Patient competence in the context of cancer: its dimensions and their relationships with coping, coping self-efficacy, fear of progression, and depression

Changes in health-related quality of life, depression, and fear of progression during oncological inpatient rehabilitation and beyond: a longitudinal study

PURPOSE

Studies evaluating oncological inpatient rehabilitation rarely include follow-up intervals beyond 6 months and larger proportions of patients other than those with breast cancer. Therefore, this study investigated changes in health-related quality of life (HRQoL), depression, and fear of progression of patients with breast, colorectal, or prostate cancer from the beginning to the end of oncological rehabilitation and a 9-month follow-up.

METHODS

Three hundred seventy-seven patients with breast, colorectal, or prostate cancer undergoing oncological inpatient rehabilitation (median age 61 years, 49% female) completed the EORTC QLQ-C30, the PHQ-9, and the FoP-Q-SF at each measurement point. Data analysis used 3 (tumor site) × 3 (time of measurement) repeated measures ANCOVAs with patient age and time since diagnosis as covariates. At each time point, we also compared our sample to the general population on the measures used.

RESULTS

Having controlled for the covariates, we found significant effects of tumor site, which were small except for Diarrhea. Effects of time of measurement were often significant and in part at least medium in size indicating improvement of HRQoL and depression during rehabilitation. At follow-up, some HRQoL domains and depression deteriorated. Women with breast cancer, in particular, showed a greater decrease in emotional functioning then. Compared to the general population, the sample's HRQoL and depression were significantly worse on most occasions.

CONCLUSION

Oncological inpatient rehabilitation may improve HRQoL. The subsequent and in part differential deterioration in some HRQoL domains suggests a need for further follow-up care within survivorship programs.

Identifying associations between sample characteristics, symptoms, and self-efficacy differences in adult patients with rare tumors of the central nervous system who participated in a novel web-based natural history study

OBJECTIVE

High self-efficacy is associated with improved self-care and reduced symptoms in cancer patients but has not been fully interrogated in adults with central nervous system (CNS) cancers. We aimed to identify the relationship between self-efficacy levels in managing emotions (SEMEM) and social interactions (SEMSI) by examining sample characteristics and symptom burden.

METHODS

Sample characteristics and patient-reported outcome (PRO) measures addressing self-efficacy (PROMIS SEMEM & SEMSI) and symptom burden (MDASI BT or SP) were collected in a novel web-based study of 158 adult patients diagnosed with rare CNS tumors.

RESULTS

The sample was predominantly female (73%), diagnosed with an ependymoma (66%), and had a median age of 45 (19-75). Low SEMEM was associated with a longer duration of symptoms before surgery (r = -0.26) and female gender (92%) among brain tumor (BT) participants and in spinal cord tumors (SCT), those with lower education (r = 0.29). Reporting low SEMSI was associated with being married (42%), lower education (r = 0.22), and a prolonged time with symptoms before surgery (r = 0.29) in those with BTs, with no associations identified in SCT. More severe mood-related interference (including mood, enjoyment of life, and relationship with others) was associated with lower SEMEM among both locations (r = -0.61 brain, r = -0.28 spine) and SEMSI in BT participants (r = -0.54).

CONCLUSIONS

Low self-efficacy was linked to a prolonged time between symptom onset and initial surgery, education, gender, and marital status and was associated with higher mood-related interference. Understanding characteristics associated with low self-efficacy underscores a need for future studies to tailor interventions that enhance self-efficacy.

The association between fear of progression and medical coping strategies among people living with HIV: a cross-sectional study

BACKGROUND

Due to the chronic nature of HIV, mental health has become a critical concern in people living with HIV (PLWHIV). However, little knowledge exists about the association between fear of progression (FoP) and medical coping modes (MCMs) in PLWHIV in China.

METHODS

A cohort of 303 PLWHIV were consecutively enrolled and their demographic, clinical and psychological information was collected. The Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Social Support Rating Scale (SSRS), Internalized HIV Stigma Scale (IHSS) and MCMs Questionnaire were utilized.

