality of life in women with advanced breast cancer and their family caregivers

Abstract

This study examines the effects of personal resources of both heart patients and their close social partners on patients' coping and quality of life. Generalized personal resources (self-efficacy beliefs, dispositional optimism, self-regulation competence) and outcomes were assessed by questionnaire 1–3 days before surgery (n = 122) and again six months later (n= 50). Outcome variables were coping styles, social resources (social support and social integration), emotional states, and further measures of quality of life. Patients' personal resources were dominant in the prediction of most of the outcomes. Partners' resources were uniquely related to social support, social integration, and quality of life as perceived by the patients. Further, partners' personality resources predicted changes in patients' loneliness and energy levels during the six-month interval.     

Embodying sexual subjectivity after cancer: A qualitative study of people with cancer and intimate partners

Research has increasingly recognised the profound impact that cancer can have upon embodied subjectivity. However, there has been little acknowledgement of the centrality of sexuality to subjectivity, and marginalisation of the experiences of intimate partners of people with cancer. This Australian qualitative study explores the post-cancer experiences of embodied sexual subjectivity for 44 people with cancer (23 women and 21 men) and 35 partners of people with cancer (18 women and 17 men) across a range of cancer types and stages. Semi-structured interviews were analysed with theoretical thematic analysis, guided by a post-structuralist approach to sexual subjectivity as a dynamic process of becoming that can change over time, and by Williams’ [(1996). The vicissitudes of embodiment across the chronic illness trajectory. Body and Society, 2, 23–47] framework on post-illness embodiment. Participants took up the following post-cancer subject positions: ‘dys-embodied sexual subjectivity’ – characterised by bodily betrayal, sexual loss, lack of acceptance, depression, and anxiety; ‘re-embodied sexual subjectivity’ – characterised by greater sexual confidence, acceptance, the exploration of non-coital sexual practices and increased relational closeness; and ‘oscillating sexual subjectivity’ – involving a shift between states of sexual dys-embodiment and sexual re-embodiment. The findings point to the importance of focusing on the sexual health of people with cancer and partners across the cancer trajectory.     

Physical and mental health trajectories of cancer patients and caregivers across the year post-diagnosis: a dyadic investigation

Objective: Evidence suggests interdependence between cancer patients’ and their caregivers’ physical and mental health. However, the extent to which caregivers’ health relates to their patients’ recovery, or patients’ health affects their caregivers’ outcomes, is largely unknown. This dyadic investigation reports the relations between cancer patients’ and their caregivers’ physical and mental health trajectories during the year following diagnosis.

Design: Ninety-two colorectal cancer patient–caregiver dyads completed questionnaires at 2, 6 and 12 months post-diagnosis.

Outcome measures: Self-reported physical and mental health using the Medical Outcomes Study Short Form Health Survey-12.

Results: Patients reported improved physical health over the year following their diagnosis, whereas caregivers reported declining physical health. Patients with lower mental health at diagnosis had stagnated physical health recovery. Caregivers’ physical health declined most noticeably among those reporting low mental health at diagnosis and whose patients reported low physical health at diagnosis.

Conclusion: Findings suggest targeting health interventions to cancer patients and caregivers reporting poor mental health at diagnosis may mitigate their long-term physical morbidity. Limited evidence of dyadic interdependence between patients’ and caregivers’ physical and mental health trajectories suggests future studies are warranted to identify psychosocial and medical characteristics moderating the relations between patients’ and caregivers’ health.     

Multiple family groups for adult cancer survivors and their families: a 1-day workshop model

With marked advances in early detection and aggressive multimodality treatment, many adult cancers are now associated with good prognoses for disease-free survival. A burgeoning literature examining posttreatment quality-of-life issues has highlighted the numerous challenges experienced by patients and families in the aftermath of cancer treatment, further underscoring a need for new family-based psychosocial support interventions for cancer survivors and their families. This paper describes the clinical protocol for one such intervention, a 1-day "workshop" version of a multiple family group (MFG) for head and neck cancer survivors and their families. Data are reported from our experiences in running five 1-day workshops. Families uniformly reported that they were highly satisfied with their MFG participation, leading us to conclude that the abbreviated 1-day MFG model we are advocating is a promising family-focused support intervention for cancer survivors and their families.     

Exploring correlations between positive psychological resources and symptoms of psychological distress among hematological cancer patients: a cross-sectional study

Hematological cancer patients experience high levels of psychological distress during diagnoses and intensive treatments. The aim of the present study is to explore the effects of positive psychological resources on depressive and anxiety symptoms in hematological cancer patients. This survey was conducted in a hospital during the period from July 2013 to April 2014. A total of 300 inpatients were recruited and finally 227 of them completed the questionnaires. Questionnaires included demographic and clinical variables, the Center for Epidemiologic Studies Depression Scale, the Self-Rating Anxiety Scale, the Life Orientation Scale-Revised, the General Perceived Self-Efficacy Scale, and the Resilience Scale-14. Results showed that the prevalence of depressive and anxiety symptoms was 66.1 and 45.8%, respectively. Both optimism (β = ?.479, p < .001) and resilience (β = ?.174, p < .05) were negatively associated with depressive symptoms, and optimism (β = ?.393, p < .001) was negatively associated with anxiety symptoms. However, resilience (β = ?.133, p > .05) was not significantly associated with anxiety symptoms, and self-efficacy was not significantly associated with depressive (β = ?.032, p > .05) or anxiety symptoms (β = ?.055, p > .05). The results suggest that hematological cancer patients who possess high levels of positive psychological resources may have fewer symptoms of psychological distress. The findings indicate that enhancing positive psychological resources can be considered in developing intervention strategies for decreasing depressive and anxiety symptoms.     

The role of meaning in gastric cancer patients: relationships among meaning structures,coping, and psychological well-being

ABSTRACT

Background and Objectives: Research demonstrates that the experience of cancer invariably violates patients’ meaning structures, prompting them to use coping strategies to alleviate stress and enhance well-being. The current study aimed to examine the mediating effects of coping strategies in the relationship between global and situational meaning and psychological well-being in gastric cancer patients.

Design and Method: One hundred eighty-seven patients (96 women and 91 men) with gastric cancer completed questionnaires measuring meaning in life, changes of beliefs and goals, coping, and psychological well-being. Participants were between 27 and 82 years of age. They were diagnosed with gastric cancer from 1 to 3.2 years ago. Using Structural Equation Modeling, both the direct and indirect associations between meaning structures, coping, and psychological well-being were examined.

Results: Meaning in life exerted significant indirect effects on psychological well-being through three coping strategies: problem-, emotion-, and meaning-focused. The relationship between changes of beliefs and goals and psychological well-being was also mediated by coping.

Conclusions: Findings suggest that coping strategies are mediators in the relationship between global and situational meaning and psychological well-being. They also provide empirical evidence that in severe cancer-related stress conditions both meaning structures and coping strategies influence patients’ psychological well-being.