Doctor of Philosophy, The Ohio State University, 2011, Psychology

Advanced and recurrent breast cancer patients experience negative biobehavioral sequelae following diagnosis. Poor marital quality has also been shown to worsen biobehavioral trajectories in earlier-stage cancer patients (e.g., Yang & Schuler, 2009; Schuler et al., under review). However, the contribution of poor marital quality among advanced or recurrent cancer patients coping with a health crisis remains unclear. This study tested the longitudinal covariation between poor marital quality and psychological distress, individual differences, health behaviors, endocrine and immune functioning, and physical health in advanced and recurrent breast cancer patients (N=98). Mixed-effects modeling compared trajectories for women in distressed marriages (n=23) to those in non-distressed marriages (n=75) at diagnosis and across a 12-month follow-up. Compared with patients in a non-distressed marriage, those in a distressed marriage showed significantly greater baseline total mood disturbance (p<.001) and differential rate of mood disturbance change across follow-up (p=.018). Immune differences were also present, with the Distressed group showing significantly higher Con A at baseline relative to the Non-Distressed group (p=.052), which persisted across 12-month follow-up. Clinical relevance and recommendations are described.

Committee: Barbara Andersen PhD (Advisor); Daniel Strunk PhD (Committee Member); Robert Cudeck PhD (Committee Member); Steven Beck PhD (Committee Member); Helen Everts PhD (Other) Subjects: Behavioral Psychology; Behavioral Sciences; Behaviorial Sciences; Clinical Psychology; Families and Family Life; Psychobiology; Psychology; Psychotherapy; Social Research

Doctor of Philosophy, Case Western Reserve University, 2023, Nursing

Quality of life (QOL) is defined as a person's overall satisfaction with their well-being. Persons with advanced cancer are susceptible to poor QOL due to the impact of their disease. Betty Ferrell's Quality-of-Life model measured the QOL among cancer survivors. It has four domains: physical well-being, emotional well-being, social well-being, and spiritual well-being. However, not all models include SWB as a component of QOL, such as the Wilson & Cleary's and the Office of Disease Prevention and Health Promotion. Both models fail to address spiritual wellness, which may be crucial to a person's cancer trajectory. The primary focus of this study is to investigate whether SWB and QOL are associated. If the evidence supports the relationship between SWB and QOL, we further argue for including SWB in QOL models and frameworks. Furthermore, researchers suggested that cancer patients who perceive adequate social support and resources cope better and adapt to their disease than patients who perceive inadequate social support. Good social support, which has been shown to affect QOL positively, may be more strongly associated with SWB. Therefore, we investigated the relationship between social support and SWB. Additionally, we examined the relationship of demographic factors that previous research has suggested may be related to SWB (age, race). This exploration can then assist nurses in understanding influences on SWB and help identify patients more likely to be at risk for spiritual distress and diminished QOL.

Committee: Barbara Daly (Committee Chair); Cynthia Owusu (Committee Member); Diana Morris (Committee Member); Sara Douglas (Committee Member) Subjects: Nursing

PHD, Kent State University, 2022, College of Arts and Sciences / Department of Sociology and Criminology

Receiving an advanced cancer diagnosis, undoubtedly, is a stressful life event. Research, however, suggests that distress among cancer patients is far from uniformly distributed. As such, this dissertation examines the extent to which (1) emotional well-being among individuals with advanced cancer varies following diagnosis until death, (2) gender differences in emotional well-being emerge over time following diagnosis until death, and (3) the association between gender and emotional well-being among persons with advanced cancer is conditioned over time by (a) types of coping styles and (b) perceptions of social support. Data come from the Aging and Supportive Care study (A&SC), and multilevel models based on a longitudinal sample of people with advanced cancer reveal the following main findings: First, compared to their male counterparts, women with advanced cancer improve in levels of emotional well-being over time. Second, women's rate of change in emotional well-being is contingent on levels of social and coping resources to a greater extent than that of their male peers. And third, differences emerge when the data are split by short- and long-term survivors, which highlights the complexity and heterogeneity in the experiences of those living with advanced cancer. The longitudinal focus of this study lends itself to demystifying the commonplace assumption that those living with advanced cancer are constantly and uniformly distressed. Instead, findings suggest that not only is there variability in the mental health of those living with advanced cancer, but that the adjustment to this terminal disease unfolds over time.

