B. Jo Hailey

Barriers to Effective Cancer Pain Management: A Review of the Literature

As many as 90% of patients with cancer-related pain can attain satisfactory relief through available pharmacological and medical means. However, as many as 45% of patients in the earlier stages of cancer and 75% of patients in the advanced stages experience at least some pain. Although published guidelines are available, the research literature suggests that health care providers continue to hold some negative misconceptions about cancer pain and its treatment. Patients also harbor similar misconceptions that contribute to ineffective management. Interventions have been discussed in the literature, and although some have proven successful, much still needs to be done to remedy this problem. This review outlines the published guidelines for cancer pain management and describes the literature related to provider and patient barriers, as well as some interventions designed to facilitate effective cancer pain management.

A Link between Hostility and Disease: Poor Health Habits?

The Cook and Medley Hostility (Ho) Scale has been found to predict the occurrence of coronary heart disease, as well as total mortality, and to be related to the severity of coronary artery disease. It has been proposed that the relationship between Ho scores and health status is mediated by an unhealthy psychosocial risk profile. The present study investigated the health habits of 202 young adults; it used a shortened version of TestWell, a self-report inventory of health behaviors. Subjects were classified as high or low scorers on the Ho scale and their overall TestWell scores and those of four subscales were compared. High scorers reported poorer health habits overall (p = .003) and on three of the four subscales (Physical Fitness, p = .04; Self-Care, p = .04; Drugs and Driving, p = .0001). These results suggest that the poor health habits of individuals with high hostility scores may be an additional explanation of the link between hostility and subsequent disease to the psychosocial risk profile explanation recently proposed.

The effects of message framing and feelings of susceptibility to breast cancer on reported frequency of breast self-examination.

One of two types of pamphlets on breast self-examination (BSE) attitudes and behavior was administered to subjects who were classified as high or low in feelings of susceptibility to breast cancer. Half of the subjects received pamphlets stressing the positive consequences of doing BSE and the other half received pamphlets stressing the negative consequences of not doing BSE. A previous study found negatively framed pamphlets to be superior in BSE promotion and these results were explained in terms of Tversky and Kahnemans framing postulate. The original framing postulate includes characteristics of the decision-maker as well as the type of frame presented, thus, we hypothesized an interaction between pamphlet type and level of susceptibility with the largest effect on the group with low perceived susceptibility who received negatively framed pamphlets. The hypothesized interaction did not occur, nor was there a significant effect for pamphlet type. However, there were significant differences between the BSE performance at follow-up of women who were high or low in perceived susceptibility prior to the intervention. These results are discussed in terms of implications for BSE training in the future, more specifically—the need to consider perceived level of susceptibility as an important subject characteristic that could have a large impact on the effectiveness of training programs.

Cultural and Emotional Components of Loneliness and Depression

The relation between loneliness and depression and the distinction between emotional and social loneliness were examined by administering the University of California, Los Angeles (UCLA) Loneliness Scale, the Belcher Extended Loneliness Scale (BELS), the Beck Depression Inventory, and self-report questions about social and emotional loneliness to the following four groups: foreign (Chinese-descent) students in American universities, Chinese students in Taiwanese universities, American students in American universities, and depressed American clients. Depressed clients reported not only more depression but also more overall loneliness than did any of the other groups; they also were more likely to report emotional loneliness or both emotional and social loneliness than were the other three groups. Foreign students, in contrast, reported more social loneliness than did Taiwanese students. Results substantiate the view that loneliness is not a unitary concept and suggest that the UCLA Loneliness Scale and the BELS emphasize emotional rather than social loneliness and that emotional loneliness is a greater component of depression than is social loneliness.

The relative effectiveness of three reminder letters on making and keeping mammogram appointments

One hundred fifty women who had previously had at least one mammogram were sent one of three prompt letters informing them that they were due for screening. The letters were either reassuring, anxiety provoking, or the standard hospital prompt. Based on a review of the literature, we hypothesized that the reassuring letter would be most effective in motivating women to schedule and keep appointments, the anxiety-provoking letter would produce an intermediate level fo compliance, and the standard hospital letter would be least effective. Our hypothesis was partially supported. Overall, 45% of the women in the study scheduled mammogram appointments. This included 54% of those who received the reassuring letter, 42% of those who received the anxiety provoking letter, and 38% of those who received the standard letter. Although the results were in the predicted direction, the results of a chi-square test indicated that differences among groups were not statistically significant. When the dependent measure was number of appointments kept, rather than scheduled, however, significantly more women who received the reassuring letter actually kept their appointments compared with those who received the standard hospital letter. Subsequent analyses suggested that having a family history of breast cancer, receiving a reassuring letter, and being older than 50 years were important factors in scheduling appointments.

