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Liu M, Wang X, Yan Z, Wang Z, Wei H, Wang J, Luan X. Network Analysis on Family Resilience, Fear of Progression, and Quality of Life in Chinese Patients with Pulmonary Hypertension. Heart Lung 2024; 64:128-136. [PMID: 38176126 DOI: 10.1016/j.hrtlng.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 12/03/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND The long-term quality of life of Chinese patients with pulmonary hypertension has been seriously compromised. Interventions to enhance patient quality of life of are urgently required. OBJECTIVE To investigate the relationship between quality of life and its influencing factors in patients through network analysis. METHOD 247 patients with pulmonary hypertension in 3 hospitals in Jinan, Shandong Province, self-reported their immediate family resilience, fear of progression, and quality of life via questionnaires. A mixed graphical model was constructed to investigate the relationship among multidimensional structures of variables. RESULTS A total of 247 patients (173 female and 74 male) were included (age 18-34, n=115; age 35-49, n=99; age 50-64, n=23; age > 65 years, n=10). "Family communication and problem solving" was at the center of the network, with serving as a bridge node. Within communities, the strongest edge was "Family communication and problem solving-maintaining a positive outlook." Across communities, the strongest edge between family resilience and quality of life was "Family communication and problem solving-environmental domain quality of life," and the strongest edge across the fear of progression and quality of life was "physiological health fear-psychological domain quality of life." CONCLUSIONS Family resilience and fear of progression may affect the quality of life in patients with pulmonary hypertension. Developing a program with "family communication and problem solving" as a primary target may reduce patient fear of progression, enhance family resilience, and improve patient quality of life.
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Affiliation(s)
- Mengqi Liu
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China
| | - Xiaoli Wang
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China
| | - Zeping Yan
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China; University of Health and Rehabilitation Sciences, Qingdao, Shandong Province, China
| | - Zhiwei Wang
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China
| | - Huimin Wei
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China
| | - Jiurui Wang
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China
| | - Xiaorong Luan
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China; Department of Infection Control, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.
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Kinnamon DD, Jordan E, Haas GJ, Hofmeyer M, Kransdorf E, Ewald GA, Morris AA, Owens A, Lowes B, Stoller D, Tang WHW, Garg S, Trachtenberg BH, Shah P, Pamboukian SV, Sweitzer NK, Wheeler MT, Wilcox JE, Katz S, Pan S, Jimenez J, Aaronson KD, Fishbein DP, Smart F, Wang J, Gottlieb SS, Judge DP, Moore CK, Mead JO, Huggins GS, Ni H, Burke W, Hershberger RE. Effectiveness of the Family Heart Talk Communication Tool in Improving Family Member Screening for Dilated Cardiomyopathy: Results of a Randomized Trial. Circulation 2023; 147:1281-1290. [PMID: 36938756 PMCID: PMC10133091 DOI: 10.1161/circulationaha.122.062507] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/15/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Managing disease risk among first-degree relatives of probands diagnosed with a heritable disease is central to precision medicine. A critical component is often clinical screening, which is particularly important for conditions like dilated cardiomyopathy (DCM) that remain asymptomatic until severe disease develops. Nonetheless, probands are frequently ill-equipped to disseminate genetic risk information that motivates at-risk relatives to complete recommended clinical screening. An easily implemented remedy for this key issue has been elusive. METHODS The DCM Precision Medicine Study developed Family Heart Talk, a booklet designed to help probands with DCM communicate genetic risk and the need for cardiovascular screening to their relatives. The effectiveness of the Family Heart Talk booklet in increasing cardiovascular clinical screening uptake among first-degree relatives was assessed in a multicenter, open-label, cluster-randomized, controlled trial. The primary outcome measured in eligible first-degree relatives was completion of screening initiated within 12 months after proband enrollment. Because probands randomized to the intervention received the booklet at the enrollment visit, eligible first-degree relatives were limited to those who were alive the day after proband enrollment and not enrolled on the same day as the proband. RESULTS Between June 2016 and March 2020, 1241 probands were randomized (1:1) to receive Family Heart Talk (n=621) or not (n=620) within strata defined by site and self-identified race/ethnicity (non-Hispanic Black, non-Hispanic White, or Hispanic). Final analyses included 550 families (n=2230 eligible first-degree relatives) in the Family Heart Talk arm and 561 (n=2416) in the control arm. A higher percentage of eligible first-degree relatives completed screening in the Family Heart Talk arm (19.5% versus 16.0%), and the odds of screening completion among these first-degree relatives were higher in the Family Heart Talk arm after adjustment for proband randomization stratum, sex, and age quartile (odds ratio, 1.30 [1-sided 95% CI, 1.08-∞]). A prespecified subgroup analysis did not find evidence of heterogeneity in the adjusted intervention odds ratio across race/ethnicity strata (P=0.90). CONCLUSIONS Family Heart Talk, a booklet that can be provided to patients with DCM by clinicians with minimal additional time investment, was effective in increasing cardiovascular clinical screening among first-degree relatives of these patients. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03037632.
