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Suresh M, Risbud R, Patel MI, Lorenz KA, Schapira L, Gallagher-Thompson D, Trivedi R. Clinic-based Assessment and Support for Family Caregivers of Patients With Cancer: Results of a Feasibility Study. CANCER CARE RESEARCH ONLINE 2023; 3:e047. [PMID: 38328267 PMCID: PMC10846853 DOI: 10.1097/cr9.0000000000000047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Background Cancer caregiving is burdensome with unique needs, highlighting the importance of assessing caregivers' distress. Caregivers often accompany patients to healthcare visits, presenting an opportunity to complete distress screening at patients' point-of-care. Objective To evaluate the feasibility of caregiver distress screening at patients' point-of-care and implementing a caregiver psychoeducational session. Methods We approached caregivers in outpatient cancer clinic waiting rooms. Participants completed depression, burden, anxiety, quality of life, and stress measures. A psychoeducational session with a psychologist was offered to those meeting clinical cutoffs for depression and/or burden. Fifty caregivers completed 1+ measure; however, due to incomplete consent documentation, findings from 23 caregivers are reported. Results 22% of caregivers screened positive for depression, 30% burden, and 70% anxiety. More than half rated stress as moderate or higher. Mental wellbeing was slightly below that of the general population. More than 75% screened positive on 1+ distress measure. Of the 9 caregivers who met cutoffs for depression and/or burden, two (22%) accepted the psychoeducational session. Conclusion Caregivers were moderately receptive to distress screening during patients' visits, but were less receptive to engaging in the psychoeducational session due to time constraints and privacy concerns. Implications for Practice Assessing caregivers' distress can facilitate referrals for supportive services. Offering caregivers psychoeducational intervention outside of patient care may not be acceptable. Future research may evaluate the integration of routine caregiver screening within patient care to promote engagement with mental health services. Foundational This research offers a unique method of assessing cancer caregivers' distress.
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Affiliation(s)
- Madhuvanthi Suresh
- Department of Neurological Sciences, Rush University Medical Center, Chicago, USA (Dr Suresh); Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA (Drs Suresh, Lorenz and Trivedi, Ms Risbud); Division of Oncology, Stanford University School of Medicine, Stanford, CA USA (Dr Patel); Medical Services, VA Palo Alto Health Care System, Palo Alto, CA USA (Drs Patel and Lorenz); Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA (Dr Shapira); Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA (Dr Gallagher-Thompson); Division of Public Mental Health and Population Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA (Dr Trivedi)
| | - Rashmi Risbud
- Department of Neurological Sciences, Rush University Medical Center, Chicago, USA (Dr Suresh); Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA (Drs Suresh, Lorenz and Trivedi, Ms Risbud); Division of Oncology, Stanford University School of Medicine, Stanford, CA USA (Dr Patel); Medical Services, VA Palo Alto Health Care System, Palo Alto, CA USA (Drs Patel and Lorenz); Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA (Dr Shapira); Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA (Dr Gallagher-Thompson); Division of Public Mental Health and Population Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA (Dr Trivedi)
| | - Manali I Patel
- Department of Neurological Sciences, Rush University Medical Center, Chicago, USA (Dr Suresh); Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA (Drs Suresh, Lorenz and Trivedi, Ms Risbud); Division of Oncology, Stanford University School of Medicine, Stanford, CA USA (Dr Patel); Medical Services, VA Palo Alto Health Care System, Palo Alto, CA USA (Drs Patel and Lorenz); Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA (Dr Shapira); Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA (Dr Gallagher-Thompson); Division of Public Mental Health and Population Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA (Dr Trivedi)
