Risk factors for psychological morbidity in women attending a one-stop diagnostic clinic with suspected breast disease

Abstract

The present study was designed to identify risk factors for psychological morbidity in women attending a one-stop diagnostic clinic with suspected breast disease. A cohort of 158 women were recruited and were asked to complete scales measuring psychological morbidity and psychosocial factors in the period immediately before their appointment and to repeat the assessments of psychological morbidity on the day of the appointment. Relevant clinical and demographic data were also collated. Within the cohort 1.4% of respondents received a diagnosis of malignant disease. Psychological morbidity, both prior to and during the diagnostic appointment was strongly predicted by psychosocial factors (i.e., acceptance-resignation coping, personal self esteem and discrepancies in social support), accounting for 54% and 63% of the variance at pre-appointment and appointment day phases respectively. Other measured variables were found not to be correlated with and/or to account for a significant proportion of the variance in the measures of morbidity. These results suggest that these psychosocial variables should be targeted in interventions designed to reduce psychological morbidity in this patient group.     

A longitudinal study of psychosocial distress in breast cancer: Prevalence and risk factors

This longitudinal study was conducted among 102 women with non-metastasic breast cancer to identify the time evolution and prevalence of distress at specific times through diagnosis and treatment of disease: preliminary diagnosis, surgery, definitive diagnosis and chemotherapy. Additionally, the study aimed to examine the role of demographic, medical and psychosocial factors on distress. The results indicated that prevalence of distress was higher at initial diagnosis (25%) than the following time points (approximately 17%). The differences inter-individuals in the levels of distress were observed over the four assessments. No relation between distress and demographic and medical factors was found. However, psychosocial aspects were significant risk factors. Patterns of emotional suppression and specific coping responses like helplessness/hopelessness, anxious preoccupation, cognitive avoidance and fatalism were positively related to distress, whereas fighting spirit and perceived social support showed a protective role. Moreover, helplessness/hopelessness and anxious preoccupation jointly predicted 75% of cases and 98% non-cases of distress. Finally, a mediational model between emotional suppression and distress through helplessness/hopelessness was tested. Results support the necessity of routine distress screening all through the illness. Implications of data for psychosocial interventions with breast cancer patients are highlighted.     

Parental experience of childhood cancer using Interpretative Phenomenological Analysis

Whilst survival rates for childhood cancer have improved dramatically over the past three decades, it is still a devastating diagnosis for family members and an illness which severely disrupts the lifestyle of the family unit. Developing an understanding of the impact of the illness on the family is crucial to better support families’ deal with the demands of the illness. In this study nine families in which a child was diagnosed with cancer were interviewed twice over a 12 month period, approximately 6 months apart. Using Interpretative Phenomenological Analysis, a semi-structured interview was used to explicate parent's experience of childhood cancer. The results revealed five super-ordinate themes; (1) a pivotal moment in time, (2) the experience of adaptation in relation to having a sick child, (3) the nature of support, (4) re-evaluation of values during a critical life experience and (5) the experience of optimism and altruism. Findings indicate that parents express both negative and positive experiences as they re-evaluate the meaning and purpose of life, seek to redefine themselves, often in terms of priorities, relationships, sense of community and achieve degrees of optimism and altruism. Implications for addressing the needs of parents and for further research are discussed.     

Associations of positive and negative life changes with well-being in young and middle-aged adult cancer survivors

Both positive and negative changes are commonly reported by cancer survivors, and both may impact quality of life. Yet few studies have directly compared the associations of positive and negative changes across multiple life domains with multiple aspects of well-being. This study examined positive and negative changes and their conjoint relation to a range of well-being indices. We used correlational and regression analyses of data from 237 young to middle aged (X?=?45.3?years) cancer survivors, several years after treatment. Measures included demographic and medical variables, medical post-cancer positive and negative changes on multiple life domains, and a range of positive and negative adjustment indices. Demographic factors, especially income, related to both positive and negative outcomes. On average, participants reported no change on most life domains, although modest amounts of both positive and negative changes were reported. Negative change, rather than positive change, was closely associated with cancer survivors’ adjustment. Detailed measurement of both positive and negative changes – as well as lack of change – is important to advance understanding of cancer's impact on survivors.     

Illness perceptions and distress in women at increased risk of breast cancer

Variation in the levels of distress in women at increased risk of breast cancer has been reported, yet there is limited understanding of the factors that are associated with heightened distress in this population. This study took a theoretical approach using Leventhal's Self Regulatory Model (SRM) to understand variation in distress levels. The study examined the associations between perceptions of breast cancer and distress in women at increased risk of breast cancer, and a comparison sample with no experience of the disease in their social environment. Questionnaire data from 117 women at increased risk of breast cancer and 100 comparison women were analysed. Women at increased risk of breast cancer showed comparable levels of general distress but significantly higher levels of cancer specific distress than the comparison group. There were few differences in illness perceptions between the samples, although a number of cognitive perceptions of breast cancer were related to both general and cancer specific distress in the increased risk sample, but not in the comparison sample. The results suggest that the SRM provides a useful framework to explore the psychological response to genetic risk. Further research is required in this population to examine illness perceptions in more detail, validate quantitative measures of illness perceptions, and examine interactions between risk perception and the SRM constructs.     

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.     

Attention and Memory in Children with Brain Tumors

The Rey Auditory Verbal Learning Test was utilized to examine attention, learning, and memory abilities in 42 children with cerebellar (N?=?18) and third ventricle tumors (N?=?24). Children with cerebellar tumors exhibited significant auditory attentional impairments and displayed adequate encoding and retrieval across subsequent learning and memory trials. In contrast, children with third ventricle tumors exhibited average auditory attentional abilities, but they displayed mild encoding deficits across trials 2–5. Furthermore, the third ventricle group's compromised performance on the delayed recall trial and average performance on the delayed recognition trial is suggestive of underlying retrieval deficits.     

An appreciative response to Niels Henrik Gregersen's JKR research conference lecture

Abstract

Using human embryos in research remains a controversial issue, especially in Christian bioethics. Although the official Catholic stance rejects human embryonic stem cell research, Christian thinkers T. Peters, K. Lebacqz and G. Bennett support it. They endorse the 14-day Rule and argue that ex vivo embryos lack moral worth. I examine and challenge the 14-day Rule and location argument (in vivo/ex vivo). I develop a theory of holistic anthropology and intrinsic moral value for human embryos. I conclude that intrinsic moral value is not equal to full moral value, and therefore use of embryos in biomedical research is morally permissible.     

A Burden to Others: A Common Source of Distress for the Terminally Ill

Recent research into the desire for death among people with terminal illness has begun to recognize the importance of “feeling oneself a burden to others” as a factor in suicidal behaviour. In this study, 69 patients with advanced cancer underwent semi‐structured interviews. The sense of self‐perceived burden was found to be a common experience, reported by 39.1% of participants as a minimal or mild concern and by 38% as a moderate to extreme concern. The sense of burden showed a low correlation with physical symptoms (r = 0.02–0.24) and higher correlations with psychological problems (r = 0.35–0.39) and existential issues (r = 0.45–0.49). Comparisons of participants with high or low levels of self‐perceived burden showed the importance of this factor for overall quality of life. In summary, self‐perceived burden is an important but underestimated dimension of social cognition in the medically ill.     

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.