Journal List > J Korean Acad Nurs > v.42(1) > 1002780

Kim and So: A Structural Model for Psychosocial Adjustment in Patients with Early Breast Cancer

Abstract

Purpose

This study was done to propose a structural model to explain and predict psychosocial adjustment in patients with early breast cancer and to test the model. The model was based on the Stress-Coping Model of Lazarus and Folkman (1984).

Methods

Data were collected from February 18 to March 18, 2009. For data analysis, 198 data sets were analyzed using SPSS/WIN12 and AMOS 7.0 version.

Results

Social support, uncertainty, symptom experience, and coping had statistically significant direct, indirect and total effects on psychosocial adjustment, and optimism had significant indirect and total effects on psychosocial adjustment. These variables explained 57% of total variance of the psychosocial adjustment in patients with early breast cancer.

Conclusion

The results of the study indicate a need to enhance psychosocial adjustment of patients with early breast cancer by providing detailed structured information and various symptom alleviation programs to reduce perceived stresses such as uncertainty and symptom experience. They also suggest the need to establish support systems through participation of medical personnel and families in such programs, and to apply interventions strengthening coping methods to give the patients positive and optimistic beliefs.

Figures and Tables

Figure 1
Path diagram for hypothetical model.
x1=Symptom experience; x2=Ambiguity; x3=Complexity; x4=Unpredictability;
y1=Family support; y2=Medical staff support; y3=Optimism; y4=Problem focused coping; y5=Emotional focused coping; y6=Psychosocial adjustment.
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Figure 2
Path diagram for the final model.
x1=Symptom experience; x2=Ambiguity; x3=Complexity; x4=Unpredictability;
y1=Family support; y2=Medical staff support; y3=Optimism; y4=Problem focused coping; y5=Emotional focused coping; y6=Psychosocial adjustment.
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Table 1
Descriptive Statistics of Variables (N=198)
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VIF=Variation inflation factor.

Table 2
Correlation among the Research Variables (N=198)
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x1=Symptom experience; x2=Ambiguity; x3=Complexity; x4=Unpredictability;

y1=Family support; y2=Medical staff support; y3=Optimism; y4=Problem focused coping; y5=Emotional focused coping; y6=Psychosocial adjustment.

Notes

This article is based on a part of the first author's doctoral thesis from Chonnam National University.

