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Myers C, Bennett K, Cahir C. Lessons learned from COVID-19: improving breast cancer care post-pandemic from the patient perspective. Support Care Cancer 2024; 32:338. [PMID: 38730019 PMCID: PMC11087304 DOI: 10.1007/s00520-024-08540-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 05/01/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Since the onset of the pandemic, breast cancer (BC) services have been disrupted in most countries. The purpose of this qualitative study is to explore the unmet needs, patient-priorities, and recommendations for improving BC healthcare post-pandemic for women with BC and to understand how they may vary based on social determinants of health (SDH), in particular socio-economic status (SES). METHODS Thirty-seven women, who were purposively sampled based on SDH and previously interviewed about the impact of COVID-19 on BC, were invited to take part in follow-up semi-structured qualitative interviews in early 2023. The interviews explored their perspectives of BC care since the easing of COVID-19 government restrictions, including unmet needs, patient-priorities, and recommendations specific to BC care. Thematic analysis was conducted to synthesize each topic narratively with corresponding sub-themes. Additionally, variation by SDH was analyzed within each sub-theme. RESULTS Twenty-eight women (mean age = 61.7 years, standard deviation (SD) = 12.3) participated in interviews (response rate = 76%). Thirty-nine percent (n = 11) of women were categorized as high-SES, while 61% (n = 17) of women were categorized as low-SES. Women expressed unmet needs in their BC care including routine care and mental and physical well-being care, as well as a lack of financial support to access BC care. Patient priorities included the following: developing cohesion between different aspects of BC care; communication with and between healthcare professionals; and patient empowerment within BC care. Recommendations moving forward post-pandemic included improving the transition from active to post-treatment, enhancing support resources, and implementing telemedicine where appropriate. Overall, women of low-SES experienced more severe unmet needs, which in turn resulted in varied patient priorities and recommendations. CONCLUSION As health systems are recovering from the COVID-19 pandemic, the emphasis should be on restoring access to BC care and improving the quality of BC care, with a particular consideration given to those women from low-SES, to reduce health inequalities post-pandemic.
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Affiliation(s)
- Charlotte Myers
- School of Population Health, RCSI University of Medicine and Health Sciences, 123 St Stephen's, Green, Dublin, D02 YN77, Ireland.
| | - Kathleen Bennett
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Caitriona Cahir
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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2
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Pettitt NJ, Petrella AR, Neilson S, Topping A, Taylor RM. Psychosocial and Support Needs of the Main Caregiver for Adolescents and Young Adults Undergoing Treatment for Cancer. Cancer Nurs 2024:00002820-990000000-00247. [PMID: 38656263 DOI: 10.1097/ncc.0000000000001352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Family relationships and social networks are critically important to adolescents and young adults (AYAs) with cancer, impacting their experience and well-being throughout the cancer trajectory. A cancer diagnosis impacts the development of independence and an adult identity, which can present challenges to psychosocial well-being needs and relationships between caregivers and AYAs. OBJECTIVE The aim of this study was to explore the psychosocial and support needs of the main caregivers of AYAs. METHODS This is a secondary analysis of the BRIGHTLIGHT caregiver survey, exploring items pertaining to support offered/engaged with, appraisal of helpfulness, and caregivers' emotional and psychological distress experience. Descriptive statistics, a correlational analysis, and a 1-way analysis of variance were conducted. RESULTS There were 518 caregiver responses (62%). Over half received information about their caregiving needs, with the majority finding this very/fairly helpful. Most (80%) of those who had not received the information would have valued it. High levels of negative emotional and psychological well-being were reported, with 91% feeling depressed or anxious since the AYAs' diagnosis and 41% always/often experiencing these feelings. Total distress was associated with being younger, a parent, female, and unemployed, and earning a below-average income. CONCLUSIONS The needs of caregivers are broad and multidimensional; however, some characteristics were associated with higher distress. When caregiver-specific information was provided by healthcare professionals, it was well received. IMPLICATIONS FOR PRACTICE Healthcare professionals should consider caregivers' needs individually and provide/signpost to support. Caregivers need to be involved in designing and implementing future research, given the heterogeneity of needs identified.
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Affiliation(s)
- Nicola J Pettitt
- Author Affiliations: Corporate Nursing, University Hospitals Birmingham NHS Foundation Trust (Mrs Pettitt and Dr Topping); Institute of Clinical Sciences, University of Birmingham (Drs Neilson and Topping); Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust (Dr Petrella); Centre for Nurse, Midwife and Allied Health Profession led Research (CNMAR), University College London Hospitals NHS Foundation Trust (Dr Taylor); and Department of Targeted Intervention, University College London (Dr Taylor), United Kingdom
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Viñolas N, Mezquita L, Corral J, Cobo M, Gil-Moncayo F, Paz-Ares L, Remon J, Rodríguez M, Ruano-Raviña A, Conde E, Majem M, Garrido P, Felip E, Isla D, de Castro J. The role of sex and gender in the diagnosis and treatment of lung cancer: the 6th ICAPEM Annual Symposium. Clin Transl Oncol 2024; 26:352-362. [PMID: 37490262 DOI: 10.1007/s12094-023-03262-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/20/2023] [Indexed: 07/26/2023]
Abstract
The incidence and mortality of lung cancer in women are rising, with both increasing by 124% between 2003 and 2019. The main risk factor for lung cancer is tobacco use, but indoor radon gas exposure is one of the leading causes in nonsmokers. The most recent evidence demonstrates that multiple factors can make women more susceptible to harm from these risk factors or carcinogens. For this consensus statement, the Association for Lung Cancer Research in Women (ICAPEM) invited a group of lung cancer experts to perform a detailed gender-based analysis of lung cancer. Clinically, female patients have different lung cancer profiles, and most actionable driver alterations are more prevalent in women, particularly in never-smokers. Additionally, the impact of certain therapies seems to be different. In the future, it will be necessary to carry out specific studies to improve the understanding of the role of certain biomarkers and gender in the prognosis and evolution of lung cancer.
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Affiliation(s)
- Nuria Viñolas
- Department of Medical Oncology, Barcelona Clinic Hospital, Translational Genomics and Targeted Therapies in Solid Tumours, IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain.
| | - Laura Mezquita
- Department of Medical Oncology, Barcelona Clinic Hospital, Translational Genomics and Targeted Therapies in Solid Tumours, IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Jesús Corral
- Department of Medical Oncology, Jerez de la Frontera University Hospital, Cádiz, Spain
| | - Manuel Cobo
- Department of Medical Oncology, Virgen de la Victoria University Hospital, Málaga, Spain
| | - Francisco Gil-Moncayo
- Department of Psycho-Oncology, Catalan Institute of Oncology-Hospitalet, Barcelona, Spain
| | - Luis Paz-Ares
- Department of Medical Oncology, 12 de Octubre University Hospital, Madrid, Spain
| | - Jordi Remon
- Department of Medical Oncology, HM Nou Delfos Hospital, Barcelona, Spain
| | - María Rodríguez
- Department of Thoracic Surgery, Clínica Universidad de Navarra, Madrid, Spain
| | - Alberto Ruano-Raviña
- Department of Medicine and Public Health, Santiago de Compostela University, Santiago de Compostela, Spain
| | - Esther Conde
- Pathology Department, 12 de Octubre University Hospital, Universidad Complutense de Madrid, Research Institute 12 de Octubre University Hospital (Imas12), CIBERONC, Madrid, Spain
| | - Margarita Majem
- Department of Medical Oncology, Santa Creu y Sant Pau University Hospital, Barcelona, Spain
| | - Pilar Garrido
- Department of Medical Oncology, Ramón y Cajal University Hospital, Madrid, Spain
| | - Enriqueta Felip
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Dolores Isla
- Department of Medical Oncology, Lozano Blesa University Clinical Hospital, Saragossa, Spain
| | - Javier de Castro
- Department of Medical Oncology, La Paz University Hospital, Madrid, Spain
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Duimel SLL, Linn AJ, Smets EMA, Smit ES, van Weert JCM. Profiling Cancer Patients Based on Their Motives for Seeking Informational and Emotional Support Online. HEALTH COMMUNICATION 2023; 38:3223-3237. [PMID: 36415021 DOI: 10.1080/10410236.2022.2144287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Understanding why patients seek informational and/or emotional support online is fundamental to providing patients with accurate and reliable support that is tailored to their needs, preferences, and personal situation. Based on the stress and coping theory and uses and gratifications theory (UGT), this study aimed to identify theoretically-founded profiles of cancer patients differing in their motives for seeking informational and/or emotional support online, and to compare the profiles in terms of patients' psychological and background characteristics, and perception of health care services. Hierarchical cluster analysis was conducted, using questionnaire data from patients visiting a large Dutch health website (N = 181). This revealed three distinctive profiles, i.e., overall seekers (n = 83, 46.0%), occasional information seekers (n = 83, 46.0%), and contact exchangers (n = 15, 8.0%). Patients across these profiles differed in their eHealth literacy, with the contact exchangers being more eHealth literate than the overall seekers and occasional information seekers. The results can be used to create awareness among health care providers, web designers, and patient organizations on different types of cancer patients with different motives for seeking informational and/or emotional support online, and help them to tailor recommendations to and development of (online) sources that fit patients' needs. Future research could further investigate the integration of stress and coping theory with UGT by acknowledging the interplay of different coping strategies and different gratifications.
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Affiliation(s)
- Song L L Duimel
- Department of Communication, Amsterdam School of Communication Research/ASCoR, University of Amsterdam
| | - Annemiek J Linn
- Department of Communication, Amsterdam School of Communication Research/ASCoR, University of Amsterdam
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam
| | - Eline S Smit
- Department of Communication, Amsterdam School of Communication Research/ASCoR, University of Amsterdam
| | - Julia C M van Weert
- Department of Communication, Amsterdam School of Communication Research/ASCoR, University of Amsterdam
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Contri A, Paltrinieri S, Torreggiani M, Chiara Bassi M, Mazzini E, Guberti M, Campanini I, Ghirotto L, Fugazzaro S, Costi S. Patient-reported outcome measure to implement routine assessment of cancer survivors' unmet needs: An overview of reviews and COSMIN analysis. Cancer Treat Rev 2023; 120:102622. [PMID: 37713972 DOI: 10.1016/j.ctrv.2023.102622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 09/17/2023]
Abstract
As the number of cancer survivors (CSs) is increasing worldwide, providing services relevant to the specific, unmet needs of these individuals is crucial. There are currently various patient-reported outcome measures (PROMs) whose aim is to identify the unmet needs of CSs. Still, limited guidance supports healthcare providers in choosing the most valid and reliable PROMs for this purpose. We conducted this overview of systematic reviews (SRs) on the psychometric properties of PROMs addressing the unmet needs of adult CSs suffering from non-cutaneous cancers. We searched databases for SRs published between 2012 and January 2023. Two SRs were included, covering 14 PROMs tested on 19,151 CSs. These were assessed according to the COSMIN methodology for SRs of PROMs for the quality of their measurement properties and risk of bias, thus providing guidance in selecting PROMs that appropriately reflect the unmet needs of CSs.
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Affiliation(s)
- Angela Contri
- Clinical and Experimental Medicine PhD Program, Via del Pozzo n.74, 41100 Modena, Italy.
| | - Sara Paltrinieri
- Public Health Sciences PhD Program, Department of Clinical Sciences and Community Health, University of Milan, Via Commenda, 19, 20122 Milan, Italy; Physical Medicine and Rehabilitation Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, via Amendola 2, 42122 Reggio Emilia, Italy.
| | - Martina Torreggiani
- Nursing and Allied Profession Research Unit, Azienda USL-IRCCS Reggio Emilia, Via Giovanni Amendola, 2, 42122 Reggio Emilia, Italy.
| | - Maria Chiara Bassi
- Medical Library, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola, 2, 42122 Reggio Emilia, Italy.
| | - Elisa Mazzini
- Medical Directorate Hospital Network, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola, 2, 42122 Reggio Emilia, Italy.
| | - Monica Guberti
- Research and EBP Unit, Health Professions Department, Azienda USL-IRCCS Reggio Emilia, Via Giovanni Amendola, 2, 42122 Reggio Emilia, Italy.
| | - Isabella Campanini
- LAM-Motion Analysis Laboratory, S. Sebastiano Hospital, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Via Circondaria 29, 42015 Correggio, Italy.
