Catherine Mosher

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https://hdl.handle.net/1805/29973

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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Predictors of Colorectal Cancer Screening Adherence among Male Veterans
(Office of the Vice Chancellor for Research, 2014-04-11) Van Antwerp, Leah R.; Christy, Shannon M.; Mosher, Catherine E.; Rawl, Susan M.; Haggstrom, David A.
Colorectal cancer (CRC) is the second leading cause of cancer mortality. However, CRC risk can be decreased through regular CRC screening and removal of precancerous polyps during endoscopic screening tests. Indeed, it has been estimated that 75%-90% of CRC cases could be prevented through adherence to CRC screening guidelines. The CDC recommends CRC screening for average risk adults starting at age 50 with five test options including: (1) annual fecal occult blood test fecal (FOBT) or fecal immunochemical test (FIT); (2) flexible sigmoidoscopy every 5 years; (3) virtual colonoscopy every 5 years; (4) double-contrast barium enema every 5 years; or (5) colonoscopy every 10 years. In the U.S. population, demographic factors predict adherence to CRC screening guidelines such as completing high school, having a partner, and older age. Other predictors of CRC screening adherence in the general population include urban residency, White race, and having health insurance. However, few studies have examined predictors of CRC screening adherence among veterans. The present study focused on male veterans, as its primary aim was to examine masculinity beliefs as predictors of CRC screening. The proposed secondary analyses examine potential demographic and health correlates of adherence to CRC screening guidelines. In one prior study, increasing age was associated with decreased likelihood that male veterans were adherent to CRC screening guidelines. In the current study, 250 male veterans aged 51-75 at the Roudebush VA primary care clinic complete a survey on one occasion. Currently, 175 participants who are adherent to CRC screening and 64 non-adherent participants are enrolled. Participants’ CRC screening behaviors are collected via self-report and medical records. Correlations will be computed between demographic factors (e.g., age, race, education), BMI, and CRC screening guideline adherence. Findings will enhance our understanding of factors associated with veterans’ CRC screening behaviors.
Relationships between Health Behaviors and HPV Vaccine Receipt and Intentions among Undergraduate Women
(Office of the Vice Chancellor for Research, 2013-04-05) Van Antwerp, Leah R.; Winger, Joseph G.; Christy, Shannon M.; Mosher, Catherine E.
The human papillomavirus (HPV) vaccine represents an important step in reducing cervical cancer incidence and mortality. In recent years, this vaccine has been routinely recommended for females under the age of 26; however, only one-third of adolescent females have initiated the 3-shot HPV vaccine series. Although a number of studies have identified predictors of HPV vaccination, few have examined its correlations with other health behaviors. Evidence suggests that health-enhancing behaviors (e.g., healthy diet, physical activity) tend to cluster together. In this study, we examined the relationships between health behaviors and HPV vaccine receipt and intentions among undergraduate women at IUPUI. Participants (N=286) completed an internet-based survey that included measures of health behaviors (e.g., diet and exercise, vaccination history, recent physical examination) as well as questions regarding HPV vaccine receipt and intentions (i.e., likelihood of being vaccinated). Participants were, on average, 19 years old (SD=1.9). The majority were Caucasian (75%), single (90%), sexually active (65%), and recipients of the HPV vaccine (58%). Results showed significant relationships between HPV vaccine receipt and the receipt of other medical care, including a flu shot in the past year (χ2(1, N=260)=3.88, p<.05), a Pap smear in the past three years (χ2(1, N=263)=6.49, p<.05), and a recent dental visit (r=.15, p<.05). Among those who had not received the HPV vaccine, increased HPV vaccine intentions were associated with the receipt of the flu shot in the past year (r=.19, p<.05) and the receipt of HIV testing (r=.19, p<.05). However, HPV vaccine receipt and intentions were not significantly related to engagement in any of the other health behaviors (e.g., diet and exercise). Findings suggest that HPV vaccine uptake and intentions to receive the vaccine are associated with the receipt of other preventative medical care among female undergraduates.
Barriers to mental health service use and preferences for addressing emotional concerns among lung cancer patients
(Wiley, 2014-07) Mosher, Catherine E.; Winger, Joseph G.; Hanna, Nasser; Jalal, Shadia I.; Fakiris, Achilles J.; Einhorn, Lawrence H.; Birdas, Thomas J.; Kesler, Kenneth A.; Champion, Victoria L.; Psychology, School of Science
OBJECTIVE: This study examined barriers to mental health service use and preferences for addressing emotional concerns among lung cancer patients (N=165) at two medical centers in the Midwestern United States. METHODS: Lung cancer patients completed an assessment of anxiety and depressive symptoms, mental health service use, barriers to using these services, and preferences for addressing emotional concerns. RESULTS: Only 45% of distressed patients received mental health care since their lung cancer diagnosis. The most prevalent patient-reported barriers to mental health service use among non-users of these services (n=110) included the desire to independently manage emotional concerns (58%) and inadequate knowledge of services (19%). In addition, 57% of distressed patients who did not access mental health services did not perceive the need for help. Seventy-five percent of respondents (123/164) preferred to talk to a primary care physician if they were to have an emotional concern. Preferences for counseling, psychiatric medication, peer support, spiritual care, or independently managing emotional concerns also were endorsed by many patients (range=40-50%). Older age was associated with a lower likelihood of preferring to see a counselor. CONCLUSIONS: Findings suggest that many distressed lung cancer patients underuse mental health services and do not perceive the need for such services. Efforts to increase appropriate use of services should address patients' desire for autonomy and lack of awareness of services.
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.
Integrating men's health and masculinity theories to explain colorectal cancer screening behavior
(Sage Publications, 2014-01) Christy, Shannon M.; Mosher, Catherine E.; Rawl, Susan M.; Department of Psychology, School of Science
