PROMOTING ADJUSTMENT IN SINGLE WOMEN WITH BREAST CANCER

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There are five purposes to the current study: (1) to test the effectiveness of a home-based counseling intervention for single women with early stage breast cancer with dependent children; (2) to investigate the causal model underlying the intervention; (3) to explore time related patterns of change in individual study participants; (4) to develop a discriminant function that effectively categorizes women and children most able to benefit from the intervention; and (5) to test the cost- effectiveness of the intervention. The goal of the intervention is to improve psychosocial adjustment in single women with early stage breast cancer and their dependent children as well as to improve the women's quality of life. This is a true experiment with random assignment of 100 women each into either the Control or the Intervention group. Women in the Intervention Group will receive 5 interventions in their homes at 2-week intervals; a psychoeducational booklet and videotape; and have 24 hour access to a Masters trained nurse counselor for the duration of the intervention phase. The Control Group will receive "treatment as usual" from their physicians and clinic nurses. Both groups will be measured on the criterion measures on 4 occasions: at pretest, after the fifth occasion of home visitation, and at 1 and 3 months follow-up. Women in the Experimental Group compared to the Control Group will: 1. report fewer illness-related demands; 2. experience higher levels of cognitive control over their illness, including higher levels of self-efficacy over their cancer; 3. report lower levels of depressed mood; 4. report a more positive self-image; 5. report lower levels of anxiety; 6. report a higher level of household functioning and 7. report a higher quality of life. It is also hypothesized that dependent children of the single women in the experimental group compared to the control group will have a more positive self-appraisal, lower anxiety, and exhibit higher levels of behavioral adjustment. There are 5 major components to assessing the effects of the intervention: tests of differences between experimental and control groups (MANCOVA); structural equation modeling (SEM) to examine the underlying explanatory mechanisms of the intervention; trend and dynamic change models to describe and explore the patterns of change over time in individuals; discriminant analysis; and cost effectiveness analyses. Results will increase our understanding of the explanatory processes by which a counseling intervention causes changes in psychosocial adjustment; the patterns of stability or change in the observed outcomes over time; the cost of affecting change; and those single women and children most likely to benefit from the intervention.