Exploring the nature of situational goal-based coping in early-stage breast cancer patients: A contextual approach.

PURPOSE: The psychosocial impact of breast cancer varies widely across patients and over time. Greater insight into goal-based coping processes theorised to underpin psychological resilience may inform efforts to support the maintenance and recovery of psychological wellbeing in the context of breast cancer treatment and recovery. This prospective study adopted a qualitative descriptive design to better understand the nature of situational goal-based coping in response to personal goal interference encountered across the six months following surgery for early-stage breast cancer. METHOD: Responses to specific instances of goal interference were derived from semi-structured interviews conducted at three time-points following surgery (i.e., approximately two, four, and six months post-surgery). Thematic and cross-case analytic techniques were utilised to identify broad patterns across the goal-specific response trajectories. RESULTS: Three broad response patterns were identified - goal-based coping only, combined goal-based coping and other (i.e., informed waiting and/or passive) responses, and informed waiting and/or passive responses only. Specific response patterns were further identified within each category. The majority of response trajectories incorporated the utilisation of assimilative and/or accommodative goal-based coping. CONCLUSIONS: Early-stage breast cancer patients utilised goal-based coping in response to many instances of goal-specific interference encountered during the study period. While the initial or delayed activation of these processes appeared generally adaptive, there was also evidence of maladaptive coping and blocked goal pursuit. Further insight into the nature of adaptive and maladaptive goal-based coping in this context could help oncology nurses facilitate ongoing personal goal pursuit and psychological resilience across the cancer continuum.

A preliminary study to develop an intervention to facilitate communication between couples in advanced cancer.

OBJECTIVE: Psychosocial interventions directed to couples where one has advanced cancer can reduce distress, enhance communication, and provide an opportunity for relational growth. The present study aimed to develop an intervention to facilitate communication about living with advanced cancer using the Patient Dignity Inventory (PDI) as the focus of a clinical interview with couples toward the end of life. METHOD: Couples were recruited from oncology and palliative care services at a Sydney hospital. After the PDI was developed and manualized as an intervention for couples, the PDI-Couple Interview (PDI-CI) was delivered by a clinical psychologist and comprised the following: (1) the patient completed the PDI; (2) the patient's identified partner completed the PDI about how they thought the patient was feeling; and (3) the clinician reviewed the results with the couple, summarizing areas of concurrence and discordance and facilitating discussion. RESULTS: Some 34 couples were referred, of which 12 consented, 9 of whom completed the clinical interview. Reported benefits included enabling couples to express their concerns together, identifying differences in understanding, and giving "permission to speak" with each other. The focus of the interview around the PDI provided a structure that was particularly acceptable for men. Most couples confirmed that they were "on the same page," and where differences were identified, it provided a forum for discussion and a mutual understanding of the challenges in managing advanced cancer within a supportive context. SIGNIFICANCE OF RESULTS: Participant couples' experiences of the PDI-CI provide valuable insight into the benefits of this intervention. This preliminary study indicates that the intervention is a relatively simple means of enhancing closer communication and connection between couples where one has advanced cancer and may be an important adjunct in helping prepare couples for the challenges inherent toward the end of life. Further investigation of feasibility with a larger sample is recommended.

Acceptance and Commitment Therapy (ACT) for improving the lives of cancer patients: a preliminary study.

BACKGROUND: This preliminary study examined the effectiveness of an Acceptance and Commitment Therapy (ACT) intervention at improving the quality of life among cancer patients. It was hypothesised that over the course of the intervention, patients would report increased psychological flexibility through acceptance of unpleasant thoughts and feelings, and that increased psychological flexibility would lead to improvements in distress, mood, and quality of life. METHOD: Forty-five cancer patients participated in an ACT intervention. Outcome measures included self-reported distress, mood disturbance, psychological flexibility, and quality of life. Data were collected at pre, mid, and post-intervention and at 3-month follow-up. RESULTS: The data showed significant improvements on outcome measures from pre to post and from pre to follow-up. Regression analyses showed that changes in psychological flexibility predicted changes in quality of life, distress, and mood. CONCLUSIONS: ACT effect sizes were comparable to those obtained in studies examining the effectiveness of other psychological therapies, such as cognitive behaviour therapy, at improving quality of life among individuals with cancer. This supports further research into ACT as an effective intervention for cancer patients.

Psychosocial oncology services in New South Wales.

There is limited published evidence about how psychosocial services should be organised or routinely integrated into cancer services to ensure that cancer patients receive appropriate psychological, social and emotional support during periods of diagnosis, treatment and follow-up. This paper reports on a survey of 26 oncology services in New South Wales, Australia, to examine the current provision of psychosocial oncology services. The aim of the study was to gather baseline data and information about the provision of services and to identify significant challenges associated with the development and implementation of psychosocial oncology services. A total of 42% of staff at psycho-oncology services reported they could provide adequate psycho-oncology services, but 58% of sites said they could provide either only limited (27%) or very limited (31%) services. We found that services frequently identified challenges such as insufficient funding to employ skilled staff to provide psychosocial interventions, inadequate data to demonstrate the effectiveness of psychosocial interventions and, at times, lack of space to allow privacy for patient consultations. Future needs identified were strategic planning of psychosocial oncology services as part of broader cancer service plans, leadership of psychosocial oncology services, cohesive teams using agreed patient pathways or tools and integration into multi-disciplinary cancer teams.

The link between value motives, value success, and well-being among people diagnosed with cancer.

OBJECTIVE: This study investigated the relationship between cancer patient's values and cancer related distress. METHOD: A total of 107 patients with cancer diagnoses completed an anonymous questionnaire. RESULTS: Less self-regulating motivation for health values was significantly related to poorer well-being. Greater success at living one's values was significantly related to improved well-being and distress-related outcomes. Sex difference analysis suggested that success at friendship values was linked to less cancer-related distress among women, but not men, whereas success at romantic relationship values was linked to less distress among men, but not women. CONCLUSION: The results have important implications for values focused interventions, highlighting the importance of facilitating success at valued living and attending to sex differences among cancer patients.

The effects of personal construct group therapy on breast cancer survivors.

In this study, the authors evaluated the effects of a brief personal construct group therapy on breast cancer survivors (N=42) randomly assigned to either the treatment or wait-list control condition. The Gottschalk Gleser Content Analysis Scales were used to measure the effects for group across time (pre- and posttreatment, pretreatment, and 3-month posttreatment) on the personal construct states of threat, threat to existence, dislocation, and hope. Analyses showed that the beneficial effects of therapy achieved posttreatment were maintained at 3-month follow-up. The therapeutic group factors (I. D. Yalom, 1995) identified by the therapy group members as helpful in achieving these outcomes are also reported.