Gerald M Devins

Publications (55)138.85 Total impact

• Article: Do behavioural self-blame and stigma predict positive health changes in survivors of lung or head and neck cancers?

  Sophie Lebel, Andrea Feldstain, Megan McCallum, Sara Beattie, Jonathan Irish, Andrea Bezjak, Gerald M Devins
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  ABSTRACT: Survivors of lung or head and neck cancers often change tobacco and alcohol consumption after diagnosis, but few studies have examined other positive health changes (PHCs) or their determinants in these groups. The present study aims to: (a) document PHCs in survivors of lung (n = 107) or head and neck cancers (n = 99) and (b) examine behavioural self-blame and stigma as determinants of PHCs. We hypothesised that: (a) survivors would make a variety of PHCs; (b) behavioural self-blame for the disease would positively predict making PHCs; and (c) stigma would negatively predict making PHCs. Methods : Respondents self-administered measures of PHC, behavioural self-blame, and stigma. Hierarchical multiple regression analysis tested the hypotheses. Results: More than 65% of respondents reported making PHCs, the most common being changes in diet (25%), exercise (23%) and tobacco consumption (16.5%). Behavioural self-blame significantly predicted PHCs but stigma did not. However, both behavioural self-blame and stigma significantly predicted changes in tobacco consumption. Conclusions : Many survivors of lung or head and neck cancers engage in PHCs, but those who do not attribute the disease to their behaviour are less likely to do so. Attention to this problem and additional counselling may help people to adopt PHCs.
  Psychology & Health 04/2013; · 1.69 Impact Factor
• Article: Negative cancer stereotypes and disease-specific self-concept in head and neck cancer.

  Janice C Wong, Ada Y M Payne, Kenneth Mah, Sophie Lebel, Ruth N F Lee, Jonathan Irish, Gary Rodin, Gerald M Devins
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  ABSTRACT: BACKGROUND: Life-threatening diseases, such as head and neck cancer (HNCa), can stimulate the emergence of a new disease-specific self-concept. We hypothesized that (i) negative cancer-stereotypes invoke distancing, which inhibits the adoption of a disease-specific self-concept and (ii) patient characteristics, disease and treatment factors, and cancer-related stressors moderate the phenomenon. METHODS: Head and neck cancer outpatients (N = 522) completed a semantic-differential measure of disease-specific self-concept (perceived similarity to the 'cancer patient') and other self-report measures in structured interviews. Negative cancer-stereotypes were represented by the number of semantic-differential dimensions (0-3) along which respondents evaluated the stereotypic 'cancer patient' negatively (i.e., negative valence). We tested the two-way interactions between negative valence and hypothesized moderator variables. RESULTS: We observed significant negative valence × moderator interactions for the following: (i) patient characteristics (education, employment, social networks); (ii) disease and treatment factors (cancer-symptom burden); and (iii) cancer-related stressors (uncertainty, lack of information, and existential threats). Negative cancer stereotypes were consistently associated with distancing of self from the stereotypic 'cancer patient,' but the effect varied across moderator variables. All significant moderators (except employment and social networks) were associated with increasing perceived similarity to the 'cancer patient' when respondents maintained negative stereotypes; perceived similarity decreased when people were employed or had extensive social networks. Moderator effects were less pronounced when respondents did not endorse negative cancer stereotypes. DISCUSSION: When they hold negative stereotypes, people with HNCa distance themselves from a 'cancer patient' identity to preserve self-esteem or social status, but exposure to cancer-related stressors and adaptive demands may attenuate these effects. Copyright © 2012 John Wiley & Sons, Ltd.
  Psycho-Oncology 06/2012; · 3.34 Impact Factor
• Article: The burden of stress in head and neck cancer.

