The effects of physical symptoms, self-efficacy and social constraints on fear of cancer recurrence in breast cancer survivors: Examining the mediating role of illness representations

OBJECTIVE

Fear of cancer recurrence (FCR) is common in breast cancer survivors (BCS). This study examined the mediating role of illness representations in the relationships between FCR and physical symptoms, social constraint and self-care self-efficacy.

METHODS

In this cross-sectional study, 385 women with breast cancer completed a series of questionnaires including the FCR Inventory, Social Constraints Scale-15, Cancer Survivors Self-Efficacy Scale, Illness Perception Questionnaire-Revised and European Organization for Research and Treatment Quality of Life Questionnaire-Breast Cancer. Structural equation modelling method was conduct by using a bootstrapping method.

RESULTS

Physical symptoms (β = 0.272, p < 0.01), social constraints (β = 0.130, p < 0.01), self-efficacy (β = -0.233, p < 0.01) and illness representation (β = 0.261, p < 0.01) have direct effects on FCR. The indirect effects of physical symptoms (β = 0.10, p < 0.01), social constraints (β = 0.076, p < 0.01) and self-efficacy (β = -0.025, p < 0.05) on FCR were partially mediated by illness representations.

CONCLUSIONS

In this study, the effects of physical symptoms, social constraints and self-efficacy on FCR were found to be mediated by illness representation. Reducing the impact of negative illness representations on FCR by reducing physical symptoms, increasing self-efficacy, and promoting open disclosure of cancer-related concerns may be effective in reducing FCR in BCS.

The influence of social constraints on the quality of life of hematopoietic stem cell transplantation survivors: The chain mediating effect of illness perceptions and the fear of cancer recurrence

Objective

This cross-sectional correlational study aims to explore the relationship between social constraints and the quality of life of hematopoietic stem cell transplantation (HCT) survivors. Additionally, we also seek to demonstrate the chain mediating effect of illness perceptions and the fear of cancer recurrence on this relationship.

Methods

Convenience sampling was employed in this study. A total of 232 HCT survivors were interviewed using the Social Constraints Scale, the Brief Illness Perception Questionnaire, the Fear of Cancer Recurrence Inventory (Short Form) and the Functional Assessment of Cancer Therapy-Bone Marrow Transplant. IBM SPSS 24.0 were used for data analyses, and PROCESS macro (Model 6) was used to examine the hypothesized chain mediation model.

Results

A positive relationship between social constraints and quality of life verified the mediating effect of illness perceptions and the fear of cancer recurrence on this relationship. Social constraints affect the quality of life of HCT survivors via three pathways: the mediating role of illness perceptions, the mediating role of fear of cancer recurrence and the chain mediating effect of both factors.

Conclusion

The chain mediating effect of illness perceptions and the fear of cancer recurrence on quality of life indicates that these two variables have important practical significance with respect to improving HCT survivors' physical and mental health. The study thus serves as a reference for health workers to improve HCT survivors' quality of life in the future.

Social constraints and cancer-related quality of life in single and partnered young adult testicular cancer survivors: a contextual approach

To examine the context of relationship status on the link between friends/family social constraints (SC_ff) and cancer-related quality-of-life (QOL) among young adult testicular cancer survivors.

Participants completed the Functional Assessment of Cancer Therapy (general version), the Social Constraints Scale (friends/family), and demographic questions.

The sample included 162 young adult testicular cancer survivors.

SC_ff, but not relationship status, significantly predicted QOL when controlling for age, time since diagnosis, education, and income. The SC_ff X relationship status interaction was significant such that SC_ff were more strongly related to lower QOL for single survivors than for partnered survivors.

Focusing on friends and family support of young adult survivors, findings highlight the vulnerability of single survivors to social constraints within their diffuse social network. Interventions that target supportive exchanges in friends and family networks may be useful in improving QOL in single young adult cancer survivors.

