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1.  Factors Predicting Adherence to Risk Management Behaviors of Women at Increased Risk for Developing Lymphedema 
Purpose
Lymphedema affects 20-30% of women following breast cancer treatment. However, even when women are informed, they do not necessarily adhere to recommended lymphedema self-management regimens. Utilizing the Cognitive-Social Health Information Processing framework, we assessed cognitive and emotional factors influencing adherence to lymphedema risk management.
Methods
Women with breast cancer who had undergone breast and lymph node surgery were recruited through the Fox Chase Cancer Centre breast clinic. Participants (N=103) completed measures of lymphedema-related perceived risk, beliefs and expectancies, distress, self-regulatory ability to manage distress, knowledge, and adherence to risk management behaviors. They then received the American Cancer Society publication “Lymphedema: What Every Woman with Breast Cancer Should Know”. Cognitive and affective variables were reassessed at 6- and 12-months post-baseline.
Results
Maximum likelihood multilevel model analyses indicated that overall adherence increased over time, with significant differences between baseline and 6- and 12- month assessments. Adherence to wearing gloves was significantly lower than that for all other behaviors except electric razor use. Distress significantly decreased, and knowledge significantly increased, over time. Greater knowledge, higher self-efficacy to enact behaviors, lower distress, and higher self-regulatory ability to manage distress were associated with increased adherence.
Conclusions
Women who understand lymphedema risk management and feel confident in managing this risk are more likely to adhere to recommended strategies. These factors should be rigorously assessed as part of routine care to ensure that women have the self-efficacy to seek treatment and the self-regulatory skills to manage distress, which may undermine attempts to seek medical assistance.
doi:10.1007/s00520-014-2321-1
PMCID: PMC4270823  PMID: 24970542
breast cancer; lymphedema; cognitive; affective; adherence; self-care
2.  The Clustering of Health Behaviours in Older Australians and its Association with Physical and Psychological Status, and Sociodemographic Indicators 
Annals of Behavioral Medicine  2014;48(2):205-214.
Background
Increasing life expectancies, burgeoning healthcare costs and an emphasis on the management of multiple health-risk behaviours point to a need to delineate health lifestyles in older adults.
Purpose
The aims of this study were to delineate health lifestyles of a cohort of older adults and to examine the association of these lifestyles with biological and psychological states and socio-economic indices.
Methods
Cluster analysis was applied to data derived from the self-reported 45 and Up cohort study (N = 96,276) of Australians over 45 years, regarding exercise, smoking, alcohol consumption, diet and cancer screening behaviours.
Results
Six lifestyle clusters emerged delineated by smoking, screening and physical activity levels. Individuals within health-risk dominant clusters were more likely to be male, living alone, low-income earners, living in a deprived neighbourhood, psychologically distressed and experiencing low quality of life.
Conclusions
Health lifestyle cluster membership can be used to identify older adults at greatest risk for physical and psychological health morbidity.
doi:10.1007/s12160-014-9589-8
PMCID: PMC4212155  PMID: 24500081
Health behaviour; Cluster analysis; Cancer screening; Ageing; Audience segmentation
3.  Cluster randomized controlled trial of a psycho-educational intervention for people with a family history of depression for use in general practice 
BMC Psychiatry  2013;13:325.
Background
The strongest risk factor for depression is having a family history of the condition. Many individuals with a family history of depression are concerned about their personal risk for depression and report unmet educational and psychological support needs. No supportive and/or educational interventions are currently available that target this group of individuals. In this study we will develop and evaluate the first online psycho-educational intervention targeted to individuals with a family history of depression. Genetic risk information and evidence-rated information on preventive strategies for depression will be provided to such individuals in a general practice setting. The intervention will also incorporate a risk assessment tool. The content and delivery of the intervention will be pilot-tested.
Methods/design
The proposed intervention will be evaluated in the general practitioner (GPs) setting, using a cluster randomized controlled trial. GP practices will be randomized to provide either access to the online, targeted psycho-educational intervention or brief generic information about depression (control) to eligible patients. Eligibility criteria include having at least one first-degree relative with either major depressive disorder (MDD) or bipolar disorder (BD). The primary outcome measure is 'intention to adopt, or actual adoption of, risk-reducing strategies’. Secondary outcome measures include: depression symptoms, perceived stigma of depression, knowledge of risk factors for development of depression and risk-reducing strategies, and perceived risk of developing depression or having a recurrence of family history. Over the course of the study, participants will complete online questionnaires at three time points: at baseline, and two weeks and six months after receiving the intervention or control condition.
Discussion
This novel psycho-educational intervention will provide individuals with a family history of depression with information on evidence-based strategies for the prevention of depression, thus, we hypothesize, enabling them to make appropriate lifestyle choices and implement behaviors designed to reduce their risk for depression. The online psycho-educational intervention will also provide a model for similar interventions aimed at individuals at increased familial risk for other psychiatric disorders.
