Group support for patients with metastatic cancer. A randomized outcome study.
01 May 1981-Archives of General Psychiatry (American Medical Association)-Vol. 38, Iss: 5, pp 527-533
TL;DR: Objective evidence is provided that a supportive group intervention for patients with metastatic cancer results in psychological benefit and mechanisms underlying the effectiveness of this group intervention are explored.
Abstract: • The effects of weekly supportive group meetings for women with metastatic carcinoma of the breast were systematically evaluated in a one-year, randomized, prospective outcome study. The groups focused on the problems of terminal illness, including improving relationships with family, friends, and physicians and living as fully as possible in the face of death. We hypothesized that this intervention would lead to improved mood, coping strategies, and self-esteem among those in the treatment group. Eighty-six patients were tested at four-month intervals. The treatment group had significantly lower mooddisturbance scores on the Profile of Mood States scale, had fewer maladaptive coping responses, and were less phobic than the control group. This study provides objective evidence that a supportive group intervention for patients with metastatic cancer results in psychological benefit. Mechanisms underlying the effectiveness of this group intervention are explored.
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TL;DR: In this article, the authors examined the relationship between coping and depressive symptoms in obstructive sleep apnea (OSA) patients and found that more passive and less active coping was associated with more depressive symptoms.
Abstract: STUDY OBJECTIVES Some, but not all, researchers report that obstructive sleep apnea (OSA) patients experience increased depressive symptoms. Many psychological symptoms of OSA are explained in part by other OSA comorbidities (age, hypertension, body mass). People who use more passive and less active coping report more depressive symptoms. We examined relationships between coping and depressive symptoms in OSA. SETTING N/A. DESIGN/PARTICIPANTS 64 OSA (respiratory disturbance index (RDI) > or = 15) patients were studied with polysomnography and completed Ways of Coping (WC), Profile of Mood States (POMS), Center for Epidemiological Studies-Depression (CESD) scales. WC was consolidated into Approach (active) and Avoidance (passive) factors. Data were analyzed using SPSS 9.0 regression with CESD as the dependent variable and WC Approach and Avoidance as the independent variables. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS WC Approach factor (B=-1.105, beta=-.317, p=.009) was negatively correlated and WC Avoidance factor (B=1.353, beta=.376, p=.007) was positively correlated with CESD scores. These factors explained an additional 8% of CESD variance (p<.001) beyond that explained by the covariates: demographic variables, RDI, and fatigue (as measured by the POMS). CONCLUSIONS More passive and less active coping was associated with more depressive symptoms in OSA patients. The extent of depression experienced by OSA patients may not be due solely to effects of OSA itself. Choice of coping strategies may help determine who will experience more depressive symptoms.
40 citations
01 Jan 2001
TL;DR: A structured, psychiatric intervention consisting of health education, stress management/behavioral training, coping including problem-solving techniques, and psychosocial group support offers the greatest potential for patients newly diagnosed or in the early stages of treatment.
