Terry A Badger

Interests

Teaching

Preparing advanced practice nurses in the Doctorate of Nursing Practice programPreparing nurse scientists in the Doctor of Philosophy in Nursing program

Research

Psychological Distress (Depression and Anxiety), Symptom Management and Health Outcomes of Cancer Survivors and Informal Cancer Caregivers, Depression in Adults and Families.

Courses

Scholarly Contributions

Books

• Rokach, A., Mesurado, B., Sacchi, C., Segrin, C., Ben-zur, H., Saari, J., Snell, K. D., Michael, K., Campbell, M., Campbell, M. A., Junttila, N., Kainulainen, S., Spirling, S., Pavri, S., Badger, T. A., Burke, T. J., Topalli, P. Z., Segrin, C. G., & Minzi, M. C. (2016). The Correlates of Loneliness. BENTHAM SCIENCE PUBLISHERS. doi:10.2174/97816810807031160101

Chapters

• Badger, T. A., & Segrin, C. (2018). Female caregivers to Male patients. In Gender in Psycho-Oncology. Oxford University Press.
• Badger, T. A., & Pace, T. W. (2017). Depression in families. In Encyclopedia of Nursing Research, 4rh Edition. Springer Publishing Company.
• Badger, T. A., & Segrin, C. (2017). Loneliness, relationships and health. In Loneliness and its correlates.
• Badger, T. A., McRee, L., & Lazenby, M. (2017). Depression. In Integration of Palliative Care in Chronic Conditions: An Interdisciplinary Approach(pp 273-287). Pittsburgh PA: Oncology Nursing Society.
• Pace, T. W., Badger, T. A., Pace, T. W., & Badger, T. A. (2017). Depression in families.. In Encyclopedia of Nursing Research, 4th ed.. New York, New York: Springer.
• Badger, T. A., Henry, B., & McCorkle, R. (2016). Education of nurses in psycho-oncology. In Psycho-Oncology. New York: Oxford.

Journals/Publications

• Crane, T. E., Badger, T. A., Sikorskii, A., Segrin, C., Hsu, C. H., & Rosenfeld, A. G. (2022). Symptom Profiles of Latina Breast Cancer Survivors: A Latent Class Analysis. Nursing research, 69(4), 264-271.
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  Symptom research among Latinas with breast cancer is limited-especially as it relates to multiple co-occurring symptoms.
• McElfresh, J. J., Skiba, M. B., Segrin, C. G., Badger, T. A., Crane, T. E., Crist, J. D., & Thomson, C. A. (2022). Interventions for Loneliness Among Adult Cancer Survivors: A Systematic Review and Meta-Analysis. Journal of psychosocial oncology, 39(4), 509-533.
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  Loneliness is common after cancer, contributing to poor outcomes. Interventions to modify loneliness are needed. This systematic review describes the current literature regarding loneliness interventions in cancer survivors. Databases including: Ovid/MEDLINE; The Cochrane Central Register of Controlled Trials (CENTRAL); Elsevier/Embase; Clarivate/Web of Science (Core Collection), EBSCO/PsycINFO, EBSCO/CINAHL were used to perform a systematic review of literature using PRISMA guidelines. Second, risk of bias, meta-analysis and a narrative synthesis approach was completed to synthesize findings from multiple studies. Six thousand five hundred three studies were initially evaluated; eight studies met inclusion criteria. Findings indicate a paucity of interventions, generally of lower quality. Interventions were feasible and acceptable; those interventions with cultural modifications were more likely to demonstrate effectiveness. There are limited interventions addressing loneliness in cancer survivors. Development and testing of culturally-relevant programs are warranted. Current studies suggest the psychosocial symptom of loneliness is modifiable among adult cancer survivors. Few interventions have been tested and shown to be effectiveness in cancer survivors in the U.S. and none have been tailored for older adult survivors, by patient gender/sex and few for specific race/ethnic groups. Results from this systematic review: a narrative synthesis and meta-analysis can inform future interventions targeting loneliness in this growing, yet vulnerable, adult cancer survivor population.
• Oblea, P. N., Adams, A. R., Nguyen-Wu, E. D., Hawley-Molloy, J. S., Balsam, K., Badger, T. A., Witwer, A. R., & Cartwright, J. (2022). Lesbian Gay Bisexual Transgender and Queer Health-Care Experiences in a Military Population. Journal of homosexuality, 1-21.
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  ABTRACTThis study aimed to understand the experiences of lesbian, gay, bisexual, transgender, and queer of former military service members. Data for this analysis was collected from the two open-ended survey questions as part of a larger online survey. The analysis was performed using the web-based data analysis application Dedoose. Eighty-eight qualitative responses were used. Analysis of the responses revealed five main themes: (1) identity, (2) negative experiences, (3) impact of experiences, (4) policy, and (5) positive experiences. These findings can influence future military research by focusing on the effects of the Don't Ask Don't Tell policy, negative and positive experiences, and the impact of those experiences.
• Badger, T. A., Sikorskii, A., Segrin, C., & Given, C. W. (2021). Supportive health education reduces health care utilization and costs in Latinas with breast cancer and their caregivers. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 29(3), 1225-1233.
  More info

  To compare costs and relative cost savings from reductions in unscheduled health services use for two 8-week psychosocial interventions (telephone interpersonal counseling [TIPC], supportive health education [SHE]) delivered by telephone to Latinas with breast cancer and their informal caregivers. Cost information is required before adopting supportive care interventions as part of routine care. There is limited information on costs of producing supportive care interventions or their impact on service use.
• Crane, T. E., Badger, T. A., O'Connor, P., Segrin, C., Alvarez, A., Freylersythe, S. J., Penaloza, I., Pace, T. W., & Sikorskii, A. (2021). Lifestyle intervention for Latina cancer survivors and caregivers: the Nuestra Salud randomized pilot trial. Journal of cancer survivorship : research and practice, 15(4), 607-619.
  More info

  Assess feasibility, acceptability, and preliminary efficacy of an integrated symptom management and lifestyle intervention (SMLI) to improve adherence to the American Cancer Society's (ACS) Guidelines on Nutrition and Physical Activity in Latina cancer survivors and their informal caregivers (dyads).
• Crane, T. E., Sikorskii, A., Segrin, C., Badger, T. A., & Pace, T. W. (2021). The Relationship Between Health-Related Quality of Life and Saliva C-Reactive Protein and Diurnal Cortisol Rhythm in Latina Breast Cancer Survivors and Their Informal Caregivers: A Pilot Study.. Journal of transcultural nursing : official journal of the Transcultural Nursing Society, 32(4), 326-335. doi:10.1177/1043659620926537
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  Introduction: To date, no study has explored associations between objective stress-related biomarkers (i.e., inflammatory markers, diurnal rhythm of cortisol) and health-related quality of life (HRQOL) in Latina breast cancer survivors and their informal caregivers (i.e., family, friends). Method: This cross-sectional feasibility study assessed saliva C-reactive protein, saliva diurnal cortisol rhythm (cortisol slope), and self-reported HRQOL (psychological, physical, and social domains) in 22 Latina survivor-caregiver dyads. Feasibility was defined as ≥85% samples collected over 2 days (on waking, in afternoon, and in evening). Associations between biomarkers and HRQOL were examined with correlational analyses. Results: Collection of saliva was feasible. Strongest associations were observed between survivor evening cortisol (as well as cortisol slope) and fatigue, a component of physical HRQOL. Discussion: Associations presented may help promote investigations of mechanisms linking stress-related biomarkers and HRQOL in Latina breast cancer survivor-caregiver dyads, which will facilitate development of culturally congruent interventions for this underserved group.
• Hebdon, M., Badger, T. A., Segrin, C., & Pasvogel, A. (2021). Social support and healthcare utilization of caregivers of Latinas with breast cancer. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 29(8), 4395-4404.
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  Family caregivers experience significant health consequences related to caregiving, including higher mortality rates. Latino caregivers may have additional challenges related to social determinants of health. Gender and social support are key factors to consider in the context of chronic illnesses and healthcare use in caregivers of Latinos diagnosed with cancer.
• Love, R., Loescher, L. J., & Badger, T. A. (2021). Breaking new ground? The dual (PhD-DNP) doctoral degree in Nursing.. Journal of professional nursing : official journal of the American Association of Colleges of Nursing, 37(2), 429-434. doi:10.1016/j.profnurs.2020.05.001
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  1) Provide background information on the PhD-DNP dual doctoral degree, specifically historical perspectives and existing programs; 2) Describe one PhD-DNP program as an exemplar to illustrate program data challenges and solutions; and 3) Discuss the national landscape of the dual doctoral degree program..PhD-DNP dual doctoral degree programs have existed for 10 years; there are five known programs nationally. Reported here for one dual doctoral degree program are data collected from the program's inception (2010) through 2019. These data include demographic program characteristics, time to degree, and achievements during and after the program. Challenges pertaining to mentorship, progression to degree, socialization and student productivity also are described. Strategies for moving the dual degree forward nationally depend on a collaborative effort for data generation and collection from existing PhD-DNP programs. These data can be instrumental for seeking funding for dual doctoral degree programs..The dual PhD-DNP degree has not yet gained a foothold nationally. There is demand for the program by nursing doctoral students and availability of these programs is slowly increasing. National nursing leaders and organizations can consider developing metrics and collecting data that will lend support to future funding initiatives for the dual degree.
• Marshall, C. A., Curran, M. A., Trejo, J., Gonzalez, A. A., Armin, J., Hamann, H. A., Badger, T. A., & Garcia, F. A. (2021). The Evolution of Un Abrazo Para La Familia: Implications for Survivors of Cancer. Journal of cancer education : the official journal of the American Association for Cancer Education, 36(5), 1075-1080.
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  Un Abrazo Para La Familia™ (Abrazo) is a 3-h modular preventive intervention designed for low-income caregivers who are co-survivors of cancer. Here we (1) consider the benefit to survivors of cancer, that is, the care recipients who participate in Abrazo; (2) summarize the literature specific to research outreach to low-income, underserved populations when they are faced with cancer; and (3) describe current steps being taken in Southern Arizona to reach these populations via Abrazo. Specific to considering the benefit to care recipients, we analyzed care recipient data derived from three existing cohorts of Abrazo participants. Analyses of the combined cohorts of these data demonstrate that Abrazo is effective with care recipients given statistically significant higher cancer knowledge and self-efficacy scores, pre- vs. post-intervention. We can now report benefit to care recipients who participate in Abrazo. This allows us, with confidence, to expand research recruitment efforts to include care recipients as part of the Abrazo intervention in our efforts to serve low-income, underserved populations when faced with cancer.
• Marshall, C. A., Trejo, M. J., Trejo, J. I., Armin, J. S., Badger, T. A., & Weihs, K. L. (2021). Implementation of Un Abrazo Para La FamiliaTM in southern Arizona with extension to survivors and assessment of effects on distress. Families, systems & health : the journal of collaborative family healthcare, 39(2), 269-281.
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  [Embracing the Family] (Abrazo) is a 3-hr psychoeducational intervention designed for low-income informal caregivers who are cosurvivors of cancer. A rehabilitation-informed preventive intervention, Abrazo reflects the importance of family, culture, and socioeconomic background. A pilot study was conducted to inform a larger geographic implementation of Abrazo. The aims were to determine if previous outcomes of increased cancer knowledge and self-efficacy could be replicated and to investigate intervention effects on distress. A pretest-posttest design was used to assess changes in cancer knowledge, self-efficacy, and distress for Abrazo participants. Distress was measured with the American Medical Association's Caregiver Assessment (Epstein-Lubow et al., 2010) and the National Comprehensive Cancer Network Distress Thermometer (Donovan et al., 2014; Forsythe et al., 2013; Fulcher & Gosselin-Acomb, 2007). The Patient Health Questionnaire-4 (PHQ-4) (Kroenke et al., 2009) measured symptoms of anxiety and depression. Both survivors ( = 37) and cosurvivors ( = 103) increased in cancer knowledge and self-efficacy after completing Abrazo. Mean levels of distress and symptoms decreased for cosurvivors, but not for survivors. At study entry, 19% of cosurvivors and 12% of survivors scored ≥6/12 on the PHQ-4, the standard cutoff for clinically significant symptoms. Only 13% of cosurvivors, but 30% of survivors exceeded this threshold at three-month follow-up. Elevated symptoms persisted in 12% of survivors from baseline to follow-up; in 18% of survivors, symptoms rose between baseline and follow-up. Increased cancer knowledge and self-efficacy in participants replicates evidence of Abrazo's effectiveness. The result of decreased distress in cosurvivors extends our understanding of Abrazo's effectiveness with this population. The increase in distress in cancer survivors warrants further attention to their intervention needs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
• Mcewen, M. M., Chico-jarillo, T. M., Mcewen, M. M., Koithan, M., Kahn-john, M., Chico-jarillo, T. M., Badger, T. A., & Arnault, D. S. (2021). The Diné (Navajo) Hózhó Lifeway: A Focused Ethnography on Intergenerational Understanding of American Indian Cultural Wisdom.. Journal of transcultural nursing : official journal of the Transcultural Nursing Society, 32(3), 256-265. doi:10.1177/1043659620920679
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  Purpose: Hózhó is the cultural wisdom that guides the Diné lifeway. This study examines understanding of cultural wisdom (CW) across three generations: elders, adults, and adolescents. Method: A focused ethnography was conducted on the Navajo Nation. Twenty-two Diné (Navajo) were recruited through convenience sampling. Data were collected via two semistructured interviews and photovoice methods. Data were analyzed using content analysis, thematic analysis, and participatory visual analysis of photos. Results: The Diné elders embodied the greatest in-depth understanding of CW followed by the adolescents. An unexpected finding was the scarcity of understanding of CW among the adults. Conclusion: The Diné understanding of CW is transferred through discussion with elders, listening to and speaking traditional language, cultural preservation activities, and participation in cultural practices. The Diné believe cultural wisdom is a health sustaining protective factor, therefore strategies to restore, promote, and support the intergenerational transfer of cultural wisdom remains a tribal priority.
• Pace, T. W., Badger, T. A., Segrin, C., Sikorskii, A., & Crane, T. E. (2021). The Relationship Between Health-Related Quality of Life and Saliva C-Reactive Protein and Diurnal Cortisol Rhythm in Latina Breast Cancer Survivors and Their Informal Caregivers: A Pilot Study. Journal of transcultural nursing : official journal of the Transcultural Nursing Society, 32(4), 326-335.
  More info

