Illness perceptions among cancer survivors

How symptom distress mediates the relationship between individual differences and perceived controllability among women with gynecologic cancer

PURPOSE

This study aims to investigate the individual differences in perceived controllability among women with gynecologic cancer who are undergoing chemotherapy. We also examined the mediating effect of symptom distress on the relationship between individual differences and perceived controllability.

METHODS

This cross-sectional study employs purposive sampling; data were collected via self-reported questionnaires. In total, 170 women completed the survey. Structural equation modeling was used to examine the proposed hypotheses of the mediating effect of symptom distress.

RESULTS

Results revealed that individual differences in age (r = -0.20, p < .05), education (t = -2.24, p < .05), employment (t = -2.05, p < .05), cancer stage (t = 2.35, p < .05), and number of chemotherapy sessions in the past three months (r = -0.16, p < .05) were significantly associated with perceived treatment control. Physical, but not psychological, symptom distress fully mediated the relationship between individual differences and perceived controllability. Participants who perceived financial distress (β = 0.179, p < .05) and those who had undergone a higher number of chemotherapy sessions within the past three months (β = 0.216, p < .05) experienced greater physical symptom distress. Additionally, those who experienced greater physical symptom distress perceived lower personal control (β = -0.199, p < .05) and treatment control (β = -0.217, p < .05).

CONCLUSIONS

Understanding the mediating effects of symptom distress on the relationship between individual differences and perceived controllability can enhance our knowledge of the mechanisms of illness acceptance, which significantly contributes to illness adaptation among women with gynecologic cancer.

Second opinion and self-efficacy in German skin cancer patients

BACKGROUND

The global incidence of skin cancer has steadily increased in recent years. Accordingly, patients require information on diagnosis and treatment options while dealing with the perceived impact of the diagnosis. In 2015, the German government enacted legislation under the Social Code (SGB V, § 27b), granting patients the right to obtain a second medical opinion.

PATIENTS AND METHODS

Utilizing a standardized questionnaire, our study aims to explore whether patients diagnosed with skin cancer actively pursue a second medical opinion and to evaluate any potential disruptions to their daily lives. We collected a total of 714 completed questionnaires.

RESULTS

The majority of those seeking a second opinion were diagnosed with malignant melanoma (96, 58%). Primary motivations for seeking a second opinion included seeking reassurance regarding treatment decisions and obtaining further information. Additionally, seeking a second opinion was correlated with a significantly lower internal locus of control, indicating a belief that their actions are not solely determined by their own abilities. Notably, we observed a greater impairment of daily life among younger participants and those with advanced cancer.

CONCLUSIONS

Overall, our study shows that second opinions often strengthened the patient-physician interaction and provided additional reassurance, especially in patients with a weak perception of control. Moreover, we found that the impairment of quality of life and both internal and external locus of control decrease significantly in advanced tumor stages. Hence, it is imperative to identify additional interventions aimed at bolstering internal resilience and locus of control, thereby enhancing patients' capacity to cope with their cancer diagnosis.

Medication perceptions mediate the association between illness perceptions and adherence to oral anticancer agents among patients with gastrointestinal tract cancer: A cross-sectional study

PURPOSE

Patients with gastrointestinal tract cancer reported suboptimal adherence to oral anticancer agents, reducing the therapeutic benefit and increasing mortality risk. The Common-Sense Model of Self-Regulation highlights patients' perceptions of illness and treatment influence adherence. However, how these perceptions influence adherence remains unknown among this population. This study aimed to explore whether illness perceptions influence adherence via their effect on medication perceptions.

METHODS

A multi-center cross-sectional study design was conducted. Between July and August 2023, a questionnaire was administered to patients from four tertiary hospitals in Mainland China. Illness perceptions were assessed using the Brief Illness Perceptions Questionnaire. Medication perceptions were measured in medication belief and self-efficacy using the Belief about Medicines Questionnaire and Self-efficacy for Appropriate Medication Use Scale, respectively. Adherence was evaluated using the Morisky 4-item Medication Adherence Scale. Mediation analyses were conducted.

RESULTS

In total, 253 participants were recruited. Patients with worse negative illness perceptions reported higher concern, lower self-efficacy, and poorer adherence. Medication self-efficacy was positively associated with adherence, whereas the necessity and concern belief of taking oral anticancer agents were not. Illness perceptions, including the cognitive and emotional dimensions, had direct and indirect effects on adherence via its effects on medication self-efficacy. The indirect effect explained 26.63% of the total effect.

CONCLUSIONS

The association between illness perceptions and adherence is partially mediated by medication self-efficacy. Strategies to foster positive illness perceptions may contribute to better medication self-efficacy and adherence. Attention should be equally focused on both the emotional and cognitive dimensions of illness perceptions.

Interventions strategies and their efficacy in illness perceptions in patients with cancer: A systematic review and meta-analysis

PURPOSES

To identify intervention strategies for improving illness perception (IP) of cancer patients and/or family caregivers; and to examine the effects of IP interventions by meta-analysis.

