Life and Treatment Goals of Patients with Advanced Cancer

poster abstractTo improve the care of patients with advanced cancer who may be near the end of life, there is a pressing need to better understand their life and treatment goals, and how these relate to psychological adjustment. Patients (N=63) with incurable advanced lung or gastrointestinal cancers completed self-report measures of hope, optimism, and symptoms of anxiety and depression. Patients also participated in a semi-structured interview and were asked to list their current life and treatment goals. Then, they selected five “priority goals” from among both lists and ranked them in order of importance. Subsequently, priority goals were coded into categories such as: Life-Fulfillment (“To go to the beach”), and Life Prolongation, (“To live another 20 years”). The three most common categories were: 1) Life Fulfillment (49% of patients); 2) Social Connection (43%); and 3) Life-Prolongation (29%). Interestingly, a sizable portion of patients (22%) listed cure as a priority goal, with several (13%) indicating it was their most important goal. Counterintuitively, patients who had cure as a priority goal were neither more hopeful nor optimistic than those who did not have cure as a priority goal. Patients who listed cure as their most important goal reported significantly greater depressive symptoms, t(62) = 2.79, p = .007. In order to examine the robustness of this association a regression analysis was conducted predicting depressive symptoms. After controlling for patient age, gender, ECOG performance status, physician-rated prognosis, and patient-rated prognosis, having cure as the most important goal remained a significant predictor of greater depressive symptoms (β = .367, p = .017). These results suggest that patient life and treatment goals may have important implications for patients’ psychological adjustment. Specifically, holding on to cure as an important goal in the face of advanced disease may place patients at risk for greater psychological distress

Understanding Hope: A Review of Measurement and Construct Validity Research

Hope has been discussed by philosophers, theologians, educators, and scientists, to name but a few groups of people, over the preceding two millennia. During the last 15 years, C. R. Snyder and his colleagues at the University of Kansas have developed a theory and associated measures of the hope construct that have received extensive, detailed attention both within and outside the field of psychology. In this chapter, we describe Snyder\u27s hope model and some of the research findings that have supported the validity of this construct. Beginning with a conceptual definition of hope, we move to relevant findings about the usefulness of hope in the lives of individuals in various life arenas. We describe measures developed for assessing hope in children and adults, as well as current issues associated with the validity of hope measurement. Finally, we discuss future directions for further investigation of hope

An experimental investigation of the relationships among race, prayer, and pain

Background and aims Compared to White individuals, Black individuals demonstrate a lower pain tolerance. Research suggests that differences in pain coping strategies, such as prayer, may mediate this race difference. However, previous research has been cross-sectional and has not determined whether prayer in and of itself or rather the passive nature of prayer is driving the effects on pain tolerance. The aim of this study was to clarify the relationships among race, prayer (both active and passive), and pain tolerance. Methods We randomly assigned 208 pain-free participants (47% Black, 53% White) to one of three groups: active prayer (“God, help me endure the pain”), passive prayer (“God, take the pain away”), or no prayer (“The sky is blue”). Participants first completed a series of questionnaires including the Duke University Religion Index, the Coping Strategies Questionnaire-Revised (CSQ-R), and the Pain Catastrophizing Scale. Participants were then instructed to repeat a specified prayer or distractor coping statement while undergoing a cold pressor task. Cold pain tolerance was measured by the number of seconds that had elapsed while the participant’s hand remained in the cold water bath (maximum 180 s). Results Results of independent samples t-tests indicated that Black participants scored higher on the CSQ-R prayer/hoping subscale. However, there were no race differences among other coping strategies, religiosity, or catastrophizing. Results of a 2 (Race: White vs. Black)×3 (Prayer: active vs. passive vs. no prayer) ANCOVA controlling for a general tendency to pray and catastrophizing in response to prayer indicated a main effect of prayer that approached significance (p=0.06). Pairwise comparisons indicated that those in the active prayer condition demonstrated greater pain tolerance than those in the passive (p=0.06) and no prayer (p=0.03) conditions. Those in the passive and no prayer distractor conditions did not significantly differ (p=0.70). There was also a trending main effect of race [p=0.08], with White participants demonstrating greater pain tolerance than Black participants. Conclusions Taken together, these results indicate that Black participants demonstrated a lower pain tolerance than White participants, and those in the active prayer condition demonstrated greater tolerance than those in the passive and no prayer conditions. Furthermore, Black participants in the passive prayer group demonstrated the lowest pain tolerance, while White participants in the active prayer group exhibited the greatest tolerance. Results of this study suggest that passive prayer, like other passive coping strategies, may be related to lower pain tolerance and thus poorer pain outcomes, perhaps especially for Black individuals. On the other hand, results suggest active prayer is associated with greater pain tolerance, especially for White individuals. Implications These results suggest that understanding the influence of prayer on pain may require differentiation between active versus passive prayer strategies. Like other active coping strategies for pain, active prayer may facilitate self-management of pain and thus enhance pain outcomes independent of race. Psychosocial interventions may help religiously-oriented individuals, regardless of race, cultivate a more active style of prayer to improve their quality of life

