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The concept and measurement of meaning in life in Dutch cancer patients.

We investigated the psychometric properties of a Dutch translation of the Personal Meaning Profile in a heterogeneous group of cancer patients. Our study resulted in a relatively short scale consisting of 39 of the 57 original items, divided into 5 factors, labeled 'relation with God'; 'dedication to life'; 'fairness of life'; 'goal-orientedness' and 'relations with other people', which can be summed to a total score of the experience of meaning in life. The internal consistency of the total scale as well as of its sub dimensions was high. The experience of meaning in life was positively related to feelings of psychological well-being and negatively to feelings of distress. Furthermore, the experience of meaning in life was also related to trait-like characteristics as personality. Future research can investigate its appropriateness for other populations than cancer patients, and if and how the experience of meaning in life eventually changes as a result of existential threats.

Adult↗

What to do when 'there is nothing more to do'? A study within a salutogenic framework of family members' experience of palliative home care staff.

The aim of this study was to develop a theoretical framework of family members' experience of palliative home care staff based on a secondary analysis of four previous studies. A salutogenic framework was used, i.e. with the origin of health in focus. Data had been collected (semi-structured tape-recorded interviews and postal questionnaires with open-ended questions) from 469 family members of mainly cancer patients referred to advanced palliative home care. Walker and Avant's strategies for theory construction were used. The secondary analysis generated three theoretical blocks: (1) general components of staff input (including five generalized resistance resources (GRRs): competence, support, spectrum of services, continuity, and accessibility); (2) specific interactions with staff (including two GRRs: being in the centre and sharing caring); (3) emotional and existential consequences of staff support (including six health-disease continuums: security-insecurity, hope-hopelessness, congruent inner reality-chaos, togetherness-isolation, self-transcendence-feelings of insufficiency and retained everyday life-disrupted everyday life). It seems important that all three aspects of family members' experience of palliative care staff are to be considered in evaluations of palliative care, in goal-setting and in teaching role models. The study is specific to the Swedish model of palliative home care and replication of the work in other countries is recommended.

Aged↗

The development and evaluation of a measure to assess cancer survivors' unmet supportive care needs: the CaSUN (Cancer Survivors' Unmet Needs measure).

BACKGROUND: Many cancer survivors experience ongoing morbidity over the survivorship continuum and their supportive care needs have yet to be comprehensively assessed. METHODS: This study aimed to develop and empirically evaluate a self-report measure of cancer survivors' supportive care needs. In Phase I, questionnaire items were generated based upon previous qualitative research that identified both unique and shared needs in survivors and their partners; items were constructed into the Cancer Survivors' Unmet Needs measure (CaSUN). In Phase 2, the CaSUN was completed by 353 cancer survivors who had been diagnosed with cancer between 1 and 15 years earlier and were currently disease-free. RESULTS: After modification, the CaSUN included 35 unmet need items, 6 positive change items and an open-ended question. Good acceptability, internal consistency and validity were demonstrated, although test-retest reliability was low. Maximum likelihood factor analysis identified five discrete factors: Existential Survivorship, Comprehensive Care, Information, Quality of Life and Relationships. CONCLUSIONS: Preliminary data indicates that the CaSUN meets the majority of psychometric criteria for assessment measures, although its low test-retest reliability awaits further investigation. The CaSUN will facilitate the evaluation of supportive care services and generation of service delivery recommendations for cancer survivors.

Adult↗

Coping and health-related quality of life in men with prostate cancer randomly assigned to hormonal medication or close monitoring.

Prostatic carcinoma and its treatment have been associated with adverse effects on health-related quality of life (HRQoL). Individual differences in appraisal and coping have been suggested to mediate these HRQoL outcomes. A randomized trial of 65 men with non-localized prostate cancer compared several treatments and tested associations between appraisal, coping, and HRQoL. These patients, and 16 community volunteers matched for age and general health, undertook psychosocial assessments before treatment and after 6 months of treatment. Compared with baseline assessments, men on hormonal treatments reported impaired sexual function. Groups did not differ on emotional distress, existential satisfaction, subjective cognitive function, physical symptoms, or social and role functioning. For individuals, hormonal treatments were more frequently associated with decreased sexual, social and role functioning, but were also associated with improved physical symptoms. In hierarchical regression analysis, HRQoL was lower for men who had more comorbid illnesses, a history of neurological dysfunction, higher threat appraisals, or higher use of coping strategies at baseline. These results showed that pharmacological hormonal ablation for prostate cancer can improve or decrease HRQoL in different domains. HRQoL in men with prostate cancer was associated more strongly with appraisal and coping than with medical variables.

