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Jacob A, Garg K, Dutta K, Saini V, Aggarwal D, Sidana A. Role of detailed psychological evaluation and treatment in pulmonary rehabilitation programs for patients with chronic obstructive pulmonary disease. Monaldi Arch Chest Dis 2024. [PMID: 38411459 DOI: 10.4081/monaldi.2024.2849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/12/2024] [Indexed: 02/28/2024] Open
Abstract
Psychological co-morbidities are common in chronic obstructive pulmonary disease (COPD) but remain overlooked. Psychosocial interventions are deemed to promote mental health and optimize management. This study aimed to determine the role of detailed psychological evaluation and treatment in the comprehensive management of COPD. COPD patients after screening with the general health questionnaire-12 (GHQ-12) for psychological co-morbidity were divided into three groups (26 patients each): i) group A [GHQ-12 score<3, received pulmonary rehabilitation (PR) and standard medical management]; ii and iii) group B and C (GHQ-12 score>3, in addition, received management by a psychiatrist and counseling by a pulmonologist, respectively). At baseline and 8 weeks of follow-up, all participants were evaluated for respiratory [forced expiratory volume in the first second (FEV1), six-minute walk distance (6-MWD), St. George's respiratory questionnaire (SGRQ), modified medical research council (mMRC) dyspnea scale], and psychological [GHQ-12, patient distress thermometer (PDT), coping strategy checklist (CSCL), World Health Organization-quality of life-brief (WHOQOL-Bref-26), and depression anxiety stress scales (DASS)] parameters. Psychological distress (GHQ-12>3) decreased significantly at follow-up, with 11.5% and 53.8% of patients having psychological distress in groups B and C, respectively, versus baseline (p<0.001). mMRC score, SGRQ score, FEV1 and 6-MWD significantly improved in all three groups. Improvement in mMRC and SGRQ was maximal in group B when compared with the other groups. PDT, CSCL, and WHO-QOL-Bref-26 scores improved significantly at follow-up in all three groups, with maximum improvement in group B, followed by group C, and then group A. The DASS score also improved maximally in group B. Patients should be screened for psychological co-morbidities using simple screening tools. PR plays an important role in improving the psychology of COPD patients. However, results are better with directed psycho-educative sessions by non-experts and best with definitive treatment by psychiatrists.
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Affiliation(s)
- Anna Jacob
- Department of Pulmonary, Critical Care and Sleep Medicine, Government Medical College and Hospital, Chandigarh.
| | - Kranti Garg
- Department of Pulmonary Medicine, Government Medical College, Patiala, Punjab.
| | - Kashish Dutta
- Department of Tuberculosis and Respiratory Diseases, Government Medical College and Hospital, Chandigarh.
| | - Varinder Saini
- Department of Pulmonary, Critical Care and Sleep Medicine, Government Medical College and Hospital, Chandigarh.
| | - Deepak Aggarwal
- Department of Pulmonary, Critical Care and Sleep Medicine, Government Medical College and Hospital, Chandigarh.
| | - Ajeet Sidana
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh.
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Zhang L, Liu X, Tong F, Zou R, Peng W, Yang H, Huang X, Yi L, Wen M, Jiang L, Liu F. Lung cancer distress: screening thermometer meta-analysis. BMJ Support Palliat Care 2024; 13:e1084-e1092. [PMID: 35172980 PMCID: PMC10850644 DOI: 10.1136/bmjspcare-2021-003290] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 01/25/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The distress is associated with the life quality and prognosis of patients with lung cancer. Distress thermometer (DT) has been widely recommended for distress screening. This study was conducted to summarise the positive rate of distress in patients with lung cancer using DT screenings. METHODS The PubMed, Embase, PsyclNFO and Cochrane Library databases were comprehensively searched to identify all eligible studies published before 31 December 2021. Studies were eligible if they were published in peer-reviewed literature and evaluated distress levels by DT. RESULTS Ten eligible studies, including a total of 2111 patients, were included in this analysis, and their methodological quality was moderate. The pooled positive rate of distress in patients with lung cancer was 49.04% (95% CI 41.51% to 56.60%). The subgroup analysis revealed that the distress positive rate was significantly different (p<0.05) across North America, Europe and China with values of 53.33% (95% CI 45.22% to 61.37%), 43.81% (95% CI 31.57% to 56.43%) and 38.57% (95% CI 33.89% to 43.41%), respectively. Moreover, the distress positive rate was significantly different between men and women (p<0.05). Additionally, in terms of histological type, clinical tumour, node, metastasis stage, previous treatment and DT threshold, the distress positive rate had no significant differences. No significant publication bias was identified by Begg's funnel plot and Egger's test. CONCLUSIONS The summarised distress positive rate was high and was significantly different according to gender and region. DT screening should be recommended for routine clinical practice and more attention should be given towards distress management.
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Affiliation(s)
- Lemeng Zhang
- Department of Thoracic Medicine, Hunan Cancer Hospital/ The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Xiaohong Liu
- Department of Clinical Spiritual Care, Hunan Cancer Hospital/ The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, CHINA
| | - Fei Tong
- Psychological Clinic, Hunan Cancer Hospital/ The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, CHANGSHA, CHINA
| | - Ran Zou
- Department of Hospice Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, CHINA
| | - Wanglian Peng
- Department of Hospice Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, CHINA
| | - Hui Yang
- Department of Clinical Spiritual Care, Hunan Cancer Hospital/ The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, CHINA
| | - Xufen Huang
- Department of Hospice Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, CHINA
| | - Lili Yi
- Department of Clinical Spiritual Care, Hunan Cancer Hospital/ The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, CHINA
| | - Minni Wen
- Department of Clinical Spiritual Care, Hunan Cancer Hospital/ The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, CHINA
| | - Ling Jiang
- Department of Clinical Spiritual Care, Hunan Cancer Hospital/ The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, CHINA
| | - Feng Liu
- Department of Radiation Oncology, Hunan Cancer Hospital/ The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, CHINA
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Tian X, Liao ZL, Yi LJ, Tang L, Chen GH, Jiménez Herrera MF. Efficacy and mechanisms of four-week MBSR on psychological distress in lung cancer patients: a single-center, single-blind, longitudinal, randomized controlled trial. Asia Pac J Oncol Nurs 2022; 10:100151. [PMID: 36406466 PMCID: PMC9667193 DOI: 10.1016/j.apjon.2022.100151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/16/2022] [Indexed: 11/30/2022] Open
Abstract
Objective This study aimed to evaluate the efficacy of a 4-week mindfulness-based stress reduction (MBSR) program on psychological distress in patients with lung cancer and elucidate its mechanisms. Methods This single-center, single-blinded, longitudinal, randomized controlled trial was conducted on 175 patients with lung cancer randomly allocated to a 4-week MBSR or a waiting-list group. The efficacy and mechanisms of the 4-week MBSR program were evaluated by outcome measures at preintervention (T0), the immediate postintervention (T1), 1 month (T2), and 3 months (T3). We analyzed the collected data using the per-protocol set principle, independent sample t-test, repeated measure analysis of variance, and structural equation modeling. Results The 4-week MBSR program significantly alleviated psychological distress (F = 15.05, P < 0.001), decreased perceived stigma (F = 8.260, P = 0.005), improved social support (F = 16.465, P < 0.001), and enhanced mindfulness (F = 17.207, P < 0.001) compared with usual care at T1, T2, and T3. All variables significantly changed over time except for copying style (P = 0.250). The changes in social support, mindfulness, and perceived stigma mediated the efficacy of the 4-week MBSR program on psychological distress (β = −0.292, P = 0.005; β = −0.358, P = 0.005). Conclusions This study shows the benefits of the MBSR program for psychological distress, social support, mindfulness, and perceived stigma in patients with lung cancer. Also, it elucidates the mechanisms by which the MBSR program alleviates psychological distress by improving social support, enhancing mindfulness, and decreasing perceived stigma. The findings provide insights into applying the MBSR program to reduce psychological distress among patients with lung cancer.
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Tian X, Tang L, Yi LJ, Qin XP, Chen GH, Jiménez-Herrera MF. Mindfulness Affects the Level of Psychological Distress in Patients With Lung Cancer via Illness Perception and Perceived Stress: A Cross-Sectional Survey Study. Front Psychol 2022; 13:857659. [PMID: 35465528 PMCID: PMC9022206 DOI: 10.3389/fpsyg.2022.857659] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/03/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose The aims of the study were first to investigate the association between illness perception and psychological distress and second to determine whether mindfulness affects psychological distress via illness perception and perceived stress in patients with lung cancer. Methods Among 300 patients with lung cancer who participated in this cross-sectional study, 295 patients made valid responses to distress thermometer (DT), the Five Facet Mindfulness Questionnaire (FFMQ), the Brief Illness Perception Questionnaire (B-IPQ), and the Perceived Stress Scale (PSS) between January and July 2021. The possible pathways of mindfulness affecting psychological distress were analyzed based on the structural equation modeling analysis. Results A total of 24.4% patients with lung cancer had DT > 4. Illness perception (β = 0.17, p = 0.002) and perceived stress (β = 0.23, p < 0.001) had a direct effect on psychological distress. Mindfulness had a direct effect on illness perception (β = -0.16, p = 0.006) and mindfulness indirectly influenced psychological distress (β = -0.04, p = 0.009) through affecting illness perception alone or simultaneously affecting both the illness perception and perceived stress in patients with lung cancer. Conclusion Lung cancer suffered from varying levels of psychological distress. Mindfulness may alleviate psychological distress by reducing the level of illness perception and perceived stress. We suggest developing a comprehensive factor model to clarify potential mechanisms of mindfulness on psychological distress due to the very low effect of mindfulness on psychological distress via illness perception and perceived stress.
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Affiliation(s)
- Xu Tian
- Department of Nursing, Universitat Rovira i Virgili, Tarragona, Spain
| | - Ling Tang
- Chongqing University Cancer Hospital, Chongqing, China
| | - Li-Juan Yi
- Department of Nursing, Universitat Rovira i Virgili, Tarragona, Spain
| | - Xiao-Pei Qin
- Department of Rehabilitation Medicine, Jiaozuo People’s Hospital, Jiaozuo, China
| | - Gui-Hua Chen
- Department of Nursing, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Schulze JB, Günther MP, Riemenschnitter C, Wicki A, von Känel R, Euler S. Distinct psycho-oncological support inclinations and needs in patients with cancer: A large sample latent class analysis approach. Gen Hosp Psychiatry 2022; 75:17-22. [PMID: 35093622 DOI: 10.1016/j.genhosppsych.2021.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND In patients with cancer, the routine recording of distress symptoms has been widely established in recent years. Psycho-oncological support has proven to reduce distress and increase quality of life. Despite high levels of distress as well as physical and emotional challenges in patients with cancer, a significant proportion forgoes psycho-oncological services. METHODS A cross-sectional retrospective evaluation was carried out. Latent class analysis was used to examine the relationship between distress, physical and emotional challenges, and desire for psycho-oncological services in 2191 patients with cancer. RESULTS Latent class analysis revealed four homogeneous subgroups: a) patients with high distress, high physical and low emotional challenges and no desire for psycho-oncology, b) patients with high distress, low physical and high emotional challenges and no desire for psycho-oncology, c) patients with high distress, high physical and emotional challenges and a desire for psycho-oncology, d) patients with low distress, low physical and emotional challenges and no desire for psycho-oncology. CONCLUSION The identification of these subgroups of patients with cancer is useful for health care providers in order to focus their efforts in patients with cancer. It might contribute to a more tailored treatment offer for specific subgroups whose needs have so far been insufficiently met.
