Role of Patient Coping Strategies in Understanding the Effects of Early Palliative Care on Quality of Life and Mood
(2018) In Journal of clinical oncology : official journal of the American Society of Clinical Oncology 36(1). p.53-60- Abstract
Purpose The early integration of oncology and palliative care (EIPC) improves quality of life (QOL) and mood for patients with advanced cancer. However, the mechanisms by which EIPC benefits these outcomes remain unclear. We therefore examined whether EIPC improved patients' coping strategies and if changes in coping accounted for intervention effects on QOL and depressive symptoms. Patients and Methods For this secondary analysis of an EIPC trial, we examined data from 350 patients with newly diagnosed incurable lung or GI cancer. Participants completed assessments of QOL (Functional Assessment of Cancer Therapy-General), depressive symptoms (Patient Health Questionnaire-9), and coping (Brief COPE) at baseline and 24 weeks. We used... (More)
Purpose The early integration of oncology and palliative care (EIPC) improves quality of life (QOL) and mood for patients with advanced cancer. However, the mechanisms by which EIPC benefits these outcomes remain unclear. We therefore examined whether EIPC improved patients' coping strategies and if changes in coping accounted for intervention effects on QOL and depressive symptoms. Patients and Methods For this secondary analysis of an EIPC trial, we examined data from 350 patients with newly diagnosed incurable lung or GI cancer. Participants completed assessments of QOL (Functional Assessment of Cancer Therapy-General), depressive symptoms (Patient Health Questionnaire-9), and coping (Brief COPE) at baseline and 24 weeks. We used linear regression to test intervention effects on use of coping strategies and mediation regression models with bias-corrected bootstrapping to examine whether improvements in coping mediated the effects of early palliative care on patient-reported outcomes. Results Compared with usual oncology care, EIPC significantly increased patient use of approach-oriented coping strategies ( B = 1.09; SE = 0.44; P = .01) and slightly reduced use of avoidant strategies ( B = -0.44; SE = 0.23; P = .06) from baseline to 24 weeks. Also, the increased use of approach-oriented coping and reduction in avoidant coping were associated with higher QOL and lower depressive symptoms at 24 weeks. The positive changes in approach-oriented coping, but not avoidant coping, significantly mediated the effects of EIPC on QOL (indirect effect, 1.27; 95% CI, 0.33 to 2.86) and depressive symptoms (indirect effect, -0.39; 95% CI, -0.87 to -0.08). Conclusion Patients with incurable cancer who received EIPC showed increased use of approach-oriented coping, which was associated with higher QOL and reduced depressive symptoms. Palliative care may improve these outcomes by providing patients with the skills to cope effectively with life-threatening illness.
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- author
- Greer, Joseph A ; Jacobs, Jamie M ; El-Jawahri, Areej ; Nipp, Ryan D ; Gallagher, Emily R ; Pirl, William F ; Park, Elyse R ; Jacobsen, Juliet C LU ; Jackson, Vicki A and Temel, Jennifer S
- publishing date
- 2018-01-01
- type
- Contribution to journal
- publication status
- published
- keywords
- Adaptation, Psychological, Affect, Aged, Depression/psychology, Female, Gastrointestinal Neoplasms/psychology, Humans, Lung Neoplasms/psychology, Male, Middle Aged, Outcome Assessment, Health Care, Palliative Care/methods, Patient Participation, Quality of Life, Surveys and Questionnaires
- in
- Journal of clinical oncology : official journal of the American Society of Clinical Oncology
- volume
- 36
- issue
- 1
- pages
- 53 - 60
- publisher
- Lippincott Williams & Wilkins
- external identifiers
-
- pmid:29140772
- scopus:85039916507
- ISSN
- 0732-183X
- DOI
- 10.1200/JCO.2017.73.7221
- language
- English
- LU publication?
- no
- id
- 18656198-cd04-464e-a399-fe5287f8f321
- date added to LUP
- 2024-11-13 14:08:09
- date last changed
- 2025-07-11 13:22:30
@article{18656198-cd04-464e-a399-fe5287f8f321,
abstract = {{<p>Purpose The early integration of oncology and palliative care (EIPC) improves quality of life (QOL) and mood for patients with advanced cancer. However, the mechanisms by which EIPC benefits these outcomes remain unclear. We therefore examined whether EIPC improved patients' coping strategies and if changes in coping accounted for intervention effects on QOL and depressive symptoms. Patients and Methods For this secondary analysis of an EIPC trial, we examined data from 350 patients with newly diagnosed incurable lung or GI cancer. Participants completed assessments of QOL (Functional Assessment of Cancer Therapy-General), depressive symptoms (Patient Health Questionnaire-9), and coping (Brief COPE) at baseline and 24 weeks. We used linear regression to test intervention effects on use of coping strategies and mediation regression models with bias-corrected bootstrapping to examine whether improvements in coping mediated the effects of early palliative care on patient-reported outcomes. Results Compared with usual oncology care, EIPC significantly increased patient use of approach-oriented coping strategies ( B = 1.09; SE = 0.44; P = .01) and slightly reduced use of avoidant strategies ( B = -0.44; SE = 0.23; P = .06) from baseline to 24 weeks. Also, the increased use of approach-oriented coping and reduction in avoidant coping were associated with higher QOL and lower depressive symptoms at 24 weeks. The positive changes in approach-oriented coping, but not avoidant coping, significantly mediated the effects of EIPC on QOL (indirect effect, 1.27; 95% CI, 0.33 to 2.86) and depressive symptoms (indirect effect, -0.39; 95% CI, -0.87 to -0.08). Conclusion Patients with incurable cancer who received EIPC showed increased use of approach-oriented coping, which was associated with higher QOL and reduced depressive symptoms. Palliative care may improve these outcomes by providing patients with the skills to cope effectively with life-threatening illness.</p>}},
author = {{Greer, Joseph A and Jacobs, Jamie M and El-Jawahri, Areej and Nipp, Ryan D and Gallagher, Emily R and Pirl, William F and Park, Elyse R and Jacobsen, Juliet C and Jackson, Vicki A and Temel, Jennifer S}},
issn = {{0732-183X}},
keywords = {{Adaptation, Psychological; Affect; Aged; Depression/psychology; Female; Gastrointestinal Neoplasms/psychology; Humans; Lung Neoplasms/psychology; Male; Middle Aged; Outcome Assessment, Health Care; Palliative Care/methods; Patient Participation; Quality of Life; Surveys and Questionnaires}},
language = {{eng}},
month = {{01}},
number = {{1}},
pages = {{53--60}},
publisher = {{Lippincott Williams & Wilkins}},
series = {{Journal of clinical oncology : official journal of the American Society of Clinical Oncology}},
title = {{Role of Patient Coping Strategies in Understanding the Effects of Early Palliative Care on Quality of Life and Mood}},
url = {{http://dx.doi.org/10.1200/JCO.2017.73.7221}},
doi = {{10.1200/JCO.2017.73.7221}},
volume = {{36}},
year = {{2018}},
}