Mariët Hagedoorn

Distress in couples coping with cancer: A meta-analysis and critical review of role and gender effects

Research concerning distress in couples coping with cancer was integrated using meta-analysis and narrative critical appraisal. Individual levels of distress were determined more by gender than by the role of being the person with cancer versus that persons partner. That is, women reported consistently more distress than men regardless of their role (standardized mean difference = 0.31). The association between patient and partner distress within couples was only moderate (r = .29) but is sufficient to warrant further consideration of the notion that these couples react as an emotional system rather than as individuals. It is noteworthy that this association is not moderated by gender. With a general lack of comparison groups, the question of how much distress can be ascribed to the cancer experience cannot be answered decisively; elevations in distress are probably modest. We critically discuss these results, identify important unanswered questions, and indicate directions for future research. Attention needs to be directed toward factors other than cancer as direct influences of distress in these couples and to mediators and moderators of the cancer experience.

Do high job demands increase intrinsic motivation or fatigue or both? The role of job control and job social support

In this study, we used Karasek’s demand-control-support model to determine whether either job control or job social support or both can reduce signs of fatigue and simultaneously enhance intrinsic motivation among employees facing high job demands. Survey data on 555 nurses suggest that job control in particular reduces fatigue in highly demanding jobs, whereas high levels of instrumental support produce elevated levels of intrinsic motivation, regardless of the level of job control and job demands. In order to become successful or even more successful, today’s work organizations need to maximize the use of their employees’ actual and potential skills. More than ever before, organizations in both the private and public sector are introducing new forms of work and organizational design and management, such as total quality management, lean production, and empowerment (Parker & Wall, 1998). These initiatives may enhance intrinsic motivation and inspire employees to learn and develop the skills they need to meet increasing job demands, but simultaneously the initiatives may raise levels of job strain and other negative healthrelated outcomes among employees, generating significant costs in terms of sickness, lost time, and low productivity (Parker & Sprigg, 1999; Theorell & Karasek, 1996). Building on the demand-controlsupport model (DCS model) developed by Karasek and his associates (Karasek, 1979; Karasek & Theorell, 1990), the present study examines job conditions that minimize job strain and maximize intrinsic motivation in highly demanding jobs. The interaction between job demands and control has been studied frequently with respect to job strain (e.g., Ganster & Fusilier, 1989; Karasek, 1979; Schaubroeck & Merritt, 1997; Theorell & Karasek, 1996; Wall, Jackson, Mullarkey, & Parker, 1996; Xie, 1996), but has been largely neglected with respect to work motivation. Moreover, the role of job social support in the interaction between demands and control has drawn little empirical attention as far as job strain is concerned, and no empirical or theoretical attention with regard to intrinsic motivation (cf. Parker & Sprigg, 1999; Van der Doef & Maes, 1999). The present study contributes substantially to management theory and empirical knowledge by focusing on intrinsic work motivation and, more specifically, by examining the interaction between job demands, job control, and job social support on fatigue and intrinsic motivation simultaneously.

Couples dealing with cancer : Role and gender differences regarding psychological distress and quality of life

The goal of the present study was to further knowledge on gender and role (i.e. patient versus partner) differences in psychological distress and quality of life as a consequence of dealing with cancer. There is some evidence that being the patient or the caregiver makes more difference for men than for women. In total, 173 couples facing various forms of cancer (two samples) and a control group of 80 couples completed the CES‐D and Cantrils Ladder. Analyses of variance revealed that both female patients and female partners of patients perceived more psychological distress and a lower quality of life than women in healthy couples. In contrast, role did have an effect on men. Specifically, male patients scored as high on psychological distress and as low on quality of life as female patients and female partners, but psychological distress and quality of life did not differ between male partners of patients and their healthy controls. However, this effect was found in only one patient sample. The finding that female partners perceived more psychological distress and a lower quality of life than male partners could not be accounted for by differences in the physical condition of the patient or the partner.

Informal caregiving for cancer patients

According to the recent worldwide estimation by the GLOBOCAN project, in total, 12.7 million new cancer cases and 7.6 million cancer deaths occurred in 2008. The worldwide number of cancer survivors within 5 years of diagnosis has been estimated at be almost 28.8 million. Informal caregivers, such as family members and close friends, provide essential support to cancer patients. The authors of this report provide an overview of issues in the study of informal caregivers for cancer patients and long‐term survivors in the United States and Europe, characterizing the caregivers commonly studied; the resources currently available to them; and their unmet needs, their psychosocial outcomes, and the psychosocial interventions tailored to their special circumstances. A broad overview of the state of research and knowledge, both in Europe and the United States, and observations on the directions for future research are provided. Cancer 2013;119(11 suppl):2160‐9.

Facial disfigurement in patients with head and neck cancer : The role of social self-efficacy

This study investigated the moderating role of social self-efficacy (i.e., the belief that one is capable of exercising control over the reactions and openness of other people) with respect to the link between facial disfigurement and psychological and n = 76) as well as their physicians. In line with the hypotheses, the results revealed that the degree of facial disfigurement, as judged by patients as well as their physicians, was positively related to psychological distress and distress in reaction to unpleasant behavior of others, but only when patients did not feel self-efficacious in social encounters. Furthermore, social self-efficacy mitigated the positive link between facial disfigurement as judged by patients and social isolation.

