Psychosocial factors, health behaviors and risk of cancer incidence: Testing interaction and effect modification in an individual participant data meta-analysis

Depression, anxiety and other psychosocial factors are hypothesized to be involved in cancer development. We examined whether psychosocial factors interact with or modify the effects of health behaviors, such as smoking and alcohol use, in relation to cancer incidence. Two-stage individual participant data meta-analyses were performed based on 22 cohorts of the PSYchosocial factors and CAncer (PSY-CA) study. We examined nine psychosocial factors (depression diagnosis, depression symptoms, anxiety diagnosis, anxiety symptoms, perceived social support, loss events, general distress, neuroticism, relationship status), seven health behaviors/behavior-related factors (smoking, alcohol use, physical activity, body mass index, sedentary behavior, sleep quality, sleep duration) and seven cancer outcomes (overall cancer, smoking-related, alcohol-related, breast, lung, prostate, colorectal). Effects of the psychosocial factor, health behavior and their product term on cancer incidence were estimated using Cox regression. We pooled cohort-specific estimates using multivariate random-effects meta-analyses. Additive and multiplicative interaction/effect modification was examined. This study involved 437,827 participants, 36,961 incident cancer diagnoses, and 4,749,481 person years of follow-up. Out of 744 combinations of psychosocial factors, health behaviors, and cancer outcomes, we found no evidence of interaction. Effect modification was found for some combinations, but there were no clear patterns for any particular factors or outcomes involved. In this first large study to systematically examine potential interaction and effect modification, we found no evidence for psychosocial factors to interact with or modify health behaviors in relation to cancer incidence. The behavioral risk profile for cancer incidence is similar in people with and without psychosocial stress.

The mediating role of health behaviors in the association between depression, anxiety and cancer incidence: an individual participant data meta-analysis

BACKGROUND

Although behavioral mechanisms in the association among depression, anxiety, and cancer are plausible, few studies have empirically studied mediation by health behaviors. We aimed to examine the mediating role of several health behaviors in the associations among depression, anxiety, and the incidence of various cancer types (overall, breast, prostate, lung, colorectal, smoking-related, and alcohol-related cancers).

METHODS

Two-stage individual participant data meta-analyses were performed based on 18 cohorts within the Psychosocial Factors and Cancer Incidence consortium that had a measure of depression or anxiety (N = 319 613, cancer incidence = 25 803). Health behaviors included smoking, physical inactivity, alcohol use, body mass index (BMI), sedentary behavior, and sleep duration and quality. In stage one, path-specific regression estimates were obtained in each cohort. In stage two, cohort-specific estimates were pooled using random-effects multivariate meta-analysis, and natural indirect effects (i.e. mediating effects) were calculated as hazard ratios (HRs).

RESULTS

Smoking (HRs range 1.04-1.10) and physical inactivity (HRs range 1.01-1.02) significantly mediated the associations among depression, anxiety, and lung cancer. Smoking was also a mediator for smoking-related cancers (HRs range 1.03-1.06). There was mediation by health behaviors, especially smoking, physical inactivity, alcohol use, and a higher BMI, in the associations among depression, anxiety, and overall cancer or other types of cancer, but effects were small (HRs generally below 1.01).

CONCLUSIONS

Smoking constitutes a mediating pathway linking depression and anxiety to lung cancer and smoking-related cancers. Our findings underline the importance of smoking cessation interventions for persons with depression or anxiety.

Looking at individual symptoms: the dynamic network structure of depressive symptoms in cancer survivors and their preferences for psychological care

PURPOSE

The majority of depressed cancer survivors do not receive psychological care, possibly because offered care does not align with their experiences and preferences. We examined (1) which depressive symptoms cancer survivors would like to receive psychological care for; (2) how distinct depressive symptoms are related to each other in the contemporaneous and temporal network of depressive symptoms; and (3) whether survivors' care needs correspond to the interconnectedness of these specific symptoms.

METHOD

Fifty-two cancer survivors suffering from at least mild depressive symptoms and were not receiving psychological care filled out a baseline questionnaire about their care needs for distinct depressive symptoms, followed by ecological momentary assessments (EMA) assessing depressive symptoms (14 days, five times a day). Multi-level vector autoregression analysis was used to estimate associations between distinct depressive symptoms as well as their centrality within the network.