Social constraints and fear of recurrence among Chinese American breast cancer survivors: An exploration of psychosocial mediators

OBJECTIVE

Fear of cancer recurrence (FCR) is commonly experienced among Caucasian and Chinese American breast cancer survivors (BCS). Emerging studies have suggested that Caucasian BCS' communication with family members contributes to their FCR. However, whether such findings apply to Chinese American BCS has yet to be explored. This study examined the association between social constraints (i.e., perceived barriers from significant others inhibiting cancer-related disclosure) and FCR among 136 Chinese American BCS, plus proposed that self-stigma (i.e., internalized feelings of shame about having cancer), bodily pain, and ambivalence over emotional expression (AEE; conflict between the desire to express emotions and the fear of its consequences) would mediate the association.

METHODS

Participants recruited through cancer associations in the USA were invited to complete a cross-sectional survey measuring their socio-demographic/cancer-related variables and the above-mentioned psychological variables.

RESULTS

Higher levels of social constraints, AEE, self-stigma, and bodily pain were associated with higher FCR (rs ranged from 0.27 to 0.40, ps < 0.01). After controlling for covariates, path analysis results supported the proposed mediation model with satisfactory fit indices (χ² (7) = 2.08, Comparative Fit index = 1.00, Tucker Lewis Index = 1.08, Root Mean Square Error of Approximation = 0.00). Specifically, social constraints were associated with higher FCR through increased self-stigma (β = 0.10, 95% confidence interval [CI] = 0.02, 0.17), AEE (β = 0.14, 95% CI = 0.01, 0.27), and bodily pain (β = 0.09, 95% CI = 0.02, 0.17), indicating significant mediation effects. After considering the mediators, the direct effect from social constraints to FCR was no longer significant.

CONCLUSIONS

The association between social constraints and higher FCR could be mediated by increased self-stigma, AEE, and bodily pain among Chinese American BCS. Interventions targeting to address those variables may reduce FCR among those BCS.

Effects of social constraints and web-based psychoeducation on cancer-related psychological adjustment early-after breast cancer diagnosis

Purpose: Social constraints are interactions between individuals that result in preventing one's disclosure of thoughts and emotions needed to facilitate cognitive processing of a traumatic event such as a breast cancer diagnosis. This study explored women's perceived social constraints from spouse/partners (S/P) and family/friends (F/F) in the first months after diagnosis while engaged in a study of CaringGuidance™ After Breast Cancer Diagnosis, a web-based, psychoeducational, self-management intervention aimed at women's psychological adjustment. Design: Randomized, controlled, pilot study. Sample: 100 women within 0-3 months of first, stage 0-II breast cancer diagnosis. Methods: Subjects were randomized to self-guided use of CaringGuidance™ for three months plus usual care or usual care alone. Social constraints (S/P) and (F/F), distress, depressive-symptoms, intrusive/avoidant thoughts, and coping were measured at baseline, 1, 2, and 3 months. Findings: The CaringGuidance™ group experienced a significantly greater decrease in perceived social constraints from S/P and F/F over three months than the usual care group. Change in social constraints from F/F significantly moderated change in depressive-symptoms and intrusive/avoidant thoughts, but the same was not true for change in S/P constraints. Conclusions: CaringGuidance™ holds promise as an intervention for newly diagnosed women to self-manage perceptions of social constraints. Implications for Psychosocial Providers: Providers should assess newly diagnosed women's perceptions of social constraining behavior from F/F, recognizing the potential significant impact of these interactions on psychological adjustment.

Self-Compassion, Social Constraints, and Psychosocial Outcomes in a Pet Bereavement Sample

This study investigated self-compassion in the context of grief following the death of a companion animal in a recently bereaved sample (N = 431). We addressed social contexts and individual differences focusing on how psychosocial outcomes vary as a function of social constraints, as well as individual differences in self-compassion and use of continuing bonds (CB). We observed that self-compassion related to the frequency of engagement in CB. Self-compassion also moderated relationships between grief severity and depression as well as social constraints and depression. We recommend future research on self-compassion training and psychosocial outcomes, especially for those experiencing social constraints or disenfranchised grief.