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Affiliation(s)
- Jan Ben Schulze
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Moritz Philipp Günther
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Cosima Riemenschnitter
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Andreas Wicki
- Department of Medical Oncology and Hematology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sebastian Euler
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Lizán L, Pérez-Carbonell L, Comellas M. Additional Value of Patient-Reported Symptom Monitoring in Cancer Care: A Systematic Review of the Literature. Cancers (Basel) 2021; 13:cancers13184615. [PMID: 34572842 PMCID: PMC8469093 DOI: 10.3390/cancers13184615] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 09/10/2021] [Indexed: 01/28/2023] Open
Abstract
Simple Summary The additional value of patient-reported symptom monitoring in routine cancer is still under discussion. With this in mind, we have reviewed recent evidence on the benefits of this strategy. The evidence examined illustrates that bringing systematic patient feedback into the oncology consultation provides objective advantages over usual care, such as better symptom control, early detection of tumor recurrence, and extended chemotherapy use. Such care improvements ultimately entail an outstanding survival benefit for advanced cancer patients, an increase in their global quality of life, and eventually, medical cost savings. Monitoring patient-reported symptoms might also have other implications in clinical practice, such as promoting patient disease awareness or enhancing patient–physician communication and relationships. Notwithstanding these advantages, there are still logistical barriers that prevent its widespread implementation—especially in the electronic modality. In addition, the real-world effectiveness and the cost-effectiveness of this strategy are yet to be proven in different settings. Abstract Background: To describe the benefit of patient-reported symptom monitoring on clinical, other patient-reported, and economic outcomes. Methods: We conducted a systematic literature review using Medline/PubMed, limited to original articles published between 2011 and 2021 in English and Spanish, and focused on the benefit of patient-reported symptom monitoring on cancer patients. Results: We identified 16 reports that deal with the benefit of patient-reported symptom monitoring (collected mostly electronically) on different outcomes. Five studies showed that patient-reported symptom surveillance led to significantly improved survival compared with usual care—mainly through better symptom control, early detection of tumor recurrence, and extended chemotherapy use. Additionally, three evaluations demonstrated an improvement in Health-Related Quality of Life (HRQoL) associated with this monitoring strategy, specifically by reducing symptom severity. Additionally, six studies observed that this monitoring approach prevented unplanned emergency room visits and hospital readmissions, leading to a substantial decrease in healthcare usage. Conclusions: There is consistent evidence across the studies that patient-reported symptom monitoring might entail a substantial survival benefit for cancer patients, better HRQoL, and a considerable decrease in healthcare usage. Nonetheless, more studies should be conducted to demonstrate their effectiveness in addition to their cost-effectiveness in clinical practice.
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Affiliation(s)
- Luís Lizán
- Department of Medicine, Jaume I University, 12071 Castellón de la Plana, Spain
- Outcomes’10, Jaume I University, 12071 Castellón de la Plana, Spain; (L.P.-C.); (M.C.)
- Correspondence: ; Tel.: +34-608-262-673
| | - Lucía Pérez-Carbonell
- Outcomes’10, Jaume I University, 12071 Castellón de la Plana, Spain; (L.P.-C.); (M.C.)
| | - Marta Comellas
- Outcomes’10, Jaume I University, 12071 Castellón de la Plana, Spain; (L.P.-C.); (M.C.)
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Al-Shaaobi A, Alahdal M, Yu S, Pan H. The efficiency of distress thermometer in the determination of supporting needs for cancer inpatients. Libyan J Med 2021; 16:1957199. [PMID: 34347581 PMCID: PMC8344234 DOI: 10.1080/19932820.2021.1957199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Psychological distress scale is highly recommended for cancer patients’ care. Several psychological scales have been implemented in cancer outpatient clinics. However, the use of the psychological distress scale, particularly distress thermometer (DT), in the inpatient has not been reported. In this study, we report the efficacy of DT in the determination of cancer inpatients’ supporting needs. A total of 170 inpatients diagnosed with cancer have been enrolled in this study. Only 132 patients matched the inclusion criteria, while other cases were excluded because of other diseases associated with cancer. The standardized problem list (PL) and Hospital Anxiety and Depression Scale (HADS) were implemented in comparison with DT. Then, the cut-off score of DT was performed to identify clinically significant differences. The analysis of the receiver operating characteristic (ROC) curve revealed that a DT cut-off score of 4 displayed 0.76 under the ROC curve. Sensitivity showed 0.86 sensitivity for cut-off score 4 and a specificity of 0.56 relative to the HADS cut-off score (≥15). DT scores were found independent of medical variables such as cancer type and stage, recurrence, or metastasis. Clinical ECOG-SP showed a significant association with the DT cut-off score (P ≤ 0.05). Regarding PL, patients with scores above DT cut-off were suffering 21 of 40 problems in all categories. Furthermore, patients that scored above the DT cut-off significantly showed an association with high support needs. DT scale showed significant performance in the evaluation of psychological distress among cancer inpatients through the efficient determination of their support needs.
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Affiliation(s)
- Abdullah Al-Shaaobi
- Department of Medical Oncology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, R. P. China
| | - Murad Alahdal
- Shenzhen Key Laboratory of Tissue Engineering, Shenzhen Laboratory of Digital Orthopedic Engineering, Guangdong Provincial Research Center for Artificial Intelligence and Digital Orthopedic Technology, Shenzhen Second People's Hospital (The First Hospital Affiliated to Shenzhen University, Health Science Center), Shenzhen, P. R. China.,Medical Laboratories Department, Faculty of Medicine and Health Sciences, Hodeidah University, Al Hudaydah, Yemen
| | - Shiying Yu
- Cancer Center of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongming Pan
- Department of Medical Oncology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, R. P. China
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LeCouteur A, Lehmann C, Knott V. Brief psychological distress screening on a cancer helpline: How nurses introduce, and callers respond to, the Distress Thermometer. Eur J Oncol Nurs 2021; 53:101986. [PMID: 34294575 DOI: 10.1016/j.ejon.2021.101986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE Helplines are increasingly used to provide information and support for people affected by cancer, and the distress routinely associated with diagnosis and treatment is a major focus for those providing such care. Little is known, however, about how the Distress Thermometer (DT), a widely used tool for the assessment of patient/carer distress on cancer-support telephone helplines, is introduced and used in such settings. METHOD Using the method of conversation analysis, we present a qualitative analysis of DT use in actual telephone interactions by looking closely at how particular practices shape interaction on a cancer helpline. Specifically, we examine how oncology-trained nurse call-takers used the DT, in situ, as a tool for assessing callers, as well as examining how callers responded to this brief screening tool. RESULTS Our findings show how particular positioning of the DT in the call, and particular forms of its delivery, tend to generate brief responses from callers that avoid topicalization of distress, and tend not to be associated with referral to support services. CONCLUSIONS Implications for successful integration of the DT as a screening tool in cancer- and other health-helpline interactions, as well as for effective training of users, are discussed.
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Affiliation(s)
- Amanda LeCouteur
- School of Psychology, Hughes Building, North Terrace, The University of Adelaide, Adelaide, South Australia, 5005, Australia.
| | - Claire Lehmann
- School of Psychology, Hughes Building, North Terrace, The University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Vikki Knott
- School of Psychology, Hughes Building, North Terrace, The University of Adelaide, Adelaide, South Australia, 5005, Australia.
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Tian X, Jin Y, Tang L, Pi YP, Chen WQ, Jiménez-Herrera MF. Predicting the Risk of Psychological Distress among Lung Cancer Patients: Development and Validation of a Predictive Algorithm Based on Sociodemographic and Clinical Factors. Asia Pac J Oncol Nurs 2021; 8:403-412. [PMID: 34159233 PMCID: PMC8186387 DOI: 10.4103/apjon.apjon-2114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/05/2021] [Indexed: 12/25/2022] Open
Abstract
Objective Lung cancer patients reported the highest incidence of psychological distress. It is extremely important to identify which patients at high risk for psychological distress. The study aims to develop and validate a predictive algorithm to identify lung cancer patients at high risk for psychological distress. Methods This cross-sectional study identified the risk factors of psychological distress in lung cancer patients. Data on sociodemographic and clinical variables were collected from September 2018 to August 2019. Structural equation model (SEM) was conducted to determine the associations between all factors and psychological distress, and then construct a predictive algorithm. Coincidence rate was also calculated to validate this predictive algorithm. Results Total 441 participants sent back validated questionnaires. After performing SEM analysis, educational level (β = 0.151, P = 0.004), residence (β = 0.146, P = 0.016), metastasis (β = 0.136, P = 0.023), pain degree (β = 0.133, P = 0.005), family history (β = -0.107, P = 0.021), and tumor, node, and metastasis stage (β = -0.236, P < 0.001) were independent predictors for psychological distress. The model built with these predictors showed an area under the curve of 0.693. A cutoff of 66 predicted clinically significant psychological distress with a sensitivity, specificity, positive predictive value, and negative predictive value of 65.41%, 66.90%, 28.33%, and 89.67%, respectively. The coincidence rate between predictive algorithm and distress thermometer was 64.63%. Conclusions A validated, easy-to-use predictive algorithm was developed in this study, which can be used to identify patients at high risk of psychological distress with moderate accuracy.
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Affiliation(s)
- Xu Tian
- Department of Nursing, Rovira I Virgili University, Tarragona, Spain.,Department of Gastroenterology, Chongqing University Cancer Hospital, Chongqing, China
| | - Yanfei Jin
- Department of Nursing, Rovira I Virgili University, Tarragona, Spain
| | - Ling Tang
- Department of Gastroenterology, Chongqing University Cancer Hospital, Chongqing, China
| | - Yuan-Ping Pi
- Department of Gastroenterology, Chongqing University Cancer Hospital, Chongqing, China
| | - Wei-Qing Chen
- Department of Gastroenterology, Chongqing University Cancer Hospital, Chongqing, China
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The chain mediating role of social support and stigma in the relationship between mindfulness and psychological distress among Chinese lung cancer patients. Support Care Cancer 2021; 29:6761-6770. [PMID: 33990878 DOI: 10.1007/s00520-021-06278-7] [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] [Received: 02/26/2021] [Accepted: 05/05/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE Psychological distress greatly impaired the psychological and physical well-being of lung cancer patients. Identification of protective and risk factors is a prerequisite of developing effective psychological treatment protocol. The study aims to determine the relationship of mindfulness and psychological distress and further clarify the mechanism of mindfulness against psychological distress through perceived stigma and social support among Chinese lung cancer patients. METHOD A cross-sectional survey study involving 441 valid Chinese lung cancer patients was conducted from September 2018 to August 2019. After all validated questionnaires that measured psychological distress, level of mindfulness, social support, and perceived stigma were returned by patients, we firstly performed correlation analysis to assess the associations between mindfulness, social support, perceived stigma, and psychological distress. Then structural equation modelling analysis was conducted to further clarify the mediating effects of perceived stigma and social support on the relationship between mindfulness and psychological distress. RESULTS According to our hypothesis and further modification, our revised model adequately fits to data. Mindfulness (β = - 0.107, p = 0.008) and social support (β = - 0.513, p < 0.001) had a direct effect on psychological distress. Meanwhile, mindfulness had a direct effect on perceived stigma (β = - 0.185, p < 0.001), and perceived stigma had a direct effect on social support (β = - 0.373, p < 0.001). Furthermore, mindfulness had also the indirect effect on psychological distress through the chain mediating role of stigma and social support among lung cancer patients. CONCLUSIONS Mindfulness has direct negative effect on psychological distress and has also indirectly negative psychological distress through impacting social support and perceived stigma.