Committee: Manacy Pai (Committee Chair); Richard Adams (Committee Member); Jennifer Taber (Committee Member); Linda Francis (Committee Member); Kristen Marcussen (Committee Member); Kelly Cichy (Committee Member) Subjects: Sociology

Doctor of Philosophy, Case Western Reserve University, 2018, Nursing

Patients with advanced cancer from Saudi Arabia (SA) are often not well informed about diagnoses, prognoses, and treatment options. Poor communication can lead to health care decisions that insufficiently meet patients' preferences, concerns, and needs and that subsequently affect patient quality of life. Effective provider communication behaviors are needed to ensure that patients make informed and shared decisions about treatment, enable them to adhere to advice about managing their diseases, and help them adjust and adapt to the fact that they have a life-threatening disease. Evidence supports a positive relationship between shared decision making approaches and a patient's quality of life. However, little is known regarding how cancer patients and providers communicate and make treatment decisions in SA. Therefore, the purpose of this study was to examine the relationships among provider communication behaviors, shared decision making, and quality of life for patients with advanced cancer in Saudi Arabia. Theoretical framework: Street's ecological theory of patient-centered communication (2009) was used to guide this study. This theory stipulates that communication between patients and providers influences their shared decision making and that shared decision making can help providers make treatment recommendation to meet patient's needs and patients with an advanced cancer diagnosis to adhere to provider recommendations to improve their quality of life. Methods: A cross-sectional descriptive correlational study was used and a convenience sample of 159 patients with stage III and IV solid cancer was recruited from King Abdul Aziz University (KAAU) hospitals in Jeddah, Saudi Arabia. The researcher orally administered all three questionnaires, and obtained demographic data using Qualtric survey. Results: 1) In the simple regression analysis, there was a significant positive relationship between provider communication behaviors and patient quality of life (ß = .18, (open full item for complete abstract)

Committee: Amy Zhang (Advisor); Faye Gary (Committee Member); Matthew Plow (Committee Member); Cynthia Owusu (Committee Member) Subjects: Communication; Medicine; Nursing

Doctor of Philosophy, University of Akron, 2007, Nursing

Cancer profoundly affects the lives of those with the diagnosis and their families. When the life of a parent is threatened by advanced cancer, the children are faced with living their lives first with a seriously ill parent and then without the physical presence of the parent. The purpose of this study was to develop a theoretical framework to describe interaction patterns between parents with advanced cancer and their adolescent children. The sample included 26 participants from 9 families; 7 parents with advanced cancer enrolled in a hospice program, 9 spouses, and 10 adolescents (12-18 years old). Grounded theory methods using unstructured interviews were used to illuminate the processes ill parents and adolescents used to manage their lives within the context of the parent's impending death, and to respond to changes over time. The adolescents and their ill parents described a process of becoming closer to each other by spending more time together. Participants described their experiences as a conscious effort made in direct responses to the parent's impending death. Limited time together was the core concept that led to spending more time together and developing means to extending their time together after the parent's death. For some adolescents the process culminated in a choice to give up their time with their ill parents when dying became too difficult to watch. The ill parents made a concerted effort to remain close to their adolescents after death by writing letters to them, and by giving them other tangible objects by which to remember them. Several ill mothers identified specific women to serves as guides and role models for their daughters after the mother's death. There are a number of direct implications for clinical practice that arose from this study. Generally, adolescents need guidance in traversing this new and unexpected experience of facing their parent's impending death from clinicians who convey empathy and understanding and help adolescent (open full item for complete abstract)

Committee: Claire Draucker (Advisor) Subjects: Health Sciences, Nursing