“Use Positive Reframing, Not Behavioural Disengagement” Coping Strategy for Caregivers of Palliative Cancer Patients

Main Article Content

Noor Melissa Nor Hadi
Fazlina Ahmad
Mohamad Rodi Isa
Salmi Razali


Caregivers of palliative cancer patients (CPCP) who are depressed put both the patients and them at risk for serious physical and psychological complications. This study investigated the prevalence of depression and it's contributing factors among the CPCP in Malaysia using the diagnostic tool and validated questionnaires. About 6% of CPCPs was diagnosed to have a major depressive disorder (MDD). Coping by ‘behavioural disengagement’ increased the odds for MDD while using ‘positive reframing’ was protective for MDD. The CPCP should be trained with beneficial types of coping strategy to help them reduce the burden of caregiving and to ensure optimum mental health status. 

Article Details

How to Cite
Nor Hadi, N. M., Ahmad, F., Isa, M. R., & Razali, S. (2020). “Use Positive Reframing, Not Behavioural Disengagement” Coping Strategy for Caregivers of Palliative Cancer Patients. Journal of ASIAN Behavioural Studies, 5(17), 1–13. https://doi.org/10.21834/jabs.v5i17.372


Antoni, M. H. (2013). Psychosocial intervention effects on adaptation, disease course and biobehavioral processes in cancer. Brain, behavior, and immunity, 30, S88-S98.

Applebaum, A. J., & Breitbart, W. (2013). Care for the cancer caregiver: a systematic review. Palliative & supportive care, 11(3), 231-252.

Brown, R. M., & Brown, S. L. (2014). Informal caregiving: A reappraisal of effects on caregivers. Social Issues and Policy Review, 8(1), 74-102.

Carver, C. S., & Connor-Smith, J. (2010). Personality and Coping. Annu. Rev. Psychol, 61, 679–704.

Chirico, A., Lucidi, F., Merluzzi, T., Alivernini, F., De Laurentiis, M., Botti, G., & Giordano, A. (2017). A meta-analytic review of the relationship of cancer coping self-efficacy with distress and quality of life. Oncotarget, 8(22), 36800.

Dijkstra, M., & Homan, A. C. (2016). Engaging in rather than disengaging from stress: Effective coping and perceived control. Frontiers in psychology, 7, 1415.

Eldridge, L. (2020). Very well health; How to Keep a Positive Attitude With Cancer.

Estel, S., Rücker, G., Friederich, H. C., Villalobos, M., Thomas, M., Hartmann, M., & Haun, M. W. (2017). Early palliative care for adults with advanced cancer. The Cochrane Database of Systematic Reviews, 2017(6).

Ezat, W., Noraziani, K., & Sabrizan, O. (2012). Improving the quality of life among cancer patients in Malaysia. Asian Pacific Journal of Cancer Prevention, 13(3), 1069-1075.

Fasse, L., Flahault, C., Brédart, A., Dolbeault, S., & Sultan, S. (2015). Describing and understanding depression in spouses of cancer patients in the palliative phase. Psycho‐oncology, 24(9), 1131-1137.

Fekete, C., Tough, H., Siegrist, J., & Brinkhof, M. W. (2017). Health impact of objective burden, subjective burden and positive aspects of caregiving: an observational study among caregivers in Switzerland. BMJ Open, 7(12), e017369.

Fredman, L., Cauley, J. A., Satterfield, S., Simonsick, E., Spencer, S. M., Ayonayon, H. N., & Harris, T. B. (2008). Caregiving, mortality, and mobility decline: The health, ageing, and body composition (Health ABC) study. Archives of internal medicine, 168(19), 2154-2162.

Given, B. A., Sherwood, P., & Given, C. W. (2011). Support for caregivers of cancer patients: transition after active treatment. Cancer Epidemiology and Prevention Biomarkers, 20(10), 2015-2021.

Herrman, H., Kieling, C., McGorry, P., Horton, R., Sargent, J., & Patel, V. (2019). Reducing the global burden of depression: a Lancet–World Psychiatric Association Commission. The Lancet, 393(10189), e42-e43.

James, S. L., Abate, D., Abate, K. H., Abay, S. M., Abbafati, C., Abbasi, N., . . . Abdelalim, A. (2018). Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 392(10159), 1789-1858.

Kang, J., Shin, D. W., Choi, J. E., Sanjo, M., Yoon, S. J., Kim, H. K., . . . Yoon, W. H. (2013). Factors associated with positive consequences of serving as a family caregiver for a terminal cancer patient. Psycho‐oncology, 22(3), 564-571.

Karabekiroğlu, A., Demir, E. Y., Aker, S., Kocamanoğlu, B., & Karabulut, G. S. (2018). Predictors of depression and anxiety among caregivers of hospitalised advanced cancer patients. Singapore medical journal, 59(11), 572.

Khalaila, R., & Cohen, M. (2016). Emotional suppression, caregiving burden, mastery, coping strategies and mental health in spousal caregivers. Aging & mental health, 20(9), 908-917.

