Breaking bad news to cancer patients: survey and analysis

Purpose: To find out how patients perceived the disclosure of news about their cancer as regards the physician counselling and how they perceived the flow of information between hospital‐based and family physicians. Methods: 272 cancer patients were polled with a 16‐item questionnaire. Results: 252 cancer patients, 92.6% of those asked, completed the questionnaire. 37.7% (f:35.4%, m:41.8%) stated that the fact that they had cancer was presented to them ‘very empathically’ or ‘empathically’. 62.3% (f:64.7%, m:58.3%) stated that it was presented to them ‘not so empathically’ or ‘ not at all empathically’. When patients had been counselled by family physicians they were more likely to state that it had been done ‘very empathically’ or ‘empathically’, in contrast to when they had been counselled by hospital‐oncologists or self‐employed specialists (81.8% vs. 41.2% vs. 41.2%; p=0.001). Significantly more patients thought that they had been given adequate opportunity to ask the questions they considered important when counselled by a family physician (81.8%) as compared to counselling by a hospital‐oncologist (43.5%; p=0.002) or a self‐employed specialist (44.3%; p=0.001). 56.8% preferred to discuss the suggested cancer therapies with an oncologist. 87.5% of patients considered the exchange of information between the hospital‐based specialists and their family physician ‘very important’ or ‘important’; more than half of all patients stated that this exchange of information was ‘rather poor’ or ‘poor’. Conclusions: Oncologists should involve family physicians in disclosing bad news to patients. There are considerable deficiencies regarding information–exchange in cancer care in Austria. Copyright © 2008 John Wiley & Sons, Ltd.     

'If we get too close to your bones they'll go brittle': women's initial fears about radiotherapy for early breast cancer

Introduction: Radiotherapy is a common treatment for breast cancer. However, previous studies have shown that women who present for radiotherapy fear its use and associated side effects. The aims of this study were to develop further understanding of breast cancer patients' fears of radiotherapy, ascertain how patients deal with these fears and determine the best time in the treatment planning trajectory for health professionals to address these concerns. Methods: Semi‐structured interviews were conducted with early breast cancer patients at four time points during their experiences of radiotherapy. Grounded theory was used to analyse the data. Symbolic interactionism informed data interpretation. Results: Thirty‐four participants were interviewed. The two main themes that emerged prior to treatment commencement were ‘fears about receiving radiotherapy’ and ‘ways of coping with the fear of radiotherapy’. Sub‐themes that emerged as components of the theme ‘fears about receiving radiotherapy’ were: ‘fearing the unknown’, ‘getting burnt’, ‘damaging internal parts’ and ‘anticipating tiredness’. Patients were able to cope with their fears by trying not to worry about their fears and by seeking information. Many patients found that their fears about radiotherapy were much worse than their actual experiences of receiving treatment and the side effects they experienced. Discussion/conclusion: In discussing radiotherapy with patients, health professionals have a window of opportunity at the planning appointment, prior to the commencement of radiotherapy, to assess patients' understanding and concerns about radiotherapy, listen to their fears, address meanings they assign to radiotherapy and provide reassurance about radiotherapy and the management of side effects. Copyright © 2007 John Wiley & Sons, Ltd.     

Facing haematopoietic stem‐cell transplantation: do patients and their physicians agree regarding the prognosis?

Objective: To evaluate the correlation and concordance between patients' and physicians' estimations of prognoses before initiation of the conditioning regimen for allogeneic haematopoietic stem‐cell transplantation. Methods: A total of 123 patients and their attending physicians were asked to estimate a prognosis on a six‐point scale. The patients were also asked to fill out questionnaires addressing their psychological state and coping. Results: The mean prognostic estimations differed by 1.17 points (p<0.001), with the patients being more optimistic than the physicians. With respect to concordance: Pearson correlation r=0.024 (ns); unweighted kappa and kappa with linear weighting are 0.115 and 0.068, respectively. The prognostic estimates of the patients correlated with their psychological state, but not with the objective disease‐ or treatment‐related variables, whereas the physicians' estimates were partially based on such objective factors. Conclusions: A clear significant association between actual survival and the physicians' estimates, but not the patients' estimates, was observed. If agreement regarding the prognosis exists, the relationship between physicians' and patients' estimates is probably non‐linear. Assessing one's chances of being cured is a highly emotional task, and psychological processes such as denial or repression most likely play a decisive role. Moreover, collusion between the patient and physician may be inevitable in this situation. Whether it is desirable to gain concordance and who will benefit from such efforts must be discussed and empirically studied. Copyright © 2009 John Wiley & Sons, Ltd.     

