A meta-analytic investigation of the relationship between the psychological distress of cancer patients and their carers

Effects of psychological distress on quality of life of adult daughters and their mothers with cancer

INTRODUCTION

As the population continues to age, adult daughters are more likely to be involved in caregiving. Given the fact that sharing emotional experiences is common in female relationships, (dis)similarity between mothers with cancer and their adult caregiving daughters is expected. However, the extent to which the (dis)similarity in psychological distress influences the quality of life of each person remains unknown.

METHOD

This study aims at addressing this concern, using a total of 98 mother-daughter dyads participating in the American Cancer Society's Study of Cancer Survivors-I and Quality of Life Survey for Caregivers.

RESULTS

Using the Actor Partner Interdependence Model, the results showed that although each person's psychological distress is the strongest predictor of their own quality of life, a mother's distress also plays a significant role in the daughter's quality of life. Specifically, when mothers experienced greater levels of psychological distress, the daughters reported better mental health but poorer physical health.

CONCLUSIONS

Our findings on the disproportionately strong association between psychological distress of mothers with cancer and their adult caregiving daughters' quality of life suggest that caregiving daughters may benefit from programs designed to assist them to cope better with their mothers' psychological distress when both are living with cancer.

Depression in family caregivers of cancer patients: the feeling of burden as a predictor of depression

PURPOSE

The purpose of this study was to explore the prevalence of and to identify the predictors of depression in family caregivers of cancer patients.

PATIENTS AND METHODS

We enrolled 310 caregivers of cancer patients from the National Cancer Center, Korea, on this study and obtained demographic information for both patients and caregivers. To assess caregiver depression and its predictors, we used the Beck Depression Inventory (BDI), the Caregiver Quality of Life Index-Cancer, and the Family Impact Questionnaire. We used logistic regression analysis to identify independent predictors of caregiver depression.

RESULTS

The majority (67%) of caregivers had high depression scores (BDI > 13), and 35% had very high depression scores (BDI > 21). In a multiple logistic regression model, caregivers who were women, the spouse of the patient, in poor health, feeling burdened, adapting poorly, unable to function normally, or caring for a patient with poor Eastern Cooperative Oncology Group performance status were more likely to experience depression (P < .01 for all values).

CONCLUSION

Depression was highly prevalent among cancer patient family caregivers, and care burden was its best predictor. Interventions aimed at reducing the psychiatric effects of cancer should focus not only on the patient but also on the caregiver.

Quality of life, anxiety and depression in Turkish breast cancer patients and in their husbands

The aim of the present study is to investigate anxiety and depression levels and quality of life of Turkish breast cancer patients and their husbands with Beck depression, STAI scoring system, and EORTC-QLQ-C30 quality of life scale. Fifty-five patients with breast cancer undergoing chemotherapy who applied to Dokuz Eylul University Faculty of Medicine, Department of Oncology, and their husbands were included in this study. The series of forms including the questions regarding the demographic characteristics of the patient, Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI), and EORTC-QLQ-C30 (version 3) were completed during face-to-face interviews by trained interviewers for determination of the psychological status and quality of life of the patients. The mean Beck depression scores of patients and their husbands were 13 +/- 9.3 (range 2-46) and 7.9 +/- 5.7 (range 0-27) (P = 0.001). The mean STAI scores of patients and their husbands were 44.9 +/- 8.7 (range 20-58) and 41.7 +/- 8.0 (range 26-59) (P = 0.09).Twenty-nine percent of the patients and 5.4% of the husbands (Beck Depression scores > or = 17 points) were determined as depressive. It was determined that the EORTC-QLQ C30 physical and social function scales of the patients were significantly lower than their husbands. The difference of global quality of life scores and other function scales (role, cognitive, emotional function scales) between patients and their husbands were not significant. It was found that depression of breast cancer patients were significantly higher than their husbands. But there was no significant difference between the EORTC-QLQ C30 global quality of life scores and STAI scores of the breast cancer patients and their husbands.

Development in quality of relationship between the significant other and the lung cancer patient as perceived by the significant other

AIM

To prospectively explore the quality of the relationship between significant others and patients during lung cancer, based on the perceptions of the significant others.

