Coping and psychological well-being in informal carers of stroke survivors with aphasia

This dissertation considers coping and psychological well-being in informal carers of stroke survivors with aphasia. Firstly, a literature review examines the main problemsreported by this group of carers, the coping strategies they use to manage these problems, and the links between coping and psychological well-being. This is followedby an empirical paper which reports on a study investigating how informal carers of stroke survivors with aphasia cope with communication problems, and examining thelinks between coping and an aspect of psychological well-being - depressive symptoms. Further, this study also explores the question of how best to measure how carers cope with communication problems, by including questions specifically developed for this topic alongside a traditional coping inventory. As expected, the results demonstrated a relationship between coping strategies and depressive symptoms in this group of carers. The use of avoidant coping strategies was associated with increased symptoms of depression. No links were found between problem-focused coping strategies and depressive symptoms, however it was shown that coping by ‘positive reframing’ was linked with reduced levels of depressive symptoms. The study also found that a traditional style coping inventory gives a useful assessment of the pertinent coping strategies used by informal carers of stroke survivors with aphasia to manage communication problems. However this is usefully supplemented by more specific questioning about the use of avoidance and withdrawal. The study concludes with a discussion of the clinical implications of the results and where future research in this area would be beneficially directed

Same gain, less pain: potential patient preferences for adjuvant treatment in premenopausal women with early breast cancer

The aim of this study was to determine the treatment preferences (adjuvant goserelin or cyclophosphamide, methotrexate and fluorouracil (CMF) chemotherapy) of healthy premenopausal women should they hypothetically develop oestrogen-receptor (ER) positive early breast cancer. Two hundred pre or peri-menopausal women read two scenarios describing goserelin or chemotherapy. Information included: How and where treatments were administered, side-effects, their likely persistence and impact on fertility. Women stated their unprompted initial and final preferences with reasons for the choices made. Respondents showed an overwhelming preference for goserelin. 156 (78%) women favoured goserelin, 22 (11%) chemotherapy and 22 (11%) remained undecided (P<0.0001). Primary reasons for preferring goserelin for were 105 (71%) avoidance of chemotherapy side-effects, especially hair loss, perceived convenience and less disruption to normal life 54 (36%). The minority who preferred chemotherapy, valued the treatment finishing more quickly. These results together with clinical trial data showing equivalence of goserelin with CMF regimens suggest that premenopausal women with ER-positive tumours should at least be offered the choice of either adjuvant hormone therapy or chemotherapy

Sometimes we get it wrong but we keep on trying: A cross-sectional study of coping with communication problems by informal carers of stroke survivors with aphasia

Background: The need to support carers of stroke survivors is widely recognised. However, research on which to base recommendations is scarce. Little research has focused on carers of stroke survivors with aphasia, and that which exists suffers from problems with sample size and methodology. More information is needed about methods used by carers to manage communication difficulties and about coping strategies that promote emotional wellbeing. Aims: To assess the coping strategies used by informal carers of stroke survivors with aphasia to manage communication problems, and their association with depressive symptoms. To assess whether a problem-specific coping inventory offers an advantage over a generic coping questionnaire for this purpose. Methods & Procedures: Questionnaires were completed by 150 informal caregivers of stroke survivors with aphasia. The Centre for Epidemiologic Studies Depression Scale measured depressive symptoms. Coping was assessed with the Brief COPE and a problem- specific questionnaire on coping with communication difficulties. Level of social support was also assessed. Multiple regression analysis explored associations between coping and depressive symptoms. Mediation analysis assessed the significance of the indirect effect of coping between the level of communication impairment in the stroke survivor and the degree of depressive symptoms in the carer. Outcomes & Results: Participants reported a wide range of coping strategies. Avoidant styles of coping were associated with increased depressive symptomatology. Coping by use of positive reframing was linked with fewer symptoms of depression. Anticipated level of social support was also associated with less depressive symptomology. The level of communication impairment of the stroke survivor was not predictive of depressive symptoms in carers after controlling for coping and social support. Limited support was found for a mediating model of coping. Inclusion of one subscale from the problem-specific questionnaire improved the amount of variance accounted for in depressive symptoms, above that explained by the Brief COPE. Conclusions: The results verify that the impairment of the stroke survivor has less effect on carers’ psychosocial functioning compared to coping. Assessment of coping can help to identify carers presenting with increased risk of depression. A traditional coping inventory provides an adequate assessment of the coping strategies used to manage communication problems, and can be supplemented by specific questions about avoidance. Interventions that develop some emotion-focused coping strategies in carers may support adaptation. Interventions should also aim to decrease the use of unhelpful coping strategies rather than solely focusing on increasing problem-focused forms of coping