Interest in a group psychotherapy program among Philippine breast cancer patients and its associated factors

Objective: A wide variety of psychosocial interventions are available for cancer patients, among which group psychotherapy (GPT) programs have made improvements in cancer patients' quality of life, coping abilities, and emotional distress. Few research data are available describing Philippine breast cancer patients' interest in GPT. This study aimed at enumerating the factors that determine Philippine breast cancer patients' interest in a GPT program. Methods: Patients recruited from the University of Santo Tomas Hospital Benavides Cancer Institute were asked to answer a survey questionnaire about their demographic, clinical, and psychosocial status, as well as whether they would be interested in joining GPT and why. Results: Of 135 patients approached, 123 patients completed the survey. 104 (85%) women indicated interest in GPT. Patients were mostly interested because they wanted to learn coping skills (79%) and gain knowledge or information in dealing with cancer (69%). Patients said they were ‘very interested’ in learning about cancer recurrence (96%) and treatments (94%). Bivariate analysis showed that compared to the uninterested group, interested patients were younger, more likely to be married, and were more likely to have used complementary therapy for breast cancer. Logistic regression showed that married women were more likely to be interested in GPT (OR 3.30, CI 1.07–10.20). Conclusion: There is a potentially high interest in GPT among Philippine breast cancer patients. The attributes of Philippine patients interested in GPT are similar to and yet unique, compared to other populations. Copyright © 2010 John Wiley & Sons, Ltd.     

Dysplasia severity, but not experiences during colposcopy, predicts adherence to follow-up colposcopy

Objective: Patient adherence with treatment recommendations is an essential factor for the effectiveness of cervical cancer screening programs. Psychological factors may play a role in patient adherence to cervical cancer screening. The present study aimed to extend knowledge of women's adherence to follow‐up colposcopy, by examining possible predictive biopsychosocial variables measured at colposcopy and objective attendance rates from patients' medical files. Methods: Baseline data on psychosocial factors (e.g. demographic variables, state anxiety, and pain) were collected from 141 women prior to undergoing colposcopy for the first time (M age = 29.63, SD = 8.39). Experiences of colposcopy and adherence to follow‐up (within two years) were assessed subsequently. Results: There were no associations between adherence and demographic variables. Women with severe dysplasia were more likely to adhere to follow‐up colposcopy than women with other histology grades. Women who did not attend for follow‐up reported significantly greater state anxiety and pain unpleasantness following colposcopy than women who did attend. A multivariate logistic regression analysis revealed that the psychological experiences of colposcopy did not predict adherence status. However, dysplasia severity made a significant contribution to the model. The odds of adhering to colposcopy for patients with severe dysplasia were 3.57 times higher than for patients with normal histology, and 4.35 times higher than for patients with moderate dysplasia (p = 0.005). Conclusions: Colposcopy‐related experiences do not appear to be strong predictors of adherence, but women with dysplasia grades other than ‘severe’ should be targeted for follow‐up recommendations and advice. Copyright © 2010 John Wiley & Sons, Ltd.     

