Family survivorship and quality of life following a cancer diagnosis

Family resilience in cancer treatment and key influencing factors: A systematic review

OBJECTIVE

To identify the status quo and key influencing factors of family resilience in cancer treatment.

METHODS

Eight electronic databases (PubMed, Cochrane Library, Embase, CINAHL, Web of Science, CNKI, Wan Fang Database, VIP Database) were searched from 2000 to 10 May 2023. Inclusion criteria were the following: (a) study subjects were cancer patients or their family caregivers, (b) family resilience was measured as a variable, (c) reported factors associated with family resilience, (d) employed either quantitative or mixed methods design, (e) written in English or Chinese, (f) published in peer-reviewed journals. All included studies were evaluated for quality using the Mixed Method Appraisal Tool.

RESULTS

Thirty studies were included in the systematic review. According to our analysis, the family resilience of cancer patients could be influenced by various factors associated with six clusters: (a) demographic characteristics, (b) severe staging and treatment of cancer, (c) psychological and health statuses, (d) family, and (e) social environment. Meanwhile, several specific protective factors and risk factors of family resilience were also identified.

CONCLUSION

Family resilience plays an important role in promoting positive adaptation in the face of adversity in families of cancer patients/caregivers. This study classifies related influencing factors by analyzing both protective factors and risk factors (and some controversial factors of family resilience). We found that longitudinal studies are needed to further verify the dynamic changes of family resilience, and future research should focus on understanding family resilience from the dual perspectives of cancer patients and their caregivers, to provide comprehensive information for health professionals, and facilitate the development of effective family resilience intervention programs.

Impact of fear of recurrence in patients with cancer on caregivers' psychological health: A meta-analysis

Objective

This study aims to quantitatively investigate the relationship between fear of cancer recurrence in patients with cancer and their caregivers' psychological health, examining the extent of the impact of this fear on caregivers.

Methods

We conducted a comprehensive search in PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, and PsycINFO databases from inception until May 2023 for relevant English publications. Pearson correlation coefficients (r) were utilized as effect sizes to assess the overall relationship between fear of recurrence and psychological outcomes among caregivers of patients with cancer.

Results

A total of 19 eligible studies were included in the analysis. The findings revealed a moderate positive correlation between fear of recurrence in patients with cancer and caregivers' fear of recurrence and depression. A relatively weaker correlation was observed between patients' fear of recurrence and caregivers' anxiety. Due to considerable heterogeneity (I2 ​= ​91.99%, Q ​= ​212.23), the primary outcome of fear of recurrence in patients with cancer influencing caregivers' fear of recurrence was examined through subgroup analyses.

Conclusions

Our meta-analysis established a significant positive correlation between fear of recurrence in patients with cancer and negative psychological consequences among caregivers, including recurrence fear, depression, and anxiety. Future research should explore the evolution of adverse psychological outcomes in both patients with cancer and their caregivers over time and delve into the bivariate psychological impact within the patient-caregiver dyads.

Systematic review registration

PROSPERO, CRD42022383866.

Family resilience and its influencing factors among advanced cancer patients and their family caregivers: a multilevel modeling analysis

BACKGROUND

Cancer is highly prevalent worldwide. Family resilience is a positive variable that helps families burdened by advanced cancer to cope effectively. This study aimed to describe the family resilience of advanced cancer patients and caregivers in dyads and identify its influencing factors at the individual and dyadic levels.

METHODS

This multisite cross-sectional study was conducted in oncology units in five tertiary hospitals in China. A total of 270 advanced cancer patient-caregiver dyads were recruited between June 2020 and March 2021. Patients' and caregivers' family resilience was measured by the Family Resilience Assessment Scale. Data on potential influencing factors, including demographic and disease-related characteristics as well as family sense of coherence, psychological resilience, perceived social support, symptom burden, and caregiver burden, were collected. Multilevel modeling analysis was adopted to control for the interdependence of the dyads.

RESULTS

A total of 241 dyads were included in the data analysis. The mean ages of patients and caregivers were 53.96 (SD 15.37) and 45.18 (SD 13.79) years, respectively. Most caregivers were spouses and adult children (45.6% and 39.0%, respectively). Patients reported a higher mean family resilience score than caregivers (152.56 vs. 149.87, respectively). Undergoing fewer than two types of treatment and a lower symptom burden of patients predicted higher patient (B = -9.702, -0.134, respectively) and caregiver (B = -5.462, -0.096, respectively) family resilience. Patients also reported higher family resilience under the following conditions: 1) were on a medical insurance plan other than the new rural cooperative medical system (B = 6.089), 2) had a better family sense of coherence (B = 0.415), 3) whose caregivers were unmarried (B = 8.618), perceived lower social support (B = -0.145) and higher psychological resilience (B = 0.313). Caregivers who were ≤ 44 years old (B = -3.221), had similar previous caregiving experience (B = 7.706), and had a stronger family sense of coherence (B = 0.391) reported higher family resilience.

CONCLUSIONS

Our findings highlight the importance of adopting a dyadic approach when caring for advanced cancer patients and their caregivers. Dyadic longitudinal research is suggested to discover more modifiable factors of family resilience and tailored interventions are needed to obtain optimal dyadic outcomes.

The influence of social alienation on maintenance hemodialysis patients' coping styles: chain mediating effects of family resilience and caregiver burden

Objective

Research on the possible impact of social alienation, family resilience, and caregiver burden on the coping styles of Chinese patients on maintenance hemodialysis (MHD) is scarce. We explore the influence of social alienation, family resilience, and caregiver burden on the coping styles of MHD patients, both directly and indirectly.

