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Catherine Mosher
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Supportive Care for Adults with Advanced Cancer and their Family Caregivers
Dr. Catherine Mosher's field of research, Pyscho-Oncology, is the study of the behavioral, psychological, and social aspects of cancer. She is interested in the experiences of both patients and their family caregivers. We know that patients often suffer from a range of debilitating symptoms such as depression, anxiety, pain and fatigue. And family caregivers are often just as distressed, if not more distressed, than the patients themselves.
Dr. Mosher's research aims to address both patients' and family caregivers' concerns by developing and testing new counseling approaches. The approaches are delivered over the telephone and online to have the broadest reach to patients and caregivers throughout the state of Indiana.
Dr. Mosher's goal is to implement and disseminate these counseling interventions into clinical practice for improved outcomes for patients with advanced cancer and their family caregivers is another excellent example of how IUPUI's faculty members are TRANSLATING their RESEARCH INTO PRACTICE.
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Browsing Catherine Mosher by Author "Adams, Rebecca N."
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Item Associations between Loneliness and Cancer Patients’ Pain and Fatigue(Office of the Vice Chancellor for Research, 2015-04-17) Stout, Madison E.; Adams, Rebecca N.; Mosher, Catherine E.Introduction: Pain and fatigue occur at higher rates in cancer patients than in the general population. One study found that loneliness predicted both pain and fatigue in cancer patients; however, the study only focused on patients with breast or colon cancer. The goal of the current study is to examine whether loneliness is associated with pain and fatigue in a sample of patients with various cancer types, including more rare diagnoses. We hypothesized that loneliness would be positively correlated with pain and fatigue, controlling for demographic and medical characteristics. Methods: Participants (N=44) were 60 years old (SD=12) on average, 68% Caucasian, and 59% female. All participants had received treatment for cancer at the Indiana University Simon Cancer Center or another Indiana University Hospital since 2013. Participants were recruited from the Indiana Tumor Registry, and after consenting, they were mailed a survey to complete at home that included measures of loneliness, pain, and fatigue. To test our hypothesis, we computed correlations between loneliness and each symptom (i.e., pain and fatigue), controlling for age, gender, and time since diagnosis. Results: As hypothesized, we found a large, positive correlation between loneliness and fatigue (r =0.51, p=0.001), controlling for demographic and medical characteristics. In addition, loneliness was positively correlated with pain, but this result fell just short of statistical significance (r=0.28, p=0.09). Conclusions: Results from this study suggest that greater loneliness is associated with greater fatigue in cancer patients, consistent with the results of one prior study. Although the association between loneliness and pain was more modest, it may reach statistical significance as the study sample size increases. If future longitudinal research shows that greater loneliness predicts cancer patients’ pain and fatigue, it would suggest that interventions to reduce loneliness may also reduce their physical symptoms.Item Avoidant Coping and Self-efficacy Mediate Relationships between Perceived Social Constraints and Symptoms among Long-term Breast Cancer Survivors(Wiley, 2016) Adams, Rebecca N.; Mosher, Catherine E.; Cohee, Andrea A.; Stump, Timothy E.; Monahan, Patrick O.; Sledge, George W., Jr; Cella, David; Champion, Victoria L.; Department of Psychology, School of ScienceObjective Many breast cancer survivors feel constrained in discussing their cancer experience with others. Limited evidence suggests that social constraints (e.g., avoidance and criticism) from loved ones may negatively impact breast cancer survivors' global health, but research has yet to examine relationships between social constraints and common physical symptoms. Informed by social cognitive processing theory, this study examined whether perceived social constraints from partners and healthcare providers (HCPs) were associated with fatigue, sleep disturbance, and attentional functioning among long-term breast cancer survivors (N = 1052). In addition, avoidant coping and self-efficacy for symptom management were examined as potential mediators of these relationships. Methods Long-term breast cancer survivors (mean years since diagnosis = 6) completed questionnaires assessing social constraints from partners and HCPs, avoidant coping, self-efficacy for symptom management, and symptoms (i.e., fatigue, sleep disturbance, and attentional functioning). Structural equation modeling was used to evaluate the hypothesized relationships