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1.
Medicina (Kaunas) ; 57(11)2021 Oct 27.
Article in English | MEDLINE | ID: mdl-34833386

ABSTRACT

Background and Objectives: Individuals with cancer, especially advanced cancer, are faced with numerous difficulties associated with the disease, including an earlier death than expected. Those who are able to confront and accept the hardships associated with the disease in a way that aligns with their beliefs benefit from more positive psychological outcomes compared to those who are aware of their diagnosis but are unable to accept it. To date, there is limited research exploring factors contributing to illness and death acceptance in the context of advanced cancer in group therapy settings. Materials and Methods: The current study used a Directed Content Analysis approach on transcripts of online advanced cancer support groups to investigate if and how Yalom's existential factors played a role in the emergence of acceptance. Results: The online support group platform, combined with the help of facilitators, offered supportive environments for individuals seeking help with cancer-related distress by helping patients move towards acceptance. Some participants had already begun the process of accepting their diagnosis before joining the group, others developed acceptance during the group process, while a few continued to be distressed. Our analysis revealed the emergence of four themes related to illness acceptance: (1) Facilitator-Initiated Discussion, including sub-themes of Mindfulness, Relaxation and Imagery, Changing Ways of Thinking, and Spirituality; (2) Personal attitudes, including sub-themes of Optimism and Letting Go of Control; (3) Supportive Environment, including the sub-themes of Providing Support to Others and Receiving Support from Others; and (4) Existential Experience, which included sub-themes of Living with the Diagnosis for an Extended Amount of Time, Legacy and Death Preparations, and Appreciating life. Conclusions: With a paradigm shift to online delivery of psychological services, recognizing factors that contribute to acceptance when dealing with advanced cancer may help inform clinical practices. Future studies should explore patient acceptance longitudinally to inform whether it emerges progressively, which has been suggested by Kübler-Ross.


Subject(s)
Mindfulness , Neoplasms , Awareness , Emotions , Humans , Neoplasms/therapy , Self-Help Groups
2.
Cancer Med ; 9(5): 1733-1740, 2020 03.
Article in English | MEDLINE | ID: mdl-31957269

ABSTRACT

PURPOSE: Chemotherapy side effects diminish quality of life and can lead to treatment delay. Nausea and vomiting can occur prior to chemotherapy because of classical conditioning. We studied the effects of 20-minute behavioral interventions, administered by oncology nurses, of higher intensity (mindfulness relaxation-MR) or lower intensity (relaxing music-RM), on anticipatory nausea and vomiting (ANV). PATIENTS AND METHODS: Patients undergoing chemotherapy for solid tumors were randomized to MR (N = 160), RM (N = 159), or standard care SC (N = 155). Subjects were mostly female (91.8%) and white (86.1%) with breast cancer (85%). Most patients had early stage disease (Stage I: 26%; II: 52.9%; III: 19%; IV: 0.1%). Anticipatory nausea and vomiting were assessed at the midpoint and end of the chemotherapy course using the Morrow Assessment of Nausea and Emesis (MANE). RESULTS: Compared to SC, there was reduced anticipatory nausea at the midpoint of chemotherapy in those receiving MR (OR 0.44, 95% CI 0.20-0.93) and RM (OR 0.40, 95% CI 0.20-0.93), controlling for age, sex, cancer stage, and emetogenic level of chemotherapy. There was no difference between treatment groups in anticipatory nausea at the end of chemotherapy or in anticipatory vomiting and postchemotherapy nausea and vomiting at either time point. CONCLUSION: A brief nurse-delivered behavioral intervention can reduce midpoint ANV associated with chemotherapy.


