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Ayvat İ, Atli Ozbas A. Is There a Difference in Unmet Supportive Care Needs Between Older and Younger Outpatients Receiving Chemotherapy? J Palliat Care 2024; 39:115-121. [PMID: 34665068 DOI: 10.1177/08258597211044248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This study investigated whether there was a difference in unmet supportive care needs between older and younger cancer patients who receive chemotherapy. Background: Physiological, physical, cognitive, and social functions, which play a key role in coping with cancer, are impaired due to aging. Age-related physiological changes and psychosocial factors and comorbid medical conditions make some of the needs of older cancer patients unique and complex. At the heart of meeting these needs lies the concept of supportive care. First step of meeting their needs is to determine these needs. Study Design and Methods: The study was conducted in the Daytime Treatment Unit of the oncology hospital of a university in Ankara, Turkey. The study sample consisted of 93 patients aged 65 years or older and 93 patients under 65 years of age. Both groups were similar in terms of sex, cancer type, and chemotherapy protocols. Data were collected using a Patient Information Form and Supportive Care Needs Scale-Short Turkish Version and analyzed using descriptive statistics, Mann-Whitney U test, Kruskal-Wallis H test, and Bonferroni correction. Results: Participants had a median total score of 1.92. Their "daily life needs" and "sexuality needs" subscale scores were highest and lowest, respectively. Older patients had lower median total scores than younger patients. Younger patients had higher median "health care and information needs" and "sexuality needs" subscale scores than older patients. Conclusion: Elderly patients reported fewer unmet needs than younger patients. This may be due to age-related cultural factors as they may have difficulty expressing their needs. Implications: Results suggest to focus on the fact that patients' needs change with age and that they have difficulty expressing their needs.
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Affiliation(s)
- İrem Ayvat
- Faculty of Nursing, Psychiatric Nursing Department, Hacettepe University, Turkey
| | - Azize Atli Ozbas
- Faculty of Nursing, Psychiatric Nursing Department, Hacettepe University, Turkey
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Hyland KA, Oswald LB, Reblin M, Small BJ, Gray JE, Jim HSL, Jacobsen PB. Goals and goal perceptions in patients with advanced stage lung cancer: a mixed methods study. Support Care Cancer 2023; 31:314. [PMID: 37126099 PMCID: PMC10150146 DOI: 10.1007/s00520-023-07745-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/10/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE Goals provide insight into what is important to an individual. We describe the development and application of a mixed methods approach to elicit goals and perceptions about goals in patients with advanced cancer. METHODS Patients receiving first-line treatment for advanced lung cancer participated in semi-structured interviews about their goals. Participants self-generated goals, then selected and ranked their three most important goals and provided Likert scale ratings of goal-related perceptions (e.g., attainability, locus of control). Independent raters coded goals into content domains. One month later, participants reported perceived progress toward goals and facilitators of and barriers to progress. RESULTS Participants (N = 75, Mage = 64.5 years, 59% female) identified goals across eight domains: social/role/relationship, everyday/practical, leisure/pleasure, psychological/existential/spiritual, major life changes or achievements, cancer treatment response/disease outcomes, palliative outcomes, and behavioral health improvement. Of all goals identified (N = 352), 72% of patients had at least one social/role/relationship goal, 68% had a leisure/pleasure goal, and 29% had a cancer treatment response goal. On average, participants considered their goals to be attainable, perceived a high degree of control over reaching goals, anticipated making "some" progress in the short term, and perceived a high likelihood of reaching goals in the future. Facilitators of progress included mental fortitude, feeling physically well, and social support. Barriers included cancer-related side effects, practical challenges, and COVID-19. CONCLUSIONS A majority of participant goals focused on meaningful engagement and living well. Goals were largely viewed as attainable and under participants' control. Cancer clinicians may consider how to support patients in working toward valued goals in conjunction with oncology care.
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Affiliation(s)
- Kelly A Hyland
- Duke University, Durham, NC, USA.
