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Objectives: Few couple-focused interventions have improved psychological and relationship functioning among men diagnosed with localized prostate cancer and their spouses. This study compared the impact of intimacy-enhancing therapy (IET), a general health and wellness intervention (GHW), and usual care (UC) on the psychological and relationship functioning of localized prostate cancer patients and their partners. Relationship length, relationship satisfaction, and patient masculinity were evaluated as moderators., Design: This study was a randomized clinical trial with three study arms and four assessment time points., Methods: A total of 237 patients and partners were randomly assigned to receive IET, GHW, or UC. Participants completed measures of psychological functioning and relationship satisfaction at baseline, 5 weeks, 3 months, and 6 months post-baseline. Primary outcomes were psychological adjustment, depression, cancer-specific distress, cancer concerns, and relationship satisfaction., Results: Spouses in IET showed greater increases in relationship satisfaction than spouses in GHW and UC between the baseline and 5-week follow-up. Among patients in longer relationships, significant increases in psychological adjustment were found in both treatments compared to UC. Among spouses in longer relationships, psychological adjustment increased in both IET and UC but declined in GHW., Conclusions: Intimacy-enhancing therapy did not show an impact on general or cancer-specific distress, but did show an early impact on relationship satisfaction among spouses. IET was superior to UC for patients in longer relationships. It will be important for researchers to understand which couple-focused interventions benefits both patients and spouses and to identify characteristics of patients, partners, and couples who may not benefit from psychological treatments. Statement of contribution What is already known on this subject? Men diagnosed with localized prostate cancer report lower health-related quality of life and both patients and spouses report elevated distress. Relationship communication plays a role in couples' psychological adaptation to prostate cancer. Couple-focused interventions have illustrated an impact on relationship communication. There are no studies comparing different couple-focused interventions. What does this study add? Intimacy-enhancing therapy was not superior to no treatment or a comparison treatment for the broad range of psychological and relationship outcomes. Intimacy-enhancing therapy was superior to no treatment for patients in longer-term relationship. The general health and wellness intervention was not beneficial for men in shorter relationships and for men who did not endorse traditional masculine norms., (© 2019 The British Psychological Society.)

Objectives: Demoralization as a form of existential distress involves poor coping, low morale, hopelessness, helplessness, and meaninglessness. In a secondary analysis of a cohort of German cancer patients, we aimed to explore latent class structure to assess the contribution that symptoms of demoralization make to anhedonic depression, anxiety, adjustment, and somatic disorders., Methods: Measures of demoralization, depression, anxiety, physical symptoms, and functional impairment had been completed cross-sectionally by 1527 patients with early or advanced cancer. Latent class analysis used maximum likelihood techniques to define the unobserved latent constructs that can be predicted as symptom clusters. Individual patients were assigned to the most probable class. Classes were compared on demographics, and logistic regression assessed the odds of individual items predicting each class., Results: A 4-class model provided the best fit. Class 1 (n = 829, 54.3%) was defined by the absence of distress; Classes 2 to 4 all carried functional impairment. Class 2 (n = 333, 21.8%) was differentiated by somatic symptoms (sleep, tiredness, and appetite); Class 3 (n = 163, 10.7%) by anhedonia, anxiety, and severe demoralization; and Class 4 (n = 202, 13.2%) by adjustment and moderate demoralization. Members of Class 3 were more likely to be younger, female, anhedonic, depressed, and anxious. In both Classes 3 and 4, functional impairment, physical symptom burden, and suicidal ideation were present., Conclusions: In contrast with the severe symptom cluster carrying anhedonia, anxiety, and demoralization, the moderate symptom cluster was formed by patients with demoralization and impaired functioning, a clinical picture consistent with a unidimensional model of adjustment disorder., (Copyright © 2018 John Wiley & Sons, Ltd.)

