Emotional support for cancer patients: what do patients really want?

A qualitative analysis and evaluation of social support received after experiencing a broken marriage engagement and impacts on holistic health

This study provides new insights into the role of social support in the largely unexplored field of broken marriage engagements and an individual's wellbeing. The study extends the optimal matching theory (OMT) and the research surrounding helpful, unhelpful, and mixed social support. It uses constant comparison to examine the social support messages individuals received after telling others their engagement ended, as described in 43, in-depth, semi-structured interviews. Six types of helpful support messengers, six types of unhelpful support messengers, and four mixed messenger types were found. Receiver-centric messengers were found to be more helpful than messengers who centered on their own feelings and needs, sometimes to the detriment of the receiver's own wellbeing. Being present, thoughtful, and intentional with words, can have a positive impact on a person's holistic health, regardless of whether the relationship is a weak-tie or strong-tie. Using study findings, the broken engagement message stoplight is proposed, detailing messages that are generally helpful to a person's overall wellbeing, messages that should likely be avoided, and messages that should be said cautiously when interacting with someone experiencing a broken engagement.

Is Social Support Associated with Colorectal Cancer Care Utilization? A Multilevel Mixed-Effects Model of a Cross-Sectional Cohort Study in Vietnam

OBJECTIVE

To investigate the relationship between the social support (SS) and colorectal cancer (CRC) care utilization of patients in the central region of Vietnam.

METHODS

This was a cross-sectional cohort study in which the cohort was defined as all residential patients diagnosed with CRC in a tertiary hospital, Hue Central Hospital (HCH), in central Vietnam from 2013 to 2019. Social support was considered the main independent variable and was evaluated using the Medical Outcomes Study Social Support Survey (MOS-SSS), a self-administered 19-item SS survey. MOS-SSS is a widely used scale for assessing social support in CRC patients because it is brief, easy to use, reliable, and valid. In this study, we considered a data framework with a multilevel structure that included the patient level and duration of diagnosis as the second level. We estimated the magnitude of SS and CRC-specific treatment modalities using multilevel mixed-effects (MM) models under a hierarchical approach.

RESULTS

The findings indicated that CRC care utilization rates were 89.9%, 48.5%, and 30.6% for surgical resection, chemotherapy, and radiation therapy, respectively. The overall trend of SS decreased significantly and affected the CRC care utilization. We found a positive effects of overall SS, as well as emotional and tangible support, on the number of hospitalization admissions and chemotherapy utilization.

CONCLUSION

This study suggests that the use of the MOS-SSS should be continued in the long term for CRC patients to enhance medical accessibility and care utilization.

A first census of skin cancer specialist nurses across UK secondary care trusts

BACKGROUND

Skin cancer specialist nurses (SCSNs) support patients and work alongside healthcare professionals throughout the care pathway. Skin cancer management is rapidly evolving, with increasing and more complex treatment options now available, so the need for patient support is growing. While SCSNs are a major source of that support, the provision of SCSN resource across the UK has never previously been assessed. We therefore undertook a first SCSN census on 1st June 2021.

METHODS

An electronic survey was disseminated to UK hospital trusts and registered skin cancer healthcare professionals. Responses were identifiable only by the respective trust name.

RESULTS

112 responses from 87 different secondary care trusts were received; 92% of trusts reporting having at least 1 established SCSN post. Average SCSN staffing per trust was 2.4 (range 0-7) whole time equivalents, managing an average caseload of 83 (range 6-400) patients per week. SCSN workload had increased in 82% hospitals in the previous year and 30% of trusts reported being under-resourced. Most SCSN time was spent managing melanoma (as opposed to non-melanoma skin cancer) patients linked to surgical services. Regional variations existed, particularly associated with provision of lymphoedema services, nurse prescribing skills and patient access to clinical trials. The COVID-19 pandemic was associated with a marked increase in SCSN-led telemedicine clinics, but loss of training and education opportunities.

CONCLUSIONS

SCSNs based in secondary care hospitals play a major role supporting both clinicians and patients throughout the care pathway. This first UK census confirmed that SCSN workload is increasing and in one third of hospital trusts, the work was reported to outstrip the staffing available to manage the volume of work. Regional variations in SCSN resource, workload and job role, as well as availability of certain skin cancer services were identified, providing valuable information to healthcare commissioners concerned with service improvement.

The role of integrated psychological support in breast cancer patients: a randomized monocentric prospective study evaluating the Fil-Rouge Integrated Psycho-Oncological Support (FRIPOS) program

PURPOSE

This study examined the effects of Fil-Rouge Integrated Psycho-Oncological Support (FRIPOS) in a group of women with breast cancer compared with a group receiving treatment as usual (TAU).

METHODS

The research design was a randomized, monocentric, prospective study with three time points of data collection: after the preoperative phase (T0), in the initial phase of treatments (T1), and 3 months after the start of treatments (T2). The FRIPOS group (N = 103) and the TAU group (N = 79) completed a sociodemographic questionnaire, the Symptom Checklist-90-R (SCL-90-R) at T0; the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ) C30 and EORTC QLQ-BR23 at T1; and SCL-90-R, EORTC QLQ-C30, and EORTC QLQ-BR23 at T2.

RESULTS

A series of independent and paired t tests showed that patients in the FRIPOS group performed better on all scales related to symptomatic manifestations and on some quality of life scales (fatigue, dyspnea, and sleep disturbances) at T2. In addition, a series of ten multiple regressions were performed to predict each SCL subscale at T2 from the SCL score at T0 and the EORTC QLQ-C30 scores at T2. In nine of ten regression models (all except somatization), both FRIPOS group membership and QoL subscale contributed significantly to prediction.

CONCLUSIONS

This study suggests that patients in the FRIPOS group have more benefits in emotional, psychological, and collateral symptoms than patients in the TAU group and that these improvements are due to integrated psycho-oncology care.

