Self-efficacy difference among patients with cancer with different socioeconomic status: application of latent class analysis and standardization and decomposition analysis

Self-efficacy of advanced cancer patients for participation in treatment-related decision-making in six European countries: the ACTION study

PURPOSE

Many patients prefer an active role in making decisions about their care and treatment, but participating in such decision-making is challenging. The aim of this study was to explore whether patient-reported outcomes (quality of life and patient satisfaction), patients' coping strategies, and sociodemographic and clinical characteristics were associated with self-efficacy for participation in decision-making among patients with advanced cancer.

METHODS

We used baseline data from the ACTION trial of patients with advanced colorectal or lung cancer from six European countries, including scores on the decision-making participation self-efficacy (DEPS) scale, EORTC QLQ-C15-PAL questionnaire, and the EORTC IN-PATSAT32 questionnaire. Multivariable linear regression analyses were used to examine associations with self-efficacy scores.

RESULTS

The sample included 660 patients with a mean age of 66 years (SD 10). Patients had a mean score of 73 (SD 24) for self-efficacy. Problem-focused coping (B 1.41 (95% CI 0.77 to 2.06)), better quality of life (B 2.34 (95% CI 0.89 to 3.80)), and more patient satisfaction (B 7.59 (95% CI 5.61 to 9.56)) were associated with a higher level of self-efficacy. Patients in the Netherlands had a higher level of self-efficacy than patients in Belgium ((B 7.85 (95% CI 2.28 to 13.42)), whereas Italian patients had a lower level ((B -7.50 (95% CI -13.04 to -1.96)) than those in Belgium.

CONCLUSION

Coping style, quality of life, and patient satisfaction with care were associated with self-efficacy for participation in decision-making among patients with advanced cancer. These factors are important to consider for healthcare professionals when supporting patients in decision-making processes.

Self-efficacy in managing post-treatment care among oral and oropharyngeal cancer survivors

OBJECTIVE

Physical and psychosocial effects of oral cancer result in long-term self-management needs. Little attention has been paid to survivors' self-efficacy in managing their care. Study goals were to characterise self-care self-efficacy and evaluate socio-demographics, disease, attitudinal factors and psychological correlates of self-efficacy and engagement in head and neck self-exams.

METHODS

Two hundred thirty-two oral cancer survivors completed measures of socio-demographics, self-care self-efficacy, head and neck self-exams and attitudinal and psychological measures. Descriptive statistics characterised self-efficacy. Hierarchical regressions evaluated predictors of self-efficacy.

RESULTS

Survivors felt moderately confident in the ability to manage self-care (M = 4.04, SD = 0.75). Survivors with more comorbidities (β = -0.125), less preparedness (β = 0.241), greater information (β = -0.191), greater support needs (β = -0.224) and higher depression (β = -0.291) reported significantly lower self-efficacy. Head and neck self-exam engagement (44% past month) was relatively low. Higher preparedness (OR = 2.075) and self-exam self-efficacy (OR = 2.606) were associated with more engagement in self-exams.

CONCLUSION

Many survivors report low confidence in their ability to engage in important self-care practices. Addressing unmet information and support needs, reducing depressive symptoms and providing skill training and support may boost confidence in managing self-care and optimise regular self-exams.

Decisional balance, self-leadership, self-efficacy, planning, and stages of change in adopting exercise behaviors in patients with stomach cancer: A cross-sectional study

PURPOSE

Previous studies have suggested the benefits of regular exercise in motivating the survivors of cancer; however, most survivors are insufficiently active, showing high rates of nonadherence to physical activity guidelines. Using the I-Change model, this study sought to determine the association of decisional balance and self-efficacy for exercise, planning, and self-leadership with the stages of change in exercise behavior among patients with stomach cancer.

METHODS

This cross-sectional study was conducted in February 2021 and included 145 patients diagnosed with primary stomach cancer via quota sampling in South Korea. Sociodemographics, comorbidity, decisional balance for exercise, self-efficacy for exercise, planning, self-leadership, and stages of change in exercise behavior were assessed.