Adaptation, Psychological↗

Is there a cost to poor communication in cancer care?: a critical review of the literature.

In this paper, the authors engage in a critical analysis of the existing empirical literature which addresses the impact of ineffective communication between cancer patients and clinicians. It is increasingly accepted that communication plays a significant role in many aspects of the care experience, and that poor communication can have a significantly negative influence on the patient's psychosocial experience, symptom management, treatment decisions, and quality of life. However, scant attention has been given to the idea that poor communication may also have an economic impact worthy of attention. This area has not been the focus of systematic inquiry or substantive critical consideration. On the basis of critical analysis of the limited empirical evidence that exists across a wide range of studies in related areas, the authors propose that the existential and material costs associated with poor communication in cancer care may well be considerable, and conclude with a call to mobilize a heightened enthusiasm for addressing the research challenges in this field.

Communication↗

Psychotherapy for delinquents?

The results of a psychotherapy consultation service for delinquents are presented. Based on the clinical material obtained from this programme, and a review of relevant delinquency and psychotherapy literature, a working model of individual psychotherapy related to attachment theory as it applies to this population is discussed. Developmental and existential difficulties that warrant resolution are included, as are issues with resistance and counter transference.

Journal Article↗

Assessment of health-related quality of life in persons after traumatic brain injury--development of the Qolibri, a specific measure.

BACKGROUND: Health-related quality of life (HRQOL) associated or not with the measurement of neuropsychological functioning is a relatively new outcome variable in the field of traumatic brain injury (TBI). In both cases, accuracy and precision are increased in outcome estimation. Validation of generic, cross-culturally (cc) administered HRQOL measures in persons after TBI is not yet well established. Disease-specific HRQOL instruments do not exist in an international context. The objective here is to present the TBI consensus group's (QOLIBRI-Group) approach in cc development of a specific HRQOL measure--the QOLIBRI (Quality of Life after Brain Injury). METHODS: Special issues of TBI-specific instrument creation will be highlighted as well as cc questionnaire construction, development, translation and psychometric testing. RESULTS: The validation process of the preliminary version of the disease-specific QOLIBRI in 15 countries and 13 languages will be described. The QOLIBRI assesses HRQOL within six domains (physical condition, thinking activities, feelings and emotions, functioning in daily life, relationships and social/leisure activities, current situation and future prospects). The QOLIBRI integrates disease-specific issues of TBI patients, i.e. cognition, existential aspects (as the sense of self) etc., which are missing in generic tools. CONCLUSION: In TBI patients, generic and disease-specific aspects of HRQOL need to be assessed with measures of adequate psychometric quality, applicable across different populations and cultural conditions. The QOLIBRI is a promising instrument for sensitive patient-centered specific outcome evaluation after TBI.

Brain Injuries↗

Psychotherapeutic interventions in melanoma patients.

OBJECTIVES: The need for and the effectiveness of psychotherapy in the treatment of patients with skin cancer have been shown. However, only insufficient data are available to answer the questions as to what kind of psychotherapy is useful and how psychotherapeutic interventions should be designed. METHODS: During the past 7 years we performed crisis intervention, focal therapy and longer-lasting psychodynamically orientated psychotherapy within a consultation liaison service with the Department of Dermatology of Innsbruck University Hospital. We investigated the type of interventions using qualitative content analysis of the written records of weekly supervisory sessions. RESULTS: Standard methods of psychotherapy are often not appropriate for the confrontation of tumor-related fears in melanoma patients. Modifications of psychotherapeutic interventions and more structured support are necessary to meet overwhelming negative emotions caused by the existential threat of the disease. Therefore, we turned to using expressive-supportive methods combining psychodynamic psychotherapy with relaxation, imaginative methods, and structured picture drawing. CONCLUSIONS: Psychotherapists treating skin cancer patients should receive special education in such methods. To better cope with distressing emotions and to avoid burn-out and withdrawal from severely ill or dying patients, psychotherapists should take part in peer supervision regularly.

Humans↗

Suffering and its professional transformation: toward an ethnography of interpersonal experience.

The authors define experience as an intersubjective medium of microcultural and infrapolitical processes in which something is at stake for participants in local worlds. Experience so defined mediates (and transforms) the relationship between context and person, meaning and psychobiology in health and illness and in healing. Building on this theoretical background, an approach to ethnography is illustrated through an analysis of suffering in Chinese society. The embodied memory of a survivor of serious trauma during the Cultural Revolution provides an example. From there, the authors go on to describe a framework of indigenous Chinese categories for the analysis of experience--mianzi (face), quanxi (connections), renqing (situated emotion), bao (reciprocity). The paper concludes with a discussion of the existential limits of this and other anthropological approaches to the study of experience as moral process.