- Moffitt Cancer Center, Tampa, FL, USA.
- University of South Florida, Tampa, FL, USA.
| | | | - Maija Reblin
- University of Vermont College of Medicine, Burlington, VT, USA
| | - Brent J Small
- Moffitt Cancer Center, Tampa, FL, USA
- University of South Florida, Tampa, FL, USA
| | | | | | - Paul B Jacobsen
- University of South Florida, Tampa, FL, USA
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
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Scobbie L, Thomson K, Pollock A, Evans J. Goal adjustment by people living with long-term conditions: A scoping review of literature published from January 2007 to June 2018. Neuropsychol Rehabil 2021; 31:1314-1345. [PMID: 32525446 DOI: 10.1080/09602011.2020.1774397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Long-term health conditions can limit achievement of personal goals. We aimed to map and synthesize definitions of goal adjustment, theoretical underpinnings, associations with recovery and supportive interventions for adults with long-term conditions. We searched multiple databases (January 2007-June 2018) and identified peer-reviewed research relating to goal adjustment. Data were charted, mapped and synthesized using content analysis and descriptive summaries. Two stakeholder consultations informed the review. Ninety-one articles were included. A range of long-term conditions were represented including cancer (22%), stroke (12%) and mixed neurological conditions (8%). Goal adjustment was one available option when faced with unattainable goals; other options were goal disengagement and goal re-engagement. Most studies were quantitative (58%), reporting mainly positive associations between goal adjustment, disengagement, reengagement and recovery. The Dual Process Model, Goal Adjustment Model and Self-Regulation Theory were most cited underpinning models/theory. Five interventions were identified; only one (self-system therapy) was evaluated in a randomized controlled trial. Our review provides original and significant insights into goal adjustment definitions, theoretical underpinnings and association with recovery. Effective interventions to support goal adjustment, disengagement and reengagement are lacking. This research-practice gap warrants attention to ensure people with long-term conditions are optimally supported when facing unattainable goals.
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Affiliation(s)
- Lesley Scobbie
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Katie Thomson
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Alex Pollock
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Jonathan Evans
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
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Zhang A, Hu R, Wang K, Antalis EP. Age moderates the association between psychological distress and engagement in mindfulness among cancer patients and survivors: A population-based study. J Psychosoc Oncol 2020; 38:513-526. [PMID: 32449497 DOI: 10.1080/07347332.2020.1764158] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE We aim to evaluate the relationship between psychological distress and engagement in mindfulness among a national representative sample of cancer survivors. SAMPLE AND DESIGN Using the 2017 National Health Interview Survey, our final analytical sample included 3068 participants who reported having been diagnosed with cancer. METHODS AND ANALYSIS We used logistic regression analysis to assess the association and to test age as a moderator. We also conducted follow-up analysis using Fisher's r-to-z transformation. All analyses were adjusted for complex sample weights. FINDINGS Cancer survivors who had subclinical and clinical psychological distress were more likely to engage in mindfulness, OR = 1.59, 95% CI [1.24, 2.02] and OR = 1.45, 95% CI [1.02, 2.05], respectively. Age significantly moderated such association with the relationship much stronger among those who are younger (younger than 65 years old) than those who are older (65 years or older), b = 0.97, 95% CI [0.95, 0.99]. CONCLUSIONS The relationship between psychological distress and engagement in mindfulness differs significantly by a survivor's age. Psychosocial oncological providers need to account for a survivor's age when delivering mindfulness based care to address psychological distress. IMPLICATIONS Providers should be mindful of a survivor's age when recommending mindfulness oriented practices.
