The effect of an online acceptance and commitment intervention on the meaning-making process in cancer patients following hematopoietic cell transplantation: study protocol for a randomized controlled trial enhanced with single-case experimental design.

BACKGROUND: Hematopoietic cell transplantation (HCT) is a highly invasive and life-threatening treatment for hematological neoplasms and some types of cancer that can challenge the patient's meaning structures. Restoring meaning (i.e., building more flexible and significant explanations of the disease and treatment burden) can be aided by strengthening psychological flexibility by means of an Acceptance and Commitment Therapy (ACT) intervention. Thus, this trial aims to examine the effect of the ACT intervention on the meaning-making process and the underlying mechanisms of change in patients following HCT compared to a minimally enhanced usual care (mEUC) control group. The trial will be enhanced with a single-case experimental design (SCED), where ACT interventions will be compared between individuals with various pre-intervention intervals. METHODS: In total, 192 patients who qualify for the first autologous or allogeneic HCT will be recruited for a two-armed parallel randomized controlled trial comparing an online self-help 14-day ACT training to education sessions (recommendations following HCT). In both conditions, participants will receive once a day a short survey and intervention proposal (about 5-10 min a day) in the outpatient period. Double-blinded assessment will be conducted at baseline, during the intervention, immediately, 1 month, and 3 months after the intervention. In addition, 6-9 participants will be invited to SCED and randomly assigned to pre-intervention measurement length (1-3 weeks) before completing ACT intervention, followed by 7-day observations at the 2nd and 3rd post-intervention measure. The primary outcome is meaning-related distress. Secondary outcomes include psychological flexibility, meaning-making coping, meanings made, and well-being as well as global and situational meaning. DISCUSSION: This trial represents the first study that integrates the ACT and meaning-making frameworks to reduce meaning-related distress, stimulate the meaning-making process, and enhance the well-being of HCT recipients. Testing of an intervention to address existential concerns unique to patients undergoing HCT will be reinforced by a statistically rigorous idiographic approach to see what works for whom and when. Since access to interventions in the HCT population is limited, the web-based ACT self-help program could potentially fill this gap. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT06266182. Registered on February 20, 2024.

To know or not to know? Opinions of patients with Parkinson's Disease on disclosing risk of phenoconversion in RBD.

INTRODUCTION: The aim of our study was to find out the opinion of patients with Parkinson's Disease (PD) whose disease was preceded by REM sleep behaviour disorder (RBD) regarding early information about the high risk of phenoconversion in RBD. CLINICAL RATIONALE FOR THE STUDY: RBD is an early clinical manifestation of α-synucleinopathies with a more than 90% risk of phenoconversion to PD, dementia with Lewy bodies (DLB) or multiple system atrophy (MSA). It remains a subject for debate as to whether and how RBD patients should be informed about the high risk of phenoconversion. The patient's right to full knowledge regarding his or her health conflicts with the potentially destructive impact of this information on his or her mental state and quality of life of them and their relatives. MATERIAL AND METHODS: Thirty-nine patients with PD whose disease was preceded by RBD were surveyed. Data on the course of RBD and PD was collected. Questions were asked about early information about the high risk of phenoconversion to patients with RBD and factors determining the opinion of the surveyed persons. RESULTS: The majority ( > 60%) of respondents gave a positive answer when asked whether patients should be informed about their high risk of developing PD once diagnosed with RBD. Only a few (7.7%) respondents believed that disclosing such information to the patient should be possible only after obtaining his or her consent. Respondents associated consent to information about the high risk of developing PD in people with RBD with high expectations of the healthcare system. We were unable to determine whether factors such as the gender of the subject, the clinical course of the PD, and the RBD duration had an impact on patients' opinions regarding disclosing knowledge about phenoconversion. CONCLUSIONS AND CLINICAL IMPLICATIONS: Our study provides important information that should influence physicians' communication with patients with RBD, especially regarding how they communicate about the high risk of phenoconversion.

Meaning-reconstruction factors and well-being in cancer survivor-caregiver dyads: Daily associations and mechanisms.