A Robotic Companion for Psychological Well-being: A Long-term Investigation of Companionship and Therapeutic Alliance

Social support plays a crucial role in managing and enhancing one's mental health and well-being. In order to explore the role of a robot's companion-like behavior on its therapeutic interventions, we conducted an eight-week-long deployment study with seventy participants to compare the impact of (1) a control robot with only assistant-like skills, (2) a coach-like robot with additional instructive positive psychology interventions, and (3) a companion-like robot that delivered the same interventions in a peer-like and supportive manner. The companion-like robot was shown to be the most effective in building a positive therapeutic alliance with people, enhancing participants' well-being and readiness for change. Our work offers valuable insights into how companion AI agents could further enhance the efficacy of the mental health interventions by strengthening their therapeutic alliance with people for long-term mental health support.

The Influence of Personality and Demographic Characteristics on Aggressive Driving Behaviors in Eastern Chinese Drivers

Purpose

Road safety research is important due to the large number of road traffic fatalities globally. This study investigated the influences of age, driving experience and other covariates on aggressive driving behavior.

Methods

A cross-sectional survey was conducted in Yixing City, Wuxi City, Jiangsu Province, China. Regression analysis was applied to explore the influences of age and driving experience and their interactions with other covariates on aggressive driving behavior. Two analyses methodologies were used to assess the simple effect of the interactions. Firstly, the Jamovi automatic analysis classification program was used to calculate the simple slope test. Second, the SPSS macro program was also used to calculate the simple slope test also.

Results

A total of 570 drivers (247 males, 282 females) participated in the survey. A negative correlation was found between age and aggressive driving behaviors, and a positive correlation was found between neuroticism and aggressive driving behaviors in the multiple regression analysis. Significant associations were also found between age, driving experience, and depression, as well as age, driving experience, and neuroticism. Simple slope tests showed that depressive symptoms could increase aggressive behaviors in the elderly and experienced drivers. When experiencing neuroticism, individuals with higher driving experience were more aggressive in driving than shorter experienced drivers.

Conclusion

Age and neuroticism influenced aggressive driving behaviors. Veteran drivers could be aggressive drivers when experiencing depressive symptoms or neuroticism. Mobile intervention could be sent to the potentially risky drivers, which would be safe and broadly feasible to prevent aggressive driving behavior in the background of COVID-19.

Information provision to older patients receiving palliative chemotherapy: a quality study

OBJECTIVES

Cancer treatment has become increasingly successful. However, prolonging and preserving life has become an important goal of therapy since many patients generally receive palliative chemotherapy. The perception of life changes when patients are informed, that no curative treatment is possible. This raises new dilemmas for patients with incurable cancer, but only sparse information is available about the thoughts of these patients.The aim of this study was to explore how older patients experience the information on absence of curative treatment options.

METHODS

Qualitative interviews were performed in eleven older patients with incurable upper gastrointestinal cancer receiving first-line palliative chemotherapy. Median age was 74 (65-76) years. We used a qualitative approach to collect data through semistructured individual interviews conducted at the hospital or by telephone interviews by an experienced researcher. The thematic analysis was conveyed by Braun and Clarke.

RESULTS

The interview findings were grouped around three main themes: hope of being cured, hearing but not comprehending, and desired milestones to reach. Further, it was determined that patients hid their feelings and avoided talking about the disease with the health professionals due to fear of being told the truth.

CONCLUSIONS

Receiving information about their incurable cancer was an ongoing dilemma for the patients. Following the message, patients shared thoughts about reaching important milestones in life, spending time with their family or hope for a cure to be found.

Understanding relationship commitment and continuous knowledge sharing in online health communities: a social exchange perspective

Purpose

Online health communities (OHCs) have become increasingly popular sources of health information in recent years. However, little is known about the factors that affect the relationship commitment and continuous knowledge sharing intention among OHC members. Thus, this study aims to integrate social exchange and commitment-trust theories to establish a theoretical model to fill the gap.

Design/methodology/approach

A research model that integrates social exchange theory and commitment-trust theory is developed. Quantitative data from 519 valid questionnaires are collected via an offline survey. Statistical product and service solutions 20.0 and analysis of a moment structures 20.0 software are used to test the hypotheses.

Findings

Relationship commitment directly influences continuous knowledge sharing intention, partially mediates the relationship between social support and continuous knowledge sharing intention, and fully mediates the relationship between perceived health risks and continuous knowledge sharing intention. Informational and emotional supports are identified as benefit factors that positively affect relationship commitment and perceived health risks are regarded as cost factors that negatively influence relationship commitment. Informational and emotional supports of OHC members produce different effects on relationship commitment when members obtain social support from different sources. Moreover, trust moderates the influences of informational support and perceived health risks on relationship commitment.

Originality/value

The findings provide additional insights that can augment the knowledge management literature by indicating how people are driven to share knowledge continuously in the context of OHCs. This study empirically clarifies the relationships of benefits (i.e. social support) and costs (i.e. perceived health risks) to continuous knowledge sharing intention by demonstrating the significant mediating effect of relationship commitment. In addition, the findings of this study highlight the importance of the social support source in OHCs and provide additional insights into commitment–trust theory by integrating the moderating effect of trust on the relationships between relationship commitment and its antecedents.

Exploring the problems faced by patients living with advanced cancer in Bengaluru, India

Purpose

Cancer is a key influence on psychosocial and emotional distress among patients. Problems that advanced cancer patients in the western world face have been widely explored, but these findings may not be applicable in the non-western world due to the cultural differences. Exploring the problems of advanced cancer patients will help professionals plan appropriate therapeutic interventions to take care of the patients' physical, emotional, social and practical needs. Hence, this study aims to explore the psychosocial and emotional problems of advanced cancer patients in India.

Methods

Data were collected from 10 advanced cancer patients from Bengaluru, using purposive sampling and semi-structured interviews. The interviews were audio-recorded and transcribed. Themes were generated using thematic analysis.

Results

The prevalent themes were financial instability, hopelessness, family anguish, self-blame, helplessness, anger, stress, and suicidal thoughts.

Conclusion

This research has highlighted that advanced cancer patients have several issues, indicating the importance of using a holistic approach while handling this vulnerable population by focusing more on the patient rather than the disease.

Assessing psychological needs in female cancer patients: a tailored model

BACKGROUND AND AIM OF THE WORK

Psychosocial needs in cancer patients seem to be underestimated and undertreated. The present research was designed to explore under-considered psychosocial needs (e.g., stressful life events, perceived social support, sense of mastery and depressive/anxious symptoms) of a female cancer group. The aim of the study was to test an assessment psycho-oncological model for female cancer patients. An assessment model of psychosocial needs and Stressful Life Events was operationalized and tests its predictive power.