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL - IRCCS Di Reggio Emilia, Via Giovanni Amendola, 2, 42122 Reggio Emilia, Italy.
| | - Stefania Fugazzaro
- Physical Medicine and Rehabilitation Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, via Amendola 2, 42122 Reggio Emilia, Italy.
| | - Stefania Costi
- Physical Medicine and Rehabilitation Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, via Amendola 2, 42122 Reggio Emilia, Italy; Department of Surgical, Medical, Dental and Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, via del Pozzo, 71, 41124 Modena, Italy
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Correia AR, Costa M, Monteiro J, Cavaco P, Falcão F, Cavaco AM. Clinical Communication Within Hospital Pharmacy Practice: Exploring Pharmaceutical Oncological Consultations. HEALTH COMMUNICATION 2023; 38:480-489. [PMID: 34289767 DOI: 10.1080/10410236.2021.1956069] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This exploratory study aimed to identify communication trends typical of pharmacists' clinical communication in the context of hospital consultations. A cross-sectional design was used to investigate the pharmacist-patient exchange, applying the Roter Interaction Analysis System (RIAS). Communication variables and RIAS composites were assessed, including therapeutic information complexity, estimated through the ad-hoc score CTICS (Cancer Therapy Information Complexity Score). The study comprised 13 consultations of cancer patients with one female pharmacist, of which 6 included a patient family member, lasting on average 22.74 minutes and presenting repeated or overlapping consultation phases. The pharmacist's talk dominance reached 53.49%, slightly higher in dyadic consultations (U = 6.0, p = .032), and with an overall predominance of closed-ended questioning (W = 81.0, p = .013). Patients' questioning on biomedical issues was higher in dyadic consultations. The level of the pharmacist's rapport-building with the relative was higher when the patient's age was ≥80 years. Several strong correlations, both positive and negative, were found between composites, including between patient positive rapport-building and relative lifestyle/psychosocial information giving (Rho = -0.971, p = .001). Pharmaceutical consultations seem to be lengthier than other hospital practitioners' interviews, indicating a lack of clear organization and flow, thus challenging their efficiency regarding therapy management. Still, several positive communication features were found regarding the pharmaceutical care of older cancer patients. Further studies are needed, involving larger samples and other hospital consultation settings.
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Affiliation(s)
| | | | | | - Patrícia Cavaco
- Pharmacy Department, Hospital de S. Francisco Xavier, Centro Hospitalar de Lisboa Ocidental EPE
| | - Fátima Falcão
- Faculty of Pharmacy, University of Lisbon
- Pharmacy Department, Hospital de S. Francisco Xavier, Centro Hospitalar de Lisboa Ocidental EPE
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Elsous A, Radwan M, Najjar S, Masad A, Abu Rayya M. Unmet needs and health-related quality of life of breast cancer survivors: survey from Gaza Strip, Palestine. Acta Oncol 2023; 62:194-209. [PMID: 36802358 DOI: 10.1080/0284186x.2023.2180326] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Cancer, especially breast cancer, remains a public health problem because of its negative consequences, which require long-term programs to alleviate its devastating effects. This study aimed to examine unmet supportive care needs and health-related quality of life of females with breast cancer. METHODS A cross-sectional study with a mixed-method design was employed. A simple, randomly selected sample of 352 females attending Al-Rantisi and Al-Amal hospitals was included in this study. A validated Arabic version of the Supportive Care Needs Survey (34 items) and The European Organization for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C15-PAL) were used. Moreover, twenty-five semi-structured interviews were performed (13 females, eight husbands, and four healthcare workers). Quantitative data were analysed using descriptive and inferential analysis, whereas thematic analysis was used for qualitative data to highlight main themes. RESULTS The highest unmet need reported by females with breast cancer was psychological needs (63%), followed by health-related systems and information (62%) and physical and daily life (61%). Pain and fatigue were the most reported symptoms (65.8% and 62.5%, respectively), followed by emotional distress, physical function, and physical symptoms; 55.8%, 54.3%, and 51.5%, respectively. These unmet needs and health-related quality of life-related dimensions were highlighted and elicited by qualitative data analysis. Unmet needs are high among married females, on conservative treatments, young females (< 40 years old), and females in the first year of diagnosis. The presence of chronic diseases did not increase needs. However, health-related quality of life was affected. Six themes are subtracted: availability of anticancer therapy, affordability of healthcare, family and social support, psychological support, health education, and self-image & intimate relationship. CONCLUSION Many needs are unmet. Caring for females with breast cancer should be comprehensive to fill gaps, including psychological care, health information and education, physical care and support, and medical care.
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Affiliation(s)
- Aymen Elsous
- Faculty of Medical Sciences, Israa University -Gaza, Gaza strip, Palestine.,Department of Planning, Unit of Planning and Institutional Development Performance, Ministry of Health, Gaza strip, Palestine
| | - Mahmoud Radwan
- Department of Foreign Relations, General Directorate of International Cooperation, Ministry of Health, Gaza strip, Palestine
| | - Shahenaz Najjar
- Health Policy and Health Informatics, Arab American University of Palestine, Palestine.,Leuven Institute for Healthcare Policy, Pillar Quality and Safety, Department of Public Health and Primary Care, KU Leuven
| | - Atef Masad
- Department of Medical Laboratories, Faculty of Medical Sciences, Israa University -Gaza, Gaza strip, Palestine
| | - Mohammed Abu Rayya
- Public Health Consultant, Aid and Hope Program for Cancer Patients Care, Gaza strip, Palestine
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Mazor MB, Li L, Morillo J, Allen OS, Wisnivesky JP, Smith CB. Disparities in Supportive Care Needs Over Time Between Racial and Ethnic Minority and Non-Minority Patients With Advanced Lung Cancer. J Pain Symptom Manage 2022; 63:563-571. [PMID: 35031503 PMCID: PMC9336182 DOI: 10.1016/j.jpainsymman.2021.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 12/02/2021] [Accepted: 12/07/2021] [Indexed: 12/27/2022]
Abstract
CONTEXT Little is known about inequities in supportive care needs among diverse patients with advanced lung cancer. OBJECTIVES We aimed to examine differences in supportive care needs between racial/ethnic minority and non-minority patients with lung cancer and identify how these needs change over time. METHODS We performed a prospective cohort study of patients newly diagnosed with advanced lung cancer (stage III and IV). Patients completed a validated survey at baseline, 4-, 8- and 12-months post-diagnosis, assessing supportive care needs: medical communication/information, psychological/emotional support, daily living, financial concerns, physical symptoms, and spiritual and social needs. Univariable and multivariable regression analyses compared differences in supportive care needs between minority (Black and Latinx) and non-minority patients. A mixed effect model with minority status, follow-up time and the interaction between minority status and time assessed the association between each need and minority status with changes over time. RESULTS We enrolled 99 patients; 55 (56%) were minorities and 44 (44%) were non-minorities. At baseline, minorities reported significantly higher needs across each domain except medical communication/information. Over time, these reported differences remained consistent except for medical communication. After adjustment, the needs of both minorities and non-minorities increased significantly in the psychological/emotional, daily living and physical symptom domains. CONCLUSION Minority patients with advanced lung cancer are more likely to have higher baseline and persistent supportive care needs relatives to non-minority patients. Clinicians caring for minority patients with lung cancer should provide targeted supportive care evaluation and treatment to ensure health equity.
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Affiliation(s)
- Melissa B Mazor
- Division of General Internal Medicine (M.B.M., J.M., J.P.W.), Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Lihua Li
- Brookdale Department of Geriatrics and Palliative Medicine (L.L., C.B.S.), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jose Morillo
- Division of General Internal Medicine (M.B.M., J.M., J.P.W.), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Olivia S Allen
- Division of Hematology/Medical Oncology (O.S.A., C.B.S.), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Juan P Wisnivesky
- Division of General Internal Medicine (M.B.M., J.M., J.P.W.), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Cardinale B Smith
- Brookdale Department of Geriatrics and Palliative Medicine (L.L., C.B.S.), Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Hematology/Medical Oncology (O.S.A., C.B.S.), Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Assessing unmet needs in advanced cancer patients: a systematic review of the development, content, and quality of available instruments. J Cancer Surviv 2021; 16:960-975. [PMID: 34363187 PMCID: PMC9489568 DOI: 10.1007/s11764-021-01088-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/13/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Advances in treatment, including biological and precision therapies, mean that more people are living with advanced cancer. Supportive care needs likely change across the cancer journey. We systematically identified instruments available to assess unmet needs of advanced cancer patients and evaluated their development, content, and quality. METHODS Systematic searches of MEDLINE, CINAHL, Embase, PubMed, and PsycINFO were performed from inception to 11 January 2021. Independent reviewers screened for eligibility. Data was abstracted on instrument characteristics, development, and content. Quality appraisal included methodological and quality assessment, GRADE, feasibility, and interpretability, following consensus-based standards for the selection of health measurement instruments (COSMIN) guidelines. RESULTS Thirty studies reporting 24 instruments were identified. These were developed for general palliative patients (n = 2 instruments), advanced cancer (n = 8), and cancer irrespective of stage (n = 14). None focused on patients using biological or precision therapies. The most common item generation and reduction techniques were amending an existing instrument (n = 11 instruments) and factor analysis (n = 8), respectively. All instruments mapped to ≥ 5 of 11 unmet need dimensions, with Problems and Needs in Palliative Care (PNPC) and Psychosocial Needs Inventory (PNI) covering all 11. No instrument reported all of the COSMIN measurement properties, and methodological quality was variable. CONCLUSIONS Many instruments are available to assess unmet needs in advanced cancer. There is extensive heterogeneity in their development, content, and quality. IMPLICATIONS FOR CANCER SURVIVORS Given the growth of precision and biological therapies, research needs to explore how these instruments perform in capturing the needs of people using such therapies.
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The BRIGHTLIGHT National Survey of the Impact of Specialist Teenage and Young Adult Cancer Care on Caregivers' Information and Support Needs. Cancer Nurs 2021; 44:235-243. [PMID: 31895170 DOI: 10.1097/ncc.0000000000000771] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Teenage and young adult cancer services in England are centralized in 13 principal treatment centers (TYA-PTC). These "specialist services" are designed to support caregivers as well as young people. OBJECTIVES To evaluate whether caregivers of young people with cancer had fewer unmet information and support needs if they had all/some care in a TYA-PTC. METHODS Participants in a cohort study of young people with cancer nominated their main carer to complete the BRIGHTLIGHT Carer Questionnaire, completed 6 months after diagnosis. Comparisons were made according to where young people's care was delivered: all, some, or no care in a TYA-PTC. Principal components analysis reduced the questionnaire to 5 dimensions, which were used as dependent variables in subsequent regression analysis. RESULTS Four hundred seventy-six responses of 514 returned questionnaires (92%) were included in the analysis. The majority of caregivers were white, middle-aged, married/cohabiting mothers. Adjusted analysis indicated caregivers who had all/some care in a TYA-PTC had more satisfaction with support and also with services specifically provided for carers. Those who had some TYA-PTC care had greater satisfaction with information but less opportunity to be involved in decisions. CONCLUSIONS Caregivers of young people who had no TYA-PTC care have the most unmet information and support needs. IMPLICATIONS FOR PRACTICE Nurses outside of the TYA-PTC need to be supported by the TYA-PTC in providing information/support for caregivers. When a young person is receiving care in multiple hospitals, nurses need to optimize opportunities for caregivers to be involved in decision making.
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Biopsychosocial Factors Associated with Supportive Care Needs in Canadian Adolescent and Young Adult Cancer Survivors. J Clin Med 2021; 10:jcm10122628. [PMID: 34203795 PMCID: PMC8232806 DOI: 10.3390/jcm10122628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/26/2021] [Accepted: 06/02/2021] [Indexed: 12/16/2022] Open
Abstract
Adolescents and young adults (AYAs) represent an overlooked population in cancer survivorship care. Identifying the needs of AYAs can guide the development of tailored programs for this population. We conducted a cross-sectional descriptive analysis to identify biopsychosocial factors associated with AYA post-treatment supportive care needs and unmet needs using data obtained from the Experiences of Cancer Patients in Transitions Study of the Canadian Partnership Against Cancer, in collaboration with cancer agencies in the 10 Canadian provinces. The analysis focused on data from n = 530 AYAs between the ages of 18 and 34 who had undergone treatment within the past 5 years. Respondents reported a median of two moderate to big (MTB) physical needs (out of 9) and one unmet physical need, two MTB emotional needs (out of 6) with two unmet MTB emotional needs, and one (out of 5) practical need reported and one unmet MTB practical need. We found some common associations across supportive care domains. Income (lower) and more complex treatment were associated with high needs and unmet needs across the three domains. Respondents with a family doctor who was “very involved” in their cancer care had a lower number of unmet physical and emotional needs. Identifying those at risk of supportive care needs and developing tailored pathways in which they are proactively connected with tailored and appropriate resources and programs may help to reduce the number of unmet needs and improve cancer survivors’ quality of life.