RESULTS

Of the participants, 4% were in the precontemplation stage of exercise behavior, 10% contemplation, 37% preparation, 23% action, and 27% maintenance. The male sex (p = 0.043), higher self-efficacy for resisting relapse (p < 0.0001), higher coping planning (p = 0.029), and higher self-leadership for behavior awareness and volition (p = 0.023) were associated with more readiness for changes in exercise behavior.

CONCLUSIONS

From the results obtained using the I-Change model, self-efficacy for resisting relapse to previous habits, coping planning, and behavior awareness and volition were associated with more readiness for changes in exercise behavior. These findings may help reduce stomach cancer survivors' nonadherence to physical activity guidelines.

Risk factors for low self-care self-efficacy in cancer survivors: Application of latent profile analysis

Aim

To identify subgroups of cancer patients with distinct self‐care self‐efficacy profiles and to explore factors that can be used to predict those at risk of low self‐efficacy.

Design

A secondary analysis of data pooled from two cross‐sectional surveys was performed.

Methods

In total, 1,367 Chinese cancer survivors were included in the analysis. Latent profile analysis (LPA) was performed to categorize participants into latent subgroups with distinct self‐efficacy profiles. Multinomial logistic regression was conducted to identify predictors of self‐care self‐efficacy subgroup classification.

Results

We identified three distinct subgroups: low, medium and high self‐care self‐efficacy. Patients with the “low” profile, which was characterized by a low education level, single marital status, complications, late cancer stage and a lower level of social support, had the poorest self‐care behaviour.

Estimation of the relationship between the persistent decrease of the suicide rate and the changes in sociodemographic composition in Hungary between 1990 and 2011

From the end of the 1980s, the Hungarian suicide rate, which had been until that point the highest in the world for decades, has decreased drastically. The reason behind this decrease was probably due to the changes in numerous and often interlinked risk factors. Studies on this topic have mostly ignored to interrogate to what extent the change of the population composition, for example the improvement of educational level, contributed to the decrease of the rate in the given period? Our aim was to assess the contribution of changes in some sociodemographic factors to the decrease of the suicide rate in Hungary. During the analysis, data from 1990 were compared with data from 2011. For the statistical calculations, the method of “Standardization and Decomposition (SDA)” was used, which according to our best knowledge, has not yet been applied in Hungarian suicide studies. The results show that the improvement of educational level helped to decrease the rate for men by about a third, while for women only by about a tenth. However, the benefit of the improvement in educational attainment during the period investigated was significantly offset by the changes primarily in marital status (the ratios of unmarried and divorced subjects increased for both genders) and in age distribution (the ratio of the elderly persons increased for both genders). The results of our study emphasise the inverse relationship between suicide and educational level and support the hypothesis that we can regard educational policy as indirect health policy.

Partitioning of time trends in prevalence and mortality of lung cancer

BACKGROUND

Time trends of lung cancer prevalence and mortality are the result of three competing processes: changes in the incidence rate, stage-specific survival, and ascertainment at early stages. Improvements in these measures act concordantly to improve disease-related mortality, but push the prevalence rate in opposite directions making a qualitative interpretation difficult. The goal of this paper is to evaluate the relative contributions of these components to changes in lung cancer prevalence and mortality.

METHODS

Partitioning of prevalence and mortality trends into their components using SEER data for 1973-2013.

RESULTS

The prevalence of lung cancer increases for females and decreases for males. In 1998, the former was due to increased incidence (45%-50% of total trend), improved survival (40%-45%), and increased ascertainment at early stages (10%-15%). In males, a rapidly declining incidence rate overpowered the effects of survival and ascertainment resulting in an overall decrease in prevalence over time. Trends in lung cancer mortality are determined by incidence during 1993-2002 with noticeable contribution of survival after 2002.

