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Gibson KA, Kaplan RM, Pincus T, Li T, Luta G. PROMIS-29 in rheumatoid arthritis patients who screen positive or negative for fibromyalgia on MDHAQ FAST4 (fibromyalgia assessment screening tool) or 2011 fibromyalgia criteria. Semin Arthritis Rheum 2024; 66:152361. [PMID: 38360468 DOI: 10.1016/j.semarthrit.2024.152361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/11/2023] [Accepted: 01/03/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND PROMIS-29 T-scores query health-related quality of life (HRQL) in 7 domains, physical function, pain, fatigue, anxiety, depression, sleep quality, and social participation, to establish population norms. An MDHAQ (multidimensional health assessment questionnaire) scores these 7 domains and includes medical information such as a FAST4 (fibromyalgia assessment screening tool) index. We analyzed PROMIS-29 T-scores in rheumatoid arthritis (RA) patients vs population norms and for positive vs negative fibromyalgia (FM) screens and compared PROMIS-29 T-scores to MDHAQ scores to assess HRQL. METHODS A cross-sectional study was performed at one routine visit of 213 RA patients, who completed MDHAQ, PROMIS-29, and reference 2011 FM Criteria. PROMIS-29 T-scores were compared in RA vs population norms and in FM+ vs FM- RA patients, based on MDHAQ/FAST4 and reference criteria. Possible associations between PROMIS-29 T-scores and corresponding MDHAQ scores were analyzed using Spearman correlations and multiple regressions. RESULTS Median PROMIS-29 T-scores indicated clinically and statistically significantly poorer status in 26-29% FM+ vs FM- RA patients, with larger differences than in RA patients vs population norms for 6/7 domains. MDHAQ scores were correlated significantly with each of 7 corresponding PROMIS-29 domains (|rho|≥0.62, p<0.001). Linear regressions explained 55-73% of PROMIS-29 T-score variation by MDHAQ scores and 56%-70% of MDHAQ score variation by PROMIS-29 T-scores. CONCLUSIONS Scores for 7 PROMIS-29 domains and MDHAQ were highly correlated. The MDHAQ is effective to assess HRQL and offers incremental medical information, including FAST4 screening. The results indicate the importance of assessing comorbidities such as fibromyalgia screening in interpreting PROMIS-29 T-scores.
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Affiliation(s)
- Kathryn A Gibson
- Department of Rheumatology, Liverpool Hospital, Ingham Research Institute, University of New South Wales, Sydney, NSW, 2170, Australia
| | - Robert M Kaplan
- Clinical Excellence Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305
| | - Theodore Pincus
- Division of Rheumatology, Department of Internal Medicine, Rush University School of Medicine, Chicago, Ill, 60612, USA.
| | - Tengfei Li
- Department of Biostatistics, Bioinformatics & Biomathematics, Georgetown University, Washington, DC, 20057, USA
| | - George Luta
- Department of Biostatistics, Bioinformatics & Biomathematics, Georgetown University, Washington, DC, 20057, USA; Clinical Research Unit, The Parker Institute, Copenhagen University Hospital, Frederiksberg, DK-2000, Denmark
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Hodgson CG, Bonifay W, Yang W, Herman KC. Establishing the measurement precision of the patient health questionnaire in an adolescent sample. J Affect Disord 2023; 342:76-84. [PMID: 37708980 DOI: 10.1016/j.jad.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/30/2023] [Accepted: 09/08/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Technically sound measures are necessary for accurately identifying youth at risk for depression, but many studies rely on classical test theory metrics or adult samples to evaluate measures. This study examined the use of the PHQ-8, a common and freely available pediatric depression screener, in an adolescent sample using item response theory (IRT). METHODS Secondary analyses were conducted on data from a study conducted in Midwestern middle schools in which 1224 youth completed the PHQ-8 as part of a battery of surveys. Polytomous IRT analyses (a Graded Response Model) were used to evaluate the PHQ-8. Items were examined for their ability to distinguish between respondents of different latent depression severity and for differential item functioning (DIF) across demographic categories. RESULTS All PHQ-8 items had adequate discriminative abilities. Items measuring anhedonia and psychomotor disturbances performed relatively poorly, and items measuring somatic symptoms (appetite and sleep) were most informative when respondents endorsed extreme response options ("not at all" or "nearly every day"). No DIF was found across grade level or race, but several items were flagged for DIF by gender and student income level. LIMITATIONS These results might not be generalizable to a broader youth population due to administration setting and the unique demographic characteristics of this sample (76.0 % African American). CONCLUSIONS Tools such as the PHQ-8 are appropriate to quickly screen for depression in adolescents, but further scrutiny of adolescent response patterns is warranted. Future research should examine items measuring anhedonia and psychomotor and somatic disturbances in adolescents.
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Affiliation(s)
| | - Wes Bonifay
- University of Missouri, Department of Educational, School and Counseling Psychology, Columbia, MO, USA
| | - Wenxi Yang
- University of Missouri, Department of Educational, School and Counseling Psychology, Columbia, MO, USA.
| | - Keith C Herman
- University of Missouri, Department of Educational, School and Counseling Psychology, Columbia, MO, USA
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Clausing D, Fowler ME, Harmon C, Tucker A, Outlaw D, Akce M, El-Rayes B, Giri S, Williams GR. Association of emotional support with quality of life, mental health, and survival in older adults with gastrointestinal malignancies-Results from the CARE registry. Cancer Med 2023; 12:19102-19111. [PMID: 37644881 PMCID: PMC10557900 DOI: 10.1002/cam4.6477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Emotional support (ES) is the most frequently reported support need among older adults with cancer. Yet, the association of ES with cancer outcomes is largely unknown. This study examined the association of ES with health-related quality of life (HRQoL), mental health, and survival among older adults with gastrointestinal (GI) malignancies. METHODS We included newly diagnosed older adults (≥60 years) with GI cancer undergoing self-reported geriatric assessment at their first clinic visit. ES was measured using an adaptation of the Medical Outcomes Study (dichotomized adequate ES vs. inadequate ES). Outcomes included physical and mental HRQoL, anxiety, depression, and survival. Multivariable linear regression evaluated the association between ES and HRQoL scores. Multivariable logistic regression evaluated the association of ES with anxiety and depression. All models were adjusted for age at geriatric assessments, race, sex, and cancer type/stage. RESULTS 795 participants were included. Median patient age was 68 years (IQR: 64-74), 58% were male, and most cancers were either colorectal (37.9%) or pancreatic (30.8%). Most (77.6%) had adequate ES. Patients with inadequate ES were more likely to be Black (31.5 vs. 20.8%, p = 0.005), disabled (24.1 vs. 10.4%, p < 0.001), widowed/divorced (54.2 vs. 24.8%, p < 0.001) and had lower physical and mental HRQoL t-scores (Physical β: -3.35, 95% CI: -5.25, -1.46; Mental β: -2.46, 95% CI: -4.11, -0.81) and higher odds of depression (aOR: 2.22, CI: 1.34-3.69). This study found no difference between those with adequate ES versus inadequate ES in the proportion of deaths within 1 year of diagnosis (24.3% vs. 24.2%, p = 0.966), or within 2 years of diagnosis (32.4% vs. 33.2%, p = 0.126). CONCLUSIONS Older adults with inadequate ES have worse physical and mental HRQoL and higher odds of depression compared to those with adequate ES.
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Affiliation(s)
- Daniel Clausing
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mackenzie E Fowler
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christian Harmon
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Abigail Tucker
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Darryl Outlaw
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mehmet Akce
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bassel El-Rayes
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Smith Giri
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Grant R Williams
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Benzo RM, Moreno PI, Fox RS, Silvera CA, Walsh EA, Yanez B, Balise RR, Oswald LB, Penedo FJ. Comorbidity burden and health-related quality of life in men with advanced prostate cancer. Support Care Cancer 2023; 31:496. [PMID: 37501020 PMCID: PMC10644679 DOI: 10.1007/s00520-023-07962-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/21/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE Identifying clinically relevant comorbidities and their effect on health-related quality of life (HRQoL) outcomes among men with advanced prostate cancer (APC) can inform patient care and improve outcomes; however, this is poorly understood. The aim of this observational study was to examine the prevalence of comorbidities, and the relationship of comorbidity burden to HRQoL and other patient-reported outcomes (PROs) among men with APC. METHODS Participants were 192 men (average age 68.8) with APC (stage III or IV) who completed a psychosocial battery including measures of sociodemographic factors, HRQoL and other PROs, and the Charlson Comorbidity Index (CCI). Hierarchical multiple regression analysis was used to examine the relationships between CCI, HRQOL, and PROs. RESULTS The vast majority (82%) of participants had at least one comorbidity, with the most common being: hypertension (59%), connective tissue disease or arthritis (31%), diabetes (24%), and problems with kidneys, vision, or another organ (24%). After controlling for covariates, regressions showed that a higher CCI score was significantly associated with worse HRQoL (p < 0.001), lower levels of positive affect (p < 0.05), and higher levels of depression (p < 0.05), fatigue (p < 0.001), pain (p < 0.01), stress (p < 0.01), and cancer-specific distress (p < 0.05). CONCLUSIONS Comorbidities were common among men with APC, and a greater CCI score was associated with detriments in several domains of HRQoL and other PROs. Our findings show the need to address comorbidities in the presence of a cancer diagnosis and subsequent treatment. TRIAL REGISTRATION CLINICALTRIALS. GOV IDENTIFIER NCT03149185.
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Affiliation(s)
- Roberto M Benzo
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Flipse Building, 5thFloor, Coral Gables, Miami, FL, 33146, USA
| | - Patricia I Moreno
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rina S Fox
- University of Arizona College of Nursing, Tucson, AZ, USA
- University of Arizona Cancer Center, Tucson, AZ, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Carlos A Silvera
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Emily A Walsh
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Flipse Building, 5thFloor, Coral Gables, Miami, FL, 33146, USA
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Raymond R Balise
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Urology, University of Miami, Miami, FL, USA
| | - Laura B Oswald
- Department of Health Outcomes and Behavior, Moffit Cancer Center, Tampa, FL, USA
| | - Frank J Penedo
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Flipse Building, 5thFloor, Coral Gables, Miami, FL, 33146, USA.
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
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Dano S, Lan HH, Macanovic S, Bartlett S, Howell D, Li M, Hanmer J, Peipert JD, Novak M, Mucsi I. Two-step screening for depressive symptoms in patients treated with kidney replacement therapies: a cross-sectional analysis. Nephrol Dial Transplant 2023; 38:1318-1326. [PMID: 36095145 PMCID: PMC10157790 DOI: 10.1093/ndt/gfac262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Systematic screening for depressive symptoms may identify patients who may benefit from clinical assessment and psychosocial support. Here we assess a two-step screening using ultrabrief pre-screeners [Edmonton Symptom Assessment Survey-revised Depression item (ESASr-D) or Patient Health Questionnaire-2 (PHQ-2)] followed by the Patient-Reported Outcomes Measurement Information System Depression questionnaire (PROMIS-D) to identify depressive symptoms in patients on kidney replacement therapies. METHODS We conducted a cross-sectional study of adults (kidney transplant recipients or treated with dialysis) in Toronto, ON, Canada. We simulated various two-step screening scenarios where only patients above a pre-screening cut-off score on the ESASr-D or PHQ-2 would move to step 2 (PROMIS-D). Screening performance was evaluated by sensitivity, specificity and positive and negative predictive values using the Patient Health Questionnaire-9 (PHQ-9) as the referent. The average number of items completed by patients in different scenarios was reported. RESULTS Of 480 participants, 60% were male with a mean age of 55 years. Based on PHQ-9, 19% of patients had moderate or severe depressive symptoms. Pre-screening with a PHQ-2 score ≥1 combined with a PROMIS-D score of ≥53 provided the best two-step results (sensitivity 0.81, specificity 0.84, NPV 0.95). Two-step screening also reduces question burden. CONCLUSIONS A two-step screening using a PHQ-2 score ≥1 followed by a PROMIS-D score ≥53 has good sensitivity and specificity for identifying potentially significant depressive symptoms among patients on kidney replacement therapies. This approach has lower question burden. Screened-in patients will need further clinical assessment to establish a diagnosis.