  Gerald M Devins, Ada Y M Payne, Sophie Lebel, Kenneth Mah, Ruth N F Lee, Jonathan Irish, Janice Wong, Gary M Rodin
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  ABSTRACT: BACKGROUND: Head and neck cancer (HNCa) introduces numerous stressors. We developed the Cancer-Related Stressors Checklist (CRSC), which documents exposure to seven categories of common stressors and emotional distress. We surveyed HNCa survivors and examined associations among exposure to cancer-related stressors, illness intrusiveness (i.e., cancer-induced interference with lifestyles, activities, and interests), and distress. We also investigated whether reported exposure rates differ between self-administered and interviewer-administered measures. METHODS: Respondents included HNCa survivors, stratified by sex, who participated in one of two clinical studies (N(1)  = 162; N(2)  = 408) examining the psychosocial impact of illness intrusiveness. All completed the CRSC, the Center for Epidemiologic Studies Depression Scale, and the Illness Intrusiveness Ratings Scale. Study 1 respondents self-administered the instruments; an interviewer administered them in Study 2. We gathered clinical data by self-report and from medical records. RESULTS: High inter-rater reliability corroborated the 8-subscale structure of the CRSC (Krippendorff alpha = .92). Cancer-related stressor exposures differed significantly across categories (interpersonal stressors were most common). Controlling for empirically identified covariates and distress, exposure to each cancer-related stressor correlated significantly and uniquely with illness intrusiveness. All stressor categories correlated significantly with distress, but coefficients were low to moderate, substantiating incremental validity. Respondents reported fewer exposures when materials were self-administered as compared with interviewer-administered, but reported distress levels did not differ by mode of administration. CONCLUSIONS: Cancer-related stressors are common and burdensome in HNCa and, therefore, merit clinical attention. Identifying specific stressors will allow more targeted and effective interventions to alleviate and prevent distress. Copyright © 2012 John Wiley & Sons, Ltd.
  Psycho-Oncology 03/2012; · 3.34 Impact Factor
• Article: The psychosocial impact of stigma in people with head and neck or lung cancer

  Sophie Lebel, Myriam Castonguay, Gudrun Mackness, Jonathan Irish, Andrea Bezjak, Gerald M. Devins
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  ABSTRACT: Background Lung and head and neck cancers are widely believed to produce psychologically destructive stigma because they are linked to avoidable risk-producing behaviors and are highly visible, but little research has tested these ideas. We examined cancer-related stigma, its determinants, and its psychosocial impact in lung (n = 107) and head and neck cancer survivors (n = 99) ≤3 years post-diagnosis. We investigated cancer site, self-blame, disfigurement, and sex as determinants, benefit finding as a moderator, and illness intrusiveness as a mediator of the relation between stigma and its psychosocial impact.Methods Prospective participants received questionnaire packages 2 weeks before scheduled follow-up appointments. They self-administered widely used measures of subjective well-being, distress, stigma, self-blame, disfigurement, illness intrusiveness, and post-traumatic growth.ResultsAs hypothesized, stigma correlated significantly and uniquely with negative psychosocial impact, but contrary to common beliefs, reported stigma was comparatively low. Reported stigma was higher in (i) men than women, (ii) lung as compared with head and neck cancer, and (iii) people who were highly disfigured by cancer and/or its treatment. Benefit finding buffered stigma's deleterious effects, and illness intrusiveness was a partial mediator of its psychosocial impact.Conclusions Stigma exerts a powerful, deleterious psychosocial impact in lung and head and neck cancers, but is less common than believed. Patients should be encouraged to remain involved in valued activities and roles and to use benefit finding to limit its negative effects. Copyright © 2011 John Wiley & Sons, Ltd.
  Psycho-Oncology 09/2011; · 3.34 Impact Factor
• Article: Do ongoing lifestyle disruptions differ across cancer types after the conclusion of cancer treatment?

