Scholars@Duke
Joseph G Winger

Joseph G Winger

Assistant Professor in Psychiatry and Behavioral Sciences
Psychiatry & Behavioral Sciences, Behavioral Medicine & Neurosciences
joseph.winger@duke.edu
DUMC Box 102506, Durham, NC 27710
2400 Pratt Street, 7th Floor, Room 7044, Durham, NC 27705

Selected Publications

Experiences in Coping with Stress-A Qualitative Study of Family Caregivers of Children with Medical Complexity.

Journal Article Children (Basel) · September 23, 2024 OBJECTIVE: To better understand the strategies family caregivers of children with medical complexity (CMC) utilize to deal with the stress and challenges associated with caregiving. METHODS: We conducted a cross-sectional qualitative study among family car ... Full text Link to item Cite

Improving symptom management for survivors of young adult cancer: rationale and study protocol for a pilot randomized controlled trial.

Journal Article Pilot Feasibility Stud · June 8, 2024 BACKGROUND: Young adult (YA) cancer survivors are a growing, yet underserved population who often face significant and long-lasting cancer-related physical (e.g., pain, fatigue) and emotional (e.g., psychological distress) symptoms. Post-treatment symptoms ... Full text Link to item Cite

Author Response to Swisher et al.

Journal Article Phys Ther · February 1, 2024 Full text Link to item Cite

Self-Reported Well-Being of Family Caregivers of Children with Medical Complexity.

Journal Article Acad Pediatr · 2024 OBJECTIVE: Provide an in-depth and psychometrically rigorous profile of the emotional well-being and sleep-related health of family caregivers of children with medical complexity (CMC). METHODS: Cross-sectional survey study of family caregivers of CMC rece ... Full text Link to item Cite

Meaning-centered pain coping skills training for patients with metastatic cancer: Protocol for a randomized controlled efficacy trial.

Journal Article Contemp Clin Trials · December 2023 BACKGROUND: Many patients with advanced cancer describe pain as a debilitating symptom that greatly interferes with daily activities and enjoyment of life. Psychosocial interventions can improve cancer-related pain but rarely address spiritual concerns (e. ... Full text Link to item Cite

Breast cancer survivors with pain: an examination of the relationships between body mass index, physical activity, and symptom burden.

Journal Article Support Care Cancer · October 2, 2023 PURPOSE: Overweight and obesity are common for breast cancer survivors and associated with high symptom burden (i.e., pain, fatigue, depressive symptoms). Physical activity may protect breast cancer survivors with higher body mass indexes (BMI) from increa ... Full text Link to item Cite

Behavioral cancer pain intervention dosing: results of a Sequential Multiple Assignment Randomized Trial.

Journal Article Pain · September 1, 2023 Behavioral pain management interventions are efficacious for reducing pain in patients with cancer. However, optimal dosing of behavioral pain interventions for pain reduction is unknown, and this hinders routine clinical use. A Sequential Multiple Assignm ... Full text Link to item Cite

Cost-Effectiveness Analysis Evaluating Delivery Strategies for Pain Coping Skills Training in Women With Breast Cancer.

Journal Article J Pain · September 2023 Pain coping skills training (PCST) is efficacious in patients with cancer, but clinical access is limited. To inform implementation, as a secondary outcome, we estimated the cost-effectiveness of 8 dosing strategies of PCST evaluated in a sequential multip ... Full text Link to item Cite

Knowledge, goals, and misperceptions about palliative care in adults with chronic disease or cancer.

Journal Article Palliat Support Care · August 10, 2023 OBJECTIVES: Limited evidence investigates how knowledge, misconceptions, and beliefs about palliative care vary across patients with cancerous versus non-cancerous chronic disease. We examined the knowledge of and misconceptions about palliative care among ... Full text Link to item Cite

Improving Symptom Management for Survivors of Young Adult Cancer: Development of a Novel Intervention.

Journal Article J Adolesc Young Adult Oncol · August 2023 Purpose: Improved symptom management is a critical although unmet post-treatment need for young adult (YA) cancer survivors (aged 18-39 at diagnosis). This study aimed to develop and refine a behavioral symptom management intervention for YA survivors. Met ... Full text Link to item Cite

Effect of Pain Coping Skills Training on Pain and Pain Medication Use for Women With Breast Cancer.