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Prue G, O'Connor D, Brown M, Santin O. Exploring patient experiences of cancer care in Northern Ireland: A thematic analysis of free-text responses to the 2018 Northern Ireland Patient Experience Survey (NICPES). BMC Health Serv Res 2021; 21:564. [PMID: 34098944 PMCID: PMC8186075 DOI: 10.1186/s12913-021-06577-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 05/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer diagnosis, treatment and survivorship is multifaceted, and the cancer patient experience can serve as a key indicator of healthcare performance and quality. The purpose of this paper was to analyse free-text responses from the second Northern Ireland Cancer Patient Experience Survey (NICPES) in 2018, to understand experiences of care, emerging themes and identify areas for improvement. METHODS A 72-item questionnaire (relating to clinical care experience, socio-demographics and 3 free-text questions) was distributed to all Health & Social Care Northern Ireland patients that met the inclusion criteria (≥ 16 years old; confirmed primary diagnosis of cancer and discharged between 1st May and 31st October 2017) in June 2018. Participants could complete the questionnaire online or access a free telephone support line if required. Open-ended free text responses were analysed thematically to identify common themes. Free text responses were divided into positive or negative comments. RESULTS In total, 3,748 people responded to the survey, with 2,416 leaving at least one free text comment (69 %). Women aged 55-74 years were most likely to comment. Overall, 3,644 comments were left across the three comments boxes, which were categorised as either positive (2,462 comments; 68 %) or negative / area for improvement (1,182 comments; 32 %). Analysis of free text responses identified six common themes (staff; speed [diagnosis and treatment]; safety; system; support services and specific concerns), which were all related to the overarching theme of survival. Staff was the largest single theme (1,458 responses) with overwhelmingly positive comments (1,322 responses; 91 %), whilst safety (296 negative comments; 70 %) and system (340 negative comments; 81 %) were predominantly negative. Negative comments relating to primary care, aftercare and the cancer system were reported. CONCLUSIONS The high response rate to the free text comments indicates patients were motivated to engage. Analysis indicates most comments provided were positive in nature. Most survey respondents reported a positive experience in relation to staff. However, there were a number of areas for improvement including the aftercare experience, and a perceived disconnect between primary care and cancer services. These results can help inform the effective delivery of cancer services in Northern Ireland.
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Affiliation(s)
- Gillian Prue
- School of Nursing & Midwifery, Queen's University Belfast, Northern Ireland, Belfast, United Kingdom.
| | - Dominic O'Connor
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Malcolm Brown
- School of Nursing & Midwifery, Queen's University Belfast, Northern Ireland, Belfast, United Kingdom
| | - Olinda Santin
- School of Nursing & Midwifery, Queen's University Belfast, Northern Ireland, Belfast, United Kingdom
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Gabriel I, Creedy D, Coyne E. Quality of life and associated factors among adults living with cancer and their family caregivers. Nurs Health Sci 2021; 23:419-429. [PMID: 33605071 DOI: 10.1111/nhs.12823] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 02/09/2021] [Accepted: 02/14/2021] [Indexed: 12/26/2022]
Abstract
This study examined the association of needs, health literacy, and quality of life among adult Nigerians with cancer and family caregivers. A descriptive study was conducted involving 240 adults with cancer and family caregivers attending a tertiary hospital. More than two-thirds of participants reported moderate or high needs. Information (90.8%) and spiritual support (85%) were the domains of highest need among adults with cancer. Family/social support (85%) and spiritual support (81.7%) ranked the highest among family caregivers. A negative correlation was found between needs and quality of life. Stepwise regression analysis showed that needs and literacy explained 36% of the variance in adults with cancer's quality of life and 28% of the variance in family caregivers' quality of life. Spiritual need accounted l for 9.5% and 9.1% of variation for adults with cancer and family caregivers, respectively. Findings suggest that interventions with a focus on social/family and spiritual needs may improve wellbeing of adults with cancer and caregivers in Nigeria. This research are generalizable to other low-income countries where family values and spirituality are often a strong feature of daily life.
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Affiliation(s)
- Israel Gabriel
- School of Nursing and Midwifery, Griffith University, Logan Campus, Meadowbrook, Queensland, Australia.,School of Post Basic Nursing Programmes, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Debra Creedy
- Perinatal Mental Health, School of Nursing and Midwifery, Transforming Maternity Care Collaborative, Griffith University, Brisbane, Queensland, Australia
| | - Elisabeth Coyne
- School of Nursing and Midwifery, Griffith University, Logan Campus, Meadowbrook, Queensland, Australia
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Salm S, Blaschke K, Ihle P, Schubert I, Dresen A, Pfaff H, Scholten N. Mental disorders and utilization of mental health services in newly diagnosed cancer patients: An analysis of German health insurance claims data. Psychooncology 2020; 30:312-320. [PMID: 33089560 DOI: 10.1002/pon.5579] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/17/2020] [Accepted: 10/19/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE People with cancer are often confronted not only with the burdens of medical treatment but also with psychological strain, which can lead to mental disorders (MD). To date, the prevalence of MD in newly diagnosed cancer patients and their utilization of mental health services (MHS) are mainly estimated through data of primary studies than considering healthcare-related claims data. METHODS Statutory health insurance claims data of the AOK/KV Hesse from 2011 to 2014 was analyzed. The number of incident cancer patients with MD and the utilization of MHS within the period of the quarter of incident cancer diagnosis and three subsequent quarters were determined. For incident cancer patients with an incident MD, the predictive values of sex, age group, and tumor entity on the documentation of MD diagnosis and utilization were investigated. RESULTS The 12-month prevalence of MD in incident cancer patients was 31.1% for depression, 11.2% for anxiety disorders, and 9.2% for post-traumatic stress/adjustment disorder (PTSD/AD). Of these, 65.9% received outpatient psychotherapy and 43.0% at least one psychopharmacological drug prescription. Men had a significantly lower chance of receiving an MD diagnosis following cancer. CONCLUSIONS The prevalence of MD observed was higher for depression and lower for PTSD/AD compared to meta-analyses of clinical trials. Male cancer patients had a lower chance of receiving an MD diagnosis than females, which coincides with existing results.
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Affiliation(s)
- Sandra Salm
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Katja Blaschke
- PMV forschungsgruppe, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Peter Ihle
- PMV forschungsgruppe, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ingrid Schubert
- PMV forschungsgruppe, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Antje Dresen
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Nadine Scholten
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany
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Relationships Between Smoking Status and Psychological Distress, Optimism, and Health Environment Perceptions at Time of Diagnosis of Actual or Suspected Lung Cancer. Cancer Nurs 2020. [PMID: 29538022 DOI: 10.1097/ncc.0000000000000579] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND While much research and practice resources have addressed smoking cessation among cancer patients, less emphasis has been placed on personal psychological and environment factors associated with smoking at the time of diagnosis. OBJECTIVE The aim of this study was to examine differences in psychological distress, optimism, and perceptions of the health environment/illness experience based on smoking status in patients with current, former, and no smoking history with newly diagnosed suspected or actual lung cancer. METHODS Data were derived from a descriptive study of 52 patients (34 men and 18 women aged 37-83 years) undergoing diagnostic evaluation for actual or suspected lung cancer. Descriptive statistics were used to characterize data. Analysis of variance, χ, and Spearman correlation tests were used to determine relationships among main study variables (smoking status, anxiety, worry, perceived cognitive functioning, optimistic outlook, health environment/illness experience perceptions). RESULTS Current smoking status was associated with higher psychological distress (anxiety and worry) among patients facing a new suspected or actual cancer diagnosis. CONCLUSIONS The study was able to provide important information relative to smoking status and psychological distress at the time of diagnosis of suspected or actual lung cancer. Findings demonstrate needs for assessment and targeted interventions to reduce psychological distress and to promote long-term adaptation in patients smoking at time of diagnosis. IMPLICATIONS FOR PRACTICE Nurses are positioned to provide support and resources for cancer patients. It is critical that smoking cessation interventions also address nicotine craving, emotion regulation, and adaptive coping skills.
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Payne JB, Dance KV, Farone M, Phan A, Ho CD, Gutierrez M, Chen L, Flowers CR. Patient and caregiver perceptions of lymphoma care and research opportunities: A qualitative study. Cancer 2019; 125:4096-4104. [PMID: 31355929 PMCID: PMC6819209 DOI: 10.1002/cncr.32401] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/06/2019] [Accepted: 06/14/2019] [Indexed: 08/30/2023]
Abstract
BACKGROUND Although the number of lymphoma survivors has increased, the needs and research priorities of survivors and their caregivers rarely are examined and addressed. Determining the needs and priorities for this population requires an assessment of the attitudes and experiences of patients and caregivers. The authors conducted a qualitative study with lymphoma survivors and their caregivers to determine care needs and research priorities. METHODS In the first phase, 2 semistructured focus groups were conducted with 15 lymphoma survivors and their caregivers. In phase 2, a total of 19 individual semistructured telephone interviews were conducted with lymphoma survivors and their caregivers. In both phases, participants discussed cancer experiences and research priorities. All interviews were transcribed. MAXQDA software (version 18.0.8) was used for coding and identifying themes. RESULTS The majority of participants felt disconnected from their clinical care team due to a lack of communication. Focus group participants noted a lack of information regarding diagnoses, treatment, research, and survivorship care. Participants coped with fear through strong social support and fostering relationships with their clinical care teams. Some caregivers felt completely ignored by clinicians. Participants expressed interest in research, but had difficulty finding relevant studies. Several interviewees desired holistic and survivorship-oriented research and more studies regarding quality of life and mental health. CONCLUSIONS The results of the current study identified unmet needs in clinical care and patient-oriented research, including needs for a focus on quality of life after treatment, communication between patients and the scientific community, and emotional well-being. Health care professionals can use these data to provide care delivery, supportive services, and research that meets the needs of lymphoma survivors and their caregivers.
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Affiliation(s)
- Jackelyn B. Payne
- Department of Hematology and Medical Oncology, Emory University – Winship Cancer Institute, Atlanta, GA
- Stony Brook University
| | - Kaylin V. Dance
- Department of Hematology and Medical Oncology, Emory University – Winship Cancer Institute, Atlanta, GA
- Rollins School of Public Health, Emory University
| | - Monique Farone
- Department of Hematology and Medical Oncology, Emory University – Winship Cancer Institute, Atlanta, GA
- Rollins School of Public Health, Emory University
| | - Anh Phan
- Department of Hematology and Medical Oncology, Emory University – Winship Cancer Institute, Atlanta, GA
- Rollins School of Public Health, Emory University
| | - Cathy D. Ho
- Department of Hematology and Medical Oncology, Emory University – Winship Cancer Institute, Atlanta, GA
| | | | - Lillian Chen
- Department of Hematology and Medical Oncology, Emory University – Winship Cancer Institute, Atlanta, GA
- Rollins School of Public Health, Emory University
| | - Christopher R. Flowers
- Department of Hematology and Medical Oncology, Emory University – Winship Cancer Institute, Atlanta, GA
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17
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Sodergren SC, Wheelwright SJ, Permyakova NV, Patel M, Calman L, Smith PWF, Din A, Richardson A, Fenlon D, Winter J, Corner J, Foster C. Supportive care needs of patients following treatment for colorectal cancer: risk factors for unmet needs and the association between unmet needs and health-related quality of life-results from the ColoREctal Wellbeing (CREW) study. J Cancer Surviv 2019; 13:899-909. [PMID: 31512164 PMCID: PMC6881415 DOI: 10.1007/s11764-019-00805-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 08/30/2019] [Indexed: 12/20/2022]
Abstract
Purpose To investigate unmet needs of patients with colorectal cancer (CRC) at the end of treatment and whether unmet needs improve over time. Identify predictors of need following treatment and whether unmet need is associated with worse health-related quality of life (HRQoL). Methods As part of the UK ColoREctal Wellbeing (CREW) cohort study, patients treated for CRC completed the Supportive Care Needs Survey Short Form-34 (SCNS SF-34) 15 and 24 months following surgery, along with questionnaires measuring HRQoL, wellbeing, life events, social support, and confidence to manage their cancer before surgery, 3, 9, 15, and 24 months post-surgery. Results The SCNS SF-34 was completed by 526 patients at 15 months and 510 patients at 24 months. About one-quarter of patients had at least one moderate or severe unmet need at both time points. Psychological and physical unmet needs were the most common and did not improve over time. Over 60% of patients who reported 5 or more moderate or severe unmet needs at 15 months experienced the same level of unmet need at 24 months. HRQoL at the beginning of treatment predicted unmet needs at the end of treatment. Unmet needs, specifically physical, psychological, and health system and information needs, were associated with poorer health and HRQoL at the end of treatment. Conclusions Unmet needs persist over time and are associated with HRQoL. Evaluation of HRQoL at the start of treatment would help inform the identification of vulnerable patients. Assessment and care planning in response to unmet needs should be integrated into person-centred care. Implications for Cancer Survivors Early identification of CRC patients at risk of unmet needs will help infrom personalised survivorship care plans. The implementation of personalised and tailored services are likely to confer HRQoL gains. Electronic supplementary material The online version of this article (10.1007/s11764-019-00805-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S C Sodergren
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
| | - S J Wheelwright
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
| | - N V Permyakova
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
- Social Statistics and Demography, Social Sciences, University of Southampton, Southampton, UK
| | - M Patel
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
| | - L Calman
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
| | - P W F Smith
- Social Statistics and Demography, Social Sciences, University of Southampton, Southampton, UK
| | - A Din
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
| | - A Richardson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - D Fenlon
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | - J Winter
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Corner
- Executive Office, University of Nottingham, Nottingham, UK
| | - C Foster
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK.
