Congress Abstracts 2003

10

ENHANCING ADAPTATION FOLLOWING RADIATION TREATMENT: CONCRETE INFORMATION VERSUS EMOTIONAL EXPRESSION. Lillian Nail, PhD, RN, FAAN, Oregon Health and Science University School of Nursing, Portland, OR; Marcia Grant, DNSc, RN, FAAN, and Grace Dean, PhD, RN, City of Hope National Medical Center, Duarte, CA; Motomi Mori, PhD, Oregon Health and Science University Cancer Institute, Portland, OR; and Lee Ellington, PhD, and Billie Walker, PhD, RN, University of Utah College of Nursing, Salt Lake City, UT.

The completion of RT is stressful because of fears about recurrence, feeling “unsafe,” and concern about symptom meaning. This three group RCT was a test of two theory-based approaches to enhancing adaptation: Concrete objective information (COI), written expression of emotions (EE), and an attention control arm. COI was based on Johnson’s self-regulation theory and EE intervention was drawn from Pennebaker’s work on using writing to integrate traumatic experiences and promote adaptation. Women completing RT for breast cancer (N = 262) provided written consent and completed baseline measures during the last two weeks of treatment. Following random assignment, the COI group listened to a tape-recorded message describing typical experiences (i.e., changes in side effects) experienced by women completing RT for breast cancer. The EE group was instructed to write about their cancer experience 30 minutes/day for 3 days. The control group listened to a brief tape-recorded message about community resources. All study variables were measured using instruments with established reliability and included disruption in activities (SIP), mood (state PANAS), trait negative affectivity (trait PANAS), cancer-specific distress (IES), and side effect severity (SEC). The sample was middle-aged (M = 55 years), white (82%), and married (66%). Repeated measures analysis of variance was used to test theory-driven hypotheses about intervention effects on disruption in function, negative mood, and cancer-specific distress controlling for trait negative affectivity and side effect severity. There were no significant group by time interactions indicating that all groups had similar scores on the dependent variables. Additional analyses revealed 20% nonadherence in the EE group with wide variation in the amount of writing among those who adhered. Unsolicited written comments indicated high levels of enthusiasm for EE in some participants. The pattern of self-report of level of disclosure in the six months following intervention suggests that EE nonadherence may reflect differences in timing of readiness for disclosure. This new finding has significant clinical implications for structuring the use of this increasingly popular intervention to accommodate preferences in participation and timing. Additional issues related to intervention design and the relevance and performance of specific outcome measures in survivorship research are discussed.