METHODS

We used Discriminant Analysis to test predictive power of the model and of the single variables included in it. 236 oncological patients (mean age 55.50 ± 13.09) were matched with 232 healthy control groups in the study. The following instruments were chosen: the Florence Psychiatric Interview, Hospital Anxiety Depression Scale, Multidimensional Scale of Perceived Social Support, Beck Depression Inventory I, and Sense of Mastery.

RESULTS

The model satisfied the assumption criteria and was significant (Ʌ= .680, X2 = 109.73, p< .001).

CONCLUSIONS

Stressful events, depression and anxiety were adequate markers of the assessment psycho-oncological model proposed for female cancer patients. The present study provides contributions in a clinical perspective: the results support the relevance of considering an assessment psychosocial model to use in female oncology for an accurate estimation of the women's needs. Women affected by female cancer with an history of Stressful Early and Recent life events and high level of anxiety and depression could positively benefit from a psychotherapy treatment.

Cognitive mechanisms underlying interaction and contribution in online health communities: the perspectives of doctors and patients

Purpose

Active interaction and knowledge contribution are vital yet challenging elements of the sustainable development of online health communities (OHCs). To investigate the cognitive mechanisms underlying these behaviours in doctors' and patients' use of OHCs, this study develops a theoretical model to examine the relationships among cognitive modes, patterns of interaction, perceived usefulness, and contribution behaviour and the impact of user identity on these relationships.

Design/methodology/approach

To test the research hypotheses, structural equation modelling and multiple-group analysis were used to analyse survey data from 207 doctors and 213 patients.

Findings

The results indicate that dual processes and perceived usefulness are the key cognitive antecedents of interaction and knowledge contribution, respectively. However, the correlation of the rational mode and instrumental interaction is significantly stronger in the doctors' group than in the patients' group, while a stronger correlation between the experiential mode and instrumental interaction is observed in the patients' group.

Practical implications

These findings support the development of information and system strategies to support the operation of dual processes underlying doctors' and patients' instrumental and affective interactions, facilitate evaluation and sense-making of interaction activities, and motivate knowledge contribution.

Originality/value

This study uncovers the invariance and variability in the relationships between salient cognitive activities and behavioural responses in doctors' and patients' use of OHCs and the impact of user identity on variability.

Social networks in coworking spaces and individual coworker’s creativity

Coworking spaces (CWS) are open creative labs that provide a community-like environment and the necessary surroundings for their users to build and maintain networks with different actors inside and outside the CWS. With a wide variety of knowledge and skills available in trusted surroundings as well as similar value orientations, coworkers enjoy favorable conditions to establish their network-style. However, research has not investigated the benefit of coworkers’ social networks as far as their individual creativity is concerned so far. This paper takes several network characteristics into account: structure in terms of network size and centrality in the CWS, but also trusted and reciprocal relationships, supportiveness, diversity of knowledge exchanged, and the individual openness to core coworking values. Based on the literature on social networks and small group research, we developed a research model. We tested it to get deeper insights into the phenomenon by relying on 113 coworkers in 33 private German coworking spaces. The results show that a central position in the CWS allowing for direct exchange and high individual openness to core coworking values positively affects social involvement and the diversity of knowledge exchanged, and finally, a coworker’s individual creativity. Managerial implications include the vital role of a central position in the CWS for creativity and a somewhat balanced composition of coworkers working alone or in a team.

A Cross-Sectional Study Examining the Relationship Between Socio-Demographics and Coping Styles in a Group of Cancer Patients

OBJECTIVE

The global number of oncological patients is expected to rise worldwide. However, the increase in the number of cases is linked with an increase in life expectancy. Hence, it's worth knowing about patients' resources for managing life with chronic illness. Specifically, the present study was aimed to examine the association between socio-demographic characteristics and coping strategies.

METHOD

Participants were one-hundred and twenty-one cancer patients (70.2% females), aged 26 to 88 years (M=61.90, SD=12.16). Socio-demographic characteristics and coping styles were measured by a self-report questionnaire and the mini-Mental Adjustment to Cancer Scale. A series of standard multiple regression analyses were performed to predict coping styles based on gender, age, education level, marital status, working status, disability pension, income, and time since diagnosis at the moment of the survey.

RESULTS

The female gender showed a positive association with hopelessness/ helplessness, anxious preoccupation, fatalism, and avoidance. Being a worker seemed positively related to the fighting spirit strategy. Age, marital status, and disability pension did not reveal any association with coping. Having an active-work status was positively associated with fighting spirit. Finally, both educational level and income were negatively associated with the use of fatalism coping strategy, whereas the cancer patients with longer elapsed time since diagnosis showed tendency to fatalism style.

CONCLUSIONS

Consistent with the recognized relevance of individual differences for gathering data about patients' risk and protective factors, our findings might be useful for both research purpose and clinical practice.

Patients' Non-Medical and Organizational Needs during Cancer Diagnosis and Treatment

The aim of this cross-sectional study was to determine non-medical and organizational needs among cancer patients during diagnosis and treatment. The study included 384 cancer patients treated in five oncological centers in Poland. A questionnaire designed for the study was used. Most of the patients received psychological support from their partner/family/friends (88%), to a lesser extent from a psychologist (21%) and priests (4%). Forty-three percent of patients received social support from their partner/family/friends and only 7% of respondents received support from a social worker. Most patients stated they would like to have a professional who would help them with their non-medical problems during the diagnostic process and cancer treatment. The youth, with a higher education level who were professionally active and living in cities seemed to be more aware of their needs. Improvements to the oncological system in Poland should focus on expanding patient access to professional support of non-medical needs.

Can online support groups address psychological morbidity of cancer patients? An artificial intelligence based investigation of prostate cancer trajectories

Background

Online Cancer Support Groups (OCSG) are becoming an increasingly vital source of information, experiences and empowerment for patients with cancer. Despite significant contributions to physical, psychological and emotional wellbeing of patients, OCSG are yet to be formally recognised and used in multidisciplinary cancer support programs. This study highlights the opportunity of using Artificial Intelligence (AI) in OCSG to address psychological morbidity, with supporting empirical evidence from prostate cancer (PCa) patients.