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Schouten B, Avau B, Bekkering G(TE, Vankrunkelsven P, Mebis J, Hellings J, Van Hecke A. Systematic screening and assessment of psychosocial well-being and care needs of people with cancer. Cochrane Database Syst Rev 2019; 3:CD012387. [PMID: 30909317 PMCID: PMC6433560 DOI: 10.1002/14651858.cd012387.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Receiving a diagnosis of cancer and the subsequent related treatments can have a significant impact on an individual's physical and psychosocial well-being. To ensure that cancer care addresses all aspects of well-being, systematic screening for distress and supportive care needs is recommended. Appropriate screening could help support the integration of psychosocial approaches in daily routines in order to achieve holistic cancer care and ensure that the specific care needs of people with cancer are met and that the organisation of such care is optimised. OBJECTIVES To examine the effectiveness and safety of screening of psychosocial well-being and care needs of people with cancer. To explore the intervention characteristics that contribute to the effectiveness of these screening interventions. SEARCH METHODS We searched five electronic databases in January 2018: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, and CINAHL. We also searched five trial registers and screened the contents of relevant journals, citations, and references to find published and unpublished trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) and non-randomised controlled trials (NRCTs) that studied the effect of screening interventions addressing the psychosocial well-being and care needs of people with cancer compared to usual care. These screening interventions could involve self-reporting of people with a patient-reported outcome measures (PROMs) or a semi-structured interview with a screening interventionist, and comprise a solitary screening intervention or screening with guided actions. We excluded studies that evaluated screening integrated as an element in more complex interventions (e.g. therapy, coaching, full care pathways, or care programmes). DATA COLLECTION AND ANALYSIS Two review authors independently extracted the data and assessed methodological quality for each included study using the Cochrane tool for RCTs and the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool for NRCTs. Due to the high level of heterogeneity in the included studies, only three were included in meta-analysis. Results of the remaining 23 studies were analysed narratively. MAIN RESULTS We included 26 studies (18 RCTs and 8 NRCTs) with sample sizes of 41 to 1012 participants, involving a total of 7654 adults with cancer. Two studies included only men or women; all other studies included both sexes. For most studies people with breast, lung, head and neck, colorectal, prostate cancer, or several of these diagnoses were included; some studies included people with a broader range of cancer diagnosis. Ten studies focused on a solitary screening intervention, while the remaining 16 studies evaluated a screening intervention combined with guided actions. A broad range of intervention instruments was used, and were described by study authors as a screening of health-related quality of life (HRQoL), distress screening, needs assessment, or assessment of biopsychosocial symptoms or overall well-being. In 13 studies, the screening was a self-reported questionnaire, while in the remaining 13 studies an interventionist conducted the screening by interview or paper-pencil assessment. The interventional screenings in the studies were applied 1 to 12 times, without follow-up or from 4 weeks to 18 months after the first interventional screening. We assessed risk of bias as high for eight RCTs, low for five RCTs, and unclear for the five remaining RCTs. There were further concerns about the NRCTs (1 = critical risk study; 6 = serious risk studies; 1 = risk unclear).Due to considerable heterogeneity in several intervention and study characteristics, we have reported the results narratively for the majority of the evidence.In the narrative synthesis of all included studies, we found very low-certainty evidence for the effect of screening on HRQoL (20 studies). Of these studies, eight found beneficial effects of screening for several subdomains of HRQoL, and 10 found no effects of screening. One study found adverse effects, and the last study did not report quantitative results. We found very low-certainty evidence for the effect of screening on distress (16 studies). Of these studies, two found beneficial effects of screening, and 14 found no effects of screening. We judged the overall certainty of the evidence for the effect of screening on HRQoL to be very low. We found very low-certainty evidence for the effect of screening on care needs (seven studies). Of these studies, three found beneficial effects of screening for several subdomains of care needs, and two found no effects of screening. One study found adverse effects, and the last study did not report quantitative results. We judged the overall level of evidence for the effect of screening on HRQoL to be very low. None of the studies specifically evaluated or reported adverse effects of screening. However, three studies reported unfavourable effects of screening, including lower QoL, more unmet needs, and lower satisfaction.Three studies could be included in a meta-analysis. The meta-analysis revealed no beneficial effect of the screening intervention on people with cancer HRQoL (mean difference (MD) 1.65, 95% confidence interval (CI) -4.83 to 8.12, 2 RCTs, 6 months follow-up); distress (MD 0.0, 95% CI -0.36 to 0.36, 1 RCT, 3 months follow-up); or care needs (MD 2.32, 95% CI -7.49 to 12.14, 2 RCTs, 3 months follow-up). However, these studies all evaluated one specific screening intervention (CONNECT) in people with colorectal cancer.In the studies where some effects could be identified, no recurring relationships were found between intervention characteristics and the effectiveness of screening interventions. AUTHORS' CONCLUSIONS We found low-certainty evidence that does not support the effectiveness of screening of psychosocial well-being and care needs in people with cancer. Studies were heterogeneous in population, intervention, and outcome assessment.The results of this review suggest a need for more uniformity in outcomes and reporting; for the use of intervention description guidelines; for further improvement of methodological certainty in studies and for combining subjective patient-reported outcomes with objective outcomes.
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Affiliation(s)
- Bojoura Schouten
- Hasselt UniversityResearch Group Health Care, Faculty of Medicine and Life SciencesHasseltLimburgBelgium3500
| | - Bert Avau
- Belgian Red CrossCentre for Evidence‐Based PracticeMotstraat 42MechelenBelgium2800
- Belgian Centre for Evidence‐Based Medicine ‐ Cochrane BelgiumKapucijnenvoer 33, blok JLeuvenBelgium3000
| | - Geertruida (Trudy) E Bekkering
- Belgian Centre for Evidence‐Based Medicine ‐ Cochrane BelgiumKapucijnenvoer 33, blok JLeuvenBelgium3000
- KU LeuvenDepartment of Public Health and Primary Care ‐ Faculty of MedicineKapucijnenvoer 33 Blok J Bus 7001LeuvenBelgium3000
| | - Patrick Vankrunkelsven
- Belgian Centre for Evidence‐Based Medicine ‐ Cochrane BelgiumKapucijnenvoer 33, blok JLeuvenBelgium3000
- KU LeuvenDepartment of Public Health and Primary Care ‐ Faculty of MedicineKapucijnenvoer 33 Blok J Bus 7001LeuvenBelgium3000
| | - Jeroen Mebis
- Jessa HospitalDepartment of Medical OncologyHasseltBelgium
- Hasselt UniversityResearch Group Immunology and BiochemistryFaculty of Medicine and Life SciencesHasseltBelgium
| | - Johan Hellings
- Hasselt UniversityResearch Group Health Care, Faculty of Medicine and Life SciencesHasseltLimburgBelgium3500
- AZ DeltaRode‐Kruisstraat 20RoeselareBelgium
| | - Ann Van Hecke
- Ghent UniversityUniversity Centre for Nursing and Midwifery, Department of Public HealthDe Pintelaan 185GhentBelgium9000
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Doherty M, Miller-Sonet E, Gardner D, Epstein I. Exploring the role of psychosocial care in value-based oncology: Results from a survey of 3000 cancer patients and survivors. J Psychosoc Oncol 2018; 37:441-455. [PMID: 30451102 DOI: 10.1080/07347332.2018.1504851] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To explore the psychosocial needs of cancer patients and survivors across the United States and their implications for value-based oncology. DESIGN A secondary analysis of findings from a cross-sectional national online survey. SAMPLE Respondents were sampled and stratified by cancer type and geographic region to approximate the cancer-affected population of the United States. Breast, prostate, and colorectal were the most common cancers reported. Across surveys, the majority of respondents were female (57%), over 55 (60%), and white (70%) and had at least some college (36%). METHODS Six online surveys were administered to cohorts of approximately 500 unique cancer patients and survivors. Survey topics included: (1) diagnosis, (2) treatment planning, (3) communication with providers, (4) insurance and financial concerns, (5) quality of life, side effects, and symptoms, and (6) survivorship and end-of-life. Descriptive analyses were used to explore psychosocial needs and experiences across three domains of patient-centered value in oncology. FINDINGS Each survey received 500-527 responses. Respondents most commonly reported needing more information regarding their insurance coverage and out-of-pocket costs (65%), access to clinical trials (89%), and support organizations (45%). Forty-one percent were very or extremely distressed about cancer's impact on their ability to work and over 25% reported high-levels of cancer-related financial hardship. CONCLUSIONS Patients and survivors reported significant unmet informational needs, financial hardship, distress, and symptoms or treatment side effects that interfered with daily life. Implications for Psychosocial Providers or Policy: Providers and payment reform advocates can improve value in oncology by ensuring access to comprehensive psychosocial care and informational support.
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Affiliation(s)
- Meredith Doherty
- a Graduate Center of the City University of New York , New York , NY , USA
| | | | - Daniel Gardner
- c Silberman School of Social Work at Hunter College , City University of New York , New York , NY , USA
| | - Irwin Epstein
- c Silberman School of Social Work at Hunter College , City University of New York , New York , NY , USA
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Bonacchi A, Fazzini E, Messina S, Muraca MG, Pacetti P, Di Miceli S, Miccinesi G. Sociodemographic, clinical, and psychological characteristics identify groups of Italian cancer patients with high rates of unmet needs. TUMORI JOURNAL 2018; 105:288-295. [PMID: 30185126 DOI: 10.1177/0300891618792458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Although an optimal goal remains the routine assessment of unmet needs of all patients with cancer, particular attention should be paid to those groups of patients with characteristics known to be more frequently associated with unmet needs in general or with specific areas of need. This report aims to describe the sociodemographic, clinical, and psychological characteristics associated with higher unmet needs in Italian cancer patients. METHODS A total of 835 cancer patients from different care settings (ward, day hospital, follow-up ambulatory, rehabilitation unit, and palliative care) filled out the Needs Evaluation Questionnaire (NEQ), the Psychological Distress Inventory, and the Sense of Coherence Scale. Association of NEQ scores with the clinical and demographic variables were tested using analysis of variance. RESULTS Higher NEQ total score was associated with lower educational level, inpatient care setting, radiotherapy treatment, psychological distress, and lower resilience trait sense of coherence. Different predictors were identified for different areas of unmet needs. Care setting, psychological distress, and resilience trait were the strongest indicators of unmet needs in every area: information/communication, assistance/care, material needs, relational needs, and psychoemotional support. CONCLUSIONS Clinicians should consider that inpatients with a high distress and a low resilience trait sense of coherence represent a group of cancer patients to be investigated with particular attention regarding unmet needs.