  Kenneth Mah, Andrea Bezjak, D Andrew Loblaw, Andrew Gotowiec, Gerald M Devins
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  ABSTRACT: Cancer interferes with participation in valued lifestyle activities (illness intrusiveness) throughout post-treatment survivorship. We investigated whether illness intrusiveness differs across life domains among survivors with diverse cancers. Intrusiveness should be highest in activities requiring physical/cognitive functioning (instrumental domain). Intrusiveness into relationship/sexual functioning (intimacy domain) should be higher in prostate, breast, and gastrointestinal cancers than in others. Cancer outpatients (N = 656; 51% men) completed the Illness Intrusiveness Ratings Scale (IIRS) during follow-up. We compared IIRS Instrumental, Intimacy, and Relationships and Personal Development [RPD] subscale and total scores across gastrointestinal, lung, lymphoma, head and neck, prostate (men), and breast cancers (women), comparing men and women separately. Instrumental subscale scores (M(men) = 3.05-3.80, M(women) = 3.02-3.63) were highest for all groups, except prostate cancer. Men with prostate cancer scored higher on Intimacy (M = 3.40) than Instrumental (M = 2.48) or RPD (M = 1.59), p's < .05; their Intimacy scores did not differ from men with gastrointestinal or lung cancer. Women collectively showed higher Instrumental (M = 3.39) than Intimacy (M = 2.49) or RPD scores (M = 2.27), p's < .001, but not the hypothesized group difference in Intimacy. Post-treatment survivors continue to experience some long-term interference with activities requiring physical and cognitive functioning. Sexual adjustment may be of special concern to men when treatments involve genitourinary functioning. Ongoing monitoring with the IIRS to detect lifestyle interference throughout survivorship may enhance quality of life. Screening and intervention should target particular life domains rather than global interference.
  Journal of Cancer Survivorship 03/2011; 5(1):18-26. · 2.63 Impact Factor
• Article: Measurement invariance of the Illness Intrusiveness Ratings Scale's three-factor structure in men and women with cancer.

  Kenneth Mah, Andrea Bezjak, D Andrew Loblaw, Andrew Gotowiec, Gerald M Devins
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  ABSTRACT: Illness- and treatment-related disruptions to valued activities and interests (illness intrusiveness) are central to quality of life in chronic disease and are captured by three subscales of the Illness Intrusiveness Ratings Scale (IIRS): the Instrumental, Intimacy, and Relationships and Personal Development subscales. Using individual (CFA) and multisample confirmatory factor analyses (MSCFA), we evaluated measurement invariance of the IIRS's 3-factor structure in men and women with cancer. Men (n = 210) and women (n = 206) with 1 of 4 cancer diagnoses (gastrointestinal, head and neck, lymphoma, lung) recruited from outpatient clinics completed the IIRS. In the MSCFA, we applied an analysis of means and covariance structures approach to test increasingly stringent equality constraints on factor structure parameters to evaluate weak, strong, and strict measurement invariance of the 3-factor structure between men and women. Individual CFAs demonstrated fit of the hypothesized 3-factor structure for men and women, although more consistently for men. The 3-factor structure was superior to an alternative 1-factor structure. MSCFA results indicated that parameters of the 3-factor structure could be considered equivalent between the sexes up to the level of strong invariance. Strict invariance was not supported. Overall, IIRS scores can be interpreted similarly for men and women with cancer. Illness intrusiveness can be considered as important in the psychosocial adaptation of people with cancer as it is for people affected by other chronic conditions.
  Rehabilitation Psychology 02/2011; 56(1):58-66. · 1.91 Impact Factor
• Article: Using the illness intrusiveness ratings scale to understand health-related quality of life in chronic disease.

  Gerald M Devins
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  ABSTRACT: Illness intrusiveness is a common, underlying determinant of quality of life in people affected by chronic disease. Illness intrusiveness results from disease- and treatment-induced disruptions to lifestyles, activities, and interests (i.e., interference with psychologically meaningful activity). This paper introduces the Illness Intrusiveness Ratings Scale (IIRS), a 13-item, self-report instrument. The IIRS can be scored to generate a total score or three subscale scores: relationships and personal development, intimacy, and instrumental. In addition to describing the IIRS, the paper presents the theoretical framework in which it is anchored, reviews the evidence, and reports psychometric properties. Qualitative literature review. Findings support the IIRS's reliability (internal consistency and test-retest), validity (construct, criterion-related, and discriminant), sensitivity to change, and factorial invariance across numerous chronic-disease groups. The paper reports IIRS reliability coefficients and normative statistics for 36 chronic, medical and psychiatric patient populations. The IIRS taps the extent to which disease- and treatment-related factors interfere with psychologically meaningful activity among people affected by chronic disease. It provides a valid, reliable measure that is easy to administer and unequivocally interpretable rendering it suitable for research designed to estimate the psychosocial impact of chronic disease and to document (and compare) the effectiveness of therapeutic interventions.
  Journal of psychosomatic research 06/2010; 68(6):591-602. · 2.91 Impact Factor
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  Available from: rc.ibim.cnr.it

  Article: Exercise program to enhance physical performance and quality of life of older hemodialysis patients: a feasibility study.

