1
|
Bigatti SM, Lydon-Lam J, Storniolo AM. Breast Cancer Worry in U.S. Female First-degree Relatives: Moderating Role of Daily Spiritual Experiences. JOURNAL OF RELIGION AND HEALTH 2023; 62:3466-3479. [PMID: 37014487 DOI: 10.1007/s10943-023-01807-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 06/19/2023]
Abstract
Female first degree relatives of breast cancer patients experience worry because of their own increased breast cancer risk. The aim in the present study was to examine the role of daily spiritual experiences as a potential protective factor against breast cancer worry. We hypothesized that daily spiritual experiences would moderate the relationship between relatives' stage of disease and breast cancer worry. Sixty-three mothers, daughters or sisters of breast cancer survivors completed surveys assessing relative's disease characteristics and their own demographics, fear of breast cancer, and daily spiritual experiences. All participants were living in the midwestern United States. Results showed that daily spiritual experiences moderated the relationship between stage of disease and breast cancer worry. Low scores on daily spiritual experiences were associated with more worry when relatives had advanced disease, and high scores on daily spiritual experiences was associated with less worry when relatives had advanced disease. Findings suggest the need to focus on this population when providing support services to families of patients.
Collapse
Affiliation(s)
- Silvia M Bigatti
- Department of Social and Behavioral Sciences, IU Fairbanks School of Public Health at IUPUI, 1050 Wishard Blvd., RG6044, Indianapolis, IN, 46202, USA.
| | - Jennifer Lydon-Lam
- Department of Social and Behavioral Sciences, IU Fairbanks School of Public Health at IUPUI, 1050 Wishard Blvd., RG6044, Indianapolis, IN, 46202, USA
| | | |
Collapse
|
2
|
Pywell CM, Caston NE, Gilbert AD, Williams CP, Ye S, Azuero A, Rocque GB. Associations Between Patient-Perceived Cancer Curability and Advance Directive Completion. J Palliat Med 2023. [PMID: 36946878 DOI: 10.1089/jpm.2022.0348] [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: 03/23/2023] Open
Abstract
Background: Despite Advance Care Planning recommendations for patients with cancer, many lack Advance Directives (ADs). AD disparities persist among Black, Indigenous, or People of Color (BIPOC) patients. Based on a hypothesized correlation, we examined the association between patient-perceived cancer incurability and AD completion. Methods: This cross-sectional study obtained self-reported AD completion and incurability perception from routine care surveys. AD completion by incurability perception was estimated using modified Poisson regression. Subgroup analyses examined patients who were BIPOC, White, and had solid organ malignancies. Results: Our sample (N = 1209) was predominantly female (70%), White (73%) with early-stage disease (60%), and solid organ malignancies (82%). AD completion was 42%, and 40% of patients reported their cancer incurable. Patient-perceived incurability was not associated with increased AD completion (likelihood ratio 0.94, 95% confidence interval 0.78-1.13) in overall or subgroup analyses. Conclusion: Patient-perceived cancer incurability was not associated with AD completion, even accounting for race/ethnicity and cancer type.
Collapse
Affiliation(s)
- Cameron M Pywell
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nicole E Caston
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Aidan D Gilbert
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Courtney P Williams
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Star Ye
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gabrielle B Rocque
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
3
|
Arvanitou E, Nikoloudi M, Tsoukalas N, Parpa E, Mystakidou K. Factors associated with anxiety and depression in cancer patients: Demographic factors and the role of demoralization and satisfaction with care. Psychooncology 2023; 32:712-720. [PMID: 36797821 DOI: 10.1002/pon.6115] [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: 09/30/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVE Anxiety and depression are common in cancer patients and seem to affect quality of life, treatment compliance and even survival. Defining factors related to anxiety and depression and exploring the role of demoralization and satisfaction with care, could contribute to the improvement of patients' quality of life and quality of health services as well. METHODS A convenience sample of 150 cancer inpatients and outpatients from two oncology centers, with various types of solid tumors, participated in a prospective cross-sectional observational study. The psychometric tools used were the Greek versions of the Hospital Anxiety and Depression Scale, FAMCARE-Patient Scale and Oncology Palliative Care (FAMCARESCALE) and Demoralization Scale (DEMORALIZATION SCALE II, DS-II). RESULTS Patients mean age was 62 years (20-85 years) and 89 patients (59.3%) were women. Among patients, 33% had breast, 24% gastrointestinal and 15% lung cancer. Eighty-two patients (54.7%) had metastatic disease. Women showed higher rates of anxiety (p = 0.054). Anxiety was inversely related to age (p = 0.043) and positively correlated with time since diagnosis (p = 0.076). Unmarried patients presented with higher rates of depression (p = 0.026). Multiple linear regression showed a statistically significant impact of Demoralization factor 'Meaning and Purpose' on anxiety (p < 0.001, R2 = 36.3%) and depression (p < 0.001, R2 = 49%). Moreover, higher educational level (p = 0.038, R2 = 3.1%) is related to higher levels of anxiety and higher scores of FAMCARESCALE factor-Information/interaction with the health care professionals, is related to lower levels of depression (p = 0.008, R2 = 2.7%). CONCLUSIONS The results highlight the significant impact of demoralization on anxiety and depression in cancer patients. Early recognition of demoralization and early referral to mental health professionals will hopefully alleviate the mental burden of cancer patients.