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Affiliation(s)
- Sumaya Dano
- Ajmera Transplant Center, University Health Network, Toronto, ON, Canada
| | - Haoyue Helena Lan
- Ajmera Transplant Center, University Health Network, Toronto, ON, Canada
| | - Sara Macanovic
- Ajmera Transplant Center, University Health Network, Toronto, ON, Canada
| | - Susan Bartlett
- Centre for Outcomes Research and Evaluation, McGill University Health Centre, Montreal, QC, Canada
- Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Doris Howell
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Madeline Li
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Janel Hanmer
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - John Devin Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center, Feinberg School of Medicine, Chicago, IL, USA
| | - Marta Novak
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
| | - Istvan Mucsi
- Ajmera Transplant Center, University Health Network, Toronto, ON, Canada
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McClintock SM, Dail RB, Howe-Martin L, Mann T, Bailey DE. Assessing Depressive Symptoms in Patients With Cancer Treated With Interleukin-2: A Comparison of 2 Measures. Cancer Nurs 2023; 46:E146-E158. [PMID: 35089873 PMCID: PMC9325919 DOI: 10.1097/ncc.0000000000001056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND High-dose interleukin-2 is a therapy available for individuals with renal cell carcinoma; however, it can produce adverse effects, specifically depressive symptoms. There is limited information regarding the trajectory of depressive symptoms and measurement-based care assessment of depressive symptoms. OBJECTIVE The purpose was to describe the trajectory of depressive symptoms and compare 2 depression measures. METHODS A descriptive, mixed-method case study approach was used to describe the longitudinal trajectory of depressive symptoms The qualitative assessment included a journal entry and an interview. The quantitative depression symptom severity measures included the 8-item self-report Patient-Reported Outcomes Measurement Information System Depression and the 30-item Inventory of Depressive Symptomatology-Clinician Rated (IDS-C). RESULTS Ten cases were enrolled. The maximum number of interleukin-2 doses that any patient received within a single hospitalization ranged from 4 to 12. Mean scores on the 8-item Patient-Reported Outcomes Measurement Information System Depression showed no changes in depressive symptoms from pretreatment to posttreatment, nor across hospitalizations. Mean total scores on the IDS-C increased from "normal" to "mild severity" depressive symptom range across all treatment cycles, suggesting transient depressive symptoms within hospitalizations. Qualitative data from the case supported the IDS-C increase, suggesting that the patient developed depressive symptoms pretreatment to posttreatment. CONCLUSIONS Understanding the trajectory of depressive symptoms allows for the identification of critical time points when depressive symptoms present and change across treatment. It is critical to use measurement-based care using validated measures to assess for the presence and changes in depressive symptoms. IMPLICATIONS FOR PRACTICE Validated self-report or clinician-rated depression symptom measures should be used to document the presence or absence of depressive symptoms in this population.
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Affiliation(s)
- Shawn M. McClintock
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
| | | | - Laura Howe-Martin
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center
- Moncrief Cancer Institute, UT Southwestern Medical Center
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Wood WA, Bailey C, Castrogivanni B, Mehedint D, Bryant AL, Lavin K, Tan X, Richardson J, Qian Y, Tan KR, Kent EE. Piloting HealthScore: Feasibility and acceptability of a clinically integrated health coaching program for people living with cancer. Cancer Med 2023; 12:8804-8814. [PMID: 36647557 PMCID: PMC10134320 DOI: 10.1002/cam4.5625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/13/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Cancer supportive care interventions often have limited generalizability, goal misalignment, and high costs. We developed and piloted a health coaching intervention, UNC HealthScore, in patients undergoing cancer treatment (ClinicalTrials.gov identifier NCT04923997). We present feasibility, acceptability, and preliminary outcome data. METHODS HealthScore is a six-month, theory-based, multicomponent intervention delivered through participant-driven coaching sessions. For the pilot study, participants were provided a Fitbit, responded to weekly symptom and physical function digital surveys, and met with a health coach weekly to develop and monitor goals. Coaching notes were discussed in weekly interdisciplinary team meetings and provided back to the treating oncology team. Symptom alerts were monitored and triaged through a study resource nurse to relevant supportive care services. Feasibility was determined based on intervention enrollment and completion. Acceptability was based on satisfaction with coaching and Fitbit-wearing and was informed by semistructured exit interviews. Outcomes evaluated for signs of improvement included several PROMIS (Patient-Reported Outcomes Measurement Information System) measures, including the primary intervention target, physical function. RESULTS From May 2020 to March 2022, 50 participants completed the single-arm pilot. Feasibility was high: 66% enrolled and 71% completed the full intervention. Participants reported an average of 4.8 and 4.7 (out of 5) on the acceptability of coaching calls and using the Fitbit, respectively. Physical function scores rose 3.1 points (SE = 1.1) from baseline to 3 months, and 4.3 (SE = 1.0) from baseline to 6 months, above established minimal clinically important difference (MCID). Improvements above MCID were also evident in anxiety and depression, and smaller improvements were demonstrated for emotional support, social isolation, cognitive function, symptom burden, and self-efficacy. DISCUSSION HealthScore shows feasibility, acceptability, and promising preliminary outcomes. Randomized studies are underway to determine the efficacy of preserving physical function in patients with advanced cancer.
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Affiliation(s)
- William A. Wood
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Department of Medicine, School of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Carly Bailey
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Brianna Castrogivanni
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Diana Mehedint
- Department of MedicineDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Ashley Leak Bryant
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- School of NursingUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Kyle Lavin
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Department of Psychiatry, School of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Xianming Tan
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Department of Biostatistics, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Jaime Richardson
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Yiqing Qian
- Department of Health Behavior, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Kelly R. Tan
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Erin E. Kent
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Department of Health Policy and Management, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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Benzo R, Moreno PI, Fox RS, Silvera CA, Walsh EA, Yanez B, Balise RR, Oswald LB, Penedo FJ. Comorbidity burden and health-related quality of life in men with advanced prostate cancer. RESEARCH SQUARE 2023:rs.3.rs-2572781. [PMID: 36824747 PMCID: PMC9949262 DOI: 10.21203/rs.3.rs-2572781/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Purpose: Identifying clinically relevant comorbidities and their effect on health-related quality of life (HRQoL) outcomes among men with advanced prostate cancer (APC) can inform patient care and improve outcomes; however, this is poorly understood. The aim of this observational study was to examine the prevalence of comorbidities, and the relationship of comorbidity burden to HRQoL and other patient-reported outcomes (PROs) among men with APC. Methods: Participants were 192 men (average age 68.8) with APC (stage III or IV) who completed a psychosocial battery including measures of sociodemographic factors, HRQoL and other PROs, and the Charlson Comorbidity Index (CCI). Hierarchical multiple regression analysis was used to examine the relationships between CCI, HRQOL, and PROs. Results: The vast majority (82%) of participants had at least one comorbidity, with the most common being: hypertension (59%), connective tissue disease or arthritis (31%), diabetes (24%), and problems with kidneys, vision, or another organ (24%). After controlling for covariates, regressions showed that a higher CCI score was significantly associated with worse HRQoL ( p < 0.001), lower levels of positive affect ( p < 0.05), and higher levels of depression ( p < 0.05), fatigue ( p < 0.001), pain ( p < 0.01), stress ( p < 0.01), and cancer-specific distress ( p < 0.05). Conclusions: Comorbidities were common among men with APC, and a greater CCI score was associated with detriments in several domains of HRQoL and other PROs. Our findings show the need to address comorbidities in the presence of a cancer diagnosis and subsequent treatment.
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Affiliation(s)
| | - Patricia I Moreno
- Department of Public Health Sciences, University of Miami Miller School of Medicine
| | | | | | | | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Raymond R Balise
- Department of Public Health Sciences, University of Miami Miller School of Medicine
| | - Laura B Oswald
- Department of Health Outcomes and Behavior, Moffit Cancer Center
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Van Blarigan EL, Chan JM, Sanchez A, Zhang L, Winters-Stone K, Liu V, Macaire G, Panchal N, Graff RE, Tenggara I, Luke A, Simko JP, Cooperberg MR, Carroll PR, Kenfield SA. Protocol for a 4-arm randomized controlled trial testing remotely delivered exercise-only, diet-only, and exercise + diet interventions among men with prostate cancer treated with radical prostatectomy (Prostate 8-II). Contemp Clin Trials 2023; 125:107079. [PMID: 36621597 DOI: 10.1016/j.cct.2023.107079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/22/2022] [Accepted: 01/03/2023] [Indexed: 01/07/2023]
Abstract
BACKGROUND Nutrition and physical activity are associated with prostate cancer recurrence and mortality. Few randomized controlled trials (RCT) have examined the effects of long-term exercise and diet changes on prostate cancer clinical, biological, and patient-reported outcomes. METHODS Prostate 8-II is a 4-arm RCT among 200 men with prostate cancer who chose radical prostatectomy (RP) as their primary treatment. Men are enrolled prior to RP and randomized to exercise-only, diet-only, exercise + diet, or usual care (50/arm). Participants begin their assigned intervention 0-5 weeks prior to RP and continue for 24-months following surgery. The 3 active intervention arms receive access to a web-portal and text messages, coaching calls, and other intervention resources (e.g., heart rate sensor and resistance bands and/or recipe booklet). Weekly exercise goals for the exercise intervention groups are 150 min moderate or 75 min vigorous aerobic exercise, 2 strength sessions, and 2 flexibility sessions. Diet intervention groups work with a dietitian to customize their goals (e.g., increase cruciferous vegetables, cooked tomatoes, healthy fats, fish; limit processed meats, whole milk). The primary endpoint is biochemical recurrence. Secondary endpoints include change in tumor biomarkers from biopsy to RP as well as patient-reported outcomes (e.g., quality-of-life), blood and urine biomarkers, and anthropometry at 0, 6, 12, and 24 months. CONCLUSION This 4-arm RCT will examine the impact of change in exercise and diet (alone or in combination) on prostate cancer recurrence, biology, and quality-of-life.
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Affiliation(s)
- Erin L Van Blarigan
- Department of Urology, University of California, San Francisco, (UCSF), San Francisco, CA, United States of America; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, United States of America
| | - June M Chan
- Department of Urology, University of California, San Francisco, (UCSF), San Francisco, CA, United States of America; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, United States of America
| | - Ada Sanchez
- Department of Urology, University of California, San Francisco, (UCSF), San Francisco, CA, United States of America
| | - Li Zhang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, United States of America; Department of Medicine, University of California, San Francisco, San Francisco, CA, United States of America
| | - Kerri Winters-Stone
- Division of Oncological Sciences, School of Medicine, Oregon Health & Sciences University, Portland, OR, United States of America
| | - Vivian Liu
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
| | - Greta Macaire
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, United States of America
| | - Neil Panchal
- UCSF Human Performance Center, San Francisco, CA, United States of America
| | - Rebecca E Graff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
| | - Imelda Tenggara
- Department of Urology, University of California, San Francisco, (UCSF), San Francisco, CA, United States of America
| | - Anthony Luke
- UCSF Human Performance Center, San Francisco, CA, United States of America; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, United States of America
| | - Jeffry P Simko
- Department of Urology, University of California, San Francisco, (UCSF), San Francisco, CA, United States of America; Department of Pathology, University of California, San Francisco, San Francisco, CA, United States of America
| | - Matthew R Cooperberg
- Department of Urology, University of California, San Francisco, (UCSF), San Francisco, CA, United States of America; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, United States of America
| | - Peter R Carroll
- Department of Urology, University of California, San Francisco, (UCSF), San Francisco, CA, United States of America; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, United States of America
| | - Stacey A Kenfield
- Department of Urology, University of California, San Francisco, (UCSF), San Francisco, CA, United States of America; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, United States of America.