  To date, no study has explored associations between objective stress-related biomarkers (i.e., inflammatory markers, diurnal rhythm of cortisol) and health-related quality of life (HRQOL) in Latina breast cancer survivors and their informal caregivers (i.e., family, friends). This cross-sectional feasibility study assessed saliva C-reactive protein, saliva diurnal cortisol rhythm (cortisol slope), and self-reported HRQOL (psychological, physical, and social domains) in 22 Latina survivor-caregiver dyads. Feasibility was defined as ≥85% samples collected over 2 days (on waking, in afternoon, and in evening). Associations between biomarkers and HRQOL were examined with correlational analyses. Collection of saliva was feasible. Strongest associations were observed between survivor evening cortisol (as well as cortisol slope) and fatigue, a component of physical HRQOL. Associations presented may help promote investigations of mechanisms linking stress-related biomarkers and HRQOL in Latina breast cancer survivor-caregiver dyads, which will facilitate development of culturally congruent interventions for this underserved group.
• Reed, P. G., Hebdon, M. C., Crane, T. E., Coombs, L. A., & Badger, T. A. (2021). Self-efficacy in caregivers of adults diagnosed with cancer: An integrative review.. European journal of oncology nursing : the official journal of European Oncology Nursing Society, 52, 101933. doi:10.1016/j.ejon.2021.101933
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  Cancer caregivers experience health challenges related to their caregiving role, and self-efficacy can contribute to health outcomes through behavioral, environmental, and personal factors. The purpose of this integrative review was to examine self-efficacy in caregivers of adults diagnosed with cancer, including its association with health factors..A systematic search of PubMed, CINAHL, and PsychInfo yielded 560 articles. Following duplicate removal, 232 articles were screened for inclusion criteria with 71 articles remaining for final review..Studies were generally quantitative (n = 67), with predominantly female (n = 55), White (n = 36) caregivers, between the ages of 45-60 (n = 48). Self-efficacy was significantly associated with quality of life, caregiver function, social support, hope, depression, anxiety, and burden as a predictor, mediator, and outcome. Physical health and social determinants of health (social support and financial well-being) were addressed among fewer studies than mental and emotional health outcomes..Addressing self-efficacy in diverse populations and within physical, mental, and social health contexts will enhance understanding of how self-efficacy impacts caregivers of adults diagnosed with cancer. Nurses and other health care professionals can then effectively address supportive needs of caregivers in the personal, behavioral, and environmental domains.
• Segrin, C., Pasvogel, A., Hebdon, M., & Badger, T. A. (2021). Social support and healthcare utilization of caregivers of Latinas with breast cancer.. Supportive Care in Cancer, 1-10. doi:10.1007/s00520-020-05983-z
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  Family caregivers experience significant health consequences related to caregiving, including higher mortality rates. Latino caregivers may have additional challenges related to social determinants of health. Gender and social support are key factors to consider in the context of chronic illnesses and healthcare use in caregivers of Latinos diagnosed with cancer. The purpose of this study was to examine the moderating effect of gender and social support on the relationship between chronic illnesses and healthcare utilization in caregivers of Latina breast cancer survivors. This was a secondary analysis of family caregivers from an experimental study with breast cancer survivors and their designated family caregivers. Participants completed telephone surveys about demographics, presence of chronic illnesses, frequency of emergency department, urgent care, and hospital visits, social support, and acculturation. Data were analyzed for direct and moderated relationships. There was a significant relationship between number of chronic illnesses and healthcare utilization, informational support, and social isolation. Income and acculturation were not related to chronic illnesses or healthcare utilization. Gender did not moderate the relationship between chronic illnesses and healthcare utilization. Informational support was a marginal moderator of the relationship between chronic illnesses and healthcare utilization alone and with acculturation and income included as covariates. Clinicians should consider the influence of informational support and social isolation on chronic illnesses and healthcare use in caregivers of Latina breast cancer survivors, specifically, how these factors may influence navigation of the healthcare system.
• Sikorskii, A., Pace, T. W., Penaloza, I., Freylersythe, S. J., Alvarez, A., Segrin, C., O'connor, P. A., Badger, T. A., & Crane, T. E. (2021). Lifestyle intervention for Latina cancer survivors and caregivers: the Nuestra Salud randomized pilot trial.. Journal of cancer survivorship : research and practice, 15(4), 607-619. doi:10.1007/s11764-020-00954-z
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  Assess feasibility, acceptability, and preliminary efficacy of an integrated symptom management and lifestyle intervention (SMLI) to improve adherence to the American Cancer Society's (ACS) Guidelines on Nutrition and Physical Activity in Latina cancer survivors and their informal caregivers (dyads)..Forty-five dyads were randomized to a 12-week telephone-delivered intervention or attention control. Intervention effects on nutrition, physical activity, symptom burden, and self-efficacy for symptom management were estimated using Cohen's ds..Mean age was 64 for survivors and 53 for caregivers. Feasibility was demonstrated by the 63% consent rate out of approached dyads. The SMLI was acceptable for 98% of dyads. Among survivors, medium-to-large effect sizes were found for increased servings of total fruits and vegetables (d = 0.55), vegetables (d = 0.72), and decreased sugar intake (d = - 0.51) and medium clinically significant effect sizes for total minutes of physical activity per week (d = 0.42) and grams of fiber intake per day (d = 0.40) for intervention versus attention control. Additionally, medium-to-large intervention effects were found for the reduction of symptom burden (d = 0.74). For caregivers, medium-to-large intervention effects were found for reduced total sugar intake (d = - 0.60) and sugar intake from sugar-sweetened beverages (d = - 0.65); vegetable intake was increased with a medium effect size (d = 0.41)..SMLI was feasible and acceptable for both dyadic members. A larger, well-powered trial is needed to formally evaluate SMLI effectiveness..Integrating symptom management with lifestyle behavior interventions may increase adherence to the ACS guidelines on nutrition and physical activity to prevent new and recurrent cancers.
• Sikorskii, A., Segrin, C., Given, C. W., & Badger, T. A. (2021). Supportive health education reduces health care utilization and costs in Latinas with breast cancer and their caregivers.. Supportive Care in Cancer, 29(3), 1225-1233. doi:10.1007/s00520-020-05593-9
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  To compare costs and relative cost savings from reductions in unscheduled health services use for two 8-week psychosocial interventions (telephone interpersonal counseling [TIPC], supportive health education [SHE]) delivered by telephone to Latinas with breast cancer and their informal caregivers. Cost information is required before adopting supportive care interventions as part of routine care. There is limited information on costs of producing supportive care interventions or their impact on service use. Latinas and their caregivers were randomized to either TIPC or SHE. At baseline and month 4, hospitalizations and urgent care and emergency department (ED) visits in the previous month were recorded. These were compared by trial arm for 181 survivors and 169 caregivers using logistic regression, adjusting for age and health services use at baseline. Total cost per 100 survivors was $28,695 for SHE and $27,399 for TIPC. Urgent care and ED visits were reduced for survivors in SHE versus TIPC (odds ratio (OR) = 0.31, 95% confidence interval (CI) [0.12, 0.88], p = .03). For hospitalizations, OR for SHE versus TIPC was 0.59, 95% CI [0.26, 1.37], p = .07. There were no differences between trial arms for caregiver health services use. Cost savings for SHE versus TIPC from reductions in health services use per 100 survivors ranged from $800 for urgent care to $17,000 for ED visits and $13,000 for hospitalizations. Based on this evidence, SHE can be a cost-saving supportive care solution that benefits not only survivors and caregivers, but also oncology practices reimbursed through episodes of care.
• Sikorskii, A., Sikorskii, A., Segrin, C., & Badger, T. A. (2021). Psychological Distress and Social Support Availability in Different Family Caregivers of Latinas With Breast Cancer.. Journal of transcultural nursing : official journal of the Transcultural Nursing Society, 32(2), 103-110. doi:10.1177/1043659619896824
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  Introduction: Latinas with breast cancer draw on a diverse range of family members for informal care. Latin cultures typically prescribe high levels of support and care for an ill family member that leave caregivers vulnerable to compromised well-being. Method: In this cross-sectional survey study, 258 family caregivers of Latinas with breast cancer completed reports of psychological distress, availability of social support, and acculturation. Results: Mothers who provide care to a daughter with breast cancer experience higher levels of psychological distress and report lower availability of informational support than most other types of family caregivers. Mothers' lower levels of acculturation may at least partially explain these reductions in well-being. Discussion: This study highlights the diverse range of family and fictive kin who participate in family caregiving for Latina breast cancer survivors. Spousal caregivers may not represent a unique population, whereas mothers as caregivers are indeed distinct for their higher distress levels.
• Thomas Hebdon, M. C., Coombs, L. A., Reed, P., Crane, T. E., & Badger, T. A. (2021). Self-efficacy in caregivers of adults diagnosed with cancer: An integrative review. European journal of oncology nursing : the official journal of European Oncology Nursing Society, 52, 101933.
  More info