METHODS

A systematic search was performed to identify literature that focused on improving the IP of cancer patients and/or family caregivers from the establishment of eight databases to August 2023. Manual screening was also applied. The IP intervention strategies for cancer populations were synthesized basing the CSM. Meta-analysis was conducted to assess the effects of IP interventions on health outcomes. Multiple subgroup analyses of the same intervention conditions were conducted to explore the optimal IP-focused intervention.

RESULTS

18 studies were included. 11 studies were conducted in a meta-analysis. No studies on family caregivers' IP were identified. Compared to general care, subgroup analysis revealed that IP interventions had favorable effects on cancer patients' IP as well as quality of life and other outcomes. Six IP intervention strategies (information support, cognitive reframing, emotion adjustment, active coping, effective appraisal, and self-social identification) were generated. Meta-analysis showed that compared with theory-less studies (Z = 8.64, p < 0.01) and single delivery formats (Z = 3.66, p < 0.01), the theory-based interventions (Z = 10.86, p < 0.01) and mixed delivery formats (Z = 7.15, p < 0.01) had higher positive effects on IP outcomes.

CONCLUSIONS

The positive outcomes of IP intervention focusing on cancer patients were highlighted. IP traits and patients' and their caregivers' needs in coping with specific cancer types should be explored before the intervention design. More IP interventions targeting cancer dyads are warranted to develop in the future.

The effect of illness perception on psychosocial adjustment of patients with breast cancer and their spouses: actor-partner independence model

OBJECTIVE

With the increase in the prevalence rate and improvements in the survival of breast cancer patients, there is a growing interest in understanding the level of psychosocial adjustment in these patients. The study aimed to describe the illness perception and psychosocial adjustment levels of both breast cancer patients and their spouses, to use the Actor-Partner Interdependence Model (APIM) to clarify the actor-partner relationships between spouses, and to explore the impact of illness perception on psychosocial adjustment to the disease within the joint actions of both spouses.

METHODS

A total of 216 female patients with breast cancer and their spouses participated in the study. They were selected from two tertiary hospitals in Guangdong Province, China from October 2022 to May 2023 using a convenience sampling method. The participants were assessed using the Brief Illness Perception Questionnaire and the Psychosocial Adjustment to Illness Scale to examine the relationship between illness perception and psychosocial adjustment. AMOS24.0 was used to test and analyze the actor-partner interdependence model.

RESULTS

The illness perception score (57.75 ± 10.91) was slightly higher than that of the spouse (57.10 ± 11.00), and the psychosocial adjustment score (64.67 ± 6.33) was slightly lower than that of the spouse (64.76 ± 7.49). The results of the actor-partner interdependence model indicated that there was a couple partner between breast cancer patients and their spouses: the spouse's illness perception significantly affected the patient's psychosocial adjustment (β = 0.095, p = 0.015); the patient's illness perception also significantly affected the spouse's psychosocial adjustment (β = 0.106, p = 0.033). Among them, the patient's psychosocial adjustment was found to be related to the patient's illness comprehensibility or coherence of illness (β = 0.433, p = 0.009), the spouse's emotional illness representation (β = 0.218, p = 0.037), and the spouse's illness comprehensibility or coherence of illness (β = 0.416, p = 0.007), while the spouse's psychosocial adjustment was only related to the spouse's illness comprehensibility or coherence of illness (β = 0.528, p = 0.007).

CONCLUSIONS

The psychosocial adjustment of breast cancer patients is affected by both their own and spouse's illness perception. Therefore, in the future, the healthcare staff can implement early psychological interventions for patients diagnosed with breast cancer and their spouses as a unit to promote the psychosocial adjustment of them.

The Illness Perceptions and Coping Experiences of Patients with Colorectal Cancer and Their Spousal Caregivers: A Qualitative Study

(1) Background: Illness perception (IP) is an important psychological construct for couples dealing with cancer, which impacts health outcomes and the psychological adjustment to cancer. More research is needed to explore the traits of IP and the efforts of couples coping with cancer. Thus, this study was designed to explore the coping experiences and features of the IPs of couples dealing with cancer. (2) Methods: A total of 24 patients with colorectal cancer (CRC) and 20 spousal caregivers (SCs) participated in semi-structured interviews. All interviews were recorded digitally, transcribed, and analyzed by using an inductive thematic analysis. (3) Results: Two themes (individualized and predominant IP; IP sharing and restructuring) were developed. A preliminary framework was formulated to illustrate the relations among subthemes and the relations between themes with an adjustment of a positive IP to CRC. In this framework, based on multiple sources and factors, the natural disparities formed the IPs of the partners of couples and determined the incongruence of IPs. The effects of IP incongruence on lives under the disease guided the three directions of coping approaches (i.e., information and available support, appropriate disclosure and reflection, and leaving the CRC diagnosis behind) which were adopted by couples dealing with CRC to share and restructure the IP with their spouses for effective dyadic coping. (4) Conclusions: This study provides insights to healthcare providers into the experiences of couples dealing with CRC and the development of couple-based IP intervention programs: (a) it initially provides adequate factual knowledge for enhancing beliefs in the ability to control illness, (b) encourages illness-centered conversations and disclosure regarding thoughts and emotions for promoting positive congruence of IP between the partners of couples dealing with a hard dilemma, and (c) guides couples to perceive positive changes and explore the illness's meaning. Understanding each theme of personalized IP and adopting effective IP coping approaches can help guide couples dealing with CRC to efficiently promote constructive IP and better health outcomes.