RESULTS

Of the participants, 215 PLWHIV were classified into the low-level FoP group, and 88 were grouped into the high-level FoP group based on their FoP-Q-SF scores, according to the criteria for the classification of dysfunctional FoP in cancer patients. The high-level group had a higher proportion of acquired immunodeficiency syndrome (AIDS) stage (P = 0.005), lower education levels (P = 0.027) and lower income levels (P = 0.031). Additionally, the high-level group had lower scores in social support (P < 0.001) and its three dimensions, with total SSRS scores showing a negative correlation with two dimensions of FoP-Q-SF, namely physical health (r2 = 0.0409, P < 0.001) and social family (r2 = 0.0422, P < 0.001). Further, the high-level group had higher scores in four dimensions of internalized HIV stigma, and a positive relationship was found to exist between IHSS scores and FoP-Q-SF scores for physical health (r2 = 0.0960, P < 0.001) and social family (r2 = 0.0719, P < 0.001). Social support (OR = 0.929, P = 0.001), being at the AIDS stage (OR = 3.795, P = 0.001), and internalized HIV stigma (OR = 1.028, P < 0.001) were independent factors for FoP. Furthermore, intended MCMs were evaluated. FoP were positively correlated with avoidance scores (r2 = 0.0886, P < 0.001) and was validated as the only factor for the mode of confrontation (OR = 0.944, P = 0.001) and avoidance (OR = 1.059, P = 0.001) in multivariate analysis.

CONCLUSION

The incidence of dysfunctional FoP in our study population was relatively high. High-level FoP was associated with poor social support, high-level internalized HIV stigma and a negative MCM among PLWHIV.

Social Support and Life Satisfaction in Women With Cervical Cancer: A Serial Multiple Mediation Model

BACKGROUND

Although the number of studies focusing on life satisfaction in women with cervical cancer is increasing, there are limited studies on the pathway between social support and life satisfaction in this population.

OBJECTIVE

This study explored the pathway between social support and life satisfaction in women with cervical cancer by examining the serial mediating effects of self-care self-efficacy, coping strategies, and depressive symptoms.

METHODS

In this cross-sectional study, a total of 292 women with cervical cancer completed a questionnaire for assessing social support, self-efficacy, coping strategies, depressive symptoms, and life satisfaction. Structural equation modeling was used to test the direct and/or indirect effects of the variables on life satisfaction.

RESULTS

Structural equation modeling analysis indicated that self-efficacy, coping strategies, and depressive symptoms mediates the effect of social support on life satisfaction. Direct paths from social support to life satisfaction, social support to self-efficacy, self-efficacy to coping strategies, coping strategies to depressive symptoms, and depressive symptoms to life satisfaction were significant ( P < .05). Moreover, indirect paths from social support to life satisfaction, self-efficacy to life satisfaction, and coping strategies to life satisfaction were also significant ( P < .05).

CONCLUSIONS

Self-care self-efficacy, coping strategies, and depressive symptoms are potential pathways through which social support may affect life satisfaction in women with cervical cancer.

IMPLICATION

Healthcare providers, family, and friends should offer more social support to the patients and make efforts to strengthen their self-care self-efficacy, facilitate active coping, and alleviate depressive symptoms to improve women's life satisfaction.

The mutual determination of self-efficacy to cope with cancer and cancer-related coping over time: a prospective study in women with breast cancer

OBJECTIVE

The aim of this study was to examine the longitudinal impact of self-efficacy to cope with cancer on the cancer-related coping reactions of breast cancer patients and vice versa.

DESIGN AND MAIN OUTCOMES MEASURES

Data from the BOUNCE Project (https://www.bounce-project.eu/) were used to address the hypotheses. Participants (N = 403) were enrolled in the study a few weeks after surgery or biopsy. Coping self-efficacy was assessed at baseline and six months later (M6). Cancer-related coping was assessed three (M3) and nine months (M9) after baseline. The analyses were performed using structural equation modeling with Mplus 8.6.

