About the Program
About the Programabout-the-program
CaringGuidance After Breast Cancer Diagnosis is a self-guided psychoeducational program designed for women newly diagnosed with breast cancer.
The program incorporates provision of information and use of supportive psycho-oncology techniques shared by psychology, oncology, oncology nursing and cognitive behavioral therapy (e.g., visualization, distraction, cognitive reframing, and provision of support/validation and information to facilitate problem solving) with the intent of helping reduce distress, and support healthy adjustment and coping strategies used by women in response to breast cancer diagnosis and its related experiences.
The theoretical basis for the program is a blended model of the Appraisal & Coping Process (Folkman & Greer, 2000) and cognitive theories of adjustment to major life stressors (Creamer, Burgess, Pattison, 1992; Lepore, 2001; Lepore & Helgeson, 1998); as well as the assumption that cognitions guide emotions and behaviors while all are influenced by social factors and the environment in a continuous system (Dobson, 2010; Hays & Iwamasa, 2006).
Selection of the major topic areas of the program was guided by the grounded theory of Acclimating to Breast Cancer (Lally, 2010; Lally et al., 2012) which explains the initial thought processes and behaviors of women working to maintain post-diagnosis self-integrity. This grounded theory was initially developed through in-depth interviews with 18 women and further modified with the addition of 26 interviews with women all newly diagnosed and awaiting their primary breast cancer surgery as well as within 30 days after surgery. Results from these studies are noted throughout the program. The remaining psychoeducational content is supported by current evidence on stress, coping, support and psychological adjustment to cancer (see Bibliography) and expert review (see list of Program Contributors below).
CaringGuidance After Breast Cancer Diagnosis has been tested among several groups of women, and results reported in 4 primary publications. The primary study to date enrolled 100 women with early stage breast cancer diagnosed in the prior 3 months. Women were randomly assigned to continue the usual care that their clinics provided or add to that access to the CaringGuidance program. Women in that group could use the program on their own computer or mobile device as much or as little as they wished for three months. Both groups of women completed surveys about their symptoms, distress, depressive symptoms, thoughts, coping. Women who were given access to the program completed surveys about the ease with which they were able to use it, the acceptability of the content and the applicability of their content to their lives and their ability to use what they learned. Women who had access to CaringGuidance reported fewer perceived social constraints (i.e., unsupportive behaviors from others), and greater reduction in distress and depressive symptoms after 2 months compared to the women who did not have access to the program. Satisfaction with the program was high and women reported applicability and use of the content.
Citations for this work:
https://doi.org/10.1080/07347332.2018.1546787
https://doi.org/10.1002/pon.5038
https://doi.org/10.1007/s00520-019-05028-0
About the Primary Author
Robin M. Lally, PhD, MS, RN, BA, AOCN, FAAN is Professor of Nursing at the University of Nebraska Medical Center College of Nursing and Member of the Fred & Pamela Buffett Cancer Center. Dr. Lally earned her PhD in nursing with an emphasis in oncology from the University of Minnesota, School of Nursing in 2006. She also holds Bachelors (1991) and Masters (1999) degrees in nursing as well as a B.A. in human physiology (1987) from the University of Minnesota. Dr. Lally has been certified as an Advanced Oncology Certified Nurse through the Oncology Nursing Certification Corporation since 2000. She practiced as a Clinical Nurse Specialist (CNS) in breast oncology for 8 years before beginning her academic career. As a CNS, Dr. Lally was instrumental in collaborating on the development of and participation in a program to provide individualized cancer information, psychosocial support, advocacy, and care coordination to women newly diagnosed with breast cancer. Dr. Lally is a member of the Oncology Nursing Society, the American Psychosocial Oncology Society, Society of Behavioral Medicine, American Society of Clinical Oncology, Multinational Association for Supportive Care in Cancer, and the American Association for Cancer Education and has authored or co-authored over 40 peer-reviewed research publications.
