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Beck KB, Nuske HJ, Becker Haimes EM, Lawson GM, Mandell DS. Helping Practitioners Stop, Drop, and Roll: Suggestions to Help Improve Responses to Intense Clinical Events. Psychiatr Serv 2024:appips20230574. [PMID: 38410040 DOI: 10.1176/appi.ps.20230574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Community practitioners inconsistently implement evidence-based interventions. Implementation science emphasizes the importance of some practitioner characteristics, such as motivation, but factors such as practitioners' emotion regulation and cognitive processing receive less attention. Practitioners often operate in stressful environments that differ from those in which they received training. They may underestimate the impact of their emotional state on their ability to deliver evidence-based interventions. This "hot-cold state empathy gap" is not well studied in mental health care. In this Open Forum, the authors describe scenarios where this gap is affecting practitioners' ability to implement evidence-based practices. The authors provide suggestions to help practitioners plan for stressful situations.
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Affiliation(s)
- Kelly B Beck
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh (Beck); Penn Center for Mental Health (Nuske, Becker Haimes, Mandell) and Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia (Lawson), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Heather J Nuske
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh (Beck); Penn Center for Mental Health (Nuske, Becker Haimes, Mandell) and Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia (Lawson), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Emily M Becker Haimes
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh (Beck); Penn Center for Mental Health (Nuske, Becker Haimes, Mandell) and Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia (Lawson), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Gwendolyn M Lawson
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh (Beck); Penn Center for Mental Health (Nuske, Becker Haimes, Mandell) and Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia (Lawson), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - David S Mandell
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh (Beck); Penn Center for Mental Health (Nuske, Becker Haimes, Mandell) and Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia (Lawson), University of Pennsylvania Perelman School of Medicine, Philadelphia
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Arch JJ, Bright EE, Finkelstein LB, Fink RM, Mitchell JL, Andorsky DJ, Kutner JS. Anxiety and Depression in Metastatic Cancer: A Critical Review of Negative Impacts on Advance Care Planning and End-of-Life Decision Making With Practical Recommendations. JCO Oncol Pract 2023; 19:1097-1108. [PMID: 37831973 PMCID: PMC10732500 DOI: 10.1200/op.23.00287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/14/2023] [Accepted: 08/15/2023] [Indexed: 10/15/2023] Open
Abstract
PURPOSE Providers treating adults with advanced cancer increasingly seek to engage patients and surrogates in advance care planning (ACP) and end-of-life (EOL) decision making; however, anxiety and depression may interfere with engagement. The intersection of these two key phenomena is examined among patients with metastatic cancer and their surrogates: the need to prepare for and engage in ACP and EOL decision making and the high prevalence of anxiety and depression. METHODS Using a critical review framework, we examine the specific ways that anxiety and depression are likely to affect both ACP and EOL decision making. RESULTS The review indicates that depression is associated with reduced compliance with treatment recommendations, and high anxiety may result in avoidance of difficult discussions involved in ACP and EOL decision making. Depression and anxiety are associated with increased decisional regret in the context of cancer treatment decision making, as well as a preference for passive (not active) decision making in an intensive care unit setting. Anxiety about death in patients with advanced cancer is associated with lower rates of completion of an advance directive or discussion of EOL wishes with the oncologist. Patients with advanced cancer and elevated anxiety report higher discordance between wanted versus received life-sustaining treatments, less trust in their physicians, and less comprehension of the information communicated by their physicians. CONCLUSION Anxiety and depression are commonly elevated among adults with advanced cancer and health care surrogates, and can result in less engagement and satisfaction with ACP, cancer treatment, and EOL decisions. We offer practical strategies and sample scripts for oncology care providers to use to reduce the effects of anxiety and depression in these contexts.