  Mika L Nonoyama, Dina Brooks, Alexandra Ponikvar, S Vanita Jassal, Pia Kontos, Gerald M Devins, Lily Spanjevic, Carol Heck, Judi Laprade, Gary Naglie
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  ABSTRACT: Evaluate the feasibility of implementing a combined in-hospital and home-based exercise program in older hemodialysis (HD) patients. A prospective longitudinal 12-week pilot study. A university hospital HD unit and patients' homes. A convenience sample of nine older (>55 years) patients undergoing HD. An individualized exercise program performed on HD days (3/week) and at home (2-3/week), including aerobic, flexibility, strength exercises and patient education. Feasibility measure: patient participation. Exercise performance: Duke Activity Status Index (DASI); 2-min walk test (2MWT); Timed-up-and-go (TUG). Quality of life: The Illness Intrusiveness Ratings Scale (IIRS); The Kidney Disease Quality of Life Questionnaire (KDQOL). The mean (SD) age of the patients was 68.1 (7.1). Participation in the in-hospital supervised exercise program was high, with patients exercising during 89% of HD sessions, but was lower for the unsupervised home-based component (56% exercised ≥ 2 times/week). Patients showed a gradual increase in the amount of exercise performed over 12 weeks. The 2MWT, TUG, IIRS and the KDQOL physical composite score demonstrated moderate responsiveness, while the DASI score exhibited only limited responsiveness. This exercise program and the outcome measures were feasible for older HD patients: in-hospital participation was high, and physical performance and QOL measures exhibited moderate levels of responsiveness. Future, larger studies are needed to demonstrate whether intra-dialysis exercise, with or without home exercise, can lead to improved outcomes in this population.
  International Urology and Nephrology 03/2010; 42(4):1125-30. · 1.47 Impact Factor
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  Available from: sbccp.org.br

  Article: Quality of life analysis in patients with anterior skull base neoplasms.

  Carsten E Palme, Jonathan C Irish, Patrick J Gullane, Mark R Katz, Gerald M Devins, Gideon Bachar
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  ABSTRACT: Significant morbidity is associated with management of anterior skull base neoplasms. The aim of this study was to evaluate the posttreatment patient's quality of life (QOL). A retrospective chart review identified 27 patients. QOL tools included the Functional Assessment of Cancer Therapy-Head & Neck, Centre for Epidemiologic Studies Depression Scale (CES-D), Atkinson Life Happiness Rating (ALHR), and Midface Dysfunction Scale (MDS). Postoperative radiotherapy and chemotherapy was required in 16 and 2 patients, respectively. The median FACT, ALHR, and CES-D scores were 118 +/- 21, 9 +/- 2, and 17 +/- 8, respectively. Smell and nasal crusting disturbance was reported by 69% and 61%, respectively. CES-D > 16 and patients with recurrent disease correlated with a lower Total-FACT score. Adjuvant radiotherapy correlated with a lower FACT-H&N score. Patient sex, marital-status, pathology, surgical technique, or complication rate did not correlate with worse QOL. Anterior skull base neoplasms survivors have an overall acceptable QOL. Most complaints relate to MDS. Recurrence, adjuvant radiotherapy, and MDS had lower QOL scores.
  Head & Neck 06/2009; 31(10):1326-34. · 2.40 Impact Factor
• Article: Cultural syndromes and age moderate the emotional impact of illness intrusiveness in rheumatoid arthritis.

