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Park KU, Padamsee TJ, Birken SA, Lee S, Niles K, Blair SL, Grignol V, Dickson-Witmer D, Nowell K, Neuman H, King T, Mittendorf E, Paskett ED, Brindle M. Factors Influencing Implementation of the Commission on Cancer's Breast Synoptic Operative Report (Alliance A20_Pilot9). Ann Surg Oncol 2024; 31:5888-5895. [PMID: 38862840 PMCID: PMC11300652 DOI: 10.1245/s10434-024-15515-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 05/09/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND The technical aspects of cancer surgery have a significant impact on patient outcomes. To monitor surgical quality, in 2020, the Commission on Cancer (CoC) revised its accreditation standards for cancer surgery and introduced the synoptic operative reports (SORs). The standardization of SORs holds promise, but successful implementation requires strategies to address key implementation barriers. This study aimed to identify the barriers and facilitators to implementing breast SOR within diverse CoC-accredited programs. METHODS In-depth semi-structured interviews were conducted with 31 health care professionals across diverse CoC-accredited sites. The study used two comprehensive implementation frameworks to guide data collection and analysis. RESULTS Successful SOR implementation was impeded by disrupted workflows, surgeon resistance to change, low prioritization of resources, and poor flow of information despite CoC's positive reputation. Participants often lacked understanding of the requirements and timeline for breast SOR and were heavily influenced by prior experiences with templates and SOR champion relationships. The perceived lack of monetary benefits (to obtaining CoC accreditation) together with the significant information technology (IT) resource requirements tempered some of the enthusiasm. Additionally, resource constraints and the redirection of personnel during the COVID-19 pandemic were noted as hurdles. CONCLUSIONS Surgeon behavior and workflow change, IT and personnel resources, and communication and networking strategies influenced SOR implementation. During early implementation and the implementation planning phase, the primary focus was on achieving buy-in and initiating successful roll-out rather than effective use or sustainment. These findings have implications for enhancing standardization of surgical cancer care and guidance of future strategies to optimize implementation of CoC accreditation standards.
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Affiliation(s)
- Ko Un Park
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Breast Oncology Program, Dana-Farber/ Brigham Cancer Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.
| | - Tasleem J Padamsee
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Sarah A Birken
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Sandy Lee
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Kaleigh Niles
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Sarah L Blair
- University of California San Diego, La Jolla, CA, USA
| | - Valerie Grignol
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | | | - Kerri Nowell
- Physicians' Clinic of Iowa, Cedar Rapids, IA, USA
| | - Heather Neuman
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Tari King
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber/ Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Elizabeth Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber/ Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Electra D Paskett
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Mary Brindle
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Surgery, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Senßfelder A, Havemann M, Pedrosa Carrasco AJ, von Blanckenburg P, Seifart C. Preserving the integrity of personhood in people with advanced cancer: An in-depth qualitative study among patients, relatives, and care professionals. Palliat Med 2024:2692163241269727. [PMID: 39152644 DOI: 10.1177/02692163241269727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2024]
Abstract
BACKGROUND Every advanced cancer diagnosis brings enormous challenges to patients and their relatives on numerous levels: be it physical, practical, social challenges, or on a more personal level. While specific aspects have been researched before, an overarching approach is lacking. AIM To understand the lived experiences of people with advanced cancer, to identify gaps along the cancer care continuum, to identify potential opportunities for meaningful interventions and to develop a theoretical framework for practitioners and researchers. DESIGN A qualitative study using in-depth interviews with patients, relatives, and care professionals. Interviews were transcribed verbatim and analysed using a conventional content analysis. SETTING/PARTICIPANTS Fifty-four interviews with 17 patients from a university oncology department and palliative care service, 15 relatives and 22 care professionals from physicians to funeral directors. All interviewees were recruited by a German university hospital. RESULTS We developed a novel model describing the diagnosis with advanced cancer as a highly disruptive experience that threatens to challenge the integrity of personhood in cancer patients through four areas: communication, knowledge, relationships, and confidence. We were able to identify factors leading to disintegration in these areas and factors supporting a restoration of integrity of personhood. CONCLUSIONS The developed model provides a more thorough understanding of patients lived experiences. It can help to develop new interventions along the cancer care continuum to support patients in the complex challenges they face. These interventions should focus on supporting the integrity of personhood.
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Affiliation(s)
- Alina Senßfelder
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Matthias Havemann
- Department of Medicine, Philipps-University of Marburg, Marburg, Germany
- Department of Anaesthesiology and Intensive Care, UKGM Marburg, Marburg, Germany
| | | | - Pia von Blanckenburg
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Carola Seifart
- Department of Medicine, Philipps-University of Marburg, Marburg, Germany
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McConnell KM, Shen MJ. The need for multilevel supportive care infrastructure for cancer caregivers. Cancer 2024; 130:1913-1915. [PMID: 38567689 DOI: 10.1002/cncr.35303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Communication with cancer caregivers occurs in the broader multilevel context of oncology care. Improving communication with caregivers requires changes across multiple levels of this context.
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Affiliation(s)
- Kelly M McConnell
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Megan J Shen
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
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Howren MB, Christensen AJ, Pagedar NA. Prevalence and persistence of depressive symptoms during the first year postdiagnosis in a large sample of patients with head and neck cancer. Am J Otolaryngol 2024; 45:104257. [PMID: 38518447 PMCID: PMC11070284 DOI: 10.1016/j.amjoto.2024.104257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 03/17/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE The experience of persistent depressive symptomatology during the first year postdiagnosis has implications for recovery and adjustment by one year postdiagnosis. The present descriptive study sought to examine the prevalence and persistence of mild to moderate-severe depressive symptomology and associated disease-specific health-related quality of life (HRQOL) in patients with HNC. MATERIALS & METHODS This study was a prospective observational study at a single-institution tertiary cancer center. Depressive symptomatology was measured using the Beck Depression Inventory (BDI), captured at diagnosis and 3-, 6-, 9-, and 12-months postdiagnosis. HNC-specific HRQOL was measured using the Head and Neck Cancer Inventory (HNCI). Four subgroups were defined by BDI scores over time: persistent-moderate/severe subgroup, persistent-mild subgroup, transient subgroup, and resilient subgroup. RESULTS The distribution of patients (N = 946) was 65 (6.9 %) in the persistent-moderate/severe subgroup, 190 (20.1 %) in the persistent-mild subgroup, 186 (19.7 %) in the transient subgroup, and 505 (53.3 %) in the resilient subgroup. Across all four HNCI domains, patients in the persistent-moderate/severe subgroup failed to reach a score of 70 by 12-months postdiagnosis which is indicative of high functioning on the HNCI (aesthetics: M = 42.32, SD = 28.7; eating: M = 32.08, SD = 25.7; speech: M = 47.67, SD = 25.3; social disruption: M = 52.39, SD = 24.3). Patients in the persistent-mild subgroup failed to reach 70 in three of four domains. Patients in the resilient subgroup reached, on average, >70 on all HNCI domains. CONCLUSIONS Depression is a considerable issue during the first year postdiagnosis. Avenues for screening and intervention should be incorporated into HNC patient care per clinical practice guidelines to optimize recovery and HRQOL.
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Affiliation(s)
- M Bryant Howren
- Center for Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System, Iowa City, IA, United States of America; Department of Internal Medicine, The University of Iowa, Iowa City, IA, United States of America; Holden Comprehensive Cancer Center, The University of Iowa, Iowa City, IA, United States of America.
| | - Alan J Christensen
- Department of Psychology, East Carolina University; Greenville, NC, United States of America
| | - Nitin A Pagedar
- Holden Comprehensive Cancer Center, The University of Iowa, Iowa City, IA, United States of America; Department of Otolaryngology-Head and Neck Surgery, Carver College of Medicine, The University of Iowa; Iowa City, IA, United States of America
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Nightingale CL, Snavely AC, McLouth LE, Dressler EV, Kent EE, Adonizio CS, Danhauer SC, Cannady R, Hopkins JO, Kehn H, Weaver KE, Sterba KR. Processes for identifying caregivers and screening for caregiver and patient distress in community oncology: results from WF-1803CD. J Natl Cancer Inst 2024; 116:324-333. [PMID: 37738445 PMCID: PMC10852602 DOI: 10.1093/jnci/djad198] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/13/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Despite their vital roles, informal caregivers of adult cancer patients are commonly overlooked in cancer care. This study describes processes for identifying cancer caregivers and processes for distress screening and management among caregivers and patients in the understudied community oncology setting. METHODS Supportive care leaders from the National Cancer Institute Community Oncology Research Program practices completed online survey questions regarding caregiver identification, caregiver and patient distress screening, and distress management strategies. We described practice group characteristics and prevalence of study outcomes. Multivariable logistic regression explored associations between practice group characteristics and caregiver identification in the electronic health record (EHR). RESULTS Most (64.9%, 72 of 111) supportive care leaders reported routine identification and documentation of informal caregivers; 63.8% record this information in the EHR. Only 16% routinely screen caregivers for distress, though 92.5% screen patients. Distress management strategies for caregivers and patients are widely available, yet only 12.6% are routinely identified and screened and had at least 1 referral strategy for caregivers with distress; 90.6% are routinely screened and had at least 1 referral strategy for patients. Practices with a free-standing outpatient clinic (odds ratio [OR] = 0.29, P = .0106) and academic affiliation (OR = 0.01, P = .04) were less likely to identify and document caregivers in the EHR. However, higher oncologist volume was associated with an increased likelihood of recording caregiver information in the EHR (OR = 1.04, P = .02). CONCLUSIONS Despite high levels of patient distress screening and management, few practices provide comprehensive caregiver engagement practices. Existing patient engagement protocols may provide a promising platform to build capacity to better address caregiver needs.
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Affiliation(s)
- Chandylen L Nightingale
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Anna C Snavely
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Laurie E McLouth
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Christian S Adonizio
- Center for Oncology Research and Innovation, Geisinger Health, Danville, PA, USA
| | - Suzanne C Danhauer
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Rachel Cannady
- Cancer Caregiver Support, American Cancer Society, Atlanta, GA, USA
| | - Judith O Hopkins
- Hematology and Oncology, Novant Health Cancer Institute, Southeast Clinical Oncology Research Consortium National Cancer Institute Community Oncology Research Program, Winston-Salem, NC, USA
| | - Heather Kehn
- Metro Minnesota Community Oncology Research Consortium, Minneapolis, MN, USA
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina College of Medicine, Charleston, SC, USA
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Børøsund E, Meland A, Eriksen HR, Rygg CM, Ursin G, Solberg Nes L. Digital Cognitive Behavioral- and Mindfulness-Based Stress-Management Interventions for Survivors of Breast Cancer: Development Study. JMIR Form Res 2023; 7:e48719. [PMID: 37725424 PMCID: PMC10548331 DOI: 10.2196/48719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Psychosocial stress-management interventions can reduce stress and distress and improve the quality of life for survivors of cancer. As these in-person interventions are not always offered or accessible, evidence-informed digital stress-management interventions may have the potential to improve outreach of psychosocial support for survivors of cancer. Few such digital interventions exist so far, few if any have been developed specifically for survivors of breast cancer, and few if any have attempted to explore more than 1 distinct type of intervention framework. OBJECTIVE This study aimed to develop 2 digital psychosocial stress-management interventions for survivors of breast cancer; 1 cognitive behavioral therapy-based intervention (CBI), and 1 mindfulness-based intervention (MBI). METHODS The development of the CBI and MBI interventions originated from the existing StressProffen program, a digital stress-management intervention program for survivors of cancer, based on a primarily cognitive behavioral therapeutic concept. Development processes entailed a multidisciplinary design approach and were iteratively conducted in close collaboration between key stakeholders, including experts within psychosocial oncology, cancer epidemiology, stress-management, and eHealth as well as survivors of breast cancer and health care providers. Core psychosocial oncology stress-management and cancer epidemiology experts first conducted a series of workshops to identify cognitive behavioral and mindfulness specific StressProffen content, overlapping psychoeducational content, and areas where development and incorporation of new material were needed. Following the program content adaptation and development phase, phases related to user testing of new content and technical, privacy, security, and ethical aspects and adjustments ensued. Intervention content for the distinct CBI and MBI interventions was refined in iterative user-centered design processes and adjusted to electronic format through stakeholder-centered iterations. RESULTS For the CBI version, the mindfulness-based content of the original StressProffen was removed, and for the MBI version, cognitive behavioral content was removed. Varying degrees of new content were created for both versions, using a similar layout as for the original StressProffen program. New content and new exercises in particular were tested by survivors of breast cancer and a project-related editorial team, resulting in subsequent user centered adjustments, including ensuring auditory versions and adequate explanations before less intuitive sections. Other improvements included implementing a standard closing sentence to round off every exercise, and allowing participants to choose the length of some of the mindfulness exercises. A legal disclaimer and a description of data collection, user rights and study contact information were included to meet ethical, privacy, and security requirements. CONCLUSIONS This study shows how theory specific (ie, CBI and MBI) digital stress-management interventions for survivors of breast cancer can be developed through extensive collaborations between key stakeholders, including scientists, health care providers, and survivors of breast cancer. Offering a variety of evidence-informed stress-management approaches may potentially increase interest for outreach and impact of psychosocial interventions for survivors of cancer. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/47195.
