Biomedical subjects

S Robin Cohen

Publications and source records attributed to S Robin Cohen.

9 recordsLinked to original sources

PubMed2006

Meaning-making and psychological adjustment to cancer: development of an intervention and pilot results.

PURPOSE/OBJECTIVES: To develop an intervention that uniquely addresses the existential impact of cancer through meaning-making coping strategies and to explore the intervention's impact on psychological adjustment. DESIGN: Descriptive, qualitative approach to develop the intervention; one-group pre- and post-test design to pilot test the intervention. SETTING: Patients' homes or ambulatory oncology clinics affiliated with a university health center in eastern Canada. SAMPLE: 18 participants who were newly diagnosed in the past three months (n = 14), had completed treatment (n = 1), or were facing recurrence (n = 3) of breast (n = 10) or colorectal (n = 8) cancer. METHODS: Data were collected during interviews using a prototype intervention for trauma patients, and content was analyzed on an ongoing basis to fit the needs of the cancer population. Pretest and post-test questionnaires were administered to determine the intervention's effect. MAIN RESEARCH VARIABLES: Meaning-making intervention (MMI), patients' background variables, disease- or treatment-related symptoms, and psychological adjustment. FINDINGS: The MMI for patients with cancer consisted of as many as four two-hour, individualized sessions and involved the acknowledgment of losses and life threat, the examination of critical past challenges, and plans to stay committed to life goals. At post-test, participants significantly improved in self-esteem and reported a greater sense of security in facing the uncertainty of cancer. CONCLUSIONS: Findings suggest that meaning-making coping can be facilitated and lead to positive psychological outcomes following a cancer diagnosis. IMPLICATIONS FOR NURSING: The MMI offers a potentially effective and structured approach to address and monitor cancer-related existential issues. Findings are useful for designing future randomized, controlled trials.

Adaptation, Psychological↗

PubMed2006

Meaning-making intervention during breast or colorectal cancer treatment improves self-esteem, optimism, and self-efficacy.

Existential issues often accompany a diagnosis of cancer and remain one aspect of psychosocial oncology care for which there is a need for focused, empirically tested interventions. This study examined the efficacy of a novel psychological intervention specifically designed to address existential issues through the use of meaning-making coping strategies on psychological adjustment to cancer. Eighty-two breast or colorectal cancer patients were randomly chosen to receive routine care (control group) or up to four sessions that explored the meaning of the emotional responses and cognitive appraisals of each individual's cancer experience within the context of past life events and future goals (experimental group). This paper reports the results from 74 patients who completed and returned pre- and post-test measures for self-esteem, optimism, and self-efficacy. After controlling for baseline scores, the experimental group participants demonstrated significantly higher levels of self-esteem, optimism, and self-efficacy compared to the control group. The results are discussed in light of the theoretical and clinical implications of meaning-making coping in the context of stress and illness.

Adaptation, Psychological↗

PubMed2006

Canada's Compassionate Care Benefit: views of family caregivers in chronic illness.

AIM: Based on a pilot evaluation of Canada's recently introduced Compassionate Care Benefit (CCB), the purpose of this paper is to highlight the experiences of family caregivers caring for people with non-malignant advanced chronic illness. DESIGN: Using Patton's (1997) utilization-focused evaluation approach, 25 telephone interviews were conducted with three groups of family caregivers: those who had successfully applied for the CCB; those who were unsuccessful in their applications; those who had never applied for the benefit. FINDINGS: The CCB has a number of limitations, particularly for caregivers of patients diagnosed with non-malignant advanced chronic illness. The central limitations are: difficulties associated with accurate prognostication; limited definition of "family member"; insufficient length of the funding period. CONCLUSION: By modelling similar programmes internationally, such as those in Sweden, Norway, and the Netherlands, Canada would likely find the CCB to have greater relevance and accessibility to Canadian caregivers, particularly those caring for people with non-malignant advanced chronic illness.

Canada↗

PubMed2005

The structural equation modeling technique did not show a response shift, contrary to the results of the then test and the individualized approaches.

BACKGROUND AND OBJECTIVE: Persons experiencing changes in their physical health may change their values and rerate the importance of basic elements of health-related quality of life (HRQL), a process known as response shift. Developing an estimator of HRQL that differentiates between objective change and response shift is essential for the interpretation of the results. The purpose of the present article was to contrast three methodologic approaches for evaluating response shift to develop a proposed set of HRQL measurement recommendations under circumstances where response shift is expected to occur. METHODS: The three approaches compared were a structural equation modeling (SEM) technique, the then test, and an individualized approach. The data collection procedures for these methods were incorporated into a poststroke randomized controlled trial. RESULTS: The SEM did not show a response shift, contrary to the results of the then test and the individualized approaches. We discuss factors that effect the selection of a methodologic approach including feasibility, subjects' memory and more advanced cognitive tasks, and whether response shift was evaluated at the group or individual level. CONCLUSION: The evaluation of response shift is an integral part of HRQL evaluations, and further comparisons between methodologic approaches are needed.

Activities of Daily Living↗

PubMed2005

Using the Patient Generated Index to evaluate response shift post-stroke.