Methods

We invited 173 MHD patients and their primary caregivers for a cross-sectional study; the study using convenience sampling method at the hemodialysis center of the First People's Hospital of Foshan. The Chinese version of the generalized social of alienation scale, the Chinese version of the simplified coping style questionnaire, and a sociodemographic questionnaire were completed by the MHD patients, while their primary caregivers had filled out the Chinese family resilience assessment scale, the Chinese version of the Zarit caregiver burden interview, and provided socio-demographic information. SPSS macro program PROCESS v3.3 Model 6 were used for analyses of chain-mediated effects.

Results

In the mediating effects model, the direct influence of social alienation upon coping styles was significant (95% CI -0.050, -0.014), and social alienation indirectly impacted coping style by family resilience in a significant way (95% CI -0.012, -0.001) or caregiver burden (95% CI -0.013, -0.001). In addition, social alienation significantly impacted coping style by both family resilience and caregiver burden (95% CI -0.008, -0.001).

Conclusion

Social alienation can exert both a direct and indirect influence on coping styles through the mediating factors of family resilience and caregiver burden. Clinicians can take interventions to strengthen family resilience and reduce caregiver burden, which may be useful in improving socially isolated behaviors and coping skills in MHD patients.

A novel smartphone application for the informal caregivers of cancer patients: Usability study

Informal caregivers are a critical source of support for cancer patients. However, their perspectives are not routinely collected, despite health impacts related to the burden of caregiving. We created the TOGETHERCare smartphone application (app) to collect observer-reported outcomes regarding the cancer patient's health and caregiver's perceptions of their own mental and physical health, and to provide tips and resources for self-care and patient care. We enrolled 54 caregivers between October 2020 and March 2021 from Kaiser Permanente Northern California (KPNC), an integrated healthcare system. Fifty caregivers used the app for approximately 28 days. Usability and acceptability were assessed using questions from the Mobile App Rating Scale (MARS), the System Usability Scale (SUS), the Net Promoter Score (NPS), and semi-structured interviews. The caregivers' mean age was 54.4 years, 38% were female and 36% were non-White. The SUS total mean score was 83.4 (SD = 14.2), for a percentile rank of 90-95 ("excellent"). Median MARS responses to the functionality questions were also high. The NPS score of 30 at the end of the study indicated that most caregivers would recommend the app. Themes from semi-structured interviews were consistent across the study period and indicated that the app was easy to use and helpful. Caregivers indicated a need for feedback from the app, suggested some changes to the wording of questions, the app's visuals, and timing of notifications. This study demonstrated that caregivers are willing to complete frequent surveys about themselves and their patients. The app is unique because it provides a remote method to collect caregivers' observations about the patient that may be useful for clinical care. To our knowledge, TOGETHERCare is the first mobile app developed specifically to capture adult cancer patient symptoms from the informal caregiver's perspective. Future research will examine whether use of this app can help improve patient outcomes.

The effects of COVID-19 stressors and family life on anxiety and depression one-year into the COVID-19 pandemic

The purpose of this study was to examine the effects of Coronavirus (COVID-19)-related stressors and family health on adult anxiety and depressive symptoms 1 year into the pandemic. The sample consisted of 442 adults living in the United States who were recruited via Amazon Mechanical Turk. Data were analyzed using multiple logistic regression. Results indicated that compared to a sample 1 month into the pandemic, participants in the current sample reported worse family health and increases in both positive and negative perceptions of the pandemic on family life and routines. COVID-19 stressors and perceived negative effects of the pandemic on family life increased the odds for moderate-to-severe depression and anxiety while having more family health resources decreased the odds for depression and anxiety symptoms. Participants reported lower odds for worse depression and anxiety since the beginning of the pandemic when they reported more positive family meaning due to the pandemic. The results suggest a need to consider the impact of family life on mental health in pandemics and other disasters.

Long-term fear of cancer recurrence in patients treated endoscopically for early Barrett's neoplasia

Previous studies on fear of cancer recurrence after endoscopic treatment for early Barrett's neoplasia focused on fear during a relatively short period after the intervention. The aim of this study was to explore whether fear of cancer (recurrence) persists during long-term follow-up in patients treated endoscopically for Barrett's neoplasia compared to patients treated surgically for a more advanced stage of esophageal adenocarcinoma. Participants previously participated in a prospective longitudinal study investigating quality of life and fear of cancer recurrence and were treated endoscopically for early Barrett's neoplasia (high-grade dysplasia-T1sm1N0M0) or surgically for a more advanced esophageal adenocarcinoma (T1N0M0-T3N1M0). For the present study, participants were again invited to complete a set of questionnaires including the fear of cancer recurrence scale (FORS), worry for cancer scale (WOCS), and the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS Anxiety). Thirty-nine patients were eligible in the endoscopy group and 28 in the surgical group. The median time between the baseline measurement (original study) and the long-term follow-up assessment was 4 years (interquartile range 3-5 years). Fear and worry for cancer recurrence and general anxiety diminished over time in both treatment groups. However, at long-term follow-up, endoscopically treated patients had significantly higher levels of worry for cancer and general anxiety than surgically treated patients. Fear of cancer recurrence did not significantly differ between endoscopically and surgically treated patients. We found that worry and fear of cancer recurrence and general anxiety in endoscopically treated patients declined over time, but not as much as in surgically treated patients.