Objective: Although a number of effective psychotherapies have been identified for cancer patients, little is known about therapy processes, as they unfold the course of treatment and the role of therapy processes in treatment outcome. We used growth curve modeling to evaluate the associations between therapy processes and outcomes among gynecological cancer patients participating in 2 types of therapy., Methods: Two hundred twenty five women newly diagnosed with gynecological cancer were randomly assigned to receive 8 sessions of a coping and communication intervention or a client-centered supportive therapy. Participants completed measures of preintervention and postintervention depression, working alliance after Session 2, and postsession progress and depressive symptoms after each session. Therapists completed measures of perceived patient progress., Results: Both patients and therapists reported a steady increase in session progress and patients reported a steady decrease in depressive symptoms over the course of both the coping and communication intervention and client-centered supportive sessions. Perceived progress in one session predicted progress in the subsequent session. Early working alliance predicted improved session progress and reductions in postsession depressive symptoms over sessions. Working alliance did not predict prepost treatment changes in depression. Patient-rated session progress predicted greater reductions in pretreatment to posttreatment depression, but therapist-rated progress did not., Conclusions: For 2 types of treatment delivered to women diagnosed with gynecological cancer, patient-rated session progress and depressive symptoms rated over therapy sessions may serve as a yardstick that can be useful to therapists to gauge patient's response to treatment., (Copyright © 2016 John Wiley & Sons, Ltd.)

Objective: Demoralization is a commonly observed syndrome in cancer patients, deserving to be carefully assessed in cross-cultural contexts., Aims: To examine the factor structure and concurrent and divergent validity of the Italian version of the Demoralization Scale (DS-IT) in cancer patients., Methods: The sample included 194 Italian cancer outpatients who were assessed by using the DS-IT and the Diagnostic Criteria of Psychosomatic Research-Demoralization module to examine demoralization. The Patient Health Questionnaire-9 (PHQ-9) to explore depression and the Mini-Mental Adjustment-to-Cancer-Hopelessness/Helplessness scale (Mini-MAC-HH) to explore maladaptive coping were also administered., Results: Four factors were extracted by exploratory factor analysis on the DS-IT (disheartenment, α = .87; sense of failure, α = .77; dysphoria, α = .73; loss of meaning/purpose, α = .72; total = 0.91), accounting for 57.1% of the variance. The DS-IT factors shared between 17% and 36% of the variance. Patients reporting a diagnosis of demoralization on the Diagnostic Criteria of Psychosomatic Research-Demoralization module (23.7%) had higher scores on DS-IT loss of meaning/purpose, sense of failure, dysphoria, and DS-IT total. About half of those who were highly demoralized were not depressed and among those who had moderate or moderately severe demoralization, about 80% were not depressed on the PHQ-9. The DS-IT was significantly associated with PHQ-9 and Mini-MAC-HH., Conclusions: The study presents further evidence that demoralization is a significant clinical condition and that the DS-IT demonstrates satisfactory levels of validity and reliability to support its use in patients in the ambulatory cancer setting., (Copyright © 2017 John Wiley & Sons, Ltd.)

Objective: Fear of cancer recurrence is an important clinical phenomenon and is associated with decrements in life domains. The study goals were to characterize patterns of global fear of recurrence (FOR) and 4 domains of fear (health, role, womanhood, and death worry) over time in women who were diagnosed with gynecological cancer and to identify demographic, medical, and psychological predictors of FOR., Method: One hundred eighteen women participating in the usual care arm of a randomized trial completed the Concerns about Recurrence scale as well as measures of depressive symptoms, cancer-specific distress, coping, coping efficacy, and social network responses at 4 time points. The majority of the sample was diagnosed with stage 3 ovarian cancer., Results: Group-based trajectory modeling identified subgroups of women with high-stable (49.1%), high-decreasing (25.3%), and low-stable (25.5%) trajectories for global FOR. For role worries, 3 similar group trajectories were identified. For health worries, modeling identified subgroups with high-decreasing (19.1%) and low-increasing (80.9%) trajectories. For womanhood worries, modeling identified subgroups with high-increasing (15.7%) and low-decreasing (84.2%) trajectories. Young age, metastatic cancer, depression, cancer distress, holding back, and lower coping efficacy were associated with the high-stable global FOR and at least 1 domain of FOR., Conclusion: Almost half of the women recently diagnosed with gynecological cancer evidence persistently elevated FOR over the 6-month period postdiagnosis. Psychological interventions to reduce FOR may be more effective if they focus on teaching patients coping skills, as well as greater comfort expressing cancer-specific concerns to others., (Copyright © 2016 John Wiley & Sons, Ltd.)