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Affiliation(s)
- Joanna J. Arch
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO
- Division of Cancer Prevention and Control, University of Colorado Cancer Center, Aurora, CO
| | - Emma E. Bright
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO
| | - Lauren B. Finkelstein
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO
| | - Regina M. Fink
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
- University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, CO
| | | | | | - Jean S. Kutner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
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Duberstein PR, Hoerger M, Norton SA, Mohile S, Dahlberg B, Hyatt EG, Epstein RM, Wittink MN. The TRIBE model: How socioemotional processes fuel end-of-life treatment in the United States. Soc Sci Med 2023; 317:115546. [PMID: 36509614 DOI: 10.1016/j.socscimed.2022.115546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/21/2022] [Accepted: 11/13/2022] [Indexed: 11/25/2022]
Abstract
Prior interventions have repeatedly failed to decrease the prescription and receipt of treatments and procedures that confer more harm than benefit at the End-of-Life (EoL); new approaches to intervention are needed. Ideally, future interventions would be informed by a social-ecological conceptual model that explains EoL healthcare utilization patterns, but current models ignore two facts: (1) healthcare is an inherently social activity, involving clinical teams and patients' social networks, and (2) emotions influence social activity. To address these omissions, we scaffolded Terror Management Theory and Socioemotional Selectivity Theory to create the Transtheoretical Model of Irrational Biomedical Exuberance (TRIBE). Based on Terror Management Theory, TRIBE suggests that the prospect of patient death motivates healthcare teams to conform to a biomedical norm of care, even when clinicians believe that biomedical interventions will likely be unhelpful. Based on Socioemotional Selectivity Theory, TRIBE suggests that the prospect of dwindling time motivates families to prioritize emotional goals, and leads patients to consent to disease-directed treatments they know will likely be unhelpful, as moral emotions motivate deference to the perceived emotional needs of their loved ones. TRIBE is unique among models of healthcare utilization in its acknowledgement that moral emotions and processes (e.g., shame, compassion, regret-avoidance) influence healthcare delivery, patients' interactions with family members, and patients' outcomes. TRIBE is especially relevant to potentially harmful EoL care in the United States, and it also offers insights into the epidemics of overtreatment in healthcare settings worldwide. By outlining the role of socioemotional processes in the care of persons with serious conditions, TRIBE underscores the critical need for psychological innovation in interventions, health policy and research on healthcare utilization.
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Affiliation(s)
- Paul R Duberstein
- Department of Health Behavior, Society, and Policy, Rutgers University School of Public Heath, 683 Hoes Lane West, Piscataway, NJ, 08854, United States.
| | - Michael Hoerger
- Department of Psychology, Psychiatry, and Medicine, Tulane University, 131 S. Robertson Building, 131 S Robertson St, New Orleans, LA, 70112, United States; Tulane Cancer Center, Tulane University, 1415 Tulane Ave, New Orleans, LA, 70112, United States.
| | - Sally A Norton
- School of Nursing, University of Rochester, 255 Crittenden Blvd, Rochester, NY, 14642, United States; Department of Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY, 14642, United States.
| | - Supriya Mohile
- Department of Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY, 14642, United States; James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, 90 Crittenden Blvd, Rochester, NY, 14642, United States.
| | - Britt Dahlberg
- Center for Humanism, Cooper Medical School of Rowan University, 401 South Broadway, Camden, NJ, 08103, United States.
| | - Erica Goldblatt Hyatt
- Rutgers School of Social Work, 536 George St, New Brunswick, NJ, 08901, United States.
| | - Ronald M Epstein
- Department of Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY, 14642, United States; James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, 90 Crittenden Blvd, Rochester, NY, 14642, United States; Department of Family Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY, 14642, United States.
| | - Marsha N Wittink
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY, 14642, United States.