among variables in two models: one focused on social constraints from partners and one focused on social constraints from HCPs. Results Both models demonstrated good fit. Consistent with theory and prior research, greater social constraints from both partners and HCPs were associated with greater symptom burden (i.e., greater fatigue and sleep disturbance, poorer attentional functioning). In addition, all relationships were mediated by avoidant coping and self-efficacy for symptom management. Conclusions Findings are consistent with social cognitive processing theory and suggest that symptom management interventions may be enhanced by addressing the impact of social constraints from survivors' partners and HCPs on their coping and self-efficacy.Item The Cancer Loneliness Scale and Cancer-related Negative Social Expectations Scale: development and validation(SpringerLink, 2017-07) Adams, Rebecca N.; Mosher, Catherine E.; Rand, Kevin L.; Hirsh, Adam T.; Monahan, Patrick O.; Abonour, Rafat; Kroenke, Kurt; Psychology, School of SciencePURPOSE: Loneliness is a known risk factor for poor mental and physical health outcomes and quality of life in the general population, and preliminary research suggests that loneliness is linked to poorer health outcomes in cancer patients as well. Various aspects of the cancer experience contribute to patients feeling alone and misunderstood. Furthermore, loneliness theory suggests that negative social expectations, which may specifically relate to the cancer experience, precipitate and sustain loneliness. Cancer-specific tools are needed to assess key constructs of this theory. In the current study, we developed and tested measures of (1) loneliness attributed to cancer (i.e., cancer-related loneliness) and (2) negative social expectations related to cancer. METHODS: First, we developed the items for the measures based on theory, prior research, and expert feedback. Next, we assessed the measures' psychometric properties (i.e., internal consistency and construct validity) in a diverse sample of cancer patients. RESULTS: The final products included a 7-item unidimensional Cancer Loneliness Scale and a 5-item unidimensional Cancer-related Negative Social Expectations Scale. Evidence of excellent reliability and validity was found for both measures. CONCLUSIONS: The resulting measures have both clinical and research utility.Item Cancer survivors' uptake and adherence in diet and exercise intervention trials: an integrative data analysis(Wiley, 2015-01-01) Adams, Rebecca N.; Mosher, Catherine E.; Blair, Cindy K.; Snyder, Denise C.; Sloane, Richard; Demark-Wahnefried, Wendy; Department of Psychology, School of ScienceBACKGROUND: The health benefits of diet and exercise interventions for cancer survivors are well documented. However, little is known regarding demographic and medical predictors of survivors' willingness to participate in diet and exercise intervention trials, study enrollment, intervention adherence, and study completion. To assist in interpreting the generalizability of trial findings and to improve the design of future trials, this study examined predictors of these process measures. METHODS: An integrative data analysis was performed on data from 3 of the largest home-based diet and exercise intervention trials for cancer survivors (n = 23,841). Demographic and medical factors (ie, sex, race, age, time since diagnosis, and cancer type) were examined as predictors of willingness to participate, study enrollment, intervention adherence, and study completion in the pooled sample. A 99% confidence interval was used to determine statistical significance. RESULTS: Across trials, 11.1% of contacted survivors were willing to participate, and 5.7% were eligible and enrolled. Among enrollees, 53.4% demonstrated ≥75% adherence to the intervention, and 91.1% completed the study. Race (Caucasian vs others), age, time since diagnosis, and cancer type predicted survivors' willingness to participate (P < .01). All examined predictors were associated with the likelihood of study enrollment (P < .01). No significant predictors of intervention adherence or study completion were found among study enrollees (P ≥ .01). CONCLUSIONS: Cancer survivors' demographic and medical characteristics predicted their interest and participation in diet and exercise intervention trials. These findings have implications for the generalizability of results and can help to guide procedures used in future trials to enhance patient representation.Item Cancer-related loneliness mediates the relationships between social constraints and symptoms among cancer patients(Springer Nature, 2018-04) Adams, Rebecca N.; Mosher, Catherine E.; Winger, Joseph G.; Abonour, Rafat; Kroenke, Kurt; Psychology, School of ScienceCancer patients have high rates of persistent and disabling symptoms. Evidence suggests that social constraints (e.g., avoidance and criticism) negatively impact symptoms, but pathways linking these variables have yet to be identified. This study examined whether cancer-related loneliness (i.e., feeling