Social constraints and fear of recurrence in couples coping with early stage breast cancer

OBJECTIVE

Fear of cancer recurrence (FCR) is a top concern of breast cancer (BC) survivors and their spouses. FCR often occurs within an interpersonal context, yet there has been little research on relationship processes that may influence FCR in patients and spouses. It was hypothesized that the inhibition of disclosure of cancer-related concerns, thoughts, and feelings because of perceived partner disinterest or avoidance (termed social constraints) would predict greater FCR in BC patients and their spouses both globally and in the context of everyday life.

METHOD

Two studies, 1 cross-sectional (N = 46 couples) and 1 daily diary (21 days; N = 72 couples), were conducted to examine the between-person and within-person associations between social constraints and FCR in early stage BC patients and their spouses. Assessments were conducted about 6 months after BC surgery.

RESULTS

Global social constraints predicted greater global FCR in patients and spouses at the cross-sectional level, controlling for anxiety symptoms, relationship quality, and patient age, physical impairment, and BC stage. At the within-person level, results indicated that on days when more social constraints were reported, both partners were more likely to report greater FCR, controlling for momentary negative affect and relationship quality.

CONCLUSIONS

This study is the first to examine the within-person association between social constraints and FCR. These findings suggest relationship processes, particularly inhibition of disclosure, can uniquely influence the experience of FCR for both BC patients and their spouses, pointing to an important consideration for future research and possible intervention development. (PsycINFO Database Record

Relationship Between Depressive Symptoms and Social Cognitive Processing in Partners of Long-Term Breast Cancer Survivors

PURPOSE/OBJECTIVES

To determine (a) if depressive symptoms in partners of long-term breast cancer survivors (BCSs) could be predicted by social cognitive processing theory and (b) if partners of younger and older BCSs were differentially affected by the cancer experience.
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DESIGN

A cross-sectional, descriptive study using self-report questionnaires.
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SETTING

Indiana University in Bloomington and 97 ECOG-ACRIN Cancer Research Group sites in the United States.
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SAMPLE

508 partners of BCSs diagnosed three to eight years prior to the study. 
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METHODS

Secondary data mediation analyses were conducted to determine if cognitive processing mediated the relationship between social constraints and depressive symptoms. Age-related differences on all scales were tested.
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MAIN RESEARCH VARIABLES

Depressive symptoms; secondary variables included social constraints, cognitive processing (avoidance and intrusive thoughts), and potentially confounding variables.
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FINDINGS

Cognitive processing mediated the relationship between social constraints and depressive symptoms for partners. Partners of younger BCSs reported worse outcomes on all measures than partners of older BCSs.
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CONCLUSIONS

As predicted by the social cognitive processing theory, cognitive processing mediated the relationship between social constraints and depressive symptoms. In addition, partners of younger BCSs fared worse on social constraints, intrusive thoughts, and depressive symptoms than partners of older BCSs. 
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IMPLICATIONS FOR NURSING

Results provide support for using the social cognitive processing theory in an intervention design with partners of long-term BCSs to decrease depressive symptoms.

Social constraints and psychological well-being after prostate cancer: A follow-up at 12 and 24 months after surgery

OBJECTIVE

Studies indicate that social constraints (barriers to emotional expression) may be a risk factor for psychological morbidity. We aimed to investigate the association between prostate cancer-related social constraints and psychological well-being following prostate cancer surgery.

METHODS

In a group of 3478 partnered patients, participating in the Laparoscopic Prostatectomy Robot Open trial, a prospective multicenter comparative study of robot-assisted laparoscopic and retropubic radical prostatectomy for prostate cancer, we used log-binomial regression analysis to investigate the links between prostate cancer-related social constraints at 3 months after surgery and psychological well-being at 12 and 24 months.

RESULTS

A total of 1086 and 1093 men reported low well-being at 12 and 24 months, respectively. Prostate cancer-related social constraints by partner predicted low psychological well-being at 12 months (adjusted RR: 1.4; 95% CI, 1.1-1.9) and by others (adjusted RR: 1.9; 95% CI, 1.1-3.5). Intrusive thoughts mediated the association.