Family communication and coping among racial-ethnic minority cancer patients: A systematic review

The ability to actively cope with cancer has been extensively associated with better patient-reported outcomes (PROs). This systematic review aims to synthesise the available literature assessing the experience of cancer patients from racial-ethnic minoritised groups. Given the role of sociocontextual factors, greater emphasis was placed on the relationship between family communication and cancer patients' coping within the three largest racial-ethnic minority groups in the United States. Five databases (CINAHL, MEDLINE, PsycINFO, PubMed, Web of Science) were used to search for peer-reviewed empirical studies published between 2008 and 2021, investigating family communication patterns, coping, and well-being among Black/African American, Asian, and Hispanic/Latinx cancer survivors. Short reports, chapters, abstracts/summaries, systematic reviews, and conference proceedings were excluded. This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA). The Criteria for Critically Appraising Systematic Reviews and Meta-Analyses were used to assess the quality and risk of bias in the included studies. The synthesis process focused on study aims, methods, measures of interests, sample characteristics, data analysis, and study findings. A total of 117 articles were identified, of which 9 met the inclusion criteria. The selected articles were cross-sectional, implementing both quantitative and qualitative designs. Studies included breast, prostate, and mixed cancer types. Sample sizes of quantitative studies ranged from 64 to 338 respondents, while qualitative studies' samples ranged between 9 and 43 participants. Family communication and coping styles varied across minoritised groups, with open family communication contributing to effective individual and family coping. However, empirical evidence about the nature and contribution of family communication to the coping process is sparse. Future research is needed to increase knowledge and psychosocial assessment techniques and interventions targeting family communication and coping among minority communities.

A systematic mixed studies review of fear of cancer recurrence in families and caregivers of adults diagnosed with cancer

PURPOSE

Fear of cancer recurrence (FCR) may be equally prevalent, persistent and burdensome in cancer caregivers as in survivors. This systematic review evaluated FCR prevalence, severity, correlates, course, impact and interventions in cancer caregivers.

METHODS

Electronic databases were searched from 1997 to May 2021. Two reviewers identified eligible peer-reviewed qualitative or quantitative studies on FCR in adult caregivers or family members of adult cancer survivors. The risk of bias was assessed using the Cochrane Risk of Bias tools for randomised and non-randomised studies and the Mixed-Methods Appraisal Tool. A narrative synthesis and thematic synthesis occurred on quantitative and qualitative studies, respectively.

RESULTS

Of 2418 papers identified, 70 reports (59 peer-reviewed articles, 11 postgraduate theses) from 63 studies were included. Approximately 50% of caregivers experienced FCR. Younger caregivers and those caring for survivors with worse FCR or overall health reported higher FCR. Most studies found caregivers' FCR levels were equal to or greater than survivors'. Caregivers' FCR was persistently elevated but peaked approaching survivor follow-up appointments. Caregivers' FCR was associated with poorer quality of life in caregivers and survivors. Three studies found couple-based FCR interventions were acceptable, but had limited efficacy.

CONCLUSIONS

FCR in caregivers is prevalent, persistent and burdensome. Younger caregivers of survivors with worse overall health or FCR are at the greatest risk. Further research on identifying and treating caregivers' FCR is required.

IMPLICATIONS FOR CANCER SURVIVORS

Caregiver and survivor FCR are similarly impactful and appear interrelated. Addressing FCR may improve outcomes for both cancer caregivers and survivors.

Study protocol for the Exercising Together© trial: a randomized, controlled trial of partnered exercise for couples coping with cancer

BACKGROUND

Most cancer survivors are married, and cancer strains the physical and mental health of each partner and their intimate relationship. We created a partnered strength training program, Exercising Together©, where the survivor and his/her partner exercise as a team in order to improve physical and mental health of both members of the couple as well as the quality of their relationship. We have not yet determined if Exercising Together© is similarly effective in couples coping with different types of cancer nor if training as a team has unique and added benefits over those derived from supervised group training and/or shared behavior change. The purpose of this study is to determine the unique benefits of Exercising Together© on physical, mental, and relational health in couples coping with breast, prostate, or colorectal cancer.

METHODS

Survivors of prostate, breast and colorectal cancer (N = 294, 98 per cancer site) and their intimate, co-residing partners are recruited to participate in a single-blind, parallel group, randomized trial comparing three exercise groups that train twice per week for 6 months. Couples are randomized to one of three groups: (1) Exercising Together© where partners train as a team in a supervised group setting; (2) separate supervised group exercise classes for survivors or partners, respectively; (3) unsupervised home exercise program provided to each partner. The primary outcome is relationship quality (dyadic coping by the Dyadic Coping scale, emotional intimacy by the Dyadic Adjustment Scale, physical intimacy by the Physical Intimacy Behavior Scale, and symptom incongruence). Secondary outcomes are physical health (% body fat by DXA, serum fasting lipids (triglycerides, HDL, and LDL cholesterol), insulin resistance (HOMA-IR), resting blood pressure, C-reactive protein, TNF alpha, and physical functioning by the short Physical Performance Battery and SF-36) and mental health (depressive symptoms, anxiety, fear of recurrence) of each partner. Outcomes are collected at baseline, mid (3 months), post-intervention (6 months), and follow-up (12 months).

DISCUSSION

Exercising Together© could shift the paradigm of survivorship care toward novel couple-based approaches that could optimize outcomes for each partner because their health is interdependent on each other and their relationship.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03630354 . Registered August 14, 2018.

Factors Associated With Fear of Cancer Recurrence in Family Caregivers of Cancer Survivors: A Systematic Review

Objective: Fear of cancer recurrence (FCR) is a significant concern for family caregivers of cancer survivors and is associated with many adverse outcomes, including increased emotional distress and poorer quality of life. Although several theoretical models have been proposed to account for FCR in cancer survivors, their applicability to caregivers is unknown. The aim of this review was to identify clinical, demographic and psychological factors that are associated with, and predict, FCR in caregivers of cancer survivors.