Patient willingness to undergo chemotherapy and thoracic radiotherapy for locally advanced non-small cell lung cancer

Objectives: To determine how Japanese patients with lung cancer weigh the chance of cure and potential survival against the potential toxicity of different treatment strategies for locally advanced non‐small cell lung cancer (NSCLC). Methods: We used a questionnaire describing a hypothetical situation involving locally advanced NSCLC. Seventy‐three patients with lung cancer who had received chemotherapy and a control group of 120 patients without cancer were asked to state the minimal benefit that would make two hypothetical treatments acceptable. Results: Patients with lung cancer were significantly more likely than were patients without cancer to accept either intensive or less‐intensive chemoradiotherapy for a potentially small benefit for ‘chance of cure’ and ‘response but not cure’. The percentages of patients who would accept intensive or less‐intensive chemoradiotherapy to prolong survival did not differ significantly between the two groups. When the chance of cure was 20%, 56 and 64% of patients with lung cancer were willing to receive intensive and less‐intensive chemoradiotherapy, respectively. If their lives were prolonged by 6 months, 20 and 30% of patients with lung cancer would choose to receive intensive and less‐intensive chemoradiotherapy, respectively. The chance of cure and the survival advantage that patients require for accepting chemoradiotherapy varied widely. No factors were associated with the choice of chemoradiotherapy in patients with lung cancer. Conclusions: Physicians must consider the substantial range of attitudes to chemoradiotherapy among patients when selecting treatment and give patients opportunities to be included in the treatment‐selection process. Copyright © 2008 John Wiley & Sons, Ltd.     

Disentangling cancer patients' trust in their oncologist: a qualitative study

Objective: Patients' trust in their physician is crucial for an optimal treatment. Yet, among oncology patients, for whom trust might be especially important, research into trust is limited. A qualitative interview study was carried out to investigate (1) to what extent aspects of trust important to cancer patients reflect the aspects described in other patient populations and (2) which additional themes emerge. Methods: In‐depth, semi‐structured interviews were performed with a purposefully selected heterogeneous sample of 29 cancer patients. Transcribed interviews were analyzed using MAXqda. Data were clustered across interviews to derive common themes related to trust. Results: Three commonly described aspects, i.e., fidelity, competence and honesty, were strongly reflected in patients' accounts of trust in their oncologist. Confidentiality was irrelevant to many. An additional aspect, labeled ‘caring’, was distinguished. Central to the accounts of these patients was their need to trust the oncologist, arising from the severe and life‐threatening nature of their disease. This necessity to trust led to the quick establishment of a competence‐based trust alliance. A deeper, more emotional bond of trust was developed only after repeated interaction and seemed primarily based on the oncologist's interpersonal skills. Conclusions: The need for trust encountered in this study underscores the power imbalance between cancer patients and their oncologist. Additionally, these results imply that when aiming to measure cancer patients' trust, what we might actually be assessing is patients' intention and determination to trust their oncologist. Copyright © 2011 John Wiley & Sons, Ltd.     

What research evidence is there for the use of art therapy in the management of symptoms in adults with cancer? A systematic review

Objective: Common psychosocial difficulties experienced by cancer patients are fatigue, depression, anxiety, and existential and relational concerns. Art therapy is one intervention being developed to address these difficulties. The purpose of this research was to assess and synthesize the available research evidence for the use of art therapy in the management of symptoms in adults with cancer. Methods: A literature search of electronic databases, ‘grey’ literature, hand searching of key journals, and personal contacts was undertaken. Keywords searched were ‘art therapy’ and ‘cancer’ or ‘neoplasm’. The inclusion criteria were: research studies of any design; adult cancer population; and art therapy intervention. There were no language or date restrictions. Data extraction occurred and quality appraisal was undertaken. Data were analyzed using narrative synthesis. Results: Fourteen papers reporting 12 studies met the inclusion criteria. Symptoms investigated spanned emotional, physical, social and global functioning, and existential/spiritual concerns. Measures used were questionnaires, in‐depth interviews, patients' artwork, therapists' narratives of sessions, and stress markers in salivary samples. No overall effect size was determined owing to heterogeneity of studies. Narrative synthesis of the studies shows art therapy is used at all stages of the cancer trajectory, most frequently by women, the most common cancer site in participants being breast. Conclusion: Art therapy is a psychotherapeutic approach that is being used by adults with cancer to manage a spectrum of treatment‐related symptoms and facilitate the process of psychological readjustment to the loss, change, and uncertainty characteristic of cancer survivorship. Research in this area is still in its infancy. Copyright © 2010 John Wiley & Sons, Ltd.     