Subject(s)
Antineoplastic Agents/adverse effects , Mindfulness/methods , Nausea/prevention & control , Neoplasms/drug therapy , Nursing Care/methods , Vomiting, Anticipatory/prevention & control , Adult , Conditioning, Classical , Female , Humans , Male , Middle Aged , Nausea/epidemiology , Nausea/psychology , Neoplasm Staging , Neoplasms/diagnosis , Neoplasms/psychology , Quality of Life , Treatment Outcome , Vomiting, Anticipatory/epidemiology , Vomiting, Anticipatory/psychology , Young Adult
3.
Psychooncology ; 29(4): 671-680, 2020 04.
Article in English | MEDLINE | ID: mdl-31984589

ABSTRACT

OBJECTIVES: Body image (BI) remains a significant survivorship challenge among breast cancer (BC) survivors. We describe an 8-week group intervention-restoring body image after cancer (ReBIC)-developed to target BI distress for BC survivors. METHODS: The intervention was informed by interviews with BC survivors and by a descriptive, exploratory approach which adapted guided imagery exercises to address BI. Educational material was selected to address sociocultural factors that may contribute to BI distress and affect adjustment. Videotape reviews and content analyses further refined the intervention. RESULTS: The intervention incorporates three active components: psychotherapeutic group principles; guided imagery exercises to address BI; and psychoeducation on relevant socialization factors and gender-based messages internalized by women in Western society. The therapeutic group was a supportive and effective way to assist BC survivors to gain insight on BI impacts, their histories, and relevant sociocultural factors contributing to BI distress. The group also facilitated the working through of grief over multiple losses. Guided imagery was well-received, and appeared to help survivors identify negative and emerging self-schema, as well as facilitate new self-views. Specific themes included negative emotions associated with an altered body and self, grief and loss, isolation, difficulties with sexual intimacy, relationship challenges, and uncertainty around sense of self and future. CONCLUSION: An empirically tested group therapy intervention is described and has implications for survivorship programs to help address BI-related challenges. Future work could consider testing a similar approach tailored for other cancer populations.


Subject(s)
Body Image/psychology , Breast Neoplasms/psychology , Cancer Survivors/psychology , Psychotherapy, Group , Adult , Female , Humans , Middle Aged
4.
Psychooncology ; 29(4): 639-646, 2020 04.
Article in English | MEDLINE | ID: mdl-31724261

ABSTRACT

OBJECTIVE: This pilot study aimed to evaluate the feasibility, acceptability, and psychosocial outcomes of a text-based online group therapy intervention, i-Restoring Body Image after Cancer (i-ReBIC). i-ReBIC was developed to reduce body image distress and psychosexual dysfunction among women diagnosed and treated for breast or gynecological cancer. METHODS: i-ReBIC was adapted from an empirically tested face-to-face group therapy intervention, ReBIC. Over the 8-week intervention, participants engaged in 90-minute weekly text-based online discussions. Each week, a new topic associated with reconnecting to the body, adjusting to a postcancer identity, and improving psychosexual functioning was addressed. Homework assignments included readings, guided imagery exercises, and journaling. RESULTS: Sixty women with cancer enrolled in the pilot study. Among them, 47 completed the intervention, and 44 filled out all prestudy and poststudy questionnaires. Ninety-three percent of participants (n = 41) were satisfied and reported that it met their expectations. Eighty percent of participants (n = 35) reported no technical difficulties during the intervention. Preoutcome and postoutcome measures on body image distress and experience of embodiment showed statistically significant improvements. Psychosexual distress and quality of life also showed improvements but were not statistically significant. CONCLUSIONS: This study suggests that i-ReBIC is feasible, well accepted, and effective in addressing persistent body image concerns experienced by women treated for breast or gynecological cancer. As an online group therapy, i-ReBIC can expand the reach of its original face-to-face intervention by mitigating barriers and improving access to care in a cost-effective manner.


