published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

Not available / text

published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy

The use of quality of life instruments to evaluate the effect of cancer and its treatment on individuals has increased but the process by which the patient comes to make these quality of life evaluations has not been addressed. Earlier studies have shown the reporting of physical symptoms and the evaluation of one's health to be related to negative affect. The purpose of this study was to investigate whether the relationship between negative affect and the evaluation of ones health would remain the same in a group of cancer patients, when a major disease and treatment symptom, fatigue was controlled for. The current study found no relationship between negative affect and the evaluation of health once fatigue was controlled for. Negative affect and fatigue were found to be moderately correlated and fatigue accounted for a large proportion of the variance in the quality of life domains of physical, functional and emotional well-being. Both empirical and theoretical issues are discussed. / Department of Counseling Psychology and Guidance Services

Health Locus of Control (HLOC) and other predictors of Quality of Life (QL) were examined for women with an initial versus recurrent breast cancer diagnosis. Twenty-eight women with an initial breast cancer (IBC) diagnoses and twenty-eight women with recurrent breast cancer (RBC) diagnoses were recruited from doctors' offices and cancer support groups. Correlational analyses were used to assess the relationships between variables. No significant differences were found between women with IBC and RBC on Psychological QL. Doctor HLOC and Psychological QL were related for women with RBC (r = .481, p = .01) and marginally so for women with IBC (r = .329, p = .09). A positive correlation was also found between Doctor HLOC and Functional QL for both women with IBC (r = .464, p = .01) and women with RBC (r = .390, p = .04). After controlling for stage of cancer, women with RBC reported higher Functional QL than did women with IBC. Advanced (stages III or IV) versus early (stages I or II) cancer stage related to lower Functional QL, controlling for initial versus recurrent diagnosis (r = -.283, p = .01). A marginally significant relationship was also found for cancer stage, regardless of initial versus recurrent diagnosis, with higher Overall QL for women with early stages of breast cancer (r = -.157, p = .09). No significant differences in Optimism or Overall QL were found between women with IBC versus RBC. No differences were found between married and single women. This research begins to explore differences in Quality of Life for women with a new versus a recurrent breast cancer diagnosis.

As the development of medical treatments and the increase in longevity of human life interface with the rising cost of medical care, the issue of quality of life appears to be coming to the forefront in understanding how health care decisions will best be realized for patients. Ethical questions relating to matters such as cost-effective economics, physician-assisted suicide, and quantity of life versus quality of life make the construct of quality of life even more important to ascertain.Quality of life can be an elusive construct to define as well as a difficult one to measure; however, recent literature has shown promising trends. Many quality-of-life measures have been developed in recent years. Initially these measures focused on life satisfaction in general. Then instruments for healthrelated concerns were developed. In the last decade such measures have become more specific as several have emerged to identify the quality-of-life experience regarding a particular illness, such as cancer. The current step is the development of measures for specific populations in oncology. Another trend is the move from objective to subjective measures of assessment. A third trend is movement toward a multidimensional perspective, with the latest addition being the inclusion of a spiritual domain.This project explored the unique experience of cancer patients with recurrent or metastatic disease by utilizing qualitative methodology to describe common themes which emerged from the data. Focus group sessions centered around defining quality of life and discussing the factors that diminish or enhance a meaningful quality of life. A unique contribution of this study was the involvement of the participants as co-researchers in the analysis of the data. Thirteen central themes were identified: control, attitude, humor, death, gratitude, faith, fear, pain, social comparison, social support, financial concerns, information and knowledge, and the focus group experience. The findings confirmed the recent trends in quality-of-life research--multidimensionality, subjectivity, and the uniqueness of a specific cancer population, those with recurrent or metastatic disease. With this elicitative data, future research could include the development of a quality-of-life instrument for this population of oncology patients with more advanced cancer. / Department of Counseling Psychology and Guidance Services

The purpose of this study was to investigate the influence of gender, time since diagnosis, and the family environment on the psychosocial adaptation of cancer patients. This study was important because there is a deficit in the literature investigating the effects of the family environment on psychosocial adaptation in male and female cancer patients with diverse diagnoses. This study measured psychosocial adaptation by the patient's ability to adjust to cancer-related stressors in the areas of social relationships, involvement in health care, psychological well-being, household and work related duties, and family relationships. The family environment was measured by the patient's perceived level of cohesion, expressiveness, and conflict in the family.The study's sample consisted of 149 stage I or II cancer patients over the age of 50 with no prior cancer diagnosis, recurrence, or metastases. Participants completed a set of questionnaires, including the Psychosocial Adjustment to Illness Scale and the Family Relationship Index. The combination of gender, time since diagnosis, and the family environment, with demographic variables held constant, was significant and accounted for nearly one-third (27 %) of the variance in cancer patients' psychosocial adaptation. Results showed that the family environment is a significant predictor of psychosocial adaptation in cancer patients. Gender and time since diagnosis were not significantly related to psychosocial adaptation. Implications from this study are offered. / Department of Counseling Psychology and Guidance Services

The purpose of the present study was to examine the role that specific factors play in the quality of life (QL) for women with recurrent breast cancer.