The effects of common-sense model interventions on cancer patients: A systematic review

BACKGROUND

From the time of new diagnosis to treatment, cancer patients experience a variety of health problems that can affect the patient's health outcomes. Individuals with cancer are being given increasing responsibility for the self-management of their health and illness. The self-regulating common-sense model (CSM) is effective in patients' disease management. This article briefly introduces the common-sense model intervention, in which patients with cancer are affected by these interventions, what they are about, and what effects they have.

METHODS

The authors systematically review evidence for the common-sense model of self-regulation for cancer using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Based on a comprehensive literature search, we searched the Cochrane Library, PsycINFO, Embase, PubMed, Medline, CINAHL, CNKI, and WanFang databases. The included studies underwent a quality assessment using the Effective Public Health Practice Project (EPHPP).

RESULTS

Eleven empirical studies illustrated the aspects of common-sense model interventions for cancer patients. It is concluded that common-sense model intervention has an effect on symptoms in cancer treatment, behavior, and quality of life, but more studies are needed to verify the use of common-sense model intervention to explore in patients with different cancers. The systematic review summarized a four-point paradigm about intervention content, including assessing the current situation, setting goals, having a disease education and psychological adjustment, and getting feedback for further response. However, the application of intervention requires specific analysis of patient behavior and outcomes.

CONCLUSION

Common-sense model interventions are beneficial for the self-management of cancer patients; however, more intervention studies are needed to specify the cognitive, emotional, and coping styles of people with a particular cancer.

The effects of illness perception on death anxiety and satisfaction with life in patients with advanced gastrointestinal cancer

OBJECTIVES

This study was conducted to determine the effects of illness perception on death anxiety and satisfaction with life in patients with advanced gastrointestinal cancer.

METHODS

This cross-sectional and correlational study was conducted with 125 patients with cancer who were admitted to the oncology clinic of a university hospital in the Central Anatolian Region of Turkey between March and December 2022 and who met the research criteria and accepted to participate in the study. The data were collected with "Patient descriptive information form," "Brief Illness Perception Questionnaire (BIPQ)," "Scale of Death Anxiety (SDA)," and "Satisfaction with Life Scale (SWLS)."

RESULTS

It was found that mean BIPQ score of the patients was 39.54 ± 12.82, the mean SDA score was 8.02 ± 3.16, and the mean SWLS score was 14.74 ± 5.19. BIPQ total score was found to affect SDA total score positively (β = .751) and SWLS total score negatively (β = - .591). SDA total score was found to affect SWLS total score negatively (β = -.216) (p < .05).

SIGNIFICANCE OF RESULTS

It was found that patients with advanced gastrointestinal cancer had moderate level of illness perception and life satisfaction, and high death anxiety. It was found that as illness perception of the patients increased, their death anxiety increased and satisfaction with life decreased. In addition, it was found that as the death anxiety of patients increased, their satisfaction with life decreased.

Return to work, work productivity loss and activity impairment in Chinese breast cancer survivors 12-month post-surgery: a longitudinal study

Introduction

Existing evidence of returning-to-work (RTW) after cancer comes predominately from Western settings, with none prospectively examined since the initial diagnostic phase. This study prospectively documents RTW-rate, time-to-RTW, work productivity loss, and activity impairment, within the first-year post-surgery among Chinese women with breast cancer (BCW) and identify potential causal co-variants.

Methods

This observational longitudinal study followed 371 Chinese BCW who were employed/self-employed at the time of diagnosis at 4-week post-surgery (baseline). RTW-status and time-to-RTW were assessed at baseline (T1), 4-month (T2), 6-month (T3), and 12-month (T4) post-baseline. WPAI work productivity loss and activity impairment were assessed at T4. Baseline covariates included demographics, medical-related factors, work satisfaction, perceived work demand, work condition, RTW self-efficacy, B-IPQ illness perception, COST financial well-being, EORTC QLQ-C30 and QLQ-BR23 physical and psychosocial functioning, and HADS psychological distress.

Results

A 68.2% RTW-rate (at 12-month post-surgery), prolonged delay in RTW (median = 183 days), and significant proportions of T4 work productivity loss (20%), and activity impairment (26%), were seen. BCW who were blue-collar workers with lower household income, poorer financial well-being, lower RTW self-efficacy, poorer job satisfaction, poorer illness perception, greater physical symptom distress, impaired physical functioning, and unfavorable work conditions were more likely to experience undesired work-related outcomes.

Discussion

Using a multifactorial approach, effective RTW interventions should focus on not only symptom management, but also to address psychosocial and work-environmental concerns. An organizational or policy level intervention involving a multidisciplinary team comprising nurses, psychologists, occupational health professionals, and relevant stakeholders in the workplace might be helpful in developing a tailored organizational policy promoting work-related outcomes in BCW.

