Coping Skills Practice and Symptom Change: A Secondary Analysis of a Pilot Telephone Symptom Management Intervention for Lung Cancer Patients and Their Family Caregivers

Joseph G. Winger, Kevin L. Rand, Nasser Hanna, Shadia Jalal, Lawrence Einhorn, Thomas Birdas, Mimi Ceppa, Kenneth Kesler, Victoria Champion, Catherine E. Mosher

Research output: Contribution to journalArticle

Abstract

Context: Little research has explored coping skills practice in relation to symptom outcomes in psychosocial interventions for cancer patients and their family caregivers. Objectives: To examine associations of coping skills practice to symptom change in a telephone symptom management (TSM) intervention delivered concurrently to lung cancer patients and their caregivers. Methods: This study was a secondary analysis of a randomized pilot trial. Data were examined from patient-caregiver dyads (n = 51 dyads) that were randomized to the TSM intervention. Guided by social cognitive theory, TSM involved four weekly sessions where dyads were taught coping skills including a mindfulness exercise, guided imagery, pursed lips breathing, cognitive restructuring, problem solving, emotion-focused coping, and assertive communication. Symptoms were assessed, including patients' and caregivers' psychological distress and patients' pain interference, fatigue interference, and distress related to breathlessness. Multiple regression analyses examined associations of coping skills practice during the intervention to symptoms at six weeks after the intervention. Results: For patients, greater practice of assertive communication was associated with less pain interference (β = −0.45, P = 0.02) and psychological distress (β = −0.36, P = 0.047); for caregivers, greater practice of guided imagery was associated with less psychological distress (β = −0.30, P = 0.01). Unexpectedly, for patients, greater practice of a mindfulness exercise was associated with higher pain (β = 0.47, P = 0.07) and fatigue interference (β = 0.49, P = 0.04); greater practice of problem solving was associated with higher distress related to breathlessness (β = 0.56, P = 0.01) and psychological distress (β = 0.36, P = 0.08). Conclusion: Findings suggest that the effectiveness of TSM may have been reduced by competing effects of certain coping skills. Future interventions should consider focusing on assertive communication training for patients and guided imagery for caregivers.

Original languageEnglish (US)
JournalJournal of Pain and Symptom Management
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Psychological Adaptation
Telephone
Caregivers
Lung Neoplasms
Imagery (Psychotherapy)
Psychology
Mindfulness
Communication
Pain
Dyspnea
Fatigue
Exercise
Practice (Psychology)
Lip
Respiration
Emotions
Regression Analysis
Research

Keywords

  • cognitive-behavioral
  • family caregivers
  • intervention components
  • Lung cancer
  • psychosocial interventions
  • symptom management

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

@article{495fd3d0acf944a9a892d6c9bcb14085,
title = "Coping Skills Practice and Symptom Change: A Secondary Analysis of a Pilot Telephone Symptom Management Intervention for Lung Cancer Patients and Their Family Caregivers",
abstract = "Context: Little research has explored coping skills practice in relation to symptom outcomes in psychosocial interventions for cancer patients and their family caregivers. Objectives: To examine associations of coping skills practice to symptom change in a telephone symptom management (TSM) intervention delivered concurrently to lung cancer patients and their caregivers. Methods: This study was a secondary analysis of a randomized pilot trial. Data were examined from patient-caregiver dyads (n = 51 dyads) that were randomized to the TSM intervention. Guided by social cognitive theory, TSM involved four weekly sessions where dyads were taught coping skills including a mindfulness exercise, guided imagery, pursed lips breathing, cognitive restructuring, problem solving, emotion-focused coping, and assertive communication. Symptoms were assessed, including patients' and caregivers' psychological distress and patients' pain interference, fatigue interference, and distress related to breathlessness. Multiple regression analyses examined associations of coping skills practice during the intervention to symptoms at six weeks after the intervention. Results: For patients, greater practice of assertive communication was associated with less pain interference (β = −0.45, P = 0.02) and psychological distress (β = −0.36, P = 0.047); for caregivers, greater practice of guided imagery was associated with less psychological distress (β = −0.30, P = 0.01). Unexpectedly, for patients, greater practice of a mindfulness exercise was associated with higher pain (β = 0.47, P = 0.07) and fatigue interference (β = 0.49, P = 0.04); greater practice of problem solving was associated with higher distress related to breathlessness (β = 0.56, P = 0.01) and psychological distress (β = 0.36, P = 0.08). Conclusion: Findings suggest that the effectiveness of TSM may have been reduced by competing effects of certain coping skills. Future interventions should consider focusing on assertive communication training for patients and guided imagery for caregivers.",
keywords = "cognitive-behavioral, family caregivers, intervention components, Lung cancer, psychosocial interventions, symptom management",
author = "Winger, {Joseph G.} and Rand, {Kevin L.} and Nasser Hanna and Shadia Jalal and Lawrence Einhorn and Thomas Birdas and Mimi Ceppa and Kenneth Kesler and Victoria Champion and Mosher, {Catherine E.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.jpainsymman.2018.01.005",
language = "English (US)",
journal = "Journal of Pain and Symptom Management",
issn = "0885-3924",
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TY - JOUR

