Lise Fillion

Biopsychosocial Determinants of Chronic Disability and Low-Back Pain: A Review

It is well known that the human and financial costs related to sick leave due to Low-Back Pain (LBP) are substantial in a small percentage of workers. A better understanding of the predictive factors for chronic disability would allow interventions to be adapted and costs to be reduced. This paper is a critical review of recent prospective studies on the biopsychosocial factors predictive of nonreturn to work due to LBP. A sample of 18 prospective studies were systematically analyzed. Despite the limited number of prospective studies and their differences, some factors are promising indicators. These include a previous history of LBP, results of certain clinical tests, a subjective negative appraisal of ones ability to work, and job dissatisfaction. The role of certain psychological variables, including attitudes and beliefs, as well as coping strategies, is also emerging. Additional studies are necessary to confirm the importance of these factors, to specify the nature of the interrelationships among them, and to integrate them into a conceptual framework.

A Conceptual Analysis of Spirituality at the End of Life

The definition of spirituality is the subject of endless debates in the empirical literature. This content analysis sought to: (1) exhaustively review the empirical literature on end-of-life spirituality to extract definitional elements of this concept and (2) elaborate on these definitional elements to create an integrative and inclusive definition of end-of-life spirituality based on the items retrieved. A search of the literature on spirituality published in the last 10 years was conducted via the the PsychINFO and MEDLINE databases. Seventy-one articles were selected based on specific inclusion criteria. A qualitative thematic analysis yielded 11 dimensions for the concept of end-of-life spirituality, namely: (1) meaning and purpose in life, (2) self-transcendence, (3) transcendence with a higher being, (4) feelings of communion and mutuality, (5) beliefs and faith, (6) hope, (7) attitude toward death, (8) appreciation of life, (9) reflection upon fundamental values, (10) the developmental nature of spirituality, and (11) its conscious aspect. The definition derived from this concept analysis, after being tested empirically, may be useful in informing the development of new measures of spirituality and new protocols to assess spirituality in clinical settings.

A brief intervention for fatigue management in breast cancer survivors.

The purpose of this randomized control trial was to verify the effectiveness of a brief group intervention that combines stress management psycho-education and physical activity (ie, independent variable) intervention in reducing fatigue and improving energy level, quality of life (mental and physical), fitness (VO2submax), and emotional distress (ie, dependent variables) in breast cancer survivors. This study applied Lazarus and Folkman stress-coping theoretical framework, as well as Salmons unifying theory of physical activity. Eighty-seven French-speaking women who had completed their treatments for nonmetastatic breast cancer at a university hospital in Quebec City, Canada, were randomly assigned to either the group intervention (experimental) or the usual-care (control) condition. Data were collected at baseline, postintervention, and at 3-month follow-up. The 4-week group intervention was cofacilitated by 2 nurses. Results showed that participants in the intervention group showed greater improvement in fatigue, energy level, and emotional distress at 3-month follow-up, and physical quality of life at postintervention, compared with the participants in the control group. These results suggest that a brief psycho-educational group intervention focusing on active coping strategies and physical activity is beneficial to cancer survivors after breast cancer treatments.

Validation evidence for the French Canadian adaptation of the Multidimensional Fatigue Inventory as a measure of cancer-related fatigue.

Cancer-related fatigue is the most reported symptom among patients with cancer. Researchers in the field of psychooncology have encouraged the development of short instruments, which allow for easier completion by clinical populations while still maintaining solid psychometric properties. The current study examined the validity and reliability of the French Canadian adaptation of the Multidimensional Fatigue Inventory (MFI) among women (n = 277) and men (n = 327) undergoing therapy for breast or prostate cancer, respectively. An exploratory factor analysis of the selected 15-item MFI yielded the following four factors: general/physical, mental, reduced motivation, and reduced activity. This was supported by a confirmatory factor analysis. The reliability, as evaluated by test-retest and Cronbach alpha internal consistency reliability coefficients of the French Canadian shortened MFI, was acceptable. In addition, the four factor-based scores correlated in a theoretically meaningful manner with existing measures of mood disturbance (Profile of Mood States and Hospital Anxiety and Depression Scale), cancer-related stressors (Inventory of Recent Life Experiences), coping with illness (Coping with Health Injuries and Problems Scale), quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire), and insomnia (Insomnia Severity Index), suggesting good construct, convergent, and concurrent criterion validity. Although further validation is recommended, the results for the French Canadian MFI in assessing cancer-related fatigue in both women and men undergoing cancer treatments showed good psychometric qualities.