Trial registration
The study is registered with the Australian and New Zealand Clinical Trials Group (Registration no: ACTRN12613000402741).
doi:10.1186/1471-244X-13-325
PMCID: PMC3897985  PMID: 24289740
Family history; Major depressive disorder; Bipolar disorder; Online intervention; Psycho-education; Prevention
4.  Screening for sexual dysfunction in women diagnosed with breast cancer: systematic review and recommendations 
Breast cancer patients are at increased risk of sexual dysfunction. Despite this, both patients and practitioners are reluctant to initiate a conversation about sexuality. A sexual dysfunction screening tool would be helpful in clinical practice and research, however, no scale has yet been identified as a “gold standard” for this purpose. The present review aimed at evaluating the scales used in breast cancer research in respect to their psychometric properties and the extent to which they measure the DSM-5/ICD-10 aspects of sexual dysfunction. A comprehensive search of the literature was conducted for the period 1992–2013, yielding 129 studies using 30 different scales measuring sexual functioning, that were evaluated in the present review. Three scales (Arizona Sexual Experience Scale, Female Sexual Functioning Index, and Sexual Problems Scale) were identified as most closely meeting criteria for acceptable psychometric properties and incorporation of the DSM-5/ICD-10 areas of sexual dysfunction. Clinical implications for implementation of these measures are discussed as well as directions for further research.
doi:10.1007/s10549-013-2685-9
PMCID: PMC3824351  PMID: 24013707
Breast neoplasms; Sexual dysfunction; Psychological; Psychometrics; Questionnaires; DSM-5; ICD-10
5.  Psychosocial approaches to participation in BRCA1/2 genetic risk assessment among African American women: a systematic review 
Journal of Community Genetics  2013;5(2):89-98.
Breast cancer is a significant health concern for African American women. Nonetheless, uptake of genetic risk assessment (including both genetic counseling and testing) for breast cancer gene mutations among these populations remains low. This paper systematically reviews cognitive (i.e., beliefs) and affective (i.e., emotions) factors influencing BRCA1/2 genetic risk assessment among African American women as well as psychosocial interventions to facilitate informed decision making in this population. A systematic search of CINAHL, PubMed, and PsycINFO was undertaken, yielding 112 published studies. Of these, 18 met the eligibility criteria. African American woman are likely to participate in genetic risk assessment if they are knowledgeable about cancer genetics, perceive a high risk of developing breast cancer, have low expectancies of stigmatization from medical professionals, view themselves as independent from family, and have fatalistic beliefs and a future temporal orientation. Anticipated negative affective responses, such as an inability to “handle” the results of testing, are barriers to uptake. Specific perceptions, beliefs, and emotional factors are associated with genetic risk assessment among African American women. Understanding these factors is key in the development of interventions to facilitate informed decision making in this population.
doi:10.1007/s12687-013-0164-y
PMCID: PMC3955455  PMID: 23934762
Genetic testing; African American; Breast cancer; Review; BRCA1/2
6.  The Identification of Cognitive Profiles among Women Considering BRCA1/2 Testing through the Utilization of Cluster Analytic Techniques 
Psychology & health  2011;26(10):1327-1343.
Based on the Cognitive-Social Health Information Processing model, we identified cognitive profiles of women at risk for breast and ovarian cancer. Prior to genetic counseling, participants (N = 171) completed a study questionnaire concerning their cognitive and affective responses to to being at genetic risk. Using cluster analysis, four cognitive profiles were generated: (a) high perceived risk/low coping; (b) low value of screening/high expectancy of cancer; (c) moderate perceived risk/moderate efficacy of prevention/low informativeness of test result; and (d) high efficacy of prevention/high coping. The majority of women in clusters one, two and three were unaffected, whereas cluster four consisted almost entirely of affected women. Women in cluster one had the highest number of affected relatives and experienced higher levels of distress than women in the other three clusters. These results highlight the need to consider the psychological profile of women undergoing genetic testing when designing counseling interventions and messages.
doi:10.1080/08870446.2010.521938
PMCID: PMC3197930  PMID: 21756124
breast and ovarian cancer risk; cluster analysis; cognitive profiles; genetic testing; psychological distress
7.  Enhanced Counseling for Women Undergoing BRCA1/2 Testing: Impact on Knowledge and Psychological Distress – Results From a Randomized Clinical Trial 
Psychology & health  2010;25(4):401-415.
This randomized controlled trial evaluated the impact of an enhanced counseling intervention on knowledge about the heritability of breast and ovarian cancer and distress, as a function of BRCA test result, among high-risk women. Before deciding about whether or not to undergo genetic testing, participants were randomly assigned to the enhanced counseling intervention (N = 69), designed to promote cognitive and affective processing of cancer risk information (following the standard individualized counseling session), or to the control condition (N = 65), which involved standard individualized counseling followed by a general health information session to control for time and attention. Women in the enhanced counseling group exhibited greater knowledge than women in the control group one week after the intervention. Further, at the affective level, the intervention was found to be most beneficial for women testing positive: specifically one week after test result disclosure, women in the intervention group who tested positive experienced lower levels of distress than women in the control group who tested positive. The findings suggest that the design of counseling aids should include a component that explicitly activates the individual's cognitive-affective processing system.
doi:10.1080/08870440802660884
PMCID: PMC2866521  PMID: 20204945
Genetic testing; enhanced counseling; intrusive ideation; breast cancer; ovarian cancer

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