METHOD

In a sample of 91 significant others, longitudinal data were collected during the first year after diagnosis, and explored on group level and as individual patterns over time.

RESULTS

Relational quality was skewed towards high quality, although 30% of the significant others reported low levels close to diagnosis. Forty-eight percent reported stability in the quality of their relationship during the disease trajectory. Within this group, 36% reported low levels of relational quality. Fifty-two percent reported change in quality of relationship and four typical patterns of change were identified. Two showed approximate linear changes in either a positive direction (15%) or a negative direction (49%), and two showed non-linear changes with a temporary ascending curve (11%) or a descending curve (26%). This implies that a change towards low levels of relational quality was most common.

CONCLUSION

The present results show that illness may be a trigger for change in relational quality, which may have implications for future family-centred practice and research, since previously high relational quality has been linked to improved emotional well-being.

Psychiatric disorders and background characteristics of cancer patients' family members referred to psychiatric consultation service at National Cancer Center Hospitals in Japan

Objective:

Psychological distress of cancer patients' family members is treated by psychiatric consultation service for outpatients at National Cancer Center Hospitals in Japan. The purpose of this study was to identify psychiatric disorders and explore background characteristics of cancer patients' family members referred to psychiatric consultation service, so that we could better understand current utilization of this psychiatric consultation service for cancer patients' family members.

Methods:

A retrospective descriptive study using clinical practice data obtained for 5 years (from January 2000 to December 2004) was conducted at two National Cancer Center Hospitals. We reviewed the psychiatric consultation database, computerized patient database of the National Cancer Center Hospitals, and medical charts of cancer patients' family members who were referred to psychiatry and their cancer patients.

Results:

Out of a total of 4992 psychiatric consultations, 118 (2%) were for cancer patients' family members. The most common psychiatric disorders among cancer patients' family members were adjustment disorders (n = 69, 58%), followed by major depression (n = 30, 25%). Female (n = 101, 86%), spouse (n = 87, 74%), married (n = 92, 78%), and housewife (n = 63, 53%) were the most common background characteristics of the family members. Sixty-four percent of cancer patients (n = 75) were hospitalized at the time of their family members' referral and 34% of cancer patients (n = 40) had already received psychiatric consultation service and 55% of cancer patients (n = 65) had delivered bad news prior to their family members' referral.

Significance of the research:

We found that very few family members were provided with psychiatric consultation service at two National Cancer Center Hospitals. Adjustment disorders are suggested to be the most common psychiatric disorders among cancer patients' family members.

Quality of life of couples dealing with cancer: dyadic and individual adjustment among breast and prostate cancer survivors and their spousal caregivers

BACKGROUND AND PURPOSE

Although evidence suggests that survivors and spousal caregivers tend to experience somewhat similar levels of distress and that the survivor's distress affects his/her own quality of life, the degree to which each person's distress has an independent effect on their partner's quality of life is unknown. Thus, this study aimed to examine the dyadic effects of psychological distress on the quality of life of couples dealing with cancer.

METHODS

A total of 168 married survivor-caregiver dyads participating in the American Cancer Society's Study of Cancer Survivors-I and Quality of Life Survey for Caregivers provided complete data for study variables. Participating survivors were diagnosed with either breast or prostate cancer approximately 2 years prior to participating in the study.

RESULTS

Using the Actor Partner Interdependence Model, results revealed that although each person's psychological distress is the strongest predictor of their own quality of life, partner's distress and (dis)similarity in distress of the couple also play significant roles in one's quality of life. In addition, the adverse effect of having a partner who is less emotionally resourceful was especially pronounced on men's physical health.

CONCLUSIONS

Our systematic investigation provided valuable evidence for identifying the subgroup of cancer survivors and their spouses who are vulnerable to poor quality of life due to their mutual psychological distress. These findings suggest that couples may benefit from interventions that enhance their ability to manage psychological distress, particularly the wife's, which may improve the mental and physical health of both partners when they are dealing with cancer.

Understanding the impact of family caregiver cancer literacy on patient health outcomes

OBJECTIVE

Family caregivers play a significant role in the diagnosis, treatment, and recovery of individuals with cancer. This position paper reviews and links the research on family caregiving and health information with the importance of cancer literacy.