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10
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Bernstein DN, Ramirez G, Thirukumaran CP, Samuel Flemister A, Oh IC, Ketz JP, Baumhauer JF. Clinical Improvement Following Operative Management of Ankle Fractures Among Patients With and Without Moderate to High Depressive Symptoms: An Analysis Using PROMIS. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114221151077. [PMID: 36741681 PMCID: PMC9893091 DOI: 10.1177/24730114221151077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Understanding the recovery trajectory following operative management of ankle fractures can help surgeons guide patient expectations. Further, it is beneficial to consider the impact of mental health on the recovery trajectory. Our study aimed to address the paucity of literature focused on understanding the recovery trajectory following surgery for ankle fractures, including in patients with depressive symptoms. Methods From February 2015 to March 2020, patients with isolated ankle fractures were asked to complete Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), Pain Interference (PI), and Depression questionnaires as part of routine care at presentation and follow-up time points. Linear mixed effects regression models were used to evaluate the patient recovery pattern, comparing the preoperative time point to <3 months, 3-6 months, and >6 months across all patients. Additional models that included the presence of depression symptoms as a covariate were then used. Results A total of 153 patients met inclusion criteria. By 3-6 months, PROMIS PF (β: 9.95, 95% CI: 7.97-11.94, P < .001), PI (β: -10.30, 95% CI: -11.87 to -8.72, P < .001), and Depression (β: -5.60, 95% CI: -7.01 to -4.20, P < .001) improved relative to the preoperative time point. This level of recovery was sustained thereafter. When incorporating depressive symptoms into our model as a covariate, the moderate to high depressive symptoms were associated with significantly and clinically important worse PROMIS PF (β: -4.00, 95% CI: -7.00 to -1.00, P = .01) and PI (β: 3.16, 95% CI: -0.55 to 5.76, P = .02) scores. Conclusion Following ankle fracture surgery, all patients tend to clinically improve by 3-6 months postoperatively and then continue to appreciate this clinical improvement. Although patients with moderate to high depressive symptoms also clinically improve following the same trajectory, they tend to do so to a lesser level than those who have low depressive symptoms. Level of Evidence Level III, case-control study.
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Affiliation(s)
- David N. Bernstein
- Harvard Combined Orthopaedic Residency Program (HCORP), Massachusetts General Hospital, Boston, MA, USA
| | - Gabriel Ramirez
- Harvard Combined Orthopaedic Residency Program (HCORP), Massachusetts General Hospital, Boston, MA, USA
- Department of Orthopaedics & Physical Performance, University of Rochester Medical Center, Rochester, NY, USA
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Caroline P. Thirukumaran
- Department of Orthopaedics & Physical Performance, University of Rochester Medical Center, Rochester, NY, USA
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - A. Samuel Flemister
- Department of Orthopaedics & Physical Performance, University of Rochester Medical Center, Rochester, NY, USA
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Irvin C. Oh
- Department of Orthopaedics and Rehabilitation, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA
| | - John P. Ketz
- Department of Orthopaedics & Physical Performance, University of Rochester Medical Center, Rochester, NY, USA
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Judith F. Baumhauer
- Department of Orthopaedics & Physical Performance, University of Rochester Medical Center, Rochester, NY, USA
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- Judith F. Baumhauer, MD, MPH, Department of Orthopaedics & Physical Performance, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA.
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11
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Comparative analysis of pediatric anxiety measures in clinical sample: evaluation of the PROMIS pediatric anxiety short forms. Qual Life Res 2022; 32:1621-1630. [PMID: 36580192 DOI: 10.1007/s11136-022-03333-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Examine the psychometric properties, validity in relation to a legacy measure, and diagnostic accuracy of the PROMIS Anxiety Short Form 2.0 (PROMIS A-SF) Caregiver and Youth Reports in a clinical sample. METHODS Participants were 301 youth and caregivers referred to a behavioral health clinic by their pediatrician. Participants and their caregivers completed PROMIS A-SF (youth and caregiver proxy), SCARED (youth and caregiver proxy), and a semi-structured interview. Descriptive, correlational, test-retest reliability, and receiver operating characteristic (ROC) analyses were conducted for both measures. RESULTS PROMIS A-SF measures were highly correlated with SCARED total scores and the panic subscale. PROMIS A-SF measures had AUCs ranging from .49-.79 for the detection of any of three primary subtypes of anxiety: Generalized Anxiety, Separation Anxiety, and Social Anxiety. IMPLICATIONS Dimensional anxiety subtypes, such as Social Anxiety may not be well detected on the PROMIS youth measure. Use of the PROMIS A-SF as a part of Evidence Based Assessment process is discussed.
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12
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Clover K, Lambert SD, Oldmeadow C, Britton B, Mitchell AJ, Carter G, King MT. Convergent and criterion validity of PROMIS anxiety measures relative to six legacy measures and a structured diagnostic interview for anxiety in cancer patients. J Patient Rep Outcomes 2022; 6:80. [PMID: 35857151 PMCID: PMC9300804 DOI: 10.1186/s41687-022-00477-4] [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: 12/13/2021] [Accepted: 06/05/2022] [Indexed: 12/03/2022] Open
Abstract
Background Detecting anxiety in oncology patients is important, requiring valid yet brief measures. One increasingly popular approach is the Patient Reported Outcomes Measurement Information System (PROMIS); however, its validity is not well established in oncology. We assessed the convergent and criterion validity of PROMIS anxiety measures in an oncology sample.
Methods 132 oncology/haematology outpatients completed the PROMIS Anxiety Computer Adaptive Test (PROMIS-A-CAT) and the 7 item (original) PROMIS Anxiety Short Form (PROMIS-A-SF) along with six well-established measures: Hospital Anxiety and Depression Scale-Anxiety (HADS-A); Generalised Anxiety Disorder-7 (GAD-7); Depression, Anxiety and Stress Scale-Anxiety (DASS-A) and Stress (DASS-S); Distress Thermometer (DT) and PSYCH-6. Correlations, area under the curve (AUC) and diagnostic accuracy statistics were calculated with Structured Clinical Interview as the reference standard.
Results Both PROMIS measures correlated with all legacy measures at p < .001 (Rho = .56–.83). AUCs (> .80) were good for both PROMIS measures and comparable to or better than all legacy measures. At the recommended mild cut-point (55), PROMIS-A-SF had sensitivity (.67) comparable to or better than all the legacy measures, whereas PROMIS-A-CAT sensitivity (.59) was lower than GAD-7 (.67) and HADS-A (.62), but comparable to PSYCH-6 and higher than DASS-A, DASS-S and DT. Sensitivity for both was .79. A reduced cut-point of 51 on both PROMIS measures improved sensitivity (.83–.84) although specificity was only adequate (.61–.62). Conclusions The convergent and criterion validity of the PROMIS anxiety measures in cancer populations was confirmed as equivalent, but not superior to, established measures (GAD-7 and HADS-A). The PROMIS-A-CAT did not demonstrate clear advantages over PROMIS-A-SF.
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13
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Key considerations to reduce or address respondent burden in patient-reported outcome (PRO) data collection. Nat Commun 2022; 13:6026. [PMID: 36224187 PMCID: PMC9556436 DOI: 10.1038/s41467-022-33826-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/05/2022] [Indexed: 11/30/2022] Open
Abstract
Patient-reported outcomes (PROs) are used in clinical trials to provide evidence of the benefits and risks of interventions from a patient perspective and to inform regulatory decisions and health policy. The collection of PROs in routine practice can facilitate monitoring of patient symptoms; identification of unmet needs; prioritisation and/or tailoring of treatment to the needs of individual patients and inform value-based healthcare initiatives. However, respondent burden needs to be carefully considered and addressed to avoid high rates of missing data and poor reporting of PRO results, which may lead to poor quality data for regulatory decision making and/or clinical care. The collection of patient-reported outcomes (PROs) may capture patients’ assessments of their health status. Here authors highlight PRO-specific issues that should be considered to minimise respondent burden in clinical trials and routine care.
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14
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Aneizi A, Gelmann D, Ventimiglia DJ, Sajak PMJ, Nadarajah V, Foster MJ, Weir TB, Akabudike NM, Pensy RA, Henn RF. Preoperative Opioid Use in Patients Undergoing Common Hand Surgeries. Hand (N Y) 2022; 17:905-912. [PMID: 33467941 PMCID: PMC9465804 DOI: 10.1177/1558944720974122] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The objectives of this study were to determine the baseline patient characteristics associated with preoperative opioid use and to establish whether preoperative opioid use is associated with baseline patient-reported outcome measures in patients undergoing common hand surgeries. METHODS Patients undergoing common hand surgeries from 2015 to 2018 were retrospectively reviewed from a prospective orthopedic registry at a single academic institution. Medical records were reviewed to determine whether patients were opioid users versus nonusers. On enrollment in the registry, patients completed 6 Patient-Reported Outcomes Measurement Information System (PROMIS) domains (Physical Function, Pain Interference, Fatigue, Social Satisfaction, Anxiety, and Depression), the Brief Michigan Hand Questionnaire (BMHQ), a surgical expectations questionnaire, and Numeric Pain Scale (NPS). Statistical analysis included multivariable regression to determine whether preoperative opioid use was associated with patient characteristics and preoperative scores on patient-reported outcome measures. RESULTS After controlling for covariates, an analysis of 353 patients (opioid users, n = 122; nonusers, n = 231) showed that preoperative opioid use was associated with higher American Society of Anesthesiologists class (odds ratio [OR], 2.88), current smoking (OR, 1.91), and lower body mass index (OR, 0.95). Preoperative opioid use was also associated with significantly worse baseline PROMIS scores across 6 domains, lower BMHQ scores, and NPS hand scores. CONCLUSIONS Preoperative opioid use is common in hand surgery patients with a rate of 35%. Preoperative opioid use is associated with multiple baseline patient characteristics and is predictive of worse baseline scores on patient-reported outcome measures. Future studies should determine whether such associations persist in the postoperative setting between opioid users and nonusers.
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Affiliation(s)
- Ali Aneizi
- University of Maryland School of
Medicine, Baltimore, USA
| | | | | | | | | | | | | | | | | | - R. Frank Henn
- University of Maryland School of
Medicine, Baltimore, USA
- University of Maryland School of
Medicine and University of Maryland Rehabilitation & Orthopaedic Institute,
Baltimore, USA
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15
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Treadwell MJ, Mushiana S, Badawy SM, Preiss L, King AA, Kroner B, Chen Y, Glassberg J, Gordeuk V, Shah N, Snyder A, Wun T. An evaluation of patient-reported outcomes in sickle cell disease within a conceptual model. Qual Life Res 2022; 31:2681-2694. [PMID: 35445915 PMCID: PMC9356962 DOI: 10.1007/s11136-022-03132-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine the relations between patient-reported outcomes (PROs) within a conceptual model for adults with sickle cell disease (SCD) ages 18 - 45 years enrolled in the multi-site Sickle Cell Disease Implementation Consortium (SCDIC) registry. We hypothesized that patient and SCD-related factors, particularly pain, and barriers to care would independently contribute to functioning as measured using PRO domains. METHODS Participants (N = 2054) completed a 48-item survey including socio-demographics and PRO measures, e.g., social functioning, pain impact, emotional distress, and cognitive functioning. Participants reported on lifetime SCD complications, pain episode frequency and severity, and barriers to healthcare. RESULTS Higher pain frequency was associated with higher odds of worse outcomes in all PRO domains, controlling for age, gender and site (OR range 1.02-1.10, 95% CI range [1.004-1.12]). Reported history of treatment for depression was associated with 5 of 7 PRO measures (OR range 1.58-3.28 95% CI range [1.18-4.32]). Fewer individual barriers to care and fewer SCD complications were associated with better outcomes in the emotion domain (OR range 0.46-0.64, 95% CI range [0.34-0.86]). CONCLUSIONS Study results highlight the importance of the biopsychosocial model to enhance understanding of the needs of this complex population, and to design multi-dimensional approaches for providing more effective interventions to improve outcomes.
