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Boquiren V.M.,Toronto General Hospital | Esplen M.J.,Toronto General Hospital | Esplen M.J.,University of Toronto | Esplen M.J.,De Souza Institute | And 5 more authors.
Psycho-Oncology | Year: 2013

Objective This study aimed to explore the relationships between gender-role socialization, objectified body consciousness and quality of life in breast cancer (BC) survivors with body image (BI) disturbance post-treatment. Methods A total of 150 BC survivors participating in an ongoing randomized clinical trial of a group psychotherapy intervention for BI-related concerns completed a baseline battery of standardized measures including the following: Body Image Scale (BIS), Body Image after Breast Cancer Questionnaire (BIBCQ), Objectified Body Consciousness Scale (OBCS) measuring Body Shame and Surveillance, Gender-Role Socialization Scale (GRSS) measuring internalization of traditional gender roles and attitudes and the Functional Assessment of Cancer Therapy-Breast Quality-of-Life Instrument (FACT-B). Correlational analyses were conducted between the two BI questionnaires, the two primary psychosocial variables GRSS and OBCS, and FACT-B. Path analysis was conducted on a proposed theoretical model delineating pathways between the two primary psychosocial variables and BI disturbance. Results Significant positive correlations were found between the two BI scales and (a) GRSS (average r = 0.53, p < 0.000), (b) Body Shame (average r = 0.53, p < 0.000) and Surveillance (average r = 0.48, p < 0.000). The BIS and BIBCQ were negatively associated with the FACT-B (r = -0.62, -0.73, respectively; p < 0.000). Results from the path analysis demonstrated support for the proposed model. Conclusion Breast cancer survivors who endorsed greater internalization of traditional gender roles and attitudes, who engaged in greater self-surveillance and experienced greater body shame, reported greater BI disturbance and poorer quality of life post-treatment. Women with these predispositions are likely to be more vulnerable for psychological distress and may experience poorer adjustment after BC treatment. Copyright © 2013 John Wiley & Sons, Ltd.


Esplen M.,Toronto General Research Institute | Esplen M.,University of Toronto | Esplen M.,De Souza Institute | Stuckless N.,University of Toronto | And 12 more authors.
Clinical Genetics | Year: 2011

A positive genetic test result may impact on a person's self-concept and affect quality of life. The purpose of the study was to develop a self-concept scale to measure such impact for individuals carrying mutations for a heritable colorectal cancer Lynch syndrome (LS). Two distinct phases were involved: Phase 1 generated specific colorectal self-concept candidate scale items from interviews with eight LS carriers and five genetic counselors, which were added to a previously developed self-concept scale for BRCA1/2 mutation carriers, Phase II had 115 LS carriers complete the candidate scale and a battery of validating measures. A 20-item scale was developed with two dimensions identified through factor analysis: stigma/vulnerability and bowel symptom-related anxiety. The scale showed excellent reliability (Cronbach's α = 0.93), good convergent validity by a high correlation with impact of event scale (r(102) = 0.55, p < 0.001) and Rosenberg self-esteem scale (r(108) = -0.59, p < 0.001), and a low correlation with the Fear questionnaire (r(108) = 0.37, p < 0.001). The scale's performance was stable across participant characteristics. This new scale for measuring self-concept has potential to be used as a clinical tool and as a measure for future studies. © 2011 John Wiley & Sons A/S.


Esplen M.J.,University of Toronto | Esplen M.J.,De Souza Institute
Healthcare Papers | Year: 2014

The article co-authored by Maureen Taylor and Sandra Martin raises important issues that are resulting in new debate and attention in our thinking concerning physician-assisted death. It is likely that a change in policy is forthcoming, especially with the emerging force of a growing demographic who value personal choice and autonomy and are well-versed in the range of medical technologies and practices available. The issue of physician-assisted death cannot be understood apart from considering current models of healthcare and the role of adequate supportive care and psychosocial support. Despite having access to research and frameworks to inform quality palliative care, as well as communication competencies and guidelines to assist practitioners in the management of debilitating symptoms, our current healthcare system consists of healthcare professionals who continue to be challenged in their abilities to alleviate complex and challenging symptoms and distress. We will need to carefully assess our systems and plan well ahead for changes in policy to provide optimal, ethical and safe approaches to the offering of services around assisted death as an option for endof-life care.


