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Gao J, Pan Q, Li SL, Chen S, Luo B, Chen L, Lin Y. Influencing factors of health promotion behaviour in patients with aortic dissection: a qualitative study using the COM-B model. BMJ Open 2025; 15:e076181. [PMID: 40044200 PMCID: PMC11883601 DOI: 10.1136/bmjopen-2023-076181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/03/2024] [Indexed: 03/09/2025] Open
Abstract
OBJECTIVES This study aimed to understand influencing factors of health promotion behaviour in patients with aortic dissection (AD) using the capability, opportunity, motivation, behaviour (COM-B) model of behaviour. DESIGN A descriptive qualitative design was adopted. Data were collected using face-to-face semi-structured interviews and analysed using directed content analysis. SETTING Fujian Medical University Union Hospital. PARTICIPANTS A purposive sample of 16 patients with AD. RESULTS The following themes and subthemes were identified. Psychological capability: (1) lack of disease knowledge; physical capability: (1) physical function limitation; (2) fatigue; physical opportunity: (1) limited access to disease knowledge; (2) communication between providers and patients; (3) objective condition restriction; social opportunity: (1) stigma; (2) social support; reflective motivation: (1) self-efficacy; (2) perceived benefits; (3) personal and family responsibilities; automatic motivation: (1) post-traumatic growth; (2) fear of disease progression. CONCLUSION This study adopted a novel approach to understanding factors affecting health promotion behaviour among patients with AD. Interventions can be implemented using the Behaviour Change Wheel framework and study findings to improve health promotion behaviour in this patient population.
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Affiliation(s)
- Jia Gao
- Department of Cardiac Surgery Nursing, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qiong Pan
- Department of Nursing, Fujian Medical University Union Hospital, Fuzhou, China
| | - Sai Lan Li
- Department of Cardiac Surgery Nursing, Fujian Medical University Union Hospital, Fuzhou, China
| | - Shaolin Chen
- Department of Cardiology Nursing, Fujian Medical University Union Hospital, Fuzhou, China
| | - Baolin Luo
- Department of Cardiac Surgery Nursing, Fujian Medical University Union Hospital, Fuzhou, China
| | - Liangwan Chen
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yanjuan Lin
- Department of Cardiac Surgery Nursing, Fujian Medical University Union Hospital, Fuzhou, China
- Department of Nursing, Fujian Medical University Union Hospital, Fuzhou, China
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Gong J, Chen M, Luo H, Li Q. Effects of a couple-based self-efficacy intervention on health outcomes among colorectal cancer patients and spousal caregivers: A randomized controlled trial. Eur J Oncol Nurs 2025; 74:102737. [PMID: 39662133 DOI: 10.1016/j.ejon.2024.102737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Revised: 10/31/2024] [Accepted: 11/13/2024] [Indexed: 12/13/2024]
Abstract
PURPOSE This study aimed to assess the feasibility and acceptability of a couple-based self-efficacy (SE) intervention, and to examine the effects of the intervention on health outcomes for CRC couples. METHODS An assessor-blinded, two-armed, randomized controlled design was used. The study randomly assigned 144 patients hospitalized for colorectal cancer to receive either the SE intervention or the usual care. SE was the primary outcome. The secondary outcomes included quality of life and mental health (positive emotions and negative emotions). Repeated measures analysis of variance was used to examine the data. RESULTS The recruitment and retention rates were 80% and 87.5%, respectively. First, we found that patients scored significantly higher on anxiety (p = 0.001), depression (p = 0.001) and benefit findings (p = 0.009) than did spousal caregivers, whereas spousal caregivers scored significantly higher than patients on the quality of life (p < 0.001 for both physical scores and mental scores) in the SE group. Second, immediately after the intervention, the SE group showed statistically significant improvements were found in SE (p < 0.001 for both couples), quality of life (mental scores) (p = 0.002 for spousal caregivers), negative emotion (anxiety, p < 0.05 for both couples; depression, p = 0.03 for patients), and positive emotion (benefit findings) (p < 0.001 for both couple) when compared to the control group. CONCLUSION A couple-based SE intervention significantly improved SE, quality of life (mental scores), and psychological well-being, suggesting a short-term intervention effect.
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Affiliation(s)
- Jiali Gong
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China; Affiliated Hospital, Jiangnan University, Wuxi, Jiangsu Province, China.
| | - Meizhen Chen
- Suqian Health School in Jiangsu Province, Suqian, Jiangsu Province, China.
| | - Huamin Luo
- Affiliated Hospital, Jiangnan University, Wuxi, Jiangsu Province, China.
| | - Qiuping Li
- Affiliated Hospital, Jiangnan University, Wuxi, Jiangsu Province, China; Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, China.