  Cancer caregivers experience health challenges related to their caregiving role, and self-efficacy can contribute to health outcomes through behavioral, environmental, and personal factors. The purpose of this integrative review was to examine self-efficacy in caregivers of adults diagnosed with cancer, including its association with health factors.
• Thomson, C. A., Skiba, M. B., Segrin, C. G., Mcelfresh, J. J., Crist, J. D., Crane, T. E., Badger, T. A., Mcelfresh, J. J., Thomson, C. A., Skiba, M. B., Segrin, C. G., Mcelfresh, J. J., Crist, J. D., Crane, T. E., & Badger, T. A. (2021). Interventions for Loneliness Among Adult Cancer Survivors: A Systematic Review and Meta-Analysis.. Journal of psychosocial oncology, 39(4), 509-533. doi:10.1080/07347332.2020.1867690
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  Problem identification: Loneliness is common after cancer, contributing to poor outcomes. Interventions to modify loneliness are needed. This systematic review describes the current literature regarding loneliness interventions in cancer survivors.Literature search: Databases including: Ovid/MEDLINE; The Cochrane Central Register of Controlled Trials (CENTRAL); Elsevier/Embase; Clarivate/Web of Science (Core Collection), EBSCO/PsycINFO, EBSCO/CINAHL were used to perform a systematic review of literature using PRISMA guidelines. Second, risk of bias, meta-analysis and a narrative synthesis approach was completed to synthesize findings from multiple studies.Data evaluation/synthesis: Six thousand five hundred three studies were initially evaluated; eight studies met inclusion criteria. Findings indicate a paucity of interventions, generally of lower quality. Interventions were feasible and acceptable; those interventions with cultural modifications were more likely to demonstrate effectiveness.Conclusions: There are limited interventions addressing loneliness in cancer survivors. Development and testing of culturally-relevant programs are warranted.Implications for psychosocial oncology: Current studies suggest the psychosocial symptom of loneliness is modifiable among adult cancer survivors. Few interventions have been tested and shown to be effectiveness in cancer survivors in the U.S. and none have been tailored for older adult survivors, by patient gender/sex and few for specific race/ethnic groups. Results from this systematic review: a narrative synthesis and meta-analysis can inform future interventions targeting loneliness in this growing, yet vulnerable, adult cancer survivor population.
• Badger, T. A., Love, R., & Loescher, L. J. (2020). Breaking new ground? The Dual (PhD-DNP) Doctoral Degree in Nursing https://doi.org/10.1016/j.profnurs.2020.05.001. Journal of Professional Nursing. doi:https://doi.org/10.1016/j.profnurs.2020.05.001
• Badger, T. A., Segrin, C., Sikorskii, A., Pasvogel, A., Weihs, K., Lopez, A. M., & Chalasani, P. (2020). Randomized controlled trial of supportive care interventions to manage psychological distress and symptoms in Latinas with breast cancer and their informal caregivers. Psychology & health, 35(1), 87-106.
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  The purpose of this study was to test two 2-month psychosocial interventions (Telephone Interpersonal Counseling [TIPC] and Supportive Health Education [SHE]) to improve quality of life (QOL) outcomes for Latinas with breast cancer and their informal caregivers. Two hundred and forty-one Latinas with breast cancer and their caregivers were assessed at baseline, immediately after the 2-month intervention, at 4 and 6 months after baseline. QOL outcomes were psychological distress, symptoms and social support. Linear mixed effects models showed that for cancer survivors at 2 months, TIPC produced lower adjusted mean depression scores compared to SHE. At 4 months, SHE had reduced total number of symptoms, global symptom distress, and social isolation compared to TIPC. Only total number of symptoms was lower in SHE than in TIPC at 6 months. Among caregivers at 2 months, total number of symptoms, global symptom distress, and anxiety were lower, and self-efficacy for symptom management was higher in SHE compared to TIPC. Caregiver depression was lower in TIPC compared to SHE at 4 months. These telephone delivered interventions improved different outcomes. TIPC demonstrated superior benefits for depression management and SHE was more successful in anxiety and cancer-related symptom management.
• Dekker, J., Graves, K. D., Badger, T. A., & Diefenbach, M. A. (2020). Management of Distress in Patients with Cancer-Are We Doing the Right Thing?. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 54(12), 978-984.
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  Screening for distress and referral for the provision of psychosocial care is currently the preferred approach to the management of distress in patients with cancer. To date, this approach has shown a limited effect on the reduction of distress. Recent commentaries have argued that the implementation of distress screening should be improved. On the other hand, the underlying assumption that a referral for psychosocial care is required for distressed patients can be questioned. This has led to the development of an alternative approach, called emotional support and case finding.
• Lopez, A. M., Pasvogel, A., Chalasani, P., Sikorskii, A., Badger, T. A., Segrin, C. G., & Weihs, K. L. (2020). Longitudinal dyadic interdependence in psychological distress among Latinas with breast cancer and their caregivers. Supportive Care in Cancer, 28(6), 2735-2743.
• Reed, P. G., Hebdon, M. T., Crane, T. E., & Badger, T. A. (2020). A Moderating Model of Self-Efficacy in Caregivers of Latina Breast Cancer Survivors (GP795). Journal of Pain and Symptom Management, 60(1), 301-302. doi:10.1016/j.jpainsymman.2020.04.222
• Reed, P. G., Hebdon, M., Crane, T. E., & Badger, T. A. (2020). A Moderating Model of Self-Efficacy in Caregivers of Latina Breast Cancer Survivors. Innovation in Aging, 4, 339-340. doi:10.1093/geroni/igaa057.1089
• Segrin, C., Badger, T. A., Sikorskii, A., Pasvogel, A., Weihs, K., Lopez, A. M., & Chalasani, P. (2020). Longitudinal dyadic interdependence in psychological distress among Latinas with breast cancer and their caregivers. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 28(6), 2735-2743.
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  Cancer diagnosis and treatment can generate substantial distress for both survivors and their family caregivers. The primary aim of this investigation is to test a model of dyadic interdependence in distress experienced by cancer survivors and their caregivers to determine if each influences the other.
• Badger, T. A., Sikorskii, A., & Segrin, C. (2019). Contextual and Cultural Influences on Caregivers of Hispanic Cancer Survivors. Seminars in oncology nursing, 35(4), 359-362.
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  To discuss contextual factors (barriers to accessing health care, immigration issues, minority stress, low education/income, challenging employment environments) and cultural values (familism, espíritu, confianza, marianismo, machismo) of Hispanic caregivers that may influence the caregiving experience.
• Crane, T. E., Badger, T. A., Sikorskii, A., Segrin, C., Hsu, C. H., & Rosenfeld, A. G. (2019). Trajectories of Depression and Anxiety in Latina Breast Cancer Survivors. Oncology nursing forum, 46(2), 217-227.
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  To identify subgroups of Latina breast cancer survivors with unique trajectories of depression and anxiety and examine predictors associated with these subgroups.
• Pace, T. W., Pace, T. W., Dodds, S. E., Dodds, S. E., Sikorskii, A., Sikorskii, A., Badger, T. A., Badger, T. A., Segrin, C., Segrin, C., Negi, L. T., Negi, L. T., Harrison, T., Harrison, T., Crane, T. E., & Crane, T. E. (2019). Cognitively-Based Compassion Training versus cancer health education to improve health-related quality of life in survivors of solid tumor cancers and their informal caregivers: study protocol for a randomized controlled pilot trial. Trials, 20(1), 247.
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  Cancer survivors and their informal caregivers (family members, close friends) often experience significant impairments in health-related quality of life (HRQOL), including disruptions in psychological, physical, social, and spiritual well-being both during and after primary cancer treatment. The purpose of this in-progress pilot trial is to determine acceptability and preliminary efficacy (as reflected by effect sizes) of CBCT® (Cognitively-Based Compassion Training) compared with a cancer health education (CHE) attention control to improve the primary outcome of depressive symptoms and secondary outcomes of other HRQOL domains (e.g., anxiety, fatigue), biomarkers of inflammation and diurnal cortisol rhythm, and healthcare utilization-related outcomes in both cancer survivors and informal caregivers.
• Reed, P. G., Moore, K., Insel, K. C., Hinds, P. S., Bajjani-gebara, J. E., & Badger, T. A. (2019). Well-being, Self-transcendence, and Resilience of Parental Caregivers of Children in Active Cancer Treatment: Where Do We Go From Here?. Cancer nursing, 42(5), E41-E52. doi:10.1097/ncc.0000000000000662
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  Childhood cancer profoundly impacts the well-being of many parental caregivers in the United States yearly. Empirical evidence is extensive for negative well-being and scarce for positive well-being in this population..Study aims were to (1) describe resilience, self-transcendence, and positive (general well-being) and negative well-being (depression and anxiety); (2) examine if caregiver-related personal factors (resilience and/or demographic characteristics) and/or child-related contextual factors (child's cancer and/or demographic characteristics) are associated with well-being; and (3) test if self-transcendence mediates the relationship between resilience and well-being..A cross-sectional study whereby 80 caregivers of children diagnosed with childhood cancer for at least 2 months completed study questionnaires. Descriptive statistics explored sample demographics, well-being, self-transcendence, and resilience levels. Bivariate correlations examined factors associated with well-being. One-way analysis of variance and independent-samples t tests explored differences in well-being across levels of independent variables. Baron and Kenny's mediation analysis tested if self-transcendence mediated the relationship between resilience and well-being..Positive well-being and negative well-being coexist in parental caregivers. No child-related contextual factors related to caregivers' well-being. Parental caregivers' resilience and self-transcendence positively related to their general well-being and negatively related to their depression and anxiety. Satisfaction with current financial status positively related to general well-being and negatively related to depression. Self-transcendence mediated the relationship between resilience and well-being..Findings confirm the importance of focusing on both positive and negative well-being, their associated factors, and mediators..The authors discuss practice implications to enhance self-transcendence such as journaling, mindfulness techniques, activities to connect with nature, and others.
• Sikorskii, A., Sikorskii, A., Segrin, C., & Badger, T. A. (2019). A dyadic analysis of loneliness and health-related quality of life in Latinas with breast cancer and their informal caregivers.. Journal of psychosocial oncology, 37(2), 213-227. doi:10.1080/07347332.2018.1520778
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  The primary aim of this investigation is to provide a novel dyadic test of a model of loneliness and health-related quality of life (HRQoL) in a sample of Latinas with breast cancer and their informal caregivers..At baseline, dyads completed measures of loneliness and HRQoL. At a 3-month follow-up, they returned to complete the HRQoL measure. Associations were tested with the Actor-Partner Interdependence Model..About 234 Latinas with breast cancer diagnosed within the past year and their informal caregivers participated in the investigation..Loneliness was concurrently and negatively associated with HRQoL at baseline for both survivors and caregivers. Survivors' baseline loneliness, controlling for their baseline HRQoL, negatively predicted their HRQoL at 3 months. Survivors' HRQoL at baseline also predicted caregivers' HRQoL at 3 months..Loneliness is a risk factor for declines in HRQoL among cancer survivors. Their caregivers are also at risk for degraded HRQoL when the survivor experiences compromised HRQoL. Loneliness complicates the HRQoL of the cancer survivor-caregiver dyad.
• Tan, H., Mccorkle, R., Lazenby, M., Jacobsen, P. B., Grant, M., Ferrucci, L. M., Ercolano, E., & Badger, T. A. (2019). Using the RE-AIM framework for dissemination and implementation of psychosocial distress screening.. European journal of cancer care, 28(4), e13036. doi:10.1111/ecc.13036
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  To evaluate the RE-AIM framework's effect on retention of participants and implementation outcomes of a 5-year cancer research education programme on psychosocial distress screening in cancer centres across the United States..A one-group pre-/post-test design was used to evaluate the programme on participant retention and implementation outcomes at 6, 12 and 24 months after enrolling in the programme (baseline) and analysed using descriptive statistics..Seventy-two cancer centres participated in four cohorts. Participant retention was 100%. At baseline and 24 months, respectively, 52 (72%) and 64 (88%) of the cancer centres had formulated a psychosocial distress screening policy; 51 (71%) and 70 (98%) had started screening in more than one clinic/population; 15 (21%) and 45 (63%) had started auditing health records for documentation of screening. Each outcome rate improved at the cancer-centre level over the 24 months..RE-AIM can be used as a framework for cancer research education programmes. Future research is needed on the use of a randomised adaptive design to test the optimal support for implementation of quality care standards according to cancer centres' needs.
• Wijdenes, K. L., Badger, T. A., & Sheppard, K. G. (2019). Assessing Compassion Fatigue Risk Among Nurses in a Large Urban Trauma Center. The Journal of nursing administration, 49(1), 19-23.
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  This study evaluated the prevalence and severity of compassion fatigue (CF) risk among nurses employed in a large southwestern hospital system.
• Gallagher, S. P., Insel, K., Badger, T. A., & Reed, P. (2018). Antidepressant adherence in United States active duty Army Soldiers: A small descriptive study. Archives of psychiatric nursing, 32(6), 793-801.
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  While much is known about depression and antidepressant adherence associations with illness perceptions, medication beliefs, social support, and stigma in the general population, there is a dearth of knowledge among United States active duty Army Soldiers. The study objective was to explore antidepressant adherence and correlations between antidepressant adherence and illness perceptions, medication beliefs, social support, stigma and select demographic variables among Army Soldiers with depression. Results indicated age and gender were significantly correlated with and predictive of adherence. Low adherence was found. Findings suggest Soldiers who are younger and those who are female are more likely to report higher levels of adherence.
• Marshall, C. A., Curran, M. A., Brownmiller, G., Solarte, A., Armin, J., Hamann, H. A., Crist, J. D., Niemelä, M., Badger, T. A., & Weihs, K. L. (2018). Oregon's Familias en Acción replicates benefits for underserved cancer co-survivors through Un Abrazo Para la Familia. Psycho-oncology, 27(10), 2405-2411.
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  Our goal in this study was to determine if we could replicate initial findings when providing the intervention, Un Abrazo Para La Familia ("Abrazo"). Abrazo is a community-focused psychoeducational preventive intervention addressing the cancer information and coping needs of low-income, underserved family members of cancer survivors, developed and first implemented in Tucson, Arizona.
• Pasacreta, N., Mccorkle, R., Lazenby, M., Knies, A. K., Jutagir, D. R., Jacobsen, P. B., Holland, J. C., Grant, M., Ercolano, E., & Badger, T. A. (2018). Psychosocial Distress Screening: An Educational Program's Impact on Participants' Goals for Screening Implementation in Routine Cancer Care.. Clinical journal of oncology nursing, 22(3), E85-E91. doi:10.1188/18.cjon.e85-e91
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  Psychosocial distress screening is a quality care standard in cancer care. Screening implementation may be facilitated by an educational program that uses goals to evaluate progress over time..This article describes the content and design of the Screening for Psychosocial Distress Program (SPDP), reports on its delivery to 36 paired participants, and evaluates its effects on distress screening activities and goals..The SPDP used a one-group pre-/post-test design. It was delivered at 2 workshops and 10 conference calls during a two-year period. Data on screening and goal achievement were collected at 6, 12, and 24 months. Data on the quality of dyads' relationships were collected at 24 months..At 24 months, all 18 dyads had begun screening. Dyads reported working effectively together and being supportive of the other member of the dyad while achieving their goals for implementing psychosocial distress screening.
• Renz, S. M., Carrington, J. M., & Badger, T. A. (2018). Two Strategies for Qualitative Content Analysis: An Intramethod Approach to Triangulation. Qualitative health research, 1049732317753586.
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  The overarching aim of qualitative research is to gain an understanding of certain social phenomena. Qualitative research involves the studied use and collection of empirical materials, all to describe moments and meanings in individuals' lives. Data derived from these various materials require a form of analysis of the content, focusing on written or spoken language as communication, to provide context and understanding of the message. Qualitative research often involves the collection of data through extensive interviews, note taking, and tape recording. These methods are time- and labor-intensive. With the advances in computerized text analysis software, the practice of combining methods to analyze qualitative data can assist the researcher in making large data sets more manageable and enhance the trustworthiness of the results. This article will describe a novel process of combining two methods of qualitative data analysis, or Intramethod triangulation, as a means to provide a deeper analysis of text.
• Segrin, C., Badger, T. A., & Sikorskii, A. (2018). A dyadic analysis of loneliness and health-related quality of life in Latinas with breast cancer and their informal caregivers. Journal of psychosocial oncology, 1-15.
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  The primary aim of this investigation is to provide a novel dyadic test of a model of loneliness and health-related quality of life (HRQoL) in a sample of Latinas with breast cancer and their informal caregivers.
• Sikorskii, A., Sikorskii, A., Segrin, C., Pace, T. W., Crane, T. E., & Badger, T. A. (2018). A dyadic analysis of stress processes in Latinas with breast cancer and their family caregivers.. Psycho-oncology, 27(3), 838-846. doi:10.1002/pon.4580