  Gerald M Devins, Anita Gupta, Jill Cameron, Kirsten Woodend, Kenneth Mah, Dafna Gladman
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  ABSTRACT: The authors investigated cultural syndromes (multidimensional vectors comprising culturally based attitudes, values, and beliefs) and age as moderators of the emotional impact of illness intrusiveness--illness-induced lifestyle disruptions--in rheumatoid arthritis (RA) and examined illness intrusiveness effects in total and separately for three life domains (relationships and personal development, intimacy, and instrumental). RESEARCH METHOD/DESIGN: People with RA (n = 105) completed the Illness Intrusiveness Ratings, Individualism-Collectivism, and Center for Epidemiologic Studies--Depression scales in a one-on-one interview. Controlling for disease and background characteristics, the association between illness intrusiveness (total score and the Relationships and Personal Development subscale) and distress was inverse when young adults with RA endorsed high horizontal individualism. Illness intrusiveness into intimacy was associated with increased distress, and this intensified when respondents endorsed high vertical individualism, horizontal collectivism, vertical collectivism, or low horizontal individualism. The negative emotional impact of illness intrusiveness into intimacy diminished with increasing age. Given an aging and increasingly pluralistic society, diversity can no longer be ignored in addressing the psychosocial impact of chronic, disabling disease.
  Rehabilitation Psychology 03/2009; 54(1):33-44. · 1.91 Impact Factor
• Article: Predicting stress-related problems in long-term breast cancer survivors.

  Sophie Lebel, Zeev Rosberger, Linda Edgar, Gerald M Devins
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  ABSTRACT: Little is known about the early clinical and psychosocial factors associated with subsequent stress-related problems in breast cancer survivors. We used data collected at 3, 7, 11, and 15 months post-diagnosis to predict stress-related problems in 86 breast cancer survivors at 6 years post-diagnosis. We examined two common stress-related problems: (a) emotional distress and (b) intrusion and avoidance. Hypothesized risk factors included perceived stressfulness of the cancer; fear of the future; poor perceived health; initial stress-related problems; avoidance coping; and second cancer experience. Hypothesized protective factors included active coping (seeking social support; positive problem solving); optimism; and social support. Hierarchical multiple regression analyses, controlling for age and education, indicated that positive problem-solving coping at 3 months and emotional distress at 7 months significantly predicted 6-year emotional distress (R(2)=.24, P<.01). Second cancer experience and 3-month intrusion and avoidance significantly predicted 6-year intrusion and avoidance (R(2)=.38, P<.001). In both cases, risk and/or protective factors measured at 11 and 15 months did not add significantly to the regression equations. Symptoms of intrusion and avoidance should be monitored carefully during the first 3 months following diagnosis because they signal the risk that these symptoms will persist in the long-term. Elevated emotional distress at 7-months post-diagnosis and second-cancer experiences may signal the need for psychosocial intervention. Overreliance on positive problem solving to cope early in the disease trajectory may be detrimental in the longer term.
  Journal of Psychosomatic Research 01/2009; 65(6):513-23. · 3.30 Impact Factor
• Article: Illness intrusiveness and subjective well-being in schizophrenia.

  Monica Bettazzoni, Robert B Zipursky, Judith Friedland, Gerald M Devins
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  ABSTRACT: This study evaluated the extent to which schizophrenia and its treatment interferes with participation in valued life activities and its impact on subjective well-being. The Illness Intrusiveness Ratings Scale was completed by 78 individuals with schizophrenia on 3 measurement occasions. Clinicians working with participants, plus a relative/friend of each participant also provided independent ratings of the person. The Illness Intrusiveness Ratings Scale displayed internal consistency (coefficient alpha = 0.82), and temporal stability across 1 day (r = 0.89), 1 week (r = 0.51), and 1 month (r = 0.78). Reported intrusiveness was high (M = 50.5) and was among the highest compared with populations with other serious medical and psychiatric illnesses. Ratings correlated with staff and family/friends' ratings of intrusiveness (r = 0.33 and r = 0.40), measures of symptomatology (average r = 0.25), and subjective well-being (average r = 0.41). Path analysis indicated that lifestyle disruption mediates the impact of symptoms and treatment on well-being. Implications for these findings and future directions for research are discussed.
  The Journal of nervous and mental disease 12/2008; 196(11):798-805. · 1.77 Impact Factor
• Article: Stigma in cancer patients whose behavior may have contributed to their disease.