Look up all of Dr. Lally's publications:
https://orcid.org/0000-0003-0323-127X
Program Contributors (position/rank at time of collaboration)
Research Team
Jean K. Brown, RN, PhD, FAAN, Former Dean and Professor Emeritus, University at Buffalo School of Nursing
Karen Meneses PhD, RN, FAAN, Associate Dean for Research and Professor, University of Alabama Birmingham School of Nursing (deceased)
Deborah O. Erwin, PhD, Director of Cancer Health Disparities Research and Distinguished Member of Cancer Prevention & Population Sciences, Roswell Park Cancer Institute
Davina Porock, PhD, Associate Dean for Research and Scholarship & Professor, University at Buffalo School of Nursing
Vicki S. Helgeson, PhD, Professor of Psychology, Carnegie Mellon University
Patrick McNees, PhD, FAAN, Professor and Associate Dean for Research University of Alabama Birmingham School of Health Professions
Stephen B. Edge, MD, FACS, Alfiero Foundation Endowed Chair in Breast Oncology, Roswell Park Cancer Institute
Steven M. Gallo, M.S., Lead Software Engineer and Database Administrator Center for Computational Research, University at Buffalo New York Center of Excellence in Bioinformatics & Life Sciences
Mary Ann Meeker, RN, DNS, Associate Professor, University at Buffalo School of Nursing
Laurie Connors, DNP, RN, Clinical Assistant Professor, University at Buffalo School of Nursing
Gina Bellavia, PhD, Research Assistant, University at Buffalo School of Nursing
Kimberly A. Rook, MPH, LCSW, CHES, Research Assistant, University at Buffalo School of Nursing
Kathleen Schwert, RN, BSN, Nurse Manager, Ambulatory Services, Roswell Park Cancer Institute
Yow-Wu (Bill) Wu, PhD, Associate Professor& Statistician, University at Buffalo School of Nursing (deceased)
Video & Sound
Jim Lichtenthal, Distance Learning Assistant, University at Buffalo School of Nursing
Mindfulness-Based Stress Reduction
Patricia Nisbet, MS, RN, PMHNP-BC, DNP(c), Clinical Instructor, University at Buffalo School of Nursing
Program Content Reviewers
At various points throughout the development of this program, academics, clinicians and cancer survivors were asked to give input into the content and design. We thank them for their time and effort:
Reverend Naomi Babcock
Gregory P. Beehler, PhD, MA
Ann M. Berger, PhD, APRN, AOCNS, FAAN
Tamara Bishop, RN
Judith Campbell, MSN, RN, AOCNS
Silvia Gisiger Camata, RN, MPH
Beverly Canin
Joann Carroll
Maureen Connors, RT, RM, CBPNI
Cheryl Crotser, PhD, RN
Carolyn Farrell, RN, MS
Katie Finch
Jeanne Harkness, RN, MS, AOCNS
Yvette Hewitt
Mercedes Holloway
Jennifer Hydeman, PhD
Esther Kopp
Jean Pupkes, MS, RN, AOCN, ACNS-BS
Kirsten Rieth
Mary Sladek, MS, RN
Ann Taylor
Lisa Teachout
Kaylynn Wrobel
The Bio-behavioral Oncology Scholarly Team, University at Buffalo School of Nursing
Website Design/Development
OtherWisz Creative Corporation, Buffalo, New York
Web Hosting
Research Information Technology, Vice Chancellor for Research Office, University of Nebraska Medical Center, Omaha, Nebraska
Center for Computational Research, University at Buffalo, Buffalo, New York (former)
Acknowledgements
A special thank you to all the women who gave their time to participate in the research leading to the development of this program and the women who leant their images and voices to this program so that others could benefit from their wisdom.
Research support services of University at Buffalo, The State University of New York and Roswell Park Cancer Institute, Buffalo, NY.
Funding provided by the American Cancer Society Mentored Research Scholar Grant MRSG – 11-101-01-CPPB
Last reviewed: February/March 2023