Mediators of change in psychosocial interventions for cancer patients: a systematic review.

Careful reviews and meta-analyses have made valuable contributions to understanding the efficacy of psychosocial interventions for cancer patients. An important next step is to determine the mediators that explain the influence of efficacious interventions on outcomes. This systematic review summarizes tests of mediating variables from twenty-two projects conducted from 1989-2010. Although all authors provided some type of rationale for considering particular mediating relationships, the investigations varied widely with respect to the extent to which formal theoretical constructs were tested, the type and goals of the interventions studied, and the broad types of outcomes and potential mediators examined. Although there was some evidence supporting selected mediating relationships, with positive findings often found when mediating variables represented behaviors targeted by an intervention, the findings were mixed. Expanding the focus of research to include mechanisms in psychosocial oncology intervention research is necessary for providing a unified picture of how mediating relationships may be operating in this field.

Why are Optimists Optimistic?

This study examined what is brought to mind when responding to the items comprising a measure of dispositional optimism. Participants (N = 113) completed the Life Orientation Test and the COPE, a measure of coping style, and described why they responded the way they did to the items assessing optimism. Participants' explanations comprised eight types of reasoning: (1) faith in a higher power; (2) belief in fate or a just world; (3) personal fortune; (4) belief in the role of one's own ability; (5) reliance on idioms; (6) beliefs about the usefulness of thinking optimistically; (7) matter-of-fact statements; and (8) a feeling, intuition, or hope. These types were also related to coping styles. Responses to positively-worded items were explained with respect to external forces and responses to negatively-worded items were explained with respect to internal forces. Understanding how people explain their optimism may be the first step in fostering this outlook.

Published versus unpublished dissertations in psycho-oncology intervention research.

OBJECTIVE: There are conflicting views regarding whether gray literature, including unpublished doctoral dissertations, should be included in systematic reviews and meta-analyses. Although publication status frequently is used as a proxy for study quality, some research suggests that dissertations are often of superior quality to published studies. METHODS: We examined 107 projects involving doctoral dissertations (42 published, 65 unpublished) that studied psychosocial interventions for cancer patients. RESULTS: Published dissertations were more likely to be supported by research funding but were not more likely than unpublished dissertations to examine specific types of interventions. Across several indices of methodological quality there were minimal differences. Dissertations with significant findings tended to be more likely to be published than those without significant findings. CONCLUSIONS: Unpublished dissertations focusing on psychosocial interventions for cancer patients are not necessarily of vastly inferior quality to those that eventually are published. Because doctoral dissertations are easy to access relative to other forms of gray literature, are free from some types of bias, and are reported thoroughly, they merit inclusion in comprehensive literature reviews.

Lessons to be learned from 25 years of research investigating psychosocial interventions for cancer patients.

Conducting rigorous psychosocial intervention research with cancer patients has many challenges including encouraging them to join studies, asking them to engage in interventions or be part of control conditions, and to provide data over follow-up assessments. Here, we highlight valuable insights regarding such challenges provided by investigators studying psychosocial interventions for cancer patients. Handling these skillfully has important implications for the internal and external validity of this research and the ethical treatment of participants. Challenges noted in research reports included in a systematic review of 25 years of research (comprising 488 unique projects) investigating interventions designed to enhance cancer patients' quality of life were compiled. Among the difficulties mentioned was the fact that patients may not feel the need for psychosocial interventions and thus may not be interested in joining an intervention study. Patients who do feel the need for such interventions may be deterred from joining trials by the prospect of being randomized to a nonpreferred group; if they do join a trial, participants may be disappointed, drop out, or seek compensatory additional assistance when they are assigned to a control group. Apart from randomization, other aspects of research may be off-putting to participants or potential participants, such as the language of consent forms or the intrusiveness of questions being asked. Potential remedies, such as research awareness interventions, monetary incentives, partnering with cancer support organizations, and using designs that take preferences into account merit consideration and further research inquiry.

Characteristics and methodological quality of 25 years of research investigating psychosocial interventions for cancer patients.

The considerable amount of research examining psychosocial interventions for cancer patients makes it important to examine its scope and methodological quality. This comprehensive overview characterizes the field with as few exclusions as possible. A systematic search strategy identified 673 reports comprising 488 unique projects conducted over a 25 year time span. Although the literature on this topic has grown over time, the research was predominantly conducted in the United States (57.0%), largely with breast cancer patients (included in 70.5% of the studies). The intervention approach used most frequently was cognitive behavioral (32.4%), the treatment goal was often improving quality of life generally (69.5%), and the professionals delivering the interventions were typically nurses (29.1%) or psychologists (22.7%). Overall, there was some discrepancy between the types of interventions studied and the types of supportive services available to and sought by cancer patients. Strengths of this research include using randomized designs (62.9%), testing for baseline group equivalence (84.5%), and monitoring treatment, which rose significantly from being used in 48.1-64.4% of projects over time. However, deficiencies in such areas as examining treatment mechanisms and the adequacy of reporting of methodology, essential for useful syntheses of research on these interventions, remain to be addressed. Methodological challenges related to the complexity of this applied research, such as participants seeking treatment outside of research, contamination, and reactions to randomization, also were apparent. Future research could benefit from closer interactions between academic and voluntary sectors and expanding the diversity of participants.