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Unmet Supportive Care Needs of Patients With Colorectal Cancer: Significant Differences by Type D Personality

Shiow-Ching Shun

Kun-Huei Yeh

Jin-Tung Liang

John Huang

Shing-Chia Chen

Been-Ren Lin

Pei-Hsuan Lee

Yeur-Hur Lai

supportive care, colorectal cancer, personality
ONF 2013, 41(1), E3-E11. DOI: 10.1188/14.ONF.E3-E11

Purpose/Objectives: To explore the association between supportive care needs and type D personality, and to identify personality traits, including negative affectivity (NA) and social inhibition (SI), and their influence on the supportive care needs of patients with colorectal cancer (CRC).

Design: Cross-sectional, correlational survey.

Setting: Oncology and surgical outpatient clinics at a medical center in northern Taiwan.

Sample: 277 patients diagnosed with CRC.

Methods: Data were collected using a set of structured questionnaires to measure supportive care needs, symptom distress, anxiety, depression, and personality traits. The associations between type D personality and supportive care needs were verified by the Mann-Whitney U test. The significant roles of personality traits were identified by generalized estimating equations, controlling for biophysical and psychological factors overall, and for the five supportive care domains.

Main Research Variables: Supportive care needs, type D personality.

Findings: Patients with CRC reported the most unmet needs in the health system and the information domain. Type D patients had higher needs overall and in most domains, except for sexuality needs. A higher level of NA indicated higher overall and psychological needs. A higher level of SI indicated lower needs in health system and information.

Conclusions: The level of unmet supportive care needs of patients with CRC is highly associated with type D personality. The trait of NA alters levels of overall supportive care and psychological needs, and the trait of SI influences needs in health system and information.

Implications for Nursing: Assessing personality traits before providing an education program is highly recommended for patients with cancer. The assessment could improve the quality of personalized education programs and better meet patient needs.

