Article

Measuring Post-Traumatic Growth in People Diagnosed With Hepatobiliary Cancer: Directions for Future Research

Jennifer L. Steel

T. Clark Gamblin

Brian I. Carr

cognitive therapy
ONF 2008, 35(4), 643-650. DOI: 10.1188/08.ONF.643-650

Purpose/Objectives: To highlight and provide preliminary data regarding issues in the measurement of post-traumatic growth in people diagnosed with primary or metastatic hepatobiliary cancer.

Design: Prospective.

Setting: A large medical center in Pittsburgh, PA.

Sample: 120 patients with hepatobiliary cancer.

Methods: Participants were administered a battery of questionnaires, including the Post-Traumatic Growth Inventory (PTGI), Center for Epidemiological Studies—Depression scale, and the Functional Assessment of Cancer Therapy—Hepatobiliary module. Family caregivers also rated patients' post-traumatic growth. Qualitative data collected from patients included positive and negative changes associated with their cancer diagnoses.

Main Research Variables: Post-traumatic growth, depression, quality of life, and caregiver ratings of patients' post-traumatic growth.

Findings: The results revealed that the PTGI is a reliable instrument in people diagnosed with cancer. The level of post-traumatic growth varies depending on hepatobiliary cancer type. The onset and process of post-traumatic growth differed based on the method of measurement employed (qualitative versus quantitative). Agreement on the PTGI was high between patients and caregivers, suggesting that the patients' growth was observable to others. Post-traumatic growth was not found to be associated with depressive symptoms, quality of life, or survival in patients diagnosed with hepatobiliary cancer.

Conclusions: The results of this study underscore the need to understand differences in the measurement and the process of post-traumatic growth in people with cancer.

Implications for Nursing: For some patients, post-traumatic growth as a result of a cancer diagnosis may be associated with positive cognitive, emotional, and behavioral changes that influence mental and physical health. For patients who experience post-traumatic growth, healthcare providers may be able to facilitate behavior changes to enhance health.