RESULTS

Cancer survivors most strongly preferred to receive care for fatigue, feeling down, little enjoyment, and sleep problems. Fatigue, together with worry and lack of concentration, most strongly predicted the onset of other symptoms. Little enjoyment and feeling down were two of the most central symptoms (i.e., strongly connected to other symptoms) in the contemporaneous network and were most strongly influenced by other symptoms in the temporal network.

CONCLUSIONS

Clinicians can offer specific interventions that target fatigue, as these played an important role in the onset of symptoms and would align with survivors' needs.

IMPLICATIONS FOR CANCER SURVIVORS

Offering such symptom-specific care may increase the uptake of psychological interventions in cancer survivors.

Depression, anxiety, and the risk of cancer: An individual participant data meta-analysis

BACKGROUND

Depression and anxiety have long been hypothesized to be related to an increased cancer risk. Despite the great amount of research that has been conducted, findings are inconclusive. To provide a stronger basis for addressing the associations between depression, anxiety, and the incidence of various cancer types (overall, breast, lung, prostate, colorectal, alcohol-related, and smoking-related cancers), individual participant data (IPD) meta-analyses were performed within the Psychosocial Factors and Cancer Incidence (PSY-CA) consortium.

METHODS

The PSY-CA consortium includes data from 18 cohorts with measures of depression or anxiety (up to N = 319,613; cancer incidences, 25,803; person-years of follow-up, 3,254,714). Both symptoms and a diagnosis of depression and anxiety were examined as predictors of future cancer risk. Two-stage IPD meta-analyses were run, first by using Cox regression models in each cohort (stage 1), and then by aggregating the results in random-effects meta-analyses (stage 2).

RESULTS

No associations were found between depression or anxiety and overall, breast, prostate, colorectal, and alcohol-related cancers. Depression and anxiety (symptoms and diagnoses) were associated with the incidence of lung cancer and smoking-related cancers (hazard ratios [HRs], 1.06-1.60). However, these associations were substantially attenuated when additionally adjusting for known risk factors including smoking, alcohol use, and body mass index (HRs, 1.04-1.23).

CONCLUSIONS

Depression and anxiety are not related to increased risk for most cancer outcomes, except for lung and smoking-related cancers. This study shows that key covariates are likely to explain the relationship between depression, anxiety, and lung and smoking-related cancers. PREREGISTRATION NUMBER: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=157677.

Stress appraisal and emotion regulation mediate the association between mindfulness and affect in cancer patients: Differential mechanisms for positive and negative affect

OBJECTIVE

Cancer patients are at an increased risk for affective problems, including feelings of anxiety and depression. Mindfulness has been linked to an array of benefits for affective functioning in various populations including cancer patients, but the mechanisms underlying this relationship are still poorly understood. Based on emotion-regulation and stress-coping models, this study examined the potential mediating role of stress appraisal and coping strategies in the associations between mindfulness and cancer patients' positive and negative affect.

METHODS

For this cross-sectional study, 245 cancer patients completed self-report questionnaires measuring mindfulness (FFMQ), positive and negative affect (PANAS), stress appraisal (SPSI-R:S), coping through positive reappraisal and positive refocusing (CERQ), rumination (RRQ), and distraction (COPE). Serial mediation analyses were conducted using the regression-based bootstrapping method.

RESULTS

Higher levels of mindfulness were associated with higher levels of positive affect; this relationship was mediated via stress appraisal and positive reappraisal. We also found an indirect effect from mindfulness directly via positive reappraisal to positive affect. In addition, higher levels of mindfulness were negatively associated with negative affect; this relationship was mediated via stress appraisal and rumination, with also an indirect effect from mindfulness directly via stress appraisal to negative affect.

CONCLUSIONS

Results suggest that stress appraisal and distinct coping strategies mediate the relationship between mindfulness and affect. Mindfulness may provide benefits for cancer patients' affect by allowing adaptive stress appraisal and ways of coping through more positive and less negative thinking.

