F M Lewis

University of Washington Seattle, Seattle, WA, United States

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Publications (70)144.38 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: The purpose of this study was to test the efficacy of a cancer parenting program for child rearing mothers with breast cancer, the Enhancing Connections Program. Primary goals were to decrease maternal depressed mood and anxiety, improve parenting quality, parenting skills and confidence, and enhance the child's behavioral-emotional adjustment to maternal breast cancer. Method: A total of 176 mothers diagnosed within 6 months with Stage 0 to Stage III breast cancer and their 8- to 12-year-old child were recruited from medical providers in 6 states: Washington, California, Pennsylvania, Minnesota, Arizona, and Indiana. After consenting and obtaining baseline measures, study participants were randomized into experimental or control groups. Experimental mothers received 5, 1-hr educational counseling sessions at 2-week intervals; controls received a booklet and phone call on communicating and supporting their child about the mother's cancer. Outcomes were assessed at 2 and 12 months. Results: Compared to controls, at 2 months experimental mothers significantly improved on depressed mood and parenting skills; experimental children improved on behavioral-emotional adjustment: total behavior problems, externalizing problems, and anxiety/depressed mood significantly declined. At 1 year, experimental children remained significantly less depressed than controls on both mother- and child-reported measures. The intervention failed to significantly affect parenting self-efficacy or maternal anxiety. Conclusions: The Enhancing Connections Program benefitted mothers and children in specific areas and warrants refinement and further testing. Public Health Significance Statement: The clinical trial results show that a brief intervention to mothers with breast cancer can significantly reduce the burden of cancer on both the child and the ill parent. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Journal of Consulting and Clinical Psychology 11/2014; · 4.85 Impact Factor
  • Youngran Yang, Frances Marcus Lewis, Daniel L Kraushaar
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    ABSTRACT: HIV transmission in Cambodia has declined considerably in recent years, yet new incidents of HIV transmission within marital relationships have increased. Evidence suggests that the cause of this is transmission from HIV-positive men to their HIV-negative spouses. The objective of this paper is to develop an evidence-based model of HIV transmission from husbands to wives in Cambodia in a context of culture and society, drawing from the published literature. A critical analysis of peer reviewed literature, professional papers, policy reports and reference books identified four plausible factors influencing inter-spousal HIV transmission: (1) a hierarchical male-dominated society, (2) husbands' involvement with sex workers, (3) cultural values concerning the ideal Khmer woman and (4) unprotected sex between an HIV-infected husband and his uninfected wife. This evidence-based explanatory model can be used to inform future culturally appropriate HIV-education and prevention programmes.
    Culture Health & Sexuality 05/2013; · 1.55 Impact Factor
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    ABSTRACT: BACKGROUND: Distress in husbands of women with early-stage breast cancer may be equivalent to or even higher than their wives. Husbands often struggle to help and support their wives cope with the illness and its treatment. In response, we developed a five-session group educational counselling intervention (Helping Her Heal-Group (HHH-G)) for husbands of women with early-stage breast cancer. The primary aim of the current pilot study was to determine the acceptability and feasibility of HHH-G and to obtain a preliminary estimate of its impact on participating men's skills, self-confidence and self care. Secondary aims were to assess the impact of the intervention on both the participating spouses' and wives' ratings of marital quality and depressed mood. METHODS: The study employed a one-arm, pre-post-intervention design whereby participating men (n = 54) and their wives (n = 54) independently completed measures at baseline (T0), immediately following the last session (T1) and 3 months after the last session (T2). RESULTS: Overall, there was very high study retention (87%). On the basis of the questionnaire data, we found significant improvements in spouses' self-efficacy (p < 0.001) and self-reported skills including wife support (p = 0.003) and self-care (p < 0.001). In addition, there was a significant improvement in wives' mood scores (p = 0.003). Post-intervention interviews support acceptability and impact of the HHH-G intervention, and provide support for the group format of the program. CONCLUSIONS: The feasibility and acceptability of HHH-G was supported, and treatment outcomes suggest the potential benefits of the intervention. Phase III evaluation of HHH-G program is warranted. Copyright © 2013 John Wiley & Sons, Ltd.