CONCLUSIONS

Negative responses from the social environment, especially from partner to talking about the prostate cancer experience affected patients' psychological well-being 2 years after radical prostatectomy. Results emphasize the importance of helping patients mobilize psychosocial resources within their social network, especially among those with a lack of quality psychosocial support.

Social Factors Linking Stigma-Related Stress with Alcohol Use among Lesbians

A conceptual model linking stigma-related stress and lesbian women's alcohol use and related problems via social factors (i.e., social constraints and social isolation), depressive symptoms, and negative reinforcement drinking motives (i.e., coping and conformity) was tested. Self-identified lesbian women (N = 1048), age 18-35 years in the United States completed an online survey of discrimination, stigma consciousness, social isolation, social constraints, depressive symptoms, drinking motives, alcohol use and related problems. The hypothesized path model showed excellent model fit. The predicted pathway of stigma-related stressors to alcohol outcomes via social factors, depressive symptoms, and coping/conformity motives was largely supported. Results highlight the importance of social factors in linking stigma-related stress to alcohol use and related problems among lesbians. Understanding the underlying social mechanisms connecting stigma to negative health outcomes may help inform intervention efforts to reduce alcohol use and related problems among lesbians and associated health disparities.

Partner social constraints and early-stage breast cancer: Longitudinal associations with psychosexual adjustment

Women with breast cancer (BC) who perceive social constraints on their disclosure of cancer-related concerns are more likely to experience distress and have difficulty adjusting after diagnosis. Much of the existing research on psychosocial adjustment is cross-sectional in nature and an important area of concern that has received little attention is psychosexual adjustment to cancer surgery and treatment. This study examined whether perceived partner social constraints were associated with psychosexual adjustment over time in 108 BC survivors. Early-stage BC patients completed measures of partner social constraints, psychosexual adjustment, and relationship dissatisfaction approximately 1 month, 8 months, and 4 years after initial surgery. Latent growth curve modeling revealed partner social constraints to be a significant time-varying, within-person predictor of psychosexual adjustment at each time point after controlling for relationship dissatisfaction. BC surgery type, reconstructive surgery, cancer stage, chemotherapy, or antihormonal adjuvant treatment did not moderate this effect. Findings point to a long-term link between social constraints and psychosexual outcomes in BC patients and clinical implications for women coping with BC. (PsycINFO Database Record

Cognitive and Situational Precipitants of Loneliness Among Patients With Cancer: A Qualitative Analysis

PURPOSE/OBJECTIVES

To identify situations and thoughts that may precipitate or protect against loneliness experienced by patients with cancer. 


RESEARCH APPROACH

Qualitative. 


SETTING

The hematology/oncology clinic at the Indiana University Melvin and Bren Simon Cancer Center, an outpatient oncology center in Indianapolis. 


PARTICIPANTS

Purposive sample of 15 patients undergoing treatment for multiple myeloma or non-Hodgkin lymphoma. 


METHODOLOGIC APPROACH

Individual, semistructured qualitative interviews were conducted. Theoretical thematic analysis was used to analyze interview data.


FINDINGS

Factors that appeared to precipitate loneliness included several situations (e.g., physical isolation, social constraints such as criticism) and thoughts (e.g., unmet expectations for visits or questions about health, belief that others do not understand their cancer experience). Several situations (e.g., social support, normal routine) and thoughts (e.g., beliefs that time alone is desirable and that others' discomfort with cancer-related discussions is normative) appeared to protect against loneliness. Certain social situations were loneliness-inducing for some patients and not for others, suggesting that patients' thoughts about their situations, rather than the situations themselves, have the greatest impact on their loneliness. 


CONCLUSIONS

The current study fills gaps in loneliness theory by identifying cancer-related situations and thoughts that patients associate with their loneliness. Consistent with theory, patients reported feeling lonely when they had negative thoughts about their social situations. 


INTERPRETATION

Findings inform nursing assessment and intervention strategies to incorporate into care plans. For instance, when conducting assessments, nurses should be more attentive to patients' satisfaction with their social environment than actual characteristics of the environment. Normalizing patients' experiences and encouraging positive thoughts about others' behavior may reduce patients' loneliness.

