Curvilinear prediction of posttraumatic growth on quality of life: a five-wave longitudinal investigation of breast cancer survivors.

PURPOSE: Do cancer survivors experience positive changes (i.e., posttraumatic growth; PTG) resulting in better quality of life? The issue has yet to yield consistent notions. This longitudinal study extends the literature on the role of PTG by examining the curvilinear relationship between PTG and Health-Related Quality of Life (HRQoL), and explored whether PTG predicts subsequent HRQoL in a quadratic relationship across 2 years following surgery. METHODS: Women with breast cancer (N = 359; Mage = 47.5) were assessed at five waves over two years. On every measurement occasion, PTG measured by the posttraumatic growth inventory and HRQoL measured by SF-36 were assessed. The five waves reflect major medical demands and related challenges in the breast cancer trajectory, in which 1-day, 3 months, 6 months, 12 months, and 24 months after surgery were adopted as the survey timing. In a series of hierarchical linear modeling (HLM) analyses, the time-lagged predictions of PTG (i.e., linear, quadratic) on HRQoL were examined, controlling demographic and medical covariates. RESULTS: The results revealed that the quadratic term of PTG consistently significantly predicted physical and mental health quality of life (PCS and MCS), while the linear term of PTG did not significantly predict PCS or MCS. CONCLUSION: With multi-wave longitudinal data, this study demonstrated that the relationship between PTG and HRQoL is curvilinear, and this finding extends to PTG's prediction of subsequent HRQoL. The quadratic relationship has critical implications for clinical assessment and intervention. Details are discussed.

The Double-Edged Sword of Reflective Pondering: The Role of State and Trait Reflective Pondering in Predicting Depressive Symptoms Among Women With Breast Cancer.

BACKGROUND AND PURPOSE: Prior research has debated whether reflective pondering is a more constructive form of rumination than brooding, which is generally considered maladaptive. This study sought to investigate whether reflective pondering predicts depressive symptoms and whether reflective pondering is adaptive under certain conditions. We predicted that the effectiveness of reflective pondering could depend on concurrent coping strategies and the trait-state distinction. METHOD: Women with breast cancer (N = 309; M age = 47.5) were assessed at four waves over 2 years. A time-lagged design was applied, with rumination (i.e., brooding and reflective pondering) and coping (i.e., engagement and disengagement) measured from T1 to T3, predicting depressive symptoms assessed from T2 to T4. These variables were measured by the Ruminative Response Scale, the Brief COPE, and the Hospital Anxiety and Depression Scale. RESULTS: Using hierarchical linear modeling, brooding, but not reflective pondering, predicted elevated depressive symptoms at both between- and within-person levels. The relationship between reflective pondering and depression was moderated by the coping strategies. Individual differences in reflective pondering predicted worse depressive symptoms, but higher use of engagement coping mitigated the detrimental effect. Within individuals, the co-occurrence of reflective pondering and disengagement coping predicted a subsequent decrease in depressive symptoms. CONCLUSIONS: The emerging role of reflective pondering in the face of breast cancer-related stress appears to be a double-edged sword. Its impact on depression may depend on concurrent coping strategies and whether reflective pondering is assessed at state and trait levels.

Regret about surgical decisions among early-stage breast cancer patients: Effects of the congruence between patients' preferred and actual decision-making roles.

OBJECTIVE: Early-stage breast cancer patients generally receive either a mastectomy or a lumpectomy, either by their own choice or that of their surgeon. Sometimes, there is regret about the decision afterward. To better understand regret about surgical decisions, this study examined 2 possibilities: The first is that women who take a dominant or collaborative role in decision making about the surgery express less regret afterward. The second is that congruence between preferred role and actual role predicts less regret. We also explored whether disease stage moderates the relationship between role congruence and decisional regret. METHODS: In a cross-sectional design, 154 women diagnosed with breast cancer completed a survey assessing decisional role preference and actual decisional role, a measure of post-decision regret, and a measure of disturbances related to breast cancer treatment. Hierarchical regression was used to investigate prediction of decisional regret. RESULTS: Role congruence, not actual decisional role, was significantly associated with less decisional regret, independent of all the control variables. The interaction between disease stage and role congruence was also significant, showing that mismatch relates to regret only in women with more advanced disease. CONCLUSIONS: Our findings suggest that cancer patients could benefit from tailored decision support concerning their decisional role preferences in the complex scenario of medical and personal factors during the surgical decision.

Buffering and direct effect of posttraumatic growth in predicting distress following cancer.

OBJECTIVE: Evidence regarding post traumatic growth (PTG) as a predictor of future reductions in distress has been inconclusive. The purpose of this study was to examine this relationship in a multiple-observation prospective study, to provide a more rigorous test of prediction over time. This longitudinal study extended previous work by taking into account perceptions of vulnerability and explored the buffering role of PTG on the links between vulnerability and psychological distress. We also explored whether individual differences in demographic and medical characteristics moderate the relationship of interests. METHOD: Participants were 312 Taiwanese women (Mage = 46.7 years) who underwent surgery for breast cancer. Measures of PTG, perceived vulnerability, and distress were assessed at Day 1 and 3, 6, 12, and 24 months after surgery. Hierarchical linear modeling was used to investigate whether PTG and vulnerability and their interaction predicted distress over time. RESULTS: A significant direct effect of PTG on distress was found: higher PTG was followed by lower distress. Analysis also yielded a significant buffering effect of PTG on vulnerability leading to distress. However, this effect was moderated by type of surgery. The buffering effect of PTG occurred only among women having mastectomy. CONCLUSIONS: We conclude that PTG tends to lead to less psychological distress overall but particularly so in a high impact context. (PsycINFO Database Record

Identification of posttraumatic growth trajectories in the first year after breast cancer surgery.