    Psycho-Oncology 03/2013; · 3.51 Impact Factor
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    Barbara B Cochrane, Frances Marcus Lewis, Kristin A Griffith
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    ABSTRACT: To provide preliminary data on a diffusion of psychosocial benefit to women diagnosed with breast cancer when only their partners receive a psychoeducational intervention focused on the breast cancer experience. Single-group, pretest/post-test pilot study; participants served as their own controls. Communities in the Pacific Northwest region of the United States. 9 women with a first diagnosis of breast cancer within the previous six months whose partners received the Helping Her Heal intervention. Data were collected from women pre- and postintervention via standardized questionnaires with established reliability and validity. Confidential exit interviews were conducted after postintervention data were returned. State anxiety (State-Trait Anxiety Inventory Form Y [STAI-Y]), depression (Center for Epidemiologic Studies-Depression scale [CES-D]), and marital quality (Dyadic Adjustment Scale [DAS]; Mutuality and Interpersonal Sensitivity scale). Wilcoxon signed-rank tests showed significant improvements on the CES-D (p = 0.01), STAI-Y (p = 0.01), and DAS affectional expression subscale (p = 0.03) in women from pre- to postintervention. Review of exit interview transcripts indicated that women generally were positive about the impact of the program and viewed their partners' gains in communication skills as the greatest benefit of participating. This study offers preliminary support for a diffusion of psychosocial benefit to women with breast cancer when a psychoeducational intervention is delivered to their partners. Diffusion of benefit should be examined in a large, randomized, clinical trial to provide evidence for focusing some clinical efforts on partners alone, rather than adding to diagnosed women's burden of multiple clinical encounters.
    Oncology Nursing Forum 03/2011; 38(2):207-14. · 1.91 Impact Factor
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    Ellen H Zahlis, Frances M Lewis
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    ABSTRACT: This study examines the experiences of 48 spouses of wives newly diagnosed with local or regional breast cancer. Their reported experiences were organized into the core construct of coming to grips reflected by four domains: (1) feeling nailed by the breast cancer, (2) changing us, (3) taking care of me, and (4) making things work. Prior studies have underestimated the extent to which the assumptive world and day-to-day lives of spouses are shattered by the diagnosis of breast cancer and the work they do to guess how to be supportive to their wives. Interventions are needed that directly assist spouses add to their ways of managing the intrusion of their wife's breast cancer in their lives.
    Journal of Psychosocial Oncology 01/2010; 28(1):79-97. · 1.04 Impact Factor
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    Kristin A Fletcher, Frances Marcus Lewis, Mel R Haberman
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    ABSTRACT: To describe spouses' reported cancer-related demands attributed to their wife's breast cancer, and to test the construct and predictive validity of a brief standardized measure of these demands. Cross-sectional and longitudinal data were obtained from 151 spouses of women newly diagnosed with non-metastatic breast cancer. Descriptive statistics were computed to describe spouses' dominant cancer-related demands, and multivariate regression analyses tested the construct and predictive validity of the standardized measure. Five categories of spouses' cancer-related demands were identified, such as concerns about spouses' own functioning, wife's well-being and response to treatment, couples' sexual activities, the family's and children's well-being, and the spouses' role in supporting their wives. A 33-item short version of the standardized measure of cancer demands demonstrated construct and predictive validity that was comparable to a 123-item version of the same questionnaire. Greater numbers of illness demands occurred when spouses were more depressed and had less confidence in their ability to manage the impact of the cancer (F=18.08 (3,103), p<0.001). Predictive validity was established by the short form's ability to significantly predict the quality of marital communication and spouses' self-efficacy at a 2-month interval. The short version of the standardized measure of cancer-related demands shows promise for future application in clinic settings. Additional testing of the questionnaire is warranted. Spouses' breast cancer-related demands deserve attention by providers. In the absence of assisting them, spouses' illness pressures have deleterious consequences for the quality of marital communication and spouses' self-confidence.
    Psycho-Oncology 12/2009; 19(10):1094-101. · 3.51 Impact Factor
  • Frances Marcus Lewis, Emily L. Darby
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    ABSTRACT: This study investigated the effects of parental functioning on adolescent adjustment during the acute phase of treatment for mothers diagnosed with breast cancer. Data from self-and parent-report questionnaires were obtained in the homes of 87 adolescents and 174 parents within six months of the mother's diagnosis. Associations between adolescent adjustment (self-esteem, behavioral problems, anxiety) and parental functioning (depressed mood, parenting quality, and marital adjustment) were examined when neither, one, or both parents were functioning at compromised levels. When both parents had depressed mood, adolescents tended to show increased behavioral problems; maternal depressed mood was the main source of influence. When the quality of the parenting relationship between the adolescent and both parents was poor, adolescents showed significantly lowered self-esteem and increased anxiety. Marital adjustment did not affect adolescent functioning significantly. Maternal depressed mood and the quality of the parent-child relationship significantly influenced adolescent adjustment during the acute phase of the mother's breast cancer.