Collapse
Affiliation(s)
- Eleni Arvanitou
- Oncology Clinic, 401 General Military Hospital, Athens, Greece
| | - Maria Nikoloudi
- Department of Radiology, Pain Relief and Palliative Care Unit, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Efi Parpa
- Department of Radiology, Pain Relief and Palliative Care Unit, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Kyriaki Mystakidou
- Department of Radiology, Pain Relief and Palliative Care Unit, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Loh KP, Seplaki CL, Sanapala C, Yousefi-Nooraie R, Lund JL, Epstein RM, Duberstein PR, Flannery M, Culakova E, Xu H, McHugh C, Klepin HD, Lin PJ, Watson E, Grossman VA, Liu JJ, Geer J, O’Rourke MA, Mustian K, Mohile SG. Association of Prognostic Understanding With Health Care Use Among Older Adults With Advanced Cancer: A Secondary Analysis of a Cluster Randomized Clinical Trial. JAMA Netw Open 2022; 5:e220018. [PMID: 35179585 PMCID: PMC8857680 DOI: 10.1001/jamanetworkopen.2022.0018] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE A poor prognostic understanding regarding curability is associated with lower odds of hospice use among patients with cancer. However, the association between poor prognostic understanding or prognostic discordance and health care use among older adults with advanced incurable cancers is not well characterized. OBJECTIVE To evaluate the association of poor prognostic understanding and patient-oncologist prognostic discordance with hospitalization and hospice use among older adults with advanced cancers. DESIGN, SETTING, AND PARTICIPANTS This was a post hoc secondary analysis of a cluster randomized clinical trial that recruited patients from October 29, 2014, to April 28, 2017. Data were collected from community oncology practices affiliated with the University of Rochester Cancer Center National Cancer Institute Community Oncology Research Program. The parent trial enrolled 541 patients who were aged 70 years or older and were receiving or considering any line of cancer treatment for incurable solid tumors or lymphomas; the patients' oncologists and caregivers (if available) were also enrolled. Patients were followed up for at least 1 year. Data were analyzed from January 3 to 16, 2021. MAIN OUTCOMES AND MEASURES At enrollment, patients and oncologists were asked about their beliefs regarding cancer curability (100%, >50%, 50%, <50%, and 0%; answers other than 0% reflected poor prognostic understanding) and life expectancy (≤6 months, 7-12 months, 1-2 years, 2-5 years, and >5 years; answers of >5 years reflected poor prognostic understanding). Any difference between oncologist and patient in response options was considered discordant. Outcomes were any hospitalization and hospice use at 6 months captured by the clinical research associates. RESULTS Among the 541 patients, the mean (SD) age was 76.6 (5.2) years, 264 of 540 (49%) were female, and 486 of 540 (90%) were White. Poor prognostic understanding regarding curability was reported for 59% (206 of 348) of patients, and poor prognostic understanding regarding life expectancy estimates was reported for 41% (205 of 496) of patients. Approximately 60% (202 of 336) of patient-oncologist dyads were discordant regarding curability, and 72% (356 of 492) of patient-oncologist dyads were discordant regarding life expectancy estimates. Poor prognostic understanding regarding life expectancy estimates was associated with lower odds of hospice use (adjusted odds ratio, 0.30; 95% CI, 0.16-0.59). Discordance regarding life expectancy estimates was associated with greater odds of hospitalization (adjusted odds ratio, 1.64; 95% CI, 1.01-2.66). CONCLUSIONS AND RELEVANCE This study highlights different constructs of prognostic understanding and the need to better understand the association between prognostic understanding and health care use among older adult patients with advanced cancer. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02107443.
Collapse
Affiliation(s)
- Kah Poh Loh
- James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Christopher L. Seplaki
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Chandrika Sanapala
- James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Reza Yousefi-Nooraie
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Jennifer L. Lund
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Ronald M. Epstein
- Center for Communication and Disparities Research, Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
- Department of Medicine, Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Paul R. Duberstein
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, New Jersey
| | - Marie Flannery
- School of Nursing, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Eva Culakova
- Department of Surgery, Cancer Control, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Huiwen Xu
- Department of Preventive Medicine and Population Health, School of Medicine, Sealy Center on Aging, University of Texas Medical Branch, Galveston
| | - Colin McHugh
- James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Heidi D Klepin
- Section on Hematology and Oncology, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina
| | - Po-Ju Lin
- Department of Surgery, Cancer Control, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | | | - Jane Jijun Liu
- Heartland National Cancer Institute Community Oncology Research Program (NCORP), Decatur, Illinois
| | - Jodi Geer
- Metro Minnesota Community Oncology Research Program, St Louis Park
| | - Mark A. O’Rourke
- NCORP of the Carolinas (Greenville Health System NCORP), Greenville, South Carolina
| | - Karen Mustian
- Department of Surgery, Cancer Control, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Supriya G. Mohile
- James P. Wilmot Cancer Center, Department of Medicine, University of Rochester, Rochester, New York
| |
Collapse
|
6
|
Mossman B, Perry LM, Walsh LE, Gerhart J, Malhotra S, Horswell R, Chu S, Raines AM, Lefante J, Blais CM, Miele L, Melancon B, Alonzi S, Voss H, Freestone L, Dunn A, Hoerger M. Anxiety, depression, and end-of-life care utilization in adults with metastatic cancer. Psychooncology 2021; 30:1876-1883. [PMID: 34157174 DOI: 10.1002/pon.5754] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/15/2021] [Accepted: 06/07/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE End-of-life care for patients with cancer is often overly burdensome, and palliative and hospice care are underutilized. The objective of this study was to evaluate whether the mental health diagnoses of anxiety and depression were associated with variation in end-of-life care in metastatic cancer. METHODS This study used electronic health data from 1,333 adults with metastatic cancer who received care at two academic health centers in Louisiana, USA, and died between 1/1/2011-12/31/2017. The study used descriptive statistics to characterize the sample and logistic regression to examine whether anxiety and depression diagnoses in the six months before death were associated with utilization outcomes (chemotherapy, intensive care unit [ICU] visits, emergency department visits, mechanical ventilation, inpatient hospitalization, palliative care encounters, and hospice utilization), while controlling for key demographic and health covariates. RESULTS Patients (56.1% male; 65.6% White, 31.1% Black) commonly experienced depression (23.9%) and anxiety (27.2%) disorders within six months of death. Anxiety was associated with an increased likelihood of chemotherapy (odds ratio [OR] = 1.42, p = 0.016), ICU visits (OR = 1.40, p = 0.013), and inpatient hospitalizations (OR = 1.85, p < 0.001) in the 30 days before death. Anxiety (OR = 1.95, p < 0.001) and depression (OR = 1.34, p = 0.038) were associated with a greater likelihood of a palliative encounter. CONCLUSIONS Patients with metastatic cancer who had an anxiety disorder were more likely to have burdensome end-of-life care, including chemotherapy, ICU visits, and inpatient hospitalizations in the 30 days before death. Depression and anxiety both increased the odds of palliative encounters. These results emphasize the importance of mental health considerations in end-of-life care.