Objective: Demoralization, a state of lowered morale and poor coping, has a prevalence of 13-18% among patients with advanced cancer. We surveyed clinicians' perspectives of the utility of "with demoralization" as a diagnostic specifier for adjustment and depressive disorders., Method: Using comparative clinical vignettes in a field survey, clinicians from a range of disciplines were asked their perception of the utility of diagnosis and treatment options. Response frequencies were compared using Cochran's Q and McNemar's tests, with sensitivity and specificity rated against expert rankings of diagnosis. Analysis of variance and paired t-tests examined significant differences in ratings of utility., Results: Vignettes were assessed by 280 clinicians; 77% supported utility of the category 'adjustment disorder with demoralization' compared to 33% supporting 'adjustment disorder with anxiety' (McNemar test, p<0.001), while 83% supported the utility of 'with demoralization' for major depressive episode, matching 83% perceiving utility for 'with melancholia.' Sensitivity and specificity ratings were 77% and 94% for adjustment disorder with demoralization and 83% and 91% for major depression with demoralization., Conclusion: Clinicians perceived the specifier 'with demoralization' to deepen diagnostic understanding, treatment choice, and ability to communicate with clinicians and patients, particularly for the category of adjustment disorder with demoralization., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: This study compared the efficacy of two psychological interventions, a coping and communication-enhancing intervention (CCI) and supportive counseling (SC), in reducing depressive symptoms, cancer-specific distress, fear of recurrence, and emotional well-being of women diagnosed with gynecological cancer. Demographic, medical, and psychological moderators of intervention effects were evaluated., Methods: Three hundred fifty-two women with gynecological cancer were randomly assigned to eight sessions of CCI, eight sessions of SC, or usual care (UC). Participants completed measures of distress and wellbeing at six time points over an 18month period of time., Results: CCI had a beneficial impact on depressive symptoms and cancer specific distress over the first six months as compared with UC and SC and had a beneficial impact on emotional well-being. The greater coping skill development in CCI has made it a more effective intervention than traditional SC across a broader range of key psychological outcomes. Declines among women in the SC condition were not significantly different from UC., Conclusions: The CCI intervention had significant effect on patients' depression, cancer-specific distress, and emotional well-being during a time when the majority of newly diagnosed patients experience elevated levels of distress. Ameliorating such distress post-diagnosis merits its incorporation into clinical care. A brief 8-session structured intervention can be readily applied to this distressed population in need. Brief supportive counseling did not evidence treatment effects, suggesting that more structured approaches are crucial to truly deliver benefits., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: A diagnosis of cancer and subsequent treatment are distressing not only for the person directly affected, but also for their intimate partner. The aim of this review is to (a) identify the main theoretical frameworks underpinning research addressing dyadic coping among couples affected by cancer, (b) summarise the evidence supporting the concepts described in these theoretical frameworks, and (c) examine the similarities and differences between these theoretical perspectives., Methods: A literature search was undertaken to identify descriptive studies published between 1990 and 2013 (English and French) that examined the interdependence of patients' and partners' coping, and the impact of coping on psychosocial outcomes. Data were extracted using a standardised form and reviewed by three of the authors., Results: Twenty-three peer-reviewed manuscripts were identified, from which seven theoretical perspectives were derived: Relationship-Focused Coping, Transactional Model of Stress and Coping, Systemic-Transactional Model (STM) of dyadic coping, Collaborative Coping, Relationship Intimacy model, Communication models, and Coping Congruence. Although these theoretical perspectives emphasised different aspects of coping, a number of conceptual commonalities were noted., Conclusion: This review identified key theoretical frameworks of dyadic coping used in cancer. Evidence indicates that responses within the couple that inhibit open communication between partner and patient are likely to have an adverse impact on psychosocial outcomes. Models that incorporate the interdependence of emotional responses and coping behaviours within couples have an emerging evidence base in psycho-oncology and may have greatest validity and clinical utility in this setting., (Copyright © 2015 John Wiley & Sons, Ltd.)

