The Effect of a Psychosocial Group Intervention on Loneliness and Social Support for Japanese Women With Primary Breast Cancer

Sakiko Fukui

Makiko Koike

Akira Ooba

Yosuke Uchitomi

ONF 2003, 30(5), 823-830. DOI: 10.1188/03.ONF.823-830

Purpose/Objectives: To examine the effects of a psychosocial group intervention on loneliness and social support in Japanese women with breast cancer.

Design: Secondary analysis of a randomized, controlled trial.

Setting: A breast cancer outpatient area of a National Cancer Center hospital in Japan.

Sample: 50 women who were less than 65 years old, were diagnosed with primary breast cancer, and had undergone surgery within 4-18 months of the start of the study.

Methods: Data were collected as part of a trial of an intervention. The investigators conducted a six-week group intervention consisting of health education, coping skills training, stress management, and psychological support. Subjects completed the revised University of California, Los Angeles, Loneliness Scale and a social support questionnaire at baseline, six weeks, and six months.

Main Research Variables: Loneliness, number of confidants, satisfaction with confidants, and satisfaction with mutual aid.

Findings: Fifty (33%) of the 151 invited patients participated and were randomized to either experimental (n = 25) or control (n = 25) groups, and 23 (92%) in each group completed the study. The experimental group had significantly lower scores than the control group for loneliness and significantly higher scores for the number of confidants, satisfaction with confidants, and satisfaction with mutual aid over the six-month study period.

Conclusions: This intervention is beneficial for Japanese patients with breast cancer experiencing loneliness and inadequate social support.

Implications for Nursing: The program can be used as an effective support for Japanese patients with cancer to manage their psychosocial concerns associated with illness.

Jump to a section

    References

    Akechi, T., Okamura, H., Yamawaki, S., & Uchitomi, Y. (1998). Predictors of patients' mental adjustment to cancer: Patient characteristics and social support. British Journal of Cancer, 77, 2381-2385.

    American Cancer Society. (2003). Cancer facts and figures 2003. Retrieved July 9, 2003, from http://www.cancer.org/docroot/STT/stt_0.asp

    American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: American Psychiatric Press.

    Asai, A. (1995). Should physicians tell patients the truth? Western Journal of Medicine, 163, 36-39.

    Bandura, A. (1990). Perceived self-efficacy in the exercise of personal agency. Journal of Applied Sport Psychology, 2, 128-163.

    Bloom, J.R. (1990). The relationship of social support and health. Social Science and Medicine, 39, 635-637.

    Bondevik, M., & Skogstad, A. (1998). The oldest old, ADL, social network and loneliness. Western Journal of Nursing Research, 20, 325-343.

    Borkman, T. (1990). Self-help groups at the turning point: Emerging egalitarian alliances with the formal health care system? American Journal of Community Psychology, 18, 321-332.

    Boston, P. (1992). Understanding cultural differences through family assessment. Journal of Cancer Education, 7, 261-266.

    Bottomly, A. (1997). Where are we now? Evaluating two decades of group interventions with adult cancer patients. Journal of Psychiatry and Mental Health Nursing, 4, 251-265.

    Cella, D.F., & Yellen, S.B. (1993). Cancer support groups: The state of the art. Cancer Practice, 1, 56-61.

    Cuevas-Renaud, C., Sobrevilla-Calvo, P.D., & Almanza, J. (2000). Development of a scale to measure psychosocial concerns of Mexican women with advanced cancer. Psycho-Oncology, 9, 79-83.

    Fawzy, F.I., Cousins, N., Fawzy, N.W., Kemeny, M.E., Elashoff, R., & Morton, D. (1990). A structured psychiatric intervention for cancer patients: I. Changes over time in methods of coping and affective disturbance. Archives of General Psychiatry, 47, 720-725.

    Fawzy, F.I., & Fawzy, N.W. (1994). A structured psychoeducational intervention for cancer patients. General Hospital Psychiatry, 16, 149-192.

    Fawzy, F.I., & Fawzy, N.W. (1998). Group therapy in the cancer setting. Journal of Psychosomatic Research, 45, 191-200.

    Fawzy, N.W. (1995). A psychoeducational nursing intervention to enhance coping and affective state in newly diagnosed malignant melanoma patients. Cancer Nursing, 18, 427-438.

    Fox, C.M., Harper, A.P., Hyner, G.C., & Lyle, R.M. (1994). Loneliness, emotional repression, marital quality, and major life events in women who develop breast cancer. Journal of Community Health, 19, 467-482.

    Friedman, G., Florian, V., & Zernitsky-Shurka, E. (1989). The experience of loneliness among young adult cancer patients. Journal of Psychosocial Oncology, 7(3), 1-15.