Impact of cancer patients' disease awareness on their family members' health‐related quality of life: a cross‐sectional survey

Background: Conflicting results exist concerning disease knowledge and patients' quality of life (QOL) while there is very limited information concerning the impact of awareness on caregivers' health‐related quality of life. The aim of this study was to explore the influence of disease awareness on both cancer patients and their caregivers during the period of chemotherapy. Materials and Methods: Two hundred and twelve cancer patient–caregiver dyads completed the QOL SF‐36 instrument on the day of chemotherapy. Hierarchical multiple linear regression analysis was performed. Results: Physical component parameters were significantly higher in the family members (p<0.001), while their mental component was lower than cancer patients. Younger patients, females, and of higher educational status were more frequently aware of their disease status while patients with gastrointestinal cancer were more likely to be unaware. Disease knowledge seems to exert a negative influence on patients' physical and mental parameters while lack of awareness affects adversely caregivers' vitality, social function, emotional role, and mental health. Multiple regression analysis confirmed disease awareness affected reversely patients' and caregivers' mental QOL while the counter‐influence of the dyad was revealed. Conclusions: A holistic approach to cancer management should be followed. Patient's treatment is the major medical concern, but health system and professionals should be involved in the mental and physical support of caregivers as well. Tailored interventions that focus on the support of the dyad patient–caregiver should be developed. Copyright © 2010 John Wiley & Sons, Ltd.     

Experiences and concerns about ‘returning to work’ for women breast cancer survivors: a literature review

Objective: To explore how female breast cancer patients experience work incapacity during the treatment and return‐to‐work phases and how interactions between patients and stakeholders affect this experience. Method: Database search for full text articles published between January 1995 and January 2008 that focused on employed female breast cancer patients, factors related to work incapacity, and returning to work. Only results based on self‐report data were included. Studies focusing on treatment, financial factors, rate of return, or absence were excluded. Results: Six articles met the inclusion criteria. Women with breast cancer receive varied reactions but little advice about returning to work. Women were primarily concerned with disclosing the diagnosis to their employer and to relatives. Uncertainties about physical appearance, ability to work, and possible job loss affected the women's decisions about working during the treatment phase. After treatment, most women wanted to regain their ‘normal life’, but concentration and arm or fatigue problems potentially interfered. Although supportive work environments were helpful, the individual needs of women differed. Employers and employees need to find a balance in defining accommodating work. Many women received favourable support, but some reported feeling discriminated against. Many women re‐evaluated the role of work in their lives after being confronted with breast cancer. Conclusion: Work adjustments could help women to keep their jobs during illness and recovery. To resolve women's concerns about returning to work, employers, physicians, and insurance institutions should consider increasing and improving communication with breast cancer patients and playing a more active and supportive role. Copyright © 2009 John Wiley & Sons, Ltd.     

The problems reported by cancer patients with major depression

Objective: To describe the problems reported by people with cancer and major depressive disorder as elicited before starting problem‐solving therapy (PST). Methods: Ninety‐eight outpatients, with a variety of cancers who met criteria for major depression, received PST as part of a system of treatment called ‘Depression Care for People with Cancer’ within a randomized trial. During the first session of PST, each patient was asked to provide an exhaustive list of problems defined as ‘anything that was bothering them’. A coding system, based on thematic content, was developed to categorize the problems listed. Each problem was then coded by two raters independently (κ=0.81). The resulting categories were organized into larger conceptual domains using a card‐sorting task. Results: Thirty‐six problem categories were generated which were in turn organized into 11 larger conceptual domains. Patients reported problems in a mean of 9.2 different categories (range 3–21) and 5.7 domains (range 2–9). The most common problem categories were ‘concerns about other people's well‐being’ (65%), ‘problems in interpersonal relations’ (61%), ‘loss of interest’ (56%), ‘low mood’ (55%), and ‘cancer recurrence or relapse’ (54%). Conclusions: People with cancer and major depression report a wide variety of problems that include, but go beyond concerns about, both cancer and depression. The large number of problems related to concerns about other people's well‐being and difficulties in interpersonal relationships, stresses the importance of these topics to patients and should be given more weight in the assessment and management of depressed cancer patients. Copyright © 2010 John Wiley & Sons, Ltd.     

