Intrapersonal and Interpersonal Factors Predicting Distress and End-of-Life Planning among Individuals with Advanced Cancers

The social-cognitive processing model of adaption to cancer posits that both intrapersonal and interpersonal factors influence psychological adjustment (Lepore, 2001). In this dissertation, two intrapersonal factors, intolerance of uncertainty (IU) and experiential avoidance (EA), were examined in relation to emotional distress (psychological outcome) and advanced care planning (behavioral outcome) among patients living with advanced cancer. EA (efforts intended to avoid negative emotions, thoughts, images or memories) was hypothesized to mediate the relationship between IU (the ability to tolerate uncertainty or the unknown) and emotional distress. In line with the social-cognitive model, two interpersonal factors, social support from family and friends and patient trust in physician, were proposed to buffer the indirect influence of IU on distress through EA. IU and EA were hypothesized to interact to predict advanced care planning (ACP), such that those higher on IU and EA would engage in less ACP compared to those higher on IU but lower on EA. The sample included 108 adults with Stage III or IV cancer (53% female; Mage = 63 years). All constructs were measured by standardized self-report scales with acceptable to strong internal consistency reliability (i.e., Intolerance of Uncertainty Scale-Short Form; The Brief Experiential Avoidance Questionnaire; The Duke-UNC Functional Social Support Questionnaire; Trust in Physician Scale; Hospital Anxiety and Depression Scale; Advanced Care Planning Checklist). The PROCESS macro for SPSS was used to conduct mediation, moderation, and conditional process analyses. IU evidenced both direct and indirect relationships with anxiety and depressive symptoms. However, the indirect influence of IU through EA was not contingent on social support. Patient trust in physician did moderate the indirect relationship between IU and anxiety (but not depressive symptoms), albeit in an unanticipated direction. Specifically, the indirect relationship between IU and anxiety symptoms (through EA) was significant for those with moderate to high physician trust but not low trust. Moreover, moderation analyses showed that EA did not influence the positive direct association between IU and ACP. Post-hoc multiple regression analysis, including age, emotional distress, interpersonal factors (social support and trust in physician) and intrapersonal factors (IU and EA), demonstrated that only age and EA remained significant predictors of ACP. Accounting for other factors, older participants engaged in more ACP and those who were more experientially avoidant engaged in less ACP. Although this dissertation used a social-cognitive processing model in which intrapersonal and interpersonal factors interact to predict adjustment, the overall findings provide stronger support for the salience of intrapersonal factors in influencing emotional distress and ACP. IU and, in particular, EA are identified as targets for intervention aimed at helping individuals with advanced cancer manage the emotional impact of illness and make end-of-life decisions

Effects of lens lesions on axonal regeneration & gene expression in retinal ganglion cells

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Screening for Distress and Health Outcomes in Head and Neck Cancer

Head and neck cancers (HNC) have higher rates of emotional distress than other cancer types and the general population. This paper compares the prevalence of emotional distress in HNC across various distress screening measures and examines whether significant distress or distress screening are associated with cancer-related survival. A retrospective observational cohort design was employed, with data collected from the Distress Assessment and Response Tool (DART) and linkages to administrative databases from 2010 to 2016. Descriptive and prevalence data were reported using multiple concurrently administered distress tools, including the Patient Health Questionaire-9 (PHQ-9), Generalized Anxiety Disorders-7 (GAD-7), Edmonton Symptom Assessment Scale-revised (ESAS-r), and MD Anderson Symptom Index-Head and Neck module (MDASI-HN). Across measures, 7.8 to 28.1% of the sample reported clinically significant emotional distress, with PHQ-9 and GAD-7 identifying lowest prevalence of moderate/severe distress, and the ultrashort distress screens within ESAS-r and MDASI-HN performing equivalently. Cox hazards models were used in univariate and multivariate survival analyses. ESAS depression (≥4), but not anxiety, was associated with increased risk of cancer-related mortality and patient completion of DART was associated with greater cancer-related survival. The findings underscore the importance of implementing routine distress screening for HNC populations and the utility of ultra-brief screening measures

Randomized trial of functional electrical stimulation therapy for walking in incomplete spinal cord injury: effects on quality of life and community participation

BACKGROUND: Functional electrical stimulation (FES) therapy has been applied to achieve functional benefits post spinal cord injury (SCI), but little is known about its effects on well-being. OBJECTIVE: Using a parallel-group randomized controlled trial (RCT) design (NCT00201968), the effects of a FES-assisted walking intervention on quality of life and participation post SCI were compared to a non-FES exercise program. METHODS: Individuals with chronic (≥18 months) incomplete SCI (level C2 to T12, AIS C or D) were randomized to a FES-assisted walking (intervention) or aerobic/resistance training (control) sessions 3 times a week for 16 weeks. The Spinal Cord Independence Measure (SCIM), Satisfaction With Life Scale, Lawton Instrumental Activities of Daily Living, Craig Handicap and Assessment Reporting Technique, Reintegration to Normal Living Index, and perceptions of intervention(s) outcomes were completed at baseline, 4, 6, and 12 months. Repeated measures general linear models were used to assess between-group differences. Perceptions of intervention(s) were analyzed using qualitative content analysis. RESULTS: Thirty-four individuals were randomized (17 per group); 27 remained at 12 months. The FES group had a significant increase (P < .01) on SCIM mobility subscores (mean [SD] = 17.27 [7.2] to 21.33 [7.6]) compared to the exercise group (mean [SD] = 19.9 [17.1] to 17.36 [5.5]). Although no significant between-group differences were detected for other outcomes, both groups reported positive gains in well-being from trial participation. CONCLUSIONS: The present study provides insight into the perceived benefits acquired by participating in an RCT comparing exercise to FES therapy and serves as a model for pinpointing domains of well-being that could be targeted for assessment in future SCI trials

Emotion regulation therapy for cancer caregivers—an open trial of a mechanism-targeted approach to addressing caregiver distress

Informal caregivers (ICs) are integral to care provided to patients facing life-threatening or incurable illnesses. This responsibility causes considerable burden, as approximately one half of ICs report clinically significant symptoms of depression and/or anxiety that persist when left untreated. Psychosocial interventions containing efficacious treatment principles (e.g., cognitive behavior therapy [CBT]) show disappointing results in reducing anxiety and depression in ICs. This may reflect failure of these interventions to specifically target crucial mechanisms underlying the central feature of distress caused by the patient's illness-notably, perseverative negative thinking (PNT). Emotion Regulation Therapy (ERT) is an efficacious CBT developed to explicitly target mechanisms underlying PNT and the emotional concomitants that arise in response to stressful situations. This open trial was conducted to evaluate the acceptability and initial efficacy of ERT adapted to the experience of cancer ICs (ERT-C). Thirty-one ICs provided informed consent and completed eight weekly individual sessions of ERT-C. Participants completed self-report measures of depression and anxiety symptoms, PNT, emotion regulation deficits, and caregiver burden before and after treatment. ERT-C was well tolerated as indicated by 22 treatment completers and feedback provided in exit interviews. ICs demonstrated reduced depression and anxiety symptoms, PNT, and emotion regulation deficits with moderate to large effect sizes (Hedge's g range: 0.36-0.92). Notably, caregiver burden was not reduced but ICs expressed more ability to confront caregiving-related challenges. Findings offer promising but preliminary support for ERT-C as a conceptual model and treatment modality for distressed cancer ICs