Methods

A validated framework of AI techniques and Natural Language Processing (NLP) methods, was used to investigate PCa patient activities based on conversations in ten international OCSG (18,496 patients- 277,805 conversations). The specific focus was on activities that indicate psychological morbidity; the reasons for joining OCSG, deep emotions and the variation from joining through to milestones in the cancer trajectory. Comparative analyses were conducted using t-tests, One-way ANOVA and Tukey-Kramer post-hoc analysis.

Findings

PCa patients joined OCSG at four key phases of psychological distress; diagnosis, treatment, side-effects, and recurrence, the majority group was ‘treatment’ (61.72%). The four groups varied in expression of the intense emotional burden of cancer. The ‘side-effects’ group expressed increased negative emotions during the first month compared to other groups (p<0.01). A comparison of pre-treatment vs post-treatment emotions showed that joining pre-treatment had significantly lower negative emotions after 12-months compared to post-treatment (p<0.05). Long-term deep emotion analysis reveals that all groups except ‘recurrence’ improved in emotional wellbeing.

Conclusion

This is the first empirical study of psychological morbidity and deep emotions expressed by men with a new diagnosis of cancer, using AI. PCa patients joining pre-treatment had improved emotions, and long-term participation in OCSG led to an increase in emotional wellbeing, indicating a decrease in psychological distress. It is opportune to further investigate AI in OCSG for early psychological intervention as an adjunct to conventional intervention programs.

The therapeutic space and doctor-parent relationship in paediatrics: trainees' experiences and perspectives

AIM

To explore paediatric trainees' experiences and perspectives regarding interactions and relationships between physicians and patients' parents.

METHODS

Email survey was sent to AAP Section of Pediatric Trainees members. Trainees were asked about 40 interactions with parents as well as perceived benefits/risks and potential influences. Analysis of associations between variables and perspectives/experiences used chi-square and Fisher exact.

RESULTS

Three hundred and seventy surveys were completed. Respondents participated in a median of nine interactions (IQR 7-13; range 0-37): 99.7% participated in at least one; 52% in 5-10; 41% in >10. 50% reported refusing to participate in at least one interaction following parental request; 8% refused 5-10; 1% refused >10. Electronic communication/social media domain had highest refusals and most interactions respondents believed should never be allowed. 94% agreed that interactions may be beneficial to providers: 75% identified at least one benefit; 86% one risk. Respondents who are parents or female reported increased interactions.

CONCLUSION

A variety of interactions with patient's parents are common amongst paediatric trainees, who identify risks and benefits. Disagreements relative to acceptability of certain interactions points to the need for additional research. A reflective educational approach, rather than a prescriptive one, may help trainees better manage these relationships.

Pity: a qualitative study on Iranian women with breast cancer

BACKGROUND

Women with breast cancer (BC) are commonly confronted with others' pity. However, there is limited information about pity in Iranian women with BC. The aim of this study was to explore perceptions, reactions, coping strategies, and consequences of pity among Iranian women with BC.

METHODS

This qualitative study was carried out from March 2016 till October 2017. A purposive sample of 36 women with BC was selected with maximum variation from three health care centers in Alborz Province, Iran. Data were collected using semistructured interviews and analyzed using a conventional content-analysis approach.

RESULTS

Our findings indicated that Iranian women with BC experienced received pity and perceived unusual attention from others as due to certain reasons. Others' pity caused negative emotional reactions in them. They used self-protection strategies against others' pity. The consequences of self-protection against pity were normalizing the patient's flow of life and/or social isolation.

CONCLUSION

Pity is a serious psychosocial challenge in Iranian women with BC, with negative effects on quality of life. Therefore, pity should be considered in counseling and psychosocial screening of patients.

Cortisol response to stress in schizophrenia: Associations with oxytocin, social support and social functioning

Previous studies reported attenuated cortisol reactivity as one explanation for poor social functioning in schizophrenia. Recent research has demonstrated that both glucocorticoid and oxytocin systems are central to stress regulation. Here, we studied the associations between basal oxytocin, stress-induced cortisol levels, and social functioning and social support in schizophrenia. A mock job interview was used as an ecologically-valid social stressor in 32 schizophrenia patients. Blood samples were taken before and after stress induction to assess basal oxytocin and cortisol levels. In addition social functioning and social support scales were collected. Patients were divided into cortisol responders and non-responders according to percentage change following stress induction. Our findings revealed a possible subgroup of patients who did not exhibit attenuated cortisol responses. Importantly, cortisol responders had generally better social functioning, but perceived social support was not different between groups. There was also no evidence of a relationship between cortisol and oxytocin. This study highlights the heterogeneity of cortisol responses to stress in a schizophrenia population, and the importance of the relationship between social functioning and cortisol reactivity. These findings could be relevant when considering therapeutic interventions that manipulate endocrinology in order to improve real-world functioning.

Seeking and using intention of health information from doctors in social media: The effect of doctor-consumer interaction

OBJECTIVE

The aim of this study is to investigate how doctor-consumer interaction in social media influences consumers' health information seeking and usage intention.

METHODS

Based on professional-client interaction theory and expectation confirmation theory, we propose that doctor-consumer interaction can be divided into instrumental interaction and affective interaction. These two types of interaction influence consumers' health information seeking and usage intention through consumer satisfaction and trust towards doctors. To validate our proposed research model, we employed the survey method. The measurement instruments for all constructs were developed based on previous literatures, and 352 valid answers were collected by using these instruments.

RESULTS

Our results reveal that consumers' intention to seek health information significantly predicts their intention to use health information from social media. Meanwhile, both consumer satisfaction and trust towards doctors influences consumers' health information seeking and usage intention significantly. With regards to the impact of the interaction between doctors and consumers, the results show that both types of doctor-consumer interaction significantly affect consumer satisfaction and trust towards doctors. The mediation analysis confirms the mediation role of consumer satisfaction and trust towards doctors.

CONCLUSIONS

Compared with many intentional intervention programs, doctor-consumer interaction can be treated as an effective intervention with low cost to promote consumers' health information seeking and usage. Meanwhile, both instrumental and affective interaction should be highlighted for the best interaction results. At last, consumer satisfaction and trust towards doctors could be considered as the important working mechanisms for the effect of doctor-consumer interaction.