OBJECTIVE: The study aimed to expand the existing research on the meaning-making processes in cancer by examining (a) the relationship between daily meaning making and meanings made versus the emotional and social well-being in survivor-caregiver dyads, (b) whether meanings made moderated or mediated the meaning-making-well-being associations at the within- and between-dyad level, and (c) whether meaning factors varied across or within persons. METHODS: Two hundred dyads completed measures of meaning making, meanings made, positive and negative affect, and loneliness for 28 consecutive posthospitalization days following hematopoietic cell transplantation. Computations were based on the actor-partner interdependence model and its extensions, using multilevel structural equation modeling. RESULTS: Positive emotional effects of meanings made and mixed effects of meaning making were found. Meanings made mediated, but not moderated, the association between meaning making and affect. Meaning factors varied substantially between- but less so within-person. CONCLUSIONS: Further research on the meaning-making process and practical actions will require a greater focus on the level of the analysis, the role in the dyad, and interpersonal aspects. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The role of psychological flexibility in the meaning-reconstruction process in cancer: The intensive longitudinal study protocol.

OBJECTIVES: Meaning-making is an important element of adapting to disease. However, this process is still poorly understood and the theoretical model has not been comprehensively verified yet, particularly in terms of complexity, dynamics, and intraindividual variability. The aim of this study is a deeper understanding of the meaning-reconstruction process in cancer and empirical verification of the integrative meaning-making model of coping extended by the psychological flexibility model. We postulate that psychological flexibility can foster the meaning-making in cancer by building more flexible and workable meaning-making explanations of disease. DESIGN: A daily-diary study conducted for 14 days in patients following the first autologous or allogeneic hematopoietic cell transplantation (HCT). METHODS: Participants (at least 150) will be requested to complete the daily-diary related to daily situational meaning, meaning-related distress, meaning-making, psychological flexibility, meanings made, and wellbeing for 14 days after hospital discharge following HCT. Also, baseline and follow-up assessment of global meaning, wellbeing, and meanings made will be performed. Statistical analysis of the data will be conducted using the multilevel and dynamic structural equation modeling. CONCLUSIONS: The study will fill in the gaps in health psychology in the understanding of the meaning-reconstruction process in cancer by within- and between-person verification of the integrative meaning-making model and its extension by the psychological flexibility model. The data obtained will be used in further research on the development of meaning-making by means of interventions based on psychological flexibility.

Physician-patient agreement on physicians' communication skills and visit satisfaction in dermatology clinics: a one-with-many design.

BACKGROUND: There is limited research on physician-patient communication skills that covers both sides of the relationship. The aim of this study was to explore two indicators of effective physician-patient communication: the agreement of physicians' and patients' perspectives of physicians' communication skills in outpatient visits to dermatology clinics and the relationship of these perceptions of the consultation with their visit satisfaction. PARTICIPANTS AND PROCEDURE: Dermatologists (n = 8) and their patients (n = 122) completed post-consultation dyadic measures of the content (what the physician communicates) and process (how the physician communicates) of the communication and satisfaction with a single office visit. Multilevel modelling was used to investigate the patient and doctor variance components at both the dyad and the doctor levels. RESULTS: The patients rated the communication content skills higher than the physicians did; however, the doctors rated themselves as better skilled at the process of communication. There was disagreement between the physicians' and the patients' ratings of the both physicians' content and process skills. In contrast, there was a high level of consensus amongst patients of the same doctor about the content and process of the doctor's communication skills, while the physicians did not perceive themselves as consistent in communication between one patient and another. However, both the physicians and the patients who reported uniquely the highest physicians' communication skills had higher visit satisfaction. Moreover, the patients who perceived their physicians as having good communication process skills on average had higher visit satisfaction. CONCLUSIONS: Although the perspectives of the same visit differed, self-rated behaviour affected satisfaction with visit.

Daily stress and received social support in hematopoietic cell transplant patient-caregiver dyads.

BACKGROUND AND OBJECTIVE: Reception of social support may foster adjustment in dyads facing cancer treatment. Still, understanding of the effects of received support in everyday life of patient-caregiver dyads remains limited. This study investigated whether the positive effect of daily received social support depends on daily stress levels and whether the effect differs by perspective (recipient vs. provider) in dyads undergoing hematopoietic cell transplantation (HCT). DESIGN AND METHODS: The sample comprised 200 patient-caregiver dyads after HCT. The participants completed measures of daily stress levels, received and provided social support as well as affect for 28 consecutive days. RESULTS: Regardless of daily stress levels, the caregivers reported better affect on days when they noticed more received support (recipient perspective), whereas the patients reported worse affect on days when they noticed more received support (recipient perspective) and/or when their caregivers reported higher provided support (provider perspective). CONCLUSION: The effects of daily received support were not related to the levels of daily stress in patient-caregiver dyads after HCT. Also, the effects varied by role (benefits in the caregivers vs. harm in the patients) and perspective (similarities in the patients vs. differences in the caregivers).

