Andrea Cohee

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https://hdl.handle.net/1805/26638

Caring for the Carers: The Psychosocial Impact of Breast Cancer on Partners

Andrea Cohee is an Assistant Professor in the IUPUI School of Nursing. Her program of research focuses on psychosocial outcomes in survivors and their partners following a breast cancer diagnosis. Her work examines the relationship between social constraints, cognitive processing, and fear of recurrence and depression in both breast cancer survivors and their partners. She is currently building on her previous research to develop interventions targeting fear of a cancer recurrence in survivors and their partners. Her long-term goal is to develop interventions for cancer survivors and their partners to improve quality of life outcomes that can be implemented into the clinical setting.

Professor Cohee's translation of research into practical interventions for breast cancer survivors and their partners to improve quality of life is another excellent example of how IUPUI's faculty members are TRANSLATING their RESEARCH INTO PRACTICE.

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Comparison of younger and older breast cancer survivors and age-matched controls on specific and overall quality of life domains
(Wiley, 2014-08) Champion, Victoria L.; Wagner, Lynne I.; Monahan, Patrick O.; Daggy, Joanne; Smith, Lisa; Cohee, Andrea A.; Ziner, Kim W.; Haase, Joan E.; Miller, Kathy; Pradhan, Kamnesh; Unverzagt, Frederick W.; Cella, David; Ansari, Bilal; Sledge, George W. Jr.; Nursing, School of
BACKGROUND: Younger survivors (YS) of breast cancer often report more survivorship symptoms such as fatigue, depression, sexual difficulty, and cognitive problems than older survivors (OS). This study sought to determine the effect of breast cancer and age at diagnosis on quality of life (QoL) by comparing 3 groups: 1) YS diagnosed at age 45 years or before, 2) OS diagnosed between 55 and 70, and 3) for the YSs, age-matched controls (AC) of women not diagnosed with breast cancer. METHODS: Using a large Eastern Cooperative Oncology Group (ECOG) database, 505 YS were recruited who were aged 45 years or younger when diagnosed and 622 OS diagnosed at 55 to 70 years of age. YS, OS, and AC were compared on physical, psychological, social, spiritual, and overall QoL variables. RESULTS: Compared to both AC and to OS, YS reported more depressive symptoms (P = .005) and fatigue (P < .001), poorer self-reported attention function (P < .001), and poorer sexual function (P < .001) than either comparison group. However, YS also reported a greater sense of personal growth (P < .001) and perceived less social constraint (P < .001) from their partner than AC. CONCLUSIONS: YS reported worse functioning than AC relative to depression, fatigue, attention, sexual function, and spirituality. Perhaps even more important, YS fared worse than both AC and OS on body image, anxiety, sleep, marital satisfaction, and fear of recurrence, indicating that YS are at greater risk for long-term QoL problems than survivors diagnosed at a later age.
The long-term psychosocial impact of breast cancer on young survivors and their partners
(2015-03-20) Cohee, Andrea A.; Champion, Victoria L.; Fife, Betsy L.; Von Ah, Diane Marie; Zoppi, Kathleen A.
Long-term psychosocial consequences of breast cancer are increasingly more important to study as survivors are living longer. However, the survivors do not experience cancer alone; their significant others often suffer just as much if not more than the survivors themselves. In this dissertation, we explore some long-term consequences of cancer within the context of the Social Cognitive Processing Theory (SCPT). SCPT proposes that an individual must be able to discuss their feelings in order to cognitively process a traumatic event, such as cancer. If discussions are hindered, in particular by a significant other, then one will be unable to work through his/her concerns, leading to poor psychological outcomes, such as depression and fear of recurrence. The purpose of this dissertation is to use SCPT to identify causal mechanisms of depressive symptoms and fear of recurrence using a large sample of young breast cancer survivors and their partners. For one paper, we also included a large set of older participants for comparison. This dissertation is divided into three distinct articles. Each article tests long-term consequences of breast cancer and its treatment on breast cancer survivors and their partners using SCPT to explain relationships. First we examine the hypothesized predictors of younger breast cancer survivors’ depressive symptoms including the partner variable of depressive symptoms. The second article addresses the partners by predicting their depressive symptoms using SCPT. The third and final article seeks to identify the relationship of predictors and FOR on both survivors and their partners again using SCPT. For survivors, structural equation modeling analyses found significant direct and indirect paths between depressive symptoms and theoretical variables, including social constraints (stb=.266, p<.001) and intrusive thoughts (stb=.453, p<.001). In partners, cognitive processing variables (intrusive thoughts and cognitive avoidance) mediated the relationship between social constraints and depressive symptoms (F(5,498)= 19.385, R2=.163, p<.001). And finally, cognitive processing mediated the relationship between social constraints and fear of recurrence both for survivors [F(3,213)= 47.541, R2=.401, p<.001] and partners [F(3,215)= 27.917, R2=.280, p<.001). The evidence from these studies supports the use of SCPT in predicting depressive symptoms and fear of recurrence in both long-term survivors and partners.