Colorectal cancer (CRC) is the third most common cause of cancer deaths among men in the United States. Although CRC screening has been found to reduce CRC incidence and mortality, current screening rates among men are suboptimal due to various practical and psychosocial barriers. One potential barrier to CRC screening identified in qualitative studies with men is the threat to masculinity that endoscopic screening methods pose. Indeed, beliefs about masculinity have been predictive of other preventive health behaviors among men. In this review article, we propose a novel conceptual framework to explain men's CRC screening behavior that integrates masculinity norms, gender role conflict, men's health care experiences, behaviors, and beliefs, and social and background variables. This framework has the potential to guide future research on men's CRC screening behaviors and other health behaviors and may inform gender-sensitive interventions that target masculinity beliefs to increase preventive health behaviors.
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 Science
BACKGROUND: 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.
Barriers to mental health service use among distressed family caregivers of lung cancer patients
(Wiley, 2015) Mosher, Catherine E.; Given, B. A.; Ostroff, J. S.; Department of Psychology, School of Science
Although family caregivers of patients with lung and other cancers show high rates of psychological distress, they underuse mental health services. This qualitative study aimed to identify barriers to mental health service use among 21 distressed family caregivers of lung cancer patients. Caregivers had not received mental health services during the patient's initial months of care at a comprehensive cancer centre in New York City. Thematic analysis of interview data was framed by Andersen's model of health service use and Corrigan's stigma theory. Results of our analysis expand Andersen's model by providing a description of need variables (e.g. psychiatric symptoms), enabling factors (e.g. finances), and psychosocial factors associated with caregivers' non-use of mental health services. Regarding psychosocial factors, caregivers expressed negative perceptions of mental health professionals and a desire for independent management of emotional concerns. Additionally, caregivers perceived a conflict between mental health service use and the caregiving role (e.g. prioritising the patient's needs). Although caregivers denied stigma associated with service use, their anticipated negative self-perceptions if they were to use services suggest that stigma may have influenced their decision to not seek services. Findings suggest that interventions to improve caregivers' uptake of mental health services should address perceived barriers.
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 Science
OBJECTIVE: 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.
Diet and exercise intervention adherence and health-related outcomes among older long-term breast, prostate, and colorectal cancer survivors
(Springer, 2014-10) Winger, Joseph G.; Mosher, Catherine E.; Rand, Kevin L.; Morey, Miriam C.; Snyder, Denise C.; Demark-Wahnefried, Wendy; Department of Psychology, School of Science
BACKGROUND: Diet and exercise interventions for cancer survivors result in health benefits; however, few studies have examined health outcomes in relation to adherence. PURPOSE: We examined associations between adherence to components of a diet-exercise intervention and survivors' physical and mental health. METHODS: A randomized controlled trial tested a telephone and mailed print intervention among 641 older, overweight, long-term survivors of breast, prostate, and colorectal cancer. Dietary and exercise behaviors were assessed at 14 time points throughout the year-long intervention; health outcomes were examined postintervention. RESULTS: Telephone session attendance had significant indirect relationships with health outcomes through intervention-period exercise and dietary behavior. Attendance showed positive indirect relationships with physical function (β = 0.11, p < 0.05), basic and advanced lower extremity function (β = 0.10, p < 0.05/β = 0.09, p < 0.05), and mental health (β = 0.05, p < 0.05), and a negative indirect relationship with body mass index (β = -0.06, p < 0.05). CONCLUSIONS: Session attendance is vital in facilitating improvement in health behaviors and attendant outcomes (Clinicaltrials.gov number NCT00303875).
Self-efficacy mediates the relationship between social norms and HPV vaccine intentions in undergraduate students
(Office of the Vice Chancellor for Research, 2016-04-08) Stout, Madison E.; Winger, Joseph G.; Christy, Shannon M.; Mosher, Catherine E.
Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. The HPV vaccine reduces incidences of genital warts and certain cancers among both men and women. Unfortunately, many undergraduate students have not been vaccinated. Previous research suggests students are more likely to report greater intentions to get vaccinated when others (e.g., friends, physicians) believe they should receive the vaccine; that is, greater social norms are associated with greater vaccine intentions. However, few studies have examined potential mediators of this association. Drawing from the Theory of Planned Behavior and the Health Belief Model, we hypothesized that social norms would be related to vaccine intentions through self-efficacy. Undergraduate students (N=210) who had not received the HPV vaccine completed an online survey. Participants were predominately White (72%), female (67%), heterosexual (92%), and on average 19.9 years of age (SD=3.2). Forty-nine percent were in a romantic relationship, and 55% were sexually active within the past three months. Participants completed HPV vaccine specific measures, including social norms regarding vaccination, self-efficacy for vaccination, and vaccine intentions. Two mediation analyses (one per gender) were conducted to examine whether self-efficacy mediated the relationship between social norms and vaccine intentions. For women and men, greater social norms were related to greater self-efficacy, and greater selfefficacy was related to greater vaccine intentions (ps<0.05); additionally, social norms were indirectly related to vaccine intentions through self-efficacy (p<0.05). For women, after accounting for self-efficacy, social norms were still significantly related to intentions (p<0.05). For men, however, after accounting for self-efficacy, social norms were not significantly related to intentions (p=0.75). Consistent with previous findings, social norms were positively related to vaccine intentions; however, we found that this association was mediated by self-efficacy. Future intervention studies should consider targeting social norms and improving students’ confidence in their ability to obtain the vaccine.

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