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Affiliation(s)
- Anao Zhang
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Rita Hu
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Kaipeng Wang
- School of Social Work, Texas State University, San Marcos, TX, USA
| | - Erin Peregine Antalis
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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Pama MR, Janse M, Sprangers MAG, Fleer J, Ranchor AV. Reducing discrepancies of personal goals in the context of cancer: A longitudinal study on the relation with well-being, psychological characteristics, and goal progress. Br J Health Psychol 2017; 23:128-147. [PMID: 28960718 DOI: 10.1111/bjhp.12278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 06/09/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To (1) examine whether reducing discrepancies between goal importance and goal attainability is an adaptive predictor of well-being, (2) investigate intrusion, awareness, optimism, and pessimism as determinants of reducing discrepancies between goal importance and goal attainability, and (3) explore how goal progress is involved in reducing discrepancies between goal importance and goal attainability during two major periods after a colorectal cancer diagnosis. DESIGN Prospective design. METHODS Newly diagnosed colorectal cancer patients (n = 120) were interviewed three times: within a month, 7 months (treatment period), and 18 months (follow-up period) post-diagnosis. Data were analysed using multiple regressions. RESULTS Results showed that (1) reducing discrepancies enhances well-being, (2) optimism and pessimism are predictors of reducing discrepancies during the treatment period but not during the follow-up period, while intrusion and awareness do not predict reducing discrepancies in either period, and (3) goal progress is a predictor of reducing discrepancies during the follow-up period, but no evidence for a moderating or mediating role of goal progress in the relation between psychological characteristics and reducing discrepancies was found. CONCLUSIONS Reducing discrepancies between goal importance and goal attainability could benefit colorectal cancer patients' well-being. Optimism, pessimism, and goal progress appear to influence cancer patients' ability to reduce discrepancies. Providing assistance in improving goal progress to those who are less optimistic and highly pessimistic may be a suitable training for cancer patients to prevent deterioration in well-being. Statement of contribution What is already known on this subject? More discrepancy between goal importance and goal attainability is associated with lower levels of well-being. People are able to change evaluations of importance and attainability, but it is unknown whether this positively impacts well-being. Underlying causes of differences in the extent to which discrepancies between goal importance and goal attainability are reduced are unknown. What does this study add? This is the first study to show that reducing discrepancies between goal importance and goal attainability is beneficial for well-being. This is the first study to show that optimism and pessimism are determinants of reducing discrepancies between goal importance and goal attainability. Goal progress might be an effective target for interventions that aim to facilitate one's ability to reduce discrepancies between goal importance and goal attainability.
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Affiliation(s)
- Marlous R Pama
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Moniek Janse
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Mirjam A G Sprangers
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Joke Fleer
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Adelita V Ranchor
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, The Netherlands
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Müller F, Tuinman MA, Janse M, Almansa J, Sprangers MAG, Smink A, Ranchor AV, Fleer J, Hagedoorn M. Clinically distinct trajectories of fatigue and their longitudinal relationship with the disturbance of personal goals following a cancer diagnosis. Br J Health Psychol 2017. [DOI: 10.1111/bjhp.12253] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Fabiola Müller
- Department of Health Psychology; University Medical Center Groningen; University of Groningen; The Netherlands
| | - Marrit A. Tuinman
- Department of Health Psychology; University Medical Center Groningen; University of Groningen; The Netherlands
| | - Moniek Janse
- Department of Health Psychology; University Medical Center Groningen; University of Groningen; The Netherlands
| | - Josué Almansa
- Division of Community and Occupational Medicine; Department of Health Sciences; University Medical Center Groningen; University of Groningen; The Netherlands
| | - Mirjam A. G. Sprangers
- Department of Medical Psychology; Academic Medical Center; University of Amsterdam; The Netherlands
| | - Ans Smink
- Department of Health Psychology; University Medical Center Groningen; University of Groningen; The Netherlands
| | - Adelita V. Ranchor
- Department of Health Psychology; University Medical Center Groningen; University of Groningen; The Netherlands
| | - Joke Fleer
- Department of Health Psychology; University Medical Center Groningen; University of Groningen; The Netherlands
