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Lee SC, Huang CY, Fu IN, Chen KL. Interpreting the results of explicit and applied theory of mind collectively in autistic children: A solution from Rasch analysis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:355-366. [PMID: 37161767 DOI: 10.1177/13623613231170698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
LAY ABSTRACT Theory of mind is an ability to infer others' mental states, which is a foundation for generating appropriate social responses. Theory of mind can be conceptually divided into two related but distinguishable constructs: explicit theory of mind (conceptual knowledge/information about others' mental states) and applied theory of mind (the ability to use theory of mind skills in real-life contexts). Although these two theory of mind scores can be described by the percentages of children in the early, basic, and advanced developmental stages, the resulting information may not be sufficient to determine the corresponding relationships between these two theory of mind constructs or identify children with mismatched theory of mind abilities (e.g. children who have difficulty in effectively applying their theory of mind knowledge in real-life contexts). To resolve these limitations, methods for simultaneously interpreting the relationships between the two theory of mind scores are proposed. Based on the findings, each applied theory of mind score can reflect multiple scores of explicit theory of mind. In particular, the results do not take measurement error into consideration, which would make them more ambiguous. Therefore, the scores of applied theory of mind should be interpreted carefully, given that children who have the same applied theory of mind score may actually have high or low explicit theory of mind. Regarding the method for joint interpretation, cutoff scores were selected to identify children who have mismatched theory of mind abilities (high explicit theory of mind with low applied theory of mind or low explicit theory of mind with high applied theory of mind) and determine the priority for interventions.
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Affiliation(s)
- Shih-Chieh Lee
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan City, Taiwan (R.O.C.)
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan (R.O.C.)
- Institute of Long-Term Care, MacKay Medical College, New Taipei City, Taiwan (R.O.C.)
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan (R.O.C.)
| | - Chien-Yu Huang
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan (R.O.C.)
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan (R.O.C.)
| | - I-Ning Fu
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan (R.O.C.)
- Child Developmental Assessment & Intervention Center, Taipei City Hospital, Taipei City, Taiwan (R.O.C.)
| | - Kuan-Lin Chen
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan City, Taiwan (R.O.C.)
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan (R.O.C.)
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan City, Taiwan (R.O.C.)
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Associations of Age and Sex with the Efficacy of Inpatient Cancer Rehabilitation: Results from a Longitudinal Observational Study Using Electronic Patient-Reported Outcomes. Cancers (Basel) 2023; 15:cancers15061637. [PMID: 36980523 PMCID: PMC10046728 DOI: 10.3390/cancers15061637] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/28/2023] [Accepted: 03/05/2023] [Indexed: 03/09/2023] Open
Abstract
Cancer rehabilitation is thought to increase the quality of life (QOL) and functioning of cancer survivors. It remains, however, uncertain whether subgroups benefit equally from rehabilitation. We wished to investigate the outcomes of multimodal rehabilitation according to age, sex and functioning. Patients of an Austrian rehabilitation center routinely completed the EORTC QLQ-C30 and the hospital anxiety and depression scale (HADS) questionnaires prior to (T1), and after rehabilitation (T2). To compare the outcomes between age groups (i.e., <40, 41–69, and ≥70 years), sex, and the Norton scale risk status, repeated measures of analyses of variance were calculated. A total of 5567 patients with an average age of 60.7 years were included, of which 62.7% were female. With T1 indicating the cancer survivors’ needs, older and high-risk patients reported lower functioning (all p < 0.001) and a higher symptom burden for most scales (all p < 0.05) before rehabilitation. Regardless of age, sex or risk status, the patients showed at a least small to medium improvement during rehabilitation for anxiety, depression, and most functioning and symptom scales. Some between-group differences were observed, none of which being of a relevant effect size as determined with the Cohen’s d. In conclusion, QOL is improved by rehabilitation in all patients groups, independently from age, sex, or the risk status.
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Schoenau MN. Dominant restitution narratives of 'being lucky': An ethnographic exploration of narratives about operable lung cancer. Eur J Cancer Care (Engl) 2022; 31:e13633. [PMID: 35697916 PMCID: PMC9541373 DOI: 10.1111/ecc.13633] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/05/2022] [Accepted: 06/06/2022] [Indexed: 11/27/2022]
Abstract
Objective Patients with operable lung cancer experience physical and psychosocial challenges early in their treatment trajectory. However, these patients have unmet needs for a dialogue with clinicians and report that especially psychosocial challenges are not addressed in the clinical encounter. Aiming to understand the reasons for this, this study explores dominant narratives about operable lung cancer. Methods An ethnographic study was conducted at a Danish hospital providing surgery for lung cancer. Interactions between patients, relatives and clinicians were observed during hospitalisation. Ten patients were included from September 2019 to March 2020. Results One overarching dominant narrative of ‘being lucky’ was found, supported by three narrative subthemes, related to different aspects of the treatment. First, the possibility of surgical treatment was ‘like winning the lottery’. Second, surgery was a minor intervention like ‘a quiet day at the office’. Third, even if adjuvant chemotherapy was necessary, as long as the surgery went well, it was ‘good news’ in the outpatient clinic. Conclusion ‘Being lucky’ is a dominant restitution narrative about operable lung cancer. A predominance of restitution narratives implies that clinicians are the active party, while patients remain passive, which limits their perspective and thus silences their concerns unrelated to curative treatment.
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Affiliation(s)
- Mai Nanna Schoenau
- Department of People and Technology, Roskilde University, Roskilde, Denmark.,Department of Cardiothoracic Surgery, Copenhagen University Hospital, Copenhagen, Denmark
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Wells KJ, Drizin JH, Ustjanauskas AE, Vázquez-Otero C, Pan-Weisz TM, Ung D, Carrizosa C, Laronga C, Roetzheim RG, Johnson K, Norton M, Aguilar RC, Quinn GP. The psychosocial needs of underserved breast cancer survivors and perspectives of their clinicians and support providers. Support Care Cancer 2022; 30:105-116. [PMID: 34231040 PMCID: PMC8639634 DOI: 10.1007/s00520-021-06286-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/09/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Breast cancer survivors (BrCS) experience many psychosocial difficulties following treatment, leading to an increased risk of psychological distress compared to the general population. This is especially true for underserved BrCS whose unmet supportive care needs can result in worse physical and mental health outcomes. This qualitative study compared healthcare and support providers' perceptions of BrCS' needs to survivors' perceptions of their own needs. METHODS Semi-structured in-depth interviews were conducted with 25 underserved BrCS and 20 cancer survivorship stakeholders identified using purposeful sampling. Using the constant comparison method and content analysis, data were analyzed via an iterative process of coding and discussion. Data were summarized according to three intermediate and proximal themes mentioned by both stakeholders and survivors: (1) psychosocial needs of cancer survivors, (2) support, and (3) benefit finding/positive feelings about cancer. Demographic data were analyzed by calculating descriptive statistics. RESULTS There was consistency in providers' and survivors' perceptions of post-treatment mood changes, financial burden, familial stress, and physical changes. Providers and survivors differed in perceptions of BrCS' preferred sources of care and support, effects of cancer treatment on body image, the effects of fear of cancer recurrence on follow-up care, and benefit finding. CONCLUSIONS This study provides valuable insight into areas in which healthcare and support providers' perceptions may differ from underserved BrCS' lived experiences. Results from this study can be used to develop interventions and inform healthcare and support providers on how to provide high-quality care to underserved BrCS.
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Affiliation(s)
- Kristen J. Wells
- San Diego State University, San Diego, CA, USA; SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Julia H. Drizin
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Amy E. Ustjanauskas
- Veteran Affairs San Diego Healthcare System, San Diego, CA, USA; University of California, San Diego, San Diego, CA, USA
| | - Coralia Vázquez-Otero
- Harvard T.H. Chan School of Public Health, Boston, MA, USA; Dana-Farber Cancer Institute, Boston, MA, USA
| | - Tonya M. Pan-Weisz
- Veteran Affairs San Diego Healthcare System, San Diego, CA, USA; University of California, San Diego, San Diego, CA, USA
| | | | | | | | | | | | | | | | - Gwendolyn P. Quinn
- Departments of OB-GYN, Population Health, Grossman School of Medicine, New York University, NY, NY
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Housman B, Flores R, Lee DS. Narrative review of anxiety and depression in patients with esophageal cancer: underappreciated and undertreated. J Thorac Dis 2021; 13:3160-3170. [PMID: 34164206 PMCID: PMC8182527 DOI: 10.21037/jtd-20-3529] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Depression and anxiety are emotional disorders that commonly affect patients with esophageal cancer. As a result of its high morbidity, mortality, and complication rates, this population is at particularly high risk for developing or exacerbating affective disorders; even when compared to patients with other forms of cancer. Many of the medical conditions and social behaviors that predispose patients to this disease are also independently associated with affective disorders, and likely compound their effects. Unfortunately, in the existing literature, there is wide variability in study design and diagnostic criteria. There is no standard method of evaluation, many studies are limited to written surveys, and widespread mental health screening is not included as a part of routine care. As a result, the prevalence of these illnesses remains elusive. Additionally, psychiatric and psychosocial illness can affect compliance with surveillance and treatment, and gaps in knowledge may ultimately influence patient outcomes and survival. This review will discuss the existing literature on depression and anxiety in patients with esophageal cancer. It will highlight current methods of psychological evaluation, the prevalence of affective disorders in this population, and their effects on treatment, compliance, and outcomes. It will also discuss possible screening tools, treatments and interventions for these comorbid illnesses that may improve oncologic outcomes as well as quality of life.