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  Breast cancer diagnosis and treatment negatively affect quality of life for survivors and their family caregivers. The stress process model has been useful for describing the cascade of social and psychological experiences that culminate in degraded quality of life for both survivors and their family caregivers. This study is designed to test theoretically specified predictors of negative psychosocial outcomes in a dyadic context..Participants were 230 dyads composed of Latinas recently diagnosed with breast cancer and their primary family caregiver, who completed measures of socioeconomic status, stress, family conflict, depression, and anxiety. Data were analyzed following the Actor-Partner Interdependence Mediation Model in structural equation modeling..For both survivors and caregivers, there were significant direct and indirect actor effects (through family conflict) of perceived stress on depression and anxiety. Several indirect partner effects were also evident in this sample. Specifically, caregivers' stress was predictive of survivors' depression and anxiety through survivors' increased perceptions of family conflict..As predicted by the stress process model, stress and family conflict were predictive of psychological distress in breast cancer survivors and their family caregivers. Significant partner effects in the Actor-Partner Interdependence Mediation Model suggest that there are some dyadic influences, particularly from caregivers' stress to survivors' perceptions of exacerbated family conflict. These findings show how strained family relationships can aggravate the well-being of cancer survivors and their family caregivers through this challenging experience.
• Sikorskii, A., Wyatt, G., Victorson, D., Sikorskii, A., Safikhani, A., O'connor, P. A., Hankin, V., Crane, T. E., & Badger, T. A. (2018). PROMIS and legacy measures compared in a supportive care intervention for breast cancer patients and caregivers: Experience from a randomized trial.. Psycho-oncology, 27(9), 2265-2273. doi:10.1002/pon.4825
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  Accurate and efficient measurement of patient-reported outcomes is key in cancer symptom management trials. The newer Patient Reported Outcomes Measurement Information System (PROMIS) and previously developed measures of similar conceptual content (legacy) are available to measure symptoms and functioning. This report compares the performance of two sets of measures, PROMIS and legacy, in a recently completed trial of a supportive care intervention that enrolled breast cancer patients and their friend or family caregivers..Patient-caregiver dyads (N = 256) were randomized to either reflexology delivered by caregivers or usual care control. Post-intervention, PROMIS and legacy measures of symptoms and functioning were analyzed in relation to trial arm, while adjusting for baseline values. Responsiveness of the two sets of measures was assessed using effect sizes and P-values for the effect of trial arm on patients' and caregivers' symptom and functioning outcomes..Similar conclusions about intervention effects were found using PROMIS and legacy measures for pain, fatigue, sleep, anxiety, physical, and social functioning. Different conclusions were obtained for patient and caregiver depression: legacy measures indicated the efficacy of reflexology, while PROMIS depression measure did not..Evidence of similar responsiveness supports the use of either set of measures for symptoms and functioning in clinical and general populations. Differences between PROMIS and legacy measures of depression need to be considered when choosing instruments for use in trials of supportive care interventions and in clinical practice.
• Badger, T., Segrin, C., Swiatkowski, P., McNelis, M., Weihs, K., & Lopez, A. M. (2017). Why Latinas With Breast Cancer Select Specific Informal Caregivers to Participate With Them in Psychosocial Interventions. Journal of transcultural nursing : official journal of the Transcultural Nursing Society, 28(4), 391-397.
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  The purpose of this study is to describe the reasons 88 Latinas with breast cancer selected specific supportive others to participate in an 8-week psychosocial intervention. Participants were asked one open-ended question during the baseline assessment for a larger clinical trial: "Could you tell me more about why you selected [insert name] to participate in the study with you?" A content analysis of the responses found three thematic categories: source of informational or emotional support, concern for the informal caregiver's welfare, and special characteristics or qualities of the informal caregiver. These findings reflected both the cultural value of familism, the woman's role as caregiver to the family ( marianismo), and the man's role of provider ( machismo). Findings provide support for including the supportive person identified by the patient during a health crisis rather than the provider suggesting who that should be. Psychosocial services designed and implemented through such a cultural lens are more likely to be successful.
• Dorros, S. M., Segrin, C., & Badger, T. A. (2017). Cancer survivors' and partners' key concerns and quality of life. Psychology & health, 32(11), 1407-1427.
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  Understanding the concerns of cancer survivors is essential for effective interventions. This study was designed to identify the primary concerns of dyads coping with cancer, how concerns differed by role and sex, and whether concerns expressed during counselling were associated with survivors' psychosocial well-being and adjustment.
• Segrin, C., Badger, T. A., Sikorskii, A., Crane, T. E., & Pace, T. W. (2017). A dyadic analysis of stress processes in Latinas with breast cancer and their family caregivers. Psycho-oncology.
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  Breast cancer diagnosis and treatment negatively affect quality of life for survivors and their family caregivers. The stress process model has been useful for describing the cascade of social and psychological experiences that culminate in degraded quality of life for both survivors and their family caregivers. This study is designed to test theoretically specified predictors of negative psychosocial outcomes in a dyadic context.
• Sikorski, A., Wyatt, G., Lehto, R., Victorson, D., Badger, T. A., & Pace, T. (2017). Using SMART Design to Improve Symptom Management among Cancer Patients: A Methodological Overview using an Integrative Oncology Exemplar Trial. Research in Nursing & Health, 70(6), 501-511. doi:https://doi.org/10.1002/nur.21836
• Badger, T. A., Oblea, P., & Hopkins_Chadwick, D. (2016). Effect of short-term separation on the behavioral health of military wives. Journal of Psychosocial and Mental Health Service, 45-51. doi:10.3928/02793695-20160518-07
• Badger, T. A., Segrin, C., Swiakowski, P., McNeils, M., Weihs, K., & Lopez, A. M. (2016). Why Latinas selected specific informal caregivers to participate with them in psychosocial interventions. Journal of Transcultural Nursing, 1-7. doi:10.1177/1043659616656391
• Oblea, P. N., Badger, T. A., & Hopkins-Chadwick, D. L. (2016). Effect of Short-Term Separation on the Behavioral Health of Military Wives. Journal of psychosocial nursing and mental health services, 54(6), 45-51.
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  In the current prospective observational study, the impact of short-term separation on female spouses of male military officers who were scheduled to participate in a resident training program was evaluated. Using pre- and post-survey designs, participants were assessed 2 weeks prior to separation and 2 weeks prior to their husbands' returns. Participants completed the following scales: the Multidimensional Scale of Perceived Social Support, Connor-Davidson Resilience Scale, Perceived Stress Scale, Relationship Assessment Scale, and Beck Depression Inventory II Scale. No significant differences were found in perceived social support, resilience, perceived stress, relationship satisfaction, or depression scores pre- and post-separation. As predicted, depression scores were positively correlated with perceived stress scores and negatively correlated with resiliency and relationship satisfaction scores. Women with higher levels of resilience experienced lower levels of post-separation stress. [Journal of Psychosocial Nursing and Mental Health Services, 54(6), 45-51.].
• Badger, T. A., Segrin, C. G., & Pasvogel, A. (2015). Loneliness and emotional support predict physical and psychological distress in Latinas with breast cancerand their supportive partners. The Open Psychology Journal, 8(1), 105-112. doi:10.2174/1874350101508010105
• Badger, T. A., Heitkemper, M., Lee, K., & Bruner, D. W. (2014). The experience of Patient-Reported Outcomes Measurement Information System: Pros and cons and unanswered questions. Nursing Outlook, 65(5), 332-338. doi:10.1016/outlook2014.06.009
• Bean*, M., Focella*, E., Covarrubias*, R., Stone, J. A., Moskowitz, G., & Badger, T. A. (2014). Evidence for nursing and medical students’ stereotypes of Hispanic and American Indian patients.. Journal of Health Disparities Research and Practice, 7, 14-22.
• Bean, M. G., Focella, E. S., Covarrubias, R., Stone, J., Moskowitz, G. B., & Badger, T. A. (2014). Documenting Nursing and Medical Students' Stereotypes about Hispanic and American Indian Patients. Journal of health disparities research and practice, 7(4), 14.
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  Hispanic Americans and American Indians face significant health disparities compared with White Americans. Research suggests that stereotyping of minority patients by members of the medical community is an important antecedent of race and ethnicity-based health disparities. This work has primarily focused on physicians' perceptions, however, and little research has examined the stereotypes healthcare personnel associate with Hispanic and American Indian patients. The present study assesses: 1) the health-related stereotypes both nursing and medical students hold about Hispanic and American Indian patients, and 2) nursing and medical students' motivation to treat Hispanic and American Indian patients in an unbiased manner.
• Moore, I. M., & Badger, T. A. (2014). The future of oncology nursing research: Research priorities and professional development. Oncology Nursing Forum, 41(1), 93-93.
• Ramirez, J. L., & Badger, T. A. (2014). Men Navigating Inward and Outward Through Depression. Archives of Psychiatric Nursing, 28(1), 21-28.
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  Abstract: Understanding of depression among men remains poor. When compared to women, men remain under diagnosed for depression and continue to commit suicide four times the rate of women. This grounded theory study explored the social psychological process that occurred in men who suffered from depression. Nine men participated in the study that ranged in age, educational level, and marital status. The theory that emerged from this study was Navigating Inward and Outward Through Depression. This study uncovered six stages men navigated through: being different, concealing feelings disconnecting, hitting bottom, acknowledging and confronting and healing with others. This study advances our understanding of men and depression by providing meanings to the behaviors men express when depressed. Based on these findings, further research can lead to better screening tools and early diagnosis of depression in men. © 2014.
• Segrin, C., & Badger, T. A. (2014). Psychological and physical distress are interdependent in breast cancer survivors and their partners. Psychology, Health and Medicine.
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  Abstract: Objective: Breast cancer diagnosis and treatment negatively affect quality of life in survivors and their supportive partners. The purpose of this investigation was to assess the degree of dyadic interdependence in psychological and physical symptom distress in dyads adjusting to breast cancer. Method: Participants were 49 breast cancer survivors and their partners, who were spouses, other family members, or friends of the survivor. Psychological distress (depression, anxiety, and negative affect) and physical symptom distress were measured at three points in time, each separated by eight weeks. Results: Survivors and partners exhibited significant interdependence in psychological and physical symptom distress over the four-month course of the investigation. This was evident in longitudinal partner effects in actor-partner interdependence models as well as in significant T1→T3 indirect effects mediated by partner distress. Conclusions: The course of breast cancer survivors' psychological and physical symptom distress is significantly affected by that of their supportive partners and vice versa. © 2013 © 2013 Taylor & Francis.
• Badger, T. A., Segrin, C. G., Lopez, A., & Pasvogel, A. (2013). The effect of psychosocial interventions delivered by telephone or videophone on quality of life of early-stage breast cancer survivors and their supportive partners. Journal of Telemedicine and Telecare, 19(5), 260-265. doi:101177/135763X13492289
• Badger, T. A., Segrin, C., Figueredo, A. J., Harrington, J., Sheppard, K., Passalacqua, S., Pasvogel, A., & Bishop, M. (2013). Who benefits from a psychosocial counselling versus educational intervention to improve psychological quality of life in prostate cancer survivors?. Psychology and Health, 28(3), 336-354.
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  PMID: 23045995;PMCID: PMC3574213;Abstract: Objective: We examined selected survivor characteristics to determine what factors might moderate the response to two psychosocial interventions.Design: Seventy-one prostate cancer survivors (PCSs) were randomly assigned to either a telephone-delivered health education (THE) intervention or a telephone-delivered interpersonal counselling (TIP-C) intervention.Measures: Psychological quality of life (QOL) outcomes included depression, negative and positive affect, and perceived stress.Results: For three of the psychological outcomes (depression, negative affect and stress), there were distinct advantages from participating in THE. For example, more favourable depression outcomes occurred when men were older, had lower prostate specific functioning, were in active chemotherapy, had lower social support from friends and lower cancer knowledge. Participating in the TIP-C provided a more favourable outcome for positive affect when men had higher education, prostate specific functioning, social support from friends and cancer knowledge.Conclusion: Unique survivor characteristics must be considered when recommending interventions that might improve psychological QOL in PCSs. Future research must examine who benefits most and from what components of psychosocial interventions to enable clinicians to recommend appropriate psychosocial care. © 2013 Copyright Taylor and Francis Group, LLC.
• Badger, T. A., Segrin, C., Hepworth, J. T., Pasvogel, A., Weihs, K., & Lopez, A. M. (2013). Telephone-delivered health education and interpersonal counseling improve quality of life for Latinas with breast cancer and their supportive partners. Psycho-Oncology, 22(5), 1035-1042.
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  PMID: 22573418;Abstract: Objective This study aims to test two telephone-delivered interventions for their efficacy in improving quality of life (QOL) (psychological, physical, social, and spiritual) among Latinas with breast cancer and their family members or friends (labeled supportive partners in this study). Methods Latinas with breast cancer and their supportive partners (SPs) were randomly assigned to one of two telephone delivered 8-week interventions: (i) telephone interpersonal counseling (TIP-C) or (ii) telephone health education (THE). QOL assessments were made at baseline, immediately after the 8-week interventions ended, and at an 8-week follow-up. Seventy Latinas and their 70 SPs completed all assessments (36 in health education and 34 in counseling) and were included in the final analysis. Results Both Latinas with breast cancer and their SPs had significant improvements in virtually all dimensions of QOL over the 16 weeks of the investigation. However, there was no evidence documenting the superiority of either intervention for improving QOL. Preliminary cost analysis found that the counseling intervention cost about $164.68 for one dyad compared with $107.03 for health education. The majority of participants reported benefit from the intervention and liked that the intervention was in Spanish, included SPs, and was delivered by telephone. Conclusion The results of this study show that relatively brief, culturally appropriate, and highly accessible telephone-delivered interventions that provide emotional and information support can bring about substantial improvements in QOL for both Latinas with breast cancer and their SPs. Copyright © 2012 John Wiley & Sons, Ltd.
• Badger, T., Segrin, C., Pasvogel, A., & Lopez, A. M. (2013). The effect of psychosocial interventions delivered by telephone and videophone on quality of life in early-stage breast cancer survivors and their supportive partners. Journal of Telemedicine and Telecare, 19(5), 260-265.
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  PMID: 24163235;Abstract: We examined the effectiveness of two psychosocial interventions for improving QOL in recently diagnosed breast cancer survivors and their partners. The interventions were telephone health education (THE) and interpersonal counselling. The latter was delivered by telephone (TC) or by videophone (VC) in 8 weekly one-to-one sessions. Fifty two dyads composed of a woman with breast cancer and her supportive partner were randomly assigned to THE, TC or VC. The average age of the survivors was 53 years (range 40-66), and they were mainly white, married, with a college education, and employed. Approximately half of the supportive partners were spouses. Surveys of quality of life (QOL) were made at three points in the study, each separated by 8 weeks. There was significantly higher attrition in the THE group compared to the videophone or telephone counselling groups among both survivors (44% vs. 10% and 8%) and partners (44% vs. 10% and 15%). Regardless of group, participants showed increased QOL over time. Survivors' and partners' social well-being improved in the telephone and videophone interpersonal counselling treatment groups, but not in the health education group. Telephone-delivered psychosocial interventions can be effective for managing QOL in breast cancer survivors and their supportive partners. There was no evidence of superior outcomes associated with using videophones over the conventional telephone.
• Bean, M. G., Stone, J., Moskowitz, G. B., Badger, T. A., & Focella, E. S. (2013). Evidence of nonconscious stereotyping of hispanic patients by nursing and medical students. Nursing Research, 62(5), 362-367.
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  PMID: 23995470;PMCID: PMC3763916;Abstract: BACKGROUND: Current research on nonconscious stereotyping in healthcare is limited by an emphasis on practicing physicians' beliefs about African American patients and by heavy reliance on a measure of nonconscious processes that allows participants to exert control over their behaviors if they are motivated to appear nonbiased. OBJECTIVES: The present research examined whether nursing and medical students exhibit nonconscious activation of stereotypes about Hispanic patients using a task that subliminally primes patient ethnicity. It was hypothesized that participants would exhibit greater activation of noncompliance and health risk stereotypes after subliminal exposure to Hispanic faces compared with non-Hispanic White faces and, because ethnicity was primed outside of conscious awareness, that explicit motivations to control prejudice would not moderate stereotype activation. METHODS: Nursing and medical students completed a sequential priming task that measured the speed with which they recognized words related to noncompliance and health risk after subliminal exposure to Hispanic and non-Hispanic White faces. They then completed explicit measures of their motivation to control prejudice against Hispanics. RESULTS: Both nursing and medical students exhibited greater activation of noncompliance and health risk words after subliminal exposure to Hispanic faces, compared with non-Hispanic White faces. Explicit motivations to control prejudice did not moderate stereotype activation. DISCUSSION: These findings show that, regardless of their motivation to treat Hispanics fairly, nursing and medical students exhibit nonconscious activation of negative stereotypes when they encounter Hispanics. Implications are discussed. © 2013 Wolters Kluwer Health Lippincott Williams and Wilkins.
• Hsu, Y., Badger, T. A., Reed, P. G., & Jones, E. G. (2013). Factors associated with depressive symptoms in older Taiwanese adults in a long-term care community. International Psychogeriatrics, 25(6), 1013-1021.