Adult↗

A cross-cultural study of depressive symptomology.

Black (N = 26), white (N = 26) and Overseas Chinese (N = 32) college students were surveyed with Zung's Self-rating Depression Scale (SDS). With the exception of two items where marginally significant differences were found, there were no quantitative differences in the results across these ethnic groups. Inter-item analyses, factor analyses and comparison of factor profiles indicated that the items clustered in different configurations for the three groups. The factors contributing the most variances differed in their item contents across the ethnic groups: a mixture of affective and somatic complaints characterizes the black group; existential and cognitive concerns characterize the white group and somatic complaints characterize the Overseas Chinese group. Discussion was focused on issues concerning cultural conception of psychological difficulties, communication styles used to communicate these difficulties and situational variables affecting performances on psychological diagnostic tests.

Adaptation, Psychological↗

Symptomatic differences between the sexes in rural Mexico.

This paper addresses the problem of the differential presentation of illness by women and men in two Spiritualist temples and a physician's office situated in rural Mexico. Women's morbidity raises the broader anthropological questions of the interplay between symptomatic expression and women's unequal status in the social structure, their cognitive evaluation of specific life experiences, cultural etiological explanations and Western models of dysphoria. Symptoms presented by patients in different health care delivery sites are compared and case vignettes of patients' illnesses and attributions are presented to demonstrate the ways in which culturally constructed illness attributions and illness expressions comprise a somatic grammar for the articulation of experimental distress. The sick population is compared with a control group of healthy women to highlight the socio-cultural and psychosocial variables that promote illness in women from the same sociocultural strata of rural Mexico. Collective understandings of the role of life events and emotional expression in illness attributions legitimize somatization as a coping style under adverse existential conditions.

Adult↗

Variations in problem conceptualizations and intended solutions among Hong Kong students.

Cognitive schema were used to explain health and illness behaviors among Chinese students. University students in Hong Kong were asked to attribute causes and suggest solutions to five health/mental health problems: Weakness/Fatigue, Tension/Anxiety, Sleep Difficulty, Hollow/Emptiness, and Headache. The patterns of endorsement on the causal and solution categories used for the five problems were compared using a new asymptotic chi-squared test. The response patterns were found to be significantly different across the five problems. Each problem was attributed to multiple causes including psychological, social, situational, somatic, and existential factors. The intended solutions were often related to the nature of the causal attributions especially when the problems were mild. In lay help-seeking, the Hong Kong students would attempt a variety of self-help measures. However, for professional consultation, the medical doctor would be the primary care professional the students would turn to for most of the problems except in the case of Hollow/Emptiness.

Adult↗

On the meaning of sports: cross cultural observations of super stress.

The definition of sports medicine indicates the possible therapeutic and research importance of games in the work of social scientists and clinicians. A cross-cultural comparison of super stressful competitions provides one insight into the importance of games in human societies. Fourteen such comparisons are made between Indians in Mexico who run 250-mile foot races and Americans in Alaska who conduct 1049-mile dog sled races. It is concluded that sports can help understand how a society defines itself and regulates violence. Games may be an essential "human-specific' need which provide entertainment, retain survival skills, ameliorate existential anxiety and promote religious and/or secular socialization. In this study, humans seem willing, if not insistent, to deploy considerable resources of time and material to sustain competitions among their own species, as well as between and with other species. A "sports history' is important for all individuals.

Adolescent↗

[A six-year follow-up study of 100 patients who attempted suicide (author's transl)].

This follow-up study assesses further suicidal risk and discusses the characteristics of patients who have repeatedly attempted suicide. Depth of coma alone due to overdose of medication does not seem to be a sufficient criterion for the assessment of further suicidal risk. Better predictors seem to be: age, family status, degree of loneliness and social disintegration, presence of existential anxiety, and lack of self-assertiveness. Patients who made repeated suicide attempts had a higher neuroticism score, were more often alcohol- and drug-dependent, and came more often from a broken home. Finally, the characteristics of various patient groups are delineated.

Adolescent↗

Measurement of quality of life in women with breast cancer. Development of a Life Satisfaction Questionnaire (LSQ-32) and a comparison with the EORTC QLQ-C30.