The role of social support, family identification, and family constraints in predicting posttraumatic stress after cancer

OBJECTIVE

We compared social support with other potential psychosocial predictors of posttraumatic stress after cancer. These included family identification, or a sense of belonging to and commonality with family members, and family constraints, or the extent to which family members are closed, judgmental, or unreceptive in conversations about cancer. We also tested the hypothesis that family constraints mediate the relationship between family identification and cancer-related posttraumatic stress.

METHODS

We used a cross-sectional design. Surveys were collected from 205 colorectal cancer survivors in Tayside, Scotland.

RESULTS

Both family identification and family constraints were stronger independent predictors of posttraumatic stress than social support. In multivariate analyses, social support was not a significant independent predictor of posttraumatic stress. In addition, there was a significant indirect effect of family identification on posttraumatic stress through family constraints.

CONCLUSIONS

Numerous studies demonstrate a link between social support and posttraumatic stress. However, experiences within the family may be more important in predicting posttraumatic stress after cancer. Furthermore, a sense of belonging to and commonality with the family may reduce the extent to which cancer survivors experience constraints on conversations about cancer; this may, in turn, reduce posttraumatic stress.

Avoidant coping and self-efficacy mediate relationships between perceived social constraints and symptoms among long-term breast cancer survivors

OBJECTIVE

Many breast cancer survivors feel constrained in discussing their cancer experience with others. Limited evidence suggests that social constraints (e.g., avoidance and criticism) from loved ones may negatively impact breast cancer survivors' global health, but research has yet to examine relationships between social constraints and common physical symptoms. Informed by social cognitive processing theory, this study examined whether perceived social constraints from partners and healthcare providers (HCPs) were associated with fatigue, sleep disturbance, and attentional functioning among long-term breast cancer survivors (N = 1052). In addition, avoidant coping and self-efficacy for symptom management were examined as potential mediators of these relationships.

METHODS

Long-term breast cancer survivors (mean years since diagnosis = 6) completed questionnaires assessing social constraints from partners and HCPs, avoidant coping, self-efficacy for symptom management, and symptoms (i.e., fatigue, sleep disturbance, and attentional functioning). Structural equation modeling was used to evaluate the hypothesized relationships among variables in two models: one focused on social constraints from partners and one focused on social constraints from HCPs.

RESULTS

Both models demonstrated good fit. Consistent with theory and prior research, greater social constraints from both partners and HCPs were associated with greater symptom burden (i.e., greater fatigue and sleep disturbance, poorer attentional functioning). In addition, all relationships were mediated by avoidant coping and self-efficacy for symptom management.

CONCLUSIONS

Findings are consistent with social cognitive processing theory and suggest that symptom management interventions may be enhanced by addressing the impact of social constraints from survivors' partners and HCPs on their coping and self-efficacy. Copyright © 2016 John Wiley & Sons, Ltd.

Social Constraints are Associated with Negative Psychological and Physical Adjustment in Bereavement

Losing a loved one is a normative life event, yet there is great variability in subsequent interpersonal experiences and adjustment. The Social-Cognitive Processing (SCP) model suggests that social constraints (i.e. limited opportunities to disclose thoughts and feelings in a supportive context) impede emotional and cognitive processing of stressful life events, which may lead to maladjustment. This study investigates personal and loss-related correlates of social constraints during bereavement, the links between social constraints and post-loss adjustment, and whether social constraints moderate the relations between loss-related intrusive thoughts and adjustment. A community sample of bereaved individuals (n = 238) provided demographic and loss-related information and reported on their social constraints, loss-related intrusions, and psychological and physical adjustment. Women, younger people, and those with greater financial concerns reported more social constraints. Social constraints were significantly associated with more depressive symptoms, perceived stress, somatic symptoms, and worse global health. Individuals with high social constraints and high loss-related intrusions had the highest depressive symptoms and perceived life stress. Consistent with the SCP model, loss-related social constraints are associated with poorer adjustment, especially psychological adjustment. In particular, experiencing social constraints in conjunction with loss-related intrusions may heighten the risk for poor psychological health.