• Marshall, C. A., Badger, T. A., Curran, M. A., Koerner, S. S., Larkey, L. K., Weihs, K. L., Verdugo, L., & A., F. (2013). Un Abrazo Para la Familia: Providing low-income Hispanics with education and skills in coping with breast cancer and caregiving. Psycho-Oncology, 22(2), 470-474.
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  PMID: 22140003;PMCID: PMC3563927;Abstract: Objective Un Abrazo Para La Familia (A Hug for the Family) is an intervention designed to increase the accessibility of cancer information to low-income and medically underserved co-survivors of cancer. Co-survivors are family members or friends of an individual diagnosed with cancer. Our goal was to increase socio-emotional support for these co-survivors and improve skills in coping with cancer. The purpose of our pilot study was to explore the effectiveness of the intervention in increasing cancer knowledge and self-efficacy among co-survivors. Methods Un Abrazo consisted of three one-hour sessions, in either Spanish or English. Sessions were delivered by a trained promotora (community health worker), in partnership with a counselor. Sixty participants completed measures of cancer knowledge and self-efficacy preceding (pre-test) and following the intervention (post-test). Results From pre-test to post-test, the percentage of questions answered correctly about cancer knowledge increased (p < 0.001), as did ratings of self-efficacy (p < 0.001). Decreases were seen in 'Do not know' responses for cancer knowledge (p < 0.01), with a negative correlation between number of 'Do not knows' on cancer knowledge at pre-test and ratings of self-efficacy at pre-test (r = -0.47, p < 0.01). Conclusions When provided an accessible format, co-survivors of cancer from underserved populations increase their cancer knowledge and self-efficacy. This is notable because research indicates that family members and friends with increased cancer knowledge assume more active involvement in the cancer care of their loved ones. Copyright © 2011 John Wiley & Sons, Ltd.
• Segrin, C. G., & Badger, T. A. (2013). Interdependent psychological distress between Latinas with breast cancer and their supportive partners. Journal of Latino/a Psychology, 1(1), 21-34.
• Segrin, C., Badger, T. A., & Harrington, J. (2012). Interdependent psychological quality of life in dyads adjusting to prostate cancer. Health Psychology, 31(1), 70-79.
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  PMID: 21895374;PMCID: PMC3882321;Abstract: Objective: Prostate cancer negatively influences quality of life (QOL) in survivors and the people with whom they are close. The purpose of this investigation was to assess the degree of dyadic interdependence in psychological QOL in dyads adjusting to prostate cancer and its treatment. Method: Participants were 70 prostate cancer survivors and their partners, most of whom were spouses. Assessments of psychological QOL (i.e., depression, anxiety, fatigue, and positive affect) were made at three points in time, each separated by 8 weeks. Results: Survivors' prostate specific function was associated with both their own and their partners' psychological QOL. There was evidence of longitudinal dyadic interdependence for psychological QOL, particularly from partners to survivors between the T2 and T3 assessments. Conclusions: Prostate cancer survivors' psychological QOL is affected substantially by their partners' psychological QOL, consistent with theories of emotional contagion. © 2011 American Psychological Association.
• Badger, T. A., Segrin, C., & Meek, P. (2011). Development and validation of an instrument for rapidly assessing symptoms: The general symptom distress scale. Journal of Pain and Symptom Management, 41(3), 535-548.
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  PMID: 21131168;PMCID: PMC3062688;Abstract: Context: Symptom assessment has increasingly focused on the evaluation of total symptom distress or burden rather than assessing only individual symptoms. The challenge for clinicians and researchers alike is to assess symptoms, and to determine the symptom distress associated with the symptoms and the patient's ability for symptom management without a lengthy and burdensome assessment process. Objectives: The objective of this article was to discuss the psychometric evaluation of a brief general symptom distress scale (GSDS) developed to assess specific symptoms and how they rank in relation to each other, the overall symptom distress associated with the symptom schema, and provide an assessment of how well or poorly that symptom schema is managed. Methods: Results from a pilot study about the initial development of the GSDS with 76 hospitalized patients are presented, followed by a more complete psychometric evaluation of the GSDS using three samples of cancer patients (n = 190) and their social network members, called partners in these studies (n = 94). Descriptive statistics were used to describe the GSDS symptoms, symptom distress, and symptom management. Point biserial correlations indexed the associations between dichotomous symptoms and continuous measures, and conditional probabilities were used to illustrate the substantial comorbidities of this sample. Internal consistency was examined using the KR-20 coefficient, and test-retest reliability was examined. Construct validity and predictive validity also were examined. Results: The GSDS demonstrated satisfactory internal consistency and test-retest reliability, and good construct validity and predictive validity. The total score on the GSDS, symptom distress, and symptom management correlated significantly with related constructs of depression, positive and negative affect, and general health. The GSDS was able to demonstrate its ability to distinguish between those with or without chronic illness, and was able to significantly predict scores on criterion measures such as depression. Conclusion: Collectively, these results suggest that the GSDS is a straightforward and useful instrument for rapidly assessing symptoms that can disrupt health-related quality of life. © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
• Badger, T. A., Segrin, C., Figueredo, A. J., Harrington, J., Sheppard, K., Passalacqua, S., Pasvogel, A., & Bishop, M. (2011). Psychosocial interventions to improve quality of life in prostate cancer survivors and their intimate or family partners. Quality of Life Research, 20(6), 833-844.
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  PMID: 21170682;PMCID: PMC3117079;Abstract: Purpose: The primary purpose was to test the effectiveness of two telephone-delivered psychosocial interventions for maintaining and improving quality of life (QOL) (psychological, physical, social, and spiritual well-being) among 71 prostate cancer survivors and the 70 intimate or family partners who were supporting them in their recovery. Methods: This study used a three-wave repeated measures experimental design. Both the interpersonal counseling intervention (TIP-C) and health education attention condition (HEAC) were delivered using the telephone. Results: Improvements in depression, negative affect, stress, fatigue, and spiritual well-being were significantly higher for survivors in the HEAC than for those in the TIP-C condition. Partners in the HEAC condition showed significantly greater improvements in depression, fatigue, social support from family members, social well-being, and spiritual well-being compared to partners in the TIP-C condition. The results revealed superior outcomes for those assigned to the HEAC intervention. Conclusions: The psychosocial interventions in this study were effective in maintaining or improving the QOL for prostate cancer survivors and their partners. Both the survivor and their intimate partner or family member benefitted from the interventions. Future research is needed to determine the optimal timing and client characteristics for each intervention. © 2010 Springer Science+Business Media B.V.
• Marshall, C. A., Larkey, L. K., Curran, M. A., Weihs, K. L., Badger, T. A., Armin, J., & García, F. (2011). Considerations of Culture and Social Class for Families Facing Cancer: The Need for a New Model for Health Promotion and Psychosocial Intervention. Families, Systems and Health, 29(2), 81-94.
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  PMID: 21688902;PMCID: PMC3521537;Abstract: Cancer is a family experience, and family members often have as much, or more, difficulty in coping with cancer as does the person diagnosed with cancer. Using both family systems and sociocultural frameworks, we call for a new model of health promotion and psychosocial intervention that builds on the current understanding that family members, as well as the individuals diagnosed with cancer, are themselves survivors of cancer. We argue that considering culture, or the values, beliefs, and customs of the family, including their choice of language, is necessary to understand fully a family's response to cancer. Likewise, acknowledging social class is necessary to understand how access to, and understanding of, otherwise available interventions for families facing cancer can be limited. Components of the model as conceptualized are discussed and provide guidance for psychosocial cancer health disparities research and the development of family-focused, strength-based, interventions. © 2011 American Psychological Association.
• Marshall, C. A., Weihs, K. L., Larkey, L. K., Badger, T. A., Koerner, S. S., Curran, M. A., Pedroza, R., & A., F. (2011). like a mexican wedding: Psychosocial intervention needs of predominately hispanic low-income female co-survivors of cancer. Journal of Family Nursing, 17(3), 380-402.
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  PMID: 21813816;Abstract: Although recent work has recognized that the influence and consequences of cancer extend beyond the individual receiving the diagnosis, no studies have focused on the specific psychosocial intervention needs of female co-survivors in low-income populations. In this qualitative study, the co-survivors, 16 women, representing 10 low-income families and predominately Hispanic, were interviewed about their experience of having someone in their family diagnosed with cancer. Several themes emerged from the data, including family stress, lack of skill in coping with the effects of cancer (e.g., depression of their loved one), a need for financial help, a willingness to share with others, and reliance on faith to see them through the cancer experience. Whereas no agreement existed as to where and how to provide an intervention, participants reported that tailoring an intervention to family needs and delivering it in a way that was accessible to them was important. © The Author(s) 201.
• Segrin, C. G., Badger, T. A., & Figueredo, A. J. (2011). Stage of disease progression moderates the association between social support and depression in prostate cancer survivors. Journal of Psychosocial Oncology, 29, 552-560. doi:10.1037/a0023975
• Badger, T. A., McCorkle, R., & LeBaron, V. T. (2010). Screening for emotional distress in older patients with lung cancer. Oncology Nurse Edition, 24(4), 25-27, 36-37.
• Badger, T., Segrin, C., & Badger, T. A. (2010). Psychological distress in different social network members of breast and prostate cancer survivors. Research in nursing & health, 33(5).
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  The purposes of this investigation were to compare psychological distress among cancer survivors' social network members with different relationships with the survivors and to compare their reported levels of distress with population norms. Participants in this investigation included spouses/significant others (n = 153), siblings (n = 11), adult children (n = 25), parents (n = 10), cousins (n = 6), and friends/others (n = 10) of English or Spanish speaking women with breast cancer and English speaking men with prostate cancer. Network members reported on their symptoms of depression, positive and negative affect, anxiety, and relationship satisfaction. The psychological distress among all relationship types was similar. Spouses, and to a lesser extent, adult children were the only groups whose levels of psychological distress were above population norms. Relationship satisfaction was negatively associated with social network members' psychological distress, and female network members had higher levels of depression than male network members due, in part, to higher perceived stress among female network members. These findings highlight the need to consider the potentially deleterious impact of cancer not just on survivors' spouses, but on other social network members as well and to make services available to network members who may play an important role in the survivor's care and adjustment.
• Dorros, S. M., Card, N. A., Segrin, C., & Badger, T. A. (2010). Interdependence in Women With Breast Cancer and Their Partners: An Interindividual Model of Distress. Journal of Consulting and Clinical Psychology, 78(1), 121-125.
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  PMID: 20099957;PMCID: PMC2843088;Abstract: Objective: The aim of this investigation was to test whether interdependence in dyads living with breast cancer could account for person-partner crossover effects in distress outcomes. Method: The sample consisted of 95 dyads with early-stage breast cancer. By using reciprocal dyadic data from women with breast cancer and their partners, we fit a structural equation model of the actor-partner interdependence model to examine the interaction of participants' depression and stress in predicting their partner's health outcomes. Results: Results revealed a pattern of influence whereby the interaction of high levels of depression coupled with high levels of stress in women with breast cancer was associated with lowered physical health and well-being in their partners. Although depression seemed to be the key mechanism in predicting distressing outcomes, when depression was combined with any additional stress, the level of physical distress was significantly greater. Results provided preliminary empirical support for crossover effects in the physical well-being of close relational partners in a cancer-related context. Further, results showed that distressing outcomes need not be limited to emotional distress but can also include physical distress. Conclusions: The findings from this study illustrate why it is not sufficient to concentrate care solely on the patient with cancer. Monitoring the social well-being of patients as they go through the cancer process could be as important as assessing their psychological state or other peripheral biomarkers. This line of inquiry would be advanced by including methods other than self-report in assessments of psychological and physical health. © 2010 American Psychological Association.
• Segrin, C., & Badger, T. A. (2010). Psychological distress in different social network members of breast and prostate cancer survivors.. Research in nursing & health, 33(5), 450-464.
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  PMID: 20672304;PMCID: PMC2966868;Abstract: The purposes of this investigation were to compare psychological distress among cancer survivors' social network members with different relationships with the survivors and to compare their reported levels of distress with population norms. Participants in this investigation included spouses/significant others (n=153), siblings (n=11), adult children (n=25), parents (n=10), cousins (n=6), and friends/others (n=10) of English or Spanish speaking women with breast cancer and English speaking men with prostate cancer. Network members reported on their symptoms of depression, positive and negative affect, anxiety, and relationship satisfaction. The psychological distress among all relationship types was similar. Spouses, and to a lesser extent, adult children were the only groups whose levels of psychological distress were above population norms. Relationship satisfaction was negatively associated with social network members' psychological distress, and female network members had higher levels of depression than male network members due, in part, to higher perceived stress among female network members. These findings highlight the need to consider the potentially deleterious impact of cancer not just on survivors' spouses, but on other social network members as well and to make services available to network members who may play an important role in the survivor's care and adjustment. © 2010 Wiley Periodicals, Inc. Res Nurs Health 33:450-464, 2010.
• Sheppard, K. G., & Badger, T. A. (2010). The lived experience of depression among culturally deaf adults. Journal of Psychiatric and Mental Health Nursing, 9, 783-789.
• Harrington, J. H., Badger, T. A., & Jones, E. G. (2009). Body Image perceptions in men with prostate cancer. Oncology Nursing Forum, 36(2), 167-172.
• Harrington, J. M., & Badger, T. A. (2009). Body image and quality of life in men with prostate cancer. Cancer Nursing, 32(2), E1-E7.
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  PMID: 19258822;Abstract: Each of the successful treatment options for men with prostate cancer is accompanied by its unique side effect profile. However, treatment with androgen deprivation therapy (ADT) and the resulting castrate level of testosterone lead to profound changes in one's physical appearance. The goal of this descriptive study was to describe the relationship between changes in body image and quality of life (QOL) among prostate cancer survivors based upon whether or not treatment was with ADT. A convenience sample of 132 men (aged ≥60 years) with prostate cancer were recruited from the oncology and urology outpatient departments at an urban Veterans Affairs Medical Center. The participants completed 2 established questionnaires, the Body Image Scale and the Quality of Life Index-Cancer Version. Descriptive and inferential statistics were used in the analysis. There was no difference in QOL based on ADT. There was a significant negative correlation between body image dissatisfaction and QOL. The findings add to our knowledge regarding body image and QOL among men with prostate cancer, provide a foundation for future research endeavors, and support the development of evidence-based interventions to mitigate body image dissatisfaction. © 2009 Lippincott Williams & Wilkins, Inc.
• Badger, T. A. (2008). A nursing perspective of depression in cancer survivors and their partners. Nursing Science Quarterly, 21(1), 43-44.
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  PMID: 18246647;
• Badger, T. A. (2008). Depression assessment and psychosocial interventions for cancer survivors and their partners. Oncology Nursing Forum, 35(5), E76-E82.
• Fulcher, C. D., Badger, T., Gunter, A. K., Marrs, J. A., & Reese, J. M. (2008). Putting evidence into practice^®: Interventions for depression. Clinical Journal of Oncology Nursing, 12(1), 131-140.
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  PMID: 18258583;Abstract: Depression and depressive symptoms are prevalent in people with cancer, yet interventions for depression are a low priority for most oncology care providers. Barriers to diagnosis and treatment include beliefs by patients and providers that depression is an expected correlate of cancer diagnosis, the reluctance of patients to share psychological concerns, and the reticence of some professionals to assess patients with cancer for depressive symptoms in the midst of busy oncology settings. Intervening to diminish depressive symptoms in people with cancer is important because depression has been associated with poorer quality of life, recovery, and possibly survival. This article reviews and summarizes the evidence for pharmacologic and nonpharmacologic interventions for people with cancer and depression and identifes opportunities for future research and practice change.
• Badger, T., Segrin, C., Dorros, S. M., Meek, P., & Lopez, A. M. (2007). Depression and anxiety in women with breast cancer and their partners. Nursing Research, 56(1), 44-53.
