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published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

This doctoral dissertation, as part of a large and ongoing CIHR-funded study, used a subset of the total sample to evaluate the contribution of interactive health communication (IHC) as a complement to more traditional means of informational support (Care-as-usual) to optimal adjustment of women newly diagnosed with breast cancer (N = 135). According to the study protocol, participants in the experimental group received an IHC educational intervention for an eight-week period. Measures of psychosocial adjustment and information-related variables were administered in interviews at Time 1 (pre-intervention) within 8 weeks of initial diagnosis, and again 8 weeks post-intervention (Time 2). Psychosocial adjustment variables included: depressive symptoms (CESD), anxiety (STAI-Y), well-being (IWB), and quality of life (SF-36)-mental and physical health components. Information-related variables included: the need for information related to cancer, cancer-specialist, and family or friend's informational support, and overall satisfaction with information. Optimism and Constructed meaning were evaluated at Time 1 and 2, respectively. A GLM MANCOVA model tested overall F-ratios and regression coefficients using difference scores. Predictors in the model were: group (experimental versus control), constructed meaning, and optimism. The overall model (df = 8, 121) was significant for Group, F = 3.66, p < .001, effect size eta2 = .20, Constructed Meaning, F = 3.04, p < .004, effect size eta2 = .17, and Optimism, F = 2.95, p < .005, effect size eta2 = .16. Participants in the dissertation experimental group had significant improvements in QOL-physical health and overall satisfaction with information when compared with the control group. Constructed meaning was significantly associated with beneficial changes in all of the adjustment-related variables. The results of this dissertation clarify the potentially significant roles IHC and constructed meaning pl

An ethnographic study was utilized to identify coping strategies of women with breast cancer. Five women were interviewed; four were interviewed on three separate occasions, and one was interviewed twice. The data were analyzed for specific coping strategies taken by the women to deal with the stresses of breast cancer. These strategies were compared and organized into categories of coping strategies: Actions Taken, Emotional Support, Positive Outcomes, Getting Control, and Keeping a Positive Attitude. These five categories were integrated as new coping incidents appeared in the data. The original five categories were merged into three categories: Getting Control, Compensating, and Emotional Support. From these three categories the theory was written: Women with breast cancer will obtain support, get control over what they can control, and compensate for what they cannot control.

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Causal modeling techniques were utilized to examine a theoretically induced coping model of resources, uncertainty and coping responses. The purpose of this study was to determine the influence of five independent resource variables which included psychological resources, socio-community resources, marital role resources, parenting role resources and physical resources, and the influence of one situational variable, ambiguity, on the selection of differing coping decision responses, that is, minimizing stress behaviors, buffering situation behaviors and mobilizing infusion behaviors. The theoretical relationships of the constructs of resources, uncertainty and coping decisions were derived from the literature on coping, decisions under ambiguity and from a previous inductive study conducted with cancer patients by the investigator. The sample(s) selected for this study were patients previously treated for Stage I or II breast cancer and who were currently in remission within Pima County, Arizona, were of caucasian race and under 70 years of age. The sample was selected from patients treated or monitored from the Arizona Health Sciences Center, Department of Radiation-Oncology and Department of Hematology-Oncology and Kino Community Outpatient Cancer Clinic. Data was collected with an interviewer-administered questionnaire conducted in the subject's home and lasting approximately one hour. The data were analyzed by examining (1) the demographic characteristics, (2) correlations among the independent variables, (3) tests for causal assumptions, and (4) regression analysis of the theory model predictions. The evidence supports the original axiom that differential resources, namely, psychological, social and physical, account for an individual's differential selection of coping responses. Specifically, this study found that strong marital resources and a sense of mastery over the environment seems to deter the use of buffering behaviors; strong parenting role resources, physical resources and a self-denigrating attitude of one's self deter the use of mobilizing infusion behaviors. Specification errors included the probable dual dimensionality of the minimizing the mobilizing coping scales. Contributing variables that are absent in the model may include: social resource of occupation, disease and treatment staging, nature of the physician-patient relationship and the amount of accessible information and risk perceived in the situation. Measurement errors included the new reliability of the mastery scale, possible instrumentation error with the physical distress scale, and less than adequate scalability with the minimizing stress scale and mobilizing infusions scale, though these last two measurement errors could also be considered as misspecified variables. A multistaged empirical model of coping was generated from the findings of this study and will serve as the basis of further theory testing. An additional resource variable includes occupational role. Disease stage directly impacts the second stage of the coping model, uncertainty, which is expanded to include information and risk factors along with ambiguity. Coping responses in the third stage includes an additional category, taking direct action. The final stage of the model depicts the outcome of coping efficacy measured by increased psychological resources and reduced ambiguity.