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Affiliation(s)
- Daniel D. Kinnamon
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
| | - Elizabeth Jordan
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
| | - Garrie J. Haas
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Mark Hofmeyer
- Medstar Research Institute, Washington Hospital Center, Washington, DC
| | - Evan Kransdorf
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | | | - Anjali Owens
- Center for Inherited Cardiovascular Disease, Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Brian Lowes
- University of Nebraska Medical Center, Omaha, NE
| | | | - W. H. Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Sonia Garg
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Barry H. Trachtenberg
- Houston Methodist DeBakey Heart and Vascular Center, J.C. Walter Jr. Transplant Center, Houston TX
| | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, VA
| | - Salpy V. Pamboukian
- University of Alabama, Birmingham, AL; current address, University of Washington, Seattle, WA
| | - Nancy K. Sweitzer
- Sarver Heart Center, University of Arizona, Tucson, AZ; current address, Division of Cardiology, Washington University, St. Louis, MO
| | - Matthew T. Wheeler
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA
| | - Jane E. Wilcox
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Stuart Katz
- New York University Langone Medical Center, New York, NY
| | - Stephen Pan
- Department of Cardiology, Westchester Medical Center & New York Medical College, Valhalla, NY
| | - Javier Jimenez
- Miami Cardiac & Vascular Institute, Baptist Health South, Miami, FL
| | | | | | - Frank Smart
- Louisiana State University Health Sciences Center, New Orleans, LA
| | - Jessica Wang
- University of California Los Angeles Medical Center, Los Angeles, CA
| | | | | | | | - Jonathan O. Mead
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
| | - Gordon S. Huggins
- Cardiology Division, Tufts Medical Center and Tufts University School of Medicine, Boston, MA
| | - Hanyu Ni
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle, WA
| | - Ray E. Hershberger
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH
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Impact of Distribution of a Tip Sheet to Increase Early Detection and Prevention Behavior among First-Degree Relatives of Melanoma Patients: A Randomized Cluster Trial. Cancers (Basel) 2022; 14:cancers14163864. [PMID: 36010858 PMCID: PMC9406196 DOI: 10.3390/cancers14163864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/28/2022] [Accepted: 08/08/2022] [Indexed: 11/21/2022] Open
Abstract
Simple Summary The risk of melanoma is higher in first-degree relatives (FDRs, i.e., brother, sister, father, mother, or children) of a patient with melanoma than in the general population. FDRs are advised to undergo annual screening to detect any melanoma earlier and to adopt sun-protective behavior by seeking shade, wearing a hat and long-sleeved clothing, staying indoors between 12 noon and 4 p.m., and applying sunscreen with SPF > 50. We know that these general instructions, usually given orally to the patients, are inconsistently followed by FDRs. Our goal was to determine whether written support intended for FDRs of patients would improve early detection and photoprotection as compared with usual oral advice. We developed and evaluated the use of a tip sheet given by patients to their FDRs. The adherence of FDRs to early detection by medical examination and to sun protection was not improved by delivery of the tip sheet as compared with the usual oral advice. Abstract Background: First-degree relatives (FDRs, defined as parents, children, and siblings) of melanoma patients are at a two-to-fivefold increased risk of developing melanoma themselves. FDRs are advised to perform self-skin examination (SSE) and annual medical total cutaneous examination (TCE) performed either by a dermatologist or a general practitioner, and to change their sun-related behavior. This advice is given orally to melanoma patients who are asked to relay the information to their FDRs. Objective: Our aim was to determine the impact of providing a tip sheet to melanoma patients intended to their first-degree relatives (FDRs) on early detection and sun-related behaviors in this group at increased risk of melanoma. Methods: A superiority, cluster-randomized trial was conducted at nine hospital centers. In the intervention group, dermatologists were asked to deliver to melanoma patients (index cases) the tip sheet and oral advice intended to their FDRs. The control group were asked to deliver the usual oral advice alone. The primary outcome was early detection of melanoma in FDRs with a medical TCE performed within one year after the first visit of the index case. Secondary outcomes were SSE and sun-related behaviors in FDRs. Results: A total of 48 index cases and 114 FDRS in the control group, 60 index cases and 166 FDRS in the intervention group were recruited. In the intervention group, 36.1% of FDRs performed a medical TCE as compared to 39.5% of FDRs in the control group (OR 0.9 [95% CI 0.5 to 1.5], p = 0.63). We did not find a between-group difference in SSE and sun-related behaviors. Conclusion: A tip sheet added to the usual oral advice did not increase medical TCE among FDRs of melanoma patients. Overall, the rate of TCE among FDRs was low. Research on other strategies is needed to increase melanoma detection in this population.