RESULTS

Baseline coping self-efficacy predicted all M3 coping reactions, while M6 coping self-efficacy also predicted changes in all but one M9 coping reaction. Moreover, one of the M3 coping reactions, that is, hopelessness/helplessness, predicted the changes in M6 coping self-efficacy. The relation between coping self-efficacy and one coping reaction (i.e. cognitive avoidance) was rather weak. Stability paths from M3 to M9 coping reactions were moderate to high.

CONCLUSION

The relationship between self-efficacy to cope with cancer and cancer-related coping is complex. New theoretical models are needed to more accurately describe the diverse aspects of this association.

Fear, Anxiety, and Coping Self-efficacy of Individuals With Cancer During COVID-19 and Predictive Risk Factors: A Descriptive and Correlational Study

OBJECTIVES

In this study, we determined COVID-19-related fear, anxiety, and coping self-efficacy in individuals with cancer and predicted the risk factors of these parameters.

DATA SOURCES

A descriptive and correlational study was conducted in a single cancer center with 396 individuals. The data were collected using the Participant Information Form, the Fear of Coronavirus Scale, the Coronavirus Anxiety Scale, and the Cancer Behavior Inventory Short Form. Approximately 94% of individuals had received the COVID-19 vaccine. The boosting effect of the vaccination on self-confidence (β = 0.209), duration of diagnosis (β = 0.219), and perception of mental health (β = 0.284) was associated with fear of COVID-19. Smoking (β = 0.116), vaccination dose (β = 0.139), disease stage (β = 0.101), perception of physical health (β = -0.262), and perception of mental health (β = -0.112) were associated with coping self-efficacy.

CONCLUSION

We found that most individuals did not have anxiety, had a moderate level of fear, and their coping self-efficacy was satisfactory.

IMPLICATIONS FOR NURSING PRACTICE

The perception of mental health was the common risk factor for fear and coping self-efficacy. Health professionals should be aware of the psychological problems experienced by individuals with cancer, and they should adopt strategies that can increase self-efficacy in coping.

Cancer survival stories: Perception, creation, and potential use case

BACKGROUND

Cancer patients often search for information about their health conditions online. Cancer patient narratives have established themselves as a way of providing information and education but also as an effective approach to improving coping with the disease.

OBJECTIVE

We investigated how people affected by cancer perceive cancer patient narratives and whether such stories can potentially improve coping during their own cancer journeys. Additionally, we reflected on whether our co-creative citizen science approach can contribute to gaining knowledge about cancer survival stories and providing peer support.

DESIGN, SETTING AND STAKEHOLDERS

We applied a co-creative citizen science approach by using quantitative and qualitative research methods with stakeholders (i.e., cancer patients, their relatives, friends and health professionals).

MAIN OUTCOME MEASURES

Understandability and perceived benefits of cancer survival stories, coping, emotional reactions to the stories and helpful characteristics of the stories.

RESULTS

Cancer survival stories were considered intelligible and beneficial, and they potentially support positive emotions and coping in people affected by cancer. Together with the stakeholders, we identified four main characteristics that evoked positive emotions and that were considered especially helpful: (1) positive attitudes towards life, (2) encouraging cancer journeys, (3) individual coping strategies for everyday challenges and (4) openly shared vulnerabilities.

CONCLUSIONS

Cancer survival stories potentially support positive emotions and coping in people affected by cancer. A citizen science approach is suitable for identifying relevant characteristics of cancer survival stories and may become a helpful educational peer support resource for people coping with cancer.

PATIENT OR PUBLIC CONTRIBUTIONS

We adopted a co-creative citizen science approach, wherein citizens and researchers were equally involved throughout the entire project.