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  PMID: 17179873;Abstract: BACKGROUND: Psychosocial interventions can improve psychological quality of life (symptoms of depression and anxiety) of both women with breast cancer and their partners, but are not offered routinely to women and their partners. OBJECTIVE: To test the hypotheses that telephone-delivered psychosocial interventions decrease depression and anxiety in women with breast cancer and their partners. METHODS: The design of the study was a three-wave repeated measures with a between-subjects factor (treatment group). Ninety-six women and their 96 partners were assigned randomly to participate in one of three different 6-week programs: (a) telephone interpersonal counseling (TIP-C); (b) self-managed exercise; or (c) attention control (AC). RESULTS: The mixed-model analysis of variance for symptoms of depression among women with breast cancer revealed women's depressive symptom scores decreased over time in all groups. For anxiety, women's symptoms of anxiety decreased in the TIP-C and exercise groups over time, but not in the AC group. A parallel set of analyses was conducted on partners' depression and anxiety data. Symptoms of depression and anxiety among the partners decreased substantially over the course of the investigation. Similar to the women, partners' symptoms of anxiety decreased significantly in the TIP-C and exercise groups, but not in the AC group. DISCUSSION: Findings from this study support that these telephone-delivered psychosocial interventions were effective for decreasing symptoms of depression and anxiety to improve psychological quality of life when compared to an AC group. © 2007 Lippincott Williams & Wilkins, Inc.
• Segrin, C., Badger, T., Dorros, S. M., Meek, P., & Lopez, A. M. (2007). Interdependent anxiety and psychological distress in women with breast cancer and their partners. Psycho-Oncology, 16(7), 634-643.
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  PMID: 17094160;Abstract: The purpose of this study was to determine the extent of interdependence on anxiety within dyads where one person was undergoing treatment for breast cancer. Perceptions of relationship quality were expected to mitigate the anxiety experienced by both members of the dyad. 96 dyads participated in a 3-wave longitudinal study that took place over 10 weeks. Dyads were composed of a woman with stage I-III breast cancer who was currently undergoing treatment, and a partner who she nominated to participate in the study along with her. Results indicated that anxiety felt by women with breast cancer was consistently associated with that of her partner. Structural equation analyses suggest that the within-dyad influence runs mostly from partners' anxiety to the anxiety of women with breast cancer. Partners' anxiety was also associated with other indicators of the women's well being including depression, fatigue, and symptom management. Perceptions of relationship quality from women with breast cancer and their partners were negatively associated with partners' anxiety. However, women's anxiety was only correlated with their partners', but not their own, perceptions of relationship quality. These findings underscore the benefit of having partners who are able to cope with or get help for their own personal distress as women cope with the stress of breast cancer and its treatment. Copyright © 2006 John Wiley & Sons, Ltd.
• Badger, T. A., & Segrin, C. (2006). Interpersonal relationship quality in people with cancer. Psycho-Oncology, 15, S2.
• Segrin, C., Badger, T., Sieger, A., Meek, P., & Lopez, A. M. (2006). Interpersonal well-being and mental health among male partners of women with breast cancer. Issues in Mental Health Nursing, 27(4), 371-389.
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  PMID: 16546936;Abstract: The focus of this investigation was on the mental health of men whose partners had recently been diagnosed with breast cancer. In accord with theoretical models that specify the importance of interpersonal relationships in maintaining mental health, men's relationship satisfaction and perceptions of social support were predicted to be positively associated with their mental health during this stressful time. The sample included 63 male partners of women with breast cancer who participated in a three-wave panel study that assessed various indicators of mental health and interpersonal well being at T1, T1 + 6 weeks, and T1 + 10 weeks. Results indicated substantial distress in at least 25% of the men. However this distress subsided over time. Relationship satisfaction was both concurrently and prospectively associated with better mental health. Social support was negatively associated with concurrent mental health but post hoc analyses suggested that men's social networks perhaps provide greater social support to the extent that the men are emotionally distressed. Copyright © Taylor & Francis Group, LLC.
• Badger, T. A., Segrin, C., Meek, P., Lopez, A., & Seiger, A. (2005). Symptom managment and QOL trajectories for women with breast cancer. Psycho-Oncology, 14, S104.
• Badger, T., Segrin, C., Meek, P., Lopez, A. M., & Bonham, E. (2005). Profiles of women with breast cancer: Who responds to a telephone interpersonal counseling intervention?. Journal of Psychosocial Oncology, 23(2-3), 79-100.
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  PMID: 16492653;Abstract: The purpose of this paper is to discuss the profiles of women with breast cancer for whom a telephone interpersonal counseling intervention (TIP-C) was beneficial for symptom management and quality of life. This analysis was based on 24 participants who completed the telephone counseling intervention and all three measurements over the course of 10-week pilot study. The typical woman with breast cancer was white, in her mid-fifties and married at the time of the study. The majority was Stage II and was receiving chemotherapy as their primary adjuvant treatment. Preliminary findings suggest that women who were in long-term marriages and reported no previous history of depression or cancer benefited most from the intervention. These women reported less depression, negative affect, symptom distress and fatigue, and improved quality of life. Several theories are proposed for these findings and implications for practice are discussed. © 2005 by The Haworth Press, Inc. All rights reserved.
• Badger, T., Segrin, C., Meek, P., Lopez, A. M., Bonham, E., & Sieger, A. (2005). Telephone interpersonal counseling with women with breast cancer: Symptom management and quality of life. Oncology Nursing Forum, 32(2), 273-279.
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  PMID: 15759065;Abstract: Purpose/Objectives: To examine the effectiveness of a telephone interpersonal counseling (TIP-C) intervention compared to a usual care attentional control for symptom management (depression and fatigue) and quality of life (positive and negative affect, stress) for women with breast cancer. Design: Experimental with repeated measures. Setting: Academic cancer center and urban, private oncology offices. Sample: 48 women with breast cancer who were in their mid-50s, married, and employed at the time of the study. Methods: Women were assigned to either the six-week TIP-C or attentional usual care groups. Women were matched on stage and treatment. Data were collected at baseline, after the six interventions, and one month postintervention. Measures included the Center for Epidemiologie Studies-Depression Scale, Positive and Negative Affect Schedule, Multidimensional Fatigue Inventory, and Index of Clinical Stress. Main Research Variables: Depression, positive and negative affect, fatigue, and stress. Findings: Women in the intervention group experienced decreases in depression, fatigue, and stress over time and increases in positive affect. Conclusions: The preliminary results partially supported the effectiveness of TIP-C for symptom management and quality of life. The authors hypothesized that decreased depression, reduced negative affect, decreased stress, decreased fatigue, and increased positive affect over time would be the resulting psychosocial effects, given the theoretical underpinnings of the intervention. Implications for Nursing: Nurses need to assess the quantity and quality of the social support network early in treatment; women with less social support need to be referred to counseling and support services. Because these women have limited participation in face-to-face interventions, they should be encouraged to participate in telephone or online support programs or in other programs or organizations (e.g., churches, social clubs) that would provide support.
• Bennett, G., & Badger, T. A. (2005). Depression in men with prostate cancer. Oncology Nursing Forum, 32(3), 545-556.
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  PMID: 15897931;Abstract: Purpose/Objectives: To summarize the current empirical knowledge base on depression in men with prostate cancer to inform psychosocial supportive care interventions for this population and chart directions for future research. Data Sources: Reports in English of quantitative studies that included measures of depression or mood in samples of men with prostate cancer published from 1988-2004. Data Synthesis: Nurse researchers are playing a key role in establishing the scientific knowledge base upon which a better understanding of the relative importance of depression in men with prostate cancer will emerge. This review indicates that (a) predictable risk factors exist for depression among men with prostate cancer, (b) different prostate cancer treatments do not tend to be associated with differential outcomes in depression or mood, and (c) overall, men with prostate cancer report fewer depressive symptoms than women with breast cancer. Conclusions: The small body of research addressing depression in men with prostate cancer is methodologically inadequate to estimate the overall prevalence of depression among men with prostate cancer and determine the clinical significance of psychoeducational interventions targeting depression or mood in this population. Implications for Nursing: Nurses can use current knowledge to identify men with prostate cancer who are most at risk for depression. Evidence supporting the benefit of psychoeducational interventions for depression in other cancer populations (e.g., women with breast cancer) may be applicable to men with prostate cancer.
• Segrin, C., Badger, T. A., Meek, P., Lopez, A. M., Bonham, E., & Sieger, A. (2005). Dyadic interdependence on affect and quality-of-life trajectories among women with breast cancer and their partners. Journal of Social and Personal Relationships, 22(5), 673-689.
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  Abstract: This study explored interdependence on quality-of-life factors for women with breast cancer and their partners. Multiple theoretical perspectives predict that the emotional distress experienced by women with breast cancer would be shared by their partners. To test these predictions, 48 women with breast cancer and their partners (husbands, daughters, friends, or other relations) participated in a three-wave, 10-week, longitudinal study. Quality-of-life (QOL) indicators (depressive symptoms, positive and negative affect, and stress) were measured in both women and their partners. Baseline data revealed significant partner effects from stress and negative affect in women with breast cancer to their partners' depression. Analysis of QOL rates and directions of change over time revealed that the QOL was on a similar trajectory. As the emotional well-being of women with breast cancer improved or deteriorated, their partners' well-being changed also. Copyright © 2005 SAGE Publications.
• Badger, T. A., Braden, C. J., Mishel, M. H., & Longman, A. (2004). Depression burden, psychological adjustment, and quality of life in women with breast cancer: Patterns over time. Research in Nursing and Health, 27(1), 19-28.
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  PMID: 14745853;Abstract: The purpose of this study was to examine how level of depression burden influences women's psychological adjustment and quality of life over time and how depression burden interacted with a community-based oncology support program to influence psychological adjustment and life quality. Participants were 169 women who completed a side effects checklist at three data collection points. Women were divided into two groups based on their depression burden scores: 123 women reporting no burden, and 46 women reporting high depression burden. For psychological adjustment, there were significant interaction effects for intervention by time and for intervention by depression burden by time and significant main effects for depression burden. For life quality, there was a significant interaction effect for intervention by time and a significant main effect for depression burden. The findings document the negative impact of depression burden on psychological adjustment and life quality. Oncology support interventions can be effective in reducing this negative impact. © 2004 Wiley Periodicals, Inc.
• Badger, T., Gelenberg, A. J., & Berren, M. (2004). Consultative intervention to improve outcomes of high utilizers in a public mental health system. Perspectives in Psychiatric Care, 40(2), 53-60+69.
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  PMID: 15323413;Abstract: PURPOSE. To examine the effectiveness of an academic consultation on outcomes among consumers in a public mental health system and to compare outcomes between high-cost/high-utilizer and midcost consumers. METHODS. Participants (N = 36) completed all questionnaires during three semistructured interviews. Using a repeated-measures experimental design, the outcomes of global functioning, quality of life, service use and need, costs, and consumer satisfaction were examined. FINDINGS. The hypothesis that consultation would change medication practices and reduce costs was supported. CONCLUSIONS. Consultation with a senior clinician helped change medication practices and reduced costs. Consultation may lead to recognition of a new diagnosis (medical, neurologic, or psychiatric) or suggestions for modifying a treatment regimen that could improve functioning and QOL. In a busy public mental health system, there is often little time for consultation and little thought to second opinions. For clients who cost the system the greatest amount, the small additional cost of a consultation is a good potential investment.
• Badger, T., Segrin, C., Meek, P., Lopez, A. M., & Bonham, E. (2004). A case study of telephone interpersonal counseling for women with breast cancer and their partners.. Oncology nursing forum, 31(5), 997-1003.
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  PMID: 15378101;Abstract: PURPOSE/OBJECTIVES: To present a case study of one woman with breast cancer and her partner to provide a firsthand account of an innovative telephone interpersonal counseling intervention. DATA SOURCES: Journal articles, book chapters, research data, and transcriptions of telephone counseling sessions. DATA SYNTHESIS: Substantial evidence exists that face-to-face psychosocial interventions improve psychological adjustment and health-related quality of life for patients with cancer. Yet psychosocial interventions are not offered routinely, and many patients with cancer do not use face-to-face counseling mechanisms. The telephone may be an innovative and effective method of delivering interventions, and telephone-delivered interpersonal counseling may be an especially effective intervention for women with breast cancer and their partners. CONCLUSIONS: Despite the fact that the telephone counseling occurred over a brief period of time, the woman and her partner in this case study reported substantial positive changes in their own distress (e.g., symptoms such as depression and anxiety) and the nature of their relationships with each other and their children. This is precisely the effect that would be predicted by interpersonal theories of psychological distress. These results were not atypical for other women and their partners who participated in the study. IMPLICATIONS FOR NURSING: Family members play a significant role in supporting women through the breast cancer experience; thus, nurses should assess the emotional distress of both partners during the course of treatment and, if needed, provide critical education and referral to psychosocial interventions. This woman and her partner clearly benefited from the intervention, resulting in improved symptom management and quality of life. Although this intervention requires additional training in the advanced practice nursing role, some techniques of the intervention can be used by all nurses, regardless of specialty training.
• Badger, T. A., & McArthur, D. B. (2003). Academic nursing clinic: Impact on health and cost outcomes for vulnerable populations. Applied Nursing Research, 16(1), 60-64.
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  PMID: 12624864;Abstract: The purpose of this study was to examine selected health and cost outcomes of clients who used an academic nursing clinic (ANC) located in a high-rise public housing facility for low-income citizens. Service use, health promotion and screening, quality of care, satisfaction and costs were examined. Health outcomes were improved. Estimated cost savings were about $36,000 during the first year with reduced paramedic and police calls, hospitalizations, and emergency room visits. Findings show that advanced practice nurses can positively influence health outcomes by providing cost-effective quality health care.
• Badger, T. A., McNiece, C., Bonham, E., Jacobson, J., & Gelenberg, A. J. (2003). Health outcomes for people with serious mental illness: A case study. Perspectives in Psychiatric Care, 39(1), 23-32.
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  PMID: 12724963;Abstract: PURPOSE. To describe outcomes of clients with serious mental illnesses who used regional public mental health services; and what the public mental health system did well or needed to change to better satisfy clients' needs. METHODS. A modal case study analysis method was used with 15 clients. Participants were interviewed three times. FINDINGS. Participants reported dissatisfaction with their social functioning and general health, and unmet needs for case management services, social/recreational activities, and vocational rehabilitation. CONCLUSIONS. The case study method is an effective way for nurses to evaluate public mental health systems and to determine areas for system intervention.
• Insel, K., & Badger, T. A. (2002). Deciphering the 4D's: Cognitive declilne, dementia, delirium and depression. Journal of Advanced Practice, 38, 1-9.
• McDonald, J., & Badger, T. A. (2002). Social function of persons with schizophrenia. Journal of Psychosocial Nursing and Mental Health Services, 40(6), 42-50.
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  PMID: 12073280;
• Badger, T. A. (2001). Depression, psychological resources and health-related quality of life in older adults: Aged 75 and older. Jouranl of Clinical Geropsychology, 7(3), 189-199.
• Badger, T. A., Braden, C. J., & Mishel, M. H. (2001). Depression burden, self-help interventions, and side effect experience in women receiving treatment for breast cancer.. Oncology nursing forum, 28(3), 567-574.
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  PMID: 11338763;Abstract: PURPOSE/OBJECTIVES: To describe effects of a set of Self-Help Intervention Project (SHIP) interventions with self-reported depression burden on the side effect experience of women receiving treatment for breast cancer. DESIGN: Repeated measures, experimental design. SETTING: Outpatient sites at a regional cancer center, private practices, and health maintenance organizations. SAMPLE: 169 women who completed data at all three data-collection points were used to answer the research questions. METHODS: Following random assignment, individuals in the treatment group participated in five different, but complementary, self-help interventions for six weeks. The control group received the usual care. Variables were measured at baseline after radiation, chemotherapy, or hormone therapies were started to allow for the side effects to emerge at six to eight weeks after treatment and three months following time 2. MAIN VARIABLES: Depression burden, fatigue burden, pain burden, nausea burden, difficulty concentrating burden, anxiety burden, number of side effects, severity of side effects, and participation in the interventions. FINDINGS: Self-reported depression burden was found to significantly influence severity of side effects, number of side effects, and the burdens of fatigue, difficulty concentrating, and anxiety. Depression burden did not significantly influence the side effect burdens of nausea or pain. Depression burden interacted with the self-help interventions over time for the side effect of fatigue, but the intervention effect on pain burden and nausea burden was not influenced by depression burden over time. No significant intervention effects were found for the burden of difficulty concentrating or anxiety, the number of side effects, or perceived severity of side effects. The interventions significantly reduced the fatigue, pain, and nausea burden in women with breast cancer. CONCLUSIONS: The interventions were particularly helpful, relative to their fatigue experience, for women reporting a high level of depression burden. Findings also contribute to conceptual clarification of essential aspects of the side effect experience and provide a basis for measure and intervention refinement. IMPLICATIONS FOR NURSING PRACTICE: Every woman who is undergoing cancer treatment should be assessed for depression and depression burden. Self-help interventions are effective and convenient treatments that reduce side effects and promote quality of life in women with breast cancer.