Collapse
Affiliation(s)
- Brenna Mossman
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Laura M Perry
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Leah E Walsh
- Department of Psychology, Fordham University, Bronx, New York, USA
| | - James Gerhart
- Department of Psychology, Central Michigan University, Mount Pleasant, Michigan, USA.,Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Sonia Malhotra
- Department of Palliative Medicine & Supportive Care, University Medical Center, New Orleans, Louisiana, USA.,Section of General Internal Medicine & Geriatrics, Deming Department of Medicine, Tulane School of Medicine, New Orleans, Louisiana, USA
| | - Ronald Horswell
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - San Chu
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Amanda M Raines
- Southeast Louisiana Veterans Health Care System (SLVHCS), New Orleans, Louisiana, USA.,South Central Mental Illness Research, Education and Clinical Center (MIRECC), New Orleans, Louisiana, USA.,Department of Psychiatry, School of Medicine, Louisiana State University, New Orleans, Louisiana, USA
| | - John Lefante
- Department of Biostatistics and Data Science, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Christopher M Blais
- Department of Infectious Disease, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Lucio Miele
- Department of Genetics and Louisiana Cancer Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Brian Melancon
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Sarah Alonzi
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Hallie Voss
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Lily Freestone
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Addison Dunn
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Michael Hoerger
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA.,Department of Palliative Medicine & Supportive Care, University Medical Center, New Orleans, Louisiana, USA.,Departments of Psychiatry and Medicine, Tulane Cancer Center, and Freeman School of Business, Tulane University, New Orleans, Louisiana, USA
| |
Collapse
|
7
|
The Evaluation of Parental Acceptance Towards Children with Sex Chromosomal Disorders of Sex Development Using A Mixed-Method. JOURNAL OF BIOMEDICINE AND TRANSLATIONAL RESEARCH 2021. [DOI: 10.14710/jbtr.v7i1.10710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Sex chromosomal Disorder of sex development (DSD) is an atypical abnormality of external genitalia which is mismatched with its sex chromosome traits. The condition of children with DSD affects the dynamics in the family. Parents’ reactions after discovering this health problem vary greatly, such as being in a state of shock, confusion, or self-blame. However, parents’ acceptance is extremely important for better quality of caring, to the healthy social and emotional child development, and to make the best decisions regarding gender assignment.Objective: To describe the acceptance process of parents that have children with sex chromosomes mosaicism DSD.Methods: This study used a mixed-method with a sequential explanatory approach, which was preceded by quantitative data collection followed by qualitative. The total respondents consisted of 14 mothers and 12 fathers of 14 sex chromosome mosaicism DSD patients with XX/XY, X/XY, XYY or XXY variants. Quantitative data were collected using the Indonesian version of the Parental Acceptance-Rejection Questionnaire (PARQ), and interviews were conducted to determine the acceptance process.Results: Most acceptance cases were based on the surgical stage completion in which a higher number of mothers (71.43%) than fathers (50%).Conclusion: It is uneasy for parents to accept children with sex chromosome mosaicisms DSD, hence the fathers struggle more than mothers in accepting those affected. To the best of our knowledge this is the first study in Indonesia to help parent understand and accept their child condition.
Collapse
|
8
|
Global Perspectives on Palliative Care for Cancer Patients: Not All Countries Are the Same. Curr Oncol Rep 2021; 23:60. [PMID: 33829323 PMCID: PMC8026388 DOI: 10.1007/s11912-021-01044-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 12/14/2022]
Abstract
Abstract Purpose of the Review The integration of cancer-related palliative care is essential to holistic, quality cancer care. While some similarities exist between countries, this manuscript will focus on five differences that impact palliative care for cancer patients including the epidemiology of cancer and related symptoms, cancer-specific integration into care, palliative care education, economic development of the country, and cultural and religious differences. Recent Findings The epidemiology of cancer varies around the world resulting in variable symptoms and the need for individualized approaches to palliative care. While palliative care is integrated in some countries, it is lacking in over half of the world, and specific integration into cancer care is virtually absent. Education and training are the key to expansion, and yet oncology-focused palliative care education is lacking or is not well-reported in the literature. To complicate this global lens even further are the economic disparities that exist. Low-to-middle-income countries (LMICs) are resource poor and have the fewest resources and least amount of integration, and yet patients with advanced cancer are over-represented in these countries. Essential to cancer-related palliative care is a tailored approach that addresses cultural and religious differences around the globe. Summary Palliative care is developing around the globe and yet palliative care specific for cancer patients is in its infancy. Cancer care professionals should (1) understand the epidemiologic differences that exist globally and the impact this has on palliative care, (2) integrate palliative care into the cancer care arena, (3) provide cancer-specific palliative education focused on the cancer trajectory from diagnosis through survivorship and end of life, (4) advocate for LMICs, which suffer from a lack of resources and services, and (5) understand cultural and religious differences that exist to provide holistic and sensitive cancer-related palliative care.
Collapse
|
9
|
Educational Disparities in COVID-19 Prevention in China: The Role of Contextual Danger, Perceived Risk, and Interventional Context. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073383. [PMID: 33805222 PMCID: PMC8036684 DOI: 10.3390/ijerph18073383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/22/2021] [Accepted: 03/05/2021] [Indexed: 12/15/2022]
Abstract
Despite the social disparities in COVID-19 infection, little is known about factors influencing social disparities in preventive behaviors during the pandemic. This study examined how educational disparities in mask-wearing, handwashing, and limiting public outings might be contingent upon three factors: contextual cue of danger, perceived risk of local outbreak, and interventional context with different levels of intensity (i.e, Wuhan vs. other areas). Data were obtained from a telephone survey of 3327 adults, who were recruited through a random-digit-dial method to be representative of all cell phone users in China. Interviews were conducted from 28 April to 26 May 2020. Stratified multiple regression models showed that educational disparities in all three behaviors were only consistently observed among people exposed to context cues of danger, with an enhanced sense of risk of a local outbreak, or in areas other than Wuhan. College education seems to make a difference in handwashing regardless of contextual cues of danger or perception of risk. The findings suggested that, in the process of an epidemic, emerging threats in one's immediate environment or raised awareness of risks are important conditions triggering educational disparities in prevention. However, effective public health interventions could potentially reduce such disparities.