Journal Article J Pain Symptom Manage · July 2023 CONTEXT: Pain is distressing for women with breast cancer. Pain medication may not provide full relief and can have negative side-effects. Cognitive-behavioral pain intervention protocols reduce pain severity and improve self-efficacy for pain management. ... Full text Link to item Cite

Meaning-centered pain coping skills training for patients with metastatic cancer: Results of a randomized controlled pilot trial.

Journal Article Psychooncology · July 2023 OBJECTIVE: For patients with advanced cancer, pain is a common and debilitating symptom that can negatively impact physical, emotional, and spiritual well-being. This trial examined the feasibility and initial effects of Meaning-Centered Pain Coping Skills ... Full text Link to item Cite

mHealth Coping Skills Training for Symptom Management (mCOPE) for colorectal cancer patients in early to mid-adulthood: Study protocol for a randomized controlled trial.

Journal Article Contemp Clin Trials Commun · June 2023 BACKGROUND: Colorectal cancer (CRC) patients in early to mid-adulthood (≤50 years) are challenged by high symptom burden (i.e., pain, fatigue, distress) and age-related stressors (e.g., managing family, work). Cognitive behavioral theory (CBT)-based coping ... Full text Link to item Cite

Relationships Between Burnout and Resilience: Experiences of Physical Therapists and Occupational Therapists During the COVID-19 Pandemic.

Journal Article Phys Ther · May 4, 2023 OBJECTIVE: Research on burnout among physical therapists and occupational therapists in the context of the coronavirus disease 2019 (COVID-19) pandemic is limited. Resilience may be important for reducing burnout and promoting well-being among rehabilitati ... Full text Link to item Cite

Role of self-efficacy for pain management and pain catastrophizing in the relationship between pain severity and depressive symptoms in women with breast cancer and pain.

Journal Article J Psychosoc Oncol · 2023 PURPOSE: This study evaluated the relationship between pain and depressive symptoms through pain self-efficacy and pain catastrophizing in breast cancer patients with pain. DESIGN: Secondary analysis of a randomized trial investigating a cognitive-behavior ... Full text Link to item Cite

Hybrid-delivered cognitive behavioral symptom management and activity coaching intervention for patients undergoing hematopoietic stem cell transplant: Findings from intervention development and a pilot randomized trial.

Journal Article J Psychosoc Oncol · 2023 OBJECTIVE: Develop and pilot test a mobile health (mHealth) cognitive behavioral coping skills training and activity coaching protocol (HCT Symptoms and Steps) for hematopoietic stem cell transplant (HCT) patients. DESIGN: Two-phase, mixed methods study. S ... Full text Link to item Cite

Virtual reality for improving pain and pain-related symptoms in patients with advanced stage colorectal cancer: A pilot trial to test feasibility and acceptability.

Journal Article Palliat Support Care · August 2022 OBJECTIVE: Virtual reality (VR) has the potential to improve pain and pain-related symptoms. We examined the feasibility, acceptability, safety, and impact of a 30-min virtual underwater/sea environment (VR Blue) for reducing pain and pain-related symptoms ... Full text Link to item Cite

Pain, depressive symptoms, and self-efficacy for pain management: examination in African-American women with breast cancer.

Journal Article Support Care Cancer · August 2022 PURPOSE: African-American women with breast cancer face significant disparities, including high levels of pain. Depressive symptoms and self-efficacy for pain management impact how women with breast cancer manage pain, yet little is known about how these v ... Full text Link to item Cite

Designing Psychosocial Intervention Pilot Studies: A Tutorial for Palliative Care Investigators.

Journal Article J Pain Symptom Manage · June 2022 This is a tutorial on designing a persuasive pilot study of a psychosocial intervention (e.g., behavioral symptom management) in the palliative care setting. This tutorial is most relevant for early stages of intervention research that aims to progress tow ... Full text Link to item Cite

Meaning-Centered Pain Coping Skills Training: A Pilot Feasibility Trial of a Psychosocial Pain Management Intervention for Patients with Advanced Cancer.