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Affiliation(s)
- Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Anders Meland
- Department of Sport and Social Sciences, School of Sport Sciences, Oslo, Norway
| | - Hege R Eriksen
- Department of Sport, Food and Natural Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Christine M Rygg
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, United States
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7
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Rohan EA, Boehm JE, Samarasinha R, Stachon K, Gallaway MS, Huang G, Ng D, Manian N. Diving deeper into distress screening implementation in oncology care. J Psychosoc Oncol 2023; 41:645-660. [PMID: 37655693 PMCID: PMC10964759 DOI: 10.1080/07347332.2023.2250774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND Responding to calls for additional research that identifies effective distress screening (DS) processes, including referral practices subsequent to screening and receipt of recommended care, we engaged in qualitative research as part of a larger (mixed methods) study of distress screening. This qualitative inquiry of oncology professionals across different facilities in the United States examined routine DS implementation, facilitators and challenges staff encounter with DS processes, and staff members' perceived value of DS. PARTICIPANTS AND METHODS We conducted key informant interviews and focus groups with staff in 4 Commission on Cancer (CoC)-accredited oncology facilities (a total of 18 participants) to understand implementation of routine DS within oncology care. We used a rigorous data analysis design, including inductive and deductive approaches. RESULTS Respondents believe DS enhances patient care and described ways to improve DS processes, including administering DS at multiple points throughout oncology care, using patient-administrated DS methods, and enhancing electronic health records infrastructure to better collect, record, and retrieve DS data. Respondents also identified the need for additional psychosocial staff at their facilities to provide timely psychosocial care. CONCLUSIONS Results reinforce the value of DS in cancer care, including the importance of follow-up to screening with psychosocial oncology providers. Understanding and resolving the barriers and facilitators to implementing DS are important to ensure appropriate psychosocial care for people with cancer. Insights from oncology staff may be used to enhance the quality of DS and subsequent psychosocial care, which is an essential component of oncology care.
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Affiliation(s)
- Elizabeth A. Rohan
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer E. Boehm
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ruvini Samarasinha
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Karen Stachon
- American College of Surgeons, Commission on Cancer, Chicago, IL
| | - M. Shayne Gallaway
- Arizona Department of Public Health, Phoenix, AZ, USA
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Grace Huang
- Public Health, Westat Inc., Rockville, MD, USA
| | - Diane Ng
- Public Health, Westat Inc., Rockville, MD, USA
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Simnacher F, Götz A, Kling S, Schulze JB, von Känel R, Euler S, Günther MP. A short screening tool identifying systemic barriers to distress screening in cancer care. Cancer Med 2023; 12:17313-17321. [PMID: 37439075 PMCID: PMC10501250 DOI: 10.1002/cam4.6331] [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: 11/18/2022] [Revised: 06/09/2023] [Accepted: 07/02/2023] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION International guidelines on cancer treatment recommend screening for early detection and treatment of distress. However, screening rates are insufficient. In the present study, a survey was developed to assess perceived systemic barriers to distress screening. METHODS A three-step approach was used for the study. Based on qualitative content analysis of interviews and an expert panel, an initial survey with 53 questions on barriers to screening was designed. It was completed by 98 nurses in a large comprehensive cancer center in Switzerland. From this, a short version of the survey with 24 questions was derived using exploratory principal component analysis. This survey was completed by 150 nurses in four cancer centers in Switzerland. A confirmatory factor analysis was then performed on the shortened version, yielding a final set of 14 questions. RESULTS The initial set of 53 questions was reduced to a set of 14 validated questions retaining 53% of the original variance. These 14 questions allow for an assessment within 2-3 min that identifies relevant barriers to distress screening from the perspective of those responsible for implementation of distress screening. Across several hospitals in Switzerland, the timing of the first distress screening, lack of capacity, patient and staff overload, and refusal of distressed patients to be referred to support services emerged as major problems. CONCLUSION The validated 14 questions on barriers to screening cancer patients for distress enable clinicians and hospital administrators to quickly identify relevant issues and take action to improve screening programs.
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Affiliation(s)
- Felice Simnacher
- Department of Consultation‐Liaison Psychiatry and Psychosomatic Medicine, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Anna Götz
- Department of Consultation‐Liaison Psychiatry and Psychosomatic Medicine, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Sabine Kling
- Computer Vision Laboratory, Department of Information Technology and Electrical EngineeringSwiss Federal Institute of Technology (ETH) ZurichZurichSwitzerland
| | - Jan Ben Schulze
- Department of Consultation‐Liaison Psychiatry and Psychosomatic Medicine, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Roland von Känel
- Department of Consultation‐Liaison Psychiatry and Psychosomatic Medicine, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Sebastian Euler
- Department of Consultation‐Liaison Psychiatry and Psychosomatic Medicine, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Moritz Philipp Günther
- Department of Consultation‐Liaison Psychiatry and Psychosomatic Medicine, University Hospital ZurichUniversity of ZurichZurichSwitzerland
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Hahn EE, Munoz-Plaza CE, Lyons LJ, Lee JS, Pounds D, La Cava S, Brasfield FM, Durna LN, Kwan KW, Beard DB, Ferreira A, Gould MK. Barriers and facilitators to implementation and sustainment of guideline-recommended depression screening for patients with breast cancer in medical oncology: a qualitative study. Support Care Cancer 2023; 31:461. [PMID: 37436477 DOI: 10.1007/s00520-023-07922-0] [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: 11/15/2022] [Accepted: 06/30/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVES Implementation of guideline-recommended depression screening in oncology presents numerous challenges. Implementation strategies that are responsive to local context may be critical elements of adoption and sustainment. We evaluated barriers and facilitators to implementation of a depression screening program for breast cancer patients in a community medical oncology setting as part of a cluster randomized controlled trial. METHODS Guided by the Consolidated Framework for Implementation Research, we employed qualitative methods to evaluate clinician, administrator, and patient perceptions of the program using semi-structured interviews. We used a team-coding approach for the data; thematic development focused on barriers and facilitators to implementation using a grounded theory approach. The codebook was refined through open discussions of subjectivity and unintentional bias, coding, and memo applications (including emergent coding), and the hierarchical structure and relationships of themes. RESULTS We conducted 20 interviews with 11 clinicians/administrators and 9 patients. Five major themes emerged: (1) gradual acceptance and support of the intervention and workflow; (2) compatibility with system and personal norms and goals; (3) reinforcement of the value of and need for adaptability; (4) self-efficacy within the nursing team; and (5) importance of identifying accountable front-line staff beyond leadership "champions." CONCLUSIONS Findings suggest a high degree of acceptability and feasibility due to the selection of appropriate implementation strategies, alignment of norms and goals, and a high degree of workflow adaptability. These findings will be uniquely helpful in generating actionable, real-world knowledge to inform the design, implementation, and sustainment of guideline-recommended depression screening programs in oncology. TRIAL REGISTRATION ClinicalTrials.gov #NCT02941614.
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Affiliation(s)
- Erin E Hahn
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., Pasadena, CA, 91101, USA.
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
| | - Corrine E Munoz-Plaza
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., Pasadena, CA, 91101, USA
| | - Lindsay Joe Lyons
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., Pasadena, CA, 91101, USA
| | - Janet S Lee
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., Pasadena, CA, 91101, USA
| | - Dana Pounds
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., Pasadena, CA, 91101, USA
- Southern California Permanente Medical Group Performance Assessment team (as of 11/2020), Pasadena, CA, USA
| | | | - Farah M Brasfield
- Southern California Permanente Medical Group, Department of Medical Oncology, Anaheim, CA, USA
| | - Lara N Durna
- Southern California Permanente Medical Group, Department of Medical Oncology, South Bay, CA, USA
| | - Karen W Kwan
- Southern California Permanente Medical Group, Department of Medical Oncology, Los Angeles, CA, USA
| | - David B Beard
- Southern California Permanente Medical Group, Department of Medical Oncology, Woodland Hills, CA, USA
| | - Alexander Ferreira
- Southern California Permanente Medical Group, Department of Medical Oncology, West Los Angeles, CA, USA
| | - Michael K Gould
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
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10
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Parmet T, Yusufov M, Braun IM, Pirl WF, Matlock DD, Sannes TS. Willingness toward psychosocial support during cancer treatment: a critical yet challenging construct in psychosocial care. Transl Behav Med 2023; 13:511-517. [PMID: 36940406 PMCID: PMC10465092 DOI: 10.1093/tbm/ibac121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Abstract
Psychosocial distress screening, mandated by the American College Surgeons' Commission on Cancer, continues to be implemented across cancer centers nationwide. Although measuring distress is critical to identifying patients who may benefit from additional support, several studies suggest that distress screening may not actually increase patients' utilization of psychosocial services. While various investigators have identified barriers that may impede effective implementation of distress screening, we posit that patients' intrinsic motivation, which we term patients' willingness, may be the biggest predictor for whether cancer patients choose to engage with psychosocial services. In this commentary, we define patient willingness towards psychosocial services as a novel construct, distinct from the intention toward a certain behavior described across pre-existing models of health behavior change. Further, we offer a critical perspective of models of intervention design that focus on acceptability and feasibility as preliminary outcomes thought to encompass the willingness construct described herein. Finally, we summarize several health service models that successfully integrate psychosocial services alongside routine oncology care. Overall, we present an innovative model that acknowledges barriers and facilitators and underscores the critical role of willingness in health behavior change. Consideration of patients' willingness toward psychosocial care will move the field of psychosocial oncology forward in clinical practice, policy initiatives, and study design.
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Affiliation(s)
- Tamar Parmet
- Harvard Medical School, Boston, MA, 02215, USA
- Division of Adult Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, 02215, USA
- Adult and Child Consortium for Outcomes Research and Delivery Science, Aurora, CO, USA
| | - Miryam Yusufov
- Harvard Medical School, Boston, MA, 02215, USA
- Division of Adult Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, 02215, USA
| | - Ilana M Braun
- Harvard Medical School, Boston, MA, 02215, USA
- Division of Adult Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, 02215, USA
| | - William F Pirl
- Harvard Medical School, Boston, MA, 02215, USA
- Division of Adult Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, 02215, USA
| | - Daniel D Matlock
- Adult and Child Consortium for Outcomes Research and Delivery Science, Aurora, CO, USA
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Veteran Affairs (VA) Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA
| | - Timothy S Sannes
- Harvard Medical School, Boston, MA, 02215, USA
- Division of Adult Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, 02215, USA
- University of Massachusetts Medical School/UMass Memorial Hospital, Worcester, MA, USA
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11
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Walsh LE, Rosenfeld B, Feuerstahler L, Pessin H, Breitbart W. Measuring hopelessness in advanced cancer: a secondary analysis of the Hopelessness Assessment in Illness questionnaire (HAI). Psychol Health 2023; 38:847-861. [PMID: 34678104 PMCID: PMC9023589 DOI: 10.1080/08870446.2021.1989430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/23/2021] [Accepted: 10/01/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Hopelessness, or a sense of despair about the future, has been a growing focus of psychological research among patients with serious medical illnesses. This study evaluated the psychometric properties of the Hopelessness Assessment in Illness (HAI) questionnaire, developed specifically for those facing a life-threatening illness. Participants were 344 advanced cancer patients (e.g. lung, breast, gastrointestinal, etc.) participating in two psychotherapy research trials. DESIGN Descriptive statistics characterised participants in regard to both demographic (age, gender, race, ethnicity, religiosity) and clinical characteristics (cancer type). Scale properties were assessed for internal consistency using Cronbach's coefficient alpha, item-total correlations, Principle Axis factor analysis, and its correlation to relevant psychological constructs. Nonlinear confirmatory factor analysis (CFA) assessed for latent construct variance by gender. MAIN OUTCOME MEASURES Psychometric properties of the Hopelessness Assessment in Illness questionnaire. RESULTS Results indicated strong internal consistency and temporal stability of the HAI, with significant correlations between the HAI and several theoretically related psychological constructs. CFA suggested the same single underlying factor for males and females. CONCLUSIONS The HAI demonstrated strong psychometric properties in the context of advanced cancer. Future research is needed to assess the utility of the HAI in more medically and geographically diverse populations.
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Affiliation(s)
- Leah E. Walsh
- Fordham University, Department of Psychology, 441 East Fordham Road, 226 Dealy Hall, Bronx, NY 10458
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, 640 Lexington Ave., 7 Fl. New York, NY 10022
| | - Barry Rosenfeld
- Fordham University, Department of Psychology, 441 East Fordham Road, 226 Dealy Hall, Bronx, NY 10458
| | - Leah Feuerstahler
- Fordham University, Department of Psychology, 441 East Fordham Road, 226 Dealy Hall, Bronx, NY 10458
| | - Hayley Pessin
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, 640 Lexington Ave., 7 Fl. New York, NY 10022
| | - William Breitbart
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, 640 Lexington Ave., 7 Fl. New York, NY 10022
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12
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Sannes TS, Yusufov M, Amonoo HL, Broden EG, Burgers DE, Bain P, Pozo-Kaderman C, Miran DM, Smith TS, Braun IM, Pirl WF. Proxy ratings of psychological well-being in patients with primary brain tumors: A systematic review. Psychooncology 2023; 32:203-213. [PMID: 36371618 PMCID: PMC10373343 DOI: 10.1002/pon.6063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/14/2022] [Accepted: 10/31/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This systematic review examined the agreement of proxy ratings of depression and anxiety in neuro-oncology patients. METHODS Searches were conducted across 4 databases (MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science) to identify studies that compared proxy ratings (non-health care providers) of anxiety and depression in patients with brain cancer. Methodological quality and potential risk of bias were evaluated using the Joanna Briggs Institute Critical Appraisal Checklist. RESULTS Out of the 936 studies that were screened for inclusion, 6 were included for review. The findings were mixed in terms of whether patient and proxy ratings were accurate (e.g., deemed equivalent), with many of the selected studies suggesting moderate level of agreement for several of the selected studies and, when both depression and anxiety were included, depression ratings from proxy raters were more accurate than for anxiety. We identified important limitations across the selected articles, such as low sample size, clarity on defining proxy raters and the different instructions that proxy raters are given when asked to assess patients' mood symptoms. CONCLUSIONS Our findings suggest that proxy ratings of depression and anxiety should be interpreted with caution. While there is some agreement in proxy and patients with brain cancer ratings of depression and anxiety (greater agreement for depression), future work should recruit larger samples, while also remaining mindful of defining proxy raters and the instructions given in collecting these ratings.
