Date of Award


Degree Type


Degree Name

Doctor of Philosophy in Psychology


Clinical Psychology



First Advisor

James O. Prochaska


Psychosocial care has been shown to improve psychological and physiological functioning in cancer patients. However, as few as five percent of cancer patients engage in psychosocial care. Therefore, Study 1 of this dissertation developed measures of core TTM constructs (Stage of Change, Decisional Balance, Self- Efficacy) relevant for increasing engagement in psychosocial care among individuals diagnosed with cancer.

Measure development entailed qualitative methods for item development and refinement followed by a series of quantitative analyses. The Stage of Change measure was validated against external constructs such as subjective present and future well-being. As expected, a chi-square test indicated that individuals in Action and Maintenance were significantly more likely to be in treatment than those in the pre- Action stages.

Measures for Decisional Balance and Self-Efficacy were developed using split-half, cross-validation procedures. In these, a series of Principal Component Analyses (PCAs) were conducted with half of the sample to narrow the item set and explore factor structure, and Confirmatory Factor Analyses (CFA) were conducted on the second half of the sample to confirm the factor structure and item loadings. For Decisional Balance, PCA supported two, 8-item factors, and CFA indicated a two-factor correlated model was the best fit to the data. For Self-efficacy, PCA supported two, 3-item factors, and CFA further supported this structure. Multivariate analyses indicated significant stage-construct relationships.

Overall results supported the validity of the measures developed and laid the foundation for applying the TTM to psychosocial treatment acceptance among cancer populations. Implications for application of the TTM to cancer populations are discussed.

Given that cancer patients frequently experience considerable distress during diagnosis and treatment, Study 2 described the development and utilization of a behavioral health program for cancer patients, at a small community hospital, as well as provided preliminary results on program efficacy. This program was co-developed by individuals from a university-based clinical psychology doctoral program and a community hospital. The behavioral health program was comprised of a licensed, PhD-level clinical psychologist and seven clinical psychology doctoral students, who met with patients in order to accrue clinical hours. Patients were typically referred by their oncologists or nurses. Distress, depression, and anxiety were evaluated for a small subsample of participants. From the time the program was initiated, 238 patients between ages 18 and 95 (M = 66.4) were evaluated over a three-year period. The majority of patients (77.8%) were offered psychosocial care. Although 49.8% declined treatment, 23.6% engaged in one session and 26.6% engaged in two or more. Patients who were referred through the STAR Program® were more likely to engage in psychosocial care than those who found out about behavioral health through other means.

First, distress tracking may be improved if nurses, oncologists, and behavioral health providers administer measures. Second, partnerships between clinical psychology doctoral programs and hospitals may be mutually beneficial. Third, hospitals offering cancer treatment may benefit from obtaining STAR® certification, in order to generate referrals for comprehensive cancer care. These efforts can serve as a model for other hospitals seeking to integrate behavioral health into routine cancer treatment.

Together, these two studies address the scarcity of studies on the intersection of cancer and mental health. As such, this work aimed to bridge the gap between the two disciplines, in order to prevent and treat mental health problems in cancer patients. Results of Study 1 may be used to guide researchers and clinicians in designing and implementing interventions. Study 2 methods and findings may be used to develop other behavioral health programs and to benchmark other integration efforts.



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