Personal Health Record for Personalizing Research and Care Trajectories: A Proof of Concept Pilot with Diet in Inflammatory Bowel Diseases

Combinations of health-related research data and clinical data generated, e.g., from wearables, can increasingly provide new insights about a person’s health. Combining these data in a personal health record (PHR), which is managed by citizens themselves, can enhance research and enable both personalized care and prevention. We piloted a hybrid PHR using it for scientific research and the concomitant return of individual findings for clinical information and prevention purposes. The obtained information on the quality of daily dietary intake allowed researchers to further investigate the association between diet and inflammatory bowel diseases (IBDs). Additionally, the feedback enabled participants to adjust their food intake to improve the quality and prevent nutritional deficiency, thereby increasing their health. Our results showed that a PHR including a Research Connection can be successfully used for both purposes but requires a good embedding in both research and healthcare processes with the cooperation of healthcare professionals and researchers. Addressing these challenges is key in the pursuit of delivering personalized medicine and building learning health systems with PHRs.

Parent-reported phenotype data on chromosome 6 aberrations collected via an online questionnaire: data consistency and data availability

BACKGROUND

Even with the introduction of new genetic techniques that enable accurate genomic characterization, knowledge about the phenotypic spectrum of rare chromosomal disorders is still limited, both in literature and existing databases. Yet this clinical information is of utmost importance for health professionals and the parents of children with rare diseases. Since existing databases are often hampered by the limited time and willingness of health professionals to input new data, we collected phenotype data directly from parents of children with a chromosome 6 disorder. These parents were reached via social media, and the information was collected via the online Chromosome 6 Questionnaire, which includes 115 main questions on congenital abnormalities, medical problems, behaviour, growth and development.

METHODS

Here, we assess data consistency by comparing parent-reported phenotypes to phenotypes based on copies of medical files for the same individual (n = 20) and data availability by comparing the data available on specific characteristics reported by parents (n = 34) to data available in existing literature (n = 39).

RESULTS

The reported answers to the main questions on phenotype characteristics were 85-95% consistent, and the consistency of answers to subsequent more detailed questions was 77-96%. For all but two main questions, significantly more data was collected from parents via the Chromosome 6 Questionnaire than was currently available in literature. For the topics developmental delay and brain abnormalities, no significant difference in the amount of available data was found. The only feature for which significantly more data was available in literature was a sub-question on the type of brain abnormality present.

CONCLUSION

This is the first study to compare phenotype data collected directly from parents to data extracted from medical files on the same individuals. We found that the data was highly consistent, and phenotype data collected via the online Chromosome 6 Questionnaire resulted in more available information on most clinical characteristics when compared to phenotypes reported in literature reports thus far. We encourage active patient participation in rare disease research and have shown that parent-reported phenotypes are reliable and contribute to our knowledge of the phenotypic spectrum of rare chromosomal disorders.

Sub-groups (profiles) of individuals experiencing post-traumatic growth during the COVID-19 pandemic

Objective

Some people experience post-traumatic growth (PTG), entailing positive changes such as a greater appreciation of life following traumatic events. We examined PTG in the context of the negative consequences of the COVID-19 pandemic, notably working from home and social distancing. We aimed to assess whether distinct sub-groups (profiles) of individuals experiencing PTG could be identified by how they appraised and coped with the COVID-19 pandemic.

Method

For this cross-sectional study, we used convenience sampling. In total, 951 participants from the general population completed an online questionnaire with items focusing on primary and secondary appraisal, positive reappraisal, rumination, and coping flexibility. For the latent profile analysis, we selected a sample of 392 individuals who had experienced moderate degrees of pandemic-related PTG, reporting at least two of the 10 positive changes in the PTG Inventory-Short Form.

Results

We identified two distinct profiles among people experiencing PTG. The first was characterised by low levels of primary appraisal and stressfulness and higher levels of secondary appraisal (e.g., resilient group), increased coping flexibility and greater use of positive reappraisal. The second was characterised by higher levels of stressfulness and primary appraisal (e.g., stressed group) and greater use of rumination.

Conclusion

The two sub-groups evidently appraised and coped with the COVID-19 pandemic differently. Therefore, future research should account for these different profiles of people experiencing PTG.

Does social support at home moderate the association between social support at work and work functioning among cancer patients?

PURPOSE

The aims of this study were to examine (1) the longitudinal associations of supervisor and colleague social support with work functioning in cancer patients who have returned to work and (2) the moderating role of social support at home.

METHODS

Data from the longitudinal Work Life after Cancer study were used (n = 384). Work functioning (low versus moderate to high work functioning) was measured with the validated Work Role Functioning Questionnaire 2.0. Social support at work was measured from both supervisor and colleagues with the Copenhagen Psychosocial Questionnaire. Social support at home was measured with the Social Support List-Discrepancies. Logistic generalized estimating equations were used to analyse associations between supervisor and colleague social support and work functioning, and to examine the possible moderating effect of social support at home.

