Linda Edgar

Coping with cancer during the first year after diagnosis. Assessment and intervention.

The emotional coping of 205 patients newly diagnosed with cancer was evaluated every 4 months during a 1‐year period. Patients received a psychosocial intervention either immediately (early intervention, EI), or after a 4‐month delay (later intervention, LI). No significant differences were found between the two groups, except at 8 months, when the LI group was significantly less depressed, anxious, and worried, and felt more in control than the EI group. The LI group continued to have less worry related to illness at, 12 months. Patients with high ego strength had low levels of distress at baseline and may not have needed the intervention. The emotional coping of patients with breast cancer improved during the year regardless of the intervention timing. Patients with other diagnoses appeared to benefit most from the LI. It was concluded that patients with low ego strength and diagnoses other than breast cancer might be at higher risk for psychosocial complications and could benefit from the intervention.

Resource use in women completing treatment for breast cancer.

Objective: To explore resources used by women completing treatment for breast cancer, how they learned about them, and the psychological factors that predicted their use. Copyright

Clarifying "meaning" in the context of cancer research: A systematic literature review

OBJECTIVES This article synthesizes the published literature related to the construct of meaning in the adult cancer population. METHODS The databases CancerLit, CINAHL, Medline, PsychINFO, and the Journal of Psychosocial Oncology and PsychoOncology were searched to identify all studies related to meaning. The methodological aspects of all studies are described and the conceptual aspects are summarized only from those studies that met criteria for methodological rigor and validity of findings. The definitions for global meaning, appraised meaning, search for meaning, and meaning as outcome as proposed by Park and Folkman were used to interpret the findings. RESULTS Of 44 studies identified, 26 met the criteria for methodological rigor. There is strong empirical and qualitative evidence of a relationship between meaning as an outcome of and psychosocial adjustment to cancer. SIGNIFICANCE OF RESULTS The qualitative findings are considered useful for the development of psychosocial interventions aimed at helping cancer patients cope with and even derive positive benefit from their experience. However, variations in the conceptual and operational definitions, frequent reliance on homogeneous and convenience sampling, and the lack of experimental designs are considered to be methodological limitations that need to be addressed to advance the study of meaning in the context of cancer.

Lessons learned: Outcomes and methodology of a coping skills intervention trial comparing individual and group formats for patients with cancer

Objective: Nucare, a short-term psychoeducational coping skills training intervention was evaluated in a randomized controlled clinical trial (RCT) of 225 newly diagnosed breast and colon cancer patients. Method: Measures of psychosocial distress, well being and optimism were evaluated every four months during a one-year period. Patients were randomized to one of four arms: Nucare presented in an individual basis; Nucare presented in a group format; a non-directive supportive group; and a no-intervention control. The interventions were provided in five sessions of ninety minutes each. Results: Patients with breast cancer who received Nucare presented in an individual format showed more significant improvements in well-being over time compared to those in the control and group arms. Conclusions: We were unable to develop functioning groups within the RCT. Partial explanations for the latter finding include the structural limitations of the RCT: the groups were small, difficult to schedule and patients indicated that they would have preferred to choose whether or not to participate in a group. The positive changes in women with breast cancer who received Nucare persisted at 12 months.

The impact of a multimedia informational intervention on psychosocial adjustment among individuals with newly diagnosed breast or prostate cancer: A feasibility study

OBJECTIVE To examine the impact of an 8-week cancer multimedia informational intervention on health-related outcomes among individuals newly diagnosed with cancer. METHODS Using a pre-/post-quasi-experimental design, participants with breast or prostate cancer (n=250) were conveniently recruited from four oncology ambulatory clinics and completed questionnaires at three points (enrolment, 1-2 weeks post-intervention, and 3 months later). RESULTS Repeated-measure analyses showed that, when compared to controls, the intervention significantly improved satisfaction with cancer information over time for women (p<.001), prevented deterioration in functional quality of life (p=.030) and marginally improved perceived oncologist informational support (p=.051). There were no significant differences in psychosocial adjustment among men. Unlike previously suggested, the intervention did not have a differential impact according to levels of personal resources (self-esteem, mastery, and optimism). However, for all outcomes and regardless of group, participants high in personal resources reported better adjustment across time. CONCLUSION Even though the hypotheses were only partially supported, the findings provide preliminary evidence that multimedia interventions can be supportive. PRACTICE IMPLICATIONS With increasing numbers of new cancer diagnoses, cancer survivors and more limited health care resources, further research is needed to evaluate potential benefits of health information technology in providing support to individuals facing cancer.

Strategies to increase research-based practice: interplay with unit culture.