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Affiliation(s)
- Brian Housman
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Raja Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Dong-Seok Lee
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
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Bergerot CD, Razavi M, Clark KL, Philip EJ, Pal SK, Loscalzo M, Dale W. Emotional problem-related distress screening and its prevalence by cancer type: Assessment by patients' characteristics and level of assistance requested. Psychooncology 2021; 30:1332-1338. [PMID: 33797817 DOI: 10.1002/pon.5685] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/09/2021] [Accepted: 03/24/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Emotional problem-related distress is a common issue faced by patients with cancer. However, patients suffering with this emotional burden do not typically seek assistance. This study sought to determine the prevalence of emotional problem-related distress by cancer type, and identify factors correlated with the level of assistance requested. METHODS Using the SupportScreen®, patients were screened for emotional problem-related distress at their first or second visit to an NCI designated Comprehensive Cancer Center. General Linear Model was used to test the association between emotional problem-related distress and type of cancer, and the relationship between level of assistance requested and patients' characteristics. RESULTS A total of 2,421 patients were included in this analysis. Patients were mostly female (62%), diagnosed with breast (24%), gynecological (16%) or gastrointestinal (15%) cancers. Highest levels of emotional problem-related distress were reported by patients diagnosed with lung, gynecological, breast and gastrointestinal cancers. Level of assistance requested were significantly associated with problem-related distress scores (p < 0.001), which were higher among patients with lower household incomes (p < 0.001) and Spanish as primary language (p = 0.001). CONCLUSION Our study found an association between Level of assistance requested and emotional problem-related distress, which were heightened by lower income and Spanish-speaking. Intervention strategies should be considered to increase access to psychosocial support services.
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Affiliation(s)
- Cristiane Decat Bergerot
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Marianne Razavi
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Karen Lynn Clark
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Errol J Philip
- Medical School, University of California San Francisco, San Francisco, California, USA
| | - Sumanta Kumar Pal
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Matthew Loscalzo
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - William Dale
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, California, USA
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Hsiao PC, Wang YC, Huang YJ, Hsueh IP, Chen MH, Hsieh CL. Correlations between subjective rating and objective assessment of balance function in individuals with stroke. Disabil Rehabil 2020; 43:3757-3763. [PMID: 32372705 DOI: 10.1080/09638288.2020.1751313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To examine the relationships among therapist-reported, patient-reported, and objective assessment scores of balance function.Methods: Inpatients with stroke and occupational therapists were recruited. The objective balance scores were measured using the Balance Computerized Adaptive Testing (Balance CAT) system. The therapist and patient-reported scores were evaluated using a visual analogue scale (VAS) and Likert-type scale.Results: Eighty-eight patients and 16 therapists participated. The correlations (r= 0.64 and 0.65; R-squared about 0.42 at baseline and follow-up assessments, respectively) between the therapist-reported VAS scores and the Balance CAT system were larger than those (r = 0.31 and 0.21) between the patient-reported VAS scores and the Balance CAT system. Low correlations (r = 0.27 and 0.26 for VAS and Likert-type scores, respectively) were found between the therapist-reported and patient-reported change scores. Low correlations (r = 0.12-0.17) were found between the change scores of therapist- and patient-reported ratings and those of the Balance CAT system.Conclusions: The therapists' judgments explained <50% of variance of the Balance CAT system scores. Neither therapist-reported nor patient-reported change scores reflected the changes demonstrated by the objective assessments. Further studies are warranted to confirm our findings.Implications for RehabilitationNeither therapist- nor patient-reported balance function and change could effectively reflect the scores resulting from objective assessments.The routine use of objective balance assessments should not be replaced by therapists' subjective judgments.Communications regarding the balance function measured by objective assessments between therapists and patients can help patients to better understand their balance function and progress.
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Affiliation(s)
- Pei-Chi Hsiao
- Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, Tainan, Taiwan
| | - Yi-Ching Wang
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Jing Huang
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - I-Ping Hsueh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Mei-Hsiang Chen
- Department of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan.,Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ching-Lin Hsieh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan
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8
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Nurses' perspectives on their communication with patients in busy oncology wards: A qualitative study. PLoS One 2019; 14:e0224178. [PMID: 31648272 PMCID: PMC6812861 DOI: 10.1371/journal.pone.0224178] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/07/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite an increase in emphasis on psychosocial care in cancer nursing, time constraints and nurses' lack of knowledge in skilled communication continue to be challenges. AIMS To examine how cancer care nurses view their communication with patients and how they deal with the psychosocial needs of patients in busy wards. DESIGN A qualitative interview study. METHODS Focus groups and individual interviews were conducted with eleven hospital-based cancer nurses in Hong Kong from July 2, 2017 to January 2, 2018. RESULTS A qualitative thematic analysis of the data identified three themes: 1. Intentional and unintentional psychosocial care that is secondary in focus; 2. Managing an emotionally challenged environment; 3. Mentoring and learning. CONCLUSION Oncology settings are time-constrained, emotionally charged environments for nurses, and providing psychosocial care for patients is a secondary concern. While proactive strategies can be used to avert patient complaints, being open and attending to the individual needs of patients is equally important to avoid blocking in nurse-patient communication. Despite emotional entanglement and tensions, the positive follow-up strategies used by nurses to manage the patients' emotions and provide psychosocial care reflect good practices. Leadership and support are needed to deal with the nurses' perception that their communication training has been ineffective and their ability to manage strong emotions deficient. Communication skills, honed by making continuous opportunities to communicate available, as well as an understanding of emotional labour, need to be integrated with mindfulness in the nurses' care of themselves and their patients. Notwithstanding the importance of experience in oncology care for junior nurses, it is necessary for both junior and senior nurses to learn about and reflect upon the different forms of emotional labour if value-based care is to be provided. In addition, it is essential for junior nurses to receive continuous coaching and mentoring, and to engage in reflective learning from each clinical encounter with oncology patients.
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Granek L, Nakash O, Ben-David M, Shapira S, Ariad S. Oncologists' Treatment Responses to Mental Health Distress in Their Cancer Patients. QUALITATIVE HEALTH RESEARCH 2018; 28:1735-1745. [PMID: 29973126 DOI: 10.1177/1049732318786479] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The objectives of this study were to identify how oncologists respond to mental health distress in their patients, what specific strategies they use in treating this distress, and what barriers they report responding to their patients' emotional distress. Twenty-three oncologists at two cancer centers were interviewed. The grounded theory method of data collection and analysis was used. Oncologists varied in their response to patients' emotional distress. Strategies used in responding to patients' distress included creating supportive relationships and prescribing medications, while barriers included patient reluctance, a lack of protocol on how to respond to patients, limited psychosocial resources, and a lack of time. Developing and adopting clear guidelines to addressing mental health distress among cancer patients is critical in assuring quality care for the whole patient and reduce the risk for poor quality of life and potential disease-related morbidity and mortality.
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Affiliation(s)
- Leeat Granek
- 1 Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ora Nakash
- 2 Smith College, Northampton, Massachusetts, USA
- 3 Interdisciplinary Center Herzliya, Herzliya, Israel
| | - Merav Ben-David
- 4 Tel Aviv University, Tel Aviv, Israel
- 5 Sheba Medical Center, Ramat-Gan, Israel
| | - Shahar Shapira
- 1 Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Samuel Ariad
- 1 Ben-Gurion University of the Negev, Beer-Sheva, Israel
- 6 Soroka University Medical Center, Beer-Sheva, Israel
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10
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Psychosocial care from the perspective of nurses working in oncology: A qualitative study. Eur J Oncol Nurs 2018; 34:68-75. [DOI: 10.1016/j.ejon.2018.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 03/07/2018] [Accepted: 03/09/2018] [Indexed: 11/19/2022]
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11
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Granek L, Nakash O, Ariad S, Shapira S, Ben-David M. Oncologists' identification of mental health distress in cancer patients: Strategies and barriers. Eur J Cancer Care (Engl) 2018; 27:e12835. [PMID: 29508452 DOI: 10.1111/ecc.12835] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2018] [Indexed: 11/30/2022]
Abstract
The purpose of this research was to examine oncologists' perspectives on indicators of mental health distress in patients: what strategies they use to identify these indicators, and what barriers they face in this task. Twenty-three oncologists were interviewed, and the grounded theory method of data collection and analysis was used. Oncologists perceived distress to be a normative part of having cancer and looked for affective, physical, verbal and behavioural indicators using a number of strategies. Barriers to identification of mental health distress included difficulty in differentiating between mental health distress and symptoms of the disease, and lack of training. A systematic, time-efficient assessment of symptoms of emotional distress is critical for identification of psychiatric disorders among patients and differentiating normative emotional responses from psychopathology. Clinical bias and misdiagnosis can be a consequence of an ad hoc, intuitive approach to assessment, which can have consequences for patients and their families. Once elevated risk is identified for mental health distress, the patient can be referred to specialised care that can offer evidence-based treatments.
