Expressive Writing and Adjustment to Metastatic Breast Cancer

描述（由申请人提供）：近二十年的主要健康样本研究表明，在几个简短的会议上写下一个人与消极事件相关的情绪可以增强身心健康。主要针对早期癌症患者的有希望的研究表明，表达性写作对健康有益，如减少疼痛和癌症相关疾病的就诊次数。迄今为止的研究还没有研究表达性写作对转移性乳腺癌女性的潜在益处，这些女性面临着对他人日益依赖、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都希望与他人分享他们与癌症相关的想法和感受，并将情感和存在性问题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限，而且很少有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名患有四期乳腺癌的女性将被随机分配到两种情况中的一种：1)情感表露写作干预，或2)控制写作。在情感表露写作条件下，女性会写下她们对乳腺癌经历最深的想法和感受，而在控制写作条件下，女性会详细地写下她们的日常活动。两种情况下的女性都将被要求完成四个20分钟的写作课程，这些课程通过电话进行管理。评估将在干预前和干预后8周进行。主要结局包括痛苦指数（即抑郁症状和士气低落），次要结局包括生活意义和平静感、疼痛严重程度、睡眠障碍、疲劳和功能障碍。我们假设被分配到情感表露写作条件的女性在随访中相对于对照组有更好的心理和身体健康。我们还假设，对于那些在与他人讨论癌症经历时感到受限的女性来说，写作干预将是最有益的。本研究将提供新的资讯，探讨电话管理的表达性写作介入治疗晚期癌症病患的可行性与效用。与国家癌症研究所的使命一致，这项研究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众健康。该项目的结果有可能为癌症患者情感表露干预的未来研究和临床实践提供信息。

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.