| | - Mariët Hagedoorn
- Department of Health Psychology; University Medical Center Groningen; University of Groningen; The Netherlands
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de Vries AM, Schulz T, Westerhuis R, Navis GJ, Niesing J, Ranchor AV, Schroevers MJ. Goal disturbance changes pre/post-renal transplantation are related to changes in distress. Br J Health Psychol 2017; 22:524-541. [PMID: 28544010 DOI: 10.1111/bjhp.12243] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 04/03/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Renal transplantation (RTx) is considered the treatment of choice for end-stage renal disease (ESRD) given its association with lower mortality, and improved overall quality of life and psychological functioning compared to dialysis. However, much less is known about which factors underlie these psychological improvements across RTx. Goal theory suggests that experienced disturbances in important goals are related to lower psychological functioning. This study aimed to (1) identify the most disturbed and most important goals for patients before RTx, (2) to examine changes in goal disturbance and goal importance pre/post-RTx, and (3) to examine whether changes in goal disturbance are associated with changes in psychological distress over time, and whether this relationship is mediated by changes in perceived control. METHODS In this longitudinal study, 220 patients completed questionnaires before and after RTx, including questionnaires to assess goals (GOALS questionnaire), psychological distress (GHQ-12), and perceived control (Mastery scale). RESULTS End-stage renal disease affected both general and disease-specific goals. Approximately 30% of the patients indicated to experience high or very high disturbance before transplantation. Goal disturbance generally decreased significantly pre- to post-RTx, whereas goal importance did not change significantly pre- to post-RTx. No mediation effect of perceived control was found. Instead, both changes in goal disturbance and perceived control showed independent effects on changes in distress. CONCLUSIONS Intervention strategies targeting attainable and realistic goal setting, and perceived control in RTx recipients who do not benefit optimally from RTx, might enhance psychological functioning in this population. Statement of contribution What is already known on this subject? Kidney transplantation improves patients' psychological functioning. Experienced disturbances in important life goals are related to lower psychological functioning in chronic illness. What does this study add? Goal disturbance decreases after renal transplantation, and this is related to a decrease in distress over time. Perceived control does not mediate the relationship between goal disturbance and distress pre/post-transplantation. Changes in perceived control have an additional main effect on changes in distress.
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Affiliation(s)
- Alicia M de Vries
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Torben Schulz
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, The Netherlands
| | | | - Gerjan J Navis
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Jan Niesing
- Department of Abdominal Surgery, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Adelita V Ranchor
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Maya J Schroevers
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, The Netherlands
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Magnuson A, Wallace J, Canin B, Chow S, Dale W, Mohile SG, Hamel LM. Shared Goal Setting in Team-Based Geriatric Oncology. J Oncol Pract 2016; 12:1115-1122. [PMID: 27624949 DOI: 10.1200/jop.2016.013623] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
We present the case of a 92-year-old man, MH, who was given a diagnosis of colorectal cancer. His primary care physician, surgeon, geriatric oncologist, and family members all played important roles in his care. MH's case is an example of a lack of explicit shared goal setting by the health care providers with the patient and family members and how that impeded care planning and health. This case demonstrates the importance of explicitly discussing and establishing shared goals in team-based cancer care delivery early on and throughout the care process, especially for older adults. Each individual member's goals should be understood as they fit within the overarching shared team goals. We emphasize that shared goal setting and alignment of individual goals is a dynamic process that must occur several times at critical decision points throughout a patient's care continuum. Providers and researchers can use this illustrative case to consider their own work and contemplate how shared goal setting can improve patient-centered care and health outcomes in various team-based care settings. Shared goal setting among team members has been demonstrated to improve outcomes in other contexts. However, we stress, that little investigation into the impact of shared goal setting on team-based cancer care delivery has been conducted. We list immediate research goals within team-based cancer care delivery that can provide a foundation for the understanding of the process and outcomes of shared goal setting.