Subject(s)
Body Image/psychology , Breast Neoplasms/psychology , Cancer Survivors/psychology , Internet-Based Intervention , Patient Acceptance of Health Care , Psychotherapy , Sexual Dysfunctions, Psychological/therapy , Adult , Feasibility Studies , Female , Humans , Middle Aged , Pilot Projects
5.
Support Care Cancer ; 28(1): 381-388, 2020 Jan.
Article in English | MEDLINE | ID: mdl-31053972

ABSTRACT

BACKGROUND: Music as a therapeutic tool, defined as "music care," can help manage physical and psychological symptoms in individuals with cancer. There is further need to understand interest level and the potential role of music care among health professionals working in the field of oncology. PURPOSE: To investigate knowledge of and attitudes toward the use of music as a therapeutic tool in cancer and palliative care, as well as to identify barriers associated with learning to use music in care among health professionals. METHODS: Participants (N = 204), mostly nurses working in oncology and palliative care, completed a survey to assess awareness, knowledge, and attitudes toward the use of music in healthcare practice. RESULTS: In total, 55.5% of participants reported being "somewhat or very knowledgeable" about how to apply/use music therapy for the management of symptoms or on how to make a music therapy referral or for any application of music care. Participants demonstrated a high interest level in learning how to incorporate music into practice (mean = 4.05; SD = 1.045). CONCLUSION: While there is generally high interest and perceived value among nurses in music care interventions, knowledge level about such interventions was low. The study has implications for knowledge translation and education needed to further support uptake and use of music care in nursing practice.


Subject(s)
Attitude of Health Personnel , Health Knowledge, Attitudes, Practice , Music Therapy , Neoplasms/therapy , Adult , Cross-Sectional Studies , Female , Health Personnel/psychology , Health Personnel/statistics & numerical data , Humans , Male , Medical Oncology/statistics & numerical data , Middle Aged , Music/psychology , Neoplasms/psychology , Nurses/psychology , Nurses/statistics & numerical data , Palliative Care/methods , Palliative Care/psychology , Palliative Care/statistics & numerical data , Surveys and Questionnaires , Young Adult
6.
Int J Group Psychother ; 70(3): 307-328, 2020 Jul.
Article in English | MEDLINE | ID: mdl-38449219

ABSTRACT

A growing number of face-to-face group therapy interventions are being translated into online versions in psycho-oncology. Yet few researchers have systematically described the complex translation process or systematic approaches used to maintain the integrity of the original empirically supported interventions. In this article, we present a case study to illustrate the process of translating an evidence-based face-to-face therapy group, Restoring Body Image after Cancer (ReBIC) into an online format. We highlight how three critical therapeutic components from the original intervention (guided imagery exercises, psychoeducational reading materials, and psychotherapeutic group processes) were maintained and translated for online delivery. We provide preliminary recommendations for future translation efforts of text-based online group therapies to encourage best practices.

7.
Psychooncology ; 27(9): 2289-2295, 2018 09.
Article in English | MEDLINE | ID: mdl-29956392

ABSTRACT

OBJECTIVE: The Therapeutic Practices for Distress Management (TPDM) project was carried out to support clinicians in integrating recommendations from four clinical practice guidelines (CPGs) in routine care at five Pan Canadian cancer care sites. METHODS: Using a concurrent, mixed-method study design and knowledge translation (KT) activities, this project included two phases: phase I-a baseline/preparation phase and phase II-an intervention phase plus evaluation. The intervention phase (the focus of this report) included a one-year education and supervision program (24 hours in virtual class; 12-hour group supervision). Primary outcomes were knowledge and self-efficacy in practicing CPGs as measured by a Knowledge and Self-Efficacy Survey (KSES). A secondary outcome was observer-rated performances with standardized patients (objective structured clinical exams). Participants included 80 (90%) nurses, and 9 (10%) social workers (N = 89). RESULTS: The TPDM program was effective in accomplishing change in knowledge, self-efficacy, and performance. All measures demonstrated significant change pre and post module, with evidence of increasing knowledge (P < .01) and confidence (P < .01) over time. Further, there was evidence of a shift in barriers and enablers to practicing in alignment with the CPGs. CONCLUSIONS: A tailored education program using case-based learning and supervision over time improves knowledge and practice among front line clinicians. The findings have implications for quality improvement in cancer care.


