Rasch analysis of positive changes following adversity in cancer patients attending community support groups

Social Support to Reduce Uncertainty in Childhood Cancer in South Texas: A Case Study

PURPOSE

To determine if supportive measures are found to be most helpful and feasible for families of children with cancer by obtaining in-depth perspectives of uncertainty and adaptation.

HYPOTHESES

Traditional methods of psychosocial support do not meet the needs of parents and families dealing with cancer. Participants prefer more informal meetings and gatherings that are more social in nature.

METHOD

A descriptive single embedded case study was used to study uncertainty and social support for families with children treated at a pediatric hematology/oncology department in south Texas. The sample included members of the health care team in a pediatric cancer/bone marrow transplant unit and parents of children diagnosed with cancer. Data were gathered through audio-recorded interviews.

DATA ANALYSIS

Data were transcribed and analyzed through thematic content and pattern matching using computer software.

RESULTS

Four themes were identified: meaning of uncertainty in parents and members of the health care team, facilitators of parental adaptation, education and psychosocial support, and patient/family obstacles hindering successful adaptation. These demonstrated aspects of care interventions, clarifying what uncertainty means and how it affects the ability of parents to adapt to life with pediatric cancer, perceptions regarding the helpfulness of education and support interventions or lack thereof, and what internal and external obstacles hinder the family's adaptation.

IMPLICATIONS FOR PRACTICE

Improving patient education through individualization and delivery time frame as well as providing opportunities for informal sharing and community building are key to reducing uncertainty and improving family adaptation to life with childhood cancer.

Rasch models suggested the satisfactory psychometric properties of the World Health Organization Quality of Life-Brief among lung cancer patients

The study examined whether the items of the World Health Organization Quality of Life-Brief questionnaire can assess its four underlying domains (Physical, Psychological, Social, and Environment) in a sample of lung cancer patients. All patients ( n = 1150) were recruited from a medical center in Tainan, and each participant completed the World Health Organization Quality of Life-Brief. Several Rasch rating scale models were used to examine the data-model fit, and Rasch analyses corroborated that each domain of the World Health Organization Quality of Life-Brief could be unidimensional. Although three items were found to have a poor fit, all the other items fit the unidimensionality with ordered thresholds.

Ethnicity moderates the relationship between perceived stress and benefit finding in HIV+ men who have sex with men (MSM)

BACKGROUND

Numerous studies conducted within the USA demonstrate higher levels of benefit finding in ethnic minority individuals compared to nonminority individuals living with chronic disease.

PURPOSE

As benefit finding may be a salient buffer for the effects of stress, the current study examined the association between perceived stress and benefit finding in human immunodeficiency virus (HIV)+ men who have sex with men (MSM) living in the southeast USA and investigated whether ethnicity was a moderator of this relationship. We hypothesized that benefit finding would be greater in ethnic minority MSM than in white MSM and that ethnic minority MSM with high levels of stress would experience greater benefit finding than their white MSM counterparts.

METHOD

The current study utilized baseline (T1) and 3-month follow-up (T2) data drawn from a previous trial of a psychosocial intervention in HIV+ MSM. Participants were 130 HIV+ MSM; 52 % were white and 48 % belonged to minority ethnic groups (African-American, Caribbean-American, Hispanic).

RESULTS

Analyses revealed that benefit finding was greater in ethnic minority MSM at baseline; however, this difference became nonsignificant when age, education level, highly active antiretroviral therapy adherence, and CD4 count were added to the model. Moderated regression analyses revealed a significant interaction between T1 perceived stress and ethnicity in predicting T2 benefit finding, such that higher levels of T1 perceived stress predicted lower levels of T2 benefit finding in ethnic minority MSM only. This association was independent of intervention group assignment.

CONCLUSION

The current study's results highlight potential differences in the relationship between stress and benefit finding processes in white and ethnic minority HIV+ MSM.

Values and options in cancer care (VOICE): study design and rationale for a patient-centered communication and decision-making intervention for physicians, patients with advanced cancer, and their caregivers

BACKGROUND

Communication about prognosis and treatment choices is essential for informed decision making in advanced cancer. This article describes an investigation designed to facilitate communication and decision making among oncologists, patients with advanced cancer, and their caregivers.

METHODS/DESIGN

The Values and Options in Cancer Care (VOICE) Study is a National Cancer Institute sponsored randomized controlled trial conducted in the Rochester/Buffalo, NY and Sacramento, CA regions. A total of 40 oncologists, approximately 400 patients with advanced cancer, and their family/friend caregivers (one per patient, when available) are expected to enroll in the study. Drawing upon ecological theory, the intervention uses a two-pronged approach: oncologists complete a multifaceted tailored educational intervention involving standardized patient instructors (SPIs), and patients and caregivers complete a coaching intervention to facilitate prioritizing and discussing questions and concerns. Follow-up data will be collected approximately quarterly for up to three years.

DISCUSSION

The intervention is hypothesized to enhance patient-centered communication, quality of care, and patient outcomes. Analyses will examine the effects of the intervention on key elements of physician-patient-caregiver communication (primary outcomes), the physician-patient relationship, shared understanding of prognosis, patient well-being, and health service utilization (secondary outcomes).

TRIAL REGISTRATION

Clinical Trials Identifier: NCT01485627.

Effects of an intervention on nutrition consultation for cancer patients

We assessed whether cancer patients given a nutritional consultation by dietitians when discharged from the hospital experienced more health benefits than those not given a nutritional consultation. The McNemar test and the general linear model were used to examine the effect of nutrition intervention. A bubble chart was plotted to show the comparison between cancer groups. A total of 537 cancer patients discharged from a 1200-bed medical centre in Taiwan in 2011 were randomly divided into experimental and control groups. In the experimental group, nutritional status [evaluated using the Subjective Global Assessment (SGA) Classification technique], weight loss, and food intake recovery were significantly affected and returned to their usual levels, but in the control group, only food intake recovery was significantly affected. The effect of nutrition consultation intervention for cancer patients is thus evident. Significant positive effects were cancer-stage-dependent but not cancer-type-dependent. Future studies are recommended using the present study's methods to see whether the nutrition intervention effect occurs in cancer patients discharged from other hospitals throughout the world.