Perceived discrimination and quality of life for African American and Caucasian American cancer patients: a coping mediation analysis of subtle and overt microaggressions.

OBJECTIVE: Perceived discrimination (PD; e.g. racism, agism, sexism, etc.) negatively impacts quality of life (QOL) among cancer patients. Prior research has established that for African American Cancer Patients (AACPs) only disengagement/denial coping mediated the PD-QOL relationship. In contrast, for Caucasian American Cancer Patients (CACPs), both agentic and disengagement/denial coping were mediators of the PD-QOL relationship. However, according to social constraint theory there may be a difference between subtle and overt PD in terms of the utility of certain coping mechanisms in relation to QOL, especially for AACPs. METHOD: 217 AACPs and 121 CACPs completed measures of PD, coping (agentic, disengagement/denial, adaptive disengagement) and QOL. PD items were classified as subtle or overt microaggressions. PD was mainly attributed to race/ethnicity by AACPs and to income, age, and physical appearance for CACPs. RESULTS: : In both subtle and overt microaggression models with CACPs, agentic coping and disengagement/denial coping were significant mediators of PD-QOL. Like CACPs, for AACPs, agentic and disengagement/denial coping were significant in the context of subtle microaggressions. In contrast, for overt microaggression only disengagement/denial coping was a significant mediator of the PD-QOL relationship for AACPs. Adaptive disengagement was related to QOL only for AACPs. CONCLUSIONS: : Whereas more research is needed, it appears that overt microaggressions for AACPs, that consist mainly of racial and ethnic maltreatment, constitute a class of social contexts that may raise above the threshold for serious threat and harm, and, as a result, disengagement/constraint may reduce negative consequences. This additional burden for AACPs contributes to disparities in QOL. Future research is needed on the utility of adaptive disengagement for AACPs in relation to PD.

Guided Imagery for Symptom Management of Patients with Life-Limiting Illnesses: A Systematic Review of Randomized Controlled Trials.

Background: Patients with life-limiting illnesses receiving palliative care have a high symptom burden that can be challenging to manage. Guided imagery (GI), a complementary and integrative therapy in which patients are induced to picture mental images with sensory components, has proven in quasi-experimental studies to be effective as a complementary therapy for symptom management. Objective: To systematically review randomized controlled trials that report evidence of guided imagery for symptom management in patients with life-limiting illnesses. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed for this review and the search strategy was applied in Medline, CINHAL, and Web of Science. The quality of articles was evaluated using the Cochrane Collaboration's Risk-of-Bias Tool 2 (RoB 2). The results are presented using the Guidance on the Conduct of Narrative Synthesis in Systematic Reviews. Results: A total of 8822 studies were initially identified through the search strategy, but after applying exclusion criteria, 14 randomized controlled trials were included in this review. The quality assessment revealed that four studies had a high risk of bias, nine had some concerns, and one had a low risk of bias. Out of the 14 studies, 6 evaluated oncological diagnosis, while the remaining 8 focused on nononcological diagnoses across 6 different diseases. GI was found to be effective in managing symptoms in 10 out of the 14 studies. Regardless of the disease stage, patients who received guided imagery experienced relief from anxiety, depression, pain, sleep disturbances, and fatigue. Conclusion: GI therapy has shown promising results regarding symptom management in palliative care patients with life-limiting illnesses at different stages.

Integration of Psychosocial Theory into Palliative Care: Implications for Care Planning and Early Palliative Care.

Palliative care improves patients' symptoms, quality of life and family satisfaction with caregiving, reduces hospital admissions and promotes alignment of medical care with the patient's needs and goals. This article proposes the utility of integrating three psychosocial theories into standard palliative care with implications for care planning, early palliative care and optimizing quality of life. First, Control Theory focuses on the complex juxtaposition of promoting agency/empowerment in patients and carers and coping with often highly uncertain outcomes. Second, Optimal Matching Theory accounts for the alignment of need and provision of care to potentiate the quality of life effects of supportive care in a complex social process involving health care providers, patients and carers. Third, Hope Theory represents a dynamic process, which is marked by variation in the qualities of hope as the patient and carer confront challenges during palliative care. Future work will be translational in nature to adapt both assessment and interventions based on this theoretically driven augmentation of palliative care as well as to evaluate whether it provides a conceptual framework that has incremental utility in palliative care planning.