METHOD

Review of literature obtained through searching in Academic Search Premier, EBSCO, Communication and Mass Media Complete, PsychArticles, PsycInfo, and Health Source: Nursing/Academic Edition library databases.

RESULTS

Family members are important sources of health information, informal caregivers who learn and enact medical procedures, and influential aspects of patients' healthcare and treatment decision-making, but are not seriously considered by healthcare practitioners or researchers in terms of assessing and improving health literacy. Further, very few studies have directly examined or acknowledged the potential importance of family caregiver health literacy.

CONCLUSION

The extent to which family caregivers can comprehend the health information they receive along with the patient is crucial for the patient to achieve the most successful health outcome.

PRACTICE IMPLICATIONS

To acknowledge the impact that family caregiver health literacy could have on patient health outcomes, targeted practical recommendations for understanding family caregiver health literacy in the cancer context are proposed: (1) family member health literacy should be assessed; (2) close relational partners should be trained as peer health educators; (3) written cancer information should be provided directly to family caregivers; (4) health interactions between family caregivers and patients should be improved; (5) theoretical perspectives into the understanding of family caregiver health literacy should be integrated into practice; and (6) patient and family caregiver health literacy should be improved.

Family caregivers' strains: comparative analysis of cancer caregiving with dementia, diabetes, and frail elderly caregiving

OBJECTIVE

This study aimed to investigate the impact of cancer from family caregivers' perspective, based on a comparative analysis of caregiving burden and distress, among four types of caregivers.

METHODS

The sample included caregivers of persons with cancer, dementia, diabetes, or frail elderly from a nationally representative sample of 606 caregivers.

RESULTS

Although the four different types of caregivers were comparable in most sociodemographic characteristics, caregiving involvement and caregiving outcomes differed among the caregiving groups. Both cancer and dementia caregivers reported greater levels of physical burden and psychological distress than other caregivers, after controlling for sociodemographic and caregiving involvement (i.e., level of burden and caregiving duration) factors.

DISCUSSION

The comparative analysis provided a systematic review of cancer caregiving in the context of three other types of caregiving. Given the high levels of burden and distress, greater emphasis should be placed on developing social service policy and practice for cancer caregivers.

Quality of life of parents with children living at home: when one parent has cancer

GOALS OF WORK

This study examined the quality of life (QoL) of cancer patients diagnosed 1-5 years previously and their spouses, with children 4-18 years living at home. Relationships between parents' QoL and the children's functioning were explored.

PATIENTS AND METHODS

166 cancer patients and their spouses provided information on their QoL (RAND-36) and on their children's functioning (Child Behavior Checklist).

MAIN RESULTS

Male and female patients scored similarly to a norm population on five domains. Patients' QoL was clinically relevantly and/or statistically lower on social functioning, role limitations because of physical problems, and vitality than the norm. Male spouses' QoL was comparable to the norm. However, female spouses reported better physical functioning but more social problems. QoL varied according to type of cancer, treatment intensity, and recurrence. Using the QoL composite scores, a significant relationship was found between patients' psychosocial and physical functioning and spouses' psychosocial functioning. Patients' psychosocial functioning correlated moderately strongly to weakly with their reports of their younger children's and adolescents' functioning; physical functioning correlated only weakly with adolescents' functioning. The patients' functioning related weakly to moderately strongly to adolescents' self-reports of functioning. Spouses' psychosocial functioning weakly related to their and adolescents' reports of adolescents' functioning.

CONCLUSIONS

Cancer patients' QoL 1-5 years after diagnosis was decreased in three of eight domains; their spouses seem to be doing well. Parents' physical and psychosocial functioning related weakly to moderately strongly to their children's functioning, depending on the child's age and information source. The patients' functioning related more strongly to the children's functioning than the spouses' did.

Factors that influence cancer patients' and relatives' anxiety following a three-person medical consultation: impact of a communication skills training program for physicians

BACKGROUND

No study has yet assessed the impact of physicians' skills acquisition after a communication skills training program on changes in patients' and relatives' anxiety following a three-person medical consultation. This study aimed at comparing, in a randomized study, the impact, on patients' and relatives' anxiety, of a basic communication skills training program and the same program consolidated by consolidation workshops and at investigating physicians' communication variables associated with patients' and relatives' anxiety.

