Quality of life and adjustment in men with prostate cancer: Interplay of stress, threat and resilience.

PURPOSE: Diagnosis and treatment of prostate cancer can generate many challenges which impact on adjustment, so understanding the psychosocial factors which contribute to individual vulnerability to poor adaptation warrants further investigation. This study investigates stress and masculine identity threat as predictors of quality of life and emotional adjustment in men with localized prostate cancer and the role of resilience as a potential protective psychological factor. METHODS: Participants were invited to complete a survey study via online prostate cancer forums. Participants were 204 men ranging in age from 44-88 years (M = 65.24±7.51) and who were diagnosed with early localized prostate cancer within the previous five years. Measures used included the Perceived Stress Scale, Cancer-Related Masculine Threat Scale and the Conor-Davidson Resilience Scale. Using a cross-sectional online survey design, the extent to which perceived stress, masculine threat and psychological resilience are associated with quality of life, positive and negative affect and distress was assessed. RESULTS: Hierarchical regression analysis demonstrated that perceived stress accounted for 26%-44% of variance on quality of life and adjustment indices, with high stress associated with low mood and poor quality of life. Low masculine threat and high resilience predicted better quality of life and emotional adjustment accounting for between 1-7% of the variance. Resilience moderated the relationship between stress and distress and mediated the association between masculine threat and distress and negative affect. CONCLUSION: Perceived stress was the most powerful predictor in the model and findings suggest it contributes significantly to functional and affective status in survivors of prostate cancer. Psychological resilience is a protective factor which buffers the negative effect of stress and masculine identity threat on emotional adjustment. Findings indicate that men should be screened as part of the diagnostic and treatment process for high perceived stress and low resilience to identify those at risk for poor adjustment during survivorship.

What predicts emotional response in men awaiting prostate biopsy?

BACKGROUND: Incidence of prostate cancer is increasing as opportunistic screening becomes widespread and life expectancy rises. Despite screening availability, research reveals conflicting results on medical outcomes, for example, disease specific mortality. However the gold standard in early diagnosis of potentially curable organ confined prostate cancer is transrectal ultrasound-guided systematic prostate biopsy (TRUS-BX). While focus has been given to medical sequalae there is a paucity of research on the psychological impact of biopsy. Awaiting biopsy may be inherently stressful but no studies to date, have assessed men's perception of stress and its impact on emotional response. This study, therefore, examines the role of stress and also personal resources namely, self-efficacy and sense of coherence in emotional adjustment in men awaiting a prostate biopsy. METHODS: Men attending a Rapid Access Prostate Cancer Clinic for a transrectal prostate biopsy (N = 114) participated in the study. They completed self report questionnaires on perceived stress (PSS), generalised self-efficacy (GSES), and sense of coherence (SOC). Adjustment was measured by the Profile of Mood States (POMS-B) which assesses tension, depression, anger, fatigue, confusion and vigour. RESULTS: Hierarchical regression analyses demonstrated that the set of predictors accounted for 17%-34% of variance across six mood states and predicted 46% of total mood disturbance. Perceived stress explained variance on all domains (11%-26%) with high stress linked to poor functioning. CONCLUSION: Perceived stress was the strongest and most consistent predictor of emotional adjustment. This is an important finding as stress appraisal has not been examined previously in this context and suggests that stress management is an important target to enhance emotional wellbeing of men attending for a prostate biopsy.

Post-traumatic growth in breast cancer: how and when do distress and stress contribute?

