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Ingerski LM, Wilkins ML, Rach AM, Patel N, Gaur AH. Use of Placebo Pills Before Treatment Initiation in Youth with HIV: Are They Ready? J Int Assoc Provid AIDS Care 2017; 16:412-417. [PMID: 28393664 DOI: 10.1177/2325957417702483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Highly active antiretroviral therapy (HAART) nonadherence is related to negative health outcomes and is well-documented in adolescents and young adults (AYAs) with behaviorally acquired HIV. Few studies describe methods to improve adherence in this population. This retrospective study describes placebo pill trial use (ie, pills with inert substance prescribed to practice taking HAART) in AYAs initiating HAART and its relation to disease outcomes. Sixty-two AYAs initiated HAART during the review period. Disease outcomes during the first year of standard clinical care were abstracted from medical records. In all, 72.6% of participants received ≥1 pill trial and 27.4% received ≥2 trials. Placebo trial use was not independently related to adherence post-HAART initiation. "Prescription" of a second trial was related to less optimal disease status over the first 6 months of treatment. Placebo trials have the potential to inform clinical care, aid in identifying AYAs at risk for nonadherence, and may provide a novel intervention strategy before/after HAART initiation.
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Affiliation(s)
- Lisa M Ingerski
- 1 Department of Psychology, St Jude Children's Research Hospital, Memphis, TN, USA.,2 Department of Pediatrics, Emory University School of Medicine; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Megan L Wilkins
- 3 Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Amanda M Rach
- 1 Department of Psychology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Nehali Patel
- 3 Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Aditya H Gaur
- 3 Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN, USA
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Martin PK, Hunter BP, Rach AM, Heinrichs RJ, Schroeder RW. Excessive decline from premorbid functioning: detecting performance invalidity with the WAIS-IV and demographic predictions. Clin Neuropsychol 2017; 31:829-843. [DOI: 10.1080/13854046.2017.1284265] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Phillip K. Martin
- Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, Wichita, KS, USA
| | - Ben P. Hunter
- Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, Wichita, KS, USA
| | - Amanda M. Rach
- Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, Wichita, KS, USA
| | - Robin J. Heinrichs
- Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, Wichita, KS, USA
| | - Ryan W. Schroeder
- Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, Wichita, KS, USA
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Rach AM, Crabtree VM, Brinkman TM, Zeltzer L, Marchak JG, Srivastava D, Tynes B, Lai JS, Robison LL, Armstrong GT, Krull KR. Predictors of fatigue and poor sleep in adult survivors of childhood Hodgkin's lymphoma: a report from the Childhood Cancer Survivor Study. J Cancer Surviv 2016; 11:256-263. [PMID: 27837445 DOI: 10.1007/s11764-016-0583-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Survivors of pediatric Hodgkin's lymphoma (HL) are at risk for a number of debilitating late effects. Excessive fatigue and poor sleep quality are primary complaints of HL survivors. Understanding the emotional and physical factors that influence fatigue and sleep quality may provide opportunities for intervention to improve health-related quality of life for HL survivors. METHODS Data from 751 adult survivors of childhood HL who participated in the Childhood Cancer Survivor Study (CCSS) from 2000-2002 were analyzed. Multivariable logistic regression analyses investigated the demographic, psychological, and physical variables that predicted clinically significant levels of poor sleep quality, fatigue, and excessive daytime sleepiness. RESULTS Survivors' self-reported level of emotional distress, pain, and physical functioning limitations did not differ from population norms. Clinically elevated levels of emotional distress (OR 8.38, 95% CI 4.28-16.42) and pain (OR 3.73, 95% CI 2.09-6.67) increased the risk for endorsing elevated levels of fatigue. Survivors with elevated levels of emotional distress (OR 6.83, 95% CI 2.71-15.90) and pain (OR 5.27, 95% CI 1.78-15.61) were more likely to report poor sleep quality. Pain (OR 2.11, 95% CI 1.39-3.34) was related to excessive daytime sleepiness. CONCLUSIONS Emotional and physical factors are associated with elevated levels of fatigue, excessive daytime sleepiness, and poor sleep quality in survivors of pediatric HL. This is consistent with findings from research conducted with non-cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS These results suggest that interventions designed to target sleep and fatigue difficulties in the general population may be well suited for pediatric HL survivors as well.
