Psychological Adjustment to Breast Cancer

Breast cancer remains a highly prevalent and extraordinarily stressful experience for hundreds of thousands of women each year in the United States and around the world. Psychological research has provided a picture of the emotional and social impact of breast cancer on patients' lives, and of factors associated with better versus worse adjustment. Psychosocial interventions have been beneficial in decreasing patients' distress and enhancing their quality of life. Recent research also suggests that psychological factors may be related to potentially important biological disease-related processes. In addition to providing an understanding of the psychological factors in breast cancer, research in this area has provided a framework for research on adaptation to health-related stress in general.     

Patient Adherence With Medical Treatment Regimens: An Interactive Approach

Inadequate patient adherence to treatment regimens is a ubiquitous problem in health care and carries a profound personal, societal, and economic cost. This article illustrates a general theoretical framework we believe to be useful for the interpretation, conception, and design of adherence research. The core tenet of this framework is that factors that influence adherence can be better understood by considering the interactive effects of patients' characteristics, type of adherence intervention, and characteristics of the illness and medical treatment context. This framework represents an extension and application of previous theory and research from personality, social, and clinical psychology concerning the value of an interactionalist perspective. We illustrate the framework using some of our past work involving treatment adherence among patients with chronic renal failure.     

Guidelines for Writing Letters to Patients

Patient letters provide a permanent record of the genetic counseling that was provided and are unique in medical care; rarely do other health care providers send summaries written specifically to their patients and families. We surveyed genetic counseling training program directors and found that while the acquisition of patient letter-writing skills was considered important, there were no specific guidelines made available to students. To develop letter-writing guidelines, we evaluated patient letters, reviewed references on professional correspondence, surveyed the medical literature, and worked with a writing consultant. The guidelines we subsequently developed and present here include a format for writing patient letters, suggestions on presenting medical information in understandable terms, and wording considerations. These patient letter-writing guidelines are intended to serve as a guide for teaching students this important skill and as a resource for practicing health care professionals.     

Treatment, Age, and Time-Related Predictors of Behavioral Outcome in Pediatric Brain Tumor Survivors

The research has shown that children surviving cancer are at risk for long-term emotional and behavioral problems secondary to the cumulative effects of cranial irradiation and chemotherapy. The purpose of this study was to investigate the emotional and behavioral outcome of children diagnosed with brain tumor and treated with cranial irradiation and chemotherapy by looking at the association between treatment, time, age, and cognitive-related variables on externalizing and internalizing behaviors at 3 years posttreatment. Fifty-four brain tumor survivors were administered a neuropsychological test battery, whereas the parents filled out the CBCL and Conners' Parent Rating Scale. The results indicate that chemotherapy treatment with vincristine, cytoxan, cisplantinum, and/or VP16 was related to poorer internalizing and externalizing behavioral outcome, especially attention, social withdrawal, and anxious–depressive symptomatology. Age at time of diagnosis or treatment, time since discontinuation of treatment, type and/or total dose of radiation therapy was not significantly correlated with any of the behavioral outcome scales. Verbal memory and learning deficits accounted for a significant portion of the variance in social withdrawal, whereas lower scores in overall intellectual functioning and verbal fluency was related to disturbances in attention, inhibition, and social functioning. The findings suggest that children treated with 1 or a combination of any of the aforementioned chemotherapy agents who exhibit declines in intellectual functioning and memory are at increased risk for long-term behavioral problems 3 years after treatment cessation. These findings support the importance for early psychotherapeutic and supportive intervention services immediately after treatment cessation, with the goal of circumventing these potentially debilitating emotional problems.     

Psychoeducational Interventions with Pediatric Cancer Patients: Part II. Effects of Information and Skills Training on Health-Related Outcomes

In Part I of this paper, we described a model that was used as a framework for reviewing studies of psychoeducational interventions intended to influence illness- and treatment-related behaviors and attitudes in pediatric cancer patients. In Part II, we distinguish between interventions that attempt to influence patients' behaviors just by providing information and interventions that specifically teach skills related to the behaviors they are trying to change. Many types of psychoeducational interventions appear to be effective and those that are training-based generally appear more effective than those that are information-based. Training-based interventions may face a barrier to wide adoption because they are resource-costly, but the development of digital-based training interventions may potentially overcome this barrier.     

The value of stress-management interventions in life-threatening medical conditions

Emotional stress has been associated with the development and progression of several chronic medical conditions. Recently, researchers have assessed the impact of stress-management interventions on patients' psychological functioning, quality of life, and various disease outcomes, including survival. This review summarizes the value of stress-management techniques in the treatment of two important, life-threatening conditions: coronary heart disease and cancer. Results from randomized clinical trials indicate that psychological interventions can improve patients' psychological functioning and quality of life. However, there is limited evidence to suggest that these interventions significantly reduce morbidity and mortality.     

The Effect of Genetic Counseling on Knowledge and Perceptions Regarding Risks for Breast Cancer

In 1994, a clinic for cancer risk counseling was opened at Hadassah University Hospital in Jerusalem. Most of the counselees have been women who had breast cancer and/or a relative with breast cancer. In order to evaluate the effect of this counseling on women's knowledge and perceptions regarding the risks for breast cancer, a questionnaire was given before and after the counseling session to 60 healthy women who came to the clinic because they have relatives with breast cancer. According to the genetic counselors' estimations, most of these women had a significantly increased risk (compared to the general population) of developing cancer. Before counseling, the women overestimated the population risk for breast cancer, the contribution of heredity to morbidity of cancer, and their own risks to get cancer. After counseling session, they gave reduced estimates, closer to the real ones. The subjective perceptions regarding these risks were reduced after counseling, except for the perceptions regarding their relativerisks which have not changed after the counseling. About 90% of the women who came to the clinic wanted to be tested for genetic predisposition to cancer. For most of these women, the expectations that the test can rule out a genetic predisposition to cancer became more realistic after the counseling. The option to first test an affected relative was offered to all families, and a test was actually conducted in 75% of the families.     

Genetic Counselors' Judgments of Patient Concerns: Concordance and Consequences

The aims of this prospective study were to determine (a) the concordance between patient concerns and genetic counselors' judgments of these concerns, (b) the predictors of patient and counselor judgments, and (c) the relationship between concordance and patient outcomes. Patients' and counselors' views were sought before and after 131 routine genetic consultations. Before consultations, there was concordance about level of patient concern to within one point in 63% (82/131) of consultations and about type of patient concern in 60–84% of consultations. Lack of concordance in judging level and type of concern was associated with lower satisfaction with information and higher anxiety after the consultation. The biggest predictor of counselor judgment of concern was professional background: doctors judged patients to be more concerned than did nurses. Concordance of concern was predicted by counselors' experience in genetics: less experienced counselors overestimated patient concern. Future research needs to determine whether improving judgment of concern improves patient outcome.