Professional Patient Navigation in Head and Neck Cancer

OBJECTIVES To discuss professional cancer navigation roles, models, implementation process and outcomes of patients and families dealing with head and neck cancers. One specific research is presented as an illustration. DATA SOURCES Published scientific papers, research review articles, implementations studies. CONCLUSION Two independent cohorts of patients with head and neck cancers were compared according to the presence of the professional navigator (Exposed cohort n=83) or not (Historical cohort n=75). The Exposed cohort showed a better profile on several indicators of outcomes. The results clearly indicate an association between the presence of the professional navigator with continuity of care (higher satisfaction and shorter duration of hospitalization), and empowerment (fewer cancer-related problems, including body images concerns, and better emotional quality of life). IMPLICATIONS FOR NURSING PRACTICE Oncology nurses can not only play an important role in continuity of care but also in supportive care by helping patients to cope better with cancer treatments, recovery or cancer progression and death issues.

Impact of a meaning-centered intervention on job satisfaction and on quality of life among palliative care nurses

Objective: Palliative care (PC) nurses experience several recurrent organizational, professional, and individual challenges. To address existential and emotional demands, the meaning‐centered intervention was recently developed. The intervention applied didactic and process‐oriented strategies, including guided reflections, experiential exercises, and education based on themes of Viktor Frankls logotherapy. The objective of this study was to test its efficiency to improve job satisfaction and quality of life in PC nurses from three regional districts in Quebec Province, Canada.

Factors related to persistent fatigue following completion of breast cancer treatment.

PURPOSE/OBJECTIVES To verify the predictive capacity of the stress-process theory to emeanplain persistent fatigue following completion of breast cancer treatments; to verify the relationship between interleukin-1b and fatigue. DESIGN Correlational. SETTING Tertiary medical center in Quebec City, Canada. SAMPLE A systematic sample of 103 women in remission from breast cancer was recruited. The mean age was 54 years. Participants with a depressive mood, insomnia, or stage IV cancer were emeancluded. METHODS Participants were met during their follow-up appointment after the end of radiation therapy. Questionnaires on fatigue, stress variables, and other confounding variables were completed by telephone interview. Blood samples also were collected to measure the serum level of interleukin-1b. MAIN RESEARCH VARIABLES Fatigue, several variables from the stress-process theory, pain, menopausal symptoms, and demographic and medical variables. FINDINGS Fatigue was related theoretically and coherently to many stress-process variables. By controlling for pain, the final regression model included cancer stressors and passive and active coping as predictors, which accounted for 41% of the variance in fatigue. No relationship was found between fatigue and interleukin-1b. CONCLUSIONS The results supported the relevance of the stress-process theory for emeanplaining cancer-related fatigue. IMPLICATIONS FOR NURSING Nursing interventions based on this theoretical framework could be developed. In addition, further clinical research that tests the efficacy of these psycho-educative interventions in preventing persistent fatigue and improving the quality of life of women with breast cancer is recommended.