  Sophie Lebel, Gerald M Devins
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  ABSTRACT: The purpose of the present review is to examine stigma and its consequences among people with cancer, with an emphasis on the situation in which one's behavior may have contributed to the disease. We examine whether voluntarily engaging in behavior that adds to cancer risk leads to increased stigma after cancer onset, as compared with when one's behavior is not considered (by the affected individual or by others) to have contributed to the onset of cancer. We conducted literature searches in PsychInfo and Medline and identified 38 published papers that empirically addressed cancer-related stigma. We found evidence of increased negative attitudes and more severe consequences of stigma among people that have engaged in a behavior that is perceived to have contributed to their cancer, compared with those who are not perceived to have contributed to their disease.
  Future Oncology 11/2008; 4(5):717-33. · 3.16 Impact Factor
• Article: Seizure freedom reduces illness intrusiveness and improves quality of life in epilepsy.

  Sonia Poochikian-Sarkissian, Souraya Sidani, Richard Wennberg, Gerald M Devins
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  ABSTRACT: Chronic illnesses are associated with multiple stressors that compromise quality of life (QOL). Implicit in many of these stressors is the concept of illness intrusiveness: the disruption of lifestyles, activities, and interests due to the constraints imposed by chronic disease and its treatment. The purpose of this study was to examine illness intrusiveness and QOL in epilepsy in patients with different levels of seizure control. Cross-sectional data were obtained and compared between two groups of patients categorized by presence of seizures: seizure freedom or continued seizures (N = 145). Standard instruments measured the following variables: illness intrusiveness, perceived personal control, subjective well-being, and disease specific QOL. Illness intrusiveness varied inversely and significantly with seizure control. Complete seizure freedom, whether achieved by pharmacological or surgical treatment, was associated with the lowest levels of illness intrusiveness. Seizure freedom was also associated with increased perceived control, positive affect, self-esteem and QOL in epilepsy. The most robust benefits of decreased illness intrusiveness in epilepsy occur when treatment leads to complete seizure control. Therefore every effort should be made by health care providers to achieve seizure freedom to reduce illness intrusiveness and improve QOL in epilepsy.
  The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques 08/2008; 35(3):280-6. · 0.97 Impact Factor
• Article: Illness intrusiveness in anorexia nervosa.

  Jacqueline C Carter, Carmen Bewell, Gerald M Devins
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  ABSTRACT: "Illness intrusiveness" refers to illness-induced lifestyle disruptions. The primary aim of the current study was to compare the level of illness intrusiveness in anorexia nervosa (AN) to that reported in a variety of other chronic medical and psychiatric conditions. A secondary aim was to compare the two subtypes of AN (binge/purge vs. restricting) in terms of the nature and extent of illness intrusiveness. A final goal was to examine changes in the level of illness intrusiveness in AN following successful completion of specialized inpatient treatment. The participants were a consecutive series of 121 female inpatients with AN who were admitted to a specialized inpatient unit for treatment of the eating disorder. Assessments took place before and after inpatient treatment and at 3-month follow-up. At baseline, illness intrusiveness scores for AN patients were significantly higher than those reported by women in the medical and psychiatric comparison groups. Overall, illness intrusiveness scores decreased (i.e., improved) significantly following successful completion of inpatient treatment. Among patients with the restricting subtype, scores continued to improve during follow-up, whereas this was not the case among patients with the binge-purge subtype of AN, whose scores did not change significantly during follow-up. Despite being notoriously ambivalent about change, these findings suggest that AN patients perceive their illness to be highly disruptive to a variety of life domains, even more so than patients with other chronic medical and psychiatric conditions.
  Journal of Psychosomatic Research 06/2008; 64(5):519-26. · 3.30 Impact Factor
• Article: Do allogeneic bone marrow transplant candidates match coping to controllability of pre-treatment stressors?