Relationships between Anxiety, Depression, and Illness Perceptions in Lung and Breast Cancer Patients throughout the Cancer Continuum

Cancer is a devastating disease that has significant psychological and biological impacts. Generally, lung cancer primarily affects men while breast cancer primarily affects women. Thus, this study aimed to investigate the levels of anxiety and depression in patients with these prevalent cancer types, as well as their perceptions of the illness and any potential connections between them. The study included a total of 252 participants, consisting of 110 breast cancer patients, 112 lung cancer patients, and 30 healthy individuals as controls. The Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were administered to assess mood, while the Illness Perception Questionnaire (IPQ) was used to evaluate cancer perceptions. Results revealed that both breast cancer and lung cancer patients had significantly higher BDI and BAI scores compared to the control group. Furthermore, the BDI and BAI scores were lower in breast cancer patients compared to lung cancer patients. The IPQ causal representation-immunity score was significantly higher in lung cancer patients than in breast cancer patients (p = 0.01). Positive correlations were found between BDI scores and BAI scores, as well as between BDI scores and certain subscale scores of the IPQ related to illness representation and causal representation. Additionally, a positive correlation was observed between BAI scores and the IPQ illness representation-timeline acute/chronic subscale, while a negative correlation was found between BAI scores and the IPQ causal representation-accident or chance scores. Overall, the study findings demonstrated that breast and lung cancer patients possess negative perceptions of their disease and experience high levels of anxiety and depression. To enhance the quality of life and promote resilience in these patients, it is recommended to incorporate psychological interventions that consider anxiety, depression, and disease perception.

Use of complementary and alternative medicine for reducing fear of cancer recurrence among cancer survivors: Does it work?

Objective

Fear of cancer recurrence among cancer survivors is a psychosocial concern that affects recovery and quality of life. They use complementary and alternative medicine to prevent the side effects of drugs and relieve anxiety and fear of cancer recurrence. This study aimed to examine the correlation between the use of complementary and alternative medicine and the fear of cancer recurrence in cancer survivors.

Methods

This cross-sectional descriptive correlational study enrolled 280 cancer survivors referred to oncology centers and medical offices in Kerman using convenience sampling. The research tools included complementary and alternative medicine questionnaire and the fear of cancer recurrence inventory. IBM SPSS Statistics version 25 was used to analyze the data.

Results

The study findings revealed that 78.2% of the participants used at least one type of complementary and alternative medicine in the last year; 71.8% used medicinal herbs, 19.6% used nutritional supplements, 7.5% used relaxation and meditation, 7.1% used dry cupping, and 5.7% used wet cupping. The mean score of fear of cancer recurrence was 80.72 ​± ​18.46, which was almost near the midpoint of the inventory score (84). The fear of cancer recurrence and its dimensions did not differ between users and nonusers of complementary and alternative medicine.

Conclusions

Our results suggested that most of the survivors used at least one type of complementary and alternative medicine in the past year, and medicinal herbs and nutritional supplements were the most used types. Patients with cancer must be aware of the effects of different kinds of complementary and alternative medicine. A moderate level in the mean score of fear of cancer recurrence was found, and no difference was noted between users and nonusers of complementary and alternative medicine. Health managers and planners should conduct effective psychological interventions and strategies to minimize the fear of cancer recurrence among cancer survivors.

Anxiety in patients with gastrointestinal cancer undergoing primary surgery

PURPOSE

Anxiety in the perioperative period is not only an unpleasant emotional state, but can also negatively affect the outcomes and quality of life of surgical patients. The present study investigated anxiety in patients with gastrointestinal cancer scheduled for primary surgery.

METHODS

A total of 101 patients in four non-university surgical departments were included. Anxiety (GAD-7), depression (PHQ-9), distress (Distress thermometer), and illness perception (Brief IPQ) were assessed at four time points: first outpatient contact before surgery (t1), preoperative inpatient contact (t2), postoperative inpatient contact before hospital discharge (t3), and postoperative outpatient follow-up contact after 30 days (t4).

RESULTS

56% of patients had an episode of mild or moderate anxiety and 5% had an episode of severe anxiety and/or depression. Subjectively perceived anxiety and depression were highest at t1, followed by t3. 30% of patients had elevated anxiety and depression scores at t1. Regression analyses showed that high subjectively perceived mental distress at t1 was associated with higher anxiety scores at t3 and t4. Women, and younger women in particular, were significantly more likely to experience stress than men. Higher levels of subjectively perceived stress at t1 were associated with higher levels of anxiety at t3 and t4. Sociodemographic factors were not relevant predictors of anxiety.

CONCLUSION

Anxiety and depression appear to be a persistent problem during the perioperative course in patients with gastrointestinal tumors. Identifying patients at risk for clinically relevant anxiety and depression remains a particular challenge. The results confirm the relevance of repeated screening for mental distress.

Assessing the Effect of Cancer Diagnosis on Beliefs about Comorbid Diabetes

OBJECTIVES

Increasingly, patients diagnosed with cancer also live with chronic comorbidities, and it is important to understand the impact of a new cancer diagnosis on perceptions about preexisting conditions. This study assessed the effect of cancer diagnosis on beliefs about comorbid diabetes mellitus and assessed changes in beliefs about cancer and diabetes over time.

