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Shi M, Meltzer KJ, Dunker AM, Hall BC. Point-of-care assessment of sexual concerns among young adult oncology active patients and survivors. Support Care Cancer 2023; 31:556. [PMID: 37665432 DOI: 10.1007/s00520-023-08026-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/27/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE Adolescent and young adult (AYA) oncology populations have unique sexual health concerns that deserve more attention. Our study aimed to describe sexual health and related concerns in young adults (YAs) to move toward integrating sexual health into routine care. METHODS A total of 127 YAs (ages 19-39) in active treatment and survivorship from three outpatient oncology clinics provided demographic and clinical information. They completed versions of the NCCN Distress Thermometer and Problem List (AYA-POST; AYA-SPOST) developed specifically for AYAs as part of an ongoing needs assessment study. RESULTS Over one quarter (27.6%) of the total sample (Mage = 31.96, SD = 5.33) - 31.9% in active treatment (n = 72) and 21.8% in survivorship (n = 55) - reported at least one sexual health concern (i.e., sexual concern, loss of libido (desire for sex), pain with sex, and unprotected sex). Those undergoing active treatment with sexual concerns had significantly higher distress than those without sexual concerns, whereas this pattern was nonsignificant for those in survivorship. Both genders often endorsed general sexual concerns and loss of libido. CONCLUSION The current study adds to the important and burgeoning literature on sexual health concerns of YAs oncology populations. The prevalence of sexual concerns, differences between treatment status and between those with and without sexual concerns highlight the utility and need to embed screening that includes sexual health items at point of care. This can facilitate discussion of these sensitive and multifaceted needs throughout the cancer continuum.
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Affiliation(s)
- Molin Shi
- Department of Psychiatry, Division of Psychology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
| | - Karen J Meltzer
- Department of Psychiatry, Division of Psychology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Alexandra M Dunker
- Moncrief Cancer Institute, The University of Texas Southwestern Medical Center, 400 West Magnolia Ave, Fort Worth, TX, 76104, USA
- Fort Worth Adolescent Young Adult Oncology Coalition, 080 S Hulen St Ste 360, PMB, Fort Worth, TX, 299, USA
| | - Brittany C Hall
- Department of Psychiatry, Division of Psychology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- Moncrief Cancer Institute, The University of Texas Southwestern Medical Center, 400 West Magnolia Ave, Fort Worth, TX, 76104, USA
- Fort Worth Adolescent Young Adult Oncology Coalition, 080 S Hulen St Ste 360, PMB, Fort Worth, TX, 299, USA
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Taghavi SE, Williams AP, Leavitt A, Hoeft A, Hall BC. Adolescent and Young Adult Communication Preferences. J Adolesc Young Adult Oncol 2023; 12:599-603. [PMID: 36383117 DOI: 10.1089/jayao.2022.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to examine adolescents and young adults preferred methods of communication by health care professionals and to identify whether this aligns/differs from overall preferred methods of social media use. Sixty-seven participants completed an electronic survey about their communication preferences. Forty-eight participants were patients and 19 were parents. Logistic regression and chi-square analysis were performed to predict social media use and communication preferences from predictors including age, gender, race, and treatment status. More research is needed to generalize these results, and future research could further evaluate the effectiveness of implementing health care interventions using preferred platforms.
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Affiliation(s)
- Sarah E Taghavi
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
- UT Southwestern Moncrief Cancer Institute, Fort Worth, Texas, USA
| | | | - Antonia Leavitt
- Cook Children's Medical Center, Fort Worth, Texas, USA
- Fort Worth Adolescent Young Adult Oncology Coalition, Fort Worth, Texas, USA
| | - Alice Hoeft
- Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Brittany C Hall
- UT Southwestern Moncrief Cancer Institute, Fort Worth, Texas, USA
- Fort Worth Adolescent Young Adult Oncology Coalition, Fort Worth, Texas, USA
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Shi M, Meltzer KJ, Dunker A, Hall BC. Point of Care Assessment of Sexual Concerns among AYA Oncology Active Patients and Survivors. Res Sq 2023:rs.3.rs-2986799. [PMID: 37398255 PMCID: PMC10312983 DOI: 10.21203/rs.3.rs-2986799/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Purpose Adolescent and young adults (AYAs) oncology populations have unique sexual health concerns that deserve more attention. The current study aimed to describe the prevalence and characteristics of sexual health and related concerns in AYAs in active treatment and survivorship to move toward integrating sexual health in routine care. Methods A total of 127 AYAs (ages 19-39) in active treatment and survivorship were recruited from three outpatient oncology clinics. In addition to providing demographic and clinical information, they completed an adapted version of the NCCN Distress Thermometer and Problem List (AYA-POST; AYA-SPOST) as part of an ongoing needs assessment study. Results Over one quarter (27.6%) of the total sample ( M age = 31.96, SD = 5.33) - 31.9% of active treatment, and 21.8% in survivorship - reported at least one sexual health concern (i.e., sexual concern, loss of libido, pain with sex, and unprotected sex). The most frequently endorsed concerns differed between active treatments and survivorship. Both genders often endorsed general sexual concerns and loss of libido. Conclusion The literature on sexual concerns in the AYA population is sparse and inconclusive, especially accounting for gender and other types of concerns. The current study highlights the need for further examination between treatment status, psychosexual concerns, emotional distress, and demographic and clinical factors. Given the prevalence of sexual concerns in AYAs in active treatment and survivorship, providers should consider integrating assessment and discussion of these needs at onset of diagnosis and as part of monitoring.