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Tian X, Jin Y, Chen H, Tang L, Jiménez‐Herrera MF. The positive effect of social support on psychological distress among Chinese lung cancer patients: The mediating role of self-esteem. Nurs Open 2021; 8:1642-1651. [PMID: 33599393 PMCID: PMC8186711 DOI: 10.1002/nop2.793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/10/2020] [Accepted: 01/29/2021] [Indexed: 12/25/2022] Open
Abstract
AIM To investigate the effect of social support on psychological distress among Chinese lung cancer patients and clarify the mediating role of self-esteem. DESIGN A cross-sectional descriptive correlational survey of 441 Chinese lung cancer patients was designed. METHODS Self-esteem was supposed to play a mediating role in the association between social support and psychological distress. We collected demographic information, the Distress Thermometer, Multidimensional Scale of Perceived Social Support and Rosenberg Self-Esteem Scale. RESULTS Our revised model demonstrated an acceptable fit to the data (χ2 = 37.489, comparative fit index (CFI) = 0.965, Tucker-Lewis index (TLI) = 0.926, root mean square error of approximation [RMSEA] = 0.099). Social support had a direct effect on self-esteem and psychological distress, and self-esteem had also a direct effect on psychological distress. Meanwhile, self-esteem also partially mediated the relationship between social support and psychological distress among Chinese lung cancer patients.
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Affiliation(s)
- Xu Tian
- Nursing DepartmentUniversitat Rovira i VirgiliTarragonaSpain
- Department of GastroenterologyChongqing University Cancer HospitalSchool of MedicineChongqing UniversityChongqingChina
| | - Yanfei Jin
- Nursing DepartmentUniversitat Rovira i VirgiliTarragonaSpain
| | - Hui Chen
- Department of GastroenterologyChongqing University Cancer HospitalSchool of MedicineChongqing UniversityChongqingChina
| | - Ling Tang
- Department of NursingChongqing University Cancer HospitalSchool of MedicineChongqing UniversityChongqingChina
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12
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Tian X, Jin Y, Chen H, Tang L, Jiménez-Herrera MF. Relationships among Social Support, Coping Style, Perceived Stress, and Psychological Distress in Chinese Lung Cancer Patients. Asia Pac J Oncol Nurs 2021; 8:172-179. [PMID: 33688566 PMCID: PMC7934593 DOI: 10.4103/apjon.apjon_59_20] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/29/2020] [Indexed: 12/24/2022] Open
Abstract
Objective: Social support is associated with improved psychological distress in cancer patients. This study investigates the impact of social support on Chinese lung cancer patients' psychological distress and further clarifies the mediating role of perceived stress and coping style. Methods: A cross-sectional survey study examined social support and psychological distress in 441 patients diagnosed with lung cancer from seven hospitals in Chongqing, China, between September 2018 and August 2019. Coping style and perceived stress were considered to be potential mediators of adjustment outcomes. Results: We found a detection rate of 17.7% for psychological distress among Chinese lung cancer patients. Social support was in significantly negative association with psychological distress, which was partially mediated by confrontation coping and perceived stress. Conclusions: Social support appears to contribute to ameliorate psychological distress by enhancing confrontation coping with cancer and enhancing perceived stress. There is a need for the development and evaluation of psychological intervention program to enhance the buffering effects of social support in lung cancer patients.
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Affiliation(s)
- Xu Tian
- Department of Nursing, Faculty of Nursing, Rovira I Virgili University, Tarragona, Spain.,Department of Gastroenterology, Chongqing University Cancer Hospital, School of Medicine, Chongqing, China
| | - Yanfei Jin
- Department of Nursing, Faculty of Nursing, Rovira I Virgili University, Tarragona, Spain
| | - Hui Chen
- Department of Gastroenterology, Chongqing University Cancer Hospital, School of Medicine, Chongqing, China
| | - Ling Tang
- Department of Nursing, Chongqing University Cancer Hospital, School of Medicine, Chongqing, China
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Johnson LA, Schreier AM, Swanson M, Ridner S. Dimensions of Distress in Lung Cancer. Oncol Nurs Forum 2020; 47:732-738. [PMID: 33063781 DOI: 10.1188/20.onf.732-738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To (a) compare the domains of distress between patients who were distressed and patients who were not distressed and (b) examine the relationship between the National Comprehensive Cancer Network Distress Thermometer and Problem List for Patients (DT-PL) and the Hospital Anxiety and Depression Scale (HADS) in individuals with advanced lung cancer. SAMPLE & SETTING Individuals with advanced lung cancer receiving chemotherapy were recruited from a comprehensive cancer center in the southeastern United States. METHODS & VARIABLES A cross-sectional, descriptive, exploratory design was used. Individuals with lung cancer completed the DT-PL and the HADS. Data were analyzed using descriptive statistics, t tests, and chi-square analysis. RESULTS Significant differences were found between the nondistressed group and the clinically distressed group in three domains of distress. IMPLICATIONS FOR NURSING Distress in individuals with advanced lung cancer goes beyond psychological stressors and includes family problems and physical problems.
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Dahill A, Al-Nakishbandi H, Cunningham K, Humphris G, Lowe D, Rogers S. Loneliness and quality of life after head and neck cancer. Br J Oral Maxillofac Surg 2020; 58:959-965. [DOI: 10.1016/j.bjoms.2020.04.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 04/28/2020] [Indexed: 02/09/2023]
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15
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Cimino T, Said K, Safier L, Harris H, Kinderman A. Psychosocial distress among oncology patients in the safety net. Psychooncology 2020; 29:1927-1935. [DOI: 10.1002/pon.5525] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 11/07/2022]
Affiliation(s)
| | - Kiana Said
- Zuckerberg San Francisco General Hospital and Trauma Center San Francisco CA USA
| | - Leslie Safier
- Zuckerberg San Francisco General Hospital and Trauma Center San Francisco CA USA
| | - Heather Harris
- Zuckerberg San Francisco General Hospital and Trauma Center San Francisco CA USA
| | - Anne Kinderman
- Zuckerberg San Francisco General Hospital and Trauma Center San Francisco CA USA
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16
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Elimimian EB, Elson L, Stone E, Butler RS, Doll M, Roshon S, Kondaki C, Padgett A, Nahleh ZA. A pilot study of improved psychological distress with art therapy in patients with cancer undergoing chemotherapy. BMC Cancer 2020; 20:899. [PMID: 32962660 PMCID: PMC7510066 DOI: 10.1186/s12885-020-07380-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 09/04/2020] [Indexed: 11/30/2022] Open
Abstract
Background Art therapy may improve the physical, mental, and emotional wellbeing of individuals for a variety of purposes. It remains understudied and underutilized in cancer care. We sought to determine the ability of a pilot art therapy program to improve the physical, mental, and emotional well-being of cancer patients. Methods Chemotherapy-recipients, age 18 years and older, diagnosed with any type or stage of cancer, were considered eligible to participate in this single arm, pilot study, using four visual analog scales (VAS) with visually-similar, 0–10 scale (10 being worst) thermometers assessing: 1) pain, 2) emotional distress, 3) depression, and 4) anxiety. Participants were asked to complete all 4 metrics, pre-treatment, post-treatment, and at 48–72 h follow-up, after an hour-long art therapy session. Primary endpoints included post-intervention changes from baseline in the 4 VAS metrics. Results Through a reasonable pilot sample (n = 50), 44% had breast cancer, 22% gastrointestinal cancers, 18% hematological malignancies, and 20% had other malignancies. A decrease in all VAS measures was noted immediately post-treatment but remained low only for pain and depression, not for emotional distress and anxiety upon follow up. There was a significant difference between the depression VAS scores of Hispanics (32%) compared to non-Hispanics (56%) (p = 0.009) at baseline. However, compared to non-Hispanics, Hispanics exhibited higher levels of depression after art therapy (P = 0.03) and during the follow-up intervals (p = 0.047). Conclusion Art therapy improved the emotional distress, depression, anxiety and pain among all cancer patients, at all time points. While depression scores were higher pre-intervention for Hispanic patients, Hispanic patients were noted to derive a greater improvement in depression scores from art therapy over time, compared to non-Hispanics patients. Discovering simple, effective, therapeutic interventions, to aid in distress relief in cancer patients, is important for ensuring clinical efficacy of treatment and improved quality of life.
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Affiliation(s)
- E B Elimimian
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic - Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - L Elson
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic - Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - E Stone
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic - Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - R S Butler
- Department of Radiation Oncology, Dana-Farber Cancer Institute/ Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - M Doll
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic - Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - S Roshon
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic - Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - C Kondaki
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic - Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - A Padgett
- Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road BC-71, Boca Raton, FL, 33431, USA
| | - Z A Nahleh
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic - Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
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Klaassen LA, Friesen-Storms JHHM, Bours GJJW, Dirksen CD, Boersma LJ, Hoving C. Perceived facilitating and limiting factors for healthcare professionals to adopting a patient decision aid for breast cancer aftercare: A cross-sectional study. PATIENT EDUCATION AND COUNSELING 2020; 103:145-151. [PMID: 31471071 DOI: 10.1016/j.pec.2019.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 06/30/2019] [Accepted: 07/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Effective healthcare innovations are often not adopted and implemented. An implementation strategy based on facilitators and barriers for use as perceived by healthcare professionals could increase adoption rates. This study therefore aimed to identify the most relevant facilitators and barriers for use of an innovative breast cancer aftercare decision aid (PtDA) in healthcare practice. METHODS Facilitators and barriers (related to the PtDA, adopter and healthcare organisation) were assessed among breast cancer aftercare health professionals (n = 81), using the MIDI questionnaire. For each category, a backward regression analysis was performed (dependent = intention to adopt). All significant factors were then added to a final regression analysis to identify to most relevant determinants of PtDA adoption. RESULTS Expecting higher compatibility with daily practice and clinical guidelines, more positive outcomes of use, higher perceived relevance for the patient and increased self-efficacy were significantly associated with a higher intention to adopt. Self-efficacy and perceived patient relevance remained significant in the final model. CONCLUSIONS Low perceived self-efficacy and patient relevance are the most important barriers for health professions to adopt a breast cancer aftercare PtDA. PRACTICE IMPLICATIONS To target self-efficacy and perceived patient relevance, the implementation strategy could apply health professional peer champions.
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Affiliation(s)
- Linda A Klaassen
- Maastricht University, Department of Radiotherapy/GROW School for Oncology and Developmental Biology/CAPHRI Care and Public Health, Research Institute, P. O. Box 616, 6200 MD Maastricht, the Netherlands.
| | - Jolanda H H M Friesen-Storms
- Zuyd University of Applied Sciences, Zuyd Health, Research Centre Autonomy and Participation for Persons with a Chronic Illness, Nursing Department, Heerlen, the Netherlands; Maastricht University, Department of Family Medicine/CAPHRI Care and Public Health, Research Institute, Nieuw Eyckholt 300, 6419 DJ Heerlen, Maastricht, the Netherlands.
| | - Gerrie J J W Bours
- Zuyd University of Applied Sciences, Zuyd Health, Research Centre for Community Care, Nursing Department, Heerlen, the Netherlands; Maastricht University, Department of Health Services Research/CAPHRI Care and Public Health Research Institute, Nieuw Eyckholt 300, 6419 DJ Heerlen, Maastricht, the Netherlands.
| | - Carmen D Dirksen
- Maastricht University Medical Centre +, Department of KEMTA/CAPHRI Care and Public Health Research Institute, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands.
| | - Liesbeth J Boersma
- Department of Radiation Oncology (MAASTRO Clinic)/GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre +, P.O. Box 3035, 6202 NA Maastricht, the Netherlands.
| | - Ciska Hoving
- Maastricht University, Department of Health Promotion/CAPHRI Care and Public Health Research Institute, P. O. Box 616, 6200 MD Maastricht, the Netherlands.