The present study evaluated intimacy as a mechanism for the effects of holding back sharing concerns about cancer on couples' psychological distress, well-being, and marital satisfaction using the actor-partner interdependence model (APIM), and evaluated 2 possible moderators of these associations: the number of patient and spouse cancer concerns. We had 139 men treated for localized prostate cancer in the past year and their spouses complete surveys about holding back sharing cancer concerns, intimacy, distress, and relationship satisfaction, as well as patient and spouse cancer concerns. APIM-indicated that the association between holding back sharing concerns, and patient and spouse distress, well-being, and relationship satisfaction could be partially accounted for by their influence on patient and spouse perceptions of relationship intimacy. The number of cancer concerns did not moderate the mediational model. Holding back has strong associations with both partners' well-being and distress. Holding back sharing concerns was particularly detrimental for couples' intimacy and relationship satisfaction., ((c) 2015 APA, all rights reserved).)

Background: Resilience has been linked to psychological adaptation to many challenging life events., Objective: The goal was to examine 3 coping strategies--expressing positive emotions, positive reframing of the cancer experience, and cultivating a sense of peace and meaning in life--as potential mechanisms by which resilience translates to quality of life among women recently diagnosed with gynecological cancer., Methods: This cross-sectional study utilized baseline data from women diagnosed with gynecological cancer participating in an ongoing randomized clinical trial (n = 281; mean age, 55 years; 80% were white). Participants completed measures of resilience, positive emotional expression, positive reappraisal, cultivating a sense of peace and meaning, and quality of life. Univariate and multiple mediation analyses were conducted., Results: Greater resilience was related to higher quality of life (P < .001). Multiple mediation analyses indicated that the coping strategies, as a set, accounted for 62.6% of the relationship between resilience and quality of life. When considered as a set, cultivating a sense of peace and meaning had the strongest indirect effect (b = 0.281, SE = 0.073, P < .05)., Conclusion: The findings suggested that resilient women may report higher quality of life during gynecological cancer diagnosis because they are more likely to express positive emotions, reframe the experience positively, and cultivate a sense of peace and meaning in their lives., Implications for Practice: Interventions promoting a sense of purpose in one's life and facilitating expression of positive emotions may prove beneficial, particularly for women reporting higher levels of resilience.

Objective: Little attention has been paid to the role of holding back sharing concerns in the psychological adaptation of women newly diagnosed with gynecological cancers. The goal of the present study was to evaluate the role of holding back concerns in psychosocial adjustment and quality of life, as well as a possible moderating role for emotional expressivity and perceived unsupportive responses from family and friends., Method: Two hundred forty-four women diagnosed with gynecological cancer in the past 8 months completed measures of holding back, dispositional emotional expressivity, perceived unsupportive responses from family and friends, cancer-specific distress, depressive symptoms and quality of life., Results: Emotional expressivity moderated the association between holding back and cancer-specific distress and quality of life, but not depressive symptoms. Greater holding back was more strongly associated with higher levels of cancer-related distress among women who were more emotionally expressive than among women who were less expressive. Perceived unsupportive responses did not moderate the associations between holding back and psychosocial outcomes., Conclusion: Holding back sharing concerns was more common in this patient population than other cancer populations. Dispositional expressivity played a role in how harmful holding back concerns was for women, while unsupportive responses from family and friends did not., (© 2014.)