Caregiver burnout among intimate partners of patients with a severe illness: an equity perspective

In the present study, caregiver burnout among the intimate partners of 106 cancer patients and 88 patients with multiple sclerosis was assessed. This study examined how burnout is related to marital quality and perceptions of inequity in the relationship. LISREL analyses showed that higher perceptions of inequity are strongly associated with higher emotional exhaustion and depersonalization, and lower feelings of personal accomplishment. Intimate partners of both cancer patients and patients with multiple sclerosis are relatively likely to experience burnout when they feel that they do not invest or benefit enough in the exchange with their ill partner. The relationship between inequity and burnout held when general marital quality, gender, the duration of the illness, the physical and psychological condition of the ill partner, and support from other persons were controlled for. This study shows that perceptions of equity or balance in the relationship between patients and their intimate partners are important for preventing caregiver burnout and for enhancing positive caregiver experiences.

Ain’t necessarily so: Review and critique of recent meta-analyses of behavioral medicine interventions in health psychology.

OBJECTIVE We examined four meta-analyses of behavioral interventions for adults (Dixon, Keefe, Scipio, Perri, & Abernethy, 2007; Hoffman, Papas, Chatkoff, & Kerns, 2007; Irwin, Cole, & Nicassio, 2006; and Jacobsen, Donovan, Vadaparampil, & Small, 2007) that have appeared in the Evidence Based Treatment Reviews section of Health Psychology. DESIGN Narrative review. MAIN OUTCOME MEASURES We applied the following criteria to each meta-analysis: (1) whether each meta-analysis was described accurately, adequately, and transparently in the article; (2) whether there was an adequate attempt to deal with methodological quality of the original trials; (3) the extent to which the meta-analysis depended on small, underpowered studies; and (4) the extent to which the meta-analysis provided valid and useful evidence-based recommendations. RESULTS Across the four meta-analyses, we identified substantial problems with the transparency and completeness with which these meta-analyses were reported, as well as a dependence on small, underpowered trials of generally poor quality. CONCLUSION Results of our exercise raise questions about the clinical validity and utility of the conclusions of these meta-analyses. Results should serve as a wake up call to prospective authors, reviewers, and end-users of meta-analyses now appearing in the literature.

Structure and reliability of Ware's Patient Satisfaction Questionnaire III: patients' satisfaction with oncological care in the Netherlands.

Background. The present study examined the structure and reliability of the Dutch version of the Patient Satisfaction Questionnaire III (PSQ III). The PSQ III was designed to measure technical competence, interpersonal manner, communication, time spent with doctor, financial aspects, and access to care. In the Dutch version, the financial items were left aside because these are not appropriate for the Dutch socialized system. Objectives. The main objectives were to assess response bias, the number of dimensions needed to describe the PSQ III items, and the reliability of the scales. In addition, distribution characteristics were examined and norm scores to interpret satisfaction scores in an oncological setting were presented. Research Design. A cross-sectional survey study. Subjects. The study was comprised of 1594 cancer patients from eight hospitals. Measures. The Dutch version of the PSQ III. Results. Approximately 14% of the respondents were found to demonstrate considerable response bias. Confirmative factor analyses were performed to test three theoretical models with a varying number of dimensions among those participants who did not demonstrate response bias. The original structure did not fit the data well, but support was found for a three-factor model (with interpersonal manner, communication, and time spent with doctor loading on one factor instead of separate factors) and a one-dimensional model. Conclusions. The PSQ III seems to be an appropriate measure of cancer patients’ satisfaction, with the note that the number of dimensions may vary for different patient groups and/or care settings and that it is important to be aware of response bias.

Does marriage protect older people from distress? The role of equity and recency of bereavement.

The association between marital status and distress was examined in a largely neglected group, namely older people (65 and older; N = 1,649). In this 2-wave study, married persons were less distressed than single persons, but perceived equity within the marriage and recency of bereavement qualified these findings. Married persons who felt inequitably treated were more distressed than persons who had always been single. Married persons reported less distress than recently (= 2 years ago) widowed persons, but only equitably treated married persons reported less distress than persons widowed for more than 2 years. Increased distress between the 2 waves occurred in recently widowed persons, and there was a decrease in distress in persons who were widowed shortly before the 1st wave. No gender effects were found.

Coping with cancer: The perspective of patients’ relatives

Abstract Cancer affects not only patients but also their loved ones. Material and methods. This paper presents a selective, narrative review of psychosocial consequences of cancer and its treatment for relatives of patients, including parents and siblings of children with cancer, children of parents with cancer and partners of adults with cancer. Results. Remarkably, most relatives adapt well to the cancer of a loved one. That is only a minority appears to be at risk for psychological morbidity. Bereavement has been found to impact psychological well being in the short-term, but it does also not appear to be a major risk factor for severe psychopathology. The exception being the loss of a child; this often appears to have intense and long-lasting effects on the parents. Furthermore, especially women were found to be at risk for distress. Conclusion. Future studies that focus on the interactions between patients and family members – parents, children and partners – are of great importance to further the field by providing more insight into the family dynamics of dealing with cancer. Such insights will offer tools for (refining) interventions for families in need.