Boquiren V.M.,University of Toronto | Boquiren V.M.,University of Manitoba | Esplen M.J.,University of Toronto | Esplen M.J.,De Souza Institute | And 6 more authors.
Psycho-Oncology | Year: 2016

Background Breast cancer treatments and the traumatic nature of the cancer experience frequently elicit considerable sexual difficulties. Breast cancer survivors (BCS) experiencing body image (BI) issues may represent a vulnerable group for developing sexual dysfunction posttreatment. The current study explores sexual functioning (SF) in this unique clinical group. Methods A descriptive study assessed 127 BCS who were engaged in sexual activity. Standardized baseline measures included the following: BI Scale, BI after Breast Cancer Questionnaire, Female Sexual Function Index (FSFI), Kansas Marital Satisfaction Scale, and Functional Assessment of Cancer Therapy - Breast. Levels of SF were compared with BCS, heterogeneous cancer, and healthy female populations. Correlational analyses were conducted between SF, BI, relationship, and health-related quality of life variables. Guided by a conceptual framework, regression analyses were conducted to determine significant demographic, clinical, and psychosocial predictors of sexual desire, satisfaction, and overall SF. Results Eighty-three per cent of BCS met the FSFI clinical cutoff score for a sexual dysfunction. Participants exhibited poorer SF when compared with other female cancer and healthy groups. No significant correlations were found between BI questionnaire total scores and SF. BI after Breast Cancer Questionnaire - Body Stigma subscale showed significant associations with FSFI Arousal, Orgasm, Satisfaction (average r = -0.23), and overall SF (r = -0.25). Vaginal dryness (β = -0.50), body stigma (β = -0.24), and relationship satisfaction (β = 0.27) were significant predictors of overall SF. Conclusion Difficulties in SF appear to be highly prevalent in BCS experiencing BI disturbance posttreatment. Brief screening tools assessing SF should adopt a biopsychosocial model, which includes questions regarding vaginal dryness, relationship satisfaction, and body stigma issues. Copyright © 2015 John Wiley & Sons, Ltd.


Crawford J.,Brock University | Brudnoy L.,De Souza Institute | Soong T.,De Souza Institute | Graham T.,De Souza Institute
Journal of Continuing Education in Nursing | Year: 2013

Nurses are ideally suited to assume professional patient navigation roles in cancer care. Continuing education and staff development are essential for nurses to implement their roles to the fullest potential. This article describes an innovative patient navigation course that was developed to meet the educational needs of nurses who work with patients who have been diagnosed with cancer or are undergoing evaluation for cancer. Adult learning principles and interactive teaching strategies facilitated learning that was relevant and applicable to all nurses. Of the 200 participants, 77.5% completed questionnaires before and after the course. The questionnaire administered after the course showed a statistically significant increase in average total confidence scores on knowledge and skills in the seven domains examined (p <.00 to.03). This change reflected improvements in overall confidence in key principles and role functions of patient navigation. The course provided an opportunity for nurses to enhance their individual practice in patient navigation in the following areas: meeting patient needs for emotional and supportive care; providing information and education; and facilitating coordination and continuity of care. © SLACK Incorporated.


Rashleigh L.,de Souza Institute
Canadian oncology nursing journal = Revue canadienne de nursing oncologique | Year: 2011

There is a growing body of evidence to support that specialization in nursing leads to improved outcomes for patients, including increased QOL, improved symptom management, and fewer hospital admissions. Oncology nurses face several challenges in pursuing specialization, due to individual and system issues such as limited time and resources. To address these challenges, de Souza Institute launched a province-wide study group for nurses in Ontario who planned to write the Canadian Nurses Association (CNA) Oncology Certification Exam. The study group was led by educators from de Souza and Princess Margaret Hospital and drew expertise from nursing leaders across Ontario who shared the same vision of oncology nursing excellence. The study group was innovative by embracing telemedicine and web-based technology, which enabled flexibility for nurses' work schedules, learning styles, physical location and practice experience. The study group utilized several theoretical perspectives and frameworks to guide the curriculum: Adult Learning Theories, Cooperative Learning, Generational Learning Styles, CANO standards for practice and the CNA exam competencies. This approach enabled 107 oncology nurses across the province in 17 different sites to connect, as a group, study interactively and fully engage in their learning. A detailed evaluation method was utilized to assess baseline knowledge, learning needs, cooperative group process, exam success rates, and document unexpected outcomes. Ninety-four per cent of participants passed the CNA Oncology Exam. Lessons learned and future implications are discussed. The commitment remains to enable thriving through generating new possibilities, building communities of practice, mentoring nurses and fostering excellence in oncology practice.


Gayner B.,Sinai University | Gayner B.,University of Toronto | Esplen M.J.,Toronto General Research Institute | De Roche P.,Sinai University | And 6 more authors.
Journal of Behavioral Medicine | Year: 2012

To determine whetherMBSR groups would help gay men living with HIV improve psychosocial functioning and increase mindfulness compared to treatment-as-usual (TAU). Methods: 117 participants were randomized 2:1 to MBSR or TAU. No new psychosocial or psychopharmacological interventions were initiated within 2 months of baseline. Standardized questionnaires were administered pre-, postintervention and at 6 months. An intent-to-treat analysis found significant benefits of MBSR: at post-intervention and 6 months follow up, MBSR participants had significantly lower avoidance in IES and higher positive affect compared to controls. MBSR participants developed more mindfulness as measured by the Toronto Mindfulness Scale (TMS) including both TMS subscales, curiosity and decentering, at 8-week and 6 months. For the sample as a whole, increase in mindfulness was significantly correlated with reduction in avoidance, higher positive affect and improvement in depression at 6 months. MBSR has specific and clinically meaningful effects in this population. © Springer Science+Business Media, LLC 2011.


