1 / 46

Enhanced Benefit Finding in Women with Early Stage Breast Cancer:

Enhanced Benefit Finding in Women with Early Stage Breast Cancer:. The Mediational Role of Skill Building and Social Functioning. Outline. 1. Introduction in brief 2. Method in brief 3. Preliminary Analyses 4. Changes in Skills 5. Changes in Social Relations

lamar
Download Presentation

Enhanced Benefit Finding in Women with Early Stage Breast Cancer:

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Enhanced Benefit Findingin Women with Early Stage Breast Cancer: The Mediational Role of Skill Building and Social Functioning

  2. Outline 1. Introduction in brief 2. Method in brief 3. Preliminary Analyses 4. Changes in Skills 5. Changes in Social Relations 6. Predictors of Benefit Finding 7. Conclusion

  3. Outline 1. Introduction in brief 2. Method in brief 3. Preliminary Analyses 4. Changes in Coping Skills 5. Changes in Social Relations 6. Predictors of Benefit Finding 7. Conclusion

  4. Enhanced Benefit Finding Enhanced Benefit Finding • Effect of CBSM on Benefit Finding Emotional Processing • Effect maintained at 3-month • and 9-month follow-ups • Benefit Finding was related to • increased emotional processing • (Antoni et al., 2001) 1.1. Benefit Finding & Breast Cancer CBSM Intervention

  5. 1.2. Goal 3 Questions: • Does the CBSM intervention contribute to generate changes in intrapersonal and interpersonal skills between pre- (T1)and post-intervention (T2) assessments? • Does the change in skills b/w T1 and T2 predict adjustment in social relations at 3-month (T3) and 9-month (T4) follow-ups? • Does social relations at T3/T4 mediate the impact of CBSM on Benefit Finding at T4?

  6. Outline 1. Introduction in brief 2. Method in brief 3. Preliminary Analyses 4. Changes in Coping Skills 5. Changes in Social Relations 6. Predictors of Benefit Finding 7. Conclusion

  7. 2.1. Sample • n = 136 (intervention = 60; control = 76) • Women with early stage Breast Cancer • Age range = 29 – 79 • Stage 0 to Stage II • Self-referral • Recruited within 1-2 months post-surgery

  8. 2.2. Variables of Interest • Intrapersonal Skills Problem-focused Coping Emotion-focused Coping • Intrapersonal Skills Seeking support from partner Seeking support from friends • Social Relations Social Interpersonal Adjustment Social Provisions Quality of life (social item) • Benefit Finding T1/T4  EACOPE SSCOPE SOCREL ZBF

  9. Outline 1. Introduction in brief 2. Method in brief 3. Preliminary Analyses 4. Changes in Coping Skills 5. Changes in Social Relations 6. Predictors of Benefit Finding 7. Conclusion

  10. 3.1. Control Variables • Failure to randomization • Age + Stage of Cancer + Chemotherapy • Control variables: • Age • Ethnicity (Black vs. non-Black) • Breast Reconstruction (had vs. did not have) • Chemotherapy (had vs. did not have) • Tamoxifen (had vs. did not have)

  11. 3.2. Methodological Choices • Primary analyses based on an available-case approach (pairwise omission) • Secondary analyses using a complete-case approach (listwise omission) • Secondary analyses using Support-seeking from friends only (SSCOPE) • Secondary analyses looking at absolute scores in coping skills at T2

  12. Presentation of Results For each hypothesis: a) Hypotheses tested b) Results c) Discussion d) Future Directions

  13. Outline 1. Introduction in brief 2. Method in brief 3. Preliminary Analyses 4. Changes in Coping Skills 5. Changes in Social Relations 6. Predictors of Benefit Finding 7. Conclusion

  14. INTRA- PERSONAL SKILLS T1 • Model tested INTRA- PERSONAL SKILLS T2 INTER- PERSONAL SKILLS T2 INTER- PERSONAL SKILLS T1 CBSM INTERVENTION CONDITION 4.a. Did the intervention generate Coping Skills (T2)? (Hyp. 1) • Hypothesis 1: Global treatment effect on coping skills post-intervention (T2)

