Verarbeitungsweisen von Paaren bei Krebserkrankungen

Transcription

Verarbeitungsweisen von Paaren bei
Krebserkrankungen Untersuchung der dyadischen Perspektive in
einer dreijährigen longitudinalen Studie
Alfred Künzler1,2,3, Priska Garbely4,
Angela Zindel1, Mario Bargetzi2, Hansjörg Znoj1
1Institute
2Division
of Psychology, University of Bern
of Oncology/Haematology, Kantonsspital Aarau
3Krebsliga Aargau
4Klinische Forschung Aargau
Dr. phil. Alfred Künzler
1
Warum diese Studie?
• wenig psycho-onkologische Coping-Forschung in der
Schweiz
• wenig Langzeit- / Verlaufsstudien (aufwändig)
• Partner meist als Unterstützende einbezogen:
2
Warum diese Studie?
Partner als Supporter oder Mitbetroffene
Support
Partner
Patient
Interaktion
Patient
Partner
Dyadisches oder Paarcoping
Gemeinsamer Umgang mit Belastung
3
Presentation Overview
1.
2.
3.
4.
5.
Method of the Aargau coping study
Patients‘ and partners‘ distress
Posttraumatic growth and couples‘ relationship
Dyadic coping
Dyadic coping predicting distress, posttraumatic
growth and relationship quality
6. Discussion
4
Research Design
• Newly diagnosed cancer patients
and their partners
• Data points:
after diagnosis (T1),
6 months (T2),
12 months (T3),
3 years (T4)
• Medical data from doctors
5
Research Design
• Pre-tested, mailed, self-report questionnaire including
standardised measures of QoL, coping, relationship:
• Anxiety and depression (HADS) Herrmann et al. (1995)
• Posttraumatic stress (IES) Horowitz et al. (1979)
• Cancer-related fatigue (BFI) Radbruch et al. (2003)
• Posttraumatic growth (PGI) Tedeschi & Calhoun (1996)
• Dyadic coping (FDCT) Bodenmann, 2000
• Relationship satisfaction (RAS) Hendrick (1981)
• 81% questionnaire return rate (overall, rising)
• 4/5 neutral or relieving, 1/5 some distress
6
Participants: Demographics
•
•
•
•
62 cancer patients and their partners
50% female
Mean age 58 (range 32-78)
Living together for 30 years on average
7
Patients: Cancer Diagnoses
• Cancer types / stages of disease: CH clinically
representative sample
8
Tumorlokalisation
9
Initialstadium der Krebserkrankung
10
Patients: Treatment, Course
• Initial treatment scope: 61% curative
• Course of disease 3 y after diagnosis:
remission 82%,
stable/partial remission 8%,
progression 10%.
• Treatments in 3 years:
surgery 72%,
chemo 63%,
radiation 48%,
hormones 31%;
multimodal therapy 63%.
11
1.
2.
3.
4.
5.
Dyadic coping
6. Discussion
12
Anxiety
patients (m)
patients (f)
general population
9
partners (m)
partners (f)
8
7
6
5
4
m
on
th
s
36
m
on
th
s
12
m
on
th
s
6
di
ag
no
si
s
3
13
Depression
patients (m)
patients (f)
general population
7
partners (m)
partners (f)
6
5
4
3
m
on
th
s
36
m
on
th
s
12
m
6
di
ag
no
s
is
on
th
s
2
14
Posttraumatic Symptoms
patients (m)
patients (f)
partners (m)
partners (f)
m
on
th
s
36
m
on
th
s
12
m
6
di
ag
no
s
is
on
th
s
14
13
12
11
10
9
8
7
6
5
15
Prevalence of Clinically Significant Distress
3 Years After Diagnosis
Female
Male
Female
Male
Patients Patients Partners Partners
Anxiety
HADS > 10
Depression
HADS > 8
PTSD
IES estimate
Severe fatigue
BFI > 7
3%
3%
23%
7%
0%
6%
10%
4%
0%
0%
3%
0%
30%
6%
13%
22%
16
Distress: Summary
• Patients and partners reported relatively steady
distress scores over the 3-year term, except for the
time shortly after diagnosis.
• Most scores were around general population norms,
except for female partners who showed elevated
distress levels;
and female patients showing low depression scores
after 1 year.
• Even 3 years after diagnosis, severe fatigue is a
concern for many patients as well as partners.
17
1.
2.
3.
4.
5.
Dyadic coping
6. Discussion
18
Posttraumatic Growth
Posttraumatisches Wachstum,
persönliche Reifung,
Sinnfindung
=
subjektive Erfahrung
positiver Veränderung
nach belastendem Ereignis
19
• „Ich habe ein neues Gefühl dafür, wie wichtig mir mein
Leben ist.“
• „Ich entwickelte einen Sinn für die Verbundenheit mit
Anderen.“
• Positive Veränderungen bzgl.:
Neue Möglichkeiten;
Beziehungen;
Wertschätzung des Lebens;
Persönliche Stärke;
Religion/Spiritualität
20
patients (m)
patients (f)
traumatised controls
70
partners (m)
partners (f)
65
60
55
50
m
on
th
s
36
m
on
th
s
12
m
6
di
ag
no
s
is
on
th
s
45
21
Relationsship Satisfaction (RAS)
patients
partners
5
4.5
4
m
on
th
s
36
m
on
th
s
12
m
6
di
ag
no
s
is
on
th
s
3.5
22
Dyadic Coping Evaluation (FDCT)
patients
partners
norm
4.5
m
on
th
s
36
m
on
th
s
12
m
6
di
ag
no
si
s
on
th
s
3.5
23
Posttraumatic Growth and Couples‘