socially disconnected related to having cancer) mediated the relationships between social constraints and symptoms (i.e., pain interference, fatigue, sleep disturbance, and cognitive complaints) in patients with various cancers (N = 182). Patients (51% female, mean age = 59) were recruited from the Indiana Cancer Registry and completed questionnaires assessing social constraints, cancer-related loneliness, and symptoms. Structural equation modeling was used to evaluate the hypothesized relationships among variables. The model demonstrated good fit. Consistent with our hypothesis, cancer-related loneliness mediated the relationships between social constraints and each symptom. Findings suggest that addressing cancer-related loneliness in symptom management interventions may mitigate the negative impact of social constraints on outcomes.Item Caregiving experiences predict changes in spiritual well-being among family caregivers of cancer patients(Wiley Online Library, 2014-10) Adams, Rebecca N.; Mosher, Catherine E.; Cannady, Rachel S.; Lucette, Aurelie; Kim, Youngmee; Department of Psychology, School of ScienceOBJECTIVE: Although enhanced spiritual well-being has been linked to positive mental health outcomes among family caregivers of cancer patients, little is known regarding predictors of spiritual well-being in this population. The current study aimed to examine caregiving experiences as predictors of change in family caregivers' spiritual well-being during the initial months following the patient's cancer diagnosis. METHODS: Seventy family caregivers of newly diagnosed cancer patients (74% female, mean age = 59 years) participated in this longitudinal survey. Caregivers completed baseline questionnaires shortly before staying with the patient at an American Cancer Society Hope Lodge. Baseline questionnaires assessed caregiving experiences (i.e., self-esteem related to caregiving, family support for providing care, impact of caregiving on finances, and impact of caregiving on one's schedule). In addition, caregivers' spiritual well-being (i.e., meaning in life, peace, and faith) was assessed at baseline and 4-month follow-up. RESULTS: In univariate analyses, all caregiving experiences studied were associated with one or more aspects of spiritual well-being at 4-month follow-up. However, in the multivariate analysis, the only caregiving experience associated with aspects of spiritual well-being at 4-month follow-up was caregivers' perceptions of family support. Specifically, lack of family support was associated with lower levels of meaning and peace. CONCLUSIONS: Findings point to the importance of family support in facilitating the search for meaning and peace shortly after a loved one's cancer diagnosis and suggest that interventions targeting caregivers' support system may enhance their spiritual well-being.Item Cognitive and Situational Precipitants of Loneliness Among Patients With Cancer: A Qualitative Analysis(Oncology Nursing Society, 2016-03) Adams, Rebecca N.; Mosher, Catherine E.; Abonour, Rafat; Robertson, Michael J.; Champion, Victoria L.; Kroenke, Kurt; Department of Psychology, School of SciencePURPOSE/OBJECTIVES: To identify situations and thoughts that may precipitate or protect against loneliness experienced by patients with cancer. RESEARCH APPROACH: Qualitative. SETTING: The hematology/oncology clinic at the Indiana University Melvin and Bren Simon Cancer Center, an outpatient oncology center in Indianapolis. PARTICIPANTS: Purposive sample of 15 patients undergoing treatment for multiple myeloma or non-Hodgkin lymphoma. METHODOLOGIC APPROACH: Individual, semistructured qualitative interviews were conducted. Theoretical thematic analysis was used to analyze interview data. FINDINGS: Factors that appeared to precipitate loneliness included several situations (e.g., physical isolation, social constraints such as criticism) and thoughts (e.g., unmet expectations for visits or questions about health, belief that others do not understand their cancer experience). Several situations (e.g., social support, normal routine) and thoughts (e.g., beliefs that time alone is desirable and that others' discomfort with cancer-related discussions is normative) appeared to protect against loneliness. Certain social situations were loneliness-inducing for some patients and not for others, suggesting that patients' thoughts about their situations, rather than the situations themselves, have the greatest impact on their loneliness. CONCLUSIONS: The current study fills gaps in loneliness theory by identifying cancer-related situations and thoughts that patients associate with their loneliness. Consistent with theory, patients reported feeling lonely when they had negative thoughts about their social situations. INTERPRETATION: Findings inform nursing assessment and intervention strategies to incorporate into care plans. For instance, when conducting assessments, nurses should be more attentive to patients' satisfaction with their social environment than actual characteristics of the environment. Normalizing