Litzelman, K., Kent, E. E., & Rowland, J. H. (2018). Interrelationships between health behaviours and coping strategies among informal caregivers of cancer survivors. Health Education & Behavior, 45(1), 90-100.

Mahadevan, R., Jaafaraafar, N. R. N., Din, S. H. S., Ahmad, S. N. A., Baharuddin, A., & Razali, R. (2013). The stress of caregiving: A study of family caregivers of breast cancer patients receiving oncologic treatment at a Malaysian general hospital. Sains Malaysiana, 42(7), 1019-1026.

Marino, V. R., Haley, W. E., & Roth, D. L. (2017). Beyond hedonia: A theoretical reframing of caregiver well-being. Translational Issues in Psychological Science, 3(4), 400.

Ministry of Health. (2018). National Cancer Registry; Malaysian Study on Cancer Survival (MyScan).

Mukhtar, F., Bakar, A. K. A., Junus, M. M., Awaludin, A., AzizϮ, S. A., MidinӁ, M., . . . Kaurᴂ, J. (2012). A preliminary study on the specificity and sensitivity values and inter-rater reliability of mini international neuropsychiatric interview (MINI) in Malaysia. ASEAN Journal of Psychiatry, 13(2).

Musa, R., Fadzil, M. A., & Zain, Z. (2007). Translation, validation and psychometric properties of Bahasa Malaysia version of the Depression Anxiety and Stress Scales (DASS). ASEAN Journal of Psychiatry, 8(2), 82-89.

Ng, G. C., Siddiq, A. A., Aida, S., Zainal, N., & Koh, O. (2010). Validation of the Malay version of the Multidimensional Scale of Perceived Social Support (MSPSS-M) among a group of medical students in Faculty of Medicine, University Malaya. Asian Journal of Psychiatry, 3(1), 3-6.

Nordin, R. B., Kaur, A., Soni, T., Por, L. K., & Miranda, S. (2017). Construct validity and internal consistency reliability of the Malay version of the 21-item depression anxiety stress scale (Malay-DASS-21) among male outpatient clinic attendees in Johor. Med J Malaysia, 72(5), 265.

Parker Oliver, D., Albright, D. L., Washington, K., Wittenberg-Lyles, E., Gage, A., Mooney, M., & Demiris, G. (2013). Hospice caregiver depression: the evidence surrounding the greatest pain of all. Journal of social work in end-of-life & palliative care, 9(4), 256-271.

Perkins, M., Howard, V. J., Wadley, V. G., Crowe, M., Safford, M. M., Haley, W. E., . . . Roth, D. L. (2013). Caregiving strain and all-cause mortality: evidence from the REGARDS study. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 68(4), 504-512.

Pottie, C. G., Burch, K. A., Montross Thomas, L. P., & Irwin, S. A. (2014). Informal caregiving of hospice patients. Journal of palliative medicine, 17(7), 845-856.

Richardson, E. M., Schüz, N., Sanderson, K., Scott, J. L., & Schüz, B. (2017). Illness representations, coping, and illness outcomes in people with cancer: a systematic review and meta‐analysis. Psycho‐oncology, 26(6), 724-737.

Robbins, M. L., Wright, R. C., María López, A., & Weihs, K. (2019). Interpersonal positive reframing in the daily lives of couples coping with breast cancer. Journal of psychosocial oncology, 37(2), 160-177.

Rumpold, T., Schur, S., Amering, M., Kirchheiner, K., Masel, E., Watzke, H., & Schrank, B. (2016). Informal caregivers of advanced-stage cancer patients: Every second is at risk for psychiatric morbidity. Supportive Care in Cancer, 24(5), 1975-1982.

Teixeira, R. J., Applebaum, A. J., Bhatia, S., & Brandão, T. (2018). The impact of coping strategies of cancer caregivers on psychophysiological outcomes: an integrative review. Psychology research and behaviour management, 11, 207.

Vanderwerker, L. C., Laff, R. E., Kadan-Lottick, N. S., McColl, S., & Prigerson, H. G. (2005). Psychiatric disorders and mental health service use among caregivers of advanced cancer patients. Journal of clinical oncology: official journal of the American Society of Clinical Oncology, 23(28), 6899.

Wen, F.-H., Chen, J.-S., Chou, W.-C., Chang, W.-C., Shen, W. C., Hsieh, C.-H., & Tang, S. T. (2019). Family Caregivers' Subjective Caregiving Burden, Quality of Life, and Depressive Symptoms Are Associated With Terminally Ill Cancer Patients' Distinct Patterns of Conjoint Symptom Distress and Functional Impairment in Their Last Six Months of Life. Journal of Pain and Symptom Management, 57(1), 64-72.

World Health Organization. (2018). Cancer Retrieved 25 February 2020 from https://www.who.int/health-topics/cancer#tab=tab_1.

Yusoff, N., Low, W., & Yip, C. (2009). Reliability and validity of the Malay version of the Brief COPE scale: A study on Malaysian women treated with adjuvant chemotherapy for breast cancer. Malaysian Journal of Psychiatry, 18(1).