| | - Karl A Lorenz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, USA (Dr Suresh); Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA (Drs Suresh, Lorenz and Trivedi, Ms Risbud); Division of Oncology, Stanford University School of Medicine, Stanford, CA USA (Dr Patel); Medical Services, VA Palo Alto Health Care System, Palo Alto, CA USA (Drs Patel and Lorenz); Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA (Dr Shapira); Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA (Dr Gallagher-Thompson); Division of Public Mental Health and Population Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA (Dr Trivedi)
| | - Lidia Schapira
- Department of Neurological Sciences, Rush University Medical Center, Chicago, USA (Dr Suresh); Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA (Drs Suresh, Lorenz and Trivedi, Ms Risbud); Division of Oncology, Stanford University School of Medicine, Stanford, CA USA (Dr Patel); Medical Services, VA Palo Alto Health Care System, Palo Alto, CA USA (Drs Patel and Lorenz); Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA (Dr Shapira); Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA (Dr Gallagher-Thompson); Division of Public Mental Health and Population Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA (Dr Trivedi)
| | - Dolores Gallagher-Thompson
- Department of Neurological Sciences, Rush University Medical Center, Chicago, USA (Dr Suresh); Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA (Drs Suresh, Lorenz and Trivedi, Ms Risbud); Division of Oncology, Stanford University School of Medicine, Stanford, CA USA (Dr Patel); Medical Services, VA Palo Alto Health Care System, Palo Alto, CA USA (Drs Patel and Lorenz); Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA (Dr Shapira); Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA (Dr Gallagher-Thompson); Division of Public Mental Health and Population Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA (Dr Trivedi)
| | - Ranak Trivedi
- Department of Neurological Sciences, Rush University Medical Center, Chicago, USA (Dr Suresh); Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA (Drs Suresh, Lorenz and Trivedi, Ms Risbud); Division of Oncology, Stanford University School of Medicine, Stanford, CA USA (Dr Patel); Medical Services, VA Palo Alto Health Care System, Palo Alto, CA USA (Drs Patel and Lorenz); Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA (Dr Shapira); Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA (Dr Gallagher-Thompson); Division of Public Mental Health and Population Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA (Dr Trivedi)
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Daniel KE, Glazer JV, Le T, Reilley MJ, Jameson MJ, Chow PI, Ritterband LM, Shaffer KM. Associations between context and affect within the daily lives of cancer caregivers. Support Care Cancer 2023; 31:542. [PMID: 37646867 DOI: 10.1007/s00520-023-08006-9] [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] [Received: 02/23/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE This study used ecological momentary assessment (EMA) to test the association between activity, location, and social company contexts with cancer caregivers' in-the-moment affect to identify precisely when and where to deliver psychological interventions for caregivers. METHODS Current cancer caregivers (N = 25) received 8 EMA prompts per day for 7 consecutive days. At each prompt, caregivers reported their current positive affect and negative affect, as well as what they were doing, where they were located, and who they were with. Multilevel logistic regressions tested the associations between caregivers' contexts with their own person-mean-centered state (concurrent momentary level) and trait (overall weekly average) positive or negative affect. RESULTS Caregivers reported lower state negative affect, as well as higher state positive affect, when socializing (ps < .001), when at a public location (ps < .03), and when around their friends, family, spouse/partner, or care recipient (i.e., person with cancer, ps < .02), relative to when not endorsing the context. Caregivers also reported lower state negative affect when eating/drinking or engaging in leisure (ps < .01; but no parallel effects for state positive affect). Caregivers reported higher state negative affect while working, when at their workplace, or when around work colleagues (ps < .001) and lower state positive affect when at home or alone (ps < .03). CONCLUSIONS Results suggest the pertinence of a behavioral activation framework to mitigate the emotional strain of caregiving. Interventions that facilitate caregivers' ability to socialize with a range of friends and family, including their loved one with cancer, outside of the home may have the strongest positive emotional impact.
