PubMed · 16021896
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Sam Windsor. Testing time.. https://doi.org/10.7748/ns.19.43.72.s60
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PURPOSE/OBJECTIVES: To test the effects of different perspective-taking instructional sets, gender, caregivers' personal histories with cancer, and caregiving relationship factors on family caregiver and patient perceptual agreement of symptom experiences of patients with lung cancer. DESIGN: Counterbalanced. SETTING: Thoracic oncology outpatient clinical setting in Canada. SAMPLE: 98 dyads consisting of patients with lung cancer and their family caregivers. METHODS: Data were collected on a one-time basis by employing an abbreviated version of the Memorial Symptom Assessment Scale targeting lack of energy and worrying. Caregivers were randomized to one of six counterbalanced conditions of perspective-taking instructions. MAIN RESEARCH VARIABLES: Caregiver discrepancy scores, instructional sets (i.e., neutral, self-report, and imagine-self and imagine-patient perspective-taking), order effects, gender, caregivers' personal history with cancer, and caregiving relationship factors. FINDINGS: No order effects were found for the instructional sets. Instructions to imagine the patient's perspective over imagining how the caregiver would feel if he or she had cancer were most effective in enhancing the caregiver's ability to estimate the patient's lack of energy and worrying. Gender had no significant effects. The amount of patient-caregiver communication had a positive impact on the accuracy of caregivers' perspectives. CONCLUSIONS: The patient-oriented instructions had a limited impact on enhancing patient-caregiver congruence on patient symptoms. This likely is related to the study's convenience sample of caregivers who appear to naturally engage in empathic processes of patient-oriented perspective-taking when they assessed and reported on patient symptom conditions. IMPLICATIONS FOR NURSING: Further exploratory work should identify interpersonal conditions that negatively hamper the effects of caregiver perspective-taking on their reasonable understanding of patient symptoms.
PURPOSE/OBJECTIVES: To develop an intervention that uniquely addresses the existential impact of cancer through meaning-making coping strategies and to explore the intervention's impact on psychological adjustment. DESIGN: Descriptive, qualitative approach to develop the intervention; one-group pre- and post-test design to pilot test the intervention. SETTING: Patients' homes or ambulatory oncology clinics affiliated with a university health center in eastern Canada. SAMPLE: 18 participants who were newly diagnosed in the past three months (n = 14), had completed treatment (n = 1), or were facing recurrence (n = 3) of breast (n = 10) or colorectal (n = 8) cancer. METHODS: Data were collected during interviews using a prototype intervention for trauma patients, and content was analyzed on an ongoing basis to fit the needs of the cancer population. Pretest and post-test questionnaires were administered to determine the intervention's effect. MAIN RESEARCH VARIABLES: Meaning-making intervention (MMI), patients' background variables, disease- or treatment-related symptoms, and psychological adjustment. FINDINGS: The MMI for patients with cancer consisted of as many as four two-hour, individualized sessions and involved the acknowledgment of losses and life threat, the examination of critical past challenges, and plans to stay committed to life goals. At post-test, participants significantly improved in self-esteem and reported a greater sense of security in facing the uncertainty of cancer. CONCLUSIONS: Findings suggest that meaning-making coping can be facilitated and lead to positive psychological outcomes following a cancer diagnosis. IMPLICATIONS FOR NURSING: The MMI offers a potentially effective and structured approach to address and monitor cancer-related existential issues. Findings are useful for designing future randomized, controlled trials.
PURPOSE/OBJECTIVES: To evaluate changes in body image and self-esteem in women with gynecologic malignancies who experience chemotherapy-induced alopecia and to examine the effectiveness of a videotape intervention on body image and self-esteem. DESIGN: A prospective, randomized study. SETTING: Subjects were accrued from 11 Gynecologic Oncology Group (GOG) member institutions participating in 14 GOG treatment protocols. SAMPLE: 136 women with chemotherapy-induced alopecia, a mean age of 57.7 years, and advanced disease at study entry. METHODS: Prior to the first course of chemotherapy, all subjects received standard counseling regarding hair loss. Body image and self-esteem scores were obtained prior to course 1 and 3 and after course 4 of chemotherapy. Prior to course 3, women with grade 2 alopecia were allocated randomly to the videotape intervention or no intervention. MAIN RESEARCH VARIABLES: Total body image and self-esteem as measured by the Body Cathexis/Self-Cathexis Scale (BCSCS). FINDINGS: A small but statistically significant change (p = 0.045) in body image was observed after chemotherapy-induced alopecia, with no change in self-esteem. The videotape did not produce a significant effect on body image score. CONCLUSIONS: The study results support prior studies that have reported changes in body image as a result of chemotherapy-induced alopecia. The intervention employed (a videotape) was not effective. The BCSCS is a simple and quick measurement for use in future studies IMPLICATIONS FOR NURSING: Chemotherapy-induced alopecia has an adverse effect on body image. Novel interventions are needed to assist women in coping with this consequence of treatment.