Val Morrison

Perceived control, coping and recovery from disability following stroke

Previous research has demonstrated that perceived control beliefs predict recovery from disability, allowing for initial levels of disability, in stroke patients. Theories of mental representations and coping would suggest that this relationship might be mediated by coping, by engaging in exercise, and that emotional factors might be involved. These hypotheses were examined in a longitudinal study of 71 patients interviewed in hospital within 3 weeks of the stroke, 1 month after discharge and 6 months after discharge. The results confirmed that perceived control predicted recovery from disability but no support was found for the mediating effects of exercise or mood. While the results offer some tentative suggestions for intervention, they point to deficiencies in current theories of disability.

Recovery from disability after stroke as a target for a behavioural intervention: results of a randomized controlled trial.

Purpose. Disability following stroke is highly prevalent and is predicted by psychological variables such as control cognitions and emotions, in addition to clinical variables. This study evaluated the effectiveness of a workbook-based intervention, designed to change cognitions about control, in improving outcomes for patients and their carers. Method. At discharge, stroke patients were randomly allocated (with their carers) to a 5-week intervention (n = 103) or control (normal care: n = 100). The main outcome (at 6 months) was recovery from disability using a performance measure, with distress and satisfaction as additional outcomes. Results. The intervention group showed significantly better disability recovery, allowing for initial levels of disability, than those in the control group, F(1,201) = 5.61, p = 0.019. Groups did not differ in distress or satisfaction with care for patients or carers. The only psychological process variable improved by the intervention was Confidence in Recovery but this did not mediate the effects on recovery. Conclusions. A large proportion of intervention participants did not complete the workbook tasks. This was perhaps associated with the fairly low level of personal contact with workbook providers. The modest success of this intervention suggests that it may be possible to develop effective behavioural interventions to enhance recovery from disability in stroke patients.

Anxiety, depression and quality of life after cancer diagnosis: what psychosocial variables best predict how patients adjust?

Significant numbers of cancer patients suffer distress, reduced quality of life and various other psychological problems. Evidence regarding psychological predictors of these outcomes is inconsistent. This study explored a range of predictors using an established psychological framework to identify the most important predictors of cancer adjustment, and when these are best assessed for optimal outcome prediction.

Common, important, and unmet needs of cancer outpatients

PURPOSE To maximize patient well-being, health and social care should, whenever possible, address individual patient needs. The present study aims firstly, to identify prevalent, salient and unmet needs amongst cancer outpatients, and secondly, to explore socio-demographic and clinical influences on expressed need. METHODS One-hundred and ten outpatients registered at a UK cancer treatment centre completed a self-report questionnaire measuring the presence, salience and degree to which 80 need items were met. Six broad cancer sites were represented: urology, colorectal, breast, gynaecology, haematology, and head and neck. RESULTS The mean number of needs reported was 27. The top five needs concerned the treatment, care and health information patients receive from healthcare professionals, all of which were rated as well met. Least met needs included receiving genetic information, information about lifestyle changes, help with worries about spread or recurrence, and parking near treatment centres. Salient needs showed greater variation across the sample and were often unmet, for example the need for genetic information, and the need for information about symptoms/indicators of recurrence. Gender (female), age (younger), having an informal caregiver, and cancer site all affected aspects of need; whereas time since diagnosis and type of treatment did not. CONCLUSIONS Acknowledging these influences on patient need could help guide patient-centred support services with potential gains to patient satisfaction and well-being.

A preliminary study into stress in palliative care: optimism, self-efficacy and social support.

Abstract Caring for the terminally ill is a demanding, but rewarding area of health care. Stressors unique to this working environment—dealing with patient death rather than cure, and supporting entire family units, for example—put caregivers at risk from stress related illness. This study investigated the buffering effects of optimism, self-efficacy and social support against two measures of stress within the palliative setting. Comparisons were made between volunteer (n = 18) and professional (n = 18) caregivers across three caregiving settings. Data were collected retrospectively about personal control variables; use of and satisfaction with, social support; and, perceived general and occupational specific stress levels. Differences in reported stress levels were found both between settings (NHS, hospice and community-based) and between caregiver type (salary status and occupational category). Optimism was more strongly and consistently associated with low levels of perceived stress than was self-efficacy. Satisfaction with social support was highest among paid workers, and in terms of buffering stress in the whole sample, appeared mediated by optimism. Worksite interventions targeting caregiver self-efficacy and optimism are recommended as a potential source of stress management within this population.