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 Science
Objective 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.
Factors associated with depressive symptoms in young long-term breast cancer survivors
(Springer, 2016-08) Cohee, Andrea A.; Stump, Timothy; Adams, Rebecca N.; Johns, Shelley A.; Von Ah, Diane; Zoppi, Kathleen; Fife, Betsy; Monahan, Patrick O.; Cella, David; Champion, Victoria L.; Department of Nursing, IU School of Nursing
Purpose Long-term breast cancer survivors frequently report distress (i.e., depressive symptoms) that impacts their quality of life. Previous studies have found that negative social interactions (“social constraints”) from partners contribute to long-term, unresolved cycling of intrusive thoughts and cognitive avoidance, resulting in psychological distress. However, these relationships have not been tested in long-term breast cancer survivors. Furthermore, the effect of partners’ depressive symptoms on the survivors’ depressive symptoms has not been tested within the context of these relationships. Therefore, the purpose of this study was to test relationships between breast cancer survivors’ depressive symptoms and (1) social constraints, cognitive avoidance, and intrusive thoughts, and (2) partners’ depressive symptoms. Methods Data were from a cross-sectional descriptive study of breast cancer survivors (N = 222) 3–8 years post-diagnosis and their partners, who completed surveys assessing demographic characteristics, social constraints, intrusive thoughts, cognitive avoidance, and depressive symptoms. Structural equation modeling confirmatory path analyses were conducted to determine significant relationships between survivors’ depressive symptoms and all other variables. Results Our model fits the data well. Breast cancer survivors’ depressive symptoms were predicted by social constraints and intrusive thoughts. The relationship between survivors’ depressive symptoms and partners’ depressive symptoms was close but not significant. Conclusions As hypothesized, depressive symptoms were predicted by social constraints and intrusive thoughts. Further research is needed to understand the possible relationship between survivors’ long-term depressive symptoms and cognitive avoidance and partners’ depressive symptoms. Our findings highlight the negative impact of social constraints from partners on psychological outcomes in long-term breast cancer survivors.
The Relationship Between Depressive Symptoms and Social Cognitive Processing in Partners of Long-Term Breast Cancer Survivors
(Oncology Nursing Society, 2017-01) Cohee, Andrea A.; Adams, Rebecca N.; Fife, Betsy L.; Von Ah, Diane M.; Monahan, Patrick O.; Zoppi, Kathleen A.; Cella, David; Champion, Victoria L.; IU School of Nursing
Purpose/Objectives: To determine 1) if depressive symptoms in partners of long-term breast cancer survivors (BCS) could be predicted by social cognitive processing theory, and 2) if partners of younger and older breast cancer survivors were differentially affected by the cancer experience. Design: A cross-sectional, descriptive study utilizing self-report questionnaires. Setting: Indiana University and 97 ECOG-ACRIN sites. Sample: Partners of breast cancer survivors (n=508) diagnosed 3-8 years prior. Methods: Secondary data mediation analyses were conducted to determine if cognitive processing mediated the relationship between social constraints and depressive symptoms. Age-related differences on all scales were tested. Main Research Variables: Depressive symptoms; secondary variables included social constraints, cognitive processing (avoidance and intrusive thoughts), and potentially confounding variables. Findings: Cognitive processing mediated the relationship between social constraints and depressive symptoms for partners (F(5,498)= 19.911, R2=.167, p<.001). Partners of young BCS reported worse outcomes on all measures than partners of older breast cancer survivors Conclusions: As predicted by the social cognitive processing theory, cognitive processing mediated the relationship between social constraints and depressive symptoms. Furthermore, partners of younger BCS fared worse on social constraints, intrusive thoughts and depressive symptoms than partners of older BCS. Implications for Nursing: Results provide support for using the social cognitive processing theory in intervention design with partners of long-term BCS to decrease depressive symptoms. Knowledge Translation: • Partners of long-term BCS report clinically significant depression. • Partners of younger BCS report higher levels of depressive symptoms than the national average and than partners of older survivors. • Addressing social constraints within the dyad may improve depressive symptoms.