Abstract: Summary Research has documented the need for and the efficacy of psychosocial interventions for patients with cancer. Based on a review of the literature and the authors' clinical and research experience, cancer patients may benefit from a variety of psychological intervention programs. A structured, psychiatric intervention consisting of health education, stress management/behavioral training, coping including problem-solving techniques, and psychosocial group support offers the greatest potential for patients newly diagnosed or in the early stages of treatment. Key words: cancer, psychological interventions. Introduction The American Cancer Society reports that there are over eight million cancer survivors in the U.S. and that more than four million have survived for five years or longer (ACS, 1997). Today there is an encouraging trend away from focusing only on terminal care and bereavement towards helping people live as fully as possible with their cancer. A significant amount of research has been done that helps us to understand the psychological distress that patients with cancer and their families experience (Weisman, 1979; Cohen et al., 1982). Numerous articles have also been published regarding differing interventions aimed at helping individuals deal with the diagnosis and treatment of cancer (Fawzy et al., 1995). Evidence is accumulating that some of these interventions may contribute to both psychological (reduction of distress and enhancement of coping and adjustment) and physical health outcomes (reduced side effects, lower rates of recurrence and improved survival) (Spiegel et al., 1989; Ornish et al., 1992; Greer, 1991; Fawzy et al., 1993). An overview of this literature will be presented. A short-term structured, psychoeducational intervention program consisting of health education, stress management, coping skills training, and psychological support will then be offered as an effective model of care for newly diagnosed patients with cancer. We will attempt to elucidate possible mechanisms underlying the positive outcomes of such interventions. Finally, the continuing gaps in our knowledge base requiring future research will be discussed. Psychosocial Issues The most frequently studied group in regard to psychosocial issues has been women with breast cancer. Breast cancer patients have been found to manifest greater anxiety and depression than general surgery patients (Maguire, 1976) or women with benign breast tumors (Maguire et al., 1978; Morris et al., 1977). Worden and Weisman (1977) reported that among 40 newly diagnosed breast cancer patients, 20% were notably depressed based upon psychological tests and clinical interviews. In addition to increased anxiety and depression, other life changes have been described in this patient population. For instance, Maguire (1978) found mastectomy patients experienced more sexual problems than did a control group of benign breast tumor patients at four and twelve months post-operatively. Meyerowitz (1980), after comprehensively reviewing the literature on psychological correlates of breast cancer, summarizes the typical responses of this patient group as: a) "Some degree of depression, anxiety and/or anger; b) disruption in everyday life patterns, including marital and/or sexual relationships, and c) considerable fear regarding the danger and mutilation of cancer and mastectomy" (p. 114). Other cancer patient groups have been studied from a psychosocial viewpoint although not nearly as extensively. Gordon et al. (1980) followed 308 breast, lung and melanoma patients through the first six months of their disease. The most often noted problems at the time of initial hospitalization were in the area of worry about the disease itself. Negative affect became the predominant concern in the period following discharge. A broader array of problems such as physical discomfort, concern about medical treatment, dissatisfaction with health care service, lack of mobility, financial concerns, family and social problems, worry about the disease, negative affect and body image difficulties was noted at three and six months post discharge. …
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TL;DR: In a pilot study, participation in the Pathfinders program was associated with reductions in distress and despair and improvements in quality of life (QOL) among advanced breast cancer patients.
Abstract: Objective: In a pilot study, participation in the Pathfinders program was associated with reductions in distress and despair and improvements in quality of life (QOL) among advanced breast cancer patients. This study explores the relationship between psychosocial resources invoked through the Pathfinders intervention and outcomes.
Methods: Advanced breast cancer patients were enrolled in a prospective, single-arm, pilot study of the Pathfinders psychosocial program. Participants met at least monthly with a licensed clinical social worker who administered the Pathfinders intervention, which focused on strengthening adaptive coping skills, identifying inner strengths, and developing a self-care plan. Longitudinal assessments over 6 months used validated instruments to assess changes in Pathfinders targets (coping, social support, self-efficacy, spirituality, and optimism) and outcomes (distress, despair, QOL, and fatigue). Multiple linear regression models examined the joint effect of average changes in target subscales on average outcome changes, adjusted for baseline outcome scores and patient characteristics.
Results: Participants (n=44) were: mean age 51 (SD, 12), 20% non-Caucasian, 50% college degree, and 75% married. Improvements in active coping skills, self-efficacy, and spiritual meaning/peace significantly correlated with an improvement in despair after adjustment for demographic characteristics (all P<0.05). Improvements in social support significantly correlated with positive changes in distress (P<0.05). Gains in learned optimism independently correlated with an increase in overall QOL (P<0.01).
Conclusions: In this pilot assessment, changes in pre-defined Pathfinders targets such as coping skills, social support, self-efficacy, spirituality, and optimism correlated with improvements in patient-reported outcomes. Copyright © 2010 John Wiley & Sons, Ltd.
40 citations
TL;DR: The results suggest that this group intervention achieved its main goal in treating sexual dysfunction as well as mood disturbance, but these improvements dissipated over time and may require further intervention in order to be maintained.