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Affiliation(s)
- Allison Magnuson
- University of Rochester; SCOREboard, Rochester, NY; The University of Chicago, Chicago, IL; and Wayne State University School of Medicine, Detroit, MI
| | - James Wallace
- University of Rochester; SCOREboard, Rochester, NY; The University of Chicago, Chicago, IL; and Wayne State University School of Medicine, Detroit, MI
| | - Beverly Canin
- University of Rochester; SCOREboard, Rochester, NY; The University of Chicago, Chicago, IL; and Wayne State University School of Medicine, Detroit, MI
| | - Selina Chow
- University of Rochester; SCOREboard, Rochester, NY; The University of Chicago, Chicago, IL; and Wayne State University School of Medicine, Detroit, MI
| | - William Dale
- University of Rochester; SCOREboard, Rochester, NY; The University of Chicago, Chicago, IL; and Wayne State University School of Medicine, Detroit, MI
| | - Supriya G Mohile
- University of Rochester; SCOREboard, Rochester, NY; The University of Chicago, Chicago, IL; and Wayne State University School of Medicine, Detroit, MI
| | - Lauren M Hamel
- University of Rochester; SCOREboard, Rochester, NY; The University of Chicago, Chicago, IL; and Wayne State University School of Medicine, Detroit, MI
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Janse M, Sprangers MAG, Ranchor AV, Fleer J. Long-term effects of goal disturbance and adjustment on well-being in cancer patients. Qual Life Res 2015; 25:1017-27. [PMID: 26446093 PMCID: PMC4830851 DOI: 10.1007/s11136-015-1139-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE To investigate the impact of personal goal disturbance after cancer diagnosis on well-being over time, and a possible moderating role of goal adjustment tendencies and actual goal adjustment strategies. METHODS Participants (n = 186) were interviewed three times: within a month, 7 months (treatment period), and 18 months (follow-up period) after being diagnosed with colorectal cancer. Participants were asked to freely mention three to ten personal goals. Goal disturbance was assessed by the patients' ratings of the amount of hindrance experienced in goal achievement. Goal adjustment tendencies were assessed using the Goal Disengagement and Re-engagement Scale and actual goal adjustment (i.e. goal flexibility) by the number of goal adjustment strategies used. Outcome measures were overall quality of life and emotional functioning, assessed with the cancer-specific EORTC QLQ-C30. RESULTS Hierarchical regression analyses showed that goal disturbance predicted well-being over both the treatment and the follow-up period. Additionally, the negative effect of goal disturbance on well-being was less for patients who scored higher on goal disengagement and not significant for patients who were more flexible in their use of actual goal adjustment strategies. CONCLUSIONS The present study is the first to test the theoretical assumption that goal adjustment is beneficial after goal disturbance. Whereas these findings need to be confirmed in future research, the possibly beneficial role of goal disengagement and actual goal adjustment strategies can be used for psychological interventions.
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Affiliation(s)
- Moniek Janse
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands.
| | - Mirjam A G Sprangers
- Department of Medical Psychology, Academic Medical Center Amsterdam, University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam Zuidoost, The Netherlands
| | - Adelita V Ranchor
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands
| | - Joke Fleer
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands
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Janse M, Ranchor AV, Smink A, Sprangers MAG, Fleer J. People with cancer use goal adjustment strategies in the first 6 months after diagnosis and tell us how. Br J Health Psychol 2015; 21:268-84. [DOI: 10.1111/bjhp.12167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 07/10/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Moniek Janse
- Department of Health Sciences; University Medical Center Groningen; University of Groningen; The Netherlands
| | - Adelita V. Ranchor
- Department of Health Sciences; University Medical Center Groningen; University of Groningen; The Netherlands
| | - Ans Smink
- Department of Health Sciences; University Medical Center Groningen; University of Groningen; The Netherlands
| | - Mirjam A. G. Sprangers
- Department of Medical Psychology; Academic Medical Center; University of Amsterdam; The Netherlands
| | - Joke Fleer
- Department of Health Sciences; University Medical Center Groningen; University of Groningen; The Netherlands
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