The Effects of Concrete Objective Information and Relaxation on Maintaining Usual Activity During Radiation Therapy

Norma J. Christman

Linda B. Cain

ONF 2004, 31(2), E39-E45. DOI: 10.1188/04.ONF.E39-E45

Purpose/Objectives: To examine the effects of concrete objective information (COI) and relaxation instruction (RI) on patients undergoing radiation therapy, as well as the contribution of symptom uncertainty and body awareness to the intervention effects.

Design: Three-group randomized trial. Assignment was stratified by cancer site. Data collectors were blinded to group assignments.

Setting: University medical center radiation therapy department serving both urban and rural communities in the southeastern United States.

Sample: 76 adults having radiation with curative intent for gynecologic, head and neck, or lung cancer. Most were Caucasian and had in situ to stage II disease. Mean age was 55 years.

Methods: COI and RI were delivered by tape recordings. Outcome measures were indicators of usual activities and emotions at treatment week 3 and two and four weeks post-treatment.

Main Research Variables: Intervention group; social, household, and recreational activities; anxiety, depression, and anger; body awareness; and symptom uncertainty.

Findings: Participants receiving either intervention reported more social activity during treatment. Those given RI who were high in body awareness reported more household activity during treatment. No effects were found regarding emotion. Symptom uncertainty partially explained COI effects.

Conclusions: The findings provide additional support for the effectiveness of COI in helping patients to maintain more of their usual activities during radiation therapy. Instruction in progressive muscle relaxation also may help in maintaining activities.

Implications for Nursing: COI helps patients to cope with treatment by reducing their uncertainty about symptoms. RI effects may vary by activity type and awareness of usual body sensations.

Jump to a section

    References

    Aspinwall, L.G., & Taylor, S.E. (1997). A stitch in time: Self-regulation and proactive coping. Psychological Bulletin, 121, 417-436.

    Auerbach, S.M., Martelli, M.F., & Mercuri, L.G. (1983). Anxiety, information, interpersonal impacts, and adjustment to a stressful health care situation. Journal of Personality and Social Psychology, 44, 1284-1296.

    Baron, R.M., & Kenny, D.A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173-1182.

    Bekker, M.H.J., Croon, M.A., & Vermaas, S. (2002). Inner body and outward appearance—The relationship between orientation toward outward appearance, body awareness, and symptom perception. Personality and Individual Differences, 33, 213-225.

    Benson, H., Alexander, S., & Feldman, C.L. (1975). Decreased premature ventricular contractions through use of the relaxation response in patients with stable ischaemic heart disease. Lancet, 2, 380-382.

    Bergner, M., Bobbitt, R.A., Carter, W.B., & Gilson, B.S. (1981). The Sickness Impact Profile: Development and final revision of a health status measure. Medical Care, 19, 787-805.

    Burish, T.G., & Lyles, J.N. (1981). Effectiveness of relaxation training in reducing adverse reactions to cancer chemotherapy. Journal of Behavioral Medicine, 4(1), 65-78.

    Carver, C.S., & Scheier, M.F. (1981). Attention and self-regulation: A control-theory approach to human behavior. New York: Springer-Verlag.

    Cassileth, B.R., Lusk, E.J., Brown, L.L., & Cross, P.A. (1985). Psychosocial status of cancer patients and next of kin: Normative data from the Profile of Mood States. Journal of Psychosocial Oncology, 3(3), 99-105.

    Christman, N.J. (1995). Preparation for radiotherapy—Outcomes and explanations, Final report. Grant No. R29 NR/CA01830.

    Christman, N.J., Cain, L.B., Cronin, S.N., & Corley, D.J. (2002, February). Correlates of symptom uncertainty. Paper presented at the meeting of the Southern Nursing Research Society, San Antonio, TX.

    Christman, N.J., Oakley, M.G., & Cronin, S.N. (2001). Developing and using preparatory information for women undergoing radiation therapy for cervical or uterine cancer. Oncology Nursing Forum, 28, 93-98.

    Cioffi, D. (1991). Beyond attentional strategies: Cognitive-perceptual model of somatic interpretation. Psychological Bulletin, 109(1), 25-41.