Daily analysis of autonomy support and well-being in patient-caregiver dyads facing haematopoietic cell transplantation.

OBJECTIVES: Caregivers may restore patient self-determination in disease by supporting their autonomy, and thus enhance their well-being. In this study, we investigated the between- and within-person effects of recipient-reported and provider-reported autonomy support on patient daily biopsychosocial well-being in patient-caregiver dyads following haematopoietic cell transplantation (HCT). DESIGN: A dyadic daily-diary study conducted for 28 days after patients' hospital discharge following HCT. METHODS: Patients and their caregivers (N = 200) participated in a 28-day daily-diary study. They completed measures of daily autonomy support reception (patients) and provision (caregivers), subjective physical health, affect (positive/negative), and relationship satisfaction. RESULTS: The patient's feeling of being supported in their autonomy was associated with their better positive affect and relationship satisfaction, both overall (between-person effect) and daily (within-person effect). Caregiver-reported overall and daily support of patient autonomy did not predict patient daily biopsychosocial well-being. CONCLUSIONS: These findings extended the evidence that autonomy support reported by patients facing HCT may have both accumulative and acute beneficial effects on their psychological and social well-being.

Interaction effect of coping self-efficacy and received support in daily life of hematopoietic cell transplant patient-caregiver dyads.

OBJECTIVES: According to the social cognitive theory, social support and self-efficacy may interact with each other i.e. compete or account jointly for better adaptation. This study examined the nature of the interaction between coping self-efficacy and received social support in daily lives of patient-caregiver dyads after cancer treatment. We tested whether the effect of daily fluctuations in coping self-efficacy and received support on daily affect was synergistic (positive jointed effect), compensatory (positive competing effect), or interference (negative competing effect). DESIGN: A dyadic daily-diary study conducted for 28 days after hospital discharge following hematopoietic cell transplantation. METHODS: Coping self-efficacy, received support, and positive and negative affect were measured in 200 patient-caregiver dyads. The analysis was based on the actor-partner interdependence moderation model using multilevel structural equation modeling. RESULTS: Statistically significant effect of interaction between daily coping self-efficacy and received support on negative affect was found, although only in the caregivers. In that group, higher daily received support compensated for lower daily coping self-efficacy but had a negative effect when coping self-efficacy was significantly higher than typical. Also, direct beneficial effects of higher daily coping self-efficacy and received support on caregiver positive affect were found. In the patients, higher daily coping self-efficacy was directly associated with better daily affect. CONCLUSIONS: Diverse effects of daily coping self-efficacy and received social support were found-the interference effect in the caregivers and the main effect of coping self-efficacy in the patients. Higher daily coping self-efficacy and optimal received social support may provide resilience against affect disturbance after cancer treatment.

Does physical activity lower the risk for metabolic syndrome: a longitudinal study of physically active older women.

BACKGROUND: The associations between physical activity and metabolic syndrome (MetS) have been mainly found in cross-sectional studies. The aim of this longitudinal study was to examine the relationship between meeting step-based guidelines and changes in the risk of metabolic syndrome. METHODS: This study included data from older women (baseline age 62.9 ± 4.3 years) from a 7-year longitudinal study in Central Europe. At baseline and follow-up, physical activity was measured by an accelerometer, and the risk for MetS was assessed according to the NCEP-ATP III criteria. In 59 women, multivariate repeated measures ANOVA was used to compare differences in changes in the risk of MetS in groups based on meeting step-based guidelines (10,000 steps/day and 9000 steps/day for women aged <65 and ≥ 65 years, respectively). RESULTS: Over 7 years, steps/day increased from 10,944 ± 3560 to 11,652 ± 4865, and the risk of MetS decreased from 41 to 12% in our sample. Women who longitudinally met step-based guidelines had a significantly higher mean concentration of high-density cholesterol (HDL-C) (64.5 and 80.3 mg/dL at baseline and follow-up, respectively) and a lower concentration of triglycerides (TGs) (158.3 and 123.8 mg/dL at baseline and follow-up, respectively) at follow-up compared to baseline. Moreover, women who increased their daily steps over 7 years to the recommended steps/day value significantly decreased the concentration of TGs (158.3 mg/dL and 123.8 mg/dL at baseline and follow-up, respectively). CONCLUSIONS: Our study might suggest that the long-term meeting of step-based guidelines or an increase in daily steps/day to achieve the recommended value could be related to a lower risk of MetS, specifically in concentrations of HDL-C and TG. These findings may help in designing interventions aiming to decrease the risk of MetS in older women.