  15. 4.b. Did the intervention generate Coping Skills (T2)?(Results) • No effect of the intervention on • Intrapersonal Skills (EACOPE) at T2 • Interpersonal Skills (SSCOPE) at T2 • But effect of the intervention on emotional processing (EAC) at T2, with a greater effect for those with lower EAC scores at T1 • Continuous decrease in • other coping skills(COPE) from T1 to T4 • Interpersonal Skills (SSCOPE) from T1 to T4

  16. 4.c. Did the intervention generate Coping Skills (T2)?(Discussion) • Coping skills at T1 predicted coping skills at T2  Minimal changes from T1 to T2 • Measures of the use of coping skills  Decrease in coping related to decrease in perceived stress?  A shift from problem-focused coping to emotion-focused coping and reflection on existential issues? • Use of social support (SS) = only 1 distinction  Intervention effective on other facets of SS (e.g., sources, types and quality of SS)?

  17. 4.d. Did the intervention generate Coping Skills (T2)?(Future Dir.) • Use indicators of acquisition of new skills • Incorporate a measure of change in perceived stress concurrent to measure of use of coping skills • Select time points with greater variations in stress (e.g., diagnosis vs. post-surgery) • Measure other facets of SS: those targeted in the intervention (e.g. sources, types, quality of social support)

  18. Outline 1. Introduction in brief 2. Method in brief 3. Preliminary Analyses 4. Changes in Coping Skills 5. Changes in Social Relations 6. Predictors of Benefit Finding 7. Conclusion

  19. Model tested CBSM SOCIAL INTERVENTION RELATIONS CONDITION T3/T4 SOCIAL RELATIONS T1 5.1.a. Did the Intervention EnhanceSocial Relations? (Hyp. 2) • Hypothesis 2: Long-term treatment effect on social relations at T3 and T4

  20. 5.1.b. Did the Intervention EnhanceSocial Relations? (Results) • No effect of the intervention on Social Relations as a whole at any time point  Mediation of a treatment effect via skill building (Hyp. 3) could not be tested • T1 reports predicted T3/T4 reports of social relations • Increase in social interactions from T1 to T3, in the absence of a treatment effect

  21. 5.1.c. Did the Intervention EnhanceSocial Relations? (Discussion) • Improvement in social interactions in the absence of a treatment effect  one of the benefits arising from the experience of breast cancer?  the change in social relations from T1 to T3 that predicted long-term benefit finding

  22. 5.1.d. Did the Intervention Enhance Social Relations? (Future Dir.) • To revisit the construct of social relations; how does it differ from the beneficial outcomes measured in benefit finding? • Distinction between quantitative and qualitative measures of social relations • Frequency of social interactions • Quality of relationships with family and friends and quality of social provisions

  23. INTRA- PERSONAL SKILLS T1 • Model tested INTRA- PERSONAL SKILLS T2 CBSM SOCIAL INTERVENTION RELATIONS CONDITION T3/T4 INTER- PERSONAL SKILLS T2 INTER- PERSONAL SKILLS T1 SOCIAL RELATIONS T1 5.2.a. Did Change in Skills predict Social Relations? (Hyp. 3 & 4) • Hypothesis 3: Mediating effect of skill building on change in social relations

  24. 5.2.a. Did Change in Skills predict Social Relations? (Hyp. 3 & 4) • Hypothesis 4: Moderating effect of skill building on social relations • Model tested: • Outcome variable = SOCREL T3/T4 • Predictors: • 1) SOCREL T1 • 2) (T2 – T1) EACOPE / SSCOPE • 3) SOCREL T1 * Condition

  25. 5.2.b. Did Change in Skills predict Social Relations? (Results -1) • Skill building did not predict (change in) social relations at T3 and T4 • Mediation of a treatment effect via skill building could not be tested • No moderating effect of skill building on T1 levels of social relations as a predictor of later social relations

