Biomedical subjects

Kevin D McCaul

Publications and source records attributed to Kevin D McCaul.

At least 19 recordsLinked to original sources

PubMed2007

Long-term telephone therapy outcomes for breast cancer patients.

We present the results of a breast cancer clinical trial that tested two therapy interventions delivered by telephone. Women (N = 218) with Stages I, II, or III breast cancer were randomly assigned to breast cancer health education or emotional expression interventions, or to a standard care control condition. Outcome and process measures were obtained at baseline, 6-month and 13-month follow-ups. Oncology certified nurses conducted the therapies in six, 30-minute individual phone sessions. Women in the health education condition reported significantly better knowledge and less perceived stress compared to women in the emotional expression and control conditions. No treatment effects, however, were obtained for quality of life or mood, and all women generally improved on these measures over time. Secondary analyses showed that younger women and women with a more advanced stage of breast cancer reported significantly greater avoidant coping. The data show that telephone therapy is a viable delivery modality and that distress improves with time for most women. Overall, this study showed that neither of the two telephone interventions tested had a meaningful effect on quality of life or mood.

Adaptation, Psychological↗

PubMed2006

Does worry about breast cancer predict screening behaviors? A meta-analysis of the prospective evidence.

OBJECTIVE: Many women worry about the possibility of developing breast cancer, but there is conflicting evidence concerning whether cancer worry acts as a facilitator or inhibitor of breast cancer screening. METHOD: We conducted a meta-analysis of 12 prospective studies that measured worry about breast cancer at baseline and subsequent breast self-examination (BSE) or mammography utilization among 3342 high-risk and general population women. RESULTS: The data consistently show that breast cancer worry has a small but reliable (r = 0.12) association with breast cancer screening behavior, such that greater worry predicts a greater likelihood of screening. We also found that the means for breast cancer worry were consistently in the lower third of the scales, despite differences in measurement approaches, sample utilization, or the date that the study was conducted. CONCLUSION: The meta-analysis supports the contention that breast cancer worry may motivate screening behavior, and that high levels of breast cancer worry are uncommon.

Anxiety↗

PubMed2006

Motivation to quit using cigarettes: a review.

This review asks why persons decide to quit using cigarettes. We summarize three literatures from five decades, including over 30 data sets grouped by different methodologies: (a) retrospective reports of ex-smokers (n = 15), (b) cross-sectional surveys of current smokers (n = 14), and (c) prospective studies of smokers in cessation studies (n = 6). Taken together, the data strongly suggest that health concern is the primary motive for quit attempts. These data fit with theoretical reasoning that persons wish to control danger and negative affect. The data also suggest that health professionals should continue emphasizing the negative health consequences of smoking to motivate cessation attempts.

Adolescent↗

PubMed2006

Absolute and comparative risk perceptions as predictors of cancer worry: moderating effects of gender and psychological distress.

Risk perceptions for cancer measured on absolute scales (e.g., "What is the likelihood that you will get cancer?") and on comparative scales (e.g., "How does your risk compare with that of someone similar to you?") are independently associated with worry about cancer. We examined this finding in a large sample across several types of cancer, and explored whether these relationships are moderated by three clinically relevant variables-gender, levels of psychological distress, and cancer experience. Participants were respondents in a national survey who reported risk perceptions and worry regarding colon cancer (923 men, 1,532 women), breast cancer (2,154 women), and prostate cancer (860 men), and completed a validated measure of psychological distress. Analyses showed that absolute and comparative risk perceptions were independent predictors of worry across all cancer sites, but that absolute risk perceptions were significantly more predictive than comparative risk perceptions of worry for women (but not men). Among people who were more highly distressed, comparative risk perceptions were the only significant predictor of worry. Absolute risk and comparative risk were equally predictive of cancer worry among people who previously had been diagnosed with cancer. These findings imply that interventions highlighting the communication of comparative risk information may be differentially effective depending on the audience.

Adult↗

PubMed2006

Unrealistic optimism in smokers: implications for smoking myth endorsement and self-protective motivation.

Although some optimists may be accurate in their positive beliefs about the future, others may be unrealistic-their optimism is misplaced. Research shows that some smokers exhibit unrealistic optimism by underestimating their relative chances of experiencing disease. An important question is whether such unrealistic optimism is associated with risk-related attitudes and behavior. We addressed this question by investigating if one's perceived risk of developing lung cancer, over and above one's objective risk, predicted acceptance of myths and other beliefs about smoking. Hierarchical regressions showed that those individuals who were unrealistically optimistic (i.e., whose perceived risk was less than their objective risk) were more likely to endorse beliefs that there is no risk of lung cancer if one only smokes for a few years and that getting lung cancer depends on one's genes. Unrealistic optimists were also more likely to believe that a greater number of lung cancer patients are cured, but they were less likely to identify smoking cessation/avoidance as a way to reduce cancer risk. Most importantly, unrealistic optimists were less likely to plan on quitting smoking. Taken together, these data suggest that in the smoking arena, unrealistic optimism is a potentially costly cognitive strategy.

