Lisa Beatty

The psychosocial concerns and needs of women recently diagnosed with breast cancer: a qualitative study of patient, nurse and volunteer perspectives

Objective  To qualitatively identify the concerns and needs of Australian women recently diagnosed with breast cancer.

A Systematic Review of Predictors of, and Reasons for, Adherence to Online Psychological Interventions.

PurposeA key issue regarding the provision of psychological therapy in a self-guided online format is low rates of adherence. The aim of this systematic review was to assess both quantitative and qualitative data on the predictors of adherence, as well as participant reported reasons for adhering or not adhering to online psychological interventions.MethodsDatabase searches of PsycINFO, Medline, and CINAHL identified 1721 potentially relevant articles published between 1 January 2000 and 25 November 2015. A further 34 potentially relevant articles were retrieved from reference lists. Articles that reported predictors of, or reasons for, adherence to an online psychological intervention were included.ResultsA total of 36 studies met the inclusion criteria. Predictors assessed included demographic, psychological, characteristics of presenting problem, and intervention/computer-related predictors. Evidence suggested that female gender, higher treatment expectancy, sufficient time, and personalized intervention content each predicted higher adherence. Age, baseline symptom severity, and control group allocation had mixed findings. The majority of assessed variables however, did not predict adherence.ConclusionsFew clear predictors of adherence emerged overall, and most results were either mixed or too preliminary to draw conclusions. More research of predictors associated with adherence to online interventions is warranted.

A prospective examination of perceived stress as a mediator of the relationship between life-events and QOL following breast cancer.

OBJECTIVES This study prospectively investigated the relationship between life-events, perceived stress, and quality of life (QOL) following breast cancer diagnosis, using the bio-behavioural model of cancer stress as a framework. DESIGN A longitudinal, self-report design was used. METHODS Three waves of data from 10,543 mid-aged Australian women (aged 45-50 at Survey 1) were collected over 5 years as part of a population-based survey. From this group a subsample (N=140) were identified who did not have breast cancer at Survey 1, but who subsequently developed breast cancer. Random regression growth curve analyses were used to investigate whether perceived stress mediated the relationship between initial life-events and change in QOL functioning overtime. RESULTS Prospective evidence was generated for each of the three criteria for testing mediation. As the number of life-events before breast cancer increased, women were significantly more likely to experience corresponding increases in perceived stress over the 5-year period. As the level of perceived stress before breast cancer increased, women were more likely to experience deteriorations overtime in role emotional, role physical, vitality, bodily pain, physical functioning, and social functioning. As the number of life-events before breast cancer increased, women were at significant risk of experiencing deteriorations overtime in bodily pain, social functioning, role emotional, and vitality. Mediational analyses revealed that perceived stress fully mediated the relationship between initial life-events and two QOL domains; role-emotional and social functioning. CONCLUSION Results partially supported the bio-behavioural model of cancer stress, but the model does not appear to fit the data as well as predicted, and may require revision.

Feasibility study of a self-guided cognitive behaviour therapy internet intervention for cancer carers.

Despite the evidence base for Internet-delivered self-help programmes, their application to cancer carers has not been reported. This feasibility study evaluated a 6-week internet cognitive behaviour therapy (CBT) programme for early stage cancer carers. The study participants comprised 13 carers who were recruited over a 17-month period. Measures included distress, quality of life and programme engagement. Changes over time were measured using effect sizes (Cohens d), whereas acceptibility was assessed using qualitative feedback. Low enrolment and high attrition rates resulted in a failure to demonstrate feasibility. Large improvements in negative affect (d=0.88) and emotional functioning (d=0.62) were found. For treatment completers, the intervention holds promise in reducing distress. However, in light of the serious challenges with recruitment and retention, further research is needed to resolve participation barriers.

The Psychosocial Impact of Cancer-Related Infertility on Women

The objective of the current article was to assess the psychosocial impact of treatment-related infertility or the possibility of infertility on young women with cancer in contrast to the general population. Literature on the subject of female infertility among the general population and treatment-related female infertility among young women with cancer was identified and examined in the context of what is known about the psychosocial impact of infertility among the general population. Women whose fertility was affected by cancer treatment were likely to experience negative emotional reactions, which can strain their relationships. Additional concerns included receiving inadequate information about infertility, enduring distress, and feeling uncertainty regarding fertility status.

