Dissertation
Sleep disturbance in groups of patients with differing cancer diagnoses: testing a prospective mediation model of a symptom cluster
Doctor of Philosophy (Ph.D.), Drexel University
Oct 2012
DOI:
https://doi.org/10.17918/etd-4214
Abstract
Sleep disturbance is one distressing symptom commonly experienced in patients with cancer and is associated with negative outcomes (e.g., decreased quality of life, poor treatment compliance, and/or physical or psychological symptoms such as pain, fatigue, and depressed mood). Conceptualizing symptoms as clusters is a way to investigate sleep disturbance and its relationships to other physical and psychological symptoms commonly experienced in patients with cancer. The purpose of this study was to evaluate the role of sleep disturbance among a cluster of symptoms commonly experienced in patients with cancer and examine a prospective mediation model whereby sleep disturbance mediates the relationship between pain and depressed mood, and then fatigue over time. Secondary analysis using data collected from a pilot study of symptom clusters in patients with cancer undergoing chemotherapy was conducted. Indices of physical and psychological symptoms collected at multiple time points during a one month period were available for analyses. Actigraphy data were collected as an objective measurement of sleep disturbance. Results indicated that sleep was poor and previous bivariate correlations between sleep disturbance and the other symptoms of interest were replicated. A single factor containing the four symptoms identified was significant via Confirmatory Factor Analyses (CFA), supporting the symptom cluster structure recognized. Prospective mediation analyses indicated that our proposed model was not significant; however, a revised model was supported. Pain and depressed mood were found to mediate the relationship between sleep disturbance and fatigue. Results confirm that sleep is poor in patients with cancer and demonstrate the need to consider or evaluate all four symptoms of the cluster when one or more symptoms are identified in clinical or research settings. The supported mediation model provides evidence for an intervention in patients with cancer where sleep disturbance is treated by addressing pain and depressed mood, which in turn, reduces fatigue.
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Details
- Title
- Sleep disturbance in groups of patients with differing cancer diagnoses
- Creators
- Sarah Horsey Simpson - DU
- Contributors
- Jacqueline D. Kloss (Advisor) - Drexel University (1970-)
- Awarding Institution
- Drexel University
- Degree Awarded
- Doctor of Philosophy (Ph.D.)
- Publisher
- Drexel University; Philadelphia, Pennsylvania
- Resource Type
- Dissertation
- Language
- English
- Academic Unit
- Psychological and Brain Sciences (Psychology); College of Arts and Sciences; Drexel University
- Other Identifier
- 4214; 991014632509404721