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Niu Z, Bhurosy T, Heckman CJ. Digital interventions for promoting sun protection and skin self-examination behaviors: A systematic review. Prev Med Rep 2022; 26:101709. [PMID: 35529530 PMCID: PMC9073560 DOI: 10.1016/j.pmedr.2022.101709] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/05/2022] [Accepted: 01/22/2022] [Indexed: 01/22/2023] Open
Abstract
A considerable number of digital interventions for skin cancer prevention have been evaluated. Most skin cancer digital interventions focus on sun protection-related outcomes. Most interventions use web-based digital technology (websites, webpages, mobile apps) rather than videos, emails or text messages alone as the delivery platform. Multi-component digital interventions are effective in promoting sun protection and skin self-examination. Almost all studies found digital interventions to be equally or more effective compared to non-digital interventions.
The skin cancer incidence rate has been rising, and digital health interventions can promote skin cancer prevention and detection behaviors. A systematic review was conducted to investigate the outcomes of digital interventions that promote sun protection and skin self-examination (SSE). This review examined studies that utilized randomized controlled designs or quasi-experiments, included outcomes related to sun safety or SSE, employed at least one digital platform, and were published in English from January 2000 to October 2020. A total of 62 studies were included in the review. Digital modalities included web-based (e.g., websites) alone (n = 29), mobile-based (e.g., mobile apps) alone (n = 12), game-based (n = 1), emails or text messages alone (n = 8), videos alone (n = 6), social media (n = 3), both text messages and mobile apps (n = 2), or both text messages and video (n = 1). Most studies (n = 44) only evaluated sun protection-related outcomes, seven studies assessed SSE outcomes only, nine studies examined both, and two assessed other related outcomes. Digital interventions are effective compared to non-intervention control conditions in promoting sun safety or SSE. Almost all studies found digital interventions to be equally or more effective compared to non-digital interventions. This review suggests that although the digital interventions varied, they showed promising effects on improving sun protection or SSE outcomes. Future research should include more sophisticated phase-based and rigorous longitudinal research designs, additional investigation of social media and other newer technologies, as well as more detailed reporting of methods and results.
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Affiliation(s)
- Zhaomeng Niu
- Section of Behavioral Sciences, Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, United States
- Corresponding author.