Abstract: This study examined changes in sexual functioning and mood disturbance among women who have been treated for gynecological cancer and who participated in a 12-week group intervention for psychosexual problems. The Changes in Sexual Functioning Questionnaire (CSFQ) assessed the sexual functioning, and the Profile of Mood States (POMS) assessed the mood disturbance of 19 women at baseline who completed follow-ups conducted posttreatment and three-month posttreatment. The results showed that the women improved significantly in their CSFQ total scores after being provided with the group therapy intervention at the posttreatment assessment (p < .01), and a statistical trend (p < .10) suggested continued improvement in CSFQ total scores at the three months posttreatment follow-up. Women's POMS total mood disturbance scores improved significantly at the posttreatment assessment (p = .01), but did not show significant improvement at the 3-month posttreatment follow-up. These results suggest that this group intervention achieved its main goal in treating sexual dysfunction as well as mood disturbance, but these improvements dissipated over time and may require further intervention in order to be maintained.
40 citations
Cites background from "Group support for patients with met..."
...Spiegel, Bloom, and Yalom (1981) found that patients with metastatic breast cancer who participated in their treatment group and who attended supportive expressive group therapy meetings had lower mood disturbance scores on the POMS....
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TL;DR: An interactive model of psychosocial support needs demonstrates that the provision of effective support is, necessarily, an integrated, not a piecemeal, process.
Abstract: Psychosocial support is acknowledged as an important aspect of the care and recovery process for women diagnosed with breast cancer. To develop an understanding of support needs, a series of focus groups were conducted with a total of 80 Australian women living with breast cancer. The psychosocial needs identified in discussion were summarised into four main categories, Organisation of Care, Sense of Control, Validation of Experience and Feeling of Reassurance. From these themes an interactive model of psychosocial support needs was developed. As a process model it demonstrates that the provision of effective support is, necessarily, an integrated, not a piecemeal, process. The categories of support are broad, and are made more inclusive through interactions with each other, providing room to accommodate individual needs and styles of adjustment. The model is not esoteric or complicated – it is an accessible overview of the process for both client and helper. Copyright © 2003 John Wiley & Sons, Ltd.
39 citations
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TL;DR: In this paper, the effects of reward or reinforcement on preceding behavior depend in part on whether the person perceives the reward as contingent on his own behavior or independent of it, and individuals may also differ in generalized expectancies for internal versus external control of reinforcement.
Abstract: The effects of reward or reinforcement on preceding behavior depend in part on whether the person perceives the reward as contingent on his own behavior or independent of it. Acquisition and performance differ in situations perceived as determined by skill versus chance. Persons may also differ in generalized expectancies for internal versus external control of reinforcement. This report summarizes several experiments which define group differences in behavior when Ss perceive reinforcement as contingent on their behavior versus chance or experimenter control. The report also describes the development of tests of individual differences in a generalized belief in internal-external control and provides reliability, discriminant validity and normative data for 1 test, along with a description of the results of several studies of construct validity.
21,451 citations
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01 Jan 1969
TL;DR: In this article, the implications of terminal illness for patients and for those involved in their care were discussed, and patients invited to talk about their experience found great relief in expressing their fear and anger and were able to move towards a state of acceptance and peace.
Abstract: Although most areas of human experience are nowadays discussed freely and openly, the subject of death is still surrounded by conventional attitudes and reticence that offer only fragile comfort because they evade the real issues. The dying may thus be denied the opportunity of sharing their feelings and discussing their needs with family, friends, or hospital staff. Although receiving devoted medical care, a dying patient is often socially isolated and avoided, since professional staff and students can find contact painful and embarrasing.
Aware of the strains imposed on all sides by this situation, Dr Kubler-Ross established a seminar at the University of Chicago to consider the implications of terminal illness for patients and for those involved in their care. Patients invited to talk about their experience often found great relief in expressing their fear and anger and were able to move towards a state of acceptance and peace. The seminar, initially composed of students of medicine, sociology, psychology, and theology, but later joined by hospital staff and relatives of patients, enabled many members to come to terms with their own feelings and to respond constructi to what the patients had to teach them.
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TL;DR: A study of 800 outpatient visits to Children's Hospital of Los Angeles as discussed by the authors explored the effect of verbal interaction between doctor and patient on patient satisfaction and follow-through on follow-up.
Abstract: Study of 800 outpatient visits to Childrens Hospital of Los Angeles to explore the effect of the verbal interaction between doctor and patient on patient satisfaction and follow-through on...
947 citations