Adolescent↗

PubMed2006

Lack of acknowledgment of fruit and vegetable recommendations among nonadherent individuals: associations with information processing and cancer cognitions.

Inadequate consumption of fruits and vegetables is regarded as an important behavioral risk factor for multiple types of cancer. Nevertheless, adherence with the National Cancer Institute (NCI) guidelines to eat between five and nine servings of fruits and vegetables per day is remarkably low. The current study explored the extent to which nonadherent respondents in a national survey (N = 5,625) listed fruit and vegetable consumption as a method by which to decrease their own or others' cancer risk. We sought to determine whether respondents who listed fruit and vegetable consumption as a method by which to decrease their own or others' cancer risk (hereafter referred to as "listers") differed from respondents who did not list fruit and vegetable consumption as a method by which to decrease their own or others' cancer risk (hereafter referred to as) "nonlisters" on measures of information processing and cancer cognitions. Nonlisters were more likely than listers to seek out cancer information but less likely to trust the information. The two groups did not differ in the amount of attention they paid to such information. Listers had lower absolute risk perceptions than nonlisters, but listers and nonlisters did not differ on measures of relative breast and colon cancer risk perceptions and worry for cancer in general. Female listers did perceive themselves to be at less relative risk for breast cancer than nonlisters. Respondents were more likely to list fruit and vegetable consumption as a cancer-risk reduction strategy for others than for themselves, suggesting a "double standard" in their beliefs. These findings suggest that communications designed to promote fruit and vegetable consumption need to account for biases in how nonadherent individuals respond to these communications.

Cognition↗

PubMed2006

A heuristics approach to understanding cancer risk perception: contributions from judgment and decision-making research.

BACKGROUND: The likelihood judgments that people make about their risks for cancer have important implications. At the individual level, risk estimates guide protective actions, such as cancer screening. However, at the extremes, exaggerated risk judgments can also lead to anxiety that degrades quality of life or to aggressive self-protective actions that are unwarranted given the objective risks. At the policy level, risk judgments may serve as an indicator of societal perceptions of the "war" against cancer. Using risk judgments, the public expresses its belief about whether we are winning. PURPOSE: We present theoretical perspectives from judgment and decision making, illustrate how they can explain some of the existing empirical findings in the cancer risk literature, and describe additional predictions that have not yet been tested. CONCLUSIONS: Overall, we suggest that theories from the judgment and decision-making perspective offer a potentially powerful view for understanding and improving risk judgments for cancer and other diseases.

Attitude to Health↗

PubMed2006

Resisting good news: reactions to breast cancer risk communication.

Many women overestimate their percentage risk of breast cancer, even after they have received careful estimates from health professionals. In 2 experiments with 134 young adult women, 6 variables were explored that might influence such risk perception persistence. In Study 1, each of the following explanations was unrelated to persistence: public commitment, self-consistency, and unique causal risk models. In Study 2, two individual difference measures, pessimism and differences in understanding percentages, were unrelated to risk perception persistence. However, providing a "risk anchor" based on downward social comparison processes resulted in better risk acceptance at posttest that persisted at a 2-week follow-up assessment. This article discusses why comparison anchors might be important in risk feedback situations and concludes with recommendations for professionals who wish to provide accurate risk information and have patients adopt that information.

Adult↗

PubMed2005

Age differences in treatment decision making for breast cancer in a sample of healthy women: the effects of body image and risk framing.

PURPOSE/OBJECTIVES: To examine the effects of age, body image, and risk framing on treatment decision making for breast cancer using a healthy population. DESIGN: An experimental 2 (younger women, older women) X 2 (survival, mortality frame) between-groups design. SETTING: Midwestern university. SAMPLE: Two groups of healthy women: 56 women ages 18-24 from undergraduate psychology courses and 60 women ages 35-60 from the university community. METHODS: Healthy women imagined that they had been diagnosed with breast cancer and received information regarding lumpectomy versus mastectomy and recurrence rates. Participants indicated whether they would choose lumpectomy or mastectomy and why. MAIN RESEARCH VARIABLES: Age, framing condition, treatment choice, body image, and reasons for treatment decision. FINDINGS: The difference in treatment selection between younger and older women was mediated by concern for appearance. No main effect for risk framing was found; however, older women were somewhat less likely to select lumpectomy when given a mortality frame. CONCLUSIONS: Age, mediated by body image, influences treatment selection of lumpectomy versus mastectomy. Framing has no direct effect on treatment decisions, but younger and older women may be affected by risk information differently. IMPLICATIONS FOR NURSING: Nurses should provide women who recently have been diagnosed with breast cancer with age-appropriate information regarding treatment alternatives to ensure women's active participation in the decision-making process. Women who have different levels of investment in body image also may have different concerns about treatment, and healthcare professionals should be alert to and empathetic of such concerns.

