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Spiritual Wellbeing and Psychosocial Adjustment in Older Adult Cancer Survivors

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Spiritual Well-being and Psychosocial Adjustment in Older Adult Cancer Survivors ... Ethnic or minority differences in cancer survivorship outcomes ... – PowerPoint PPT presentation

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Title: Spiritual Wellbeing and Psychosocial Adjustment in Older Adult Cancer Survivors


1
Spiritual Well-being and Psychosocial Adjustment
in Older Adult Cancer Survivors
  • Kimberly S. Clay, PhD, MPH, MSW
  • Assistant Professor
  • UGA School of Social Work

2
Prevalence Data
  • Survivors 65 yr old comprise 60 of the cancer
    survivor population 33 are aged 40-64 yr
  • Population trends estimate that 12.6 of
    Americans were 65 yr old as of July 2000 and
    that 20 of Americans will be 65 yr old by 2035

3
Prevalence Data
  • 11 of all female cancer survivors have a history
    of colorectal cancer (CRC) 13 of male survivors
    have a history of CRC
  • CRC is the third most prevalent cancer for both
    African-American male and female cancer survivors
    (12 n 68,590)
  • African-Americans show poorer survival rates for
    male and female CRC

4
Survivorship Issues
5
Challenges and Opportunity
  • Rapidly growing population of aging
  • Ethnic or minority differences in cancer
    survivorship outcomes
  • Physiologic and psychosocial outcomes among
    survivors of colorectal and lung cancers
  • Role of spiritual well-being and adjustment in
    management of symptoms
  • Development of interventions to treat or
    ameliorate physiologic and psychosocial late
    effects

6
Purpose
  • To examine the relationship between spiritual
    well-being and psychosocial adjustment and its
    implications for treatment-related outcomes such
    as cancer recurrence, co-morbidities, and
    cancer-related pain.

7
Research Design
  • Cross-sectional
  • Mixed methods
  • CanCORS study cohort
  • Mail, self-administered survey
  • IRB approval/informed consent
  • 10 Wal-Mart gift card incentive

8

Questions
Methods
How do patients score on the meaning/peace and
faith subscales?
Descriptive Analysis
Is spiritual well-being associated with
psychosocial adjustment?
  • Linear Logistic Regression
  • Logistic Regression
  • Stepwise Logistic Regression

Which subscale score best predicts a given
measure of psychosocial adjustment?
Which subscale score best predicts positive
treatment- related outcomes?
Stepwise Logistic Regression
9
Instrumentation
  • Functional Assessment of Chronic Illness Therapy
    Spiritual Well-being Scale (FACIT-Sp-Ex)
  • Standardized 23-item previously validated
    instrument
  • Mail, self-administered survey
  • Respondent asked to indicate truth of each
    statement has been during the past 7 days
  • 0Not at All, 1A Little Bit, 2Somewhat
  • 3Quite a Bit, 4Very Much
  • Consists of two subscales, including Additional
    Sources of Concern (ASC)

10
Subscales of Spiritual Well-being
  • Meaning and Peace
  • I feel peaceful.
  • I have a reason for living.
  • My life has been productive.
  • I have trouble feeling peace of mind.
  • I feel a sense of purpose in my life.
  • I am able to reach down deep into myself for
    comfort.
  • I feel a sense of harmony within myself.
  • My life lacks meaning and peace.
  • Faith
  • I find comfort in my faith or spiritual beliefs.
  • I find strength in my faith or spiritual beliefs.
  • My illness has strengthened my faith or spiritual
    beliefs.
  • I know that whatever happens with my illness,
    things will be okay.
  • I feel connected to a higher power (or God).

11
Subscales of Spiritual Well-being
  • Additional Sources of Concern (ASC)
  • I feel connected to other people.
  • I feel loved.
  • I feel love for others.
  • I am able to forgive others for any harm they
    have ever caused me.
  • Throughout the course of my day, I feel a sense
    of thankfulness for my life.
  • I feel hopeful.
  • I feel a sense of appreciation for the beauty of
    nature.
  • I feel compassion for others in the difficulties
    they are facing.

12
Additional Measures
  • From CanCORS Baseline Survey
  • Psychosocial adjustment (e.g., measures of
    anxiety and depression)
  • Treatment-related outcomes (e.g., cancer
    recurrence, co-morbidity, and cancer-related
    pain)

13
Research Findingsby Specific Aim
14
Sample
  • Sampled from1400 patients completed the baseline
    and follow-up surveys (n 338)
  • Age 25 to 90 years of age (M65, SD11.4)
  • 53 Female, 64 White, 67 Colorectal Cancer
  • Median educational level GED or Completed 12
    grade

15
Sample
Table 1. Demographic Illness-related
Characteristics of Sample (n 338)
16
Summary of Findings
  • There are no apparent differences in level of
    spiritual well-being by age (homogeneous sample).
  • This sample reported high spiritual well-being
    scores (for all three subscales).
  • Meaning and Peace (subscale scores) are strong
    predictors of psychosocial adjustment.
  • Scores on Faith subscale were statistically
    significant among women, African Americans, and
    CRC survivors.
  • Pain management in newly-diagnosed colorectal and
    lung cancer survivors in this study was
    positively associated with spiritual well-being
    and psychosocial adjustment.

17
Specific Aim 1 Differing Levels of Spiritual
Well-being
  • Meaning/Peace significant with CRC mean gt Lung
    Cancer mean (Plt0.0421)
  • Faith significant with Female mean gt Male mean
    (Plt0.0004)
  • Faith significant with AA mean gt Caucasian mean
    (Plt0.0006)
  • Faith significant with CRC mean gt Lung Cancer
    mean (Plt0.0437)

18
Specific Aim 1 Differing Levels of Spiritual
Well-being
  • SPEX trend towards significance with Female
    mean gt Male mean (Plt0.0653)
  • SPEX significant with CRC mean gt Lung Cancer
    mean (Plt0.0319)

19
Specific Aim 2 Relationship between Spiritual
Well-being and Psychosocial Adjustment
  • Logistic Regression
  • Most psychosocial items are statistically
    significant predictors of SPEXScore (when
    psychosocial adjustment is the independent
    variable).
  • SPEXScore is a statistically significant
    predictor of most psychosocial items (when
    psychosocial adjustment is the dependent
    variable).

20
Specific Aim 2 Relationship between Spiritual
Well-being and Psychosocial Adjustment
  • Stepwise Logistic Regression
  • Meaning/Peace subscale score is a strong
    predictor of many of the psychosocial items
    (8.6-12, 8.16a-h, 8.23e, 8.25d) at Plt0.01.
  • Faith subscale score is sometimes a predictor of
    these items (8.16b, 8.16g, 8.25a-d) at Plt0.05. 
  • ASC subscale score is a significant predictor of
    only one of these items (8.16g).

21
Specific Aim 3 Multivariate Analysis
Predicting Treatment-related Outcomes
  • Spiritual Well-being (particularly ASC, Plt0.0213)
    is a statistically significant predictor of pain
    management (P 0.0214)

22
Spiritual Well-being and Psychosocial Adjustment
in Older Adult Cancer Survivors
  • Kimberly S. Clay, PhD, MPH, MSW
  • Assistant Professor
  • UGA School of Social Work
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