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Affiliation(s)
- Molin Shi
- The University of Texas Southwestern Medical Center, Department of Psychiatry, Division of Psychology
| | - Karen J Meltzer
- The University of Texas Southwestern Medical Center, Department of Psychiatry, Division of Psychology
| | - Alexandra Dunker
- The University of Texas Southwestern Medical Center, Moncrief Cancer Institute
| | - Brittany C Hall
- The University of Texas Southwestern Medical Center, Department of Psychiatry, Division of Psychology
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Markwardt HS, Taghavi SE, Williams AP, Olivares MN, McDuffee PR, Hall BC. Tablet Versus Quick Response Code: Difference in Research Participation Rates? J Technol Behav Sci 2023; 8:178-181. [PMCID: PMC9982167 DOI: 10.1007/s41347-023-00311-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/26/2023] [Accepted: 02/18/2023] [Indexed: 03/06/2023]
Abstract
Conducting research with immunocompromised populations, especially within the context of a global pandemic, warrants consideration of alternative research methods and modes of administration to keep participants safe. Digital and internet-based research methods have been utilized to minimize the risk of harm with cancer patients; however, adolescents and young adults with cancer (AYAs) remain an under served and understudied population with high levels of unmet needs. The purpose of the current study was to examine differences in AYA research participation rates based on two digital survey administration methods (tablet versus QR code). AYAs were randomly assigned to complete an online survey using either a tablet or quick response (QR) code, and participation rates in each group were compared. The total participation rate was 22.9%, with 75% of completed surveys from the tablet group and 25% from the QR code group. While the use of a QR code allows for reduced costs for in-clinic recruitment and may be the most sanitary option during COVID-19, eligible patients in the current study showed trends of increased engagement using a sanitized tablet. It is important to consider how psychosocial research and electronic surveys are administered, as the method may impact recruitment and/or information obtained.
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Affiliation(s)
- Haley S. Markwardt
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX USA ,Department of Psychiatry, UT Southwestern Moncrief Cancer Institute, 400 West Magnolia Avenue, Fort Worth, TX 76104 USA
| | - Sarah E. Taghavi
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX USA ,Department of Psychiatry, UT Southwestern Moncrief Cancer Institute, 400 West Magnolia Avenue, Fort Worth, TX 76104 USA
| | - Addison P. Williams
- Department of Psychiatry, UT Southwestern Moncrief Cancer Institute, 400 West Magnolia Avenue, Fort Worth, TX 76104 USA
| | - Matthew N. Olivares
- Department of Psychiatry, UT Southwestern Moncrief Cancer Institute, 400 West Magnolia Avenue, Fort Worth, TX 76104 USA
| | - Peyton R. McDuffee
- Department of Psychiatry, UT Southwestern Moncrief Cancer Institute, 400 West Magnolia Avenue, Fort Worth, TX 76104 USA
| | - Brittany C. Hall
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX USA ,Department of Psychiatry, UT Southwestern Moncrief Cancer Institute, 400 West Magnolia Avenue, Fort Worth, TX 76104 USA ,Fort Worth Adolescent and Young Adult Oncology Coalition, Fort Worth, TX USA
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5
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Markwardt HS, Taghavi SE, Williams AP, Olivares MN, McDuffee PR, Al Achkar M, Hall BC. The AYA Care Plan: Initial Evaluation of a Web-Based Psychosocial Intervention. JCO Clin Cancer Inform 2022; 6:e2200086. [DOI: 10.1200/cci.22.00086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Adolescents and young adults (AYA) with cancer do not fit neatly into pediatric or older adult oncology care settings. Recent efforts have led to the development of psychosocial interventions for AYAs, but studies show AYAs demonstrate low levels of engagement in psychosocial services. The AYA Care Plan is one of the only web-based tools providing a personalized, psychosocial resource that addresses unmet needs for AYAs in active treatment and post-treatment survivorship. The current study aims to assess the usability and utility of the AYA Care Plan and identify opportunities for improvement. METHODS Clinic staff administered an online distress and needs assessment to AYA patients with cancer at outpatient oncology clinics. Personalized