    Journal of Psychosocial Oncology. 10/2008; 21(4):81-104.
  • Ellen Hooper Zahlis, Frances Marcus Lewis
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    ABSTRACT: Semistructured interviews were conducted with 26 mothers (aged 35–50 yrs) who had one or more children ( N = 36) aged 8–12 years when they were diagnosed with early stage breast cancer. Formal methods were used to analyze the content of the data inductively. Mothers identified times during their diagnosis and treatment that were most difficult for their children, behaviors they observed indicating that the child was having a difficult time, and factors that prevented them from helping the child during those difficult times. The data provide a partial basis for developing materials, programs, and services designed to minimize the children's distress and to enhance the effectiveness of parenting when a mother has early stage breast cancer. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
    Journal of Psychosocial Oncology 10/2008; · 1.04 Impact Factor
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    ABSTRACT: Depressed mood in spouses of women with breast cancer deleteriously affects their own and their wife's functioning and their marital communication. However, no study has examined why some spouses get depressed whereas others do not, particularly during the first months of diagnosis and treatment, a known difficult time for couples. The current study has two purposes: to test a predictive model of spouses' depressed mood and to evaluate the model's accuracy in distinguishing between normal and clinically depressed spouses. Data were obtained from standardized questionnaires completed by 206 spouses and 206 wives recently diagnosed with nonmetastatic breast cancer. Spouses' depressed mood was measured by the Center for Epidemiological Studies-Depression Scale. A total of 19 variables were extracted from the literature for testing in the model, including psychological, social, demographic, and disease- and treatment-related variables. Spouses were more likely to be depressed if they were older, less well educated, more recently married, reported heightened fears over their wife's well-being, worried about their job performance, were more uncertain about their future, or were in less well-adjusted marriages. The model correctly classified 89.2% of spouses' mood (chi(2) = 79.1; P < .001). Spouses of women with local or regional breast cancer need to be screened for depressed mood and triaged into supportive services to better assist them manage the threat of their wife's breast cancer.
    Journal of Clinical Oncology 04/2008; 26(8):1289-95. · 18.04 Impact Factor
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    ABSTRACT: Breast cancer is known to cause substantial anxiety, depressed mood, and diminished marital functioning in the diagnosed woman's spouse. Despite the scope and magnitude of these issues, few intervention studies have included spouses or addressed the causes of their lower functioning. The purpose of this pilot study was to evaluate the short-term impact of a 5-session, clinic-based, educational counseling intervention for spouses whose wife was recently diagnosed with early stage breast cancer. The goals of the intervention were to enhance spouses' skills and confidence to communicate and interpersonally support his wife about the breast cancer as well as improve spouses' self-care, depressed mood, anxiety, and marital adjustment. Pre-post-test results obtained from 20 spouses from valid and reliable standardized questionnaires showed significant improvements in spouses' depressed mood, anxiety, skills, self-confidence, and self-care. Confidential post-intervention interviews with spouses and wives included detailed examples of positive changes in the spouse's communication and support to his wife about the breast cancer, diminished tension in the spouse, and improved quality in the couple's relationship. Further evaluation of the Helping Her Heal Program is warranted within a clinical trial.
    Psycho-Oncology 03/2008; 17(2):131-7. · 3.51 Impact Factor
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    ABSTRACT: To describe a process for, response rates of, and indicated interest in recruiting patients with breast cancer and their spouses and family members from a clinical setting into behavioral and psychiatric research studies since the Health Insurance Portability and Accountability Act (HIPAA) regulations have taken effect. Published articles, books and book chapters, MEDLINE, government agency information and HIPAA regulatory Web sites, and survey data. Response rates among the three target groups--patients, spouses and partners, and female first-degree relatives--were 77%, 95%, and 88%, respectively. Interest was high in the three target groups, with 77%, 87%, and 65% of responding patients, spouses and partners, and female first-degree relatives, respectively. Taken together, these data indicate that high participation rates can be expected from patients with breast cancer and their families in clinical settings.Implications for Nursing: Regulations pose barriers to patient and family recruitment, but thoughtful systems actually can improve rates of recruitment.