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Dwyer LA, Epstein RM, Feeney BC, Blair IV, Bolger N, Ferrer RA. Responsive social support serves important functions in clinical communication: Translating perspectives from relationship science to improve cancer clinical interactions. Soc Sci Med 2022; 315:115521. [PMID: 36384086 PMCID: PMC9722606 DOI: 10.1016/j.socscimed.2022.115521] [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: 03/02/2022] [Revised: 07/26/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022]
Abstract
Patient-clinician interactions are critical to patient-centered care, including in cancer care contexts which are often defined by multiple patient-clinician interactions over an extended period. Research on these dyadic interactions has been guided by perspectives in clinical communication science, but the study of clinical communication has not been fully integrated with perspectives on interpersonal interactions from relationship science research. An overlapping concept in both fields is the concept of responsive socialsupport. In this article, we discuss responsiveness as a concept that offers opportunities for connections between these two disciplines. Next, we focus on how relationship science can be applied to research in clinical settings. We discuss how three areas of relationship science define responsiveness and have potential for extension to clinical communication: (1) (in)visibility of social support, (2) attachment orientations, and (3) shared meaning systems. We also discuss how social biases can impede responsiveness and suggest research avenues to develop ideas and understand potential challenges in connecting these two fields. Many opportunities exist for interdisciplinary theory development that can generate momentum in understanding interpersonal processes in cancer care.
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Affiliation(s)
| | - Ronald M Epstein
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Brooke C Feeney
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Irene V Blair
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Niall Bolger
- Department of Psychology, Columbia University, New York, NY, USA
| | - Rebecca A Ferrer
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Perry LM, Mossman B, Lewson AB, Gerhart JI, Freestone L, Hoerger M. Application of Terror Management Theory to End-Of-Life Care Decision-Making: A Narrative Literature Review. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221107723. [PMID: 35687031 PMCID: PMC9734278 DOI: 10.1177/00302228221107723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Patients with serious illnesses often do not engage in discussions about end-of-life care decision-making, or do so reluctantly. These discussions can be useful in facilitating advance care planning and connecting patients to services such as palliative care that improve quality of life. Terror Management Theory, a social psychology theory stating that humans are motivated to resolve the discomfort surrounding their inevitable death, has been discussed in the psychology literature as an underlying basis of human decision-making and behavior. This paper explores how Terror Management Theory could be extended to seriously ill populations and applied to their healthcare decision-making processes and quality of care received.
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Affiliation(s)
- Laura M. Perry
- Department of Medical Social Sciences, Northwestern
University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Psychology, Tulane University, New Orleans,
Louisiana, USA
| | - Brenna Mossman
- Department of Psychology, Tulane University, New Orleans,
Louisiana, USA
| | - Ashley B. Lewson
- Department of Psychology, Indiana University–Purdue
University Indianapolis, Indianapolis, Indiana, USA
| | - James I. Gerhart
- Department of Psychology, Central Michigan University,
Mount Pleasant, Michigan, USA
| | - Lily Freestone
- Department of Psychology, Tulane University, New Orleans,
Louisiana, USA
| | - Michael Hoerger
- Department of Psychology, Tulane University, New Orleans,
Louisiana, USA
- Departments of Psychiatry and Medicine, Tulane University
School of Medicine, New Orleans, Louisiana, USA
- Tulane Cancer Center, Tulane University School of
Medicine, New Orleans, Louisiana, USA
- Freeman School of Business, Tulane University, New
Orleans, Louisiana, USA
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Ovaitt AK, McCammon S. Ethical Considerations in Caring for Patients with Advanced Malignancy. Surg Oncol Clin N Am 2021; 30:581-589. [PMID: 34053670 DOI: 10.1016/j.soc.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Patients with advanced malignancy have decisions to make about next steps that are multifactorial and highly ramified. At each step, they, their loved ones, and their health care providers will attempt to make right decisions and avoid wrong ones. Beyond bare ethical principles, these patients face tensions between what they hope for, what is possible, and what those around them expect and advise. This article uses a case-based approach to explore the balance between prognostication and directive counsel; affective forecasting and decisional regret; hope and the therapeutic misconception; and issues of patient ownership and abandonment at the end of life.