T1 - Coping Skills Practice and Symptom Change

T2 - A Secondary Analysis of a Pilot Telephone Symptom Management Intervention for Lung Cancer Patients and Their Family Caregivers

AU - Winger, Joseph G.

AU - Rand, Kevin L.

AU - Hanna, Nasser

AU - Jalal, Shadia

AU - Einhorn, Lawrence

AU - Birdas, Thomas

AU - Ceppa, Mimi

AU - Kesler, Kenneth

AU - Champion, Victoria

AU - Mosher, Catherine E.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Context: Little research has explored coping skills practice in relation to symptom outcomes in psychosocial interventions for cancer patients and their family caregivers. Objectives: To examine associations of coping skills practice to symptom change in a telephone symptom management (TSM) intervention delivered concurrently to lung cancer patients and their caregivers. Methods: This study was a secondary analysis of a randomized pilot trial. Data were examined from patient-caregiver dyads (n = 51 dyads) that were randomized to the TSM intervention. Guided by social cognitive theory, TSM involved four weekly sessions where dyads were taught coping skills including a mindfulness exercise, guided imagery, pursed lips breathing, cognitive restructuring, problem solving, emotion-focused coping, and assertive communication. Symptoms were assessed, including patients' and caregivers' psychological distress and patients' pain interference, fatigue interference, and distress related to breathlessness. Multiple regression analyses examined associations of coping skills practice during the intervention to symptoms at six weeks after the intervention. Results: For patients, greater practice of assertive communication was associated with less pain interference (β = −0.45, P = 0.02) and psychological distress (β = −0.36, P = 0.047); for caregivers, greater practice of guided imagery was associated with less psychological distress (β = −0.30, P = 0.01). Unexpectedly, for patients, greater practice of a mindfulness exercise was associated with higher pain (β = 0.47, P = 0.07) and fatigue interference (β = 0.49, P = 0.04); greater practice of problem solving was associated with higher distress related to breathlessness (β = 0.56, P = 0.01) and psychological distress (β = 0.36, P = 0.08). Conclusion: Findings suggest that the effectiveness of TSM may have been reduced by competing effects of certain coping skills. Future interventions should consider focusing on assertive communication training for patients and guided imagery for caregivers.

AB - Context: Little research has explored coping skills practice in relation to symptom outcomes in psychosocial interventions for cancer patients and their family caregivers. Objectives: To examine associations of coping skills practice to symptom change in a telephone symptom management (TSM) intervention delivered concurrently to lung cancer patients and their caregivers. Methods: This study was a secondary analysis of a randomized pilot trial. Data were examined from patient-caregiver dyads (n = 51 dyads) that were randomized to the TSM intervention. Guided by social cognitive theory, TSM involved four weekly sessions where dyads were taught coping skills including a mindfulness exercise, guided imagery, pursed lips breathing, cognitive restructuring, problem solving, emotion-focused coping, and assertive communication. Symptoms were assessed, including patients' and caregivers' psychological distress and patients' pain interference, fatigue interference, and distress related to breathlessness. Multiple regression analyses examined associations of coping skills practice during the intervention to symptoms at six weeks after the intervention. Results: For patients, greater practice of assertive communication was associated with less pain interference (β = −0.45, P = 0.02) and psychological distress (β = −0.36, P = 0.047); for caregivers, greater practice of guided imagery was associated with less psychological distress (β = −0.30, P = 0.01). Unexpectedly, for patients, greater practice of a mindfulness exercise was associated with higher pain (β = 0.47, P = 0.07) and fatigue interference (β = 0.49, P = 0.04); greater practice of problem solving was associated with higher distress related to breathlessness (β = 0.56, P = 0.01) and psychological distress (β = 0.36, P = 0.08). Conclusion: Findings suggest that the effectiveness of TSM may have been reduced by competing effects of certain coping skills. Future interventions should consider focusing on assertive communication training for patients and guided imagery for caregivers.

KW - cognitive-behavioral

KW - family caregivers

KW - intervention components

KW - Lung cancer

KW - psychosocial interventions

KW - symptom management

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