Subject(s)
Depression/therapy , Health Promotion/organization & administration , Neoplasms/rehabilitation , Patient Education as Topic/organization & administration , Canada , Critical Pathways , Depression/etiology , Humans , Neoplasms/psychology , Practice Guidelines as Topic , Program Evaluation , Self Efficacy
8.
J Clin Oncol ; 36(8): 749-756, 2018 03 10.
Article in English | MEDLINE | ID: mdl-29356610

ABSTRACT

Purpose This study aimed to test a group psychosocial intervention focused on improving disturbances of body image (BI), sexual functioning, and quality of life in breast cancer (BC) survivors. Methods A prospective, randomized controlled trial was conducted to assess the efficacy of an 8-week group intervention in women after BC treatment. The manual-based intervention combined two powerful ingredients: expressive guided-imagery exercises integrated within a model of group-therapy principles. The intervention facilitates exploration of identity, the development of new self-schemas, and personal growth. In addition, the intervention included an educational component on the social and cultural factors affecting women's self-esteem and BI. The control condition included standard care plus educational reading materials. One hundred ninety-four BC survivors who had expressed concerns about negative BI and/or difficulties with sexual functioning participated in the study; 131 were randomly assigned to the intervention, and 63 were assigned to the control condition. Participants were followed for 1 year. Results Women in the intervention group reported significantly less concern/distress about body appearance ( P < .01), decreased body stigma ( P < .01), and lower level of BC-related concerns ( P < .01), compared with women in the control group. BC-related quality of life was also better in the intervention group compared with the control group at the 1-year follow-up ( P < .01). There was no statistically significant group difference in sexual functioning. Conclusion Restoring Body Image After Cancer (ReBIC), a group intervention using guided imagery within a group-therapy approach, is an effective method for addressing BI-related concerns and quality of life post-BC. The manual-based intervention can be easily adapted to both cancer centers and primary care settings.


Subject(s)
Body Image/psychology , Breast Neoplasms/psychology , Quality of Life/psychology , Sexual Behavior/psychology , Female , Humans , Middle Aged
9.
Can Fam Physician ; 59(1): e39-47, 2013 Jan.
Article in English | MEDLINE | ID: mdl-23341678

ABSTRACT

OBJECTIVE: To explore views of women and health care providers (HCPs) about the changing recommendations regarding maternal age-based prenatal screening. DESIGN: Mixed-methods design. SETTING: Ontario. PARTICIPANTS: A sample of women who had given birth within the previous 2 years and who had attended a family medicine centre, midwifery practice, or baby and mother wellness program (n = 42); and a random sample of family physicians (n = 1600), and all Ontario obstetricians (n = 694) and midwives (n = 334) who provided prenatal care. METHODS: We used focus groups (FGs) to explore women's views. Content analysis was used to uncover themes and delineate meaning. To explore HCPs' views, we conducted a cross-sectional self-completion survey. MAIN FINDINGS: All FG participants (42 women in 6 FGs) expressed the importance of individual choice of prenatal screening modality, regardless of age. They described their perception that society considers women older than 35 to be at high obstetric risk and raised concerns that change in the maternal age-related screening policy would require education. The HCP survey response rate was 40%. Results showed 24% of HCPs agreed that women of any age should be eligible for invasive diagnostic testing regardless of prenatal screening results; 15% agreed that the age for diagnostic testing should be increased to 40 years, 14% agreed that diagnostic testing should be reserved for women with positive prenatal screening results, and 45% agreed that prenatal screening should remain unchanged. CONCLUSION: Maternity care organizations have recommended that maternal age-based prenatal screening is no longer appropriate. Informed choice is of paramount importance to women and should be part of any change. Health care providers need to be engaged in and educated about any change to screening guidelines to offer women informed choices.