| | - Trishnee Bhurosy
- Department of Population Health, Hofstra University, Hempstead, NY, United States
| | - Carolyn J. Heckman
- Section of Behavioral Sciences, Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, United States
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Manne S, Kashy DA, Pagoto S, Peterson SK, Heckman CJ, Gallo J, Berger A, Buller DB, Kulik A, Frederick S, Pesanelli M. Family Attitudes and Communication about Sun Protection and Sun Protection Practices among Young Adult Melanoma Survivors and Their Family Members. JOURNAL OF HEALTH COMMUNICATION 2021; 26:781-791. [PMID: 34844521 PMCID: PMC9270718 DOI: 10.1080/10810730.2021.2008552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Young melanoma survivors and their family are at increased risk for developing melanoma, but seldom engage in sun protection behaviors. Little is known about the role of family factors in sun protection. Our goals were: 1) examine correspondence between survivors and family sun protection, individual attitudes, and family attitudes and communication about risk-reducing behaviors, and; 2) evaluate the mediating role of family attitudes and communication in the association between individual sun protection attitudes and behavior. Measures of individual attitudes, family attitudes and communication, and sun protection behaviors were completed by 529 participants. Multilevel modeling assessed family correspondence in sun-related attitudes and behaviors and mediation. Families had varying levels of shared attitudes and behaviors, with higher correspondence for family norms. Survivors reported stronger family norms, greater family benefits, and more discussion than siblings. For both sexes, family discussion was associated with higher sun protection. For women only, more favorable attitudes were associated with sun protection partly because women discussed sun protection with family and held stronger norms. Because families' attitudes and practices correspond, family-focused interventions may prove effective. Among females, increasing risk awareness and sunscreen efficacy and overcoming barriers may foster enhanced normative standards, communication about, and engagement in sun protection.
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Affiliation(s)
- Sharon Manne
- Department of Medicine, Behavioral Sciences Section, Rutgers Cancer Institute of New Jersey, USA
| | - Deborah A Kashy
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Sherry Pagoto
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Susan K Peterson
- Department of Behavioral Science, Division of of Cancer Prevention and Population Sciences, University of Texas Md Anderson Cancer Center, USA
| | - Carolyn J Heckman
- Department of Medicine, Behavioral Sciences Section, Rutgers Cancer Institute of New Jersey, USA
| | - Joseph Gallo
- Department of Medicine, Behavioral Sciences Section, Rutgers Cancer Institute of New Jersey, USA
| | - Adam Berger
- Department of Medicine, Behavioral Sciences Section, Rutgers Cancer Institute of New Jersey, USA
| | | | - Alexandria Kulik
- Department of Medicine, Behavioral Sciences Section, Rutgers Cancer Institute of New Jersey, USA
| | - Sara Frederick
- Department of Medicine, Behavioral Sciences Section, Rutgers Cancer Institute of New Jersey, USA
| | - Morgan Pesanelli
- Department of Medicine, Behavioral Sciences Section, Rutgers Cancer Institute of New Jersey, USA
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Conley CC, Otto AK, McDonnell GA, Tercyak KP. Multiple approaches to enhancing cancer communication in the next decade: translating research into practice and policy. Transl Behav Med 2021; 11:2018-2032. [PMID: 34347872 DOI: 10.1093/tbm/ibab089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Communicating risk and other health information in a clear, understandable, and actionable manner is critical for the prevention and control of cancer, as well as the care of affected individuals and their family members. However, the swift pace of development in communication technologies has dramatically changed the health communication landscape. This digital era presents new opportunities and challenges for cancer communication research and its impact on practice and policy. In this article, we examine the science of health communication focused on cancer and highlight important areas of research for the coming decade. Specifically, we discuss three domains in which cancer communication may occur: (a) among patients and their healthcare providers; (b) within and among families and social networks; and (c) across communities, populations, and the public more broadly. We underscore findings from the prior decade of cancer communication research, provide illustrative examples of future directions for cancer communication science, and conclude with considerations for diverse populations. Health informatics studies will be necessary to fully understand the growing and complex communication settings related to cancer: such works have the potential to change the face of information exchanges about cancer and elevate our collective discourse about this area as newer clinical and public health priorities emerge. Researchers from a wide array of specialties are interested in examining and improving cancer communication. These interdisciplinary perspectives can rapidly advance and help translate findings of cancer communication in the field of behavioral medicine.
