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Pezzolato M, Spada GE, Fragale E, Cutica I, Masiero M, Marzorati C, Pravettoni G. Predictive Models of Psychological Distress, Quality of Life, and Adherence to Medication in Breast Cancer Patients: A Scoping Review. Patient Prefer Adherence 2023; 17:3461-3473. [PMID: 38143947 PMCID: PMC10748751 DOI: 10.2147/ppa.s440148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/27/2023] [Indexed: 12/26/2023] Open
Abstract
Purpose An interplay of clinical and psychosocial variables affects breast cancer patients' experiences and clinical trajectories. Several studies investigated the role of socio-demographic, clinical, and psychosocial factors in predicting relevant outcomes in breast cancer care, thus developing predictive models. Our aim is to summarize predictive models for specific psychological and behavioral outcomes: psychological distress, quality of life, and medication adherence. Specifically, we aim to map the determinants of the outcomes of interest, offering a thorough overview of these models. Methods Databases (PubMed, Scopus, Embase) have been searched to identify studies meeting the inclusion criteria: a breast cancer patients' sample, development/validation of a predictive model for selected psychological/behavioral outcomes (ie, psychological distress, quality of life, and medication adherence), and availability of English full-text. Results Twenty-one papers describing predictive models for psychological distress, quality of life, and adherence to medication in breast cancer were included. The models were developed using different statistical approaches. It has been shown that treatment-related factors (eg, side-effects, type of surgery or treatment received), socio-demographic (eg, younger age, lower income, and inactive occupational status), clinical (eg, advanced stage of disease, comorbidities, physical symptoms such as fatigue, insomnia, and pain) and psychological variables (eg, anxiety, depression, body image dissatisfaction) might predict poorer outcomes. Conclusion Predictive models of distress, quality of life, and adherence, although heterogeneous, showed good predictive values, as indicated by the reported performance measures and metrics. Many of the predictors are easily available in patients' health records, whereas others (eg, coping strategies, perceived social support, illness perceptions) might be introduced in routine assessment practices. The possibility to assess such factors is a relevant resource for clinicians and researchers involved in developing and implementing psychological interventions for breast cancer patients.
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Affiliation(s)
- M Pezzolato
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - G E Spada
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
| | - E Fragale
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
| | - I Cutica
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - M Masiero
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - C Marzorati
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
| | - G Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Guthrie DM, Williams N, O'Rourke HM, Orange JB, Phillips N, Pichora-Fuller MK, Savundranayagam MY, Sutradhar R. Development and validation of risk of CPS decline (RCD): a new prediction tool for worsening cognitive performance among home care clients in Canada. BMC Geriatr 2023; 23:792. [PMID: 38041046 PMCID: PMC10693097 DOI: 10.1186/s12877-023-04463-3] [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: 07/03/2023] [Accepted: 11/06/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND To develop and validate a prediction tool, or nomogram, for the risk of a decline in cognitive performance based on the interRAI Cognitive Performance Scale (CPS). METHODS Retrospective, population-based, cohort study using Canadian Resident Assessment Instrument for Home Care (RAI-HC) data, collected between 2010 and 2018. Eligible home care clients, aged 18+, with at least two assessments were selected randomly for model derivation (75%) and validation (25%). All clients had a CPS score of zero (intact) or one (borderline intact) on intake into the home care program, out of a possible score of six. All individuals had to remain as home care recipients for the six months observation window in order to be included in the analysis. The primary outcome was any degree of worsening (i.e., increase) on the CPS score within six months. Using the derivation cohort, we developed a multivariable logistic regression model to predict the risk of a deterioration in the CPS score. Model performance was assessed on the validation cohort using discrimination and calibration plots. RESULTS We identified 39,292 eligible home care clients, with a median age of 79.0 years, 62.3% were female, 38.8% were married and 38.6% lived alone. On average, 30.3% experienced a worsening on the CPS score within the six-month window (i.e., a change from 0 or 1 to 2, 3, 4, 5, or 6). The final model had good discrimination (c-statistic of 0.65), with excellent calibration. CONCLUSIONS The model accurately predicted the risk of deterioration on the CPS score over six months among home care clients. This type of predictive model may provide useful information to support decisions for home care clinicians who use interRAI data internationally.
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Affiliation(s)
- Dawn M Guthrie
- Department of Kinesiology & Physical Education, Wilfrid Laurier University, Waterloo, ON, Canada
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Nicole Williams
- Department of Kinesiology & Physical Education, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Hannah M O'Rourke
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Joseph B Orange
- School of Communication Sciences and Disorders, Western University, London, ON, Canada
| | - Natalie Phillips
- Department of Psychology, Centre for Research in Human Development, Concordia University, Montreal, QC, Canada
| | | | | | - Rinku Sutradhar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Lapointe-Shaw L, Kiran T, Costa AP, Na Y, Sinha SK, Nelson KE, Stall NM, Ivers NM, Jones A. Physician home visits in Ontario: a cross-sectional analysis of patient characteristics and postvisit use of health care services. CMAJ Open 2022; 10:E732-E745. [PMID: 35944922 PMCID: PMC9377547 DOI: 10.9778/cmajo.20210307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND It is unknown how much of current physician home visit volume is driven by low-complexity or low-continuity visits. Our objectives were to measure physician home visit volumes and costs in Ontario from 2005/06 to 2018/19, and to compare patient characteristics and postvisit use of health care services across home visit types. METHODS This was a retrospective cross-sectional study using health administrative data. We examined annual physician home visit volumes and costs from 2005/06 to 2018/19 in Ontario, and characteristics and postvisit use of health care services of residents who received at least 1 home visit from any physician in 2014/15 to 2018/19. We categorized home visits as palliative, provided to a patient who also received home care services or "other," and compared characteristics and outcomes between groups. RESULTS A total of 4 418 334 physician home visits were performed between 2005/06 and 2018/19. More than half (2 256 667 [51.1%]) were classified as "other" and accounted for 39.1% ($22 million) of total annual physician billing costs. From 2014/15 to 2018/19, of the 413 057 home visit patients, 240 933 (58.3%) were adults aged 65 or more, and 323 283 (78.3%) lived in large urban areas. Compared to the palliative care and home care groups, the "other" group was younger, had fewer comorbidities, and had lower rates of emergency department visits and hospital admissions in the 30 days after the visit. INTERPRETATION About half of physician home visits in 2014/15 to 2018/19 were to patients who were receiving neither palliative care nor home care, a group that was younger and healthier, and had low use of health care services after the visit. There is an opportunity to refine policy tools to target patients most likely to benefit from physician home visits.