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Chu Q, Sun F, Zhu X, Xia H, Bian D, He G, Yang J, Zhang P, He Y. Longitudinal relationship between posttraumatic growth and distress in lung cancer patients during neoadjuvant immunotherapy. Int J Clin Health Psychol 2025; 25:100549. [PMID: 39981132 PMCID: PMC11840545 DOI: 10.1016/j.ijchp.2025.100549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Accepted: 01/28/2025] [Indexed: 02/22/2025] Open
Abstract
Purpose Posttraumatic growth (PTG) has been recognized as beneficial for the emotional well-being of cancer patients. However, the longitudinal relationship between PTG and emotional distress remains unclear and has rarely been investigated among patients undergoing neoadjuvant therapy. We investigated the linear and quadratic longitudinal associations between distress (depression, anxiety, and negative affect) and PTG in lung cancer patients undergoing neoadjuvant immunotherapy. We also tested individual variations in the longitudinal associations. Methods Data were pooled from three clinical trials (n = 231) evaluating the efficacy of neoadjuvant immunotherapy in lung cancer patients. At the beginning of each treatment cycle, patients completed questionnaires assessing PTG and distress. Cross-lagged panel analysis was used to evaluate longitudinal associations, and multi-group structural equation modeling was conducted to examine individual variations in these relationships. Results A unidirectional linear relationship was observed, with lower levels of distress predicting greater PTG over time. The impact of anxiety on PTG was more pronounced in patients with higher education or lower financial burdens, while the effect of negative affect was more salient in older patients. No significant quadratic effects of distress on PTG were observed. Conclusions Lower emotional distress may facilitate the development of PTG over time. The longitudinal effect of distress on PTG varied on age, education, and financial burdens. Implications Psychosocial interventions to promote PTG may be more effective by incorporating stress management and emotion regulation strategies, and need to be tailored to patients' socioeconomic characteristics.
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Affiliation(s)
- Qiao Chu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, No.227 South Chongqing Rd, Shanghai 200025, China
| | - Fenghuan Sun
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
| | - Xinsheng Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
| | - Haoran Xia
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
| | - Dongliang Bian
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
| | - Gan He
- School of Public Health, Shanghai Jiao Tong University School of Medicine, No.227 South Chongqing Rd, Shanghai 200025, China
| | - Jinhuan Yang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, No.227 South Chongqing Rd, Shanghai 200025, China
| | - Peng Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
| | - Yaping He
- School of Public Health, Shanghai Jiao Tong University School of Medicine, No.227 South Chongqing Rd, Shanghai 200025, China
- Center for Health Technology Assessment, Shanghai Jiao Tong University China Hospital Development Institute, Shanghai Jiao Tong University, No.227 South Chongqing Rd, Shanghai 200025, China
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Zhao S, Yu Y, Frey KP, Wegener ST, Castillo RC. Posttraumatic growth among burn patient family caregivers in China. Burns 2024; 50:107292. [PMID: 39520870 DOI: 10.1016/j.burns.2024.107292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 10/01/2024] [Accepted: 10/13/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Burns carries a high risk of severe physical damage, prolonged recovery, and mental health implications for both patients and their caregivers. While distress among caregivers of burn patients has been studied, less attention has been given to potential positive psychological changes. This study focuses on the prevalence, temporal dynamics, and predictors of posttraumatic growth (PTG) among caregivers. METHODS A cross-sectional survey was conducted with 161 family caregivers from two Chinese burn units in 2016-2017. Participants completed a general information questionnaire and four measures: Posttraumatic Growth Inventory, Posttraumatic Stress Disorder Checklist, Depression, Anxiety, and Stress Scale-21, and Multidimensional Scale of Perceived Social Support. RESULTS The PTG scores for caregivers, with an average of 59.8 (± 13.9), exhibited a curvilinear pattern over a period of 36 months, initially decreasing and then increasing. Multiple linear and quadratic regression analyses affirmed that heightened anxiety (p < 0.001), male gender (p < 0.05), college education (p < 0.05), and increased social support (p < 0.05) positively predicted family caregiver PTG. CONCLUSIONS This is the first study of burn injury caregiver PTG. The study indicates caregivers of burn patients may undergo positive psychological transformation. Variations in predictive factors necessitate validation through longitudinal research. The dynamic interplay of psychological outcomes between patients and caregivers requires further exploration.