RESULTS

More supervisor (OR: 1.21; 95% CI: 1.10, 1.32) and colleague (1.13; 1.03, 1.24) social support were significantly associated with moderate to high work functioning. The association between colleague social support and work functioning was attenuated for those who did not experience enough social support at home but remained almost significant for supervisor social support (1.17; 1.00, 1.37).

CONCLUSIONS

Supervisor social support is associated with better work functioning regardless of social support at home, while colleague social support is only associated with better work functioning when cancer patients experience enough social support at home.

IMPLICATIONS FOR CANCER SURVIVORS

Occupational physicians may play a key role in creating awareness that social support at work and at home are beneficial for cancer patients' work functioning.

Parental experiences of rapid exome sequencing in cases with major ultrasound anomalies during pregnancy

BACKGROUND

Adding rapid exome sequencing (rES) to conventional genetic tests improves the diagnostic yield of pregnancies showing ultrasound abnormalities but also carries a higher chance of unsolicited findings. We evaluated how rES, including pre- and post-test counseling, was experienced by parents investigating its impact on decision-making and experienced levels of anxiety.

METHODS

A mixed-methods approach was adopted. Participating couples (n = 46) were asked to fill in two surveys (pre-test and post-test counseling) and 11 couples were approached for an additional interview.

RESULTS

All couples accepted the rES test-offer with the most important reason for testing emphasizing their hope of finding an underlying diagnosis that would aid decision-making. The actual impact on decision-making was low, however, since most parents decided to terminate the pregnancy based on the major and multiple fetal ultrasound anomalies and did not wait for their rES results. Anxiety was elevated for most participants and decreased over time.

CONCLUSION

Major congenital anomalies detected on ultrasound seem to have more impact on prenatal parental decision-making and anxiety then the offer and results of rES. However, the impact of rES on reproductive decision-making and experienced anxiety requires further investigation, especially in pregnancies where less (severe) fetal anomalies are detected on ultrasound.

Psychosocial factors and cancer incidence (PSY-CA): Protocol for individual participant data meta-analyses

OBJECTIVES

Psychosocial factors have been hypothesized to increase the risk of cancer. This study aims (1) to test whether psychosocial factors (depression, anxiety, recent loss events, subjective social support, relationship status, general distress, and neuroticism) are associated with the incidence of any cancer (any, breast, lung, prostate, colorectal, smoking-related, and alcohol-related); (2) to test the interaction between psychosocial factors and factors related to cancer risk (smoking, alcohol use, weight, physical activity, sedentary behavior, sleep, age, sex, education, hormone replacement therapy, and menopausal status) with regard to the incidence of cancer; and (3) to test the mediating role of health behaviors (smoking, alcohol use, weight, physical activity, sedentary behavior, and sleep) in the relationship between psychosocial factors and the incidence of cancer.

METHODS

The psychosocial factors and cancer incidence (PSY-CA) consortium was established involving experts in the field of (psycho-)oncology, methodology, and epidemiology. Using data collected in 18 cohorts (N = 617,355), a preplanned two-stage individual participant data (IPD) meta-analysis is proposed. Standardized analyses will be conducted on harmonized datasets for each cohort (stage 1), and meta-analyses will be performed on the risk estimates (stage 2).

CONCLUSION

PSY-CA aims to elucidate the relationship between psychosocial factors and cancer risk by addressing several shortcomings of prior meta-analyses.

Understanding care needs of cancer patients with depressive symptoms: The importance of patients' recognition of depressive symptoms

Objective

The majority of cancer patients with depressive symptoms does not perceive a need for psychological care. Reasons for this are still unclear. We examined the mediating role of cancer patients' perceptions of depressive symptoms in the relationship between depressive symptoms and perceived need for psychological care.

Methods

For this cross‐sectional study, we recruited 127 Dutch cancer patients with moderate to severe levels of depressive symptoms (Patient Health Questionnaire [PHQ]‐9≥10) who did not receive professional psychological care. Depressive symptoms were measured with the PHQ‐9 questionnaire, by using three different depression score operationalizations. We used mediation analyses to test the mediating role of patients' illness perceptions (measured with subscales of the Brief Illness Perception Questionnaire) in the relation between depressive symptoms and need for care.

