Professional Documents
Culture Documents
to cancer.
Gender
Female
Male
9
5
Marital status
Single, live alone
Single, live with partner
Married, live with spouse
Other
1
4
8
1
Employment status
Employed
Unemployed or disabled
5
9
Ethnicity
White
Native American
African American
12
1
1
11
3
Type of cancer
Breast
Gynecologic
Leukemia
Lymphoma
Marfan's syndrome
Melanoma
4
1
4
3
1
1
Treatment status
Therapy completed
Under observation
Active chemotherapy
9
2
3
the seeks social support subscale, because it was hypothesized that group
participation would increase use of this coping strategy.
Intervention
The intervention used standard group therapy techniques to provide
psychological support, establish group cohesion, and emphasize the
universality of young adults' problems (Yalom, 1970). Additionally, we
incorporated psychoeducational techniques such as providing information,
teaching stress management, and discussing problem solving. This structured
intervention was described by Fawzy et al. (1990) in their successful
structured six-week intervention with cancer patients. We followed the format
of the Fawzy et al. model (number of meetings, 90-minute length, introduction
of specific topics at each meeting, and allotment of time for therapeutic group
interaction and support). However, the content of the presentations was
tailored to the needs of young adults with cancer. The group was cofacilitated
by a female licensed clinical social worker and a male social work graduate
student. Meetings were held on weekday evenings, and light refreshments
were served. Some minor changes were made for the second series of
meetings (group B) on the basis of observations made during the first series
(group A).
Session 1: Anxiety about Health. Recognition by group members that anxiety
about health and fear of recurrence are realistic concerns shared by cancer
survivors was the goal of the first session. Group members assembled at the
designated meeting site and began conversations among themselves before
formal introductions were made. The group facilitators and the research
assistant were introduced, and their roles were explained. The facilitators
emphasized that excessive anxiety can be managed through the use of
relaxation and visualization techniques. The group was led through a
relaxation and visualization exercise by a member of the interdisciplinary
team. Members responded positively to these exercises. However, one
member stated,"I felt funny closing my eyes and doing this in front of people I
don't even know." Following the relaxation exercise, the cofacilitators directed
a discussion concerning the relaxation exercise. Without exception, the group
members found the exercise to be valuable. Group members offered
alternative methods of relaxation they found helpful.
Following the exercise and discussion of relaxation, the members introduced
themselves by giving their name, age when diagnosed, date of diagnosis, type
of treatment, marital status, number of children, and employment status. The
group was attentive and supportive while each individual spoke. Many of the
members also discussed how cancer had affected their lives. One member
stated, "I don't take anything for granted anymore," and others strongly
agreed. Another member commented, "My sister really minimized my
experience and downplayed what I had been through with my cancer and
treatment and all." This statement generated much discussion as the group
members shared similar experiences and validated their common bond. The
cofacilitators asked the group members about the support they received from
family and friends. All the members contributed to this discussion.
In this meeting as in others, the group often discussed topics - without
prompting - such as insurance, financial assistance, treatment, self-advocacy,
and relationships. One member was scheduled to go into isolation for
treatment the following day. Those who had been through isolation offered
reassurance. The cofacilitators ended the group meeting about 30 minutes
after the scheduled 90 minutes. Many of the group members stayed and
continued to talk after the group had formally ended.
Session 2: Anxiety about Health and Loss of Physical Well-Being. The goals of
session 2 were to continue discussion of management of health-related
anxiety and to focus on physical well-being by presenting strategies to
minimize fatigue, improve sleep habits, and pace activities. At this and
subsequent sessions, the facilitators began by asking how the week had gone,
giving members the opportunity to discuss current anxiety-laden issues such
as results of a biopsy, treatment progress, or pressing financial and insurance
problems. Following this dialogue, the cofacilitators introduced the topic of
discussion. The group members discussed difficulty in falling asleep, and each
identified problems with sleep experienced at one time or another since the
cancer diagnosis. One member observed that she had a lot of anxiety and
restlessness before undergoing treatments and procedures, which all agreed
was a universal reaction.
The cofacilitators presented an outline for good sleep hygiene. The group
members discussed these ideas and then moved on to a more general
discussion about how cancer had changed their lives. One commented, "I
never wanted to go out of the house." Others shared similar feelings and
validated the disruptive nature of the disease. One member vowed, "I will not
be controlled by my cancer. It is part of me, but it is not who I am." This
statement elicited emphatic approval and agreement. Some members
verbalized their belief that the lifestyles they led caused them to develop
cancer, but others strongly disagreed. One member stated, "My cancer has
really caused me to take inventory of my life. I don't get stressed out about
little things anymore." The group ended with a discussion of how cancer
helped them develop more meaningful lifestyles.
Session 3: Worry about Children. A medical oncologist with a warm
interpersonal style was the invited speaker for this session. The speaker asked
members to introduce themselves and encouraged them to choose the topics
for discussion. They asked questions concerning cancer and fertility, genetics,
and the chances of the cancer being passed on to the next generation. Many
of the members asked if their chemotherapy treatments could affect their
fertility. One member who was pregnant asked if chemotherapy and radiation
were harmful to her developing fetus, and others also asked questions
concerning the dangers of radiation and chemotherapy. The need for medical
information was expressed several times.
