Resilience in middle-aged partners of patients diagnosed with incurable cancer : a thematic analysis

Background : Providing care for patients with advanced cancer is often the responsibility of the partner. Being confronted with an incurable cancer diagnosis can be highly disruptive for the patient's partner and can be considered a potentially traumatic event. However, most caregivers seem to adapt well during the process of providing care. This finding is in line with the concept of resilience in literature: a dynamic process of adapting well, resulting from the interplay between intrinsic and extrinsic resources and risks. Resilience is age-related, with the elderly population being higher in resilience as compared to the younger generation. However, resilience has been understudied in middle-aged caregivers. Aim : To explore what intrinsic and extrinsic resources facilitate or hamper resilience in the middle-aged partner of a patient with incurable cancer. Methods : Nine middle-aged partners of patients who died at home of cancer were selected and interviewed in depth within the first year following the death of their partner. A thematic analysis utilizing an inductive approach was conducted. Findings : Resilience was challenged by the partner's diagnosis of incurable cancer. All participants made use of a set of interacting, caregiver-specific and context-related resources, facilitating a resilient process and leading to positive feelings and even personal growth. The partners demonstrated individual competences: adaptive flexibility, positivism, a sense of self-initiative and adaptive dependency. Furthermore, they relied on their context: cancer-related professionals and relatives. Context and situation interact continuously. The resulting dynamics were based on the context-availability, meaningful relationships and the patient's role. Conclusion : A resilient trajectory results from an interplay between individual and contextual resources. To build resilience in middle-aged partners of patients with incurable cancer, health care professionals should address all available resources. Moreover, they should be aware of being part of the caregiver's context, a complex adaptive system that can be either resilience-supporting or -threatening

To control or not? A motivational perspective on coping with pain

Pain relief is often the primordial treatment objective in pain patients. However, an exclusive focus upon pain relief may have costs. Evidence is accumulating that persistent attempts to gain control over pain may, paradoxically, hinder successful adaptation to pain and increase frustration and limitations due to pain. To better understand these apparently paradoxical findings, we propose to adopt a motivational perspective on coping with pain. Within this perspective, pain control is recast as an attempt to protect and restore valued life goals threatened by pain. This framework explains why some patients engage excessively in pain control strategies despite the costs associated with this, such as overuse of medication. A clinical implication is that cautiousness is warranted in promoting strategies exclusively aimed at pain relief. Beyond standard medical care, interventions should also be aimed at the improvement of functioning despite pain. Certainly those patients for whom there is no definite or sound cure to pain and who increasingly experience emotional and physical problems due to pain might benefit from paramedical help by psychologists and/or physiotherapists

'To mean something to someone' : sport-for-development as a lever for social inclusion

Background Socially excluded groups are at higher risk of low well-being and poor health. The link between social exclusion and health inequities is complex, and not being involved in society makes it difficult to be reached by standard prevention programs. Sport-for-development (SFD) programs are low-threshold and may be promising settings for inclusive actions. We explore the underlying mechanisms through which SFD might have an impact on social inclusion and examine the necessary conditions that work as a catalyst for these underlying mechanisms. Methods A realist evaluation approach was adopted. A non-profit SFD organization in a middle-large city in Flanders, Belgium, formed the setting for a single case study. Document analysis, participatory observations, interviews, and a focus group, were sources for identifying necessary context elements and essential mechanisms through which SFD could promote its participants' health and wellbeing. Results Among the most efficient mechanisms triggered by the Foundation's activities are learning by fun, connecting with peers (of whom some serve as role model) and engaging as a volunteer with some responsibilities. Building trust in oneself and in others is a necessary process throughout all these mechanisms. Facilitating context factors include the activities' accessibility and unconditional approach (creating a sense of safety), the popularity of the first division football team the Foundation is associated with (leading to a sense of belonging), a steady network of social partners and a strongly positive relationship with the SFD coach(es). Conclusions Our findings demonstrate that a SFD setting may be a vehicle for engaging hard-to-reach population groups. It enhances socially vulnerable persons' sense of competence and connectedness, leading to opportunities to improve life and work skills transferrable outside SFD settings. Based on these findings, suggestions are provided that may enhance the field and help to develop feasible (policy-led) interventions designed to promote social inclusion

Goal pursuit in individuals with chronic pain: a personal project analysis

Objectives: In individuals with chronic pain (ICPs), controlling pain often is a salient goal, despite the difficulty to achieve it. This situation may bring along frustration and distress. Yet much remains unknown about the content, appraisal, and structure of goals that ICPs pursue. Here, we explore these goals, and specifically focus upon possible differences and interrelations between pain control goals (e.g., "to control my pain") and non-pain goals (e.g., "to go to work"). Design and Methods: "Personal Project Analysis" was used in 73 ICPs (48 females; 25 males; M-age = 49.85 years; SD = 9.72) to elicit goals and goal appraisals. Interrelations between pain and non-pain goals, namely interference (i.e., negative influence), facilitation (i.e., positive influence), and necessary condition (i.e., conditional relation between pain control goal and non-pain goals) were measured with three items. Self-report measures of pain intensity, pain catastrophizing, problem solving and acceptance were completed. Results: Participants reported a variety of goals. Appraisals of pain control goals were less favorable than appraisals of non-pain goals. ICPs with higher acceptance and meaningfulness of life reported more control over pain goals, and more progress in reaching pain control goals. These individuals also reported an overall much more positive appraisal of non-pain goals (i.e., less stress, difficulty, more progress, control). In contrast, high catastrophizing and the need to solve pain were negatively related to goal appraisals. Importantly. ICP's with high perceived meaningfulness of life despite pain experienced less necessity to achieve pain control goals in order to achieve non-pain goals. This was opposite for individuals with high levels of catastrophizing. Discussion: An understanding of why ICPs may become stuck in attempts to control their pain does not only require an understanding of how individuals appraise their pain, but also requires an understanding of how pain and non-pain goals interrelate. In particular, the view that controlling pain is necessary in order to be able to achieve other goals seems detrimental