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Affiliation(s)
- Andrea Bonacchi
- 1 Clinical and Descriptive Epidemiology Unit, Institute for Cancer Research and Prevention-ISPO, Florence, Italy.,2 Centro Studi e Ricerca Synthesis, Florence, Italy
| | | | | | - Maria Grazia Muraca
- 3 Centro Riabilitazione Oncologica, Institute for Cancer Research and Prevention-ISPO, Florence, Italy
| | - Paola Pacetti
- 4 Azienda USL Nordovest, Oncologia Ambito Territoriale di Massa Carrara, Carrara, Italy
| | - Stefania Di Miceli
- 5 Rete di Cure Palliative, Zona Nord Ovest, USL Centro Firenze, Florence, Italy
| | - Guido Miccinesi
- 1 Clinical and Descriptive Epidemiology Unit, Institute for Cancer Research and Prevention-ISPO, Florence, Italy
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Carey M, Sanson-Fisher R, Clinton-McHarg T, Boyes A, Olver I, Oldmeadow C, Paul C, D'Este C, Henskens F. Examining variation across treatment clinics in cancer patients' psychological outcomes: results of a cross sectional survey. Support Care Cancer 2018; 26:3201-3208. [PMID: 29619554 PMCID: PMC6096527 DOI: 10.1007/s00520-018-4188-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 03/28/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE The majority of research on psychological outcomes for cancer patients has focussed on the role of individual characteristics, and disease and treatment factors. There has been very little exploration of the potential contribution of the treatment clinic to these outcomes. This study explored whether there is variation among clinics in cancer patients' psychological outcomes. METHODS Cancer outpatients were recruited from 22 medical oncology and haematology clinics in Australia. Participants completed a pen and paper survey including the Hospital Anxiety and Depression Scale (HADS), as well as sociodemographic, disease and treatment characteristics. RESULTS Of those eligible to participate, 4233 (82%) consented and 2811 (81% of consenters) returned the completed survey. There was no statistically significant variation in HADS depression scores across clinics. Some difference in anxiety scores derived from the HADS questionnaire between clinics (p = 0.03) was found with the percentage of between-clinic variation estimated to be 1.11%. However, once all demographic, disease and treatment predictors were adjusted for there was no statistical differences between clinics (percent of between-clinic variation = 0.53%; p = 0.1415). CONCLUSIONS Psychological outcomes were not found to vary between clinics. Other sources of variation including patient characteristics may over-ride between-clinic variability, if it exists.
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Affiliation(s)
- Mariko Carey
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, The University of Newcastle, W4 HMRI Building, Callaghan, NSW, 2308, Australia.
- Hunter Medical Research Institute, New Lambton, NSW, 2305, Australia.
| | - Robert Sanson-Fisher
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, The University of Newcastle, W4 HMRI Building, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, New Lambton, NSW, 2305, Australia
| | - Tara Clinton-McHarg
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, The University of Newcastle, W4 HMRI Building, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, New Lambton, NSW, 2305, Australia
| | - Allison Boyes
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, The University of Newcastle, W4 HMRI Building, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, New Lambton, NSW, 2305, Australia
| | - Ian Olver
- Samson Institute for Health Research, University of South Australia, Adelaide, SA, 5001, Australia
| | | | - Christine Paul
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, The University of Newcastle, W4 HMRI Building, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, New Lambton, NSW, 2305, Australia
| | - Catherine D'Este
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, 2601, Australia
| | - Frans Henskens
- School of Electrical Engineering and Computer Science, The University of Newcastle, Callaghan, NSW, 2308, Australia
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22
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Ferrari M, Ripamonti CI, Hulbert-Williams NJ, Miccinesi G. Relationships among unmet needs, depression, and anxiety in non-advanced cancer patients. TUMORI JOURNAL 2018; 105:144-150. [PMID: 29714666 DOI: 10.1177/0300891618765546] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION In oncology settings, less attention is given to patients' unmet needs and to existential and emotional distress compared to physical symptoms. We aimed to evaluate correlations between unmet needs and emotional distress (self-reported anxiety and depression) in a consecutive cohort of cancer patients. The influence of sociodemographic and clinical factors was also considered. METHODS A total of 300 patients with cancer recruited from an outpatient Supportive Care Unit of a Comprehensive Cancer Centre completed the Need Evaluation Questionnaire and the Edmonton Symptom Assessment System (ESAS). Unmet needs covered 5 distinct domains (informational, care/assistance, relational, psychoemotional, and material). RESULTS After removal of missing data, we analyzed data from 258 patients. Need for better information on future health concerns (43%), for better services from the hospital (42%), and to speak with individuals in the same condition (32%) were the most frequently reported as unmet. Based on the ESAS, 27.2% and 17.5% of patients, respectively, had a score of anxiety or depression >3 and needed further examination for psychological distress. Female patients had significantly higher scores for anxiety ( p < 0.001) and depression ( p = 0.008) compared to male patients. Unmet needs were significantly correlated with both anxiety ( rs = 0.283) and depression ( rs = 0.284). Previous referral to a psychologist was significantly associated with depression scores ( p = 0.015). Results were confirmed by multiple regression analysis. CONCLUSIONS Screening for unmet needs while also considering sociodemographic and clinical factors allows early identification of cancer patients with emotional distress. Doing so will enable optimal management of psychological patient-reported outcomes in oncology settings.
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Affiliation(s)
- Martina Ferrari
- 1 Department of Psychology, University of Chester, Chester, UK
| | - Carla I Ripamonti
- 2 Supportive Care in Cancer Unit, Department of Onco-Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | - Guido Miccinesi
- 3 Clinical Epidemiology Unit, Cancer Prevention and Research Institute-ISPO Clinical Epidemiology Unit, Florence, Italy
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23
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Le Saux O, Lapotre-Aurelle S, Watelet S, Castel-Kremer E, Lecardonnel C, Murard-Reeman F, Ravot C, Falandry C. Systematic review of care needs for older patients treated with anticancer drugs. J Geriatr Oncol 2018; 9:441-450. [PMID: 29573968 DOI: 10.1016/j.jgo.2018.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/05/2017] [Accepted: 02/23/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE When treated with anticancer therapies, a number of issues are raised for older patients such as physical needs (coping with symptoms and side-effects) or psychological needs. Geriatric tailored interventions addressing these needs may be effective in terms of improving quality of life of our patients. METHODS A systematic review was performed in September 2017 in MEDLINE. All reports assessing older patients with cancer care needs in the context of anticancer systemic therapy were reviewed. RESULTS A total of 357 articles were analyzed. From these, 35 studies were included in the analysis. Compared to younger patients, the elderly had less supportive care needs. While older patients asked for less information than their younger counterparts, they still requested information on diagnosis, seriousness of the disease, chances of cure, spread of the disease, recovery, courses of illness, possible consequences, treatment procedures, treatment options, possible side effects and how to deal with them, and what they could do in daily life. When taking into consideration the various needs as assessed by the "Supportive Care Needs Survey", physical and daily living were the most frequently reported needs with emphasis on nutrition, coping with physical symptoms, dealing with side effects of treatment, and performing usual physical tasks and activities. CONCLUSION Information demand seemed moderate but a great deal of attention was paid to nutrition and well-being.
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Affiliation(s)
- Olivia Le Saux
- Medical Oncology Department, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), Pierre-Bénite, France; Lyon 1 University, EMR 3738, Faculté de Médecine Lyon-Sud, Oullins, France; Geriatric Oncology Department, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.
| | | | - Sophie Watelet
- Geriatric Oncology Department, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | | | - Clémence Lecardonnel
- Geriatric Oncology Department, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | | | - Christine Ravot
- Geriatric Oncology Department, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Claire Falandry
- Geriatric Oncology Department, Centre Hospitalier Lyon Sud, Pierre-Bénite, France; CarMen Biomedical Research Laboratory (Cardiovascular Diseases, Metabolism, Diabetology and Nutrition) INSERM UMR 1060, Université de Lyon, Oullins, France
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24
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Ringwald J, Marwedel L, Junne F, Ziser K, Schäffeler N, Gerstner L, Wallwiener M, Brucker SY, Hautzinger M, Zipfel S, Teufel M. Demands and Needs for Psycho-Oncological eHealth Interventions in Women With Cancer: Cross-Sectional Study. JMIR Cancer 2017; 3:e19. [PMID: 29175813 PMCID: PMC5722981 DOI: 10.2196/cancer.7973] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/28/2017] [Accepted: 09/22/2017] [Indexed: 01/22/2023] Open
Abstract
Background Over the last decade, a growing body of studies regarding the application of eHealth and various digital interventions has been published and are widely used in the psycho-oncological care. However, the effectiveness of eHealth applications in psycho-oncological care is still questioned due to missing considerations regarding evidence-based studies on the demands and needs in cancer-affected patients. Objective This cross-sectional study aimed to explore the cancer-affected women’s needs and wishes for psycho-oncological content topics in eHealth applications and whether women with cancer differ in their content topics and eHealth preferences regarding their experienced psychological burden. Methods Patients were recruited via an electronic online survey through social media, special patient Internet platforms, and patient networks (both inpatients and outpatients, University Hospital Tuebingen, Germany). Participant demographics, preferences for eHealth and psycho-oncological content topics, and their experienced psychological burden of distress, quality of life, and need for psychosocial support were evaluated. Results Of the 1172 patients who responded, 716 were included in the study. The highest preference for psycho-oncological content topics reached anxiety, ability to cope, quality of life, depressive feelings, and adjustment toward a new life situation. eHealth applications such as Web-based applications, websites, blogs, info email, and consultation hotline were considered to be suitable to convey these content topics. Psychological burden did not influence the preference rates according to psycho-oncological content and eHealth applications. Conclusions Psycho-oncological eHealth applications may be very beneficial for women with cancer, especially when they address psycho-oncological content topics like anxiety, ability to cope, depressive feelings, self-esteem, or adjustment to a new life situation. The findings of this study indicate that psycho-oncological eHealth applications are a promising medium to improve the psychosocial care and enhance individual disease management and engagement among women with cancer.
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Affiliation(s)
- Johanna Ringwald
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.,Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital Tuebingen, Tuebingen, Germany
| | - Lennart Marwedel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Katrin Ziser
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Norbert Schäffeler
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Lena Gerstner
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | - Sara Yvonne Brucker
- Department of Obstetrics and Gynecology, University Hospital Tuebingen, Tuebingen, Germany
| | - Martin Hautzinger
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.,Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital Tuebingen, Tuebingen, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, LVR-Clinic Essen, University of Duisburg-Essen, Essen, Germany
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Becherer BE, Kamali P, Paul MA, Wu W, Curiel DA, Rakhorst HA, Lee B, Lin SJ, Kansal KJ. Prevalence of psychiatric comorbidities among women undergoing free tissue autologous breast reconstruction. J Surg Oncol 2017; 116:803-810. [PMID: 28743179 DOI: 10.1002/jso.24755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 06/11/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES Autologous breast reconstruction (BR) can be a stressful life event. Therefore, women undergoing mastectomy and autologous BR are required to have sufficient coping mechanisms. Although mental health problems are widespread, information regarding the prevalence of psychiatric diagnosis among these patients is scarce. METHODS Retrospective analysis was performed using data from a large tertiary teaching hospital and the Nationwide Inpatient Sample (NIS) database. Patients undergoing autologous BR after mastectomy were included and evaluated for psychiatric disorders. Prevalence of each disorder, timing of diagnosis (preoperative or postoperative), and data per age group were reviewed. RESULTS Between 2004 and 2014, 817 patients were included from the institutional database and 26 399 from the NIS database. Preoperatively, 15.3% of the patients were diagnosed with a psychiatric disorder within our institution and 17.6% nationwide (P < 0.001). Postoperatively, 20.5% of the institutional patients were diagnosed with a psychiatric disorder. No major differences in prevalence were seen between age groups. CONCLUSIONS Approximately, one in six patients were diagnosed with a psychiatric comorbidity preoperatively. Postoperatively, an additional 20.5% developed a psychiatric disorder. There was no difference in prevalence and timing of diagnosis between age groups.
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Affiliation(s)
- Babette E Becherer
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Parisa Kamali
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Marek A Paul
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Winona Wu
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Daniel A Curiel
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Hinne A Rakhorst
- Division of Plastic, Reconstructive and Hand Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.,Division of Plastic, Reconstructive and Hand Surgery, Enschede, The Netherlands
| | - Bernard Lee
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Kari J Kansal
- Division of Surgical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Brage E, Vindrola-Padros C. An ethnographic exploration of the delivery of psychosocial care to children with cancer in Argentina. Eur J Oncol Nurs 2017; 29:91-97. [PMID: 28720272 DOI: 10.1016/j.ejon.2017.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 02/21/2017] [Accepted: 05/08/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE The integration of psychosocial care in the routine care of cancer patients has been set as an international standard, but there are healthcare contexts where these services are lacking as psychosocial care providers are not incorporated in multidisciplinary teams and screening for psychological distress is not carried out routinely or systematically. METHOD In this article, we discuss the findings from an ethnographic study that focused on exploring the working experiences of psychosocial care providers from one children's hospital in Buenos Aires, Argentina. The study is based on 10 in-depth interviews with hospital staff members and participant observation in selected hospital areas. The transcripts from the interviews and fieldnotes from the observations were analyzed using thematic analysis. RESULTS We found that psychosocial care providers encounter difficulties while attempting to deliver services to children and their families, produced mainly by their lack of collaboration with other professional groups, insufficient human resources, and a growing patient population. As a result of this situation, psychosocial care providers often prioritize some patients over others, leaving a considerable number of patients and family members without psychosocial support. CONCLUSIONS The study highlighted the barriers psychosocial care providers encounter while attempting to deliver services to children and their families. Further work needs to be carried out to fully integrate psychosocial care in national health policies and ensure this type of support is available for all patients and their families.