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Lungu DA, Pennucci F, De Rosis S, Romano G, Melfi F. Implementing successful systematic Patient Reported Outcome and Experience Measures (PROMs and PREMs) in robotic oncological surgery-The role of physicians. Int J Health Plann Manage 2019; 35:773-787. [PMID: 31793689 DOI: 10.1002/hpm.2959] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 01/04/2023] Open
Abstract
Patient Reported Outcome and Experience Measures (PROMs and PREMs) play an increasingly important role in monitoring the quality of the oncological pathway. The aim of this study is to describe the case of five hospitals a year after the adoption of PROMs and PREMs for robotic oncological colorectal surgery in Tuscany and to investigate how the clinicians can impact the process of implementation and the efficacy of such measures. We used 14 months of data from the five robotic centers in Tuscany. Above all, the physician's personal motivation to improve the treatment of patients, the teamwork, and the possibility to use data for research purposes proved to be the essential factors for their engagement and the successful implementation of patient reported measures. Physicians play a key role in the adoption of systematic PROMs and PREMs. The higher their level of engagement, the higher the collection success, both in terms of number of patients enrolled and response rates. Moreover, the collection of patient reported measures may become part of physicians' daily practice and may lead to a change in their relationship and communication with patients, as clinicians accept to have their job reviewed and are not afraid to be evaluated by their patients.
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Affiliation(s)
- Daniel Adrian Lungu
- Health and Management Laboratory (MeS Lab), Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Francesca Pennucci
- Health and Management Laboratory (MeS Lab), Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Sabina De Rosis
- Health and Management Laboratory (MeS Lab), Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Gaetano Romano
- Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, Pisa, Italy
| | - Franca Melfi
- Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, Pisa, Italy
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Johnston L, Young J, Campbell K. The implementation and impact of Holistic Needs Assessments for people affected by cancer: A systematic review and thematic synthesis of the literature. Eur J Cancer Care (Engl) 2019; 28:e13087. [DOI: 10.1111/ecc.13087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/14/2019] [Accepted: 04/17/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Lucy Johnston
- School of Health and Social Care Edinburgh Napier University Edinburgh UK
| | - Jenny Young
- School of Health and Social Care Edinburgh Napier University Edinburgh UK
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20
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Briggs L, Cooper J, Cox K, Blake H. Concerns, coping and the electronic Holistic Needs Assessment: experiences of UK breast cancer survivors. J Res Nurs 2019; 25:97-110. [PMID: 34394613 DOI: 10.1177/1744987119829801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Physical and psychological concerns associated with a breast cancer diagnosis continue long after treatment. Macmillan Cancer Support developed an electronic Holistic Needs Assessment (eHNA) to help identify these concerns and allow a healthcare professional to address these as part of The Recovery Package. Aims The study aim was to understand the women's experiences of having breast cancer, and of completing Macmillan's eHNA as part of their care. Methods A qualitative approach was adopted. Semi-structured interviews were undertaken with 15 women, 12-18 months following surgical treatment for invasive breast cancer. Thematic analysis identified key themes. Results Four main themes were identified in relation to experiences of the eHNA, experiences of breast cancer, coping with breast cancer and the psychological effects of surviving. Perceptions towards the eHNA varied; some women viewed the eHNA as a research tool for hospital use rather than a beneficial aspect of their care. Several participants felt unable to raise their psychological concerns on the eHNA. Conclusions Although experiences differ, psychological issues remain a key factor for women with breast cancer, lasting long after treatment. The eHNA is not currently used to its potential or recognised by women as a tool to support their care. Further research is needed into how the eHNA can be used effectively to capture psychological concerns and determine best approaches to implementation of the tool to support individualised care.
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Affiliation(s)
- Lydia Briggs
- PhD Student, School of Health Sciences, University of Nottingham, UK
| | - Joanne Cooper
- Assistant Director of Nursing (Research, Innovation and Professional Regulation), Nottingham University Hospitals NHS Trust, UK
| | - Karen Cox
- Vice Chancellor & President, University of Kent, UK
| | - Holly Blake
- Associate Professor of Behavioural Science, Director of Postgraduate Research & Environment, School of Health Sciences, University of Nottingham, UK; NIHR Nottingham Biomedical Research Centre, UK
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Development and validation of self- and caregiver-report of a distress screening tool for pediatric cancer survivors. Support Care Cancer 2019; 27:4179-4187. [PMID: 30805727 DOI: 10.1007/s00520-019-04708-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To develop and validate the Distress Screening Tool (DST) for child and adolescent cancer survivors. METHODS In part 1, items of the DST were generated through literature search and group interviews. Initially, the DST was tested on pediatric cancer survivors and their caregivers. In part 2, the modified version of the DST was retested with a different set of participants. Lastly, the psychometric properties and cutoff scores of the DST were evaluated on a separate set of survivors and caregivers. RESULTS In part 1, six items of the DST self- and caregiver-report versions were generated. The initial 6 DST items of both versions showed acceptable internal consistency, but low inter-item correlation. Following the item modification, both versions of the DST showed improved inter-item correlation. In part 2, the modified DST had acceptable internal consistency and convergent validity, with acceptable psychometric properties. Cutoff scores were also generated. CONCLUSIONS The DST could be a useful tool for pediatric cancer survivors.
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Looijmans M, van Manen AS, Traa MJ, Kloover JS, Kessels BLJ, de Vries J. Psychosocial consequences of diagnosis and treatment of lung cancer and evaluation of the need for a lung cancer specific instrument using focus group methodology. Support Care Cancer 2018; 26:4177-4185. [PMID: 29948393 PMCID: PMC6209000 DOI: 10.1007/s00520-018-4291-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 05/23/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Patients with lung cancer (LC) have high rates of psychosocial symptoms and international guidelines recommend regular psychosocial screening during treatment. This study evaluates psychosocial consequences of diagnosis and treatment of LC in a qualitative way and evaluates the need for a LC specific screening instrument. METHODS Focus group meetings with LC patients were divided by treatment type. Patients discussed psychological and social consequences of diagnosis and treatment. Major themes were identified using content analysis. Themes were re-evaluated in a subsequent focus group, in accordance with the European Organization for Research and Treatment of Cancer (EORTC) guidelines. RESULTS Patients reported a range of psychosocial consequences, such as frustration due to physical limitations, fear of recurrence, sadness of leaving behind partner and children, and disappointing social support. Patients treated with palliative intent specifically indicated insecurities about the future. Patients from all treatment modalities indicated a need for family support during treatment. No themes specific to LC arose. CONCLUSIONS Patients with LC are coping with a range of psychosocial consequences, independent of the type of treatment they receive. Fear of recurrence/metastasis and insecurity about the future were more prominent in patients receiving palliative chemotherapy. Themes were not specific to LC; therefore, a screening instrument specific for the LC population does not seem required. However, the current standard for screening is considered insufficiently sensitive and a stepped screening approach with specific screening tools and a clinical interview is suggested as usual care.
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Affiliation(s)
- Milou Looijmans
- CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000, Tilburg, LE, The Netherlands
| | - Annick S van Manen
- CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000, Tilburg, LE, The Netherlands
| | - Marjan J Traa
- CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000, Tilburg, LE, The Netherlands
- Department of Medical Psychology, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Jeroen S Kloover
- Department of Respiratory Diseases, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Bart L J Kessels
- Department of Respiratory Diseases, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Jolanda de Vries
- CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000, Tilburg, LE, The Netherlands.
- Department of Medical Psychology, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands.
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Ni J, Feng J, Denehy L, Wu Y, Xu L, Granger CL. Symptoms of Posttraumatic Stress Disorder and Associated Risk Factors in Patients With Lung Cancer: A Longitudinal Observational Study. Integr Cancer Ther 2018; 17:1195-1203. [PMID: 30354698 PMCID: PMC6247540 DOI: 10.1177/1534735418807970] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 09/22/2018] [Accepted: 09/27/2018] [Indexed: 12/21/2022] Open
Abstract
PURPOSE This study aimed to measure symptoms of posttraumatic stress disorder (PTSD) in Chinese patients following a new diagnosis of lung cancer. Secondary aims were to explore factors at diagnosis that may predict PTSD symptoms at 6 months. METHODS This was a prospective longitudinal observational study that included 93 patients with newly diagnosed lung cancer. PTSD symptomology was assessed using the PTSD Checklist Civilian Version (PCL-C) and health-related quality of life (HRQoL) was assessed with the European Organisation for the Research and Treatment of Cancer questionnaire. Measures were completed at diagnosis and 6 months. RESULTS No patient had PTSD at baseline or 6 months as measured by a score of ⩾50 in the PCL-C. However, at diagnosis, 44% of patients had "mild" symptoms of PTSD. At 6 months, 64% of patients had "mild" and 8% had "moderate" PTSD symptoms. PTSD symptom scores significantly worsened over 6 months (mean difference [95% CI] = 7.2 [5.4 to 9.0]). Six months after diagnosis, higher PTSD scores were seen in people who at diagnosis were younger ( P = .003), had a lower smoking pack history ( P = .012), displayed less sedentary behavior ( P < .005), or initially had worse cancer symptoms, including fatigue ( P = .001) and poorer HRQoL ( P = .004). CONCLUSIONS Mild PTSD symptoms are common in patients with lung cancer 6 months after treatment; however, a full diagnosis of PTSD is uncommon. Screening for PTSD symptoms may be considered for at-risk patients with newly diagnosed lung cancer.
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Affiliation(s)
- Jun Ni
- Affiliated Hospital of Nantong University, Jiangsu, China
- Nantong University, Jiangsu, China
| | - Jian Feng
- Affiliated Hospital of Nantong University, Jiangsu, China
| | - Linda Denehy
- The University of Melbourne, Australia
- Peter MacCallum Cancer Centre, Australia
| | - Yi Wu
- Affiliated Hospital of Nantong University, Jiangsu, China
- Nantong University, Jiangsu, China
| | - Liqin Xu
- Affiliated Hospital of Nantong University, Jiangsu, China
- Nantong University, Jiangsu, China
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McCarter K, Baker AL, Britton B, Beck AK, Carter G, Bauer J, Wratten C, Halpin SA, Holliday E, Oldmeadow C, Wolfenden L. Effectiveness of clinical practice change strategies in improving dietitian care for head and neck cancer patients according to evidence-based clinical guidelines: a stepped-wedge, randomized controlled trial. Transl Behav Med 2018; 8:166-174. [PMID: 29365187 DOI: 10.1093/tbm/ibx016] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Best practice guidelines make a number of recommendations regarding dietitian management of head and neck cancer (HNC) patients. Randomized trials assessing the effectiveness of clinical practice change strategies for improving the nutritional management of HNC patients have not previously been conducted. The purpose of this study was to evaluate the effect of practice change strategies on improving the implementation of best practice guideline recommendations for the nutritional management of HNC patients. Four Australian radiotherapy departments participated in a stepped-wedge, randomized controlled trial. Baseline data were collected across all sites simultaneously, and the intervention was then introduced to each site sequentially, in a randomly determined order. During the intervention phase, sites received a range of supportive clinical practice change strategies to facilitate dietitian adherence to clinical practice guidelines. To assess the associated practice change by dietetic staff, we evaluated the change in implementation of six guideline recommendations for dietitians from preintervention to postintervention periods. Adherence to the clinical practice guidelines during the preintervention period was generally very low. The clinical practice change strategies significantly improved the odds of provision of four of the six guideline recommendations. The study found the intervention significantly enhanced dietitian provision of recommended care for HNC patients during the postintervention period. This finding holds clinical importance for clinician and health service effective implementation of guideline recommendations as well as HNC patient treatment outcomes. Trial registration number ACTRN12613000320752, https://www.anzctr.org.au.