Method: AMED, CINAHL, Medline, PsycINFO, and Scopus were systematically searched for relevant studies reporting quantitative data on factors associated with FCR or similar constructs (e.g., worry or anxiety about cancer recurrence) in family caregivers of adult cancer survivors. Included studies were assessed for methodological quality using a standardized checklist adapted from the Agency for Healthcare Research and Quality.

Results: Sixteen studies, half of which were cross-sectional, were included and summarized narratively. Non-modifiable factors, including age (n = 6) and treatment modality (n = 4), were found to be associated with increased FCR. Significant positive associations were also reported between illness perceptions and FCR (n = 3). However, there was heterogeneity across included studies with regards to factors examined and most were conducted in the USA. There were also several methodological limitations to the included studies.

Conclusions: Research examining FCR in caregivers of cancer survivors has predominantly focused on demographic and clinical factors. Given the paucity of research exploring the psychological mechanisms underpinning FCR, future research should investigate theoretical underpinnings of FCR in caregivers of cancer survivors to support the development of psychological interventions for this population.

Systematic Review Registration: PROSPERO, identifier [CRD42019119729].

Caregiver burden: A concept analysis

OBJECTIVE

Caregiver burden is used frequently within the nursing literature. It has not yet been clearly defined as there are different opinions regarding this concept. The purpose of this paper is to provide clarity surrounding the concept caregiver burden.

METHODS

An electronic search of MEDLINE, CINAHL, Health Source Nursing/Academic Edition and Academic Search Complete (ASC) of EBSCO, China National Knowledge Infrastructure (CNKI) and Google Scholar were searched with a limit of 10 years and published in the English or Chinese language. The paper adopted the framework by Walker and Avant. The attributes, antecedents, consequences and uses of the concept were identified.

RESULTS

At total of 33 articles were included. The three attributes of caregiver burden were identified as self-perception, multifaceted strain, and over time. The antecedents included insufficient financial resources, multiple responsibility conflict, lack of social activities. The consequences of caregiver burden resulted in negative change which included decreased care provision, decrease in quality of life, physical and psychological health deterioration.

CONCLUSION

A definition of caregiver burden was developed. Tools to measure caregiver burden were identified. The findings from this analysis can be used in nursing practice, nursing education, research and administration.

Fear of cancer recurrence in patients with multiple myeloma: Prevalence and predictors based on a family model analysis

Objective

Fear of cancer recurrence (FCR) is a common psychosocial sequela among cancer survivors, but data on patients with multiple myeloma are scarce. This study calculated the prevalence of FCR and identified family and social factors that predict FCR in the study population.

Methods

We recruited 127 myeloma patients and their partners to participate in a cross‐sectional survey from a regional tertiary cancer centre in China. The questionnaires included items on demographic characteristics and from the fear of disease progression simplified scale, family hardiness index and Social Support Scale. Univariate and multivariate regression was used to identify predictors of FCR.

Results

Of the participants, 56.4% patients reported high‐level FCR, which was similar to the partner‐reported proportion. The partners' FCR was positively associated with the patients' FCR, while family hardiness and social support were statistically significant, negative predictors.

Conclusions

Interventions to mitigate partners' FCR and improve family hardiness and social support may help with the psychological adjustment and well‐being of myeloma patients.

Impact of supports and partnership on family quality of life

BACKGROUND

In recent decades, Family Quality of Life (FQOL) has emerged as a decisive construct, both to improve the living conditions of the families of people with disabilities and to assess the results on the services and supports that they receive. The aim of this research is to determine the perception of the families regarding their support needs, the quality of their partnerships with professionals, and their FQOL and then identify to what extent the supports of early childhood intervention centers have a positive impact on the families' FQOL while exploring whether the family-professional partnership has become a fundamental intervening factor of FQOL.

METHOD

The participants were 202 families with children aged 0-6 with intellectual and developmental disabilities. We used the structural equation model to analyze the influence that the adequacy of the supports and the partnerships exerted on FQOL.

RESULTS

The results indicate that the families have language and speech support needs for their children and information needs for themselves, and that they are mostly satisfied with their partnerships with the professionals and their FQOL. Our results also indicate that their degree of satisfaction with the support was a good predictor of FQOL and their ratings of partnership quality was a key factor interceding on this effect.

CONCLUSIONS

This study provides professionals and public institutions with guidance when designing plans to improve early childhood intervention centers so the quality of life of these families and the progress of children with disabilities living in Spain become progressively stronger.

Family resilience and psychological well-being among Chinese breast cancer survivors and their caregivers

Walsh's family resilience theory indicated that families could foster resilient outcomes among their members when they are facing changes or crises. However, little is known about family resilience and psychological well-being among Chinese breast cancer survivors and their caregivers. Therefore, this study aimed to examine the direct and indirect relationships between family resilience, breast cancer survivors' post-traumatic growth (PTG), quality of life (QOL), and their principal caregivers' caregiver burden. A total of 108 breast cancer survivors/principal caregivers pairs completed a cross-sectional questionnaire survey in a comprehensive cancer of a public hospital in Shandong Province, China. The structural equation modelling (SEM) results showed that family resilience had direct and indirect effects on QOL and caregiver burden, and it was positively related to the PTG of the survivors. The survivors' PTG was positively related to their QOL, and their QOL was negatively associated with caregiver burden. Therefore, a better understanding of how family resilience contributes to PTG and QOL of the survivors and caregiver burden could help clinicians tailor interventions to enhance interventions aimed at improving both survivors' and caregivers' well-being.

A protocol for an updated and expanded systematic mixed studies review of fear of cancer recurrence in families and caregivers of adults diagnosed with cancer

BACKGROUND

Fear of cancer recurrence (FCR) is reportedly common, persistent, associated with significant morbidity and often higher in cancer caregivers than cancer patients. This review will summarise empirical research on FCR to understand its prevalence, severity, correlates, course and impact in families and caregivers of adults diagnosed with cancer, and identify tested interventions that reduce its effects.