Impact of a 2-Week Oncology Placement on Medical Students' Perception of Cancer

Statistics show that more than one in two people born after 1960 in the UK will develop cancer during their lifetime. However, a 2013 study found that only 36 % of UK medical schools offer dedicated clinical teaching in oncology. The aim of this study was to assess the views of medical students on five domains of oncology before and after their first clinical placement, to assess the impact, and to obtain students' views on the oncology curriculum. A 28-item questionnaire was developed to compare responses before and after the students' first 2-week clinical placement, and impact was measured as a positive or negative deviation from a baseline response. Students were asked about their career intentions and to evaluate their received teaching. Thirty-six (80 %) students responded to the questionnaire. The largest areas of change were identified in students' confidence in breaking bad news, recognising red flag symptoms, and awareness of the complications of cancer management. Following their placement, 19 students said they would consider a career in oncology, 14 said they would not, and 2 were undecided. Students stated that Maggie's Centre, a patient support facility, was the most useful learning experience. The evidence demonstrates that all students should experience oncology in a variety of settings to aid their learning. Student feedback and perception can help to guide and shape medical teaching.

Understanding a Nonlinear Causal Relationship Between Rewards and Physicians' Contributions in Online Health Care Communities: Longitudinal Study

Background

The online health care community is not just a place for the public to share physician reviews or medical knowledge, but also a physician-patient communication platform. The medical resources of developing countries are relatively inadequate, and the online health care community is a potential solution to alleviate the phenomenon of long hospital queues and the lack of medical resources in rural areas. However, the success of the online health care community depends on online contributions by physicians.

Objective

The aim of this study is to examine the effect of incentive mechanisms on physician’s online contribution behavior in the online health community. We addressed the following questions: (1) from which specialty area are physicians more likely to participate in online health care community activities, (2) what are the factors affecting physician online contributions, and (3) do incentive mechanisms, including psychological and material rewards, result in differences of physician online contributions?

Methods

We designed a longitudinal study involving a data sample in three waves. All data were collected from the Good Doctor website, which is the largest online health care community in China. We first used descriptive statistics to investigate the physician online contribution behavior in its entirety. Then multiple linear and quadratic regression models were applied to verify the causal relationship between rewards and physician online contribution.

Results

Our sample included 40,300 physicians from 3607 different hospitals, 10 different major specialty areas, and 31 different provinces or municipalities. Based on the multiple quadratic regression model, we found that the coefficients of the control variables, past physician online contributions, doctor review rating, clinic title, hospital level, and city level, were .415, .189, –.099, –.106, and –.143, respectively. For the psychological (or material) rewards, the standardized coefficient of the main effect was 0.261 (or 0.688) and the standardized coefficient of the quadratic effect was –0.015 (or –0.049). All estimates were statistically significant (P<.001).

Conclusions

Physicians with more past physician online contribution, with higher review ratings, coming from lower level clinics, not coming from tertiary hospitals, and not coming from big cities were more willing to participate in online health care community activities. To promote physician online contribution, it is necessary to establish an appropriate incentive mechanism including psychological and material rewards. Finally, our findings suggest two guidelines for designing a useful incentive mechanism to facilitate physician online contribution. First, material reward is more useful than psychological reward. Second, as indicated by the concave-down-increasing causal relationship between rewards and physician online contribution, although an appropriate reward is effective in encouraging willingness on the part of physicians to contribute to the online health care community, the effect of additional rewards is limited.

Two is a perfect number: Patient–doctor relationship and patient attachment style in palliative care

We tested the association between the palliative patient’s attachment style and the patient–doctor relationship, by means of Revised Adult Attachment Scale and a self-designed, patient–doctor relationship questionnaire. The study included 110 (52 M, 58 F) cancer, hospice patients, aged 36–80 years. We observed 54 percent of secure, 18 percent of dismissive, 9 percent of preoccupied, and 19 percent of fearful styles. Securely attached patients developed significantly ( p < .05) better relationships with doctors than insecure patients. There was no difference in the quality of the patient–doctor relationship among dismissive versus preoccupied versus fearful patients. We argue that attachment theory should be applied in palliative care to improve patients’ quality of life and dying.

Toward Predicting Social Support Needs in Online Health Social Networks

Background

While online health social networks (OHSNs) serve as an effective platform for patients to fulfill their various social support needs, predicting the needs of users and providing tailored information remains a challenge.

Objective

The objective of this study was to discriminate important features for identifying users’ social support needs based on knowledge gathered from survey data. This study also provides guidelines for a technical framework, which can be used to predict users’ social support needs based on raw data collected from OHSNs.

Methods

We initially conducted a Web-based survey with 184 OHSN users. From this survey data, we extracted 34 features based on 5 categories: (1) demographics, (2) reading behavior, (3) posting behavior, (4) perceived roles in OHSNs, and (5) values sought in OHSNs. Features from the first 4 categories were used as variables for binary classification. For the prediction outcomes, we used features from the last category: the needs for emotional support, experience-based information, unconventional information, and medical facts. We compared 5 binary classifier algorithms: gradient boosting tree, random forest, decision tree, support vector machines, and logistic regression. We then calculated the scores of the area under the receiver operating characteristic (ROC) curve (AUC) to understand the comparative effectiveness of the used features.

Results

The best performance was AUC scores of 0.89 for predicting users seeking emotional support, 0.86 for experience-based information, 0.80 for unconventional information, and 0.83 for medical facts. With the gradient boosting tree as our best performing model, we analyzed the strength of individual features in predicting one’s social support need. Among other discoveries, we found that users seeking emotional support tend to post more in OHSNs compared with others.

Conclusions

We developed an initial framework for automatically predicting social support needs in OHSNs using survey data. Future work should involve nonsurvey data to evaluate the feasibility of the framework. Our study contributes to providing personalized social support in OHSNs.