Psychological well-being outcomes in disease-free survivors of mid-low rectal cancer following curative surgery

Objective: The aim of this cross‐sectional study was to evaluate psychological well‐being outcomes in disease‐free survivors who previously underwent radical surgery for rectal adenocarcinoma. Methods: All patients with rectal adenocarcinoma who underwent primary surgery at a single institution from 1990 to 2002 were considered for inclusion in the study. We identified and sent questionnaires to 145 patients after excluding those who had died or had recurrent disease. One hundred and seventeen patients (men/women: 74/43; median age: 65 years) returned the questionnaires. Patients' well being was evaluated using the Psychological General Well‐Being Index (PGWBI) questionnaire. The mean PGWBI score was compared with normative data of the general population. The impact of patient‐, tumor‐ and treatment‐related factors on patients' long‐term psychological well‐being status was also evaluated. Results: Compared with the general population, study patients had significantly better anxiety, depressed mood, positive well being, general health, vitality scales and global index scores. On multivariate analysis, positive well being was independently affected by time from diagnosis (36 months; p=0.025) and occurrence of early major complications (p=0.024). Variables that were independently associated with worse self‐control included primary education (p=0.04) and the presence of fecal urgency (p=0.049). General health was negatively affected by time from diagnosis (36 months; p=0.047) and fecal urgency (p=0.009). Conclusions: Patients who have survived cancer are likely to re‐evaluate the importance of everyday events and this may explain why they had better PGWBI scores. This study also identified that a short time from diagnosis, early adverse events and bowel dysfunction had a negative impact on patients' well being. Copyright © 2010 John Wiley & Sons, Ltd.     

Psychological states and coping strategies after bereavement among the spouses of cancer patients: a qualitative study

Objective: Encouraging coping strategies that contribute to positive psychological states in bereaved individuals is assumed to be desirable; however, little is known about the components of positive psychological states and bereavement‐specific coping strategies. The purpose of this study was to describe the components of psychological states and coping strategies after bereavement among the spouses of cancer patients. Methods: Semi‐structured interviews were conducted among bereaved spouses of cancer patients. Meaning units of the psychological state and coping strategy in the interview records were grouped into categories and themes based on their similarities using content analysis and constant comparison methods. Negative/positive psychological states and general/bereavement‐specific coping strategies were identified by discussion among the authors. The number of participants who responded to each category was determined by two raters who were unaware of the categorized procedure. Results: Seven men and 17 women participated in the interviews. Forty‐two categories of psychological states identified from 784 meaning units were grouped into six themes: ‘Anxiety’, ‘Yearning’, ‘Anger’, and ‘Depression’ were negative psychological states, while ‘Acceptance’ and ‘Future‐oriented Feelings’ were positive psychological states. Thirty‐three categories of coping strategies identified from 559 meaning units were grouped into six themes: ‘Avoidance’, ‘Distancing’, ‘Emotional Expression’, and ‘Seeking Support’ were general coping strategies, while ‘Continuing Bonds’ and ‘Reconstruction of Life’ were bereavement‐specific coping strategies. Conclusions: Several original components of positive psychological states after bereavement and bereavement‐specific coping strategies were identified, whereas most of the other components were consistent with previous studies. Copyright © 2009 John Wiley & Sons, Ltd.     

Patient versus clinician symptom reporting: how accurate is the detection of distress in the oncologic after‐care?

Objective: The high prevalence of psychosocial distress in cancer patients is well known. The objective of this study was to investigate the agreement between the self‐report of patients and the detection of distress by the treating physicians. Methods: The participating patients were all enrolled in a structured 5‐year after‐care program in Palatinate, Germany. All tumor‐free patients with a scheduled follow‐up exam in a 3‐month time frame were asked to fill in a questionnaire regarding their psychosocial distress. The treating physicians participating in the program are family doctors or specialized physicians working in general practices. Their assessment of the patients' distress is part of the program. Agreement was evaluated using the kappa statistic. Results: The levels of psychosocial distress were very high in the self‐rating of 2642 patients. Low concordance was observed between the ratings of the patients and the physicians, with all kappa values below 0.1. Only about every 10th patient reporting weak to severe problems with depression or anxiety was identified as such. Detection of problems by physicians was somewhat better for female than male patients and highest among breast cancer patients. Conclusions: Overall the results of our study show that the need for psychosocial support extends past the acute treatment phase. The recognition of psychosocial distress in their patients seems to be extremely low in the outpatient, follow‐on care phase. The application of an efficient rating method should become a routine part of the follow‐up exams with physicians being trained to improve their abilities to detect the distress in the patient. Copyright © 2011 John Wiley & Sons, Ltd.     