OBJECTIVE: While several theoretical models provide explanation for the genesis and development of post-traumatic growth (PTG) in the aftermath of stressful events, empirical evidence regarding the predictors and consequences of PTG in breast cancer patients in active treatment and early survivorship is inconclusive. This study, therefore, examines the role of distress and stress as predictors and outcomes of PTG in women with breast cancer over an 18-month period. METHODS: These effects are tested in two structural equation models that track pathways of PTG in a sample of 253 recently diagnosed women. Questionnaires were completed at diagnosis and at 4 follow-up time points assessing cancer-specific stress (Impact of Events Scale), global stress (Perceived Stress Scale), and depression and anxiety (Hospital Anxiety and Depression Scale). Post-traumatic growth (Silver Lining Questionnaire) was assessed at follow-up time points. RESULTS: Cancer-specific stress was related to higher PTG concurrently and longitudinally. Anxiety was related concurrently to higher PTG, but overall general distress had minimal impact on PTG. Global stress was inversely related to PTG. Positive growth at 6 months was associated with subsequent reduction in stress. CONCLUSIONS: This study showing that early stage higher cancer-specific stress and anxiety were related to positive growth supports the idea that struggle with a challenging illness may be instrumental in facilitating PTG, and findings show positive implications of PTG for subsequent adjustment.

The effect of mode of detection of breast cancer on stress and distress.

OBJECTIVE: The number of women with screen-detected breast cancer is increasing, but it is not clear if these women experience the same levels of distress as women with symptomatic breast cancer. The current study compared stress and distress in women with screen-detected or symptomatic breast cancer at diagnosis and 12 months post-diagnosis. METHODS: Ninety-two women with screen-detected breast cancer and 129 women with symptomatic breast cancer completed measures of perceived stress, anxiety, and depression at diagnosis and 12 months post-diagnosis. Women also completed a measure of cancer-related stress 12 months post-diagnosis. RESULTS: Both groups reported similar levels of perceived stress, anxiety, and depression at diagnosis. A third of women in both groups reported clinical levels of anxiety at diagnosis, which decreased over time. There were no differences in depression. Analyses revealed that at 12 months post-diagnosis, the symptomatic group reported a significant reduction in anxiety, but the screen-detected group reported a nonsignificant trend for a reduction over time. The screen-detected group reported significantly higher cancer-related stress at 12 months than the symptomatic group. CONCLUSIONS: Screen-detected women report similar distress at diagnosis but may be more at risk for greater distress requiring further psychological support 1 year after diagnosis. Future interventions that focus on preparation for screening may help to reduce ongoing levels of anxiety and cancer-related stress for this group.

Information Literacy Advocates: developing student skills through a peer support approach.

Since 2013/2014, an Information Literacy Advocates (ILA) scheme has been running at the University of Nottingham as an extracurricular module on the Nottingham Advantage Award programme. The Information Literacy Advocates scheme, which recruits medicine and health sciences students in their second year or above, aims to facilitate development of information literacy skills and confidence, as well as communication, organisation and teamwork, through the provision of peer support. Previous research indicates peer assistance effectively enhances such skills and is valued by fellow students who welcome the opportunity to approach more experienced students for help. This article, written by guest writer Ruth Curtis from the University of Nottingham, provides an overview of administering the ILA scheme and explores its impact on the Information Literacy Advocates, peers and librarians, and discusses future developments for taking the scheme forward. H. S.

Stress and self-efficacy predict psychological adjustment at diagnosis of prostate cancer.

Prostate cancer is the most frequently non-skin cancer diagnosed among men. Diagnosis, a significant burden, generates many challenges which impact on emotional adjustment and so warrants further investigation. Most studies to date however, have been carried out at or post treatment with an emphasis on functional quality of life outcomes. Men recently diagnosed with localised prostate cancer (N = 89) attending a Rapid Access Prostate Clinic to discuss treatment options completed self report questionnaires on stress, self-efficacy, and mood. Information on age and disease status was gathered from hospital records. Self-efficacy and stress together explained more than half of the variance on anxiety and depression. Self-efficacy explained variance on all 6 emotional domains of the POMS (ranging from 5-25%) with high scores linked to good emotional adjustment. Perceived global and cancer specific stress also explained variance on the 6 emotional domains of the POMS (8-31%) with high stress linked to poor mood. These findings extend understanding of the role of efficacy beliefs and stress appraisal in predicting emotional adjustment in men at diagnosis and identify those at risk for poor adaptation at this time. Such identification may lead to more effective patient management.