The International Nurses Association is pleased to welcome Sharon R. MacKnight, RN, to their prestigious organization with her upcoming publication in the Worldwide Leaders in Healthcare. Sharon R. MacKnight is a Registered Nurse with 15 years of experience in her field and an extensive expertise in all facets of nursing, especially palliative care, wound care, and healthcare management. Sharon is currently serving patients as a Visiting Registered Nurse at SRT Med Staff in Toronto, Ontario, Canada. Sharon graduated with her Nursing Degree and Oncology Certification in 2001 from the Ontario Advanced Care Course at the De Souza Institute in Toronto, Ontario. To keep up to date with the latest advances in her field, Sharon maintains a professional membership with the Registered Nurses Association of Ontario, and for her excellence, she has been nominated several times for the Florence Nightingale Award. Sharon attributes her success to growing up watching her mother, who is a nurse, doing palliative care. Learn more about Sharon R. MacKnight here: http://inanurse.org/network/index.php?do=/4135389/info/ and be sure to read her upcoming publication in the Worldwide Leaders in Healthcare.


Esplen M.J.,University of Toronto | Esplen M.J.,De Souza Institute | Wong J.,University of Toronto | Wong J.,De Souza Institute | And 8 more authors.
Clinical Genetics | Year: 2015

A cross-sectional study of 155 participants who underwent genetic testing for Lynch syndrome (LS) examined long-term psychosocial and behavioral outcomes. Participants completed standardized measures of perceived risk, psychosocial functioning, knowledge, and a questionnaire of screening activities. Participants were on average 47.3 years and had undergone testing a mean of 5.5 years prior. Eighty four (54%) tested positive for a LS mutation and 71 (46%) negative. For unaffected carriers, perceived lifetime risk of colorectal cancer was 68%, and surprisingly, 40% among those testing negative. Most individuals demonstrated normative levels of psychosocial functioning. However, 25% of those testing negative had moderate depressive symptoms, as measured by the Center for Epidemiologic Studies for Depression Scale, and 31% elevated state anxiety on the State-Trait Anxiety Inventory. Being female and a stronger escape - avoidant coping style were predictive of depressive symptoms. For state anxiety, similar patterns were observed. Quality of life and social support were significantly associated with lower anxiety. Carriers maintained higher knowledge compared to those testing negative, and were more engaged in screening. In summary, most individuals adapt to genetic test results over the long term and continue to engage in screening. A subgroup, including some non-carriers, may require added psychosocial support. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.


Esplen M.J.,University of Toronto | Esplen M.J.,De Souza Institute | Cappelli M.,Childrens Hospital of Eastern Ontario | Wong J.,University of Toronto | And 11 more authors.
BMJ Open | Year: 2013

Objectives: To develop a brief, reliable and valid instrument to screen psychosocial risk among those who are undergoing genetic testing for Adult-Onset Hereditary Disease (AOHD). Design: A prospective two-phase cohort study. Setting: 5 genetic testing centres for AOHD, such as cancer, Huntington's disease or haemochromatosis, in ambulatory clinics of tertiary hospitals across Canada. Participants: 141 individuals undergoing genetic testing were approached and consented to the instrument development phase of the study (Phase I). The Genetic Psychosocial Risk Instrument (GPRI) developed in Phase I was tested in Phase II for item refinement and validation. A separate cohort of 722 individuals consented to the study, 712 completed the baseline package and 463 completed all follow-up assessments. Most participants were female, at the mid-life stage. Individuals in advanced stages of the illness or with cognitive impairment or a language barrier were excluded. Interventions: Phase I: GPRI items were generated from (1) a review of the literature, (2) input from genetic counsellors and (3) phase I participants. Phase II: further item refinement and validation were conducted with a second cohort of participants who completed the GPRI at baseline and were followed for psychological distress 1-month postgenetic testing results. Primary and secondary outcome measures: GPRI, Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Brief Symptom Inventory (BSI) and Impact of Event Scale (IES). Results: The final 20-item GPRI had a high reliability-Cronbach's a at 0.81. The construct validity was supported by high correlations between GPRI and BSI and IES. The predictive value was demonstrated by a receiver operating characteristic curve of 0.78 plotting GPRI against follow-up assessments using HAM-D and HAM-A. Conclusions: With a cut-off score of 50, GPRI identified 84% of participants who displayed distress postgenetic testing results, supporting its potential usefulness in a clinical setting.

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