Collapse
|
10
|
Guo XM, Tom L, Leung I, O'Brian C, Zumpf K, Simon M. Associations between Fatalistic Cancer Beliefs and Cancer-Screening Behaviors in Chinese American Immigrant Women. J Immigr Minor Health 2021; 23:699-706. [PMID: 33515161 DOI: 10.1007/s10903-021-01144-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 11/25/2022]
Abstract
Chinese Americans have among the lowest rates of up-to-date cancer screening in the United States. Fatalistic health beliefs are also common in this population and can lead to decreased healthcare utilization. We sought to understand how these fatalistic beliefs are associated with cancer screening behaviors in this underserved population. A cross-sectional survey was conducted with 732 Chinese women from the greater Chinatown area of Chicago, Illinois. Surveyed questions included sociodemographic information, self-reported healthcare utilization and cancer screening behaviors. The majority of respondents were older than 50, spoke Chinese, had less than a college education, public or no medical insurance, and an annual income < $20,000. Approximately 20% had never received Papanicolaou or mammogram screening. Fatalistic beliefs were common and associated with increased health-seeking behaviors and appropriate Pap and mammogram screening. In this cohort of Chinese American immigrant women in an urban Chinatown community, fatalistic cancer beliefs were prevalent and associated with increased health-seeking and positive cancer screening behaviors. This previously unreported relationship could be leveraged in improving health outcomes of an underserved population.
Collapse
Affiliation(s)
- Xiaoyue Mona Guo
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E. Superior St., Suite 5-2177, Chicago, IL, 60611, USA. .,, 2020 Zonal Ave, IRD, Room 220, Los Angeles, CA, 90033, USA.
| | - Laura Tom
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E. Superior St., Suite 5-2177, Chicago, IL, 60611, USA.,Center for Health Equity Transformation, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ivy Leung
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E. Superior St., Suite 5-2177, Chicago, IL, 60611, USA.,Center for Health Equity Transformation, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Catherine O'Brian
- Center for Health Equity Transformation, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katelyn Zumpf
- Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Melissa Simon
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E. Superior St., Suite 5-2177, Chicago, IL, 60611, USA.,Center for Health Equity Transformation, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of General/Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
11
|
Loh KP, Xu H, Epstein RM, Mohile SG, Prigerson HG, Plumb S, Ladwig S, Kadambi S, Wong ML, McHugh C, An A, Trevino K, Saeed F, Duberstein PR. Associations of Caregiver-Oncologist Discordance in Prognostic Understanding With Caregiver-Reported Therapeutic Alliance and Anxiety. J Pain Symptom Manage 2020; 60:20-27. [PMID: 32061833 PMCID: PMC7311277 DOI: 10.1016/j.jpainsymman.2020.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 01/28/2023]
Abstract
CONTEXT Discordance in prognostic understanding between caregivers of adults with advanced cancer and the oncologist may shape caregivers' views of the oncologist and bereavement outcomes. OBJECTIVES We examined prospective associations of caregiver-oncologist discordance with caregiver-oncologist therapeutic alliance and caregiver anxiety after patient death. METHODS We conducted a secondary analysis of data collected in a cluster randomized controlled trial from August 2012 to June 2014 in Western New York and California. At enrollment, caregivers and oncologists used a seven-point scale to rate their beliefs about the patient's curability and living two years or more: 100%, about 90%, about 75%, about 50 of 50, about 25%, about 10%, and 0%. Discordance was defined as a difference of two points or more. Outcomes at seven months after patient death included caregiver-oncologist therapeutic alliance (The Human Connection scale, modified into five items) and caregiver anxiety (Generalized Anxiety Disorder-7). We conducted multivariable linear regression models to assess the independent associations of discordance with alliance and anxiety. RESULTS We included 97 caregivers (mean age 63) and 38 oncologists; 41% of caregiver-oncologist dyads had discordant beliefs about the patient's curability, and 63% of caregiver-oncologist dyads had discordant beliefs about living two years or more. On multivariate analysis, discordance in beliefs about curability was associated with lower anxiety (β = -2.20; SE 0.77; P = 0.005). Discordance in beliefs about length of life was associated with a weaker alliance (β = -5.87; SE = 2.56; P = 0.02). CONCLUSION A better understanding of how caregivers understand and come to terms with poor prognoses will guide interventions to improve cancer care delivery and outcomes of cancer treatment.