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Affiliation(s)
- Eugenia Brage
- Facultad de Filosofia y Letras, Universidad de Buenos Aires, CONICET, Buenos Aires, Argentina
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27
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Feasibility and Acceptability of the Use of Patient-Reported Outcome Measures in the Delivery of Nurse-Led, Supportive Care to Women With Cervical Cancer. CLIN NURSE SPEC 2017; 31:E1-E10. [DOI: 10.1097/nur.0000000000000306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Kotronoulas G, Papadopoulou C, MacNicol L, Simpson M, Maguire R. Feasibility and acceptability of the use of patient-reported outcome measures (PROMs) in the delivery of nurse-led supportive care to people with colorectal cancer. Eur J Oncol Nurs 2017; 29:115-124. [PMID: 28720258 DOI: 10.1016/j.ejon.2017.06.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 05/30/2017] [Accepted: 06/07/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Logistical issues pertinent to the use of patient-reported outcome measures (PROMs) by colorectal cancer nurse specialists (CNS) to identify the needs of people with colorectal cancer (CRC) in acute care remain unknown. We explored the feasibility and acceptability of PROMs-driven, CNS-led consultations to enhance delivery of supportive care to people with CRC completing adjuvant chemotherapy. METHODS A systematic literature review and focus groups with patients and CNS (Phase 1) were followed by a repeated-measures, exploratory study (Phase 2), whereby pre-consultation PROM data were collected during three consecutive, monthly consultations, and used by the CNS to enable delivery of personalised supportive care. RESULTS Based on Phase 1 data, the Supportive Care Needs Survey was selected for use in Phase 2. Fourteen patients were recruited (recruitment rate: 56%); thirteen (93%) completed all study assessments. Forty in-clinic patient-clinician consultations took place. At baseline, 219 unmet needs were reported in total, with a notable 21% (T2) and 32% (T3) over-time reduction. Physical/daily living and psychological domain scores declined from T1 to T3, yet not statistically significantly. In exit interviews, patients described how using the PROM helped them shortlist and prioritise their needs. CNS stressed how the PROM helped them tease out more issues with patients than they would normally. CONCLUSIONS Nurse-led, PROMs-driven needs assessments with patients with CRC appear to be feasible and acceptable in clinical practice, possibly associated with a sizeable reduction in the frequency of unmet needs, and smaller decreases in physical/daily living and psychosocial needs in the immediate post-chemotherapy period.
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Affiliation(s)
- Grigorios Kotronoulas
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, UK.
| | | | - Lorna MacNicol
- Wishaw General Hospital, NHS Lanarkshire, Lanarkshire, UK.
| | - Mhairi Simpson
- Wishaw General Hospital, NHS Lanarkshire, Lanarkshire, UK.
| | - Roma Maguire
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, UK.
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Vuong QH. Economic Benefits and Treatment Progress as Determinants of the Sustainability of Vietnamese Voluntary Co-Located Patients Clusters. J Public Health Res 2017; 6:788. [PMID: 28480174 PMCID: PMC5402188 DOI: 10.4081/jphr.2017.788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/06/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Over the past 15 years or so, in Vietnam, a phenomenon has steadily grown more and more widespread: the forming of co-located patients communities. Poor patients choose to live together, seeking/lending supports from/to one another. Despite the undeniable existence of these communities, little is researched or known about how co-located patients perceive the value of what they receive as cluster members, or how they assess their future connection to the communities they are living in. MATERIALS AND METHODS The study employs multiple logistic regressions method to investigate relationships between factors such as perceived satisfaction from community-provided financial means, reported health improvements, along with patients' short-and longer-term commitments to these communities. RESULTS The results suggest meaningful empirical relationships: 1) between, on one hand, gender, perceived values and sustainability of patients communities, financial stress faced by patients and the financial benefits they received from the community, and, on the other hand, their propensity to stay connected to it; and 2) between economic conditions, length of stay with a community, general level of satisfaction, health improvements on one hand and long-term commitment to these communities on the other hand. CONCLUSIONS Patients who choose to stick to co-location clusters do so for an economic reason: finding means to fight their financial hardship. This may suggest a degree of complication higher than one would have thought in dealing with poor patients from a social point of view. Concretely, the majority of the public only focuses on charity programs and in-king donations, while ignoring the more sustainable - and, at the same time, more complicated - alternative which is to create suitable income-generating jobs for patient. In addition, patients are not only those who seek to ask for supports but can potentially be the donors contributing to the sustainability of those voluntary communities.
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30
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Markovitz LC, Drysdale NJ, Bettencourt BA. The relationship between risk factors and medication adherence among breast cancer survivors: What explanatory role might depression play? Psychooncology 2017; 26:2294-2299. [PMID: 28032940 DOI: 10.1002/pon.4362] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 12/06/2016] [Accepted: 12/23/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Despite the efficacy of clinical treatments (eg, adjuvant hormonal therapy) for breast cancer survivors (BCS), nonadherence rates remain high, increasing the risk of recurrence and mortality. The current study tested a theoretical model of medical nonadherence that proposes depression to be the most proximal predictor of medical nonadherence among BCS. METHODS Breast cancer survivors were recruited from radiation clinics in Missouri. Survey data were collected 12 months after the end of primary treatment. The sample size included 133 BCS. RESULTS Findings show substantial support for the model, demonstrating that depression mediated the relation between physical symptoms, cognitive symptoms, social support, and adherence to medication. This finding was replicated with a measure of mood disturbance. CONCLUSIONS These findings support the prediction that medication nonadherence among BCS multiply determined process and have compelling implications for healthcare providers and interventions designed to increase medication adherence among BCS.
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31
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Raphael D, Frey R, Gott M. Psychosocial distress in haematological cancer survivors: An integrative review. Eur J Cancer Care (Engl) 2017; 26. [DOI: 10.1111/ecc.12640] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2016] [Indexed: 01/07/2023]
Affiliation(s)
- D. Raphael
- School of Nursing; Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | - R. Frey
- School of Nursing; Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | - M. Gott
- School of Nursing; Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
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Bracher M, Corner DJ, Wagland R. Exploring experiences of cancer care in Wales: a thematic analysis of free-text responses to the 2013 Wales Cancer Patient Experience Survey (WCPES). BMJ Open 2016; 6:e011830. [PMID: 27591021 PMCID: PMC5020838 DOI: 10.1136/bmjopen-2016-011830] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To provide the first systematic analysis of a national (Wales) sample of free-text comments from patients with cancer, to determine emerging themes and insights regarding experiences of cancer care in Wales. DESIGN Thematic analysis of free-text data from a population-based survey. SETTING AND PARTICIPANTS Adult patients with a confirmed cancer diagnosis treated within a 3-month period during 2012 in the 7 health boards and 1 trust providing cancer care in Wales. MAIN OUTCOME MEASURES Free-text categorised by theme, coded as positive or negative, with ratios. Overarching themes are identified incorporating comment categories. METHODS 4672 respondents (of n=7352 survey respondents) provided free-text comments. Data were coded using a multistage approach: (1) coding of comments into general categories (eg, nursing, surgery, etc), (2) coding of subcategories within main categories (eg, nursing care, nursing communication, etc), (3) cross-sectional analysis to identify themes cutting across categories, (4) mapping of categories/subcategories to corresponding closed questions in the Wales Cancer Patient Experience Survey (WCPES) data for comparison. RESULTS Most free-text respondents (82%, n 3818) provided positive comments about their cancer care, with 49% (n=2313) giving a negative comment (ratio 0.6:1, negative-to-positive). 3172 respondents (67.9% of free-text respondents) provided a comment mapping to 1 of 4 overarching themes: communication (n=1673, 35.8% free-text respondents, a ratio of 1.0:1); waiting during the treatment and/or post-treatment phase (n=923, 19.8%, ratio 1.5:1); staffing and resource levels (n=671, 14.4% ratio 5.3:1); speed and quality of diagnostic care (n=374, 8.0%, ratio 1.5:1). Within these areas, constituent subthemes are discussed. CONCLUSIONS This study presents specific areas of concern for patients with cancer, and reveals a number of themes present across the cancer journey. While the majority of comments were positive, analysis reveals concerns shared by significant numbers of respondents. Timely communication can help to manage these anxieties, even where delays or difficulties in treatment may be encountered.
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Affiliation(s)
- Michael Bracher
- Faculty of Health Sciences, University of Southampton, Highfield, Southampton, UK
| | - Dame Jessica Corner
- Faculty of Health Sciences, University of Southampton, Highfield, Southampton, UK
| | - Richard Wagland
- Faculty of Health Sciences, University of Southampton, Highfield, Southampton, UK
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Suhonen R, Charalambous A, Berg A, Katajisto J, Lemonidou C, Patiraki E, Sjövall K, Stolt M, Radwin L. Hospitalised cancer patients’ perceptions of individualised nursing care in four European countries. Eur J Cancer Care (Engl) 2016; 27. [DOI: 10.1111/ecc.12525] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2016] [Indexed: 12/17/2022]
Affiliation(s)
- R. Suhonen
- Department of Nursing Science; University of Turku; Turku Finland
- Turku University Hospital; Turku Finland
- City of Turku; Welfare Division; Turku Finland
| | - A. Charalambous
- Department of Nursing Studies; Cyprus University of Technology; Limassol Cyprus
- University of Turku; Turku Finland
| | - A. Berg
- Kristianstad University; Kristianstad Sweden
- University West; Trollhättan Sweden
| | - J. Katajisto
- Department of Mathematics and Statistics; University of Turku; Turku Finland
| | - C. Lemonidou
- Faculty of Nursing; National and Kapodistrian University of Athens; Athens Greece
| | - E. Patiraki
- Faculty of Nursing; National and Kapodistrian University of Athens; Athens Greece
| | - K. Sjövall
- Department of Health Sciences and Skåne University Hospital; Lund University; Lund Sweden
| | - M. Stolt
- Department of Nursing Science; University of Turku; Turku Finland
| | - L.E. Radwin
- Center for Healthcare Organization & Implementation Research (CHOIR); Veteran Administration Boston Healthcare System; Boston MA USA
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Gonzalez-Saenz de Tejada M, Bilbao A, Baré M, Briones E, Sarasqueta C, Quintana JM, Escobar A. Association of social support, functional status, and psychological variables with changes in health-related quality of life outcomes in patients with colorectal cancer. Psychooncology 2015; 25:891-7. [PMID: 26582649 DOI: 10.1002/pon.4022] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 10/02/2015] [Accepted: 10/12/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND The aim of this study was to explore the association of social support received, and functional and psychological status of colorectal cancer patients before surgery with changes in health-related quality of life (HRQoL) outcomes measured by EORTC QLQ-C30 at 1-year post-intervention. METHODS Consecutive patients that were because of undergo therapeutic surgery for the first time for colon or rectum cancer in nine hospitals in Spain were eligible for the study. Patients completed questionnaires before surgery and 12 months afterwards: one HRQoL instrument, the EORTC QLQ-C30; a social network and social support questionnaire, the Duke-UNC Functional Social Support Questionnaire; the Hospital Anxiety and Depression Scale, to assess anxiety and depression; and the Barthel Index, to assess functional status; as well as questions about sociodemographic information. General linear models were built to explore the association of social support, functional status, and psychological variables with changes in HRQoL 12 months after intervention. RESULTS A total of 972 patients with colorectal cancer took part in the study. Patients' functional status, social support, and anxiety and depression were associated with changes in at least one HRQoL domain. The higher functional status, and the higher social support, the more they improved in HRQoL domains. Regarding anxiety and depression, the more anxiety and depression patients have at baseline, less they improve in HRQoL domains. CONCLUSIONS Patients with colorectal cancer who have more social support and no psychological distress may have better results in HRQoL domains at 1 year after surgery. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- M Gonzalez-Saenz de Tejada
- Research Unit, Basurto University Hospital, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
| | - A Bilbao
- Research Unit, Basurto University Hospital, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
| | - M Baré
- Unitat d'Epidemiologia, Corporació Sanitària Parc Taulí, REDISSEC, Sabadell, Barcelona, Spain
| | - E Briones
- Unidad de Salud Pública. Distrito Sanitario Sevilla, Consorcio de Investigación Biomédica de Epidemiología y Salud Pública, Madrid, Spain
| | - C Sarasqueta
- Research Unit, Donostia University Hospital, REDISSEC, San Sebastián, Spain
| | - J M Quintana
- Research Unit, Hospital of Galdakao-Usansolo, REDISSEC, Bilbao, Spain
| | - A Escobar
- Research Unit, Basurto University Hospital, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
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Schmidt A, Kowalski C, Pfaff H, Wesselmann S, Wirtz M, Ernstmann N. The Influence of Health Literacy on Information Needs Among Women Newly Diagnosed With Breast Cancer, With Special Reference to Employment Status. JOURNAL OF HEALTH COMMUNICATION 2015; 20:1177-84. [PMID: 26086892 DOI: 10.1080/10810730.2015.1018626] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Breast cancer is the most frequent type of malignancy among women throughout Germany. The present analysis aimed to identify information needs and aspects of health literacy in women of working age newly diagnosed with breast cancer. PIAT is a prospective multicenter cohort study in which patients were asked about their information needs at 3 assessment points: postoperatively, after 10 weeks, and after 40 weeks. The present analysis includes data from 1,344 female patients after the first assessment point. In addition to descriptive analyses, logistic regression analyses were calculated. Results of the study show that, in addition to sociodemographic characteristics, the level of health literacy and the employment status of the women who responded to the inquiry influence specific unmet information needs. Most frequently mentioned unmet information needs relate to supplementary naturopathy, nutrition, health-promoting measures, and working during breast cancer. Patients with breast cancer are often provided with large amounts of information during their hospital stay indicating this information is not targeted to patient needs and may be overwhelming. The results show that information on everyday life needs such as supplementary naturopathy were important for the sample newly diagnosed with breast cancer. Employed women in particular have questions regarding working during cancer or tax relief.