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Affiliation(s)
- Timothy S Sannes
- Division of Adult Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Miryam Yusufov
- Division of Adult Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Hermioni L Amonoo
- Division of Adult Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Brigham and Women's Hospital, Mass General Brigham, Boston, Massachusetts, USA
| | - Elizabeth G Broden
- Division of Adult Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Darcy E Burgers
- Division of Adult Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Paul Bain
- Countway Library, Harvard Medical School, Boston, Massachusetts, USA
| | - Cristina Pozo-Kaderman
- Division of Adult Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Damien M Miran
- Division of Adult Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy S Smith
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ilana M Braun
- Division of Adult Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - William F Pirl
- Division of Adult Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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13
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Lim SY, Ke Y, Mok NKM, Tan YY, Neo PSH, Chan A, Yang GM. Factors associated with distress and the impact of distress on acute health-care service utilization among patients diagnosed with breast and gynecological cancers. Palliat Support Care 2023:1-8. [PMID: 36622079 DOI: 10.1017/s1478951522001444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Patients with cancer often have unmet needs (e.g., physical, psychosocial, and emotional) during their cancer journey, putting them at risk for distress. This study aimed to identify factors associated with distress and to investigate the association between distress and acute health-care services utilization in a cohort of breast and gynecological cancer patients across different survivorship stages. METHODS This was a retrospective cohort study of patients who visited National Cancer Centre Singapore between September 2019 and July 2020. Distress was evaluated using the self-reported Distress Thermometer and Problem List, with a distress thermometer score ≥4 signifying high distress. Data were extracted from electronic medical records. Multivariable logistic regression was used to identify demographic or clinical variables associated with distress and estimate the odds of emergency department (ED) visits and hospitalizations within 30 days of distress screening, adjusted for covariates. RESULTS Of the 1386 patients included in the analysis, 510 (36.8%) reported high distress on their first distress screening. Variables associated with high distress included younger age, presence of psychiatric diagnosis, poorer Eastern Cooperative Oncology Group performance status, and shorter duration from cancer diagnosis to distress screening. Patients with high distress were associated with higher odds of ED visits (adjusted odds ratio [OR] = 2.25, 95% confidence interval [CI]: 1.14-4.43) and hospitalizations (adjusted OR = 2.11, 95% CI: 1.27-3.50) within 30 days of distress screening. SIGNIFICANCE OF RESULTS Self-reported high distress was associated with higher odds of increased acute health-care services utilization (ED visits and hospitalizations) in patients with breast and gynecological cancer. Identifying the subgroups at risk of high distress could trigger early interventions that reduce unplanned health-care services utilization and possibly health-care costs.
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Affiliation(s)
- Sut Yee Lim
- Doctor of Medicine (MD) programme, Duke-NUS Medical School Singapore, Singapore, Singapore
| | - Yu Ke
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Natalie Kah-Mun Mok
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Yung Ying Tan
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Patricia Soek Hui Neo
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Alexandre Chan
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
- Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore
- Department of Clinical Pharmacy Practice, University of California Irvine, Irvine, USA
| | - Grace Meijuan Yang
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Department of General Medicine, Sengkang General Hospital, Singapore, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
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14
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Khalid S, Abbas I, Javed S. Psychological Support for Cancer Patients. Cancer Treat Res 2023; 185:255-283. [PMID: 37306913 DOI: 10.1007/978-3-031-27156-4_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
From the time a person is diagnosed with cancer, a psychological sequalae of intense emotional challenges emerge for the patient as well as family members. Different stages require different types of psychosocial support including those for previvors, survivors, and people who need palliative care. Currently, there is an emphasis on not only providing psychological assistance to cope with emotional, interpersonal, and economic stresses, but training programs specially designed to activate personal and social resources to find happiness and meaning in adversity. Within this perspective, the chapter is divided into three sections, each considering the common mental health issues and positive changes and intervention and therapies for cancer patients, family members, caregivers, onco-staff, and professionals.
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Affiliation(s)
- Shazia Khalid
- Department of Psychology, National University of Medical Sciences (NUMS), Rawalpindi, Pakistan.
| | - Imran Abbas
- Oncoplastic Breast Surgeon, Royal Cornwall Hospitals, NHS Trust, Cornwall, UK
| | - Saira Javed
- Department of Psychology, National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
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15
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Azizoddin DR, Allsop M, Farah S, Salim F, Hauser J, Baltazar AR, Molokie R, Weber J, Weldon C, Feldman L, Martin JL. Oncology distress screening within predominately Black Veterans: Outcomes on supportive care utilization, hospitalizations, and mortality. Cancer Med 2022; 12:8629-8638. [PMID: 36573460 PMCID: PMC10134375 DOI: 10.1002/cam4.5560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND We evaluated whether patients' initial screening symptoms were related to subsequent utilization of supportive care services and hospitalizations, and whether patient-level demographics, symptoms, hospitalizations, and supportive care service utilization were associated with mortality in primarily low-income, older, Black Veterans with cancer. METHODS This quality improvement project created collaborative clinics to conduct cancer distress screenings and refer to supportive care services at an urban, VA medical center. All patients completed a distress screen with follow-up screening every 3 months. Supportive care utilization, hospitalization rates, and mortality were abstracted through medical records. Poisson regression models and cox proportional hazard models were utilized. RESULTS Five hundred and eighty five screened patients were older (m = 72), mostly Black 70% (n = 412), and had advanced cancer 54%. Fifty-eight percent (n = 340) were screened only once with 81% (n = 470) receiving ≥1 supportive care service and 51.5% (n = 297) being hospitalized ≥1 time 18 months following initial screen. Symptom severity was significantly related to number of hospitalizations. Low mood was significantly related to higher supportive services (p < 0.001), but not hospitalizations (p ≥ 0.52). Pain, fatigue, physical function, nutrition, and physical symptoms were significantly associated with more supportive services and hospitalizations (p < 0.01). Twenty percent (n = 168) died; Veterans who were Black, had lower stage cancers, better physical health, and utilized less supportive care services had lower odds of mortality (p ≤ 0.01). CONCLUSION Individuals with elevated distress needs and those reporting lower physical function utilized more supportive care services and had higher hospitalization rates. Lower physical function, greater supportive care use, higher stage cancer, and being non-Black were associated with higher odds of death.
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Affiliation(s)
- Desiree R. Azizoddin
- Health Promotion Research Center, Stephenson Cancer Center University of Oklahoma Health Sciences Center Oklahoma City Oklahoma USA
- Department of Psychosocial Oncology and Palliative Care Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Matthew Allsop
- Academic Unit of Palliative Care Leeds Institute of Health Sciences, University of Leeds Leeds UK
| | - Subrina Farah
- Center for Clinical Investigation Brigham and Women's Hospital Boston Massachusetts USA
| | - Farah Salim
- Department of Medicine Jesse Brown VA Medical Center Chicago Illinois USA
| | - Joshua Hauser
- Department of Medicine Jesse Brown VA Medical Center Chicago Illinois USA
- Northwestern University Feinberg School of Medicine Chicago Illinois USA
| | - Ashton R. Baltazar
- Health Promotion Research Center, Stephenson Cancer Center University of Oklahoma Health Sciences Center Oklahoma City Oklahoma USA
| | - Robert Molokie
- Department of Medicine Jesse Brown VA Medical Center Chicago Illinois USA
- University of Illinois Hospital and Health Sciences System Chicago Illinois USA
| | - Jane Weber
- Department of Medicine Jesse Brown VA Medical Center Chicago Illinois USA
| | | | - Lawrence Feldman
- Department of Medicine Jesse Brown VA Medical Center Chicago Illinois USA
- University of Illinois Hospital and Health Sciences System Chicago Illinois USA
| | - Joanna L. Martin
- Department of Medicine Jesse Brown VA Medical Center Chicago Illinois USA
- Northwestern University Feinberg School of Medicine Chicago Illinois USA
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16
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Dibble KE, Kaur M, Connor AE. Disparities in healthcare utilization and access by length of cancer survivorship among population-based female cancer survivors. J Cancer Surviv 2022; 16:1220-1235. [PMID: 34661881 PMCID: PMC9013726 DOI: 10.1007/s11764-021-01110-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/07/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE The current study examined disparities in the associations between medically vulnerable populations and healthcare-related outcomes among population-based female cancer survivors and determined if these associations differed by length of cancer survivorship. METHODS One thousand eight hundred ninety-seven women with a cancer history from the National Health and Nutrition Examination Survey from 1999 to 2016 contributed data. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated with multivariable logistic regression models to measure the associations between the predictors (race/ethnicity, poverty status, education, comorbidity status, US nativity) and outcomes (perceived health, healthcare utilization and access outcomes), overall and by length of survivorship. RESULTS There was an average of 14.3 years (SD = 11.7; range = 2-84) since initial cancer diagnosis, with 25.1% being short-term and 74.9% being long-term survivors. Overall, racial/ethnic minority women were more likely to report poor/fair health status (OR, 2.68; 95% CI 1.73-4.15) and utilizing routine care other than a doctor's office/HMO (OR, 1.61; 95% CI 1.12-2.29) in comparison with NHW survivors. Length of survivorship significantly modified the association between race/ethnicity and odds of seeing a mental health provider in the last year (p-interaction = 0.003), with short-term minority survivors being significantly more likely (OR, 2.63; 95% CI 1.29-5.35) and long-term minority survivors being less likely (OR, 0.68; 95% CI 0.37-1.23). CONCLUSIONS Racial/ethnic disparities exist among female cancer survivors for perceived health status and certain healthcare utilization outcomes, with some differences observed by length of cancer survivorship. IMPLICATIONS FOR CANCER SURVIVORS This study can begin to inform cancer survivorship care for medically vulnerable women along the cancer continuum.
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Affiliation(s)
- Kate E Dibble
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Maneet Kaur
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Avonne E Connor
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, 21205, USA
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17
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Götz A, Kröner A, Jenewein J, Spirig R. Evaluation of distress management in inpatients with cancer by means of the distress thermometer: A mixed methods approach. Palliat Support Care 2022:1-8. [PMID: 36367151 DOI: 10.1017/s1478951522001493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To improve psychosocial care for oncology inpatients, we implemented screening for distress by means of distress thermometer (DT) at the Comprehensive Cancer Centre Zurich in 2011. Since then, several screening barriers have been reported regarding the application of the DT. This study aimed to evaluate the distress screening process between 2012 and 2016 to identify barriers preventing sustainability. METHODS In this sequential explanatory mixed methods study, we synthesized the results of 2 quantitative retrospective descriptive studies and 1 qualitative focus group study. To compare and analyze the data, we used thematic triangulation. RESULTS Nurses screened 32% (N = 7034) of all newly admitted inpatients with the DT, and 47% of the screenings showed a distress level ≥5. Of these cases, 9.7% were referred to psycho-oncological services and 44.7% to social services. In 15.7% of these cases, nurses generated a psychosocial nursing diagnosis. In focus group interviews, nurses attributed the low screening rate to the following barriers: adaptation to patients' individual needs, patient-related barriers and resistance, timing, communication challenges, established referral practice, and lack of integration in the nursing process. SIGNIFICANCE OF RESULTS To improve distress screening performance, the screening process should be tailored to patients' needs and to nurses' working conditions (e.g., timing, knowledge, and setting-specific factors). To gain more evidence on distress management as a basis for practical improvements, further evaluations of distress screening are required.