Results

Whilst results did not show significant direct associations between depressive symptoms and perceived need for psychological care, we found positive indirect effects of severity (B = 0.07, SE = 0.04, p < 0.02), meeting the DSM‐5 diagnosis (B = 0.45, SE = 0.26, p < 0.02) and having relatively more affective symptoms (B = 2.37, SE = 1.10, p < 0.02) on need for care through the identity perception.

Conclusions

Including assessments of patients' recognition of depressive symptoms and their perceptions of depression treatment efficacy might improve depression screening in cancer patients by more accurately identifying those with a need for psychological care. Moreover, improving patients' knowledge and recognition of symptoms as being depressive symptoms might be a possible target point in increasing care needs and hereby optimizing the uptake of psychological care in cancer patients with depressive symptoms.

Trajectories of fatigue in cancer patients during psychological care

OBJECTIVE

Psycho-oncological institutions offer specialized care for cancer patients. Little is known how this care might impact fatigue. This study aimed to identify fatigue trajectories during psychological care, examined factors distinguishing these trajectories and predicted fatigue severity after nine months of psychological care.

DESIGN

Naturalistic, longitudinal study of 238 cancer patients receiving psycho-oncological care in the Netherlands. Data were collected before initiation of psychological care (T1) and three (T2) and nine months (T3) afterwards. Latent class growth analysis, repeated measure analyses (RMA) and linear regression analysis were performed.

MAIN OUTCOME MEASURES

Fatigue severity: Checklist Individual Strength.

RESULTS

Three fatigue trajectories were identified: high- (30%), moderate- (62%) and low-level fatigue (8%). While statistically significant decreases in fatigue were found, this decrease was not clinically relevant. RMA showed main effects for time for fatigue trajectories on depression, anxiety, personal control and illness cognitions. Fatigue severity and physical symptoms at T1, but not demographic or clinical factors, were predictive of fatigue severity at T3.

CONCLUSIONS

Fatigue is very common during psycho-oncological care, and notably not clinically improving. As symptoms of fatigue, depression, anxiety and physical symptoms often cluster, supplementary fatigue treatment should be considered when it is decided to treat other symptoms first.

Changes in empowerment and anxiety of patients and parents during genetic counselling for epilepsy

Genetic testing and counselling are increasingly important in epilepsy care, aiming at finding a diagnosis, understanding aetiology and improving treatment and outcome. The psychological impact of genetic counselling from patients' or parents' perspectives is, however, unknown. We studied the counselee-reported outcome of genetic counselling before and after genetic testing for epilepsy by evaluating empowerment - a key outcome goal of counselling reflecting cognitive, decisional and behavioural control, emotional regulation and hope - and anxiety. We asked patients or their parents (for those <16 years or intellectually disabled) referred for genetic testing for epilepsy in two university hospitals between June 2014 and 2017 to complete the same two questionnaires at three timepoints: before and after pre-test counselling and after post-test counselling. Empowerment was measured with the Genetic Counselling Outcome Scale (GCOS-18); anxiety with the short State Trait Anxiety Inventory (STAI-6). A total of 63 participants (55 parents with the age of 29-66 years; 8 patients with the age of 21-42 years) were included in our study. Empowerment significantly increased during the genetic counselling trajectory with a medium effect size (p < 0.001, d = 0.57). A small but significant increase in empowerment was already seen after pre-test counselling (p = 0.038, d = 0.29). Anxiety did not change significantly during the counselling trajectory (p = 0.223, d = -0.24). Our study highlights that patients with epilepsy or their parents show a clinically relevant increase in empowerment after genetic counselling. Empowerment was already increased after pre-test counselling, suggesting the importance of counselling before initiating genetic testing for epilepsy. However, individual differences in changes in empowerment and anxiety were seen, suggesting that counselling could be further improved, based on individual needs.

Psychological outcomes, knowledge and preferences of pregnant women on first-trimester screening for fetal structural abnormalities: A prospective cohort study

INTRODUCTION

The primary aim of this study is to investigate the impact of a 13-week anomaly scan on the experienced levels of maternal anxiety and well-being. Secondly, to explore women's knowledge on the possibilities and limitations of the scan and the preferred timing of screening for structural abnormalities.