METHODS

Consultations with a cancer patient and a relative were recorded and analyzed by the Cancer Research Campaign Workshop Evaluation Manual. Patients' and relatives' anxiety were assessed with the State-Trait Anxiety Inventory-State.

RESULTS

No statistically significant change over time and between groups was observed. Mixed-effects modeling of changes in patients' and relatives' anxiety showed that decreases in both patients' and relatives' anxiety were linked with patients' and relatives' self-reported distress (p = 0.031 and 0.005), and that increases in both patients' and relatives' anxiety were linked with physicians' breaking bad news (p = 0.028 and 0.005).

CONCLUSION

No impact of the training program was observed. Results indicate the need to further study communication skills which may help reduce patients' and relatives' anxiety especially when breaking bad news.

Factors influencing physicians' detection of cancer patients' and relatives' distress: can a communication skills training program improve physicians' detection?

PURPOSE

This study aimed to assess the impact on physicians' detection of patients' and relatives' distress of six 3-h consolidation workshops (CW) following a 2.5-day communication skills basic training (BT) program and to investigate factors associated with detection of distress.

METHODS

Physicians, after BT, were randomized to CW or to a waiting list. Physicians' detection of patients' and relatives' distress was measured through differences between physicians' ratings of patients' and relatives' distress (VAS) and patients' and relatives' self-reported distress (HADS). Communication skills were analysed according to the CRCWEM.

RESULTS

Mixed-effects modelling of physicians' detection of patients' distress showed a positive group by time effect in favour of physicians in the CW group. Detection of patients' distress was associated negatively with patients' distress, positively with physicians' concurrent use of psychological assessment and supportive skills, and negatively with general assessment skills. Mixed-effects modelling of physicians' detection of relatives' distress showed no significant group by time effect. Detection of relatives' distress was associated negatively with relatives' distress and with general assessment skills.

CONCLUSION

CW following a 2.5-day BT are needed to improve physicians' detection of patients' distress in three-person interviews. Results indicate the need to further improve physicians' detection of relatives' distress.

Improving well-being in caregivers of terminally ill patients. Making the case for patient suffering as a focus for intervention research

Family caregivers are integral to the care of patients with physical or mental impairments. Unfortunately, providing this care is often detrimental to the caregivers' health. As a result, in the last decade, there has been a proliferation of interventions designed to improve caregivers' well-being. Interventions for caregivers of persons at end of life, however, are relatively few in number and are often underdeveloped. They also are typically designed to help reduce the work of caregiving or to help caregivers cope with the physical and emotional demands of providing care. Although useful, these interventions generally ignore a primary stressor for family caregivers -- a loved one's suffering. Patient suffering, whether physical, psychosocial, or spiritual, has a major impact on family caregivers. However, interventions that focus on the relief of patient suffering as a way to improve caregiver well-being have rarely been tested. It is our view that more research in this area could lead to new and more effective interventions for family caregivers of seriously or terminally ill patients. In support of our view, we will define suffering and review the relationships between patient suffering and caregiver well-being. We will then discuss a conceptual framework for intervention design. Finally, we conclude with a discussion of implications and future directions for intervention research.

Risk Factors of Distress in Alzheimer’s Patients

Introduction: Distress of Alzheimer’s disease (AD) contribute significantly to decreased quality of life, increased morbidity, higher levels of caregiver distress, and the decision to institutionalise a patient. However, the risk factors of distress in AD patients have not been thoroughly discussed. The aim of this study was to identify the risk factors of distress in AD patients. Materials and Methods: A large randomised controlled clinical trial on AD was analysed in this study. Both linear regression and decision tree models were used to identify the factors of distress in AD patients. Results: The following variables were recognised as risk factors for AD patient’s distress: Care recipients often visit physicians or have medical examinations; Care recipients take medicines that affect the central nervous system or stomach; Care recipients seldom visit nurses; Caregivers have chronic disease or cancer; Caregiver experience distress, feel lonely, or have an unsatisfactory relationship with patients. In addition, caregiver’s smoking and drinking were found to correlate negatively with AD patient’s distress. Conclusions: Multiple factors influence the distress of Alzheimer’s patients, including patient’s examination and medication, patient-caregiver relationships, caregiver’s psychological and physical status, and the use of nursing services. These factors should be targeted when designing prevention and intervention strategies. Key words: Alzheimer’s disease, Distress, Factors