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Affiliation(s)
- Anna Götz
- Comprehensive Cancer Centre Zurich, University Hospital Zurich, Zürich, Switzerland
- Department of Nursing Science, University Witten/Herdecke, Witten, Germany
| | - Anja Kröner
- Department of Oncology, Cantonal Hospital Glarus AG, Glarus, Switzerland
| | - Josef Jenewein
- Comprehensive Cancer Centre Zurich, University Hospital Zurich, Zürich, Switzerland
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, University Hospital Graz, Graz, Austria
- Private Clinic Hohenegg, Meilen, Switzerland and University of Zurich, Zurich, Switzerland
| | - Rebecca Spirig
- Department of Nursing Science, University Witten/Herdecke, Witten, Germany
- Institute of Nursing Science, University of Basel, Basel, Switzerland
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18
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Liu T, Xu J, Cheng H, Zhang Y, Wang S, Lin L, Tian L. Effects of internet-based cognitive behavioral therapy on anxiety and depression symptoms in cancer patients: A meta-analysis. Gen Hosp Psychiatry 2022; 79:135-145. [PMID: 36375342 DOI: 10.1016/j.genhosppsych.2022.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE This meta-analysis was to critically evaluate the effects of Internet-based cognitive behavioral therapy (ICBT) on the symptoms of anxiety and depression in cancer patients. METHODS Eight Chinese and English databases (CNKI, Wanfang, VIP, CBM, Cochrane Library, PubMed, Embase, and PsycINFO) were systematically searched from the inception of databases to May 2022 for relevant randomized controlled trials (RCTs). According to the Cochrane Collaboration criteria, two reviewers independently assessed the risk of bias and extract data from included studies. All analyses were performed with Review Manager 5.4. RESULTS Thirteen qualified studies were included in the meta-analysis, twelve of which reported the effect of ICBT on anxiety in 2079 cancer patients; thirteen of the studies reported the effect of ICBT on depression in 2179 patients. The meta-analysis indicated that ICBT was effective in improving anxiety [SMD = -0.37, 95%CI (-0.62, -0.12), P < 0.01, I2 = 86%] and depression [SMD = -0.27, 95%CI (-0.44, -0.09), P < 0.01, I2 = 72%] symptoms in cancer patients, especially those undergoing anti-cancer treatment. Therapist-guided ICBT was more effective than self-directed ICBT. ICBT lasting for ≤12 weeks could relieve anxiety and depressive symptoms of cancer patients. ICBT with number of modules ≥5 had a small effect on anxiety and depression relief while ICBT with number of modules <5 was found to be ineffective. CONCLUSIONS ICBT lasting for ≤12 weeks, especially therapist-directed, helps relieve the anxiety and depressive symptoms of cancer patients. The ideal number of modules for ICBT and its long-term efficacy need to be validated by more studies of higher-quality.
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Affiliation(s)
- Tingting Liu
- The First Affiliated Hospital of Soochow University, Suzhou 215006, People's Republic of China; School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Juan Xu
- The First Affiliated Hospital of Soochow University, Suzhou 215006, People's Republic of China
| | - Hui Cheng
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Yueyue Zhang
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Shaotong Wang
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Lu Lin
- The First Affiliated Hospital of Soochow University, Suzhou 215006, People's Republic of China; School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China.
| | - Li Tian
- The First Affiliated Hospital of Soochow University, Suzhou 215006, People's Republic of China; School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China.
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Valued Outcomes in the Cancer Experience (VOICE)™: Development and validation of a multidimensional measure of perceived control. Palliat Support Care 2022; 21:465-476. [PMID: 36285508 DOI: 10.1017/s1478951522000724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Objective
Enhancing cancer patients’ sense of control can positively impact psychological well-being. We developed and assessed the psychometric properties of Valued Outcomes in the Cancer Experience (VOICE)TM, a measure of patients’ perceived control over key personal priorities within their cancer experience.
Methods
VOICE construction and testing were completed in three phases with separate participant samples: (1) item generation and initial item pool testing (N = 459), (2) scale refinement (N = 623), and (3) confirmatory validation (N = 515).
Results
A 21-item measure was developed that captures cancer patients’ sense of control in seven key domains: (1) Purpose and Meaning, (2) Functional Capacity, (3) Longevity, (4) Quality Care, (5) Illness Knowledge, (6) Social Support, and (7) Financial Capability. VOICE demonstrated adequate internal consistency (full-scale α = 0.93; factor α = 0.67–0.89) and adequate to strong convergent and discriminatory validity.
Significance of results
VOICE measures cancer patients’ perceived control across a diverse range of personal priorities, creating a platform for elevating patient perspectives and identifying pathways to enhance patient well-being. VOICE is positioned to guide understanding of the patient experience and aid the development and evaluation of supportive care interventions to enhance well-being.
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20
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Rohan EA, Gallaway MS, Huang GC, Ng D, Boehm JE, Samarasinha R, Stachon K. Disparities in Psychosocial Distress Screening and Management of Lung and Ovarian Cancer Survivors. JCO Oncol Pract 2022; 18:e1704-e1715. [PMID: 35939778 PMCID: PMC9835932 DOI: 10.1200/op.22.00078] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/26/2022] [Accepted: 06/17/2022] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Since 2016, the American College of Surgeons' Commission on Cancer (CoC) has required routine distress screening (DS) of cancer survivors treated in their accredited facilities to facilitate early identification of survivors with psychosocial concerns. Lung and ovarian cancer survivors have relatively low 5-year survival rates and may experience high levels of distress. We examined the extent to which ovarian and lung cancer survivors received CoC-mandated DS and whether DS disparities exist on the basis of diagnosis, sociodemographic factors, or facility geography (urban/rural). METHODS This study included a quantitative review of DS documentation and follow-up services provided using existing electronic health records (EHRs). We worked with 21 CoC-accredited facilities across the United States and examined EHRs of 2,258 survivors from these facilities (1,618 lung cancer survivors and 640 ovarian cancer survivors) diagnosed in 2016 or 2017. RESULTS Documentation of DS was found in half (54.8%) of the EHRs reviewed. Disparities existed across race/ethnicity, cancer type and stage, and facility characteristics. Hispanic/Latino and Asian/Pacific Islander survivors were screened at lower percentages than other survivors. Patients with ovarian cancer, those diagnosed at earlier stages, and survivors in urban facilities had relatively low percentages of DS. Non-Hispanic Black survivors were more likely than non-Hispanic White survivors to decline further psychosocial services. CONCLUSION Despite the mandate for routine DS in CoC-accredited oncology programs, gaps remain in how many and which survivors are screened for distress. Improvements in DS processes to enhance access to DS and appropriate psychosocial care could benefit cancer survivors. Collaboration with CoC during this study led to improvement of their processes for collecting DS data for measuring standard adherence.
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Affiliation(s)
- Elizabeth A. Rohan
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - M. Shayne Gallaway
- Arizona Department of Public Health, Phoenix, AZ
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | - Jennifer E. Boehm
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ruvini Samarasinha
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Karen Stachon
- American College of Surgeons, Commission on Cancer, Chicago, IL
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Papadopoulou A, Govina O, Tsatsou I, Mantzorou M, Mantoudi A, Tsiou C, Adamakidou T. Quality of life, distress, anxiety and depression of ambulatory cancer patients receiving chemotherapy. Med Pharm Rep 2022; 95:418-429. [PMID: 36506609 PMCID: PMC9694751 DOI: 10.15386/mpr-2458] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 06/09/2022] [Accepted: 06/23/2022] [Indexed: 11/07/2022] Open
Abstract
Objective and aim Cancer and its treatment have substantial physical and psychological consequences that severely affect the patients' quality of life (QoL) and emotional status. This study aimed to investigate the relationship between distress, anxiety, depression, and QoL of ambulatory cancer patients undergoing chemotherapy. Methods A descriptive, cross-sectional study of 150 cancer patients who were receiving chemotherapy in the outpatient unit of a central anticancer hospital in Athens. The data were collected through convenience sampling between November 2017 and January 2018, using a demographic and clinical characteristics questionnaire, the Distress Thermometer (DT) and Problem List (PL), the Hospital Anxiety and Depression Scale (HADS) and the European Organization for Research and Treatment for Cancer QoL assessment Questionnaire (EORTC QLQ-C30). Results Variability characterized the sample's demographic and clinical characteristics. The majority of patients were women (64%), married (66%), high school graduates (43%), had breast cancer (35%), with a mean age of 60.07 ± 11.42. 83% reported anxiety, 75% reported fear, 51% nervousness and sadness, 34% depression and 84.7% fatigue. The DT was positively correlated with HADS (p<0.001) and with almost all EORTC QLQ-C30 functional subscales and symptoms (p<0.001). The HADS-Anxiety was significantly correlated with overall QoL and with almost all the EORTC QLQ-C30 functional scales and symptoms (p<0.001). HADS-Depression was significantly correlated with overall QoL and all the EORTC QLQ-C30 functional scales and symptoms (p<0.001). Women tended to have higher level of distress (p=0.003). There was a statistically significant relationship between educational level, the cognitive functioning scale (p=0.017) and financial difficulties (p=0.026). Conclusions Ambulatory cancer patients undergoing chemotherapy are at risk of facing distress in all aspects of daily living, along with anxiety and depression, which decreases their QoL. Oncology nurses as members of multidisciplinary teams should assess the affected aspects of patients' QoL and appropriate interventions should be implemented at community level.
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Affiliation(s)
| | - Ourania Govina
- Nursing Department, Postgraduate program “Neurological Disorders – Evidence Based Practice”, University of West Attica, Athens, Greece
| | - Ioanna Tsatsou
- Oncology-Hematology Department, Hellenic Airforce General Hospital, Athens, Greece
| | - Marianna Mantzorou
- Nursing Department, Postgraduate program “Neurological Disorders – Evidence Based Practice”, University of West Attica, Athens, Greece
| | - Alexandra Mantoudi
- Nursing Department, Postgraduate program “Neurological Disorders – Evidence Based Practice”, University of West Attica, Athens, Greece
| | - Chrysoula Tsiou
- Nursing Department, Postgraduate program “Neurological Disorders – Evidence Based Practice”, University of West Attica, Athens, Greece
| | - Theodoula Adamakidou
- Nursing Department, Postgraduate program “Neurological Disorders – Evidence Based Practice”, University of West Attica, Athens, Greece
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22
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Biddell CB, Spees LP, Petermann V, Rosenstein DL, Manning M, Gellin M, Padilla N, Samuel-Ryals CA, Birken SA, Reeder-Hayes K, Deal AM, Cabarrus K, Bell RA, Strom C, DeAntonio PA, Young TH, King S, Leutner B, Vestal D, Wheeler SB. Financial Assistance Processes and Mechanisms in Rural and Nonrural Oncology Care Settings. JCO Oncol Pract 2022; 18:e1392-e1406. [PMID: 35549521 PMCID: PMC9509146 DOI: 10.1200/op.21.00894] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/28/2022] [Accepted: 04/06/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patients with cancer are at heightened risk of experiencing financial hardship. Financial navigation (FN) is an evidence-based approach for identifying and addressing patient and caregiver financial needs. In preparation for the implementation of a multisite FN intervention, we describe existing processes (ie, events and actions) and mechanisms (ie, how events work together) connecting patients to financial assistance, comparing rural and nonrural practices. METHODS We conducted in-depth, semistructured interviews with stakeholders (ie, administrators, providers, and staff) at each of the 10 oncology care sites across a single state (five rural and five nonrural practices). We developed process maps for each site and analyzed stakeholder perspectives using thematic analysis. After reporting findings back to stakeholders, we synthesized themes and process maps across rural and nonrural sites separately. RESULTS Eighty-three stakeholders were interviewed. We identified six core elements of existing financial assistance processes across all sites: distress screening (including financial concerns), referrals, resource connection points, and pharmaceutical, insurance, and community/foundation resources. Processes differed by rurality; however, facilitators and barriers to identifying and addressing patient financial needs were consistent. Open communication between staff, providers, patients, and caregivers was a primary facilitator. Barriers included insufficient staff resources, challenges in routinely identifying needs, inadequate preparation of patients for anticipated medical costs, and limited tracking of resource availability and eligibility. CONCLUSION This study identified a clear need for systematic implementation of oncology FN to equitably address patient and caregiver financial hardship. Results have informed our current efforts to implement a multisite FN intervention, which involves comprehensive financial toxicity screening and systematization of intake and referrals.