Introduction: Erectile dysfunction (ED) is one of the most frequent sources of distress after treatment for prostate cancer (PCa), yet evidence suggests that men do not easily adjust to loss of sexual function over time. A hypothesized determinant of men's adaptation to ED is the degree to which they experience a loss of masculine identity in the aftermath of PCa treatment., Aims: The aims of this study were (i) to describe the prevalence of concerns related to diminished masculinity among men treated for localized PCa; (ii) to determine whether diminished masculinity is associated with sexual bother, after controlling for sexual functioning status; and (iii) to determine whether men's marital quality moderates the association between diminished masculinity and sexual bother., Methods: We analyzed cross-sectional data provided by 75 men with localized PCa who were treated at one of two cancer centers. Data for this study were provided at a baseline assessment as part of their enrollment in a pilot trial of a couple-based intervention., Main Outcome Measures: The sexual bother subscale from the Prostate Health-Related Quality-of-Life Questionnaire and the Masculine Self-Esteem and Marital Affection subscales from Clark et al's PCa-related quality-of-life scale., Results: Approximately one-third of men felt they had lost a dimension of their masculinity following treatment. Diminished masculinity was the only significant, independent predictor of sexual bother, even after accounting for sexual functioning status. The association between diminished masculinity and sexual bother was strongest for men whose spouses perceived low marital affection., Conclusions: Diminished masculinity is a prominent, yet understudied concern for PCa survivors. Regardless of functional status, men who perceive a loss of masculinity following treatment may be more likely to be distressed by their ED. Furthermore, its impact on adjustment in survivorship may rely on the quality of their intimate relationships., (© 2012 International Society for Sexual Medicine.)

Objective: The objective of this study was to describe the experience of undertaking meaning and purpose (MaP) therapy for patients with advanced cancer, with an aim of refining therapeutic processes involved prior to pilot testing. Specifically, we were interested in examining the themes arising from participation in the intervention in relation to our therapeutic goals, and how acceptable both the number of sessions and processes used were., Method: A convenience sample of people living with advanced cancer was recruited to participate in this process, resulting in 24 therapy sessions for analysis., Results: A thematic analysis of each session illustrated that the process of MaP therapy is one that encourages reflection, offers insights, and can be confrontational, but can also allow participants to "shift" their perspective and focus onto meaningful goals. Results illustrate how the therapist creates a therapeutic frame that holds up a poignant portrayal of the meaning of life lived, and mirrors this to the patient, such that they grasp its rich texture. Participants' descriptions showed how they were buoyed forward as a result, with renewed vigor and enthusiasm, despite their illness and any physical restrictions that it imposed., Significance of Results: A planned pilot test of this intervention will enable us to determine potential effect sizes of this therapy in reducing distress and increasing meaning prior to a full randomized controlled trial. Understanding the processes involved and the experiences of participation in meaning-based therapies is crucial to the future strength of this area of psychotherapy.

The objective was to explore the psychosocial adaptation of female partners living with men with a diagnosis of either localized or metastatic prostate cancer. Semi-structured qualitative interviews were conducted with 50 women at two time points (baseline and 6 months later). The interviews examined emotions, experiences, attitudes to sexual and continence issues and treatment decision making. As part of a larger prospective observational study, demographic data and scores for depression and anxiety were collected. Initial analysis demonstrated that the group of 11 women assessed as distressed on the anxiety and depression measures described reduced coping skills and poorer adaptation after 6 months. In contrast, the 39 women in the non-distressed group reported emotional adaptation that fitted the Lazarus and Folkman pattern of coping through appraisal of the impact of the diagnosis on their partner and themselves, appraisal of coping strategies and reappraisal of the situation. A surprise finding was the high level of resilience displayed by majority of these women. Results suggest that a psychosocial intervention could strengthen healthy adaptation and provide better coping skills for distressed couples.

Introduction: The present study evaluated intimacy as a mechanism for the effects of relationship-enhancing (self-disclosure, mutual constructive communication) and relationship-compromising communication (holding back, mutual avoidance, and demand-withdraw communication) on couples' psychological distress., Methods: Seventy-five men diagnosed with localized prostate cancer in the past year and their partners completed surveys about communication, intimacy, and distress., Results: Multi-level models with the couple as unit of analyses indicated that the association between mutual constructive communication, mutual avoidance, and patient demand-partner withdraw and distress could be accounted for by their influence on relationship intimacy. Intimacy did not mediate associations between self-disclosure, holding back, and partner demand-patient withdraw communication and distress., Discussion/conclusions: These findings indicate that the way in which couples talk about cancer-related concerns as well as the degree to which one or both partners avoid talking about cancer-related concerns can either facilitate or reduce relationship intimacy, and that it is largely by this mechanism that these three communication strategies impact psychological distress., Implications for Cancer Survivors: Relationship intimacy and how patients and partners communicate to achieve this intimacy is important for the psychological adjustment of early stage prostate cancer survivors and their partners.