References

1. Bae B.L. Structural equation modeling with AMOS 7. 2007. Seoul: Chung Ram Book Publisher.
2. Ben-Zur H., Gilbar O., Lev S. Coping with breast cancer: Patient, spouse, and dyad models. Psychosomatic Medicine. 2001. 63:32–39.
3. Budin W.C. Psychosocial adjustment to breast cancer in unmarried women. Research in Nursing and Health. 1998. 21:155–166.
4. Carver C.S., Pozo C., Harris S.D., Noriega V., Scheier M.F., Robinson D.S., et al. How coping mediates the effect of optimism on distress: A study of women with early stage breast cancer. Journal of Personality and Social Psychology. 1993. 65:375–390.
5. Cho O.H. Uncertainty, anxiety and coping with mastectomy for breast cancer. Journal of Korean Academy of Nursing. 2000. 30:1006–1017.
6. Christman N.J., McConnell E.A., Pfeiffer C., Webster K.K., Schmitt M., Ries J. Uncertainty, coping, and distress following myocardial infarction: Transition from hospital to home. Research in Nursing and Health. 1988. 11(2):71–82.
7. Cohen F., Lazarus R.S. Stone G.C., Cohen F., Adler N.E, editors. Coping with the stress of illness. Health psychology: A handbook. 1979. San Francisco: Jossey-Bass;217–254.
8. Davis L.A. Hardiness, social support, uncertainty, and adjustment in women clinically free of breast cancer. 1997. Brimingham, U.S.A: Alabama University;Unpublished doctoral dissertation.
9. Derogatis L.R., Lopez M. The psychosocial adjustment to illness scale: Administration, scoring, and procedures manual I. 1983. Baltimore: Clinical Psychometric Research.
10. Dukes H.K., Holahan C.K. The relation of social support and coping to positive adaptation to breast cancer. Psychology and Health. 2003. 18:15–29.
11. Folkman S., Lazarus R.S. If it changes it must be a process: Study of emotion and coping during three stages of a college examination. Journal of Personality and Social Psychology. 1985. 48:150–170.
12. Gotay C. The experience of cancer during early and advanced stages: The views of patients and their mates. Social Science and Medicine. 1984. 18:605–613.
13. Hoskins C.N., Budin W.C. Measurement of psychosocial adjustment to breast cancer: A unidimensional or multidimensional construct. Psychological Reports. 2000. 87:649–663.
14. Kim G.S. Analysis structural equation modeling. 2007. Seoul: SPSS Academy Series.
15. Kirsner R.S., Ma F., Fleming L.E., Federman D.D., Rapido E., Duncan R., et al. Earlier stage at diagnosis and improved survival among Medicare HMO patients with breast cancer. Journal of Women's Health. 2010. 19:1619–1624.
16. Lazarus R.S., Folkman A. Monat A., Lazarus R, editors. Stress and coping: Some current issues and controversies. Stress and coping: An anthology. 1984. New York, NY: Columbia university press;1–11.
17. Lee Y.J., Ham E.M., Kim K.S. A correlational study on uncertainty, coping and depression of cancer patients. Journal of Korean Academy of Nursing. 2001. 31:244–256.
18. Mazanec S.R., Daly B.J., Douglas S., Musil C. Predictors of psychosocial adjustment during the postradiation treatment transition. Western Journal of Nursing Research. 2011. 33:540–559. http://dx.doi.org/10.1177/0193945910382241.
19. Mishel M.H. The measurement of uncertainty in illness. Nursing Research. 1981. 30:258–263.
20. Mishel M.H. Uncertainty in illness. Journal of Nursing Scholarship. 1988. 20:225–232.
21. Mishel M.H., Sorenson D. Revision of the ways of coping checklist for a clinical population. Western Journal of Nursing Research. 1993. 15:59–76.
22. National cancer statistics. National Cancer Information Center. 2008. Retrieved October 10, 2008. from http://www.cancer.go.kr.
23. Samarel N., Leddy S.K., Greco K., Cooley M.E., Torres S.C., Tulman L., et al. Development and testing of the symptom experience scale. Journal of Pain and Symptom Management. 1996. 12:221–228.
24. Saneha C. Relationships among optimism, cognitive appraisal, coping strategies, and psychosocial adjustment in Thai women newly diagnosed with breast cancer. 2006. 03. In : Poster session presented at the 9th East Asian Forum of Nursing Scholars; Bangkok.
25. Scheier M.F., Carver C.S., Bridges M.W. Distinguishing optimism from neuroticism and trait anxiety, self mastery, and self-esteem: A reevaluation of the life orientation test. Journal of Personality and Social Psychology. 1994. 67:1063–1078.
26. So H.S. Changes on the uncertainly, ways of coping, and depression for patients with uterine cervical cancer during the early adaptation process: A longitudinal study. 1996. Seoul: Yonsei University;Unpublished doctoral dissertation.
27. Tae Y.S., Kang E.S., Lee M.H., Park G.J. The relationship among percieved social support, hope and quality of life of cancer patients. Korean Journal of Rehabilitation Nursing. 2001. 4:219–231.
28. Thewes B., Butow P., Girgis A., Pendlebury S. The psychosocial needs of breast cancer survivors: A qualitative study of the shared and unique needs of younger versus older survivors. Psycho-oncology. 2004. 13:177–189. http://dx.doi.org/10.1002/pon.710.
29. Vos P.J., Garssen B., Visser A.P., Duivenvoorden H.J., de Haes H.C. Early stage breast cancer: Explaining level of psychosocial adjustment using structural equation modeling. Journal of Behavioral Medicine. 2004. 27:557–580.
30. Westbrook J.M. Attachment, optimism, coping, and social support as predictors of psychosocial and psychological adjustment in women with breast cancer. 2005. Santa Barbara, U.S.A: Fielding Graduate University;Unpublished Doctoral dissertation.
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