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Cancer Stressors and Protective Factors: Predictors of Stress Experienced During Treatment for Childhood CancerThe purpose of this study was to evaluate cancer stressors and protective factors as predictors of stress experienced during treatment for childhood cancer. The conceptual framework evolved from the stress and coping literature and childhood cancer research. A convenience sample of 44 children between 6 ½ and 13 ½ years of age receiving treatment for cancer were evaluated during two clinic visits. Protective factors included the child’s self-perception, coping strategies, perceived social support, and family environment. Cancer stressors include acute stressors represented by the type of treatment received during two clinical visits. Chronic stressors were evaluated by the child’s perception of stressors related to the cancer experience. Responses to stressors were assessed by physiologic and psychologic indicators of stress. Physiologic measures include epinephrine, norepinephrine, and cortisol measures of urine and psychologic measures of state and trait anxiety. No significant differences were found in the physiologic or psychologic response to stressors in relation to the type of treatment received during either clinic visit. Epinephrine and norepinephrine were elevated for children during both clinic visits. Stepwise multiple regression analyses revealed that family expressiveness and the child’s perceived global self-worth were the best predictors of epinephrine levels. Family activities and recreation and family intellectual cultural orientation were the best predictors of state anxiety. The intensity of chronic cancer stressors, family activities and recreation, family intellectual cultural orientation, the child’s perception of physical appearance, and presence of family conflict had the greatest effect of trait anxiety. This study is the first to examine the child’s perception of chronic cancer stressors and protective factors associated with treatment for cancer. The findings provide insight into the importance of the interactions among the nature of the stressor, perceptual meaning of the stressor, and physiologic and psychologic responses to stressors that may affect long-term adjustment to childhood cancer.
A Counseling Intervention to Improve Personal Control, Affective Outcomes, and Satisfaction in Surrogate Decision Makers at End-of-LifeThis study investigated whether personal control, situational anxiety, situational depression, and satisfaction with end-of-life (EOL) care might be improved in surrogate decision makers who receive a cognitive-behavioral decision making intervention. The sample consisted of 38 surrogate decision makers for 38 incapacitated patients in three hospitals in a moderate sized city in the Southeastern United States. The demographic characteristics of sample included: 50% female and 50% male, 50% African-American and 50% White, and 81.6% Protestant. Although the sample was small, the demographic composition of the sample was highly consistent with the population of the community in which the study was conducted. Guided by Bandura’s Social Cognitive Theory, it was hypothesized that experimental (DMCI) group subjects would score higher on posttest measures of personal control and satisfaction with EOL care than subjects in the usual care group. It was also hypothesized that experimental group subjects would score lower on posttest measures of depression and anxiety. Pretest and posttest scores on five instruments were compared and analyzed for an experimental group, N=19 which received the DMCI versus a control group, N=19, that received only usual care. Instruments used to assess the dependent variables of personal control, affective outcomes, and satisfaction with end-of-life care were: the Pearlin Mastery Scale, the Perceived Personal Control Questionnaire, the Beck Depression Inventory, the Beck Anxiety Inventory, and the FAMCARE Scale. Data were collected over a seven month period from Summer 2004 to Spring 2005. After obtaining informed consent experimental participants completed all instruments (pretest), received three counseling sessions over approximately 14 days and then completed all instruments again (posttest). Control group members after providing informed consent also completed all instruments (pretest), received three attention- usual care contacts, and subsequently completed all instruments again (posttest). Data were analyzed using descriptive statistics, Chi-Square, Mann-Whitney Test, and 2-way ANOVA with one repeated measure. The factors were group assignment (experimental vs. control) and time (pretest vs. posttest) with time as the repeated factor. Chi-square, and Mann-Whitney tests showed the groups were comparable at pretest and that demographically the random assignment to groups was effective. The 2-way ANOVA results showed significant interaction effects in each case. The experimental group scored higher or lower posttest as predicted by the hypotheses compared to the control group.