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Affiliation(s)
- L Granek
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - O Nakash
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzilya, Israel
| | - S Ariad
- Department of Oncology, Soroka University Medical Center, Ben- Gurion University of the Negev, Beer Sheva, Israel
| | - S Shapira
- Department of Gender Studies, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - M Ben-David
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Radiation Oncology Department, Sheba Medical Center, Ramat-Gan, Israel
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Gouveia L, Lelorain S, Brédart A, Dolbeault S, Bonnaud-Antignac A, Cousson-Gélie F, Sultan S. Oncologists' perception of depressive symptoms in patients with advanced cancer: accuracy and relational correlates. BMC Psychol 2015; 3:6. [PMID: 25815195 PMCID: PMC4359512 DOI: 10.1186/s40359-015-0063-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/19/2015] [Indexed: 11/18/2022] Open
Abstract
Background Health care providers often inaccurately perceive depression in cancer patients. The principal aim of this study was to examine oncologist-patient agreement on specific depressive symptoms, and to identify potential predictors of accurate detection. Methods 201 adult advanced cancer patients (recruited across four French oncology units) and their oncologists (N = 28) reported depressive symptoms with eight core symptoms from the BDI-SF. Various indices of agreement, as well as logistic regression analyses were employed to analyse data. Results For individual symptoms, medians for sensitivity and specificity were 33% and 71%, respectively. Sensitivity was lowest for suicidal ideation, self-dislike, guilt, and sense of failure, while specificity was lowest for negative body image, pessimism, and sadness. Indices independent of base rate indicated poor general agreement (median DOR = 1.80; median ICC = .30). This was especially true for symptoms that are more difficult to recognise such as sense of failure, self-dislike and guilt. Depression was detected with a sensitivity of 52% and a specificity of 69%. Distress was detected with a sensitivity of 64% and a specificity of 65%. Logistic regressions identified compassionate care, quality of relationship, and oncologist self-efficacy as predictors of patient-physician agreement, mainly on the less recognisable symptoms. Conclusions The results suggest that oncologists have difficulty accurately detecting depressive symptoms. Low levels of accuracy are problematic, considering that oncologists act as an important liaison to psychosocial services. This underlines the importance of using validated screening tests. Simple training focused on psychoeducation and relational skills would also allow for better detection of key depressive symptoms that are difficult to perceive.
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Affiliation(s)
- Lucie Gouveia
- Centre de recherche, CHU Sainte-Justine, 3175, Chemin de la Côte-Sainte-Catherine, H3T 1C5 Montreal, Qc Canada
| | - Sophie Lelorain
- Université de Lille, UFR de Psychologie, UDL, SCALab UMR 9193, Rue du Barreau, BP 60149, F-59653 Villeneuve d'Ascq cedex, France
| | - Anne Brédart
- Psycho-Oncology Unit, Institut Curie, 26 rue d'Ulm Cedex, 75248 Paris, France
| | - Sylvie Dolbeault
- Psycho-Oncology Unit, Institut Curie, 26 rue d'Ulm Cedex, 75248 Paris, France
| | - Angélique Bonnaud-Antignac
- Université de Nantes, UFR des Sciences Pharmaceutiques, Équipe de Biostatistique, Pharmacoépidémiologie et Mesures Subjectives en Santé, 1 rue Gaston Veil, BP 53508, Nantes Cedex 1, 44035 France
| | - Florence Cousson-Gélie
- Institut régional du cancer, Pôle prévention Epidaure, Université Montpellier 3, 208 Avenue des Apothicaires, Montpellier Cedex 5, 34298 Montpellier, France
| | - Serge Sultan
- Centre de recherche, CHU Sainte-Justine, 3175, Chemin de la Côte-Sainte-Catherine, H3T 1C5 Montreal, Qc Canada
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Cook KF, Victorson DE, Cella D, Schalet BD, Miller D. Creating meaningful cut-scores for Neuro-QOL measures of fatigue, physical functioning, and sleep disturbance using standard setting with patients and providers. Qual Life Res 2014; 24:575-89. [PMID: 25148759 DOI: 10.1007/s11136-014-0790-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE To establish clinically relevant classifications of health outcome scores for four Neuro-QOL measures (lower extremity function, upper extremity function, fatigue, and sleep disturbance). METHODS We employed a modified educational standard-setting methodology to identify cut-scores for symptom severity. Clinical vignettes were developed to represent graduated levels of symptom severity. A clinician panel and a panel of persons with multiple sclerosis (PwMS) were recruited, and, in separate, 1-day meetings, the panelists identified adjacent vignettes they judged to represent the threshold between two levels of severity for a given domain (e.g., threshold between a vignette that indicated "no problems" with sleep and the adjacent one that represented "mild problems" with sleep). Working independently, each panel (PwMS and clinicians) reached consensus on its recommended thresholds for each of the four targeted measures. Cut-scores were defined as the mean location for each pair of threshold vignettes. RESULTS PwMS and clinician panels derived identical thresholds for severity levels of lower extremity function and sleep disturbance, but slightly different ones for upper extremity function and fatigue. In every case of divergence, PwMS set higher thresholds for more severe classifications of symptoms (by 0.5 SDs) than did clinicians. CONCLUSIONS The modified bookmarking method is effective for defining thresholds for symptom severity based on self-reported outcome scores and consensus judgments. Derived cut-scores and severity levels provide an interpretative context for Neuro-QOL scores. Future studies should explore whether these findings can be replicated and evaluate the validity of the classifications compared to external criteria.
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Affiliation(s)
- Karon F Cook
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,
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Groenewegen A, Tofighy A, Ryvlin P, Steinhoff BJ, Dedeken P. Measures for improving treatment outcomes for patients with epilepsy--results from a large multinational patient-physician survey. Epilepsy Behav 2014; 34:58-67. [PMID: 24704566 DOI: 10.1016/j.yebeh.2014.02.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/24/2014] [Accepted: 02/27/2014] [Indexed: 10/25/2022]
Abstract
In this large-scale, multinational, descriptive survey, we sought to identify measures for improving treatment outcomes for individuals with epilepsy. As a framework, questions relating specifically to each of the five steps of the 'patient-physician journey', namely, patient identification (omitted in this survey), diagnosis, choice of drug, disease and drug information, and patient monitoring were asked. Overall, 337 physicians and 1150 patients across France, Germany, and the United States returned questionnaires. Results indicated that 16% of the patients were initially misdiagnosed. Treatment choice was driven by efficacy, safety, experience with a drug (physician only), and convenience (patient only). Physicians were identified as the primary source of information for patients, and, as expected, better informed patients were found to adhere better to their therapy than those who were less well informed. Approximately 50% of the patients had not seen their specialist in the last year, which indicates poor follow-up; furthermore, important topics such as seizures, treatment, and its side effects were not discussed at every visit. Specialists, but not primary care practitioners (PCPs), consistently reported discussing all topics more frequently than their patients, suggesting that specialists may overestimate the clarity of their questions. There was also substantial disparity in the reasons cited for nonadherence - patients overwhelmingly cited forgetfulness, while both PCPs and specialists cited complacency, forgetfulness, and tolerability. We also noted a disparity between physicians and their patients, as well as between PCPs and specialists, in their views on the impact of epilepsy on patients' lives. Our results indicate multiple opportunities to intervene at all stages of the patient-physician journey to improve treatment outcomes. We provide practical suggestions to achieve the most from these opportunities.
