Expressive Writing and Adjustment to Metastatic Breast Cancer

描述(由申请者提供)：近20年来对主要是健康样本的研究表明，在几次简短的会议上写下一个人与负面事件相关的情绪可以增强身体和心理健康。对主要是早期癌症患者的有希望的研究表明，富于表现力的写作对健康有好处，比如减轻疼痛，减少癌症相关疾病的就诊。到目前为止，还没有研究过表达写作对患有转移性乳腺癌的女性的潜在好处，她们面临着越来越依赖他人、认知和身体衰退，以及最终死亡的前景。数据显示，大多数晚期癌症患者渴望与他人分享他们与癌症相关的想法和感受，并将情感和生存关切视为非常重要的问题。然而，一些患者在讨论他们与癌症相关的经历时感到受到限制，而且几乎没有开发出正式的干预措施来帮助癌症患者应对临终关怀。在这项研究中，74名患有IV期乳腺癌的女性将被随机分配到两种情况中的一种：1)情绪披露写作干预，或2)控制写作。情绪化写作状态的女性会写出她们对乳腺癌经历最深刻的想法和感受，而控制型写作状态的女性会详细地写下她们的日常活动。这两种情况的女性都将被要求完成四个20分钟的写作环节，这些写作环节通过电话进行。将在干预前和干预后8周进行评估。主要结果包括痛苦指数(即抑郁症状和士气低落)，次要结果包括对生活和和平的意义、疼痛严重程度、睡眠障碍、疲劳和功能障碍。我们假设，与对照组相比，被分配到情绪披露写作条件的女性在后续的心理和身体健康方面会有更好的体验。我们还假设，写作干预将对那些在与他人讨论自己的癌症经历时感到受限的女性最有益。这项研究将为晚期癌症患者电话管理的表达写作干预的可行性和实用性提供新的信息。这项研究与国家癌症研究所的使命一致，旨在通过减少癌症及其治疗的不良后果和提高患者的福祉来促进公共健康。这一项目的结果有可能为未来癌症患者情绪披露干预的研究和临床实践提供参考。

DESCRIPTION (provided by applicant): Nearly two decades of research with primarily healthy samples have documented that writing about one's emotions associated with negative events over several brief sessions can enhance physical and psychological well-being. Promising studies with predominantly early-stage cancer patients suggest that expressive writing produces health benefits such as reduced pain and medical visits for cancer-related morbidities. Research to date has not examined the potential benefits of expressive writing for women with metastatic breast cancer who confront a growing dependence on others, cognitive and physical decline, and the ultimate prospect of death. Data suggest that most advanced cancer patients desire to share their cancer-related thoughts and feelings with others and view emotional and existential concerns as very important. Yet, some patients feel constrained in discussing their cancer-related experiences, and very few formal interventions have been developed to help cancer patients cope with end-of-life concerns. In this study, 74 women with Stage IV breast cancer will be randomly assigned to one of two conditions: 1) emotional disclosure writing intervention, or 2) control writing. Women in the emotional disclosure writing condition will write about their deepest thoughts and feelings regarding their breast cancer experience, whereas women in the control writing condition will write about their daily activities in a detailed manner. Women in both conditions will be asked to complete four, 20-minute writing sessions that are administered via telephone. Assessments will be conducted before the intervention and at 8 weeks post- intervention. Primary outcomes include indices of distress (i.e., depressive symptoms and demoralization), and secondary outcomes include a sense of meaning in life and peace, pain severity, sleep disturbance, fatigue, and functional impairment. We hypothesize that women assigned to the emotional disclosure writing condition will experience better psychological and physical health at follow-up relative to controls. We also hypothesize that the writing intervention will be most beneficial for women who feel constrained in discussing their cancer experience with others. This study will provide new information regarding the feasibility and utility of a telephone- administered expressive writing intervention for advanced cancer patients. Consistent with the mission of the National Cancer Institute, this research aims to promote public health by reducing adverse outcomes of cancer and its treatment and enhancing patients' well-being. Results of this project have the potential to inform future studies of emotional disclosure interventions for cancer patients and clinical practice.