  26. 5.2.b. Did Change in Skills predict Social Relations? (Results-2) • T2 interpersonal skills predicted social relations at T3, with a greater effect for those who reported lower levels of social relations at baseline • T2 intrapersonal skills and SS from friends only predicted social relations at T4, with a positive effect for those reporting lower levels of social relations at T1 and a negative effect for those with higher levels of social relations at T1

  27. 5.2.c. Did Skill Building predict Social Relations? (Discussion) • Using coping skills (target of the intervention) at T2 should result in better social relations later on (beneficial outcome)  T2 skills predicted frequency of social interactions and perceived quality of support • T1 and T2 skills were highly correlated (r = .50) • Change in coping skills did not predict later social relations (low effect size) • Benefits to those “who need it the most” • What about the other participants?

  28. 5.2.d. Did Skill Building predict Social Relations? (Future Dir.) • Further explore the negative effects of the use of intrapersonal skills on those who reported higher levels of social relations at T1

  29. Outline 1. Introduction in brief 2. Method in brief 3. Preliminary Analyses 4. Changes in Coping Skills 5. Changes in Social Relations 6. Predictors of Benefit Finding 7. Conclusion

  30. Model Tested: CBSM BENEFIT INTERVENTION FINDING T3/T4 CONDITION BENEFIT FINDING T1 6.1.a. Did the Intervention Enhance Benefit Finding ? (Hyp. 5) • Hypothesis 5: Long-term global treatment effect on benefit finding (BF) at T3 and T4

  31. 6.1.b. Did the Intervention Enhance Benefit Finding ? (Results) • Effect of the intervention on benefit finding at T3, not at T4  Long-term effect of CBSM intervention • Greater positive effect for those who started with lower levels of benefit finding at baseline  Positive effect on the participants “who needed it the most”

  32. INTRA- PERSONAL SKILLS T1 • Model tested: INTRA- PERSONAL SKILLS T2 INTER- PERSONAL SKILLS T2 BENEFIT INTER- FINDING T3/T4 PERSONAL SKILLS T1 BENEFIT FINDING T1 6.2.a. Did Skill Building predict Benefit Finding ? (Hyp. 6 & 7) • Hypothesis 6: Long-term effect of skill building on benefit finding at T3 and T4

  33. INTRA- PERSONAL SKILLS T1 • Model tested: INTRA- PERSONAL SKILLS T2 CBSM INTERVENTION CONDITION INTER- PERSONAL SKILLS T2 INTER- PERSONAL BENEFIT SKILLS T1 FINDING T3/T4 BENEFIT FINDING T1 6.2.a. Did Skill Building mediate Benefit Finding ? (Hyp. 6 & 7) • Hypothesis 7: Mediating effect of skill building on benefit finding at T3 and T4

  34. 6.2.b. Did Skill Building predict Benefit Finding ? (Results-1 ) • No evidence of a long-term effect of changes in coping skills on benefit finding  Change scores did not predict BF • T2 Interpersonal skills predicted BF at T3 and T4 • Positive effect of T2 intrapersonal skills* on BF at T3 for those who reported lower BF at T1, and negative effect for those who reported higher BF  Absolute scores predicted BF * Analyses with SS from friends only & listwise

  35. 6.2.b. Did Skill Building mediate Benefit Finding ? (Results-2) • No evidence of a mediation of the long-term treatment effect on BF at T3 via changes in coping skills  Skill building did not mediate the long-term treatment effect on benefit finding • No evidence of a mediation of the long-term • treatment effect on BF at T3 via T2 coping skills • Coping skills at T2 did not mediate the long-term treatment effect on benefit finding either