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Affiliation(s)
- Caitlin B. Biddell
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Policy and Management, Chapel Hill, NC
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Lisa P. Spees
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Policy and Management, Chapel Hill, NC
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Victoria Petermann
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NC
| | - Donald L. Rosenstein
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Michelle Manning
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Mindy Gellin
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Neda Padilla
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Cleo A. Samuel-Ryals
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Policy and Management, Chapel Hill, NC
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Sarah A. Birken
- Wake Forest School of Medicine, Winston-Salem, NC
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | - Katherine Reeder-Hayes
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
- University of North Carolina at Chapel Hill, Division of Oncology, Chapel Hill, NC
| | - Allison M. Deal
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Kendrel Cabarrus
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Policy and Management, Chapel Hill, NC
| | - Ronny A. Bell
- Wake Forest School of Medicine, Winston-Salem, NC
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | - Carla Strom
- Wake Forest School of Medicine, Winston-Salem, NC
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | | | - Tiffany H. Young
- Novant Health Cancer Institute, Buddy Kemp Support Center, Charlotte, NC
| | - Sherry King
- Carteret Health Care Cancer Center, Morehead City, NC
| | | | | | - Stephanie B. Wheeler
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Policy and Management, Chapel Hill, NC
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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23
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Brauer ER, Lazaro S, Williams CL, Rapkin DA, Madnick AB, Dafter R, Cheng G, Porter A, Abemayor E, Chai-Ho W, Morasso E, Erman A, Chhetri D, John MS, Wong DJ. Implementing a Tailored Psychosocial Distress Screening Protocol in a Head and Neck Cancer Program. Laryngoscope 2022; 132:1600-1608. [PMID: 34953151 PMCID: PMC9875715 DOI: 10.1002/lary.30000] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/03/2021] [Accepted: 12/14/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVES/HYPOTHESIS Psychosocial distress is common among patients with head and neck cancer (HNC) and is associated with poorer quality of life and clinical outcomes. Despite these risks, distress screening is not widely implemented in HNC care. In this study, we investigated the prevalence of psychosocial distress and its related factors in routine care of patients with HNC. METHODS Data from medical records between September 2017 and March 2020 were analyzed. Psychosocial distress was measured by the National Comprehensive Cancer Network's Distress Thermometer (DT), and a modified HNC-specific problem list; depression and anxiety were assessed using the Patient Health Questionnaire-4. Descriptive statistics and logistic regression were conducted to report prevalence of distress, depression and anxiety, and factors associated with clinical distress. Implementation outcomes, including rates of referrals and follow-up for distressed patients, are also reported. RESULTS Two hundred and eighty seven HNC patients completed the questionnaire (age 64.3 ± 14.9 years), with a mean distress score of 4.51 ± 3.35. Of those, 57% (n = 163) reported clinical distress (DT ≥ 4). Pain (odds ratio [OR] = 3.31, 95% CI = 1.75-6.26), fatigue (OR = 2.43, 95% CI = 1.1.7-5.05), anxiety (OR = 1.63, 95% CI = 1.30-2.05), and depression (OR = 1.51, 95% CI = 1.04-2.18) were significantly associated with clinical distress (P < .05). Of patients identified as distressed, 79% received same-day psychosocial evaluation. CONCLUSIONS Clinical distress was identified in 57% of patients who completed the questionnaire, suggesting that an ultra-brief psychosocial screening protocol can be implemented in routine ambulatory oncology care, and identifies patients whose distress might otherwise go unrecognized. LEVEL OF EVIDENCE 4 Laryngoscope, 132:1600-1608, 2022.
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Affiliation(s)
- Eden R Brauer
- Department of Nursing, UCLA School of Nursing, Los Angeles, CA
| | - Stephanie Lazaro
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Charlene L Williams
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - David A Rapkin
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Amy B Madnick
- Department of Care Coordination & Clinical Social Work, Ronald Reagan-UCLA Medical Center
| | - Roger Dafter
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Guo Cheng
- Department of Physiology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Ashleigh Porter
- Department of Hematology Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Elliot Abemayor
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Wanxing Chai-Ho
- Department of Hematology Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Elizabeth Morasso
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Andrew Erman
- Department of Audiology and Speech Pathology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA
| | - Dinesh Chhetri
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Maie St. John
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Deborah J. Wong
- Department of Hematology Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
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24
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Razavi M, Bergerot CD, Clark KL, Loscalzo M, Nuristani H, Obenchain R, Baik SH, Dale W. Association between requests for supportive care assistance and patients' characteristics, prior to treatment in a comprehensive cancer center. Psychooncology 2022; 31:1347-1353. [PMID: 35416373 PMCID: PMC9545017 DOI: 10.1002/pon.5938] [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: 09/07/2021] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 11/24/2022]
Abstract
Purpose Patients with cancer experience a wide array of distress symptoms (emotional, practical, physical, and functional), which often hinders their quality of life and survival. Unfortunately, only a small proportion of these patients request assistance for these problems. This study explored the relationship between requests for supportive care assistance and distress of patients newly diagnosed with cancer. Methods This study was conducted at city of hope, an NCI‐designated comprehensive cancer center, and included 2658 patients treated between 2009 and 2017. Patients were asked to complete a 30‐item biopsychosocial problem‐related distress survey via SupportScreen®, prior to any treatment. Correlations between requests for assistance and distress domains were evaluated. Primary types of requests were examined for all patients, and general linear modeling was used to determine the significant predictors of requests for assistance. p‐values <0.05 were considered significant. Results Strong correlations were observed between distress subscales and requests for assistance (r ranging from 0.67 to 0.69). The primary types of requests varied by domain: items such as feeling anxious or fearful, finances, and sleep ranked first within the emotional, practical, and physical‐functional domains respectively (∼20% requests for each item). Verbal assistance was generally preferred to the written form of assistance, with the exception of a few items, including finances. Overall, household income of <$100,000 and completing the survey in Spanish were significant predictors of requests for assistance. Regarding the practical and physical‐functional domains, having an advanced stage of disease was significantly related to an increase in demands for assistance. Being older was associated to a decrease in requests for assistance vis‐à‐vis both the emotional and physical functional subscales. Conclusion We demonstrated that distress levels were strongly correlated with requests for assistance. Patients' clinical and demographic characteristics such as age, household income, disease stage and survey language were associated with inquiries for psychosocial support, highlighting the importance of targeting interventions towards those most likely to need them, to better aim patients' needs. Therefore, tailoring supportive care assistance to patients' characteristics could help boost the frequency of requests, reduce distress burden, and improve health outcomes.
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Affiliation(s)
- Marianne Razavi
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA
| | | | - Karen Lynn Clark
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Matthew Loscalzo
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Hussai Nuristani
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Richard Obenchain
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Sharon H Baik
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - William Dale
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA
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25
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Efficacy of an Algorithm-Based Nursing Intervention to Promote a Balance Between Cancer Patients’ Social Roles and Outpatient Treatment. Cancer Nurs 2022:00002820-990000000-00015. [DOI: 10.1097/ncc.0000000000001108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Assessing the Relationship between Socioeconomic Status, Race, and Psychological Distress in Cancer Survivors: A Population Based Study. Curr Oncol 2022; 29:2575-2582. [PMID: 35448185 PMCID: PMC9025824 DOI: 10.3390/curroncol29040211] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/22/2022] [Accepted: 04/07/2022] [Indexed: 11/16/2022] Open
Abstract
Psychological distress is more common in cancer survivors than the general population, and is associated with adverse outcomes. This cross-sectional study aimed to assess the relationship between socioeconomic status (SES), race and psychological distress, using data from a nationally representative sample of cancer survivors in the United States. Outcomes of interest were mild, moderate, and severe psychological distress as assessed by the Patient Health Questionnaire-4 (PHQ-4). In our univariate model, there was no statistically significant difference in the PHQ-4 scores of Caucasian and African American respondents. On the other hand, a lower SES correlated with a higher likelihood of psychological distress, and this persisted in our multivariate model. This study brings additional awareness to the negative impact of a lower socioeconomic status on mental health outcomes in cancer survivors, and further highlights the importance of the timely identification and screening of individuals at a high risk of psychological distress, in order to limit missed opportunities for relevant mental health interventions in this population.
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27
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Hahn EE, Munoz-Plaza CE, Pounds D, Lyons LJ, Lee JS, Shen E, Hong BD, La Cava S, Brasfield FM, Durna LN, Kwan KW, Beard DB, Ferreira A, Padmanabhan A, Gould MK. Effect of a Community-Based Medical Oncology Depression Screening Program on Behavioral Health Referrals Among Patients With Breast Cancer: A Randomized Clinical Trial. JAMA 2022; 327:41-49. [PMID: 34982119 PMCID: PMC8728610 DOI: 10.1001/jama.2021.22596] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/01/2021] [Indexed: 12/20/2022]
Abstract
Importance Implementation of guideline-recommended depression screening in medical oncology remains challenging. Evidence suggests that multicomponent care pathways with algorithm-based referral and management are effective, yet implementation of sustainable programs remains limited and implementation-science guided approaches are understudied. Objective To evaluate the effectiveness of an implementation-strategy guided depression screening program for patients with breast cancer in a community setting. Design, Setting, and Participants A pragmatic cluster randomized clinical trial conducted within Kaiser Permanente Southern California (KPSC). The trial included 6 medical centers and 1436 patients diagnosed with new primary breast cancer who had a consultation with medical oncology between October 1, 2017, through September 30, 2018. Patients were followed up through study end date of May 31, 2019. Interventions Six medical centers in Southern California participated and were randomized 1:1 to tailored implementation strategies (intervention, 3 sites, n = 744 patients) or education-only (control, 3 sites, n = 692 patients) groups. The program consisted of screening with the 9-item Patient Health Questionnaire (PHQ-9) and algorithm-based scoring and referral to behavioral health services based on low, moderate, or high score. Clinical teams at tailored intervention sites received program education, audit, and feedback of performance data and implementation facilitation, and clinical workflows were adapted to suit local context. Education-only controls sites received program education. Main Outcomes and Measures The primary outcome was percent of eligible patients screened and referred (based on PHQ-9 score) at intervention vs control groups measured at the patient level. Secondary outcomes included outpatient health care utilization for behavioral health, primary care, oncology, urgent care, and emergency department. Results All 1436 eligible patients were randomized at the center level (mean age, 61.5 years; 99% women; 18% Asian, 17% Black, 26% Hispanic, and 37% White) and were followed up to the end of the study, insurance disenrollment, or death. Groups were similar in demographic and tumor characteristics. For the primary outcome, 7.9% (59 of 744) of patients at tailored sites were referred compared with 0.1% (1 of 692) at education-only sites (difference, 7.8%; 95% CI, 5.8%-9.8%). Referrals to a behavioral health clinician were completed by 44 of 59 patients treated at the intervention sites (75%) intervention sites vs 1 of 1 patient at the education-only sites (100%). In adjusted models patients at tailored sites had significantly fewer outpatient visits in medical oncology (rate ratio, 0.86; 95% CI, 0.86-0.89; P = .001), and no significant difference in utilization of primary care, urgent care, and emergency department visits. Conclusions and Relevance Among patients with breast cancer treated in community-based oncology practices, tailored strategies for implementation of routine depression screening compared with an education-only control group resulted in a greater proportion of referrals to behavioral care. Further research is needed to understand the clinical benefit and cost-effectiveness of this program. Trial Registration ClinicalTrials.gov Identifier: NCT02941614.
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Affiliation(s)
- Erin E. Hahn
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | | | - Dana Pounds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
- Now with Southern California Permanente Medical Group Performance Assessment team, Pasadena
| | - Lindsay Joe Lyons
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Janet S. Lee
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Ernest Shen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Benjamin D. Hong
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | | | - Farah M. Brasfield
- Department of Medical Oncology, Southern California Permanente Medical Group, Anaheim
| | - Lara N. Durna
- Department of Medical Oncology, Southern California Permanente Medical Group, South Bay
| | - Karen W. Kwan
- Department of Medical Oncology, Southern California Permanente Medical Group, Los Angeles
| | - David B. Beard
- Department of Medical Oncology, Southern California Permanente Medical Group, Woodland Hills
| | - Alexander Ferreira
- Department of Medical Oncology, Southern California Permanente Medical Group, West Los Angeles
| | - Aswini Padmanabhan
- Department of Medical Oncology, Southern California Permanente Medical Group, Baldwin Park
| | - Michael K. Gould
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
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28
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Rivest J, Desbeaumes Jodoin V, Martineau JT, Folch N, Charpentier D. “I Want to Help Others Like Me”: A Pilot Qualitative Study on Patients’ Participation in a Screening for Distress Program. J Patient Exp 2022; 9:23743735221106593. [PMID: 35719417 PMCID: PMC9203945 DOI: 10.1177/23743735221106593] [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] [Indexed: 11/17/2022] Open
Abstract
Screening for distress was implemented in our academic hospital with the engagement of patients as partners. Little is known about how they appreciate such participation. This pilot qualitative study aimed to explore their experience. Six participants completed a semi-structured interview, which was transcribed verbatim. Thematic analysis was performed on the transcripts. Four themes emerged: “opinions about their participation”, “working with others”, “role of patient partners”, and “barriers encountered”. Mean global satisfaction reported on a Likert scale reached 8.92 over 10. Our preliminary findings suggest that patients-as-partners appreciated their participation, and also identified barriers that should be explored in future quality improvement (QI) projects.
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Affiliation(s)
- Jacynthe Rivest
- Department of Psychiatry, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
| | | | | | - Nathalie Folch
- Nursing Directorate (ND), Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Danielle Charpentier
- Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
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Brauer ER, Long EF, Petersen L, Ganz PA. Current practice patterns and gaps in guideline-concordant breast cancer survivorship care. J Cancer Surviv 2021; 17:906-915. [PMID: 34970715 PMCID: PMC9243187 DOI: 10.1007/s11764-021-01152-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/30/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE Breast cancer-specific survivorship care guidelines for the more than 3.8 million survivors in the U.S. are available, but implementation in clinical practice remains challenging. We examined current practice patterns and factors associated with guideline-concordant survivorship care among oncologists. METHODS A national sample of medical oncologists, recruited using two databases, participated in a survey focused on practice patterns for breast cancer survivorship care. A "survivorship care composite score" was calculated for each respondent based on provision of services recommended in the survivorship guidelines. Descriptive statistics and multivariable linear regression analyses examined associations between physician and practice characteristics and composite scores. RESULTS The survey was completed by 217 medical oncologists, with an overall response rate of 17.9% and eligibility rate of 56.9% for those who responded. Oncologists reported high engagement in evaluation of disease recurrence (78%). Performed less frequently were the provision of survivorship care plans (46%), assessment of psychosocial long-term and late effects (34%), and screening for subsequent cancers (34%). Lack of survivorship care training (p = 0.038) and not routinely informing patients about potential late effects (p = 0.003) were significantly associated with poorer survivorship care composite scores. CONCLUSIONS Despite the availability of disease-specific survivorship care guidelines, adherence to their recommendations in clinical practice is suboptimal. Survey results identified key gaps in survivorship care for breast cancer survivors, particularly related to subsequent primary cancers and psychosocial long-term and late effects. IMPLICATIONS FOR CANCER SURVIVORS Improving the delivery of comprehensive survivorship care for the growing population of breast cancer survivors is a high priority. Disease-specific clinical guidelines for cancer survivorship provide valuable recommendations, but innovative strategies are needed to integrate them into the care of long-term breast cancer survivors.