Background: With medical advances since the 1990s, a growing proportion of patients are living for many years with prostate cancer (PCA) and the consequences of its treatment., Objective: The authors investigated the experience of being diagnosed with cancer and the effects of its treatment on patients' partners., Method: The authors conducted an observational, longitudinal study of 103 couples facing the diagnosis of either localized (potentially curable) or metastatic (incurable) PCA at Time 1 and then 6 months later (Time 2)., Results: At both Time 1 and Time 2, psychological distress, marital satisfaction, and family functioning were measured in patients and partners; coping was measured in partners only. Partner maladaptive coping patterns of avoidance and self-blame at Time 1 predicted greater partner psychological distress at Time 2, as did "wishful thinking" at Time 2., Discussion: Psychosocial interventions designed to promote adaptive coping in couples facing PCA warrant systematic study.

Objectives: In the clinical setting of cancer, meaning may well have a central role in the life changes the illness experience brings about. As health care professionals working with people with life-threatening illness, we are exposed to one of the major turning points in life and the ways people confront this transition. Meaning can assist coping by offering a framework, perspective, and counterbalance to the challenge of illness. However, the absence of meaning can be a precursor to profound despair., Methods: This article brings together the clinical implications of two studies conducted by the authors that explored the role of meaning in adjustment to cancer, presenting a theoretical understanding of the experience of meaning in cancer and identifying some potential approaches to intervention., Results: Our findings point to some specific goals of care as well as a number of therapeutic modalities aimed to meet these goals. We examine four goals of care--acknowledging suffering, encouraging a search for meaning, strengthening connection with others, and ensuring optimal physical care--as foundational in any clinical approach and then examine the key models of therapy that assist the clinician in pursuing these goals., Significance of Results: Our aim is to create an integrated approach to care provision that locates meaning centrally in any patient's adaptation.

Objectives: This study builds on previous work that explored the lived experience of meaning in advanced cancer. The aims were to explore the associations of suffering (physical and existential distress) and coping (via social support) with psychological distress and global meaning using a battery of instruments among adults attending an Australian metropolitan cancer service (n=100)., Methods: The contribution of suffering and coping via social support to psychological distress and meaning were examined using a variety of statistical methods. Multiple regression analyses were conducted to further examine relative contributions to both psychological distress and global meaning., Results: Physical and existential distress were found to be positively associated with psychological distress whereas high social support and personal meaning are related to lower levels of psychological distress. Social support was the strongest correlate of global meaning whereas high levels of existential distress were related to lower levels of global meaning. On the basis of this study, it is concluded that the factors related to suffering clearly promote psychological distress, and the reverse is true for global meaning for those living with cancer., Significance of Results: This study speaks to the clinical complexity of the dynamic experience of suffering and meaning in cancer. We need to better understand the impact of physical suffering and meaning in the lives of this population and to actively work toward the enhancement of social support and connection with others for this group. Optimal palliative and family-centered care blended with therapies that promote a sense of meaning of life lived appear crucial to ameliorate suffering.

Advances in prostate cancer treatments since the 1990s have led to a growing proportion of patients living with the effects of the cancer. Various challenges face the man and his partner from the point of learning of the diagnosis: deciding among numerous diverse treatment options, dealing with side-effects of treatment and possibly facing the terminal phase of the illness. This invariably has an impact on the patient's family and, in view of the older age group of men usually affected, the experience of a partner is particularly relevant. A thorough review of the research literature reporting directly from partners of prostate cancer patients has not been undertaken previously. For this review, five databases were searched for the decade 1994-2005, during which most of the work in this field has been done. Very few evaluations of psychosocial interventions involving the partner were found, but there was a preponderance of qualitative studies involving small numbers of participants and quantitative surveys with little consistency in the measures used. The literature suggests that partners report more distress than patients, yet believe that patients are the more distressed, and the focus of concern of patients on their sexual function is not shared to an equal degree by their partners.

