Greater fertility distress and avoidance relate to poorer decision making about family building after cancer among adolescent and young adult female survivors.

BACKGROUND: Many adolescent and young adult female (AYA-F) cancer survivors face decisions about family building using reproductive medicine or adoption to achieve parenthood. This study evaluated associations among reproductive distress, avoidance, and family-building decision making and identified sociodemographic and clinical characteristics related to high distress and avoidance. METHODS: A cross-sectional survey assessed AYA-F survivors' oncofertility experiences. Measures included an investigator-designed Unmet Information Needs scale, Reproductive Concerns After Cancer Scale, Impact of Events Scale-Avoidance subscale, Decision Self-Efficacy scale, and Decision Conflict Scale. Two linear regression models evaluated correlates of decision self-efficacy and decisional conflict about family building after cancer. Bivariate analyses evaluated correlates of avoidance using Pearson's correlation, t-test, and ANOVA. RESULTS: AYA-Fs (N = 111) averaged 31-years-old (SD = 5.49) and 3 years post-treatment (range: 1-23 years); 90% were nulliparous. Most common diagnoses were leukemia (24%) and breast cancer (22%). Average decisional conflict was 52.12 (SD = 23.87, range: 0-100); 74% of the sample reported DCS scores within the clinically significant range. Higher levels of reproductive distress (B = -0.23, p = 0.04) and avoidance (B = -0.24, p = 0.02) related to lower decision self-efficacy. Younger age (B = -0.18, p = 0.03), greater unmet information needs (B = 0.33, p < 0.001), and higher levels of reproductive distress (B = 0.34, p = 0.001) related to worse decisional conflict. Predictors of distress and avoidance were identified. CONCLUSIONS: After cancer treatment, high fertility distress and avoidant coping were associated with poorer quality decision making about family building after cancer. Fertility counseling post-treatment should support self-efficacy and constructive coping skills to counteract high distress, maladaptive coping, and facilitate values-based decision making.

Stressors, social support, and adjustment in kidney transplant patients and their spouses.

Kidney transplant patients and their spouses (n = 121 couples) rated their overall stress, social support, and adjustment following transplantation. Patients experienced significantly more overall stress than did spouses, although spouses were equally or more stressed than patients on some issues. Patients and spouses did not differ in marital satisfaction, although patients reported significantly more depression than did spouses. Overall stress was related to lower marital satisfaction and increased depression for both patients and spouses. Patients who were experiencing higher stress benefitted more from the support they received from their spouses. Spouses who were less stressed offered more helpful and less unhelpful support to patients. Implications for social work practice are discussed.

Correlates of noncompliance among renal transplant recipients.

The purpose of this study was to identify variables that are associated with noncompliance among adult renal transplant recipients, including demographic characteristics, transplant-related variables, and psychosocial factors. The measurement of noncompliance was improved by assessing noncompliant behaviors (i.e., noncompliance with medications and the follow-up regimen) prior to the onset of complications and/or graft loss and by measuring compliance as a continuous rather than dichotomous variable. Two-hundred-and-forty-one renal transplant recipients completed the Beck Depression Inventory, the anxiety and hostility subscales of the Brief Symptom Inventory, the Multidimensional Health Locus of Control Scale, the Inventory of Socially Supportive Behaviors, the Coping Strategies Inventory, a measure of transplant-related stressors, and self-report measures of compliance with medications and the follow-up regimen. Approximately half of our sample reported at least some degree of noncompliance. Recipients who were younger, female, unmarried, retransplanted, and with lower incomes tended to be noncompliant with medications (all p's < 0.05). Recipients who were unmarried, low income, not insulin-dependent, and with a longer time since transplant tended to be noncompliant with the follow-up regimen. In addition, recipients who reported higher stress and more depression, who coped with stress by using avoidant coping strategies, and who believed that health outcomes are beyond their control were less compliant with both medications and follow-up (all p's < 0.05). Regression analyses revealed that stress was the strongest predictor of both medication and follow-up compliance.

Recognizing cancer as a family disease: worries and support reported by patients and spouses.

Data were obtained via mailed questionnaire from 91 adults with cancer and 78 spouses of adults with cancer. Findings suggest that spouses and patients worry equally about their own personal health, and that spouses worry more about patients' futures than the patients do themselves. In addition, spouses and patients report participating equally in the treatment process, yet patients report receiving significantly more social support than do spouses. The results point to the need for expanded attention to the concept of cancer as a "family disease," with special emphasis on the unique and often neglected experience of spouses of adult cancer patients.