Evaluating Work Impairment as a Source of Financial Toxicity in Cancer Healthcare and Negative Impacts on Health Status

How the socioeconomic factors intersect for a particular patient can determine their susceptibility to financial toxicity, what costs they will encounter during treatment, the type and quality of their care, and the potential work impairments they face. The primary goal of this study was to evaluate financial factors leading to worsening health outcomes by the cancer subtype. A logistic model predicting worsening health outcomes while assessing the most influential economic factors was constructed by the University of Michigan Health and Retirement Study. A forward stepwise regression procedure was implemented to identify the social risk factors that impact health status. Stepwise regression was done on data subsets based on the cancer types of lung, breast, prostate, and colon cancer to determine whether significant predictors of worsening health status were different or the same across cancer types. Independent covariate analysis was also conducted to cross-validate our model. On the basis of the model fit statistics, the two-factor model has the best fit, that is, the lowest AIC among potential models of 3270.56, percent concordance of 64.7, and a C-statistics of 0.65. The two-factor model used work impairment and out-of-pocket costs, significantly contributing to worsening health outcomes. Covariate analysis demonstrated that younger patients with cancer experienced more financial burdens leading to worsening health outcomes than elderly patients aged 65 years and above. Work impairment and high out-of-pocket costs were significantly associated with worsening health outcomes among cancer patients. Matching the participants who need the most financial help with appropriate resources is essential to mitigate the financial burden.

Significance

Among patients with cancer, work impairment and out-of-pocket are the two primary factors contributing to adverse health outcomes. Women, African American or other races, the Hispanic population, and younger individuals have encountered higher work impairment and out-of-pocket costs due to cancer than their counterparts.

Couples coping with advanced prostate cancer: an explorative study on decision-making preferences, self-efficacy and fear of progression

PURPOSE

To date, there is a lack of understanding of the treatment/disease-related health behaviors of patients with advanced prostate cancer (PCa) and their spouses. The purpose of this study was to explore the characteristics of treatment decision-making (DM) preferences, general self-efficacy (SE) and fear of progression (FoP) among couples coping with advanced PCa.

METHODS

In this explorative study, 96 patients with advanced PCa and their spouses answered the multiple choice version of the Control Preferences Scale (CPS, regarding DM), General Self-Efficacy Short Scale (ASKU, regarding SE), and short form of the Fear of Progression Questionnaire (FoP-Q-SF, regarding FoP). Corresponding questionnaires were employed for patients' spouses were evaluated, and correlations were subsequently drawn.

RESULTS

More than half of the patients (61%) and spouses (62%) preferred active DM. Collaborative DM was preferred by 25% of patients and 32% of spouses, and 14% of patients and 5% of spouses preferred passive DM. FoP was significantly higher among spouses than among patients (p < 0.001). The difference in SE was not significant between patients and spouses (p = 0.064). FoP and SE negatively correlated among patients (r = - 0.42; p < 0.001) and among spouses (r = - 0.46; p < 0.001). DM preference did not correlate with SE and FoP.

CONCLUSIONS

High FoP and low general SE are related among both patients with advanced PCa and their spouses. FoP seems to be higher among female spouses than among patients. Couples seem to be largely in agreement when it comes to playing an active role in treatment DM.

TRIAL REGISTRATION

www.germanctr.de , number DRKS 00013045.

Patientenkompetenz zur Krankheitsbewältigung – eine qualitative Analyse bei Frauen mit Brustkrebs und gynäkologischen Tumoren

Ziel Die Studie exploriert Herausforderungen, persönliche Kompetenzen und hilfreiche Unterstützung bei der Krankheitsbewältigung von Patienteninnen mit Brustkrebs und gynäkologischen Tumoren und wie die Patientenkompetenz als Zusammenspiel dieser Faktoren gefördert werden kann.

Methodik Teilstrukturierte Leitfadeninterviews wurden mit 19 Patientinnen im Akutsetting, 20 Rehabilitandinnen und 16 Teilnehmerinnen einer Selbsthilfegruppe geführt und mittels qualitativer Inhaltsanalyse ausgewertet.

