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Summary of Findings from Studies of Coping with Cancer
Implications for Practice and Research
The findings suggest that rehabilitation practitioners should focus on instilling in their clients coping skills that directly seek to: (a) enhance more positive attitudes and beliefs in one's ability to challenge the disease; (b) plan and implement strategies to address daily living problems triggered by the functional limitations (e.g., pain, fatigue, nausea) imposed by cancer and its treatment; (c) establish and maintain a supportive social network that includes the client's family, peers, and, when applicable, coworkers; and (d) reframe negative thoughts or pessimistic outlook to foster a more positive view that focuses on one's remaining abilities, realistic goals, and potential future contributions. Indeed, evidence exists that suggests the benefits of cognitive-behavioral skill training programs to promote effective psychosocial adaptation to cancer (Fawzy et al., 1990; Greer, 1987; Gordon et al., 1980; Telch & Telch, 1986).
For instance, in their landmark study, Gordon and coworkers (1980) studied the efficacy of a multifaceted program for improving the level of psychosocial functioning among cancer survivors. The interventions were composed of three broad components: (a) education which focused on providing information to patients on cancer and its treatment, on relaxation techniques, and on the recognition of emotional reactions to the disease; (b) counseling which encouraged patients to vent and share feelings with others, to become aware of their feelings, and to act on their environment (i.e., problem solve daily issues); and (c) their environment which assisted patients in gaining referrals to other health care personnel. As compared to a control group of cancer patients who received only psychosocial evaluation, the treatment group evidenced a more rapid decline in negative affect (i.e., anxiety, depression, hostility), experienced a more realistic outlook on life, engaged in more active use of time, and returned to work more often. The results strongly attested to the benefits inherent in the use of a comprehensive coping skill training program that focused on providing social and emotional support, problem identification and solving, and in general, on creating a positive, goal-directed rehabilitation atmosphere.
Another comprehensive, coping-based, psychosocial intervention model that merits attention is that posited by Meyerowitz, Heinrich, and Schag (1983). In their model, the authors delineated a three-phase competency-based approach for cancer survivors. The phases include: (a) problem-specification, in which daily stressors, including cognitions, emotions, and situations (e.g., physical discomfort, psychological distress, job-related problems) which the client faces are identified; (b) response enumeration, in which the type and spectrum of potential responses to each problem area are determined, followed by a list of all available coping strategies to each specified problem; and (c) response evaluation, where the relative efficacy of each response for alleviating the problem is determined. Meyerowitz et al.'s model, likewise, focuses on instilling in cancer survivors those cognitive-behavioral coping skills necessary for goal setting, confronting, solving, and ultimately alleviating the problems associated with the functional limitations imposed by cancer and its treatment.
More recently, Nezu, Nezu, Friedman, Faddis, and Houts (1998) described a comprehensive problem-solving approach to coping with cancer. This therapeutic model aims at "helping individuals to understand the nature of problems in living and directs their attempts at changing the nature of the problematic situation itself, their reactions to them, or both" (p.71). Goals include: (a) identifying life situations that increase distress, (b) reducing the scope of distressing emotions and their impact on coping efforts, (c) increasing the effectiveness of problem-solving coping efforts to manage problematic situations, and (d) teaching skills that will enable the cancer survivor to deal effectively with distressing emotions and anticipated problems. To this end, the authors developed a 10-week intervention program comprised of the following phases: (a) problem orientation, (b) problem definition and formulation, (c) generation of alternatives, (d) decision making, (e) solution implementation and verification, and (f) practice and termination. This coping-oriented cognitive-behavioral approach, therefore, focuses on the use of engagement-type coping skills to help clients change both the problematic nature of the situation and the stressful emotional responses prompted by it. In sum, these models posit that the psychosocial mechanisms underlying the utility of these interventions revolve around enhanced selfefficacy, personal control, problem-solving ability, and realistic appraisals of current and future situations (Andersen, 1992).
Future research on coping with cancer should address the following concerns.
-Livneh, Hanoch; Psychosocial Adaptation to Cancer: The Role of Coping Strategies; Journal of Rehabilitation; April-June 2000; Vol. 66, Issue 2The article above contains foundational information. Articles below contain optional updates.
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