    Conn, V.S., Rantz, M.J., Wipke-Tevis, D.D., & Maas, M.L. (2001). Designing effective nursing interventions. Research in Nursing and Health, 24, 433-442.

    Devine, E.C., & Westlake, S.K. (1995). The effects of psychoeducational care provided to adults with cancer: Meta-analysis of 116 studies. Oncology Nursing Forum, 22, 1369-1381.

    Ferguson, R.J., & Ahles, T.A. (1998). Private body consciousness, anxiety and pain symptom reports of chronic pain patients. Behaviour Research and Therapy, 36, 527-535.

    Heide, F.J., & Borkovec, T.D. (1983). Relaxation-induced anxiety: Paradoxical anxiety enhancement due to relaxation training. Journal of Consulting and Clinical Psychology, 51, 171-182.

    Heide, F.J., & Borkovec, T.D. (1984). Relaxation-induced anxiety: Mechanisms and theoretical implications. Behaviour Research and Therapy, 22, 1-12.

    Higgins, L.J. (1995). The associations of personal body awareness, symptom perception, and time line anticipation with adherence behavior of adults with primary hypertension (Doctoral dissertation, University of Kentucky). Dissertation Abstracts International, 56, 3692.

    Hillenberg, J.B., & Collins, F.L., Jr. (1983). The importance of home practice for progressive relaxation training. Behaviour Research and Therapy, 21, 633-642.

    Hyman, R.B., Feldman, H.R., Harris, R.B., Levin, R.F., & Malloy, G.B. (1989). The effects of relaxation training on clinical symptoms: A meta-analysis. Nursing Research, 38, 216-220.

    Johnson, J.E. (1973). Effects of accurate expectations about sensations on the sensory and distress components of pain. Journal of Personality and Social Psychology, 27, 261-275.

    Johnson, J.E. (1996). Coping with radiation therapy: Optimism and the effect of preparatory interventions. Research in Nursing and Health, 19, 3-12.

    Johnson, J.E. (1999). Self-regulation theory and coping with physical illness. Research in Nursing and Health, 22, 435-448.

    Johnson, J.E., Christman, N.J., & Stitt, C. (1985). Personal control interventions: Short- and long-term effects on surgical patients. Research in Nursing and Health, 8, 131-145.

    Johnson, J.E., Fieler, V.K., Jones, L.S., Wlasowicz, G.S., & Mitchell, M.L. (1997). Self-regulation theory: Applying theory to your practice. Pittsburgh, PA: Oncology Nursing Society.

    Johnson, J.E., Fieler, V.K., Wlasowicz, G.S., Mitchell, M.L., & Jones, L.S. (1997). The effects of nursing care guided by self-regulation theory on coping with radiation therapy. Oncology Nursing Forum, 24, 1041-1050.

    Johnson, J.E., Lauver, D.R., & Nail, L.M. (1989). Process of coping with radiation therapy. Journal of Consulting and Clinical Psychology, 57, 358-364.

    Johnson, J.E., Nail, L.M., Lauver, D., King, K.B., & Keys, H. (1988). Reducing the negative impact of radiation therapy on functional status. Cancer, 61, 46-51.

    Johnson, J.E., Rice, V.H., Fuller, S.S., & Endress, M.P. (1978). Sensory information, instruction in a coping strategy, and recovery from surgery. Research in Nursing and Health, 1, 4-17.

    Johnston, M., & Vögele, C. (1993). Benefits of psychological preparation for surgery: A meta-analysis. Annals of Behavioral Medicine, 15, 245-256.

    King, K.B., Nail, L.M., Kreamer, K., Strohl, R.A., & Johnson, J.E. (1985). Patients' descriptions of the experience of receiving radiation therapy. Oncology Nursing Forum, 12(4), 55-61.

    Leventhal, H., Benyamini, Y., Brownlee, S., Diefenbach, M., Leventhal, E., Patrick-Miller, L., et al. (1997). Illness representations: Theoretical foundations. In K.J. Petrie & J.A. Weinman (Eds.), Perceptions of health and illness: Current research and applications (pp. 19-45). Amsterdam: Harwood.

    Leventhal, H., & Diefenbach, M. (1991). The active side of illness cognition. In J.A. Skelton & R.T. Croyle (Eds.), Mental representation in health and illness (pp. 247-272). New York: Springer-Verlag.