Exposure to violence, social cognitive processing, and sleep problems in urban adolescents

Exposure to violence is associated with elevated levels of sleep problems in adolescence, which contributes to poor mental and physical health and impaired academic performance. However, reasons underlying the associations between exposure to violence and sleep difficulty have not been examined. This study tested a social cognitive processing path model linking experiences of witnessing and directly experiencing community violence and sleep problems. Participants were 362 early adolescents (M age = 12.45 years, SD = 0.59; range 11-14 years; 48.9% male; 51% Latino/a; 34% black) from urban communities enrolled in a middle-school-based intervention study on the east coast of the United States that was designed to reduce the negative effects of exposure to violence. All youth in the current study reported witnessing or directly experiencing community violence. Adolescents completed four school-based assessments over an 18-month period, reporting on their exposure to community violence, sleep problems, intrusive thoughts about and social constraints in talking about violence, and life events. A path model that included both victimization and witnessing violence revealed that wave 1 witnessing violence, but not victimization, was associated with elevated social constraints in talking about violence at wave 2, which was associated with elevated intrusive thoughts at wave 3, which was associated with poor sleep quality at wave 4. Prior levels of all constructs were controlled in the analysis, in addition to life events, single parent household status, children's age and sex, intervention condition, and school. Youth exposed to violence may benefit from help in processing their experiences, thus reducing social constraints in talking about their experiences and associated intrusive thoughts. This is turn may improve sleep outcomes.

Randomised controlled trial of expressive writing and quality of life in men and women treated for colon or rectal cancer

OBJECTIVE

This randomised trial tested (i) whether a home-based expressive writing (EW) intervention improves quality of life in patients with colorectal cancer (CRC) and (ii) whether the intervention is more beneficial for men or for people who feel constrained in disclosing cancer-related concerns and feelings.

DESIGN

Patients treated for CRC were randomised to an EW (n = 101) or control writing (CW; n = 92) group. Assessments were completed at 1 month pre- and post-intervention. Sex and perceived social constraints on disclosure were evaluated as moderators.

MAIN OUTCOME MEASURES

Primary outcomes were depressive symptoms, sleep problems and quality of life indicators.

RESULTS

Eighty-one per cent of participants completed all writing assignments. Consistent with hypotheses, relative to the CW group, participants in the EW group expressed more negative emotion in writing and rated their writings as more meaningful, personal and emotionally revealing. There were no significant main effects of EW or moderating effects of sex or social constraints on outcomes.

CONCLUSIONS

Although EW is feasible to use with persons who have CRC, it was not effective as a stand-alone psychotherapeutic intervention. Neither was it more effective for men nor for people who felt they could not freely disclose cancer-related concerns and feelings.

Police officers' experiences of supportive and unsupportive social interactions following traumatic incidents

BACKGROUND

Police officers are routinely exposed to potentially traumatic incidents yet the majority do not develop post-traumatic stress disorder (PTSD). Social support has been identified as one factor that may maintain wellbeing in this population, although what constitutes supportive or unsupportive interactions is unclear.

OBJECTIVE

To explore police officers' experiences of supportive and unsupportive interactions following distressing incidents.

METHOD

Semi-structured interviews were conducted with 19 police officers. Transcripts were analysed using Braun and Clarke's (2006) thematic analysis approach.

RESULTS

Participants described a range of supportive interactions with colleagues, friends, and family, as well as social constraints that hindered interactions. Ambivalence about talking about the impact of distressing events was striking throughout the accounts. The context and source of available support, as well as beliefs about talking, influenced their interactions. Humour was a central feature of interactions with colleagues; more emotional talk occurred with partners and close family, albeit with officers limiting details in order to protect others.

CONCLUSIONS

The findings provide tentative insights into the processes of social support that may contribute to the resilience of police officers following traumatic incidents. Further research is needed to examine whether the experiences of supportive and unsupportive interactions differ for those with and without PTSD.