Purpose: A major focus of clinical nurse specialist nursing practice is the integration of research findings into practice. The purpose of this study was to describe strategies used to facilitate research utilization (RU) by nurses in a practice setting. Design: This multiple-case study identified the strategies that clinical nurse specialists and masters degree-prepared nurse educators, working collaboratively, used to facilitate RU. Setting/Sample: The setting included 8 units in 4 sites of a university hospital with all willing nurses participating. Methods: Open-ended focus groups and individual interviews and observational sessions were conducted using investigator-designed interview guides. Comprehensive qualitative analysis led to identification of categories and themes related to RU and the unit culture that supported it. Findings: Findings demonstrated that strategies to facilitate RU by staff at the unit level included conducting original research, supporting nurses participating in research, assessing and meeting staff learning needs, promoting staff attendance at conferences, stimulating goal-setting for presentations and publications, encouraging and responding to new ideas, questioning practice and stimulating inquiry, capitalizing on expertise in research knowledge and skills, and generating information and material resources. Characteristics of unit culture were linked to varying degrees of success with these strategies. The interplay of strategies with unit culture and research-based practice is described. Conclusion: A wide repertoire of strategies is needed to facilitate RU, and the outcome of these strategies is influenced by the unit culture. Implications for Practice: Consideration of the findings and the scope of the strategies used by nurses in the study can help clinical nurse specialist and other nursing leaders facilitate the building of practice on research.

An oncology volunteer support organization: The benefits and fit within the health care system

Psychosocial support programs and organizations provide a range of resources to cancer patients and their families. In spite of well‐documented research attesting to their positive impact, such organizations are often not well integrated into the medical system. This paper examines the benefits to patients and families of using Hope and Cope, a voluntary support system. Also, it explores the ways in which these benefits may relate to the health care team. A total of 121 patient users and non‐users of Hope and Cope and 50 family members were surveyed about their specific needs and how they were met. The users and non‐users assessed their needs for information and emotional support differently: those with greater needs utilized the resources and were satisfied with the outcomes, while those with fewer needs did not. The need for emotional support significantly discriminated users of Hope and Cope from non‐users. Participants saw the program as helping them manage side effects, handle medical treatment, and know which questions to ask their physicians. This study concludes that patients appear to choose wisely according to their needs and that organizations such as Hope and Cope help. However, questions are raised about the relationship between the health care team and voluntary support programs. How and when information about resources is conveyed to patients continues to be problematic. Responses to these concerns may lead to strategies to increased collaboration between oncology volunteer support services and the health care team.

Patterns of Coping in women completing treatment for breast cancer: A randomized controlled trial of nucare, a brief psychoeducational workshop

Abstract Two cost-effective one-day workshops presenting either problem-focused or emotion-focused coping strategies for women completing treatment for breast cancer were evaluated for their impact on three robust patterns of coping resulting from a previous factor analysis. A factor analysis was carried out on the Ways of Coping Questionnaire using a sample of patients six months after diagnosis. Three factors were found: positive problem solving, escape/avoidance, and seeking social support. These factors were used as dependent variables in a study on the effects of two brief, psychoeducational workshop interventions on coping among 156 women completing treatment for breast cancer. The women were randomized to either a problem-focused or emotion-focused coping workshop or to a waiting-list (the control group). The results indicated that women who were positive problem solvers made gains in this pattern of coping if they participated in the problem-focused workshop, whereas women in the emotion-focused workshop showed a trend to reduce their use of escape/avoidance. The coping pattern of seeking social support was unchanged by either intervention. The workshops were well accepted and cost-effective. Whether patterns of coping are potentially amenable to growth and change is worthy of future study.

Providing Psychosocial Distress Screening, Coping Resources, and Self-care to Newly Diagnosed Cancer Survivors in a Canadian Small Town Setting

This chapter presents a unique method of screening for distress among newly diagnosed cancer patients in a Canadian out patient oncology clinic setting. We developed, implemented, and evaluated a program that was presented to patients as soon as possible after diagnosis. The project met the objectives of screening and assessing newly diagnosed cancer patients for distress, linking them to appropriate resources, communicating that information to the oncology team in a timely manner, and providing information on coping strategies and self-assessment of distress to patients and accompanying family members. The results from 60 patients who we were able to reach for follow-up indicated strong support for the program. Distress levels as measured by the distress thermometer fell from an average of 4.2 at baseline to 2.6 after 2 months, and the number of patients with the highest levels of distress (above 7) also fell from 12 % to zero. Thirty-eight percent continued to monitor their levels at home and utilized appropriate resources as needed. We conclude with a discussion of the issues around making a change in clinical practice.