Validation of the shortened COPE for use with breast cancer patients undergoing radiation therapy

To study the relationship between cancer and emotional adjustment, investigation of situation-specific coping behaviors with respect to narrowly defined Stressors has recently been promoted. The development and validation of shorter instruments, designed to facilitate completion by clinical populations, has also been recommended. The current study examined the coping skills used by French-Canadian women undergoing radiation therapy for breast cancer. A factor analysis of the 28-item shortened COPE (Carver, Scheier, & Weintraub, 1989) yielded the following eight factors: disengagement, self-distraction, active coping, using emotional support from husband/ partner, using emotional support from friends, turning to religion, humor, and substance use. The test-retest and Cronbach alpha internal consistency reliability coefficients of the French-Canadian shortened COPE were actually higher than those observed in the full-length version of the instrument. In addition, the eight factor-based scores correlated in a theoretically meaningful manner with existing measures of coping skills with illness (Coping with Health Injuries and Problems; CHIP) and mood disturbance (Profile of Mood States; POMS), thus suggesting good construct convergent and concurrent criterion validity. In particular, the disengagement COPE scale was correlated highly with anxiety, depression, and anger. While further validation is recommended, the results show promise for the shortened COPE in assessing coping in women with breast cancer, and also provide continued evidence for the notion that specific coping skills are associated with particular mood states.

Impact of an Educational Program on Pain Management in Patients With Cancer Living at Home

PURPOSE/OBJECTIVES To assess the effect of an educational homecare program on pain relief in patients with advanced cancer. DESIGN Quasi-experimental (pretest post-test, nonequivalent group). SETTING Four community-based primary care centers providing social and healthcare services in the Quebec City region of Canada. SAMPLE 80 homecare patients with advanced cancer who were free of cognitive impairment, who presented with pain or were taking analgesics to relieve pain, and who had a life expectancy of six weeks or longer. METHODS The educational intervention included information regarding pain assessment and monitoring using a daily pain diary and the provision of specific recommendations in case of loss of pain control. Pain intensity data were collected prior to the intervention, and reassessments were made two and four weeks later. Data on beliefs were collected at baseline and two weeks. All data were collected by personal interviews. MAIN RESEARCH VARIABLES Patients beliefs about the use of opioids; average and maximum pain intensities. FINDINGS Patients beliefs regarding the use of opioids were modified successfully following the educational intervention. Average pain was unaffected in the control group and was reduced significantly in patients who received the educational program. The reduction remained after controlling for patients initial beliefs. Maximum pain decreased significantly over time in both the experimental and control groups. CONCLUSIONS An educational intervention can be effective in improving the monitoring and relief of pain in patients with cancer living at home. IMPLICATIONS FOR NURSING Homecare nurses can be trained to effectively administer the educational program during their regular homecare visits.

Low-back-pain related disability: An integration of psychological risk factors into the stress process model

&NA; The purpose of this study was to verify the usefulness of an adaptation of the stress process model in organizing the psychological variables associated with the development of low‐back‐pain related disability. French‐speaking Canadian workers on compensated sick leave (N = 439) due to recent occupational low back pain (LBP) were evaluated during the sub‐acute stage of LBP (between 30 and 83 days after injury). They were assessed for the following factors: life events, injury‐specific cognitive appraisal, emotional distress, avoidance coping, and functional disability. Confirmatory factor analyses were used to test and modify the measurement model. An important modification in the measurement model was the association of catastrophizing with the emotional distress factor. During the sub‐acute stage, path analyses revealed a satisfactory fit of the following model (the following coefficients are standardized): (a) life events (.30) and cognitive appraisal (.42) explained emotional distress (r2 = .30); (b) emotional distress (.42) and cognitive appraisal (.36) explained the use of avoidance coping (r2 = .45); and (c) emotional distress (.24) and avoidance coping (.56) explained functional disability (r2 = .53). The stress model tested here reaffirms the importance of life events in the development of disability through the more established emotional distress factor. Also, cognitive appraisal appears to have an indirect effect on disability through activity avoidance and distress. This adaptation of the stress model makes it possible to integrate risk factors into a reduced set of meaningful factors and proposes a more general adaptation explanation of disability than the specific fear‐avoidance model.