DATA SOURCES

We recruited 75 patients with type 2 diabetes who were newly diagnosed with early-stage breast, prostate, lung, or colorectal cancer and 104 age-, sex-, and hemoglobin A1c-matched controls. Participants completed the Brief Illness Perception Questionnaire four times over 12 months. The authors examined within-patient and between-group differences in cancer and diabetes beliefs at baseline and over time.

RESULTS

Overall, diabetes beliefs did not differ between cancer patients and controls at baseline. Cancer patients' beliefs about diabetes varied significantly over time; they reported less concern about cancer, less emotional effect, and greater cancer knowledge over time. Participants without cancer were significantly more likely to report that diabetes affected their life across all time points, though this effect did not persist after adjustment for sociodemographic variables.

CONCLUSION

While all patients' diabetes beliefs were similar at baseline and 12 months, cancer patients' beliefs about both illnesses fluctuated during the months following cancer diagnosis.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses can play a key role in recognizing the effects of cancer diagnosis on beliefs about comorbid conditions and fluctuations in these beliefs during treatment. Assessing and communicating patient beliefs between oncology and other practitioners could produce more effective care plans based on patients' current outlook on their health.

Factors related to preoperative uncertainty among patients with breast cancer in Wenzhou, China: A cross-sectional study

Background

One of the most prevalent psychological signs of breast cancer is uncertainty, which is more prevalent in Chinese patients during the preoperative period. Despite the numerous factors contributing to preoperative uncertainty, there is limited relevant research conducted in China.

Objective

This study aimed to describe the current state of preoperative uncertainty and to investigate the relationship between anxiety, illness perception, social support, and preoperative uncertainty in patients with breast cancer in Wenzhou, China.

Methods

This cross-sectional research used a simple random sampling technique to select 122 participants from a university hospital in Wenzhou, China, from July 2022 to December 2022, employing validated instruments. Descriptive statistics and Pearson's correlation coefficient were utilized to analyze the data.

Results

The average preoperative uncertainty scores of the patients fell within a moderate range (M = 61.92, SD = 7.51). Significant correlations were found between anxiety (r = 0.638, p <0.01), illness perception (r = 0.704, p <0.01), social support (r = -0.481, p <0.01), and preoperative uncertainty.

Conclusions

The results can assist healthcare professionals, especially nurses, in recognizing the factors contributing to uncertainty before surgery in patients with breast cancer. This knowledge enables them to promptly address and minimize this issue, leading to improved outcomes.

Return to Work and Work Productivity During the First Year After Cancer Treatment

Objectives

Working-age cancer patients face barriers to resuming work after treatment completion. Those resuming work contend with reduced productivity arising from persisting residual symptoms. Existing studies of return to work (RTW) after cancer diagnosis were done predominantly in Western countries. Given that employment and RTW in cancer survivors likely vary regionally due to healthcare provision and social security differences, we documented rates and correlates of RTW, work productivity, and activity impairment among Chinese cancer survivors in Hong Kong at one-year post-treatment.

Methods

Of 1,106 cancer patients assessed at six-months post-cancer treatment (baseline), 593 previously worked; detailed work status, psychological distress (HADS), physical symptom distress (MSAS-SF), supportive care needs (SCNS-SF34-C), health-related quality of life (SF12), and illness perception (B-IPQ) were assessed. Six months later (follow-up), work productivity and activity impairment were assessed (WPAI; n = 402). Descriptive analyses examined RTW rate. Fully adjusted regressions determined RTW, work productivity, and activity impairment predictors.

Results

At baseline, 39% (232/593) were working, 26% (153/593) on sick leave, and 35% (208/593) were unemployed. Compared to patients returning to work, unemployed participants were older, likely manual/service-oriented workers, and had lower family income, chemotherapy, fewer unmet health system and information needs, poorer physical functioning, and negative illness perceptions. Sick leave participants were likely service-oriented workers, who had head and neck cancer, chemotherapy, and poor physical functioning. At FU, baseline depressive symptoms, physical symptom distress, and negative illness perceptions predicted presenteeism and work productivity loss; gynecological cancer, fewer unmet health system and information needs, and greater unmet sexuality needs predicted absenteeism; physical symptom distress, negative illness perception, and poor physical functioning predicted activity impairment.

Conclusion

Cancer survivors who had more physically demanding jobs and poorer physical functioning delayed RTW. Unmanaged physical symptom and psychological distress hindered work productivity.

The mechanism of knowledge seeking and sharing behaviors influenced by individual cognition and motivation of online health community users in China

Abstract This study is to solve the problem of blocked help-seeking behavior and “hitchhiking” in patient user groups, to explore the mechanism of knowledge seeking and sharing behaviors influenced by individual cognition and motivation. The thesis integrates the ERG theory cognitive behavior factors then construct the theoretical model of cognition-motivation-behavior. The structural equation model of 390 valid data is analyzed. The results showed that: (1) Perceived ease of use has no effect on motivation and knowledge seeking, but only on knowledge sharing; (2) survival motivation, relationship motivation and growth motivation, all promote knowledge seeking, while only growth motivation promotes knowledge sharing; (3) perceived usefulness, perceived interpersonal trust and disease cognition have different effects on all these three motivations; (4) perceived usefulness, perceived interpersonal trust and disease cognition have direct effects on knowledge seeking, while perceived usefulness and perceived ease of use have direct effects on knowledge sharing; (5) the key factor to promote knowledge seeking is perceived usefulness, while the key factor to promote knowledge sharing is perceived ease of use; (6) survival motivation and growth motivation play an intermediary role between perceived usefulness, perceived interpersonal trust, disease cognition and knowledge seeking respectively, while only growth motivation plays an intermediary role between these three cognitive factors and knowledge sharing.