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Affiliation(s)
- André Groenewegen
- UCB Pharma, Brussels, Belgium; Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | | | - Philippe Ryvlin
- Department of Functional Neurology and Epileptology and Institute for Children and Adolescent with Epilepsy (IDEE), Hospices Civils De Lyon, Lyon, France
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Brunelli C, Kaasa S, Knudsen AK, Hjermstad MJ, Pigni A, Caraceni A. Comparisons of Patient and Physician Assessment of Pain-Related Domains in Cancer Pain Classification: Results From a Large International Multicenter Study. THE JOURNAL OF PAIN 2014; 15:59-67. [DOI: 10.1016/j.jpain.2013.09.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 08/27/2013] [Accepted: 09/20/2013] [Indexed: 11/29/2022]
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Lee TY, Chen HH, Yeh ML, Li HL, Chou KR. Measuring reliability and validity of a newly developed stress instrument: Newly Diagnosed Breast Cancer Stress Scale. J Clin Nurs 2013; 22:2417-25. [PMID: 23472936 DOI: 10.1111/jocn.12107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2012] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To assess the reliability and validity of a developed instrument entitled Newly Diagnosed Breast Cancer Stress Scale. BACKGROUND Distress, clinical anxiety and depression are evident in patients with cancer, leading to poor psychosocial and quality-of-life outcomes. DESIGN Instrument development study with norm-referenced measurements. METHODS Content validity was determined by expert review. Cronbach's α was used to assess internal consistency reliability and product-moment correlations were conducted. Exploratory factor analysis measured validity of items using varimax rotation method. Criterion-related validity testing used the Perceived Stress Scale and the convergent validity test of construct validity used the Hospital Anxiety and Depression Scale. A total of 125 women pathologically diagnosed with breast cancer were interviewed on the day prior to initial breast surgery. RESULTS After testing, the Newly Diagnosed Breast Cancer Stress Scale consisted of four main factors with 17 items with acceptable reliability and good validity, and its length and time to complete the questionnaire were appropriate. Internal consistency reliability of the scale was shown by Cronbach's α = 0·84, the criterion validity of Perceived Stress Scale-10 was r = 0·46 (p < 0·001), the convergent validity of Hospital Anxiety and Depression Scale-14 was r = 0·57 (p < 0·001) for anxiety and r = 0·35 (p < 0·001) for depression. CONCLUSIONS The Newly Diagnosed Breast Cancer Stress Scale has acceptable reliability and good validity to measure stress in newly diagnosed patients with breast cancer. RELEVANCE TO CLINICAL PRACTICE The Newly Diagnosed Breast Cancer Stress Scale can provide healthcare workers with an instrument to better identify stress levels in newly diagnosed breast cancer patients and provide valuable information when defining psychosocial care interventions.
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Affiliation(s)
- Tso-Ying Lee
- Nursing Department, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
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Hladschik-Kermer B, Kierner KA, Heck U, Miksovsky A, Reiter B, Zoidl H, Medicus E, Masel EK, Watzke HH. Patients and staff perceptions of cancer patients' quality of life. Eur J Oncol Nurs 2013; 17:70-4. [DOI: 10.1016/j.ejon.2012.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Revised: 12/29/2011] [Accepted: 01/24/2012] [Indexed: 11/29/2022]
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Akin S, Durna Z. A comparative descriptive study examining the perceptions of cancer patients, family caregivers, and nurses on patient symptom severity in Turkey. Eur J Oncol Nurs 2013; 17:30-7. [DOI: 10.1016/j.ejon.2012.02.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 02/07/2012] [Accepted: 02/09/2012] [Indexed: 11/30/2022]
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Correlations in health status between estimates of families of people with amyotrophic lateral sclerosis and estimates of staff. Palliat Support Care 2012; 11:183-9. [PMID: 23013718 DOI: 10.1017/s1478951512000089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to compare self-estimates of the physical, psychological, and general well-being of patients with amyotrophic lateral sclerosis (ALS) and their next of kin with the assessment of the nurses and physician of these participants. METHOD The well-being of 35 pairs of patients and their next of kin was rated by themselves, and by a physician and nurses. The well-being was examined over time, using a visual analogue scale (VAS). Patients' physical function was estimated at the same time with the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised and the Norris scale. RESULTS The correlations between the staff's estimates of the well-being of patients and next of kin were similar to their own estimates, even though staff to a higher degree estimated a decrease in well-being over time among the patients. The estimates by the nurses correlated better to that of the patients and next of kin in psychological and general well-being than the physicians' estimates did. SIGNIFICANCE OF RESULTS Even though the staff's estimates of participants were roughly equivalent to their self-estimates, there were some differences. This result calls attention to the importance of working in teams in which different professional roles are combined and integrated, making it possible to form a holistic view of the situation of each family. A concern overlooked by one member of staff might be covered by another, and different focuses on the family may give a better composite picture of their life situation, which could lead to better support to the family.
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Siminoff LA, Dorflinger L, Agyemang A, Baker S, Wilson-Genderson M. Oncologists' assessments of lung cancer patient and family disagreements regarding treatment decision making. Lung Cancer 2012; 77:212-6. [PMID: 22405569 DOI: 10.1016/j.lungcan.2012.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 02/03/2012] [Accepted: 02/10/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Disagreements between cancer patients and their caregivers about treatment and care can affect the patient's physical and mental well-being. Therefore it is important to understand if oncologists can accurately identify the presence of patient-caregiver decisional conflict. This study examined assessments made by lung cancer patients, their caregivers, and their oncologists regarding patient-caregiver disagreements concerning treatment and care decisions. PARTICIPANTS AND METHODS We assessed the extent to which the patient, caregiver, and oncologist reported disagreement between the patient and the family member regarding treatment decisions in 134 patient-caregiver-oncologist triads. Descriptive statistics were used to explore rates of concordance amongst all possible combinations of raters. Loglinear models were tested for 3-way agreement. RESULTS Most patient-caregiver pairs, 82.1% (n = 110), reported agreement concerning presence or absence of decisional conflict. Oncologists were more successful in detecting absence of conflict than the presence of conflict. When the caregiver and the oncologist agreed, it was regarding the absence of conflict (64.9%), rather than the presence of conflict. In 10.6% (n = 15) of cases, oncologists reported that conflictual relationships negatively impacted their ability to provide patient care. CONCLUSIONS Recent models of cancer patient care promote including the caregiver fully in the process while respecting the primacy of the patient's perspective. However, these models assume that the oncologist will recognize when disagreements exist and be able to assist in conflict resolution. The degree to which the oncologist identified that conflict exists and implications for their ability to provide patient care when familial disagreements existed are discussed.
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Affiliation(s)
- Laura A Siminoff
- Department of Social and Behavioral Health, Massey Cancer Center, School of Medicine, Virginia Commonwealth University, VA 23298, USA.
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Lidén Y, Olofsson N, Landgren O, Johansson E. Pain and anxiety during bone marrow aspiration/biopsy: Comparison of ratings among patients versus health-care professionals. Eur J Oncol Nurs 2012; 16:323-9. [PMID: 22341718 DOI: 10.1016/j.ejon.2011.07.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 07/19/2011] [Accepted: 07/23/2011] [Indexed: 11/18/2022]
Abstract
PURPOSE To assess pain and anxiety during bone marrow aspiration/biopsy (BMA) among patients versus health-care professionals (HCPs). METHOD 235 adult hematologic patients undergoing BMA were included. BMA was performed by 16 physicians aided by nine registered nurses (RNs). Questionnaires were used to obtain patients and HCPs ratings of patients' pain and anxiety during BMA. Patterns of ratings for pain and anxiety among patients HCPs were estimated with proportions of agreement P(A), Cohen's kappa coefficient (κ), and single-measure intra-class correlation (ICC). We also explored if associations of ratings were influenced by age, sex, type and duration of BMA. RESULTS The P(A) for occurrence of rated pain during BMA was 73% between patients and RNs, and 70% between patients and physicians, the corresponding κ was graded as fair (0.37 and 0.33). Agreement between patients and HCPs regarding intensity of pain was moderate (ICC=0.44 and 0.42). Severe pain (VAS>54) was identified by RNs and physicians in 34% and 35% of cases, respectively. Anxiety about BMA outcome and needle insertion was underestimated by HCPs. P(A) between patients and RNs and patients and physicians regarding anxiety ranged from 53% to 59%. The corresponding κ was slight to fair (0.10-0.21). ICC showed poor agreement between patients and HCPs regarding intensity of anxiety (0.13-0.36). CONCLUSIONS We found a better congruence between patients and HCPs in pain ratings than in anxiety ratings, where the agreement was low. RNs and physicians underestimated severe pain as well as anxiety about BMA outcome and needle insertion.
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Affiliation(s)
- Y Lidén
- Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care, Karolinska Institutet, Stockholm, Sweden.