The correlation between coping strategies, doctor-patient/spouse relationships and psychological distress among women cancer patients and their spouses

OBJECTIVES

The objectives of the study were (1) to assess similarities and differences between women cancer patients and their spouses in terms of coping strategies, psychological distress and doctor-patient/spouse relationships; and (2) to investigate the impact of formal social support, namely the doctor-patient relationship and coping strategies, on patients' and spouses' psychological distress.

METHOD

Fifty-seven women with cancer, and their spouses, completed questionnaires that measured distress (BSI), coping strategies (PF, EF) and doctor-patient relationships (Pat, Md).

RESULTS

Patient distress was greater than that of spouses. Patients used more strategies involving problem-focused coping than spouses. A positive relationship was found between patients and spouses in terms of psychological distress, paternalism and emotion-focused strategies. Emotion-focused strategies were found to impact patient psychological distress, as indicated in a hierarchical regression model.

CONCLUSION

The paternalism relationship model is an important factor in patient psychological distress but not in spousal psychological distress.

Patient Suffering and Caregiver Compassion: New Opportunities for Research, Practice, and Policy

The purpose of this article is to stimulate discussion and research about patient suffering and caregiver compassion. It is our view that these constructs are central to understanding phenomena such as family caregiving, and that recognizing their unique role in the caregiving experience provides new directions for intervention research, clinical practices, and social policy. We first define and characterize these constructs, review empirical evidence supporting the distinct role of suffering and compassion in the context of caregiving, and then present a conceptual model linking patient suffering with caregiver compassion. We conclude with a discussion of implications and future directions for clinical intervention, research, and policy.

Asking the right question of informal caregivers about patient symptom experiences: multiple proxy perspectives and reducing interrater gap

Recent conceptual work on multiple proxy perspectives indicates that clinicians should be more reflective in terms of how they question or prompt informal caregivers to report on patient illness experiences. There are different ways in which therapeutic questions might be posed that can influence perceptual agreement between patients and caregivers. The purpose of this randomized, between-subjects study was to test the hypothesis that "The interrater gap between patient self-assessment and caregiver assessment on patient multidimensional symptom experiences will be reduced when caregivers are prompted to imagine-patient perspective-take." We also tested the hypothesis that "Regardless of the perspective-taking prompt provided to the caregiver, gender will have no impact on patient and caregiver discrepancy scores on patient symptom experiences." This study comprised a convenience sample of 126 dyads consisting of breast and prostate cancer patients, and their informal caregivers. Patients provided self-reports on the abbreviated Memorial Symptom Assessment Scale (MSAS). Informal caregivers also completed the abbreviated MSAS under one of three randomly assigned instructional set conditions: neutral, imagine-patient perspective-taking, and imagine-self perspective-taking. The imagine-patient prompt was effective in reducing caregiver discrepancy across symptoms and underlying dimensions in comparison to the imagine-self prompt. However, the least discrepancy between patients and caregivers occurred in the neutral condition. The greatest discrepancy by caregivers occurred in imagine-self condition. For the most part, there was no significant interaction effect between caregiver gender and induced perspective-taking across each of the symptoms and underlying frequency, severity, and distress. These results lend support for Pickard and Knight's multiple proxy perspectives model in that different perspective-taking prompts can result in varying levels of perceptual agreement, of which clinicians need to be aware to deliver sensitive patient and family centered care.

Promoting Enhanced Patient and Family Caregiver Congruence on Lung Cancer Symptom Experiences

PURPOSE/OBJECTIVES

To test the effects of different perspective-taking instructional sets, gender, caregivers' personal histories with cancer, and caregiving relationship factors on family caregiver and patient perceptual agreement of symptom experiences of patients with lung cancer.

DESIGN

Counterbalanced.

SETTING

Thoracic oncology outpatient clinical setting in Canada.

SAMPLE

98 dyads consisting of patients with lung cancer and their family caregivers.