Causal Attributions in Breast Cancer Patients Planning to Undergo Adjuvant Endocrine Therapy

The aim of this study was to explore causal attributions among Korean breast cancer patients who were planning to undergo adjuvant endocrine therapy (AET) as well as the relationships between patient demographic and clinical characteristics and their causal attributions. Causal attributions were assessed with an open-ended response item, which asked patients to list what they thought were the three most important causal factors of their illness. The relationships between patient characteristics and causal attributions were determined through univariate analysis, and the relationships between causal attributions were obtained using social network analysis. A total of 299 participants provided 707 responses. Stress, diet, and exercise were believed to be the three most likely causes of breast cancer. There were no significant differences between causal attributions and the age, education level, marital status, or cancer stage of patients. However, there were differences in the associations between personality, genetics, and reproductive history and patient-identified causal attributions according to the patients' family history of cancer. Patients with a family history of cancer were more likely to believe that personality and genetics/family history were causes of breast cancer compared to patients without such a history. Therefore, it is necessary to educate patients to perceive stress and lifestyle-related factors as modifiable causal factors in order to have a positive effect on their adherence to AET.

Eliciting the Concept of Cancer in Nursing Students in Turkey: an Exploratory Metaphor Analysis

OBJECTIVES

Although there are promising studies on cancer treatment, it is still a frightening disease. For effective treatment, an integrative and positive perspective is required. Using the power of metaphors to facilitate understanding of complex and intangible ideas, this study aims to define cancer from the perspective of Turkish nursing students.

SAMPLE AND SETTING

This study was conducted with 166 nursing students at a nursing faculty in Turkey. It was a mixed method study using qualitative and quantitative methods.

METHODS AND VARIABLES

To capture the picture in a human mind of the complexity of feelings for cancer, writing a description and elicitation interviews were employed. Moreover, to reach ontological and epistemological level thoughts in the deepest layers of elicited metaphors, the data were analyzed in an analytical framework.

RESULTS

The study provides a conceptualization of "Cancer." The students produced 92 valid metaphors. The most commonly used metaphors were found to be 'death', 'war', 'a virus', 'a malady' and 'a spider'. It was found that the metaphors produced by the students on the concept of cancer generally used negative themes.

IMPLICATIONS FOR NURSING

This study provides a framework for understanding all aspects of the concept of cancer on the metaphor axis. It is believed that the results will provide an holistic approach toward the concept of cancer, especially in nursing education, and will increase awareness of this concept.

Effects of illness perceptions on health-related quality of life in patients with rheumatoid arthritis in China

Objectives

For patients with rheumatoid arthritis (RA) in China, little is known of how their illness perceptions affect their health-related quality of life (HRQoL). The present study investigated associations between specific illness perceptions due to RA and HRQoL features.

Methods

For 191 patients with RA, illness perceptions were measured using the Brief Illness Perceptions Questionnaire (BIPQ) comprising 8 domains. HRQoL was determined with the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Multivariate linear regression analyses were performed.

Results

The overall BIPQ of patients with RA was 49.09 ± 11.06. The highest and lowest scores were for concern (9.15 ± 1.81) and personal control (4.30 ± 2.52), respectively. Multivariate stepwise regression analyses showed that the overall BIPQ was significantly negatively associated with each HRQoL feature, and HRQoL total score (β = − 0.343, P < 0.001, 95% CI − 7.080 to − 4.077). Positive associations between BIPQ features and HRQoL included personal control (β = 0.119, P = 0.004, 95% CI 2.857–14.194) and treatment control (β = 0.084, P = 0.029, 95% CI 0.640–12.391). Negative associations with HRQoL were identity (β = − 0.105, P = 0.034, 95% CI − 13.159 to − 0.430) and emotional response (β = − 0.207, P < 0.001, 95% CI − 18.334 to − 6.811).

Conclusions

Patients with RA in China perceive their illness in ways that affect their HRQoL. These results suggest that strategies that target these perceptions may improve the quality of life of these patients.

Illness perceptions predict health practices and mental health following hematopoietic stem cell transplantation

OBJECTIVE

Beliefs about illness have been shown to shape health practices and coping efforts. The present study investigated illness perceptions among patients undergoing hematopoietic stem cell transplant (HSCT). We also examined the extent to which perceptions predicted health practices and mental health following transplant.

METHODS

Participants (N = 332) completed measures of illness perceptions (beliefs about cancer consequences and course, personal and treatment control over cancer, and understanding of one's cancer) prior to HSCT. Health practices (diet, physical activity, and alcohol use) and mental health (depression, anxiety, and psychological well-being) were assessed pre transplant and at 1, 3, 6, and 12 months post transplant.