Long-Term Fear of Recurrence in Young Breast Cancer Survivors and Partners
(Wiley, 2017-01) Cohee, Andrea A.; Adams, Rebecca N.; Johns, Shelley A.; Von Ah, Diane; Zoppi, Kathleen; Fife, Betsy; Monahan, Patrick O.; Stump, Timothy; Cella, David; Champion, Victoria L.; Department of Nursing, IU School of Nursing
Background Fear of a breast cancer recurrence is the most prevalent and disruptive source of distress for long-term survivors and their partners. However, few studies have focused on predictors of fear of recurrence. The aim of this study is to test the efficacy of the Social Cognitive Processing Theory (SCPT) in predicting fear of recurrence in long-term breast cancer survivors diagnosed at age 45 years or younger and their partners. Methods In a large cross-sectional study, breast cancer survivors (n = 222) 3–8 years from diagnosis and their partners completed a survey assessing demographic characteristics, fear of recurrence, social constraints, and cognitive processing (intrusive thoughts and cognitive avoidance). Mediation analyses were conducted for survivors and partners separately to determine if cognitive processing would mediate the relationship between social constraints and fear of recurrence. Results Cognitive processing mediated the relationship between social constraints and fear of recurrence both for survivors [F(3,213) = 47.541, R2 = 0.401, p < 0.001] and partners [F(3,215) = 27.917, R2 = 0.280, p < 0.001). Demographic variables were not significant predictors of fear of recurrence. Conclusions As predicted, cognitive processing mediated the relationship between social constraints and fear of recurrence. Results expand the utility of the SCPT in long-term survivors and their partners by supporting its use in intervention design.
Breast Cancer Survivors' Perceptions of Partners' Intervention Needs
(2018) Cohee, Andrea A.; Johns, Shelley A.
Breast cancer survivors and their partners report similar levels of fear of recurrence; however, partners are rarely the subject of intervention. Survivors' perceptions for partners' interests and barriers in a survivorship education intervention are discussed.
Quality of Life in Partners of Young and Old Breast Cancer Survivors
(Wolters Kluwer, 2018-11) Cohee, Andrea A.; Bigatti, Silvia M.; Shields, Cleveland G.; Johns, Shelley A.; Stump, Timothy; Monahan, Patrick O.; Champion, Victoria L.; School of Nursing
Background: Partners of breast cancer survivors experience the effects of a spouse's cancer years after treatment. Partners of younger survivors (YP) may experience greater problems than partners of older survivors (OP), just as younger survivors experience greater problems than their older counterparts. Objectives: To 1) compare quality of life (QoL) in YP and OP, and 2) determine contributing factors to each group's QoL. Methods: Cross-sectional data were collected from YP (n=227) and OP (n=281) through self-report. MANOVA was used to determine differences between YP and OP on QoL while controlling for covariates. Multiple regression analyses were conducted to determine what contributes to each group's QoL. Results: YP reported better physical function (effect size (ES)= -0.57), lower marital satisfaction (ES=0.39), and lower overall QoL (ES=0.43) than partners of older survivors. Predictors of QoL also differed between partner groups. For YP, overall QoL was predicted by greater physical functioning, fewer depressive symptoms, higher marital satisfaction, higher parenting satisfaction, and more personal resources. R2= .47; F(5, 195)= 35.05; p<.001. For OP, overall QoL was predicted by fewer depressive symptoms, higher parenting satisfaction, higher spirituality, and greater social support from the breast cancer survivor spouse. R2= .33; F(4, 244)= 29.80; p<.001. Conclusions: OP reported greater QoL than YP. Common factors contributing to QoL between YP and OP were fewer depressive symptoms and higher parenting satisfaction. Implications for Practice: Partners of breast cancer survivors may need support coping with their spouse’s/partner’s cancer. Partners of younger survivors may require more support than partners of older survivors.
