Applying SDT in a context of pain provides new insights into why chronic pain affects partners and how partners impact patient outcome. Directions for future research are outlined.

Background Providing care for patients with advanced cancer is often the responsibility of the partner. Being confronted with an incurable cancer diagnosis can be highly disruptive for the patient’s partner and can be considered a potentially traumatic event. However, most caregivers seem to adapt well during the process of providing care. This finding is in line with the concept of resilience in literature: a dynamic process of adapting well, resulting from the interplay between intrinsic and extrinsic resources and risks. Resilience is age-related, with the elderly population being higher in resilience as compared to the younger generation. However, resilience has been understudied in middle-aged caregivers. Aim To explore what intrinsic and extrinsic resources facilitate or hamper resilience in the middle-aged partner of a patient with incurable cancer. Methods Nine middle-aged partners of patients who died at home of cancer were selected and interviewed in depth within the first year following the death of their partner. A thematic analysis utilizing an inductive approach was conducted. Findings Resilience was challenged by the partner’s diagnosis of incurable cancer. All participants made use of a set of interacting, caregiver-specific and context-related resources, facilitating a resilient process and leading to positive feelings and even personal growth. The partners demonstrated individual competences: adaptive flexibility, positivism, a sense of self-initiative and adaptive dependency. Furthermore, they relied on their context: cancer-related professionals and relatives. Context and situation interact continuously. The resulting dynamics were based on the context-availability, meaningful relationships and the patient’s role. Conclusion A resilient trajectory results from an interplay between individual and contextual resources. To build resilience in middle-aged partners of patients with incurable cancer, health care professionals should address all available resources. Moreover, they should be aware of being part of the caregiver’s context, a complex adaptive system that can be either resilience-supporting or -threatening.

Method: The ICQ was administered to 821 individuals with chronic pain and 295 patients with chronic fatigue. Confirmatory factor analyses were performed to assess the hypothesized three-factor structure, containing the factors "helplessness", "acceptance" and "perceived benefits". A multi-group analysis was performed to investigate the stability of the factor structure in both groups.Results: Results confirmed the three-factor structure in the two samples. The factor structure was invariant across individuals with chronic pain and chronic fatigue.Conclusion: As the three-factor structure provided a good fit in both groups, we confirm the usefulness of the subscale scores in research and clinical practice.

and PerspectiveInstruments to assess chronic pain acceptance have been developed and used.Uninvestigated is whether and to what extent the content of the items reflects acceptance. A content analysis of thirteen instruments that aim to measure acceptance of chronic pain was performed. A coding scheme was used that consisted of three categories that represent key components of acceptance, i.e. "disengagement from pain control", "pain willingness", and "engagement in activities other than pain control". The coding scheme consisted of five additional categories in order to code items that do not to represent acceptance, i.e., "controlling pain", "pain costs", "pain benefits", "unclear", and "no fit". Two coders rated to what extent the items of acceptance instruments belonged to one or more of these categories.Results indicated that acceptance categories were not equally represented in the acceptance instruments. Of note, some instruments had many items in the category "controlling pain". Further analyses revealed that the meaning of acceptance differs between different instruments, and between different versions of the same instrument. This study illustrates the importance of content validity when developing and evaluating self-report instruments.Perspective. This article investigated the content validity of questionnaires designed to measure acceptance in individuals with chronic pain. Knowledge about the content of the instruments will provide further insight into the features of acceptance and how to measure these.

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Background: Close relatives provide much of the care to people with cancer. As resilience can shield family caregivers from mental health problems, there has been a burgeoning interest in resilience-promoting interventions. However, the evidence necessary for the development of these interventions is scant and unsynthesized. Aim: To create an overall picture of evidence on resilience in cancer caregiving by a theory-driven meta-synthesis. Design: In this systematically constructed review a thematic synthesis approach has been applied. The original findings were coded and structured deductively according to the theoretical framework. Consequently, the codes were organized inductively into themes and subthemes. Data sources: Through September 2019, five electronic databases were searched for qualitative studies on resilience in cancer caregiving. The search was extended by a supplementary hand search. Seventeen studies met the eligibility criteria. Results: The elements of resilience, as described in the pre-defined theoretical framework of Bonanno, are reflected in the lived experiences of family caregivers. The resilience process starts with the diagnosis of advanced cancer and may result in mental wellbeing, benefit finding, and personal growth. The process is influenced by context elements such as individual history, sociocultural background, caregiver characteristics, and the behavior of the supportive network. A repertoire of coping strategies that caregivers use throughout the caregiving process moderates the resilience process. Conclusion: This review and theoretical synthesis reveal key elements of resilience in the process of cancer caregiving, including influencing factors and outcomes. Implications and avenues for further research are discussed.

Objectives: In individuals with chronic pain (ICPs), controlling pain often is a salient goal, despite the difficulty to achieve it. This situation may bring along frustration and distress. Yet much remains unknown about the content, appraisal, and structure of goals that ICPs pursue. Here, we explore these goals, and specifically focus upon possible differences and interrelations between pain control goals (e.g., "to control my pain") and non-pain goals (e.g., "to go to work").Design and Methods: "Personal Project Analysis" was used in 73 ICPs (48 females; 25 males; M age = 49.85 years; SD = 9.72) to elicit goals and goal appraisals. Interrelations between pain and non-pain goals, namely interference (i.e., negative influence), facilitation (i.e., positive influence), and necessary condition (i.e., conditional relation between pain control goal and non-pain goals) were measured with three items. Self-report measures of pain intensity, pain catastrophizing, problem solving and acceptance were completed.Results: Participants reported a variety of goals. Appraisals of pain control goals were less favorable than appraisals of non-pain goals. ICPs with higher acceptance and meaningfulness of life reported more control over pain goals, and more progress in reaching pain control goals. These individuals also reported an overall much more positive appraisal of non-pain goals (i.e., less stress, difficulty, more progress, control). In contrast, high catastrophizing and the need to solve pain were negatively related to goal appraisals. Importantly, ICP's with high perceived meaningfulness of life despite pain experienced less necessity to achieve pain control goals in order to achieve non-pain goals. This was opposite for individuals with high levels of catastrophizing.Discussion: An understanding of why ICPs may become stuck in attempts to control their pain does not only require an understanding of how individuals appraise their pain, but also requires an understanding of how pain and non-pain goals interrelate. In particular, the view that controlling pain is necessary in order to be able to achieve other goals seems detrimental.

Research on resilience in general and in cancer caregiving in particular is hampered by the lack of a universally accepted definition and a theoretical framework. A hybrid approach drawing on the American Psychological Association's definition and Bonanno's framework offers a guide for the study of resilience in caregivers of advanced cancer patients.