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Affiliation(s)
- Anna Schmidt
- a Institute for Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Science and Faculty of Medicine , University of Cologne , Cologne , Germany
| | | | - Holger Pfaff
- a Institute for Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Science and Faculty of Medicine , University of Cologne , Cologne , Germany
| | | | - Markus Wirtz
- c Institute for Psychology , University of Education , Freiburg , Germany
| | - Nicole Ernstmann
- a Institute for Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Science and Faculty of Medicine , University of Cologne , Cologne , Germany
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Taillandier-Schmitt A, Michinov E. Stéréotypes et préjugés à l’égard de personnes atteintes de cancer : étude auprès d’une population générale et de professionnels de santé. PRAT PSYCHOL 2015. [DOI: 10.1016/j.prps.2015.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Castro EM, Jiménez JC, Quinn G, García M, Colón Y, Ramos A, Brandon T, Simmons V, Gwede C, Vadaparampil S, Nazario CM. Identifying clinical and support service resources and network practices for cancer patients and survivors in southern Puerto Rico. Support Care Cancer 2015; 23:967-75. [PMID: 25249352 PMCID: PMC4346447 DOI: 10.1007/s00520-014-2451-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 09/14/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objectives of this study were to identify cancer-related health care services and to explore the presence of inter-organizational interactions among clinical and support oncology services in southern Puerto Rico. METHODS From January through July of 2010, a survey was completed by 54 health care organizations offering clinical, supportive, or both services to cancer patients/survivors (CPS) in southern PR. Survey data were compiled and descriptive analyses performed using the software Statistical Package for a Social Science (SPSS), version 18.0. RESULTS The distribution of the primary services provided by the participating organizations was the following: 26 had clinical services, 16 had support services, and 12 offered a combination of clinical and support services. Only 24 % of the surveyed organizations offered their services exclusively to patients diagnosed with cancer. In terms of referral practices, 61 % of the responses were for medical specialists, 43 % were for mental health services, and 37 % were referrals for primary care services. The most common reason for interacting (n = 27) was to provide a given patient both a referral and information. CONCLUSION Findings suggest gaps in both the availability of oncology services and the delivery of integrated health care. Lack of communication among clinical and support organizations (for cancer patients, specifically) could negatively impact the quality of the services that they offer. Further network analysis studies are needed to confirm these gaps. Until systemic, structural changes occur, more efforts are needed to facilitate communication and collaboration among these kinds of organization.
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Affiliation(s)
- Eida M Castro
- Department of Psychology, Ponce School of Medicine and Health Sciences, #388 Zona Industrial Reparada 11, Ponce, 00716, Puerto Rico,
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Kim SH. An Ethnographic Research on Psychological Experiences of Mothers Caring for their Children with Recurent Cancer. ASIAN ONCOLOGY NURSING 2015. [DOI: 10.5388/aon.2015.15.2.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Seong-Heui Kim
- Department of Nursing, Seoul National University Hospital, Seoul, Korea
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Jansen F, van Uden-Kraan CF, van Zwieten V, Witte BI, Verdonck-de Leeuw IM. Cancer survivors’ perceived need for supportive care and their attitude towards self-management and eHealth. Support Care Cancer 2014; 23:1679-88. [PMID: 25424520 DOI: 10.1007/s00520-014-2514-7] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 11/10/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Femke Jansen
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
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Yi M, Park K, Park EY. Psychosocial needs of low-income people with cancer in Korea. Eur J Oncol Nurs 2014; 18:549-56. [PMID: 25300446 DOI: 10.1016/j.ejon.2014.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 06/25/2014] [Accepted: 07/14/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of the study was to investigate significant psychosocial needs of low-income people with cancer in Korea and the extent to which these needs are unmet and which factors influence them. METHODS A descriptive study with a cross-sectional design was used. The data were collected by questionnaires from a convenience sample of 238 low-income people with cancer during 2009. A psychosocial needs inventory consisting of 7 categories with 48 items was used to identify significant psychosocial needs and unmet needs. Unmet psychosocial needs were defined to the needs that the participants reported as both important and unsatisfied. Influencing factors defined with multivariate regression analysis. RESULTS "Health professionals" was the most important needs category, followed by "information. Among the 48 items, 37 were identified to be important or very important by more than 50% of the participants. All 37 important psychosocial needs were also identified to be unmet needs. "Emotional and spiritual" was the most unmet psychosocial needs category, followed by "practical matters" and "identity" categories. The most unmet need item was 'help with financial matters' (50.0%). The strongest influencing factor was 'no one to talk with'. CONCLUSION Low-income people with cancer experience high levels of unmet needs across a wide range of psychosocial needs. They need to be supported not only for practical matters but also for emotional and spiritual areas. The results provide a first step towards a development of interventions tailored to meet psychosocial needs and expectations of low-income people with cancer.
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Affiliation(s)
- Myungsun Yi
- College of Nursing, and The Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea.
| | - Keeho Park
- Cancer Risk Appraisal & Prevention Branch, National Cancer Center, Goyang, Republic of Korea
| | - Eun Young Park
- College of Nursing, Gachon University, Incheon, Republic of Korea.
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Yokoo M, Akechi T, Takayama T, Karato A, Kikuuchi Y, Okamoto N, Katayama K, Nakanotani T, Ogawa A. Comprehensive assessment of cancer patients' concerns and the association with quality of life. Jpn J Clin Oncol 2014; 44:670-6. [PMID: 24829467 DOI: 10.1093/jjco/hyu060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Comprehensive assessment of perceived concerns can be used to guide supportive care appropriate to individual cancer patients. This study sought to determine the prevalence of cancer patients' concerns and the degree to which these concerns contribute to patients' quality of life. METHODS Participants were patients with all types of cancer, who completed an Internet survey questionnaire regarding comprehensive concerns about physical, psychological, psychosocial and economic aspects of having cancer. The questionnaire was based on the newly developed Comprehensive Concerns Assessment Tool and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. RESULTS We obtained complete data from 807 patients. Factors related to 'self-management' concerns were the most common (61.2%), followed by concerns about 'psychological symptoms' (48.5%), 'medical information' (46.2%), 'daily living' (29.9%), 'pain' (17.6%), 'constipation' (15.6%) and other 'physical symptoms' (15.2%). Multiple regression analysis revealed that all concerns except those about 'medical information' significantly contributed to quality of life. CONCLUSIONS Cancer patients' concerns were shown to be multidimensional and significantly associated with quality of life. Thus, assessment of patients' concerns should be multidimensional in nature, and a multidisciplinary care team should help patients improve their quality of life.
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Affiliation(s)
- Minori Yokoo
- Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center East Hospital, Kashiwa, Chiba
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City Graduate School of Medical Sciences, Nagoya, Aichi
| | - Tomoko Takayama
- Cancer Information Service Division, Center for Cancer Control and Information Service, National Cancer Center, Tsukiji, Tokyo
| | - Atsuya Karato
- Patient Support Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake, Tokyo
| | - Yuki Kikuuchi
- Department of Patient and Family Support, Shikoku Cancer Center, Matsuyama, Ehime
| | - Naoyuki Okamoto
- Cancer Prevention and Cancer Control Division, Kanagawa Cancer Center Research Institute, Yokohama, Kanagawa, Japan
| | - Kayoko Katayama
- Cancer Prevention and Cancer Control Division, Kanagawa Cancer Center Research Institute, Yokohama, Kanagawa, Japan
| | - Takako Nakanotani
- Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center East Hospital, Kashiwa, Chiba
| | - Asao Ogawa
- Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center East Hospital, Kashiwa, Chiba
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Appleton L, Flynn M. Searching for the new normal: exploring the role of language and metaphors in becoming a cancer survivor. Eur J Oncol Nurs 2014; 18:378-84. [PMID: 24785792 DOI: 10.1016/j.ejon.2014.03.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 03/17/2014] [Accepted: 03/26/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE This qualitative exploratory study was grounded in local patient and service user experiences and was designed to investigate how the language and metaphors of cancer influence personal and social adjustment after completion of a course of treatment. METHODS The study employed a focus group design, in which eighteen people, recruited through regional networks and support groups, participated. Meetings elicited participants' stories and focused discussion on key words and common phrases in the cancer lexicon. Data from transcribed focus group recordings were analysed thematically and organised into descriptive categories concerned with the interpretations of common terms and how these influenced the management of identity and emotions. RESULTS The thematic categories emphasised the importance of language in the way participants managed their illness and sought to control their feelings and their interactions with others. Interpretation of findings revealed a strong central idea linking participants' accounts, which was that language, metaphor and euphemism are central to adjustment and the forging of an altered identity as a survivor of cancer diagnosis and treatment. CONCLUSIONS The findings are consistent with what is already known about the language and metaphors of cancer, with language being an important mechanism for managing uncertainty. From participants' accounts it also appears that there may be subtle but important differences in professional and lay understandings of cancer language and metaphor. This suggests a need for oncology nurses to elaborate their broad understanding of communication skills and move toward a more detailed understanding of the language used during interactions with patients.
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Affiliation(s)
- Lynda Appleton
- The Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Bebington, Wirral CH63 4JY, UK.
| | - Maria Flynn
- School of Health Sciences, University of Liverpool, Thompson Yates Building, Liverpool L69 3GB, UK.
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Swash B, Hulbert-Williams N, Bramwell R. Unmet psychosocial needs in haematological cancer: a systematic review. Support Care Cancer 2014; 22:1131-41. [PMID: 24464526 DOI: 10.1007/s00520-014-2123-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 01/06/2014] [Indexed: 01/06/2023]
Abstract
PURPOSE Psychosocial need implies a desire or requirement for support that underlies a person's psychological, social and emotional wellbeing. This is not a new concept in the wider cancer literature, yet remains a relatively unexplored area in relation to haematological malignancies. The well-recognised differences between haematological and other types of cancer diagnosis warrant further investigation to try and highlight the potential differences in the needs of this patient group. METHOD A systematic review of key online databases and psycho-oncology journals was conducted to identify papers that formally assessed unmet psychosocial needs in adults with a diagnosis of haematological cancer. The breadth of methodologies of included studies made a meta-analytical approach unfeasible, therefore studies were analysed using a narrative synthesis approach. RESULTS Eighteen studies were found to be relevant and a specific focus was placed on those papers that looked solely at participants with a haematological diagnosis. The key areas of need identified were: psychological need, notably fear of recurrence; information needs; and needs relating to both family and healthcare professionals. Fear of recurrence was the most commonly identified psychosocial need within this literature. CONCLUSIONS The clinical implications of these findings highlight the need for more widespread access to psychological support for haematology patients and for more to be done to tackle patients' fears and concerns throughout the course of their illness. Assessment and identification of unmet needs is an important step enabling the development of clinical services that support and maintain psychological wellbeing through treatment and into survivorship.