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Jones JM, McPherson CJ, Zimmermann C, Rodin G, Le LW, Cohen SR. Assessing agreement between terminally ill cancer patients' reports of their quality of life and family caregiver and palliative care physician proxy ratings. J Pain Symptom Manage 2011; 42:354-65. [PMID: 21454041 DOI: 10.1016/j.jpainsymman.2010.11.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 11/22/2010] [Accepted: 11/23/2010] [Indexed: 11/19/2022]
Abstract
CONTEXT Proxy ratings, if valid, may provide an alternative approach to evaluating patient quality of life (QoL) at the end of life. OBJECTIVES To examine agreement between terminally ill cancer patients' self-reported QoL and proxy assessment of patient QoL by their family caregiver (FCG) and palliative care physicians (PCPs) at two time points. METHODS Patients admitted to an acute palliative care unit and their FCGs and PCPs completed the McGill Quality of Life Questionnaire (MQOL) at Days 3 and 6 after admission. Response bias and response precision were examined at the individual and group levels. Furthermore, we examined patient factors affecting agreement and responsiveness of proxy MQOL scores to changes in patients' QoL between Days 3 and 6. RESULTS Statistically and clinically significant mean differences were detected between the patient and both proxy groups' reports of QoL on Day 3, with the magnitude of the differences decreasing somewhat by Day 6. Proxies underestimated patients' QoL compared with patients' self-report. Response precision based on intraclass correlation values and proportion of approximate agreement was poor to fair at both time points. Agreement was better for patients with greater physical burden and more cognitive difficulties. Proxies' responsiveness to change from Day 3 to Day 6 was low, and proxies were not able to detect minimally important changes in QoL. CONCLUSION The findings suggest that moderate agreement between patient and proxy ratings of QoL develops over time but that precision at the individual level, which is more clinically relevant, is less reliable. New strategies for improving proxy reliability are needed.
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Affiliation(s)
- Jennifer M Jones
- Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, Toronto, Ontario, Canada.
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McCormack LA, Treiman K, Rupert D, Williams-Piehota P, Nadler E, Arora NK, Lawrence W, Street RL. Measuring patient-centered communication in cancer care: a literature review and the development of a systematic approach. Soc Sci Med 2011; 72:1085-95. [PMID: 21376443 DOI: 10.1016/j.socscimed.2011.01.020] [Citation(s) in RCA: 215] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 11/07/2010] [Accepted: 01/15/2011] [Indexed: 11/19/2022]
Abstract
Patient-centered communication (PCC) is a critical element of patient-centered care, which the Institute of Medicine (Committee on Quality of Health Care in America, 2001) promulgates as essential to improving healthcare delivery. Consequently, the US National Cancer Institute's Strategic Plan for Leading the Nation (2006) calls for assessing the delivery of PCC in cancer care. However, no comprehensive measure of PCC exists, and stakeholders continue to embrace different conceptualizations and assumptions about how to measure it. Our approach was grounded in the PCC conceptual framework presented in a recent US National Cancer Institute monograph (Epstein & Street, 2007). In this study, we developed a comprehensive inventory of domains and subdomains for PCC by reviewing relevant literature and theories, interviewing a limited number of cancer patients, and consulting experts. The resulting measurement domains are organized under the six core functions specified in the PCC conceptual framework: exchanging information, fostering healing relationships, recognizing and responding to emotions, managing uncertainty, making decisions, and enabling patient self-management. These domains represent a promising platform for operationalizing the complicated PCC construct. Although this study focused specifically on cancer care, the PCC measurements are relevant to other clinical contexts and illnesses, given that patient-centered care is a goal across all healthcare. Finally, we discuss considerations for developing PCC measures for research, quality assessment, and surveillance purposes. United States Department of Health and Human Services, National Institutes of Health, National Cancer Institute (2006). The NCI Strategic Plan for Leading the Nation: To Eliminate the Suffering and Death Due to Cancer. NIH Publication No. 06-5773.
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Affiliation(s)
- Lauren A McCormack
- Health Communication Program, RTI International, 3040 Cornwallis Road, RTP, NC 27709, USA.
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Wessels H, de Graeff A, Wynia K, de Heus M, Kruitwagen CLJJ, Teunissen SCCM, Voest EE. Are health care professionals able to judge cancer patients' health care preferences correctly? A cross-sectional study. BMC Health Serv Res 2010; 10:198. [PMID: 20615226 PMCID: PMC2911431 DOI: 10.1186/1472-6963-10-198] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 07/08/2010] [Indexed: 11/29/2022] Open
Abstract
Background Health care for cancer patients is primarily shaped by health care professionals. This raises the question to what extent health care professionals are aware of patients' preferences, needs and values. The aim of this study was to explore to what extent there is concordance between patients' preferences in cancer care and patients' preferences as estimated by health care professionals. We also examined whether there were gender differences between health care professionals with regard to the degree in which they can estimate patients' preferences correctly. Methods To obtain unbiased insight into the specific preferences of cancer patients, we developed the 'Cancer patients' health care preferences' questionnaire'. With this questionnaire we assessed a large sample of cancer patients (n = 386). Next, we asked health care professionals (medical oncologists, nurses and policymakers, n = 60) to fill out this questionnaire and to indicate preferences they thought cancer patients would have. Mean scores between groups were compared using Mann-Whitney tests. Effect sizes (ESs) were calculated for statistically significant differences. Results We found significant differences (ESs 0.31 to 0.90) between patients and professionals for eight out of twenty-one scales and two out of eight single items. Patients valued care aspects related to expertise and attitude of health care providers and accessibility of services as more important than the professionals thought they would do. Health care professionals overestimated the value that patients set on particularly organisational and environmental aspects. We found significant gender-related differences between the professionals (ESs 0.69 to 1.39 ) for eight out of twenty-one scales and two out of eight single items. When there were significant differences between male and female healthcare professionals in their estimation of patients health care preferences, female health care professionals invariably had higher scores. Generally, female health care professionals did not estimate patients' preferences and needs better than their male colleagues. Conclusions Health care professionals are reasonably well able to make a correct estimation of patients preferences, but they should be aware of their own bias and use additional resources to gain a better understanding of patients' specific preferences for each patient is different and ultimately the care needs and preferences will also be unique to the person.
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Affiliation(s)
- Hester Wessels
- 1Department of Corporate Communications, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
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MÅRTENSSON G, CARLSSON M, LAMPIC C. Are cancer patients whose problems are overestimated by nurses less satisfied with their care? Eur J Cancer Care (Engl) 2010; 19:382-92. [DOI: 10.1111/j.1365-2354.2009.01070.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mårtensson G, Carlsson M, Lampic C. Is nurse-patient agreement of importance to cancer nurses’ satisfaction with care? J Adv Nurs 2010; 66:573-82. [DOI: 10.1111/j.1365-2648.2009.05228.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rogers MS, Todd C. Can cancer patients influence the pain agenda in oncology outpatient consultations? J Pain Symptom Manage 2010; 39:268-82. [PMID: 19963336 DOI: 10.1016/j.jpainsymman.2009.05.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 05/21/2009] [Accepted: 06/17/2009] [Indexed: 11/23/2022]
Abstract
Pain in cancer patients is common, yet it is often inadequately managed. Although poor assessment has been implicated, how patients contribute to this process has not been explicated. This study aims to uncover patients' contributions to discussions about pain during oncology outpatient consultations. Seventy-four medical encounters were observed and audiotaped. Verbatim transcriptions of pain talk were examined using conversational analysis. Thirty-nine of 74 patients talked about pain with 15 different doctors during consultations for follow-up or active treatment. Patients' talk about pain varied consistently according to how pain talk was initiated. In 20 consultations where pain was put on the agenda by patients, they used communication tactics that emphasized their pain experiences, seemingly to attract and maintain their doctors' attention. These tactics appear necessary, as the cancer treatment agenda restricts opportunities for patients to have supportive care needs addressed. On the other hand, in 19 consultations where doctors elicited information about pain, patients used communication tactics that minimized their pain experiences, seemingly to conceal potential disease progression or recurrence, the very focus of these specialist consultations. Where cancer was implicated as the source of pain, chemotherapy or radiotherapy was offered, and where cancer was suspected, referrals for investigations were made. Two of the 20 patients appeared to influence the treatment-focused agenda and were given referrals to pain clinic rather than further cancer therapy as initially recommended.
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Affiliation(s)
- Margaret S Rogers
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester M13 9PL, Lancashire, United Kingdom.