RESULTS

On average, HSCT recipients felt they understood their cancer, viewed their cancer to be a chronic condition with severe consequences, and believed they had moderate personal control over their cancer but that medical treatment provided more control. Perceptions varied by transplant type. Mixed-effects linear regression models revealed that HSCT recipients who perceived the consequences of their cancer to be more serious experienced more depression and anxiety, less well-being, and ate a healthier diet, but were less physically active during the year following transplant. Those with greater personal and treatment control ate a healthier diet and reported greater well-being. Patients with a better understanding of their cancer also ate a healthier diet and reported less depression, less anxiety, and greater well-being.

CONCLUSIONS

Perceptions of cancer shape HSCT recipients' health practices and psychological well-being during the critical first year of recovery after transplant.

Evaluation of Illness Perception of Women with Breast Cancer in Turkey

Objective

The aim of this study is to examine the illness perceptions of women with breast cancer and possible relationships between these perceptions and descriptive characteristics such as sociodemographic and clinical characteristics in Turkey.

Materials and Methods

The study was conducted in compliance with correlational, descriptive research principles. Three hundred eighty women with breast cancer who were treated in various hospitals in seven regions of the country were included in the study. A sociodemographic and clinical characteristics form, and The Illness Perception Questionnaire were used for data collection.

Results

The mean age of the patients with breast cancer was 49.8±11.5, among them, 83.95% were married, 37.37% were at stage 2 breast cancer, and 67.11% experienced mastectomy. It was found that the patients perceived higher personal control over illness (20.88±4.76). The patients perceived most common risk factors as the cause of the illness (19.42±6.38). This study show that variety sociodemographic and clinical characteristics of the patients affected their perceptions of illness.

Conclusion

The meaning of illness from the perspective of patient with breast cancer should be assessed. The care, education and counselling programs should be planned according to the patient's illness perceptions.

Illness perceptions as predictors of psychological distress among head and neck cancer survivors: a longitudinal study

BACKGROUND

Leventhal's commonsense model implies illness perceptions influence illness outcomes. This study examined illness perceptions among head and neck cancer survivors, and whether these predicted subsequent psychological distress.

METHODS

A total of 124 survivors of head and neck cancer (87% nasopharyngeal carcinoma; NPC) completed measures of psychological distress (Hospital Anxiety and Depression Scale; HADS), illness perceptions (Brief Illness Perception Questionnaire; B-IPQ), dispositional optimism (revised Chinese version of the Life Orientation Test; C-LOT-R), and clinical and demographic data approximately12.9 months after diagnosis (T1). Six months later (T2) psychological distress (HADS) was again measured. Adjusted multivariate analyses tested whether illness perceptions predicted T2 HADS scores.

RESULTS

Illness perception dimensions were significantly intercorrelated (0.01-0.68), explaining 8.0% of anxiety and 4.8% of depression symptom variability at T2. After adjustment for T1 distress, illness identity (β = 0.270, P < .01) and sex identification as a woman (β = 0.275, P < .01) predicted T2 anxiety symptoms while illness identity (β = 0.195, P < .05), unemployment (β = 0.195, P < .05), and pessimism (β = -0.227, P < .01) predicted T2 depression symptoms.

CONCLUSION

Perceived illness identity predicted psychological distress, accounting for modest levels of distress variance. Unresolved symptoms may exacerbate distress.

Alexithymia and perception of illness in patients with cancer

This study aimed to determine how alexithymia affects the perception of illness in patients with cancer. This was a descriptive study conducted at the Atatürk University Health, Research and Practice Hospital and the Erzurum Regional Training and Research Hospital's Medical Oncology Clinic and Chemotherapy Unit. The study data were collected between July 2013 and January 2014. In total, data were collected from 283 patients with cancer. The data were collected using questionnaires enquiring about demographic and medical information: the IPQ and TAS-20. The study concluded that 50.5% of the participating patients had alexithymia. It was found that the alexithymic patients with cancer perceived the negative outcomes of their illness more strongly, and their negative feelings about the illness were more intense. This study suggests that further research should be carried out on alexithymia in patients with cancer and that their positive beliefs about the illness could be enhanced using psychosocial interventions.

Modifiable correlates of illness perceptions in adults with chronic somatic conditions: A systematic review

When individuals become ill, they want to understand and give meaning to their illness. The interpretation of this illness experience, or illness perception, is influenced by a range of individual, contextual, and cultural factors. Some of these factors may be modifiable by nursing interventions. The purpose of this systematic review was to investigate which modifiable factors were correlated with illness perceptions across studies of adults with different chronic somatic diseases. Using search terms tailored to each of four electronic databases, studies retrieved were reviewed by two independent evaluators, and each relevant article was assessed for methodological quality. Results were standardized by calculating correlation coefficients. Fifteen papers on illness perceptions in a variety of chronic diseases met the inclusion criteria. All used standardized measures of illness perceptions. We identified five groups of modifiable correlates of illness perceptions: illness-related factors, psychosocial factors, medication beliefs, information provision and satisfaction with information received, and quality of care. Our findings add to the knowledge of modifiable factors correlated with illness perceptions, including the importance of illness-related factors and psychosocial factors such as anxiety and depression. Knowledge of these correlates can facilitate understanding of patients' illness perceptions and might be useful in tailoring patient education programs.