• Badger, T. A., Gagan, M. J., & McNiece, C. (2001). Community analysis for health planning with vulnerable populations.. Clinical nurse specialist CNS, 15(3), 95-102.
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  PMID: 11855466;Abstract: This article describes how advanced practice nurses used a theory-based community health analysis process to examine the healthcare services most needed and used by an adult public housing community and to examine the satisfaction of the community with those services. The goal of the project was to determine if the identified needs would be amenable to an alternative healthcare delivery model, such as an academic nursing clinic. Data were collected using the Health Needs and Health Status Survey, Center for Epidemiological Studies-Depression scale, interactive participant interviews, key informant interviews and observations. Community residents (N = 242) were typically unmarried, middle-aged, and low income and had multiple chronic physical illnesses, serious and persistent mental illnesses, and/or disabilities. Despite the high identified service need, use of preventative or routine healthcare services was low, with residents using emergency services inappropriately or delaying care until requiring more expensive intensive healthcare services.
• Badger, T. A. (2000). Depression, psychosocial resources, and functional ability in older adults. Clinical Nursing Research, 9(3), 238-255.
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  PMID: 11276618;Abstract: The purpose of this study was twofold: to examine the differences between two groups of older adults (depressed, nondepressed) for physical health impairment, psychosocial resources, and functional abilities, and to describe the impact of depression, physical health impairment, and psychosocial resources on functional ability. Seventy-eight community-dwelling older adults, age 60 to 75 years, were divided into two groups based on their depression scores. Depressed and nondepressed participants were not significantly different for demographic and illness characteristics, except for income. Depressed participants reported greater physical health impairment, decreased social resources, diminished feelings of economic well-being, and decreased functional abilities when compared to nondepressed participants. Mastery, physical health impairment, and social support were significant predictor variables of functional ability. Mastery was aparticularly salient psychological resource for total functional abilities and interventions should be targeted to increasing mastery in older adults. © 2000 Sage Publications, Inc.
• Badger, T. A., McNiece, C., & Gagan, M. J. (2000). Depression, service need, and use in vulnerable populations. Archives of Psychiatric Nursing, 14(4), 173-182.
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  PMID: 10969637;Abstract: Health care reform has created opportunities for mental health nurses to develop innovative health care delivery models to provide integrated behavioral health and primary health care. A community health analysis is one method to ensure appropriate services are planned. This study examined the health care services most needed and those used by depressed and nondepressed participants (N = 231), and their satisfaction with these services. Individual and system characteristics were examined using a framework developed by Anders on and Aday. Significant differences were found between the 2 groups for predisposing characteristics, enabling characteristics, need for care, service use, and satisfaction with services. Copyright © 2000 by W.B. Saunders Company.
• Mishel, M. M., Longman, A. J., Braden, C. J., & Badger, T. A. (2000). Depression Burden, Self-Help Interventions, and Social Support in Women Receiving Treatment for Breast Cancer. Journal of Psychosocial Oncology, 17(2), 17-35. doi:10.1300/j077v17n02_02
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  Abstract The purpose of this article is to describe the interaction effects of depression burden (depressive symptoms experienced as a burdensome side effect) with a set of oncology support interventions on social support for women receiving treatment for breast cancer. A repeated measures design was used with measurement occurring at three points in time: T1 (baseline after adjuvant medical treatment was initiated), T2 (six to eight weeks after T1) and T3 (three months after T2). Two hundred forty-seven women were randomly assigned to treatment (n = 194) or control (n = 53). The treatment group consisted of women participating in three different, but complimentary self-help interventions. Depression burden, even at low levels, influenced the critical dimensions of social support structure, function, and nature.
• Badger, T. A., Braden, C. J., Longman, A. J., & Mishel, M. M. (1999). Depression burden, self-help interventions, and social support in women receiving treatment for breast cancer. Journal of Psychosocial Oncology, 17(2), 17-35.
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  Abstract: The purpose of this article is to describe the interaction effects of depression burden (depressive symptoms experienced as a burdensome side effect) with a set of oncology support interventions on social support for women receiving treatment for breast cancer. A repeated measures design was used with measurement occurring at three points in time: T1 (baseline after adjuvant medical treatment was initiated), T2 (six to eight weeks after T1) and T3 (three months after T2). Two hundred forty-seven women were randomly assigned to treatment (n = 194) or control (n = 53). The treatment group consisted of women participating in three different, but complimentary self- help interventions. Depression burden, even at low levels, influenced the critical dimensions of social support structure, function, and nature.
• Gagan, M. J., Badger, T. A., & de, M. (1999). Nurse practitioner interventions for domestic violence.. Clinical excellence for nurse practitioners : the international journal of NPACE, 3(5), 273-278.
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  PMID: 10763625;Abstract: The purposes of this study were to (1) identify interventions used by a sample of adult and family nurse practitioners (NPs) with suspected cases of domestic violence and (2) determine if the interventions used had theoretical and empirical support. Sixty vignette responses from 20 NPs were analyzed using content analysis and compared with the literature. The NPs in this sample diagnosed domestic violence in only 60% of the cases. A total of 12 intervention categories (e.g., screening, physical examination, medical treatment, or counseling) were developed. Twelve categories were theoretically supported, and one category had empirical support. These findings support the need for heightened awareness of domestic violence for proper diagnosis and for use of theoretically and empirically supported interventions.
• Badger, T. A. (1998). Depression, Physical Health Impairment and Service Use Among Older Adults. Public Health Nursing, 15(2), 136-145.
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  PMID: 9564218;Abstract: The purposes of this study were: (1) to compare service use and need among 80 community-dwelling older adults (55 women and 25 men); and (2) to examine the influence of depression on service use and need. Participants were divided into three groups based on their depression scores (no depression, mild depression, severe depression) and compared on a wide range of services (e.g., medical services, social/recreational, transportation) typically used by older adults. There were no significant differences among the three groups for demographic characteristics and chronic illness types, but there were significant differences for physical health impairment (PHI). When controlling for PHI, significant differences were found among the groups for mental health services, psychotropic medications, number of sick days, hospitalizations, home help, frequency of transportation, social/recreational services, and sports-related activities. Mildly and severely depressed older adults used and needed more medical services than did their non-depressed cohorts, but used less of other types of services (e.g., social/recreational services). Depression was a significant predictor of social/recreational service use, and for need of mental health services, psychotropic medications, financial assistance, and assessment and referral services. A consistent pattern was found of depression influencing service use and need.
• Badger, T. A. (1996). Family Members' Experiences Living with Members with Depression. Western Journal of Nursing Research, 18(2), 149-171.
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  PMID: 8638421;Abstract: Using interview data from 11 family members and grounded theory methods, this study describes family members' experiences in living with a member with depression. Findings suggest that this process can be described as family transformations. In the first stage of this processacknowledging the strangers within - family members described observing the metamorphosis of the person and other family members, finding socially acceptable explanations, living two lives, searching for reasons and solutions, and hoping for what was. In the second stage - fighting the battle - family members alternated between the strategies of holding our ground (protective) and of moving forward (coercive) to counteract the metamorphosis, and the strategy of working the system to get help for their ill member. In the third and final stage, family members described gaining a new perspective and identified preserving oneself, refocusing on others, redesigning the relationship, and becoming hopeful as strategies used in this stage.
• Badger, T. A. (1996). Living with Depression Family Members' Experiences and Treatment Needs. Journal of Psychosocial Nursing and Mental Health Services, 34(1), 21-29.
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  PMID: 8720012;
• Badger, T. A. (1996). Living with depression: Family members' experiences and treatment needs.. Capsules & Comments on Psychiatric Nursing, 3(1), 1.
• Badger, T. A., Dumas, R., & Kwan, T. (1996). Knowledge of depression and application to practice: A program evaluation. Issues in Mental Health Nursing, 17(2), 93-109.
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  PMID: 8707537;Abstract: The purposes of this program were to determine whether participants gained more comprehensive knowledge about depression and if that knowledge was applied in practice following attendance at a 3-day educational workshop. Twelve programs were conducted in three southwestern states. The majority of the 363 participants were Anglo-White female registered nurses whose ages ranged from 23 to 74 years and who worked in general medical-surgical units, nursing homes, or community health settings. This study was a repeated-measures design to evaluate the effects of depression education on depression knowledge and its clinical application. Participants demonstrated increased depression knowledge and practice application following the program. Knowledge of depression remained stable across postprogram measures. Although application of interventions decreased between 6 weeks and 6 months, assessment skills remained stable. Mental health nurses can improve patient outcomes through programs such as the one described by educating nurses in the detection and management of depression.
• Badger, T. A. (1994). Mental health care for depressed older adults. Applied Nursing Research, 7(3), 144-146.
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  PMID: 7979359;
• Mackel, C. L., Sheehy, C. M., & Badger, T. A. (1994). The challenge of detection and management of alcohol abuse among elders.. Clinical nurse specialist CNS, 8(3), 128-135.
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  PMID: 7874639;Abstract: Alcohol abuse and dependence, defined in the Diagnostic and Statistical Manual of Mental Disorders (3rd edition, revised), is a serious mental health problem in older adults. It affects an estimated 2.5 million older adults. The true extent of alcohol abuse and dependence among elders is likely even greater as many problem drinkers go undetected. Alcohol abuse can seriously predispose the elderly to accidents, nutritional deficiencies, and diseases, and eventually result in loss of independence. The purpose of this article is to (1) describe the profile of older alcoholics in the acute care setting who typically mask as medical management seekers, (2) relate some of the difficulties involved in accurately identifying the problem of elder alcohol abuse, and (3) suggest strategies to improve intervention by CNSs.
• Badger, T. A. (1993). Physical health impairment and depression among older adults.. Image--the journal of nursing scholarship, 25(4), 325-330.
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  PMID: 8288301;Abstract: Factors were examined that contribute to depression among older adults, aged 60 to 75 years. A convenience sample of 80 older adults living independently in the community was used. There were no differences found between participants with high or low physical impairment for demographic characteristics. Significant differences were found between the two groups for mastery, social resources and depression. Mastery, social resources and economic resources were significant predictors of depression. The findings support the empirical and theoretical links between stressful life events, specifically physical health impairment, and depression.
• Badger, T. A. (1992). Coping, life-style changes, health perceptions, and martial adjustment in middle-aged women and men with cardiovascular disease and their spouses.. Health care for women international, 13(1), 43-55.
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  PMID: 1556031;Abstract: This descriptive study was designed to compare the coping responses, life-style changes, health perceptions, and current marital adjustment in 11 middle-aged women (CD women) with those of 37 men (CD men) who had been diagnosed as having cardiovascular disease. A secondary purpose was to compare their spouses' responses on these same measures. Participants were comparable on demographic and illness characteristics. CD women differed from CD men for the three coping responses of distancing, accepting responsibility, and planful problem-solving; for the total health perceptions scale; and for the current health and resistance to illness subscales. The CD women and CD men differed from their partners in total health perceptions, current health, and resistance to illness. CD women and their husbands were more dissimilar in their coping responses than were CD men and their wives. Age and pre-illness satisfaction were significant predictor variables for the coping strategies of distancing and accepting responsibility.
• Jones, E., Badger, T. A., & Moore, I. (1992). Children's knowledge of internal human anatomy: Conceptual orientation and review of research. Journal of Pediatric Nursing, 7(4), 262-268.
• Badger, T. A., Mishel, M. H., Biocca, L. J., & Cardea, J. M. (1991). Depression assessment and management: evaluating a community-based mental health training program for nurses.. Public health nursing (Boston, Mass.), 8(3), 170-175.
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  PMID: 1946152;Abstract: This mental health training program was designed to increase primary care nurses' knowledge and skills about depression. The program emphasized criteria for assessing depression, presented psychopharmacologic and psychotherapeutic content, discussed care coordination among several agencies and providers, and addressed referral resources. Cultural and developmental issues were highlighted. The 237 participants had significant knowledge gains after the program on comparison of pretest and posttest measures. Client record audit found significant increases in the assessment of and intervention with depression. The training program successfully increased primary care nurses' abilities to use knowledge about depression in clinical practice.
• Jones, E., & Badger, T. A. (1991). Deaf's childrens knowledge of internal human anatomy. Journal of Special Education, 25(2), 252-260.
• Badger, T. A. (1990). Men with cardiovascular disease and their spouses: Coping, health, and marital adjustment. Archives of Psychiatric Nursing, 4(5), 319-324.
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  PMID: 2260891;Abstract: This study examined the coping methods, health perceptions, and marital adjustment of 37 middle-aged men with chronic cardiovascular disease and their spouses. Despite variation in disease types and the absence of disease among the spouses, the couples were similar in their coping responses. Both partners used more emotionally focused strategies than problem-focused strategies to cope with chronic illness. Subjective health perceptions were more useful than objective indices for predicting coping. Preillness and current marital adjustment were satisfactory for both partners. The major implications for nursing practice are in the area of assessment, and suggested interventions are discussed. © 1990.
• Badger, T. A., & Jones, E. G. (1990). Practice applications of research: Deaf and hearing children's conceptions of the body interior. Pediatric Nursing, 16(2), 201-205.
• Badger, T. A., Cardea, J. M., Biocca, L. J., & Mishel, M. H. (1990). Assessment and management of depression: An imperative for community-based practice. Archives of Psychiatric Nursing, 4(4), 235-241.
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  PMID: 2241243;Abstract: The purpose of this mental health training program was to increase primary care nurses' knowledge and skills about depression. The program emphasized criteria for assessing depression, presented psychopharmacological and psychotherapeutic content, discussed care coordination among multiple agencies and providers, and addressed referral resources. Highlighted were cultural and developmental issues for Native Americans, Mexican-Americans, the elderly, and adolescents. The training program successfully increased primary care nurses' knowledge about depression and their abilities to use this knowledge in clinical practice. © 1990.
• Badger, T. A., & Adaskin, E. J. (1989). Using motivational theory with the long-term psychiatric client.. Issues in mental health nursing, 10(1), 41-53.
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  PMID: 2494129;Abstract: This article discusses how psychiatric nurses or nursing students can use motivational theory to work with the long-term client. It is primarily nurses who work most continually with all phases of the long-term client's responses to his or her illness and deal most directly with his or her frustration and despair. This article describes the practical application of motivational theory with a group of clients who demonstrate typical variability in their illness responses. A combination of paper-and-pencil exercises, the Goal Attainment Scaling form (Garwick & Brintelli, 1977) and Checklist for In-Session Achievement, can be used with role play to assist clients to achieve their goals. Nurses and clients are both more likely to experience success when reasonable goals are set, and the focus for treatment is on ability rather than disability.
• Badger, T. A. (1988). Mental health consultation with a surgical unit nursing staff.. Clinical nurse specialist CNS, 2(3), 144-148.
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  PMID: 2458820;

