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Psychosocial resources and subjective well-being of cancer patients
Abstract
Based on Taylor's theory of cognitive adaptation to cancer and on the distinction between psychological and social resources, we analyse whether optimism, internal health locus of control, self-esteem, purpose in life, and perceived availability of social support assessed prior to the commencement of chemotherapy predict concurrent subjective well-being (SWB), SWB at a 9-month follow-up, and change in SWB over time. Longitudinal data were collected from 163 cancer patients. Analyses showed that social support, self-esteem, and to a lesser extent, optimism and purpose in life showed concurrent associations with SWB. In addition, social support and purpose in life at T(1) predicted improvement in SWB over time. However, when resources at T(1) and T(2) are included in the analysis simultaneously, only concurrent resources were related to SWB at T(2) and to change in SWB over time. It is concluded that the effect of initial resources on change in SWB is mediated by the levels of later resources.
... The same authors indicated data based on a study conducted on 173 women who survived mammary gland carcinoma, at an average age of 55.4 years (SD=10.99). The results obtained from the study showed that the higher levels of social support ( =0.21) predicted improvement of the subjective well-being and lower levels of overall stress ( =-0.59) [46]. Similar results were con rmed by the data obtained in the study of Pinquart et al. (2009) on 163 patients with oncological diseases before the initiation of chemotherapy [46]. ...
... The results obtained from the study showed that the higher levels of social support ( =0.21) predicted improvement of the subjective well-being and lower levels of overall stress ( =-0.59) [46]. Similar results were con rmed by the data obtained in the study of Pinquart et al. (2009) on 163 patients with oncological diseases before the initiation of chemotherapy [46]. The authors stated that social support, self-con dence and, to a lesser extent optimism and purpose in life, correlated with subjective well-being. ...
... The results obtained from the study showed that the higher levels of social support ( =0.21) predicted improvement of the subjective well-being and lower levels of overall stress ( =-0.59) [46]. Similar results were con rmed by the data obtained in the study of Pinquart et al. (2009) on 163 patients with oncological diseases before the initiation of chemotherapy [46]. The authors stated that social support, self-con dence and, to a lesser extent optimism and purpose in life, correlated with subjective well-being. ...
Symptoms of fatigue and exhaustion are considered to be the most common complaints in patients with oncological diseases during and after treatment. The manifestations can be on a physical, cognitive and emotional level. At diagnosis, 40% of patients report fatigue, and this percentage increases to 90% during treatment. However, the exact determinants of fatigue are not yet known. This article is a literary review of the problem of cancer-related fatigue – mechanisms, risk factors, and the impact on the lives of those affected. Literary data on the role of subjective well-being in terms of fatigue and emotional responses of patients with oncological diseases are described. A number of contemporary studies of the combined effect of fatigue and pain on the functioning of oncology patients have been discussed. It is concluded that the symptoms of fatigue, exhaustion and pain are considered the most common complaints in patients with oncologic pathology during and after treatment, whose manifestations may be physical, cognitive and emotional. On the other hand, human health satisfaction is one of the most important predictors of life satisfaction, which contributes significantly to the overall well-being of the patients group discussed.
... O diagnostico de câncer representa uma importante ameaça ao bem-estar subjetivo, ocasionando reações emocionais nos individuos que afentem na compreensão do diagnostico e na realização terapêutica (PINQUART, FROHLICH, 2009). Os principais estressores para os pacientes e seus acompanhantes estão relacionados ao tratamento, perda de controle, ambiente hospitalar, recidivas, o medo de morrer, má imagem corporal, falta de auto-estima e dificuldades de transição na vida social (SHERIEF et al, 2015). ...
... O apoio psicossocial,pode representar uma fonte importante no tratamento do câncer, promovendo relações positivas nos papéis pessoais, bem estar e autoestima, que protege a saúde psicológica, diminuindo os efeitos dos estressores relacionados ao câncer (PINQUART, FROHLICH, 2009). Esse apoio psicossocial deve ser desenvolvido náo somente com o paciente oncologico, mas tambem com o seus acompanhantes, que direcionam toda a atenção apenas para o doente e seu acompanhamento integral no tratamento, levando a mudanças na rotina da vida diária, comprometimento do autocuidado, e conflitos com o conjuge ou demais familiares (SHERIEF et al, 2015). ...
... O sofrimento ocasionado pelos efeitos adversos da quimioterapia resulta em mudanças que afetem nas mais diversas esferas da vida do paciente, e em diferentes níveis socioeconômicos (CHENG et al, 2018); (LEMIEUX, MAUNSELL, PROVENCHER, 2008). O retorno ao trabalho pode significar em decorrência dos diferentes níveis de alteração na aparência, aflição, agústia e baixo rendimento no trabalho para o paciente (CHANG et al, 2014), e que podem se agravar com a falta de recursos (PINQUART, FROHLICH, 2009), como informação, falta de apoio social, o que pode dificultar sua capacidade para enfrentar as barreiras gerenciar o sofrimento (CHANG et al, 2014). ...
Objetivo: Analisar as produções científicas sobre a avaliação da autoestima de pacientes oncológicos, submetidos ao tratamento quimioterápico. Metodologia: Trata-se de uma revisão integrativa da literatura, onde foi formulada a seguinte questão PICo (não-clínica): Quais as evidências cientificas apontam as mudanças na autoestima dos pacientes oncológicos submetidos ao tratamento quimioterápico? Resultados: As alterações na autoestima em pacientes oncológicos estão relacionadas a efeitos adversos da quimioterapia, como a alopecia, e ao estado psicológico baixo associado à depressão, comprometimento familiar, isolamento social, estresse, e alguns sintomas como náuseas, vômitos, anorexia, debilidade física, que provocam sentimento de impotência e desesperança afetando diretamente na autoestima. A produção dos bundles de intervenção propôs estimular a pratica de atividade física e outras atividades de lazer em pacientes oncológicos, oferecer um programa de apoio psicossocial integrado para os pacientes e seus acompanhantes no enfrentamento da doença e mudança na autoestima, Orientar sobre o surgimento da alopecia durante a quimioterapia, e os efeitos negativos na autoimagem, Promover atividades de apoio ao retorno ao trabalho e aconselhamento ocupacional em pacientes oncológicos, Desenvolver atividades de embelezamento e do uso de adornos em pacientes submetidos a quimioterapia. Considerações Finais: O tratamento quimioterapico pode ser considerado um fator determinante nas alterações da autoestima, pois possibilita a ocorrência de inúmeros impactos na vida do paciente oncológico, tais coomo, fisíco, emocionais e sociais.
... However, special attention should be given to these types of activities carried out in a group-based setting since studies put forward its multiple advantages for oncological patients [33]. It is demonstrated that women that perceive having a solid social support network, which could be achieved through leisure engagement, show higher levels of purpose in life and this predicts an increase in the levels of SWB [34]. Belonging to a group whose members have lived similar illness-related challenges can offer the opportunity of a safe space to express freely and foster feelings of relatedness, empathy and courage. ...
... An important dimension of this study was the analysis of social support and its effects on wellbeing during cancer treatment and recovery. Contradicting previous evidence on the impact of social support for wellbeing during illness [34,47] we did not find a significant relationship between general levels of support and wellbeing. This may be related to questions of measurement and conceptualization of social support, notably discussed by Pahl [48]. ...
In contemporary societies, a significant proportion of women will be affected by breast or ovarian cancer over the course of their lives. Dealing with illness is known to impact profoundly on the general quality of life of women, but this assessment is usually made in clinical terms, and less attention is given to the social determinants of quality of life for cancer patients, and to the implications of cancer for their subjective wellbeing. In this article, we specifically discuss the impact of being engaged in a leisure activity for the subjective wellbeing of women experiencing breast or ovarian cancer. Based on an exploratory comparative study among Honduras, Nicaragua and Portugal, we analyze the influence of leisure engagement, country of residence, treatment and social support for the subjective wellbeing of women dealing with cancer, proposing a discussion on the intersections of wellbeing, leisure and illness. The research was supported by a survey applied to 128 women diagnosed with breast and ovarian cancer. Significant relationships were found amongst subjective wellbeing, leisure engagement, country and support from patients’ associations. Results highlight the need to consider the effects of leisure among cancer patients, and the importance of institutionalized support to improve their quality of life.
... A literatura existente sugere que o BES pode ser um fator preditivo na incidência de cancro e de taxas de sobrevivência na doença oncológica (Williams & Schneiderman, 2002). Pacientes oncológicos optimistas e com uma elevada auto-estima apresentam uma associação com o BES (Pinquart & Fröhlich, 2009); e o suporte social e sentido de vida são bons preditores do aumento do BES destes pacientes (Pinquart & Fröhlich, 2009). ...
... A literatura existente sugere que o BES pode ser um fator preditivo na incidência de cancro e de taxas de sobrevivência na doença oncológica (Williams & Schneiderman, 2002). Pacientes oncológicos optimistas e com uma elevada auto-estima apresentam uma associação com o BES (Pinquart & Fröhlich, 2009); e o suporte social e sentido de vida são bons preditores do aumento do BES destes pacientes (Pinquart & Fröhlich, 2009). ...
Objectives
To build a structural model to explore the predictors of adjustment to aging (AtA) reported by older women in breast cancer remission.
Methods
Older women in breast cancer remission (n = 214) aged between 75 and 94 years participated in this study. A questionnaire to determine socio-demographic (age, income, professional and marital status, education, household, living setting and self-reported spirituality), lifestyle and health-related characteristics (physical activity, leisure, perceived health, recent disease and medication), and measures to assess AtA, sense of coherence and subjective well-being, were employed. Structural equation modeling was used to explore a structural model of the self-reported AtA, encompassing all variables.
Results
Preliminary results indicated that self-reported spirituality (β = .397; P < .001), leisure (β = .383; P < .001), physical activity (β = .267; P < .001), perceived health (β = .211; P < .001), marital status (β = .173; P < .001), professional status (β = .156; P = .009), sense of coherence (β = .138; P < .001), and living setting (β = .129; P = .007), predicted AtA. The variables accounted for 79.2% of the variability of AtA.
Conclusion
Self-reported spirituality and leisure were the strongest predictors of AtA. Our preliminary findings suggest that health care interventions with older women in breast cancer remission still living in the community may benefit from clearly including predictors of AtA, as these are essential for promoting older women’ s aging well.
... Longitudinal studies have yielded mixed results regarding the stability of SOC, with some studies showing decreases in SOC following a traumatic event [28,29]. Similarly, MiL has been shown to change over time and often fluctuates concurrently with emotional well-being [30,31]. In sum, MiL and SOC share some commonalities; however, these constructs are theoretically distinct and have not been compared in relation to distress in cancer patients. ...
... Thus, the directions of the MiL-distress and SOC-distress associations cannot be confirmed. To date, only a few studies have longitudinally examined these associations, and the results have been mixed [24,30,31]. Given the lack of prospective research in this area, the extent to which a cancer diagnosis may shatter one's global meaning is unclear. ...
Cancer patients report high rates of distress. The related constructs of meaning in life (MiL) and sense of coherence (SOC) have long been recognized as important factors in the psychological adjustment to cancer; however, both constructs' associations with distress have not been quantitatively reviewed or compared in this population. Informed by Park's integrated meaning-making model and Antonovsky's salutogenic model, the goals of this meta-analysis were the following: (1) to compare the strength of MiL-distress and SOC-distress associations in cancer patients; and (2) to examine potential moderators of both associations (i.e., age, gender, ethnicity, religious affiliation, disease stage, and time since diagnosis).