Daily received support and relational functioning in HCT survivors and their caregivers.

OBJECTIVES: Numerous authors have expressed their interest in adjustment and social support in the context of cancer. However, none of the previous studies has directly examined the models describing the links between daily social support and adjustment fluctuation, particularly at the relational level. This study aimed to verify the additive and buffering models of daily received support regarding the relational level of patient-caregiver relationship, that is, the relationship-related stress and relationship satisfaction following hematopoietic cell transplantation (HCT). METHODS: Two hundred patient-caregiver dyads participated in a 28-day diary study that was started on the first day after post-HCT discharge. The participants rated the extent of daily relationship-related stress, relationship satisfaction, and received support every evening during the study. The analyses were based on the actor-partner interdependence moderation model. RESULTS: Daily deviations in received support were directly associated with concurrent and lagged daily deviations in relationship satisfaction, regardless of relationship-related stress level in both patients and caregivers. In addition, in caregivers, the effect of daily deviations in received support on relationship satisfaction depended on deviations in relationship-related stress and was significant on the days with higher relationship-related stress. CONCLUSIONS: The findings supported both the additive (in patients and caregivers) and the buffering hypotheses (in caregivers) of daily received support in patient-caregiver dyads during the first month following HCT. The theoretical and practical implications of the findings are further highlighted.

Protective Buffering and Individual and Relational Adjustment Following Hematopoietic Stem Cell Transplantation: A Dyadic Daily-Diary Study.

BACKGROUND: Supportive communication (e.g., protective buffering, PB) may impact individual and relational adjustment in patients following hematopoietic stem cell transplantation (HSCT) and their caregivers. Previous studies revealed that PB (i.e., hiding one's concerns and denying one's worries) has mixed effects, namely it is beneficial, costly or unrelated to dyadic adjustment. This study aimed to verify these findings by addressing some unresolved issues, i.e., examining (1) both individual and relational as well as both positive and negative indicators of adjustment, (2) the effect of within-dyad congruence (i.e., complementarity/similarity) in PB, and (3) within-dyad causal associations between PB and adjustment. METHODS: Two hundred patients (following first autologous or allogeneic HSCT) and their caregivers independently completed measures of daily PB, relationship satisfaction, relationship stress, and positive affect (PA) and negative affect (NA) for 28 consecutive evenings after discharge of patients. FINDINGS: For both patients and caregivers, the results showed a same-day association between daily PB and individual (positive and negative) and relational (positive and negative) adjustment indicators showing the advantage of PB. In terms of the dyad congruence, complementarity (one partner high and the other low) in daily PB was related to higher same-day relationship satisfaction for both patients and caregivers and lower same-day relationship stress in caregivers. The benefits from similarity (both patient and caregiver high or low in PB) had delayed effects, although only in patients. As far as the causal associations were concerned, day-to-day changes in PB preceded changes in daily adjustment. In caregivers, reverse causality was found, i.e., changes in adjustment predicted next-day changes in support. DISCUSSION: Contrary to previous studies, daily PB has a rather beneficial effect in dyads following HSCT. Patients seemed to have benefited the most from the similarity in daily PB fluctuation, while caregivers profited from complementarity. Causal associations between PB and adjustment within-dyad were also different. The findings may add to a better understanding of PB-adjustment relationship in dyads facing HSCT.

Salutary effect of daily coping self-efficacy: impact on day-by-day coping to mood effects within dyads following hematopoietic stem cell transplantation.