Mood as a predictor of disability and survival in patients newly diagnosed with ALS/MND

Objectives. To investigate whether poor psychological status predicts shorter survival, faster progress of disease and greater disabiliry in patients with ALS/MND (amyotrophic lateral sclerosis/motor neurone disease). Design. A prospective study of mood as a predictor of 6-month outcome in a consecutive cohort of patients with ALS/MND. Methods. A cohort of 38 consecutive patients completed mood, self-esteem, well-being and disability measures at the time of diagnosis and 6 weeks later. Survival and disability were assessed at 6 months. Results. The 10 patients who died had poorer overall mood at the 6-week interviews. Low mood early in disease also predicted greater disability at 6 months. The poor outcomes of patients with poor psychological well-being were not due to confounding associations between mood and disease severity. Conclusions. The data confirm McDonald, Weidenfeld, Hillel, Carpenter & Walters (1994) finding that poor psychological status predicts poor survival in ALS/MND. This study also extend their findings by (a) recruiting patients at the point of diagnosis and therefore controlling for effects due to the duration of disease, and (b) demonstrating that mood also predicts disease progression and disability. The findings are unlikely to be due to simple spurious association of the psychological status measures with recognized indices of disease or of expected survival. Explanations for the results can be considered in the context of other findings of mood predicting outcomes of life-threatening disease and the possible value of psychological interventions may be considered.

Perceived control and recovery from functional limitations : Preliminary evaluation of a workbook-based intervention for discharged stroke patients

Background. Previous research has demonstrated that control cognitions predict functional limitations following stroke. This paper reports a preliminary evaluation of the effects of a workbook intervention, designed to enhance perceptions of control, in reducing disability in patients discharged from hospital following stroke. Methods. Thirty-nine patients living at home who had had a stroke within the 2 previous years completed baseline assessments of functional limitations, mood and perceived control. They were then randomly allocated to either a Workbook Intervention or a Wait control group and functional limitation and mood outcomes were assessed 1 month later. Results. Results showed no benefit of the intervention, but both groups showed reduced functional limitations. Reductions in functional limitations were correlated with increases in perceptions of control. Conclusions. Clearly, the workbook intervention needs to be strengthened before a full evaluation would be worthwhile for this clinical group. It is possible that both groups demonstrated spontaneous recovery or may have benefited from the additional attention given by the researcher. These benefits were associated with enhanced perceptions of control, contributing to previous findings suggesting that control cognitions may be both a consequence and a determinant of functional limitations.

Predicting adherence to medications using health psychology theories: a systematic review of 20 years of empirical research.

OBJECTIVES This review sought to identify the empirical evidence for the application of models from sociocognitive theory, self-regulation theory, and social support theory at predicting patient adherence to medications. METHODS A systematic review of the published literature (1990-2010) using MEDLINE, EMBASE, Cochrane Library, CINAHL, and PsychINFO identified studies examining the application of health psychology theory to adherence to medication in adult patients. Two independent reviewers extracted data on medication, indication, study population, adherence measure, theory, model, survey instruments, and results. Heterogeneity in theoretical model specification and empirical investigation precluded a meta-analysis of data. RESULTS Of 1756 unique records, 67 articles were included (sociocognitive = 35, self-regulation = 21, social support = 11). Adherence was most commonly measured by self-report (50 of 67). Synthesis of studies highlighted the significance (P ≤ 0.05) of self-efficacy (17 of 19), perceived barriers (11 of 17), perceived susceptibility (3 of 6), necessity beliefs (8 of 9), and medication concerns (7 of 8). CONCLUSIONS The results of this review provide a foundation for the development of theory-led adherence-enhancing interventions that could promote sustainable behavior change in clinical practice.

Ethnic variations in the caregiver role: A qualitative study

The present study aimed to establish an in-depth qualitative analysis of the convergence and divergence of the experiences of caregivers from four ethnic groups. Eight Bangladeshi, nine Indian, four Pakistani and nine White-British caregivers participated in five focus groups. Differences and similarities between motivations for role adoption, willingness to care, experience of role, adaptation to role, coping, use of and satisfaction with support were discussed. Key differences were found in adaptation to care role and use of social support. The article highlights the need for further study of the ethnic minority caregiver experience and has implications for service development.

Does self-efficacy influence recovery and well-being in osteoarthritis patients undergoing joint replacement? A systematic review:

Objective: To investigate the role of self-efficacy in functional recovery and well-being outcomes in osteoarthritis patients, undergoing hip or knee replacement surgery. Data sources: Studies were identified using MEDLINE via PUB med, PsycINFO and CINAHL from inception to July 2013. Methods: Three search strategies that combined key terms of ‘self-efficacy’, ‘functional recovery’, ‘well-being’ and ‘joint replacement’ were applied. Titles and abstracts were screened for eligibility and, accordingly, potentially eligible studies were retrieved for review. Included studies were assessed in terms of their quality, and data were extracted by two independent reviewers. A narrative synthesis of results was conducted. Results: In total, 836 articles were identified and after electronic de-duplication, 708 articles remained. After screening 15 articles were retrieved as potentially eligible and eight articles were included in the review. Of the eight studies (n = 967 patients), seven had a prospective design and all studies were considered of good quality. No fully conclusive evidence for the influence of self-efficacy upon functional recovery outcomes was found. When the timing of self-efficacy measurement was examined, post-operative self-efficacy was found to be related to functional recovery outcomes. Conclusion: Presurgical self-efficacy was the least consistent predictor of functional outcomes while postoperative self-efficacy was more consistently associated with recovery outcomes such as longer distance ambulation, exercise repetition and frequency, walking speed and disability.