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Affiliation(s)
- Marsha J Treadwell
- University of California San Francisco Benioff Children's Hospital Oakland, 747 52nd Street, Oakland, CA, 94609, USA.
| | | | - Sherif M Badawy
- Anne & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Liliana Preiss
- Research Triangle International, Research Triangle Park, NC, USA
| | | | - Barbara Kroner
- Research Triangle International, Research Triangle Park, NC, USA
| | - Yumei Chen
- University of California San Francisco Benioff Children's Hospital Oakland, 747 52nd Street, Oakland, CA, 94609, USA
| | | | | | | | | | - Theodore Wun
- University of California Davis, Sacramento, CA, USA
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16
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Elsman EBM, Flens G, de Beurs E, Roorda LD, Terwee CB. Towards standardization of measuring anxiety and depression: Differential item functioning for language and Dutch reference values of PROMIS item banks. PLoS One 2022; 17:e0273287. [PMID: 35998333 PMCID: PMC9398458 DOI: 10.1371/journal.pone.0273287] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction The outcomes anxiety and depression are measured frequently by healthcare providers to assess the impact of a disease, but with numerous instruments. PROMIS item banks provide an opportunity for standardized measurement. Cross-cultural validity of measures and the availability of reference values are prerequisites for standardized measurement. Methods PROMIS Anxiety and Depression item banks were completed by 1002 representative Dutch persons. To evaluate cross-cultural validity, data from US participants in PROMIS wave 1 were used and differential item functioning (DIF) was investigated, using an iterative hybrid of logistic regression and item response theory. McFadden’s pseudo R2-change of 2% was the critical threshold. The impact of any DIF on full item banks and short forms was investigated. To obtain Dutch reference values, T-scores for anxiety and depression were calculated for the complete Dutch sample, and age-group and gender subpopulations. Thresholds corresponding to normal limits, mild, moderate and severe symptoms were computed. Results In both item banks, two items had DIF but with minimal impact on population level T-scores for full item banks and short forms. The Dutch general population had a T-score of 49.9 for anxiety and 49.6 for depression, similar to the T-scores of 50.0 of the US general population. T-scores for age-group and gender subpopulations were also similar to T-scores of the US general population. Thresholds for mild, moderate and severe anxiety and depression were set to 55, 60 and 70, identical to US thresholds. Conclusions The limited number of items with DIF and its minimal impact, enables the use of standard (US) item parameters and comparisons of scores between Dutch and US populations. The Dutch reference values provide an important tool for healthcare professionals and researchers to evaluate and interpret symptoms of anxiety and depression, stimulating the uptake of PROMIS measures, and contributing to standardized outcome measurement.
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Affiliation(s)
- Ellen B. M. Elsman
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gerard Flens
- Alliance for Quality in Mental Health Care, Utrecht, The Netherlands
| | - Edwin de Beurs
- Arkin GGZ, Amsterdam, The Netherlands
- Clinical Psychology, Faculty of Social Sciences, Leiden University, Amsterdam, The Netherlands
| | - Leo D. Roorda
- Amsterdam Rehabilitation Research Center | Reade, Amsterdam, The Netherlands
| | - Caroline B. Terwee
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- * E-mail:
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17
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Tarrasch J, England P, Hurst VT, McDonald D, O'Keefe R, Cipriano C. Patients With Metastatic Disease Are at Highest Risk for Anxiety and Depression in an Orthopedic Oncology Patient Population. JCO Oncol Pract 2022; 18:e1407-e1416. [PMID: 35649193 DOI: 10.1200/op.21.00905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patients with cancer are at risk for anxiety and depression; however, the patterns and predictors of symptoms in an orthopedic oncology population have not been studied. METHODS We retrospectively reviewed Patient-Reported Outcomes Measurement Information System scores of all adult patients who underwent palliative surgery for metastatic cancer, resection of a sarcoma, or nononcologic total joint arthroplasty at a single institution from 2015 to 2020. Backward stepwise linear regression was used to determine risk factors for perioperative anxiety and depression. RESULTS Postoperative anxiety and depression were more prevalent in patients with metastatic disease than localized cancer or nononcologic conditions (P < .001 and P < .001, respectively). Worse preoperative pain and function were associated with higher preoperative anxiety (β = .321, P = .001; β = -.236, P = .012, respectively) and depression (β = .245, P = .009; β = -.279, P = .003, respectively). Worse preoperative anxiety, preoperative depression, and postoperative pain were associated with higher postoperative anxiety (β = .204, P = .012; β = .260, P = .001; β = .447, P < .001, respectively). Worse preoperative depression and postoperative pain also predicted higher postoperative depression (β = .542, P < .001; β = .325, P < .001, respectively). CONCLUSION Anxiety and depression were most prevalent in patients with metastatic disease. Compared with total joint arthroplasty patients, patients with cancer less frequently experienced postoperative improvements in anxiety and depression. Worse preoperative pain and function were independently associated with greater preoperative anxiety and depression. Providers should maintain awareness of the relationship between mental and physical health to optimize outcomes.
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Affiliation(s)
- Jeffrey Tarrasch
- Washington University in St Louis School of Medicine, St Louis, MO
| | - Patrick England
- Washington University in St Louis School of Medicine, St Louis, MO
| | - V Tillman Hurst
- Washington University in St Louis School of Medicine, St Louis, MO
| | - Douglas McDonald
- Washington University in St Louis School of Medicine, St Louis, MO
| | - Regis O'Keefe
- Washington University in St Louis School of Medicine, St Louis, MO
| | - Cara Cipriano
- Hospital of the University of Pennsylvania, Department of Orthopaedic Surgery, Philadelphia, PA
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18
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Development of computer adaptive testing for measuring depression in patients with cancer. Sci Rep 2022; 12:8247. [PMID: 35581321 PMCID: PMC9114408 DOI: 10.1038/s41598-022-12318-x] [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: 01/24/2022] [Accepted: 04/29/2022] [Indexed: 11/10/2022] Open
Abstract
The usefulness of depression scales for patients with cancer based on item response theory (IRT) and computer adaptive testing (CAT) has not yet been fully explored. This study thus aimed to develop an IRT-based tool for measuring depression in patients with cancer. We analyzed data from 393 patients with cancer from four tertiary centers in Japan who had not received psychiatric treatment. They answered 62 questions across five categories regarding their psychiatric status over the previous week. We selected 28 items that satisfied the assumptions of IRT, fitted a graded response model to these items, and performed CAT simulations. The CAT simulation used an average of 6.96 items and showed a Pearson’s correlation coefficient of 0.916 (95% confidence interval, 0.899–0.931) between the degree of depression estimated by simulation and that estimated using all 28 items. The measurement precision of CAT with only four items was superior to that of the estimation using the calibrated Patient Health Questionnaire-9. These results imply that this scale is useful and accurate for measuring depression in patients with cancer.
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Johnson AJ, Laffitte Nodarse C, Peraza JA, Valdes-Hernandez PA, Montesino-Goicolea S, Huo Z, Fillingim RB, Cruz-Almeida Y. Psychological profiles in adults with knee OA-related pain: a replication study. Ther Adv Musculoskelet Dis 2021; 13:1759720X211059614. [PMID: 34900003 PMCID: PMC8664321 DOI: 10.1177/1759720x211059614] [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: 05/19/2021] [Accepted: 10/26/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Psychological factors have been associated with knee osteoarthritis pain severity and treatment outcomes, yet their combined contribution to phenotypic heterogeneity is poorly understood. In particular, empirically derived psychological profiles must be replicated before they can be targeted or considered for treatment studies. The objectives of this study were to (1) confirm previously identified psychological profiles using unsupervised clustering methods in persons with knee osteoarthritis pain, (2) determine the replicability of profiles using supervised machine learning in a different sample, and (3) examine associations with clinical pain, brain structure, and experimental pain. Methods Participants included two cohorts of individuals with knee osteoarthritis pain recruited as part of the multisite UPLOAD1 (n = 270, mean age = 56.8 ± 7.6, male = 37%) and UPLOAD2 (n = 164, mean age = 57.73 ± 7.8, male = 36%) studies. Similar psychological constructs (e.g. optimism, coping, somatization, affect, depression, and anxiety), sociodemographic and clinical characteristics, and somatosensory function were assessed across samples. UPLOAD2 participants also completed brain magnetic resonance imaging. Unsupervised hierarchical clustering analysis was first conducted in UPLOAD1 data to derive clusters, followed by supervised linear discriminative analysis to predict group membership in UPLOAD2 data. Associations among cluster membership and clinical variables were assessed, controlling for age, sex, education, ethnicity/race, study site, and number of pain sites. Results Four distinct profiles emerged in UPLOAD1 and were replicated in UPLOAD2. Identified psychological profiles were associated with psychological variables (ps < 0.001), and clinical outcomes (ps = 0.001-0.03), indicating good internal and external validation of the cluster solution. Significant associations between psychological profiles and somatosensory function and brain structure were also found. Conclusions This study highlights the importance of considering the biopsychosocial model in knee osteoarthritis pain assessment and treatment.
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Affiliation(s)
- Alisa J Johnson
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | | | - Julio A Peraza
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | | | | | - Zhiguang Huo
- Department of Biostatistics, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Roger B Fillingim
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Yenisel Cruz-Almeida
- Pain Research & Intervention Center of Excellence, University of Florida, PO Box 103628, 1329 SW 16th Street, Ste 5180, Gainesville, FL 32610, USA
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van Maren K, Brown LE, Cremers T, Khatiri MZ, Ring D, Fatehi A. In Orthopaedic Speciality Care, Longer Explanations Are Not More Caring or More Satisfying. Clin Orthop Relat Res 2021; 479:2601-2607. [PMID: 34114977 PMCID: PMC8726551 DOI: 10.1097/corr.0000000000001860] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/25/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Research consistently documents no correlation between the duration of a musculoskeletal specialty care visit and patient experience (perceived empathy of the specialist and satisfaction with care). Based on a combination of clinical experience and other lines of research, we speculate that longer visits are often related to discordance between specialist and patient interpretation of symptoms and weighting of available test and treatment options. If this is true, then the specific duration of time discussing the specialist's interpretations and options with the patient (expertise transfer) might correlate with satisfaction with care and perceived empathy of the clinician even if the total visit time does not. QUESTIONS/PURPOSES (1) What demographic or mental health factors are associated with the duration of expertise transfer? (2) What factors, including the duration of expertise transfer, are associated with the patient's satisfaction with the visit and perceived clinician empathy? METHODS In a cross-sectional study, 128 new and returning English-speaking adult outpatients seeking care from one of three orthopaedic specialists in two urban practices between September and November 2019 were enrolled and agreed to audio recording of the visit. A total of 92% (118) of patients completed the questionnaire and had a usable recording. Participants completed a sociodemographic survey, the Patient-Reported Outcome Measure Information System Depression computer adaptive test (PROMIS Depression CAT; a measure of symptoms of depression), the Short Health Anxiety Index (SHAI-5; a measure of symptoms of hypochondriasis, a form of symptoms misinterpretation), the Pain Catastrophizing Scale (PCS-4; a measure of misinterpretation of symptoms), an ordinal measure of patient satisfaction (dichotomized into satisfied or not because of strong ceiling effects), and the Jefferson Scale of Patient Perception of Physician Empathy (JSPPPE; a measure of perceived clinician empathy). The duration of expertise transfer and the total duration of the visit were measured by two raters with acceptable reliability using software that facilitates segmentation of the visit audio recording. To determine factors associated with the duration of expertise transfer, satisfaction, and empathy, we planned a multivariable analysis controlling for potential confounding variables identified in exploratory bivariable analysis. However, there were insufficient associations to merit multivariable analysis. RESULTS A longer duration of expertise transfer had a modest correlation with catastrophic thinking (r = 0.24; p = 0.01). Complete satisfaction with the visit was associated with less health anxiety (6 [interquartile range 5 to 7] for complete satisfaction versus 7 [5 to 7] for less than complete satisfaction; p = 0.02) and catastrophic thinking (4 [1 to 7] versus 5 [3 to 11]; p = 0.02), but not with the duration of expertise transfer. Greater perceived clinician empathy had a slight correlation with less health anxiety (r = -0.19; p = 0.04). CONCLUSION Patients with greater misinterpretation of symptoms experience a slightly less satisfying visit and less empathetic relationship with a musculoskeletal specialist despite a longer duration of expertise transfer. This supports the concept that directive strategies (such as teaching healthy interpretation of symptoms) may be less effective then guiding strategies (such as nurturing openness to alternative, healthier interpretation of symptoms using motivational interviewing tactics, often over more than one visit or point of contact). LEVEL OF EVIDENCE Level II, therapeutic study.