Journal Article J Palliat Med · January 2022 Background: Pain from advanced cancer can greatly reduce patients' physical, emotional, and spiritual well-being. Objective: To examine the feasibility and acceptability of a behavioral pain management intervention, Meaning-Centered Pain Coping Skills Trai ... Full text Link to item Cite

DEVELOPMENT, FEASIBILITY, AND ACCEPTABILITY OF A BEHAVIORAL WEIGHT AND SYMPTOM MANAGEMENT INTERVENTION FOR BREAST CANCER SURVIVORS AND INTIMATE PARTNERS.

Journal Article J Cancer Rehabil · 2022 BACKGROUND: Weight gain is common for breast cancer survivors and associated with disease progression, recurrence, and mortality. Traditional behavioral programs fail to address symptoms (i.e., pain, fatigue, distress) experienced by breast cancer survivor ... Full text Open Access Link to item Cite

Feasibility, engagement, and acceptability of a behavioral pain management intervention for colorectal cancer survivors with pain and psychological distress: data from a pilot randomized controlled trial.

Journal Article Support Care Cancer · September 2021 PURPOSE: Colorectal cancer survivors report pain and psychological distress to be burdensome long-term cancer consequences. Quality cancer survivorship care includes interventions for managing these symptoms. Yet, no studies have tested the efficacy of an ... Full text Link to item Cite

Relationship between social support, physical symptoms, and depression in women with breast cancer and pain.

Journal Article Support Care Cancer · September 2021 PURPOSE: Fatigue and pain are common among women with breast cancer, and often related to depressive symptoms. Social support may influence levels of fatigue, pain interference, and depressive symptoms. We tested a theory-based, structural model examining ... Full text Link to item Cite

Predictors of Response to an Evidence-Based Behavioral Cancer Pain Management Intervention: An Exploratory Analysis From a Clinical Trial.

Journal Article J Pain Symptom Manage · August 2021 CONTEXT: Interventions that teach patients cognitive and behavioral strategies for managing cancer pain have demonstrated effectiveness. Systematic reviews of such interventions call for research to inform their implementation in practice, including invest ... Full text Link to item Cite

Two Questions About the Design of Cluster Randomized Trials: A Tutorial.

Journal Article J Pain Symptom Manage · April 2021 This is a short tutorial on two key questions that pertain to cluster randomized trials (CRTs): 1) Should I perform a CRT? and 2) If so, how do I derive the sample size? In summary, a CRT is the best option when you "must" (e.g., the intervention can only ... Full text Link to item Cite

Behavioral cancer pain intervention using videoconferencing and a mobile application for medically underserved patients: Rationale, design, and methods of a prospective multisite randomized controlled trial.

Journal Article Contemp Clin Trials · March 2021 BACKGROUND: Women with breast cancer in medically underserved areas are particularly vulnerable to persistent pain and disability. Behavioral pain interventions reduce pain and improve outcomes. Cancer patients in medically underserved areas receive limite ... Full text Link to item Cite

Current measures of distress may not account for what's most important in existential care interventions: Results of the outlook trial.

Journal Article Palliat Support Care · December 2020 OBJECTIVE: Compare the efficacy of two interventions addressing emotional and existential well-being in early life-limiting illness. METHOD: Primary trial analysis (n = 135) included patients with advanced cancer, congestive heart failure, or end-stage ren ... Full text Link to item Cite

Self-efficacy and HPV Vaccine Attitudes Mediate the Relationship Between Social Norms and Intentions to Receive the HPV Vaccine Among College Students.

Journal Article J Community Health · December 2020 Human papillomavirus (HPV) has been linked to genital warts and multiple cancers affecting both men and women. Despite college students' high risk for HPV, their vaccination rates remain suboptimal. The current observational study examined the relationship ... Full text Link to item Cite

Predictors of Intervention Session Completion in a Randomized Clinical Trial of a Behavioral Cancer Pain Intervention.

Journal Article J Pain Symptom Manage · June 2020 CONTEXT: Some patients with cancer are able to complete psychosocial pain management intervention sessions, and others find it difficult to do so. OBJECTIVES: Conduct a secondary analysis of a randomized clinical trial (N = 178) that compared delivery form ... Full text Link to item Cite

Enhancing meaning in the face of advanced cancer and pain: Qualitative evaluation of a meaning-centered psychosocial pain management intervention.