    Oncology Nursing Forum 10/2007; 34(5):1049-54. · 1.91 Impact Factor
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    Frances M. Lewis
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    ABSTRACT: The primary aim of this study was to test a theoretically derived predictive model of adolescent functioning to maternal breast cancer. Standardized questionnaires with well-established validity and reliability were used to measure 6 theoretical concepts in the model and were obtained from 222 study participants, including mothers recently diagnosed with breast cancer, their spouse, and their adolescent child. Results from tests of the theoretical model revealed that the adolescent was deleteriously impacted under two conditions: when the mother's mood was more depressive or when there was heightened tension between the parents. Both heightened marital tension and maternal depressed mood deleteriously affected adolescents' self-esteem. However, the quality of parenting was a protective factor that significantly improved children's self-esteem and enhanced their behavioral-emotional functioning. Results argue for programs and services to help both the ill and non-ill parent sustain quality parenting of the adolescent during the first year of diagnosis, treatment, and early recovery from the mother's breast cancer.
  • Frances M Lewis
    Psycho-Oncology 03/2007; 16(2):97-8. · 3.51 Impact Factor
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    ABSTRACT: Although clinicians and scientists have a growing awareness of breast cancer as a couple's joint experience, no one has studied the concerns couples choose to address with a professional coach to better manage the impact of the cancer. The purpose of the current study was to describe illness-related concerns couples worked on together with masters-educated professional coaches during the first eleven months of the wife's treatment for early stage breast cancer. Intervention sessions were conducted with twenty-nine couples in their homes in the Pacific Northwest. Data were obtained from single occasion case intensive interviews with couples. Inductive coding of the audiorecorded intervention sessions yielded four domains of core concerns: dealing with tension in the relationship; needing to be together as a couple; wondering about the children; and managing the threat of breast cancer. Over half the couples chose to address and do something about the stress, tension and dissatisfaction they were feeling in their relationship that each attributed to the breast cancer. Future family-focused cancer care needs to include services that assist couples to address these core concerns.
    Psycho-Oncology 01/2007; 15(12):1055-64. · 3.51 Impact Factor
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    Arlene Houldin, Frances Marcus Lewis
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    ABSTRACT: To describe the experiences of patients living with newly diagnosed stage III or IV colorectal cancer. Qualitative; inductive coding methods were used to identify open codes that were analyzed, compared, and grouped into categories. An urban ambulatory cancer center in the northeastern United States. 14 patients newly diagnosed with stage III or stage IV colorectal cancer. Semistructured interviews were recorded on audiotape. Interviewers asked participants to describe their experiences with the diagnosis and treatment of colorectal cancer. Content analysis with inductive coding was used to code the transcribed interview data. Categories were reviewed and organized into larger groupings, from which the core category was derived. Experiences of living with a diagnosis of colorectal cancer, impact on daily living, quality of life, coping strategies used, level of preparedness, and impact on children. The coded interview data yielded six domains: feeling life is disrupted, experiencing physicians, feeling unprepared for everything, rethinking parenting, wondering "why me?," and dealing with it. The core category that explained study participants' experiences with recently diagnosed colorectal cancer was "salvaging their normal lives." The dominant experience of the study participants focused on four aspects of their illness experience: (a) framing it in ways that enabled them to recreate a semblance of normalcy or of their preillness state, (b) trying to tell children about the illness in stabilizing ways, (c) generating or maintaining a positive outlook no matter what, and (d) concretely managing the distress of the illness and its symptoms. Targeted assessment is important in the six dimensions of the study domains. Clinicians who work with patients with cancer should offer support as patients search for meanings to explain this potentially devastating life event. Teaching active coping strategies as patients with advanced cancer struggle to come to terms with the demands of the disease while attempting to live their lives as fully and as normally as possible is important.
    Oncology Nursing Forum 08/2006; 33(4):719-25. · 1.91 Impact Factor
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    ABSTRACT: In 2005, approximately 211,240 women in the US will be diagnosed with early stage breast cancer and an estimated 22% will be child rearing. Research reveals that both mothers and children have elevated distress attributed to the cancer; struggle with how to talk about and deal with the impact of the cancer; and both fear the mother will die. The Enhancing Connections Program (EC) was developed to reduce this cancer-related distress and morbidity. The program involves five, 1-hour educational counseling sessions delivered at 2-week intervals by specially trained clinicians. This study reports on the program's short-term impact on mothers' and children's adjustment. Thirteen households were recruited within 7.5 months of the mother's diagnosis with early stage breast cancer. Impact was evaluated within a single group design using data obtained from standardized questionnaires with established reliability and validity. Results revealed significant improvements in the mother's depressed mood, anxiety, and self-confidence to assist her child (mother report). There were also significant decreases in the child's behavioral problems (mother and father report); the child's cancer-related worries (child report); and the child's anxiety/depressed mood (mother and father report). Further evaluation is warranted within a clinical trial.