The Science and Art of Health Behavior: Theory of Prevention.

poster abstractAccording to Glanz, Rimer and Viswanath (2008), “The science and art of health behavior and health education are eclectic and rapidly evolving; they reflect an amalgamation of approaches, methods, and strategies from social and health sciences, drawing on theoretical perspectives, research, practice tools of such diverse disciplines as psychology, sociology, anthropology, communications, nursing, economics, and marketing” (p. 1). The view of health education as an instrument of social change has received renewed interest in the past few years. Most recently, experts have recommended that interventions on social and behavioral factors related to health should link multiple levels of influence, including the individual, interpersonal, institutional, community, and policy levels (Smedley and Syme, 2000). The author’s current work on a health education simulation titled; Suicide Intervention Prevention focuses on a health behavior theory of prevention. Prevention theory is used to guide the framework for this simulation. Examples of causal relationships (immersion and interaction) between the characters in the simulation and the participant (player) become more meaningful and provide a unique platform to promote health education on the topic of mental health. Prevention theory enhances our work as researchers and practitioners in many ways. Theory helps us build the science of prevention by directing our hypotheses and research questions and informs the selection of appropriate populations to study. “Ultimately, theories of prevention determine intervention approaches including individual treatments, models of health care delivery, public health practice, and health policy” (Shumaker, Ockene, & Riekert, 2009, p. 4)

Memento Mori: The development and validation of the Death Reflection Scale

Despite its potential for advancing organizational behavior (OB) research, the topic of death awareness has been vastly understudied. Moreover, research on death awareness has predominantly focused on the anxiety‐provoking aspect of death‐related cognitions, thus overlooking the positive aspect of death awareness, death reflection. This gap is exacerbated by the lack of a valid research instrument to measure death reflection. To address this issue, we offer a systematic conceptualization of death reflection, develop the Death Reflection Scale, and assess its psychometric properties across four studies. Further, using a sample of 268 firefighters, we examine whether death reflection buffers the detrimental impact of mortality cues at work on employee well‐being and safety performance. Results provide strong support for the psychometric properties of the Death Reflection Scale. Further, moderation analysis indicates death reflection weakens the negative effect of mortality cues on firefighters' safety performance. Overall, these findings suggest the newly developed Death Reflection Scale will prove useful in future research on death‐related cognitions

Dyadic influence of hope and optimism on patient marital satisfaction among couples with advanced breast cancer

PURPOSE: An estimated 10-40 % of breast cancer (BC) patients report negative changes to their partnered relationships. Literature suggests that for these patients, marital satisfaction is related to depression and other quality of life factors which are associated with survivorship and treatment response. However, existing literature does not provide a clear explanation of the factors that strengthen vs. create strain in couples facing cancer. Given the benefits of a satisfying relationship to patient quality of life, it is important to better understand factors that put patients at greater risk for marital difficulties. This study examined the differential and combined roles of hope and optimism among BC patients and their partners on patient marital satisfaction. METHOD: Fifty-six breast cancer patient-partner dyads completed study questionnaires as part of a larger study. Regression analyses were used to examine the main and interaction effects of patient and partner hope and optimism on patient marital satisfaction. RESULTS AND CONCLUSION: Higher patient and partner hope predicted greater patient marital satisfaction, whereas optimism did not. These results are divergent from the literature on optimism and well-being, which shows the importance of studying these two traits concurrently. Interaction effects suggest certain combinations of patient and partner hope and optimism are more beneficial than others for patient marital satisfaction and suggest a dyadic approach is important for investigation of well-being in breast cancer

