AnnMarie Groarke

The impact of illness representations and disease activity on adjustment in women with rheumatoid arthritis: A longitudinal study

This longitudinal study examined the extent to which illness representations and disease indicators predict physical and psychological outcomes in patients with rheumatoid arthritis. Baseline data was collected on 75 women attending an out-patient clinic in the west of Ireland. Data was available for a final study sample of 52 at two-year follow-up. Disease status was assessed by physician ratings of joint involvement and laboratory indices of erythrocyte sedimentation rate and c-reactive protein. The Illness Perception Questionnaire and the Arthritis Impact Measurement Scale were administered during a semi-structured interview held at yearly intervals over a three-year period. In hierarchical regression analyses the illness representations accounted for 17–33% of the variance in measures of physical function, pain, depression and anxiety. All relationships were in the expected direction. Disease status explained 10–15% of the variance in illness related aspects of physical function and pain and predicted pain over time. Illness perceptions outweighed the impact of medical disease status on concurrent physical and psychological adjustment. Interventions based on understanding and modifying illness representations may prove useful in facilitating patient well-being.

Dental floss behaviour: A test of the predictive utility of the Theory of Planned Behaviour and the effects of making implementation intentions

A prospective study was conducted in order to investigate the utility of the Theory of Planned Behaviour in predicting dental floss intentions and behaviour. The efficacy of making implementation intentions as an intervention to increase dental floss behaviour was also tested. A sample of 119 participants was recruited from a university population. At Time 1, participants completed measures of the Theory of Planned Behaviour, past behaviour and half of the participants formed implementation intentions specifying where and when they would use dental floss. Behaviour was assessed using a diary card in which participants recorded their dental floss use over a 3-week period. Results showed that the Theory of Planned Behaviour variables predicted 46% of the variance in intention and 29% of the variance in behaviour. Implementation intentions were not found to be an effective intervention in increasing dental floss behaviour. Results suggest that interventions should target an individuals attitude and perceptions of control in order to increase dental floss intentions and behaviour.

The influence of disease severity, perceived stress, social support and coping in patients with chronic illness: a 1 year follow up

This study examined the extent to which psychological stress, social support and clinical disease indicators predict physical, social and psychological wellbeing in patients with rheumatoid arthritis. Participants were 59 women recruited at an outpatient clinic. Data were available for 52 of the sample at 1-year follow-up. A range of psychological measures was administered and disease status was assessed by physician ratings of joint involvement and blood assays of inflammatory indices. Findings from correlational and hierarchical regression analyses reveal a number of statistically significant relationships (p < 0.01), for example higher perceived stress and lower social support were associated with poor emotional adjustment. Partial correlations showed that while social support did not mediate the relationship between psychological stress and adjustment, the use of venting emotions as a coping strategy was a mediator of the association between stress and negative affect. Results demonstrated that disease status predicted illness related functioning but did not predict emotional or social adjustment. Perceived stress was a better predictor than disease of concurrent positive and negative emotionality with explained variance ranging from 14% - 55%. Coping also predicted variance on these affective domains (10 - 19%). In longitudinal analyses, perceived stress accounted for variability in negative affect 1 year later and coping predicted positive affect over this time. Level of social support explained variance on social activity in cross-sectional and longitudinal analysis (10 - 14%). Results suggest that a cognitive behavioural intervention to facilitate patient adjustment could usefully include management of stress and its appraisal, the fostering of adaptive coping strategies and utilization of social support resources. In improving patient adjustment to rheumatoid arthritis it is envisaged that reliance on physicians for emotional rather than disease related problems will diminish.

Global stress predicts both positive and negative emotional adjustment at diagnosis and post-surgery in women with breast cancer

Individual differences in stress appraisal, coping, optimism and social support have contributed to variability in adjustment to breast cancer, but less is known about their relative influence particularly at diagnosis. The purpose of this study was to compare the predictive role of these variables on both positive and negative adjustment in a sample of recently diagnosed women.

Cognitive-behavioural stress management enhances adjustment in women with breast cancer.

OBJECTIVE This randomized controlled trial examines whether a briefer cognitive-behavioural (CBT) stress management intervention than the norm can reduce stress and distress and enhance benefit finding in women with breast cancer. It further aims to identify characteristics of those women most likely to benefit from the intervention. DESIGN AND METHOD A randomized controlled trial was conducted to assess the efficacy of a psychological intervention. Women (N = 355) who had undergone surgery for breast cancer 4 months earlier, the majority of whom were currently undergoing adjuvant therapy, completed questionnaires assessing global and cancer-specific stress, depression, anxiety, optimism and benefit finding. They were randomly assigned to a 5-week group cognitive-behavioural stress management (CBSM) programme plus standard care or standard care only. Reassessment occurred post-intervention and 12 months later. RESULTS Analyses of variance revealed that patients who received the intervention showed significant lowering of global stress and anxiety and increased benefit finding compared to controls. These differences, however, were not maintained at 12 months. Effects of the intervention were moderated by stress such that women with high global stress at baseline showed greater reduction in both stress and anxiety. CONCLUSIONS A CBSM intervention, which was briefer than the norm (5 weeks vs. 9-20 weeks), had beneficial effects on adjustment for women with breast cancer and was particularly effective for those with increased global stress. Screening on this basis may facilitate optimal and cost-effective psychological treatment.