This study explores the facilitation of preparation for breast cancer surgery. The aim of the study was to develop a reasonably comprehensive scheme of categories that would describe, from the perspective of women with breast cancer, what facilitates or hinders positive psychological preparation for breast cancer surgery and, therefore, identify and conceptually organize a broad array of these experiences. The research method involved interviews with 30 women who underwent an operation for breast cancer 6-12 months prior to their interviews. The Critical Incident Technique was used to collect and analyze the data. The women were interviewed and asked to recall incidents that were helpful or hindering in their preparation for a breast cancer surgery. A total of 362 incidents from 30 participants were collected, analyzed, and placed into categories. These incidents were organized into twenty-three categories: Receiving Educational Materials and/or Information; Obtaining an Explanation of Medical Procedures or Problems; Discussing Problems with Loved One; Getting Support and Encouragement from Others; Being Accompanied to a Medical Appointment; Helping Others; Engaging Oneself in Physical and Creative Activities; Developing Helpful Habits; Taking Action on Realizing Own Mortality; Experiencing Physical Closeness; Experiencing Deep Emotional Closeness; Realizing Shift in Relationship with Loved Ones; Healing Through Spiritual Experience and Visualization; Changing Perspective Through Comparison; Using Inspiring, Comforting Material; Getting Alternative Treatment; Establishing Professional Communication; Waiting for Medical Results; Sharing Experiences in Support Groups and Counseling; Perceiving Professional Manners; Experiencing Positive Medical Settings; Getting a Recommendation/Approval of Medical Personnel, Questioning Competence of Medical Care or Personnel. The data also included information about participants' decision-making process regarding the type of operation for breast cancer and some observations on them were drawn. Several procedures were used to examine validity, soundness and trustworthiness of the categories and subcategories. Three narrative accounts were analyzed in an effort to provide meaning and action to these categories. The findings of this study may serve as a basis for better understanding of the process of preparation for breast cancer surgery. Through further examination of the categories and narratives some suggestions and recommendation for research and practice were made.

Coming to terms with breast loss and its effect on body image, femininity and self-esteem are major issues confronting women who have lost a breast to cancer. Furthermore, messages from the media, cosmetic industry and health care profession perpetuate the 'beauty myth' affecting the self-esteem of breast cancer patients. This emphasis on the aesthetic often takes precedence the grief associated with losing a body part that for many women is strongly linked to their self-concept. Based on interviews with nine breast cancer survivors in Winnipeg, Manitoba and Montreal, Quebec, three issues will be addressed: first how the cultural influences that support and perpetuate the 'beauty myth' affect breast cancer survivors; how, as a result of this issue, the grieving process is hindered and third, the experiences of women treated for breast cancer within the medical system. Implications for social work will also be discussed.

There is no abstract available for this dissertation. / Department of Counseling Psychology and Guidance Services

This study explores the facilitation of preparation for breast cancer surgery. The aim of the study was to develop a reasonably comprehensive scheme of categories that would describe, from the perspective of women with breast cancer, what facilitates or hinders positive psychological preparation for breast cancer surgery and, therefore, identify and conceptually organize a broad array of these experiences. The research method involved interviews with 30 women who underwent an operation for breast cancer 6-12 months prior to their interviews. The Critical Incident Technique was used to collect and analyze the data. The women were interviewed and asked to recall incidents that were helpful or hindering in their preparation for a breast cancer surgery. A total of 362 incidents from 30 participants were collected, analyzed, and placed into categories. These incidents were organized into twenty-three categories: Receiving Educational Materials and/or Information; Obtaining an Explanation of Medical Procedures or Problems; Discussing Problems with Loved One; Getting Support and Encouragement from Others; Being Accompanied to a Medical Appointment; Helping Others; Engaging Oneself in Physical and Creative Activities; Developing Helpful Habits; Taking Action on Realizing Own Mortality; Experiencing Physical Closeness; Experiencing Deep Emotional Closeness; Realizing Shift in Relationship with Loved Ones; Healing Through Spiritual Experience and Visualization; Changing Perspective Through Comparison; Using Inspiring, Comforting Material; Getting Alternative Treatment; Establishing Professional Communication; Waiting for Medical Results; Sharing Experiences in Support Groups and Counseling; Perceiving Professional Manners; Experiencing Positive Medical Settings; Getting a Recommendation/Approval of Medical Personnel, Questioning Competence of Medical Care or Personnel. The data also included information about participants' decision-making process regarding the type of operation for breast cancer and some observations on them were drawn. Several procedures were used to examine validity, soundness and trustworthiness of the categories and subcategories. Three narrative accounts were analyzed in an effort to provide meaning and action to these categories. The findings of this study may serve as a basis for better understanding of the process of preparation for breast cancer surgery. Through further examination of the categories and narratives some suggestions and recommendation for research and practice were made. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate