Browsing by Author "Shelby, Rebecca"

Regular pelvic exams in the first two years after completing cancer treatment are critical for early detection of endometrial and cervical cancer recurrence. Gynecologic cancer survivors often report high levels of anxiety, pain and discomfort during this procedure. Despite increased attention to screening for distress during cancer treatment and follow up appointments, no interventions currently exist to support patients in coping with this recommended procedure. This dissertation aims to address this gap in health services research.The first study involved conducting in-depth individual interviews with gynecologic cancer patients (N=13) and interdisciplinary oncology providers (N=10) to explore patients’ experiences of distress associated with pelvic exams and intervention needs and preferences. The intervention development process is described including the development of a conceptual model, qualitative data collection and analysis, and the resulting content of each intervention session. Findings suggested that patients experience several types and sources of distress related to surveillance pelvic exams. Patients expressed interest in psychosocial support for managing anxiety related to pelvic exams. Patients and providers reported that a proposed brief telemedicine cognitive behavioral skills-based intervention targeting anxiety and pain related to pelvic exams would be acceptable and feasible. These findings informed the development of the PEACE intervention (Pelvic Examination and Anxiety Coping skills for Empowerment). The second study was a proof-of concept pilot study conducted with a quasi-experimental, within-subject design (N=16) to evaluate the acceptability and feasibility of the coping skills intervention and patterns of change in anxiety and pain symptoms. Mixed methods approaches were used. Participants (n=14) completed the 3-session telemedicine delivered coping skills intervention, completed assessments at baseline, post-intervention, and post pelvic exam, and completed a feedback interview. Findings suggested high overall acceptability and feasibility of PEACE. While the PEACE proof of concept trial was not powered to detect significant changes across time, patterns of change suggest promising results. While state anxiety during exams increased over time, the single-item measures of anxiety, fear and embarrassment indicated statistically significant decreases in distress over time. Participants demonstrated significant decreases in fear of recurrence after the intervention that were maintained after the follow up exam. Trends in patterns suggest that pain and discomfort severity decreased as well, though those changes were not significant. Self-efficacy for tension release and mindful attention significantly increased from pre- to post- intervention and generally remained high. Participants reported increased use of CBT skills and all reported they would use the skills in the future. Self-efficacy for communicating with providers and use of communication skills use did not follow a uniform pattern. Results suggest that a brief CBT intervention can reduce psychological distress, and may be suitable for implementation in collaborative care settings. Findings also indicate that patients with psychosocial stressors may benefit from flexible intervention delivery (i.e., phone sessions, booster sessions) and that adding a provider sensitive practice training component to PEACE may help strengthen the effects of the communication skill in particular. PEACE responds to a great need for evidence based, trauma-informed OB/GYN interventions and is well suited for further efficacy and implementation testing in the future.