    Psycho-Oncology 07/2006; 15(6):486-97. · 3.51 Impact Factor
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    Frances Marcus Lewis PhD
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    ABSTRACT: The family, not merely the diagnosed individual, experiences the demands and contingencies of cancer. There is substantial cumulative evidence that these illness-related demands occur during the early stages of illness diagnoses and treatment as well as during the ongoing illness experience. Pressures seem to exacerbate during disease recurrence. The partner, as well as the school age children, are affected by the illness experience. For the partner there is the problem of depression and marital tension. Such factors, in turn, affect the partner's relationship with the children and the child's subsequent psychosocial adjustment. Support programs for the family, as well as the patient, are clearly indicated. Many types of supportive services seem indicated: informational, interpretive, anticipatory, physical, skill building, and problem-focused services.
    Cancer 06/2006; 65(S3):752 - 759. · 5.20 Impact Factor
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    Frances Marcus Lewis
    The American Journal of Nursing 04/2006; 106(3 Suppl):20-5. · 1.39 Impact Factor
  • Frances Marcus Lewis
    Cancer Nursing 01/2006; 29(2 Suppl):20-1, 23-5. · 1.82 Impact Factor
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    ABSTRACT: The purpose of this study was to determine the long-term benefits of participating in a structured, 8-week educational telephone intervention delivered by expert cardiovascular nurses post-ICD. The intervention was aimed to (1) increase physical functioning, (2) increase psychological adjustment, (3) improve self-efficacy in managing the challenges of ICD recovery, and (4) lower levels of health care utilization over usual care in the first 12 months post-ICD. This article reports on the 6- and 12-month outcomes of the nursing intervention trial. A two-group (N = 168) randomized control group design was used to evaluate intervention efficacy with persons receiving an ICD for the secondary prevention of sudden cardiac arrest. Measures were obtained at baseline, 6 and 12 months post hospitalization. Outcomes included (1) physical functioning (Patient Concerns Assessment [PCA], Short Form Health Survey [SF-12], ICD shocks), (2) psychological adjustment (State-Trait Anxiety Inventory [STAI], Centers for Epidemiologic Studies-Depression [CES-D], fear of dying), (3) self-efficacy (Sudden Cardiac Arrest-Self-Efficacy [SCA-SE], Sudden Cardiac Arrest-Behavior [SCA-B], Sudden Cardiac Arrest-Knowledge [SCA-K]), and (4) health care utilization (emergency room [ER] visits, outpatient visits, hospitalizations). Using repeated measures ANOVA, the 6- and 12-month benefits of the intervention over usual care were in reductions in physical concerns (P = 0.006), anxiety (P = 0.04), and fear of dying (P = 0.01), with enhanced self-confidence (P = 0.04) and knowledge (P = 0.001) to manage ICD recovery. There were no statistically significant differences between the groups on total outpatient visits, hospitalizations, or ER visits over 12 months. A structured 8-week post-hospital telephone nursing intervention after an ICD had sustained 12-month improvements on patient concerns, anxiety, fear of dying, self-efficacy, and knowledge. Results may not apply to individuals with congestive heart failure who receive an ICD for primary prevention of sudden cardiac arrest.
    Pacing and Clinical Electrophysiology 12/2005; 28(11):1157-67. · 1.75 Impact Factor

Publication Stats

1k Citations
144.38 Total Impact Points


  • 1986–2010
    • University of Washington Seattle
      • • Department of Family and Child Nursing
      • • Department of Psychiatry and Behavioral Sciences
      • • School of Nursing
      Seattle, WA, United States
  • 2005–2009
    • Fred Hutchinson Cancer Research Center
      • Division of Public Health Sciences
      Seattle, Washington, United States
  • 2006
    • University of Pennsylvania
      • School of Nursing
      Philadelphia, PA, United States
  • 1999
    • Seattle Children's Hospital
      • Children's Hospital and Regional Medical Center
      Seattle, Washington, United States
  • 1993
    • University of Texas at Austin
      • School of Nursing
      Texas City, TX, United States