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Affiliation(s)
- Alyssa K Ovaitt
- Department of Otolaryngology-Head and Neck Surgery, The University of Alabama at Birmingham, Faculty Office Tower 1155, 1720 2nd Avenue South, Birmingham, AL 35294-3412, USA
| | - Susan McCammon
- Department of Otolaryngology-Head and Neck Surgery, The University of Alabama at Birmingham, Faculty Office Tower 1155, 1720 2nd Avenue South, Birmingham, AL 35294-3412, USA; Department of Internal Medicine, Division of Gerontology, Geriatrics, and Palliative Care, Community-Based Palliative Care, UAB Center for Palliative and Supportive Care, The University of Alabama at Birmingham, Faculty Office Tower 1155, 1720 2nd Avenue South, Birmingham, AL 35294-3412, USA.
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Ferrer RA, Ellis EM. Preliminary evidence for differential effects of integral and incidental emotions on risk perception and behavioral intentions: A meta‐analysis of eight experiments. JOURNAL OF BEHAVIORAL DECISION MAKING 2020. [DOI: 10.1002/bdm.2209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Rebecca A. Ferrer
- Basic Biobehavioral and Psychological Sciences Branch National Cancer Institute Bethesda MD USA
| | - Erin M. Ellis
- Behavioral Research Program, Division of Cancer Control and Population Sciences National Cancer Institute Bethesda MD USA
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Klein WMP, Rothman AJ, Suls J. Bridging Behavioral Science with Cancer Prevention and Control: Contributions of an NCI Working Group (2009-2019). Cancer Prev Res (Phila) 2020; 13:337-342. [PMID: 31969345 DOI: 10.1158/1940-6207.capr-19-0484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/12/2019] [Accepted: 01/16/2020] [Indexed: 11/16/2022]
Abstract
Human behavior plays a central role in cancer-related morbidity and mortality. Much behavior is, in turn, attributable to several core biological, cognitive, emotional, motivational, and interpersonal processes. Understanding the systematic and interactive impact of these processes can inform efforts to address cancer-relevant outcomes such as tobacco use, reliance on cancer misinformation, engagement in genetic testing, adherence to treatment, and acceptance of palliative care. Here, we review efforts of the NCI-supported Cognitive, Affective, and Social Processes in Health Research working group. Since 2009, this group has endeavored to advance the integration of basic behavioral science with cancer prevention and control by addressing topics such as the degree to which behavioral interventions alter cognitions underlying behavior, how technological innovations might facilitate behavioral measurement and intervention in areas such as smoking cessation, whether decision science principles might be applied to genetic testing decisions, how the cognitive effects of chemotherapy impair self-regulation, and the extent to which emotional factors drive palliative care decisions. The group has initiated numerous activities to build capacity for research in these areas including state-of-the-science meetings, written syntheses, conference symposia, and training workshops. We conclude with reflections about future needs as well as how to sustain such integrative efforts.
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Ferrer RA, Ellis EM. Moving beyond categorization to understand affective influences on real world health decisions. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2019; 13. [PMID: 33912229 DOI: 10.1111/spc3.12502] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This paper provides an overview of affect and health decision-making research, with a focus on identifying gaps, opportunities, and challenges to guide future research. We begin by defining common categorical distinctions of affective processes that influence health decisions: integral (i.e., related to the decision) and incidental (i.e., normatively unrelated to the decision) influences, and current (experienced in the moment) and anticipated ("cognitive representations" of future affect) affect. We then summarize key discoveries within the most common categories of affective influences on health decision making: current integral affect, current incidental affect, and anticipated integral affect. Finally, we highlight research gaps, challenges, and opportunities for future directions for research aimed at translating affective and decision science theory to improve our understanding of, and ability to intervene upon, health decision making.
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Affiliation(s)
- Rebecca A Ferrer
- Basic Biobehavioral and Psychological Sciences Branch, National Cancer Institute
| | - Erin M Ellis
- Office of Disease Prevention, National Institutes of Health
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