Ergebnisse Die thematisierten Herausforderungen sind in die Hauptkategorien – Diagnoseverarbeitung, Behandlungs-/Rezidivängste, Krankheitsverarbeitung und Adaptation, Sorgen um Angehörige, Reaktionen des sozialen Umfeldes, Sorgen um den Arbeitsplatz – zusammengefasst. Die benannten persönlichen Kompetenzen im Umgang mit diesen Herausforderungen sind den folgenden Hauptkategorien zugeordnet: kognitionsbezogenes Coping, handlungsbezogenes Coping, Selbstregulation Krankheitsverarbeitung, Unterstützung einholen und annehmen, selbstbestimmte Kommunikation der Erkrankung, hilfreiche Strategien identifizieren und anwenden, krankheitsbezogene Erfahrung, günstige Lebensumstände, Offenheit für Hilfsangebote. Hilfreiche emotionale, informationelle oder instrumentelle Unterstützung wird durch Angehörige, Freunde, Tiere, Arbeitskollegen/Arbeitgeber, Behandler, Rehabilitation, Mitpatientinnen/Betroffene, Selbsthilfe und Beratungseinrichtungen wahrgenommen.

Diskussion Die Frauen beschreiben eine Vielzahl an persönlichen Kompetenzen, die einem bedürfnisorientierten, selbstgesteuerten Bewältigungsprozess entsprechen. Die Individualität und Komplexität des Zusammenspiels der Komponenten der Patientenkompetenz unterstreicht die Relevanz von patientenorientierter Versorgung. Empowerment und eine aktive Patientenrolle sind erforderlich, um bedürfnisbezogen Bewältigungsfertigkeiten zu fördern. Unterstützung durch Behandler oder das private Umfeld kann dabei Herausforderungen vermindern oder Kompetenzen und deren Anwendung fördern.

Influence of Social Workers' Empathy Ability on Suicidal Ideation of Cancer Patients

Background

The nursing goal of patients with cancer is to provide them with holistic care, including physical, psychological, and social adaptation, and spirituality. This research aimed to explore the influence of the social workers' empathy ability on suicidal ideation of patients with cancer and its path.

Methods

There was a sum of 358 patients with cancer and the 45 social workers serving them participated in the survey. Data of their self-efficacy, depression symptom, stigma, and suicidal ideation were measured before the social work provided (T1) and 3 months after the social work finished (T2) were collected and compared. Pearson correlation analysis was used to assess the relationships between social workers' empathy ability and patient indicators at T2. The influence path of social workers' empathy ability on cancer patients' suicidal ideation was explored by path analysis at T2.

Results

At T2, patients reported higher self-efficacy and lower depression symptoms, stigma, and suicidal ideation than at T1. At T2, social workers' empathy ability was positively related to patients' self-efficacy and was negatively related to depression symptoms, stigma, and suicidal ideation. Social workers' empathy ability affected patients' suicidal ideation directly. In addition, patients' self-efficacy, depression symptoms, and stigma played mediating roles in the influence of social workers' empathy abilities on their suicidal ideation.

Conclusion

Social workers' empathy ability not only directly affected cancer patients' suicide ideation but also affected suicide ideation through the mediating roles of self-efficacy, depression symptoms, and stigma. Therefore, the improvement of the empathy ability of medical social workers needs to be paid attention to.

Predicting Innovative Work Behaviour in an Interactive Mechanism

The purpose of this paper is to investigate the impacts of employees’ creative self-efficacy (CSE) and creative self-identity (CSI) on their innovative work behaviour (IWB), with the indirect effects of creative process engagement (CPE) and creative climate (CC). Following the deductive reasoning approach, the study was conducted on IT-based firms in Bangladesh. A total of 348 surveys were collected using a multi-item questionnaire. The collected data were then analyzed using structural equation modeling (SEM). The study reveals a significant relationship between CSE and IWB, and CSI and IWB. It further explores the significant mediating effects of CPE and the moderating effects of CC on CSE and IWB, and CSI and IB, relationships. Based on the premise of interactionist perspectives on creativity, this study contributes to the literature proposing a distinctive model comprising five variables to investigate employees’ IWB from a multi-level perspective. This integrated model, using predictors from multiple levels, supports the theoretical assumption that IB results from employees’ CSE, CSI, and, finally, CPE. Distinct from the other literature, the study also portrays the moderating and mediating impact of CC and CPE simultaneously.