METHODS

This review will include peer-reviewed, empirical, qualitative and/or quantitative studies on fear, worry or concern of patients' cancer returning or progressing among adult family members or caregivers of the cancer patient. It will exclude records reporting no original empirical research on FCR. We will search CINAHL, Embase, PubMed, PsycINFO, ProQuest Dissertations and Theses GLOBAL from 1997 onwards. Pairs of reviewers will conduct independent screening, data extraction and risk of bias assessment. Risk of bias will be assessed with the Cochrane Risk of Bias tool for randomised studies, the Risk of Bias Assessment tool for Nonrandomized Studies and the questions for qualitative studies in the mixed methods appraisal tool. We will conduct a narrative synthesis of quantitative studies and a thematic synthesis of qualitative studies.

DISCUSSION

This review will provide further clarity on the prevalence and severity of FCR in families and caregivers and differences by caregiver and care recipient demographic and medical characteristics. Any intervention studies located may indicate therapies or treatments that could reduce FCR in families and caregivers. Findings are expected to provide guidance for individuals and organisations working to manage FCR in families and caregivers of those with cancer.

SYSTEMATIC REVIEW REGISTRATION

This protocol will be registered with PROSPERO after peer-review.

Development of an eHealth tool for cancer patients: monitoring psycho-emotional aspects with the Family Resilience (FaRe) Questionnaire

In the last decade, clinicians have started to shift from an individualistic perspective of the patient towards family-centred models of care, due to the increasing evidence from research and clinical practice of the crucial role of significant others in determining the patient's adjustment to cancer disease and management. eHealth tools can be considered a means to compensate the services gap and support outpatient care flows. Within the works of the European H2020 iManageCancer project, a review of the literature in the field of family resilience was conducted, in order to determine how to monitor the patient and his/her family's resilience through an eHealth platform. An analysis of existing family resilience questionnaires suggested that no measure was appropriate for cancer patients and their families. For this reason, a new family resilience questionnaire (named FaRe) was developed to screen the patient's and caregiver's psycho-emotional resources. Composed of 24 items, it is divided into four subscales: Communication and Cohesion, Perceived Family Coping, Religiousness and Spirituality, and Perceived Social Support. Embedded in the iManageCancer eHealth platform, it allows users and clinicians to monitor the patient's and the caregivers' resilience throughout the cancer trajectory.

Perceived psychosocial stress and gestational weight gain among women with gestational diabetes

Growing evidence links perceived stress-a potentially modifiable psychosocial risk factor-with health behaviors and obesity. Yet little is known about the relationship between stress during pregnancy and gestational weight gain, particularly among women with pregnancy complications. We conducted a cross-sectional analysis to examine associations between psychosocial stress during pregnancy and gestational weight gain among women with gestational diabetes. We used baseline data from the Gestational Diabetes's Effects on Moms (GEM) study: 1,353 women with gestational diabetes who delivered a term singleton within Kaiser Permanente Northern California were included. Perceived stress near the time of gestational diabetes diagnosis was measured using the validated Perceived Stress Scale (PSS10). Gestational weight gain was categorized according to the 2009 Institute of Medicine recommendations. Binomial regression analyses adjusted for gestational age and maternal age at the time of gestational diabetes diagnosis, and race/ethnicity and estimated rate ratios (RR) and their 95% confidence interval (CI). Among women with a normal pregravid Body Mass Index (BMI 18.5-24.9 kg/m2), there was a significant association between high (Q4) PSS score and risk of both exceeding and gaining below the Institute of Medicine recommendations compared to those with lower stress (Q1) [adjusted RR = 2.16 95% CI 1.45-3.21; RR = 1.39 95% CI 1.01-1.91, respectively.] Among women with pregravid overweight/obesity (BMI≥25 kg/m2), there was no association. Although the temporal relationship could not be established from this study, there may be a complex interplay between psychosocial stress and gestational weight gain among women with gestational diabetes. Further studies examining stress earlier in pregnancy, risk of developing gestational diabetes and excess/inadequate gestational weight gain are warranted to clarify these complex relationships.

The influence of dyadic symptom distress on threat appraisals and self-efficacy in advanced cancer and caregiving

PURPOSE

Physical and psychological symptoms experienced by patients with advanced cancer influence their well-being; how patient and family caregiver symptom distress influence each other's well-being is less understood. This study examined the influence of patient and caregiver symptom distress on their threat appraisals and self-efficacy to cope with cancer.

METHODS

We conducted a secondary analysis of baseline data from an RCT that enrolled patients with advanced cancer and their family caregivers (N = 484 dyads). Structural equation modeling and the actor-partner interdependence mediation model (APIMeM) were used to examine two models: threat appraisals as a mediator of the relationship between symptom distress and individual and family-related self-efficacy; and, self-efficacy (individual and family dimensions) as mediators of the relationship between symptom distress and threat appraisals.

RESULTS

Data suggest the self-efficacy mediation model was the preferred model. More patient and caregiver symptom distress was directly associated with their own lower self-efficacy and more threatening appraisals. Patient and caregiver individual self-efficacy also mediated the relationship between their own symptom distress and threat appraisals. There were also significant interdependent effects. More patient symptom distress was associated with less caregiver family-related self-efficacy, and more caregiver symptom distress was directly associated with more threatening patient appraisals.