Emotional distress and dysfunctional illness perception are associated with low mental and physical quality of life in Chinese breast cancer patients

Background

To evaluate the relationship between quality of life (QOL) and physical as well as psychological variables in Chinese breast cancer patients.

Methods

This multicenter cross-sectional study enrolled 254 Chinese breast cancer patients in different stages and treatment phases. They answered standard instruments assessing QOL (EORTC), somatic symptom severity (PHQ-15), depression (PHQ-9), anxiety (GAD-7), health-related anxiety (WI-7), illness perception (BIPQ), and sense of coherence (SOC-9). Canonical correlation was applied to identify the strongest correlates between the physical, emotional and social QOL scales and the physical and psychological variables.

Results

In our sample, a low global QOL was significantly associated with the following physical and psychological variables: symptom-related disability (Karnofsky Index) (r = .211, p < .01), somatic symptom severity (r = −.391, p < .001), depression (r = −.488, p < .001), anxiety (r = −.439, p < .001), health-related anxiety (r = −.398, p < .001), dysfunctional illness perception (r = −.411, p < .001), and sense of coherence (r = .371, p < .001). In the canonical correlation analysis, high somatic symptom severity, depression, anxiety, dysfunctional illness perception, and low sense of coherence showed the strongest correlations with low physical, emotional and social functioning. The first three significant canonical correlations between these two sets of variables were .78, .56, and .45.

Conclusions

QOL in Chinese breast cancer patients is strongly associated with psychological factors. Our results suggest that Chinese physicians and nurses should incorporate these factors into their care for women with breast cancer to improve patients’ QOL.

Illness perception is a strong parameter on anxiety and depression scores in early-stage breast cancer survivors: a single-center cross-sectional study of Turkish patients

BACKGROUND

Illness perception has been suggested to have a significant effect on anxiety and depression in cancer patients. In this cross-sectional study, we aimed to evaluate this on Turkish breast cancer patients with follow-up periods up to 12 years.

PATIENTS AND METHODS

A total of 225 patients (with 6 months to 12 years follow-up) were recruited in this cross-sectional study. The patients were divided into three groups of follow-up: 6 months-2 years, 2-5 years, and >5 years. Beck Depression Inventory, Beck Anxiety Inventory, Duke-University of North Carolina Functional Social Support Questionnaire, and Brief Illness Perception Questionnaire were used to assess the depression, anxiety, functional social support (FSS), and illness perception, respectively. Statistical significance of the associations was analyzed using Spearman correlation, Student's t, Mann-Whitney U, and ANOVA tests.

RESULTS

Rates of moderate-severe anxiety and depression scores were not correlated with follow-up period and disease stage, whereas all these parameters were associated significantly with FSS and age. Parameters of illness perception were also not correlated with follow-up period and stage of disease. However, illness perception scores were noticeably better with increments in FSS. Also, the parameters of illness perception were strongly associated with the depression/anxiety score.

CONCLUSION

Illness perception is an important determinant of the depression/anxiety score in Turkish breast cancer patients.

Psychometric assessment of the Chinese version of the brief illness perception questionnaire in breast cancer survivors

OBJECTIVE

The eight-item Brief Illness Perception Questionnaire (B-IPQ) supposedly evaluates cognitive and emotional representations of illness. This study examined the validity and reliability of a traditional Chinese version of the B-IPQ in Hong Kong Chinese breast cancer survivors.

METHODS

358 Chinese breast cancer survivors who had recently ended their primary treatment completed this B-IPQ Chinese version. Confirmatory factor analysis (CFA) tested the factor structure. The internal consistency, construct, predictive and convergent validities of the scale were assessed.

RESULTS

CFA revealed that the original three-factor (cognitive-emotional representations and illness comprehensibility) structure of the B-IPQ poorly fitted our sample. After deleting one item measuring illness coherence, seven-item gave an optimal two-factor (cognitive-emotional representations) structure for the B-IPQ (B-IPQ-7). Cronbach's alpha for the two subscales were 0.653 and 0.821, and for the overall seven-item scale of B-IPQ was 0.783. Correlations of illness perception and physical symptom distress, anxiety, depression and known-group comparison between different treatment status suggested acceptable construct validity. The association between baseline illness perception and psychological distress at 3-month follow up supported predictive validity.

CONCLUSIONS

B-IPQ-7 appears to be a moderately valid measure of illness perception in cancer population, potentially useful for assessing illness representations in Chinese women with breast cancer.

Factor Structure and Psychometric Properties of the Brief Illness Perception Questionnaire in Turkish Cancer Patients

OBJECTIVE

The main aim of this study was to investigate the factor structure and psychometric properties of the Brief Illness Perception Questionnaire (BIPQ) in Turkish cancer patients.

METHODS

This methodological study involved 135 cancer patients. Statistical methods included confirmatory or exploratory factor analysis and Cronbach alpha coefficients for internal consistency.

RESULTS

The values of fit indices are within the acceptable range. The alpha coefficients for emotional illness representations, cognitive illness representations, and total scale are 0.83, 0.80, and 0.85, respectively.

CONCLUSIONS

The results confirm the two-factor structure of the Turkish BIPQ and demonstrate its reliability and validity.