Cancer patients' decisions about discussing Internet information with their doctors

Objective: To explore cancer patients' and caregivers' decisions regarding whether to discuss cancer‐related information they found on the Internet with their doctors. Methods: 238 participants (cancer patients and caregivers) from three online cancer communities responded to a survey about their experiences finding information on the Internet about their cancer and their reasons for discussing or not discussing that information with their doctors. The reasons were coded into mutually exclusive categories. Results: Participants most frequently reported discussing information in order to be proactive in improving their health. Other reasons included appealing to the doctor as expert, wanting to become more educated, meeting a psychological or coping need, and checking up on or testing the doctor. Of the participants, caregivers were more likely than patients to cite checking up on or testing the doctor as a reason for discussing Internet information. Sixty‐two percent of participants reported sometimes or never talking about Internet information that they thought was important with their doctors. Across all participants, the most frequently reported reasons for not talking about Internet information were attributions about the information and systems‐related reasons. Participants who reported information attribution as a reason for not discussing it with their doctors had higher overall comfort levels with these types of discussions. Conclusions: Many factors influence cancer patients' and caregivers' decisions about discussing Internet information with their doctors. The coherence of the reasons across the communities in this study and in other studies suggests that this typology of reasons is both thorough and valid. Copyright © 2009 John Wiley & Sons, Ltd.     

‘Admission into a helping plan’: a watershed between positive and negative experiences in breast cancer

Cancer patients are in an exposed situation that raises certain psychosocial needs in contact with health care. Previous studies have mainly investigated these needs by assessments on pre‐defined categories. Objective: The purpose of the present study is, from the patients' perspective, to identify breast cancer patients' psychosocial needs, and to synthesise them in a model reflecting the core of these needs. Methods: Seventy‐one patients treated with radiation therapy were consecutively included and repeatedly interviewed about their experiences of health care. ‘Critical incidents’ where identified from the interviews and analysed due to the similarities–differences technique in grounded theory. Results: Four categories of needs where detected: ‘access’, ‘information’, ‘treatment’ and ‘how approached’. These categories and their properties merged into a core category—‘admission into a helping plan’. These findings are well understood in terms of attachment theory. In times of immanent danger and stress people strive to find a ‘safe haven’ to attach to. Cancer patients' ‘safe haven’ can be described as ‘a helping plan’. It is not the result of a separate patient–caregiver relationship but is created by a pattern of individual experiences from all kind of contacts with the health‐care system as a whole. Conclusions: The presented model of patients needs as converging into ‘admission into a helping plan’ may serve as an easily comprehendible model for caregivers, guiding them to contribute to the patient's feeling of security and trust, and thus to the patient's own ‘hope work’. Copyright © 2009 John Wiley & Sons, Ltd.     

De‐stigmatising human papillomavirus in the context of cervical cancer: a randomised controlled trial