A literature search was conducted using electronic databases. Overall, 62 records met inclusion criteria. The average MiL-distress and SOC-distress associations were quantified as Pearson's r correlation coefficients and compared using a one-way ANOVA.
Both MiL and SOC demonstrated significant, negative associations with distress (r = -0.41, 95% CI: -0.47 to -0.35, k = 44; and r = -0.59, 95% CI: -0.67 to -0.51, k = 18, respectively). Moreover, the MiL-distress association was significantly smaller than the SOC-distress association (Qb = 10.42, df = 1, p < 0.01). Neither association varied by the tested moderators.
Findings provide support for the clinical relevance of MiL and SOC across demographic and medical subgroups of cancer patients. The strength of the SOC-distress association suggests that incorporating aspects of SOC (e.g., the perceived manageability of life circumstances) into meaning-centered interventions may improve their effectiveness for distressed cancer patients. Copyright © 2015 John Wiley & Sons, Ltd.
Copyright © 2015 John Wiley & Sons, Ltd.
... A literatura existente sugere que o BES pode ser um fator preditivo na incidência de cancro e de taxas de sobrevivência na doença oncológica (Williams & Schneiderman, 2002). Pacientes oncológicos optimistas e com uma elevada auto-estima apresentam uma associação com o BES (Pinquart & Fröhlich, 2009); e o suporte social e sentido de vida são bons preditores do aumento do BES destes pacientes (Pinquart & Fröhlich, 2009). ...
... A literatura existente sugere que o BES pode ser um fator preditivo na incidência de cancro e de taxas de sobrevivência na doença oncológica (Williams & Schneiderman, 2002). Pacientes oncológicos optimistas e com uma elevada auto-estima apresentam uma associação com o BES (Pinquart & Fröhlich, 2009); e o suporte social e sentido de vida são bons preditores do aumento do BES destes pacientes (Pinquart & Fröhlich, 2009). ...
... Pomembno je vedeti, kakšna je njegova soodvisnost v odnosih. Biti ljubljen in sprejet ter imeti ob sebi druge ljudi, so pomembni viri pozitivnih čustev (Pinquart & Frohlich, 2009). Cilj štirih prilagoditvenih načinov medsebojne odvisnosti je doseči fiziološko, psihološko in socialno celovitost (Marriner-Tomey & Raile Alligood, 2006). ...
... Osnovna potreba prilagoditvenega načina medsebojne odvisnosti je socialna celovitost ali dajati in prejemati ljubezen, spoštovanje in biti cenjen s strani pomembnih drugih in socialnih podpornih sistemov (Roy, 1997). Pomembno je vedeti, kakšna je njegova soodvisnost v odnosih (Pinquart & Frohlich, 2009). V našem primeru se je komunikacija in vzpostavljanje dobrega medosebnega odnosa izkazalo za zelo pomembno. ...
Uvod: Prilagajanje je ključni dejavnik za uspešno soočenje posameznika s spremembami v svojem notranjem in zunanjem okolju. Z aktivnostmi zdravstvene nege medicinske sestre pomagajo zagotoviti potrebne vire za uspešnejši proces prilagajanja. Avtorji v prispevku razpravljajo, ali bi teoretični model prilagoditve Calliste Roy ustrezal pri obravnavi in zdravstveni negi v enoti za zdravljenje bolečine.
Metode: Uporabljena je triangulacija metod pregleda literature in kvalitativne metode z raziskovalno tehniko kritičnega dogodka. Pregled literature je bil narejen v vzajemni bibliografsko-kataložni bazi COBIB.SI in Cumulative Index to Nursing and Allied Health Literature (CINAHL). Pridobljenih je bilo 165 zadetkov in uporabljenih 34 znanstvenih člankov ter 7 monografij. Kriteriji izbora so bili primarni viri Calliste Roy, dostopnost, relevantnost, kritična ponazoritev teoretičnega modela. Tehnika kritičnega dogodka v treh fazah opiše incident, ga analizira ter poda možne izide.
Rezultati: Adaptacijski model Calliste Roy je aplikativen, uporaben in v sedanji situaciji se dobro dopolnjuje s štirinajstimi temeljnimi življenjskimi aktivnostmi po Virginie Henderson. Model daje možnost ocene tako fizičnega kot psihosocialnega stanja. Najpomembnejše prepoznane intervencije medicinske sestre, ki pripomorejo k prilagoditvenemu procesu pacienta, so psihosocialna podpora, učenje in svetovanje.
Diskusija in zaključek: Prednost obravnave pacienta z rakom in bolečino po izbranem modelu zdravstvene nege je v možnosti ocene stanja po vseh štirih ravneh prilagajanja in v prikazu načrta zdravstvene nege. Pokazalo se je kot pozitivno, da medicinska sestra lahko s psihosocialno podporo in informiranjem vpliva na kakovost življenja pacienta. Pacient in družina se soočata s kronično boleznijo, načinom življenja in pomenom poznavanja ter nadzorovanja bolečine.
... These three life domains have been commonly found to be among the top four important life domains for overall life satisfaction [42][43][44]. The finding of a strong influence of the relationships domain in cancer patients is consistent with the literature, which found that social participation and strong personal relationships help individuals suffering from illness recover more quickly and adjust better [45][46][47][48][49]. As compared to patients with other chronic diseases (e.g., heart diseases) or the general public, the health domain ranks relatively lower in cancer patients in this study [43,44]. ...
Different wellbeing measures have been used among cancer patients. This study aimed to first investigate the sensitivity of health state utility (HSU), capability, and subjective wellbeing (SWB) instruments in cancer. A cancer-specific instrument (QLQ-C30) was included and transferred onto the cancer-specific HSU scores. Furthermore, it examined the relative importance of key life domains explaining overall life satisfaction. Data were drawn from the Multi-instrument Comparison survey. Linear regression was used to explore the extent to which the QLQ-C30 sub-scales explain HSU and SWB. Kernel-based Regularized Least Squares (KRLS), a machine learning method, was used to explore the life domain importance of cancer patients. As expected, the QLQ-C30 sub-scales explained the vast majority of the variance in its derived cancer-specific HSU (R2 = 0.96), followed by generic HSU instruments (R2 of 0.65–0.73) and SWB and capability instruments (R2 of 0.33–0.48). The cancer-specific measure was more closely correlated with generic HSU than SWB measures, owing to the construction of these instruments. In addition to health, life achievements, relationships, the standard of living, and future security all play an important role in explaining the overall life satisfaction of cancer patients.
... In the study of mental and social resources and their relationship to well-being in cancer patients, the relationship between perceived availability of social support for subjective well-being, impact on well-being after 9 months and change in well-being over time was examined. Social support was important in terms of well-being and predicted well-being changes over time (Pinquart and Fröhlich, 2009). ...
The aim of this article is to present cancer as a serious, life-threatening chronic disease that strongly impacts all aspects of a patient’s quality of life, including the physical, psychological, social, and spiritual ones. This theoretical article describes selected variables related to the quality of life of a cancer victim during the processes of diagnosis and treatment. These variables include stress and coping with the specific stress of having cancer, appraisal of the disease, acceptance of illness, and social support. Also discussed is the role of the variables listed above in quality of life in cancer and current research on these connections. Implications of the presented theory and research indicate that cancer affects quality of life in all areas and that the process of adaptation to the disease is facilitated by adopting adaptive coping strategies, appraising the disease as a challenge rather than as a threat or loss, accepting the inevitable limitations to everyday life, and seeking and using various sources of social support.
... Крім того, соціальні ресурси, такі як наявність та використання соціальної підтримки, можуть становити ще один важливий факторвпливу на суб'єктивне благополуччя онкопацієнтів. Але зв'язки з суб'єктивним благополуччям були виявлені лише для соціальної підтримки, самооцінки і, в меншій мірі, оптимізму та сенсу життя [32]. Подібні результати отримали і в іншому дослідженні: із високим суб'єктивним благополуччям онкопацієнтів з РМЗ корелювала соціальна підтримка і низький рівень стресу [27]. ...
... Despite such diverse measures, findings have converged on the beneficial effect of PSS on SWB. PSS has been positively associated with SWB (Finch et al., 1989;Pinquart and Frohlich, 2009) or psychological wellbeing (Turner, 1981), and negatively related to anxiety and depression (Bolger and Eckenrode, 1991;Brissette et al., 2002;Lara et al., 1997;Lin et al., 1999), and has been found to mitigate the negative impact of stressful life events on psychological and physical functioning (Cohen and Wills, 1985;Cohen, 2004). Consistent with existing research, we hypothesize that PSS will have a positive relationship with SWB. ...
The present study attempts to incorporate individual personality into a social network account of subjective wellbeing (SWB) by proposing and testing a path model in which social relationships (egocentric social networks and perceived social support, PSS) mediate the relationship between personality and SWB. We found that network characteristics (including network size, emotional closeness, and pro- portion of new contacts) are related to SWB largely via the mediation of PSS. Additionally, network size and proportion of new contacts function as important mediating mechanisms linking extraversion, agreeableness and openness to PSS and SWB.
... Some other studies also found support present at diagnosis to be relevant for quality of life or well-being a few months later. 39,40 Another explanation could be that patients who express high levels of distress tend to mobilize more intense and more frequent social support from friends and family. Studies with breast and colorectal cancer patients report declining social support after diagnosis and cancer treatment. ...
Purpose
Social support has been shown to be positively associated with quality of life and adjustment after a cancer diagnosis. The present study investigates the course of social support up to one year after partial laryngectomy and its association with distress.
Design
Longitudinal questionnaire study.
Sample
A total of 428 patients after partial laryngectomy (mean age: 64, SD = 11, 91% male).
Methods
Patients completed questionnaires before treatment (t1), one week after a partial laryngectomy (t2), 3 months (t3), and one year (t4) thereafter. Social support was evaluated at t2, t3, and t4 using a brief version of the Social Support Questionnaire. Distress was measured at t2, t3, and t4 using the HADS. Descriptive statistics for social support were computed across the three measurement points. Changes were analyzed by Wilcoxon signed-rank tests. Associations with distress were identified using linear regression analyses.
Findings
Social support increased between t2 and t3 and decreased to baseline level between t3 and t4. Distress at t2 was associated with social support at t2 (B = −0.15, p < 0.01) and distress at t3 with social support at t3 (B = −0.19, p < 0.01). Distress at t4 was related to social support at t2 (B = −0.10, p = 0.05).
Conclusions
Although perceived social support increases after partial laryngectomy, it decreases again during the course of aftercare.
Implications for Psychosocial Providers or Policy
Social support resources should be assessed to identify patients at risk for worse psychological well-being.
... Na podstawie literatury przedmiotu (Filazoglu, Griva, 2008; lewis i in., 2001) można wnioskować, że wysoki poziom spostrzeganego wsparcia społecznego może mieć kluczowe znaczenie w procesie leczenia i dochodzenia do zdrowia u kobiet z rakiem piersi, zwłaszcza jeśli odczuwane jest jako pomocne i satysfakcjonujące. Tylko kilka badań nie potwierdziło takich relacji, po części z powodu nielicznych grup osób badanych oraz niedociągnięć metodologicznych (Pinquart, Fröhlich, 2009). Badania podłużne przeprowadzone przez Grassi i Rosti (1996) wykazały, że pozytywnie spostrzegane wsparcie społeczne w okresie na krótko po diagnozie prognozuje wyższe poczucie jakości życia do 6 lat od momentu postawienia diagnozy. ...
