“Social Separation” Among Women Under 40 Years of Age Diagnosed with Breast Cancer and Carrying a BRCA1 or BRCA2 Mutation

We conducted an exploratory, qualitative study investigating experiences of women who had developed breast cancer under the age of 40 and who were identified as BRCA1 or BRCA2 mutation carriers. These germline mutation carriers face an increased lifetime risk of a second primary breast cancer and an increased risk for a primary ovarian cancer. Thirteen women who fit this criteria participated in three focus groups conducted at a major cancer center in the UK during Spring 2003. We asked broad, open-ended questions that allowed for a wide range of responses about their cancer and genetic testing experiences, physical and psycho-social concerns, family and partner reactions and their need for social support. The women expressed feelings of devastation, loneliness, feeling different and isolation, ambivalence about having to support family members, worries about partner’s anxiety and depression, and anxiety about talking to family members, especially children. These feelings were stronger after the cancer diagnosis and compounded by the genetic test results that occurred at a later time. We also found that, at least temporarily, the women experienced what we call “social separation”—emotional distance from, or dissonance with groups they interact with or are part of, e.g., family and friends, frequently leading to a reduction in communication or a change in previously unstated, but accepted normal interaction. We concentrate on a few characteristics of social separation—feelings of aloneness, isolation and separation, use of silence and verbal discretion, the relationship between estrangement and kinship interaction and norm disruption, and are looking at social patterns of interpersonal relationships that may occur when risk and illness statuses are new and framing and feeling rules have not as yet been clearly developed due to a cultural lag.     

A Comparison of Patient Satisfaction with Telehealth and On-Site Consultations: A Pilot Study for Prenatal Genetic Counseling

Many different fields of medicine are now utilizing video conferencing as a means to offer consultations to individuals in rural communities. However, there is a lack of published literature regarding the use of telehealth in clinical genetics and, specifically, in genetic counseling. Those experiences that have been reported mostly centered on cancer genetic counseling, sickle cell anemia consultation and care, or pediatric/adult genetic assessment. In these studies, the patients reported an overall satisfaction with telehealth, signifying that this type of communication may play an important role in the future of medicine. This pilot study compared patient satisfaction with prenatal genetic counseling performed via video conferencing versus that performed on-site. The results show that there was a high level of patient satisfaction when video conferencing was used to conduct prenatal genetic counseling consultations, suggesting that telehealth can be utilized as a means to offer this service to underserved populations. Telehealth refers to any type of communication technology in health care, distance education, transmission of radiological images, etc. The actual screening, diagnosis, treatment, management, etc., using distance technology is referred to as telemedicine.The term on-site indicates that genetic counseling was performed in person, rather than using telehealth.     

Facilitating Family Communication About Predictive Genetic Testing: Probands’ Perceptions

The responsibility of informing relatives that predictive genetic testing is available often falls to the proband. Support is required during this process, however the perceived utility of genetic counseling and other strategies to facilitate communication have not been explored. We investigated the experiences of 12 individuals with hereditary nonpolyposis colorectal cancer (HNPCC) in a semistructured telephone interview. Respondents informed their immediate family about the availability of genetic testing, however many more-distant relatives were not directly informed. Respondents were mostly satisfied with the way they told family members about testing and had mixed views about the usefulness of genetic counseling. Gender differences were observed, with most men expressing a need for guidance or support in communicating to relatives. Letters and booklets were thought to enhance the quality of information but the provision of further aids is unlikely to increase the number of relatives made aware of predictive testing by the proband.     

Breast Cancer and the Descent: The Loss and Return of Spring

This article approaches breast cancer as an initiation into a healing process that provides the opportunity for the transformation of a basic fault in the personality. Breast cancer will be approached as a metaphor alerting one to a crises of interiority, a loss of connection to ones inner dimension and ones feminine consciousness. This metaphor contains both the loss of the connection and the possibility of its recovery. The process involves a velocity of descent very difficult to endure; it involves a profound and accelerated unraveling of the rationality that previously served as a container stabilizing the ego. The perilousness of the descent imagery reflects the precipitousness of this unraveling. The precipitous descent is seen as an attempt of the soul to heal and reintegrate the personality by revisiting and illuminating a space abandoned long ago. The integration of this part of the personality results in a return of generativity, energy, and creativity.     

Factors Influencing Men's Interest in Gene Testing for Prostate Cancer Susceptibility

Interest in genetic testing for inherited cancer susceptibility is high in the general population. Women at risk for BRCA1 and BRCA2 mutations represent the best-studied population undergoing genetic testing for cancer susceptibility. However, it is unclear whether factors influencing interest in genetic testing in women are directly applicable to men. We designed a study to examine factors associated with men's interest in genetic testing to identify prostate cancer susceptibility. Our sample consisted of 267 men present in waiting rooms of a urology clinic in an urban area. We examined whether the concept of monitoring could be used to predict the interest of men in a genetic test for prostate cancer susceptibility. Our results indicated that monitoring trait was positively associated with interest in genetic testing in these men, but principally for patients rather than nonpatients. Moreover we found that monitoring was associated with over estimation of risk in those men with prostate cancer. Other factors found to influence interest in genetic testing included recommendation by a doctor, family history of prostate cancer, and cost. This study indicated that interest in genetic testing and estimation of risk is influenced by a complex interaction between both psychological factors (monitoring) and nonbehavioral factors (such as patient status, cost, and doctor recommendation).     