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Affiliation(s)
- Koen van Maren
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - Laura E. Brown
- Department of Communication Studies, Moody College of Communication, the University of Texas at Austin, Austin, TX, USA
| | - Teun Cremers
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - Michael Zoulfi Khatiri
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - Amirreza Fatehi
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
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21
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Stockly OR, Wolfe AE, Goldstein R, Roaten K, Wiechman S, Trinh NH, Goverman J, Stoddard FJ, Zafonte R, Ryan CM, Schneider JC. Predicting Depression and Post-Traumatic Stress Symptoms Following Burn Injury: A Risk Scoring System. J Burn Care Res 2021; 43:899-905. [PMID: 34751379 DOI: 10.1093/jbcr/irab215] [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: 11/13/2022]
Abstract
Depression and post-traumatic stress are common psychiatric comorbidities following burn injury. The purpose of this study was to develop an admission scoring system that assesses the risk of development of depression or post-traumatic symptoms in the burn population. This study is a retrospective review of the prospectively collected Burn Model System National Database. Adult burn survivors enrolled from 2014-2018 (n=486) were included. The primary outcome was the presence of depression or post-traumatic stress symptoms at 6, 12, or 24 months post-injury. Logistic regression analysis was used to identify demographic and clinical predictors of depression and post-traumatic stress symptoms. A risk scoring system was then created based on assigning point values to relevant predictor factors. The study population had a mean age of 46.5±15.8 years, mean burn size of 18.3±19.7%, and was 68.3% male. Prior to injury, 71.3% of the population was working, 47.9% were married, and 50.8% had completed more than a high school education. An 8-point risk scoring system was developed using the following predictors of depression or post-traumatic stress symptom development: gender, psychiatric treatment in the past year, graft size, head/neck graft, etiology of injury, and education level. This study is the first to develop a depression and post-traumatic stress symptom risk scoring system for burn injury. This scoring system will aid in identifying burn survivors at high risk of long-term psychiatric symptoms that may be used to improve screening, monitoring, timely diagnosis and interventions.
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Affiliation(s)
- Olivia R Stockly
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA
| | - Audrey E Wolfe
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA
| | - Richard Goldstein
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA
| | - Kimberly Roaten
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - Shelley Wiechman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Nhi-Ha Trinh
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jeremy Goverman
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Frederick J Stoddard
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.,Harvard Medical School, Boston, MA.,Shriners Hospitals for Children-Boston, Boston, MA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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22
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Cohen ML, Harnish SM, Lanzi AM, Brello J, Victorson D, Kisala PA, Nandakumar R, Tulsky DS. Adapting a Patient-Reported Outcome Bookmarking Task to be Accessible to Adults With Cognitive and Language Disorders. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:4403-4412. [PMID: 34699261 DOI: 10.1044/2021_jslhr-21-00071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background Patient-reported outcome (PRO) measures produce scores that do not always have obvious clinical meaning. The PRO-bookmarking procedure is a new and promising way to make PRO measures more meaningful and interpretable. However, the materials and procedures of the task may benefit from adaptations to be more accessible to individuals with cognitive and language disorders. Aims This study aims to provide an overview of the iterative refinement process used to modify the materials and procedures of the PRO-bookmarking task so that they are more accessible to adults with acquired cognitive and language impairments. Method and Procedures Our team of health psychologists, neuropsychologists, and speech-language pathologists (SLPs) conducted two focus groups with SLPs and care partners of people with aphasia using the same PRO-bookmarking materials and procedures as previous reports. These PRO-bookmarking materials and procedures were then refined iteratively based on discussion with those who participated in focus groups and among the research team, and three more times in the course of 16 additional focus groups of different stakeholders: people with Parkinson's disease, aphasia, or traumatic brain injury; care partners of people with those conditions; and SLPs who have experience with those, and other adult-acquired conditions. Outcomes and Results The PRO-bookmarking materials and procedures underwent four iterations to make them clearer, simpler, and more accessible. For example, the materials included more structured text and graphic supports where appropriate and the procedures were clustered into smaller discrete tasks and displayed graphically when possible and appropriate. Conclusions PRO-bookmarking materials and procedures were made simpler and more structured to increase their accessibility to adults with cognitive and language impairments. In fact, these adaptations made the tasks simpler and clearer for all types of stakeholders.
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Affiliation(s)
- Matthew L Cohen
- Department of Communication Sciences and Disorders, University of Delaware, Newark
- Center for Health Assessment Research and Translation, University of Delaware, Newark
| | - Stacy M Harnish
- Department of Speech and Hearing Science, The Ohio State University, Columbus
| | - Alyssa M Lanzi
- Department of Communication Sciences and Disorders, University of Delaware, Newark
| | - Jennifer Brello
- Department of Speech and Hearing Science, The Ohio State University, Columbus
| | - David Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Pamela A Kisala
- Center for Health Assessment Research and Translation, University of Delaware, Newark
| | | | - David S Tulsky
- Center for Health Assessment Research and Translation, University of Delaware, Newark
- Department of Physical Therapy, University of Delaware, Newark
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23
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Craner JR, Flegge LG, Lake ES, Perra AEA. Patients with Clinically Elevated Depressive Symptoms Report Improvements in Mood, Pain, and Functioning following Participation in Interdisciplinary Pain Rehabilitation. PAIN MEDICINE 2021; 23:362-374. [PMID: 34343314 DOI: 10.1093/pm/pnab242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Chronic pain and depression frequently co-occur and exacerbate one another; therefore, it is important to treat both conditions to improve patient outcomes. The current study evaluates an interdisciplinary pain rehabilitation program (IPRP) with respect to the following questions: 1) How do clinically elevated depressive symptoms impact pain-related treatment outcomes? and 2) To what extent does IPRP participation yield reliable and clinically significant change in depressed mood? METHODS Participants in this study included 425 adults who engaged in a 10-week IPRP and completed self-report measures of pain, mood, and functioning at intake and discharge. Participants were categorized into 4 groups based on self-reported depressive symptoms (PROMIS Depression): within normal limits (WNL; n = 121), Mild (n = 115), Moderate (n = 153), and Severe (n = 36). RESULTS Participants reported significant improvement in pain, pain-related life interference, health-related quality of life, pain catastrophizing, and depressed mood regardless of initial symptom level. In addition, 43.4% of patients with Mild, Moderate, or Severe depressed mood reported reliable and clinically significant improvement in depressive symptoms and 30.3% were in remission at the end of treatment. CONCLUSIONS These findings support the assertion that IPRPs represent an effective treatment for patients with comorbid chronic pain and depression and that participation is associated with improvement in both conditions.
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Affiliation(s)
- Julia R Craner
- Mary Free Bed Rehabilitation Hospital, 235 Wealthy St. SE, Grand Rapids, MI, 49503.,Michigan State University College of Human Medicine, 15 Michigan St. NE, Grand Rapids, MI, 49503
| | - Lindsay G Flegge
- Mary Free Bed Rehabilitation Hospital, 235 Wealthy St. SE, Grand Rapids, MI, 49503.,Michigan State University College of Human Medicine, 15 Michigan St. NE, Grand Rapids, MI, 49503
| | - Eric S Lake
- Mary Free Bed Rehabilitation Hospital, 235 Wealthy St. SE, Grand Rapids, MI, 49503
| | - Arianna E A Perra
- Michigan State University College of Human Medicine, 15 Michigan St. NE, Grand Rapids, MI, 49503.,Mary Free Bed Rehabilitation Hospital at Munson Medical Center, 5191 Rosewood Dr., Traverse City, MI, 49684
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24
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Kroenke K, Stump TE, Kean J, Krebs EE, Damush TM, Bair MJ, Monahan PO. Diagnostic operating characteristics of PROMIS scales in screening for depression. J Psychosom Res 2021; 147:110532. [PMID: 34052655 DOI: 10.1016/j.jpsychores.2021.110532] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine the diagnostic operating characteristics of The Patient Reported Outcomes Measurement Information Systems (PROMIS) depression scales in screening for major depression. METHODS Interview data from patients enrolled in clinical trials involving patients with chronic pain (2 trials) or post-stroke (1 trial) were analyzed. This included baseline and follow-up interviews in 648 and 586 study patients, respectively. Patients completed PROMIS depression scales of varying lengths (4-item, 6-item, and two 8-item scale versions) as well as the Patient Health Questionnaire 9-item (PHQ-9) depression scale. A Structured Clinical Interview for DSM Disorders (SCID) was administered to establish diagnoses of major depression and any depression. Sensitivity and specificity at various score cutpoints as well as area under the curve (AUC) were calculated. RESULTS PROMIS scales of varying lengths had similar diagnostic operating characteristics. The optimal screening cutpoint for PROMIS raw scores on the 4-, 6-, and 8-item scales was 8, 12, and 16, respectively, which corresponds to a PROMIS T-score of 55. The average sensitivity and specificity of the two PROMIS 8-item scales for major depression across the 3 trials using a T-score cutpoint ≥55 was 0.81 and 0.84, respectively. This was almost identical to 0.81 and 0.82 for the PHQ-9 at its standard cutpoint score ≥ 10. The average AUC for major depression was identical (0.91) for the two PROMIS 8-item scales and PHQ-9, and also similar for any depression (0.87 to 0.89). CONCLUSION PROMIS scales ranging from 4 to 8 items have strong operating characteristics comparable to the PHQ-9 in screening for depression. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT01236521, NCT01583985, NCT01507688.
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Affiliation(s)
- Kurt Kroenke
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA.
| | - Timothy E Stump
- Department of Biostatistics, Indiana University Fairbanks School of Public Health and School of Medicine, Indianapolis, IN, USA
| | - Jacob Kean
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Erin E Krebs
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, MN, USA; University of Minnesota Medical School, Minneapolis, MN, USA
| | - Teresa M Damush
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA; VA Health Services Research and Development Center for Health Information and Communication, Indianapolis, IN, USA
| | - Matthew J Bair
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA; VA Health Services Research and Development Center for Health Information and Communication, Indianapolis, IN, USA
| | - Patrick O Monahan
- Department of Biostatistics, Indiana University Fairbanks School of Public Health and School of Medicine, Indianapolis, IN, USA
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25
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Dunne J, Flores M, Gawande R, Schuman-Olivier Z. Losing trust in body sensations: Interoceptive awareness and depression symptom severity among primary care patients. J Affect Disord 2021; 282:1210-1219. [PMID: 33601698 PMCID: PMC10398840 DOI: 10.1016/j.jad.2020.12.092] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 12/14/2020] [Accepted: 12/22/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Interoceptive dysfunction is emerging as an important biomarker for mental illnesses, such as depression which is a leading cause of disability and death worldwide. Little empirical research explains the relationship between interoception and depression. METHODS Using multivariable linear regression models and cross-sectional baseline data from a randomized control trial of primary care patients (N = 281), we analyzed the relationship between depression severity (none/slight, mild, and moderate/severe via the PROMIS depression scale) and the Multidimensional Assessment of Interoceptive Awareness (MAIA) subscales (noticing, not distracting, not worrying, attention regulation, emotional awareness, selfregulation, body listening and trusting). RESULTS Adjusted results suggest moderate/severe depression was inversely associated with body trusting (p < .001), body listening (p < .01), noticing (p < .01), emotional awareness (p < .01), and self-regulation (p < .05). Mild depression was inversely associated with body trusting (p <.01). After correction for multiple comparisons, the relationship between MAIA body trusting and mild and moderate/severe depression remained significant. LIMITATIONS Our findings may not be generalizable to other populations or healthcare settings. Additionally, findings cannot be interpreted as causal due to our inability to establish temporality. CONCLUSIONS Lack of body trust appears important for understanding how individuals with depression interpret or respond to interoceptive stimuli and may represent the leading edge of interoceptive dysregulation seen in depressive disorders. Our findings support a hypothesis about mechanisms of action underlying hypoactivation in depression. Further, these results support clinical identification of subtypes of depression, such as those with high levels of co-occurring anxiety.