CONCLUSION

Lung cancer incidence was the main driving force behind trends in prevalence and mortality. Improved survival played essential role from 2000 onwards. Trends in stage ascertainment played a small but adverse role. Our results suggest that further improvement in lung cancer mortality can be achieved through advances in early stage ascertainment, especially for males, and that in spite of success in treatment, adenocarcinoma continues to exhibit adverse trends (especially in female incidence) and its role among other histology-specific lung cancers will increase in the near future.

Association between long-term care and chronic and lifestyle-related disease modified by social profiles in community-dwelling people aged 80 and 90; SONIC study

BACKGROUND

Chronic and lifestyle-related diseases and social status were reported to be associated with long-term care (LTC). The social factors should be treated as social sub-groups of which characteristics show social profiles. However, few previous studies considered that. The present study aimed to investigate the associations between LTC and chronic and lifestyle-related diseases, and whether the associations were modified by the social sub-groups in the community-dwelling elderly.

METHOD

A cross-sectional study was conducted among 1004 community-dwelling participants aged 80 and 90. LTC was used as the outcome. Chronic and lifestyle-related diseases (i.e., stroke, heart disease, joint pain, osteoporosis, lung disease, cancer, hypertension, dyslipidemia, and diabetes) were used as the predictors. Education, household income, residential area, and support environment were analyzed by latent class analysis (LCA) to derive social profiles. We obtained odds ratios (ORs) of LTC from those diseases and tested interactions between those diseases and the social profiles by logistic regression analyses.

RESULT

The participants were categorized into two sub-groups of social factors (n = 675 and 329) by LCA. Logistic regression analyses showed ORs (95% CI) of LTC were 4.69 (2.49, 8.71) from stroke, 2.22 (1.46, 3.38) from joint pain, 1.99 (1.22, 3.25) from osteoporosis, and 2.05 (1.22, 3.40) from cancer adjusting for the social sub-groups. There were no significant interactions between the social subgroups and those diseases in relation to LTC except for osteoporosis.

CONCLUSION

The associations between LTC and chronic and lifestyle-related diseases were significant with adjusting for the social sub-groups, and not modified by that except osteoporosis.

Standardization of medical service indicators: A useful technique for hospital administration

Background

Many comparability problems appear in the process of the performance assessment of medical service. When comparing medical evaluation indicators across hospitals, or even within the same hospital, over time, the differences in the population composition such as types of diseases, comorbidities, demographic characteristics should be taken into account. This study aims to introduce a standardization technique for medical service indicators and provide a new insight on the comparability of medical data.

Methods

The medical records of 142592 inpatient from three hospitals in 2017 were included in this study. Chi-square and Kruskal-Wallis tests were used to explore the compositions of confounding factors among populations. The procedure of stratified standardization technique was applied to compare the differences of the average length of stay and the average hospitalization expense among three hospitals.

Results

Age, gender, comorbidity, and principal diagnoses category were considered as confounding factors. After correcting all factors, the average length of stay of hospital A and C were increased by 0.21 and 1.20 days, respectively, while that of hospital B was reduced by 1.54 days. The average hospitalization expenses of hospital A and C were increased by 1494 and 660 Yuan, whilst that of hospital B was decreased by 810 Yuan.

Conclusions

Standardization method will be helpful to improve the comparability of medical service indicators in hospital administration. It could be a practical technique and worthy of promotion.

Recent Approaches to Improve Medication Adherence in Patients with Coronary Heart Disease: Progress Towards a Learning Healthcare System

PURPOSE OF REVIEW

Non-adherence to medications for the secondary prevention of myocardial infarction (MI) is a major contributor to morbidity and mortality in these patients. This review describes recent advances in promoting adherence to therapies for coronary artery disease (CAD).