MATERIAL AND METHODS

In a prospective-cohort study conducted between 2013-2015, pregnant women in the North-Netherlands underwent a 13-week anomaly scan. Four online-questionnaires (Q1, Q2, Q3 and Q4) were completed before and after the 13- and the 20-week anomaly scans. In total, 1512 women consented to participate in the study and 1118 (74%) completed the questionnaires at Q1, 941 (64%) at Q2, 807 (55%) at Q3 and 535 (37%) at Q4. Psychological outcomes were measured by the state-trait inventory-scale (STAI), the patient's positive-negative affect (PANAS) and ad-hoc designed questionnaires.

RESULTS

Nine-nine percent of women wished to be informed as early as possible in pregnancy about the absence/presence of structural abnormalities. In 87% of women levels of knowledge on the goals and limitations of the 13-week anomaly scan were moderate-to-high. In women with a normal 13-week scan result, anxiety levels decreased (P < .001) and well-being increased over time (P < .001). In women with false-positive results (n = 26), anxiety levels initially increased (STAI-Q1: 39.8 vs. STAI-Q2: 48.6, P = 0.025), but later decreased around the 20-week anomaly scan (STAI-Q3: 36.4 vs. STAI-Q4: 34.2, P = 0.36).

CONCLUSIONS

The 13-week scan did not negatively impact the psychological well-being of pregnant women. The small number of women with screen-positive results temporarily experienced higher anxiety after the scan but, in false-positive cases, anxiety levels normalized again when the abnormality was not confirmed at follow-up scans. Finally, most pregnant women have moderate-to-high levels of knowledge and strongly prefer early screening for fetal structural abnormalities.

The role of personality and socio‐economic status in the stress–illness relation: A longitudinal study

Although a wide variety of factors have been found to be related to health in some way, researchers on the subject of health generally fail to integrate findings of other research disciplines within their own line of research. This study has attempted to bring together two research disciplines: (a) research on personality and health, and (b) research on socio‐economical differences in health. Personality factors as well as social class have been found to mediate the stress‐illness relation. Based on empirical and theoretical considerations, we proposed a simple model for the occurrence and course of disease. The personality factors studied were neuroticism, locus of control, and self‐esteem. Socio‐economic status (SES) was represented by education level, occupation status, and income. Health was operationalized as the number of somatic diseases. The research questions were investigated (using t‐tests andpath analysis) in a longitudinal set of data that were collected between 1970 and 1984 among 245 subjects in the normal population. Neuroticism appeared to be an important mediator of the stress‐illness relation. Of the SES variables, occupation and education served as mediators; education was especially infuential on the course of disease. The role of neuroticism is discussed.

Patients and Medical Staff Attitudes Toward the Future Inclusion of eHealth in Tuberculosis Management: Perspectives From Six Countries Evaluated using a Qualitative Framework

Background

Digitally delivering healthcare services is very attractive for tuberculosis (TB) management as this disease has a complex diagnosis and lengthy management and involves multiple medical and nonmedical specialists. Especially in low- and middle-income countries, eHealth could potentially offer cost-effective solutions to bridge financial, social, time, and distance challenges.

Objective

The goal of the research is to understand what would make eHealth globally applicable and gain insight into different TB situations, opportunities, and challenges.

Methods

We performed focus group interviews with TB experts and patients from 6 different countries on 4 different continents. The focus group interviews followed the theory of planned behavior framework to offer structured recommendations for a versatile eHealth solution. The focus group interviews were preceded by a general demographic and technology use questionnaire. Questionnaire results were analyzed using basic statistics in Excel (Microsoft Corporation). Focus group interview data were analyzed using ATLAS.ti 8 (ATLAS.ti Scientific Software Development GmbH) by assigning codes to quotations and grouping codes into the 5 domains within the framework.

Results

A total of 29 patients and 32 medical staff members were included in our study. All medical staff had used the internet, whereas 31% (9/61) of patients had never been online. The codes with the most quotations were information in relation to eHealth (144 quotations) and communication (67 quotations). The consensus among all participants from all countries is that there are important communication and information gaps that could be bridged by an eHealth app. Participants from different countries also highlighted different challenges, such as a majority of asylum-seeker patients or lack of infrastructure that could be addressed with an eHealth app.

Conclusions

Within the 6 countries interviewed, there is high enthusiasm toward eHealth in TB. A potential app could first target information and communication gaps in TB, with additional modules aimed at setting-specific challenges.