METHODS

Data were collected on a one-time basis by employing an abbreviated version of the Memorial Symptom Assessment Scale targeting lack of energy and worrying. Caregivers were randomized to one of six counterbalanced conditions of perspective-taking instructions.

MAIN RESEARCH VARIABLES

Caregiver discrepancy scores, instructional sets (i.e., neutral, self-report, and imagine-self and imagine-patient perspective-taking), order effects, gender, caregivers' personal history with cancer, and caregiving relationship factors.

FINDINGS

No order effects were found for the instructional sets. Instructions to imagine the patient's perspective over imagining how the caregiver would feel if he or she had cancer were most effective in enhancing the caregiver's ability to estimate the patient's lack of energy and worrying. Gender had no significant effects. The amount of patient-caregiver communication had a positive impact on the accuracy of caregivers' perspectives.

CONCLUSIONS

The patient-oriented instructions had a limited impact on enhancing patient-caregiver congruence on patient symptoms. This likely is related to the study's convenience sample of caregivers who appear to naturally engage in empathic processes of patient-oriented perspective-taking when they assessed and reported on patient symptom conditions.

IMPLICATIONS FOR NURSING

Further exploratory work should identify interpersonal conditions that negatively hamper the effects of caregiver perspective-taking on their reasonable understanding of patient symptoms.

A review of distress and its management in couples facing end-of-life cancer

The aim of this review paper is to (1) provide an overview of the impact of cancer on the couple, (2) to identify potential outcomes for couple's interventions targeted specifically when one spouse is facing end of life, (3) to review and critique the empirical literature on psychosocial interventions for couple's facing end of life to date, and (4) to provide direction for research in this area. Based on our review, we found that there is clear evidence of significant distress arising from the impact of terminal illness on the marital relationship, which can result in greater suffering in the last months and weeks of life. Currently, there is a very small body of evidence on the effectiveness of couple interventions for those where one is in palliative care. Future randomized controlled trials are needed to examine the impact of couple therapy adapted for couples facing the end of life, and to guide in providing information on the number of sessions and format required for this population. Outcomes, such as more effective communication, reduction in the experience of hopelessness, uncertainty, isolation, depression, anxiety, and more adaptive coping strategies should be considered.

Caring for a loved one with advanced cancer: determinants of psychological distress in family caregivers

BACKGROUND

Family caregivers caring for a patient with terminal cancer may experience significant psychological distress.

OBJECTIVE

The purpose of this study was to determine the extent to which the family caregivers' psychological distress is influenced by the patients' performance status while taking into account individual characteristics of caregivers and their unmet needs.

METHODS

Two hundred twelve family caregivers were assigned to three cohorts according to the patient's performance status, as measured by the Eastern Collaborative Oncology Group Functional Scale (ECOGS). Interview information was collected on the services and care provided, as well as on the caregivers' characteristics and level of psychological distress.

RESULTS

Family caregivers' psychosocial distress is strongly associated with the patients' terminal disease progress and declined functioning. The level of psychological distress varies from 25.2 to 33.5 (p = 0.0008) between the groups. Moreover, the percentage of caregivers with a high level of psychological distress varies from 41% to 62%, while this percentage is estimated at 19.2% in general population. A high distress index was significantly associated with the caregiver's burden, the patient's young age, the patient's symptoms, the caregiver's young age and gender, a poor perception of his/her health and dissatisfaction with emotional and tangible support.

CONCLUSIONS

Family caregivers of patients in the advanced stages of cancer experience a high level of psychological distress, which increases significantly as the patient loses autonomy. Health care policies and programs need to be revisited in order to take the reality of these patients and their families into account.

Informal caregiver training on home care and cancer symptom management prior to hospital discharge: a feasibility study

PURPOSE/OBJECTIVES

To determine the feasibility of individualized caregiver training for home care and symptom management conducted at the bedside of older patients with cancer prior to hospital discharge.

DESIGN

Pilot study.

SETTING

The Extended Care Rehabilitation Center at the Durham Veterans Affairs Medical Center in North Carolina.

SAMPLE

7 female informal caregivers with a mean age of 56 (range = 26-76). More than half were African American. Most commonly, caregivers were spouses of the patients with cancer.

