Featured Researchers—Mary Anne Kreshka and Cheryl Koopman, Ph.D.
Mary Anne Kreshka is the Community Principle Investigator representing the Northern Sierra Rural Health Network and Cheryl Koopman, Ph.D., is an
 Mary Anne Kreshka |
 Cheryl Koopman, Ph.D. |
Associate Research Professor of Psychiatry and Behavioral Sciences at Stanford University
Providing Support Services for Rural Cancer Patients
Partnerships between community groups and academic researchers help communities look at specific health concerns in a scientifically rigorous way and find unique answers to the issues that affect the community. Mary Anne Kreshka and Cheryl Koopman formed The Sierra Stanford Partnership to find a better way to provide psychosocial support for rural, isolated, and low-income breast cancer patients. For example, the team developed a workbook-journal, “One in Eight: Women Speaking to Women”, which has been shown to improve the overall mental health and fighting spirit of the women who used it. Read more >
Ask the Experts
If you’d like to ask Dr. Koopman or Ms. Kreshka a question about their research, please email koopman-kreshka@cabreastcancer.org any time between May 7 and June 22. New questions and answers will be posted regularly, so check back for updates.
- Q. Is the workbook available for other groups to use, and if so how can it be obtained? How was the workbook developed?
A. We are just now beginning a three-year study funded by the CBCRP to evaluate a support-group intervention delivered via video-conferencing whose sessions will be guided by the workbook journal, One in Eight. All women will receive a copy of this workbook journal that will be used during the support group sessions to standardize the content. Although we need to wait until after this study is concluded to produce and distribute One in Eight, we are very interested in suggestions about how at that time we can most effectively produce and disseminate copies to women diagnosed with breast cancer. The workbook was developed with the input of a number of individuals and groups, as described in more detail in our response to the next question.
- Q. Which individuals and groups provided significant input into the workbook?
A. Mary Anne Kreshka, a community breast cancer advocate, wrote One in Eight, who worked closely with Kathy Graddy, a graphic artist who lost a parent to cancer, who created the graphics. Others who had significant input into the workbook journal included an oncology social worker at the Sierra Nevada Memorial Cancer Center in Grass Valley, CA, and members of La Loba, a community breast cancer support group. The idea for this intervention originated in La Loba, during discussions of the limits of psychosocial services for women in rural areas. Its content was guided by Dr. David Spiegel's Supportive Expressive model of providing support. After One in Eight was drafted, it was refined to incorporate feedback from physicians, research psychologists, and cancer survivors.
- Q. What are some specific components of the workbook that are effective at measuring psychological distress?
A. We are slightly re-wording your question to ask about why the workbook journal "reduces" psychological distress. Our research does not yet allow us to answer this question with any scientific rigor. However, in our newly funded project, we will interview a subset of the women about their reactions to the workbook to try to shed greater understanding of how it may be helpful in alleviating distress. We suspect that one factor in reducing women's distress is the emotional support that many women experience after receiving One in Eight. When women in our original pilot study were asked: "How emotionally supported did you feel by the Workbook-Journal?", 74% reported that they felt more emotional support after receiving it, with only 26% reporting no change in their feeling of emotional support.
- Q. What have your studies determined about the specific needs of rural women facing breast cancer?
A. We have found that many women in rural communities experience high levels of depression and traumatic stress regarding their breast cancer. In our original pilot study, the average woman considered her diagnosis of breast cancer to be among the four most stressful life events that she had ever experienced. These women also on average reported considerable helplessness/hopelessness in coping with their cancer. Furthermore, women with breast cancer in rural areas are particularly likely to exhaust their usual sources of support while still facing challenges posed by breast cancer, but are unlikely to have access to professionally-led support groups. In our second CBCRP-funded pilot study, we identified no professionally-led support groups for women with breast cancer in the 9-county Intermountain Region of northeastern California other than those provided during our pilot study. This vast region covers more than 33,000 square miles of rugged terrain (one-fifth of the state's total area) where isolated towns are connected by two-lane highways that in the winter are often impassable. The region is too sparsely populated to support in-person support groups, and even in communities where there are enough women with breast cancer to form a group, there are no social workers, counselors, or psychologists with support group expertise to facilitate the groups.
- Q. Would this workbook be generalizeable to different rural communities in the US?
A. We are hoping that our new CBCRP-funded three-year study will help us to some degree to answer this question because it will be evaluating the effects of an intervention that uses One in Eight in areas designated as "frontier," meaning there are fewer than 11 people per square mile, compared to 232 people per square mile for the state. It is common in this region to travel hundreds of miles to access specialty medical services. We would be interested in collaborating with other groups who would like to evaluate the benefits of One in Eight with women in other rural communities in the US to be able to better address this question about generalizability to other rural communities.
- Q. Did your team find specific differences related to or ethnicity limited English proficiency women?
A. We were not able to examine for ethnic differences or to evaluate the effects of One in Eight among persons with limited-English proficiency. Thus far, One in Eight has not yet been translated into other languages, although we would be very interested in having assistance with that after we complete our current study. Also, we would be interested in collaborating with other groups who would like to evaluate the benefits of One in Eight with women of diverse ethnic backgrounds to be able to further address questions about generalizability and possible ethnic differences.
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