care plans were sent to participants on the basis of their responses. A total of 11 AYAs between the ages 18 and 39 years, with a mean age of 31.64 years, then completed qualitative interviews about their experiences. Thematic analysis was used to identify themes on the AYA Care Plan. RESULTS A majority of participants reported positive usability features. Half of the participants reported using their care plan to make health care decisions. One person indicated not finding the resources helpful, and the other half of participants reported not engaging with the care plan. Participants also offered suggestions for improvement. CONCLUSION The AYA Care Plan appears to be a useful psychosocial intervention for some AYAs with cancer. Future research should continue to examine the AYA Care Plan's usability and utility, and specify when, how, and for whom the AYA Care Plan is useful.
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Affiliation(s)
- Haley S. Markwardt
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX
- UT Southwestern Moncrief Cancer Institute, Fort Worth, TX
| | - Sarah E. Taghavi
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX
- UT Southwestern Moncrief Cancer Institute, Fort Worth, TX
| | | | | | | | | | - Brittany C. Hall
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX
- UT Southwestern Moncrief Cancer Institute, Fort Worth, TX
- Fort Worth Adolescent Young Adult Oncology Coalition, Fort Worth, TX
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6
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Markwardt HS, Taghavi SE, Sligar KB, Al Achkar M, Hall BC. Web-Based Psychosocial Care Plan for Adolescent and Young Adult Patients With Cancer: A Proposed Model and Plan for Analysis. JCO Clin Cancer Inform 2021; 5:490-493. [PMID: 33950709 DOI: 10.1200/cci.21.00029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Haley S Markwardt
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX.,UT Southwestern Moncrief Cancer Institute, Fort Worth, TX
| | - Sarah E Taghavi
- UT Southwestern Moncrief Cancer Institute, Fort Worth, TX.,Department of Psychology, Texas Christian University, Fort Worth, TX
| | - Kylie B Sligar
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX.,UT Southwestern Moncrief Cancer Institute, Fort Worth, TX
| | | | - Brittany C Hall
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX.,UT Southwestern Moncrief Cancer Institute, Fort Worth, TX.,Fort Worth Adolescent Young Adult Oncology Coalition, Fort Worth, TX
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Giberson SA, Hall BC, Jester B, Short VM, Roaten K, de la Garza N, Trivedi MH, Howe-Martin L. Suicidal Ideation and Depression Among Adolescent and Young Adult Cancer Patients. J Adolesc Young Adult Oncol 2021; 10:549-554. [PMID: 33857381 DOI: 10.1089/jayao.2020.0180] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/12/2022] Open
Abstract
Purpose: Adolescent and young adult (AYA) cancer patients (aged 18-39 years) represent a unique population within oncology. The developmental and mental health challenges that can co-occur with a diagnosis of cancer during this age range make AYAs a high-risk group for mental health problems, including depression and suicidal ideation. Therefore, the objective of this study was to assess the differences in rates of suicidal ideation and depression between AYAs and older adults (OAs; aged 40+ years) within an outpatient cancer support clinic. Methods: Depression screening data from routine clinical care were gathered and analyzed for adult patients receiving support services at an outpatient academic cancer clinic. The general mental health screening protocol included the Patient Health Questionnaire (PHQ)-9, which was used as a measure of depression symptoms, including suicidal ideation. Results: Five hundred cancer survivors were included in the initial data analysis, with 21 (40.38%) of the AYAs and 143 (31.92%) of the OAs scoring ≥5 on the PHQ-9. Statistical analysis of groups at this cutoff score reflected no significant difference in depression between AYA and OA groups. However, a chi-square analysis revealed significantly higher suicidal ideation endorsement by AYAs versus OAs in this sample (χ2 [1, N = 500] = 3.98, p = 0.046). Conclusion: Results from routinely collected clinical data reveal a higher rate of suicidal ideation in AYAs compared with OA cancer patients, which supports the need for additional research on AYA cancer patient suicidal ideation in different settings and the implementation of mental health programs specifically for AYA patients.