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Affiliation(s)
- SiNing Zhao
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, United States.
| | - Yongpei Yu
- Peking University Clinical Research Institute, China.
| | - Katherine P Frey
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, United States.
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Medicine, United States.
| | - Renan C Castillo
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, United States.
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Brown SL, Hope-Stone L, van der Voort N, Hussain R, Heimann H, Coventry WL, Cherry MG. Associations between empirically proportionate and disproportionate fears of cancer recurrence and anxiety and depression in uveal melanoma survivors: Five-year prospective study. Br J Health Psychol 2024; 29:662-675. [PMID: 38462481 DOI: 10.1111/bjhp.12719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/01/2024] [Accepted: 02/21/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE Fear of cancer recurrence (FCR) may develop into elevated anxiety or depression symptoms, but few risk factors for this development are known. Objective recurrence risk estimation is possible in some cancers. Using theories of risk communication and phobias, we examined whether the proportionality of FCR to known objective recurrence risk influences the development of anxiety and depression symptoms. METHOD Uveal melanoma (UM) patients can opt for reliable prognostic testing. Patients experience either a 'good' or 'poor' prognostic outcome, whereby 10-year mortality due to metastatic disease is, respectively, low or high. In a five-year prospective study of a consecutive sample of 589 UM survivors, we used random intercept cross lagged panel analyses to examine whether proportionality differentially influences whether FCR progresses to anxiety and depression. RESULTS Positive cross paths predicting anxiety from FCR were stronger in the poor prognosis group than the good prognosis and not tested groups. Prognostic group differences were not evident for depression. CONCLUSIONS FCR was more likely to progress to elevated anxiety symptoms when proportionate to the known objective recurrence risk. Objective evidence may play a prominent role in the development and structure of fear because it assumes a high epistemic weight that activates a wide range of emotional and cognitive responses. Interventions that assist survivors to tolerate FCR in the presence of higher recurrence risks may be important in reducing anxiety symptoms.
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Affiliation(s)
| | - Laura Hope-Stone
- University of Liverpool, Liverpool, UK
- Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Nicola van der Voort
- Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Rumana Hussain
- University of Liverpool, Liverpool, UK
- Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Heinrich Heimann
- University of Liverpool, Liverpool, UK
- Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Wang Z, Chen X, Zhou J, Lin C, Zhao J, Li Q. The effect of a couple-based posttraumatic growth intervention in supporting couples coping with colorectal cancer: A randomized controlled study. Psychooncology 2024; 33:e6326. [PMID: 38498049 DOI: 10.1002/pon.6326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 01/23/2024] [Accepted: 03/05/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES To promote posttraumatic growth (PTG) in colorectal cancer (CRC) couples, a couple-based PTG intervention was conducted, and the intervention had previously proved be feasible in CRC couples. The current study was conducted to validate the effects of intervention in CRC couples. METHOD This is a randomized controlled study that included 174 CRC couples. All participants were randomized to either the intervention (usual care plus 5-week PTG intervention, n = 87) or the control group (usual care, n = 87). Data were collected from CRC couple dyads at baseline and immediately post-intervention periods. Primary outcome refers to positive changes, and secondary outcomes include marital satisfaction, quality of life (QOL), and anxiety and depression. Multilevel modeling was applied to analyze the intervention effects. RESULTS Participants in the program showed increased PTG, marital satisfaction, and QOL both physically and mentally, and decreased levels of anxiety and depression over time. And spousal caregivers showed greater improvement in marital satisfaction and physical QOL compared with patients. In addition, significant intervention effects were shown in the participants' benefit finding, physical health and depressive symptoms. CONCLUSION The study confirmed the effect of the PTG intervention on CRC couples' benefit finding, physical health and depressive symptoms. However, this study only measured outcome variables at two time-points. Future studies should add follow-up assessments to evaluate long-term effects of the intervention in CRC couples. REGISTRATION NUMBER ChiCTR2300067809.