This study used qualitative methods to elicit the thoughts and attitudes of patients with advanced cancer. Our two interrelated aims were to explore how participants experience and apply meaning; and to consider whether this experience can be understood within an integrated framework of assumptive world (AW), sense of coherence (SOC) and meaning-based coping (MBC). Using semi-structured interviews, 26 conversations were held overall with 10 participants. Transcriptions were analysed for themes of lived-experience and for evidence of the principal elements of AW, SOC, and MBC. Findings suggest three interrelated domains that form an adaptive pathway towards coherence and sense of self. While this pathway is essentially linear it is also responsive to the ongoing stressful nature of advanced cancer.

Partners of women with breast cancer are intimately affected by their disease. This study describes the lived experience of the significant others of women with early stage breast cancer at the point of their partners' completion of adjuvant therapies. Significant others describe their need to adapt to the fear of losing their partner, the impact on their own mortality and their new role of caregiver for which they were unprepared. The greatest divergence between patient and partner was at the point of treatment completion. Whereas the women were continuing to experience difficulties at this time, their significant others were focused on 'getting back to normal.' There is a need to increase our understanding of the psychosocial needs of primary carers in order to better support them, as integral members of the care team.

Purpose: To determine whether making patient-reported cancer needs, quality-of-life (QOL), and psychosocial information available to the health care team, allowing coordinated specifically targeted psychosocial interventions, resulted in reduced cancer needs, improved QOL, and increased satisfaction with care received., Methods: Self-reported cancer needs, QOL, and psychosocial information was collected from 450 people with cancer, using standardized questionnaires via a touch-screen computer. For a randomly chosen two thirds, this information was made available to the health care team who coordinated targeted psychosocial interventions. Information from the remaining one third was not seen. Patients were assessed 2 and 6 months after randomization for changes in their cancer needs, QOL, and psychosocial functioning and satisfaction with overall care received., Results: There were no significant differences between the two arms with respect to changes in cancer needs, QOL, or psychosocial functioning between the baseline and follow-up assessments, nor with respect to satisfaction with care. However, for the subgroup of patients who were moderately or severely depressed at baseline, there was a significant reduction in depression for the intervention arm relative to the control arm at the 6-month assessment (P =.001)., Conclusion: Making patient-reported cancer needs, QOL, and psychosocial data available to the health care team at a single consultation together with coordinated psychosocial interventions does not seem to reduce cancer needs nor improve QOL, psychosocial functioning, or satisfaction with the care received. However, identification of patients with moderate or severe levels of depression may be valuable in reducing subsequent levels of depression.

The meaning of dignity is commonly assumed but rarely examined in palliative care. Dying with dignity often forms the basis of clinical decision making at the end of life, but is constructed differently depending upon setting and context. A discourse analysis of patient and family case studies found that relationships and embodiment were important aspects of dignity that have been neglected in the literature, although these constructions of dignity matter to dying people and their families. An understanding of these constructions can assist clinicians in providing sensitive palliative care across a range of community and medical settings.

Background: Assessment of adjustment of patients in cancer treatment trials is becoming more common and increasingly regarded as a useful outcome measure. The widely used Mental Adjustment to Cancer (MAC) Scale was designed to measure Fighting Spirit (FS), Anxious Preoccupation (AP), Helpless-hopelessness (HH) and Fatalism., Methods: Questionnaire responses from 632 breast cancer patients were randomly divided into two groups, one for exploratory analyses and possible scale refinement, and the other for validation purposes., Results: Estimates of reliability (Cronbach's alpha) were satisfactory for two scales, FS (alpha = 0.85) and HH (alpha = 0.81), but lower for AP (alpha = 0.65) and Fatalism (alpha = 0.64). Exploratory factor analysis suggested that the MAC Scale might be measuring six independent constructs including two related to Fighting Spirit (Positive Orientation to the Illness, Minimizing the Illness), two related to Fatalism (Fatalism-revised, Loss of Control), a construct we have named Angst, and an unchanged HH construct. Scales developed to measure these constructs were satisfactorily replicated in confirmatory analyses but some reliabilities were lower than desirable. The general structure of the MAC Scale remained little changed despite the division of two scales and the suggested removal of six items. The refined scales correlated with the Hospital Anxiety and Depression scale and the Medical Coping Modes Questionnaire, indicating good concurrent validity., Conclusions: While reasonable reliability of the original scales persists through analyses of the MAC Scale, the original factor structure could not be reproduced. Six refined constructs with strong construct validity were identified within the overall domain of mental adjustment to cancer.