    Fukui, S., Kamiya, M., Koike, M., Kugaya, A., Okamura, H., Nakanishi, T., et al. (2000). Applicability of a Western-developed psychosocial group intervention for Japanese patients with primary breast cancer. Psycho-Oncology, 9, 169-177.

    Fukui, S., Kugaya, A., Okamura, H., Kamiya, M., Koike, M., Nakanishi, T., et al. (2000). A psychosocial group intervention for Japanese women with primary breast carcinoma. Cancer, 89, 1026-1036.

    Gottlieb, B.H. (2000). Self help, mutual aid and support groups among older adults. Canadian Journal of Aging, 19(Suppl. 1), 58-74.

    Greer, S., Moorey, S., Baruch, J.D., Watson, M., Robertson, B.M., & Mason, A. (1992). Adjuvant psychological therapy for patients with cancer: A prospective randomized trial. BMJ, 304, 675-680.

    Hagerty, B.M., & Williams, R.A. (1999). The effects of sense of belonging, social support, conflict, and loneliness on depression. Nursing Research, 48, 215-219.

    Heller, K. (1990). Social and community intervention. Annual Review of Psychology, 41, 141-168.

    Holmen, K., Ericsson, K., Andersson, L., & Winblad, B. (1992). Loneliness among elderly people living in Stockholm: A population study. Journal of Advanced Nursing, 17, 43-51.

    Holmen, K., Ericsson, K., Andersson, L., & Winblad, B. (1993). ADL capacity and loneliness among elderly persons with cognitive impairment. Scandinavian Journal of Primary Health Care, 11, 56-60.

    House, J.S., Landis, K.R., & Umberson, D. (1988). Social relationship and health. Science, 241, 540-544.

    Inoue, E. (1986). Gendaijin ni totteno shi [The meaning of death in Japan today]. In A. Deeken (Ed.), Shi o kangaeru [A study of death] (pp. 173-192). Tokyo: Medical Friend Press.

    Ishiwata, R., & Sakai, A. (1994). The physician-patient relationship and medical ethics in Japan. Cambridge Quarterly of Healthcare Ethics, 3, 60-66.

    Jylha, M., & Jokela, J. (1990). Individual experience as cultural: A cross-cultural study on loneliness among the elderly. Ageing and Society, 10, 295-315.

    Kagawa-Singer, M., Wellish, D.K., & Durvasula, R. (1997). Impact of breast cancer on Asian American and Anglo American women. Culture, Medicine and Psychiatry, 21, 449-480.

    Keele-Card, G., Foxall, M., & Barron, C.R. (1993). Loneliness, depression, and social support of patients with COPD and their spouses. Public Health Nursing, 10, 245-251.

    Kim, O. (1999). Predictors of loneliness in elderly Korean immigrant women living in the United States of America. Journal of Advanced Nursing, 29, 1082-1088.

    Kim, O. (2001). Sex differences in social support, loneliness, and depression among Korean college students. Psychological Reports, 88, 521-526.

    Koopman, C., Hermanson, K., Diamond, S., Angell, K., & Spiegel, D. (1998). Social support, life stress, pain and emotional adjustment to advanced breast cancer. Psycho-Oncology, 7, 101-111.

    Kudou, R., & Nishikawa, M. (1983). Kaiteiban UCLA kodokukan shakudo [The study for loneliness: Assessment of reliability and validity of the Revised UCLA Loneliness scale]. Experimental Social Psychological Research, 22, 99-108.

    Kugaya, A., Akechi, T., Okuyama, T., Nakano, T., Mikami, I., Okamura, H., et al. (2000). Prevalence, predictive factors, and screening for psychologic distress in patients with newly diagnosed head and neck cancer. Cancer, 15, 2817-2823.

    Kugaya, A., Akechi, T., Okuyama, T., Okamura, H., & Uchitomi, Y. (1998). Screening for psychological distress in Japanese cancer patients. Japanese Journal of Clinical Oncology, 28, 333-338.

    Maguire, L. (1991). Social support systems in practice. Silver Spring, MD: National Association of Social Workers Press.

    Massie, M.J., & Holland, J.C. (1989). Overview of normal reactions and prevalence of psychiatric disorders. In J.C. Holland & J.H. Rowland (Eds.), Handbook of psychooncology: Psychological care of the patient with cancer (pp. 309-328). New York: Oxford University Press.

    Maunsell, E., Brisson, J., & Deschenes, L. (1995). Social support and survival among women with breast cancer. Cancer, 76, 631-637.

