Erin L. O'Hea

Body image issues in women with breast cancer

Abstract Diagnosis and treatment of breast cancer affects women physically as well as psychologically. There are many obvious and real factors that are related to psychological distress in women coping with breast cancer, such as facing a life-threatening illness, painful and impairing treatments, and significant role changes. Although these factors are clearly important, issues related to body image in women faced with breast cancer can also add to psychological distress. Women, in general, are concerned with their appearance, their weight, and their body, with recent studies suggesting 89% of women reported concerns with weight. Such premorbid concerns are often deeply ingrained and can contribute to psychological distress in women treated for breast cancer. The present article is a summary of the literature that has examined body image issues and related psychological adjustment in women with breast cancer. Implications for clinical practice and recommendations for future investigations are discussed.

Predicting medical regimen adherence: the interactions of health locus of control beliefs

The present study examined the interactions between five dimensions of health locus of control beliefs and their relationships with medical regimen adherence in low-income individuals diagnosed with type 2 diabetes. One hundred and nine patients were administered an expanded Multidimensional Health Locus of Control (MHLC) scale. HbA1c was used as a biological indicator of medical regimen adherence. Multivariate regression analyses demonstrated that three interactions were significantly related to HbA1c. The present findings suggest that HLOC may be meaningfully related to medical outcomes. However, these relationships may not be captured through the examination of main effects and may be only found when interactions are considered.

The interaction of locus of control, self-efficacy, and outcome expectancy in relation to HbA1c in medically underserved individuals with type 2 diabetes

A common thread among health behavior theories is the importance of perceived control, often defined within the health psychology literature as locus of control. Inconsistencies have been found regarding the role of locus of control in predicting health behaviors. These inconsistencies may be resolved by exploring interactions between internal locus of control and other perceived control constructs such as self-efficacy and outcome expectancy. The present study tested the interaction of internal locus of control, self-efficacy and outcome expectancy in relation to HbA1c in patients with Type 2 diabetes. One hundred and nine medical patients who were diagnosed with Type 2 diabetes, predominantly from an African American as well as disadvantaged background, participated in the study. HbA1c was used to indicate gradations of medical regimen adherence. A three way interaction among the perceived control measures was related to HbA1c. Patients who reported low self-efficacy and low outcome expectancy tended to benefit the most from high internal locus of control. However, for patients with low self-efficacy and high outcome expectancy, higher scores on internal locus of control were related to poorer HbA1c levels. Future research examining perceived control constructs may benefit from investigating the interacting effects of such variables when evaluating health behaviors.

Changes in smoking associated with an acute health event: theoretical and practical implications

Background: Experiencing a serious adverse behavior-related consequence may motivate behavior change.Purpose: To examine how a sentinel health event is associated with changes in smoking.Methods: We used a prospective cohort design. Adult emergency department (ED) patients provided demographic data, a smoking history, ratings of quit intentions, and endorsement of self-identified smoking-related health problems. A chart review collected data on acuity, ED disposition, and medical diagnoses. Smoking was reassessed 1 month postvisit. Hierarchical regression analyses were conducted to predict (a) intention to quit, (b) any quit attempt of 24 hr or more, and (3) 7-day abstinence.Results: Of 717 smokers enrolled, 189 (26%) intended to quit within the next month. Of the 253 participants reached 1 month postvisit, 126 (50%) reported they had attempted to quit, with 44 (19%) reporting 7-day abstinence. After controlling for other predictors, several event-related variables, such as having a smoking-related ED visit and being admitted to the hospital, were strong predictors of outcomes.Conclusion: Compared to community-based estimates, many more smokers in our sample attempted to quit and achieved 7-day abstinence. This was especially true among smokers who attributed their ED visit to a smoking-related health problem and who were admitted to the hospital. We discuss the implications for tobacco intervention design in medical settings.