Collapse
Affiliation(s)
- Kah Poh Loh
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
| | - Huiwen Xu
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Ronald M Epstein
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Medicine, Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Supriya G Mohile
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Holly G Prigerson
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA; Cornell Center for Research on End-of-Life Care, New York, New York, USA
| | - Sandra Plumb
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Susan Ladwig
- Department of Medicine, Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Sindhuja Kadambi
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Melisa L Wong
- Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, USA
| | - Colin McHugh
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Amy An
- Department of Medicine, Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Kelly Trevino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Fahad Saeed
- Department of Medicine, Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Division of Nephrology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Paul R Duberstein
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| |
Collapse
|
12
|
Perceptions of medical status and treatment goal among older adults with advanced cancer. J Geriatr Oncol 2020; 11:937-943. [DOI: 10.1016/j.jgo.2019.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/20/2019] [Accepted: 11/18/2019] [Indexed: 01/26/2023]
|
13
|
Vlckova K, Tuckova A, Polakova K, Loucka M. Factors associated with prognostic awareness in patients with cancer: A systematic review. Psychooncology 2020; 29:990-1003. [DOI: 10.1002/pon.5385] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/25/2020] [Accepted: 03/27/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Karolina Vlckova
- Center for Palliative Care Prague Czech Republic
- First Faculty of MedicineCharles University Prague Czech Republic
| | - Anna Tuckova
- Center for Palliative Care Prague Czech Republic
- Faculty of Social SciencesCharles University Prague Czech Republic
| | | | - Martin Loucka
- Center for Palliative Care Prague Czech Republic
- Third Faculty of MedicineCharles University Prague Czech Republic
| |
Collapse
|
14
|
Gray TF, Temel JS, El-Jawahri A. Illness and prognostic understanding in patients with hematologic malignancies. Blood Rev 2020; 45:100692. [PMID: 32284227 DOI: 10.1016/j.blre.2020.100692] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 03/04/2020] [Accepted: 04/02/2020] [Indexed: 12/25/2022]
Abstract
It is critical for patients with hematologic malignancies to have an accurate understanding of their illness and prognosis to make informed treatment decisions. Illness and prognostic understanding have primarily been studied in patients with solid tumors, however, data in patients with hematologic malignancies are rapidly growing. Patients with hematologic malignancies often face a unique and unpredictable illness trajectory with the possibility of cure persisting even in relapsed and refractory settings. These patients often require intensive therapies such as high-dose chemotherapy, hematopoietic stem cell transplantation (HCT), or CAR T-cell therapy, which carry with them significant risk of morbidity, mortality, and prognostic uncertainty. In this review article, we first described the current literature on illness and prognostic understanding in patients with hematologic malignancies including 1) patients' varying desire for prognostic information; (2) patients' prognostic misperceptions, (3) the association between patients' prognostic understanding and their psychological outcomes; and (4) barriers to prognostic understanding. Next, we examined insights gained from the literature about illness and prognostic understanding in patients with solid tumors to guide our understanding of the research gaps in hematologic malignancies. Future studies are needed to better delineate the longitudinal relationship between prognostic understanding, psychological distress, and coping in patients with hematologic malignancies. Strategies such as communicating effectively about prognosis, cultivating adaptive coping in the face of a terminal prognosis, and integrating specialty palliative care for patients with hematologic malignancies have the potential to improve patients' prognostic understanding and their quality of life and care.
Collapse
Affiliation(s)
- Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Jennifer S Temel
- Massachusetts General Hospital Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Areej El-Jawahri
- Massachusetts General Hospital Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
15
|
Lim E, Humphris G. The relationship between fears of cancer recurrence and patient age: A systematic review and meta-analysis. Cancer Rep (Hoboken) 2020; 3:e1235. [PMID: 32671982 DOI: 10.1002/cnr2.1235] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Fears of cancer recurrence (FCR) is one of the most prevalent concerns and a common unmet need reported by cancer patients. Patient age is a demographic variable that has been linked to FCR, among others. Although it is recognised by researchers that age and FCR may be negatively correlated, the strength of this correlation has yet to be established. AIM The aims of this study were to (a) conduct a meta-analysis to investigate the overall association of patient age in years with FCR across studies from 2009 to February 2019 and (b) scrutinise for patterns of these effect sizes across studies. METHODS AND RESULTS Peer-reviewed papers were gathered from the literature via online databases (PubMed, EMBASE, MEDLINE, and PsycINFO). Systematic review guidelines including a quality assessment were applied to the 31 selected studies (pooled participant N size = 19 777). The meta-analysis demonstrated a significant negative association between age and FCR (ES = -0.12; 95% CI, -0.17, -0.07). Meta-regression revealed the association of patient age and FCR significantly reduced over the last decade. A significant effect (β = -0.17, P = 0.005) of breast cancer versus other cancers on this age by FCR association was also identified. CONCLUSION The reliable and readily accessible personal information of age of patient can be utilised as a weak indicator of FCR level especially in the breast cancer field, where the majority of studies were drawn. The suggestion that age and FCR association may be attenuated in recent years requires confirmation.
Collapse
Affiliation(s)
- Edward Lim
- Medical School, University of St Andrews, St Andrews, UK
| | - Gerald Humphris
- Medical School, University of St Andrews, St Andrews, UK.,Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| |
Collapse
|
16
|
Outcome Expectancies, Health Information Seeking, and Cancer Beliefs Associated with Multivitamin/Mineral Use in a National Sample, HINTS-FDA 2015. J Acad Nutr Diet 2020; 120:1368-1376. [PMID: 32061553 DOI: 10.1016/j.jand.2019.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 12/07/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Dietary supplements, including multivitamins/minerals, are commonly reported by adults, yet little is known about multivitamin/mineral use in relation to information seeking, cancer-specific outcome expectancies, and cancer beliefs. OBJECTIVE To examine the relationship of heath information seeking, beliefs about cancer, and outcome expectancies with multivitamin/mineral use within a national sample. DESIGN A secondary analysis of data collected by The Health Information National Trends Survey (HINTS) and the US Food and Drug Administration (FDA) (HINTS-FDA 2015) was conducted. HINTS-FDA 2015 evaluated information seeking, beliefs about cancer, and health behaviors and was a self-administered, two-stage mail survey sent to a random sample of US postal addresses stratified by county smoking rates. PARTICIPANTS Adult household residents were invited to participate, resulting in a 33% response rate (n=3,738). MAIN OUTCOME MEASURES Participants self-reported use of multivitamin/mineral products. STATISTICAL ANALYSES Adjusting for covariates (demographics, single-ingredient and herbal supplement use) weighted stepwise binary logistic regression was used to examine correlates of self-reported multivitamin/mineral use. RESULTS Intake was associated with less than a high school education, having health insurance, and single-ingredient and herbal supplement use. Trust in health organizations (odds ratio [OR]=1.67, P<0.001) and the expectancy that cancer could be avoided with dietary supplements (OR=1.76, P<0.001) correlated with use. Agreement that supplements labeled as "anticarcinogenic" could treat (OR=3.07, P<0.001) or prevent cancer (OR=6.06, P<0.001) correlated with multivitamin/mineral use. Fatalistic beliefs (P<0.001) and negative information-seeking experiences (P<0.001) were associated with slightly lower odds of use. CONCLUSIONS Despite leading health organizations' discouragement of dietary supplements for cancer prevention, this study found that trust in health organizations and outcome expectancies were associated with multivitamin/mineral use. This divergence presents a need to explore how dietary supplement evidence based recommendations can be translated and disseminated for the public.