METHODS

Individualized and experiential training on home care and cancer symptom management was conducted at the bedside of patients before hospital discharge. Caregiver demographic data were collected. An informal interview at the end of the training asked about the usefulness of the training in preparing for home caregiving.

MAIN RESEARCH VARIABLES

Feasibility of the training.

FINDINGS

Individualized bedside training to caregivers prior to hospital discharge is feasible. All caregivers noted the relevance of the content as well as the approach to the training.

CONCLUSIONS

When given an opportunity for training on symptom management and home care, informal caregivers were very interested in participating. The individualized approach gave caregivers an opportunity to have their particular needs met. The flexibility of when to conduct the training proved to be crucial when soliciting attendance. The biggest challenge was in recruiting caregiver subjects through patients with cancer.

IMPLICATIONS FOR NURSING

The impetus now is to look at the effects of the training on caregiver-patient variables as well as the cost-effectiveness and sustainability of such an approach to caregiver training.

Cancer survivorship: a new challenge in comprehensive cancer control

Cancer survivors are a growing population in the United States because of earlier cancer diagnosis, the aging of society, and more effective risk reduction and treatment. Concerns about the long-term physical, psychosocial, and economic effects of cancer treatment on cancer survivors and their families are increasingly being recognized and addressed by public, private, and non-profit organizations. The purpose of this paper is to discuss how survivorship fits within the framework of comprehensive cancer control. We summarize three national reports on cancer survivorship and highlight how various organizations and programs are striving to address the needs of cancer survivors through public health planning, including the challenges these groups face and the gaps in knowledge and available services. As cancer survivorship issues are being recognized, many organizations have objectives and programs to address concerns of those diagnosed with cancer. However, better coordination and dissemination may decrease overlap and increase the reach of efforts and there is limited evidence for the effectiveness and impact of these efforts.

Cancer-related communication between female patients and male partners scale: a pilot study

BACKGROUND

The study's objective was to evaluate the reliability and validity of the Cancer-Related Communication Problems within Couples Scale (CRCP), a measure to assess whether patients and their partners have difficulty talking about cancer with each other.

METHODS

The CRCP Scale included 18 items concerning open communication/emotional support, treatment-specific issues, self-protection, and protective buffering. Patients and partners responded through the American Cancer Society's website and mailed questionnaires through Y-ME. The CRCP's validity was tested using the Hospital Anxiety and Depression Scale (HADS) and the Dyadic Adjustment Scale (DAS, marital relationship).

RESULTS

189 female patients and 135 male partners participated in the survey. Three items were deleted based on lack of clarity or an item not being applicable to many respondents, resulting in a 15 item scale. The number of CRCP problems' internal consistency in the 15 item scale was good for both patients and partners (alpha coefficient = 0.87, 0.81, respectively). The number of patients' CRCP problems correlated with the DAS (p < 0.0001), and the number of partners' CRCP problems correlated with the HADS (p < 0.0001) and the DAS (p < 0.0001).

CONCLUSION

Analyses supported the CRCP Scale's reliability and validity for female cancer patients and male partners.

Coping and psychological well being in families of elderly cancer patients

This article reviews research directions on elderly cancer patients and the consequences of their disease for their partners and families. In a systematic review of the research literature, five research directions were identified: first, the relationship between the family and the etiology of the disease; second, the importance of the family as a source of social support; third, family caregivers as second order patients and the moderating role of psychological factors; fourth, cancer as a challenge for the family and fifth, ways of providing social and psychological support for the families of patients including examples for intervention programs. It is shown that the assumption of a "psychogenic" etiology may inhibit adaptive processes. Depending on its quality, social support can trigger adaptive coping in the patients. Elderly patients seem to be ambivalent in their attitudes towards social support because they may feel hindered with respect to their autonomy. Distress among family members is sometimes very similar to the distress experienced by patients. Several studies have shown that distress is differentially influenced by disease-related, personal and interpersonal factors as well as social resources. Interpersonal factors seem to have a specific impact on the adaptive capacities of patients and their family members. Open communication, a "healthy" family cohesion and adaptive competence seem to positively influence patients' coping. Support programs which actively include family members seem to be effective in reducing the distress of patients and their relatives. Some conclusions will be drawn including a discussion of future research directions.