Effects of interventions on rumination among individuals with cancer: A systematic review and meta-analysis

Individual Rumination in Adult Cancer Care: A Concept Analysis

OBJECTIVE

To conceptualize rumination in adult cancer care.

METHODS

Walker and Avant's concept analysis method was used to examine rumination in adults with cancer. A systematic search was conducted across psychology, nursing, medicine, and public health disciplines in PsycINFO, PubMed, Web of Science, CINAHL, and Scopus databases from their inception to April 2024. Additional records were identified by manually searching reference lists of relevant studies.

RESULTS

Analysis of 50 articles identified rumination's three defining attributes (intrusions, brooding, instrumentality), antecedents (cancer-related adversity, pre-existing susceptibilities), and consequences (psychophysiological functioning impairments, long-term adaptation). Key features included trait-state duality, internal variability, external cyclicality, and high emotional correlation.

CONCLUSIONS

This concept analysis establishes a preliminary conceptual model of rumination in adult cancer care, integrating its attributes, antecedents, and consequences. The model offers insights into rumination mechanisms, highlighting its complexity and variability, and may inform the development of targeted interventions and theoretical development for cancer population. Further research is needed to validate the model and explore its clinical applications.

IMPLICATIONS FOR NURSING PRACTICE

Understanding rumination in adult cancer care helps nurses identify and support at-risk patients. By recognizing key signs, nurses can implement targeted interventions to improve patients' emotional and psychological well-being, ultimately enhancing their long-term adaptation and quality of life.

Serial Cascade Effects of Relative Deprivation and Anger Rumination on the Development of Social Aggression Over 2.5 Years in Emerging Adults

Although the mechanisms of development of aggression have been focused on day by day, the complicated effects of distal and proximal factors on the development of social aggression in emerging adults have not been uncovered. A serial cascade model of aggression was proposed to address this issue. A longitudinal investigation over 2.5 years was conducted to test this model by exploring the serial cascade effects of relative deprivation (a representative of distal factors) and anger rumination (a representative of proximal factors) on the development of social aggression. A total of 1113 Chinese university students (Mage = 18.95 ± 0.96, 63.10% female) from six universities in five areas participated in this study. The results suggest that developmental trajectories and longitudinal changes in anger rumination mediate the relationship between developmental trajectories and longitudinal changes in relative deprivation and social aggression, and developmental trajectories and changes in relative deprivation mediate the longitudinal relationship between anger rumination and social aggression. These findings support the serial cascade effects of distal and proximal factors on the development of aggression and expand upon the general aggression model (GAM).

Latent Profiles of Fear of Cancer Recurrence and Associations with Physical and Mental Health Outcomes

BACKGROUND

Fear of cancer recurrence (FCR) is a multidimensional construct; however, few studies have meaningfully integrated FCR severity (i.e., level of fear) with FCR-related concepts (e.g., triggers).

PURPOSE

The present study determined (a) latent profiles of FCR; (b) socio-demographic variations between identified profiles; (c) interactions between identified profiles and resilience and rumination on chronic physical disorders, depressive/anxiety symptoms, and quality of life.

METHODS

The present study is a secondary data analysis of which 404 cancer survivors were included in this study. All participants completed the Fear of Cancer Recurrence Inventory and measures of resilience, rumination, depressive/anxiety symptoms, and quality of life.

RESULTS

Latent profile analysis identified three distinct profiles based on varying levels of FCR and FCR-related concepts; Profile 1 "Low FCR" (n = 108; 26.4%), Profile 2 "Moderate FCR, High coping" (n = 197; 49.4%), and Profile 3 "High FCR, distress and impairment" (n = 99; 24.3%). Profile 3 was associated with younger age and history of radiotherapy. Latent profiles of FCR significantly interacted with resilience and rumination on depressive/anxiety symptoms.

CONCLUSIONS

Latent profile analysis integrates FCR severity and FCR-related concepts to support a nuanced understanding of FCR. Our results suggest specific points of intervention, which extend beyond addressing FCR severity.

The effectiveness of mindfulness-based interventions for ruminative thinking: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

To systematically evaluate the effectiveness of mindfulness-based interventions for ruminative thinking.

METHODS

Cochrane Library, Web of Science, Embase, EBSCO, PubMed and Science Direct databases were searched to include randomized controlled trials of mindfulness-based interventions for rumination that met the criteria. The Rumination scale was used as the primary outcome indicator, and the secondary outcome indicator included the Mindfulness scale. An evaluation of bias risk was conducted to identify possible sources of bias based on methodological and clinical factors. Stata 16.0 software was used to perform meta-analysis, subgroup analysis, sensitivity analysis, meta-regression analysis and publication bias detection of the extracted data.

RESULTS

A total of 61 studies with 4229 patients were included. Meta-analysis results revealed a significant intervention effect on ruminative thinking (SMD = -0.534, 95 % CI = [-0.675, -0.394], z = -7.449, P < 0.001). However, there was no significant difference between mindfulness-based interventions and CBT (SMD = 0.009, 95%CI = [-0.239, 0.258], z = 0.073, P = 0.941). Meta-analysis showed that mindfulness-based interventions significantly enhanced the level of mindfulness (SMD = 0.495, 95 % CI = [0.343, 0.647], z = 6.388, P < 0.001), while it was not significant compared to CBT (SMD = 0.158, 95%CI = [-0.087, 0.403], z = 1.266, P = 0.205). The two subgroups with >65 % (SMD = -0.534, 95%CI = [-0.681, -0.386], z = -7.081, P < 0.001) and 80 % (SMD = -0.462, 95%CI = [-0.590, -0.334], z = -7.071, P < 0.001) of females showed significant improvement in ruminative thinking. There were significant intervention effects for depression, students, cancer, healthy adults, and clinical patients. Significant intervention effects were demonstrated for various participant ages and intervention periods.

CONCLUSION

This study confirmed the feasibility of mindfulness-based interventions in improving ruminative thinking and enhancing the level of mindfulness. However, the effectiveness of mindfulness-based interventions was not significant compared to CBT. The two subgroups with a higher proportion of females showed a more significant improvement in ruminative thinking, whereas there were no significant differences in participant characteristics, age, and the duration of intervention.

Covid-19-related ruminations: A qualitative study based on the perspectives of the cancer survivors

Cancer survivors can develop repetitive ruminations due to the unexpected and challenging effects of Covid-19. This qualitative descriptive design study aimed to comprehend the Covid-19-related ruminations from the subjective perspective of cancer survivors (n = 33), accessed via online Facebook self-help groups of a cancer association. A semi-structured interview guide was used for data collection followed by systematic analysis. Based on the descriptive analysis of the data, three main themes emerged-"Welcome to my life," "Cancer versus Covid-19," and "Fight versus lose"-based on cancer survivors' experience and having two subthemes each. The findings suggested that cancer survivors have many ruminations about cancer and the pandemic. Their ruminations were mainly concerned with the possibility of suffering from cancer again and catching Covid-19. Nonetheless, participants also had positive cognitions that they could overcome the pandemic as they have previously beat cancer. The findings may also offer a promising resource for nurses to understand the ruminations of cancer survivors and develop novel approaches and interventions to help cancer survivors replace their intrusive ruminations with deliberate ones.