Stress and coping with advanced cancer.

OBJECTIVE: For people with advanced cancer, the months preceding death can be very stressful. Moreover, cancer-related stressors can arise within multiple dimensions. However, little research has examined how people cope differentially with different types of stressors. The goal of this study was to examine patterns of coping across different dimensions of stress. METHOD: Fifty-two patients who were receiving palliative care for cancer were asked to indicate their most significant stressors within social, physical, and existential dimensions. A structured interview was then conducted to describe how the participants coped with these stressors. RESULTS: Overall, stressor severity ratings were correlated significantly across the three dimensions, although physical symptoms received the highest mean rating. Participants generally used a range of coping strategies to deal with their stressors, but there were clear differences across dimensions in the relative use of problem-focused versus emotion-focused strategies. Problem-focused coping was less frequent for existential issues, whereas emotion-focused strategies were used less frequently for physical stressors. Coping efforts were not clearly related to psychological distress. SIGNIFICANCE OF RESULTS: Although coping is an important research theme within psycho-oncology, it may be overly broad to ask, "How do people cope with cancer"? In fact, different cancer-related stressors are coped with in very different ways. There is not necessarily any particular pattern of coping that is best for relieving psychological distress.

Structured interview assessment of symptoms and concerns in palliative care.

OBJECTIVE: Assessment in palliative care requires a multidimensional review of physical symptoms and psychosocial concerns in a format appropriate for patients with advanced illness. In this study, we describe the initial development and validation of a structured interview for assessing common symptoms and concerns faced by terminally ill individuals. METHOD: We constructed a 13-item Structured Interview for Symptoms and Concerns (SISC) based on a review of end-of-life issues and administered it to 69 patients receiving palliative care for advanced cancer. Along with the interview, each participant completed visual analog scales (VAS) addressing the same constructs. Test-retest and interrater reliability were determined, as was the concordance between interview ratings and VAS scores. RESULTS: Overall, the interview items had excellent interrater reliability (intraclass correlations were > 0.90) and at least moderate temporal stability (test-retest correlations ranged from 0.50 to 0.90). Concurrent validity was evident in the good concordance between interview items and VAS measures (correlations were > 0.70). The SISC was also sensitive to individual differences between subgroups of participants who did or did not meet diagnostic criteria for anxiety or depressive disorders. CONCLUSIONS: This study demonstrates that structured interviews provide a reliable and valid approach to assessment in palliative care and may be an appropriate alternative for some research applications.