    Leventhal, H., & Johnson, J.E. (1983). Laboratory and field experimentation: Development of a theory of self-regulation. In P.J. Wooldridge, M.H. Schmitt, J.K. Skipper, & R.C. Leonard (Eds.), Behavioral science and nursing theory (pp. 190-262). St. Louis, MO: Mosby.

    Lyles, J.N., Burish, T.G., Krozely, M.G., & Oldham, R.K. (1982). Efficacy of relaxation training and guided imagery in reducing the aversiveness of cancer chemotherapy. Journal of Consulting and Clinical Psychology, 50, 509-524.

    McCorkle, R., & Young, K. (1978). Development of a Symptom Distress Scale. Cancer Nursing, 1, 373-378.

    McNair, D.M., Lorr, M., & Droppleman, L.F. (1992). Profile of Mood States. San Diego, CA: Educational and Industrial Testing Service.

    Meyer, D., Leventhal, H., & Gutmann, M. (1985). Common-sense models of illness: The example of hypertension. Health Psychology, 4, 115-135.

    Miller, L.C., Murphy, R., & Buss, A.H. (1981). Consciousness of body: Private and public. Journal of Personality and Social Psychology, 41, 397-406.

    Miller, S.M., & Mangan, C.E. (1983). Interacting effects of information and coping style in adapting to gynecologic stress: Should the doctor tell all? Journal of Personality and Social Psychology, 45, 223-236.

    Mishel, M.H. (1981). The measurement of uncertainty in illness. Nursing Research, 30, 258-263.

    Mishel, M.H. (1984). Perceived uncertainty and stress in illness. Research in Nursing and Health, 7, 163-171.

    Mishel, M.H. (1999). Uncertainty in chronic illness. In J.J. Fitzpatrick (Ed.), Annual review of nursing research (pp. 269-294). New York: Springer.

    National Institutes of Health. (1985/2001). Radiation therapy and you (NIH Publication No. 01-2227). Bethesda, MD: National Cancer Institute.

    Nerenz, D.R., Leventhal, H., & Love, R.R. (1982). Factors contributing to emotional distress during cancer chemotherapy. Cancer, 50, 1020-1027.

    Pennebaker, J.W. (1982). Psychology of physical symptoms. New York: Springer-Verlag.

    Rainey, L.C. (1985). Effects of preparatory patient education for radiation oncology patients. Cancer, 56, 1056-1061.

    Selby, P.J., Chapman, J.A.W., Etazadi-Amoli, J., Dalley, D., & Boyd, N.F. (1984). The development of a method for assessing the quality of life of cancer patients. British Journal of Cancer, 50, 13-22.

    Shipley, R.H., Butt, J.H., Horwitz, B., & Farbry, J.E. (1978). Preparation for a stressful medical procedure: Effect of amount of stimulus preexposure and coping style. Journal of Consulting and Clinical Psychology, 43, 499-507.

    Sime, A.M., & Libera, M.B. (1985). Sensation information, self-instruction and responses to dental surgery. Research in Nursing and Health, 8, 41-47.

    Stam, H.J., McGrath, P.A., & Brooke, R.I. (1984). The effects of a cognitive-behavioral treatment program on temporo-mandibular pain and dysfunction syndrome. Psychosomatic Medicine, 46, 534-545.

    Tarler-Benlolo, L. (1978). The role of relaxation in biofeedback training: A critical review of the literature. Psychological Bulletin, 85, 727-755.

    Watkins, L.O., Weaver, L., & Odegaard, V. (1986). Preparation for cardiac catheterization: Tailoring the content of instruction to coping style. Heart and Lung, 15, 382-389.

    Wells, N. (1982). The effect of relaxation on postoperative muscle tension and pain. Nursing Research, 31, 236-238.

    Wilson, J.F. (1981). Behavioral preparation for surgery: Benefit or harm? Journal of Behavioral Medicine, 4(1), 79-102.

    Wilson, J.F., Moore, R.W., Randolph, S., & Hanson, B.J. (1982). Behavioral preparation of patients for gastrointestinal endoscopy: Information, relaxation, and coping style. Journal of Human Stress, 8(4), 13-23.