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    Andreoni, B., Chiappa, A., Bertani, E., Bellomi, M., Orecchia, R., Zampino, M., … Monfardini, L. (2007). Surgical outcomes for colon and rectal cancer over a decade: Results from a consecutive monocentric experience in 902 unselected patients. World Journal of Surgical Oncology, 5, 73. doi:10.1186/1477-7819-5-73
    Ballinger, G.A. (2004). Using generalized estimating equations for longitudinal data analysis. Organizational Research Methods 7, 127-150. doi:10.1177/1094428104263672
    Börjeson, S., Starkhammar, H., Unosson, M., & Berterö, C. (2012). Common symptoms and distress experienced among patients with colorectal cancer: A qualitative part of mixed method design. Open Nursing Journal, 6, 100-107. doi:10.2174/1874434601206010100
    Boyes, A., Girgis, A., & Lecathelinais, C. (2009). Brief assessment of adult cancer patients' perceived needs: Development and validation of the 34-item Supportive Care Needs Survey (SCNS-SF34). Journal of Evaluation in Clinical Practice, 15, 602-606. doi:10.1111/j.1365-2753.2008.01057.x
    Bureau of Health Promotion, Department of Health. (2012). Taiwan Cancer Registry: Interactive database. Retrieved from
    Butow, P.N., Phillips, F., Schweder, J., White, K., Underhill, C., & Goldstein, D. (2012). Psychosocial well-being and supportive care needs of cancer patients living in urban and rural/regional areas: A systematic review. Supportive Care in Cancer, 20, 1-22. doi:10.1007/s00520-011-1270-1
    Campbell, H.S., Sanson-Fisher, R., Turner, D., Hayward, L., Wang, X.S., & Taylor-Brown, J. (2010). Psychometric properties of cancer survivors' unmet needs survey. Supportive Care in Cancer, 19, 221-230. doi:10.1007/s00520-009-0806-0
    Chen, S.C., Liao, C.T., Lin, C.C., Chang, J.T., & Lai, Y.H. (2009). Distress and care needs in newly diagnosed oral cavity cancer patients receiving surgery. Oral Oncology, 45, 815-820. doi:10.1016/j.oraloncology.2009.01.001
    Cohen, J., & Cohen, P. (1983). Applied multiple regression/correlation analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.
    Costa, P.T., Jr., Terracciano, A., & McCrae, R.R. (2001). Gender differences in personality traits across cultures: Robust and surprising findings. Journal of Personality and Social Psychology, 81, 322-331. doi:10.1037/0022-3514.81.2.322
    De Fruyt, F., & Denollet, J. (2002). Type D personality: A five-factor model perspective. Psychology and Health, 17, 671-683. doi:10.1080/08870440290025858
    Denlinger, C.S., & Barsevick, A.M. (2009). The challenges of colorectal cancer survivorship. Journal of the National Comprehensive Cancer Network, 7, 883-893.
    Denollet, J. (2000). Type D personality. A potential risk factor refined. Journal of Psychosomatic Research, 49, 255-266.
    Denollet, J. (2005). DS14: Standard assessment of negative affectivity, social inhibition, and Type D personality. Psychosomatic Medicine, 67, 89-97. doi:10.1097/01.psy.0000149256.81953.49
    Denollet, J., Pedersen, S.S., Vrints, C.J., & Conraads, V.M. (2006). Usefulness of type D personality in predicting five-year cardiac events above and beyond concurrent symptoms of stress in patients with coronary heart disease. American Journal of Cardiology, 97, 970-973. doi:10.1016/j.amjcard.2005.10.035
    Faul, L.A., Shibata, D., Townsend, I., & Jacobsen, P.B. (2010). Improving survivorship care for patients with colorectal cancer. Cancer Control, 17, 35-43.
    Ferguson, E., Williams, L., O'Connor, R.C., Howard, S., Hughes, B.M., Johnston, D.W., … O'Carroll, R.E. (2009). A taxometric analysis of type-D personality. Psychosomatic Medicine, 71, 981-986. doi:10.1097/PSY.0b013e3181bd888b
    Heine, S.J., & Buchtel, E.E. (2009). Personality: The universal and the culturally specific. Annual Review of Psychology, 60, 369-394. doi:10.1146/annurev.psych.60.110707.163655
    Lai, Y.H., Chang, J.T., Keefe, F.J., Chiou, C.F., Chen, S.C., Feng, S.C., … Liao, M.N. (2003). Symptom distress, catastrophic thinking, and hope in nasopharyngeal carcinoma patients. Cancer Nursing, 26, 485-493. doi:10.1097/00002820-200312000-00008
    Lai, Y.H., Guo, S.L., Keefe, F.J., Tsai, L.Y., Shun, S.C., Liao, Y.C., … Lee, Y.H. (2009). Multidimensional Pain Inventory-Screening Chinese Version (MPI-sC): Psychometric testing in terminal cancer patients in Taiwan. Supportive Care in Cancer, 17, 1445-1453. doi:10.1007/s00520-009-0597-3
    McCorkle, R., & Young, K. (1978). Development of a symptom distress scale. Cancer Nursing, 1, 373-378. doi:10.1097/00002820-197810000-00003
    McDowell, M.E., Occhipinti, S., Ferguson, M., Dunn, J., & Chambers, S.K. (2010). Predictors of change in unmet supportive care needs in cancer. Psycho-Oncology, 19, 508-516. doi:10.1002/pon.1604
    McElduff, P., Boyes, A., Zucca, A., & Girgis, A. (2004). The supportive care needs survey: A guide to administration, scoring, and analysis. Newcastle, Australia: Centre for Health Research and Psycho-Oncology.