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Affiliation(s)
- Kristen McCarter
- School of Psychology, University of Newcastle, Newcastle, New South Wales, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Ben Britton
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Alison Kate Beck
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Gregory Carter
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Judith Bauer
- Centre for Dietetics Research, University of Queensland, St Lucia, Queensland, Australia
| | - Chris Wratten
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Newcastle, New South Wales, Australia
| | - Sean A Halpin
- School of Psychology, University of Newcastle, Newcastle, New South Wales, Australia
| | - Elizabeth Holliday
- Clinical Research Design, IT and Statistical Support Unit, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Christopher Oldmeadow
- Clinical Research Design, IT and Statistical Support Unit, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
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Anderson J, Slade AN, McDonagh PR, Burton W, Fields EC. The long-lasting relationship of distress on radiation oncology-specific clinical outcomes. Adv Radiat Oncol 2018; 4:354-361. [PMID: 31011681 PMCID: PMC6460100 DOI: 10.1016/j.adro.2018.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/10/2018] [Accepted: 11/02/2018] [Indexed: 12/25/2022] Open
Abstract
Purpose The diagnosis and treatment of cancer can have significant mental health ramifications. The National Comprehensive Cancer Network currently recommends using a distress screening tool to screen patients for distress and facilitate referrals to social service resources. Its association with radiation oncology–specific clinical outcomes has remained relatively unexplored. Methods and materials With institutional review board approval, National Comprehensive Cancer Network distress scores were collected for patients presenting to our institution for external beam radiation therapy during a 1-year period from 2015 to 2016. The association between distress scores (and associated problem list items and process-related outcomes) and radiation oncology–related outcomes, including inpatient admissions during treatment, missed treatment appointments, duration of time between consultation and treatment, and weight loss during treatment, was considered. Results A total of 61 patients who received either definitive (49 patients) or palliative (12 patients) treatment at our institution and completed a screening questionnaire were included in this analysis. There was a significant association between an elevated distress score (7+) and having an admission during treatment (36% vs 11%; P = .04). Among the patients treated with definitive intent, missing at least 1 appointment (71% vs 26%; P = .03) and having an admission during treatment (57% vs 10%; P = .009) were significantly associated with our institutional definition of elevated distress. We found no correlation between distress score and weight loss during treatment or a prolonged time between initial consult and treatment start. Conclusions High rates of distress are common for patients preparing to receive radiation therapy. These levels may affect treatment compliance and increase rates of hospital admissions. There remains equipoise in the best method to address distress in the oncology patient population. These results may raise awareness of the consequences of distress among radiation oncology patients. Specific interventions to improve distress need further study, but we suggest a more proactive approach by radiation oncologists in addressing distress.
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Affiliation(s)
- Justin Anderson
- Virginia Commonwealth University Health System, Massey Cancer Center, Department of Radiation Oncology, Richmond, Virginia
| | - Alexander N Slade
- Virginia Commonwealth University Health System, Massey Cancer Center, Department of Radiation Oncology, Richmond, Virginia
| | - Philip Reed McDonagh
- Virginia Commonwealth University Health System, Massey Cancer Center, Department of Radiation Oncology, Richmond, Virginia
| | - Whitney Burton
- Virginia Commonwealth University Health System, Massey Cancer Center, Department of Radiation Oncology, Richmond, Virginia
| | - Emma C Fields
- Virginia Commonwealth University Health System, Massey Cancer Center, Department of Radiation Oncology, Richmond, Virginia
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Buonaccorso L, Martucci G, Miccinesi G, Maruelli A, Ripamonti C. Construction of new personal meanings by cancer patients: a qualitative analysis in an Italian patient population. Support Care Cancer 2018; 27:1911-1918. [DOI: 10.1007/s00520-018-4444-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 08/26/2018] [Indexed: 10/28/2022]
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Snowden A, Young J, Savinc J. Proactive community support tailored to holistic needs: A cohort study. Cancer Med 2018; 7:4836-4845. [PMID: 30101561 PMCID: PMC6144151 DOI: 10.1002/cam4.1709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 06/28/2018] [Accepted: 07/05/2018] [Indexed: 11/17/2022] Open
Abstract
Background It is increasingly internationally recognized that a cancer diagnosis impacts on people practically and financially as well as physically and psychologically. It is less clear what to do about this. This study introduces an original community service designed to mitigate this wider impact. Nonclinical “link officers” use holistic needs assessment (HNA) to help newly diagnosed people identify and quantify the severity of their physical, psychological, practical, financial, and social concerns. A care plan is then agreed, usually involving community interventions from partner agencies. Following intervention, assessment is repeated. The primary aim of this study was to establish whether there was a significant difference between initial assessment and follow‐up, postintervention. Secondary aim was to identify potential predictors of increased levels of concern at baseline and follow‐up. Method Pre‐ and postintervention observational cohort study. Paired t test examined the difference in mean (SD) concern severity between baseline and follow‐up. Multiple linear regression models were computed to hypothesize potential predictors of initial concern severity and severity change. Results The service saw 2413 people 2014‐2017. Participants identified average 5.5 (4.7) concerns, financial concerns being most frequent. Mean severity at baseline was 7.12 (out of 10) (2.50), reducing to 3.83 (3.49) post‐treatment, paired t(4454) = 64.68, P < 0.0001, reduction of 3.31 (95% CI 3.21‐3.41). Factors associated with higher initial concern included unemployment and caring responsibilities. Unemployment was also associated with a smaller reduction of concern severity at follow‐up. Conclusion Patient level of concern went from a level associated with specialist referral to a much more manageable level. This original finding is internationally significant because it extends Khera et al's (2017) “provocative idea” that all patients should be screened for financial problems to show that they can be helped with all their concerns. This article describes a successful, transferable model of community care.
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Affiliation(s)
- Austyn Snowden
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Jenny Young
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Jan Savinc
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
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Qin S, Tan Y, Lu B, Cheng Y, Nong Y. Survey and analysis for impact factors of psychological distress in HIV-infected pregnant women who continue pregnancy. J Matern Fetal Neonatal Med 2018; 32:3160-3167. [PMID: 29764247 DOI: 10.1080/14767058.2018.1459550] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Objective: The objective of this study is to explore the psychological distress of HIV-infected pregnant women who continue pregnancy, and analyze the possible influencing factors. Methods: A total of 194 HIV-infected pregnant women who continue pregnancy were enrolled for this study by a convenient sampling method during June 2012-August 2016. Participants completed questionnaires including Hospital Anxiety and Depression Scale (HADS), Berger HIV Stigma Scale (BHSS), Distress Thermometer (DT) and Problem List (PL), and to determine the cut-off value of DT in the group. Results: The positive detection rate of psychological distress in the HIV-infected pregnant women who continue pregnancy was 69.1%, and the highest frequency of PL was the emotional problems. The positive detection rate of anxiety was 60.8%, the positive detection rate of depression was 54.1%, and the discrimination score was 113.16 ± 19.21. Spearman relevant analysis showed that psychological distress score was positively correlated with anxiety, depression and discrimination score (p < .001). Multiple linear regression analysis showed that relationship between husband and wife, family misfortune, Medicaid, chronic disease or high-risk pregnancy, viral load, CD4+T cell count, infection and confidentiality could affect the psychological distress (p < .05). The ideal cut-off value of DT in the group was 5. Conclusion: HIV-infected pregnant women who continue pregnancy have higher incidence of psychological distress, and the psychological distress is not inferior to cancer patients. The influencing factors are mainly related to the infection and pregnancy characteristics, and have nothing to do with the general social demographic characteristics. The DT can be used as a screening tool to quickly identify psychological distress of the group.
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Affiliation(s)
- Shouxue Qin
- a Guigang Maternal and Child Health-Care Hospital , Guigang City , Guangxi , China
| | - Yanping Tan
- a Guigang Maternal and Child Health-Care Hospital , Guigang City , Guangxi , China
| | - Bingyan Lu
- b Pingnan People's Hospital , Pingnan County , Guangxi , China
| | - Yuqing Cheng
- c Pingnan Maternal and Child Health-Care Hospital , Pingnan County , Guangxi , China
| | - Yanli Nong
- d Guiping Maternal and Child Health-Care Hospital , Guiping County , Guangxi , China
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Katzan IL, Thompson NR, Dunphy C, Urchek J, Lapin B. Neurologic provider views on patient-reported outcomes including depression screening. Neurol Clin Pract 2018; 8:86-92. [PMID: 29708224 DOI: 10.1212/cpj.0000000000000438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 10/04/2017] [Indexed: 11/15/2022]
Abstract
Background We sought to assess neurologic provider satisfaction with the systematic electronic collection of patient-reported outcome measures (PROMs) for both disease-specific measures and depression screening (Patient Health Questionnaire [PHQ-9]). Methods A web-based survey was sent to 299 staff physicians and advanced practice providers on the staff email list of a large group neurologic practice, of whom 206 used the PROM system. The survey consisted of 11 questions with Likert response options regarding perceived usefulness of PROM collection; usefulness of PROM data for clinical care, quality, and research activities according to provider age group and type; and perceived usefulness between disease-specific information and the PHQ-9 depression screen. Results Of those who use the PROM system, 73.3% (151/206) responded. PROM collection was useful for patient care (strongly agree or agree 59.6%), research (strongly agree or agree 68.5%), and to a lesser extent, quality improvement (strongly agree or agree 48.6%). Providers aged 66-75 years believed PROM data were less useful for research (p < 0.01). PROM collection affected patient interactions or clinical management (always or usually 34.6% for disease-specific information and 31.3% for the PHQ-9). Responses were similar concerning perceived clinical usefulness (strongly agree or agree 67.3%) for center-selected disease-specific PROMs and the mandated PHQ-9 (69.8%). Conclusions Providers favorably viewed systematic electronic collection of PROMs in neurologic patients. A mandated depression screening was perceived as favorably as center-selected disease-specific information and should be considered when implementing PROMs in neurologic practice.