    Meyer, T.J., & Mark, M.M. (1995). Effects of psychosocial intervention with adult cancer patients: A meta-analysis of randomized experiments. Health Psychology, 14, 101-108.

    Meyer, T.J., & Mark, M.M. (1996). Statistical power and implications of meta-analysis for clinical research in psychosocial oncology. Journal of Psychosomatic Research, 41, 409-413.

    Nilchaikovit, T., Hill, J.M., & Holland, J.C. (1993). The effects of culture on illness behavior and medical care: Asian and American differences. General Hospital of Psychiatry, 15, 41-50.

    Pearlin, L. (1991). Life strains and psychological distress among adults. In A. Monat & R. Lazarus (Eds.), Stress and coping: An anthology (pp. 319-336). New York: Columbia University Press.

    Perry, G.R. (1990). Loneliness and coping among tertiary-level adult cancer patients in the home. Cancer Nursing, 13, 293-302.

    Petryshen, P.M., Hawkins, J.D., & Fronchak, T.A. (2001). An evaluation of the social recreation component of a community mental health program. Psychiatry Rehabilitation Journal, 24, 293-298.

    Prince, M.J., Harwood, R.H., Blizard, R.A., Thomas, A., & Mann, A.H. (1997). Social support deficits, loneliness and life events as factors for depression in old age. The Gospel Oak Project VI. Psychological Medicine, 27, 323-332.

    Reynolds, P., & Kaplan, G. (1990). Social connection and risk factor. Prospective evidence from the Alameda County Study. Behavioral Medicine, 16, 101-110.

    Rokach, A. (1999). Cultural background and coping with loneliness. Journal of Psychology, 133, 217-229.

    Rokach, A. (2000). Loneliness and the life cycle. Psychological Reports, 86, 629-642.

    Russell, D., Peplau, L.A., & Cutrona, C.E. (1980). The Revised UCLA Loneliness Scale: Concurrent and discriminant validity evidence. Journal of Personality and Social Psychology, 39, 472-480.

    Sagara, M., & Pickett, M. (1998). Sociocultural influences and care of dying children in Japan and the United States. Cancer Nursing, 21, 274-281.

    Sarason, I.G., & Sarason, B.R. (1985). Social support: Theory, research, application. Dordrecht, Netherlands: Martinus Nijhoff.

    Savelkoul, M., de Witte, L.P., Candel, M.J., van der Tempel, H., & van der Borne, B. (2001). Effects of a coping intervention on patients with rheumatic diseases: Results of a randomized controlled trial. Arthritis Rheumatism, 45, 69-76.

    Sheard, T., & Maguire, P. (1999). The effect of psychological interventions on anxiety and depression in cancer patients: Results of two meta-analyses. British Journal of Cancer, 80, 1770-1780.

    Spiegel, D. (1995). Essentials of psychotherapeutic intervention for cancer patients. Supportive Care in Cancer, 3, 252-256.

    Stewart, M., Craig, D., MacPherson, K., & Alexander, S. (2001). Promoting positive affect and diminishing loneliness of widowed seniors through a support intervention. Public Health Nursing, 18, 54-63.

    Stewart, M., Hart, G., & Mann, K. (1995). Living with haemophilia and HIV/ AIDS: Support and coping. Journal of Advanced Nursing, 22, 1101-1111.

    Stewart, M.J., Geraldine, H., Karen, M., Jackson, S., Langille, L., & Reidy, M. (2001). Telephone support group intervention for persons with hemophilia and HIV/AIDS and family caregivers. International Journal of Nursing Studies, 38, 209-225.

    Stokes, J.P. (1985). The relation of social network and individual difference variables to loneliness. Journal of Personality and Social Psychology, 48, 981-990

    Tamura, T., & Lau, A. (1992). Connectedness versus separateness: Applicability of family therapy to Japanese families. Family Process, 31, 319-340.

    Trijsburg, R.W., Van Knippenberg, F.C.E., & Rijpma, S.E. (1992). Effects of psychosocial treatment on cancer patients: A critical review. Psychosomatic Medicine, 54, 489-517.

    Uchitomi, Y., Mikami, I., Kugaya, A., Akizuki, N., Nagai, K., Nishiwaki, Y., et al. (2000). Depression after successful treatment for nonsmall cell lung carcinoma. Cancer, 89, 1172-1179.

    Vries, M.J., Schilder, J.N., Mulder, C.L., Vrancken, A.M., Remie, M., & Garssen, B. (1997). Phase II study of psychotherapeutic intervention in advanced cancer. Psycho-Oncology, 6, 129-137.

    Vugia, H.D. (1991). Support groups in oncology: Building hope through the human bond. Journal of Psychosocial Oncology, 9, 89-107.