Comorbidity, Functional Impairment, and Emotional Distress: A Coping Mediation Model for Persons With Cancer.

BACKGROUND: Comorbid disease in cancer patients can substantially impact medical care, emotional distress, and mortality. However, there is a paucity of research on how coping may affect the relationship between comorbidity and emotional distress. PURPOSE: The current study investigated whether the relations between comorbidity and emotional distress and between functional impairment and emotional distress were mediated by three types of coping: action planning (AP), support/advice seeking (SAS), and disengagement (DD). METHODS: Four hundred and eighty-three persons with cancer completed a measure of functional impairment (Sickness Impact Profile), the Checklist of Comorbid Conditions, the Brief COPE, the Hospital Anxiety and Depression Scale, the Quality of Life Assessment for Cancer Survivors (Negative Feelings Scale), and the Distress Screening Schedule (Emotional Distress Scale). The latter three measures were used to form a latent construct representing the outcome, emotional distress. RESULTS: Model comparison analysis indicated that the model with DD as a mediator had a better fit than models containing AP and SAS. DD mediated the relationship between functional impairment and emotional distress, so that engaging in DD was associated with greater distress. In addition, comorbidity and functional impairment were directly and positively related to emotional distress, but the relation between comorbidity and distress was not mediated by coping type. CONCLUSIONS: Both comorbidity and functional impairment may be associated with distress, but disengagement coping only mediated the relation involving functional impairment and was positively associated with distress. Future studies can investigate whether teaching active coping or adaptive coping (e.g., through mindfulness exercises) can decrease distress in cancer patients, despite functional impairments.

Social relationship coping efficacy: A new construct in understanding social support and close personal relationships in persons with cancer.

OBJECTIVE: Social relationship coping efficacy (SRCE) is the confidence to engage in behaviors that can maintain or enhance close social relationships in the context of illness. This study focused on psychometric analyses of the SRCE scale and its role in maintaining or enhancing personal relationships, social support, and quality of life (QOL). METHOD: A mixed diagnosis sample (N = 151) of cancer patients completed a variety of measures: physical debilitation, received emotional and instrumental support, SRCE, and QOL. RESULTS: The SRCE scale is a 10-item, one-factor, internally reliable (α = 0.965) measure with strong concurrent validity in relation to measures of social support. SRCE fully mediated the relationship between physical debilitation and both instrumental and emotional received support. SRCE also was directly related to both social/family well-being and psychological distress, and this relationship was also partially mediated by social support. CONCLUSIONS: The results corroborated that SRCE might account for changes in both instrumental and emotional support. Also, the direct and indirect relationship (mediated by social support) of SRCE with both social/family well-being and distress indicated that interventions to increase SRCE with those at risk for social support loss may bolster social support in personal relationships as well as enhance emotional well-being and quality of life.

Self-efficacy for coping with cancer: Revision of the Cancer Behavior Inventory (Version 3.0).

Based on self-regulation and self-efficacy theories, the Cancer Behavior Inventory (CBI; Heitzmann et al., 2011; Merluzzi & Martinez Sanchez, 1997; Merluzzi, Nairn, Hegde, Martinez Sanchez, & Dunn, 2001) was developed as a measure of self-efficacy strategies for coping with cancer. In the latest revision, CBI-V3.0, a number of psychometric and empirical advances were made: (a) the reading level was reduced to 6th-grade level; (b) individual interviews and focus groups were used to revise items; (c) a new spiritual coping subscale was added; (d) data were collected from 4 samples (total N = 1,405) to conduct an exploratory factor analysis with targeted rotation, 2 confirmatory factor analyses, and differential item functioning; (e) item trimming was used to reduce the total number to 27; (f) internal consistency and test-retest reliability were computed; and (g) extensive validity testing was conducted. The results, which build upon the strengths of prior versions, confirm a structurally and psychometrically sound and unbiased measure of self-efficacy strategies for coping with cancer with a reduced number of items for ease of administration. The factors include Maintaining Activity and Independence, Seeking and Understanding Medical Information, Emotion Regulation, Coping With Treatment Related Side Effects, Accepting Cancer/Maintaining a Positive Attitude, Seeking Social Support, and Using Spiritual Coping. Internal consistency (α = .946), test-retest reliability (r = .890; 4 months), and validity coefficients with a variety of relevant measures indicated strong psychometric properties. The new 27-item CBI-V3.0 has both research utility and clinical utility as a screening and treatment-planning measure of self-efficacy strategies for coping with cancer. (PsycINFO Database Record