... There is also some suggestive evidence that the distribution of purpose may vary by physical health, although such evidence remains mixed. For example, while some studies suggest that self-reported health is positively associated with purpose (Hill & Weston, 2019;Saajanaho et al., 2016) and that purpose declines following occurrences of physical diseases (Lewis, Brazeau, & Hill, 2018), other studies have not observed such trends (Pinquart & Frohlich, 2009). ...
Potential antecedents to having a sense of purpose in life remain understudied. As researchers begin contemplating purpose as a promising target of public health intervention, it is critical to identify its antecedents. Using prospective data from the Nurses' Health Study II (2009-2016; N ranged from 3,905 to 4,189), this study evaluated a wide range of potential antecedents of purpose, including: psychosocial well-being, psychological distress, employment characteristics, lifestyle, and physical health factors. In separate regression models we regressed purpose in life on each candidate antecedent. In each model, we adjusted for the prior value of purpose, prior values of all exposure variables, and various other covariates simultaneously. Bonferroni correction was used to correct for multiple testing. The results suggested that positive affect and the number of close relatives were each associated with higher purpose (e.g., β=0.14, 95% CI: 0.11, 0.17 for positive affect). Several psychological distress indicators were inversely associated with purpose, including depressive symptoms, anxiety symptoms, loneliness, and hopelessness (e.g., β=-0.16, 95% CI: -0.19, -0.13 for depressive symptoms). There was also some evidence suggesting that fewer close friends, living alone, and unemployment/retirement were associated with lower purpose. There was, however, little evidence that health behaviors or physical health were associated with subsequent purpose. This study extends the literature by providing longitudinal evidence with rigorous analytic methodologies, and by considering a wide range of potential antecedents of purpose including some that have seldom been examined previously.
... Por tanto, los recursos psicológicos que formarían parte de la adaptación cognitiva de Taylor ante el cáncer y otros estresores severos serían el optimismo, la percepción de control ante la enfermedad, la autoestima y el sentido de propósito y significado en la vida a raíz de la situación estresante (Pinquart y Fröhlich, 2009). ...
Introduction: Breast cancer is the most diagnosed oncology pathology in Spain and the western world. One of the most significant aspects and suffering a strong deterioration is the emotional aspect, with the appearance of anxiety, sadness, fear, anger, loss of self-esteem, difficulties in relation to the environment or loss of feeling of control in the situation. Quality of life is an important concept to consider, in order to evaluate both the psychosocial status of the patients and the effectiveness of the treatments and the adaptation to the oncological situation. Among the characteristics that could dampen the impact of cancer and its treatment on the lives of patients, is optimism.
Objective: The aim of the thesis is to study the influence of dispositional optimism and some of its strategic cognitive mechanisms on the quality of life of breast cancer patients at different times of the disease.
Results The results show relationships between dispositional optimism and patients' quality of life: patients in the same medical situation, if they are optimistic, have less loss of quality of life. However, the influence of dispositional optimism diminishes when the medical situation is objectively more stressful, and then some of the resources of the optimistic personality will become more important: recalling the past in a positive way, develop expectations of a positive solution to the disease, perception of Control over the situation and evaluate positive aspects of the medical situation. It would seem that for the emotional and social well-being of the patients it would be more important to be optimistic than the medical situation. Conclusion: The data obtained in the present research support the hypothesis that the emotional and social well-being of the patients depends more on the optimism than on the medical situation in which they are.
Spanish abstract
Introducción: El cáncer de mama es la patología oncológica más diagnosticada en España y el mundo occidental. Su diagnóstico y tratamiento suponen una situación estresante que puede durar meses o incluso cronificarse cuando aparecen recidivas. Las diferentes fases de la enfermedad desencadenan distintas consecuencias físicas, emocionales y sociales que afectan a la vida diaria de las personas. Uno de los aspectos más significativos y que sufre un fuerte deterioro es el aspecto emocional, con la aparición de ansiedad, tristeza, miedo, rabia, pérdida de autoestima, dificultades de relación con el entorno o pérdida de sensación de control ante la situación. La adaptación pues, a una situación de estrés como el cáncer de mama, las reacciones emocionales, cognitivas y conductuales a los resultados, al dolor, a los tratamientos y a las pérdidas, se evalúan mediante la percepción subjetiva que la persona tiene de ella misma y de la situación. La calidad de vida es un importante concepto a considerar, para evaluar tanto el estado psicosocial de los enfermos como la eficacia de los tratamientos y la adaptación a la situación oncológica. Entre las características que podrían amortiguar el impacto del cáncer y su tratamiento en la vida de las pacientes, se halla el optimismo. Objetivo: El objetivo de la tesis es estudiar la influencia del optimismo disposicional y algunos de sus mecanismos cognitivos estratégicos en la calidad de vida de las pacientes de cáncer de mama, en diferentes momentos de la enfermedad. Resultados: Los resultados muestran relaciones entre el optimismo disposicional y la calidad de vida de las pacientes: pacientes en la misma situación médica, si son optimistas, tienen menos pérdida de calidad de vida. Sin embargo la influencia del optimismo disposicional disminuye cuando la situación médica es objetivamente más estresante, y entonces adquiere mayor importancia la utilización de estrategias optimistas como: recordar el pasado de forma positiva, desarrollar expectativas de solución positiva ante la enfermedad, la percepción de control sobre la situación y valorar aspectos positivos ante la situación médica. Conclusión: Los datos obtenidos en la presente investigación apoyan la hipótesis de que el bienestar emocional y social de las pacientes depende más del optimismo que de la situación médica en que se encuentran.
... Recently, diagnosed cancer patients before their first cycle of chemotherapy were found to report more optimism and purpose in life than healthy controls, but those resources declined to the levels of the control group 9 months later over the course of chemotherapy [13]. The initial level of some selfreported resources (social support, self-esteem, optimism, purpose in life) however was associated with higher subjective well-being after therapy [14]. Hence, high levels of resource utilization may on the one hand reflect the level of perceived distress but on the other hand may also reduce it. ...
Purpose:
Many long-term cancer survivors still have to adjust to possible adverse consequences of the illness or treatment. Resources can play an important role in this adjustment process, but research on this topic is limited, especially for very long-term survivors. This study explores, which resources are most frequently indicated by different subgroups of cancer survivors, and what role resources play for functioning and health-related quality of life (HRQL) in cancer survivors with and without recurrence.
Methods:
The sample of 6030 breast, colorectal, and prostate cancer survivors (5-16 years post-diagnosis) was recruited in a German multi-regional population-based study. Personal resources were assessed by a 27-item checklist; HRQL was assessed by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). General linear models were used to analyze associations of resources with HRQL.
Results:
Participants indicated on average 11.4 (SD 5.1) resources as helpful. Family, activities with others, and partnership were indicated most commonly overall, but frequencies varied according to age, sex, and tumor site. Physical activity, health, professional help, calmness, hope, optimism, and hobbies were most important in explaining HRQL variance. Cancer survivors with recurrence and many resources were found to report similar HRQL as survivors without recurrence and only few resources.
Conclusions:
The study underlines the importance and situational variability of personal and social resources for cancer survivors' HRQL, even years post-diagnosis. Not only the availability, but also the individual perception and significance of resources should be considered in follow-up cancer care.
... Early detection, advances in technology, and more effective treatments have significantly increased cancer survival rates, which translates to 2.4 million deaths averted since 1991 (American Cancer Society, 2018). Unfortunately, cancer survivorship is defined primarily in medical terms, despite significant psychological and spiritual distress survivors experience from such an existential threat (Pinquart & Frohlich, 2009;Sandler-Gerhardt, Reynolds, Britton, & Kruse, 2010;Shannonhouse et al., 2014). One's sense of meaning has been found to have a causal role in alleviating distress in cancer survivors (Yanez et al., 2009), andWinger andcolleagues (2016) found in their meta-analysis of 44 studies of cancer patients that meaning was negatively correlated with distress (r ϭ Ϫ.41). ...
This study explored Evangelical Christians’ narratives regarding their cancer diagnoses ( N = 29) through grounded theory methodology. Participants drew on their religious resources to construct meaning in coping with their diagnosis. Results indicated that the predominant narrative was the redemption of suffering. Four varieties of redemption stories were evident, and appeared to be tied to feelings that emerged in response to the existential threat of the cancer diagnosis. These redemption stories detailed movements from despair to hope, from grief to consolation, from being alone to being in community, and from loss of control to spiritual surrender. Implications regarding the religion-specific nuances in the meaning-making coping process are provided.
... In a meta-analysis of studies examining purpose in middle and older adults, Pinquart (2002) found that poor physical health was associated with lower purpose in life, which was later demonstrated to lead to disengagement from past activities and loss of social roles that were once related to one's purpose (Scheier et al., 2006). Conversely, other research has found comparable levels of purpose between patients diagnosed with cancer and healthy controls (Cordova et al., 2001;Tomich and Helgeson, 2002), and longitudinal work found no significant change in purpose prior to chemotherapy and 9 months later (Pinquart and Fröhlich, 2009). However, a prominent limitation of the literature examining purpose following illness diagnosis has been the use of cross-sectional designs or employing longitudinal designs that lack pre-illness assessments of purpose, limiting the ability to address whether within-person change occurs following the onset of a major health condition. ...
It is unclear how the onset of a major health condition, such as a stroke, may impact sense of purpose long-term and whether social factors influence this change. We examined changes in purpose in 716 stroke patients (Mage = 72.09 years, 52.5% female) who participated in the Health and Retirement Study between 2006 and 2014. Multilevel growth modeling indicated that recent stroke patients’ sense of purpose declined over time relative to pre-stroke purpose, whereas those suffering stroke prior to baseline demonstrated relative stability. Furthermore, social support was associated with initial levels but not change in sense of purpose.
... SWB could also be a predictive factor regarding cancer incidence and survival rates (Williams and Schneiderman 2002). Moreover, a higher self-esteem, purpose of life, social support and optimism in cancer patients were associated with a higher SWB (Pinqüart and Fröhlich 2009). ...
This study aims to build a structural model to explore the predictors of adjustment to aging (AtA) reported by older women in breast cancer remission. A community-dwelling sample of 771 older women in breast cancer remission aged between 75 and 98 years answered a questionnaire to determine socio-demographic (age, income, marital status, education, household, and living setting), and health-related characteristics (self-reported functional limitations and disabilities, time since remission, other type of cancer, breast reconstruction, perceived health, recent disease and medication). Several measures were employed to assess AtA, sense of coherence and subjective well-being. Structural equation modeling was used to explore a structural model of the self-reported AtA, encompassing all variables. Significant predictors of AtA are self-reported disability (β = .404; p < .001), time since remission (β = .371; p < .001), perceived health (β = .257; p < .001), other type of cancer (β = .231; p < .001), breast reconstruction (β = .153; p = .008), marital status (β = .141; p < .001), sense of coherence (β = .140; p < .001), and living setting (β = .139; p = .006). These variables accounted for 84.3% of the variability of AtA. Self-reported disability and time since remission were the strongest predictors of AtA. Our findings suggest that health care interventions with older women in breast cancer remission still living in the community may benefit from clearly including these predictors of AtA, as they are relevant for promoting older women’ s aging well.