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Affiliation(s)
- Irene L Katzan
- Neurological Institute Center for Outcomes Research & Evaluation (ILK, NRT, BL), and Clinical Systems Office (ILK, CD, JU), Cleveland Clinic, OH
| | - Nicolas R Thompson
- Neurological Institute Center for Outcomes Research & Evaluation (ILK, NRT, BL), and Clinical Systems Office (ILK, CD, JU), Cleveland Clinic, OH
| | - Cheryl Dunphy
- Neurological Institute Center for Outcomes Research & Evaluation (ILK, NRT, BL), and Clinical Systems Office (ILK, CD, JU), Cleveland Clinic, OH
| | - John Urchek
- Neurological Institute Center for Outcomes Research & Evaluation (ILK, NRT, BL), and Clinical Systems Office (ILK, CD, JU), Cleveland Clinic, OH
| | - Brittany Lapin
- Neurological Institute Center for Outcomes Research & Evaluation (ILK, NRT, BL), and Clinical Systems Office (ILK, CD, JU), Cleveland Clinic, OH
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Cunningham KB, Kroll T, Wells M. Development of the cancer-related loneliness assessment tool: Using the findings of a qualitative analysis to generate questionnaire items. Eur J Cancer Care (Engl) 2017; 27:e12769. [PMID: 28913913 DOI: 10.1111/ecc.12769] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2017] [Indexed: 11/26/2022]
Abstract
The aim of this research was to develop a tool to identify and assess the qualities of cancer-related loneliness in adult cancer survivors who have completed treatment. In addition to reporting the development of the tool, we explicate the process of using the findings of a qualitative analysis to generate questionnaire items, as currently little guidance exists on this topic. The findings of our qualitative research exploring the experience of loneliness in adult cancer survivors who had completed treatment, together with the findings of our concept analysis of loneliness, were used to develop an assessment tool for cancer-related loneliness following treatment completion. Cognitive testing was undertaken to assess fidelity of comprehension and feasibility in administration. The Cancer-Related Loneliness Assessment Tool is a 10-item self-report questionnaire capturing the essential elements of cancer-related loneliness following treatment completion. Experts believed the questionnaire to be face-valid and usable in clinical practice, and preliminary cognitive testing indicated that the items generate the information intended and individuals have little trouble completing the tool. Following further development work, the tool could be employed to identify cancer-related loneliness following treatment completion. It could also aid with the development/adaptation and evaluation of person-centred interventions to address such loneliness.
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Affiliation(s)
| | - T Kroll
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Belfield, Dublin, Ireland
| | - M Wells
- NMAHP Research Unit, University of Stirling, Stirling, UK
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Patient-reported outcome use in oncology: a systematic review of the impact on patient-clinician communication. Support Care Cancer 2017; 26:41-60. [PMID: 28849277 DOI: 10.1007/s00520-017-3865-7] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 08/21/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Patient-reported outcomes (PROs) are an increasingly popular tool to optimize care and bridge the gap between patient experience and clinician understanding. The aim of this review was to identify mechanisms through which PROs facilitate patient-clinician communication in the adult oncology population. METHODS We conducted a systematic review of the published literature using the following data sources: MEDLINE, EMBASE, CINAHL, PsycINFO, Cab Direct, and CDSR. Studies included in this review reported on the outcomes of PRO use, used PROs as an intervention and not as a study outcome measurement tool, included cancer patients or survivors as study participants, and analyzed patient-clinician communication. RESULTS We identified 610 unique records, of which 43 publications met the inclusion and exclusion criteria. Synthesis of the reviewed studies provided evidence of the usefulness of PROs in facilitating patient-clinician communication on a variety of topics. We identified mechanisms though which PROs influenced patient-clinician communication to include increasing symptom awareness, prompting discussion, streamlining consultations, and facilitating inter-professional communication. Barriers to PRO use in communication improvement include technical problems impeding its administration and completion, compliance issues due to lack of incentive or forgetfulness, and use of PROs that do not appropriately assess issues relevant to the patient. Facilitators include increased education on PRO use, using PRO tools that patients find more acceptable, and providing patient data summaries in an easily accessible format for clinicians. CONCLUSIONS Our review suggests that PROs facilitate patient-clinician communication through various mechanisms that could perhaps contribute to improvements in symptom management and survival. The impact of PROs on clinical outcomes, however, remains poorly studied.
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Pacchiana MV, Capelletto E, Carnio S, Gridelli C, Rossi A, Galetta D, Montagna ES, Bordi P, Ceribelli A, Cortinovis D, Scotti V, Martelli O, Valmadre G, Del Conte A, Miccianza A, Morena R, Rosetti F, Di Maio M, Ostacoli L, Novello S. Patients' Attitudes and Physicians' Perceptions Toward Maintenance Therapy for Advanced Non–Small-cell Lung Cancer: A Multicenter Italian Survey. Clin Lung Cancer 2017; 18:381-387. [DOI: 10.1016/j.cllc.2016.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 10/17/2016] [Accepted: 10/18/2016] [Indexed: 12/01/2022]
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Feasibility of advanced practice nursing in lung cancer consultations during early treatment: A phase II study. Eur J Oncol Nurs 2017; 29:106-114. [PMID: 28720257 DOI: 10.1016/j.ejon.2017.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/21/2017] [Accepted: 05/22/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE There are limited data on the effectiveness of Advanced Practice Nurses in Lung Cancer (APNLC). Previous studies have demonstrated barriers to investigation including low recruitment and high attrition rates in lung cancer population. The primary aim of this study was to assess the feasibility of APNLC consultations and the ability to collect patient-reported outcome measures (PROMs) during first-line treatment. The secondary aim was to describe changes in self-efficacy for managing lung cancer-related symptoms, symptom intensity/burden and unmet supportive care needs of APNLC patients during first-line treatment. METHODS An exact single-stage phase II design was applied. We recruited a consecutive sample of newly diagnosed lung cancer patients receiving systemic treatment in a Swiss oncology outpatient center. The intervention consisted of four systematic, alternating face-to-face/telephone consultations during first line-treatment. Feasibility of the study was defined by at least 55% of patients receiving all scheduled APNLC-led consultations and completing PROMs assessments at the three timepoints. RESULTS In total, 35/46 (76%) (95% CI, 0.61 to 0.87) of patients met the feasibility criteria receiving all scheduled APNLC consultations. Fifty-six percent (26/46) (95% CI, 0.41 to 0.71) completed the PROMs at the three timepoints. Self-efficacy for managing symptoms remained stable, intensity of predominant symptoms increased. Unmet information needs decreased significantly while psychological and sexuality related needs increased over time. CONCLUSION Results were promising for the feasibility of the APNLC consultation and the ability to collect PROMs. Further investigations are needed to increase the impact of the APNLC consultations on symptom intensity and sexual and psychological needs.
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Salander P. Does advocating screening for distress in cancer rest more on ideology than on science? PATIENT EDUCATION AND COUNSELING 2017; 100:858-860. [PMID: 27916462 DOI: 10.1016/j.pec.2016.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 10/26/2016] [Accepted: 11/14/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Pär Salander
- Department of Social Work, Umeå University, Umeå, Sweden.
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Predictors of psychological distress among cancer patients receiving care at a safety-net institution: the role of younger age and psychosocial problems. Support Care Cancer 2017; 25:2305-2312. [DOI: 10.1007/s00520-017-3641-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/10/2017] [Indexed: 01/30/2023]
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O’Connor M, Tanner P, Miller L, Watts K, Musiello T. Detecting Distress: Introducing Routine Screening in a Gynecologic Cancer Setting. Clin J Oncol Nurs 2017; 21:79-85. [DOI: 10.1188/17.cjon.79-85] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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The use of semistructured interviews to assess quality of life impacts for patients with uveal melanoma. Can J Ophthalmol 2016; 52:181-185. [PMID: 28457288 DOI: 10.1016/j.jcjo.2016.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 07/02/2016] [Accepted: 10/31/2016] [Indexed: 01/02/2023]
Abstract
OBJECTIVE There are limited studies on uveal melanoma and patient quality of life. However, the burden of implementing a patient-reported outcome measure to collect this information in a clinical setting is unknown. The objectives of this study were (i) to understand the issues of quality of life that are most important to patients undergoing treatment for uveal melanoma, (ii) to explore patient views on the European Organization for Research and Treatment of Cancer's (EORTC) ophthalmic oncology quality of life questionnaire (QLQ-OPT30), and (iii) to assess patient willingness to complete questionnaires measuring quality of life on an ongoing basis. DESIGN This was a qualitative study. PARTICIPANTS The study included 10 patients treated for uveal melanoma with brachytherapy at the Alberta Ocular Brachytherapy Program, with a mean follow-up period of 16.3 months (range 5-33 months) after diagnosis. METHODS The participants completed a qualitative interview over the phone with a trained interviewer between November 2014 and January 2015. Participants completed the QLQ-OPT30 according to their current symptoms and then elaborated on their responses. The participants then completed a semistructured interview to provide more information about the symptoms or issues that had the most impact on quality of life. RESULTS The participants expressed positive feelings about the QLQ-OPT30; however, the participants' responses revealed that several themes, including mental health, impact of diagnosis and treatment on family, travel and financial burdens of treatment, and impact on work and home life, were missing in the questionnaire. CONCLUSIONS The QLQ-OPT30 performed well, but some missing constructs were identified. Furthermore, participants took 23 minutes to complete the QLQ-OPT30 with a trained interviewer, and this could present logistical challenges when using it at the point of care.
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Qureshi WT, Alirhayim Z, Khalid F, Al-Mallah MH. Prognostic value of extracardiac incidental findings on attenuation correction cardiac computed tomography. J Nucl Cardiol 2016; 23:1266-1274. [PMID: 26202878 DOI: 10.1007/s12350-015-0223-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/23/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Attenuation corrected computed tomography (CTAC) is often performed to improve the specificity of single-photon emission tomography imaging. Extracardiac incidental findings are frequently observed. It is unclear whether these findings have any prognostic value. METHODS Consecutive patients (n = 1139) at a tertiary care center were retrospectively evaluated for incidental findings on CTAC. Clinically significant incidental findings were defined as findings warranting physician follow-up. Information regarding subsequent resource utilization was obtained by chart review. Cox proportional hazard model adjusted for demographic and clinical variables was used to evaluate association of these incidental findings with all-cause and cancer-specific mortality. RESULTS A total of 135 (12%) patients with incidental findings were identified, 83 of whom (68%) were newly diagnosed. Lung nodules were the most common finding, present in 92 (68%) patients. Over a median follow-up of 468 days, incidental findings were not significantly associated with increased risk of all-cause mortality (HR 1.34; 95% CI 0.77-2.33, P = 0.29) but was significantly associated with cancer-specific mortality (HR 3.21; 95% CI 1.26-8.14, P = 0.01). This association remained statistically significant when the analysis was limited to newly diagnosed incidental findings. Among patients with incidental findings, follow-up radiographic studies were conducted in 87%, and invasive procedures performed in 32%. Physician office-based follow-up of these findings occurred in 42% of patients and incidental finding-related hospitalization occurred in 14%. CONCLUSIONS This study shows that incidental findings are common and were associated with all-cause and cancer-specific mortality but only the later remained statistically significant after multivariable adjustment.
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Affiliation(s)
- Waqas T Qureshi
- Wake Forest University School of Medicine, Winston Salem, NC, 27157, USA
| | - Zaid Alirhayim
- Henry Ford Hospital/Wayne State University, 2799 W. Grand Blvd., Detroit, MI, 48202, USA
- The University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Fatima Khalid
- Wake Forest University School of Medicine, Winston Salem, NC, 27157, USA
| | - Mouaz H Al-Mallah
- Henry Ford Hospital/Wayne State University, 2799 W. Grand Blvd., Detroit, MI, 48202, USA.
- Wayne State University, 540 E Canfield St., Detroit, MI, 48201, USA.
- King Abdul-Aziz Cardiac Center, King Abdul-Aziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, MC 1413, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia.