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Mårtensson G, Carlsson M, Lampic C. Do Oncology Nurses Provide More Care to Patients With High Levels of Emotional Distress? Oncol Nurs Forum 2009; 37:E34-42. [DOI: 10.1188/10.onf.e34-e42] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Effect of oral tumour size on quality of life judgements by health care professionals working with head and neck cancer patients: a pilot study. The Journal of Laryngology & Otology 2009; 123:1352-7. [PMID: 19765326 DOI: 10.1017/s0022215109990934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIM To investigate whether information about the size of an oral tumour influences the multi-disciplinary team's judgement about the quality of life of head and neck cancer patients. METHOD Using a between-group design, two groups of health care professionals rated a hypothetical patient on 20 outcome variables. The patient description was identical for both groups, except for the tumour size. RESULTS Comparison of variable ratings revealed only three significant differences between the groups' predictions and no consistency within conditions, suggesting that the participants held few common assumptions about the impact of tumour size on a range of patient experiences. CONCLUSION The lack of agreement amongst the health care professionals suggests that, where humane judgements are used in treatment decisions for head and neck cancer patients, these may be random and inconsistent. Consequently, patients should have a direct input into treatment decisions, via formalized quality of life data.
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Agreement of patient and physician ratings on mobility and self-care in neurological diseases. Qual Life Res 2009; 18:999-1010. [DOI: 10.1007/s11136-009-9520-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Accepted: 07/11/2009] [Indexed: 12/13/2022]
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Timmermans B, De Bodt M, Wuyts F, Van de Heyning P. Vocal hygiene in radio students and in radio professionals. LOGOP PHONIATR VOCO 2009; 28:127-32. [PMID: 14596331 DOI: 10.1080/14015430310018333] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In this study 27 future professional voice users (i.e., radio students) and 53 professional voice users (i.e., radio professionals) were questioned on their vocal hygiene. Both groups differed clearly in age and in radio experience. The mean age of the radio students was 22 years, whereas the mean age of the radio professionals was 41 years; radio students had no radio experience and radio professionals' experience ranged from 2 to 32 years. This study shows that the vocal hygiene of radio professionals is not superior to the vocal hygiene of radio students. On the contrary, every group has a distinctive vocal hygiene profile. The intake of coffee was significantly higher in radio professionals (p < 0.001) and they indicated significantly more vocal fatigue (p = 0.028). The radio students, on the other hand, experienced more acid reflux problems (p < 0.001) and signalled significantly more hoarseness (p = 0.012). Next to this, both groups smoked more than one could expect from (future) professional voice users (radio students: 33%; radio professionals: 28%). This study demonstrates the necessity of an adapted vocal hygiene education programme for both future and professional voice users, as they seem to underestimate the negative implications of bad vocal hygiene.
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Abstract
It is generally agreed that patients are the best raters of their quality of life (QL). Where it is not possible to obtain information from the patient the use of proxies can be an alternative. The proxy can be a significant other or a healthcare provider. The use of a proxy offers a solution to non-response. The accuracy of proxy reports is most typically determined by examining the extent to which patient and proxy ratings agree. A literature overview shows that agreement depends on several factors. Methodological limitations may have an impact on agreement. Agreement also varies according to the QL domains under study; the highest agreement is usually found for concrete domains. In addition, patient and proxy characteristics are related to agreement. When designing QL studies the threat of selection bias due to exclusion of patients has to be balanced against the threat of information bias due to proxy ratings.
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Affiliation(s)
- Louise von Essen
- Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden.
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Junghaenel DU, Broderick JE. Validation of the MPI patient profiles by partners and healthcare providers. Pain 2009; 144:130-8. [PMID: 19410367 DOI: 10.1016/j.pain.2009.03.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 01/11/2009] [Accepted: 03/26/2009] [Indexed: 11/16/2022]
Abstract
The Multidimensional Pain Inventory (MPI) is one of the most widely used instruments to assess patients' coping with chronic pain. It provides a psychosocial classification system that categorizes patients into three coping styles: Adaptive, Dysfunctional, and Interpersonally Distressed. To date, comprehensive information about the validity of the MPI taxonomy obtained from informants other than the patient has been unavailable. This has limited conclusions about the extent to which the MPI captures patients' adaptation to chronic pain beyond self-report. The present study is the first to examine whether the distinct multidimensional profiles underlying the patient clusters can be confirmed by proxy report. Ninety-nine chronic pain patients, their partners, and their healthcare providers participated in the study. Patients completed the MPI twice to determine stability of classification. Partners and providers rated the patient on MPI proxy versions developed for this study. Results revealed that partner- and provider-reported MPI ratings corresponded with the self-report patient profiles. The profiles of patients showing classification stability rather than switching of cluster assignment between the two MPI assessments had the highest correspondence with proxy ratings. These results extend prior validity research on the MPI and demonstrate that differential psychological adaptational styles to chronic pain can be reliably recognized by partners and healthcare providers.
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Affiliation(s)
- Doerte U Junghaenel
- Department of Psychiatry & Behavioral Science, Putnam Hall, Stony Brook University, Stony Brook, NY 11794-8790, USA.
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Fagerlind H, Lindblad ÅK, Bergström I, Nilsson M, Nauclér G, Glimelius B, Ring L. Patient-physician communication during oncology consultations. Psychooncology 2008; 17:975-85. [DOI: 10.1002/pon.1410] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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MRTENSSON G, CARLSSON M, LAMPIC C. Do nurses and cancer patients agree on cancer patients' coping resources, emotional distress and quality of life? Eur J Cancer Care (Engl) 2008; 17:350-60. [DOI: 10.1111/j.1365-2354.2007.00866.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Mulders M, Vingerhoets A, Breed W. The impact of cancer and chemotherapy: Perceptual similarities and differences between cancer patients, nurses and physicians. Eur J Oncol Nurs 2008; 12:97-102. [DOI: 10.1016/j.ejon.2007.10.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Revised: 09/25/2007] [Accepted: 10/03/2007] [Indexed: 10/22/2022]
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38
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Lebel S, Rosberger Z, Edgar L, Devins GM. Comparison of four common stressors across the breast cancer trajectory. J Psychosom Res 2007; 63:225-32. [PMID: 17719358 DOI: 10.1016/j.jpsychores.2007.02.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Studies of cancer stressors have typically assessed a limited number of factors using cross-sectional designs. There is little information about aspects of cancer that patients consider most stressful at different points along the disease trajectory. METHODS Seventy-two breast cancer patients rated the degrees to which they experienced each of four common cancer concerns as stressful during the preceding month at 3, 7, 11, and 15 months, and at 6 years after diagnosis. Stressors included fear of the future; physical limitations; pain; and problems with family or friends due to cancer. RESULTS Overall, the cancer concerns were rated as not especially stressful, with the exception of fear of the future which was the most stressful of the four concerns on all measurement occasions. Although fear of the future decreased from 3 to 7 months following diagnosis, it remained elevated at all of other time points. Physical limitations and pain were reported to induce equivalent levels of stress and their intensities decreased over time. However, there was a resurgence of the stressfulness of physical limitations and pain at the 6-year follow-up point when women experienced a second cancer during the long-term follow-up period. At all measurement occasions, breast cancer survivors reported very low levels of concern in relation to family and friends. CONCLUSION Breast cancer can be stressful for years after diagnosis for some women and especially for those who experience a second cancer. Fear of the future is the most pressing target for psychosocial interventions.
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Affiliation(s)
- Sophie Lebel
- Princess Margaret Hospital, Toronto, Ontario, Canada.
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39
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Lyons C, Brotherton A, Stanley N, Carrahar M, Manthorpe J. The Mental Capacity Act 2005: implications for dietetic practice. J Hum Nutr Diet 2007; 20:302-10. [PMID: 17635307 DOI: 10.1111/j.1365-277x.2007.00795.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The Mental Capacity Act (MCA) 2005 will be implemented in England and Wales in 2007 and have consequences for dietitians who work with people who may lack capacity to make specific decisions. This paper will explore issues arising from the introduction of the Act and considers the implications for dietitians involved in the delivery of clinical care, using enteral feeding as an illustrative example. If patients lack capacity to make specific decisions, dietitians will be required to record if, how and why they reached a decision, how they are involved in the decision making process and need to be able to justify their actions in relation to those decisions. This paper discusses the importance of dietitians' involvement in best interests decision making and considers the implications of decision making where people have drawn up a Lasting Power of Attorney. The role of such advance decisions is discussed and consideration is given to the potential compatibility of perspectives between the patient and family that may give rise to disputes. Dietitians may be well placed within multidisciplinary team working to ensure patients and their carers are part of the decision making process through effective communication and support for patients. Dietitians in England and Wales must consider the implications of the MCA upon their clinical practice and others outside these jurisdictions may like to reflect on the relevance of such developments in their own contexts.
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Affiliation(s)
- C Lyons
- Faculty of Health, University of Central Lancashire, Preston, Lancashire, UK.