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Affiliation(s)
- Scott A Giberson
- Behavioral Sciences, UT Southwestern Moncrief Cancer Institute, Fort Worth, Texas, USA
| | - Brittany C Hall
- Behavioral Sciences, UT Southwestern Moncrief Cancer Institute, Fort Worth, Texas, USA.,Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA.,Fort Worth Adolescent Young Adult Oncology Coalition, Fort Worth, Texas, USA
| | - Bryan Jester
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Victoria M Short
- Behavioral Sciences, UT Southwestern Moncrief Cancer Institute, Fort Worth, Texas, USA
| | - Kimberly Roaten
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Nancy de la Garza
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Laura Howe-Martin
- Behavioral Sciences, UT Southwestern Moncrief Cancer Institute, Fort Worth, Texas, USA.,Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
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Hall BC, Short VM, Giberson S, Howe-Martin L. A Cognitive Behavioral Therapy Group for Adolescent and Young Adult Cancer Patients: A Review of a Pilot Program. J Adolesc Young Adult Oncol 2020; 9:422-425. [DOI: 10.1089/jayao.2019.0104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Brittany C. Hall
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
- UT Southwestern Moncrief Cancer Institute, Fort Worth, Texas, USA
- Fort Worth Adolescent Young Adult Oncology Coalition, Fort Worth, Texas, USA
| | - Victoria M. Short
- UT Southwestern Moncrief Cancer Institute, Fort Worth, Texas, USA
- Department of Psychology, Texas Christian University, Fort Worth, Texas, USA
| | - Scott Giberson
- UT Southwestern Moncrief Cancer Institute, Fort Worth, Texas, USA
- Department of Psychology, Texas Christian University, Fort Worth, Texas, USA
| | - Laura Howe-Martin
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
- UT Southwestern Moncrief Cancer Institute, Fort Worth, Texas, USA
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Abstract
Background:
Thought records are a core component of Cognitive Behavior Therapy. Over
time, thought records have been modified to suit various needs or preferences. A diversity of thought
records have been developed, which include differing components and cognitive change strategies.
Yet, due to a lack of specificity in the literature and field, different thought records are often treated as
though they are interchangeable. Limited extant literature suggests that differing thought records may
have unique clinical effects. However, meta-analyzing the comparable or differing effects of the distinct
extant thought records is impeded by the lack of a coding system for thought records.
Objective:
The current study sought to prepare a way for further understanding the differential utility
and effectiveness of different iterations of thought records by creating a coding system, which is
described in detail. This coding system will be used to guide future research into which thought
records work best for which problems.
Method:
Thought records were gathered from seminal texts and solicited from the certified members
of the Academy of Cognitive Therapy and the American Board of Behavioral and Cognitive
Psychology.
Results:
In total, 110 non-identical thought records were gathered and coded into 55 unique combinations.
These results demonstrate that the variability of thought records used by qualified therapists
extends well beyond those found in seminal CBT texts.
Conclusion:
This broad diversity justifies the need for a coding system to inform future lines of
research.
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Affiliation(s)
- Scott H. Waltman
- Warrior Resiliency Program, Regional Health Command-Central, San Antonio, TX 78230, United States
| | - Sarah A. Frankel
- Columbia University Medical Center, New York, NY 10032, United States
| | | | - Michael A. Williston
- Aaron T. Beck Psychopathology Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Shari Jager-Hyman
- Aaron T. Beck Psychopathology Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
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Waltman SH, Hall BC, McFarr LM, Creed TA. Clinical Case Consultation and Experiential Learning in Cognitive Behavioral Therapy Implementation: Brief Qualitative Investigation. J Cogn Psychother 2018; 32:112-127. [PMID: 32746401 DOI: 10.1891/0889-8391.32.2.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/25/2022]
Abstract
There has been an increased emphasis on the implementation of cognitive behavioral therapy (CBT) to community mental health (CMH) systems due to its broad efficacy. Previous research has highlighted the importance of ongoing consultation in this process. The current study clarifies the role and process of clinical case consultation in the implementation of CBT to CMH from the consultants' perspective. Trainers from two large-scale implementation initiatives (n = 27) were surveyed regarding their strategies used in the consultation process. Historically, researchers have focused on trainees who view relational variables as the most effective elements of consultation; however, in the current study, trainers perceived experiential learning as being the most effective consultation strategy for helping CMH clinicians learn CBT. Other aspects of consultation such as case conceptualization and practice sample review are discussed in terms of their relative perceived utility in raising CMH clinician's competency to treat comorbid patients.