African American breast cancer survivors (N=22) in this exploratory study had a mean of 15.55 years since diagnosis (SD=10.734, min-5 years, max= 47 years). The women reported good quality of life, good health, good health care, very good provider care, very good sensitivity by their provider for their being a cancer survivor, and very good sensitivity and competence by their provider for treating them as an African American breast cancer survivor. Both the quantitative and qualitative data reinforce each other, showing evidence of posttraumatic growth from breast cancer, including a significant increase from before breast cancer to after breast cancer in their spirituality. Perhaps, most importantly, this exploratory study with a small sample found suggestive positive correlations between two types of self-efficacy coping and quality of life: i.e., the higher the rating for quality of life, then the greater the use of problem focused coping (r=.798, p=.000), and greater the use of support from friends/family coping (r=.776, p=.000). Hence, coping emerges as vital with regard to achieving a higher quality of life. This is consistent with Gaston-Johansson et al. (2013), urging exposing women to a Comprehensive Coping Strategy Program (CCSP). As an implication of this study, such a focus on coping strategies is recommended for health educators in their work with breast cancer survivors, and also with the newly diagnosed. While women may emerge from a breast cancer diagnosis with greater spirituality and having discovered they are stronger than they think, there may be those women who are struggling. They have yet to achieve the key factors associated with a higher quality of life such as high self-efficacy to cope with stress. Thus, health educators are advised to ensure that African American breast cancer survivors and those newly diagnosed receive culturally tailored interventions designed to improve their self-efficacy to cope. Health educators may conduct support groups with survivors and newly diagnosed women, so as to ensure they have adequate social support—especially if spousal/partner support is not high. This may counter the tendency of some women to withdraw and isolate, as per the emergent theme: emotional numbing, withdrawing, and isolating.

Indiana University-Purdue University Indianapolis (IUPUI) / Loneliness is a known risk factor for poor mental and physical health outcomes in the general population, and preliminary research suggests that loneliness is linked to poorer health in cancer patients as well. Various aspects of the cancer experience (e.g., heightened existential concerns) lend themselves to making patients feel alone and misunderstood. Furthermore, loneliness theory suggests that negative social expectations, which may specifically relate to the cancer experience, precipitate and sustain loneliness. Thus, loneliness interventions in cancer should be tailored to address illness-related social conditions and negative social expectations. Prior to the development of loneliness interventions for cancer populations, cancer-specific tools are needed to assess: (1) loneliness attributed to cancer (i.e., cancer-related loneliness), and (2) negative social expectations related to cancer. In the current project I developed measures of cancer-related loneliness and cancer-related negative social expectations for use in future theory-based loneliness research. A mixed-methods study design was employed. First, I developed items for the measure of cancer-related loneliness (i.e., the Cancer Loneliness Scale) based on theory, prior research, and expert feedback. Second, I conducted a clinic-based qualitative study (n=15) to: (1) obtain cancer patient feedback on the Cancer Loneliness Scale items, and (2) inform development of the item pool for the measure of negative social expectations (i.e., the Cancer-related Negative Social Expectations Scale). Interviews were audiotaped, transcribed verbatim, and then transferred to Atlas.ti for analysis. Content analysis was used to analyze data regarding patient feedback and theoretical thematic analysis was used to analyze data regarding negative social expectations. Overall, patients said they liked the Cancer Loneliness Scale and no changes were made to the items based on patient feedback. Based on results, I also created five content domains of negative social expectations that were represented in the item pool for the Cancer-related Negative Social Expectations Scale. Third, I conducted a telephone and mail-based quantitative study (n=186) to assess psychometric properties of the two new measures. Dimensionality was determined using confirmatory factor analysis. Reliability was assessed by examining internal consistency coefficients and construct validity was assessed by examining theoretical relationships between the Cancer Loneliness Scale, the Cancer-related Negative Social Expectations Scale, and existing reliable and valid measures of health and social well-being. The final products of the project included a 7-item unidimensional Cancer Loneliness Scale and 5-item unidimensional Cancer-related Negative Social Expectations Scale. Excellent evidence for reliability and validity was found for both measures. The resulting measures have both clinical and research utility.