The purpose was to develop and validate a new instrument suitable for measuring perceived quality of life in women with breast cancer. The instrument is to be used within conventional cancer therapy as well as in complementary care, and is called the LSQ-32 (Life Satisfaction Questionnaire). The subjects were 362 women with breast cancer in all cancer stages. Cronbach's alpha reliability coefficient of the LSQ was 0.89. The construct validity was estimated by a principal component analysis. Six orthogonal factors were identified: (1) 'Quality of family relation', (2) 'Physical symptoms', (3) 'Socioeconomic situation', (4) 'Quality of daily activities', (5) 'Sickness impact' and (6) 'Quality of close friend relation'. The criterion-related validity was estimated by comparing the LSQ-32 and the EORTC QLQ-C30. The scales/items of the EORTC QLQ-C30 were represented in the LSQ-32, but the factors 'Quality of family relation' and 'Quality of close friend relation' were not found in the EORTC QLQ-C30. It was concluded that the LSQ-32 as well as the EORTC QLQ-C30 are valuable tools in the measurement of quality of life in women with breast cancer. The LSQ-32, however, also contains an existential factor.

Adult↗

Some aspects of separation and loss in therapy with disturbed children.

I have suggested that the impact of loss and separation on disturbed children can best be assessed from a developmental point of view that takes into account not only the reality of the object loss but the subjective experiences of the loss or separation, which will be determined by a host of subtle psychological variables. I have attempted to illustrate these existential variables with clinical examples.

Anxiety, Separation↗

Breast cancer survivors: psychosocial concerns and quality of life.

PURPOSE: To describe the psychosocial concerns and quality of life of breast cancer survivors evaluated 2 and 3 years after primary treatment. METHODS: A sample of 139 breast cancer survivors who had been interviewed during the first year after primary treatment participated in a mailed survey at 2 years (N = 69) and 3 years (N = 70) after initial surgery. A random sample of these survivors were also interviewed in person. The mailed questionnaire included standardized instruments to assess quality of life (QL), rehabilitation needs, and psychological distress. Additional survey questions were developed to examine post-surgical recovery, employment and insurance problems, social support, and existential concerns. The in-person interviews expanded on these questions and systematically compared these patients' rehabilitation needs to those which existed at the time of an interview 1 year after surgery. RESULTS: The 2 and 3 year participants in this follow-up study did not differ from each other on their prior assessments with standardized QL instruments during the first year after surgery, nor did they differ from the full study sample of 227 women. The scores on the Profile of Mood States and the Functional Living Index-Cancer were the same for the 2 and 3 year survivor groups and did not differ from the previous assessments at 1 year after initial treatment. The scores on the Cancer Rehabilitation Evaluation System showed a significant decline in Global Quality of Life, Sexual Functioning and Marital Functioning between the 1 year and 3 year evaluations. For the 2 year sample only Sexual Functioning showed a deterioration between the 1 and 2 year evaluations. Using the RAND 36-Item Health Survey 1.0, the breast cancer survivors were compared with patients from the Medical Outcomes Study. The breast cancer survivors demonstrated higher levels of functioning in many dimensions (role functioning, social functioning, pain, and general health) than the patients with chronic medical conditions. In spite of relatively good physical and emotional functioning on this generic measure of health status and quality of life, these breast cancer survivors reported a number of important and severe rehabilitation problems that persisted beyond one year after primary treatment. Especially frequent were problems associated with physical and recreational activities, body image, sexual interest, sexual function, and problems with dating for those who were single. CONCLUSIONS: Breast cancer survivors appear to attain maximum recovery from the physical and psychological trauma of cancer treatment by one year after surgery. A number of aspects of QL and rehabilitation problems worsen after that time. Nevertheless, breast cancer survivors rate their QL more favorably than outpatients with other common medical conditions, and they identify many positive aspects from the cancer experience.

Adaptation, Psychological↗

Experiences of torture and ill-treatment and posttraumatic stress disorder symptoms among Palestinian political prisoners.

The relationship between the nature and severity of experiences of torture and ill-treatment and posttraumatic stress disorder (PTSD) symptoms was studied in 550 male nonhelp-seeking Palestinian political ex-prisoners from the Gaza Strip. Results showed that the more a prisoner had been exposed to physical, chemical and electric torture, psychological ill-treatment, and sensory deprivation or bombardment, the more he subsequently suffered from intrusive reexperiencing, withdrawal and numbness, and hyperarousal. Existential problems were not related to torture experiences. Furthermore, duration of imprisonment, health problems during the imprisonment, harassment during arrest and after release, family, marriage and economic difficulties all predicted intrusive reexperiences of trauma. Also, ex-prisoners who continued to be harassed by military authorities and had economic problems suffered more from withdrawal, numbness, and hyperarousal than others.

Adaptation, Psychological↗