Why people choose to not use complementary therapies during cancer treatment: a focus group study.

While 50% of cancer patients use complementary therapies (CT) during treatment, few studies have examined why individuals choose not to use CT. This study aimed to address this gap in knowledge using a focus group methodology, where 36 participants took part in one of eight groups; participants were recruited until saturation of themes was achieved. Three categories of participants were investigated: patients/recent survivors (n= 14); volunteers/advocates (n= 16), the majority of whom were also long-term survivors; and health professionals (n= 6). Focus groups were digitally audio-recorded, transcribed, and coded thematically using NVivo software. Reasons for non-use fell into four broad themes: (1) Resource barriers, particularly the cost and lack of time; (2) fear and distrust, including the potential for drug interactions; (3) lack of evidence, including the unproven nature of many CT practices; and (4) satisfaction with conventional treatment. Two further themes related to the benefits of non-use and reasons for discontinuation. A sub-analysis indicated that reasons for non-use differed by CT category, with non-use being mentioned more frequently for biologically based and body-based therapies. Differences in understanding CT non-use emerged between patients, volunteers and health professionals. Findings have clinical implications regarding tailoring information for patients during and after cancer.

An effectiveness study of a CBT group program for women with breast cancer

Abstract Cognitive Behaviour Stress Management for women with breast cancer has demonstrable empirical efficacy, however its effectiveness in the applied clinical setting has not been examined to date in an Australian setting. A 10-week group program was offered to five women with early stage breast cancer. Clinical changes in distress, coping, and social support from pre-test, to post-test and 1-month follow-up are reported. Overall, the group yielded strong favourable effect sizes indicating clinical improvement over time in PTSD symptoms and social support, but strong unfavourable effect sizes in cognitive avoidance. In terms of clinical cut-offs, all women met criteria for PTSD at baseline, with two women recovering at follow-up. The two participants with highest baseline distress experienced large improvements in depression, anxiety and PTSD at post-treatment, but rebounded to baseline at follow-up. Women qualitatively reported the major benefits of the program to be acquiring skills in relaxation an...

A systematic review of psychotherapeutic interventions for women with metastatic breast cancer: context matters

To summarise the evidence‐base of psychological interventions for women with metastatic breast cancer, by mode of delivery (group, individual, or low‐intensity interventions). To synthesise data regarding core intervention‐elements (eg, intervention duration) and context factors (trial setting, uptake and adherence, and demographic characteristics).

Patient preferences on the integration of complementary therapy with conventional cancer care

Complementary therapy use by patients with cancer is highly prevalent, although little is known about the optimal model of integration with conventional care. This study explored patient preferences regarding integration in an Australian context.

A systematic review and meta-analysis of written self-administered psychosocial interventions among adults with a physical illness

OBJECTIVE The cost of implementing professionally-led psychosocial interventions has limited their integration into routine care. To enhance the translation of effective psychosocial interventions in routine care, a self-administered format is sometimes used. The meta-analysis examined the efficacy of written self-administered, psychosocial interventions to improve outcomes among individuals with a physical illness. METHODS Studies comparing a written self-administered intervention to a control group were identified through electronic databases searching. Pooled effect sizes were calculated across follow-up time points using random-effects models. Studies were also categorised according to three levels of guidance (self-administered, minimal contact, or guided) to examine the effect of this variable on outcomes. RESULTS Forty manuscripts were retained for the descriptive review and 28 for the meta-analysis. Findings were significant for anxiety, depression, distress, and self-efficacy. Results were not significant for quality of life and related domains as well as coping. Purely self-administered interventions were efficacious for depression, distress, and self-efficacy; only guided interventions had an impact on anxiety. CONCLUSIONS Findings showed that written self-administered interventions show promise across a number of outcomes. PRACTICE IMPLICATIONS Self-administered interventions are a potentially efficacious and cost-effective approach to address some of the most common needs of patients with a physical illness.