Asylum seekers' perspectives on vaccination and screening policies after their arrival in Greece and The Netherlands

Introduction

Europe has been dealing with an increasing number of refugees during the past 5 years. The timing of screening and vaccination of refugees is debated by many professionals, however refugees’ perspectives on health issues are infrequently taken into account. In this study, we aimed to investigate asylum seekers’ perspectives on infectious diseases screening and vaccination policies.

Materials and methods

Interviews were conducted in Greece and the Netherlands. Asylum seekers and recently arrived refugees were approached and informed with the help of interpreters; consent forms were acquired. The survey focused on demographic data, vaccination status, screening policies and prevention of infectious diseases.

Results

A total of 61 (43 male, 70.5%) refugees (30 Afghanis, 16 Syrian, 7 Erithrean) were interviewed. Mean age was 35.2 years (SD 13.5) and 50% had received primary or secondary education, while 24.6% received none. Median time after arrival in Greece and the Netherlands was 24 months (IQR 8.5–28). 44 out of 61 (72.1) participants were willing to be vaccinated after arrival in Europe, 26 preferred vaccination and screening to be performed at the point of entry. The need for screening and vaccination was perceived higher amongst participants in Greece (100% vs 43.3%) due to living conditions leading to increased risk of outbreaks.

Conclusion

Participants were willing to communicate their perspectives and concerns. Screening and vaccination programs could be more effective when implemented shortly after arrival and by involving asylum seekers and refugees when developing screening and vaccination interventions.

The predictive role of self-compassion in cancer patients' symptoms of depression, anxiety, and fatigue: A longitudinal study

Objective Self-compassion is consistently found to be related to better psychological outcomes. As most studies were cross-sectional, little is known about the predictive role of self-compassion for future psychological outcomes. This longitudinal study in cancer patients investigated the predictive role of self-compassion at the time of cancer diagnosis for the course of symptoms of depression, anxiety, and fatigue in the period of receiving cancer treatment.

METHODS

This longitudinal study was conducted at the Shaanxi Provincial Tumour Hospital in Xi'an, China. A total of 153 heterogeneous cancer patients were assessed within 1 week after cancer diagnosis (T1) as well as at the start (T2) and the end (T3) of medical treatment. Hierarchical linear regression analyses were conducted to examine the research questions.

RESULTS

Cross-sectional regression analyses at T1 showed that a self-compassion total score and negative self-compassion (and to a lesser extent positive self-compassion) were significantly related to symptoms of depression, anxiety, and fatigue. When controlling for symptoms at T1, positive self-compassion significantly predicted all three outcomes at T3. A self-compassion total score only predicted symptoms of anxiety at T2, controlling for T1 symptoms. In contrast, we found no significant predictive value of negative self-compassion.

CONCLUSIONS

This study suggests that the positive aspects of self-compassion are beneficial for cancer patients for their future functioning, in terms of fewer symptoms of depression, anxiety, and fatigue over time. Future interventions should test how and to what extent self-compassion can be cultivated and whether increases in self-compassion are associated with better outcomes.

Experiences and views of older people on their participation in a nurse-led health promotion intervention: "Community Health Consultation Offices for Seniors"

Background

The growing number of community-dwelling older adults and the increased risks of adverse health events that accompany ageing, call for health promotion interventions. Nurses often lead these interventions. The views and experiences of older adults participating in these interventions have rarely been studied. To understand the views of targeted older adults, qualitative studies are essential. The aim of this study was to investigate the views and experiences of older adults on their participation in a nurse-led intervention, taking into account their views on healthy aging.

Methods

In a qualitative study, nineteen Dutch older adults aged 62 to 92 years participated in semi-structured interviews. These were transcribed verbatim and coded with the Qualitative Data Analysis Miner software program. The Qualitative Analysis Guide of Leuven was used for data analysis.

Results

Based on the analysis of the interviews, the following main themes emerged from the data reflecting the experiences of the participants: 1) awareness of aging, 2) experienced interaction with the nurse, and 3) perception of the consultations as a check-up and/or personal support.

Conclusions

This study underscores the importance of nurse-led interventions that match older adults’ personal views concerning healthy living, and their views and experiences concerning these interventions. Older adults’ holistic views of healthy living were not always assessed and valued by the nurses. Also, our study shows a wide variety of expectations, views and experiences among the participating older adults. This implies that health professionals should adjust their working and communication methods to the older adult’s views on life.