... The main purpose of any psychological intervention in patients diagnosed with cancer is to aid toleration of the diagnosis and treatment, decreasing the feelings of defencelessness and abandonment, reducing the anxiety related to the treatments, and clarifying any erroneous information and perceptions (Dempster, McCorry, Brennan, Donnelly, Murray & Johnston, 2011;Dobkin & Costa, 2000;Hou, Law & Fu, 2010;Novoa, Vargas, Obispo, Petrus & Rivera, 2010;Pinquart & Fröhlich, 2009) 32,33,34,35,36) . According to Bárez, et al. (2003) 37) , the strategies that are carried out in this type of situation are related to emotional support, in terms of the patient feeling that they are being listened to, understood, encouraged and well cared for, to educational-informational support, which favours the necessary level of information to be able to handle the whole process, and to instrumental support, where the patients are provided with different economic and material resources or with home assistance. ...
The aim of this work has been to determine the repercussions a psycho-oncological program has on patients who need to undergo a haematopoietic stem cell transplantation (HPT). We have studied two groups, an intervention group (n=21), formed with patients that have gone through the program of psycho-oncologic preparation previous to the transplant, and a control group (n=15), without psychological intervention. The program consists of four sessions: analysis and handling of the information, coping skills, management of stress, and preparation for the isolation. The results show that patients who receive the psychological intervention. appear to obtain minor levels in anxiety and depression and has a more adaptive perception of the passage of time and a more positive mood with more activity than the control group. However, such differences are not significant in the perception of the physical symptomatology as the amount of time in isolation increases.
... The first line of empirical evidence suggesting that meaning may play a favorable role in adjustment pertains to studies documenting associations between meaning and general well-being variables. For example, meaning has been favorably linked to positive affect and hope (Burrow & Hill, 2011), life satisfaction (Bronk, Hill, Lapsley, Talib, & Finch, 2009), internal locus of control (Pinquart & Fröhlich, 2009) and self-rated heath (Scheier et al., 2006) and inversely to anxiety (Debats, Van Der Lubbe & Wezeman, 1993), depression (Mascaro & Rosen, 2005), and hopelessness (Harris & Standard, 2001). Longitudinal studies have found meaning to prospectively predict suicidal ideation (Kleiman & Beaver, 2013), myocardial infarctions (Kim, Sun, Park, Kubzansky, & Peterson, 2013), sleep quality (Kim, Hershner, & Strecher, 2015), mortality (Hill & Turiano, 2014), and daily levels of positive and negative affect (Burrow & Hill, 2011). ...
Having a sense of meaning in life is often considered to be a positive resource that can facilitate better adjustment to major stressors. However, few studies have directly and adequately examined this idea. The present study addresses this question by examining 1) if meaning predicts trajectories and changes in key distress-exacerbating factors and distress 2) if meaning buffers negative effects of distress-exacerbating factors on distress, and 3) if the different dimensions of meaning are differentially important in adjustment. The sample consisted of 180 undergraduates prescreened to have had a recent stressor that they found stressful at prescreening. Participants were assessed at four time points over a 9-week period with three weeks in between each time point. At baseline, participants completed a measure of meaning; at all time points, participants completed measures of key distress-exacerbating factors and distress. Overall, results provided some evidence of meaning as a positive resource in adjustment. HLM analyses of adjustment trajectories showed that those with higher baseline meaning had better adjustment at baseline, although those with lower meaning seemed to catch up over time. Residual change regression models showed meaning to predict favorable changes in distress-exacerbating factors and distress. Moderation analyses showed meaning to buffer the negative effects of distress-exacerbating factors on distress. Finally, the meaning dimension of comprehension appeared to be relatively more important in adjustment than were purpose and mattering. These results have implications such as greater support for clinical interventions aimed at fostering meaning, and the need for more multidimensional examinations of meaning.
... The main purpose of any psychological intervention in patients diagnosed with cancer is to aid toleration of the diagnosis and treatment, decreasing the feelings of defencelessness and abandonment, reducing the anxiety related to the treatments, and clarifying any erroneous information and perceptions (Dempster, McCorry, Brennan, Donnelly, Murray & Johnston, 2011;Dobkin & Costa, 2000;Hou, Law & Fu, 2010;Novoa, Vargas, Obispo, Petrus & Rivera, 2010;Pinquart & Fröhlich, 2009) 32,33,34,35,36) . According to Bárez, et al. (2003) 37) , the strategies that are carried out in this type of situation are related to emotional support, in terms of the patient feeling that they are being listened to, understood, encouraged and well cared for, to educational-informational support, which favours the necessary level of information to be able to handle the whole process, and to instrumental support, where the patients are provided with different economic and material resources or with home assistance. ...
Efectos del entrenamiento en habilidades de comunicación en la expresión de emociones y locus de control en pacientes de trasplante de precursores hematopoyéticos (TPH)
Soledad de Linares-Fernández [1] ; Mª Nieves Pérez-Marfil [2] ; Francisco Cruz-Quintana [2] ; Antonio Romero-Aguilar [1] ; Lucía Moratalla-López [1] ; Elisa López-Fernández [1]
[1] Hospital Universitario Virgen de las Nieves
[2] Universidad de Granada
Localización: Revista argentina de clínica psicológica, ISSN 0327-6716, Vol. 27, Nº. 1 (Enero de 2018), 2018, págs. 14-23
Idioma: español
Títulos paralelos:
Effects of training in communication skills in the expression of emotions and locus of control in patients of haematopoietic stem cell transplantation (HSCT)
Resumen
Español
El TPH supone un periodo de aislamiento en el que se puede experimentar un gran malestar debido a los efectos secundarios, al riesgo de complicaciones y a la separación socio-familiar. El objetivo de este trabajo ha sido comprobar el efecto del entrenamiento en comunicación emocional medido a través de los cambios en locus de control y en niveles de supresión emocional. Participaron dos grupos de pacientes, uno que realizó un programa de intervención psicooncológica (n = 22) y otro que realizó además un módulo adicional de habilidades de comunicación (n= 26). Los resultados mostraron que el entrenamiento en comunicación aumentaba los beneficios del programa psicológico pre-trasplante. El grupo que recibió el módulo adicional aumentó su Locus de Control Interno y la expresión emocional, en comparación con el grupo de intervención estándar.
English
The HSCT requires a period of isolation in which great discomfort due the side effects, risk of complications and separation from family and social relationships, can be experienced. The aim was to determine the effect of training on emotional communication measured through changes in locus of control and in levels of emotional suppression. We had two groups of patients, one performed a program of pycho-oncological intervention (n = 22) and the other performed the same program plus an additional module in communication (n = 26). The results showed that the training in communication increased the benefits of the psychological program pre-transplant. The group that received the additional module improved the internal locus control and the emotional expression of anger, worry and sadness.
... Results of several studies suggest that the two kinds of variables (hedonic vs eudaimonic) cannot be seen as opposing or unrelated, but, rather, they should be understood as positively bound together with each other. Meaning in life correlates with self-esteem, satisfaction with life, and optimism, to a moderate extent (e.g., Feder et al. 2008;Heisel and Flett 2004;Ho et al. 2010;Lyubomirsky et al. 2006;Pinquart and Frohlich 2009;Steger and Frazier 2005;Steger and Kashdan 2007;Vaughan and Kinnier 1996). Life engagement is also moderately correlated with optimism, satisfaction with life, and self-esteem (Scheier et al. 2006). ...
Positive orientation (PO) is proposed as a common base for hedonistic and eudemonistic senses of happiness. PO involves a tendency to formulate positive judgments concerning the self, one’s personal life, and the future. Previously, PO had been investigated in the context of the hedonistic approach to well-being. In this article, we tested a broader understanding of PO, which is conceptualized, here, as a latent factor underlying variables that exemplify hedonistic and eudemonistic view on happiness. Using two samples (N = 159 and N = 200), we tested three models of PO extended to include various measures of meaning of life. The extended models fitted the data well. Results suggest that PO can be a general factor that is the basis for integrating two aspects of well-being: searching for positivity and pleasure, as well as striving for meaning.
... Individuals high in meaning are better able to make sense of their lives and life events and to know what is important to them, what goals to pursue, and how to move forward with their lives. In fact, meaning has been positively linked to life satisfaction (Bronk, Hill, Lapsley, Talib, & Finch, 2009), internal locus of control (Pinquart & Fröhlich, 2009), and self-rated heath (Scheier et al., 2006). In longitudinal studies, meaning prospectively predicted suicidal ideation (Kleiman & Beaver, 2013), myocardial infarction (Kim, Sun, Park, Kubzansky, & Peterson, 2013), sleep quality (Kim, Hershner, & Strecher, 2015), and even mortality (Hill & Turiano, 2014). ...
The provision of a sense of meaning in life, especially during adverse life circumstances, is widely considered to be a central function of spirituality. However, limited empirical evidence exists for this notion. The present study used cross-lagged panel analyses, in samples of 140 congestive heart failure patients and 161 cancer survivors, to examine whether spirituality can provide meaning in the context of serious illness. Survey data were collected at baseline and 6 (heart failure patients) or 12 months (cancer survivors) later. In both studies, cross-lagged paths showed that higher baseline spirituality predicted more positive change in meaning over time. These results support the widely held notion that spirituality can provide increased meaning in life among individuals dealing with substantial adversity.
... Similarly, advice to "think positive" might be beneficial to some survivors as a coping strategy, but it might be unhelpful and perhaps even harmful to others. Researchers have argued that optimism can be beneficial for cancer survivors' well-being (Hodges and Winstanley, 2012;Pinquart and Frohlich, 2009). American oncology culture often emphasizes the importance of hope in recovery (Del Vecchio Good et al., 1990). ...
Hematopoietic stem cell transplant survivors often share advice with patients undergoing this difficult treatment. We content analyzed narratives written by 59 transplant survivors given the opportunity to share advice with patients. Analyses described categories of advice they shared and evaluated their perceptions of the helpfulness of advice they had received. We found nine advice categories and evidence for variation in their perceived helpfulness, especially for advice to “be your own advocate,” “have someone you can rely on,” and “think positive.” Findings suggest the need to investigate how seemingly innocuous advice can be unhelpful and potentially distressing to some patients.
... A recent systematic review examined the role of social support on disease progression and found evidence for a relationship between social support and breast cancer; although the evidence was less convincing for other types of cancers or studies with a mix of cancers (8). The availability of social support also has a positive influence on cancer patients' subjective well being (9,10). Cancer patients high in perceived social support are more likely to experience post-traumatic growth (11). ...
Supportive-expressive group therapy is a well established model of therapy delivered as a weekly group intervention with the goals of fostering mutual support, promoting openness and emotional expression, improving social and family support, integrating the cancer and its effects into self and body image, detoxifying death and dying, optimising coping skills, improving the physician-patient relationship and reordering life's priorities. Conceptually derived from existential psychotherapy, it has been widely tested in breast cancer with strong evidence for its efficacy in improving mood, relieving traumatic stress and improving quality of life. As a result, it has become the most widely used form of group therapy in psycho-oncology.
... The first major finding was that social support is positively linked to life satisfaction and negatively linked to negative affect among Israeli Muslim parents dealing with stressors related to their children's cancer. The current findings coincide with similar outcomes from prior studies testifying to the centrality of social support in the well-being of the individual ( S. Cohen & Wills, 1985;Pinquart & Fröhlich, 2009). ...
No single study has examined the subjective well-being (SWB) among Israeli Muslim parents of children treated for cancer.
To fill this gap in the literature, this preliminary study espouses a positive psychology orientation and examines the contribution
of social support and religious coping to the SWB among this population. The study’s sample consisted of 70 Israeli Muslim
parents of children who were receiving active treatment for their cancer. Participants were asked to provide demographic information
on themselves and their ill child and to complete measures of SWB (that is, positive affect, negative affect, satisfaction
with life), social support, and religious coping (that is, positive religious coping, punishing God reappraisal). The authors
found that higher scores on social support were correlated with higher scores on satisfaction with life and lower scores on
negative affect. Higher scores on positive religious coping were correlated with higher scores on satisfaction with life.