patients' experiences and encouraging positive thoughts about others' behavior may reduce patients' loneliness.Item Family Caregiving Challenges in Advanced Colorectal Cancer: Patient and Caregiver Perspectives(Springer, 2016-05) Mosher, Catherine E.; Adams, Rebecca N.; Helft, Paul R.; O'Neil, Bert H.; Shahda, Safi; Rattray, Nicholas A.; Champion, Victoria L.; Department of Psychology, School of SciencePurpose Family caregivers of advanced colorectal cancer patients may be at increased risk for psychological distress. Yet their key challenges in coping with the patient’s illness are not well understood. Soliciting both patient and caregiver perspectives on these challenges would broaden our understanding of the caregiving experience. Thus, the purpose of this research was to identify caregivers’ key challenges in coping with their family member’s advanced colorectal cancer from the perspective of patients and caregivers. Methods Individual, semi-structured qualitative interviews were conducted with 23 advanced colorectal cancer patients and 23 primary family caregivers. Interview data were analyzed via thematic analysis. Results In nearly all cases, patient and caregiver reports of the caregiver’s key challenge were discrepant. Across patient and caregiver reports, caregivers’ key challenges included processing emotions surrounding the patient’s initial diagnosis or recurrence and addressing the patient’s practical and emotional needs. Other challenges included coping with continual uncertainty regarding the patient’s potential functional decline and prognosis and observing the patient suffer from various physical symptoms. Conclusions Findings suggest that eliciting the perspectives of both patients and caregivers regarding caregivers’ challenges provides a more comprehensive understanding of their experience. Results also point to the need to assist caregivers with the emotional and practical aspects of caregiving.Item A meta-analysis of the relationship between social constraints and distress in cancer patients(Springer-Verlag, 2015-04) Adams, Rebecca N.; Winger, Joseph G.; Mosher, Catherine E.; Department of Psychology, School of ScienceSocial constraints on cancer-related disclosure have been associated with increased distress among cancer patients. The goals of this meta-analysis were: (1) to quantify the average strength of the relationships between social constraints and general and cancer-specific distress in cancer patients; and (2) to examine potential moderators of these relationships. A literature search was conducted using electronic databases, and 30 studies met inclusion criteria. Moderate, significant relationships were found between social constraints and both general distress (r = 0.37, 95 % CI 0.31-0.43) and cancer-specific distress (r = 0.37, 95 % CI 0.31-0.44). The relationship between social constraints and cancer-specific distress was stronger for studies of patients who, on average, had been diagnosed more recently. Relationships between social constraints and both general and cancer-specific distress did not vary by age or gender. Findings suggest that social constraints may be important to target in interventions to reduce distress in cancer patients, especially those who have been recently diagnosed.Item Positive changes among patients with advanced colorectal cancer and their family caregivers: a qualitative analysis(Taylor & Francis, 2017-01) Mosher, Catherine E.; Adams, Rebecca N.; Helft, Paul R.; O'Neil, Bert H.; Shahda, Safi; Rattray, Nicholas A.; Champion, Victoria L.; Psychology, School of ScienceOBJECTIVE: This study assessed positive changes in patients with advanced colorectal cancer and their family caregivers following diagnosis. We compared self-reported positive changes within patient-caregiver dyads as well as self-reports and patient reports of positive changes in caregivers. DESIGN: Individual, semi-structured qualitative interviews were conducted with 23 patients with advanced colorectal cancer and 23 caregivers. A theoretical thematic analysis of interview transcripts was framed by posttraumatic growth theory. RESULTS: Patients and caregivers described five positive changes: closer relationships with others, greater appreciation of life, clarifying life priorities, increased faith, and more empathy for others. Additionally, only caregivers reported better health habits following the cancer diagnosis, and a minority of patients and caregivers reported no positive changes. In about half of cases, patients reported at least one positive change that was identical to that of their caregiver. However, in most cases, patient and caregiver reports of the caregiver's positive change were discrepant. CONCLUSION: Findings suggest that positive changes are a shared experience for many patient-caregiver dyads and obtaining both patient and caregiver reports of caregiver positive changes provides a more comprehensive understanding of their experience. Interventions may capitalise on positive changes to promote meaningful living in the context of advanced cancer.