Theological Strategies,Constructing Meaning,and Coping with Breast Cancer: A Qualitative Study

Examines ways in which the experience of breast cancer has impacted the theology and the ability to create meaning for 10 female breast cancer patients. Discusses three theological strategies emerging from participant interviews: 1) God causes cancer for a purpose, 2) God does not cause cancer, but there can still be meaning in illness, and 3) cancer is just part of life and has no inherent meaning, though meaning can be constructed through the experience.     

Measurement of Depressive Symptoms in Women With Breast Cancer and Women With Clinical Depression: A Differential Item Functioning Analysis

Differential item functioning (DIF) analyses of the Beck Depression Inventory-II (BDI-II) were conducted on samples of 267 women with breast cancer and 294 women with clinical depression. Patterns of items in which there was significant and nonsignificant DIF were identified using statistical tests and measures of DIF effect size. At the most general level, 15 of 21 BDI-II items were associated with nontrivial DIF suggesting that the item responses of these samples do not reflect the same underlying construct. Factor analyses of the BDI-II using a psychometrically defensible method for item level factor analysis supported the conclusions from the DIF analyses. These findings suggest that researchers and practitioners should apply caution when interpreting self-report depression symptoms in breast cancer patients.     

Are American children's problems still getting worse? A 23-year comparison

Child Behavior Checklists were completed in home interviews by parents of 7–16-year-olds in 1976, 1989, and 1999. Competence scores decreased from 1976 to 1989, but increased in 1999. Problem scores increased from 1976 to 1989 and decreased in 1999 but remained higher than in 1976. Items, empirically based scales, and DSM-oriented scales showed similar patterns for demographically similar nonreferred samples assessed in 1976, 1989, and 1999 and for national samples that included referred children assessed in 1989 and 1999. For the 114 problem items that were common to the 1976, 1989, and 1999 assessments, the Q correlation was .98 between the mean scores on the 114 items in 1976 versus 1989 and was .94 between the mean scores on the 114 items in 1976 vs. 1999. This indicated very high stability in the rank ordering of item scores across intervals up to 23 years. For all children, the 1-year prevalence rate for mental health services use was 13.2% in 1989 versus 12.8% in 1999. For children with deviant Total Problems scores, the 1989 prevalence for service use was 30.5 versus 26.6% in 1999. Neither difference was statistically significant.     

The Prophylactic Mastectomy Dilemma: A Support Group for Women at High Genetic Risk for Breast Cancer

The goal of this pilot study was to test the usefulness of a six session psychoeducational support group for women at high genetic risk for breast cancer who were considering prophylactic mastectomy. The themes of the group sessions included overestimation of and anxiety about risk; desire for hard data; the emotional impact of watching a mother die of breast cancer; concerns about spouse reactions; self- and body image; the decision-making process; and confusion over whom to trust in decision making. Both the participants and the multidisciplinary leaders concluded that as a supplement to individual counseling, a support group is a beneficial and cost-effective treatment modality. Recommendations for the optimal format for such a group are described.     

Intrusive memories and depression in cancer patients

Matched samples of depressed and nondepressed cancer patients were interviewed about past life events, particularly experiences of death and illness. They identified and described any spontaneous intrusive visual memories they had experienced in the past week corresponding to these events. About one quarter reported such memories and, as predicted, the majority of intrusive memories concerned illness, injury and death. The mean levels of intrusion and avoidance were equivalent to patients with post-traumatic stress disorder. Consistent with prediction, depressed patients reported significantly more intrusive memories than controls, and described the memories as typically beginning with or being exacerbated by the onset of depression. Greater numbers of intrusive memories were associated with more maladaptive coping, and greater avoidance with deficits in autobiographical memory functioning.     

Cancer Risk Assessment and Genetic Counseling in an Academic Medical Center: Consultands' Satisfaction, Knowledge, and Behavior in the First Year

In 1995, we formally established a multifaceted cancer genetics program of clinical services, research, and education at a general academic medical center. In the first year, 58 families, mostly physician referred, received cancer risk assessment and genetic counseling for a family and/or medical history of cancer. The primary reasons for seeking consultation were to determine their risk or their offspring's risk for developing certain cancers and to inquire about the availability of DNA testing for predisposition to breast, ovarian, or colon cancers. To assess the level of satisfaction with program services, 51 consultands (22% with a personal history of cancer) were interviewed independently by telephone 3–12 months after the session. One goal of the survey was to improve program service. Ninety percent of respondents reported that the consultation was worth their time and money. Forty-two percent stated that their anxiety related to their cancer risk had decreased following counseling and 56% indicated no change. Recall of exact numerical risk was poor and one-third could not remember hearing any risk estimate. More respondents would recommend the service to friends (90%) than to family members (75%). Overall, the service was positively received by the majority of patients.     

Nonlinearity in the Epidemiology of Complex Health and Disease Processes

Theoretical Medicine and Bioethics - The challenges posed by chronic illness have pointed out to epidemiologists the multifactorial complex nature of disease causality. This notion has been...     

Is the conflict model of decision making applicable to the decision to be screened for cervical cancer? A field study

The present study examined aspects of the conflict model of decision making (Janis and Mann, 1977) in the context of attending for a screening test for cervical cancer. In addition, the ability of decision coping styles as measured by Mann's (1982) Decision Making Questionnaire II (DMQ II) to predict screening status was examined. Three hundred and two women answered a questionnaire operationalizing the constructs in the conflict model about their beliefs and knowledge of cervical cancer and the Pap smear test. Four screening categories were identified: never screened, not screened in the last two years (overdue), screened in last two years and initiated the test, and screened in last two years and recruited to have the test. Differences in the decision processes of these groups were examined. Women who were overdue for their Pap test showed greater decisional conflict and were more likely to adopt a defensive avoidance coping pattern than those who had been screened in the last two years. Regression analyses exploring predictors of decisional stress and defensive avoidance for each group, except the never screen, showed that the model's suggested pathways were evidenced among the Overdue Group. Results failed to find any association between coping styles as measured by the DMQ II and screening status. Implications of these findings are discussed.     

Neuropsychological changes in children with cancer: The treatment of missing data in longitudinal studies

Researchers conducting longitudinal studies with children or adults are inevitably confronted with problems of attrition and missing data. Missing data in longitudinal studies is frequently handled by excluding from analyses those cases for whom data are incomplete. This approach to missing data is not optimal. On the one hand, if data are missing at random, then dropping incomplete cases ignores information collected on those cases that could be used to improve estimates of population parameters (e.g., means, variances, covariances, and growth rates) and improve the power of significance tests of statistical hypotheses. On the other hand, if data are not missing at random, then dropping incomplete cases leads to biased parameter estimates and hypothesis tests that may be internally and externally invalid. This study uses three years of follow-up data from a longitudinal investigation of neuropsychological outcomes of cancer in children to demonstrate the problems presented by missing data in repeated measures designs and some solutions. In evaluating potential biasing effects of attrition, the study extends previous research on neuropsychological outcomes in pediatric cancer by inclusion of patients whose disease had relapsed, and by comparison of surviving and nonsurviving patients. Although the data presented have specific relevance to the study of neuropsychological outcome in pediatric cancer, the problems of missing data and the solutions presented are relevant to a wide variety of diseases and conditions of interest to researchers in child and adult neuropsychology.