Experience of breast cancer: burden, benefit, or both?

Background: Transactional models of stress emphasize the role of appraisal of stress in adjustment to illness. The current qualitative study uses this framework to explore the subjective response to these stressors in women with breast cancer. Reappraisals or opportunities for growth from the experience are also examined. Objective: The objective of this study was to explore the experience of stress in Irish women with breast cancer using the Stress-Coping Model. Methods: The diaries of 30 women newly diagnosed with breast cancer were analyzed using thematic template analysis. A template of 5 themes based on elements of the Stress-Coping Model was defined prior to analysis. Results: Six top-level and 14 second-level themes were defined in the final template. Following initial diagnosis of breast cancer, women viewed it as either a threat or a challenge. After diagnosis, however, other stressful events included treatment effects, loss of womanhood, and illness disclosure. Women described coping strategies and social interactions that both increased and decreased their stress. In tandem with negative consequences of breast cancer, women also reported benefit from the experience. Conclusions: Women differed in their identification of stressful events and subsequent coping strategies. Their reports also illustrated the complex relationships between appraisal of the event, personal resources, and social interactions, which can result in both positive and negative outcomes. Implications for Practice: Appraisal of breast cancer can vary, and awareness of this by health professionals can facilitate adjustment. Women need advice in regard to disclosure of diagnosis to others and need more information on managing treatment effects.

Stress and self-efficacy predict psychological adjustment at diagnosis of prostate cancer

Prostate cancer is the most frequently non-skin cancer diagnosed among men. Diagnosis, a significant burden, generates many challenges which impact on emotional adjustment and so warrants further investigation. Most studies to date however, have been carried out at or post treatment with an emphasis on functional quality of life outcomes. Men recently diagnosed with localised prostate cancer (N = 89) attending a Rapid Access Prostate Clinic to discuss treatment options completed self report questionnaires on stress, self-efficacy, and mood. Information on age and disease status was gathered from hospital records. Self-efficacy and stress together explained more than half of the variance on anxiety and depression. Self-efficacy explained variance on all 6 emotional domains of the POMS (ranging from 5–25%) with high scores linked to good emotional adjustment. Perceived global and cancer specific stress also explained variance on the 6 emotional domains of the POMS (8–31%) with high stress linked to poor mood. These findings extend understanding of the role of efficacy beliefs and stress appraisal in predicting emotional adjustment in men at diagnosis and identify those at risk for poor adaptation at this time. Such identification may lead to more effective patient management.

Can risk and illness perceptions predict breast cancer worry in healthy women

Predictors of breast cancer worry in healthy women remain unclear. Healthy women less than 50 years (N = 857) completed measures of family history, anxiety, absolute and comparative risk perceptions, illness perceptions, and breast cancer worry. Regression analyses revealed that having a family history of breast cancer, greater anxiety, higher absolute risk perceptions and negative illness perceptions predicted 45 per cent of the variance in breast cancer worry. Risk perceptions also partially mediated the relationship between illness perceptions and worry. This study provides novel evidence that both illness and risk perceptions are predictors of breast cancer worry in younger women from the community.

Post-traumatic growth in breast cancer: how and when do distress and stress contribute?

While several theoretical models provide explanation for the genesis and development of post‐traumatic growth (PTG) in the aftermath of stressful events, empirical evidence regarding the predictors and consequences of PTG in breast cancer patients in active treatment and early survivorship is inconclusive. This study, therefore, examines the role of distress and stress as predictors and outcomes of PTG in women with breast cancer over an 18‐month period.

Protocol for a pilot randomised controlled trial of an online intervention for post-treatment cancer survivors with persistent fatigue

Introduction Many post-treatment cancer survivors experience persistent fatigue that can disrupt attempts to resume normal everyday activities after treatment. Theoretical models that aim to explain contributory factors that initiate and sustain fatigue symptoms, or that influence the efficacy of interventions for cancer-related fatigue (CrF) require testing. Adjustment to fatigue is likely to be influenced by coping behaviours that are guided by the representations of the symptom. Objectives This paper describes the protocol for a pilot trial of a systematically and theoretically designed online intervention to enable self-management of CrF after cancer treatment. Methods and analysis This 2-armed randomised controlled pilot trial will study the feasibility and potential effectiveness of an online intervention. Participants will be allocated to either the online intervention (REFRESH (Recovery from Cancer-Related Fatigue)), or a leaflet comparator. Participants 80 post-treatment cancer survivors will be recruited for the study. Interventions An 8-week online intervention based on cognitive–behavioural therapy. Primary and secondary outcome measures The primary outcome is a change in fatigue as measured by the Piper Fatigue Scale (revised). Quality of life will be measured using the Quality of Life in Adult Survivors of Cancer Scale. Outcome measures will be collected at baseline, and at completion of intervention. Results The feasibility of trial procedures will be tested, as well as the effect of the intervention on the outcomes. Conclusions This study may lead to the development of a supportive resource to target representations and coping strategies of cancer survivors with CrF post-treatment. Setting Recruitment from general public in Ireland. Ethics and dissemination This trial was approved by the Research Ethics Committee at National University of Ireland Galway in January 2013. Trial results will be communicated in a peer-reviewed journal. Trial registration number ISRCTN55763085; Pre-results.