The Psychological Experience of Pregnancy

The goal of this investigation was to evaluate objectively the psychological experience of pregnancy. Previous research, using symptoms checklists, interview information, and projective testing strategies has suggested that pregnancy presents a woman with emotional and psychological changes. The goal of this study was to substantiate objectively the assertion that pregnant women have different psychological experiences and emotional needs than nonpregnant women. To assess these needs a group of nineteen women experiencing their first pregnancy was compared to a nonpregnant control group on a variety of objective personality measures. The investigation results indicated that the pregnant women differed from the nonpregnant women on some fundamental dimensions of personality. These differences included a stronger introverted, inward personality orientation, and a lower level of self-acceptance and independence. Suggestions for future research are offered.

Community attitudes toward childhood suicide and attempted suicide

To assess whether peoples reactions to family members of child suicide attemptors were similar to reactions to family members of (a) actual suicides and (b) actual suicides that were preceded by a failed suicide attempt, 120 shoppers (60 men and 60 women) read and responded to one of five short newspaper articles about an incident of a 10-year-old child who either (a) attempted suicide, (b) committed suicide, (c) committed suicide after a previous suicide attempt, (d) died accidentally, or (e) died of a viral illness. Opinions about the psychological health of the victim and reactions to the surviving family varied depending on the nature of the incident. However, in many instances reactions to families of suicide attemptors could not be differentiated from reactions to families of actual suicides. Therefore, it is likely that the number of people affected by negative community reactions to suicidal behavior has been previously underestimated.

A case of trichotillomania in a three year old treated by response prevention

Abstract Trichotillomania (chronic hair-pulling) in a 3 yr old boy was successfully treated by his mother after she had been trained to reinforce appropriate play behaviour and ignore hair-pulling. Seventeen days had passed without recurrence of hair-pulling when the mother terminated treatment and hair-pulling returned to baseline levels. The mother refused to reinstate the initial treatment procedure but finally agreed to a response prevention procedure—trimming the childs hair—which immediately terminated hair-pulling. A six month follow-up revealed no reappearance of hair-pulling or other problem behavior. This study demonstrates the successful treatment of trichotillomania through a minimally intrusive response prevention procedure.

Pain patient profile: A scale to measure psychological distress

OBJECTIVE To evaluate the construct validity of the Pain Patient Profile (P-3), a brief self-report instrument designed to measure anxiety, depression, and somatization in patients presenting with pain. DESIGN Comparison of P-3 scores with previously established measures of depression, anxiety, and somatization, and comparison of P-3 scores of pain patients with those of patients with diabetes. SETTINGS Hospital-based outpatient pain clinic, family practice clinic, diabetes education group. PATIENTS Seventy pain patients and 40 patients with diabetes. RESULTS High positive correlations (.69 to .90) were found between the P-3 scales of Depression, Anxiety, and Somatization and the corresponding measures of these constructs, and high intercorrelations were found among the three P-3 scales. Significant differences were found between pain patients and diabetes patients for the P-3 Depression and Somatization scale scores, but not for the P-3 Anxiety scale scores. CONCLUSIONS The P-3 is a useful instrument for initial screening of psychological distress in pain patients. Some patients may show elevations on more than one of the clinical scales, which either indicates that the P-3 does not distinguish well among these constructs or reflects the well-established comorbidity of these constructs.

The anger expression (AX) scale: correlations with the state-trait personality inventory and subscale intercorrelations

Undergraduate students (N = 502) completed the State-Trait Personality Inventory (STPI; Spielberger et al., 1979), and the Anger Expression Scale (AX; Spielberger et al., 1986), composed of three subscales, Anger Out (AX/Out), Anger In (AX/In), and Anger Control (AX/Con), and a total score of Anger Experienced (AX/EX). Correlations between each of the scales and subscales of the personality inventories were calculated and were compared with one another. As predicted, correlations between AX/EX and STPI subscales related to anger and anxiety were significantly higher than that between AX/EX and the STPI Curiosity subscale. Furthermore, the STPI Trait Anger Temperament subscale was more highly correlated with AX/Out than were any of the other personality subscales except STPI Trait Anger. Correlations between subscales of the AX were compared with those obtained by Spielberger et al. (1985) Whereas Spielberger et al. (1985) made a case for the independence of AX/Out and AX/In by presenting correlations of essentially zero for both male and female subjects, the present study showed a significant positive correlation between the two subscales for men, casting some doubt on the independence of the subscales.