Journal Article Palliat Support Care · June 2020 OBJECTIVES: The objectives of this study were to obtain patient evaluations of the content, structure, and delivery modality of Meaning-Centered Pain Coping Skills Training (MCPC), a novel psychosocial intervention for patients with advanced cancer and pai ... Full text Link to item Cite

Unmet Spiritual Care Needs in Women Undergoing Core Needle Breast Biopsy.

Journal Article J Breast Imaging · March 25, 2020 OBJECTIVE: Spiritual care is an important part of healthcare, especially when patients face a possible diagnosis of a life-threatening disease. This study examined the extent to which women undergoing core-needle breast biopsy desired spiritual support and ... Full text Link to item Cite

A cohort study of quality of life in partners of young breast cancer survivors compared to partners of healthy controls.

Journal Article J Patient Rep Outcomes · March 6, 2020 BACKGROUND: Partners of young breast cancer survivors (BCS) are at increased risk for deficits in quality of life (QoL). To intervene effectively, it is important to understand how the breast cancer experience impacts partners. The purpose of this study wa ... Full text Link to item Cite

Coping Skills Training and Acceptance and Commitment Therapy for Symptom Management: Feasibility and Acceptability of a Brief Telephone-Delivered Protocol for Patients With Advanced Cancer.

Journal Article J Pain Symptom Manage · February 2020 CONTEXT: Patients with advanced cancer face a life-limiting condition that brings a high symptom burden that often includes pain, fatigue, and psychological distress. Psychosocial interventions have promise for managing symptoms but need additional tailori ... Full text Link to item Cite

A feasible and acceptable multicultural psychosocial intervention targeting symptom management in the context of advanced breast cancer.

Journal Article Psychooncology · February 2020 OBJECTIVE: Advanced breast cancer patients around the world experience high symptom burden (ie, distress, pain, and fatigue) and are in need of psychosocial interventions that target symptom management. This study examined the feasibility, acceptability, a ... Full text Link to item Cite

A behavioral cancer pain intervention: A randomized noninferiority trial comparing in-person with videoconference delivery.

Journal Article Psychooncology · August 2019 OBJECTIVE: Behavioral cancer pain interventions are efficacious for improving important pain outcomes; yet, traditional in-person delivery limits patient access. This study compared videoconference-delivered mobile health pain coping skills training (mPCST ... Full text Link to item Cite

Does Self-Efficacy Mediate the Relationships Between Social-Cognitive Factors and Intentions to Receive HPV Vaccination Among Young Women?

Journal Article Clin Nurs Res · July 2019 Drawing upon health behavior change theories, the current study examined whether self-efficacy mediated relationships between social-cognitive factors (i.e., perceived risk, perceived benefits, perceived barriers, perceived severity, and cue to action) and ... Full text Link to item Cite

Development and pilot testing of an mHealth behavioral cancer pain protocol for medically underserved communities.

Journal Article J Psychosoc Oncol · 2019 The purpose of this study was to refine and test a mobile-health behavioral cancer pain coping skills training protocol for women with breast cancer and pain from medically underserved areas. Three focus groups (Phase 1) were used to refine the initial pro ... Full text Link to item Cite

Coping Skills Practice and Symptom Change: A Secondary Analysis of a Pilot Telephone Symptom Management Intervention for Lung Cancer Patients and Their Family Caregivers.

Journal Article J Pain Symptom Manage · May 2018 CONTEXT: Little research has explored coping skills practice in relation to symptom outcomes in psychosocial interventions for cancer patients and their family caregivers. OBJECTIVES: To examine associations of coping skills practice to symptom change in a ... Full text Link to item Cite

Cancer-related loneliness mediates the relationships between social constraints and symptoms among cancer patients.

Journal Article J Behav Med · April 2018 Cancer patients have high rates of persistent and disabling symptoms. Evidence suggests that social constraints (e.g., avoidance and criticism) negatively impact symptoms, but pathways linking these variables have yet to be identified. This study examined ... Full text Link to item Cite

Effects of diet and exercise on weight-related outcomes for breast cancer survivors and their adult daughters: an analysis of the DAMES trial.

Journal Article Support Care Cancer · August 2017 PURPOSE: Few trials have aimed to promote diet and exercise behaviors in both cancer survivors and their family members and examine their associations with weight-related outcomes. We conducted a secondary analysis to examine associations between change in ... Full text Link to item Cite

A systematic review of psychosocial interventions for colorectal cancer patients.