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Affiliation(s)
- Amanda M Rach
- UVA Neurocognitive Assessment Lab, The University of Virginia Health System, Charlottesville, VA, 22908, USA
| | - Valerie McLaughlin Crabtree
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 101, Memphis, TN, 38105, USA
| | - Tara M Brinkman
- Epidemiology and Cancer Control, St. Jude Children's Research Hospital, MS 735, Room S6047, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Lonnie Zeltzer
- Division of Pediatric Hematology-Oncology, David Geffen School of Medicine at UCLA, 22-464 MDCC, 10833 LeConte Ave, Los Angeles, CA, 90095, USA
| | | | - Deokumar Srivastava
- Biostatistics, St. Jude Children's Research Hospital, MS 768, Room 6010, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Brooklee Tynes
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 101, Memphis, TN, 38105, USA
| | - Jin-Shei Lai
- Department of Medical Social Sciences, Northwestern University, 633 N St. Clair 19th Floor, Chicago, IL, 60611, USA
| | - Leslie L Robison
- Epidemiology and Cancer Control, St. Jude Children's Research Hospital, MS 735, Room S6010, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Gregory T Armstrong
- Epidemiology and Cancer Control, St. Jude Children's Research Hospital, MS 735, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Kevin R Krull
- Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Ms 735, Room S6037, 262 Danny Thomas Place, Memphis, TN, 38105, USA.
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Chochinov HM, McClement SE, Hack TF, McKeen NA, Rach AM, Gagnon P, Sinclair S, Taylor-Brown J. Health care provider communication: an empirical model of therapeutic effectiveness. Cancer 2013; 119:1706-13. [PMID: 23341092 PMCID: PMC3654554 DOI: 10.1002/cncr.27949] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 10/02/2012] [Accepted: 10/23/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients who are facing life-threatening and life-limiting cancer almost invariably experience psychological distress. Responding effectively requires therapeutic sensitivity and skill. In this study, we examined therapeutic effectiveness within the setting of cancer-related distress with the objective of understanding its constituent parts. METHODS Seventy-eight experienced psychosocial oncology clinicians from 24 health care centers across Canada were invited to participate in 3 focus groups each. In total, 29 focus groups were held over 2 years, during which clinicians articulated the therapeutic factors deemed most helpful in mitigating patient psychosocial distress. The content of each focus group was summarized into major themes and was reviewed with participants to confirm their accuracy. Upon completion of the focus groups, workshops were held in various centers, eliciting participant feedback on an empirical model of therapeutic effectiveness based on the qualitative analysis of focus group data. RESULTS Three primary, interrelated therapeutic domains emerged from the data, forming a model of optimal therapeutic effectiveness: 1) personal growth and self-care (domain A), 2) therapeutic approaches (domain B), and 3) creation of a safe space (domain C). Areas of domain overlap were identified and labeled accordingly: domain AB, therapeutic humility; domain BC, therapeutic pacing; and domain AC, therapeutic presence. CONCLUSIONS This empirical model provides detailed insights regarding the elements and pedagogy of effective communication and psychosocial care for patients who are experiencing cancer-related distress.
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Affiliation(s)
- Harvey M Chochinov
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.
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Chochinov HM, McClement SE, Hack TF, McKeen NA, Rach AM, Gagnon P, Sinclair S, Taylor-Brown J. The Patient Dignity Inventory: applications in the oncology setting. J Palliat Med 2013; 15:998-1005. [PMID: 22946576 DOI: 10.1089/jpm.2012.0066] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Patient Dignity Inventory (PDI) is a novel 25-item psychometric instrument, designed to identify multiple sources of distress (physical, functional, psychosocial, existential, and spiritual) commonly seen in patients who are terminally ill. It was also designed to help guide psychosocial clinicians in their work with patients. While its validity and reliability have been studied within the context of palliative care, its utility in clinical settings has not as yet been examined. PURPOSE The purpose of this study was to determine how psychosocial oncology professionals would use the PDI with within their practice and what utility it might have across the broad spectrum of cancer. METHODS Between October 2008 and January 2009, psychosocial oncology clinicians from across Canada were invited to use the PDI to determine their impressions of this approach in identifying distress and informing their practice. RESULTS Ninety participants used the PDI and submitted a total of 429 feedback questionnaires detailing their experience with individual patients. In 76% of instances, the PDI revealed one or more previously unreported concerns; in 81% of instances, clinicians reported that the PDI facilitated their work. While it was used in a wide range of circumstances, clinicians were more inclined to apply the PDI to patients engaged in active treatment or palliation, rather than those in remission, having recently relapsed, or newly diagnosed. Besides its utility in identifying distress, the PDI enabled clinicians to provide more targeted therapeutic responses to areas of patient concern. CONCLUSIONS While this study suggests various clinical applications of the PDI, it also provides an ideal forerunner for research that will directly engage patients living with cancer.
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Affiliation(s)
- Harvey Max Chochinov
- Department of Psychiatry, Manitoba Palliative Care Research Unit, Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada.
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