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Affiliation(s)
- Julie Dunne
- Cambridge Health Alliance, Center for Mindfulness and Compassion, 1035 Cambridge Street, Suite 21, Cambridge, MA, 02141, USA; Boston College, W. F. Connell School of Nursing, 140 Commonwealth Ave, Chestnut Hill, MA, 02467, USA.
| | - Michael Flores
- Cambridge Health Alliance, Health Equity Research Lab, 1035 Cambridge Street, Suite 26, Cambridge, MA, 02141, USA; Harvard Medical School, Department of Psychiatry, 1493 Cambridge Street, Cambridge, MA, 02139, USA
| | - Richa Gawande
- Cambridge Health Alliance, Center for Mindfulness and Compassion, 1035 Cambridge Street, Suite 21, Cambridge, MA, 02141, USA; Harvard Medical School, Department of Psychiatry, 1493 Cambridge Street, Cambridge, MA, 02139, USA
| | - Zev Schuman-Olivier
- Cambridge Health Alliance, Center for Mindfulness and Compassion, 1035 Cambridge Street, Suite 21, Cambridge, MA, 02141, USA; Harvard Medical School, Department of Psychiatry, 1493 Cambridge Street, Cambridge, MA, 02139, USA
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26
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Nwachukwu BU, Rasio J, Beck EC, Okoroha KR, Sullivan SW, Makhni EC, Nho SJ. Patient-Reported Outcomes Measurement Information System Physical Function Has a Lower Effect Size and is Less Responsive Than Legacy Hip Specific Patient Reported Outcome Measures Following Arthroscopic Hip Surgery. Arthroscopy 2020; 36:2992-2997. [PMID: 32679295 DOI: 10.1016/j.arthro.2020.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the use and responsiveness of Patient Reported Outcomes Measurement Information System (PROMIS) to legacy patient-reported outcome measures (PROMs) in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) at 6-month follow-up. METHODS Data from patients who underwent primary hip arthroscopy with routine capsular closure between August 2018 and January 2019 for the treatment of FAIS were analyzed. Preoperative outcomes, 6-month postoperative outcomes, and demographics were recorded. Primary outcome measures included PROMIS Physical Function (PROMIS-PF), PROMIS Pain Interference (PROMIS-PI), and PROMIS Depression. The legacy PROMs included Hip Outcome Score Activities of Daily Living (HOS-ADL), Hip Outcome Score Sport Subscale (HOS-SS), and the international hip outcome tool 12 questions (iHOT-12). Floor and ceiling effects along with the responsiveness and Cohen's d effect size of each PROM tool were calculated. RESULTS Ninety-six patients with an average age and body mass index of 32.4 ± 11.9 years and 25.9 ± 6.1 kg/m2, respectively, were included in the final analysis. All outcomes were significantly higher at 6 months compared with the preoperative level (P < .001) except for PROMIS Depression (P = .873). PROMIS-PF demonstrated excellent correlation with HOS-SS (r = 0.81; P < .001), very good correlation with HOS-ADL (r = 0.73; P < .001), and good correlation with iHOT-12 (r = 0.68; P < .001). No floor was observed for any measure. The effect size was large for all outcomes, except PROMIS Depression (d = 0.04), but largest for iHOT12 (d = 1.87) followed by HOS-ADL (d = 1.29). The iHOT-12 was more responsive than PROMIS-PI (relative efficiency [RE] = 3.95), PROMIS-PF (RE = 4.13), HOS-ADL (RE = 2.26), and HOS-SS (RE = 3.84). HOS-SS was similarly responsive to PROMIS-PI (RE=1.03) and PROMIS-PF (RE=1.08). However, PROMIS-PF was overall the least responsive. CONCLUSIONS In patients at 6 months postoperatively from hip arthroscopy for FAIS, iHOT-12 was the most responsive and had the largest effect size. In contrast, PROMIS-PF had a lower effect size compared with legacy hip-specific PROMs. Additionally, PROMIS-PF did not correlate as well with iHOT-12 compared with HOS-SS. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A..
| | - Jonathan Rasio
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Edward C Beck
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Kelechi R Okoroha
- Department of Orthopaedic Surgery, Henry Ford Health Center, Detroit, Michigan, U.S.A
| | - Spencer W Sullivan
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Eric C Makhni
- Department of Orthopaedic Surgery, Henry Ford Health Center, Detroit, Michigan, U.S.A
| | - Shane J Nho
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
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27
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Menon NK, Shanafelt TD, Sinsky CA, Linzer M, Carlasare L, Brady KJS, Stillman MJ, Trockel MT. Association of Physician Burnout With Suicidal Ideation and Medical Errors. JAMA Netw Open 2020; 3:e2028780. [PMID: 33295977 PMCID: PMC7726631 DOI: 10.1001/jamanetworkopen.2020.28780] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
IMPORTANCE Addressing physician suicide requires understanding its association with possible risk factors such as burnout and depression. OBJECTIVE To assess the association between burnout and suicidal ideation after adjusting for depression and the association of burnout and depression with self-reported medical errors. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted from November 12, 2018, to February 15, 2019. Attending and postgraduate trainee physicians randomly sampled from the American Medical Association Physician Masterfile were emailed invitations to complete an online survey in waves until a convenience sample of more than 1200 practicing physicians agreed to participate. MAIN OUTCOMES AND MEASURES The primary outcome was the association of burnout with suicidal ideation after adjustment for depression. The secondary outcome was the association of burnout and depression with self-reported medical errors. Burnout, depression, suicidal ideation, and medical errors were measured using subscales of the Stanford Professional Fulfillment Index, Maslach Burnout Inventory-Human Services Survey for Medical Personnel, and Mini-Z burnout survey and the Patient-Reported Outcomes Measurement Information System depression Short Form. Associations were evaluated using multivariable regression models. RESULTS Of the 1354 respondents, 893 (66.0%) were White, 1268 (93.6%) were non-Hispanic, 762 (56.3%) were men, 912 (67.4%) were non-primary care physicians, 934 (69.0%) were attending physicians, and 824 (60.9%) were younger than 45 years. Each SD-unit increase in burnout was associated with 85% increased odds of suicidal ideation (odds ratio [OR], 1.85; 95% CI, 1.47-2.31). After adjusting for depression, there was no longer an association (OR, 0.85; 95% CI, 0.63-1.17). In the adjusted model, each SD-unit increase in depression was associated with 202% increased odds of suicidal ideation (OR, 3.02; 95% CI, 2.30-3.95). In the adjusted model for self-reported medical errors, each SD-unit increase in burnout was associated with an increase in self-reported medical errors (OR, 1.48; 95% CI, 1.28-1.71), whereas depression was not associated with self-reported medical errors (OR, 1.01; 95% CI, 0.88-1.16). CONCLUSIONS AND RELEVANCE The results of this cross-sectional study suggest that depression but not physician burnout is directly associated with suicidal ideation. Burnout was associated with self-reported medical errors. Future investigation might examine whether burnout represents an upstream intervention target to prevent suicidal ideation by preventing depression.
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Affiliation(s)
- Nikitha K. Menon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Tait D. Shanafelt
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Christine A. Sinsky
- Professional Satisfaction and Practice Sustainability, American Medical Association, Chicago, Illinois
| | - Mark Linzer
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Lindsey Carlasare
- Professional Satisfaction and Practice Sustainability, American Medical Association, Chicago, Illinois
| | - Keri J. S. Brady
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts
| | | | - Mickey T. Trockel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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28
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Penedo FJ, Fox RS, Oswald LB, Moreno PI, Boland CL, Estabrook R, McGinty HL, Mohr DC, Begale MJ, Dahn JR, Flury SC, Perry KT, Kundu SD, Yanez B. Technology-Based Psychosocial Intervention to Improve Quality of Life and Reduce Symptom Burden in Men with Advanced Prostate Cancer: Results from a Randomized Controlled Trial. Int J Behav Med 2020; 27:490-505. [PMID: 31898309 DOI: 10.1007/s12529-019-09839-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Men with advanced prostate cancer (APC) face multiple challenges including poor prognosis, poor health-related quality of life (HRQOL), and elevated symptom burden. This study sought to establish the efficacy of a tablet-delivered, group-based psychosocial intervention for improving HRQOL and reducing symptom burden in men with APC. We hypothesized that men randomized to cognitive-behavioral stress management (CBSM) would report improved HRQOL and reduced symptom burden relative to men randomized to an active control health promotion (HP) condition. Condition effects on intervention targets and moderators of these effects were explored. METHODS Men with APC (N = 192) were randomized (1:1) to 10-week tablet-delivered CBSM or HP, and followed for 1 year. Multilevel modeling was used to evaluate condition effects over time. RESULTS Changes in HRQOL and symptom burden did not differ between groups. Men in both groups improved across several intervention targets; men in the CBSM condition reported greater increases in self-reported ability to relax, and both conditions showed improvements in cancer-related anxiety, cancer-related distress, and feelings of cohesiveness with other patients over time. Moderating factors included baseline interpersonal disruption, fatigue, and sexual functioning. CONCLUSIONS Tablet-delivered CBSM and HP were well received by men with APC. The hypothesized effects of CBSM on HRQOL and symptom burden were not supported, though improvements in intervention targets were observed across conditions. Participants reported high-baseline HRQOL relative to cancer and general population norms, possibly limiting intervention effects. The identified moderating factors should be considered in the development and implementation of interventions targeting HRQOL and symptom burden. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03149185.
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Affiliation(s)
- Frank J Penedo
- Departments of Psychology and Medicine, University of Miami, 5665 Ponce de Leon Boulevard, Flipse Building, 5th Floor, Coral Gables, FL, 33146, USA.
| | - Rina S Fox
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Laura B Oswald
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Patricia I Moreno
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Cody L Boland
- Departments of Psychology and Medicine, University of Miami, 5665 Ponce de Leon Boulevard, Flipse Building, 5th Floor, Coral Gables, FL, 33146, USA
| | - Ryne Estabrook
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Heather L McGinty
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - David C Mohr
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Jason R Dahn
- Mental Health and Behavioral Sciences Service, Miami Veterans Affairs Healthcare System, Miami, FL, USA
| | - Sarah C Flury
- Department of Urology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kent T Perry
- Department of Urology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Shilajit D Kundu
- Department of Urology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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29
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Smarr KL, Keefer AL. Measures of Depression and Depressive Symptoms. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:608-629. [PMID: 33091258 DOI: 10.1002/acr.24191] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 03/17/2020] [Indexed: 01/27/2023]
Affiliation(s)
- Karen L Smarr
- Harry S. Truman Memorial Veterans' Hospital and University of Missouri School of Medicine, Columbia
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30
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Godby RC, Dai C, Al-Obaidi M, Giri S, Young-Smith C, Kenzik K, McDonald AM, Paluri RK, Gbolahan OB, Bhatia S, Williams GR. Depression among older adults with gastrointestinal malignancies. J Geriatr Oncol 2020; 12:599-604. [PMID: 33160953 DOI: 10.1016/j.jgo.2020.10.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/15/2020] [Accepted: 10/28/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Depression among older adults with cancer is under recognized and under treated. This study characterizes the burden of depression in older adults with gastrointestinal (GI) malignancies prior to chemotherapy and its relationship with geriatric assessment (GA) domains, health-related quality of life (HRQOL), and self-reported healthcare utilization. METHODS Patients ≥60 years in GI oncology clinics at UAB were asked to complete a GA entitled the Cancer & Aging Resilience Evaluation (CARE). We examined depression using the Patient-Reported Outcomes Measurement Information System (PROMIS®) Depression four-item short form; moderate/severe depression was defined by a t-score ≥ 60. Multivariate analysis was used to examine associations between those with and without moderate/severe depression. RESULTS Of 355 included patients, 46 had mild depression (13%) and an additional 46 patients had moderate/severe depression (13%). After adjustment for age, sex, education, cancer type, and cancer stage, those who reported moderate/severe depression had a significantly increased odds of reporting falls (adjusted odds ratio [aOR] 4.01, 95% confidence interval [CI] 1.94-8.26), dependence in IADLs (aOR 7.06,CI 2.91-17.1), dependence in ADLs (aOR 6.23, CI 2.89-13.4), malnutrition (aOR 5.86, CI 2.40-14.3), frailty (aOR 13.7, CI 5.80-32.1), and fatigue (aOR 11.2, CI 3.31-37.6). Moderate/severe depression was also significantly associated with worse physical (aOR 7.58, CI 3.30-17.4) and mental (aOR 26.3, CI 10.1-68.8) HRQOL sub-scores, without significant differences in healthcare utilization. CONCLUSIONS More than one out of eight older adults with a GI malignancy reported moderate/severe depression prior to chemotherapy, which was associated with impairments in several GA domains and HRQOL.