A Randomized Trial to Compare a Tailored Web-Based Intervention and Tailored Phone Counseling to Usual Care for Increasing Colorectal Cancer Screening
(AACR, 2018-12) Champion, Victoria L.; Christy, Shannon M.; Rakowski, William; Gathirua- Mwangi, Wambui G.; Tarver, Will L.; Carter-Harris, Lisa; Cohee, Andrea A.; Marley, Andrew R.; Jessup, Nenette M.; Biederman, Erika; Kettler, Carla D.; Stump, Timothy E.; Monahan, Patrick; Lairson, David R.; Rawl, Susan M.; School of Nursing
Background: Colorectal cancer mortality could be decreased with risk-appropriate cancer screening. We examined the efficacy of three tailored interventions compared with usual care for increasing screening adherence. Methods: Women (n = 1,196) ages 51 to 74, from primary care networks and nonadherent to colorectal cancer guidelines, were randomized to (1) usual care, (2) tailored Web intervention, (3) tailored phone intervention, or (4) tailored Web + phone intervention. Average-risk women could select either stool test or colonoscopy, whereas women considered at higher than average risk received an intervention that supported colonoscopy. Outcome data were collected at 6 months by self-report, followed by medical record confirmation (attrition of 23%). Stage of change for colorectal cancer screening (precontemplation or contemplation) was assessed at baseline and 6 months. Results: The phone (41.7%, P < 0.0001) and combined Web + phone (35.8%, P < 0.001) interventions significantly increased colorectal cancer screening by stool test compared with usual care (11.1%), with ORs ranging from 5.4 to 6.8 in models adjusted for covariates. Colonoscopy completion did not differ between groups except that phone significantly increased colonoscopy completion compared with usual care for participants in the highest tertile of self-reported fear of cancer. Conclusions: A tailored phone with or without a Web component significantly increased colorectal cancer screening compared with usual care, primarily through stool testing, and phone significantly increased colonoscopy compared with usual care but only among those with the highest levels of baseline fear. Impact: This study supports tailored phone counseling with or without a Web program for increasing colorectal cancer screening in average-risk women.
A Multisite Health System Survey to Assess Organizational Context to Support Evidence-Based Practice
(Wiley, 2019) Pittman, Joyce; Cohee, Andrea; Storey, Susan; LaMothe, Julie; Gilbert, Jason; Bakoyannis, Giorgos; Ofner, Susan; Newhouse, Robin
Background Implementation and sustainability of a culture of evidence-based practice (EBP) require a systematic approach. A baseline assessment of the organizational context can inform implementation efforts. Aims To examine organizational hospital context and provider characteristics associated with EBP readiness and to describe EBP context across hospitals. Methods A nonexperimental descriptive correlational design was used to conduct a web-based survey of direct-care registered nurses (N = 701) and nurse managers (N = 94) across a large Midwestern multisite healthcare system using the Alberta Context Tool (ACT). Results Many significant relationships existed among nurse characteristics and ACT domains, including age (lower age had higher Leadership, Evaluation, and Formal Interactions), education (graduate education had lower Social Capital than a bachelor's or associate degree), role (direct-care nurses had lower Culture than managers and lower Social Capital), and work status (full-time employees had lower Evaluation and Social Capital). EBP context across type of hospitals is similar, with marginal differences in Social Capital and Organizational Slack (higher in critical access hospitals). Linking Evidence to Action Assessing organizational context to support EBP is the first step in developing and enhancing a sustainable culture of inquiry. The ACT has been tested across countries, settings, and healthcare disciplines to measure perception of readiness of the practice environment toward EBP. Optimal organizational context is essential to support EBP and sustain the use of evidence in professional nursing practice. Nursing leaders can use baseline assessment information to identify strengths and opportunities to enhance EBP implementation. Enhancing organizational context across nurse characteristics (e.g., age, role, and work status) to acknowledge nurses’ contributions, balance nurses’ personal and work life, enhance connectedness, and support work culture is beneficial. Fostering development of Social Capital in nurses is needed to influence EBP readiness. A systematic and standardized approach to foster EBP across health systems is key to successful implementation.

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