Verbal Social Support for Newly Diagnosed Breast Cancer Patients during Surgical Decision-Making Visits

This study reports an analysis of verbal social support strategies directed by surgeons and patients' companions to breast cancer patients using the social support behavior code (SSBC). Additionally, the influence of companions on the provision of social support is examined. Forty-six videotapes of appointments where treatment regimens were being decided were analyzed. Results demonstrated that the majority of units spoken by surgeons were coded as verbal social support, primarily in the form of informational social support. Companions' social support was lower (relative to surgeons) in nearly every category of social support assessed. Patients who brought companions were found to receive more network social support from surgeons. Overall, these results point to low emotional support from surgeons and companions for patients during these appointments, which indicates a need for modifications in empathy training for medical providers.

Impact of Emotional Support on Serum Cortisol in Breast Cancer Patients

CONTEXT

Breast cancer is the most commonly occurring female cancer in the world. Research gap exists regarding emotional support for breast cancer patients.

AIM

The main aim of this study was to compare the efficiency of Emotional Support- Focused Nurse directed Intervention on serum cortisol among arm I, II and III in breast cancer patients.

METHODS

The study was designed to compare the effectiveness of emotional support focused nurse directed intervention in terms of verbal, written and telephone basis on serum cortisol among breast cancer patients in Cancer Centre at Erode. Participants were randomly allocated by using Sequentially Numbered Opaque Sealed Envelope (SNOSE) method. 2 ml of blood samples were collected from 30 breast cancer patients who were selected randomly by adopting random number table, 10 in each experimental arm during evening at 18 hour; radioimmunoassay method was used to measure the level of serum cortisol before and after intervention. The intervention was given twice in a week for the duration of 30-45 minutes, in which early 20-30 minutes spares to express thoughts and feelings of the participants and subsequent 10-15 minutes for rendering informational support and later follow up session for the period of 1 month.

RESULTS

Emotional support was effective in reducing serum cortisol level among breast cancer patients. There was no statistically significant difference between arms on serum cortisol levels.

CONCLUSIONS

Marginal differences were noted between posttest mean scores of serum cortisol among verbal, written and telephone arms. Further emotional support can be rendered according to the preference of the breast cancer patients.

The effect of individualized patient education, along with emotional support, on the quality of life of breast cancer patients - A pilot study

PURPOSE

This study aimed to determine the effect of individualized patient education along with emotional support on the quality of life (QoL) of breast cancer patients undergoing chemotherapy. It also aimed to determine the intervention's feasibility in the Pakistani context.

METHODS

A quasi-experimental design, with pre- and post-test, in two groups, via time block, was used. The study was conducted at a public hospital in Karachi with a sample of 50 patients; 25 patients each in the intervention and control group. The intervention was delivered over a period of six weeks. It comprised verbal and written patient education, availability of a nurse during patients' chemotherapy administration and over the telephone, and a telephone follow-up of the patients by the nurse. patients' QoL was assessed at baseline and at the sixth week of receiving chemotherapy.

RESULTS

Tests indicated a significant improvement in the overall QoL, breast cancer subscale scores, and the physical and emotional well-being of the intervention group, as compared to the control group. The intervention effect size was moderate (0.655) for the QoL.

CONCLUSION

The intervention was found to be effective in improving patients' QoL. However, a larger study, in a multi-center setting, is recommended to ascertain the findings of this pilot study.

A chronic care ostomy self-management program for cancer survivors

BACKGROUND

Individuals with ostomies experience extensive changes in health-related quality of life (HRQOL) and daily routine. Patients and families are typically forced to use trial and error to improve self-management.

METHODS

This is a longitudinal one-group design pilot study of a five-session ostomy self-care curriculum based on the Chronic Care Model to improve HRQOL and self-management for cancer survivors with ostomies. Participants were surveyed to evaluate each session. Multiple instruments were administered to examine outcomes at baseline, post-intervention, and at 6-month follow-up (Patient Activation Measure, self-efficacy, Hospital Anxiety and Depression Scale, Ways of Coping, Group Health Association of America Satisfaction with ostomy care survey, and the City of Hope Quality of Life Ostomy). Changes from pre-intervention to post-intervention and pre-intervention to follow-up were evaluated with paired t-tests. Text responses were coded and evaluated for important themes and recommendations.

RESULTS

Thirty-eight subjects participated in the study. Most had a history of rectal cancer (60.5%) or bladder cancer (28.9%). Participants rated the overall program high (4.4-4.8 on 5-point scale). Text feedback indicated that participants enjoyed the group forums, wanted more participants, and more hands-on training. Scores on multiple surveys were shown to be improved and sustained, including patient activation (p = 0.0004), self-efficacy (p = 0.006), total HRQOL (p = 0.01), physical well-being (p = 0.005), and social well-being (p = 0.002). Survivor anxiety was significantly reduced by follow-up (p = 0.047).

CONCLUSIONS

This self-management ostomy program can help cancer survivors with ostomies adapt to their stoma. Initiating this program in the community setting would be beneficial to many cancer survivors.

Use of Social Media by Fathers of Premature Infants

Although parents of premature infants experience many challenges when transitioning home from the neonatal intensive care unit, healthcare providers and social support systems tend to focus on mothers and infants rather than fathers. Unfortunately, very little is known about paternal concerns and needs as compared with maternal ones. The lack of understanding about paternal needs may lead to inadequate designs of neonatal intensive care unit family support programs with less involved fathers, all of which contribute to increased burdens on mothers and poor health outcomes for their infants. Although information technology (IT) might have the potential to increase support for the fathers of preterm infants, only a few studies have examined systematically how IT applications can be beneficial. This study aims to advance the understanding of needs and concerns of fathers with preterm infants and how fathers use the IT applications (eg, social networking Web sites) to support themselves. We observed qualitatively various social networking Web sites (ie, 29 Web sites) where fathers share their experiences about preterm infants. We discovered that fathers used various social media to discuss their concerns and, in turn, obtained informational, companionship, and emotional supports. On the basis of our analysis, we provide insights into a father-centered technology intervention design.

Patients' Knowledge and Attitudes towards Cancer Peer Support Programs

The objective of this study was to gain a better understanding of cancer patients' preexisting knowledge, expectations and concerns towards peer support programs. Data were collected and analyzed in 51 patients using a standardized short interview and content analysis. Only 37% of the patients claimed to know peer support programs, and half of these regularly attended a support group. Forty-seven percent of the patients who did not know these programs showed a general interest. Reasons for attending a support group were primarily the exchange with other patients (18% of all statements), obtaining information about disease and treatment (10%) and receiving emotional support (9%). The main argument against participation was the fear of suffering when confronted with problems of others (21%). Utilization may be increased if volunteers and health care practitioners give patients more detailed information about the various offers of peer support.