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Affiliation(s)
- Richard C Godby
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Chen Dai
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mustafa Al-Obaidi
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Smith Giri
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA; Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Crystal Young-Smith
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA; Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kelly Kenzik
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA; Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrew M McDonald
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ravi K Paluri
- Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Olumide B Gbolahan
- Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Grant R Williams
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA; Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
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The Role of e-Health in the Delivery of Care for Patients with Hematological Cancers: A Systematic Literature Review. Telemed J E Health 2020; 26:1093-1105. [DOI: 10.1089/tmj.2019.0231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Yardeni M, Abebe Campino G, Bursztyn S, Shamir A, Mekori-Domachevsky E, Toren A, Gothelf D. A three-tier process for screening depression and anxiety among children and adolescents with cancer. Psychooncology 2020; 29:2019-2027. [PMID: 32691478 DOI: 10.1002/pon.5494] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/03/2020] [Accepted: 07/06/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To establish and to evaluate the effectiveness of a three-tier screening process of depressive and anxiety disorders among children and adolescents with cancer based on questionnaires (first tier), semistructured psychiatric interviews (second tier), and referral for psychiatric assessment and recommendations for treatment (third tier). We also aimed to determine the rates of depressive and anxiety disorders among participants. METHODS Participants and their parents completed the Patient Reported Outcomes Measurement Information System (PROMIS) Depression and Anxiety modules. Then, they were interviewed separately using the semistructured Affective and Anxiety Modules of the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS). PROMIS cutoff values for diagnosing depressive and anxiety disorders, based on the K-SADS, were calculated by receiver-operating characteristics (ROCs). RESULTS Of 91 participants 34 (37.4%) aged 7 to 21 years with cancer met the K-SADS criteria for depressive and/or anxiety disorders. The results of the ROC analyses were stronger for depressive disorders than for anxiety disorders and for more severe cases. The cutoff of 13 on the child-reported PROMIS for a major depressive episode had a sensitivity of 0.80 and a specificity of 0.82, and a cutoff of 14 on the parent-reported PROMIS for generalized anxiety disorder had a sensitivity of 0.78 and a specificity of 0.79. CONCLUSIONS Using the K-SADS, we found that anxiety and depressive disorders are very common in youngsters with cancer. The three-tier screening process we developed for depression and anxiety in this population provides practical cutoff values for identifying depressive and anxiety disorders in children with cancer.
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Affiliation(s)
- Maya Yardeni
- Pediatric Hemato-Oncology Division, Sheba Medical Center Tel Hashomer, Tel Hashomer, Israel
| | - Gadi Abebe Campino
- Pediatric Hemato-Oncology Division, Sheba Medical Center Tel Hashomer, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Bursztyn
- Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Anat Shamir
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Mekori-Domachevsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Amos Toren
- Pediatric Hemato-Oncology Division, Sheba Medical Center Tel Hashomer, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Doron Gothelf
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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Lu Y, Agarwalla A, Patel BH, Nwachukwu BU, Baker JD, Verma NN, Cole BJ, Forsythe B. Relationship between the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing and legacy instruments in patients undergoing isolated biceps tenodesis. J Shoulder Elbow Surg 2020; 29:1214-1222. [PMID: 32113866 DOI: 10.1016/j.jse.2019.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/31/2019] [Accepted: 11/07/2019] [Indexed: 02/05/2023]
Abstract
HYPOTHESIS The purpose of this study was to correlate the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing (CAT) domains with commonly used legacy patient-reported outcome measures (PROMs) preoperatively in a population of patients presenting to a tertiary care orthopedic center for biceps and labral pathology. METHODS Prospective data were collected on 175 patients scheduled to undergo isolated biceps tenodesis at a tertiary center. Enrollees completed legacy scores (Veterans RAND 12-Item Health Survey, Short Form 12, American Shoulder and Elbow Surgeons [ASES] Assessment Form, Single Assessment Numeric Evaluation, and Constant-Murley score) and PROMIS CAT questionnaires (Upper Extremity [UE], Pain Interference [PIF], and Depression). In addition, patients were asked to provide an assessment of the strength, function, and pain of the affected shoulder using a custom visual analog scale (VAS) questionnaire. Spearman rank correlations of the PROMIS CAT with legacy measures and the custom VAS were calculated. Floor and ceiling effects were assessed. RESULTS The UE CAT yielded moderate correlations with the ASES score (r = 0.57) and the custom VAS strength score (r = 0.50-0.57). The PIF CAT demonstrated moderate correlations with the VAS pain score (r = 0.45) and high-moderate correlations with the ASES score, VR6D score, and UE CAT (r = 0.61-0.66). The Depression CAT demonstrated high-moderate correlations with the mental health legacy measures (r = -0.64 to -0.61). There was a significant relative floor effect for the Depression CAT at a score of 34.2 (19%). CONCLUSION The PIF CAT was comparable to the ASES score, the current gold standard. Compared with legacy measures, both the UE CAT and PIF CAT are less burdensome and have few floor or ceiling effects. The PIF CAT may be a viable alternative to describe the physical and psychosocial impact of pain in biceps tenodesis patients.
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Affiliation(s)
- Yining Lu
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | | | - Bhavik H Patel
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Benedict U Nwachukwu
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - James D Baker
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil N Verma
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Brian J Cole
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Brian Forsythe
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.
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Associations of Frailty Status with Low-Mileage Driving and Driving Cessation in a Cohort of Older Drivers. Geriatrics (Basel) 2020; 5:geriatrics5010019. [PMID: 32204350 PMCID: PMC7151033 DOI: 10.3390/geriatrics5010019] [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: 02/28/2020] [Revised: 03/14/2020] [Accepted: 03/15/2020] [Indexed: 01/24/2023] Open
Abstract
The US older adult population is projected to considerably increase in the future, and continued driving mobility is important for health aspects in populations with fewer transportation alternatives. This study evaluated whether frailty is associated with low-mileage driving (<1865 miles per year) and driving cessation among older adults. Baseline demographics and health data were collected for 2990 older drivers via in-person assessments and questionnaires, with 2964 reporting baseline frailty data. Multivariable log-binomial regression models were used to evaluate the association between baseline frailty status and low-mileage driving. Multivariable Cox proportional hazards regression were used to evaluate the association between baseline frailty status and driving cessation. For every unit increase in frailty, the estimated adjusted risk of driving fewer than 1865 miles/year increased by 138% (adjusted risk ratio: 2.38, 95% CI: 1.63-3.46). Relative to older drivers who were not frail, the adjusted hazard ratios of driving cessation were 4.15 (95% CI: 1.89-9.10) for those classified as prefrail and 6.08 (95% CI: 1.36-27.26) for those classified as frail. Frailty is positively associated with low-mileage driving status and driving cessation in a dose-response fashion. Public health interventions that reduce frailty, such as physical activity, may help older drivers maintain safe and independent mobility.
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Cohen ML, Hula WD. Patient-Reported Outcomes and Evidence-Based Practice in Speech-Language Pathology. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:357-370. [PMID: 32011905 DOI: 10.1044/2019_ajslp-19-00076] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose The patient's perspective of their health is a core component of evidence-based practice (EBP) and person-centered care. Patient-reported outcomes (PROs), captured with PRO measures (PROMs), are the main way of formally soliciting and measuring the patient's perspective. Currently, however, PROs play a relatively small role in mainstream speech-language pathology practice. The purpose of this article is to raise important questions about how PROs could be applied to EBP in speech-language pathology for individuals with communication disorders and to propose preliminary approaches to address some of these questions. Method Based on a narrative review of the literature, this article introduces relevant terminology and broadly describes PRO applications in other health care fields. The article also raises questions related to PRO-informed clinical practice in speech-language pathology. To address some of these questions, the article explores previous research to provide suggestions for clinical administration, interpretation, and future research. Conclusion More routine measurement of subjective health constructs via PROMs-for example, constructs such as effort, participation, self-efficacy, and psychosocial functioning-may improve EBP. More routine use of PROMs could significantly expand the information that is available to clinicians about individual clients and add to the evidence base for the profession of speech-language pathology. However, careful consideration and more research are needed on how to capture and interpret PROs from individuals with cognitive and language disorders.
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Affiliation(s)
- Matthew L Cohen
- Department of Communication Sciences and Disorders and Center for Health Assessment Research and Translation, University of Delaware, Newark
| | - William D Hula
- Geriatric Research, Education, and Clinical Center, VA Health Care System, and Department of Communication Sciences and Disorders, University of Pittsburgh, PA
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Recklitis CJ, Blackmon JE, Chang G. Screening young adult cancer survivors with the PROMIS Depression Short Form (PROMIS-D-SF): Comparison with a structured clinical diagnostic interview. Cancer 2020; 126:1568-1575. [PMID: 31913510 DOI: 10.1002/cncr.32689] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND The current study was conducted to evaluate the Patient-Reported Outcomes Measurement Information System Depression Short Form (PROMIS-D-SF) as a screening measure for young adult cancer survivors (YACS) compared with a structured diagnostic interview. METHODS A total of 249 YACS (aged 18-40 years) completed the PROMIS-D-SF and Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (SCID). Based on the SCID, participants were classified as having: 1) an SCID depression diagnosis; 2) depression symptoms without an SCID diagnosis; or 3) no depression symptoms. Receiver operating characteristic analyses evaluated PROMIS-D-SF and SCID concordance and the sensitivity and specificity of PROMIS-D-SF cutoff t -scores. RESULTS The PROMIS-D-SF had overall good agreement with the SCID for both depression diagnosis (area under the curve, 0.89) and the presence of depressive symptoms (area under the curve, 0.83). A PROMIS-D-SF cutoff t-score of ≥53.2 came closest to meeting study criteria for detecting a SCID depression diagnosis (sensitivity ≥0.85 and specificity ≥0.75), with a sensitivity of 0.81 and a specificity of 0.74. For identifying survivors with depression symptoms, a t-score cutoff value of 49.4 was found to have slightly superior sensitivity (0.84) and inferior specificity (0.64). In hypothetical screening examples, these cutoff scores led to moderate levels of missed cases (15%-19%) and a high percentage of clinical referrals that were unnecessary by SCID criteria (56%-70%). CONCLUSIONS The PROMIS-D-SF demonstrated moderately strong concordance with depressive diagnoses and symptoms measured by the SCID, but cutoff t-scores did not meet study criteria for clinical screening. The PROMIS-D-SF may be useful for assessing depression in YACS, but the limitations in its sensitivity and specificity identified in the current study are likely to limit its usefulness as a stand-alone screening instrument in this population.
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Affiliation(s)
- Christopher J Recklitis
- Perini Family Survivors' Center, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Jaime E Blackmon
- Perini Family Survivors' Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Grace Chang
- Department of Psychiatry, VA Boston Healthcare System, Brockton, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Greer S, Ramo D, Chang YJ, Fu M, Moskowitz J, Haritatos J. Use of the Chatbot "Vivibot" to Deliver Positive Psychology Skills and Promote Well-Being Among Young People After Cancer Treatment: Randomized Controlled Feasibility Trial. JMIR Mhealth Uhealth 2019; 7:e15018. [PMID: 31674920 PMCID: PMC6913733 DOI: 10.2196/15018] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/05/2019] [Accepted: 09/24/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Positive psychology interventions show promise for reducing psychosocial distress associated with health adversity and have the potential to be widely disseminated to young adults through technology. OBJECTIVE This pilot randomized controlled trial examined the feasibility of delivering positive psychology skills via the Vivibot chatbot and its effects on key psychosocial well-being outcomes in young adults treated for cancer. METHODS Young adults (age 18-29 years) were recruited within 5 years of completing active cancer treatment by using the Vivibot chatbot on Facebook messenger. Participants were randomized to either immediate access to Vivibot content (experimental group) or access to only daily emotion ratings and access to full chatbot content after 4 weeks (control). Created using a human-centered design process with young adults treated for cancer, Vivibot content includes 4 weeks of positive psychology skills, daily emotion ratings, video, and other material produced by survivors, and periodic feedback check-ins. All participants were assessed for psychosocial well-being via online surveys at baseline and weeks 2, 4, and 8. Analyses examined chatbot engagement and open-ended feedback on likability and perceived helpfulness and compared experimental and control groups with regard to anxiety and depression symptoms and positive and negative emotion changes between baseline and 4 weeks. To verify the main effects, follow-up analyses compared changes in the main outcomes between 4 and 8 weeks in the control group once participants had access to all chatbot content. RESULTS Data from 45 young adults (36 women; mean age: 25 [SD 2.9]; experimental group: n=25; control group: n=20) were analyzed. Participants in the experimental group spent an average of 74 minutes across an average of 12 active sessions chatting with Vivibot and rated their experience as helpful (mean 2.0/3, SD 0.72) and would recommend it to a friend (mean 6.9/10; SD 2.6). Open-ended feedback noted its nonjudgmental nature as a particular benefit of the chatbot. After 4 weeks, participants in the experimental group reported an average reduction in anxiety of 2.58 standardized t-score units, while the control group reported an increase in anxiety of 0.7 units. A mixed-effects models revealed a trend-level (P=.09) interaction between group and time, with an effect size of 0.41. Those in the experimental group also experienced greater reductions in anxiety when they engaged in more sessions (z=-1.9, P=.06). There were no significant (or trend level) effects by group on changes in depression, positive emotion, or negative emotion. CONCLUSIONS The chatbot format provides a useful and acceptable way of delivering positive psychology skills to young adults who have undergone cancer treatment and supports anxiety reduction. Further analysis with a larger sample size is required to confirm this pattern.