The relationship between hope and patient activation in consumers with schizophrenia: Results from longitudinal analyses

Hope (goal-directed thinking) and patient activation (knowledge and skills to manage one’s illness) are both important in managing chronic conditions like schizophrenia. The relationship between hope and patient activation has not been clearly defined. However, hope may be viewed as a foundational, motivating factor that can lead to greater involvement in care and feelings of efficacy. The purpose of the present study was to understand the prospective relationship between hope and patient activation in a sample of adults with schizophrenia (N=118). This study was a secondary data analysis from a study on Illness Management and Recovery (IMR) – a curriculum-based approach to schizophrenia self-management. Data were collected at baseline (prior to any intervention), and at 9 and 18-month follow-up. As predicted, hope and patient activation were significantly related with each other, showing large positive concurrent correlations. Demographics and background characteristics were not significantly related to patient activation or hope. Longitudinal analyses found no specific directional effect, yet suggested that hope and patient activation mutually influence each other over time. Our findings add flexibility in designing recovery-based interventions – fostering hope may not be a pre-requisite for activating consumers to be more involved in their own care

Using a model of family adaptation to examine outcomes of caregivers of individuals with autism spectrum disorder transitioning into adulthood

Background The study examined the burden of caring for individuals with autism spectrum disorder (ASD) transitioning from high school and factors associated with burden derived from the Double ABCX model of family adaptation (i.e., autism symptom severity, problem behaviors, pile-up life demands, personality traits, social support, cognitive appraisals, and coping strategies). In particular, we were interested in the potential association between the “big 5” personality traits and burden. Method Participants (N = 105) were caregivers of individuals with ASD within two years pre- or post-graduation from high school. Results Primary caregivers reported moderate levels of burden. As hypothesized, burden was significantly associated with both child (i.e., increased autism symptom severity and problem behaviors) and caregiver characteristics (i.e., greater neuroticism, lower levels of extraversion, conscientiousness, agreeableness, and social support, and increased use of threat appraisals and passive-avoidance coping strategies). Using multiple regression, increased child behavior problems and increased caregiver use of passive-avoidance coping were identified as independent predictors of burden. Passive-avoidance coping mediated the relationship between caregiver burden and individual personality traits (i.e., neuroticism, extraversion, conscientiousness). Conclusions The results suggest that proximal variables, such as caregivers’ use of maladaptive coping strategies, explain the associations between burden and personality. Suggestions for interventions to relieve burden are discussed

Sleep Disturbances in Fibromyalgia Syndrome: Relationship to Pain and Depression

Objective This study is an examination of sleep, pain, depression, and physical functioning at baseline and 1-year followup among patients with fibromyalgia syndrome (FMS). Although it is clear that these symptoms are prevalent among FMS patients and that they are related, the direction of the relationship is unclear. We sought to identify and report sleep problems in this population and to examine their relationship to pain, depression, and physical functioning. Methods Patients diagnosed with fibromyalgia were recruited from a Southern California health maintenance organization and evaluated according to American College of Rheumatology criteria in the research laboratory. Six hundred patients completed the baseline assessment and 492 completed the 1-year assessment. Measures included the Center for Epidemiologic Studies Depression Scale, the McGill Pain Questionnaire, the Pittsburgh Sleep Quality Index, and the Fibromyalgia Impact Questionnaire. Results The majority of the sample (96% at baseline and 94.7% at 1 year) scored within the range of problem sleepers. Path analyses examined the impact of baseline values on 1-year values for each of the 4 variables. No variable of interest predicted sleep, sleep predicted pain (β = 0.13), pain predicted physical functioning (β = −0.13), and physical functioning predicted depression (β = −0.10). Conclusion These findings highlight the high prevalence of sleep problems in this population and suggest that they play a critical role in exacerbating FMS symptoms. Furthermore, they support limited existing findings that sleep predicts subsequent pain in this population, but also extend the literature, suggesting that sleep may be related to depression through pain and physical functioning