Adolescent↗

PubMed2005

Linking decision-making research and cancer prevention and control: important themes.

This article describes 6 themes underlying the multiple presentations from the Basic and Applied Decision Making in Cancer Control meeting, held February 19-20, 2004. The following themes have important implications for research and practice linking basic decision-making research to cancer prevention and control: (a) Traditional decision-making theories fail to capture real-world decision making, (b) decision makers are often unable to predict future preferences, (c) preferences are often constructed on the spot and thus are influenced by situational cues, (d) decision makers often rely on feelings rather than beliefs when making a decision, (e) the perspective of the decision maker is critical in determining preferences, and (f) informed decision making may--or may not--yield the best decisions.

Congresses as Topic↗

PubMed2005

Basic and applied decision making in cancer control.

Decision making is fundamental to all aspects of cancer care--prevention, detection, treatment, survivorship, and end of life--yet researchers and clinicians have limited knowledge of the ways in which patients and their health care providers make critical health decisions. Recognizing how important it is to understand how patients and their providers make potentially life-altering decisions, the National Cancer Institute developed a decision making in cancer control initiative. The goal of this initiative is to enhance understanding of human decision-making processes so that individuals can make more informed and satisfying choices regarding their health. This article describes the multidisciplinary meeting that provided the scientific foundation for this initiative.

Decision Support Techniques↗

PubMed2004

Coping after cancer: risk perceptions, worry, and health behaviors among colorectal cancer survivors.

This study asks whether the experience of cancer motivates healthy behavior change. Further, we asked whether such changes relate to risk perceptions and worry, as suggested by Leventhal's Parallel Processing Model. Male (n=41) and female (n=40) survivors of colorectal cancer were interviewed 1-14 years after they first completed treatment. Younger age was associated with stronger risk perceptions, more worry, and greater anxiety. Shorter-term, compared to longer-term survivors, reported higher risk perceptions and more frequent intrusive thoughts. Greater perceived risk, worry and anxiety correlated positively with intentions to make positive health behavior changes. Overall, these survivors did not report exaggerated risk perceptions, and they were not overly worried or anxious about cancer recurrence. However, low-level risk perceptions, worry, and anxiety motivated interest in adopting protective health behaviors.

Adaptation, Psychological↗

PubMed2004

Confidant and breast cancer patient reports of quality of life.

It is well known that breast cancer patients report a temporary decline in their quality of life following diagnosis. Caregivers observe these changes, but only a few studies have examined the shared perceptions of patients and others concerning the patient's QOL. In this study, 112 women (96% white, 4% Native American), ages 34-84, rated their QOL 1-3 months after diagnosis on the Functional Assessment of Cancer Therapy (FACT). The patients identified their main source of emotional support, and this confidant also completed the FACT. Most participants selected a spouse (60%); others selected a child (11%), friend (11%), or sibling (7%). Comparisons on five QOL subscales showed good agreement between patients and their confidants, with an average patient-confidant correlation across subscales of r = 0.34. At baseline, patients reported a higher overall QOL (M = 90.30) than their confidants (87.32), p = 0.05. At a 4-month follow up, significant patient/confidant difference was only obtained for the emotional well being subscale. Overall, the data attest to the reliability of the FACT, but they also suggest that confidants may overestimate how distressed patients feel, or that patients are reluctant to admit to distress. Such discrepancies could cause misguided social support efforts.

Adult↗

PubMed2003

Information gathering over time by breast cancer patients.