Relationship : Summary
• Patients and partners reported steady scores for PG
and relationship measures over the 3-year term.
• Female patients indicated elevated PG as compared
to male patients and partners.
24
1.
2.
3.
4.
5.
Dyadic coping
6. Discussion
25
Dyadic Coping: Operationalization
• FDCT-N (Bodenmann, 2000),
• 41 items, 21 original subscales (including own and
partner‘s coping with stress, from both perspectives)
→ merged into 4 factors (cronbach‘s alpha = .54 - .91)
• Stress communication
• Supportive coping (helpful interactions)
• Negative coping (unhelpful interactions)
• Evaluation of dyadic coping
26
Dyadic Coping
Patient
Partnerin
?
27
Dyadic Coping
Partner
Patientin
?
28
Dyadic Coping: Sample Items
• Wenn ich gestresst / belastet bin…
• bitte ich meinen Partner, Aufgaben zu übernehmen
• Auf meine Belastungs- / Stressäusserung…
• macht sich mein Partner über meinen Stress lustig
• Wenn mein Partner gestress / belastet ist…
• teilt er mit, ob er emotionale oder praktische Unterstützung
braucht
• Auf die Belastungs- / Stressäusserung meines Partners…
• ziehe ich mich zurück
• Mit Belastungen, die uns beide betreffen…
• tauschen wir unsere Gefühle dazu aus
29
Couples‘ Stress Communication
patient's view
partner's view
norm
3.5
m
on
th
s
36
m
on
th
s
12
m
6
di
ag
no
s
is
on
th
s
2.5
30
Couples‘ Supportive Coping
patient's view
partner's view
norm
4
m
on
th
s
36
m
on
th
s
12
m
6
di
ag
no
si
s
on
th
s
3
31
Couples‘ Negative Dyadic Coping
patient's view
partner's view
norm
2.5
m
on
th
s
36
m
on
th
s
12
m
6
di
ag
no
s
is
on
th
s
1.5
32
Dyadic Coping: Summary
• Patients and partners reported a relatively steady
dyadic coping style over the 3-year term.
• Exception 1: Elevated rates shortly after diagnosis for
• Supportive coping
• Exception 2: Deterioration from 6 months onward in
33
1.
2.
3.
4.
5.
Dyadic coping
6. Discussion
34
Multivariate General Linear Model (GLM) Analyses
•
Independent variables: DC, means of T1, T2, T3
• Supportive coping
• Negative coping
•
Control variable:
• Age
• (stage of disease: no sig. correlation with dependents)
•
Dependent variables: T4
• Anxiety and Depression (HADS)
• Posttraumatic stress (IES)
• Fatigue (BFI)
•
Posttraumatic growth (PGI)
•
•
Relationship satisfaction (RAS)
Dyadic coping evaluation (FDCT)
35
Criteria
Predictors
Anxiety
Posttraumatic
Stress
Relationship
Satisfaction
Dyadic
Coping
Evaluation
+ ∑** / m** / f**
+ ∑**
+ ∑**
+ ∑* / m*
+ ∑* / m*
+ ∑* / f*
- ∑*
Stress
Communication
Supportive
Dyadic Doping
Negative
Dyadic Coping
Posttraumatic
Growth
+ m* / f**
+ m** / f**
+ m*
+ m*
- m** / f**
- ∑* / f*
Partner
m = male
* p ≤ .05
Patient
f = female
**p ≤ .01
∑ = fe-/ male
+ / - association
36
1.
2.
3.
4.
5.
Dyadic coping
6. Discussion
37
General Summary
• Female partners are at high-risk for elevated distress
over the full 3-year term.
• Substantial prevalence of severe fatigue 3 years after
cancer diagnosis.
• Female patients low depression & high PG, most
pronounced 1 year after cancer diagnosis.
• Supportive coping predicted more posttraumatic
growth, and better relationship quality;
negative coping predicted higher distress, and poorer
relationship quality.
38
Implications for Research
• Long-term research looking at dyadic coping with
chronic or lethal illness might help understand
individual adjustment processes.
• Why do female patients experience less depression,
and more posttraumatic growth?
• Better understanding of the cancer-related fatigue
concept is required. Further long-term research in this
field is necessary. Interdisciplinarity!
39
Clinical Implications
• Cancer patients‘ women should routinely be included
in cancer care: high risk-group for psychological
strain.
• Cancer patients and their partners should be
instructed about dyadic coping possibilities and
pitfalls.
40
Special Thanks go to…
•
•
•
•
•
•
•
•
•
All participants for their being dedicated
Kantonsspital Aarau: esp. Institut für Pathologie, PD R.H. Laeng,
and oncologists at the Zentrum für Onkologie/Hämatologie,
Frauenklinik, Innere Medizin, Chirurgie, Urologie, HNO
Regionalspitäler / Onkologen / Hausärzte im Kanton AG
Onkologische Praxis H. Michel / B. Berger, Schaffhausen
Onkologische Praxis U. Müller, Sargans
J. Skorek, Bündner Krebsliga
B. Leuthold, Krebsliga St. Gallen-Appenzell
Sponsors
You, for your attention
41

Verarbeitungsweisen von Paaren bei Krebserkrankungen

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