Objective: To identify the components of a human papillomavirus (HPV) message contributing to reducing the stigma of HPV in cervical cancer. Methods: 294 ethnic Chinese women attending a community‐based clinic in Hong Kong were randomly allocated to read one of three written HPV messages: Group ‘lr+hrHPV’: low‐risk and high‐risk HPVs facts, Group ‘hrHPV’: high‐risk HPV facts only and Group ‘ds+hrHPV’: high‐risk HPV facts and de‐stigmatising components, namely being anti‐stereotypical, motivational and low in complexity. Main outcome measures were high‐risk HPV‐related sexual stigma, knowledge, attitude towards message, and intention to be HPV‐tested measured by self‐administered questionnaires immediately before and after reading. Results: Message allocation had a significant effect on sexual stigma (F=5.219, p=0.006). Participants who read message ds+hrHPV showed the least stigma, and were significantly less likely to believe that high‐risk HPV infection implicated promiscuity, non‐monogamy or that monogamy offered complete protection against high‐risk HPV. The genital HPV‐focused message was more stigmatising than cervical cancer‐focused messages. Of all participants, 93% (237/254) and 97% (260/269) indicated a positive intention to be HPV‐tested before and after reading, respectively. There were no between‐group differences noted in terms of knowledge and intention to be HPV‐tested before or after reading. Conclusions: Our findings show that an HPV message containing specific de‐stigmatising components may reduce public stigma towards high‐risk HPV. Also, focusing solely on high‐risk HPV in the context of cervical cancer helps to avoid the stigmatising effect of genital warts from tainting perceptions about high‐risk HPV infection. Copyright © 2010 John Wiley & Sons, Ltd.     

Psychological benefits for cancer patients and their partners participating in mindfulness‐based stress reduction (MBSR)

Objective: Cancer patients experience many negative psychological symptoms including stress, anxiety, and depression. This distress is not limited to the patient, as their partners also experience many psychological challenges. Mindfulness‐based stress reduction (MBSR) programs have demonstrated clinical benefit for a variety of chronic illnesses, including cancer. This is the first study to report MBSR participation with partners of cancer patients. Methods: This study examined the impact of an 8‐week MBSR program for 21 couples who attended the program together on outcomes of mood disturbance, symptoms of stress, and mindfulness. Results: Significant reductions for both patients and partners in mood disturbance (p<0.05) and the Calgary Symptoms of Stress Inventory (C‐SOSI) subscales of muscle tension (p<0.01), neurological/GI (p<0.05), and upper respiratory (p<0.01) symptoms were observed after program participation. Significant increases in mindfulness (p<0.05) were also reported in both groups. No significant correlations were observed between patient and partner scores on any measures at baseline or on change scores pre‐ to post‐intervention; however, after MBSR participation couple's scores on the Profile of Mood States and C‐SOSI were more highly correlated with one‐another. Post‐intervention, partners' mood disturbance scores were significantly positively correlated with patients' symptoms of stress and negatively correlated with patients' levels of mindfulness. Conclusions: Overall, the MBSR program was helpful for improving psychological functioning and mindfulness for both members of the couple. Several avenues of future research are suggested to further explore potential benefits of joint couple attendance in the MBSR program. Copyright © 2010 John Wiley & Sons, Ltd.     

Value of religious care for relief of psycho‐existential suffering in Japanese terminally ill cancer patients: the perspective of bereaved family members

Objective: This study aimed to clarify the experience of bereaved family members of cancer patients regarding the usefulness of religious care (perceived usefulness). The value of this care to palliate psycho‐existential suffering in future patients was also examined (predicted usefulness). Methods: A questionnaire was sent to 592 bereaved family members of cancer patients who were admitted to certified palliative care units in Japan. Responses were obtained from 378 families, indicating whether the patient received religious care, the perceived usefulness of the care, and its predicted usefulness for palliation of psycho‐existential suffering. Results: About 25% (N=83) indicated that the patient had received religious care, whereas 75% (N=255) had not received it. Families of patients who had received religious care evaluated pastoral care workers (86%), religious services (82%), and religious music (80%) as ‘very useful’ or ‘useful’. Families predicted usefulness of religious care for future patients: attending a religious service (very useful or useful, 56%; not useful or harmful, 44%), a religious atmosphere (48%, 52%), meeting with a pastoral care worker (50%, 50%), and religious care by physicians (26%, 74%), and nurses (27%, 73%). Families with a religion were significantly more likely to rate religious care as useful for future patients. Conclusions: Families of patients who received religious care generally evaluated this care to be very useful or useful. For future patients, some families felt that religious care would be useful, but some did not. In Japan, religious care is more likely to provide benefits to patients who have a religion. Copyright © 2009 John Wiley & Sons, Ltd.