COVID-19 pandemic stress, tolerance of uncertainty and well-being for persons with and without cancer.

Stress related to the COVID-19 pandemic has implications for mental and physical well-being, but especially for persons with cancer. The stress mitigating role of tolerance of uncertainty (TU) was investigated in those with and without a cancer diagnosis. DESIGN: 155 persons with and 150 without a cancer diagnosis completed measures of pandemic stress and TU (mediating variable). MAIN OUTCOME MEASURES: Measures of emotional and physical well-being (WB) were the outcome variables. RESULTS: The mediated, indirect effect of TU in the pandemic stress-emotional WB relationship was significant for the cancer group and the non-cancer group. However, the indirect effects involving TU in the pandemic stress-physical WB relationship was not significant for the cancer group, whereas TU fully mediated the pandemic stress-physical WB relationship for the non-cancer group. CONCLUSIONS: Whereas TU was active as a mediator with emotional WB for both groups, it was ineffective as a mediator of the pandemic stress-physical WB relationship with the cancer group. Thus, the cancer group's physical WB was determined exclusively by pandemic stress. Stress reduction and enhancing TU may be critical for all people but for those with cancer decreasing pandemic stress would provide the most viable option for increasing physical well-being.

"Letting go" - Relinquishing control of illness outcomes to God and quality of life: Meaning/peace as a mediating mechanism in religious coping with cancer.

BACKGROUND: Relinquishing control (RC) of outcomes to God is a long-standing form of religious coping with serious illness. Placing cancer outcomes "in God's hands" has been positively related to coping and quality of life (QOL). However, the mechanisms involved in this relationship have not been established. A serial mediation model [i.e., RC (X)-Meaning/Peace (M1)-Coping Efficacy (M2)-Symptoms, Physical QOL, Functional QOL (Ys)] tested the hypothesis that Meaning/Peace alone and in conjunction with coping would mediate the RC-QOL relationship. METHOD: 548 persons with a cancer diagnosis completed the Religious Problem-Solving Scale (RPSS), FACIT-Sp Meaning and Peace Scales, Cancer Behavior Inventory (coping efficacy), and measures of Physical Quality of Life (PQOL), Functional Quality of Life (FQOL) and Symptoms. RESULTS: As hypothesized, the single mediation effects of Meaning/Peace were significant [Indirect Effects: PQOL: .23 (95% CI: 0.15, 0.34); FQOL: 0.46 (95% CI: 0.33, 0.61); Symptoms: -0.18 (95% CI: -0.27, -0.10)]. In addition, mediation was confirmed for the serial mediation model (i.e., Meaning/Peace - Coping Efficacy as serial mediators) with significant indirect effects [Indirect Effects: PQOL: 0.37 (95% CI: 0.27, 0.48); FQOL: 0.57 (95% CI: 0.42, 0.72); Symptoms: -0.25 (95% CI: -0.35, -0.17)]. CONCLUSIONS: In the mediation models tested, the RC-QOL and RC-Symptoms relationships were mediated by the confluence of a sense of peace perhaps due to patients' feelings that outcomes were "in God's hands" and a sense of coherence between their current situation and a spiritually-based meaning system. Meaning/Peace was also related to coping efficacy, suggesting that these mediating constructs could be used to inform evidence-based interventions, such as Meaning-Centered therapies, that are sensitive to the belief systems of cancer patients and enhance QOL.

Discerning critical stressors and resources in the lives of cancer patients: A multivariate analysis of targets of intervention for enhancing cancer care and quality of life.