Background and Objectives: Little is known how coping self-efficacy (CSE) interacts with coping in dyad everyday life. The present study examined the moderating role of daily CSE in the relationship between coping and the next-day positive (PA) or negative (NA) affect in patient-caregiver dyads, following hematopoietic stem cell transplantation. Design: This intensive longitudinal study was conducted during the first 28 days after post-transplant discharge. Methods: Patients and their caregivers (N = 200) maintained daily diaries on CSE, coping strategies, and affect. Results: Daily CSE moderated daily coping-affect relationship: Positive emotion-focused coping increased PA in patients with higher than usual emotion-related CSE, whereas a buffering effect was found at lower than usual emotion-related CSE. A positive association between negative emotion-focused coping and NA in both patients and caregivers was stronger among those with lower than usual levels of emotion-related CSE. Higher than usual instrumental coping reduced NA in patients whose caregivers had higher than usual problem-related CSE, but increased NA for those whose caregivers had lower than usual instrumental CSE. Conclusion: The findings show that daily CSE contributes to the effectiveness of daily coping within dyad, confirming its significance in effective adaptation and the role in the dyadic coping process.

Working Memory Capacity as a Predictor of Cognitive Training Efficacy in the Elderly Population.

Aging is associated with a decline in a wide range of cognitive functions and working memory (WM) deterioration is considered a main factor contributing to this. Therefore, any attempt to counteract WM decline seems to have a potential benefit for older adults. However, determination of whether such methods like WM trainings are effective is a subject of a serious debate in the literature. Despite a substantial number of training studies and several meta-analyses, there is no agreement on the matter of their effectiveness. The other important and still not fully explored issue is the impact of the preexisting level of intellectual functioning on the training's outcome. In our study we investigated the impact of WM training on variety of cognitive tasks performance among older adults and the impact of the initial WM capacity (WMC) on the training efficiency. 85 healthy older adults (55-81 years of age; 55 female, 30 males) received 5 weeks of training on adaptive dual N-back task (experimental group) or memory quiz (active controls). Cognitive performance was assessed before and after intervention with measures of WM, memory updating, inhibition, attention shifting, short-term memory (STM) and reasoning. We found post-intervention group independent improvements across all cognitive tests except for inhibition and STM. With multi-level analysis individual learning curves were modeled, which enabled examining of the intra-individual change in training and inter-individual differences in intra-individual changes. We observed a systematic and positive, but relatively small, learning trend with time. Moderator analyses with demographic characteristics as moderators showed no additional effects on learning curves. Only initial WMC level was a significant moderator of training effectiveness. Older adults with initially lower WMC improved less and reached lower levels of performance, compared to the group with higher WMC. Overall, our findings are in accordance with the research suggesting that post-training gains are within reach of older adults. Our data provide evidence supporting the presence of transfer after N-back training in older adults. More importantly, our findings suggest that it is more important to take into account an initial WMC level, rather than demographic characteristics when evaluating WM training in older adults.

Dyadic support and affect in patient-caregiver dyads following hematopoietic stem-cell transplantation: A diary study.

OBJECTIVE: Cancer and its treatment are highly stressful events that may significantly affect the daily emotional well-being of patients and their informal caregivers. Patient- and caregiver-reported received and provided support may contribute to both dyad members' fluctuation in daily affect, but few studies have examined these associations from a dyadic perspective so far. The current study examined predictions derived from 3 theories on patterns of relations between subjectively assessed dyadic provided and received support and daily affect within dyad members: (a) invisible support theory, (b) the suggestion that providing support may be better than receiving it, and (c) beneficial supportive equity. METHOD: Actor-partner interdependence models were tested using 28-day diary data from 200 patient-caregiver dyads. Diary assessments started on the first day following patients' discharge from the hospital, that is, about 3 weeks following patients' hematopoietic stem cell transplantation (HSCT). RESULTS: Daily invisible support was not related to more positive indicators of patients' or caregivers' daily affect. For patients' affect, findings generally supported the hypothesis of psychological benefits of support provision over receipt, in both concurrent and lagged analyses. For caregivers, visible received support from patients and supportive equity (i.e., both provided and received support relatively high), both concurrently and lagged, were related with better emotional state. CONCLUSIONS: The findings highlight the costs, benefits, and complexities of daily support transactions in dyads following HSCT, thus indicating the practical implications of the study: the importance of screening for support needs and abilities in both patients and caregivers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Coping Flexibility and Health-Related Quality of Life Among Older Adults: The Compensatory Effect of Co-rumination.

