Donald R. Nicholas

World views, systems theory, and health promotion

As the field of health promotion grows, it is important to investigate new conceptual and theoretical models of health. To date, health promotion has relied primarily on theories and models from other fields. This limits the development of health promotion as a discipline. These limitations become apparent when health promotion programming is analyzed from three different “world views”: formism, mechanism, and organicism. The health promotion professionals “world view” affects the manner in which they plan programs. As a discipline, health promotion needs to move beyond the current dominance of the mechanistic world view to organismic or systemic thinking. In doing so, general systems theory provides a generic, contentless theoretical framework to guide newly developing health promotion programs.

On Being a Psycho-Oncologist: A Counseling Psychology Perspective

This special issue of TCP focuses on the psychological and psychosocial components of coping with cancer and its aftermath. Psycho-oncology, a subspecialty within professional psychology, is a multidisciplinary field emphasizing the psychological and social aspects of cancer. In this introductory article, I show the congruence between counseling psychology and psycho-oncology, indicate how counseling psychologists can expand their parameters of practice to include cancer patients and families, and explain what evidence-based resources are needed to acquire relevant background knowledge. Health care reform changes—in general and oncology-specific—are explained as they currently open new opportunities for counseling psychologists in psycho-oncology. Finally, the five articles that make up this special issue are previewed. Psycho-oncology is a challenging yet rewarding subspecialty within counseling psychology, congruent with its values and parameters of practice, and now is an opportune time to expand one’s practice to include psycho-oncology and help those coping with cancer and its aftermath.

A forbidden topic at the end of life: “What about you after I'm gone?”

Many cancer patients with a life expectancy of less than 6 months continue to seek answers to existential questions. Although patients worry about the future of their family members, especially their spouses, end‐of‐life discussions often remain practical in nature—pain relief, funeral arrangements, and distributing personal belongings. Couples at this stage often struggle with relational distress and can benefit from couples interventions. However, discussing the surviving partners romantic future—whether the surviving partner will stay single or find a new partner—is often avoided as it might be seen as a “forbidden topic.” Although the topic of future dating and remarriage should never be forcefully introduced, psycho‐oncologists may encourage couples to see if such a topic can help them find meaning in their life journey before death. In this article, we stress the importance of such conversations, as avoidance could be detrimental. When a surviving spouse seeks a new intimate partner after the death of their loved one, they often feel guilty, restrained, and confused. Also, it is not rare that adult children and extended family discourage widows/widowers from seeking a new partner. They often consider such choices as disloyal to the previous partner. In some cases, due to concerns about decreased likelihood of future asset distributions (eg, inheritance), family members may resist and react negatively to a new partner. Therefore, a prior discussion about post‐death intimate relationships enables couples and families to explorewhat is best for all concerned. Having the agreement or permission of a dying patient could lessen possible negative consequences associated with a new romantic relationship if pursed. Such conversationmay lessen existential distress, increase peace of mind, andmove the dying patient to a state of a relief. Literature suggests an increase in existential distress for cancer patients nearing the end of life. In a qualitative interview of cancer

Evaluating the effectiveness and implementation of evidence-based treatment: A multisite hybrid design.

The gap between treatment development and efficacy testing to scaled up implementations of evidence-based treatment (EBT) is an estimated 20 years, and hybrid research designs aim to reduce the gap. One was used for a multisite study in cancer control, testing coprimary aims: (a) determine the feasibility and utility of a flexible EBT implementation strategy and (b) determine the clinical effectiveness of an EBT as implemented by newly trained providers. Therapists from 15 diverse sites implemented the biobehavioral intervention (BBI) for cancer patients (N = 158) as part of standard care. For implementation, therapists determined treatment format, number of sessions, and so forth and reported session-by-session fidelity. Patients completed fidelity and outcome assessments. Results showed therapists BBI implementation was done with fidelity, for example, session “dose” (59%), core content coverage (60–70%), and others. Patient reported fidelity was favorable and comparable to the BBI efficacy trial. Effectiveness data show the primary outcome, patients’ scores on the Profile of Mood States total mood disturbance, significantly improved (R2 = 0.06, &bgr; = −0.24, p < .01) as did a secondary outcome, physical activity (R2 = 0.02, &bgr; = 0.13, p < .05). This first use of a hybrid design in health psychology provided support for a novel strategy that allowed providers implementation flexibility. Still, the EBT was delivered with fidelity and in addition, therapists generated novel procedures to enhance setting-specific usage of BBI and its ultimate effectiveness with patients. This research is an example of translational research spanning theory and efficacy tests to dissemination and implementation.