Care strategies for people with cancer in light of Uncertainty in Illness Theory.

Inflammatory bowel disease (IBD) is an umbrella term that consists of 2 main chronic inflammatory conditions of the gastrointestinal tract, Crohn’s disease (CD) and ulcerative colitis (UC). Some patients may exhibit overlapping features of CD and UC, leading to a third classification known as inflammatory bowel disease unclassified (IBD-U). Increasing evidence suggests a strong association between the gastrointestinal system and the nervous system, often referred to as the gut-brain axis. The gut-brain axis represents a complex and bidirectional communication network, combining signalling routes of the enteric and central nervous systems. The gut-brain axis has offered additional insight into the biopsychosocial model, providing an extensive framework to understand the relationship between IBD and psychological well-being through the interaction of biological, psychological, and social factors. Based on the concept of the gut-brain axis, accumulating evidence indicates that prolonged psychological stress may worsen IBD symptoms and lead to IBD flares. Furthermore, patients with IBD are more likely to experience symptoms of anxiety and depression compared to healthy individuals. The precise mechanism of this association remains partially unknown. Other psychological attributes, both positive (eg, optimism, mindfulness) and negative (eg, anxiety, catastrophizing, shame), have been shown to impact the lived experience of IBD including pain and quality of life. Abdominal pain is a key symptom of IBD. Multiple factors can account for pain, including physical, psychological, and social factors, supporting a multidimensional biopsychosocial model for the experience of pain in IBD. A multidimensional view on pain recognizes that pain is a subjective experience, thereby allowing it to be a target for psychological interventions. For example, pain catastrophizing has been associated with adverse clinical outcomes in overall health, functioning, and quality of life across multiple populations/samples. Psychological interventions of pain often attempt to improve functioning by increasing self-management behaviours and decreasing catastrophizing behaviours. Recent research has explored resilience-based coping as a supplement to existing disease management approaches. One example is the Resilience5 model, which targets individuals living with IBD and highlights 5 key positive psychological attributes that support disease-interfering self-management behaviours: self-efficacy, disease acceptance, self-regulation, social support, and optimism. Individuals high in the Resilience5 components are likely confident in their ability to take necessary action to effectively manage their condition, while adhering to treatment plans recommended by healthcare providers. Approximately 10%-20% of individuals newly diagnosed with IBD are under the age of 18, in a pivotal developmental stage. Early identification and intervention of IBD, in physical and psychological mechanisms, may assist adolescents in developing resilience, while establishing effective coping mechanisms. The aim of this study was to examine the association between resilience factors and abdominal pain in adolescences with IBD. Based on the Resilience5 core components, 4 resilience factors (optimism, self-efficacy, mindfulness, and psychological flexibility) and 2 social factors (friendship satisfaction, family functioning) were selected for assessment. We hypothesized that higher levels of resilience factors would be associated with the absence of abdominal pain or a decreased degree of pain. Through identifying resilience factors or specific resilience skills associated with pain, our research aimed to identify treatment targets for minimizing the impact of abdominal pain in an IBD sample.