Psycho-Oncology Psycho-Oncology 23: 1441–1442 (2014) Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/pon.3715
Letter to the Editor
Response to Salander’s Letter to the Editor
Dear Editor, We would like to thank Professor Salander for reading and commenting on our recently published paper. First, the authors would like to highlight that the design of this study was based on a previously established theoretical framework, that is, the Vulnerability Model of Organ Transplantation [1]. This model proposes that situational symptoms (e.g. affective states) and personality-related traits exert independent influences on patients’ physical and psychological outcomes post-transplantation. Thus, the measures in this study were chosen to represent the different constructs (i.e. state and trait variables). The sense of coherence (SOC) concept was developed to measure the resilience resources that are available for an individual to draw on when facing challenging stressors [2], such as those experienced during stem cell transplant treatment. Previous research has supported the construct validity of SOC, highlighting that it is a dispositional characteristic, as it is related to other personality factors, including self-efficacy [3], self-esteem, personal mastery and the use of adaptive coping strategies [4]. The above-mentioned dispositional factors have also been found to be associated with psychological symptoms and wellbeing, as individuals with particular dispositional orientations are better able to manage encountered stress, both emotionally and at a practical level. Contrary to Professor Salander’s assertion, the Brief Symptom Inventory 18 (measure of anxiety and depression) and Orientation to Life Questionnaire (OLQ) (measure of SOC) measure psychological constructs in very different ways. The OLQ does not aim to assess acute psychological symptoms such as depression or anxiety. Notably, the questions in the measure require respondents to reflect on their general sentiments and responses to the world in the past, and anticipations about the future. This differs from a psychopathology measure such as the BSI 18, which requires respondents to state how much they were distressed by each symptom in the past seven days. Furthermore, in the OLQ, participants are required to respond according to a range of positive or negative responses, on a semantic differential scale. For example, item 16 states: Doing the things I do everyday is a source of: 1 = Deep pleasure and satisfaction to 7 = pain and boredom. In the BSI 18, however, participants are only asked to rate the extent to which they have experienced negative affect (e.g. feelings of worthlessness), with no focus on Copyright © 2014 John Wiley & Sons, Ltd.
positive or protective aspects. Therefore, Professor Salander is incorrect in assuming that the associations between SOC and psychological outcomes reported in the study existed simply because of grammatical reasons. Instead, the findings reported in the paper suggested that patients reporting access to higher levels of resilience resources before the transplant experienced fewer depressive symptoms in the acute phase post-treatment. In addition to assessing the relationships between SOC and depressive symptoms, the present study also examined how SOC was related to different quality of life (QoL) dimensions, as assessed by the Functional Assessment of Cancer Therapy (FACT) measure. The FACT scale assesses patient wellbeing (i.e. physical wellbeing, functional wellbeing and social wellbeing) over the past seven days, and is therefore a state, rather than trait measure. Given that the OLQ measure does not assess these QoL constructs, findings regarding the relationships between SOC and specific domains of wellbeing following a stressful treatment procedure are of significant importance. Furthermore, it is important to note that the timing of administration of the various measures was matched to the clinical experience of patients. Patient SOC was measured prior to transplantation, at a time when patients report fewer treatment-related side effects. This was done so that the assessment of patient disposition was less influenced by acute medical or psychological symptoms that are experienced following HSCT. Thus, the findings regarding the relationships between pre-transplant SOC and post-transplant levels of depression and anxiety, as well as functional, social and emotional wellbeing, endorse the importance of assessing the resilience resources available to patients before treatment commences. While not explored in the study due to limited sample size and consequently statistical power, future research would benefit from assessing the independent contributions of the three components of SOC as measured by the OLQ (comprehensibility, manageability and meaningfulness). This would provide further understanding of the domains of SOC that may make a stronger contribution to patient outcomes following HSCT. The authors emphasise the importance of grounding study design in theory and patient experience so as to ensure the value and integrity of clinical research. The study’s findings clearly demonstrate the importance of assessing patients’ affective states and wellbeing, as well as, their dispositional orientations and personal
1442
resources. This would provide a more holistic and dynamic approach to rendering support to patients.
References 1. Goetzmann L, Klaghofer R, Wagner-Huber R, et al. Psychosocial vulnerability predicts psychosocial outcome after an organ transplant: results of a prospective study with lung, liver, and bone-marrow patients. J Psychosom Res 2007;62(1):93–100. 2. Antonovsky, A. The structure and properties of the sense of coherence scale. Soc Sci Med 1993;36:725–733. 3. Posadzki P, Glass N. Self-efficacy and the sense of coherence: narrative review and a conceptual synthesis. Scientific World Journal 2009; 9:924–933. 4. Pallant J, Lae L. Sense of coherence, well-being, coping and personality factors: Further evaluation of the sense of coherence scale. Pers Indiv Differ 2002;33:39–48.
Copyright © 2014 John Wiley & Sons, Ltd.