Background: Coping flexibility, defined as a wide range of coping strategies, may be a promising construct in determining coping effectiveness, especially in conjunction with a person-centered approach. However, no studies have focused on these issues. The study aimed to identify the distinct, multidimensional patterns of strategies for coping with chronic health conditions and their association with changes in physical and psychological health-related quality of life (HRQoL) among older adults over a one month period. Methods: Coping strategies (brooding, reflection, co-rumination, and positive reappraisal) and HRQoL psychological and physical domains were assessed twice (at the baseline and one month later) among 210 older adults (age 76.12 ± 9.09 years, 66% women). Findings: The parallel process analysis demonstrated the sample heterogeneity regarding coping. In multidimensional latent class growth analysis (MLCGA), four coping classes of overall strategies were identified: consistently low (46%), medium and decreasing (18%), medium and increasing (20%), and consistently high (16%). The last two can be considered the coping flexibility. Participants in the medium and increasing subgroup reported enhancement in HRQoL psychological domain, whereas members of the consistently high subgroup indicated its decrease. The favorable effects were related to an increase in co-rumination. Discussion: The findings shed light on the longitudinal patterns of coping in older adults, showing that coping flexibility is more adaptive when it relies on modifying coping efforts rather than coping complexity. Co-rumination played a key role, compensated by the effect of maladaptive strategies.

Fluctuation in physical symptoms, coping, and mood in patients following hematopoietic stem cell transplantation: assessing mediation effects using a daily diary approach.

This study examines the indirect effect between parallel fluctuation in daily physical symptoms, symptom-related coping, and mood in patients following hematopoietic stem cell transplantation. Two models were analyzed with a within-person mediating role of coping and mood, respectively. Physical symptoms, coping (brooding, reflection, co-rumination, positive reframing, venting, acceptance, and active coping), and positive (PA) and negative affect (NA) were reported by 229 patients for 28 consecutive evenings after post-transplant hospital discharge. The mediating role of coping fluctuation was partially supported since a competitive model assuming coping reactivity was more reliable. Fluctuation in daily PA and NA mediated relationship of physical symptoms with brooding, co-rumination and venting. Daily changes in positive reframing, acceptance and reflection, partially mediated the association between changes in physical symptoms and mood. The study results indicate the usefulness of intervention addressed to the management of daily mood and stimulation of positive reframing and acceptance in post-HSCT patients.

Positive and negative adjustment in couples undergoing infertility treatment: The impact of support exchange.

BACKGROUND: Perceived social support relates to infertility-related distress in couples undergoing assisted reproductive technology (ART) treatment. Studies examining the effect of other support types on both positive and negative adjustment among infertile couples are scarce or non-existent. Therefore, this study investigated the effects of support receipt, provision, invisibility (the discrepancy between one partner's received and the other partner's provided support), and equity (the discrepancy between each partner's received and provided support) on the positive (life purpose) and negative (depressive symptoms) indices of well-being in couples undergoing ART treatment. METHODS: Depressive symptoms (CES-D), life purpose (PIL), and social support (BSSS) were assessed among 31 married couples (mean age 32.67 years) undergoing ART treatment. Data were analyzed by applying the Actor-Partner-Interdependence Model (APIM) using multilevel modeling. FINDINGS: Both receiving and providing support had beneficial effects in women and men. However, sub-analysis showed differences according to gender and the support exchange effects. Women reported higher depression and lower life purpose but benefited more from support, and their well-being was more dependent on their own perception of support provision and receipt. Men demonstrated higher adjustment to infertility but benefited less from support, and their well-being was mostly correlated with supportive behaviors of their wives. DISCUSSION: Adjustment mechanisms of women and men undergoing ART treatment vary considerably; thus, gender should be taken into consideration in interventions. Future studies should focus on costs/benefits and gender differences of visible and invisible support in infertility settings.

Everyday life following hematopoietic stem cell transplantation: decline in physical symptoms within the first month and change-related predictors.

