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      Resilience and hope during advanced disease: a pilot study with metastatic colorectal cancer patients

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          Abstract

          Background

          The balance between hope-hopelessness plays an important role in the way terminally ill patients report quality of life, and personal resilience may be related to hope at the end of life. The objective of this study was to explore associations between personal resilience, hope, and other possible predictors of hope in advanced cancer patients.

          Methods

          A cross-sectional pilot study was carried out with metastatic colorectal cancer patients in a tertiary hospital. The patients answered the Connor-Davidson Resilience Scale, Herth Hope Index, Barthel Index, an instrument addressing family and social support, visual-numeric scales for pain and suffering, a two-item screening for depression, socio-demographic and socio-economic information about the family.

          Results

          Forty-four patients were interviewed (mean age 56 years; range 29-86). A strong correlation was noted between resilience and hope (0.63; p < 0.05). No correlation was found between hope and independence for activities of daily living, support from family and community, and pain and suffering levels. Of the 44 patients, 20 presented with depressive symptoms. These depressive patients had lower resilience ( p = 0.005) and hope ( p = 0.003), and higher scores of suffering ( p < 0.001). The association between resilience and hope kept stable after adjusting for age, gender, and presence of depression ( p < 0.001).

          Conclusion

          Given that resilience is a dynamic, changeable path that can improve hope, resilience-fostering interventions should be most valued in palliative care settings and should be commenced as soon as possible with cancer patients. Patients with advanced stages of non-malignant conditions would also probably benefit from such interventions.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12904-016-0139-y) contains supplementary material, which is available to authorized users.

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          Most cited references58

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          Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC).

          Resilience may be viewed as a measure of stress coping ability and, as such, could be an important target of treatment in anxiety, depression, and stress reactions. We describe a new rating scale to assess resilience. The Connor-Davidson Resilience scale (CD-RISC) comprises of 25 items, each rated on a 5-point scale (0-4), with higher scores reflecting greater resilience. The scale was administered to subjects in the following groups: community sample, primary care outpatients, general psychiatric outpatients, clinical trial of generalized anxiety disorder, and two clinical trials of PTSD. The reliability, validity, and factor analytic structure of the scale were evaluated, and reference scores for study samples were calculated. Sensitivity to treatment effects was examined in subjects from the PTSD clinical trials. The scale demonstrated good psychometric properties and factor analysis yielded five factors. A repeated measures ANOVA showed that an increase in CD-RISC score was associated with greater improvement during treatment. Improvement in CD-RISC score was noted in proportion to overall clinical global improvement, with greatest increase noted in subjects with the highest global improvement and deterioration in CD-RISC score in those with minimal or no global improvement. The CD-RISC has sound psychometric properties and distinguishes between those with greater and lesser resilience. The scale demonstrates that resilience is modifiable and can improve with treatment, with greater improvement corresponding to higher levels of global improvement. Copyright 2003 Wiley-Liss, Inc.
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            Critério de classificação econômica Brasil

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              Gene-environment interplay and psychopathology: multiple varieties but real effects.

              Gene-environment interplay is a general term that covers several divergent concepts with different meanings and different implications. In this review, we evaluate research evidence on four varieties of gene-environment interplay. First, we consider epigenetic mechanisms by which environmental influences alter the effects of genes. Second, we focus on variations in heritability according to environmental circumstances. Third, we discuss what is known about gene-environment correlations. Finally, we assess concepts and findings on the interaction between specific identified genes and specific measured environmental risks. In order to provide an understanding of what may be involved in gene-environment interplay, we begin our presentation with a brief historical review of prevailing views about the role of genetic and environmental factors in the causation of mental disorders, and we provide a simplified account of some of the key features of how genes 'work'.
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                Author and article information

                Contributors
                55-11-996226216 , joaopaulocsolano@uol.com.br
                amanda.gomeshc@gmail.com
                ivan_agurtov@hotmail.com
                ashmawi@gmail.com
                joaquimev@usp.br
                Journal
                BMC Palliat Care
                BMC Palliat Care
                BMC Palliative Care
                BioMed Central (London )
                1472-684X
                2 August 2016
                2 August 2016
                2016
                : 15
                : 70
                Affiliations
                [1 ]Hospital das Clínicas of Universidade de São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44 (INCOR), 2° andar, bloco I, Zipcode: 05403-900 São Paulo, Brazil
                [2 ]A.C. Camargo Cancer Center, São Paulo, Brazil
                [3 ]Centro Universitário São Camilo Medical School, São Paulo, Brazil
                [4 ]Department of Anesthesiology, Universidade de São Paulo Medical School, São Paulo, Brazil
                Article
                139
                10.1186/s12904-016-0139-y
                4971726
                27484092
                46091c8c-f18e-4a9b-9a05-19f4d5d826e2
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 26 January 2016
                : 25 July 2016
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Anesthesiology & Pain management
                cancer,oncology,resilience,psychological,hope,terminal care,palliative care

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