Collapse
|
17
|
Loh KP, Xu H, Back A, Duberstein PR, Gupta Mohile S, Epstein R, McHugh C, Klepin HD, Abel G, Lee SJ, El-Jawahri A, LeBlanc TW. Patient-hematologist discordance in perceived chance of cure in hematologic malignancies: A multicenter study. Cancer 2019; 126:1306-1314. [PMID: 31809566 DOI: 10.1002/cncr.32656] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/29/2019] [Accepted: 11/07/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Ensuring that patients with hematologic malignancies have an accurate understanding of their likelihood of cure is important for informed decision making. In a multicenter, longitudinal study, the authors examined discordance in patients' perception of their chance of cure versus that of their hematologists, whether patient-hematologist discordance changed after a consultation with a hematologist, and factors associated with persistent discordance. METHODS Before and after consultation with a hematologist, patients were asked about their perceived chance of cure (options were <10%, 10%-19%, and up to 90%-100% in 10% increments, and "do not wish to answer"). Hematologists were asked the same question after consultation. Discordance was defined as a difference in response by 2 levels. The McNemar test was used to compare changes in patient-hematologist prognostic discordance from before to after consultation. A generalized linear mixed model was used to examine associations between factors and postconsultation discordance, adjusting for clustering at the hematologist level. RESULTS A total of 209 patients and 46 hematologists from 4 sites were included in the current study. Before consultation, approximately 61% of dyads were discordant, which improved to 50% after consultation (P < .01). On multivariate analysis, lower educational level (<college vs postgraduate: odds ratio [OR], 2.24; 95% CI, 1.02-4.92), higher social support-affection subscale score (1-unit change in score: OR, 1.15; 95% CI, 1.00-1.32), and discordance before consultation (OR, 6.17; 95% CI, 2.99-12.72) were found to be significantly associated with discordance after consultation. CONCLUSIONS Patient-hematologist concordance in prognostic understanding appears to improve after a hematology consultation, but approximately one-half of patients' views of their prognoses were found to remain discordant with those of their hematologists. Interventions are needed to improve prognostic understanding among patients with hematologic malignancies.
Collapse
Affiliation(s)
- Kah Poh Loh
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York
| | - Huiwen Xu
- Department of Surgery, Cancer Control, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Anthony Back
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Paul R Duberstein
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, New Jersey
| | - Supriya Gupta Mohile
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York
| | - Ronald Epstein
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York.,Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Palliative Care Program, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Colin McHugh
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York
| | - Heidi D Klepin
- Section on Hematology and Oncology, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina
| | - Gregory Abel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Areej El-Jawahri
- Department of Hematology-Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Thomas W LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| |
Collapse
|
18
|
Duberstein PR, Kravitz RL, Fenton JJ, Xing G, Tancredi DJ, Hoerger M, Mohile SG, Norton SA, Prigerson HG, Epstein RM. Physician and Patient Characteristics Associated With More Intensive End-of-Life Care. J Pain Symptom Manage 2019; 58:208-215.e1. [PMID: 31004774 PMCID: PMC6679778 DOI: 10.1016/j.jpainsymman.2019.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/12/2019] [Accepted: 04/12/2019] [Indexed: 12/25/2022]
Abstract
CONTEXT Although patient and physician characteristics are thought to be predictive of discretionary interventions at the end of life (EoL), few studies have data on both parties. OBJECTIVE To test the hypothesis that patient preferences and physician attitudes are both independently associated with discretionary interventions at the EoL. METHODS We report secondary analyses of data collected prospectively from physicians (n = 38) and patients with advanced cancer (n = 265) in the Values and Options in Cancer Care study. Predictor variables were patient attitudes toward EoL care and physician-reported comfort with medical paternalism, assessed indirectly using a modified version of the Control Preference Scale. We explored whether the magnitude of the physician variable was influenced by the inclusion of particular patient treatment-preference variables (i.e., effect modification). Outcomes were a chemotherapy use score (≤14 days before death [scored 2], 15-31 days before death [scored 1], and >31 days [scored 0]) and an emergency department visit/inpatient admission score (two or more admissions in the last 31 days [scored 2], one admission [1], and 0 admissions [0]) in the last month of life. RESULTS Chemotherapy scores were nearly 0.25 points higher if patients expressed a preference for experimental treatments with unknown benefit at study entry (0.238 points, 95% CI = 0.047-0.429) or reported an unfavorable attitude toward palliative care (0.247 points, 95% CI = 0.047-0.450). A two-standard deviation difference in physician comfort with medical paternalism corresponded to standardized effects of 0.35 (95% CI = 0.03-0.66) for chemotherapy and 0.33 (95% CI = 0.04-0.61) for emergency department visits/inpatient admissions. There was no evidence of effect modification. CONCLUSION Patient treatment preferences and physician attitudes are independently associated with higher levels of treatment intensity before death. Greater research, clinical, and policy attention to patient treatment preferences and physician comfort with medical paternalism might lead to improvements in care of patients with advanced disease.
Collapse
Affiliation(s)
- Paul R Duberstein
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Health Behavior, Society, and Policy, Rutgers University School of Public Heath, Piscataway, New Jersey, USA.