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Affiliation(s)
- Claire C Conley
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Amy K Otto
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Glynnis A McDonnell
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Kenneth P Tercyak
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
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Development of a Secure Website to Facilitate Information Sharing in Families at High Risk of Bowel Cancer-The Familyweb Study. Cancers (Basel) 2021; 13:cancers13102404. [PMID: 34065728 PMCID: PMC8155923 DOI: 10.3390/cancers13102404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 11/22/2022] Open
Abstract
Simple Summary Families with an inherited high risk of bowel cancer may struggle to share information about their diagnosis. This means that relatives are not always aware of their increased risk of cancer or able to access screening for the early detection of cancer. Through this study, we aimed to help such families by creating a website where patients could share confidential information with their relatives securely online. Following a survey and telephone interviews with affected individuals, the content of the website was developed to suit the needs of families. Website function was tested with patients to check feasibility and acceptability. Most participants wanted more information to support their adaptation to the diagnosis and help inform their relatives. This study demonstrates how health professionals can improve access to genetic testing and cancer screening in families at high risk of cancer, thus reducing morbidity and mortality. Abstract Individuals with pathogenic variants in genes predisposing to bowel cancer are encouraged to share this information within their families. Close relatives at 50% risk can have access to bowel cancer surveillance. However, many relatives remain unaware of their vulnerability or have insufficient information. We investigated the feasibility and acceptability of using a secure website to support information sharing within families at high risk of bowel cancer. Patients (n = 286) answered an anonymous cross-sectional survey, with 14 participating in telephone interviews. They reported that the diagnosis had a profound effect on them and their family relationships, and consequently desired more support from health professionals. Website content was created in response to the preferences of survey and interview participants. Reactions to the website from 12 volunteers were captured through remote usability testing to guide further refinement of the website. Participants welcomed the opportunity to store and share personal information via the website and wanted more information and help informing their relatives about the diagnosis. Important website topics were: healthy lifestyle; genetic testing; and how to talk to children about the diagnosis. A website providing online access to confidential documents was both feasible and acceptable and could translate into increased uptake of cancer surveillance, resulting in lower morbidity and mortality in these families.
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Bowen DJ, Hyams T, Laurino M, Woolley T, Cohen S, Leppig KA, Jarvik G. Development of FamilyTalk: an Intervention to Support Communication and Educate Families About Colorectal Cancer Risk. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:470-478. [PMID: 30737640 PMCID: PMC6688969 DOI: 10.1007/s13187-019-1484-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
IFamily members of individuals with colorectal cancer (CRC) may be at increased risk of developing the disease. However, the majority of CRC can be prevented through colonoscopy screening and family members may not be aware if they are recommended to pursue earlier screening because of their family history of CRC. As such, tools must be developed to effectively communicate potential changes to the recommended age for colonoscopy screening and other important CRC-related information to family members. We modified and adapted a successful intervention for families with melanoma to be appropriate for families with CRC to increase communication and screening in family members. The multistep process included the following: (1) developing a paper version of the intervention, (2) piloting the paper version among families with CRC, (3) developing the web-based version, and (4) testing the intervention for usability. Qualitative data was collected and analyzed for pilot testing. Usability testing utilized both qualitative and quantitative data. Patients with CRC liked the paper version and had multiple suggestions, including adding a better introduction, sections on genetics and family history, and clearer communication assistance. The web-based tool was well received and improved upon the linear book format with links, better section instructions, and more proactive communication tools for families. These processes produced materials that satisfied individuals from various families with assistance and support for communicating about CRC. Evaluating the effects of the tools in rigorous research projects is the next step.
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Affiliation(s)
- Deborah J Bowen
- Department of Bioethics and Humanities, University of Washington, Box 357120, Seattle, WA, 98195, USA.