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Affiliation(s)
- Katharine E Daniel
- Center for Behavioral Health and Technology, University of Virginia, PO Box 801075, Charlottesville, VA, 22908, USA
| | - Jillian V Glazer
- Center for Behavioral Health and Technology, University of Virginia, PO Box 801075, Charlottesville, VA, 22908, USA
| | - Tri Le
- Emily Couric Comprehensive Cancer Center, University of Virginia, Charlottesville, VA, USA
| | - Matthew J Reilley
- Emily Couric Comprehensive Cancer Center, University of Virginia, Charlottesville, VA, USA
| | - Mark J Jameson
- Avera Medical Group ENT-Head & Neck Surgery, Sioux Falls, SD, USA
| | - Philip I Chow
- Center for Behavioral Health and Technology, University of Virginia, PO Box 801075, Charlottesville, VA, 22908, USA
| | - Lee M Ritterband
- Center for Behavioral Health and Technology, University of Virginia, PO Box 801075, Charlottesville, VA, 22908, USA
| | - Kelly M Shaffer
- Center for Behavioral Health and Technology, University of Virginia, PO Box 801075, Charlottesville, VA, 22908, USA.
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Heathcote LC, Cunningham SJ, Webster SN, Tanna V, Mattke E, Loecher N, Spunt SL, Simon P, Dahl G, Walentynowicz M, Murnane E, Tutelman PR, Schapira L, Simons LE, Mueller C. Smartphone-based Ecological Momentary Assessment to study "scanxiety" among Adolescent and Young Adult survivors of childhood cancer: A feasibility study. Psychooncology 2022; 31:1322-1330. [PMID: 35411626 PMCID: PMC9545782 DOI: 10.1002/pon.5935] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Scan-related anxiety ("scanxiety") refers to the fear, stress, and anxiety in anticipation of tests and scans in follow-up cancer care. This study assessed the feasibility of Ecological Momentary Assessment (EMA) for real-world, real-time capture of scanxiety using patients' personal smartphone. METHODS Adolescent and Young Adult survivors of childhood cancer were prompted to complete EMA surveys on a smartphone app three times per day for 11 days (33 surveys total) around their routine surveillance scans. Participants provided structured feedback on the EMA protocol. RESULTS Thirty out of 46 contacted survivors (65%) enrolled, exceeding the preregistered feasibility cutoff of 55%. The survey completion rate (83%) greatly exceeded the preregistered feasibility cutoff of 65%. Participants generally found the smartphone app easy and enjoyable to use and reported low levels of distress from answering surveys. Participants reported significantly more daily fear of cancer recurrence (FCR) and negative affect in the days before compared to the days after surveillance scans, aligning with the expected trajectory of scanxiety. Participants who reported greater FCR and scanxiety using comprehensive measures at baseline also reported significantly more daily FCR around their surveillance scans, indicating validity of EMA items. Bodily threat monitoring was prospectively and concurrently associated with daily FCR, thus warranting further investigation as a risk factor for scanxiety. CONCLUSIONS Findings indicate the feasibility, acceptability, and validity of EMA as a research tool to capture the dynamics and potential risk factors for scanxiety.
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Affiliation(s)
- Lauren C. Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College LondonLondonUK
| | - Sarah J. Cunningham
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Sarah N. Webster
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Vivek Tanna
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Elia Mattke
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Nele Loecher
- Department of Mental Health Law and PolicyUniversity of South FloridaTampaFloridaUSA
| | - Sheri L. Spunt
- Stanford Cancer Institute, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Pamela Simon
- Lucile Packard Children's Hospital at StanfordPalo AltoCaliforniaUSA
| | - Gary Dahl
- Stanford Cancer Institute, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Marta Walentynowicz
- Centre for the Psychology of Learning and Experimental Psychopathology, KU LeuvenLeuvenBelgium
- Psychological Science Research InstituteUniversité Catholique de LouvainLouvain‐la‐NeuveBelgium
| | | | | | - Lidia Schapira
- Stanford Cancer Institute, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Laura E. Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Claudia Mueller
- Department of Pediatrics, Stanford University School of MedicineStanfordCaliforniaUSA
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