CONCLUSIONS

Patient and caregiver symptom distress influenced their own and in some cases each other's cognitive appraisals. Limitations of this study include the use of cross-sectional data and assessments of individually-focused (vs. family-focused) threat appraisals. These findings highlight the need to consider the management of patient and caregiver symptoms during advanced cancer.

Psychological impact of lymphoma on adolescents and young adults: not a matter of black or white

PURPOSE

The purpose of the study is to examine differences in perceived impact of cancer (IOC) between adolescents and young adults (AYAs; 18-35 years at cancer diagnosis), adults (36-64 years) and elderly (65-84 years) with a history of (non-)Hodgkin lymphoma. Furthermore, to investigate the association of socio-demographic, clinical and psychological characteristics with IOC; and the association between IOC and health-related quality of life (HRQoL) among AYAs only.

METHODS

This study is part of a population-based PROFILES registry survey among lymphoma patients diagnosed between 1999 and 2009. Patients (n = 1.281) were invited to complete the IOCv1 and EORTC-QLQ-C30 questionnaires. Response rate was 67 % (n = 861).

RESULTS

AYA lymphoma survivors scored higher on the positive IOC summary scale, compared to adult and elderly patients (p < 0.001), while no significant differences were observed for negative IOC. Among AYAs, females, survivors with a partner, and survivors with elevated psychological distress levels scored significantly higher on the negative IOC summary scale. The negative IOC summary scale was negatively associated with all EORTC QLQ-C30 functioning scales (β ranging from -0.39 to -0.063; p < 0.05). The positive IOC summary scale was negatively associated with the EORTC QLQ-C30 subscale 'Emotional functioning' (β = -0.24; p < 0.05).

CONCLUSION

AYA, adult and elderly with a history of (non-)Hodgkin lymphoma experienced different types of IOC in terms of positive and negative aspects.

IMPLICATIONS FOR CANCER SURVIVORS

Although AYAs experience a more positive IOC compared to older survivors, some AYAs experience more negative IOC and may require developmentally appropriate interventions to address their specific concerns.

Role of Occupational Therapy in Case Management and Care Coordination for Clients With Complex Conditions

Specific aspects of the profession of occupational therapy support a distinct value for its practitioners participating fully in the development of case management and care coordination systems. The expectation in the 21st century is that the U.S. health care system must be transformed from one that promotes volume of service to one that promotes value of care. Case management and care coordination will be critical components of that transformation. Occupational therapy's principles, education, practice, approach, and perspective offer much to benefit this increased attention to case management and care coordination. Occupational therapy practitioners should promote themselves and their profession as these system changes develop.

Worry about recurrence in a multi-ethnic population of breast cancer survivors and their partners

PURPOSE

The objectives of this study are to describe racial/ethnic differences and clinical/treatment correlates of worry about recurrence and examine modifiable factors in the health care experience to reduce worry among breast cancer survivors, partners, and pairs.

METHODS

Women with non-metastatic breast cancer identified by the Detroit and Los Angeles SEER registries between 6/05 and 2/07 were surveyed at 9 months and 4 years. Latina and Black women were oversampled. Partners were surveyed at time 2. Worry about recurrence was regressed on sociodemographics, clinical/treatment, and modifiable factors (e.g., emotional support received by providers) among survivors, partners, and pairs.

RESULTS

The final sample included 510 pairs. Partners reported more worry about recurrence than survivors. Compared to Whites, Latinas(os) were more likely to report worry and Blacks were less likely to report worry (all p < 0.05). Partners of survivors who received chemotherapy reported more worry (OR = 2.47 [1.45, 4.22]). Among modifiable factors, survivors and pairs who received more emotional support from providers were less likely to report worry than those survivors and pairs who did not receive such support (OR = 0.56 [0.32, 0.97]) and (OR = 0.45 [0.23,0.85]), respectively.

CONCLUSIONS

Early identification of survivors and partners who are reporting considerable worry about recurrence can lead to targeted culturally sensitive interventions to avoid poorer outcomes. Interventions focused on health care providers offering information on risk and emotional support to survivors and partners is warranted.

Assessing family resources: validation of the Swedish version of the Family Hardiness Index

All families face normative transitions. Some are perceived as stressful and calls for family resources to maintain or restore family well-being. In times of illness, families also need to develop strengths and capabilities to enhance family well-being. The way these are developed is related to family hardiness. Family hardiness is thus seen as a family resource, and the Family Hardiness Index (FHI) was developed to measure family stress resistance and adaptation resources. The index was not available in Swedish and no extensive international psychometric evaluation was found. Therefore, the aim was to translate and validate the Swedish version of the FHI. The study was approved by a Regional Ethical Review Board. Data from 174 Swedish participants, family members to persons with cognitive dysfunctions (n = 95) and nursing students (n = 79) were included. Family members were enrolled in outpatient clinics in primary care and rehabilitation, and nursing students at a nursing school. Psychometric properties were evaluated through calculations of missing data, distributions of item and scale scores, item correlations, Cronbach's alpha, confirmatory factor analyses and correlations with theoretically related constructs. Sample scores had acceptable data quality, internal consistency for the FHI total scale was satisfactory (α = 0.86), and construct validity was supported. Our findings cast some doubt on the intended interpretation since confirmatory factor analyses showed that a modified four-subscale version, excluding one subscale, showed best fit. The Control subscale lacked important psychometric properties in terms of homogeneity, internal consistency and construct validity. The sample size was probably sufficiently large for the factor analyses, but the subgroup analyses should be treated with caution. The conclusion is that the Swedish version of the FHI is a promising scale for assessing family hardiness, but more solid evidence for the factor structure in various Swedish and international samples is needed.