The impact of physician posture during oncology patient encounters

Non-verbal communication is an important component of the physician-patient interaction. Oncology patients face specific emotional and psychological issues requiring additional physician emotional support. Multiple studies in oncology patients have revealed that patients perceive physicians seated during the medical interview to be more compassionate, caring, and likely to spend more time with the patients. These are all associated with improved patient outcomes. Barriers to sitting may be due to those imposed by time, space, and reduced perceived benefit of sitting by the physician. Although a sitting posture alone is unlikely to compensate for poor communication skills, assessing patient preference to physician posture, and following their preference, can be a simple way of improving communication, and thus patient outcomes, especially in oncology patients. The widespread introduction of the electronic medical record (EMR) system over the last decade has added a "third wheel" to the original dyadic physician-patient relationship. Physician posture and eye gaze towards to the EMR and its components has a deleterious effect on communication. Appropriate training and sensitization in this regard should be provided for physicians.

Palliative care for patients with end-stage liver disease

Liver disease results in over four million physician visits and over 750,000 hospitalizations per year in the USA. Those with chronic liver disease frequently progress to cirrhosis, end-stage liver disease (ESLD), and death. Patients with ESLD experience numerous complications, including muscle cramps, confusion (hepatic encephalopathy), protein calorie malnutrition, muscle wasting, fluid overload (ascites, edema), bleeding (esophagogastric variceal hemorrhage), infection (spontaneous bacterial peritonitis), fatigue, anxiety, and depression. Despite significant improvements in palliation of these complications, patients still suffer reduced quality of life and must confront the fact that their disease will often inexorably progress to death. Liver transplantation is a valid option in this setting, increasing the duration of survival and palliating many of the symptoms. However, many patients die waiting for an organ or are not candidates for transplantation due to comorbid illness. Others receive a transplant but succumb to complications of the transplant itself. Patients and families must struggle with simultaneously hoping for a cure while facing a life-threatening illness. Ideally, the combination of palliative care with life-sustaining therapy can maximize the patients' quality and quantity of life. If it becomes clear that life-sustaining therapy is no longer an option, these patients are then already in a system to help them with end-of-life care.

The association between partner support and psychological distress among prostate cancer survivors in a nationwide study

PURPOSE

Up to 38% of prostate cancer survivors experience significant psychological distress; 6-16% are diagnosed with depression or anxiety disorders. Support from a relationship partner can ameliorate psychological distress, but many studies treat relationship status as a dichotomous predictor without accounting for level of support provided by the partner.

METHODS

The current study is a secondary analysis of a sample of 292 prostate cancer survivors recruited by nine Community Clinical Oncology Program (CCOP) sites around the USA to a larger randomized controlled trial. Self-reported distress was measured at a baseline visit using the Profile of Mood States (POMS) and partner support was measured using the Social Network and Support Assessment (SNSA). Post hoc groups consisting of unmarried survivors, married survivors with low partner support (SNSA scores below the median), and married survivors with high partner support (SNSA scores above the median) were compared on distress using univariate and analysis of covariance (ANCOVA) analyses.

RESULTS

Married prostate cancer survivors with high partner support reported significantly lower levels of psychological distress than the other two groups on the total distress scale (16.20-19.19 points lower, p < 0.001). After adjusting for multiple comparisons, this pattern was also seen for subscales of distress.

CONCLUSIONS

This study highlights the importance of assessing both partner support and marital status when evaluating a survivor's psychosocial functioning and support network.

IMPLICATIONS FOR CANCER SURVIVORS

Assessing support could improve understanding of the association between partner support and prostate cancer survivors' psychological distress and could lead to interventions to bolster support and reduce distress.

Giving and Receiving Emotional Support Online: Communication Competence as a Moderator of Psychosocial Benefits for Women with Breast Cancer

This study examines the moderating role of emotional communication competence in the relationship between computer-mediated social support (CMSS) group participation, specifically giving and receiving emotional support, and psychological health outcomes. Data were collected as part of randomized clinical trials for women diagnosed with breast cancer within the last 2 months. Expression and reception of emotional support was assessed by tracking and coding the 18,064 messages that 236 patients posted and read in CMSS groups. The final data used in the analysis was created by merging (a) computer-aided content analysis of discussion posts, (b) action log data analysis of system usage, and (c) baseline and six-month surveys collected to assess change. Results of this study demonstrate that emotional communication competence moderates the effects of expression and reception of emotional support on psychological quality of life and breast cancer-related concerns in both desired and undesired ways. Giving and receiving emotional support in CMSS groups has positive effects on emotional well-being for breast cancer patients with higher emotional communication, while the same exchanges have detrimental impacts on emotional well-being for those with lower emotional communication competence. The theoretical and practical implications for future research are discussed.

The association of psychosocial factors and obstetric history with depression in pregnant women: focus on the role of emotional support

OBJECTIVE

Depression during pregnancy can negatively affect both maternal and fetal health. The benefits of early detection and treatment for antenatal depression have been emphasized. Therefore, we investigated risk factors for antenatal depression with a focus on emotional support.

METHODS

We conducted a cross-sectional study of pregnant women (n=1262) enrolled from the local division of a community mental health center. All subjects completed self-report questionnaires that assessed depressive mood, emotional support and other risk factors. Associations between antenatal depression and potential risk factors including emotional support were analyzed by logistic regression analysis.

RESULTS

Antenatal depression was associated with various biopsychosocial correlates: unmarried state, low education, cigarette smoking, low income, familial history of depression, past history of depression, physical abuse history, sexual abuse history, premenstrual syndrome, primiparity and unplanned pregnancy. When the associations of emotional support with antenatal depression were specified by its resources, current emotional support from partner [odds ratio (OR)=2.26, 95% confidence interval (CI)=1.94-2.64] and mother (OR=1.43, 95% CI=1.26-1.62) and past experience for emotional support from mother (OR=1.52, 95% CI=1.32-1.74), but not from father significantly influenced depression during pregnancy.