    Mols, F., & Denollet, J. (2010a). Type D personality among noncardiovascular patient populations: A systematic review. General Hospital Psychiatry, 32, 66-72. doi:10.1016/j.genhosppsych.2009.09.010
    Mols, F., & Denollet, J. (2010b). Type D personality in the general population: A systematic review of health status, mechanisms of disease, and work-related problems. Health and Quality of Life Outcomes, 8, 9. doi:10.1186/1477-7525-8-9
    Mols, F., Denollet, J., Kaptein, A.A., Reemst, P.H., & Thong, M.S. (2012). The association between Type D personality and illness perceptions in colorectal cancer survivors: A study from the population-based PROFILES registry. Journal of Psychosomatic Research, 73, 232-239. doi:10.1016/j.jpsychores.2012.07.004
    Mols, F., Holterhues, C., Nijsten, T., & van de Poll-Franse, L.V. (2010). Personality is associated with health status and impact of cancer among melanoma survivors. European Journal of Cancer, 46, 573-580. doi:10.1016/j.ejca.2009.09.016
    Mols, F., Oerlemans, S., Denollet, J., Roukema, J.A., & van de Poll-Franse, L.V. (2012). Type D personality is associated with increased comorbidity burden and health care utilization among 3,080 cancer survivors. General Hospital Psychiatry, 34, 352-359. doi:10.1016/j.genhosppsych.2012.01.014
    Mor, V., Laliberte, L., Morris, J.N., & Wiemann, M. (1984). The Karnofsky Performance Status Scale. An examination of its reliability and validity in a research setting. Cancer, 53, 2002-2007. doi:10.1002/1097-0142(19840501)53:9<2002::AID-CNCR2820530933>3.0.CO;2-W
    Paulson, E.C., Mahmoud, N.N., Wirtalla, C., & Armstrong, K. (2010). Acuity and survival in colon cancer surgery. Diseases of the Colon and Rectum, 53, 385-392. doi:10.1007/DCR.0b013e3181b71837
    Sanders, S.L., Bantum, E.O., Owen, J.E., Thornton, A.A., & Stanton, A.L. (2010). Supportive care needs in patients with lung cancer. Psycho-Oncology, 19, 480-489. doi:10.1002/pon.1577
    Schneider, E.C., Malin, J.L., Kahn, K.L., Ko, C.Y., Adams, J., & Epstein, A.M. (2007). Surviving colorectal cancer: Patient-reported symptoms 4 years after diagnosis. Cancer, 110, 2075-2082. doi:10.1002/cncr.23021
    Schofield, P., Gough, K., Lotfi-Jam, K., & Aranda, S. (2012). Validation of the Supportive Care Needs Survey-short form 34 with a simplified response format in men with prostate cancer. Psycho-Oncology, 21, 1107-1112. doi:10.1002/pon.2016
    Shaha, M., Cox, C.L., Talman, K., & Kelly, D. (2008). Uncertainty in breast, prostate, and colorectal cancer: Implications for supportive care. Journal of Nursing Scholarship, 40, 60-67. doi:10.1111/j.1547-5069.2007.00207.x
    Shih, F.J., Lin, H.R., Gau, M.L., Chen, C.H., Hsiao, S.M., Shih, S.N., & Sheu, S.J. (2009). Spiritual needs of Taiwan's older patients with terminal cancer [Online exclusive]. Oncology Nursing Forum, 36, E31-E38. doi:10.1188/09.ONF.E31-E38
    Shun, S.C., Beck, S.L., Pett, M.A., & Berry, P.H. (2006). Psychometric testing of three Chinese fatigue instruments in Taiwan. Journal of Pain and Symptom Management, 32, 155-167. doi:10.1016/j.jpainsymman.2006.02.011
    Shun, S.C., Chen, C.H., Sheu, J.C., Liang, J.D., Yang, J.C., & Lai, Y.H. (2012). Quality of life and its associated factors in patients with hepatocellular carcinoma receiving one course of transarterial chemoembolization treatment: A longitudinal study. Oncologist, 17, 732-739. doi:10.1634/theoncologist.2011-0368
    Shun, S.C., Hsiao, F.H., Lai, Y.H., Liang, J.T., Yeh, K.H., & Huang, J. (2011). Personality trait and quality of life in colorectal cancer survivors [Online exclusive]. Oncology Nursing Forum, 38, E221-E228. doi:10.1188/11.ONF.E221-E228
    Sörensen, S., Duberstein, P.R., Chapman, B., Lyness, J.M., & Pinquart, M. (2008). How are personality traits related to preparation for future care needs in older adults? Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 63, P328-P336. doi:10.1093/geronb/63.6.P328
    Sutherland, G., Hill, D., Morand, M., Pruden, M., & McLachlan, S.A. (2009). Assessing the unmet supportive care needs of newly diagnosed patients with cancer. European Journal of Cancer Care, 18, 577-584. doi:10.1111/j.1365-2354.2008.00932.x
    Tofthagen, C., McAllister, R.D., & McMillan, S.C. (2011). Peripheral neuropathy in patients with colorectal cancer receiving oxaliplatin. Clinical Journal of Oncology Nursing, 15, 182-188. doi:10.1188/11.CJON.182-188
    World Health Organization. (2013). Cancer fact sheet. Retrieved from
    Zeger, S.L., & Liang, K.Y. (1986). Longitudinal data analysis for discrete and continuous outcomes. Biometrics, 42, 121-130. doi:10.2307/2531248
    Zeger, S.L., Liang, K.Y., & Albert, P.S. (1988). Models for longitudinal data: A generalized estimating equation approach. Biometrics, 44, 1049-1060. doi:10.2307/2531734