Patient competencies, coping self-efficacy, and coping: Do they change during oncological inpatient rehabilitation and beyond?

OBJECTIVE

The construct of Patient Competencies (PCs) has been suggested to allow a more comprehensive understanding of cancer patients' abilities to confront emotion- and problem-focused coping tasks arising from the diagnosis, treatment and survivorship of cancer. While providing a reliable and valid measure of PCs, research thus far has not clarified whether PCs change across time and/or through intervention. This study asks whether PCs change during oncological inpatient rehabilitation and beyond.

METHODS

N = 377 breast, colorectal, and prostate cancer patients from clinics for oncological rehabilitation were included to complete self-report measures of PC, coping and self-efficacy for coping with cancer at the beginning and the end of rehabilitation and 9 months afterward. In order to determine differences between tumor diagnostic groups and changes across time 3 (tumor site) x 3 (time) repeated measures analyses of variance were computed.

RESULTS

Tumor diagnostic groups differed only marginally in PCs, coping self-efficacy and coping. The PCs of self-regulation and managing distress and coping self-efficacy improved slightly during rehabilitation but returned to initial levels at 9 months. Differential improvement was evident in the competencies of seeking information and interest in social services. Two of five coping behaviors decreased markedly from the end of rehabilitation to follow-up.

CONCLUSIONS

This study suggests that oncological inpatient rehabilitation may contribute to advancing PCs, albeit to a limited extent. Aside from addressing conceptual, diagnostic and measurement issues, future research should clarify which interventions may be most effective for advancing problem- and emotion-focused PCs.

Cognitive, emotional, and behavioral mediators of the impact of coping self-efficacy on adaptation to breast cancer: An international prospective study

OBJECTIVE

The main objective of this prospective multicenter study was to examine whether illness representations of control, affect, and coping behaviors mediate the effects of self-efficacy to cope with cancer on psychological symptoms and overall quality of life, in breast cancer patients.

METHOD

Data from 413 women (Mean age = 54.87; SD = 8.01), coming from four countries (i.e., Finland, Israel, Italy, Portugal), who received medical therapy for their early breast cancer, were analyzed. Coping self-efficacy was assessed at baseline. Potential mediators were assessed three months later, and outcomes after six months.

RESULTS

Coping self-efficacy was related to all mediators and outcomes. Illness representations of treatment control, positive and negative affect, and certain coping behaviors (mostly, anxiety preoccupation) mediated the effects of coping self-efficacy. Coping self-efficacy was related to each outcome through a different combination of mediators.

CONCLUSIONS

Coping self-efficacy is a major self-regulation factor which is linked to well-being through multiple cognitive, emotional, and behavioral pathways. Enhancement of coping self-efficacy should be a central intervention goal for patients with breast cancer, towards promotion of their well-being.

Transfer of the presence seminar concept "Peer-support and Patient Competence" with participation of patients sharing their experience into a virtual teaching format

Background: In the innovative seminar "Peer-support and Patient Competence", which was conceived as a face to face course, we teach various concepts of patient competence and invite patients to report about their illness experience and peer-group activities. Method: Implementation of a face to face course into a virtual format via video conference. Result: Despite concerns regarding the sensitive topic and technical challenges, the conversion of the seminar with interactive character, which was originally designed in a face-to-face format, into a virtual one was successful. Both lecturers and participants experienced the seminar as satisfactory. Conclusion: In times of Covid-19, this virtual course experience can encourage colleagues to restructure their face to face seminars into innovative and virtual teaching formats.