Randomized Pilot Trial of a Telephone Symptom Management Intervention for Symptomatic Lung Cancer Patients and Their Family Caregivers

Context Lung cancer is one of the most common cancers affecting both men and women and is associated with high symptom burden and psychological distress. Lung cancer patients’ family caregivers also show high rates of distress. However, few interventions have been tested to alleviate significant problems of this population. Objectives This study examined the preliminary efficacy of telephone-based symptom management (TSM) for symptomatic lung cancer patients and their family caregivers. Methods Symptomatic lung cancer patients and caregivers (N=106 dyads) were randomly assigned to 4 sessions of TSM consisting of cognitive-behavioral and emotion-focused therapy or an education/support condition. Patients completed measures of physical and psychological symptoms, self-efficacy for managing symptoms, and perceived social constraints from the caregiver; caregivers completed measures of psychological symptoms, self-efficacy for helping the patient manage symptoms and managing their own emotions, perceived social constraints from the patient, and caregiving burden. Results No significant group differences were found for all patient outcomes and caregiver self-efficacy for helping the patient manage symptoms and caregiving burden at 2 and 6-weeks post-intervention. Small effects in favor of TSM were found regarding caregiver self-efficacy for managing their own emotions and perceived social constraints from the patient. Study outcomes did not significantly change over time in either group. Conclusion Findings suggest that our brief telephone-based psychosocial intervention is not efficacious for symptomatic lung cancer patients and their family caregivers. Next steps include examining specific intervention components in relation to study outcomes, mechanisms of change, and differing intervention doses and modalities

The Problematization of Sexuality among Women Living with HIV and a New Feminist Approach for Understanding and Enhancing Women’s Sexual Lives

In the context of HIV, women’s sexual rights and sexual autonomy are important but frequently overlooked and violated. Guided by community voices, feminist theories, and qualitative empirical research, we reviewed two decades of global quantitative research on sexuality among women living with HIV. In the 32 studies we found, conducted in 25 countries and composed mostly of cis-gender heterosexual women, sexuality was narrowly constructed as sexual behaviours involving risk (namely, penetration) and physiological dysfunctions relating to HIV illness, with far less attention given to the fullness of sexual lives in context, including more positive and rewarding experiences such as satisfaction and pleasure. Findings suggest that women experience declines in sexual activity, function, satisfaction, and pleasure following HIV diagnosis, at least for some period. The extent of such declines, however, is varied, with numerous contextual forces shaping women’s sexual well-being. Clinical markers of HIV (e.g., viral load, CD4 cell count) poorly predicted sexual outcomes, interrupting widely held assumptions about sexuality for women with HIV. Instead, the effects of HIV-related stigma intersecting with inequities related to trauma, violence, intimate relations, substance use, poverty, aging, and other social and cultural conditions primarily influenced the ways in which women experienced and enacted their sexuality. However, studies framed through a medical lens tended to pathologize outcomes as individual “problems,” whereas others driven by a public health agenda remained primarily preoccupied with protecting the public from HIV. In light of these findings, we present a new feminist approach for research, policy, and practice toward understanding and enhancing women’s sexual lives—one that affirms sexual diversity; engages deeply with society, politics, and history; and is grounded in women’s sexual rights

Age and attachment style impact stress and depressive symptoms among caregivers: a prospective investigation

Family members begin their role as caregivers to persons with cancer with little advance notice. In this situation, the caregivers' existing psychosocial resources, including their stage in life and the nature of their relationship with the patient, can play important roles in the extent of stress caregivers experience during this unique time. Family caregivers (N = 98) of diagnosed colorectal cancer patients at community hospitals participated in the study around the time of diagnosis (T1) and at 6 months post-diagnosis (T2). Hierarchical regression analyses revealed that younger caregivers reported greater increases in caregiving stress at T2, controlling for the level of caregiving stress at T1. This was more prominent when they had an anxious attachment orientation to the care recipient (i.e., cancer survivor), which was characterized as a strong desire for closeness to the cancer survivor, hypervigilance for cues of abandonment, and emotional upset both at separation and reunion with the survivor. The same interaction effect between age and anxious attachment was found for depressive symptoms. Results suggest that younger caregivers are more vulnerable to the challenges imposed by their relative's cancer, and this vulnerability is exacerbated by the quality of their relationship. Our findings imply that younger caregivers whose relationship with the survivor can be characterized by the features above can be identified early and might benefit from intervention or additional support to reduce the caregiving stress and depressive symptoms as they carry out their new role as a cancer caregiver

Studying Psychotherapy Using the One-With-Many Design: The Therapeutic Alliance as an Exemplar

