Expressive writing in women with advanced breast cancer

Purpose/Objectives: To explore the relationships between patterns of affective word use (words with positive or negative connotations) in expressive writing conducted over four consecutive days and quality of life (COL) three months after the writing exercise in women with metastatic breast cancer. Design: Descriptive, correlational. Setting: Six clinical sites in New England. Sample: 68 women with metastatic breast cancer. Main Research Variables: Patterns of positive and negative affective word use and QOL. Methods: Usage patterns of affective words in expressive writing were identified through the Linguistic Inquiry and Word Count (LIWC). Relationships between patterns of affective word use and QOL were explored. QOL was measured at baseline and three months after the writing exercise by the Functional Assessment of Cancer Therapy-Breast. Correlations between patterns of word use and COL were investigated using general linear regression. Findings: A significant relationship was found between positive-affect word use and emotional well-being. Manual scoring of 10 expressive writing texts to validate LIWC data identified a significant difference between LIWC and manual counts for negative language. Contextual evaluation suggested marked ambivalence in how the women wrote about cancer. Conclusions: A positive relationship between affective language in disclosure and COL was demonstrated, illustrating a cognitive process occurring in expressive writing. Implications for Nursing: The findings suggest that expressive writing is a positive, helpful intervention for patients with cancer attempting to reintegrate the experience in life. Nurses should gain deeper understanding of underlying cognitive processes of disclosure to identify the most effective manner in which to use such interventions.