(N = 11)
Score
M
Subscale
Difference
SD
M
SD
Tension-anxiety
Pretest
Posttest
9.64
8.27
6.02
5.37
1.36
4.08
1.11
.147
Depression
Pretest
Posttest
12.73
13.54
11.82
13.01
-.82
5.64
-.48
.321
13.64
12.73
12.79
10.64
.91
9.62
.31
.380
13.00
13.18
6.29
5.58
-.18
5.08
-.12
.454
10.18
7.18
6.27
7.44
3.00
6.28
1.59
9.72
7.82
5.97
5.46
Anger
Pretest
Posttest
Vigor
Pretest
Posttest
Fatigue
Pretest
Posttest
.072
Confusion
Pretest
Posttest
1.91
3.67
1.72
.058
68.91
57.45
38.89
32.97
11.45
24.98
1.52
.080
Members were also asked how the group could have been more helpful. Five of
the 14 participants indicated that they would make no changes to the format;
others suggested allowing more opportunity for discussion and fewer formal
presentations. Overall Assessment of Goal Achievement
Another approach to analysis of results is to synthesize the quantitative
measures and qualitative observations, including members' feedback, and
relate these aggregated findings to the six topics the group was designed to
address. How successful and in what manner was the support group
intervention in meeting its objectives?
Anxiety about Health. Group members showed improvement in the fatigue and
confusion subscales of the POMS. Further, they noted in their posttest
evaluations that receiving information about cancer and treatments was
helpful.
Loss of Physical Well-Being. This topic is closely related to anxiety about
health; therefore, the above findings apply. Chronic fatigue and lingering
effects of treatment are common in cancer patients. Perhaps the greatest
value of the intervention was helping the group members realize that their
diminished sense of physical well-being was "normal" and shared by their
peers.
Concern about Children. The question-and-answer session with the medical
oncologist regarding fertility was very well received. General discussion of this
sensitive information in a group setting may be less anxiety producing than an
individual consultation.
Problems in Relationships. The impact of cancer on relationships with spouses,
family, and friends was a recurrent theme of group discussion. Our data could
not offer definitive answers as to whether or how the support group experience
alleviated interpersonal problems. However, it is clear that participants valued
the supportive relationships they formed with one another.
Financial and Vocational Concerns. Group members were appreciative of the
information they were given on disability benefits and vocational rehabilitation.
The opportunity to ventilate and to share frustrations about derailment of
career plans may have had as much therapeutic value as the factual
information.
Feelings of Unattractiveness. The exercises used to promote self-acceptance
appeared helpful but may have been superfluous. Concern about personal
appearance was spontaneously addressed at the first meeting by group
members who, on introduction to a member wearing a hat, began to share
their own experiences with baldness. The universality of the hair loss
experience was openly discussed and joked about. Group members' mutual
acceptance of altered appearance appeared to be therapeutic.
CONCLUSIONS
The positive changes in psychological well-being after this six-week structured
group intervention were gratifying and indicate that continued research with a
larger sample is warranted. With no control group, a possible threat to the
internal validity of this experiment is maturation; the young adults might have
had less distress merely with the passage of time. However, the study by
Fawzy and colleagues (1990) showed improvement on the POMS in the
intervention group but no change in the control group, strengthening our
conclusion that maturation was not responsible for the decrease in
Roberts, C. S., Rossetti, K., Cone, D., & Cavanagh, D. (1992). A descriptive
study of the psychosocial impact of gynecologic cancer. Journal of Psychosocial
Oncology, 8, 33-47.
Roberts, C. S., Severinsen, C., Carraway, C., Clark, D., Freeman, M., & Daniels,
P. (in press). Life changes and problems experienced by young adults with
cancer. Journal of Psychosocial Oncology.
Schag, C. C., & Heinrich, R. L. (1988). CARES Cancer Rehabilitation Evaluation
System. Los Angeles: CARES Consultants.
Vinokur, A.D., Threatt, B. A., Vinokur-Kaplan, D., & Satariano, W. A. (1990). The
process of recovery from breast cancer for younger and older patients:
Changes during the first year. Cancer, 65, 1242-1254.
Vitaliano, P. P., Russo, J., Carr, J. E., Mauiro, R., & Becker, J. (1985). The Ways of
Coping Checklist: Revision and psychometric properties. Multivariate
Behavioral Research, 20, 3-26.
Weisman, A.D., Worden, J. W., & Sobel, H. J. (1980). Psychosocial screening
intervention with cancer patients. Boston: Project Omega.
Yalom, I. D. (1970). Theory and practice of group psychotherapy. New York:
Basic Books.
Cleora S. Roberts, PhD, ACSW, is associate professor of social work, University
of South Florida, and research social worker, H. Lee Moffitt Cancer Center and
Research Institute, 12902 Magnolia Drive, Tampa, FL 33612-9497. Lori Piper,
LCSW, is clinical social worker II, Department of Psychosocial Oncology, H. Lee
Moffitt Cancer Center, Tampa, FL. John Denny, MSW, and Gary Cuddeback,
MSW, were student interns, University of South Florida School of Social Work,
at the time of the research project. This research was supported by the
American Cancer Society, Florida Division.
-1Questia Media America, Inc. www.questia.com
Publication Information: Article Title: A Support Group Intervention to
Facilitate Young Adults' Adjustment to Cancer. Contributors: Cleora S. Roberts author, Lori Piper - author, John Denny - author, Gary Cuddeback - author. Journal
Title: Health and Social Work. Volume: 22. Issue: 2. Publication Year: 1997. Page
Number: 133+. COPYRIGHT 1997 National Association of Social Workers;
COPYRIGHT 2002 Gale Group