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A stepped care stress management intervention on cancer-related traumatic stress symptoms among breast cancer patients: A randomized study in group vs. individual setting
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
Department of Oncology, University Hospital of Örebro, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
2015 (English)In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 24, no 9, 1028-1035 p.Article in journal (Refereed) Published
Abstract [en]

Objective

To evaluate the mode of delivery of a stress management intervention, in a group or individual setting, on self-reported cancer-related traumatic stress symptoms. A secondary aim was to evaluate a stepped care approach.

Methods

All study participants (n  = 425), who were female, newly diagnosed with breast cancer and receiving standard oncological care were offered Step I of the stepped care approach, a stress management education (SME). Thereafter, they were screened for cancer-related traumatic stress symptoms, and, if present (n = 304), were invited to join Step II, a more intense intervention, derived from cognitive behavioral therapy, to which they were randomized to either a group (n = 77) or individual (n  = 78) setting. To assess cancer-related traumatic stress symptoms, participants completed the Impact of Event Scale and the Hospital Anxiety and Depression Scale at the time of inclusion, three-months post-inclusion and approximately 12-months post-inclusion.

Results

The SME did not significantly decrease any of the cancer-related traumatic stress symptoms. No statistically significant differences were found between the group and the individual setting interventions. However, only 54% of the participants attended the group setting compared to 91% for the individual setting.

Conclusion

The mode of delivery had no effect on the cancer-related traumatic stress symptoms; however, the individual setting was preferred. In future studies, a preference-based RCT design will be recommended for evaluating the different treatment effects.

Place, publisher, year, edition, pages
2015. Vol. 24, no 9, 1028-1035 p.
Keyword [en]
Screening, Impact of Event Scale, Hospital Anxiety and Depression Scale, Group vs. individual therapy, Breast cancer, Oncological rehabilitation
National Category
Nursing
Identifiers
URN: urn:nbn:se:uu:diva-229041DOI: 10.1002/pon.3763ISI: 000360992900006PubMedID: 25631707OAI: oai:DiVA.org:uu-229041DiVA: diva2:735435
Funder
Swedish Cancer Society, 96 2577
Available from: 2014-07-28 Created: 2014-07-28 Last updated: 2017-12-05Bibliographically approved
In thesis
1. Distress, Emotional reactivity and Fatigue following Breast Cancer: A Theoretical Approach and a Randomised Intervention Study
Open this publication in new window or tab >>Distress, Emotional reactivity and Fatigue following Breast Cancer: A Theoretical Approach and a Randomised Intervention Study
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: Overall aims were to evaluate a stress management intervention with a stepped care approach among women with breast cancer and to explore distress, emotional reactivity and fatigue, both using a theoretical approach and self-reported assessment.

Methods: A total of 821 women were approached, 372 women rejected participation, 23 women failed to return the questionnaire and one died, hence, 425 patients (52%) accepted participation. Study I evaluated the cognitive processing model with the aid of an untreated patient group, including 189 women according to the main study protocol. Sixty-six of these women were ineligible for the intervention, as they did not report clinical levels of distress. The remaining 123 women were eligible but they declined participation. Study II explored the validation of the ELSS and emotional reactivity among women with breast cancer. The population comprised of all 425 women (breast cancer sample) and 176 women randomly selected from the PAR register (random women sample). Studies III and IV evaluated the intervention and included all 425 women.

Main findings: Study I: avoidance does not mediate the relationship between intrusion and later psychological distress in an early stage breast cancer population. Study II: the ELSS has acceptable validity and reliability. The factor structure of the ELSS was similar in both samples and correlated well with the STAQ (gold standard). Younger age was the only variable associated with emotional reactivity at the start of curative treatment. Studies III and IV: a stepped care approach did not reduce the number of women who require a more extensive treatment at three-months post-diagnosis. Both intervention groups (group/individual) reduced their levels of distress, but there were no significant differences between them. Only about half of the women who were randomised in the second step of the intervention accepted participation.

Conclusions: The present thesis provides information regarding distress, emotional reactivity and fatigue among women with breast cancer. A majority of women with early stage breast cancer seem to process the trauma of a cancer diagnosis in a satisfactory way but may experience some emotional reactivity, and younger women may experience more emotional distress. The results also highlight the need for validated measures and carefully planned psychosocial interventions.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. 67 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1012
Keyword
Breast cancer, randomised intervention study, Group vs. individual therapy, Oncological rehabilitation, cognitive processing, validation
National Category
Medical and Health Sciences
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-229042 (URN)978-91-554-8982-3 (ISBN)
Public defence
2014-09-10, Universitetshuset, Sal IX, Biskopsgatan 3, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2014-08-20 Created: 2014-07-28 Last updated: 2014-09-08

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Rissanen, RitvaNordin, KarinArving, Cecilia

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