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Affiliation(s)
- Eden R. Brauer
- School of Nursing, University of California, Los Angeles (UCLA)
| | - Elisa F. Long
- Anderson School of Management, University of California, Los Angeles (UCLA)
| | - Laura Petersen
- Cancer Prevention and Control Research, University of California, Los Angeles (UCLA)
| | - Patricia A. Ganz
- David Geffen School of Medicine and Fielding School of Public Health, University of California, Los Angeles (UCLA)
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30
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Screening for distress in cancer care: How to overcome barriers after unsuccessful implementation? Palliat Support Care 2021; 20:1-3. [PMID: 34809730 DOI: 10.1017/s1478951521001759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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31
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Alias A, Bertrand L, Bisson-Gervais V, Henry M. Suicide in obstructive lung, cardiovascular and oncological disease. Prev Med 2021; 152:106543. [PMID: 34538370 DOI: 10.1016/j.ypmed.2021.106543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 01/04/2023]
Abstract
Healthcare institutions face increasing demands stemming from the burden of noncommunicable diseases. The personal, social, financial and societal impact of these diseases are well-documented. However, the mental health concerns and trajectories of patients afflicted by chronic medical diseases have been under-recognized and are under-resourced. Despite that chronic diseases are associated with substantially increased risk of suicide, the medical world has largely failed to properly address suicide in the medically ill. Considering their high prevalence and mortality rate, this review article will highlight the mental health burden and suicide risk in obstructive lung, cardiovascular (including stroke) and oncological disease, in light of relevant data and conceptual models of suicide. Finally, general evidence-based suicide intervention strategies and potential selective adaptation of these strategies to the chronic medically ill patient populations and medical settings will be reviewed.
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Affiliation(s)
- Ali Alias
- Faculty of Medicine and Health Sciences, McGill University, 3605 de la Montagne, Montreal, QC H3G 2M1, Canada
| | - Lia Bertrand
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, St Joseph's Healthcare Hamilton, West 5(th) Campus, 100 West 5(th) Street, Hamilton, ON L8N 3K7, Canada.
| | - Vanessa Bisson-Gervais
- Faculty of Medicine and Health Sciences, McGill University, 3605 de la Montagne, Montreal, QC H3G 2M1, Canada
| | - Melissa Henry
- Gerald Bronfman Department of Oncology, Faculty of Medicine and Health Sciences, McGill University, 5100 de Maisonneuve Blvd. West, Suite 720, Montreal, QC H4A 3T2, Canada; Segal Cancer Centre, Jewish General Hospital, 3755 Chemin de la Cote-Sainte-Catherine, Montreal, QC H3T 1E2, Canada; Lady-Davis Institute for Medical Research, Jewish General Hospital, 3755 Chemin de la Cote-Sainte-Catherine, Montreal, QC H3T 1E2, Canada
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Deshields TL, Wells-Di Gregorio S, Flowers SR, Irwin KE, Nipp R, Padgett L, Zebrack B. Addressing distress management challenges: Recommendations from the consensus panel of the American Psychosocial Oncology Society and the Association of Oncology Social Work. CA Cancer J Clin 2021; 71:407-436. [PMID: 34028809 DOI: 10.3322/caac.21672] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 12/11/2022] Open
Abstract
Distress management (DM) (screening and response) is an essential component of cancer care across the treatment trajectory. Effective DM has many benefits, including improving patients' quality of life; reducing distress, anxiety, and depression; contributing to medical cost offsets; and reducing emergency department visits and hospitalizations. Unfortunately, many distressed patients do not receive needed services. There are several multilevel barriers that represent key challenges to DM and affect its implementation. The Consolidated Framework for Implementation Research was used as an organizational structure to outline the barriers and facilitators to implementation of DM, including: 1) individual characteristics (individual patient characteristics with a focus on groups who may face unique barriers to distress screening and linkage to services), 2) intervention (unique aspects of DM intervention, including specific challenges in screening and psychosocial intervention, with recommendations for resolving these challenges), 3) processes for implementation of DM (modality and timing of screening, the challenge of triage for urgent needs, and incorporation of patient-reported outcomes and quality measures), 4) organization-inner setting (the context of the clinic, hospital, or health care system); and 5) organization-outer setting (including reimbursement strategies and health-care policy). Specific recommendations for evidence-based strategies and interventions for each of the domains of the Consolidated Framework for Implementation Research are also included to address barriers and challenges.
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Affiliation(s)
- Teresa L Deshields
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - Sharla Wells-Di Gregorio
- Department of Internal Medicine, Division of Palliative Medicine, The Ohio State University Wexner Medical Center, James Cancer Hospital, Columbus, Ohio
| | - Stacy R Flowers
- Department of Family Medicine, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Kelly E Irwin
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ryan Nipp
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lynne Padgett
- Department of Psychology, Veterans Affairs Medical Center, Washington, District of Columbia
| | - Brad Zebrack
- School of Social Work, University of Michigan, Ann Arbor, Michigan
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Meggiolaro E, De Padova S, Ruffilli F, Bertelli T, Bragagni M, Prati S, Pisotti L, Massa I, Foca F, Tamberi S, De Giorgi U, Zerbinati L, Tiberto E, Grassi L. From Distress Screening to Uptake: An Italian Multicenter Study of Cancer Patients. Cancers (Basel) 2021; 13:cancers13153761. [PMID: 34359662 PMCID: PMC8345103 DOI: 10.3390/cancers13153761] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Little consideration is given to the referral and uptake of available supportive services after distress screening. However, identifying the reasons for accepting or refusing help is mandatory for implementing a screening policy. The present study explored the practical usefulness of and potential barriers to the application of distress management. METHODS 406 cancer patients were consecutively selected and asked to complete the Distress Thermometer (DT) and Problem Check List (PL). All patients with a DT score ≥6 were invited for a post-DT telephone interview with a trained psychologist. RESULTS The 112 patients who refused to take part were more often older, retired, at a more advanced stage of illness, and with no previous experience of psychological intervention with respect to those who accepted. Of the 78 patients with a score ≥6 who were referred to the Psycho-Oncology Service, 65.4% accepted the telephone interview. Twenty-two patients rejected the initial invitation immediately for various reasons including logistic difficulties, physical problems, and feeling embarrassed about opening up to a psychologist. CONCLUSIONS Our study confirms that screening per sé is insufficient to deal with the problem of distress and that more emphasis should be placed on implementing referral and treatment.
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Affiliation(s)
- Elena Meggiolaro
- Psycho-Oncology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (S.D.P.); (F.R.); (T.B.)
- Correspondence: ; Tel.: +39-0543-739260; Fax: +39-0543-739151
| | - Silvia De Padova
- Psycho-Oncology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (S.D.P.); (F.R.); (T.B.)
| | - Federica Ruffilli
- Psycho-Oncology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (S.D.P.); (F.R.); (T.B.)
| | - Tatiana Bertelli
- Psycho-Oncology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (S.D.P.); (F.R.); (T.B.)
| | - Marina Bragagni
- Nursing and Technical Administration, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (M.B.); (S.P.); (L.P.)
| | - Sabrina Prati
- Nursing and Technical Administration, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (M.B.); (S.P.); (L.P.)
| | - Lidia Pisotti
- Nursing and Technical Administration, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (M.B.); (S.P.); (L.P.)
| | - Ilaria Massa
- Healthcare Administration, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy;
| | - Flavia Foca
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy;
| | - Stefano Tamberi
- Medical Oncology Unit, Ospedale degli Infermi, 48018 Faenza, Italy;
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy;
| | - Luigi Zerbinati
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, 44121 Ferrara, Italy; (L.Z.); (E.T.); (L.G.)
| | - Elisa Tiberto
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, 44121 Ferrara, Italy; (L.Z.); (E.T.); (L.G.)
| | - Luigi Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, 44121 Ferrara, Italy; (L.Z.); (E.T.); (L.G.)
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Not seeing the forest for the trees: a systematic review of comprehensive distress management programs and implementation strategies. Curr Opin Support Palliat Care 2021; 14:220-231. [PMID: 32657813 DOI: 10.1097/spc.0000000000000513] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Clinically significant distress is common in patients with cancer and if untreated can be associated with adverse outcomes. This article offers a review of current approaches to implementing and reporting the minimum components of distress screening and management interventions in cancer services. RECENT FINDINGS Twenty-two relevant published articles were identified from January 2018 to February 2020. The reporting of recommended minimum components of distress screening and management interventions in these articles was not consistent. The majority of studies used validated tools to conduct initial screening. However, recommendations were either not reported or not followed regarding subsequent pathway components, secondary assessment, referral pathways linked to screening results and rescreening. The majority of studies did not include a description of the implementation of the distress screening program. A small number of studies described a comprehensive set of implementation strategies. SUMMARY Distress screening and management interventions in cancer are an important component of comprehensive cancer care. To improve patient outcomes and guide researchers and services to identify effective models, studies must include and evaluate minimum recommended components and implementation strategies. Addressing these limitations with high-quality, robust interventions is vital for advancing the implementation of effective distress management.
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Prevalence and risk factors for suicidality in cancer patients and oncology healthcare professionals strategies in identifying suicide risk in cancer patients. Curr Opin Support Palliat Care 2021; 14:239-246. [PMID: 32740271 DOI: 10.1097/spc.0000000000000503] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to summarize the literature on prevalence and risk factors for suicidality in cancer patients and to document the research on oncology healthcare professionals' strategies in identifying this risk. RECENT FINDINGS Cancer patients exhibit increased risk of suicidality compared with the general population. Various risk factors have been identified including sociodemographic factors such as poverty, being male and elderly as well as disease-related attributes such as cancer type and stage. The literature on how healthcare professionals identify suicide risk is sparse. Ten articles were found that focused on two main themes. These included information on systematic strategies in identifying suicide risk and factors that affect healthcare professionals' ability to identify risk in their patients. SUMMARY Although there is an immense amount of literature documenting the problem of suicidality among patients, the research on how healthcare professionals identify and respond to these indications in patients is nearly nonexistent. Cancer centres should implement standardized and systematic screening of cancer patients for suicidality and research on this patient population should collect and report these data. Ongoing training and education for healthcare professionals who work in the oncology setting on how to identify and respond to suicide risk among cancer patients is urgently needed.
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Partnering with healthcare facilities to understand psychosocial distress screening practices among cancer survivors: pilot study implications for study design, recruitment, and data collection. BMC Health Serv Res 2021; 21:238. [PMID: 33731095 PMCID: PMC7968218 DOI: 10.1186/s12913-021-06250-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We sought to understand barriers and facilitators to implementing distress screening (DS) of cancer patients to inform and promote uptake in cancer treatment facilities. We describe the recruitment and data collection challenges and recommendations for assessing DS in oncology treatment facilities. METHODS We recruited CoC-accredited facilities and collected data from each facility's electronic health record (EHR). Collected data included cancer diagnosis and demographics, details on DS, and other relevant patient health data. Data were collected by external study staff who were given access to the facility's EHR system, or by facility staff working locally within their own EHR system. Analyses are based on a pilot study of 9 facilities. RESULTS Challenges stemmed from being a multi-facility-based study and local institutional review board (IRB) approval, facility review and approval processes, and issues associated with EHR systems and the lack of DS data standards. Facilities that provided study staff remote-access took longer for recruitment; facilities that performed their own extraction/abstraction took longer to complete data collection. CONCLUSION Examining DS practices and follow-up among cancer survivors necessitated recruiting and working directly with multiple healthcare systems and facilities. There were a number of lessons learned related to recruitment, enrollment, and data collection. Using the facilitators described in this manuscript offers increased potential for working successfully with various cancer centers and insight into partnering with facilities collecting non-standardized DS clinical data.
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Lewis S, Pandey S, Salins N, Deodhar J, Patil V, Gupta T, Laskar SG, Budrukkar A, Murthy V, Joshi A, Prabhash K, Nair S, Chaturvedi P, Noronha V, Agarwal JP. Distress Screening in Head and Neck Cancer Patients Planned for Cancer-Directed Radiotherapy. Laryngoscope 2021; 131:2023-2029. [PMID: 33720420 DOI: 10.1002/lary.29491] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/01/2021] [Accepted: 02/17/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE/HYPOTHESIS To estimate the prevalence of baseline clinically significant distress (distress score ≥ 4) in head and neck cancer patients planned and treated with radical intent radiotherapy using the National Comprehensive Cancer Network Distress Thermometer (DT) and assess factors predictive of distress. STUDY DESIGN Cross-sectional study. METHODS This was a cross-sectional study evaluating distress in 600 head and neck cancer patients undergoing radiation therapy. The DT was used to screen patients for distress at baseline before radiotherapy. RESULTS The median distress score of the entire cohort was 4 interquartile range (IQR) (IQR: 3-5), and 340 patients (56.7%) had clinically significant distress. On univariate analysis, the causal factors predictive of distress were low socioeconomic status (P = .04), presence of proliferative growth at presentation (P = .008), site of the tumor (oral cavity, P = .02), comorbidity (P = .04), and presence of Ryle's tube or tracheostomy tube at baseline (P = .01). Low socioeconomic status was significant (P = .04) on multivariate analysis for high levels of distress. CONCLUSIONS Among head and neck cancer patients, 56% of patients had clinically significant baseline distress, and patients with low socioeconomic status had high distress. There is a need for interventions to mitigate distress. LEVEL OF EVIDENCE 4 Laryngoscope, 131:2023-2029, 2021.