OBJECTIVE: This study examined the relationship between a broad variety of stressors, resources, and outcomes to identify targets of intervention to enhance the quality of life of cancer patients and contribute to a comprehensive model of cancer care. METHODS: Five hundred and sixty persons with a diagnosis of cancer completed measures of stressors (past negative life events, current problems, current symptoms, comorbidities), resources (coping self-efficacy, social support, satisfaction with care) and outcomes (emotional and functional well-being). RESULTS: Multivariate canonical correlations between pairs of canonical variates (stressors-outcomes, Rc  = 0.56; stressors-resources, Rc  = 0.42, resources-outcomes Rc  = 0.66) were significant (all ps < 0.0001), which confirmed the relationship between those components and supported proceeding to more granular levels of analysis. More refined analyses revealed that the most critical variables in relation to outcomes (i.e., emotional and functional well-being), were current problems and symptoms among the stressors and coping self-efficacy, social support and patient satisfaction among the resources. CONCLUSIONS: This study provided an approach to the discernment of the most critical aspects of interventions that may improve supportive care and quality of life outcomes. Thus, efforts to address current problems (e.g., financial, home life, work), as well as effective management of symptoms (e.g., pain, fatigue, sleep), using the coordinated integration of medical care, support services and psycho-social interventions would provide the greatest impact on quality-of-life outcomes. Interventions that focus on problem solving and reinforce patient agency and activation may be most effective in sustaining quality of life outcomes into survivorship.

The effectiveness of hope-fostering interventions in palliative care: A systematic review and meta-analysis.

BACKGROUND: The concept of hope is an important theme in chronic illness and palliative care and has been associated with increased psycho-spiritual well-being and quality of life. Psycho-spiritual interventions have been described in this population, but no systematic review of hope-enhancing interventions or hopelessness-reducing interventions has been conducted for persons with palliative care diseases. AIM: To describe and assess the effectiveness of interventions in palliative care that measure hope and/or hopelessness as an outcome. DESIGN: This systematic review and meta-analysis was pre-registered (Prospero ID: CRD42019119956). DATA SOURCES: Electronic databases, journals, and references were searched. We used the Cochrane criteria to assess the risk of bias within studies. RESULTS: Thirty-five studies (24 randomized controlled trials, 5 quasi-experimental, 6 pre-post studies) involving a total of 3296 palliative care patients were included. Compared with usual/standard cancer care alone, interventions significantly increased hope levels at a medium effect size (g = 0.61, 95% confidence interval (CI) = 0.28-0.93) but did not significantly reduce hopelessness (g = -0.08, 95% CI = -0.18 to 0.02). It was found that interventions significantly increase spirituality (g = 0.70, 95% CI = 0.02-1.37) and decrease depression (g = -0.29, 95% CI = -0.51 to -0.07), but had no significant effect over anxiety, quality of life, and symptom burden. Overall, quality of evidence across the included studies was rated as low. CONCLUSIONS: Evidence suggests that interventions can be effective in increasing hope in palliative care patients.

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.

The costs, resource use and cost-effectiveness of Clinical Nurse Specialist-led interventions for patients with palliative care needs: A systematic review of international evidence.

BACKGROUND: Patients with palliative care needs do not access specialist palliative care services according to their needs. Clinical Nurse Specialists working across a variety of fields are playing an increasingly important role in the care of such patients, but there is limited knowledge of the extent to which their interventions are cost-effective. OBJECTIVES: To present results from a systematic review of the international evidence on the costs, resource use and cost-effectiveness of Clinical Nurse Specialist-led interventions for patients with palliative care needs, defined as seriously ill patients and those with advanced disease or frailty who are unlikely to be cured, recover or stabilize. DESIGN: Systematic review following PRISMA methodology. DATA SOURCES: Medline, Embase, CINAHL and Cochrane Library up to 2015. Studies focusing on the outcomes of Clinical Nurse Specialist interventions for patients with palliative care needs, and including at least one economic outcome, were considered. The quality of studies was assessed using tools from the Joanna Briggs Institute. RESULTS: A total of 79 papers were included: 37 randomized controlled trials, 22 quasi-experimental studies, 7 service evaluations and other studies, and 13 economic analyses. The studies included a wide variety of interventions including clinical, support and education, as well as care coordination activities. The quality of the studies varied greatly. CONCLUSION: Clinical Nurse Specialist interventions may be effective in reducing specific resource use such as hospitalizations/re-hospitalizations/admissions, length of stay and health care costs. There is mixed evidence regarding their cost-effectiveness. Future studies should ensure that Clinical Nurse Specialists' roles and activities are clearly described and evaluated.