Punishing God reappraisal did not correlate with any of the SWB indices. Social support emerged as a partial mediator between
positive religious coping and satisfaction with life. Social support and some methods of religious coping seem to enhance
the SWB of Israeli Muslim parents of children treated for cancer.
... Perceived control and social support are often considered together as important social-psychological resources predicting well-being (e.g., Pinquart & Fröhlich, 2009;Yuan, 2007). Previous studies involving perceived control, social support, and well-being have found a significantly positive association between each of these three constructs. ...
This study examined the unique effects of three forms of enacted (i.e., received) support (emotional, unpaid assistance, financial) on well-being and tested the potential mediating role of perceived control. The analysis was based on a national sample collected through the second wave of the Midlife in the United States (MIDUS) survey conducted in 2004-2006. Findings revealed emotional support exhibited a positive effect direction on well-being, while unpaid assistance and financial support both showed negative effect directions. Perceived control was found to fully mediate the relationships between all three forms of enacted support and well-being: Emotional support boosted well-being through higher perceived control, while unpaid assistance and financial support reduced well-being through lower perceived control. Findings provide evidence that effects of social resources on well-being are mediated through psychological resources.
... Systematic reviews showed that psychological factors, such as self-efficacy, mastery, purpose in life, and optimism (6)(7), and social factors, such as social support and social skills (8), are consistently associated with better mental health in persons with SCI. Predictors of mental health in persons with SCI correspond with those found in the general population and with those in studies in persons with other chronic health conditions, such as cancer, diabetes, heart disease, stroke, rheumatoid arthritis and multiple sclerosis (9)(10)(11). ...
To examine the course of mental health and psychological factors over time in persons with a recent spinal cord injury and to determine whether change in psychological factors is associated with change in mental health.
Prospective cohort study in the Netherlands with 3 measurement time-points.
A total of 60 persons with recently acquired spinal cord injury.
Standardized validated measurement instruments were used to assess mental health, self-efficacy, mastery, optimism, illness cognitions, purpose in life, and social compa-rison. Descriptive statistics and multilevel analysis were used.
Multilevel regression analyses showed that neither mental health nor psychological factors, except for social comparison-upward identification, showed statistically significant change over time. However, increasing scores for self-efficacy, mastery, acceptance cognitions, and purpose in life were significantly associated with increasing mental health. In contrast, increasing scores for optimism, social comparison, helplessness cognitions, and disease benefits cognitions were not significantly associated with increasing mental health in persons with spinal cord injury.
Most psychological factors showed stability up to 6 months post-discharge. Purpose in life, acceptance cognitions, self-efficacy, and mastery showed more variability and seem to be most promising as targets for interventions, which may lead to an improvement in mental health in persons with spinal cord injury.
... Factors such as social support, selfesteem and, to a lesser extent, optimism and purpose in life are associated with concurrent subjective well-being and improvement in subjective well-being over time. 15 For example, socially isolated women have higher risk of mortality after a diagnosis of breast cancer, probably because of reduced access to care and lack of beneficial caregiving from friends and close relatives. 16 Women with head and neck cancer who experience less social support and facedisfiguring treatment are at greatest risk for psychosocial dysfunction. ...
The study aim was to explore the underlying dimensions of patients’ perceptions and experiences of facial disfigurement following surgery for cancer treatment, using a qualitative approach based on individual in-depth interviews. Data analysis and interpretation consisted of separating responses into phrases or statements with a single thematic aspect. Subsequently, a number of dimensions and categories were created using a deductive–inductive content analysis. Three main categories emerged: discovering of the cancer, coping with the disease and disfigurement, and reconstructing a new identity. The initial stage elicited feelings of fear, denial, and guilt as a reaction to the stigma and prejudice. Coping strategies included resignation and acceptance, deepening religiosity, reinforcement of familiar cohesion, and creation of a social network of solidarity and support. The final stage comprised incorporation of the altered facial image, rehabilitation possibilities, reconstruction of personality and self-image, and the feeling of having overcome the disease. It was concluded that individual experiences are complex, challenging, and have striking effects on their lives. There is an urgent need for training and improvement in human resources to manage these patients in a multidisciplinary approach, aimed at their reintegration into society and reducing the prejudice and stigma of the disease and disfiguration.
Personal health-related resources are essential for women with breast cancer, as these help them to maintain their own health and well-being during different phases of their illness. The purpose of this integrative review was to identify, describe and synthetise what personal health-related resources have already been identified for this patient group. We carried out an integrative review to find papers that focused on personal health-related resources for women with breast cancer aged 18–64 years. The search covered 1 January 2005 to 31 May 2021 and was carried out using the CINAHL, PubMed, PsycINFO, Web of Science and Cochrane Library databases. It was limited to peer-reviewed scientific papers with abstracts published in English and 23 papers met the inclusion criteria. The data were analysed using content analysis. Personal health-related resources for women with breast cancer consisted of three different, but inherently interconnected, categories of personal strengths, person-centred cancer care and social support from and involvement in their cultural community. Personal health-related resources for women with breast cancer were multifaceted. Women need nursing support to identify and use these resources and future studies are needed to strengthen how they are measured.
Objective
To investigate the dynamic changes in the health locus of control (HLC) and subjective well-being (SWB) of older women with breast cancer, to explore the relationship between the HLC and SWB of these patients at different time points.
Design
The research method adopted was a longitudinal study. Convenience sampling was used to select older women with breast cancer and their HLC and SWB at different times were evaluated. The ages of the patients were ≥60 years. The survey was conducted starting from the day of admission and at 1 month, 3 months, and 6 months after surgery.
Main outcome measures
HLC and SWB
Results
The HLC and SWB of older women with breast cancer changed dynamically (P < 0.05), and the patients were in poor condition at T1. At each time point, the internal HLC (IHLC) for these patients was positively correlated with the total SWB score. Additionally, powerful others HLC (PHLC), chance HLC (CHLC), and SWB were negatively correlated (P < 0.05).
Conclusion
The HLC and SWB of older women with breast cancer change dynamically. Medical staff should pay more attention to the HLC and SWB of patients 1 month after surgery. SWB can be improved by improving the patients’ IHLC and reducing their PHLC and CHLC.
Resumo O que nos faz sentir bem é uma interrogação desde a antiguidade. Tem-se verificado uma mudança de paradigma na investigação com uma maior atenção dedicada às variáveis positivas. Baseado numa conceção hedónica, o bem-estar subjetivo é um conceito-chave da psicologia positiva que ao priorizar o ponto de vista das pessoas permite aceder à sua qualidade de vida percebida. O objetivo deste trabalho é conhecer o bem-estar do doente paliativo. Para tal foi efetuada uma ampla pesquisa acerca deste tema, recorrendo maioritariamente a artigos de revistas científicas internacionais e livros de referência. Abordam-se os conceitos de cuidados paliativos e de bem-estar e o estado da arte ao nível do bem-estar subjetivo. São ainda aprofundadas a realidade de ser um doente paliativo, os aspetos promotores e inibidores do seu bem-estar, bem como o papel da família e dos profissionais de saúde nesta equação. O artigo finaliza com a consideração que usufruir de cuidados paliativos assume um papel preponderante no bem-estar do doente, porém o seu acesso ainda é limitado. Com o acompanhamento adequado o doente paliativo pode alcançar uma boa perceção de bem-estar, mesmo em fim de vida. Abstract What makes us feel good has been a question since Antiquity. There has been a paradigm shift in research with a greater attention paid to positive variables. Based on a hedonic conception, subjective well-being is a key concept of positive psychology. It prioritizes the people's point of view thus allowing access to their perceived quality of life. The objective of this work is to know the palliative patient well-being. To this end it was done an extensive research on this subject, using mainly articles of international journals and reference books. It addresses the concepts of palliative care and well-being, and the state of the art of subjective well-being. It is further explored the reality of being a palliative patient, promoters and inhibitors aspects of their well-being, and the role of family and health professionals in this equation. The article concludes with the consideration that receiving palliative care plays an important role in the patient's well-being, but its access is still limited. With proper monitoring, the palliative patient can achieve a good perception of well-being, even at the end of life.
Theorists have long assumed that people's self-esteem and social relationships influence each other. However, the empirical evidence has been inconsistent, creating substantial uncertainty about whether relationships are in fact an influential factor in self-esteem development and vice versa. This meta-analysis synthesizes the available longitudinal data on the prospective effect of social relationships on self-esteem (48 samples including 46,231 participants) and the prospective effect of self-esteem on social relationships (35 samples including 21,995 participants). All effects controlled for prior levels of the outcomes. Results showed that relationships and self-esteem reciprocally predict each other over time with similar effect sizes (β = .08 in both directions). Moderator analyses suggested that the effects held across sample characteristics such as mean age, gender, ethnicity, and time lag between assessments, except for the self-esteem effect on relationships, which was moderated by type of relationship partner (stronger for general relationships than for specific partners) and relationship reporter (stronger for self-reported than for informant-reported relationship characteristics). The findings support assumptions of classic and contemporary theories on the influence of social relationships on self-esteem and on the consequences of self-esteem for the relationship domain. In sum, the findings suggest that the link between people's social relationships and their level of self-esteem is truly reciprocal in all developmental stages across the life span, reflecting a positive feedback loop between the constructs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Optimism and mastery are two cognitive traits that involve positive expectations for the future and that have been demonstrated to be important predictors of reduced anxiety as well as superior coping and physical health in many populations, including cancer survivors. There is limited research, however, examining the unique effects of these traits when examined simultaneously. The present cross-sectional study used structural equation modeling to examine the unique effects of optimism and mastery on emotion, coping, and health in 603 adult cancer survivors, and whether results were consistent in men and women. Results indicated that both optimism and mastery were associated with improved emotion, coping, and health and together accounted for a small to moderate amount of variance. Although the effects of optimism were generally greater, mastery also uniquely predicted most dependent variables and there was some evidence that gender influenced these effects, with optimism predicting health control more so in women and mastery predicting health control more so in men. These results demonstrate that it is important to examine both generalized positive expectancies such as optimism and positive expectancies regarding mastery when investigating resilience and emotional well-being in cancer survivors.
Previous literature on growth after major life events has primarily focused on negative experiences and operationalized growth with measures which rely on the post hoc self-perception of change. Because this method is prone to many biases, two questions have become increasingly controversial: Is there genuine growth after major life events and does growth require suffering? The present meta-analysis is the first synthesis of longitudinal research on the effects of life events on at least one subdomain of psychological well-being, posttraumatic, or postecstatic growth. Studies needed to have a longitudinal design, assess changes through independent measures over time, and provide sufficient data to estimate change scores. The present meta-analysis comprises 364 effect sizes from 154 independent samples (total N = 98,436) in 122 longitudinal studies. A positive trend has been found for self-esteem, positive relationships, and mastery in prospective studies after both positive and negative events. We found no general evidence for the widespread conviction that negative life events have a stronger effect than positive ones. No genuine growth was found for meaning and spirituality. In the majority of studies with control groups, results did not significantly differ between event and control group, indicating that changes in the outcome variables cannot simply be attributed to the occurrence of the investigated life events. More controlled prospective studies are necessary to validate the genuine nature of postevent growth. Overall, the meta-analysis provides a systematic overview of the state of life event research and delineates important guidelines for future research on genuine growth.