BACKGROUND: Individualized measures allow for the assessment of health-related quality of life (HRQL) based on areas that are relevant to the person and may prove to be useful for evaluating response shift (reconceptualization of HRQL and change in values). OBJECTIVE: The objective of this study was to assess reconceptualization of HRQL and change of individual values among persons with stroke during the first six months of recovery. METHODS: The data collection for this study was incorporated into a randomized trial of acute post-stroke care. Individualized HRQL was evaluated at 6 and 24 weeks post-stroke using the Patient Generated Index (PGI). At 24 weeks a semi-structured interview was administered to assess whether verbalizations given by subjects indicated that they had experienced a response shift. RESULTS: Ninety two subjects (61%) had complete PGI information at the 6- and 24-week evaluations, and of these, 46 completed the semi-structured interview. Between the 6- and 24-week evaluations, the domains selected were: the same for 10 (11%) subjects, reduced for 27 (29%), expanded for 11 (12%), and completely different for 44 (48%) subjects. Twenty eight percent (n = 13) of subjects recovering from stroke experienced a response shift as evidenced by the semi-structured interviews. CONCLUSION: The PGI provides valuable information regarding changes in person's conceptualization of HRQL and values, but the feasibility of using an individualized measure during the first six months post-stroke is limited by the added complexity of completing and interpreting such a measure.

Aged↗

PubMed2005

Parental perspectives on hospital staff members' acts of kindness and commemoration after a child's death.

OBJECTIVES: Acts of kindness and commemoration by staff members often follow the death of a patient. Acts include attending funerals, sending sympathy cards, sending cards on birthdays/anniversaries, telephoning/visiting family homes, and attending memorial services. This study explores the significance of these acts for bereaved parents. METHODS: Twelve parents whose children died in the ICU of a tertiary care pediatric hospital were interviewed, to explore their experiences of the death. Investigators reviewed transcripts and observational field notes. Multidisciplinary team triangulation was used to corroborate themes, with cross-case analysis. RESULTS: Three themes emerged regarding parental experiences of staff members' acts, ie, (1) parents placed great importance on the hospital's memorial service and on staff members' presence at the service; (2) parents found it difficult to return to the hospital after the child's death but all attended the memorial service, finding some closure in the return; and (3) parents appreciated receiving cards and greatly valued staff members' efforts to telephone/visit and to attend the funeral. Months later, parents remembered positively which staff members engaged in which activities. Conversely, parents expressed disappointment when staff members did not engage in these activities and/or were absent from memorial/funeral services. CONCLUSIONS: Efforts to support families and to commemorate deceased children are appreciated by bereaved parents. Staff members' absences at commemorative events and a lack of supportive acts are noticed and regretted by families. Staff members and program administrators should attempt to arrange workloads to ensure meaningful contact between staff members and parents during the bereavement period.

Bereavement↗

PubMed2004

Response shift influenced estimates of change in health-related quality of life poststroke.

OBJECTIVE: The interpretability of changes in perceived health status over time is threatened if people experience a response shift. This study assessed whether the recovery process following stroke altered individuals' perceptions of past health status and the impact that change in internal standards (response shift) had on ratings over time. We hypothesized that individuals with stroke would experience changes in internal standards, not experienced by the control group. Two other hypotheses related to objective criterion measures also were tested. STUDY DESIGN AND SETTING: Individuals were recruited through a randomized trial of acute poststroke care. Health status was evaluated at baseline (within the first week poststroke), 6 and 24 weeks later using the EQ VAS. At 6 and 24 weeks, subjects were asked to retrospectively re-evaluate their health status for the preceding evaluation using the then test technique. RESULTS: The pattern of mean scores was indicative of changes in internal standards among individuals with stroke but not for the control group. Memory had an impact on estimates of response shift. Hypotheses related to the objective criterion measures were not supported. CONCLUSION: The results suggest that there was a change in internal standards, and that measures of improvement in health status are different based on prospective as compared to retrospective ratings. Further understanding of the impact of recall on the assessment of response shift using the then test is needed to validate the use of this technique.

Aged↗

PubMed2004

Clarifying "meaning" in the context of cancer research: a systematic literature review.

OBJECTIVES: This article synthesizes the published literature related to the construct of meaning in the adult cancer population. METHODS: The databases CancerLit, CINAHL, Medline, PsychINFO, and the Journal of Psychosocial Oncology and PsychoOncology were searched to identify all studies related to meaning. The methodological aspects of all studies are described and the conceptual aspects are summarized only from those studies that met criteria for methodological rigor and validity of findings. The definitions for global meaning, appraised meaning, search for meaning, and meaning as outcome as proposed by Park and Folkman were used to interpret the findings. RESULTS: Of 44 studies identified, 26 met the criteria for methodological rigor. There is strong empirical and qualitative evidence of a relationship between meaning as an outcome of and psychosocial adjustment to cancer. SIGNIFICANCE OF RESULTS: The qualitative findings are considered useful for the development of psychosocial interventions aimed at helping cancer patients cope with and even derive positive benefit from their experience. However, variations in the conceptual and operational definitions, frequent reliance on homogeneous and convenience sampling, and the lack of experimental designs are considered to be methodological limitations that need to be addressed to advance the study of meaning in the context of cancer.

Adaptation, Psychological↗

PubMed2002

What determines the quality of life of terminally ill cancer patients from their own perspective?

BACKGROUND: Although several instruments have been developed to measure the quality of life (QOL) of palliative care patients, a rigorous research study has not specifically asked patients themselves what is important to their QOL. It is, therefore, not clear whether these instruments measure what is most important to these patients' QOL. PURPOSE: To understand the primary determinants of the QOL of palliative care patients with cancer. METHOD: The study used a qualitative paradigm. Participants were interviewed concerning what was important to their QOL. A systematic content analysis of the transcripts was carried out by all the investigators. RESULTS: Five broad domains were found to be importnat determinants of patient QOL: (1) the patient's own state, including physical and cognitive functioning, psychological state, and physical condition; (2) quality of palliative care; (3) physical environment; (4) relationships; and (5) outlook. CONCLUSIONS: Existing instruments cover many of these domains, but no single instrument includes all of the relevant content. The McGill Quality of Life Questionnaire, which we developed previously, has been revised based on these data.

Activities of Daily Living↗