RECENT FINDINGS

Two large randomized controlled trials to "incentivize" adherence were somewhat disappointing; neither financial incentives nor "peer pressure" successfully increased rates of adherence in the post-MI population. Patient education and provider engagement appear to be critical aspects of improving adherence to CAD therapies, where the provider is a physician, pharmacist, or nurse and follow-up is performed in person or by telephone. Fixed-dose combinations of CAD medications, formulated as a so-called "polypill," have shown some early efficacy in increasing adherence. Technological advances that automate monitoring and/or encouragement of adherence are promising but seem universally dependent on patient engagement. For example, medication reminders via text message perform better if patients are required to respond. Multifaceted interventions, in which these and other interventions are combined together, appear to be most effective. There are several available types of proven interventions through which providers, and the health system at large, can advance patient adherence to CAD therapies. No single intervention to promote adherence will be successful in all patients. Further study of multifaceted interventions and the interactions between different interventions will be important to advancing the field. The goal is a learning healthcare system in which a network of interventions responds and adapts to patients' needs over time.

Association between childhood socioeconomic status and fruit and vegetable intake among older Japanese: The JAGES 2010 study

Fruit and vegetable intake (FVI) contributes to the prevention of non-communicable diseases. Although food preference is considered to be determined early in life, few studies have investigated the association between childhood socioeconomic status (SES) and FVI in older age. Because a school lunch program was initiated in Japan after World War II, we were able in this study to examine this association in an older Japanese population. We used data from a population of physically and cognitively independent adults aged 65years or older who were living independently in the community and were recruited from 27 municipalities in the Japan Gerontological Evaluation Study 2010 project (August 2010-January 2012). Three categories of childhood SES (low, middle, and high) and current FVI were evaluated via a self-reported questionnaire. Poisson regression was used to investigate the association between childhood SES and FVI in 19,920 individuals. After adjustment for age and sex, older people with low childhood SES were 1.36 times more likely (95% CI 1.23-1.52) to have poor FVI than those with high childhood SES. In the fully adjusted model, the significant association disappeared. Further age-stratified analysis revealed a positive association between childhood SES and FVI among people aged 70-76years who were partially exposed to the school lunch program, but not among people aged 65-69years old who were fully exposed to the program. In conclusion, social policy such as school lunches targeting children with low SES could help improve FVI in old age.

Women with Neck Pain on Long-Term Sick Leave-Approaches Used in the Return to Work Process: A Qualitative Study

Purpose There are difficulties in the process of return to work (RTW) from long-term sick leave, both in general and regarding sick leave because of neck pain in particular. Neck pain is difficult to assess, problematic to rehabilitate, and hard to cure; and it is not always easy to decide whether the pain is work-related. The outcome of RTW could be dependent upon individuals' approaches, defensive or offensive behaviors, and choices related to their self-efficacy. The aim of this study was to identify approaches used in the RTW process among women with neck pain on long-term sick leave from human service organizations. Methods This is a qualitative descriptive study based on grounded theory. A Swedish cohort of 207 women with a history of long-term sick leave with neck pain from human service organizations answered open-ended written questions at 0, 6, and 12 months, and 6 years; and 16 women were interviewed. Results Individuals expressed their coping approaches in terms of fluctuating in work status over time: either as a strategy or as a consequence. Periods of sick leave were interwoven with periods of work. The women were either controlling the interaction or struggling in the interaction with stakeholders. Conclusions Return to work outcomes may be improved if the fluctuating work status over time is taken into account in the design of rehabilitation efforts for women with a history of long-term sick leave and with chronical musculoskeletal conditions.

Alexithymia and psychosocial problems among Italian preadolescents. A latent class analysis approach

The study, conducted on Italian preadolscents aged 11 to 13 belonging to the general population, aims to investigate the relationship between the emotional functioning, namely, alexithymia, and the risk of developing behavioral and emotional problems measured using the Strength and Difficulty Questionnaire. The latent class analysis approach allowed to identify two latent variables, accounting for the internalizing (emotional symptoms and difficulties in emotional awareness) and for the externalizing problems (conduct problems and hyperactivity, problematic relationships with peers, poor prosocial behaviors and externally oriented thinking). The two latent variables featured two latent classes: the difficulty in dealing with problems and the strength to face problems that was representative of most of the healthy participants with specific gender differences. Along with the analysis of psychopathological behaviors, the study of resilience and strengths can prove to be a key step in order to develop valuable preventive approaches to tackle psychiatric disorders.