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Affiliation(s)
- Lauren Lapointe-Shaw
- Division of General Internal Medicine and Geriatrics (Lapointe-Shaw, Sinha, Stall), University Health Network and Sinai Health System; Department of Medicine (Lapointe-Shaw, Sinha, Stall), University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Ivers), Women's College Hospital; ICES (Lapointe-Shaw, Kiran, Costa, Na, Nelson, Ivers, Jones); Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Sinha, Stall, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.; Department of Paediatrics (Nelson), The Hospital for Sick Children; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.
| | - Tara Kiran
- Division of General Internal Medicine and Geriatrics (Lapointe-Shaw, Sinha, Stall), University Health Network and Sinai Health System; Department of Medicine (Lapointe-Shaw, Sinha, Stall), University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Ivers), Women's College Hospital; ICES (Lapointe-Shaw, Kiran, Costa, Na, Nelson, Ivers, Jones); Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Sinha, Stall, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.; Department of Paediatrics (Nelson), The Hospital for Sick Children; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont
| | - Andrew P Costa
- Division of General Internal Medicine and Geriatrics (Lapointe-Shaw, Sinha, Stall), University Health Network and Sinai Health System; Department of Medicine (Lapointe-Shaw, Sinha, Stall), University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Ivers), Women's College Hospital; ICES (Lapointe-Shaw, Kiran, Costa, Na, Nelson, Ivers, Jones); Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Sinha, Stall, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.; Department of Paediatrics (Nelson), The Hospital for Sick Children; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont
| | - Yingbo Na
- Division of General Internal Medicine and Geriatrics (Lapointe-Shaw, Sinha, Stall), University Health Network and Sinai Health System; Department of Medicine (Lapointe-Shaw, Sinha, Stall), University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Ivers), Women's College Hospital; ICES (Lapointe-Shaw, Kiran, Costa, Na, Nelson, Ivers, Jones); Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Sinha, Stall, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.; Department of Paediatrics (Nelson), The Hospital for Sick Children; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont
| | - Samir K Sinha
- Division of General Internal Medicine and Geriatrics (Lapointe-Shaw, Sinha, Stall), University Health Network and Sinai Health System; Department of Medicine (Lapointe-Shaw, Sinha, Stall), University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Ivers), Women's College Hospital; ICES (Lapointe-Shaw, Kiran, Costa, Na, Nelson, Ivers, Jones); Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Sinha, Stall, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.; Department of Paediatrics (Nelson), The Hospital for Sick Children; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont
| | - Katherine E Nelson
- Division of General Internal Medicine and Geriatrics (Lapointe-Shaw, Sinha, Stall), University Health Network and Sinai Health System; Department of Medicine (Lapointe-Shaw, Sinha, Stall), University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Ivers), Women's College Hospital; ICES (Lapointe-Shaw, Kiran, Costa, Na, Nelson, Ivers, Jones); Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Sinha, Stall, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.; Department of Paediatrics (Nelson), The Hospital for Sick Children; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont
| | - Nathan M Stall
- Division of General Internal Medicine and Geriatrics (Lapointe-Shaw, Sinha, Stall), University Health Network and Sinai Health System; Department of Medicine (Lapointe-Shaw, Sinha, Stall), University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Ivers), Women's College Hospital; ICES (Lapointe-Shaw, Kiran, Costa, Na, Nelson, Ivers, Jones); Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Sinha, Stall, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.; Department of Paediatrics (Nelson), The Hospital for Sick Children; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont
| | - Noah M Ivers
- Division of General Internal Medicine and Geriatrics (Lapointe-Shaw, Sinha, Stall), University Health Network and Sinai Health System; Department of Medicine (Lapointe-Shaw, Sinha, Stall), University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Ivers), Women's College Hospital; ICES (Lapointe-Shaw, Kiran, Costa, Na, Nelson, Ivers, Jones); Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Sinha, Stall, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.; Department of Paediatrics (Nelson), The Hospital for Sick Children; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont
| | - Aaron Jones
- Division of General Internal Medicine and Geriatrics (Lapointe-Shaw, Sinha, Stall), University Health Network and Sinai Health System; Department of Medicine (Lapointe-Shaw, Sinha, Stall), University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Ivers), Women's College Hospital; ICES (Lapointe-Shaw, Kiran, Costa, Na, Nelson, Ivers, Jones); Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Sinha, Stall, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.; Department of Paediatrics (Nelson), The Hospital for Sick Children; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont
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