CONCLUSIONS

The multidimensional biopsychosocial approach would be needed to identify and assess antenatal depression. Promoting emotional support from the partner, family member and, possibly, the health provider could be a protective effect against the development of antenatal depression.

When cure is no option: how explicit and hopeful can information be given? A qualitative study in breast cancer

OBJECTIVE

To investigate how oncologists can balance explicit with general and realistic with hopeful information when discussing various topics at the transition from curative to palliative care in breast cancer.

METHODS

Qualitative analysis of focus groups consisting of female breast cancer survivors and healthy women.

RESULTS

Perceptions of survivors and healthy women largely overlapped. Participants thought that oncologists can help patients regain a future perspective during this consultation. To achieve this, four themes seemed important: honest medical information, availability of continued support, hope has many faces, and space to choose. Moreover, participants stressed they would need time to let the message sink in before any further information was provided.

CONCLUSION

Participants thought that when confronted with this type of consultation they would need - more or less explicit - medical information and information regarding support. In order to maintain hope, knowledge about (treatment) possibilities is important, but also the certainty not to be abandoned by the hospital at a later stage of the disease and the confidence to remain able to make one's own decisions.

PRACTICE IMPLICATIONS

A life-limiting diagnosis may shatter patients' future perspective; however, this study provides suggestions for oncologists to create a new perspective.

A qualitative study of breast cancer treatment decisions: evidence for five decision-making styles

Being diagnosed with breast cancer requires that women make a number of decisions about their medical treatments. To gain insight into the variety of forces that shape a woman's breast cancer treatment decisions, we conducted semistructured interviews with 44 breast cancer survivors. Through an interpretive analysis, we identified five treatment decision-making styles: (a) medical expert, (b) self-efficacy, (c) relationship embedded, (d) inhibition, and (e) constellation of information, which are differentiated by two dimensions: (a) low versus high information needs and (b) self versus other preferences.

Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours (NETs)

These guidelines update previous guidance published in 2005. They have been revised by a group who are members of the UK and Ireland Neuroendocrine Tumour Society with endorsement from the clinical committees of the British Society of Gastroenterology, the Society for Endocrinology, the Association of Surgeons of Great Britain and Ireland (and its Surgical Specialty Associations), the British Society of Gastrointestinal and Abdominal Radiology and others. The authorship represents leaders of the various groups in the UK and Ireland Neuroendocrine Tumour Society, but a large amount of work has been carried out by other specialists, many of whom attended a guidelines conference in May 2009. We have attempted to represent this work in the acknowledgements section. Over the past few years, there have been advances in the management of neuroendocrine tumours, which have included clearer characterisation, more specific and therapeutically relevant diagnosis, and improved treatments. However, there remain few randomised trials in the field and the disease is uncommon, hence all evidence must be considered weak in comparison with other more common cancers.

[The experience of disease and treatments among teenagers and young adults with hematological malignancies]

We conducted an exploratory study of young patients (&#60; 25 years) in remission from hematologic malignancies to better understand their experiences of care, the impact of disease and therapeutics on their quality of life (assessed by the FACT-BMT) and on their mental state (assessed by the HADS). On the plan of research, the findings of this study confirm the relevance of the qualitative approach; on the plan of care, the need of interdisciplinary support for these patients in remission.

Differences in information seeking among breast, prostate, and colorectal cancer patients: results from a population-based survey

OBJECTIVE

There is much research describing cancer patients' information needs and their use of the Internet, print media, and other sources to fulfill these needs. Yet little is known about whether patients with different types of cancer vary in their information needs and seeking behaviors. This study used population-based data to address this question.

METHODS

A sample was randomly drawn from the list of patients with breast, prostate, or colorectal cancer reported to the Pennsylvania Cancer Registry in 2005. Patients completed a mail survey (N=2010); respective response rates were 68%, 64%, and 61%.

RESULTS

Colorectal cancer patients reported consistently less information seeking than breast and prostate cancer patients. Multivariate analyses revealed that differences by cancer type were not explained by sex or other demographics, disease stage, or treatment received. These differences were most pronounced among patients with early stage cancer.

CONCLUSION

Cancer patients have myriad information needs and use a range of sources to satisfy these needs, but there appear to be important differences in information engagement by cancer type.

PRACTICE IMPLICATIONS

Understanding differences in information seeking among disease-specific populations may help guide future patient education and decision making across the care continuum.

Family members of patients with cancer: what they know, how they know and what they want to know

BACKGROUND

Recent changes in healthcare management generally and in cancer care in particular, indicate a major shift in the clinical management of cancer from hospitals and healthcare professionals (HCPs) to patients and families. In light of these changes national and international policies and reports by the Department of Health and Children (2001, 2006) and the World Health Organisation (2004) have recommended that HCPs support family members (FMs) to care for loved ones. The purpose of this review therefore was to explore the extent to which FMs' needs are realised by HCPs in practice.

OBJECTIVES

To examine recent research (2000-2010) in relation to; the type of information that FMs of patients with cancer generally seek, how they seek this information from HCPs, and, FMs' experiences of communicating with HCPs in this context.

METHODS

A review of the literature was conducted using key databases Medline, Pub med, Psych-Info and CINAHL.

RESULTS

Thirty four papers were included in the review. Overall the studies demonstrated that FMs of patients with cancer have similar information needs and demonstrate similar strategies for seeking information. While many FMs report positive communication experiences with HCPs and have information needs met, the majority of FMs report negative communication encounters with HCPs.

CONCLUSION

HCPs are highly significant in the lives of FMs of patients with cancer. The review concludes with identifying; FMs most wanted information needs, their struggles with accessing HCPs and the type of communication encounters FMs most desire to have with HCPs. Recommendations for education, practice and research are addressed.

How do cancer patients navigate the public information environment? Understanding patterns and motivations for movement among information sources

Little is known about how patients move among information sources to fulfill unmet needs. We interviewed 43 breast, prostate, and colorectal cancer patients. Using a grounded theory approach, we identified patterns and motivations for movement among information sources. Overall, patients reported using one source (e.g., newspaper) followed by the use of another source (e.g., Internet), and five key motivations for such cross-source movement emerged. Patients' social networks often played a central role in this movement. Understanding how patients navigate an increasingly complex information environment may help clinicians and educators to guide patients to appropriate, high-quality sources.