Proceedings Publications

• Badger, T. A. (2019, March). SPECIAL SESSION: Managing Psychosocial Distress and Symptoms for Cancer Survivors and Their Caregivers. In IPOS.

Presentations

• Crane, T. E., Harrison, T., Negi, L. T., Segrin, C. G., Badger, T. A., Pahlitzsc, K. H., Sikorskii, A., Dodds, S., & Pace, T. W. (2019, February). Feasibility and Acceptability of Cognitively-Based Compassion Training to Improve Indicators of Distress in Solid Tumor Cancer Survivors and Their Informal Caregivers. American Psychosocial Oncology Society. Atlanta, GA.
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  Background: Cancer survivors and their informal caregivers (ICs)(family members or friends) often experience higher depression, anxiety, and fatigue both during and after primary cancer treatment. Our prior work suggests these impairments are interdependent between survivors and ICs. The goal of this trial is to promote well-being in dyads consisting of solid tumor cancer survivors and ICs with an 8-week compassion meditation-based intervention called CBCT® (Cognitively-Based Compassion Training). We expect that CBCT® will leverage emotional contagion to promote sharing of positive affect and well-being within dyads, potentially dismantling the possibility of shared negative affect.Methods: Dyads include survivors within 10 years of completing primary treatments (chemotherapy, radiation, surgery) and at least one member with mild depression or anxiety symptoms (determined by Patient Reported Outcomes Measurement Information System [PROMIS] 4a short forms). Dyads are randomized to either CBCT® or an 8-week active attention control (cancer health education, CHE). Feasibility was measured by retention, and acceptability by CBCT® and CHE intervention attendance and at-home practice (CBCT® only). We used PROMIS 8a forms to assess depression and anxiety, and PROMIS 7a to assess fatigue, before and after the 8-week interventions.Results: To date 16 individuals have been enrolled in the study. The retention rate is 88%. Participants randomized to CBCT and CHE attended 75% and 87.5% of classes, respectively. At-home practice of CBCT® averaged 4.90 (SD=1.92) sessions per week, with an average of 18.44 (SD=1.97) minutes per session. Baseline PROMIS depression, anxiety, and fatigue scores were 54.02 (SD=10.29), 61.59 (SD=3.53), and 56.49 (SD=5.82) for survivors and 51.44 (SD=6.56), 53.06 (SD=9.01), and 54.24 (SD=7.76) for caregivers, respectively.Conclusions: Intervention attendance and adherence were good, and better than prior studies involving CBCT® including with breast cancer survivors. Both CBCT® and CHE are feasible and acceptable in survivor-IC dyads experiencing mild-moderate depression, anxiety, and fatigue.Acknowledgement of funding: Jack Challem Trust
• Badger, T. A., & Crane, T. E. (2018, Fall). Symptom Management in Latinas with Breast Cancer and Their Informal Caregivers. Grand Rounds. Tucson, Az: University of Arizona Health Sciences College of Medicine.
• Badger, T. A., & Crane, T. E. (2018, Spring). Cultivating Relationships, Diversifying Funding Streams and Mentoring Junior Investigators. American Psycosocial Oncology Society Annual Meeting. Tucson, AZ: American Psycosocial Oncology Society.
• Crane, T. E., Sikorskii, A., Segrin, C. G., Badger, T. A., & Pace, T. W. (2018, April / Spring). Saliva C-reactive Protein and Diurnal Cortisol Rhythm in Hispanic Breast Cancer Survivors and Their Informal Caregivers: Relationship with Cancer Treatments and Health-Related Quality of Life. Western Institute of Nursing Annual Conference. Spokane, WA, United States: Western Institute of Nursing.
• Pace, T. W., Sikorskii, A., Segrin, C. G., Badger, T. A., & Crane, T. E. (2018, Fall). Personalizing Symptom Management Interventions: Symptom Burden among Latinas with Breast Cancer and Their Informal Caregivers. State of the Science Congress. Washington DC: American Academy of Nursing.
• Pace, T. W., Sikorskii, A., Segrin, C. G., Badger, T. A., & Crane, T. E. (2018, Spring). Body Mass Index and Depression among Latina Breast Cancer Survivors. American Psycosocial Oncology Society Annual Meeting. Tucson, AZ: American Psycosocial Oncology Society.
• Pace, T. W., Sikorskii, A., Segrin, C. G., Badger, T. A., & Crane, T. E. (2018, Spring). Depression and Anxiety is Associated with Body Mass Index, but not Fatigue among Latina Breast Cancer Survivors. Western Institute of Nursing Annual Meeting. Spokane, WA: Western Institute of Nursing.
• Crane, T. E., Badger, T. A., Segrin, C. G., Hsu, C., Sikorskii, A., & Rosenfeld, A. G. (2017, February). Symptom Clusters in Latinas with Breast Cancer. APOS. Tampa Florida: APOS.
• Crane, T. E., Badger, T. A., Segrin, C. G., Hsu, C., Sikorskii, A., & Rosenfeld, A. G. (2017, Spring). Symptom clusters in Latinas with breast cancer.. WIN. Denver, CO: Western Institute of Nursing 50th Annual Conference.
• Kahn-John, M., McEwen, M. M., & Badger, T. A. (2017, Fall). Measuring Emotional Distress and Inflammation before and after a Diné Ceremony. Navajo Nation Human Research Review Board Research Conference. Window Rock, AZ.
• Rosenfeld, A. G., Badger, T. A., Love, R. A., Love, R. A., Badger, T. A., & Rosenfeld, A. G. (2017, spring). Growing a DUAL Degree Phd/DNP Program in Nursing.. Western Institute of Nursing 50th Annual Conference. Denver, CO.: Western Institute of Nursing.
• Rosenfeld, A. G., Sikorskii, A., Hsu, C., Segrin, C. G., Badger, T. A., Crane, T. E., Rosenfeld, A. G., Sikorskii, A., Hsu, C., Segrin, C. G., Badger, T. A., & Crane, T. E. (2017, February). Symptom Clusters in Latinas with Breast Cancer. American Psychosocial Oncology Society. Orlando, Florida: APOS.
• Sikorskii, A., Badger, T. A., Wyatt, G., Crane, T. E., Safikhani, A., Victorson, D., Hankin, V., OConnor, P., OConnor, P., Hankin, V., Victorson, D., Safikhani, A., Wyatt, G., Crane, T. E., Sikorskii, A., Badger, T. A., Badger, T. A., Crane, T. E., Safikhani, A., , Hankin, V., et al. (2017, fall). Performance of PROMIS and legacy measures among advanced breast cancer patients and their caregivers.. HealthMeasures Users Conference. Chicago, IL: Health Measures Users Conference.
• Badger, T. A. (2016, February). Working in teams to improve distress screening. American Psychosocial Oncology Society. San Diego, CA: American Psychosocial Oncology Society.
• Pasvogel, A., Crane, T. E., Segrin, C. G., Badger, T. A., Badger, T. A., Segrin, C. G., Pasvogel, A., Crane, T. E., Pasvogel, A., Segrin, C. G., Badger, T. A., & Crane, T. E. (2016, April). Symptom distress, depression and anxiety in Latinas with breast cancer and their supportive partners. Western Institute of Nursing Annual Communicating Research conference. Anaheim, CA: WIN.
• Pasvogel, A., Crane, T. E., Segrin, C. G., Badger, T. A., Badger, T. A., Segrin, C. G., Pasvogel, A., Crane, T. E., Pasvogel, A., Segrin, C. G., Badger, T. A., & Crane, T. E. (2016, February). Symptom distress, depression and anxiety in Latinas with breast cancer and their supportive partners. Annual American Psychosocial Oncology Society conference. San Diego, CA: American Psychosocial Oncology Society.
• Sikorskii, A., Sikorskii, A., Wyatt, G., Wyatt, G., Pace, T. W., Pace, T. W., Badger, T. A., Badger, T. A., Victorson, D., & Victorson, D. (2016, December). Using SMART design to improve symptom management among cancer patients.. Cancer Prevention and Control Seminar. University of Arizona Cancer Center.

Poster Presentations

• Badger, T. A., Segrin, C., Sikorskii, A., & Rainbow, J. (2021, March). Worker Productivity: Presenteeism and Absenteeism among survivor-caregiver dyads. American Psychosocial Oncology Society 18th Annual Conference. Online due to Covid-19: APOS.
• Crane, T. E., Harrison, T., Negi, L. T., Segrin, C. G., Badger, T. A., Sikorskii, A., Dodds, S., & Pace, T. W. (2020, April). Cognitively-Based Compassion Training to Improve Health-Related Quality of Life in Solid Tumor Cancer Survivors and Their Informal Caregivers: Findings from a Pilot Randomized Trial. American Society of Preventive Oncology. online.
• Crane, T. E., Harrison, T., Negi, L. T., Segrin, C. G., Badger, T. A., Sikorskii, A., Dodds, S., & Pace, T. W. (2020, March). Cognitively-Based Compassion Training to Improve Health-Related Quality of Life in Solid Tumor Cancer Survivors and Their Informal Caregivers: Findings from a Pilot Randomized Trial. American Psychosocial Oncology Society. online.
• Crane, T. E., Harrison, T., Segrin, C. G., Negi, L. T., Sikorskii, A., Badger, T. A., Dodds, S., & Pace, T. W. (2019, April). FEASIBILITY AND ACCEPTABLITY OF COGNITIVELY-BASED COMPASSION TRAINING FOR SOLID TUMOR CANCER SURVIVORS AND THEIR INFORMAL CAREGIVERS. Western Institute of Nursing 2019 Conference. San Diego, CA.
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  Purpose/Aims: The purpose of this study was to determine the feasibility and acceptability of an 8-week compassion meditation-based intervention called CBCT® (Cognitively-Based Compassion Training) for survivors of solid tumor cancers and their informal caregivers (ICs) (i.e. family members or friends). We also worked to demonstrate feasibility of measuring features of depression, anxiety, and fatigue in survivor-IC dyads taking part in the intervention.Rationale/Conceptual Basis/Background: Cancer survivors and their ICs often experience higher depression, anxiety, and fatigue both during and after primary cancer treatment. Our prior work suggests these impairments are interdependent between survivors and ICs. The goal of this trial was to assess feasibility and acceptability of CBCT for survivor-IC dyads, with the longer-term goal of establishing CBCT in order to promote well-being in survivor-IC dyads. We expect that CBCT will leverage “emotional contagion” within survivor-IC dyads to promote sharing of positive affect and well-being for both dyad members, potentially dismantling the possibility of shared negative affect.Methods: Dyads included survivors within 10 years of completing primary treatments (chemotherapy, radiation, surgery) and at least one member with mild depression or anxiety symptoms (determined by Patient Reported Outcomes Measurement Information System [PROMIS] 4a short forms). Dyads were randomized to either CBCT or an 8-week active attention control (cancer health education, CHE). Both the CBCT and CHE groups met for 90 minutes each week, for 8 continuous weeks. At-home meditation practice was encouraged in the CBCT group. Feasibility was measured by retention, and acceptability by CBCT and CHE intervention attendance and at-home practice (CBCT only). We used PROMIS 8a forms to assess depression and anxiety, and the PROMIS 7a to assess fatigue.Results: Thirty-two individuals were enrolled in the study with a retention rate of 88%. Participants randomized to CBCT and CHE attended 75% and 87.5% of classes, respectively. At-home practice of CBCT averaged 4.90 (SD=1.92) sessions per week, with an average of 18.44 (SD=1.97) minutes per session. Baseline PROMIS depression, anxiety, and fatigue scores were 53.29 (SD=7.49), 58.19 (SD=5.35), and 55.83 (SD=4.86) for survivors and 52.55 (SD=5.21), 53.58 (SD=7.37), and 54.98 (SD=5.88) for caregivers, respectively.Conclusions: Intervention attendance and adherence was good, and better than prior studies involving CBCT including a study by us with breast cancer survivors. Both CBCT and CHE are feasible and acceptable in survivor-IC dyads experiencing mild-moderate depression, anxiety, and fatigue. The results of this trial are an important step toward exploring the benefits of CBCT for both survivors of solid tumor cancers and their informal caregivers.Acknowledgement of funding: Jack Challem Trust
• Crane, T. E., Thomson, C. A., Segrin, C., Sikorskii, A., Badger, T. A., Slack, S., & Yatsenko, S. (2018, Fall). Abstract: Neustra Salud Study: An integrated intervention for symptom management and adoption of healthy lifestyle behaviors in Latina breast cancer survivors and their informal caregivers. UACC Scientific Retreat. Tucson, AZ.
• Hebdon, M., McComb, S., Palos, G., & Badger, T. A. (2017, spring). Hebdon, M, Mccomb, S, Palos,G, Badger TA (April 2017). Organizational Perspectives of an Academic Cancer Survivorship Program. Poster at the Western Institute of Nursing 50th Annual conference. Denver, CO.. Western Institute of Nursing 50th Annual conference. Denver, Co: WIN.

Others

• Badger, T. A., Fulcher, C. D., Gunter, A. K., Mars, J. A., & Reese, J. M. (2007, May). What interventions are effective in preventing and treating depression in people with cancer?. Oncology Nursing Society.
• Badger, T. A. (2005, May). Measuring nurse-sensitive patient outcomes: Evidence-based summary of depression. Oncology Nursing Society.