Using a three-phase longitudinal design, the bereavement of 115 adult Australian families following the death of a parent from cancer was studied. The cohort comprised 115 spouses and 153 offspring: 670 individual responses were obtained. A range of psychosocial variables was studied through a semistructured interview covering the experience of the deceased's illness, death and funeral, spousal health, family coping, sources of support, use of ritual and completion of estate duties. Bereavement outcome was measured by standardized questionnaires of the intensity of grief (Bereavement Phenomenology Questionnaire), depression (Beck Depression Inventory), psychological distress (Brief Symptom Inventory) and social adjustment (Social Adjustment Scale). Those psychosocial variables found to be significantly correlated with bereavement outcome were entered into best sub-set regression analyses. Family coping was the most consistent correlate of bereavement outcome in these regression analyses, which accounted for up to 38% of the variance in grief, 64% in distress, 53% in depression and 46% in social adjustment. The nature of family functioning is a key aspect of social support in influencing the outcome of bereavement.

Objective: The aim of this study was to identify patterns of family functioning in adult families after the death of a parent., Method: One hundred fifteen families completed measures of family functioning, grief, psychological state, and social adjustment 6 weeks (time 1), 6 months (time 2), and 13 months (time 3) after the death of a parent (a total of 670 individual responses). Cluster analytic methods were applied to develop a typology of perceptions of family functioning during bereavement., Results: Five types of families emerged from dimensions of cohesiveness, conflict, and expressiveness on the Family Environment Scale. Thirty-six percent of the families were considered supportive because of their high cohesiveness, and another 23% resolved conflict effectively. Two types were dysfunctional: hostile families, distinguished by high conflict, low cohesiveness, and poor expressiveness, and sullen families, who had more moderate limitations in these three areas; they declined in frequency from 30% at time 1 to 15% at time 3. The remaining type (26%), termed intermediate, exhibited midrange cohesiveness, low control, and low achievement orientation. The typology at time 1 predicted typologies at time 2 and time 3. There were no age or gender differences among the family types, but offspring, as compared with spouses, were overrepresented in the hostile families., Conclusions: Family types can be identified, allowing at-risk families to be helped to prevent complications of grief. Screening with the family relationship index of the Family Environment Scale would facilitate such a family-centered approach.

Objective: The aim of this study was to describe the intensity of grief, the psychosocial morbidity, and the coping patterns in members of families classified according to a typology of family functioning comprising supportive, conflict-resolving, intermediate, sullen, and hostile classes., Method: One hundred fifteen families were assessed longitudinally 6 weeks (time 1), 6 months (time 2), and 13 months (time 3) after the death of a parent (constituting 670 individual responses) on measures of grief intensity, psychological state, social adjustment, and family coping. A previously described typology of perceptions of family functioning was applied. Repeated measures multivariate analysis of variance based on both individuals and families and post hoc comparisons of significant results were undertaken., Results: Sullen families displayed the most intense grief and the most severe psychosocial morbidity. Well-functioning families (supportive and conflict-resolving) resolved their grief and adjusted more adaptively than their dysfunctional counterparts (intermediate, sullen, and hostile families). There were no cluster-by-time interactions. The clusters accounted for 15.7% of the variance in depression (Beck Depression Inventory) and 27.9% of the variance in social functioning (Social Adjustment Scale). Well-functioning families used more family coping strategies (Family Crisis Oriented Personal Evaluation Scales)., Conclusions: More intense grief and greater psychosocial morbidity are found in sullen, hostile, and intermediate bereaved families than in the more adaptive supportive and conflict-resolving types. At-risk families are identifiable and could be treated preventively to reduce morbidity.