Subject(s)
Attitude of Health Personnel , Chromosome Disorders/diagnosis , Genetic Testing/methods , Health Knowledge, Attitudes, Practice , Maternal Age , Prenatal Diagnosis/psychology , Adult , Cross-Sectional Studies , Family Practice/methods , Female , Focus Groups , Humans , Male , Middle Aged , Midwifery/methods , Obstetrics/methods , Patient Preference , Patient Selection , Practice Guidelines as Topic , Pregnancy , Prenatal Diagnosis/methods , Surveys and Questionnaires , Young Adult
10.
J Behav Med ; 35(3): 272-85, 2012 Jun.
Article in English | MEDLINE | ID: mdl-21597980

ABSTRACT

UNLABELLED: To determine whether MBSR groups would help gay men living with HIV improve psychosocial functioning and increase mindfulness compared to treatment-as-usual (TAU). METHODS: 117 participants were randomized 2:1 to MBSR or TAU. No new psychosocial or psychopharmacological interventions were initiated within 2 months of baseline. Standardized questionnaires were administered pre-, postintervention and at 6 months. An intent-to-treat analysis found significant benefits of MBSR: at post-intervention and 6 months follow up, MBSR participants had significantly lower avoidance in IES and higher positive affect compared to controls. MBSR participants developed more mindfulness as measured by the Toronto Mindfulness Scale (TMS) including both TMS subscales, curiosity and decentering, at 8-week and 6 months. For the sample as a whole, increase in mindfulness was significantly correlated with reduction in avoidance, higher positive affect and improvement in depression at 6 months. MBSR has specific and clinically meaningful effects in this population.


Subject(s)
Affective Symptoms/therapy , HIV Infections/psychology , HIV Seropositivity/psychology , Homosexuality, Male/psychology , Meditation/psychology , Quality of Life/psychology , Stress, Psychological/therapy , Adult , Affective Symptoms/psychology , Humans , Male , Middle Aged , Psychiatric Status Rating Scales , Stress, Psychological/psychology , Surveys and Questionnaires , Treatment Outcome
11.
Birth ; 37(4): 296-306, 2010 Dec.
Article in English | MEDLINE | ID: mdl-21083721

ABSTRACT

BACKGROUND: Hypertension occurs in nearly 10 percent of pregnancies, and is associated with higher risk of infant and maternal morbidity and mortality than in normal pregnancies. Previous studies have suggested that relaxation therapies reduce blood pressure in nonpregnant adults. The objectives of this pilot randomized trial were to provide preliminary evidence of whether relaxation by means of guided imagery would reduce blood pressure in hypertensive pregnant women, and to assess the feasibility of a larger trial. METHODS: A total of 69 pregnant women with hypertension were randomized to periods of guided imagery or of quiet rest, twice daily for 4 weeks or until delivery, whichever came first. Daytime ambulatory mean arterial pressure, systolic and diastolic blood pressure, and anxiety were measured weekly for up to 4 weeks. RESULTS: Women allocated to guided imagery had lower mean arterial pressure elevations over time than those allocated to quiet rest (guided imagery: M = 1.58 mmHg, SD = 7.63; quiet rest: M = 5.93 mmHg, SD = 6.55; t = 2.36, p = 0.02). However, when adjusted for baseline mean arterial pressure and gestation, the effect was not significant (p = 0.14). Numbers of women prescribed antihypertensive medication postrandomization were similar (guided imagery: n = 16; quiet rest: n = 13, χ(2) = 0.74, p = 0.46). There was also no evidence of an effect on women's anxiety. Nearly 90 percent (n = 26) of the guided imagery group indicated that they would use it again. CONCLUSIONS: Further rigorous study is warranted to determine effects of guided imagery on maternal blood pressure and perinatal health outcomes.


Subject(s)
Hypertension, Pregnancy-Induced/therapy , Imagery, Psychotherapy/methods , Prenatal Care/methods , Women's Health , Adult , Antihypertensive Agents/therapeutic use , Anxiety/prevention & control , Blood Pressure , Combined Modality Therapy , Feasibility Studies , Female , Humans , Hypertension, Pregnancy-Induced/prevention & control , Pilot Projects , Pregnancy , Single-Blind Method , Treatment Outcome , Young Adult
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