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Affiliation(s)
| | - Danielle Ramo
- Hopelab, San Francisco, CA, United States.,Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | | | - Michael Fu
- Hopelab, San Francisco, CA, United States
| | - Judith Moskowitz
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Kazmers NH, Stephens AR, Tyser AR. Effects of Baseline Opioid Medication Use on Patient-Reported Functional and Psychological Impairment Among Hand Clinic Patients. J Hand Surg Am 2019; 44:829-839. [PMID: 31477406 DOI: 10.1016/j.jhsa.2019.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 04/22/2019] [Accepted: 07/12/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To test the null hypothesis that baseline opioid use is not associated with functional or psychological impairment among new hand surgery clinic patients, as measured by Patient-Reported Outcomes Measurement Information System (PROMIS) instruments. METHODS New adult (≥ 18 years) patient visits to a tertiary academic orthopedic nonshoulder hand and upper extremity clinic between February 2014 and April 2018 were eligible. Collected outcomes include the question, "Are you currently taking narcotic pain medications?", the PROMIS Upper Extremity (UE) computerized adaptive testing (CAT), abbreviated version of the Disorders of the Arm, Shoulder, and Hand (QuickDASH), PROMIS Physical Function (PF) CAT, PROMIS Pain Interference (PI) CAT, PROMIS Depression CAT, and PROMIS Anxiety CAT. Patients responding to the opioid question, plus the UE CAT or QuickDASH, were included. Bivariate and multivariable logistic regression modelling were used to assess factors associated with baseline scores. RESULTS Of 5997 included patients, 1,046 (17.4%) reported baseline opioid use. Patients in the opioid group demonstrated significantly worse scores on all patient-reported outcomes, and a significantly greater proportion of patients with PROMIS Depression CAT scores exceeding 60 (associated with a clinical diagnosis of depression; 29.5% vs 15.5%). Lower functional scores were observed in the opioid group after controlling for age, sex, other activity-limiting comorbidities, and either depression (UE CAT -7.0; QuickDASH +18.1; and PF CAT -6.6 points), anxiety (UE CAT -6.3; QuickDASH +16.4; PF CAT -6.3), or PI (UE CAT -3.7; QuickDASH +9.5; and PF CAT -4.2 points). Pain interference was greater among opiate users when controlling for age, sex, other activity-limiting comorbidities, and baseline function or psychological status: PI was 2.5, 5.0, or 4.3 points greater when controlling for the PROMIS UE CAT, Depression CAT, or Anxiety CAT. CONCLUSIONS New patients presenting to a hand surgery clinic who endorse use of opioid medications at baseline report significantly decreased physical function, increased psychological burden, and greater levels of pain interference than nonusers. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic III.
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Whitley MD, Coulter ID, Gery RW, Hays RD, Sherbourne C, Herman PM, Hilton LG. Researching the Appropriateness of Care in the Complementary and Integrative Health Professions Part 3: Designing Instruments With Patient Input. J Manipulative Physiol Ther 2019; 42:307-318. [PMID: 31255308 PMCID: PMC6698201 DOI: 10.1016/j.jmpt.2019.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 12/28/2018] [Accepted: 02/07/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The purpose of this article is to describe how we designed patient survey instruments to ensure that patient data about preferences and experience could be included in appropriateness decisions. These actions were part of a project that examined the appropriateness of spinal manipulation and mobilization for chronic low back pain and chronic neck pain. METHODS We conducted focus groups, cognitive interviews, a literature review of measures in prior chiropractic and complementary and integrative health research, and a pilot study to develop questionnaires of patient preferences, experiences, values, and beliefs. RESULTS Questionnaires were administered online to 2024 individuals from 125 chiropractic clinics. The survey included 3 long questionnaires and 5 shorter ones. All were administered online. The baseline items had 2 questionnaires that respondents could complete in different sittings. Respondents completed shorter biweekly follow-ups every 2 weeks and a final questionnaire at 3 months. The 2 initial questionnaires had 81 and 140 items, the 5 biweekly follow-up questionnaires had 37 items each, and the endline questionnaire contained 121 items. Participants generally responded positively to the survey items, and 91% of the patients who completed a baseline questionnaire completed the endpoint survey 3 months later. We used "legacy" measures, and we also adapted measures and developed new measures for this study. Preliminary assessment of reliability and validity for a newly developed scale about coping behaviors indicates that the items work well together in a scale. CONCLUSIONS This article documents the challenges and the efforts involved in designing data collection tools to facilitate the inclusion of patient data into appropriateness decisions.
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Affiliation(s)
| | - Ian D Coulter
- RAND Corporation, University of California Los Angeles, Southern California Health Sciences, Santa Monica, California.
| | - Ryan W Gery
- RAND Corporation, Health, Santa Monica, California
| | - Ron D Hays
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
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Kennedy JE, Reid MW, Lu LH, Cooper DB. Validity of the CES-D for depression screening in military service members with a history of mild traumatic brain injury. Brain Inj 2019; 33:932-940. [DOI: 10.1080/02699052.2019.1610191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- J E Kennedy
- Department of Neurology, Defense and Veterans Brain Injury Center (DVBIC) Brooke Army Medical Center, Ft Sam Houston, Texas, USA
| | - M W Reid
- Department of Neurology, Defense and Veterans Brain Injury Center (DVBIC) Brooke Army Medical Center, Ft Sam Houston, Texas, USA
| | - L H Lu
- Department of Neurology, Defense and Veterans Brain Injury Center (DVBIC) Brooke Army Medical Center, Ft Sam Houston, Texas, USA
| | - D B Cooper
- Defense and Veterans Brain Injury Center (DVBIC) San Antonio VA Polytrauma Rehabilitation Center, South Texas Veterans Healthcare System, San Antonio, Texas, USA
- Department of Psychiatry, UT-Health San Antonio, San Antonio, Texas, USA
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Decker V, Sikorskii A, Given CW, Given BA, Vachon E, Krauss JC. Effects of depressive symptomatology on cancer-related symptoms during oral oncolytic treatment. Psychooncology 2018; 28:99-106. [PMID: 30311987 DOI: 10.1002/pon.4916] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/29/2018] [Accepted: 09/02/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This manuscript assesses association between depressive symptoms and symptoms from cancer and its treatment during the first 12 weeks of a new oral oncolytic treatment. METHODS This secondary analysis used data from a recently completed trial of an intervention to improve adherence to oral oncolytic treatment and manage symptoms. Following the initiation of the new oral oncolytic medication, 272 patients were interviewed at intake and weeks 4, 8, and 12 to assess depressive symptoms, and symptoms from cancer and its treatment. Depressive symptoms were measured using the Center for Epidemiologic Studies-Depression (CES-D20). The summed index of 18 cancer-related and treatment-related symptoms as well as the number of symptoms above threshold at intake, weeks 4, 8, and 12 were related to intake and time-varying CES-D20 using linear mixed effects models. RESULTS Depressive symptomatology was a significant predictor of cancer-related and treatment-related symptoms at all-time points, but the strength of this relationship was greatest at the time of oral oncolytic agent initiation and at week 4. The strength of this relationship was the same for both summed symptom severity index and the number of symptoms above threshold, and using either intake or time-varying CES-D20. CONCLUSION Introducing strategies to treat and manage symptoms of depression along with other symptoms might have added benefits among patients who start a new oral oncolytic treatment and report modest to higher levels of depressive symptoms. Assessments for the impact of strategies to lower depressive symptoms can be taken within the first 4 weeks.
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Affiliation(s)
- Veronica Decker
- College of Nursing, University of Central Florida, Orlando, FL, United States
| | - Alla Sikorskii
- Department of Psychiatry and Department of Statistics and Probability, Michigan State University, East Lansing, MI, United States
| | - Charles W Given
- College of Nursing, Michigan State University, East Lansing, MI, United States
| | - Barbara A Given
- College of Nursing, Michigan State University, East Lansing, MI, United States
| | - Eric Vachon
- College of Nursing, Michigan State University, East Lansing, MI, United States
| | - John C Krauss
- Hematology Oncology, University of Michigan, Ann Arbor, MI, United States
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Wilford J, Osann K, Hsieh S, Monk B, Nelson E, Wenzel L. Validation of PROMIS emotional distress short form scales for cervical cancer. Gynecol Oncol 2018; 151:111-116. [PMID: 30078504 DOI: 10.1016/j.ygyno.2018.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/21/2018] [Accepted: 07/29/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Cervical cancer patients are at high risk for emotional distress. In this study we evaluate the PROMIS emotional distress-Depression and -Anxiety Short Forms for assessing depression and anxiety in a cervical cancer population. METHODS A 15-item questionnaire was used in a cervical cancer biobehavioral randomized clinical trial, testing psychosocial telephone counseling (PTC) against usual care (UC). It was administered to 204 patients prior to randomization, four months post-enrollment, and nine months post-enrollment, together with legacy measures of depression. The short forms were evaluated in patients participating in this study over three time points for internal consistency, convergent validity, and responsiveness to change over time. RESULTS Overall, 45% and 47% of patients scored in the moderate to severe range for anxiety and depression, respectively. Internal consistency coefficients were ≥ 0.95 at baseline, 4 months, and 9 months for depression and anxiety. The average inter-item correlation was 0.65 and 0.73 at baseline assessment for depression and anxiety, respectively. The depression short form T-score was correlated with legacy distress scales ranging from 0.44-0.76, and the anxiety short form ranging from 0.45-0.78. The depression short form demonstrated sensitivity to change as patients randomized to the counseling intervention reported greater improvement over time in depression (p = 0.014), and a nonsignificant improvement in anxiety, compared to the patients receiving usual care. CONCLUSIONS The PROMIS depression and anxiety short forms reliably and validly assess cervical cancer-specific emotional distress, capture salient features of distress in this population, and perform as well or better than legacy measures.
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Affiliation(s)
- Justin Wilford
- Program in Public Health, University of California, Irvine, Irvine, CA, USA
| | - Kathryn Osann
- Department of Medicine, Division of Hematology/Oncology, University of California, Irvine, Irvine, CA, USA; Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA
| | - Susie Hsieh
- Department of Medicine, Division of Hematology/Oncology, University of California, Irvine, Irvine, CA, USA; Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA
| | - Bradley Monk
- Creighton University School of Medicine at St. Joseph's Hospital & Medical Center, Phoenix, AZ, USA
| | - Edward Nelson
- Department of Medicine, Division of Hematology/Oncology, University of California, Irvine, Irvine, CA, USA; Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA; Institute for Immunology, University of California, Irvine, Irvine, CA, USA
| | - Lari Wenzel
- Program in Public Health, University of California, Irvine, Irvine, CA, USA; Department of Medicine, Division of Hematology/Oncology, University of California, Irvine, Irvine, CA, USA; Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA.
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