Experience of breast cancer: burden, benefit, or both?

BACKGROUND: Transactional models of stress emphasize the role of appraisal of stress in adjustment to illness. The current qualitative study uses this framework to explore the subjective response to these stressors in women with breast cancer. Reappraisals or opportunities for growth from the experience are also examined. OBJECTIVE: The objective of this study was to explore the experience of stress in Irish women with breast cancer using the Stress-Coping Model. METHODS: The diaries of 30 women newly diagnosed with breast cancer were analyzed using thematic template analysis. A template of 5 themes based on elements of the Stress-Coping Model was defined prior to analysis. RESULTS: Six top-level and 14 second-level themes were defined in the final template. Following initial diagnosis of breast cancer, women viewed it as either a threat or a challenge. After diagnosis, however, other stressful events included treatment effects, loss of womanhood, and illness disclosure. Women described coping strategies and social interactions that both increased and decreased their stress. In tandem with negative consequences of breast cancer, women also reported benefit from the experience. CONCLUSIONS: Women differed in their identification of stressful events and subsequent coping strategies. Their reports also illustrated the complex relationships between appraisal of the event, personal resources, and social interactions, which can result in both positive and negative outcomes. IMPLICATIONS FOR PRACTICE: Appraisal of breast cancer can vary, and awareness of this by health professionals can facilitate adjustment. Women need advice in regard to disclosure of diagnosis to others and need more information on managing treatment effects.

Factors influencing adherence among Irish haemodialysis patients.

OBJECTIVE: Adherence to dietary and fluid restrictions among haemodialysis patients with end stage renal failure (ESRD) is a multi-factorial concept. This study seeks to assess the predictive value of demographic and psychological variables in non-adherence. METHODS: A multi-centre cross sectional design assessed 50 haemodialysis patients on self reported adherence, attitudes towards dietary restrictions, quality of life, depression and anxiety. Adherence to fluid and dietary restrictions was measured objectively using potassium (K), phosphorus (PO4) and inter-dialytic weight gain (IDWG) parameters. RESULTS: 62% of patients were non-adherent with at least one aspect of the treatment regime. Regression analysis revealed age as significantly associated with adherence, in particular IDWG, with younger patients displaying poorer adherence. CONCLUSION: Younger patients may experience greater difficulty integrating complex treatment demands into their lifestyles, and non-adherence may be a consequence of the severe lifestyle limitations imposed by the haemodialysis treatment regime. PRACTICE IMPLICATIONS: Individualised interventions may be more effective than traditional methods of adherence monitoring in reducing the non-adherent behaviour.

Global stress predicts both positive and negative emotional adjustment at diagnosis and post-surgery in women with breast cancer.

OBJECTIVES: Individual differences in stress appraisal, coping, optimism and social support have contributed to variability in adjustment to breast cancer, but less is known about their relative influence particularly at diagnosis. The purpose of this study was to compare the predictive role of these variables on both positive and negative adjustment in a sample of recently diagnosed women. METHOD: Data was collected from 241 women at diagnosis and post-surgery (4 months later). They completed questionnaires which assessed global and cancer-specific stress, general and cancer-specific coping, emotional adjustment (depression, anxiety, positive and negative affect) at Times 1 and 2 and benefit finding at Time 2. RESULTS: Hierarchical regression analyses (all p < 0.01) taking account of age and cancer related variables (disease stage and type of surgery) showed that stress appraisal was the strongest and most consistent predictor of adjustment. The coping strategies, while significant, were less powerful predictors of emotional adjustment, but they explained more variance than stress on benefit finding. Stress and coping outweighed the impact of social support and optimism. CONCLUSIONS: Global appraisal of stress was the most powerful predictor in the model, and findings suggest that it contributes to patients' affective status, indicating that women should be screened as part of the diagnostic process to identify those at risk for poor adaptation to the illness.

Cognitive-behavioural stress management enhances adjustment in women with breast cancer.

