Lay Etiology, Self-Efficacy and Patient Activation Among Cancer Patients

BACKGROUND

We aimed at clarifying correlations between lay etiologies, self-efficacy, and patient activation among cancer patients.

METHODS

Patients with different kinds of cancer answered a questionnaire on self-efficacy, lay etiology, and patient activation.

RESULTS

639 patients participated. Psychological reasons/stress (43.3%) and destiny (41.6%) were the most cited causes. Lay etiology was influenced by demographics, self-efficacy, and patient activation. Men, younger people, and active patients more often described internal causes of cancer, women and religious patients more often external causes. Patients with higher scores of self-efficacy were more often convinced of external cancer causes.

CONCLUSION

By identifying individual disease theories, physicians may improve patient-physician communication.

Patients' beliefs about the causes of myomas: a pilot study from a large European city

INTRODUCTION

Patients usually develop subjective concepts about their illness, which then influences their further health behaviors and treatment decisions. This study aimed to evaluate several possible patient beliefs about the causal factors of illness, in a large sample of women seeking treatment for myomas.

METHODS

From November 2011 to October 2013, all patients at a specialized myoma clinic in a large European city were surveyed about their beliefs about the causes of myomas. We used a modified version of the Patient Theory Questionnaire from Zenz et al., which presented 16 of the most common possible beliefs about the causes of myomas, and asked patients to rate them on a five-point scale of likelihood. Retrospectively, statistical analysis was performed on their answers and sociodemographic data.

RESULTS

Data from 482 patients was included (return rate of 91.5%). The most frequent answers for possible causes were "inherited susceptibility for myomas" (67.3%), "reorganization in the body during a particular phase of life" (63.5%), "stress at work or home" (49.3%) and "an in-born tendency to react to emotional agitation with physical disorders" (41.8%). Significant differences were found for the factors of age, immigration background and self-rated knowledge about myomas.

CONCLUSIONS

It is curious that two of the four most common explanations for myomas were stress and somatization, and were endorsed by nearly half of all patients. Physicians seeing women for myomas should consider that many such patients may have further hidden reasons for seeking medical care.

Decay, Transformation, and Growth: Meaning-Making Processes of Patients With Acute Leukemia Within the First Year After Diagnosis or Relapse

PURPOSE/OBJECTIVES

To explore the processes through which patients construct their meanings of acute leukemia (AL).


RESEARCH APPROACH

An exploratory design was employed using serial, in-depth interviews, guided by Smith's Interpretative Phenomenological Analysis approach.


SETTING

Two inpatient hematology clinics in the United Kingdom.


PARTICIPANTS

10 adult patients with AL. 


METHODOLOGIC APPROACH

Two serial interviews were conducted with each participant, two to four weeks apart, within the first year of diagnosis or post-relapse.


FINDINGS

AL creates a state of imbalance, which may initiate a search for new equilibrium. Patients' journeys toward making sense of their illness may involve three interchangeable processes.

CONCLUSIONS

Findings of this contextually and methodologically novel study highlight the complex nature of sense-making for patients experiencing AL.


INTERPRETATION

Nurses can take valuable lessons on how to manage the invisibility of AL, enhance trust in healthcare professionals, address the impact of isolation, and facilitate the making-sense processes of patients in ways that favor their short- and long-term psychosocial adjustment.

Empirical relationships between health literacy and treatment decision making: a scoping review of the literature

OBJECTIVES

This study asked: What is known from the existing literature about the empirical relationships between health literacy (HL) and the three stages of the treatment decision making (TDM) process: information exchange, deliberation, and deciding on the treatment to implement?

METHODS

A scoping review of the literature was conducted. Four databases were searched and a total of 2772 records were returned. After de-duplication and three levels of relevance screening, 41 primary studies were included.

RESULTS

Relationships between HL and information exchange were studied more often than relationships between HL and deliberation and deciding on the treatment to implement. Across the 41 studies, there was little overlap in terms the measure(s) of HL adopted, the aspect of TDM considered, and the characteristics of the study populations--making comparisons of the findings difficult. Multiple knowledge gaps and measurement-related problems were identified; including, the possibility that the process of TDM influences HL.

CONCLUSION

The importance of HL to the three stages of TDM is unclear because of the knowledge gaps and measurement-related problems that exist.

PRACTICE IMPLICATIONS

There are many uncertainties about how TDM, or the design and use of patient decision aids, should respond to patients with different levels of HL.

Physician's Attitude Towards Treatment of Older Patients and the Choice of Therapy

The treatment of acute myeloid leukemia in older patients is still object of controversies, because of considerable heterogeneity among patients and different characteristics in the disease. Reluctance in administering conventional intensive chemotherapy relies on life-threatening complications induced by treatment in an often frail patient population. Nonetheless, while there is general consensus on the management of frail patients with supportive care only, a wide area of uncertainty remains for a considerable proportion of patients in whom treatment beyond support is feasible, with the aim of altering the natural history of the disease. Several predictive score have been proposed in order to prevent toxicity in absence of survival advantage; however in the daily practice patients' and physician attitude does still play a major role in the final therapeutic decision.

Contemporary perspectives on psychosomatics in Germany: A commentary on Karen Gubb's paper, "Psychosomatics today: a review of contemporary theory and practice"

Karen Gubb's (2013) review focuses on contemporary developments in psychoanalytic theory and practice in relation to psychosomatics, starting with some historical remarks, and Paris School with the Attachment approach. This paper examines the question of how the German scene fits into the issues raised in Gubb's discussion. From a historical point of view, psychosomatic thinking had already come into existence at the beginning of the twentieth century in internal medicine, influenced not only by Freud's ideas, but also by holistic philosophical approaches, anthropology, and semiotic systems theory as well. Psychosomatics is still under the influence of psychodynamic thinking, but as a required subject for all medical students, it is currently more involved in inpatient treatment settings than in psychoanalyses in the classical couch setting. Research projects using standardized questionnaires, neuroimaging, and other empirical methods have also proved that these treatments are as effective as therapy based on psychoanalytic concepts like alexithymia or the Attachment approach. In addition, qualitative methods have been implemented to grasp the fine-grained conscious and unconscious processes in the inner life of patients and in the verbal and nonverbal interaction phenomena of therapies. To sum up: Recent developments in psychoanalytic theory, which begin to overcome the differences among psychoanalytic schools in favor of re-erecting a common psychoanalytic understanding like that demonstrated in Gubb's article, fit together in bridging the gap between insights from classical psychoanalyses and results from empirical research.