| | - Travis Hyams
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Mercy Laurino
- Genetics and Cancer Prevention Programs, Seattle Cancer Care Alliance, Seattle, WA, USA
| | | | - Stacey Cohen
- Division of Oncology, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Gail Jarvik
- Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, WA, USA
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
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Treanor CJ, Santin O, Prue G, Coleman H, Cardwell CR, O'Halloran P, Donnelly M. Psychosocial interventions for informal caregivers of people living with cancer. Cochrane Database Syst Rev 2019; 6:CD009912. [PMID: 31204791 PMCID: PMC6573123 DOI: 10.1002/14651858.cd009912.pub2] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Increasingly, cancer is recognised as a chronic condition with a growing population of informal caregivers providing care for cancer patients. Informal caregiving can negatively affect the health and well-being of caregivers. We need a synthesised account of best evidence to aid decision-making about effective ways to support caregivers for individuals 'living with cancer'. OBJECTIVES To assess the effectiveness of psychosocial interventions designed to improve the quality of life (QoL), physical health and well-being of informal caregivers of people living with cancer compared with usual care. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, ProQuest, Open SIGLE, Web of Science from inception up to January 2018, trial registries and citation lists of included studies. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials comparing psychosocial interventions delivered to adult informal caregivers of adults affected by cancer on a group or individual basis with usual care. Psychosocial interventions included non-pharmacological interventions that involved an interpersonal relationship between caregivers and healthcare professionals. We included interventions delivered also to caregiver-patient dyads. Interventions delivered to caregivers of individuals receiving palliative or inpatient care were excluded. Our primary outcome was caregiver QoL. Secondary outcomes included patient QoL, caregiver and patient depression, anxiety, psychological distress, physical health status and intervention satisfaction and adverse effects. DATA COLLECTION AND ANALYSIS Pairs of review authors independently screened studies for eligibility, extracted data and conducted 'Risk of bias' assessments. We synthesised findings using meta-analysis, where possible, and reported remaining results in a narrative synthesis. MAIN RESULTS Nineteen trials (n = 3, 725) were included in the review. All trials were reported in English and were undertaken in high-income countries. Trials targeted caregivers of patients affected by a number of cancers spanning newly diagnosed patients, patients awaiting treatment, patients who were being treated currently and individuals post-treatment. Most trials delivered interventions to caregiver-patient dyads (predominantly spousal dyads) and there was variation in intervention delivery to groups or individual participants. There was much heterogeneity across interventions though the majority were defined as psycho-educational. All trials were rated as being at 'high risk of bias'.Compared to usual care, psychosocial interventions may improve slightly caregiver QoL immediately post intervention (standardised mean difference (SMD) 0.29, 95% confidence interval (CI) 0.04 to 0.53; studies = 2, 265 participants) and may have little to no effect on caregiver QoL at 12 months (SMD 0.14, 95% CI - 0.11 to 0.40; studies = 2, 239 participants) post-intervention (both low-quality evidence).Psychosocial interventions probably have little to no effect on caregiver depression immediately to one-month post-intervention (SMD 0.01, 95% CI -0.14 to 0.15; studies = 9, 702 participants) (moderate-quality evidence). Psychosocial interventions may have little to no effect on caregiver anxiety immediately post-intervention (SMD -0.12, 95 % CI -0.33 to 0.10; studies = 5, 329 participants), depression three-to-six months (SMD 0.03, 95% CI -0.33 to 0.38; studies = 5. 379 participants) post-intervention and patient QoL six to 12 months (SMD -0.05, 95% CI -0.37 to 0.26; studies = 3, 294 participants) post-intervention (all low-quality evidence). There was uncertainty whether psychosocial interventions improve patient QoL immediately (SMD -0.03, 95 %CI -0.50 to 0.44; studies = 2, 292 participants) or caregiver anxiety three-to-six months (SMD-0.25, 95% CI -0.64 to 0.13; studies = 4, 272 participants) post-intervention (both very low-quality evidence). Two studies which could not be pooled in a meta-analysis for caregiver physical health status found little to no effect immediately post-intervention and a small intervention effect 12 months post-intervention. Caregiver or patient satisfaction or cost-effectiveness of interventions were not assessed in any studies. Interventions demonstrated good feasibility and acceptability.Psychosocial interventions probably have little to no effect on patient physical health status immediately post-intervention (SMD 0.17, 95 % CI -0.07 to 0.41; studies = 4, 461 participants) and patient depression three to six months post-intervention (SMD-0.11, 95% CI -0.33 to 0.12; studies = 6, 534 participants) (both moderate-quality evidence).Psychosocial interventions may have little to no effect on caregiver psychological distress immediately to one-month (SMD -0.08, 95% CI -0.42 to 0.26; studies = 3, 134 participants), and seven to 12 months (SMD 0.08, 95% CI -0.42 to 0.58; studies = 2, 62 participants) post-intervention; patient depression immediately (SMD -0.12, 95% CI -0.31 to 0.07; studies = 9, 852 participants); anxiety immediately (SMD -0.13, 95% CI -0.41 to 0.15;studies = 4, 422 participants), and three to six months (SMD -0.22, 95% CI -0.45 to 0.02; studies = 4, 370 participants); psychological distress immediately (SMD -0.02, 95% CI -0.47 to 0.44; studies = 2, 74 participants) and seven to 12 months (SMD -0.27, 95% CI -0.78 to 0.24; studies = 2, 61 participants); and physical health status six to 12 months (SMD 0.06, 95% CI -0.18 to 0.30; studies = 2, 275 participants) post-intervention (all low-quality evidence).Three trials reported adverse effects associated with the interventions, compared with usual care, including higher distress, sexual function-related distress and lower relationship satisfaction levels for caregivers, higher distress levels for patients, and that some content was perceived as insensitive to some participants.Trials not able to be pooled in a meta-analysis did not tend to report effect size and it was difficult to discern intervention effectiveness. Variable intervention effects were reported for patient and caregiver outcomes. AUTHORS' CONCLUSIONS Heterogeneity across studies makes it difficult to draw firm conclusions regarding the effectiveness of psychosocial interventions for this population. There is an immediate need for rigorous trials with process evaluations and clearer, detailed intervention descriptions. Cost-effectiveness studies should be conducted alongside future trials.