Objectives: To analyze significant differences among two groups of older women with and without breast cancer, regarding subjective well-being (SWB); to assess the association of SWB with breast cancer; and to examine the association of the affective with the cognitive dimension of SWB in both groups. Methods: We recruited 387 older women (M = 85.27; SD = 6.59; range 75-100). Measures included demographics, the Satisfaction with Life Scale and the Positive and Negative Affect Schedule. Results: Women with breast cancer in remission presented a significantly higher SWB score. Cognitive and affective dimensions of SWB were correlated to breast cancer, and were strongly associated in both groups. Conclusions: Clinical and program development may benefit from addressing SWB of older cancer survivors.
In the last decades there has been a paradigm shift from pathogenesis (etiology of disease) to salutogenesis (origins of health) in the conceptualization of functioning following trauma. The resilience literature best represents this paradigm shift. Traditionally resilience literature focused on childhood development and on adolescence development. However in the last years the resilience studies have considered the adulthood, mainly in the face of loss or potential trauma. The resilience research suggests two key points. First resilience has recently been recognized as a common human response to potentially traumatic events. Second there are multiple resources, both at the individual and at the environmental level that could foster adaptation in face of challenge. The purpose of this chapter is to review the evidences concerning psychosocial factors contributing to resilience outcome in the aftermath of potentially traumatic events in adulthood. Resilience factors are defined as resources that can be categorized according to time (pre-event and post-event) and level (individual versus environment). This model is derived from stress appraisal theories (
Objective:
The purpose of this study was to examine the longitudinal relationship between Positivity (POS), defined as a stable disposition to view at experience under a positive outlook, and physical and psychological functioning in a sample of cancer patients immediately after diagnosis and one year later.
Methods:
110 patients (40% males) with pulmonary, colorectal and breast cancer, aged 30-75 (M age= 59.62; SD=10.33), have been prospectively enrolled between 2012 and 2013, at the S. Andrea Hospital in Rome. All patients were previously aware of their diagnosis. A follow-up one year after diagnosis was conducted. We used SEM in order to analyze the specific effects of POS on functioning impairment from diagnosis to follow up.
Results:
Pos was associated with less functioning impairment both at diagnosis and follow- up assessments. Furthermore, POS level at diagnosis continued to be associated with less functioning impairment one year later, after controlling for its stability.
Conclusions:
Patients with higher level of POS tended to report less symptoms associated with negative affect such as anxiety and despondency and to preserve their habitual relationships and social roles. POS may act as a basic disposition that sustains patients' efforts to deal efficaciously with severe illness, by complying with medical treatment and by using cognitive strategies that enable individuals to cope with concurrent and prospective challenges of illness.
The exponential growth of older population, along with the incidence of breast cancer on older women, is a worldwide concern. Objectives: To analyze significant differences among two groups of older women with and without breast cancer, regarding subjective well-being (SWB) and its affective and cognitive dimensions. Method: We recruited 387 non-institutionalized women aged 75 years or older (M = 85.27; SD = 6.59; range 75-100), who were allocated in two groups (with and without breast cancer). Measures were completed including demographics, the Satisfaction with Life Scale and the Positive and Negative Affect Schedule. Results: The group with breast cancer in remission presented a higher SWB score, particularly the positive affect score. These differences were statistically significant. Conclusions: Although breast cancer represents an important threat to older womens SWB, those participants presented a significantly high score, in comparison to the other participants.
Spirituality and purpose in life have been associated with positive mental health outcomes. This study examined the effects of spirituality, religiousness, and purpose in life on self-objectification and disordered eating. An ethnically diverse sample of college women (N = 161), aged 18–25, who were enrolled in the undergraduate level psychology courses, participated by completing a survey assessing relational spirituality, intrinsic religiousness, and purpose in life, as well as self-objectification and disordered eating. Results supported a relationship between self-objectification and disordered eating. Intrinsic religiousness was also associated with self-objectification after controlling for religious affiliation. In addition, women who had less purpose in their lives displayed more disordered eating. These findings suggest that a sense of purpose in life may be a key dimension of spirituality that is associated with eating disturbance.
Group interventions have been useful for survivors to overcome the challenges of cancer. This study employed a pre/post, mixed-methods design to explore the influence of an 8-week support group on the holistic wellness of 14 breast cancer survivors. Pairing experiential activities with wellness-centered psychoeducation was viewed positively by participants and corresponded to increased scores on the Five Factor Wellness Inventory. Interview data generated insight for future group work with cancer survivors. Notably, care should be taken to consider the varied individual cancer experiences and it may be worthwhile to structure groups so that members can “pay forward” their new knowledge.
This study examined the potential role of social support, neuroticism, and self-efficacy as predictors of the short-term and long-term adaptation to the diagnosis of cancer. Psychological adjustment was defined in terms of psychological distress. It is argued that these factors may provide insights that might be helpful in the provision of medical care to patients. We hypothesized that they would be especially predictive of long- term psychological adjustment. The study was conducted in a truly prospective design with one pre-morbid assessment and two post-morbid assessments used in the present analyses. Participants of a baseline as- sessment among 5279 subjects (aged 57 years and older) in 1993 were monitored for cancer incidence by their general practitioners. The study sample included 99 cancer patients who had completed all pre-morbid and post-morbid assessments. Multivariate analyses revealed that high neuroticism was associated with higher levels of distress in the short- and long-term. Higher levels of social support were associated with higher levels of distress in the long-term. The direction of this association was opposite to what might be expected on the basis of the literature. Implications of the findings for health care as well as explanations for the social support findings are discussed.
The development of the Multidimensional Health Locus of Control scales is described. Scales have been developed to tap beliefs that the source of reinforcements for health-related behaviors is primarily internal, a matter of chance, or under the control of powerful others. These scales are based on earlier work with a general Health Locus of Control Scale, which, in turn, was developed from Rotter's social learning theory. Equivalent forms of the scales are presented along with initial internal consistency and validity data. Possible means of utilizing these scales are provided.
This article describes a scale measuring dispositional optimism, defined in terms of generalized outcome expectancies. Two preliminary studies assessed the scale's psychometric properties and its relationships with several other instruments. The scale was then used in a longitudinal study of symptom reporting among a group of undergraduates. Specifically, respondents were asked to complete three questionnaires 4 weeks before the end of a semester. Included in the questionnaire battery was the measure of optimism, a measure of private self-consciousness, and a 39-item physical symptom checklist. Subjects completed the same set of questionnaires again on the last day of class. Consistent with predictions, subjects who initially reported being highly optimistic were subsequently less likely to report being bothered by symptoms (even after correcting for initial symptom-report levels) than were subjects who initially reported being less optimistic. This effect tended to be stronger among persons high in private self-consciousness than among those lower in private self-consciousness. Discussion centers on other health related applications of the optimism scale, and the relationships between our theoretical orientation and several related theories.
Although a growing body of research evidence suggests that persons encountering stressful life circumstances are protected from potential declines in health and well-being by supportive relationships, the evidence for the stress-buffering qualities of social support for cancer patients is equivocal. This study examines the relationship between naturally occurring, supportive behaviors and psychological adjustment to the illness for 32 nonhospitalized adult cancer patients, and includes follow-up data collected 7 months after the initial interview. Results indicated that although support appeared to have few effects on adjustment at either time point for the sample as a whole, social support was related to poorer adjustment for patients not undergoing chemotherapy or radiation treatments, or for those with many limitations on physical functioning. These findings, though tentative because of the sample size, point to the need to consider the specific contextual stresses the cancer patient is experiencing in evaluating psychosocial adjustment to the illness, and suggest caution in assuming social supports to be a universal boon.
When life crises occur, significant others are thought to help alleviate distress and resolve practical problems. Yet life crises may overwhelm significant others, eroding their ability to provide effective support. The accuracy of these contrasting accounts of relationship functioning was evaluated in a study of 102 breast cancer patients and their significant others, interviewed at 4 and 10 months after diagnosis. Results largely confirmed the negative account of relationship functioning. Although significant others provided support in response to patients' physical impairment, they withdrew support in response to patients' emotional distress. Moreover, support from significant others did not alleviate patients' distress or promote physical recovery. These results reveal limits to the effectiveness of close relationships in times of severe stress.
Because of women's higher risk of being widowed, having health problems, and needing care, one might expect them to have a more negative self-concept and lower subjective well-being (SWB). However, women may also have greater access to sources of SWB (e.g., relations to adult children) and may engage in processes to protect the self (e.g., lowered aspirations). Meta-analysis was used to synthesize findings from 300 empirical studies on gender differences in life satisfaction, happiness, self-esteem, loneliness, subjective health, and subjective age in late adulthood. Older women reported significantly lower SWB and less positive self-concept than men on all measures, except subjective age, although gender accounted for less than 1% of the variance in well-being and self-concept. Smaller gender differences in SWB were found in younger than in older groups. Statistically controlling for gender differences in widowhood, health, and socioeconomic status decreased gender differences in SWB. Cohort differences in SWB are reported as well.
In considering well-being among survivors of life-threatening illnesses such as breast cancer, 2 important questions are whether there is continuity between initial adjustment and longer term adjustment and what role personality plays in long-term adjustment. In this research, a sample of 163 early stage breast cancer patients whose psychosocial adjustment was first assessed during the year after surgery completed the same measures 5-13 years after surgery. Initial reports of well-being were relatively strong predictors of follow-up well-being on the same measures. Initial optimism and marital status also predicted follow-up adjustment, even controlling for earlier adjustment, which exerted a substantial unique effect in multivariate analyses. In contrast, initial medical variables played virtually no predictive role. There is substantial continuity of subjective well-being across many years among survivors of breast cancer, rooted partly in personality and social connection.
The effect of psychosocial counseling on tumor progression was studied in 96 cancer patients, who were no longer amenable to regular medical treatment. Patients were offered 12 sessions of individual experiential‐existential counseling, each session lasting 1.5 to 2 hours. In addition patients participated fortnightly in group counseling meetings. In five out of 35 evaluable patients, tumor growth became stationary during or immediately following therapy. In four patients this stationary period last 3–9 months, and in one patient 2 years. Natural Killer cell activity, self‐reported loneliness, depression, purpose in life and locus of control showed no change from pre‐ to post intervention. © 1997 John Wiley & Sons, Ltd.
We explored the reciprocal relations between social support and adjustment following a recurrence of breast cancer. The sample was composed of 30 women, ages 34 to 80, 90% Caucasian, who had sustained a recurrence of breast cancer. Social support, coping, and adjustment were measured through telephone interviews on two occasions (T1 and T2) separated by 6 months. Emotional support from a partner and informational support from an oncologist were related to decreased physical problems over time, but were not related to psychological distress over time. Women's use of positive reinterpretation appeared to mediate these relations. Interestingly, psychological distress was related to decreased partner emotional support over time. These results suggest that it is not enough to consider how social support may influence women's adjustment; it is also important to consider how women's adjustment may shape their social support networks.
The effects of family environment on the psychological adjustment of 54 women with metastatic carcinoma of the breast were studied over a one-year period. Family environment was assessed using the Family Environment Scale (FES) and a descriptive checklist, and adjustment was measured using the Profile of Mood States (POMS). Patients described their families as supportive and relatively free of conflict, and their spouses or other family members agreed moderately with them. Patient mood disturbance during the year was made the dependent variable in a stepwise multiple regression analysis, with FES subscale scores at the beginning of the year and other control variables as predictors. Better adjustment was found to be predicted by more expressiveness and less conflict and moral-religious orientation in the family. These findings are presented as evidence that the family is a crucial factor in patient adjustment, and that 'conspiracies of silence' in the family may be harmful. A clinical illustration is presented.