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Affiliation(s)
- B Swash
- Department of Psychology, University of Chester, Chritchley Building, Parkgate Road, Chester, CH1 4BJ, UK,
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Harrison JD, Young JM, Butow PN, Solomon MJ. Needs in health care: what beast is that? INTERNATIONAL JOURNAL OF HEALTH SERVICES 2013; 43:567-85. [PMID: 24066422 DOI: 10.2190/hs.43.3.l] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Need is a pivotal concept within health systems internationally given its driving force in health care policy, development, and delivery at population and individual levels. Needs assessments are critical activities undertaken to ensure that health services continue to be needed and to identify new target populations that demonstrate unmet need. The concept of need is underpinned by varied theoretical definitions originating from various disciplines. However, when needs are assessed, or health interventions developed based on need, little, if any, detail of the theoretical or conceptual basis of what is being measured is ever articulated. This is potentially problematic and may lead to measurement being invalid and planned health services being ineffective in meeting needs. Seldom are theoretical definitions of need ever compared and contrasted. This critical review is intended to fill this gap in the literature. Interpretations of the concept of need drawing from areas such as psychology, social policy, and health are introduced. The concept and relevance of unmet need for health services are discussed. It is intended that these definitions can be used to operationalize the term "need" in practice, theoretically drive needs assessment, and help guide health care decisions that are based upon need.
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Affiliation(s)
- James D Harrison
- Division of Hospital Medicine, University of California-San Francisco, San Francisco, CA 94143, USA.
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Appleton L, Goodlad S, Irvine F, Poole H, Wall C. Patients' experiences of living beyond colorectal cancer: A qualitative study. Eur J Oncol Nurs 2013; 17:610-7. [DOI: 10.1016/j.ejon.2013.01.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 12/20/2012] [Accepted: 01/05/2013] [Indexed: 01/11/2023]
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Krok J, Baker T, McMillan S. Sexual activity and body image: examining gender variability and the influence of psychological distress in cancer patients. JOURNAL OF GENDER STUDIES 2013; 22:409-422. [PMID: 24778465 PMCID: PMC3999973 DOI: 10.1080/09589236.2012.708828] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Psychosocial factors impacting on the overall quality of life for cancer patients may differ between men and women. This study examined the influence that psychological distress, clinical, and social variables have on sexual activity and body image in adult oncology patients. Symptom data was collected from the Memorial Symptom Assessment Scale (MSAS). Analysis indicated women and patients with reported functional limitations were more likely to be less satisfied with how they looked. The final model showed that younger adults, Caucasians, those who were married and patients with some functional limitations were more likely to have problems with sexual interest/activity. Gender was not a significant predictor of having problems with sexual interest/activity. These results can be used by clinicians to identify patients who may be at an increased risk for negative body image and problems in sexual functioning. Further research regarding gender differences in cancer-related psychological symptoms is needed to assist healthcare professionals in providing comprehensive care while alleviating unresolved and interrelated health and psychosocial symptoms.
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Affiliation(s)
- Jessica Krok
- The Ohio State University, Comprehensive Cancer Center 1590 N. High Street, Suite 525, Columbus, OH 43201
| | - Tamara Baker
- University of South Florida, School of Aging Studies 13301 Bruce B. Downs Blvd., MHC 1300, Tampa, FL 33612
| | - Susan McMillan
- University of South Florida, College of Nursing 12901 Bruce B. Downs Blvd., MDC Box 22, Tampa, FL 33612
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Valdes-Stauber J, Vietz E, Kilian R. The impact of clinical conditions and social factors on the psychological distress of cancer patients: an explorative study at a consultation and liaison service in a rural general hospital. BMC Psychiatry 2013; 13:226. [PMID: 24053562 PMCID: PMC3815628 DOI: 10.1186/1471-244x-13-226] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 09/06/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent decades, increasing attention has been paid to the subjective dimension of cancer, especially to psychosocial screening procedures, major psychiatric disorders but also psychological and psychosocial distress, and finally to met needs of oncologic patients. This study aims first to describe cancer patients in a rural hospital attended by a psycho-oncological consultation-liaison team, second to assess predictors for psychological distress in cancer patients, and finally to identify predictors for recommendation of further psychosocial support. METHODS The sample (n = 290) comprises a full survey of patients at breast and bowel cancer services (n=209) and patients referred by other medical and surgical services because of psychosocial impairment (n = 81). All patients were assessed by means of the PO-Bado (Psycho-Oncological Basic Documentation) expert rating scale. Assessment of predictors for psychological distress was conducted by multivariate regression models and assessment for predictors for need for outpatient psychosocial support by a logistic regression analysis. All analyses were conducted using STATA 12. RESULTS Most members of the assessed sample (average age 65, 82% women) were not severely impaired from a functional and psychological point of view. A total of 14% had received psychiatric treatment before. Mood swings, anxiety, grief, and fatigue were the most important distress symptoms. Selectively referred patients vs. full survey patients of cancer centres, as well as bowel vs. breast cancer patients show a higher level of psychological and physical distress. Fatigue, assessed metastases, and functional limitations were the best predictors for psychological burden. Referral mode, gender, age, family problems, fatigue, and previous psychiatric treatment were associated with further need of psychosocial support. CONCLUSIONS Psycho-oncological consultation and liaison services may offer support to patients in an early stage of cancer, especially in cancer centres. Because of selectively referred patients show a higher burden, the use of basic screening instruments could be meaningful. Fatigue, metastases status, and functional limitations may better predict psychological distress than pain, duration of illness, psychosocial conditions or previous psychiatric treatment. More attention has to be paid to outpatient follow-up with older cancer patients, those with family problems, and those suffering from significant fatigue.
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Affiliation(s)
- Juan Valdes-Stauber
- Zentrum für Psychiatrie Südwürttemberg, Department of Psychiatry and Psychotherapy I, University of Ulm, Ulm, Germany.
| | - Eva Vietz
- Outpatient Clinic, Bezirkskrankenhaus Kaufbeuren, Kaufbeuren, Germany
| | - Reinhold Kilian
- Bezirkskrankenhaus Günzburg, Department of Psychiatry and Psychotherapy II, University of Ulm, Ulm, Germany
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Mackenzie LJ, Carey ML, Paul CL, Sanson-Fisher RW, D'Este CA. Do we get it right? Radiation oncology outpatients' perceptions of the patient centredness of life expectancy disclosure. Psychooncology 2013; 22:2720-8. [PMID: 23801643 DOI: 10.1002/pon.3337] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 03/26/2013] [Accepted: 05/20/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE A patient-centred approach to discussing life expectancy with cancer patients is recommended in Western countries. However, this approach to eliciting and meeting patient preferences can be challenging for clinicians. The aims of this study were the following: (i) to examine cancer patients' preferences for life expectancy disclosure; and (ii) to explore agreement between cancer patients' preferences for, and perceived experiences of, life expectancy disclosure. METHODS Cancer patients undergoing radiotherapy treatment in metropolitan Australia completed a cross-sectional touchscreen computer survey including optional questions about their life expectancy disclosure preferences and experiences. RESULTS Of the 208 respondents, 178 (86%) indicated that they would prefer their clinician to ask them before discussing life expectancy, and 30 (14%) indicated that they would prefer others (i.e. clinicians, family) to decide whether they were given life expectancy information. Of the 175 respondents who were classified as having a self- determined or other-determined disclosure experience, 105 (60%) reported an experience of life expectancy disclosure that was in accordance with their preferences. Cohen's κ was -0.04 (95% CI, -0.17, 0.08), indicating very poor agreement between patients' preferences for and perceived experiences of life expectancy disclosure (p = 0.74). CONCLUSIONS In light of patient-centred prognosis disclosure guidelines, our findings of a majority preference for, and experience of, a self-determined approach to life expectancy disclosure amongst radiation oncology patients are encouraging. However, poor agreement between preferences and experiences highlights that additional effort from clinicians is required in order to achieve a truly patient-centred approach to life expectancy disclosure.
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Affiliation(s)
- Lisa J Mackenzie
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, Newcastle, Australia
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Gamlen E, Arber A. First assessments by specialist cancer nurses in the community: an ethnography. Eur J Oncol Nurs 2013; 17:797-801. [PMID: 23623650 DOI: 10.1016/j.ejon.2013.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 03/04/2013] [Accepted: 03/08/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of the study is to explore how specialist cancer nurses carry out first assessments of patients in the community, their use of the Symptoms and Concerns Checklist (SCC) and their views on first assessments. METHODS & SAMPLE An ethnographic approach was taken. The data were collected by use of non-participant observation of specialist nurses carrying out a first assessment of patients with cancer, followed by semi-structured interviews with six specialist nurses. Data were analysed using iterative thematic analysis. KEY RESULTS All the specialist nurses recognised the value of facilitating the patients' narrative. Use of the SCC was seen to jar with the overall theme of building relationships during the first assessment visit. It was recognised by the specialist nurses that the SCC was beneficial in prompting the patients to discuss psycho-social concerns. CONCLUSIONS This study gives insight into the conflict and ambiguity for specialist nurses when using the SCC during the first assessment visit. It confirms the SCC as beneficial in cueing some patients to identify specific concerns and for these concerns to be recognised by the specialist nurses.
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Affiliation(s)
- Elizabeth Gamlen
- The Beacon Centre, Virgin Care Ltd., Guildford, Surrey G22 7WW, UK
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Giese-Davis J, Waller A, Carlson LE, Groff S, Zhong L, Neri E, Bachor SM, Adamyk-Simpson J, Rancourt KMS, Dunlop B, Bultz BD. Screening for distress, the 6th vital sign: common problems in cancer outpatients over one year in usual care: associations with marital status, sex, and age. BMC Cancer 2012; 12:441. [PMID: 23031647 PMCID: PMC3528655 DOI: 10.1186/1471-2407-12-441] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 09/22/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Very few studies examine the longitudinal prevalence of problems and the awareness or use of clinical programs by patients who report these problems. Of the studies that examine age, gender and marital status as predictors of a range of patient outcomes, none examines the interactions between these demographic variables. This study examined the typical trajectory of common practical and psychosocial problems endorsed over 12 months in a usual-care sample of cancer outpatients. Specifically, we examined whether marital status, sex, age, and their interactions predicted these trajectories. We did not actively triage or refer patients in this study in order to examine the natural course of problem reports. METHODS Patients completed baseline screening (N = 1196 of 1707 approached) and the sample included more men (N = 696) than women (N = 498), average age 61.1 years. The most common diagnoses were gastrointestinal (27.1%), prostate (19.2%), skin (11.1%) and gynecological (9.2%). Among other measures, patients completed a Common Problem Checklist and Psychosocial Resources Use questions at baseline, 3, 6, and 12 months using paper and pencil surveys. RESULTS Results indicated that patients reported psychosocial problems more often than practical and both decreased significantly over time. Younger single patients reported more practical problems than those in committed relationships. Younger patients and women of all ages reported more psychosocial problems. Among a number of interesting interactions, for practical problems, single older patients improved more; whereas among married people, younger patients improved more. For psychosocial problems we found that older female patients improved more than younger females, but among males, it was younger patients who improved more. Young single men and women reported the most past-and future-use of services. CONCLUSIONS Younger women are particularly vulnerable to experiencing practical and psychosocial problems when diagnosed with cancer, but being married protects these younger women. Marriage appeared to buffer reports of both practical and psychosocial problems, and led to less awareness and use of services. Unexpectedly, young men reported the highest use of psychosocial services. This study informs clinical program development with information on these risk groups.
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Affiliation(s)
- Janine Giese-Davis
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Canada
- Department of Oncology, University of Calgary, Calgary, California
- Department of Psychosocial Resources, Holy Cross Site, 2202 2nd St. S.W, Calgary, Alberta, T2S 3C1, Canada
| | - Amy Waller
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Canada
- Department of Oncology, University of Calgary, Calgary, California
| | - Linda E Carlson
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Canada
- Department of Oncology, University of Calgary, Calgary, California
| | - Shannon Groff
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Canada
| | - Lihong Zhong
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Canada
- Department of Oncology, University of Calgary, Calgary, California
| | - Eric Neri
- Department of Psychiatry and Behavioral Sciences, Stanford University, Halifax, Nova Scotia, Canada
| | - Sacha M Bachor
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Canada
| | | | - Kate MS Rancourt
- Department of Psychology, Dalhousie University, Stanford, California
| | - Bernie Dunlop
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Canada
| | - Barry D Bultz
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Canada
- Department of Oncology, University of Calgary, Calgary, California
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