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Brotherton AM, Abbott J, Hurley MA, Aggett PJ. Home percutaneous endoscopic gastrostomy feeding: perceptions of patients, carers, nurses and dietitians. J Adv Nurs 2007; 59:388-97. [PMID: 17524044 DOI: 10.1111/j.1365-2648.2007.04307.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This paper is a report of a study to compare the perceptions of adult patients, family carers, nurses and dietitians regarding home percutaneous endoscopic gastrostomy feeding. BACKGROUND Healthcare professionals have a major role in patient selection for gastrostomy placement and the provision of aftercare but it is not clear if patients, their carers and healthcare professionals have similar perceptions of the initiation and delivery of feeding and of the care in general. METHOD A cross-sectional mixed-method study using purposive sampling, semi-structured interviews and questionnaires was performed. Interviews were undertaken during 2005 with adult patients and carers of adults receiving home feeding. A questionnaire containing comparable questions was distributed to the lead district nurse and dietitian providing the individual patient's care. Binomial regression was used to analyse any differences in perceptions across the groups of respondents. RESULTS Nurses and dietitians had similar perceptions of gastrostomy feeding in adults. Family carers' perceptions matched those of professionals more closely than did those of patients. The greatest difference in perceptions was between patients and their family carers. Respondents' views about success of feeding and the appropriateness of the feeding regimen were similar, but greater differences existed regarding quality of life, withdrawal of feeding and choice in decision-making about tube placement. CONCLUSION There is a need for increased patient and carer involvement in decision-making and for sufficient, appropriate information to facilitate informed decision-making. Practitioners who involve carers in decision-making, where patients lack capacity, need to be aware that carers may not represent the views of patients.
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Affiliation(s)
- Ailsa M Brotherton
- Department of Nursing, Faculty of Health, University of Central Lancashire, Preston, UK.
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41
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Bjorvatn C, Eide GE, Hanestad BR, Øyen N, Havik OE, Carlsson A, Berglund G. Risk perception, worry and satisfaction related to genetic counseling for hereditary cancer. J Genet Couns 2007; 16:211-22. [PMID: 17279329 DOI: 10.1007/s10897-006-9061-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
In this multi center study, genetic counseling for hereditary cancer was evaluated by assessing patients' worry, perceived risk of developing cancer and satisfaction with genetic counseling. An overall aim was to identify characteristics of vulnerable patients in order to customize genetic counseling. In addition, agreement between patients' and counselors' scores was measured. A total of 275 Norwegian patients were consecutively recruited, and 213 completed questionnaires before and after genetic counseling. Patients' perceived risk decreased after the genetic counseling session. There was incongruence between risk perception expressed as a percentage and in words. Patients were significantly less worried after counseling. Higher levels of worry were predicted by low instrumental satisfaction with counseling, high degree of perceived risk of developing cancer and younger age. In conclusion, counselors met the patients' psychological needs to a satisfactory degree during counseling. However, patients did not fully understand their risk of developing cancer.
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Affiliation(s)
- Cathrine Bjorvatn
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
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42
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Chu DT, Kim SW, Kuo HP, Ozacar R, Salajka F, Krishnamurthy S, Damyanov D, Altug S, Reece WHH, Wang L. Patient attitudes towards chemotherapy as assessed by patient versus physician: a prospective observational study in advanced non-small cell lung cancer. Lung Cancer 2007; 56:433-43. [PMID: 17346847 DOI: 10.1016/j.lungcan.2007.01.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2006] [Revised: 01/26/2007] [Accepted: 01/28/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND In the treatment of advanced cancer, a physician's ability to accurately identify a patient's attitude towards treatment is critical. This paper describes the extent of any differences observed between patient attitudes towards chemotherapy for advanced non-small cell lung cancer (NSCLC) as assessed by patients themselves versus their physicians. PATIENTS AND METHODS Patients with stage IIIB or IV NSCLC who received gemcitabine plus cisplatin or carboplatin were enrolled into this prospective observational study. Patients and their physicians completed questionnaires containing descriptions of seven patient-specific attitudes. A pre-defined algorithm was used to categorize patients into one of the three 'need' categories based on the questionnaire responses: (A) "maximum extension of survival with acceptance of high toxicity", (B) "maximum extension of survival only if coupled with normal life style", and (C) "relief of symptoms". Each patient was categorized based on his own response, as well as his physician's response. RESULTS A total of 1895 patients were enrolled from 19 countries across 3 continents. Data from 1884 patients were analysed. Based on patient versus physician responses, respectively, the distribution of patients was 60% versus 39% in need category A, 26% versus 33% in B, and 14% versus 29% in C. Patient self-assessed versus physician-assessed need category identification was aligned for 891 patients (47.3%): 541 (29%) in A, 218 (12%) in B, 132 (7%) in C. While there was slight agreement between the identification of 'need' categories by physicians and patients (kappa=0.18, 95% CI: 0.15-0.21), physicians also tended to place patients further down the scale (towards C) than patients placed themselves (P<0.001). CONCLUSIONS Patients have varying needs from cancer chemotherapy and it may not always be correctly identified by the treating physician. Physicians may underestimate patient's desire for extended survival compared with symptom relief.
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Affiliation(s)
- Da-Tong Chu
- Cancer Institute & Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China
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43
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Griffiths J, Ewing G, Rogers M, Barclay S, Martin A, McCabe J, Todd C. Supporting Cancer Patients With Palliative Care Needs. Cancer Nurs 2007; 30:156-62. [PMID: 17413782 DOI: 10.1097/01.ncc.0000265013.63547.4a] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to examine UK district nurses' perceptions of their role in supporting palliative care cancer patients. Patients with cancer are living longer with the disease. District nurses are the largest UK workforce caring for people with cancer at home, the preferred place of care. Meeting patients' supportive and palliative care needs is complex. Little is known about district nurses' supportive role in the early phase of palliative care. Semistructured interviews were conducted with 34 district nurses. Data were analyzed thematically, with assistance from Atlas/ti. A dominant theme emerging from the interviews was ambiguity in the district nurses' supportive role in early palliative care. District nurses discussed the importance of making contact early on to support cancer patients and their families but had difficulty articulating this "support." Ambiguity, lack of confidence, and perceived skill deficits presented district nurses with dilemmas that were difficult to resolve. District nurses have great potential for meeting cancer patients' supportive and palliative care needs, a potential not currently realized. Education alone is unlikely to improve practice without an understanding of the tensions faced by district nurses in their work. Recognizing and addressing dilemmas in the everyday work of district nurses is central to moving practice forward.
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Affiliation(s)
- Jane Griffiths
- School of Nursing Midwifery and Social Work, University of Manchester, Manchester, United Kingdom.
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Carlsson C, Segesten K, Nilbert M, Nilsson K. Captured voices in cancer: experiences from networking between individuals with experiential and professional knowledge. BMC Health Serv Res 2007; 7:23. [PMID: 17309806 PMCID: PMC1808449 DOI: 10.1186/1472-6963-7-23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Accepted: 02/19/2007] [Indexed: 11/10/2022] Open
Abstract
Background Patients needs and experiences attract increasing attention within health care. In order to generate knowledge about the voices that emerge from collaborative experiences between members of patient associations for cancer patients (PACP) and health care professionals (HCPs), we studied a permanent network aimed at improving cancer care through increased attention to the cancer patients' view and experiences. Methods Open-ended interviews were carried out with 16 individuals; 6 PACP members and 10 HCPs, and after transcription the texts were analysed by inductive content analysis. Results Four voices, which represent various experiences from networking, were identified; the hesitant voice, the enlightened voice, the liberated voice, and the representative voice. The hesitant voice reflects uncertainty experienced when the participants were exposed to different views and opinions within the network. The enlightened voice reflects new points of view and gain of knowledge. The liberated voice signifies trust, balance, and confidence related to individual experiences and responsibilities being viewed in a broader perspective. The representative voice is derived from the transformation of experiences and responsibilities through insight, understanding, and new perspectives. Conclusion Networking between representatives for PACPs and HCPs may help the participants manage uncertainty, strengthen the patient's perspective and provide new views on common issues. The different voices identified in this study demonstrate that both PACP members and HCPs distanced themselves from their individual experiences in order to be perceived as unselfish and knowledgeable within the network. Although the climate was characterized by trustfulness, the members' unique positions need to be defined in order to obtain an optimal balance between the groups and prevent members' patient experiences of losing their character by learning to much from the HCPs. Increased understanding of the hesitant, the enlightened, the liberated, and the representative voices, and awareness of experiential versus professional knowledge of cancer may facilitate and probably improve future networking efforts.