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Affiliation(s)
- Shirley Lewis
- Department of Radiotherapy and Oncology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Saket Pandey
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Naveen Salins
- Department of Palliative Medicine and supportive care, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Jayita Deodhar
- Department of Palliative Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sudhir Nair
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Pankaj Chaturvedi
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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El-Jawahri A, Greer JA, Park ER, Jackson VA, Kamdar M, Rinaldi SP, Gallagher ER, Jagielo AD, Topping CEW, Elyze M, Jones B, Temel JS. Psychological Distress in Bereaved Caregivers of Patients With Advanced Cancer. J Pain Symptom Manage 2021; 61:488-494. [PMID: 32882355 PMCID: PMC7914132 DOI: 10.1016/j.jpainsymman.2020.08.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/23/2020] [Accepted: 08/25/2020] [Indexed: 12/23/2022]
Abstract
CONTEXT Individuals caring for patients with advanced cancer (caregivers) experience psychological distress during the patient's illness course. However, data on the prevalence of bereaved caregivers' psychological distress and its relationship with the quality of patient's end of life (EOL) care are limited. OBJECTIVES To describe rates of depression and anxiety symptoms in bereaved caregivers of patients with advanced cancer and to understand the relationship between these outcomes and patient distress at the EOL. METHODS We conducted a secondary analysis of 168 caregivers enrolled in a supportive care trial for patients with incurable lung and gastrointestinal cancers and their caregivers. We used the Hospital Anxiety and Depression Scale to assess caregivers' depression and anxiety symptoms at three months after the patient's death. Caregivers also rated the patient's physical and psychological distress in the last week of life on a 10-point scale three months after the patient death. We used linear regression adjusting for caregiver age, sex, randomization, and cancer type to explore the relationship between bereaved caregivers' depression and anxiety symptoms and their ratings of physical and psychological distress in patients at the EOL. RESULTS Of the 168 bereaved caregivers, 30.4% (n = 51) and 43.4% (n = 73) reported clinically significant depression and anxiety symptoms, respectively. Caregiver ratings of worse physical (B = 0.32; P = 0.009) and psychological (B = 0.50; P < 0.001) distress experienced by the patient at the EOL were associated with worse depression symptoms in bereaved caregivers. Only caregiver rating of worse psychological distress experienced by the patient at the EOL (B = 0.42; P < 0.001) was associated with worse bereaved caregivers' anxiety symptoms. CONCLUSION Many bereaved caregivers of patients with advanced cancer experience symptoms of depression and anxiety, which are associated with their perceptions of distress in their loved ones at the EOL.
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Affiliation(s)
- Areej El-Jawahri
- Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
| | - Joseph A Greer
- Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Elyse R Park
- Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Vicki A Jackson
- Harvard Medical School, Boston, Massachusetts, USA; Division of Palliative Care, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mihir Kamdar
- Harvard Medical School, Boston, Massachusetts, USA; Division of Palliative Care, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Simone P Rinaldi
- Division of Palliative Care, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emily R Gallagher
- Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Annemarie D Jagielo
- Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Carlisle E W Topping
- Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Madeleine Elyze
- Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Bailey Jones
- Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Jennifer S Temel
- Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
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Ganz PA, Bower JE, Partridge AH, Wolff AC, Thorner ED, Joffe H, Irwin MR, Petersen L, Crespi CM. Screening for Depression in Younger Breast Cancer Survivors: Outcomes From Use of the 9-item Patient Health Questionnaire. JNCI Cancer Spectr 2021; 5:pkab017. [PMID: 34164605 PMCID: PMC8216636 DOI: 10.1093/jncics/pkab017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
Background Major cancer organizations recommend depression screening in patients and survivors. The 9-item Patient Health Questionnaire (PHQ-9) is often suggested, with limited information about its use. Methods Enrollment data collected from younger breast cancer survivors participating in a behavioral intervention trial were used to examine the relationship between PHQ-9 scores (range = 0-27), patient characteristics, and responses to standardized psychosocial assessment tools. Major depressive disorder criterion was met if responses to the first 2 PHQ-9 items (range = 0-6) were 3 or greater. The sample was categorized by total PHQ-9 scores: less than 5 (minimal depressive symptoms), 5-9 (mild to moderate depressive symptoms), and 10 or greater (moderate to severe depression). PHQ-9 category associations with medical, demographic, psychosocial, and behavioral characteristics were examined using analysis of variance for continuous variables and χ2 tests for categorical variables. Results A total of 231 women met the study prescreening eligibility criterion of mild depressive symptoms and enrolled in the study. On average, they were 45.2 years old and 2.6 years since diagnosis. At enrollment, 22.1% met the screening criterion for possible major depressive disorder; among those with PHQ-9 scores of 10 or greater, 58.3% met this criterion. Anxiety, fatigue, insomnia, and intrusive thoughts about cancer were frequent and were associated with depressive symptom severity (all P < .001). In contrast, neither demographic nor cancer treatment characteristics were associated with depressive symptoms. Conclusions Depressive symptoms in this selected sample of younger breast cancer survivors were independent of demographic characteristics or cancer treatment history, suggesting that depression screening is necessary to detect uncontrolled depressive symptoms.
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Affiliation(s)
- Patricia A Ganz
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.,Department of Medicine (Hematology-Oncology), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Julienne E Bower
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute, Los Angeles, CA, USA.,Department of Psychology, UCLA, Los Angeles, CA, USA.,Cousins Center for Psychoneuroimmunology, UCLA, Los Angeles, CA, USA
| | - Ann H Partridge
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Antonio C Wolff
- The Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Elissa D Thorner
- The Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Hadine Joffe
- Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Michael R Irwin
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute, Los Angeles, CA, USA.,Cousins Center for Psychoneuroimmunology, UCLA, Los Angeles, CA, USA
| | - Laura Petersen
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Catherine M Crespi
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA.,Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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Götz A, Kröner A, Jenewein J, Spirig R. Wie erleben und beurteilen Pflegende das Screening von stationären onkologischen Patient_innen mit dem Belastungsthermometer? Pflege 2021; 34:71-79. [PMID: 33535833 DOI: 10.1024/1012-5302/a000790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
How do nurses experience and interpret the screening of hospitalised cancer patients by means of the distress thermometer? - A qualitative study Abstract. Background: People with cancer experience distress and may need professional support. In 2012, the University Hospital Zurich introduced its distress thermometer (DT) screening, whereby all inpatients were to be screened to gauge their support need. However, after five years, the screening rate was 40 % and the referral rate to psycho oncology was 7.9 %, surprisingly low. Aim: The aim of this qualitative study was to describe how nurses experience the screening and how they interpret the screening and referral rate. Methods: The evaluation of three focus group interviews with 14 nurses followed the principles of qualitative content analysis according to Mayring. Results: The analysis revealed four main categories. The first category "Trying to perform useful screening in a complex daily routine" comprises three subcategories: "Using the benefits of screening for comprehensive care", "The best way to recognize the individuality of the counterpart" and "Failing due to structural and personal barriers". Three further main categories addressing nurses' personal attitudes complete the screening experience: "Experiencing fewer difficulties due to competence and experience", "Being careful due to hesitations", and "Reflecting one's responsibility". Conclusions: Nurses want to use the DT. However, they need more practical and scientific support to usefully integrate screening into their everyday life.
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Affiliation(s)
- Anna Götz
- Comprehensive Cancer Center Zürich, Universitätsspital Zürich.,PhD Programm, Department für Pflegewissenschaft, Universität Witten / Herdecke
| | | | - Josef Jenewein
- Triaplus Ag - Integrierte Psychiatrie Uri, Schwyz und Zug
| | - Rebecca Spirig
- PhD Programm, Department für Pflegewissenschaft, Universität Witten / Herdecke.,Institut für Pflegewissenschaft, Universität Basel
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CancerSupportSource®-15+: development and evaluation of a short form of a distress screening program for cancer patients and survivors. Support Care Cancer 2021; 29:4413-4421. [PMID: 33447863 PMCID: PMC8236438 DOI: 10.1007/s00520-021-05988-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/21/2020] [Indexed: 02/07/2023]
Abstract
Purpose CancerSupportSource® (CSS) is a distress screening program implemented at community-based organizations and hospitals nationwide. The 25-item CSS assesses distress across five domains, with capacity to screen for clinically significant depression and anxiety. This study examined psychometric properties of a shortened form to enhance screening opportunities when staff or patient burden considerations are significant. Methods Development and validation were completed in multiple phases. Item reduction decisions were made with 1436 cancer patients by assessing external/internal item quality and judging theoretical and practical implications of items. Pearson correlations and confirmatory factor analysis were conducted on a separate sample of 957 patients to corroborate psychometric properties and dimensionality of the shortened scale. Nonparametric receiver operating characteristic (ROC) curve analyses determined scoring thresholds for depression and anxiety risk scales. Results Scale refinement resulted in a 15-item short form plus one screening item assessing tobacco and substance use (CSS-15+). At least two items from each CSS domain were retained to preserve multidimensionality. In confirmatory analysis, the model explained 59% of the variance and demonstrated good fit. Correlation between CSS-15+ and 25-item CSS was 0.99, p < 0.001. Sensitivity of 2-item depression and 2-item anxiety risk scales in the confirmatory sample were 0.82 and 0.83, respectively. Conclusions CSS-15+ is a brief, reliable, and valid multidimensional measure of distress. The measure retained excellent internal consistency (α = 0.94) and a stable factor structure. CSS-15+ is a practical and efficient screening tool for distress and risk for depression and anxiety among cancer patients and survivors, particularly in community-based settings.
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Dekker J, Karchoud J, Braamse AMJ, Buiting H, Konings IRHM, van Linde ME, Schuurhuizen CSEW, Sprangers MAG, Beekman ATF, Verheul HMW. Clinical management of emotions in patients with cancer: introducing the approach "emotional support and case finding". Transl Behav Med 2020; 10:1399-1405. [PMID: 33200793 PMCID: PMC7796719 DOI: 10.1093/tbm/ibaa115] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The current approach to the management of emotions in patients with cancer is “distress screening and referral for the provision of psychosocial care.” Although this approach may have certain beneficial effects, screening and referral programs have shown a limited effect on patient psychological well-being. We argue that this limited effect is due to a mismatch between patient needs and the provision of care, and that a fundamental reconceptualization of the clinical management of emotions in patients with cancer is needed. We describe the rationale and characteristics of “emotional support and case finding” as the approach to the management of emotions in patients with cancer. The two main principles of the approach are: (1) Emotional support: (a) The treating team, consisting of doctors, nurses, and allied health staff, is responsive to the emotional needs of patients with cancer and provides emotional support. (b) The treating team provides information on external sources of emotional support. (2) Case finding: The treating team identifies patients in need of mental health care by means of case finding, and provides a referral to mental health care as indicated. We present a novel perspective on how to organize the clinical management of emotions in patients with cancer. This is intended to contribute to a fruitful discussion and to inform an innovative research agenda on how to manage emotions in patients with cancer.
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Affiliation(s)
- Joost Dekker
- Department of Psychiatry, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands
| | - Jeanet Karchoud
- Department of Psychiatry, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands
| | - Annemarie M J Braamse
- Department of Medical Psychology, Amsterdam University Medical Centers (location AMC), Amsterdam, the Netherlands
| | - Hilde Buiting
- Department of Psychiatry, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands
| | - Inge R H M Konings
- Department of Medical Oncology, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands
| | - Myra E van Linde
- Department of Medical Oncology, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands
| | | | - Mirjam A G Sprangers
- Department of Medical Psychology, Amsterdam University Medical Centers (location AMC), Amsterdam, the Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands
| | - Henk M W Verheul
- Department of Medical Oncology, Radboud UMC, Nijmegen, the Netherlands
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Dekker J, Graves KD, Badger TA, Diefenbach MA. Management of Distress in Patients with Cancer-Are We Doing the Right Thing? Ann Behav Med 2020; 54:978-984. [PMID: 33416842 PMCID: PMC7791612 DOI: 10.1093/abm/kaaa091] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Screening for distress and referral for the provision of psychosocial care is currently the preferred approach to the management of distress in patients with cancer. To date, this approach has shown a limited effect on the reduction of distress. Recent commentaries have argued that the implementation of distress screening should be improved. On the other hand, the underlying assumption that a referral for psychosocial care is required for distressed patients can be questioned. This has led to the development of an alternative approach, called emotional support and case finding. PURPOSE In the context of finding innovative solutions to tomorrow's health challenges, we explore ways to optimize distress management in patients with cancer. METHODS AND RESULTS We discuss three different approaches: (i) optimization of screening and referral, (ii) provision of emotional support and case finding, and (iii) a hybrid approach with multiple assessments, using mobile technology. CONCLUSIONS We suggest continued research on the screening and referral approach, to broaden the evidence-base on improving emotional support and case finding, and to evaluate the utility of multiple assessments of distress with new interactive mobile tools. Lessons learned from these efforts can be applied to other disease areas, such as cardiovascular disease or diabetes.