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Johnson RL, Larson C, Black LL, Doty KG, VanHoose L. Significance of Nonphysical Predictors of Distress in Cancer Survivors. Clin J Oncol Nurs 2016; 20:E112-7. [PMID: 27668382 DOI: 10.1188/16.cjon.e112-e117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Distress Thermometer (DT) is a well-validated tool that is frequently used in patients with cancer to screen for general distress and to generate referrals. However, a majority of the DT problem list items relate to physical concerns; this may lead to psychosocial issues being overshadowed. OBJECTIVES The purpose of the current study is to examine the endorsement rates for nonphysical items, as well as the relationship between these items and overall DT scores. METHODS A multiple logistic regression analysis of the first-time distress rating scale of 1,209 patients from 2005-2009 was conducted to determine whether nonphysical items on the DT significantly contributed to a patient falling into one of two categories. FINDINGS This study provides evidence that emotional variables are particularly significant for patients who are at risk for distress and, consequently, should be prioritized for intervention when endorsed on the DT problem list.
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Castelli L, Tonello D, D'Agata F, Caroppo P, Baudino B, Zotta M, Cauda S, Pinessi L, Mortara P, Grassi L, Bisi G, Torta R. The Neurobiological Basis of the Distress Thermometer: A PET Study in Cancer Patients. Stress Health 2015; 31:197-203. [PMID: 24677552 DOI: 10.1002/smi.2546] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 08/27/2013] [Accepted: 09/30/2013] [Indexed: 11/06/2022]
Abstract
The objective of this study was to investigate the possible associations between the Distress Thermometer (DT) scores and the brain metabolism of structures involved in stress response. Twenty-one cancer patients were assessed using the DT, Problem Checklist and Hospital Anxiety and Depression Scale (HADS). The psychological measures were correlated with [18 F]PET-FDG brain glucose metabolism. Multiple and linear regression and binary logistic regression were run to analyse data. The DT and HADS scores illustrated that 48% of patients were distressed, 19% were depressed and 48% were anxious. Results showed that some subcortical areas activity, such as part of midbrain and of hypothalamus, was correlated with the DT scores. The Problem Checklist scores correlated with the activity of the same areas and included more regions in the limbic forebrain and brainstem. Compared with the DT and Problem Checklist, HADS-Depression scores showed a more extensive pattern of correlation with brain activity, including limbic and cortical areas. The results highlighted that the DT scores correlated with the activity of brain areas typically involved in stress response. Indeed, hypothalamus metabolism was found to be the best predictor of distressed patients.
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Affiliation(s)
- L Castelli
- Department of Psychology, University of Turin, Turin, Italy.,Clinical Psychology and Psycho-oncology Unit, Città della Salute e della Scienza, Turin, Italy
| | - D Tonello
- Department of Psychology, University of Turin, Turin, Italy
| | - F D'Agata
- Department of Neuroscience, University of Turin, Turin, Italy
| | - P Caroppo
- Department of Neuroscience, University of Turin, Turin, Italy
| | - B Baudino
- Nuclear Medicine, AOU San Giovanni Battista, Turin, Italy
| | - M Zotta
- Nuclear Medicine, AOU San Giovanni Battista, Turin, Italy
| | - S Cauda
- Nuclear Medicine, AOU San Giovanni Battista, Turin, Italy
| | - L Pinessi
- Department of Neuroscience, University of Turin, Turin, Italy
| | - P Mortara
- Department of Neuroscience, University of Turin, Turin, Italy
| | - L Grassi
- Section of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - G Bisi
- Nuclear Medicine, AOU San Giovanni Battista, Turin, Italy
| | - R Torta
- Department of Neuroscience, University of Turin, Turin, Italy.,Clinical Psychology and Psycho-oncology Unit, Città della Salute e della Scienza, Turin, Italy
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Support for Patients and Family Caregivers in Lung Cancer: Educational Components of an Interdisciplinary Palliative Care Intervention. J Hosp Palliat Nurs 2015; 17:309-318. [PMID: 26640416 DOI: 10.1097/njh.0000000000000165] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Consistent with the recommendations of the Institute of Medicine Report on quality cancer care, attention to symptom management and quality of life concerns of patients with lung cancer should be addressed throughout the disease trajectory. As part of a NCI-funded Program Project grant, this paper reports on the patient and family caregiver education component of a nurse-lead, tailored palliative care intervention for patients with early (I-III, n=130) and late (IV, n=142) stage lung cancer. Patients and family caregivers received 4 separate educational sessions organized around the Quality of Life model domains (physical, psychological, social, and spiritual well-being). Each patient and caregiver was presented at a weekly interdisciplinary case conference which also informed the educational sessions. Based on needs and team suggestions, an individualized palliative care plan was created and a tailored educational intervention was designed based on topics chosen by each participant. The most common topics chosen by patients in each domain were fatigue, worry and fear, social support/isolation, and hope. Family caregivers most commonly chose fatigue, worry and fear, communication, and purpose and meaning in life. The mean time spent in each teaching session ranged from 31 to 44 minutes for patients and 25 to 35 minutes for family caregivers. There is a vital need for interdisciplinary palliative care interventions for patients across all stages and across the disease trajectory. Nurses are vital to integrating palliative care into routine care. Providing a tailored educational intervention is an important aspect of palliative care for patients and family caregivers. This paper focuses on the process of the tailored educational intervention.
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Serena A, Castellani P, Fucina N, Griesser AC, Jeanmonod J, Peters S, Eicher M. The role of advanced nursing in lung cancer: A framework based development. Eur J Oncol Nurs 2015; 19:740-6. [PMID: 26059323 DOI: 10.1016/j.ejon.2015.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 05/13/2015] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Advanced Practice Lung Cancer Nurses (APLCN) are well-established in several countries but their role has yet to be established in Switzerland. Developing an innovative nursing role requires a structured approach to guide successful implementation and to meet the overarching goal of improved nursing sensitive patient outcomes. The "Participatory, Evidence-based, Patient-focused process, for guiding the development, implementation, and evaluation of advanced practice nursing" (PEPPA framework) is one approach that was developed in the context of the Canadian health system. The purpose of this article is to describe the development of an APLCN model at a Swiss Academic Medical Center as part of a specialized Thoracic Cancer Center and to evaluate the applicability of PEPPA framework in this process. METHOD In order to develop and implement the APLCN role, we applied the first seven phases of the PEPPA framework. RESULTS This article spreads the applicability of the PEPPA framework for an APLCN development. This framework allowed us to i) identify key components of an APLCN model responsive to lung cancer patients' health needs, ii) identify role facilitators and barriers, iii) implement the APLCN role and iv) design a feasibility study of this new role. CONCLUSIONS The PEPPA framework provides a structured process for implementing novel Advanced Practice Nursing roles in a local context, particularly where such roles are in their infancy. Two key points in the process include assessing patients' health needs and involving key stakeholders.
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Affiliation(s)
- A Serena
- Institute of Higher Education and Research in Health Care, University of Lausanne, Switzerland; University Hospital Center of Lausanne, Switzerland; University of Applied Arts and Sciences Western Switzerland, School of Health Fribourg, Switzerland.
| | - P Castellani
- University Hospital Center of Lausanne, Switzerland.
| | - N Fucina
- University Hospital Center of Lausanne, Switzerland.
| | - A-C Griesser
- University Hospital Center of Lausanne, Switzerland.
| | - J Jeanmonod
- University Hospital Center of Lausanne, Switzerland.
| | - S Peters
- University Hospital Center of Lausanne, Switzerland.
| | - M Eicher
- Institute of Higher Education and Research in Health Care, University of Lausanne, Switzerland; University of Applied Arts and Sciences Western Switzerland, School of Health Fribourg, Switzerland.
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Howell D, Molloy S, Wilkinson K, Green E, Orchard K, Wang K, Liberty J. Patient-reported outcomes in routine cancer clinical practice: a scoping review of use, impact on health outcomes, and implementation factors. Ann Oncol 2015; 26:1846-1858. [PMID: 25888610 DOI: 10.1093/annonc/mdv181] [Citation(s) in RCA: 320] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 03/31/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND This review focused on the identification of patient-reported outcome measures (PROMs) used in routine cancer clinical practice, the impact on patient, provider, and system outcomes, and the implementation factors influencing uptake. METHODS A scoping review of the published health literature was conducted using empirical databases, namely, Ovid Medline (2003 to September 2013), CINAHL (2003-2013) and PsycINFO (2003-2013). Scoping reviews are systematic literature reviews in a broad topic area that provide relevant and quantified results about the knowledge available on a particular topic and aim to rapidly map and synthesize the evidence to emphasize what is known. RESULTS From a total of 2447 unique publications, 30 articles that met eligibility criteria were reviewed. PRO use appears to be acceptable to patients, enables earlier detection of symptoms and may improve communication between clinicians and patients. However, the impact of routine PROMs collection on health outcomes is less clear and high-quality research is still warranted. CONCLUSION PROMs use in routine cancer clinical practice is growing with improvements on essential care processes shown but a number of implementation barriers must still be addressed. The lack of standardization in PROMs used in cancer organizations may make it difficult to use these data for quality monitoring in the future.
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Affiliation(s)
- D Howell
- Nursing, University Health Network (Princess Margaret Cancer Centre), Toronto.
| | - S Molloy
- Symptom Management, Cancer Care Ontario, Toronto
| | - K Wilkinson
- Symptom Management, Cancer Care Ontario, Toronto
| | - E Green
- Nursing and Psychosocial Oncology, Cancer Care Ontario, Toronto
| | - K Orchard
- Evidence Search and Review Service, Cancer Care Ontario, Toronto, Canada
| | - K Wang
- Evidence Search and Review Service, Cancer Care Ontario, Toronto, Canada
| | - J Liberty
- Evidence Search and Review Service, Cancer Care Ontario, Toronto, Canada
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Brown-Johnson CG, Berrean B, Cataldo JK. Development and usability evaluation of the mHealth Tool for Lung Cancer (mHealth TLC): a virtual world health game for lung cancer patients. PATIENT EDUCATION AND COUNSELING 2015; 98:506-511. [PMID: 25620075 PMCID: PMC4451946 DOI: 10.1016/j.pec.2014.12.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 12/04/2014] [Accepted: 12/21/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To test the feasibility and usability of mHealth TLC, an interactive, immersive 3-dimensional iPad health game that coaches lung cancer patients toward assertive communication strategies during first-person virtual clinics visits. METHOD We observed players and conducted semi-structured interviews. Research questions focused on scenario believability, the impact of technical issues, transparency of game goals, and potential of mHealth TLC to decrease lung cancer stigma (LCS) and improve patient-clinician communication. RESULTS Eight users confirmed mHealth TLC to be: (1) believable, (2) clinic-appropriate, and (3) helpful in support of informed healthcare consumers. Concerns were expressed about emotionally charged content and plans to use mHealth TLC in clinic settings as opposed to at home. CONCLUSIONS Although the dialog and interactions addressed emotionally charged issues, players were able to engage, learn, and benefit from role-play in a virtual world. Health games have the potential to improve patient-clinician communication, and mHealth TLC specifically may decrease LCS, and promote optimal self-management. PRACTICE IMPLICATIONS Process reflection revealed the need for health games to be created by experienced game developers in collaboration with health care experts. To prepare for this best practice, research institutions and game developers interested in health games should proactively seek out networking and collaboration opportunities.
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Affiliation(s)
- Cati G Brown-Johnson
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, USA
| | - Beth Berrean
- S/M Operating Units, University of California, San Francisco, San Francisco, USA
| | - Janine K Cataldo
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, USA.