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Affiliation(s)
- Charlene J Treanor
- Queen's University BelfastCentre for Public HealthInstitute of Clinical Sciences Block B, Royal Victoria Hospital SiteGrosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
| | - Olinda Santin
- Queen's University BelfastSchool of Nursing and Midwifery97 Lisburn RoadBelfastUKBT9 7BL
| | - Gillian Prue
- Queen's University BelfastSchool of Nursing and Midwifery97 Lisburn RoadBelfastUKBT9 7BL
| | - Helen Coleman
- Queen's University BelfastCentre for Public HealthInstitute of Clinical Sciences Block B, Royal Victoria Hospital SiteGrosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
| | - Chris R Cardwell
- Queen's University BelfastCentre for Public HealthInstitute of Clinical Sciences Block B, Royal Victoria Hospital SiteGrosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
| | - Peter O'Halloran
- Queen's University BelfastSchool of Nursing and Midwifery97 Lisburn RoadBelfastUKBT9 7BL
| | - Michael Donnelly
- Queen's University BelfastCentre for Public HealthInstitute of Clinical Sciences Block B, Royal Victoria Hospital SiteGrosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
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Kinnamon DD, Morales A, Bowen DJ, Burke W, Hershberger RE. Toward Genetics-Driven Early Intervention in Dilated Cardiomyopathy: Design and Implementation of the DCM Precision Medicine Study. ACTA ACUST UNITED AC 2018; 10:CIRCGENETICS.117.001826. [PMID: 29237686 DOI: 10.1161/circgenetics.117.001826] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/11/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND The cause of idiopathic dilated cardiomyopathy (DCM) is unknown by definition, but its familial subtype is considered to have a genetic component. We hypothesize that most idiopathic DCM, whether familial or nonfamilial, has a genetic basis, in which case a genetics-driven approach to identifying at-risk family members for clinical screening and early intervention could reduce morbidity and mortality. METHODS On the basis of this hypothesis, we have launched the National Heart, Lung, and Blood Institute- and National Human Genome Research Institute-funded DCM Precision Medicine Study, which aims to enroll 1300 individuals (600 non-Hispanic African ancestry, 600 non-Hispanic European ancestry, and 100 Hispanic) who meet rigorous clinical criteria for idiopathic DCM along with 2600 of their relatives. Enrolled relatives will undergo clinical cardiovascular screening to identify asymptomatic disease, and all individuals with idiopathic DCM will undergo exome sequencing to identify relevant variants in genes previously implicated in DCM. Results will be returned by genetic counselors 12 to 14 months after enrollment. The data obtained will be used to describe the prevalence of familial DCM among idiopathic DCM cases and the genetic architecture of idiopathic DCM in multiple ethnicity-ancestry groups. We will also conduct a randomized controlled trial to test the effectiveness of Family Heart Talk, an intervention to aid family communication, for improving uptake of preventive screening and surveillance in at-risk first-degree relatives. CONCLUSIONS We anticipate that this study will demonstrate that idiopathic DCM has a genetic basis and guide best practices for a genetics-driven approach to early intervention in at-risk relatives. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT03037632.