The Influence of Income Level and Ethnicity on Coping Strategies

The Ways of Coping Questionnaire (WCQ) by S. Folkman and R. S. Lazarus (1988) has been used widely; however, few studies have evaluated this assessment tool in research concerning populations from different income levels and ethnic backgrounds. The purpose of this study was to compare the endorsement of the 8 coping strategies as outlined by Folkman and Lazaruss original research with Caucasian, middle class participants to the endorsement of coping approaches in a low income, primary care sample. Results suggest that low income individuals report utilizing greater rates of coping strategies overall and specifically employ emotion-focused coping strategies more than Folkman and Lazaruss original sample. Ethnic differences within the present studys low income sample were also examined and suggest that even within this low income sample, African Americans use certain emotion-focused coping strategies significantly more than Caucasian participants.

The transtheoretical model: gender differences across 3 health behaviors.

OBJECTIVE To investigate gender differences in stage-of-change distribution, self-efficacy, and decisional balance, for 3 health behaviors. METHODS Five hundred fifty-four (males = 107; females = 447) low-income, predominantly African American, patients completed stage-of- change, self-efficacy, and decisional balance scales for smoking cessation, exercise adoption, and dietary fat reduction. RESULTS Males and females differ in stage of change for smoking and exercise, but not dietary fat intake. CONCLUSIONS Gender-specific interventions may be needed to promote certain health behaviors but not others, and self-efficacy and decisional balance may be related differently to stage of change in low-income populations.

Spiritual role in healing. An alternative way of thinking

Research shows convincingly that patients with serious medical illnesses commonly use spiritual methods to cope with and manage their illnesses. This reliance on spirituality seems to be associated with a range of positive outcomes in the form of an enhanced sense of well-being, improved feelings of resiliency, and decreased adverse physical symptoms (e.g., pain and fatigue) and psychologic symptoms (e.g., anxiety). The methodologic flaws and limitations of this literature, however, make more research necessary before confident conclusions can be made regarding the objective, biologic benefit. Further efforts should focus on identifying the potential mechanisms through which spirituality enhances both subjective and objective outcomes. Care should be taken to use reliable, valid spirituality assessment measures and more advanced methodologic designs, such as prospective, longitudinal studies, and randomized, controlled trials.

Social problem solving and depression in couples coping with cancer

Objective: When one person in a couple has cancer, both members may experience depressive symptoms and may react as an emotional system. However, the variables that influence this depressive system have not been identified. This study examined whether social problem solving, an important moderator of individual cancer‐related depression, is related to depression in the couple system.

Initial Development of the Mental Health Assessment and Dynamic Referral for Oncology (MHADRO)

The Mental Health Assessment and Dynamic Referral for Oncology (MHADRO) is a program that conducts a computerized assessment of physical, psychological, and social functioning related to oncology treatment, prints personalized summary reports for both the patient and the provider, and for those who provide consent, faxes a referral and assessment summary report to a matched mental health treatment provider (i.e., dynamic referral). The functionality, feasibility, and end user satisfaction of the MHADRO were tested in a comprehensive care center. Of the 101 participants enrolled, 61 (60%) exhibited elevated distress on at least one of the mental health indices, and, of these, 12 (20%) chose a dynamic referral for mental health services. Patients and health care providers exhibited high levels of satisfaction with the program. The MHADRO has potential for assisting in meeting the psychosocial needs faced by individuals with cancer and should be tested further for its facilitation of mental health treatment initiation.

Predictors of psychological distress and interest in mental health services in individuals with cancer

Identifying risk factors for psychological distress in patients with cancer may help providers more efficiently screen, identify, and manage distress. This article presents predictors of psychological distress in a large heterogeneous sample of cancer patients. In total, 836 patients were enrolled in a large randomized control trial and completed computerized psychosocial assessments Mental Health Assessment and Dynamic Referral for Oncology. Multivariate regressions examined predictors of distress and interest in mental health services. Final models suggest that psychological distress was related to six variables, and interest in mental health services was related to previous history of mental health counseling, total number of cancer-related symptoms, and race/ethnicity. Results may be used to identify high-risk patients who may benefit from proactive psychosocial interventions.