集体心理干预对癌症患者应对方式影响的研究

为了探索集体心理干预对癌症患者应对方式的影响,本研究在90名癌症患者中随机选取46人进行干预研究。为考察干预效果,在干预后分别以医学应对方式问卷各维度因子的前测得分为协变量,以医学应对方式问卷各维度因子的后测得分为因变量,进行2(分组:实验组、对照组)×2(性别:男、女)×3(年龄:低龄组、中龄组、高龄组)的三因素协方差分析。结果表明,经过集体心理干预的实验组在应对方式各分量表上的得分要显著高于对照组,集体心理干预在性别和年龄上不存在显著差异。研究结果表明集体心理干预能够有效地改善癌症患者的应对方式。     

Impact of the telephone motivational interviewing on the colorectal cancer screening participation. A randomized controlled study

IntroductionWhile high participation rates ensure the cost-effectiveness of colorectal cancer screening programs, it is well known that postal requests do not achieve acceptable levels of participation.ObjectiveThis randomized controlled study aimed to test the impact of individualized phone counseling to prompt people aged 50 to 74 to take a colorectal cancer test.MethodTwo phone strategies were compared. The first involved computer-aided individualized counseling while the second was based on motivational interviewing. A total of 49,972 people were randomly assigned to a control group (CG) and to the individualized counseling (IC) and motivational interviewing (MI) telephone groups.ResultsA simple call doubled the participation rate per protocol (19.2% > 9.2%; p < .001; r = .131; OR = 2.374), and tripled it when the interview was conducted (30.4% > 9.2%; p < .001; r = .219; OR = 4.321). In an intention-to-treat analysis, the benefit of calling by phone remained even higher than postal requests (10% > 9.2%; p < .01; r = .014; OR = 1.103). However, there was no impact of the type of interview on participation rates.ConclusionThe results are discussed for future research.     

Perceived positive and negative consequences after surviving cancer and their relation to quality of life

Surviving childhood cancer has multiple implications on both physical and psychological domains of the individual. However, its study and possible effects on health‐related quality of life (HRQoL) outcomes of adolescent survivors has been understudied. The objective of this study was twofold; to assess positive and negative cancer‐related consequences (psychosocial and physical) in a sample of adolescent cancer survivors and to explore their relationship with HRQoL outcomes. Forty‐one participants answered two questions about positive and negative consequences in the aftermath of cancer and filled in the KIDSCREEN‐52 self‐reported version. Data were analysed using mixed methods approach. Overall, 87.8% of the studied sample identified positive consequences and 63.4% negative consequences in survivorship. Four positive categories and five negative categories with regard to cancer‐related consequences were found. Changed perspectives in life narratives seem to be the positive consequence more related to HRQoL (physical well‐being, mood & emotions, autonomy, social support & peers), followed by useful life experience (physical well‐being, autonomy, social support & peers). Psychological impact was the most referred negative consequence with a significant detrimental effect on social support and peers HRQoL dimension. Even if the majority of survivors reported benefit finding in the aftermath of cancer, concomitant positive and negative consequences have been found. However, findings only reveal a significant relationship between positive narratives and HRQoL, and negative consequences do not seem to have a significant influence on overall HRQoL in survivorship.     

The Impact of Cancer on Psychological and Social Outcomes

Cancer is now the biggest cause of mortality worldwide. Although the debilitating physical symptoms of cancer have long been known, the psychological and social impacts of cancer have become the subject of examination only relatively recently. The psychological outcomes that have been examined are primarily negative emotional variables, e.g., anxiety, but emerging research has focused on positive emotional variables, e.g., post‐traumatic growth, or cognitive outcomes. In this article, we provide a synthesis of reviews that have addressed the psychosocial impact of cancer. The framework for this synthesis is provided by a conceptualisation in which the presence of cancer impacts on psychosocial outcomes either directly or via mediating variables, including physical symptoms and treatment, and that this effect may be moderated by several variables, some characteristic of the person with cancer (demographic or personality‐related variables) and some characteristic of their environment (social support and medical variables). We also briefly examine the impact of cancer on the broader family unit following cancer diagnosis, treatment, survivorship and bereavement. We conclude that the heterogeneity of the cancer experience highlights the need for theoretically driven research and consistency in measurement approaches to determine mechanisms by which cancer exerts influence on psychosocial outcomes. This would allow development and delivery of targeted psychological interventions and a clearer delineation of the roles of the various parties, including clinical psychologists, family members and policymakers.     

Associations of spontaneous self-affirmation with health care experiences and health information seeking in a national survey of US adults

Objective: Self-affirming – such as by reflecting on one’s strengths and values – reduces defensiveness to threatening information, reduces negative effects of stereotype threat and promotes prosociality. These outcomes may promote physical health, highlighting a need to examine the role of self-affirmation in medical and health contexts.

Design: Data were collected as part of the nationally representative, cross-sectional, 2013 Health Information National Trends Survey. Items were completed by 2731 respondents.

Main Outcome Measures: Respondents answered questions about spontaneous self-affirmation tendencies, perceptions of providers and health care, involvement in medical appointments, health information seeking and engagement in medical research.

Results: Spontaneous self-affirmation was associated with more positive perceptions of communication with one’s provider, better perceived quality of care, greater likelihood of asking questions in a medical appointment, greater information seeking for oneself and multiple indices of surrogate information seeking (i.e. seeking information for others). Four of eight significant associations remained significant when controlling for optimism. The associations of self-affirmation with aspects of the patient–provider relationship were not modified by factors likely to be associated with stereotype threat (e.g. race or BMI).

Conclusion: Spontaneous self-affirmation was related to positive outcomes in health contexts. Experimental research is needed to further explore the causal nature of these associations.