Clinical Research
Social Support as a Mediator Between Symptom Distress and Quality of Life in Women With Breast Cancer

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Objective:

To examine relationships between symptom distress and quality of life when religious support and personal support were introduced as mediating variables.

Design:

Cross-sectional, correlational.

Setting:

Internet recruitment following university institutional review board approval.

Participants:

Mailed questionnaires from 100 women with breast cancer, mean age 46, length of time since surgery 1 to 24 months, predominantly White.

Instruments:

Symptom Distress Scale, Religious Support Scale, FACT-B, and Facit-Sp-12.

Results:

Personal support was positively related to quality of life and partially mediated the effects of symptom distress. Religious support did not mediate symptom distress and was not directly related to quality of life.

Conclusions:

Social support from family members and friends helped to decrease the negative effects of symptoms on quality of life. This study underscores the need to continue to assess for symptom distress and adequacy of personal support throughout the cancer trajectory and to facilitate the garnering of support resources when needed.

Section snippets

Study Background

Adapting to a breast cancer diagnosis occurs, in part, as a result of successful coping with stressors. A model of stress and coping (Lazarus & Folkman, 1984), which identifies coping as a critical mediator of stressful events and adaptational outcomes, provided a suitable umbrella under which to propose the following model of relationships among symptom distress, social support, and QOL (see Figure 1). The proposed model is consistent with earlier work (Northouse et al., 1999) in that it

Symptom Distress

There is wide variability in individual responses to diagnosis and treatment of breast cancer (Munkres, Oberst, & Hughes, 1992). Women with breast cancer may begin experiencing symptoms such as emotional distress and fatigue at the time of diagnosis (Cimprich, 1999) and 20% to 30% report that symptoms persist for as long as 2 years after treatment is complete (Glanz & Lerman, 1992).

Symptoms are subjective phenomena that result in physical or mental suffering and indicate a condition departing

Social Support

Social support is a complex multidimensional phenomenon including both quantity of social ties and quality of relationships (Lugton, 1997). The dimensions of social support include perceived availability of support, actual support received, and reciprocity (giving as well as receiving support) (Budin, 1998, Krause, 1999a) and may take the form of emotional (caring and concern), instrumental (provision of material goods and services), or informational (educational) assistance (Helgeson & Cohen,

Quality of Life

Quality of life is an increasingly important concept in evaluation of treatments and interventions. Traditionally, medical and health decisions have been made based largely on potential for survival and longevity. As knowledge has grown and treatment options have increased, new ways of making treatment choices have developed, and QOL has become as salient an issue in decision making as length of life (Ferrans & Powers, 1992).

Although consistency across studies in both conceptual and operational

Purpose

The purpose of this study, which was part of a larger study examining a model of stress and coping in women with breast cancer, was to examine the relationships between symptom distress and QOL when religious support and personal support were introduced as mediating variables.

Design

A cross-sectional descriptive correlational design with a convenience sample obtained via Internet recruitment was used. Although cross-sectional sampling does not allow for determination of time order as a test of

Ethical Issues and Approval

Access to the Web site used for Internet recruitment was open and did not require permission or registration by the investigator prior to contacting women who had made guest book entries nor to posting the entry inviting participation. Approval of the study protocol was obtained from a university institutional review board. The university institutional review board did not request or require permission from the Web site before contacting potential participants.

Sample/Setting

A convenience sample of 100

Results

Demographic characteristics of the sample (n = 100) are listed in Table 2. In general, and as might be expected related to the population who uses computer access to the Internet, the women were well educated (mean = 14.75 years, SD = 2.0) when compared to the U.S. national average for women ages 25 and over (“Educational Attainment,” 2000). In this sample, 98% graduated from high school, 43% graduated from college, and 30% completed graduate-level degrees. A majority were married or had a

Discussion

Hypotheses were partially supported by the findings. The inverse relationship between symptom distress and QOL was expected. Women in the sample were experiencing moderate levels of symptom distress that were comparable to women who were newly diagnosed but had not yet been treated for breast cancer (Cimprich, 1999, Cimprich, 2002), women who had recently completed radiation therapy for breast cancer (Graydon, 1994), and people in treatment for a variety of cancer diagnoses (McCorkle & Young,

Limitations

Because of the convenience sample and cross-sectional design, results of this study may not be generalizable beyond the current sample. Sampling bias may have occurred in that participants were seeking support from Internet sources and self-selected themselves into the study. Cross-sectional design did not allow an examination of social support over time. Longitudinal studies could provide understanding of where gaps between perceived need for support and actual support may exist and if support

Conclusions

Despite limitations of this study, the findings suggest some potential implications for practicing nurses. Nurses need to assess for the presence of supportive persons in a woman’s family and friend network so that social interventions can be matched to her individual needs. Individuals from this network can be included in patient teaching and care planning, especially as it relates to dealing with issues and symptoms throughout the trajectory of the breast cancer illness. Members of the

Acknowledgments

Funded in part by a dissertation grant from Horace H. Rackham School of Graduate Studies, University of Michigan, Ann Arbor.

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