  36. 6.2.c. Did Skill Building predict Benefit Finding ? (Discussion) • Patterns of variations in coping skills may explain these initial results:  small variations from T1 to T2 (n.s.)  decrease in most skills instead of a build-up • T2(or T1) levels of interpersonal skills predicted BF at T3, but the variation (T2-T1) did not  Maybe the predictive part of T2 levels was already present in T1 levels • Other components of the intervention contributed to the long-term effect of the intervention on BF

  37. 6.2.d. Did Skill Building mediate Benefit Finding ? (Future Dir.) • Revise the operationalization of skill building: • Changes in skills (not in the use of skills) • Select time points likely to produce larger effect sizes • Concurrent measure of perceived stress • Revise the operational design: • Address the various changes (frequency, quality) • Select different stages (diagnosis, treatment) • Allow to distinguish intra-individual vs. inter-individual patterns of change across time points • What are the other ingredients, which contributed to long-term benefit finding?

  38. INTRA- PERSONAL SKILLS T1 • Model tested: INTRA- PERSONAL SKILLS T2 SOCIAL BENEFIT RELATIONS FINDING T4 T3/T4 INTER- PERSONAL SKILLS T2 INTER- PERSONAL SKILLS T1 SOCIAL RELATIONS T1 BENEFIT FINDING T1 6.3.a. Did Social Relations mediate Benefit Finding ? (Hyp. 8) • Hypothesis 8:Mediating effect of changes in social relations on Benefit finding (T3/T4)

  39. 6.3.b. Did Social Relations mediate Benefit Finding ? (Results-1) • Changes in social relations from T1 to T3 predicted benefit finding at T3 • Changes in social relations could not mediate the effect of skill building on benefit finding (absence of such an effect)* • Changes in social relations from T1 to T3 did not mediate the treatment effect on benefit finding at T3 * Yet, mediation evidenced with an analysis listwise

  40. Social Relations T3  = -.18 (p = .044)  = .20 (p = .036)  = .20 (p = .011) Interpersonal Skills T2 X Social Relations T1 Interpersonal Skills T2 Benefit Finding T3  = .14 (p = .064) 6.3.b. Did Social Relations mediate Benefit Finding ? (Results-2) A tentative illustration of a mediation of the relationship between interpersonal skills at T2 and benefit finding at T3 via social relations at T3 (analysis listwise)

  41. 6.3.c. Did Social Relations mediate Benefit Finding ? (Discussion) • Improvement in social interactions from T1 to T3 contributed to explain enhanced benefit finding at T3 • The absence of a mediating effect of social relations again suggests that other products of the intervention contributed to the long-term effect of the intervention on benefit finding

  42. 6.3.d. Did Social Relations mediate Benefit Finding ? (Future Dir.) • Could the results obtained with a complete-case approach be reproduced with a larger and more complete sample? Replicate the study, with a new methodology: • Revise the operationalization of variables • Incorporate a measure of perceived stress • Multiple imputations to handle missing data • Hierarchical modeling statistical procedure • Eventually, collect data prior to surgery

  43. Outline 1. Introduction in brief 2. Method in brief 3. Preliminary Analyses 4. Results 5. Discussion 6. Methodological Limitations 7. Conclusion

  44. 7.1. Conclusion 3 Factors predicted Benefit Finding at T3: • Emotional processing and other coping skills at T2 for those who reported lower levels of benefit finding at baseline • Support-seeking behaviors at T2 • Changes in social relations from T1 to T3 But did not mediate the treatment effect observed at T3

  45. 7.2. Conclusion (Cont’d) • Diversity of beneficial outcomes for a limited range of coping tools  some facets of BF may not be influenced by the CBSM intervention • What is measured in the BF scale may be largely independent from what is targeted in the CBSM modules (e.g., life readjustment, shift in life priorities and relationships, enhanced sense of purpose)  Existential/Experiential dimension of BF

  46. 7.3. Conclusion (Cont’d) • Early detection of perceived benefits  Existential content in the intervention as early as at the treatment stage  Need for indicators of those facets of benefit finding to measure the impact of the intervention and variations across time and situations

More Related