BACKGROUND: Unlike many patients of the past, today's health-care users want to become more informed about their illnesses, and they want the most current information. The Internet has become a popular way to access current information, and since its introduction more people are turning to it to find medical information. Studies report that anywhere from 36% to 55% of the American population that use the Internet is using the Internet to research medical information, and these percentages have been rising. Cancer is 1 of the top 2 diseases about which people seek information on the Internet. Some studies have specifically asked whether breast cancer patients access the Internet for medical information; estimates range from 10% to 43% of breast cancer patients who use the Internet, with higher usage being associated with more education, greater income, and younger age. OBJECTIVE: To identify where breast cancer patients find medical information about their illness and to track changes over time, from active treatment to survivorship status. METHODS: Participants were 224 women who had been recently diagnosed with Stage I, Stage II, or Stage III breast cancer. Each woman was contacted approximately 8 months and 16 months after diagnosis and was asked about 10 different information sources they could have used to obtain information or support about their breast cancer. RESULTS: Eight months after diagnosis, the top 3 information sources used by women were books (64%), the Internet (49%), and videos (41%). However, at follow-up (16 months after diagnosis), the most frequently cited information source was the Internet (40%), followed by books (33%), and the American Cancer Society (17%). We found that women continued to use the Internet as a means of gathering information even after their treatment ended. Significant unique predictors of Internet use were more years of formal education and younger ages. Cancer stage was not a significant predictor of Internet use. CONCLUSIONS: Previous research has been mixed about the percentage of cancer patients who use the Internet to gather information about their illnesses. The results of the present study corroborate 2 other data sets of breast cancer patients, as just over 44% of the women reported using the Internet after diagnosis. Sixteen months after diagnosis, the percentage of women using the Internet dropped slightly, but other chief sources dropped sharply at that time. The Internet continues to play an important role for cancer survivors after medical treatment has ended, and health professionals can use this knowledge to provide their patients with Internet advice.

Adult↗

PubMed2003

Short-term effects of telephone therapy for breast cancer patients.

The authors report the short-term effects of a clinical trial testing 2 telephone therapies for breast cancer patients. Women (N = 222) with breast cancer were recruited and randomly assigned to cancer education, emotional expression, or standard care. Oncology nurses conducted 6 individual 30-min-therapy phone sessions. Women in the cancer education condition reported greater perceived control than women in the standard care condition. No treatment effects were obtained for mood or quality of life. These are the 1st data from a large-scale study testing telephone therapy, and they suggest that such therapies may be ineffective. Explanations for the results include therapy type and delivery, participant characteristics, short- versus long-term results, therapy conent, and whether therapy is necessary for breast cancer patients.

Adult↗

PubMed2002

Risk involvement and risk perception among adolescents and young adults.

Adolescents as a group know about the connections between many risky behaviors and negative outcomes. However, it is unclear whether adolescents who engage in risky behavior differ in risk perceptions from those who do not. We proposed that risk differences between risk-involved and risk-uninvolved adolescents depend on how risk questions are framed. High school and college students estimated their risk of smoking and unprotected sex by replying to four different questions. The results revealed that, for both high school and college students, smokers saw their outcome risk (risk of negative outcomes) as higher than that of nonsmokers. A similar finding was obtained for sexual behavior, though only for high school students. No significant differences between risk groups were obtained when risk was measured by asking about behavior risk (general riskiness of the behavior). Overall, the data suggest that adolescents engaged in risky behavior do not have a complete appreciation of their exposure to harm. Programs intended to prevent or reduce risky behavior need to take a multifaceted approach to persuasion about risk.

Adolescent↗

PubMed2002

The effects of mailed reminders and tailored messages on mammography screening.

A mail campaign to promote mammography screening was tested with 3,887 Medicare recipients in North Dakota who had not had a mammogram in 2 1/2 years. Three types of mailings were compared: (1) a simple reminder message, (2) a reminder accompanied by a persuasive communication emphasizing personal risk, and (3) a reminder accompanied by a message tailored to the participants' chief barrier to having a mammogram. Overall, subsequent mammography rates for women in these conditions did not differ from the rate observed among women who did not receive any mailing. However, post-hoc analyses suggested that women who reported a barrier to having a mammogram were more likely to have a mammogram. Population-wide mail campaigns of the kinds tested here may be generally ineffective for Medicare recipients who are obtaining screenings infrequently. Tailoring messages may be one potentially effective intervention, if investigators can develop ways to increase responses to inquiries about barriers.

Aged↗

PubMed2002

The effects of framing and action instructions on whether older adults obtain flu shots.

The authors tested the effects of cues to action--messages intended to increase flu immunizations. North Dakota counties were randomly assigned to reminder letters, action letters, or no letters. Within the reminder-letter counties, Medicare recipients received either (a) a reminder from the state peer review organization (PRO) to obtain a flu shot or (b) a reminder from the PRO, framed either in terms of the loss associated with failing to get a shot or (c) the benefits associated with getting a shot. Within the action-letter counties, Medicare recipients leaned where and when to receive a flu shot. Reminder type failed to differentially affect the immunization rate (overall M = 24.5%). However, the action messages worked better (28.2%) than no message (19.6%).

Aged↗