Fear of disease progression questionnaire for parents: Psychometric properties based on a sample of caregivers of children and adolescents with cystic fibrosis

BACKGROUND

Parents caring for a child with a chronic somatic condition are at risk of increased distress and impaired quality of life. Fear of disease progression (FoP) is known to be an important source of distress in patients and their partners, and may be of relevance for parents as well. Existing measures are not applicable to parents. This study describes the adaptation of the FoP questionnaire for parental caregivers and investigated its psychometric properties.

METHODS

Sixteen items appropriate for parents were derived from existing measures and from interviews with clinical experts in family-oriented psychosocial care. Factor structure, internal consistency, validity and sensitivity to change were analyzed in a clinical sample of 162 caregivers (M(age)=42.07 years, SD=6.0 years, 87.8% female) of a child with cystic fibrosis.

RESULTS

The exploratory factor analysis reveal ed a two-factor structure, which was not supported by confirmatory analysis. Cronbach's α was examined for total score (.91) and significant positive correlations of the total score with anxiety (HADS: r=.70) and depression (CES-D: r=.60, BDI-II: r=.59), and a significant negative correlations with quality of life (r=-.66) could be demonstrated. A significant decrease in FoP was found (d=1.11) in a group of highly distressed caregivers undergoing web-based cognitive behavioral intervention.

CONCLUSIONS

The FoP questionnaire is a reliable and valid instrument for parents of children with CF. Further studies in larger samples are needed to clarify dimensionality and validity among parents of children with other chronic conditions.

Do families cope communally with breast cancer, or is it just talk?

Cancer experiences are sites of transition and struggle that are made meaningful through communication with others. As such, they are events in which communal coping might occur as survivors and families deal with cancer collectively. I conducted 64 interviews with family members who had coped with breast cancer. Using relational dialectics theory, I analyzed data for discursive struggle and competition via a contrapuntal analysis. Thematic and discourse analyses revealed that communal coping was not highly prevalent in family member talk of their experiences. Individual coping by female breast cancer survivors typified the experience, and family members depicted coping as an individual identity disruption as opposed to a communal experience. This article contributes to a more comprehensive theoretical understanding of communal coping within a context of cancer. I offer suggestions for a reconceptualization of communal coping to benefit health practitioners and researchers.

Communication, coping, and quality of life of breast cancer survivors and family/friend dyads: a pilot study of Chinese-Americans and Korean-Americans

OBJECTIVE

This study aimed to understand the dyadic relationships between family communication and quality of life (QOL) and between coping and QOL in Chinese-American and Korean-American breast cancer survivor (BCS)-family member dyads.

METHODS

A cross-sectional survey design was used. A total of 32 Chinese-American and Korean-American BCS-family member dyads were recruited from the California Cancer Surveillance Program and area hospitals in Los Angeles County, California, USA. The dyadic data were analyzed using a pooled regression actor-partner interdependence model.

RESULTS

The study findings demonstrated that the survivors' general communication and use of reframing coping positively predicted their own QOL. The survivors' and family members' general communication was also a strong predictor of the family members' physical-related QOL score specifically. Meanwhile, each person's use of mobilizing coping negatively predicted his or her partner's QOL.

CONCLUSIONS

The study findings add important information to the scarce literature on the QOL of Asian-American survivors of breast cancer. The findings suggest that Chinese-American and Korean-American BCS and their family members may benefit from interventions that enhance communication and coping within the family unit.

Social support sources, types, and generativity: a focus group study of cancer survivors and their caregivers

Various research studies have identified the sources and types of support that people with cancer receive; however, few have focused on identifying the specific characteristics of emotional, instrumental, and informational support. In this study, focus groups consisting of Gilda's Club members explored the types of support that people with cancer and their caregivers experienced and valued. Results showed that although men and women with cancer and caregivers identify similar sources of support, they experience different types of support. Results also indicated a desire among participants to help and support others, a concept referred to as generativity. Implications for social workers and health care providers are explored.

The impact of caregiving on the psychological well-being of family caregivers and cancer patients

OBJECTIVES

To provide an overview of patient and caregiver emotional distress; examine the sources of their distress, review evidence-based interventions that can reduce distress, and provide guidelines for assessment and intervention.

DATA SOURCES

Peer-reviewed publications.

CONCLUSION

There is a significant, reciprocal relationship between patient and caregiver emotional distress. Sources of distress vary by phase of illness. Evidence-based interventions can reduce distress and anxiety, but often are not implemented in practice.

IMPLICATIONS FOR NURSING PRACTICE

Nurses need to assess patients and family caregivers for distress and intervene to reduce distress by fostering patient-caregiver teamwork, communication, and self-care; providing information; and referring to resources as needed.

Helping patients and their family caregivers cope with cancer

Family caregivers face multiple demands as they care for their loved ones with cancer, and these demands have increased dramatically in recent years. Patients with cancer now receive toxic treatments in outpatient settings and return home to the care of their family members. Some patients receive in-home infusions, which were unheard of a few years ago. Family caregivers provide tasks that were previously provided by nurses; however, caregivers lack the educational preparation that nurses receive.

A brief intervention to minimize psychosexual morbidity in dyads coping with breast cancer

PURPOSE/OBJECTIVES

To develop and evaluate the feasibility of a brief intervention to attenuate the incidence of psychosexual morbidity within the dyad secondary to the diagnosis and treatment of breast cancer.

DESIGN

Quasiexperimental, including intervention and treatment-as-usual comparison groups.

SETTING

Breast clinic of a comprehensive cancer center in the Midwest United States.

SAMPLE

65 recently diagnosed breast cancer survivors who were pre- or perimenopausal and aged 20-55 years, and their partners.