| | - Richard L Kravitz
- Department of Internal Medicine, University of California, Davis, Sacramento, California, USA; Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA; UC Davis Comprehensive Cancer Center, University of California, Davis, Sacramento, California, USA
| | - Joshua J Fenton
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA; UC Davis Comprehensive Cancer Center, University of California, Davis, Sacramento, California, USA; Department of Family and Community Medicine, University of California, Davis, Sacramento, California, USA
| | - Guibo Xing
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA
| | - Daniel J Tancredi
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA; Department of Pediatrics, University of California, Davis, Sacramento, California, USA
| | - Michael Hoerger
- Tulane Cancer Center, Tulane University, New Orleans, Louisiana, USA; Departments of Psychology, Psychiatry, and Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Supriya G Mohile
- James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Sally A Norton
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; School of Nursing, University of Rochester, Rochester, New York, USA
| | - Holly G Prigerson
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA; Cornell Center for Research on End-of-Life Care, New York, New York, USA
| | - Ronald M Epstein
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| |
Collapse
|
19
|
Loh KP, Mohile SG, Lund JL, Epstein R, Lei L, Culakova E, McHugh C, Wells M, Gilmore N, Mohamed MR, Kamen C, Aarne V, Conlin A, Bearden J, Onitilo A, Wittink M, Dale W, Hurria A, Duberstein P. Beliefs About Advanced Cancer Curability in Older Patients, Their Caregivers, and Oncologists. Oncologist 2019; 24:e292-e302. [PMID: 31015317 PMCID: PMC6656513 DOI: 10.1634/theoncologist.2018-0890] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/11/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Ensuring older patients with advanced cancer and their oncologists have similar beliefs about curability is important. We investigated discordance in beliefs about curability in patient-oncologist and caregiver-oncologist dyads. MATERIALS AND METHODS We used baseline data from a cluster randomized trial assessing whether geriatric assessment improves communication and quality of life in older patients with advanced cancer and their caregivers. Patients were aged ≥70 years with incurable cancer from community oncology practices. Patients, caregivers, and oncologists were asked: "What do you believe are the chances the cancer will go away and never come back with treatment?" Options were 100%, >50%, 50/50, <50%, and 0% (5-point scale). Discordance in beliefs about curability was defined as any difference in scale scores (≥3 points were severe). We used multivariate logistic regressions to describe correlates of discordance. RESULTS Discordance was present in 60% (15% severe) of the 336 patient-oncologist dyads and 52% (16% severe) of the 245 caregiver-oncologist dyads. Discordance was less common in patient-oncologist dyads when oncologists practiced longer (adjusted odds ratio [AOR] 0.90, 95% confidence interval [CI] 0.84-0.97) and more common in non-Hispanic white patients (AOR 5.77, CI 1.90-17.50) and when patients had lung (AOR 1.95, CI 1.29-2.94) or gastrointestinal (AOR 1.55, CI 1.09-2.21) compared with breast cancer. Severe discordance was more common when patients were non-Hispanic white, had lower income, and had impaired social support. Caregiver-oncologist discordance was more common when caregivers were non-Hispanic white (AOR 3.32, CI 1.01-10.94) and reported lower physical health (AOR 0.88, CI 0.78-1.00). Severe discordance was more common when caregivers had lower income and lower anxiety level. CONCLUSION Discordance in beliefs about curability is common, occasionally severe, and correlated with patient, caregiver, and oncologist characteristics. IMPLICATIONS FOR PRACTICE Ensuring older patients with advanced cancer and their caregivers have similar beliefs about curability as the oncologist is important. This study investigated discordance in beliefs about curability in patient-oncologist (PO) and caregiver-oncologist (CO) dyads. It found that discordance was present in 60% (15% severe) of PO dyads and 52% (16% severe) of CO dyads, raising serious questions about the process by which patients consent to treatment. This study supports the need for interventions targeted at the oncologist, patient, caregiver, and societal levels to improve the delivery of prognostic information and patients'/caregivers' understanding and acceptance of prognosis.
Collapse
Affiliation(s)
- Kah Poh Loh
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Supriya G Mohile
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Jennifer L Lund
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ronald Epstein
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
- Department of Psychiatry, Palliative Care, University of Rochester Medical Center, Rochester, New York, USA
- Department of Family Medicine, Palliative Care, University of Rochester Medical Center, Rochester, New York, USA
- Department of Medicine, Palliative Care, University of Rochester Medical Center, Rochester, New York, USA
| | - Lianlian Lei
- Department of Public Health Services, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Eva Culakova
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Colin McHugh
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Megan Wells
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Nikesha Gilmore
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Mostafa R Mohamed
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Charles Kamen
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Valerie Aarne
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Alison Conlin
- Pacific Cancer Research Consortium NCORP, Seattle, Washington, USA
| | - James Bearden
- Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, North Carolina, USA
| | | | - Marsha Wittink
- Department of Psychiatry, Palliative Care, University of Rochester Medical Center, Rochester, New York, USA
| | - William Dale
- City of Hope National Medical Center, Duarte, California, USA
| | - Arti Hurria
- City of Hope National Medical Center, Duarte, California, USA
| | - Paul Duberstein
- Department of Psychiatry, Palliative Care, University of Rochester Medical Center, Rochester, New York, USA
- Rutgers School of Public Health, Piscataway, New Jersey, USA
| |
Collapse
|
20
|
Saeed F, Sardar MA, Davison SN, Murad H, Duberstein PR, Quill TE. Patients' perspectives on dialysis decision-making and end-of-life care
. Clin Nephrol 2019; 91:294-300. [PMID: 30663974 PMCID: PMC6595398 DOI: 10.5414/cn109608] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 04/10/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Few studies have explored dialysis patients' perspectives on dialysis decision-making and end-of-life-care (EoLC) preferences. We surveyed a racially diverse cohort of maintenance dialysis patients in the Cleveland, OH, USA, metropolitan area. MATERIALS AND METHODS In this cross-sectional study, we administered a 41-item questionnaire to 450 adult chronic dialysis patients. Items assessed patients' knowledge of their kidney disease as well as their attitudes toward chronic kidney disease (CKD) treatment issues and EoLC issues. RESULTS The cohort included 67% Blacks, 27% Caucasians, 2.8% Hispanics, and 2.4% others. The response rate was 94% (423/450). Most patients considered it essential to obtain detailed information about their medical condition (80.6%) and prognosis (78.3%). Nearly 19% of respondents regretted their decision to start dialysis. 41% of patients would prefer treatment(s) aimed at relieving pain rather than prolonging life (30.5%), but a majority would want to be resuscitated (55.3%). Only 8.4% reported having a designated healthcare proxy, and 35.7% reported completing a living will. A significant percentage of patients wished to discuss their quality of life (71%), psychosocial and spiritual concerns (50.4%), and end-of-life issues (38%) with their nephrologist. CONCLUSION Most dialysis patients wish to have more frequent discussions about their disease, prognosis, and EoLC planning. Findings from this study can inform the design of future interventions.
.