Most psychotherapy research uses a one-with-many design, in which each therapist (the one) treats multiple clients (the many), which raises the challenge of nonindependent data. We present a statistical model for analyzing data from studies that use a one-with-many design. This model addresses the problems associated with nonindependence and can address theoretically relevant questions. To illustrate this model, we analyzed data in which 65 therapists and their 227 clients rated their therapeutic alliance. The primary finding was that both therapist and client alliance ratings were largely relational (i.e., specific to the unique therapist-client combination). There was little consensus among clients treated by the same therapist about the quality of the therapeutic alliance, although some therapists reported forming stronger alliances than other therapists. There was substantial dyadic reciprocity, indicating that if a therapist reported an especially good alliance with a particular client (better than with his or her other clients), then that client was also likely to report an especially good alliance (better than those reported by the therapist\u27s other clients)

Preadoptive Factors Predicting Lesbian, Gay, and Heterosexual Couples’ Relationship Quality Across the Transition to Adoptive Parenthood

The authors examined preadoptive factors as predictors of relationship quality (love, ambivalence, and conflict) among 125 couples (44 lesbian couples, 30 gay male couples, and 51 heterosexual couples) across the 1st year of adoptive parenthood. On average, all new parents experienced declines in their relationship quality across the 1st year of parenthood regardless of sexual orientation, with women experiencing steeper declines in love. Parents who, preadoption, reported higher levels of depression, greater use of avoidant coping, lower levels of relationship maintenance behaviors, and less satisfaction with their adoption agencies reported lower relationship quality at the time of the adoption. The effect of avoidant coping on relationship quality varied by gender. Parents who, preadoption, reported higher levels of depression, greater use of confrontative coping, and higher levels of relationship maintenance behaviors reported greater declines in relationship quality. These findings have implications for professionals who work with adoptive parents both pre- and postadoption

Preadoptive Factors Predicting Lesbian, Gay, and Heterosexual Couples’ Relationship Quality Across the Transition to Adoptive Parenthood

The authors examined preadoptive factors as predictors of relationship quality (love, ambivalence, and conflict) among 125 couples (44 lesbian couples, 30 gay male couples, and 51 heterosexual couples) across the 1st year of adoptive parenthood. On average, all new parents experienced declines in their relationship quality across the 1st year of parenthood regardless of sexual orientation, with women experiencing steeper declines in love. Parents who, preadoption, reported higher levels of depression, greater use of avoidant coping, lower levels of relationship maintenance behaviors, and less satisfaction with their adoption agencies reported lower relationship quality at the time of the adoption. The effect of avoidant coping on relationship quality varied by gender. Parents who, preadoption, reported higher levels of depression, greater use of confrontative coping, and higher levels of relationship maintenance behaviors reported greater declines in relationship quality. These findings have implications for professionals who work with adoptive parents both pre- and postadoption

Gender-typed play behavior in early childhood: Adopted children with lesbian, gay, and heterosexual parents

This study examined whether the gender-typed play of young children varies as a function of family structure. Using a sample of 126 couples (44 lesbian couples, 34 gay male couples, and 48 heterosexual couples) located throughout the United States, with an adopted child between the age of 2 and 4 years old (mean = 2. 5 years), we examined parent reports of children\u27s gender-typed play behavior utilizing the Pre-School Activities Inventory (PSAI; Golombok and Rust 1993). Findings revealed that the perceived play behaviors of boys and girls in same-gender parent families were more similar (i. e., less gender-stereotyped) than the perceived play behavior of boys and girls in heterosexual-parent families (which were more divergent; that is, gender-stereotyped). Sons of lesbian mothers were less masculine in their play behavior than sons of gay fathers and sons of heterosexual parents. Our findings have implications for researchers who study gender development in children and adolescents. © 2012 Springer Science+Business Media, LLC

Preadoptive Factors Predicting Lesbian, Gay, and Heterosexual Couples\u27 Relationship Quality Across the Transition to Adoptive Parenthood

The authors examined preadoptive factors as predictors of relationship quality (love, ambivalence, and conflict) among 125 couples (44 lesbian couples, 30 gay male couples, and 51 heterosexual couples) across the 1st year of adoptive parenthood. On average, all new parents experienced declines in their relationship quality across the 1st year of parenthood regardless of sexual orientation, with women experiencing steeper declines in love. Parents who, preadoption, reported higher levels of depression, greater use of avoidant coping, lower levels of relationship maintenance behaviors, and less satisfaction with their adoption agencies reported lower relationship quality at the time of the adoption. The effect of avoidant coping on relationship quality varied by gender. Parents who, preadoption, reported higher levels of depression, greater use of confrontative coping, and higher levels of relationship maintenance behaviors reported greater declines in relationship quality. These findings have implications for professionals who work with adoptive parents both pre- and postadoption. © 2010 American Psychological Association