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Expérimentation du parcours personnalisé des patients atteints d’un cancer des voies aéro-digestives supérieures. Bull Cancer 2014; 101:910-5. [DOI: 10.1684/bdc.2014.2040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hermelink K, Höhn H, Hasmüller S, Gallwas J, Härtl K, Würstlein R, Köhm J. Brief Distress Screening in Clinical Practice: Does it Help to Effectively Allocate Psycho-Oncological Support to Female Cancer Inpatients? ACTA ACUST UNITED AC 2014; 9:129-33. [PMID: 24944557 DOI: 10.1159/000360788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The usefulness of distress screening in cancer inpatient settings has rarely been investigated. This study evaluated a brief distress screening of inpatients in a breast cancer centre and a gynaecological cancer centre. PATIENTS AND METHODS Hospitalised patients with breast or gynaecological cancers were screened with the Distress Thermometer. Patients who scored above the cut-off, were referred by the medical staff, or self-referred were offered bedside psycho-oncological counselling. RESULTS Of 125 patients, 68 (54.4%) received an offer of counselling, and 62 patients (49.6%) accepted. Most of the counselling was induced by distress screening. Only 4 (3.2%) patients self-referred to the counselling service. Of the counselled patients, 65.8% stated that they had substantially benefited from psycho-oncological support; only 5.6% of the non-counselled patients indicated that they might have benefited from psycho-oncological support. CONCLUSION Almost all patients who will accept and benefit from psycho-oncological counselling can be identified if distress screening is used in conjunction with referrals by physicians and nurses. Distress screening is a worthwhile component in a framework of psycho-oncological support in a cancer inpatient setting. It paves the way to counselling for cancer inpatients who need it and are willing to accept it but hesitate to self-refer to psycho-oncological services.
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Affiliation(s)
- Kerstin Hermelink
- Department of Gynaecology and Obstetrics and Comprehensive Cancer Center, Ludwig Maximilian University, Munich, Germany
| | - Henrik Höhn
- Department of Gynaecology and Obstetrics and Comprehensive Cancer Center, Ludwig Maximilian University, Munich, Germany
| | - Stephan Hasmüller
- Department of Gynaecology and Obstetrics and Comprehensive Cancer Center, Ludwig Maximilian University, Munich, Germany
| | - Julia Gallwas
- Department of Gynaecology and Obstetrics and Comprehensive Cancer Center, Ludwig Maximilian University, Munich, Germany
| | - Kristin Härtl
- Department of Gynaecology and Obstetrics and Comprehensive Cancer Center, Ludwig Maximilian University, Munich, Germany
| | - Rachel Würstlein
- Department of Gynaecology and Obstetrics and Comprehensive Cancer Center, Ludwig Maximilian University, Munich, Germany
| | - Janna Köhm
- Department of Gynaecology and Obstetrics and Comprehensive Cancer Center, Ludwig Maximilian University, Munich, Germany
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Grant M, Sun V, Fujinami R, Sidhu R, Otis-Green S, Juarez G, Klein L, Ferrell B. Family caregiver burden, skills preparedness, and quality of life in non-small cell lung cancer. Oncol Nurs Forum 2014; 40:337-46. [PMID: 23803267 DOI: 10.1188/13.onf.337-346] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe burden, skills preparedness, and quality of life (QOL) for caregivers of patients with non-small cell lung cancer (NSCLC), and describe how the findings informed the development of a caregiver palliative care intervention that aims to reduce caregiver burden, improve caregiving skills, and promote self-care. DESIGN Descriptive, longitudinal. SETTING A National Cancer Institute-designated comprehensive cancer center in southern California. SAMPLE 163 family members or friends aged 18 years or older and identified by patients as being a caregiver. METHODS All eligible caregivers were approached by advanced practice nurses during a regularly scheduled patient clinic visit. Informed consent was obtained prior to study participation. Outcome measures were completed at baseline and repeated at 7, 12, 18, and 24 weeks. Descriptive statistics were computed for all variables, and one-way repeated-measures analysis of variance was used to test for change over time for all predictor and outcome variables. MAIN RESEARCH VARIABLES Caregiver burden, skills preparedness, psychological distress, and QOL. FINDINGS Caregivers were highly functional. Caregiver burden related to subjective demands increased significantly over time. Perceived skills preparedness was high at baseline but decreased over time. Psychological distress was moderate but increased in the study period. Overall QOL was moderate at baseline and decreased significantly over time. Psychological well-being had the worst QOL score. CONCLUSIONS Caregivers experienced high levels of caregiver burden and reported deteriorations in psychological well-being and overall QOL. IMPLICATIONS FOR NURSING Oncology nurses need to ensure that caregivers receive information that supports the caregiving role throughout the cancer trajectory. KNOWLEDGE TRANSLATION Although family caregivers are profoundly impacted by a loved one's lung cancer diagnosis, the literature about caregiver burden, skills preparedness, and QOL is limited. Current evidence suggests that family caregivers can be negatively impacted by a loved one's cancer diagnosis. Caregiver-specific support interventions are needed to eliminate the burden of caregiving in lung cancer.
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Affiliation(s)
- Marcia Grant
- Nursing Research and Education, Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, USA.
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Hong JS, Tian J. Sensitivity and specificity of the Distress Thermometer in screening for distress in long-term nasopharyngeal cancer survivors. ACTA ACUST UNITED AC 2013; 20:e570-6. [PMID: 24311958 DOI: 10.3747/co.20.1617] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Distress Thermometer (dt) is a screening tool recommended to quickly identify cancer patients with distress. Our study aimed to examine the sensitivity and specificity of the dt in detecting psychological distress in long-term Chinese nasopharyngeal cancer (npc) survivors. METHODS Data for the 442 participating npc survivors were collected through a self-administered questionnaire based on the dt and the Hospital Anxiety and Depression Scale (hads). The hads was used to define cases of psychological distress. Positive and negative groups were defined based on 4 hads criteria (Anxiety, Depression, Anxiety or Depression, and overall score). Receiver operating characteristic (roc) curves were used to examine the ability of all possible cut-off values of the dt to detect positive and negative cases. For each roc curve, the area under the curve (auc) was used as an indicator of the overall accuracy of the dt to identify positive cases of distress. RESULTS The positive auc values [with 95% confidence intervals (ci)] for the 4 hads criteria were 0.715 (95% ci: 0.667 to 0.764), 0.714 (95% ci: 0.661 to 0.768), 0.724 (95% ci: 0.677 to 0.771), and 0.724 (95% ci: 0.664 to 0.775) respectively. At a cut-off score of 4, the sensitivity of the dt to the four hads criteria was, respectively, 0.366 (95% ci: 0.296 to 0.436), 0.448 (95% ci: 0.364 to 0.532), 0.362 (95% ci: 0.299 to 0.425), and 0.421 (95% ci: 0.339 to 0.502), and the specificity of the dt to the 4 hads criteria was, respectively, 0.860 (95% ci: 0.818 to 0.902), 0.860 (95% ci: 0.821 to 0.899), 0.854 (95% ci: 0.814 to 0.894), and 0.854 (95% ci: 0.814 to 0.894). At a cut-off score of 5, the corresponding sensitivities were lower than those at the cut-off score of 4. All potential cut-off scores showed poor sensitivity (<0.90). CONCLUSIONS The roc analysis showed poor discrimination. No potential dt cut-off score had an acceptable sensitivity. The dt showed poor sensitivity in npc survivors. Thus, the dt might not be a valid scale for psychological distress screening in long-term Chinese npc survivors.
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Affiliation(s)
- J S Hong
- Department of Radiation Oncology, Department of Radiation Biology, First Affiliated Hospital of Fujian Medical University, Fuzhou, PR China
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Ma L, Poulin P, Feldstain A, Chasen M. The association between malnutrition and psychological distress in patients with advanced head-and-neck cancer. Curr Oncol 2013; 20:e554-60. [PMID: 24311956 PMCID: PMC3851352 DOI: 10.3747/co.20.1651] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Malnutrition and psychological distress are often seen in patients with head-and-neck cancer, but little is known about the interrelationships between those two symptoms. The present study examined the relationship between malnutrition and psychological distress in patients with advanced head-and-neck cancer. METHODS Using the Patient-Generated Subjective Global Assessment, 99 patients with advanced-stage head-and-neck cancer were screened for nutrition status. The patients were also screened for psychosocial distress (using the Distress Thermometer) and for psychosocial issues (using the Problem Checklist). Any relationship between malnutrition and psychosocial distress was determined by regression and correlation analysis. We also used t-tests to compare distress levels for patients with and without specific nutrition-related symptoms. RESULTS The study group included 80 men and 19 women [mean age: 58.4 ± 10.9 years (range: 23-85 years)]. The correlation between poorer nutrition status and level of psychological distress was significant r = 0.37 (p < 0.001). Specifically, reduced food intake and symptoms were both positively associated with distress: r = 0.27 and r = 0.29 respectively, both significant at p < 0.01. After controlling for the effects of psychosocial problems and pain, nutrition status remained a significant predictor of distress, explaining 3.8% of the variance in the distress scores of the patients (p < 0.05). CONCLUSIONS Malnutrition and symptoms were strongly related to distress in patients with advanced head-and-neck cancer. Our results suggest the need for further research into the complex relationship between nutrition status and distress and into the management of both nutrition and distress in cancer care.
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Affiliation(s)
- L. Ma
- Ottawa Hospital Research Institute, The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - P. Poulin
- Psychosocial Oncology Program, The Ottawa Hospital Health Institute, Ottawa, ON
| | - A. Feldstain
- School of Psychology, University of Ottawa, Ottawa, ON
| | - M.R. Chasen
- Ottawa Hospital Research Institute, The Ottawa Hospital Cancer Centre, Ottawa, ON
- Division of Palliative Care, The Ottawa Hospital Cancer Centre, Ottawa, ON
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Perception and fulfillment of cancer patients' nursing professional social support needs: from the health care personnel point of view. Support Care Cancer 2013; 22:1049-58. [PMID: 24287509 DOI: 10.1007/s00520-013-2062-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 11/15/2013] [Indexed: 11/12/2022]
Abstract
PURPOSE This study aimed to (1) explore the needs of cancer patients regarding common nursing professional social support from the perspective of physicians and nurses, (2) identify what type of needs clinical nurses actually fulfill and what remains to be improved, and (3) analyze the potential reasons for the gap between the identified needs and those that are fulfilled. METHODS A qualitative approach using focus group interviews was adopted to explore the perception and provision of cancer patients' needs regarding nursing professional social support. A purposive sample of 32 health care professionals was recruited from two teaching hospitals in Anhui province, China. Five focus group interviews were conducted and all interviews were tape-recorded and transcribed verbatim. A content analysis was performed with the data. RESULTS The healthcare professionals perceived various nursing professional support needs of cancer patients; these include informational, emotional/psychological, and technical support needs; the mobilization of social resources; and palliative care during certain stages. The findings also indicated that there are still many unmet needs, especially needs related to the mobilization of social resources and palliative care. The reasons for the deficiencies in the fulfillment of these needs varied and included both subjective and objective aspects, such as the patients' lack of awareness of how to search for professional support, a shortage of professional staff, and the lack of a culturally appropriate assessment tool. CONCLUSIONS Cancer patients' supportive care needs were not always fully provided by nurses, even when these needs were identified by healthcare professionals. Nursing professional social support needs should be assessed quickly and effectively so that the appropriate interventions can be offered to cancer patients.
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