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Affiliation(s)
- Daniel D Kinnamon
- From the Division of Human Genetics (D.D.K., A.M., R.E.H.) and Cardiovascular Division (R.E.H.), Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus; and Department of Bioethics & Humanities, University of Washington, Seattle (D.J.B., W.B.).
| | - Ana Morales
- From the Division of Human Genetics (D.D.K., A.M., R.E.H.) and Cardiovascular Division (R.E.H.), Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus; and Department of Bioethics & Humanities, University of Washington, Seattle (D.J.B., W.B.)
| | - Deborah J Bowen
- From the Division of Human Genetics (D.D.K., A.M., R.E.H.) and Cardiovascular Division (R.E.H.), Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus; and Department of Bioethics & Humanities, University of Washington, Seattle (D.J.B., W.B.)
| | - Wylie Burke
- From the Division of Human Genetics (D.D.K., A.M., R.E.H.) and Cardiovascular Division (R.E.H.), Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus; and Department of Bioethics & Humanities, University of Washington, Seattle (D.J.B., W.B.)
| | - Ray E Hershberger
- From the Division of Human Genetics (D.D.K., A.M., R.E.H.) and Cardiovascular Division (R.E.H.), Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus; and Department of Bioethics & Humanities, University of Washington, Seattle (D.J.B., W.B.).
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11
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Bowen DJ, Hay JL, Harris-Wai JN, Meischke H, Burke W. All in the family? Communication of cancer survivors with their families. Fam Cancer 2018; 16:597-603. [PMID: 28374161 DOI: 10.1007/s10689-017-9987-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Families often bear the burden of communication about cancer risk, as well as support during and after treatment for cancer in family members. These activities are left up to survivors and their families, with little support or knowledge of useful methods. We present data on aspects of family that are most relevant to risk of cancer-related communication and health promotion among family members. Families (a survivor, one first-degree relative and one parent; n = 313 families) were enrolled in the survey-based study. We assessed multiple aspects of family communication about risk for melanoma among family participants. Families communicate less frequently than desired about cancer risk. Most families do identify a "family health provider" who keeps family data and serves a resource for family members. The reasons given for lack of family communication are diverse but many can be addressed as part of a family communication intervention. Families are poised to improve their family communication about cancer risk and so can play a role in increasing the health of their members.
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Affiliation(s)
- Deborah J Bowen
- Department of Bioethics and Humanities, University of Washington, P. O. Box 357120, Seattle, WA, 98195, USA.
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, Seventh Floor, New York, NY, 10022, USA
| | - Julie N Harris-Wai
- Department of Social and Behavioral Sciences, University of California San Francisco, 3333 California Street, San Francisco, CA, 94110, USA
| | - Hendrika Meischke
- Department of Health Services, University of Washington, Seattle, WA, 98105, USA
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, P. O. Box 357120, Seattle, WA, 98195, USA
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Smit A, Keogh L, Newson A, Butow P, Dunlop K, Morton R, Kirk J, Espinoza D, Cust A. Does personalized melanoma genomic risk information trigger conversations about skin cancer prevention and skin examination with family, friends and health professionals? Br J Dermatol 2017. [DOI: 10.1111/bjd.15744] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- A.K. Smit
- Cancer Epidemiology and Prevention Research Sydney School of Public Health The University of Sydney Australia
- Centre for Values Ethics and the Law in Medicine Sydney School of Public Health The University of Sydney Australia
| | - L.A. Keogh
- Melbourne School of Population and Global Health The University of Melbourne Australia
| | - A.J. Newson
- Centre for Values Ethics and the Law in Medicine Sydney School of Public Health The University of Sydney Australia
| | - P.N. Butow
- Centre for Medical Psychology and Evidence‐based Decision‐making School of Psychology The University of Sydney Australia
| | - K. Dunlop
- The Centre for Genetics Education NSW Health Sydney Australia
| | - R.L. Morton
- NHMRC Clinical Trials Centre The University of Sydney Australia
- Melanoma Institute Australia The University of Sydney Australia
| | - J. Kirk
- Westmead Clinical School and Westmead Institute for Medical Research Sydney Medical School The University of Sydney Australia
| | - D. Espinoza
- NHMRC Clinical Trials Centre The University of Sydney Australia
| | - A.E. Cust
- Cancer Epidemiology and Prevention Research Sydney School of Public Health The University of Sydney Australia
- Melanoma Institute Australia The University of Sydney Australia
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