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: Some of the factors other than phase of illness that might influence group treatment effects (e.g., intervention parameters, participant characteristics) are examined, and mechanisms of action are explored.
Abstract: Growing evidence supports the value of group interventions for individuals who are at risk for or have developed cancer or HIV disease. However, information is more limited concerning how these services can be delivered in an optimal manner, and what processes contribute to their benefits. Parts I and II of this review examined the efficacy of different interventions for individuals at different phases of illness, ranging from primary prevention to late-stage disease, in both psychosocial and biological domains. The current paper examines some of the factors other than phase of illness that might influence group treatment effects (e.g., intervention parameters, participant characteristics), and explores mechanisms of action.
29 citations
Cites background or methods from "Group support for patients with met..."
...Structured interventions led to positive changes (Edelman et al., 1999a, 1990; Helgeson et al., 1999) while less structured groups did not (Helgeson et al., 1999; Spiegel et al., 1981)....
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...…included increased active-behavioral coping, active-cognitive coping (Fawzy et al., 1990), positive reappraisal (Esplen et al., 2000), and seeking social support (Richardson et al., 1997), in conjunction with diminished reliance on poor health habits to manage stress (Spiegel et al., 1981)....
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...More broadly, self-esteem was assessed in four studies (Edelman, Bell, & Kidman, 1999a; Edelman et al., 1999b; Helgeson, Cohen, Schulz, & Yasko, 1999; Spiegel et al., 1981)....
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...LOC was assessed in six studies, which varied in focus on generic versus illness-related perceptions of control (Baider et al., 1994; De Vries et al., 1997; Evans & Connis, 1995; Gruber et al., 1993; Ilnyckj, Farber, Cheang, & Weinerman, 1994; Spiegel et al., 1981)....
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...The instrument seems better understood as a measure of psychological adjustment to illness, as posited by the authors. et al., 1997; Roberts, Piper, Denny, & Cuddleback, 1997; Spiegel et al., 1981, Wenzel, Robinson, & Blake, 1995)....
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TL;DR: A review of the literature revealed 20 studies that examined the extent to which cognitive behavioral therapy (CBT), supportive-expressive group therapy (SEGT), and a combination of these two treatments impact women with breast cancer as discussed by the authors.
Abstract: A review of the literature revealed 20 studies that examined the extent to which cognitive behavioral therapy (CBT), supportive-expressive group therapy (SEGT), and a combination of these two treatments impact women with breast cancer. Based on this review, it is determined that CBT and SEGT have repeated experimental support for positively altering certain affective disturbances for this population. However, all three treatments were found to improve the lives of women with breast cancer. The combination of CBT and SEGT treatment approach did not have repeated positive results, as did the CBT and SEGT studies. The specific outcomes of these therapies are discussed along with the implications for researchers, therapists, and women with breast cancer.
29 citations
Cites background or methods from "Group support for patients with met..."
...…EFFECTIVENESS OF GROUP THERAPY FOR WOMEN 275 disturbance (Classen et al., 2001; Goodwin, et al., 2001; Spiegel & Bloom, 1983), reduced depression (Goodwin, et al.; Spiegel & Bloom; Spiegel, Bloom, & Yalom, 1981), and less tension (Goodwin et al., 2001; Spiegel & Bloom, 1983; Spiegel et al., 1981)....
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...Outcomes included less confusion (Goodwin et al., 2001; Spiegel et al., 1981), and decreased pain (Goodwin et al....
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...Outcomes included less confusion (Goodwin et al., 2001; Spiegel et al., 1981), and decreased pain (Goodwin et al., 2001; Spiegel & Bloom, 1983)....
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...Still, there is some evidence that group therapy positively affects the lives of women with breast cancer in many ways, such as reducing fatigue (Spiegel et al., 1981) and enhancing self-esteem (Edelman et al., 1999b), adjustment (Fobair et al., 2002), and perceived family support (Kissane et al.,…...
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...For example, SEGT has been found to reduce phobias, improve vigor, coping, reduce fatigue (Spiegel et al., 1981), improve survival (Spiegel, Bloom, Kraemer, & Gottheil, 1989), suppression of affect, restraint of aggressive actions (Giese-Davis et al., 2002), and physiological immune functioning…...
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TL;DR: Several requirements of psychotherapeutic intervention (PI) research are presented and the inconsistency between Spiegel's control survival curve and that produced from local population normative data is discussed.
Abstract: Several requirements of psychotherapeutic intervention (PI) research are presented. Some major problems are discussed. First, confidence in experimental results may be diminished by interference of possible confounders. A large number of these exist, both physical, perhaps more easily measurable, and psychological or psychosocial. Second, the value and limitations of randomization are presented, with special reference to small N. Validity and reliability are addressed, with emphasis on things that may dilute the strength of both of these measures. Natural remedies are proposed. Internal consistency and reliability are compared and cautions are given regarding their use and possible invalid substitution of consistency for reliability. Comparison of different PIs is commented on, with some relevant examples. Finally, a matter of special interest is discussed: the inconsistency between Spiegel's control survival curve and that produced from local population normative data.
29 citations
TL;DR: Rationale and organization of group therapy is described along with the preliminary pilot study results, which represents a novel approach to the psychological treatment of cancer patients.
Abstract: Cognitive behavioural therapy has been shown to be effective in reducing anxiety and depression in cancer patients when provided within the context of individual sessions. We describe the application of a cognitive behavioural model to a group therapy context. This represents a novel approach to the psychological treatment of cancer patients. Fourteen breast cancer patients attending the Royal Marsden Hospital were included in an assessment of treatment outcome pre-and post-group therapy. Outcome was assessed using the Hospital Anxiety and Depression (HAD) Scale and a study-specific visual analog measure relating to perceived efficacy of the therapeutic techniques. Rationale and organization of group therapy is described along with the preliminary pilot study results.
29 citations
TL;DR: Brain tumor support group facilitators can expect to encounter a range of medical and psychosocial issues in accommodating patients' and caregivers' diverse concerns.
Abstract: Brain tumors are associated with neurological sequelae and poor survival, contributing to distress in patients and their families. Our institution has conducted separate support groups for brain tumor patients and caregivers since 1999. This retrospective cohort study aimed to identify characteristics of brain tumor group participants in relation to attendance frequency, and compare themes of discussion in patient and caregiver groups. Demographic and medical characteristics were obtained from patient and caregiver group registration sheets and medical chart review. We quantified discussion topics recorded by group facilitators between 1999 and 2006, extracted themes, and examined similarities and differences in the way these themes were expressed. A total of 137 patients and 238 caregivers attended the groups; about half attended more than one session. The chart review of a randomly selected subset of patient participants revealed that 57.5 % were married, 58.8 % had high-grade gliomas, and 55 % attended their first group within 3 months of diagnosis or at tumor progression. Both groups discussed physical and cognitive consequences, emotional reactions, relationships, coping, end of life, and practical issues. Caregivers discussed difficulties achieving self-care and caregiver burden. Brain tumor support group facilitators can expect to encounter a range of medical and psychosocial issues in accommodating patients' and caregivers' diverse concerns. Separate brain tumor patient and caregiver groups may allow participants to explore those concerns without worrying about effects on their friends or family. It remains to be seen whether the groups meet the needs of attendees, and whether those who do not attend the groups have unmet needs.
29 citations
References
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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.
5,220 citations
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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