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Affiliation(s)
- Scott H Waltman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania .,Warrior Resiliency Program, Brooke Army Medical Center, San Antonio, Texas
| | | | | | - Torrey A Creed
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Waltman S, Hall BC, McFarr LM, Beck AT, Creed TA. In-Session Stuck Points and Pitfalls of Community Clinicians Learning CBT: Qualitative Investigation. Cognitive and Behavioral Practice 2017. [DOI: 10.1016/j.cbpra.2016.04.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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12
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Hall BC, Stewart DG, Arger C, Athenour DR, Effinger J. Modeling motivation three ways: effects of MI metrics on treatment outcomes among adolescents. Psychol Addict Behav 2014; 28:307-12. [PMID: 24467198 DOI: 10.1037/a0033845] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of this study was to determine how three different measures of motivation (cognitive motivation, taking steps, and self-efficacy for change and maintenance) predict substance use outcomes after engaging in a Motivational Interviewing intervention. Participants were 225 high school students enrolled in Project Reducing the Effects of Alcohol and Drugs on Youth (Project READY), a NIDA-funded intervention initially developed with Motivational Interviewing (MI) principles for adolescents identified by schools as having problems with alcohol or other drug use. We measured motivation at multiple time points during the intervention in multiple methods. Cognitive motivation was assessed using a Decisional Balance matrix at Session 3 of treatment. We measured self-efficacy with the Situational Confidence Questionnaire, administered at 4-, 8-, 12-, and 16-week follow-ups. A measure of taking steps (SOCRATES, v. 8) was administered at intake and Session 8. We hypothesized that motivation would follow the Transtheoretical Model (TTM) pathway, and we proposed a model where cognitive motivation would predict self-confidence for change and taking steps toward change, and self-confidence and taking steps would predict substance use outcomes. We tested our model using path analysis in AMOS and found support for a motivational continuum predicting percent days abstinent at 16-week follow-up [χ(2) = 2.75, df = 7, p = .90, CFI = 1, RMSEA (90% confidence interval) = .00 - .03]. This model demonstrates that motivational metrics predict unique outcomes at different time points and serve as important components of intervention.
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Affiliation(s)
- Brittany C Hall
- School of Psychology, Family, & Community, Seattle Pacific University
| | - David G Stewart
- School of Psychology, Family, & Community, Seattle Pacific University
| | - Chris Arger
- School of Psychology, Family, & Community, Seattle Pacific University
| | - Dylan R Athenour
- School of Psychology, Family, & Community, Seattle Pacific University
| | - Jenell Effinger
- School of Psychology, Family, & Community, Seattle Pacific University
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Green DM, Hyland A, Barcos MP, Reynolds JA, Lee RJ, Hall BC, Zevon MA. Second malignant neoplasms after treatment for Hodgkin's disease in childhood or adolescence. J Clin Oncol 2000; 18:1492-9. [PMID: 10735897 DOI: 10.1200/jco.2000.18.7.1492] [Citation(s) in RCA: 117] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the frequency of and risk factors for second malignant neoplasms (SMNs) after treatment for Hodgkin's disease diagnosed in children and adolescents. PATIENTS AND METHODS One hundred eighty-two consecutive, previously untreated patients with Hodgkin's disease who were younger than 20 years of age at diagnosis and who were referred to Roswell Park Cancer Institute (Buffalo, NY) for treatment between January 1, 1960, and December 31, 1989, were studied. Sex-specific standardized incidence ratios (SIRs) were calculated. Kaplan-Meier survival estimates and Cox regression analyses were performed to determine the relationship of several demographic and treatment variables to SMN incidence. RESULTS Twenty-eight patients developed an SMN at a mean of 14.93 +/- 8.09 years (range, 2.65 to 29.88 years) after diagnosis of Hodgkin's disease. The cumulative percentage of patients who developed an SMN was 26.27 +/- 6.75% at 30 years after diagnosis. The SIR was 9.39 (95% confidence interval [CI], 4.05 to 18.49) for male patients and 10.16 (95% CI, 5.56 to 17.05) for female patients. The most frequent SMNs were thyroid cancer, breast cancer, nonmelanoma skin cancer, non-Hodgkin's lymphoma, and acute leukemia. Multivariate analysis of sex, treatment with any alkylating agent, treatment with doxorubicin, splenectomy, and relapse (as a time-dependent covariate) with time to SMN onset gave nonsignificant results. CONCLUSION Successfully treated children and adolescents with Hodgkin's disease have a substantial risk for the occurrence of subsequent neoplasms. The most frequent SMNs (skin, thyroid, and breast) are readily detected by physical examination and available screening procedures.