Self-concept and social function following radical, modified radical or simple mastectomy for Stage I or II breast cancer, breast biopsy for benign breast disease, cholecystectomy or no operative procedure were measured across a fifteen-month period in a cross-sectional design and across a twelve-month period in a repeated measures design. Women selected for study were without other preexisting mental or physical illness. The degree of disability observed following mastectomy was considerably less than previously reported in uncontrolled studies, with the incidence of actual disturbance extremely small. Women receiving adjuvant therapies following mastectomy, but not women treated by mastectomy alone, reported significantly more body-image dissatisfaction and feminine selfimage concerns than the comparison groups. The findings refute previously published impressions of severe psychosocial maladjustments following mastectomy. The study suggests that post-mastectomy women vulnerable to poorer outcome would be those with lower expectations of good quality social support, other present life stressors, other pre-existing chronic diseases, and a disposition to believe in life outcomes as less under their own control.
In recent studies of the structure of affect, positive and negative affect have consistently emerged as two dominant and relatively independent dimensions. A number of mood scales have been created to measure these factors; however, many existing measures are inadequate, showing low reliability or poor convergent or discriminant validity. To fill the need for reliable and valid Positive Affect and Negative Affect scales that are also brief and easy to administer, we developed two 10-item mood scales that comprise the Positive and Negative Affect Schedule (PANAS). The scales are shown to be highly internally consistent, largely uncorrelated, and stable at appropriate levels over a 2-month time period. Normative data and factorial and external evidence of convergent and discriminant validity for the scales are also presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
In a quest to understand individuals' positive adaptation to life crises, researchers have emphasized factors that enable people to confront stressors and maintain healthy functioning and have begun to identify specific resources that may engender personal growth. The authors have developed a conceptual model to encompass the most important sets of relevant variables and to conceptualize the determinants of positive outcomes of crises. The model posits that environmental and personal system factors shape life crises and their aftermath and influence appraisal and coping responses, and thereby contribute to the development of positive outcomes or personal growth in which coping functions as one essential mechanism through which personal and social resources foreshadow improved psychological functioning after a person experiences a life crisis.
In this chapter we review selected life crises that may be associated with successful adaptations and PTG, and use our model to identify factors that provide the context for growth. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Proposes a theory of cognitive adaptation to threatening events. It is argued that the adjustment process centers around 3 themes: A search for meaning in the experience, an attempt to regain mastery over the event in particular and over life more generally, and an effort to restore self-esteem through self-enhancing evaluations. These themes are discussed with reference to cancer patients' coping efforts. It is maintained that successful adjustment depends, in a large part, on the ability to sustain and modify illusions that buffer not only against present threats but also against possible future setbacks. (84 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Investigated adjustment in 59 10–15 yr old long-term survivors of childhood cancer and their parents at 2 points 1 yr apart. Behavioral concerns, parental distress, anxiety, hopelessness, social support, and family functioning were assessed. Gender and the presence of learning problems were examined. The data indicated levels of adjustment that were near normative levels. However, gender differences were found, with male adolescents reporting low levels of anxiety and hopelessness. Those survivors with learning difficulties appeared particularly vulnerable with respect to long-term adjustment. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
To test the hypotheses that pessimists might benefit from concrete objective information based on self-regulation theory and that optimists might benefit from instruction in self-care and coping based on self-care theory, 62 patients receiving radiation therapy (RT) for prostate cancer were studied. The two experimental and control intervention messages were given three times during and three times after RT. Mood and disruption of activities were assessed three times during and three times after RT. The self-care instruction had no effects on either outcome. The prediction from self-regulation theory was supported, in part, with concrete objective information having a positive effect on mood among pessimistic patients. Concrete objective information resulted in less recreation and pastime disruption in both optimistic and pessimistic patients at the times they experienced the most RT side effects. © 1996 John Wiley & Sons, Inc.
A representative community sample of 274 breast cancer (BC) patients from the Metropolitan Detroit Cancer-Surveillance System was studied longitudinally during the year after their BC diagnosis. The adjustment of these patients to their disease was examined in terms of (1) the changes in their physical and mental health functioning; and (2) the factors that predict or facilitate the recovery process, including the independent and interactive effects of age. Comparison of the outcomes at 4 and 10 months after diagnosis manifested a significant and consistent improvement in physical functioning. In contrast, there was an absence of any improvement in indicators of mental health and well-being. Whereas the cross-sectional analyses demonstrated that stage of disease had an impact on physical impairment, the longitudinal analyses revealed that physical impairment at time 1 was the significant predictor of deteriorating mental health at time 2. Furthermore, younger age was shown to exacerbate the impact of impairment on mental health. The more seriously impaired younger patients experienced significantly greater deterioration in their mental health and well-being than similarly impaired older patients. However, older age was found to exacerbate the impact of more extensive surgery on symptoms that produce limitations in activity.
There are few topics so fascinating both to the research investigator and the research subject as the self-image. It is distinctively characteristic of the human animal that he is able to stand outside himself and to describe, judge, and evaluate the person he is. He is at once the observer and the observed, the judge and the judged, the evaluator and the evaluated. Since the self is probably the most important thing in the world to him, the question of what he is like and how he feels about himself engrosses him deeply. This is especially true during the adolescent stage of development.
Current debate exists regarding the timing of reconstructive surgery following mastectomy for breast cancer, with research pointing in favour of immediate reconstruction. This cross-sectional study sought to compare the psychological outcome of breast cancer treatment in women who had either received mastectomy and immediate reconstruction using autogenous tissue (n = 30), or mastectomy alone (n = 34), and also determine adjustment factors in this population as a whole. Participants completed measures of depression, anxiety, body image, self-esteem, coping and perceived social support at a time point 3 - 15 months after initial surgery. No significant differences were revealed between the two groups on any of the outcome measures. Poor body image, low self-esteem, and a tendency to use coping strategies characterized by helpless/hopelessness and anxious preoccupation, rather than fighting spirit, were highly predictive of distress. Reasons for the lack of differences between the two groups are explored.
"Thèse présentée à la Faculté des études supérieures en vue de l'obtention du grade de Philosophiae Doctor (Ph.D.) en psychologie recherche/intervention option clinique" Thèse (Ph. D.)--Université de Montréal, 2005.
Individual differences in characteristics such as optimism, pessimism, and coping responses have been shown to contribute to variability in distress during stressful situations. However, the interrelationships among these characteristics are not well established. The purpose of this study was to investigate the interrelations among optimism, pessimism, and coping in predicting distress levels among patients scheduled for surgery related to breast cancer. Sixty surgical patients (mean age = 52; SD = 12.21) completed the Brief Cope and the Life Orientation Test as a part of a presurgery take-home packet. Distress was measured with the Profile of Mood States in the waiting area, just prior to surgery. Results revealed that optimism and pessimism were directly related to distress levels prior to surgery (p < 0.05). Coping responses also were related to distress (p < 0.05); however, these effects appeared to be largely mediated by optimism and pessimism.
Data were obtained from 50 mastectomy patients and their husbands at 3 days and 30 days postsurgery to determine the nature of the relationship between social support and the adjustment of mastectomy patients and their husbands over time. Psychosocial adjustment was related to both patients' and husbands' levels of social support. Patients and husbands who reported higher levels of social support reported fewer adjustment difficulties at both 3 days and 30 days postsurgery. Patients and husbands differed significantly in the levels of support they perceived over time; husbands perceived less support from friends, nurses, and physicians. This study underscores the importance of assessing the support resources of both patients and husbands over time.
Self-concept and social function following radical, modified radical or simple mastectomy for Stage I or II breast cancer, breast biopsy for benign breast disease, cholecystectomy or no operative procedure were measured across a fifteen-month period in a cross-sectional design and across a twelve-month period in a repeated measures design. Women selected for study were without other preexisting mental or physical illness. The degree of disability observed following mastectomy was considerably less than previously reported in uncontrolled studies, with the incidence of actual disturbance extremely small. Women receiving adjuvant therapies following mastectomy, but not women treated by mastectomy alone, reported significantly more body-image dissatisfaction and feminine self-image concerns than the comparison groups. The findings refute previously published impressions of severe psychosocial maladjustments following mastectomy. The study suggests that post-mastectomy women vulnerable to poorer outcome would be those with lower expectations of good quality social support, other present life stressors, other pre-existing chronic diseases, and a disposition to believe in life outcomes as less under their own control.
Three hundred and forty-nine healthy adolescents were compared with 168 adolescents with various chronic or serious diseases on standardized measures of trait anxiety, self-esteem, and health locus of control (perception of self-control over health and illness). No differences in anxiety or self-esteem were found between healthy and ill groups or between various ill groups. Patients with oncologic, renal, cardiac, and rheumatologic disorders perceived significantly less control over their health than did healthy adolescents and patients with cystic fibrosis or diabetes mellitus. Stability of prognosis was related to low anxiety, as was length of time since diagnosis. Other physician-rated variables including course of disease, visible signs of illness, severity, and number of hospitalizations did not relate to psychologic variables. The data are interpreted as casting doubt upon the supposition that chronic or serious disease inevitably leads to psychopathology in adolescents. The overall pattern presented was one of psychologic normalcy, and attitudes regarding control over health are seen as reflecting realistic perceptions on the part of patients. The importance of looking at the effects of serious disease upon day-to-day functioning, as opposed to emphasizing inferred psychologic deviance, is stressed.
Employing the stress and coping theory of Lazarus and Folkman, this study followed 117 women age 40 or over regarding personality, cognitive appraisal, coping, and mood variables before breast biopsy, after diagnosis, and, for those who had cancer, after surgery. Upon biopsy, 36 received a cancer diagnosis, and 81 received a benign diagnosis. The 2 groups did not differ on appraisals, coping, or affect before diagnosis. With prebiopsy affect controlled, cancer patients reported more negative affect postbiopsy than did benign patients. Postsurgery, cancer patients expressed less vigor and more fatigue than benign patients, but the groups did not differ on other negative emotions. Prebiopsy, psychosocial predictors accounted for 54% and 29% of the variance in negative and positive emotion, respectively. Prebiopsy variables also predicted postbiopsy and postsurgery mood; cognitive avoidance coping was a particularly important predictor of high distress and low vigor.
The effect of marital support and support from other adults on the emotional and physical adjustment of 128 women with breast cancer was examined. Role function and satisfaction with health care also were evaluated as predictors of adjustment. Intact data series were obtained at 7-10 days, at 1, 2, 3, and 6 months, and 1 year postsurgery. Emotional adjustment could be predicted by satisfaction with a spouse's response to interactional and emotional needs and by support from other adults. The relationships were significant at concurrent times, across contiguous times, and predicting from the 7-10 day postsurgical period to both the 6-month and 1-year end points. Physical adjustment was not predicted by support but satisfaction with health care was predictive of perceived overall health status. Functional status in vocational, domestic, and social roles was significantly related to emotional and physical adjustment at all phases with few exceptions.
Psychiatric morbidity (DSM-III-R) and adjustment to illness (psychological stress, illness behavior, and coping) were prospectively studied in 52 cancer patients who had been evaluated at the time of cancer diagnosis 6 years earlier. The prevalence of psychiatric disorders decreased from 47% to 37%. Improvement in psychological adjustment (low interpersonal sensitivity, psychoticism, paranoia, disease conviction, and anxious preoccupation) was found between these two assessment points. A lifetime history of psychopathology and psychiatric problems at baseline was associated with a current mental disorder. External locus of control, low social support, abnormal illness behavior, emotional stress, and poor coping mechanisms, as evaluated at first assessment, were also associated with psychological symptoms and maladjustment to cancer at follow-up. From the data reported, the need to maintain a continuity of psychosocial care among cancer survivors is inferred.