Journal Article Support Care Cancer · July 2017 PURPOSE: A significant minority of colorectal cancer (CRC) patients experience clinically meaningful distress that may warrant intervention. The goal of this systematic review was to assess the impact of psychosocial interventions on quality-of-life and ps ... Full text Link to item Cite

Optimizing delivery of a behavioral pain intervention in cancer patients using a sequential multiple assignment randomized trial SMART.

Journal Article Contemp Clin Trials · June 2017 BACKGROUND/AIMS: Pain is common in cancer patients and results in lower quality of life, depression, poor physical functioning, financial difficulty, and decreased survival time. Behavioral pain interventions are effective and nonpharmacologic. Traditional ... Full text Link to item Cite

Mental health outcomes during colorectal cancer survivorship: a review of the literature.

Journal Article Psychooncology · November 2016 OBJECTIVE: This article reviews literature on adults' mental health outcomes during acute and long-term colorectal cancer (CRC) survivorship. METHODS: We identified articles that included at least one measure of psychological symptoms or mental quality of ... Full text Link to item Cite

Randomized Pilot Trial of a Telephone Symptom Management Intervention for Symptomatic Lung Cancer Patients and Their Family Caregivers.

Journal Article J Pain Symptom Manage · October 2016 CONTEXT: Lung cancer is one of the most common cancers affecting both men and women and is associated with high symptom burden and psychological distress. Lung cancer patients' family caregivers also show high rates of distress. However, few interventions ... Full text Link to item Cite

Associations of health behaviors with human papillomavirus vaccine uptake, completion, and intentions among female undergraduate students.

Journal Article J Health Psychol · September 2016 This study explored associations between health behaviors and human papillomavirus vaccine receipt/intentions among female undergraduates. Participants (N = 286) completed a survey assessing human papillomavirus vaccine uptake (receiving 1-3 shots vs no sh ... Full text Link to item Cite

The role of anticipated regret and health beliefs in HPV vaccination intentions among young adults.

Journal Article J Behav Med · June 2016 Although cognitions have predicted young adults' human papillomavirus (HPV) vaccine decision-making, emotion-based theories of healthcare decision-making suggest that anticipatory emotions may be more predictive. This study examined whether anticipated reg ... Full text Link to item Cite

Relations of meaning in life and sense of coherence to distress in cancer patients: a meta-analysis.

Journal Article Psychooncology · January 2016 OBJECTIVE: Cancer patients report high rates of distress. The related constructs of meaning in life (MiL) and sense of coherence (SOC) have long been recognized as important factors in the psychological adjustment to cancer; however, both constructs' assoc ... Full text Link to item Cite

A meta-analysis of the relationship between social constraints and distress in cancer patients.

Journal Article J Behav Med · April 2015 Social constraints on cancer-related disclosure have been associated with increased distress among cancer patients. The goals of this meta-analysis were: (1) to quantify the average strength of the relationships between social constraints and general and c ... Full text Link to item Cite

Diet and exercise intervention adherence and health-related outcomes among older long-term breast, prostate, and colorectal cancer survivors.

Journal Article Ann Behav Med · October 2014 BACKGROUND: Diet and exercise interventions for cancer survivors result in health benefits; however, few studies have examined health outcomes in relation to adherence. PURPOSE: We examined associations between adherence to components of a diet-exercise in ... Full text Link to item Cite

Barriers to mental health service use and preferences for addressing emotional concerns among lung cancer patients.

Journal Article Psychooncology · July 2014 OBJECTIVE: This study examined barriers to mental health service use and preferences for addressing emotional concerns among lung cancer patients (N=165) at two medical centers in the Midwestern United States. METHODS: Lung cancer patients completed an ass ... Full text Link to item Cite

Neuroscience exposure and perceptions of client responsibility among addictions counselors.

Journal Article J Subst Abuse Treat · June 2012 Members of the National Association of Alcoholism and Drug Abuse Counselors (n = 231) participated in a survey concerning their view of the role of personal responsibility in addictions treatment and its relation to their exposure to neuroscience (i.e., th ... Full text Link to item Cite