  Kenneth Mah, Mireille Khoraych, Jeffrey H Lipton, Hans A Messner, Ghada Khoraych, Katherine Krawiec, France Lefebvre, Gerald M Devins
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  ABSTRACT: According to the Person x Situation theoretical framework, people adjust their coping to address the unique challenges of encountered stressors. Whether their strategies fit or appropriately address these stressor challenges influences adjustment. We examined the fit between pre-treatment stressors reported by hematological cancer patients awaiting allogeneic bone marrow transplantation (alloBMT) and their coping responses. Stressors were categorized as controllable versus uncontrollable; coping responses were categorized as problem- versus emotion-focused versus mixed (i.e., elements of both coping types). We hypothesized that patients would employ coping responses that fit the controllability of stressors (i.e., a match between stressor and coping response): problem-focused coping for controllable stressors and emotion-focused coping for uncontrollable stressors. In qualitative interviews, pre-BMT patients (10 men, 7 women) described encountered stressors and how they coped with them. Every reported stressor was linked with its associated coping response, resulting in a stressor-coping pair. We determined the proportion of total stressor-coping pairs in which the coping response matched the controllability of its linked stressor. Most stressor-coping pairs involving uncontrollable stressors showed the hypothesized match with emotion-focused or mixed coping. Contrary to hypotheses, fewer stressor-coping pairs that involved controllable stressors matched with problem-focused or mixed coping. Rather, these pairs were more likely to link controllable stressors with emotion-focused coping (i.e., mismatch between stressor controllability and type of coping). AlloBMT candidates may appraise the pre-treatment stage, globally, as permitting very little control. Coping efforts may consequently emphasize regulation of negative emotions (i.e., emotion-focused coping).
  Psychology Health and Medicine 06/2008; 13(3):337-45. · 1.18 Impact Factor
• Article: Psychological impact of illness intrusiveness in epilepsy - comparison of treatments.

  Sonia Poochikian-Sarkissian, Souraya Sidani, Richard A Wennberg, Gerald M Devins
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  ABSTRACT: Chronic illnesses are associated with multiple stressors that compromise quality of life (QOL). Implicit in many of these is the concept of illness intrusiveness, the disruption of lifestyles and activities attributable to constraints imposed by chronic disease and its treatment. This study tested the illness intrusiveness theoretical framework in epilepsy and compared the impact of pharmacological and surgical treatments on illness intrusiveness and QOL. Cross-sectional data compared three epilepsy groups (N = 145): (a) 40 patients admitted for presurgical evaluation to an Epilepsy Monitoring Unit; (b) 52 patients treated pharmacologically; and (c) 53 post-surgical patients. Illness intrusiveness differed significantly across epilepsy patients with the differences primarily related to seizure control. Illness intrusiveness varied inversely with seizure control (p < .05). Seizure freedom, whether achieved by surgical or pharmacological treatments, was associated with maximal reduction of illness intrusiveness. Increased illness intrusiveness correlated significantly with decreased QOL and increased depressive symptoms. Perceived control over diverse life domains correlated positively with QOL and psychosocial outcomes. Path analysis supported the validity of the illness intrusiveness theoretical framework in epilepsy. Illness intrusiveness is an important determinant of the psychosocial impact of epilepsy and its treatment. Effective pharmacological or surgical treatment may reduce illness intrusiveness in epilepsy. Findings also offer encouragement that QOL in epilepsy, as in other chronic conditions, may be enhanced by multidisciplinary bio-psychosocial efforts. Health care providers should consider multifaceted interventions to reduce illness intrusiveness and, thereby, improve QOL.
  Psychology Health and Medicine 03/2008; 13(2):129-45. · 1.18 Impact Factor
• Article: Development and validation of a Patient-Reported Oral Mucositis Symptom (PROMS) scale.