METHODS

Three intervention sessions were delivered based on a manual developed for the study. Twenty-five dyads received treatment as usual, 26 dyads received a face-to-face intervention, and 14 dyads received the same intervention by telephone. Questionnaires were completed at baseline, following completion of the intervention, six months postintervention, and from the comparison group at equivalent data points.

MAIN RESEARCH VARIABLES

Intimacy, sexual functioning, and dyadic adjustment.

FINDINGS

About 98% of dyads completed all intervention sessions, with an equal level of satisfaction among those in the telephone and face-to-face groups. Interesting trends in differences between the intervention and comparison groups on the relationship variables of intimacy, sexual functioning, and dyadic adjustment were obtained; however, given the sample size, power was not sufficient to reach statistical significance.

CONCLUSIONS

The intervention is feasible and acceptable for dyads comfortable discussing their relationship. Intervention by telephone was demonstrated to be as effective as the face-to-face mode of delivery.

IMPLICATIONS FOR NURSING

Nurses need to provide an opportunity for women to discuss problems they are experiencing relative to sexuality, intimacy, and body image.

Interdependent psychological quality of life in dyads adjusting to prostate cancer

OBJECTIVE

Prostate cancer negatively influences quality of life (QOL) in survivors and the people with whom they are close. The purpose of this investigation was to assess the degree of dyadic interdependence in psychological QOL in dyads adjusting to prostate cancer and its treatment.

METHOD

Participants were 70 prostate cancer survivors and their partners, most of whom were spouses. Assessments of psychological QOL (i.e., depression, anxiety, fatigue, and positive affect) were made at three points in time, each separated by 8 weeks.

RESULTS

Survivors' prostate specific function was associated with both their own and their partners' psychological QOL. There was evidence of longitudinal dyadic interdependence for psychological QOL, particularly from partners to survivors between the T2 and T3 assessments.

CONCLUSIONS

Prostate cancer survivors' psychological QOL is affected substantially by their partners' psychological QOL, consistent with theories of emotional contagion.

The meaning of cancer: implications for family finances and consequent impact on lifestyle, activities, roles and relationships

OBJECTIVE

This study explores the impact that cancer-related financial hardship/worries can have on family life.

METHODS

Forty patients (19 male and 21 female) and 17 carers participated in a qualitative study, which drew on certain elements of grounded theory methods. Participants were 18 years or older and were accessed through a regional cancer centre, an acute National Health Service trust, a support group and the Macmillan Benefits Helpline. Interviews were transcribed verbatim and analysed thematically with the aid of nvivo 7 (QSR International, Cambridge, MA, USA).

RESULTS

Many participants said that prior to experiencing cancer, they had never thought about its effects on finances. The early part of the cancer journey was characterised by a need to be positive about the future, limited discussion about money within families and a lack of action in relation to finances. Many participants, especially those of working age, described cancer-related financial worries and difficulties that had impacted on family lifestyle, roles and relationships. Consequences included house repossession, bankruptcy, loss of independence and relationship breakdown.

CONCLUSIONS

Health and social care professionals have a role in prompting people affected by cancer to take stock of their finances early in the cancer trajectory, in order to avert knock-on effects. An approach that combines hope with proactivity is needed. More work into the long-term effects of financial difficulties/worries and specific financial issues that affect people from Black and minority ethnic backgrounds is needed.

Exploration of the family's role and strengths after a young woman is diagnosed with breast cancer: views of women and their families

PURPOSE

This exploratory descriptive study examined the role and strengths of the family when supporting the younger woman (<50 years) after a diagnosis of breast cancer. The perspectives of women and family members were sought.

METHOD

Participants were recruited from oncology outpatient units in Australia. Semi-structured interviews guided by the Family Resiliency Framework were undertaken with 14 young women with breast cancer and 11 family members who reflected on the roles of family. Transcripts were analysed individually and in family groupings.

RESULTS

Women with breast cancer and their family members experienced a range of emotions during the treatment period. Roles within the family changed as members responded to their circumstances. Analysis of interview transcripts identified the following primary themes; 'just being there', 'paradox of help' and 'buffer from society'. A secondary theme related to support, specifically 'the changing role of support for family members', highlighting the strengths and experiences of family.

CONCLUSION

Recognition needs to be given to the complexity of changing roles experienced by young women with breast cancer and their families. Young women with breast cancer require unique forms of support because of the nature of their experience. Family roles were shaped through a shared sense of commitment and open communication amongst members. Families may demonstrate a range of strengths but are also vulnerable during this stressful period. Health professionals need to be aware of the possible needs of families, assess their adaptation to changing circumstances, and intervene through the provision of information, and counselling to enhance coping.

Interventions with family caregivers of cancer patients: meta-analysis of randomized trials

Family caregivers of cancer patients receive little preparation, information, or support to perform their caregiving role. However, their psychosocial needs must be addressed so they can maintain their own health and provide the best possible care to the patient. The purpose of this article is to analyze the types of interventions offered to family caregivers of cancer patients, and to determine the effect of these interventions on various caregiver outcomes. Meta-analysis was used to analyze data obtained from 29 randomized clinical trials published from 1983 through March 2009. Three types of interventions were offered to caregivers: psychoeducational, skills training, and therapeutic counseling. Most interventions were delivered jointly to patients and caregivers, but they varied considerably with regard to dose and duration. The majority of caregivers were female (64%) and Caucasian (84%), and ranged in age from 18 to 92 years (mean age, 55 years). Meta-analysis indicated that although these interventions had small to medium effects, they significantly reduced caregiver burden, improved caregivers' ability to cope, increased their self-efficacy, and improved aspects of their quality of life. Various intervention characteristics were also examined as potential moderators. Clinicians need to deliver research-tested interventions to help caregivers and patients cope effectively and maintain their quality of life.