OBJECTIVE: This randomized controlled trial examines whether a briefer cognitive-behavioural (CBT) stress management intervention than the norm can reduce stress and distress and enhance benefit finding in women with breast cancer. It further aims to identify characteristics of those women most likely to benefit from the intervention. DESIGN AND METHOD: A randomized controlled trial was conducted to assess the efficacy of a psychological intervention. Women (N = 355) who had undergone surgery for breast cancer 4 months earlier, the majority of whom were currently undergoing adjuvant therapy, completed questionnaires assessing global and cancer-specific stress, depression, anxiety, optimism and benefit finding. They were randomly assigned to a 5-week group cognitive-behavioural stress management (CBSM) programme plus standard care or standard care only. Reassessment occurred post-intervention and 12 months later. RESULTS: Analyses of variance revealed that patients who received the intervention showed significant lowering of global stress and anxiety and increased benefit finding compared to controls. These differences, however, were not maintained at 12 months. Effects of the intervention were moderated by stress such that women with high global stress at baseline showed greater reduction in both stress and anxiety. CONCLUSIONS: A CBSM intervention, which was briefer than the norm (5 weeks vs. 9-20 weeks), had beneficial effects on adjustment for women with breast cancer and was particularly effective for those with increased global stress. Screening on this basis may facilitate optimal and cost-effective psychological treatment.

Anaphylaxis: how do you live with it?

This article reports on a study of the needs of families coping with life-threatening allergies in a child. Due to the scarcity of publications on the psychosocial dimensions of anaphylaxis, the authors draw on selected literature on family coping with chronic illness, asthma, and allergy to provide a conceptual context for the research and discussion of findings. Using qualitative methodology, parents from 17 families were interviewed about their experiences adjusting to a diagnosis of anaphylaxis in a child. From participants' responses about the nature and sources of information and support, parenting dilemmas, family activities, anxieties, challenges, and coping strategies, the authors identify patterns in the adaptive processes related to predictable developmental and episodic events that increase anxiety and support needs. Social work clinicians and other family-serving professionals can help families maintain an optimal balance between protective and debilitating anxiety. Potential interventions in community and health settings are suggested.

Psychological stress as a predictor of psychological adjustment and health status in patients with rheumatoid arthritis.

This study examined the extent to which perceived stress, social support, coping and clinical disease indicators predict physical, psychological and social adjustment in patients with rheumatoid arthritis (RA). Participants were 59 women recruited at an outpatient clinic at University College Hospital, Galway. A range of psychological measures was administered and disease status was assessed by physician ratings of joint involvement and blood assays of inflammatory indices. Findings from correlational and hierarchical regression analyses revealed a number of statistically significant relationships (p<.01). Perceived stress was a better predictor than disease severity of positive and negative emotionality. Coping explained variability on positive and negative affect. Social support was linked to level of social activity. Results demonstrated that disease status predicted illness related functioning but did not predict emotional or social adjustment. Results suggest that a cognitive behavioural intervention to facilitate patient adjustment could usefully include management of stress and its appraisal, the fostering of adaptive coping strategies and utilization of social support resources. It is concluded that improving patient adjustment to rheumatoid arthritis has implications for medical care seeking.

Anxiety levels in women attending a colposcopy clinic: a randomised trial of an educational intervention using video colposcopy.

A video colposcopy allows the real-time images viewed by the doctor performing the examination to be viewed by patients on a television monitor during the consultation. Eighty-one women (requiring either laser treatment or a normal recheck) were randomly assigned to either the video intervention group or the control group. A significant decrease in state anxiety was observed from one visit to the next in all patients (P = 0.000). This decrease in anxiety was significantly greater in the laser patients in the video colposcopy condition than patients in the control group for both groups of patients. Patients in the experimental groups also reported less pain than patients in the control conditions (P < 0.05). This benefit associated with video colposcopy was not observed on the second (treatment) visit. In conclusion, video colposcopy is a useful and time-efficient method that reduces patient anxiety and pain during examination visits, but not necessarily during visits where laser treatment is required.