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    References

    Weiss, T. (2002). PTG in women with breast cancer and their husbands: An intersubjective validation study. Journal of Psychosocial Oncology, 20(2), 65-80.
    Younossi, Z., Kallman, J., & Kincaid, J. (2007). The effects of HCV infection and management on health-related quality of life. Hepatology, 45(3), 806-816.
    Zabora, J., Brintzenhofeszoc, K., Curbow, B., Hooker, C., & Piantadosi, S. (2001). The prevalence of psychological distress by cancer site. Psycho-Oncology, 10(10), 19-28.
    Frazier, P., & Burnett, J. (1994). Immediate coping strategies among rape victims. Journal of Counseling and Development, 72(6), 633-639.
    Frazier, P., Conlon, A., & Glaser, T. (2001). Positive and negative life changes following sexual assault. Journal of Consulting and Clinical Psychology, 69(6), 1048-1055.
    Fromm, K., Andrykowski, M. A., & Hunt, J. (1996). Positive and negative psychosocial sequelae of bone marrow transplantation: Implications for quality of life assessment. Journal of Behavioral Medicine, 19(3), 221-240.
    Hann, D., Winter, K., & Jacobsen, P. (1999). Measurement of depressive symptoms in cancer patients: Evaluations of the Center for Epidemiological Studies Depression Scale (CES-D). Journal of Psychosomatic Research, 46(5), 437-443.
    Heffernan, N., Cella, D., Webster, K., Odom, L., Martone, M., Passik, S., et al. (2002). Measuring health-related quality of life in patients with hepatobiliary cancers: The Functional Assessment of Cancer Therapy—Hepatobiliary questionnaire. Journal of Clinical Oncology, 20(9), 2229-2239.
    Helgeson, V. S. (2005). Recent advances in psychosocial oncology. Journal of Consulting and Clinical Psychology, 73(2), 268-271.
    Kalantar-Zadeh, K., & Unruh, M. (2005). Health-related quality of life in patients with chronic kidney disease. International Urology and Nephrology, 37(2), 367-378.
    Lechner, S. C., Zakowski, S. G., Antoni, M. H., Greenhawt, M., Block, K., & Block, P. (2003). Do sociodemographic and disease-related variables influence benefit-finding in cancer patients? Psycho-Oncology, 12(5), 491-499.
    Linley, P. A., & Joseph, S. (2004). Positive change following trauma and adversity: A review. Journal of Traumatic Stress, 17(1), 11-21.
    Manne, S., Ostroff, J., Winkel, G., Goldstein, L., Fox, K., & Grana, G. (2004). PTG after breast cancer: Patient, partner, and couple perspectives. Psychosomatic Medicine, 66(3), 442-454.
    McCance, D. J. (1998). Human tumor viruses. Washington, DC: ASM Press.
    McGregor, B. A., Antoni, M. H., Boyers, A., Alfer, S. M., Bloomberg, B. B., & Carver, C. S. (2004). Cognitive-behavioral stress management increases benefit finding and immune function among women with early-stage breast cancer. Journal of Psychosomatic Research, 56(1), 1-8.
    McMillen, J. C., Smith, E., & Fisher, R. (1997). Perceived benefit and mental health after three types of disaster. Journal of Consulting and Clinical Psychology, 65(5), 733-739.
    Okun, A., Stein, R., Bauman, L., & Silver, E. J. (1996). Content validity of the Psychiatric Symptom Index, CES-Depression Scale, and State-Trait Anxiety Inventory from the perspective of DSM-IV. Psychological Reports, 79(3, Pt. 1), 1059-1069.
    O'Leary, V., Alday, C., & Ickovics, J. (1998). Models of life change and post-traumatic growth. In R. Tedeschi, C. Park, & L. Calhoun (Eds.), PTG: Positive changes in the aftermath of crisis (pp. 127-151). Mahwah, NJ: Lawrence Erlbaum.
    Park, C. L., Cohen, L. H., & Murch, R. (1996). Assessment and prediction of stress-related growth. Journal of Personality, 64(1), 71-105.
    Petrie, K. J., Buick, D. L., Weinman, J., & Booth, R. J. (1999). Positive effects of illness reported by myocardial infarction and breast cancer patients. Journal of Psychosomatic Research, 47(6), 537-543.
    Radloff, L. S. (1977). The Center for Epidemiological Studies Depression Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385-401.
    Rothbaum, F., Weisz, J. R., & Snyder, S. S. (1982). Changing the world and changing the self: A two-process model of perceived control. Journal of Personality and Social Psychology, 42(1), 5-37.
    Sears, S. R., Stanton, A. L., & Danoff-Burg, S. (2003). The yellow brick road and the emerald city: Benefit finding, positive reappraisal coping, and post-traumatic growth in women with early-stage breast cancer. Health Psychology, 22(5), 487-497.
    Stanton, A. L., Danoff-Burg, S., Sworowski, L. A., Collins, C. A., Branstetter, A. D., Rodriguez-Hanley, A., et al. (2002). Randomized, controlled trial of written emotional expression and benefit finding in breast cancer patients. Journal of Clinical Oncology, 20(20), 4160-4168.
    Tedeschi, R. G., & Calhoun, L. G. (1995). Trauma and transformation: Growing in the aftermath of suffering. Thousand Oaks, CA: Sage.
    Tedeschi, R. G., & Calhoun, L. G. (1996). The Post-Traumatic Growth Inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9(3), 455-471.
    Tennen, H., & Affleck, G. (1998). Personality and transformation in the face of adversity. R. G. Tedeschi & L. C. Park (Eds), PTG: Positive changes in the aftermath of crisis. The LEA series in personality and clinical psychology (pp. 65-98). Mahwah, NJ: Lawrence Erlbaum.
    Thompson, S. C. (1985). Finding positive meaning in a stressful event and coping. Basic and Applied Social Psychology, 6(4), 279-295.
    Tomich, P. L., & Helgeson, V. S. (2004). Is finding something good in the bad always good? Benefit finding among women with breast cancer. Health Psychology, 23(1), 16-23.
    Tuzun, E. H. (2007). Quality of life in chronic musculoskeletal pain. Practice and Research in Clinical Rheumatology, 21(3), 567-579.
    Affleck, G., & Tennen, H. (1996). Construing benefits from adversity: Adaptation significance and dispositional underpinnings. Journal of Personality, 64(4), 899-922.
    Affleck, G., Tennen, H., Croog, S., & Levine, S. (1987). Causal attribution, perceived benefits, and morbidity after a heart attack: An 8-year study. Journal of Consulting and Clinical Psychology, 5(1), 29-35.
    Affleck, G., Tennen, H., & Gershman, K. (1985). Cognitive adaptations to high-risk infants: The search for mastery, meaning, and protection from future harm. American Journal of Mental Deficiency, 89(6), 653-656.
    American Cancer Society. (2008). Cancer facts and figures 2008. Atlanta, GA: Author.
    Antoni, M. H., Lehman, J. M., Kilbourn, K. M., Boyers, A. E., Culver, J. L., Alferi, S. M., et al. (2001). Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer. Health Psychology, 20(1), 20-32.
    Bower, J. E., Kemeny, M. E., Taylor, S. E., & Fahey, J. L. (1998). Cognitive processing, discovery of meaning, CD4 decline, and AIDS-related mortality among bereaved HIV-seropositive men. Journal of Consulting and Clinical Psychology, 66(6), 979-986.
    Cella, D. F., Tulsky, D. S., Gray, G., Sarafian, B., Linn, E., Bonomi, A., et al. (1993). The Functional Assessment of Cancer Therapy scale: Development and validation of the general measure. Journal of Clinical Oncology, 11(3), 570-579.
    Cohen, L. H., Hettler, T. R., & Pane, N. (1998). Assessment of post-traumatic growth. In R. G. Tedeschi, C. L. Park, & L. G. Calhoun (Eds.), PTG: Positive changes in the aftermath of crisis. The LEA series in personality and clinical psychology (pp. 23-42). Mahwah, NJ: Lawrence Erlbaum.
    Cordova, M. J., Cunningham, L. L., Carlson, C. R., & Andrykowski, M. A. (2001). Posttraumatic growth following breast cancer: A controlled comparison study. Health Psychology, 20(3), 176-185.
    Curbow, B., Somerfield, M., Baker, F., Wingard, J., & Legro, M. (1993). Personal changes, dispositional optimism, and psychological adjustment to bone marrow transplantation. Journal of Behavioral Medicine, 16(5), 423-443.
    Davis, C. G., Nolen-Hoeksema, S., & Larson, J. (1998). Making sense of loss and benefiting from the experience: Two constructs of meaning. Journal of Personality and Social Psychology, 75(2), 561-574.
    Ettema, T. P., Droes, R. M., de Lange, J., Ooms, M. E., Mellenbergh, G. J., & Ribbe, M. W. (2005). The concept of quality of life in dementia in the different stages of the disease. International Psychogeriatrics, 17(3), 353-370.