Letter to the Editor
Brindha Pillay1, Stuart J Lee2, Lynda Katona3, Sue De Bono4, Sue Burney5 and Sharon Avery6 1 School of Psychological Sciences, Monash University, Victoria, Australia E-mail: [email protected] 2 Monash Alfred Psychiatry Research Centre, Alfred Health and Monash University, Victoria, Australia 3 Department of Psychology and Consultation Liaison Psychiatry, Alfred Health, Victoria, Australia 4 Patient and Family Services, Alfred Health, Victoria, Australia 5 Cabrini Monash Psycho-oncology Unit, Cabrini Health, Victoria, Australia 6 Malignant Haematology and Stem Cell Transplantation, Alfred Health, Victoria, Australia DOI: 10.1002/pon.3715
Psycho-Oncology 23: 1441–1442 (2014) DOI: 10.1002/pon
Copyright of Psycho-Oncology is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Letter to the Editor
Response to Salander’s Letter to the Editor
Dear Editor, We would like to thank Professor Salander for reading and commenting on our recently published paper. First, the authors would like to highlight that the design of this study was based on a previously established theoretical framework, that is, the Vulnerability Model of Organ Transplantation [1]. This model proposes that situational symptoms (e.g. affective states) and personality-related traits exert independent influences on patients’ physical and psychological outcomes post-transplantation. Thus, the measures in this study were chosen to represent the different constructs (i.e. state and trait variables). The sense of coherence (SOC) concept was developed to measure the resilience resources that are available for an individual to draw on when facing challenging stressors [2], such as those experienced during stem cell transplant treatment. Previous research has supported the construct validity of SOC, highlighting that it is a dispositional characteristic, as it is related to other personality factors, including self-efficacy [3], self-esteem, personal mastery and the use of adaptive coping strategies [4]. The above-mentioned dispositional factors have also been found to be associated with psychological symptoms and wellbeing, as individuals with particular dispositional orientations are better able to manage encountered stress, both emotionally and at a practical level. Contrary to Professor Salander’s assertion, the Brief Symptom Inventory 18 (measure of anxiety and depression) and Orientation to Life Questionnaire (OLQ) (measure of SOC) measure psychological constructs in very different ways. The OLQ does not aim to assess acute psychological symptoms such as depression or anxiety. Notably, the questions in the measure require respondents to reflect on their general sentiments and responses to the world in the past, and anticipations about the future. This differs from a psychopathology measure such as the BSI 18, which requires respondents to state how much they were distressed by each symptom in the past seven days. Furthermore, in the OLQ, participants are required to respond according to a range of positive or negative responses, on a semantic differential scale. For example, item 16 states: Doing the things I do everyday is a source of: 1 = Deep pleasure and satisfaction to 7 = pain and boredom. In the BSI 18, however, participants are only asked to rate the extent to which they have experienced negative affect (e.g. feelings of worthlessness), with no focus on Copyright © 2014 John Wiley & Sons, Ltd.
positive or protective aspects. Therefore, Professor Salander is incorrect in assuming that the associations between SOC and psychological outcomes reported in the study existed simply because of grammatical reasons. Instead, the findings reported in the paper suggested that patients reporting access to higher levels of resilience resources before the transplant experienced fewer depressive symptoms in the acute phase post-treatment. In addition to assessing the relationships between SOC and depressive symptoms, the present study also examined how SOC was related to different quality of life (QoL) dimensions, as assessed by the Functional Assessment of Cancer Therapy (FACT) measure. The FACT scale assesses patient wellbeing (i.e. physical wellbeing, functional wellbeing and social wellbeing) over the past seven days, and is therefore a state, rather than trait measure. Given that the OLQ measure does not assess these QoL constructs, findings regarding the relationships between SOC and specific domains of wellbeing following a stressful treatment procedure are of significant importance. Furthermore, it is important to note that the timing of administration of the various measures was matched to the clinical experience of patients. Patient SOC was measured prior to transplantation, at a time when patients report fewer treatment-related side effects. This was done so that the assessment of patient disposition was less influenced by acute medical or psychological symptoms that are experienced following HSCT. Thus, the findings regarding the relationships between pre-transplant SOC and post-transplant levels of depression and anxiety, as well as functional, social and emotional wellbeing, endorse the importance of assessing the resilience resources available to patients before treatment commences. While not explored in the study due to limited sample size and consequently statistical power, future research would benefit from assessing the independent contributions of the three components of SOC as measured by the OLQ (comprehensibility, manageability and meaningfulness). This would provide further understanding of the domains of SOC that may make a stronger contribution to patient outcomes following HSCT. The authors emphasise the importance of grounding study design in theory and patient experience so as to ensure the value and integrity of clinical research. The study’s findings clearly demonstrate the importance of assessing patients’ affective states and wellbeing, as well as, their dispositional orientations and personal
1442
resources. This would provide a more holistic and dynamic approach to rendering support to patients.
References 1. Goetzmann L, Klaghofer R, Wagner-Huber R, et al. Psychosocial vulnerability predicts psychosocial outcome after an organ transplant: results of a prospective study with lung, liver, and bone-marrow patients. J Psychosom Res 2007;62(1):93–100. 2. Antonovsky, A. The structure and properties of the sense of coherence scale. Soc Sci Med 1993;36:725–733. 3. Posadzki P, Glass N. Self-efficacy and the sense of coherence: narrative review and a conceptual synthesis. Scientific World Journal 2009; 9:924–933. 4. Pallant J, Lae L. Sense of coherence, well-being, coping and personality factors: Further evaluation of the sense of coherence scale. Pers Indiv Differ 2002;33:39–48.
Copyright © 2014 John Wiley & Sons, Ltd.
Letter to the Editor
Brindha Pillay1, Stuart J Lee2, Lynda Katona3, Sue De Bono4, Sue Burney5 and Sharon Avery6 1 School of Psychological Sciences, Monash University, Victoria, Australia E-mail: [email protected] 2 Monash Alfred Psychiatry Research Centre, Alfred Health and Monash University, Victoria, Australia 3 Department of Psychology and Consultation Liaison Psychiatry, Alfred Health, Victoria, Australia 4 Patient and Family Services, Alfred Health, Victoria, Australia 5 Cabrini Monash Psycho-oncology Unit, Cabrini Health, Victoria, Australia 6 Malignant Haematology and Stem Cell Transplantation, Alfred Health, Victoria, Australia DOI: 10.1002/pon.3715
Psycho-Oncology 23: 1441–1442 (2014) DOI: 10.1002/pon
Copyright of Psycho-Oncology is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