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Affiliation(s)
- Zhiming Wang
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, China
| | - Xuan Chen
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, China
| | - Junrui Zhou
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, China
| | - Chunyan Lin
- Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Jie Zhao
- Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Qiuping Li
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, China
- Affiliated Hospital of Jiangnan University, Wuxi, China
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Wang Z, Chen X, Zhou J, Lin C, Luo H, Li Q. Feasibility and preliminary effect of a couple-based posttraumatic growth intervention for colorectal cancer couples: A randomized controlled pilot study. Clin Psychol Psychother 2023; 30:1433-1445. [PMID: 37483083 DOI: 10.1002/cpp.2884] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/07/2023] [Accepted: 07/05/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) causes severe physical and psychological impacts on the patients as well as their spousal caregivers. To facilitate the psychological adaptation of the CRC suffered couples, a couple-based posttraumatic growth (PTG) intervention was developed based on the PTG affective-cognitive processing model. The feasibility, acceptability and preliminary effect of this intervention were tested. METHODS A pre-post randomized controlled pilot trail was conducted for Chinese couples coping with CRC. Participants in the intervention group were provided five weekly sessions consecutively, while those in the control group were treated with usual care during the testing period. Outcomes were described as positive changes (PTG, benefit finding [BF]), marital satisfaction, quality of life and anxiety and depression. Qualitative method was also used to evaluate the programme participating sense of the couples. RESULTS The rate of programme recruitment and programme retention amounts to 78.6% and 87.5%, respectively. The participants have reported overall satisfaction for the programme attendance and have suggested detailed diet guidance. Significant effects were revealed in the outcomes for the CRC couples, including PTG, marital satisfaction, BF, physical and mental health and anxiety and depression. CONCLUSION The study confirmed the feasibility and preliminary positive effect of the couple-based PTG intervention for the CRC couples. However, in order to extend it in more general applications, large-scale researches are warranted. PRACTICAL IMPLICATION The couple-based intervention is effective for couples coping with CRC. Clinicians should take the components of the intervention into consideration in their practice work for the CRC couples.
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Affiliation(s)
- Zhiming Wang
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Xuan Chen
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Junrui Zhou
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Chunyan Lin
- Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Huamin Luo
- Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Qiuping Li
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
- Affiliated Hospital of Jiangnan University, Wuxi, China
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Bayraktar S, Ozkan M. Unchanging dynamics in posttraumatic growth in cancer patients: ways of coping and illness perception. Front Psychol 2023; 14:1223131. [PMID: 37736156 PMCID: PMC10509471 DOI: 10.3389/fpsyg.2023.1223131] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/14/2023] [Indexed: 09/23/2023] Open
Abstract
Introduction This study aims to address the positive changes due to traumatic experiences, such as being diagnosed with cancer and experiencing this disease for a certain period. Within this purpose, socio-demographic and disease-related variables, coping ways and illness perceptions that affect posttraumatic growth in cancer patients were examined. Secondly, the findings of this study, which is one of the first studies on posttraumatic growth in cancer patients in Turkey, were compared with the findings of current studies on the subject. Method Datums were collected by an interview form and three scales (Posttraumatic Growth Scale, Ways of Coping Inventory and Illness Perception Scale-R) to 78 cancer outpatients in Istanbul University Oncology Institute in 2007. Results Results showed that cancer patients have higher posttraumatic growth levels than the mean. According to analysis, posttraumatic growth total score between confrontive coping (t = -2.344, p < 0.05), self-controlling (t = -3.704, p < 0.001), accepting responsibility (t = -3.032, p < 0.01), escape-avoidance (t = -2.285, p < 0.05), planful problem solving (t = -2.502, p < 0.05), positive reappraisal (t = -5.241, p < 0.001), and seeking social support (t = -3.527, p < 0.01) has relationship. Also, there is a relation between posttraumatic growth subscales and the Revised form of Illness Perception Questionnaire; Change in relationships with others subscale (t = 2.887, p < 0.01) and Change in self-perception subscale (t = 2.660, p < 0.01) between timeline (acute/chronic), Change in self-perception subscale between timeline (cyclical) (t = -2.788, p < 0.01) and uncontrollable body factors (t = -1.916, p < 0.05) Change in philosophy of life subscale between external attributions (t = -2.057, p < 0.05) and Change in relationships with others subscale (t = -2.920, p < 0.01) between chance factors. It was found that positive reappraisal (F = 78.290, p < 0.001), self-controlling (F = 39.814, p < 0.001), and distancing (F = 46.311, p < 0.001) were significant predictors of posttraumatic growth total score. Results showed that ways of coping and illness perceptions were essential variables in posttraumatic growth. Discussion Studies on posttraumatic growth in Turkey and the world have significantly increased in recent years. This study aimed to examine the findings obtained from cancer patients in 2007 in discussion with the findings in the current literature. In this context, it is seen that the relevant variables affecting posttraumatic growth in cancer patients in different cultures do not change.
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Affiliation(s)
- Seda Bayraktar
- Faculty of Literature, Department of Psychology, Akdeniz University, Antalya, Türkiye
| | - Mine Ozkan
- Faculty of Medicine, Department of Psychiatry, Istanbul University, Istanbul, Türkiye
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