Significant Psychosocial Factors Related to Holistic Wellbeing among Cancer Survivors: A Mixed-Methods Evaluation

摘要

Cancer survivors are known to experience significant changes to psychosocial wellbeing (e.g., Everdingen et al., 2007; Houldin, 2000). In particular, cancer is considered to be a highly impactful and traumatic event (Kallay, & Degi, 2014; Kangas, 2013), and often contributes to negative changes in mental and emotional functioning. It has been projected that up to 50% of cancer survivors will experience impairment from mental health symptoms (Derogatis et al., 1983; Honda & Goodwin, 2004; Massie & Holland, 1990), with depression, being the most common, projected to affect 20-30% of cancer survivors (Honda & Goodwin, 2004; Irwin, Henderson, Knight, & Pirl, 2014).;Problematically, identification of psychosocial needs of cancer survivors within oncological care is lacking (Adler et al., 2008; Holland et al., 2011; Nakash et al., 2014). Oncological primary care providers may often fail to identify psychosocial needs of cancer survivors (Forsythe et al., 2013; Sollner et al., 2001), resulting in unmet psychosocial needs and a lack of mental health referrals (Nakash et al., 2014). Researchers have identified the need for improvements in assessment of psychosocial needs of cancer survivors as a critical step in reducing gaps in psychosocial care (Adler et al., 2008). Biopsychosocial models, which theoretically include physical, emotional, social, and functional health factors (Engel, 1980; Hatala 2012), have been identified as particularly salient in assessing holistic wellbeing of individuals with chronic illnesses such as cancer (Sperry, 2006).;Currently, measures of quality of life (QoL) remain the most commonly utilized biopsychosocial assessment tools in cancer care (King & Hinds, 2012; Lavdaniti & Tsitsis, 2015). However, QoL and other biopsychosocial assessments utilized in medical care have been criticized for bias towards the measurement of bio-medical functioning (Jacob, 2013; Moons, Budts, & De Geest, 2006), and may fail to appropriately assess psychosocial factors---particularly those relevant to co-occuring mental health symptoms (Adler et al., 2008; Alonso, 2004; Connell, O'Cathain, & Brazier, 2014). Alternatively, wellness-based models, biopsychosocial models commonly utilized in psychosocial health professions, are generally more inclusive of psychosocial factors, and may provide a more robust assessment of cancer survivors' psychosocial needs (Jamner & Stokols, 2000; Myers et al., 2005a; Swarbrick, 2013). Additionally, researchers have suggested the inclusion of patient feedback in improving disciplinary conceptualization of wellbeing (Connell et al., 2014; Weston, 2005), as QoL and wellness are theoretically subjective concepts of health (Sirgy, 2012). To this end, the purpose of this research study was to examine connections between multidisciplinary frameworks of wellbeing, QoL and wellness, and their ability to assess significant psychosocial factors that impact the holistic wellbeing of cancer survivors. This study also compared multidisciplinary models of wellbeing to significant psychosocial factors identified by cancer survivors.;In the current study, both of the examined models of biopsychosocial wellbeing were found to account for significant variance in depression scores among cancer survivors. Additionally, both models were found to have significant commonality, as well as have unique contributions in predicting depression among cancer survivors. These findings suggest the utility of multidisciplinary inspection of biopsychosocial assessment models for use in cancer care. Furthermore, while the QoL assessment model was found to be superior in capturing the unique social and physical needs of survivors within the cancer context, the wellness model was found to contribute a new significant construct to the overall biopsychosocial model of wellbeing: coping styles. Qualitative analysis of semi-structured interviews held with eight cancer survivors resulted in the identification of additional salient psychosocial factors among cancer survivors not present in either of the models; namely, items related to post-traumatic growth, satisfaction with health providers and settings, and the impact of cancer-related financial burden. The qualitative results also provided further support for the quantitative results. While it is clear that current assessment models utilized in biomedical and mental health settings provide reasonable utility in accounting for the psychosocial needs of cancer survivors, the results of this study indicate the need for further refinement of biopsychosocial models utilized in the cancer context. Interdisciplinary inspection, as well as further analysis of the self-identified needs of cancer survivors may contribute to the creation of more robust biopsychosocial assessment models of wellbeing, and the resultant improvement of psychosocial care for cancer survivors. Furthermore, implications for theory, mental health and biomedical practice, and suggestions for future research will be shared while taking into consideration relevant literature on cancer survivorship.