Collapse
Affiliation(s)
- Fahad Saeed
- Department of Medicine, Division of Nephrology
- Division of Palliative Care University of Rochester School of Medicine and Dentistry, Rochester
| | | | - Sara N. Davison
- Division of Nephrology & Immunology, University of Alberta, Edmonton, Alberta, Canada, and
| | - Haris Murad
- Section of Nephrology, Yale School of Medicine, New Haven, CT, USA
| | - Paul R. Duberstein
- Division of Palliative Care University of Rochester School of Medicine and Dentistry, Rochester
- Department of Psychiatry, and Department of Family Medicine and Center for Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Timothy Edward Quill
- Division of Palliative Care University of Rochester School of Medicine and Dentistry, Rochester
| |
Collapse
|
21
|
Loh KP, Mohile SG, Epstein RM, McHugh C, Flannery M, Culakova E, Lei L, Wells M, Gilmore N, Babu D, Whitehead MI, Dale W, Hurria A, Wittink M, Magnuson A, Conlin A, Thomas M, Berenberg J, Duberstein PR. Willingness to bear adversity and beliefs about the curability of advanced cancer in older adults. Cancer 2019; 125:2506-2513. [PMID: 30920646 DOI: 10.1002/cncr.32074] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/07/2019] [Accepted: 02/28/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Older patients with advanced cancer who are 100% certain they will be cured pose unique challenges for clinical decision making, but to the authors' knowledge, the prevalence and correlates of absolute certainty about curability (ACC) are unknown. METHODS Cross-sectional data were collected in a geriatric assessment trial. ACC was assessed by asking patients, "What do you believe are the chances that your cancer will go away and never come back with treatment?" Response options were 100% (coded as ACC), >50%, 50/50, <50%, 0%, and uncertain. The willingness to bear adversity in exchange for longevity was assessed by asking patients to consider trade-offs between survival and 2 clinical outcomes that varied in abstractness: 1) maintaining quality of life (QOL; an abstract outcome); and 2) specific treatment-related toxicities (eg, nausea/vomiting, worsening memory). Logistic regression was used to assess the independent associations between willingness to bear adversity and ACC. RESULTS Of the 524 patients aged 70 to 96 years, approximately 5.3% reported that there was a 100% chance that their cancer would be cured (ACC). ACC was not found to be significantly associated with willingness to bear treatment-related toxicities, but was more common among patients who were willing to trade QOL for survival (adjusted odds ratio, 4.08; 95% CI, 1.17-14.26). CONCLUSIONS Patients who were more willing to bear adversity in the form of an abstract state, namely decreased QOL, were more likely to demonstrate ACC. Although conversations regarding prognosis should be conducted with all patients, those who are willing to trade QOL for survival may especially benefit from conversations that focus on values and emotions.
Collapse
Affiliation(s)
- Kah Poh Loh
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Supriya G Mohile
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Ronald M Epstein
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Division of Palliative Care, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Colin McHugh
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Marie Flannery
- School of Nursing, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Eva Culakova
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Lianlian Lei
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Megan Wells
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Nikesha Gilmore
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Dilip Babu
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Mary I Whitehead
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - William Dale
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Arti Hurria
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Marsha Wittink
- Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Allison Magnuson
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Alison Conlin
- Pacific Cancer Research Consortium National Cancer Institute Community Oncology Research Program (NCORP), Seattle, Washington
| | - Melanie Thomas
- Southeast Clinical Oncology Research Consortium (SCOR), Winston-Salem, North Carolina
| | - Jeffrey Berenberg
- Hawaii Minority Underserved National Cancer Institute Community Oncology Research Program (MU-NCORP), Honolulu, Hawaii
| | - Paul R Duberstein
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Social and Behavioral Health Sciences, Rutgers School of Public Health, New Brunswick, New Jersey
| |
Collapse
|
22
|
Abstract
OBJECTIVES To describe pediatric palliative care (PPC) in pediatric oncology, the importance of PPC for pediatric oncology patients, disparities within pediatric palliative oncology, innovative strategies for improving PPC access in underserved populations, and implications for oncology nursing practice. DATA SOURCES Published pediatric oncology and palliative peer-reviewed articles and guidance documents. CONCLUSION Disparities exist within pediatric palliative oncology. There is much work needed to improve the reach and quality of PPC for pediatric oncology patients, especially those from underserved populations. IMPLICATIONS FOR NURSING PRACTICE Nurses serve a critical role in advocating for PPC for seriously ill pediatric cancer patients and their families.
Collapse
|
23
|
Saeed F, Hoerger M, Norton SA, Guancial E, Epstein RM, Duberstein PR. Preference for Palliative Care in Cancer Patients: Are Men and Women Alike? J Pain Symptom Manage 2018; 56:1-6.e1. [PMID: 29581034 PMCID: PMC6015521 DOI: 10.1016/j.jpainsymman.2018.03.014] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 03/02/2018] [Accepted: 03/13/2018] [Indexed: 11/21/2022]
Abstract
CONTEXT Men and those with low educational attainment are less likely to receive palliative care. Understanding these disparities is a high priority issue. OBJECTIVES In this study of advanced cancer patients, we hypothesized that men and those with lower levels of educational attainment would have less favorable attitudes toward palliative care. METHODS We performed a cross-sectional analysis of data collected from 383 patients at study entry in the Values and Options in Cancer Care (VOICE) clinical trial. Patients were asked about their preferences for palliative care if their oncologist informed them that further treatment would not be helpful. Palliative care was defined as "comfort care" that focuses on "quality of life, but not a cure." Response options were definitely no, possibly no, unsure, possibly yes, and definitely yes. Those preferring palliative care (definitely or possibly yes) were compared to all others. Predictors were patient gender and education level. Covariates included age, race, disease aggressiveness, and financial strain. RESULTS Women were more likely [odds ratio (95% CI)] than men to prefer palliative care [3.07 (1.80-5.23)]. The effect of education on preferences for palliative care was not statistically significant [0.85 (0.48-1.48)]. CONCLUSION Significant gender differences in patients' preferences for palliative care could partially account for gender disparities in end-of-life care. Interventions to promote palliative care among men could reduce these disparities.
Collapse
Affiliation(s)
- Fahad Saeed
- Division of Nephrology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
| | - Michael Hoerger
- Department of Psychology, Tulane University, New Orleans, Louisiana
| | - Sally A Norton
- Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; School of Nursing, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Elizabeth Guancial
- Division of Hematology Oncology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Ronald M Epstein
- Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Family Medicine and Center for Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Paul R Duberstein
- Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Family Medicine and Center for Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| |
Collapse
|