The effect of psychosocial counseling on tumor progression was studied in 96 cancer patients, who were no longer amenable to regular medical treatment. Patients were offered 12 session of individual experiential-existential counseling, each sessions lasting 1.5 to 2 hours. In addition patients participated fortnightly in group counseling meetings. In five out of 35 evaluable patients, tumor growth became stationary during or immediately following therapy. In four patients this stationary period last 3-9 months, and in one patient 2 years. Natural Killer cell activity, self-reported loneliness, depression, purpose in life and locus of control showed no change from pre- to post intervention.
Psychological adjustment and locus of control were measured in 257 South African women both with and without breast cancer. Adjustment was defined as positive affect, negative affect, the balance between the two, satisfaction with various domains of life, and an overall sense of well-being. Health locus of control was measured separately for internal, external, and chance loci. The instrument's reliability was comparable to that reported for U.S. norms. The women with breast cancer reported significantly lower affect and had lower internal and higher external and chance perceptions of control. The more invasive the surgical treatment, the greater the negative impact on adjustment. Data suggested that using written instructions to stress the importance of exercise to rebuild arm strength immediately following the surgery had a long-lasting positive impact on affect. Side of intervention was also related to psychological adjustment. Significant differences across racial groups were found for both adjustment and health locus of control.
The present prospective study aimed at (1) investigating the frequency of high levels of psychological distress in women with early-stage breast cancer almost two years after diagnosis and (2) identifying characteristics associated with long-term distress. One hundred and seventy women participated on two occasions. Two months after surgery, patients completed questionnaires measuring psychosocial variables (e.g., stressful life-events, health complaints, sleep problems, social support, subjective distress, personality factors), demographic and biomedical variables (e.g., TNM status, type of surgery). At the second measurement, subjective distress was assessed for a second time by means of the Impact of Events Scale (IES). Almost two years after diagnosis, 16% of the women reported a high level of psychological distress as measured by the Intrusion scale (IES). Best predictors of a high level of distress were: intrusive thoughts about the disease, trait-anxiety, health complaints and problems with sleeping. No significant association was found between previous life-events, social support or biomedical variables and levels of distress.
Women following the stress resulting from the diagnosis and treatment for breast cancer draw resources from their network of friends and relatives. These resources include both emotional support and instrumental resources such as getting a ride to a medical appointment. Emotional support buffers the effects of the stresses they face and improves their mental well-being while the existence, rather than the use, of instrumental supports is positively related to physical well-being. These hypotheses are tested on a population-based cohort of 336 women in the United States, diagnosed and treated for breast cancer when aged 50 or less. Most are married (65%), work (75%), have dependent children (63%), are white (70%), and had a mastectomy (51%). Results of the multi-variate analyses indicate that consistent with predictions, controlling for socio-demographic and treatment-related variables, the size of the social network was related to greater emotional and instrumental support, and greater emotional support was related to better mental well-being. Contrary to predictions, greater use of instrumental resources was related to poorer physical well-being. The results indicate the importance of social resources on well-being following life-threatening illness.
Although a number of studies have focused on initial adjustment to cancer, less is known about long-term survival issues. The present study compared breast cancer survivors with age-matched healthy controls (N=328) in terms of more subtle indicators of psychological well-being as well as their general quality of life 5 yrs post-diagnosis. Results indicated survivors generally perceive the world as less controllable and more random compared to healthy women. However, survivors perceive the same control over their daily lives as healthy women. Beliefs about personal control are most strongly associated with quality of life in both groups of women. Survivors also indicated that they derived some benefits from their experience with cancer, but these benefits had only a modest impact on quality of life. However, the belief that the experience had lasting harmful effects was associated with poor quality of life for survivors. In both groups, a continued search for meaning in life had a negative impact on quality of life. The strongest and most consistent correlate of quality of life for both survivors and healthy women was having a sense of purpose in life.
The purpose of this study was to describe and examine the relationships among self-esteem, locus of control, and perceived health status in African Americans with cancer and to identify predictors of perceived health status. A convenience sample of 95 oncology outpatients at two large medical facilities completed the Tennessee Self-Concept Scale, the Multidimensional Health Locus of Control Scale, and the Cantril Ladder, a measurement of perceived health. In an audiotaped interview two open-ended questions were used to clarify participants' Cantril Ladder scores. A significant positive relationship was discovered between self-esteem and powerful others health locus of control (p <.05). Participants tended to view God as the Powerful Other capable of influencing their health and well-being. Self-esteem and an internal health locus of control were found to account for 23% of the perceived variance in health status. In addition, interview data indicated that participants with normal to high levels of self-esteem and an internal health locus of control perceived their state of health and well-being positively.
The key focus of this longitudinal study in the Netherlands was to determine the role of social support (i.e. perceived availability of emotional support, lack of received problem-focused emotional support, and negative interactions) and positive and negative self-esteem in depressive symptoms in 475 recently diagnosed cancer patients and 255 individuals without cancer from the general population. Patients and the comparison group were interviewed and filled in a questionnaire at two points in time: 3 months (T1) and 15 months (T2) after diagnosis. The results indicated that social support and self-esteem were weakly to moderately related to each other. Negative self-esteem was more strongly related to all three types of social support, compared to positive self-esteem. Regression analyses showed that social support and self-esteem were independently related to depressive symptoms (concurrently), such that lower levels of social support and self-esteem were strongly associated with higher levels of depressive symptoms. This finding suggests that these two resources supplement each other additively. A longitudinal analysis showed that social support and self-esteem also predicted future levels of depressive symptoms, although the explained variance was much lower than in a cross-sectional analysis. Comparisons between cancer patients and the comparison group generally revealed no significant differences between the two groups in the associations of social support and self-esteem with depressive symptoms. The only exception was a lack of problem-focused emotional support. At three months after diagnosis, a lack of this type of support, characterised by reassuring, comforting, problem-solving, and advice, was more strongly related to depressive symptoms in patients than in the comparison group.
Taylor's theory of cognitive adaptation proposes that adjustment depends on the ability to sustain and modify illusions (i.e. unrealistic optimism, exaggerated perceptions of control, and self-aggrandizement) that buffer against threats but also against possible future setbacks. Because the question of whether cancer patients show these illusions has received little attention, the present study compared patients' perceptions of optimism, control, and self-esteem at different stages of the cancer process with that of healthy references. The effects of these perceptions on psychological distress were also assessed.
The present study has a longitudinal design. Including a group of healthy references enabled us to draw more firm conclusions about the effect of cancer upon cognitive perceptions.
The participants were 67 cancer patients and 50 healthy references. Patients filled out questionnaires prior to their first radiotherapy (T1), at 2 weeks (T2), and at 3 months (T3) after completing radiotherapy. Healthy references were assessed at similar intervals.
T tests revealed that patients experienced significantly higher levels of optimism and self-esteem than the healthy reference group. Concerning control, no group differences were found. Importantly, regression analyses showed that lower levels of optimism and control at T1 were predictive of feelings of anxiety at T3. Lower perceived control also predicted depressive symptoms.
Results support the theory of cognitive adaptation in that patients are indeed able to respond to cancer with high levels of optimism and self-esteem and that lower levels of optimism and control are predictive of psychological distress.
Patients with advanced cancer frequently express positive attitudes and can be unduly optimistic about the potential benefits of treatment. In order to evaluate an illusory domain in the context of advanced cancer, we developed a scale of will to live and characterized the beliefs that patients held about the curability of their cancer, and how committed they were to using alternative treatments. A measure of quality of life was used as the dependent variable in order to assess the association between these attributes. After a preliminary exploration confirmed the presence of an illusory domain, these concepts were prospectively tested in 149 ambulant patients with advanced cancer who attended for palliative systemic treatment, radiation treatment or supportive care. The scale of global quality of life was reliable (Cronbach's alpha coefficient 0.72). The distribution of the scores of will to live was skewed, with no respondent scoring poorly, and the scale was reliable (Cronbach's alpha coefficient 0.82). The scale of belief in curability showed diverse beliefs. In some cases, there was a discrepancy between respondents' beliefs in curability and what they believed to be the report by their doctors. There was also an association between a committed use of alternative treatments and a belief in the curability of the cancer (p<0.001). In a multiple regression analysis, both will to live and performance status remained associated with better quality of life scores after adjustment for other relevant variables (p<0.05 and <0.001, respectively). These results suggest that positive illusory beliefs can be measured and are an important component of adaption for some patients with advanced cancer. Furthermore, this illusory domain may influence the perception and measurement of quality of life.
When one member of a couple develops a serious illness, the lives of both partners are likely to be affected. Interventions directed at both partners are generally lacking, however. In the present study, a brief counseling program directed at couples confronted with cancer was evaluated. The intervention focused mainly on the exchange of social support and help between both partners and was aimed at restoring perceptions of equity. Couples were randomly assigned to an experimental group or a waiting-list group. After the intervention, both patients and their partners reported lower levels of perceptions of underinvestment and overbenefit, and higher levels of relationship quality. Moreover, among patients psychological distress decreased after the intervention. These effects were generally maintained until follow-up three months later. Associations between perceptions of equity and relationship quality and psychological distress were also examined.
We aimed to describe the levels of anxiety and depression in patients during the 3 month period following the end of chemotherapy treatment and to identify factors that predict psychological morbidity.
We performed a prospective study in women with ovarian cancer to determine the changes in psychological status in the 3 months following completion of chemotherapy. Sixty-three consecutive patients were assessed at the completion of chemotherapy (Time 1) and 57 at 3 months follow-up (Time 2). Relevant disease and patient characteristics were recorded and patients were assessed at Time 1 for anxiety, depression and their perception of emotional support, an index of their psychosocial environment. Anxiety and depression were re-assessed at Time 2.
The results indicate significant initial psychological morbidity, with clinical caseness for anxiety (38%) and depression (33%) being common. Follow-up at Time 2 shows that patients undergo a significant reduction in cases (19%) and symptoms of depression but an increase in cases of anxiety (47%). The principal factors associated with symptoms of anxiety at Time 2 were poor perceived social support, increased intrusive thoughts and, to a lesser extent, younger age. Medical parameters, such as the stage of disease, response of the cancer to treatment, Ca125 (a tumour glycoprotein) and Karnofsky Performance status (a measure of how well the patients is) were not associated with worse psychological outcome.
These data show for the first time that social support and intrusive thoughts, rather than physical parameters, are the principal determinants of psychological morbidity in patients with ovarian cancer.
Incorporating holistic health perspectives, this study compared and examined relationships among meaning in life, spirituality, perceived stress, and psychological distress in breast cancer survivors (BCS) and healthy women.
Standardized self-report measures were completed once by all participants (N = 78).
Group comparison revealed statistically significant variances across the measures. Covariate analysis identified BCS without children had less meaningful lives and greater stress and distress than BCS with children and participants without cancer. Significant correlations (p > .001) between meaning in life and spirituality (r = .43), stress (r = -.39), and distress (r = -.41) were also identified.
Personal factors (i.e., being a parent) may be especially important in BCS. Also, psychological and spiritual variables are highly correlated, suggesting the use of an integrated term psycho-spiritual functioning.
Holistic nursing interventions can facilitate self-awareness, interpersonal connection, and living a meaningful life, particularly in vulnerable patients such as BCS without children.