PURPOSE: Lower quality of life, especially in the physical domain (Physical-QOL), is common in patients after hematopoietic stem cell transplantation (HSCT). However, few studies explore changes in the Physical-QOL, i.e., physical symptoms, in everyday life of patients following HSCT. The present study addresses this gap by examining patient daily physical symptoms and their predictors in terms of demographic and clinical characteristics. METHODS: Physical symptoms were reported by 188 patients (56.9% men; aged 47.6 ± 13.4 years) for 28 consecutive days after post-HSCT hospital discharge. Multilevel modeling was used to investigate fixed and random effects for physical symptom changes over time. RESULTS: The results indicated that the initial level of physical symptoms (immediately after hospital discharge) systematically decreased over 28 days. Treatment toxicity (WHO scale; ß = 0.09, p < .01) and baseline depressive symptoms (CES-D scale; ß = 0.06, p < .01) were associated with the initial level of physical symptoms. Patients with more depressive symptoms before HSCT and with more adverse treatment effects presented with more physical symptoms immediately after hospital discharge. The type of transplant, diagnosis, and conditioning regimen differentiated the course of physical symptoms. Patients with leukemias and other myeloid neoplasms (ß = 0.05, p < .01), after allogeneic HSCT (ß = -0.06, p < .01), and with non-myeloablative conditioning (ß = -0.09, p < .01) showed a significant lower decrease in symptoms over time. Patients with multiple myeloma presented with the most rapid improvement (ß = -.03, p < .05). CONCLUSIONS: The findings suggest a heterogeneous and rather positive response to HSCT. Treatment-related conditions occurred to be a significant predictor of the intensity of change in physical functioning after HSCT.

Psychophysical well-being profiles in patients before hematopoietic stem cell transplantation.

OBJECTIVES: The literature offers very few in-depth reports on the time directly before hematopoietic stem cell transplantation (HSCT). Also, researchers have focused on selected aspects of psychophysical well-being and treated the sample as homogeneous. Thus, we chose to investigate distinct multidimensional well-being profiles (including anxiety, depressive symptoms, and health-related quality of life [HRQOL] domains) among patients just before HSCT, as well as profile predictors (generalized self-efficacy) and outcomes (transplant appraisal) on the basis of the transactional stress model. METHODS: Depression (CES-D), anxiety (HADS-A), HRQOL (EORTC QOL-C30), generalized self-efficacy (GSES), and transplant appraisal (single-item scale referred to threat and challenge) were measured in 290 patients (56.9% male; mean age = 47.28, SD = 13.79) after admission for HSCT (67.2% autologous). Unconditional and conditional latent profile analyses were applied. RESULTS: Four latent well-being profiles were identified: well-functioning (51%, highest well-being in all aspects), dysfunctional (10%, weakest functioning in all aspects), and 2 profiles with moderate HRQOL and high (5.6%) or low (33.4%) anxiety and depressive symptoms. Generalized self-efficacy predicted profile membership, controlling for demographic and clinical variables. The highest levels were observed in the well-functioning group (P < .01). Appraisal was predicted by latent profile analyses classes: low threat in the well-functioning group (P < .001) and the highest threat and challenge in the dysfunctional group (P < .01). CONCLUSIONS: The findings highlight the diverse nature of well-being in pre-HSCT patients and the manner in which transplant appraisal and generalized self-efficacy are related to different profiles of pre-HSCT multidimensional well-being, thus indicating the practical implications of the study.

Mixed Psychological Changes Following Mastectomy: Unique Predictors and Heterogeneity of Post-traumatic Growth and Post-traumatic Depreciation.

Objectives: Post-traumatic growth (PTG) and its opposite-post-traumatic depreciation (PTD)-may be treated as important indicators of the patient quality of life. In the absence of studies on both, PTG and PTD in cancer patients, we investigated (1) coping strategies and support effectiveness as predictors of PTG and PTD in post-mastectomy women, (2) homogeneous classes with different intensity of PTG and PTD symptoms, and (3) correlates of class membership. Methods: Coping strategies (Brief COPE), support effectiveness (SSE-Q), PTG (PTGI), and PTD (negatively reworded items of PTGI) were measured in 84 post-mastectomy women (mean age = 62.27, SD = 8.38). Multiple regression, two-step cluster, and multinomial logistic regression were applied. Results: PTG and PTD had unique predictors: time since diagnosis and positive emotion-focused coping predicted PTG (R2 = 0.24), while negative emotion-focused and avoidance-focused coping and low support effectiveness were linked to PTD (R2 = 0.14). Four groups of PTG × PTD symptoms were identified: high PTG low PTD group (52.4%), low PTG low PTD group (17.9%), high PTG high PTD group (15.5%), and low PTG high PTD group (14.3%). Higher emotion- and avoidance-focused coping was characteristic for the high PTD low PTG group (R2 = 0.41). Conclusion: Our findings shed light on the coexistence and unique predictors of PTG and PTD after mastectomy, indicating heterogeneity in PTG and PTD levels among post-mastectomy women.