BACKGROUND: Empirical studies of the relationship between posttraumatic growth (PTG) and adjustment outcomes reveal a fairly inconclusive picture. We argue that the inconsistent findings are likely due to the heterogeneity of the PTG experience over time. In this regard, we predicted that individuals with different PTG trajectories vary in the level of adjustment and the correlational patterns between PTG and adjustment. METHODS: Participants were 124 Taiwanese women who underwent surgery for breast cancer. Measures of PTG and adjustment variables, including positive affect, negative affect, mental and physical quality of life, anxiety, and depression, were assessed at 1 day and 3, 6, and 12 months after surgery. A group-based trajectory model was used to identify subpopulations of individuals who shared homogenous growth patterns. Then, we determined whether the trajectory predicted adjustment at 12 months after surgery. The correlations between PTG and adjustment outcomes were computed in each subpopulation across every time point. RESULTS: The patients were categorized into the following four groups, which showed very different patterns of PTG change over the first year after breast cancer surgery: stable high (27.4%), high decreasing (39.4%), low increasing (16.9%), and low decreasing (16.9%). Differences in the level of adjustment at 12 months and the patterns of the correlations across time were found among these latent subgroups CONCLUSIONS: This study was the first longitudinal examination of PTG trajectories and their different levels of adjustment. The findings support our argument that identifying distinct PTG trajectories can better determine the nature of the relationship between PTG and adjustment.

Using cognitive modelling to investigate the psychological processes of the Go/NoGo discrimination task in male abstinent heroin misusers.

AIMS: To use cognitive modelling to investigate psychological processes underlying decision-making in male abstinent heroin misusers (AHMs). DESIGN: A case-control study design. SETTING: A drug misuse treatment centre in Taiwan. PARTICIPANTS: Eighty-eight male AHMs and 48 male controls. MEASUREMENTS: Four parameters representing the attention to wins, learning rate, response sensitivity and incentive of heroin-related stimuli from the modified Go/NoGo discrimination task. FINDINGS: A modified cue-dependent learning (CD) model with four parameters representing attention to wins, learning rate, response sensitivity and incentive of heroin-related stimuli had a lower value of the sum of Bayesian information criterion (showing a better fit) than the original CD model (9555.50 versus 11,192.22, P < 0.001). The AHM group had a higher value of the heroin-incentive parameter than the control group (0.26 versus -1.66, P < 0.05). The attention to wins and heroin-incentive parameters were associated positively with total commission rate and negatively with total omission rate in the AHM group (P < 0.001). CONCLUSIONS: Male abstinent heroin misusers appear to be more influenced by heroin-related stimuli during decision-making than males with no history of heroin misuse.

Mental adjustment at different phases in breast cancer trajectory: re-examination of factor structure of the Mini-MAC and its correlation with distress.

OBJECTIVE: The aim of this study is twofold. First, it aims to determine the factor structure of the Mini-Mental Adjustment to Cancer (Mini-MAC) Scale by using confirmatory factor analysis (CFA) to compare the three-factor, four-factor, and five-factor structures among 340 Taiwanese breast cancer patients. Second, it aims to test the difference in the correlations of coping strategies and the outcome measures between two populations: one-month newly diagnosed and five-year long-term survival patients. METHODS: Two samples, composed of 142 newly diagnosed and 198 long-term survival breast cancer patients, were recruited. Cancer-specific coping and distress were assessed via the Mini-MAC Scale and the Hospital Anxiety and Depression Scale (HADS), respectively. RESULTS: The CFA confirmed Watson's original five-factor structure fit the data best. The correlation difference between the two samples lies in the fighting spirit (FS), which correlated negatively with distress among the newly diagnosed sample but had no correlation among the long-term survivors. Moreover, fatalism (FA) was found to correlate positively with distress. CONCLUSIONS: The five-factor structure represents a more psychometrically sound measure of psychological adjustment in the current data set. The findings also support the argument that the relationships between coping and distress vary, to some degree, at different phases in the cancer trajectory. FS is only a positive predictor of psychological adjustment among newly diagnosed patients. Because of the exclusion of two items, FA showed a positive correlation with distress, a result that contradicts previous findings. Further theoretical and practical implications for FS and FA are discussed.

[Appending Chinese language names to medicine labels: the effect on nursing staff label recognition efficacy].

BACKGROUND: Oral medication administration error is a common occurrence in medical malpractice. While recent widespread medical order system computerization has reduced transcription errors (previously, the most prevalent medication administration error) by over 50%, oral medication administration error (previously, the second most prevalent medication administration error) has fallen by only 2%. Significant room exists for improvement in this latter error category. PURPOSE: This paper was designed to identify the effect on proper medication recognition of including Chinese language medication names on medication sheets and cards. METHODS: Medication name examination in this study comprised two elements, namely search and check. Instruments were simulations of actual medication sheets and cards. One was presented in English only, and the other was in English appended with the medication name in Chinese. Two medical wards were chosen at a medical center in middle Taiwan as target populations. The sample for this study consisted of 53 nurses, all of whom provided informed consent. Time and errors were measured, and the checking order of medical sheets was completely counterbalanced. RESULTS: 2x2 tables of chi-square (5.165*) for independence showed that average time consumed by accurate checking was significantly less than the average time consumed by inaccurate checking after Chinese labeling had been added. The differences in time spent and checking accuracy between these two versions were not significant. It was further found that the similar shape of Chinese characters caused more errors than similar pronunciation on medication sheets. CONCLUSIONS: From the perspectives of attention and character recognition, we examined whether time consumption and accurate checking ratios differed between the standard (English) medication sheet and the new one with added Chinese. In addition to partially supporting the hypothesis of the study, results provide valuable information for medication administration procedures and for labeling medications in the future.