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Affiliation(s)
- Joost Dekker
- Department of Psychiatry and Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Kristi D Graves
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Terry A Badger
- College of Nursing, University of Arizona, Tucson, AZ, USA
| | - Michael A Diefenbach
- Institute for Clinical Outcomes Research (iCOR), Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
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Peters L, Brederecke J, Franzke A, de Zwaan M, Zimmermann T. Psychological Distress in a Sample of Inpatients With Mixed Cancer-A Cross-Sectional Study of Routine Clinical Data. Front Psychol 2020; 11:591771. [PMID: 33329254 PMCID: PMC7734182 DOI: 10.3389/fpsyg.2020.591771] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/09/2020] [Indexed: 01/30/2023] Open
Abstract
Background The diagnosis and treatment of cancer are associated with psychological distress that often leads to a significant reduction in emotional and physical well-being and quality of life. Early detection of psychological distress is therefore important. This study aims to assess the psychological distress of inpatient cancer patients using routine clinical data. Furthermore, variables and problems most strongly associated with psychological distress should be identified. Materials and Methods N = 1,869 inpatients were investigated (mean age = 60.89 years; 35.94% female) using the National Comprehensive Cancer Network Distress Thermometer and problem checklist to assess distress as well as multiple possible problem areas. Visceral oncological cancer (31.6%) was the most common tumor diagnosis, followed by skin cancer (26.2%) and urological cancer (21.7%). Results 65.9% of the sample experienced high levels of distress (Distress Thermometer ≥ 5). Female sex, stage 4 of disease, and visceral and head and neck cancer emerged as risk factors for high distress. A younger age (<65 years) was significantly correlated with higher distress. The most frequently self-reported problems were fears (50.1%), worry (49.9%), and fatigue (49.1%). Patients with all 3 of these problems had 24 times higher risk [odds ratio (OR) = 23.9] for high levels of distress than patients without these problems. Women reported significantly more practical, emotional, and physical problems than men. Younger (<50 years) and middle-aged patients (50-64 years) reported increased levels of practical, family, and emotional problems compared with older patients (≥65 years). Discussion Almost two-thirds of the sample reported high levels of distress. The most frequently reported problem areas were emotional and physical problems. These results can help to identify patients with high risk for psychological distress and, therefore, be used to optimize psychosocial and psycho-oncological care for patients with cancer.
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Affiliation(s)
- Luisa Peters
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Jan Brederecke
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Anke Franzke
- Department of Hematology and Oncology, Hannover Medical School, Hanover, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Tanja Zimmermann
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
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Nightingale CL, Sterba KR, McLouth LE, Kent EE, Dressler EV, Dest A, Snavely AC, Adonizio CS, Wojtowicz M, Neuman HB, Kazak AE, Carlos RC, Hudson MF, Unger JM, Kamen CS, Weaver KE. Caregiver engagement practices in National Cancer Institute Clinical Oncology Research Program settings: Implications for research to advance the field. Cancer 2020; 127:639-647. [PMID: 33136296 DOI: 10.1002/cncr.33296] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/20/2020] [Accepted: 10/06/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Supportive care interventions have demonstrated benefits for both informal and/or family cancer caregivers and their patients, but uptake generally is poor. To the authors' knowledge, little is known regarding the availability of supportive care services in community oncology practices, as well as engagement practices to connect caregivers with these services. METHODS Questions from the National Cancer Institute Community Oncology Research Program (NCORP)'s 2017 Landscape Survey examined caregiver engagement practices (ie, caregiver identification, needs assessment, and supportive care service availability). Logistic regression was used to assess the relationship between the caregiver engagement outcomes and practice group characteristics. RESULTS A total of 204 practice groups responded to each of the primary outcome questions. Only 40.2% of practice groups endorsed having a process with which to systematically identify and document caregivers, although approximately 76% were routinely using assessment tools to identify caregiver needs and approximately 63.7% had supportive care services available to caregivers. Caregiver identification was more common in sites affiliated with a critical access hospital (odds ratio [OR], 2.44; P = .013), and assessments were less common in safety-net practices (OR, 0.41; P = .013). Supportive care services were more commonly available in the Western region of the United States, in practices with inpatient services (OR, 2.96; P = .012), and in practices affiliated with a critical access hospital (OR, 3.31; P = .010). CONCLUSIONS Although many practice groups provide supportive care services, fewer than one-half systematically identify and document informal cancer caregivers. Expanding fundamental engagement practices such as caregiver identification, assessment, and service provision will be critical to support recent calls to improve caregivers' well-being and skills to perform caregiving tasks.
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Affiliation(s)
- Chandylen L Nightingale
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Laurie E McLouth
- Department of Behavioral Science, Markey Cancer Center, Center for Health Equity Transformation, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Alexandra Dest
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anna C Snavely
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Christian S Adonizio
- Center for Oncology Research and Innovation, Geisinger Cancer Institute, Danville, Pennsylvania
| | - Mark Wojtowicz
- Center for Oncology Research and Innovation, Geisinger Cancer Institute, Danville, Pennsylvania
| | - Heather B Neuman
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, Delaware
| | - Ruth C Carlos
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Matthew F Hudson
- NCORP of the Carolinas, Prisma Health Cancer Institute, Greenville, South Carolina
| | - Joseph M Unger
- SWOG Cancer Research Network Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Charles S Kamen
- Department of Surgery, University of Rochester, Rochester, New York
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Bush NJ, Goebel JR, Hardan-Khalil K, Matsumoto K. Using a Quality Improvement Model to Implement Distress Screening in a Community Cancer Setting. J Adv Pract Oncol 2020; 11:825-834. [PMID: 33489423 PMCID: PMC7810268 DOI: 10.6004/jadpro.2020.11.8.3] [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] [Indexed: 11/28/2022] Open
Abstract
Background Quality cancer care includes routine screening for psychosocial distress. This quality improvement project focused on the implementation of distress screening at a licensed affiliate of Cancer Support Community, a community-based non-profit organization that provides professionally led cancer support. Methods An advanced practice oncology nurse assisted the staff in implementing and evaluating the process of distress screening. CancerSupportSource (CSS), a validated web-based distress screening program developed by Cancer Support Community for use in community cancer settings, was employed to screen for distress, identify potential resources, and improve in-house and community referrals. For purposes of this quality improvement project, CSS was administered in interview format by staff. The Plan-Do-Study-Act (PDSA) quality improvement approach was used to implement CSS. Results To implement the practice of distress screening, 21 patient participants were initially screened and evaluated for distress, including risk for clinically significant levels of depression, using CSS. The tool identified participant concerns and flagged thirteen persons as at risk for depression. After implementation and evaluation of distress screening using PDSA, in a year, 51 participants were screened. Participants stated that distress screening allowed for discussion of intimate questions that may not have otherwise occurred in an intake interview. Conclusion It was demonstrated that CSS identified psychosocial and practical needs, facilitating the referral process and identification of community resources. Application of the PDSA model was an effective quality improvement model that can be used for the implementation and sustainability of distress screening across settings.
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Affiliation(s)
- Nancy Jo Bush
- University of California, Los Angeles, Los Angeles, California
| | - Joy R Goebel
- California State University, Long Beach, Long Beach, California
| | | | - Kayo Matsumoto
- Cancer Support Community, Valley/Ventura/Santa Barbara, Westlake Village, California
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Courtnage T, Bates NE, Armstrong AA, Seitz MK, Weitzman TS, Fann JR. Enhancing integrated psychosocial oncology through leveraging the oncology social worker's role in collaborative care. Psychooncology 2020; 29:2084-2090. [DOI: 10.1002/pon.5582] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/21/2020] [Accepted: 10/07/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Tiffany Courtnage
- Department of Psychosocial Oncology Seattle Cancer Care Alliance Seattle Washington USA
| | - Nicole E. Bates
- Department of Psychosocial Oncology Seattle Cancer Care Alliance Seattle Washington USA
- Department of Psychiatry and Behavioral Sciences University of Washington Seattle Washington USA
| | - Anne A. Armstrong
- Department of Psychosocial Oncology Seattle Cancer Care Alliance Seattle Washington USA
| | - M. Katherine Seitz
- Department of Psychosocial Oncology Seattle Cancer Care Alliance Seattle Washington USA
| | - Tammy S. Weitzman
- Department of Psychosocial Oncology Seattle Cancer Care Alliance Seattle Washington USA
| | - Jesse R. Fann
- Department of Psychosocial Oncology Seattle Cancer Care Alliance Seattle Washington USA
- Department of Psychiatry and Behavioral Sciences University of Washington Seattle Washington USA
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Rivest J, Jodoin VD, Leboeuf I, Folch N, Martineau JT, Beaudet-Hillman G, Tremblay C. Les patients-partenaires dans les soins du cancer : Une stratégie novatrice dans le dépistage de la détresse? Can Oncol Nurs J 2020; 30:186-192. [PMID: 33118974 DOI: 10.5737/23688076303186192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Jacynthe Rivest
- Département de psychiatrie, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC
| | | | - Irène Leboeuf
- Direction des soins infirmiers, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC
| | - Nathalie Folch
- Direction des soins infirmiers, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC
| | - Joé T Martineau
- Département de management, HEC Montréal, Canada; également patient-partenaire
| | - Geneviève Beaudet-Hillman
- Département de psychiatrie, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC Direction des soins infirmiers, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC
| | - Claudine Tremblay
- Direction des soins infirmiers, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC
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49
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Rivest J, Jodoin VD, Leboeuf I, Folch N, Martineau JT, Beaudet-Hillman G, Tremblay C. Engaging patients as partners in cancer care: An innovative strategy to implement screening for distress? Can Oncol Nurs J 2020; 30:180-185. [PMID: 33118972 DOI: 10.5737/23688076303180185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Patient distress is frequently missed in everyday cancer care, yet can be associated with decreased quality of life and satisfaction with care, as well as increased risk for comorbidity and morbidity. Considered as an aspect of a patient-centred approach, screening for distress is now an international standard of practice and constitutes an accreditation criterion for cancer centers in the USA and Canada. Inspired by existing health partnership models, the Centre Hospitalier de l'Université de Montréal's (CHUM) Integrative Cancer Care Center recruited patients to act as partners during the creation and implementation of its screening for distress program. Patient partner roles in the program included becoming a member of a specialized psychosocial oncology team, contributing to a healthcare professional training program and helping to select tools to detect distress. This paper describes why and how the CHUM cancer care centre developed an innovative screening for distress program, using a patient partnership approach, to better meet the needs of patients with cancer.
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Affiliation(s)
- Jacynthe Rivest
- Department of Psychiatry, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC
| | | | - Irène Leboeuf
- Nursing Directorate (ND), Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC
| | - Nathalie Folch
- Nursing Directorate (ND), Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC
| | - Joé T Martineau
- Department of Management, HEC Montréal, QC; Patient-partner as well
| | - Geneviève Beaudet-Hillman
- Department of Psychiatry ; Nursing Directorate (ND), Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC
| | - Claudine Tremblay
- Nursing Directorate (ND), Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC
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50
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Newton JC, O'Connor M, Saunders C, Moorin R, Ali S, Nowak AK, Halkett GKB. The role of psychosocial support in the experiences of people living with advanced cancer: A qualitative exploration of patients' perspectives. Psychooncology 2020; 30:287-295. [PMID: 33037707 DOI: 10.1002/pon.5569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/21/2020] [Accepted: 10/06/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND People living with advanced cancer experience significant distress and reduced quality of life due to their symptom burden and life-limiting prognosis. Limited qualitative research has investigated their experiences accessing psychosocial supportive care, and how it meets their needs. AIM To explore patients' perspectives of the role of psychosocial support in their experiences of living with advanced cancer. METHODS This study used an exploratory qualitative research design and drew upon a social constructionist interpretive framework. Semi-structured interviews were conducted with 23 participants. Participants were asked about their experiences accessing and using psychosocial support following their diagnosis. Audio-recorded interviews were transcribed and analysed using deductive thematic analysis. RESULTS The following six themes can be used to describe participants' experiences with psychosocial support: (1) accessing different types of support, (2) appreciating support, (3) need, (4) difficulties accessing support, (5) knowing about support and (6) asking for support. Sources of psychosocial support included family and friends, health professionals, and psychosocial supportive care services. Not all participants were able to access care that met their needs; barriers included suitability of available support, accessibility and stigma surrounding support use. CONCLUSION Participants experienced broad variation in their awareness and access to psychosocial support services to meet their needs. Providers of psychosocial supportive care for advanced cancer patients need to consider service accessibility issues. Future psychosocial interventions targeting people living with advanced cancer should consider these issues during development and implementation.
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Affiliation(s)
- Jade C Newton
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Moira O'Connor
- WA Cancer Prevention Research Unit (WACPRU), School of Psychology, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Christobel Saunders
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Rachael Moorin
- School of Public Health, Curtin University, Perth, Western Australia, Australia.,School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Sayed Ali
- Medical Oncology Department, St John of God Midland Public Hospital, Midland, Western Australia, Australia
| | - Anna K Nowak
- Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Georgia K B Halkett
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
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