  Jennifer A Kushner, Herenia P Lawrence, Irit Shoval, Thomas L Kiss, Gerald M Devins, Linda Lee, Howard C Tenenbaum
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  ABSTRACT: Oral mucositis, a painful condition with potentially life-threatening sequelae, often develops in association with allogeneic bone marrow transplantation. This condition has an adverse impact on the oral-health-related quality of life of patients undergoing marrow transplantation therapy. The purpose of this study was to create and validate a Patient-Reported Oral Mucositis Symptom (PROMS) scale. This scale allows evaluation of symptoms of oral mucositis that threaten quality of life. The PROMS scale was compared with previously validated tools measuring quality of life (Functional Assessment of Cancer Therapy--Bone Marrow Transplant), symptoms of depression (Center for Epidemiologic Studies Depression Scale), psychological well-being (Affect Balance Scale) and stressful life events, as well as an objective, clinician-rated assessment of oral mucositis (Visual Analogue Scale--Oral Mucositis Assessment Scale). Thirty-four patients who were to undergo allogeneic bone marrow transplantation at Princess Margaret Hospital in Toronto, Ontario, were enrolled in this validation study. The PROMS scale had high internal reliability, as well as good convergent and discriminant validity relative to subjective measures of well-being. Longitudinal assessments showed that changes in PROMS scores were strongly correlated with changes in clinical assessment of oral mucositis over the first 2 weeks after transplantation, when the onset of oral mucositis typically occurs and the lesions are most severe. Oral mucositis in patients who have undergone bone marrow transplantation can be quantified reliably with the easily administered PROMS scale. The PROMSscale provides a valid measure of the impact of oral mucositis on the oral-health-related quality of life of patients affected by this malady.
  Journal (Canadian Dental Association) 03/2008; 74(1):59. · 1.00 Impact Factor
• Article: Do single and partnered women with gynecologic cancer differ in types and intensities of illness- and treatment-related psychosocial concerns? A pilot study.

  Janet M de Groot, Kenneth Mah, Anthony Fyles, Susan Winton, Sarah Greenwood, Denny DePetrillo, Gerald M Devins
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  ABSTRACT: We compared the psychosocial and psychosexual concerns of single and partnered women with gynecologic cancer, since relationship status and psychosocial context are known to affect sexuality, a life domain commonly affected by this cancer. A cross-sectional convenience sample of 49 women (68% response), with ovarian (n=31), endometrial (n=12), and cervical (n=6) cancer, responded to a 72-item self-report Cancer Concerns Questionnaire and additional psychosocial questionnaires. Single (n=13) and partnered women (n=36) similarly reported prognosis as their highest concern, but single women (26% of the sample) reported that communication with the treatment team, treatment side effects, and prognosis were of greater salience to them than did partnered women. The latter group had greater sexuality and partner relationship concerns. These preliminary findings suggest that relationship status, whether partnered or single, influences current psychosocial concerns among women with gynecologic cancer, despite similar levels of illness- and treatment-related intrusions on important life domains.
  Journal of Psychosomatic Research 10/2007; 63(3):241-5. · 3.30 Impact Factor
• Article: Comparison of four common stressors across the breast cancer trajectory.

  Sophie Lebel, Zeev Rosberger, Linda Edgar, Gerald M Devins
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  ABSTRACT: Studies of cancer stressors have typically assessed a limited number of factors using cross-sectional designs. There is little information about aspects of cancer that patients consider most stressful at different points along the disease trajectory. Seventy-two breast cancer patients rated the degrees to which they experienced each of four common cancer concerns as stressful during the preceding month at 3, 7, 11, and 15 months, and at 6 years after diagnosis. Stressors included fear of the future; physical limitations; pain; and problems with family or friends due to cancer. Overall, the cancer concerns were rated as not especially stressful, with the exception of fear of the future which was the most stressful of the four concerns on all measurement occasions. Although fear of the future decreased from 3 to 7 months following diagnosis, it remained elevated at all of other time points. Physical limitations and pain were reported to induce equivalent levels of stress and their intensities decreased over time. However, there was a resurgence of the stressfulness of physical limitations and pain at the 6-year follow-up point when women experienced a second cancer during the long-term follow-up period. At all measurement occasions, breast cancer survivors reported very low levels of concern in relation to family and friends. Breast cancer can be stressful for years after diagnosis for some women and especially for those who experience a second cancer. Fear of the future is the most pressing target for psychosocial interventions.
  Journal of Psychosomatic Research 10/2007; 63(3):225-32. · 3.30 Impact Factor