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Affiliation(s)
- Christina Carlsson
- Institute of Clinical Sciences, Department of Oncology, Lund University, Lund, Sweden
| | - Kerstin Segesten
- Department of Health Sciences, University College of Borås, Borås, Sweden
| | - Mef Nilbert
- Institute of Clinical Sciences, Department of Oncology, Lund University, Lund, Sweden
| | - Kerstin Nilsson
- Faculty of Health and Caring Sciences, Institute of Nursing, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden
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Wennman-Larsen A, Tishelman C, Wengström Y, Gustavsson P. Factors influencing agreement in symptom ratings by lung cancer patients and their significant others. J Pain Symptom Manage 2007; 33:146-55. [PMID: 17280920 DOI: 10.1016/j.jpainsymman.2006.07.019] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Revised: 07/19/2006] [Accepted: 07/19/2006] [Indexed: 11/25/2022]
Abstract
Comparisons of symptom ratings and health-related quality of life between significant others and patients have been the focus of numerous studies during the past decades. Additional studies are needed to assess the discrepancies identified in this work. In the present cross-sectional exploratory study, focus has been on evaluating the accuracy of significant other proxy ratings and on investigating factors that influence agreement between lung cancer patients and significant others based on dyadic assessments from 52 patients and 54 significant others. Results indicate that the levels of agreement are fair to good, but that significant others consistently rate the patients' symptoms higher and functioning lower than the patients do themselves. Factors found to influence agreement in various dimensions of symptoms and functioning were gender, patient age, and significant others' self-reported lack of family support, health problems, and caregiver esteem.
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Affiliation(s)
- Agneta Wennman-Larsen
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
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46
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Broberger E, Sprangers M, Tishelman C. Do Internal Standards of Quality of Life Change in Lung Cancer Patients? Nurs Res 2006; 55:274-82. [PMID: 16849980 DOI: 10.1097/00006199-200607000-00008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Measurement of health-related quality of life (QOL) over time often yields results that may be difficult to understand. Patients may change their internal standards of QOL as a result of adaptation to deteriorating health, a phenomenon referred to as response shift. OBJECTIVES To examine changes in internal standards of fatigue, global health/QOL, and physical function in patients with inoperable lung cancer at 3 months (n = 115) and 6 months (n = 89) after a baseline measurement close to diagnosis. Significant changes were expected to occur only in patients who reported improvement or deterioration in fatigue and global health/QOL. METHODS Fatigue, global health/QOL, and physical function were assessed with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30, version 3.0). At follow-up, this questionnaire was administered conventionally and as a retrospective baseline assessment (thentest). Subjective transition questions were used to form mutually exclusive patient subgroups (i.e., deterioration, stable, or improvement). RESULTS With respect to fatigue, significant changes occurred in patients reporting deterioration at 3 months follow-up and in patients reporting improvement after 6 months, but not in patients reporting improvement after 3 months or deterioration after 6 months. Significant changes in global health/QOL were found in patients reporting improvement at both 3 and 6 months follow-up and unexpectedly in stable patients after 3 months. No significant changes were found in patients reporting deteriorated global health/QOL at 3 and 6 months. Unexpectedly, changes occurred at both 3 and 6 months in patients reporting improved physical function. DISCUSSION Given these mixed findings, it cannot be concluded that changes in internal standards occurred. These severely ill patients reported high levels of symptoms at baseline and may in part have adapted to their symptoms before study entry.
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Affiliation(s)
- Eva Broberger
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
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47
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Carlsson C, Nilbert M, Nilsson K. Patients' involvement in improving cancer care: experiences in three years of collaboration between members of patient associations and health care professionals. PATIENT EDUCATION AND COUNSELING 2006; 61:65-71. [PMID: 16533678 DOI: 10.1016/j.pec.2005.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2004] [Revised: 02/04/2005] [Accepted: 02/17/2005] [Indexed: 05/07/2023]
Abstract
OBJECTIVE The aim of this study was to explore how members of patient associations (PACPs) and health care professionals (HCPs) experience collaboration in a network initiated by the health care system and aimed at improving cancer care. METHODS The participants were asked to describe, after 1 and 3 years, their experiences of collaboration. Data collected were in the form of a written answer to a single, open-ended question, and the answers were analysed using inductive content analysis. RESULTS The analysis revealed four themes: the impact of processes that occur within the network, the impact of learning, the impact of innovation and development in cancer care, and the impact of PACP members' personal cancer experience. Statements about the impact of the processes that occur within the network dominated at both occasions. CONCLUSION This study of experiences of collaboration provides new data on the importance ascribed to such efforts between patients in an organised association and HCPs. PRACTICE IMPLICATIONS We suggest that differences in perceptions and expectations should be taken into account in future collaborations between representatives of patient associations and of health care systems in order to reach out and to influence developments in cancer care.
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Affiliation(s)
- Christina Carlsson
- Department of Oncology, Institute of Clinical Sciences, Lund University Hospital, SE-221 85 Lund, Sweden.
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Abstract
This paper discusses the state of the science in prospective measurement in end-of-life research and identifies particular areas for focused attention. Topics include defining the scope of inquiry, evaluating experiences of patients too ill to communicate, the role of proxy and family response, measurement sensitivity to change, the role of theory in guiding measurement efforts, evaluating relationships between domains of end-of-life experience, and measurement of cultural comprehensiveness. The state of the sciences calls for future research to (1) conduct longitudinal studies to capture transitions in end-of-life trajectories; (2) evaluate the quality of proxy reporting as it varies by rater relationship, domain, and over time; (3) use state-of-the art psychometric and longitudinal techniques to validate measures and to assess sensitivity to change; (4) develop further and test conceptual models of the experience of dying; (5) study the inter-relatedness of multiple dimensions of end-of-life trajectories; (6) compile updated information evaluating available measurement tools; and (7) conduct population- based research with attention to ethnic and age diversity.
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Affiliation(s)
- Karen E Steinhauser
- Center for Palliative Care, Center for Health Services Research in Primary Care, Durham VA Medical Center, and the Department of Medicine, Duke University, Durham, North Carolina 27705, USA.
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Fung D, Cohen M, Stewart S, Davies A. Can the Iowa Satisfaction with Anesthesia Scale Be Used to Measure Patient Satisfaction with Cataract Care Under Topical Local Anesthesia and Monitored Sedation at a Community Hospital? Anesth Analg 2005; 100:1637-1643. [PMID: 15920188 DOI: 10.1213/01.ane.0000154203.00434.23] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Patient satisfaction ratings provide a means to evaluate and monitor quality of health care. We tested the ability of the Iowa Satisfaction with Anesthesia Scale (ISAS) to measure satisfaction with cataract care under topical local anesthesia and monitored sedation given by an anesthesiologist at a community hospital. Three hundred six patients were administered the ISAS along with alternate ratings of quality of care and patient satisfaction. There were no incomplete questionnaires. The ISAS demonstrated reasonable reliability (Cronbach's alpha = 0.68; test-retest = 0.48-0.67). The ISAS had excellent construct validity; ISAS scores were lower in patients who gave lower ratings of quality (4.98 versus 5.64), who had lower satisfaction visual analog scale scores (5.12 versus 5.65), who wanted changes in their care (4.76 versus 5.67), who had suggestions to improve care (5.08 versus 5.63), or who preferred more sedation (4.85 versus 5.66) (P < 0.0001). Our results indicate that the ISAS questionnaire is a feasible, reliable, and valid tool to measure patient satisfaction in patients undergoing cataract surgery under topical anesthesia and monitored sedation.
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Affiliation(s)
- Donald Fung
- *North Bay General Hospital, North Bay, and Department of Anesthesia, Faculty of Medicine, University of Toronto, Toronto; †Centre for Research in Women's Health, Sunnybrook & Women's College Health Sciences Centre and the Department of Health Policy, Management & Evaluation, University of Toronto, Toronto; and ‡North Shores District Health Council, North Bay, Ontario, Canada
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Broberger E, Tishelman C, von Essen L. Discrepancies and similarities in how patients with lung cancer and their professional and family caregivers assess symptom occurrence and symptom distress. J Pain Symptom Manage 2005; 29:572-83. [PMID: 15963866 DOI: 10.1016/j.jpainsymman.2004.11.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2004] [Indexed: 12/01/2022]
Abstract
Historically, conceptual distinctions have not been made between the components of symptom experience--symptom distress and symptom occurrence--nor has the question of how distressing patients perceive different symptoms to be, irrespective of their current occurrence, been addressed. The aim of this study was to explore the hypothesis that there may be different patterns in discrepancies between how lung cancer patients and their caregivers assess symptom distress and in how they assess symptom occurrence. Thirty-three patient-nurse dyads and 54 patient-family caregiver dyads assessed patients' symptom distress and symptom occurrence. Discrepancies with regard to how patients, nurses, and family caregivers assessed symptom distress and symptom occurrence were identified. Patients and caregivers were more in agreement about which symptoms might cause distress than about current symptom occurrence. Caregivers rated symptom occurrence as greater than patients. The findings highlight the need to further explore what symptom characteristics caregivers address when assessing patients' symptom experiences.
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Affiliation(s)
- Eva Broberger
- Department of Nursing, Karolinska Institutet, SE 141 83 Huddinge, Sweden
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