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Affiliation(s)
- D M Green
- Departments of Pediatrics, Cancer Prevention, Epidemiology and Biostatistics, Pathology, Radiation Medicine, and Psychology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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14
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Green DM, Hyland A, Chung CS, Zevon MA, Hall BC. Cancer and cardiac mortality among 15-year survivors of cancer diagnosed during childhood or adolescence. J Clin Oncol 1999; 17:3207-15. [PMID: 10506620 DOI: 10.1200/jco.1999.17.10.3207] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.0] [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: 11/20/2022] Open
Abstract
PURPOSE To evaluate the impact of cardiac disease and second malignant neoplasms on late mortality rate and to identify risk factors for late mortality among 15-year survivors of cancer diagnosed during childhood or adolescence. PATIENTS AND METHODS Gender-specific all-cause and cause-specific (cardiac disease, cancer) standardized mortality ratios were calculated. Kaplan-Meier survival estimates and Cox regression analyses were performed to determine the relationship of several demographic and treatment variables to survival. RESULTS Patients who survived for 15 years after diagnosis had excess subsequent all-cause, cancer (second malignant neoplasms only), and cardiac mortality rates. No decrease in the late mortality rate by treatment era (1960 to 1970, 1971 to 1984) was identified. Risk factors for males included disease recurrence during the first 15 years after diagnosis, treatment with doxorubicin, and the diagnosis of Hodgkin's disease. Those for females included treatment with radiation therapy, treatment with an alkylating agent, and disease recurrence during the first 15 years after diagnosis. Cox regression analysis demonstrated that only an initial duration of remission of less than 15 years (P <.01) and treatment with doxorubicin (P =.08) were significantly associated with shorter survival time for males. No variable was significantly associated with shorter survival time for females in Cox regression analysis. CONCLUSION Fifteen-year survivors of childhood cancer have excess mortality. More effective treatments must be developed to reduce this excess risk. Fifteen-year relapse-free survivors did not have excess mortality. This group will require continued observation to determine whether excess mortality will become apparent as more events occur.
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Affiliation(s)
- D M Green
- Department of Cancer Prevention, Pediatrics, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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15
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Bruce MI, Hall BC, Skelton BW, White AH. Cleavage of a Bicyclo[2.2.1]hepta-2,5-dienyl Ligand During Transfer From Nickel to Ruthenium. X-Ray Structure of Ru2{μ-η1,O:η2-C(CO2Me)=CHC(O) Ome }(CO)4Cp. Aust J Chem 1996. [DOI: 10.1071/ch9961019] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The reaction between Ru3(CO)12 and Ni{η1,η2-C5H5C2(CO2Me)2}Cp afforded orange Ru2{μ-η1,O:η2-C(CO2Me)=CHC(O) Ome }(CO)4Cp(43%) as the only isolable complex. An X-ray structure determination showed that a C(CO2Me)=CHC(O) OMe ligand bridges an Ru-Ru bond [2.7744(9) Ǻ] via a μ-η1:η2-vinyl interaction and by coordination of one of the ester CO groups [ Ru -O 2.148(2) Ǻ]. One ruthenium atom bears three terminal CO ligands and the other ruthenium atom has one CO ligand and an η5-C5H5 group. In the reaction, transfer of Cp and the vinyl group (from the bicyclo [2.2.1]hepta-2,5-dienyl ligand originally present) from nickel to ruthenium has occurred.
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Vinogradov SN, Shlom JM, Hall BC, Kapp OH, Mizukami H. The dissociation of Lumbricus terrestris hemoglobin: a model of its subunit structure. Biochim Biophys Acta 1977; 492:136-55. [PMID: 16663 DOI: 10.1016/0005-2795(77)90221-5] [Citation(s) in RCA: 104] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Vinogradov SN, Hall BC, Shlom JM. Subunit homology in invertebrate hemoglobins: a primitive heme binding chain? Comp Biochem Physiol B 1976; 53:89-92. [PMID: 1248223 DOI: 10.1016/0305-0491(76)90103-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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