Expanded carrier screening for autosomal recessive conditions in health care: Arguments for a couple-based approach and examination of couples' views

Background

Expanded carrier screening (ECS) is aimed at detecting carrier states for autosomal recessive (AR) or X‐linked conditions in couples from the general population planning a pregnancy. ECS is currently usually offered on an individual basis despite the fact that, for AR conditions, only carrier couples are at risk of affected offspring. In this paper, we present a couple‐based ECS test‐offer for AR conditions, where results are offered as couple‐results only, and describe how couples view such an offer.

Methods and results

An online survey covering attitudes, perceived difficulty, and intention to take up couple‐based ECS was used to examine couples' views. Results show that in 76% of the participating couples there is no objection at all towards receiving couple‐results only. Most couples display similar views. Observed discrepancies usually involved one of the couple members having a positive view, whilst the other was neutral. Although views stayed strikingly stable after discussion, the partner's opinion was regarded as important in deciding whether or not to have testing.

Conclusion

This study shows that most couples do not object to receiving couple rather than individual ECS results, have similar views towards the offer, and are able to discuss differences in views and intentions.

What's already known about this topic?

Expanded carrier screening (ECS) has become widely available

ECS is usually offered on individual basis, and individual carrier states are reported

Views of potential individual users have been researched

What does this study add?

A couple‐based ECS test‐offer for autosomal recessive conditions, where results are offered as couple‐results only

An examination of couples' views towards this offer: most couples do not object to receiving couple‐results only

Feasibility of couple-based expanded carrier screening offered by general practitioners

Expanded carrier screening (ECS) aims to inform couples’ reproductive choice, preferably before conception. As part of an implementation study in which trained general practitioners (GPs) offered a population-based ECS couple-test, we evaluated the feasibility of the test-offer and degree of participant informed choice (IC). Trained GPs from nine practices in the northern Netherlands invited 4295 female patients aged 18–40 to take part in couple-based ECS. Inclusion criteria were having a male partner, planning for children and not being pregnant. We evaluated the feasibility of the organizational aspects, GP competence and the content of the pre-test counselling. Participant satisfaction, evaluation of pre-test counselling and degree of IC were measured using a longitudinal survey. We explored GP experiences and their views on future implementation through semi-structured interviews. 130 consultations took place. All participating GPs were assessed by genetic professionals to be competent to conduct pre-test counselling. Most (63/108 (58%)) consultations took place within the planned 20 min (median 20, IQR 18–28). GPs considered couples’ prior knowledge level an important determinant of consultation length. 91% of patients were (very) satisfied with the GP counselling. After pre-test counselling, 231/237(97%) participants had sufficient knowledge and 206/231(88%) had a positive attitude and proceeded with testing. Our pilot demonstrates that offering couple-based ECS through trained and motivated GPs is feasible. Future large-scale implementation requires a well-informed general public and a discussion about appropriate reimbursement for GPs and health care coverage for couples. Providing (more) test information pre-appointment may help reduce average consultation time.

A validated PROM in genetic counselling: the psychometric properties of the Dutch version of the Genetic Counselling Outcome Scale

Patient empowerment has been identified as a key outcome goal in genetic counselling, and a patient reported outcome measure (PROM) has been developed to measure empowerment in genetic services: the Genetic Counselling Outcome Scale (GCOS). Here we validate the GCOS for a large and diverse Dutch study sample of 2194 patients referred to two clinical genetic centres for counselling about a wide range of conditions (heart disease, neurological disorders, cancer, congenital syndromes, intellectual disability and prenatal pathology). Our results suggest that the GCOS consists of a hierarchical 6-factor structure, with a main scale for empowerment and six subscales: uncertainty about heredity, hope, negative emotions, knowledge about the condition, knowledge about genetic services and uncertainty about the treatment. Six of the original 24 GCOS items were removed due to low factor loadings and small inter-item correlations. Internal consistency and test-retest reliability of the main scale and most subscales were satisfactory. Convergent validity was confirmed by moderate positive and moderate/strong negative associations between the GCOS main scale and other validated outcome measures. Responsiveness was comparable to that of other validated outcome measures. We saw significant improvement in the GCOS main scale and all the subscales after the first genetic counselling session. This study contributes to the international validation process of the GCOS, with the ultimate goal of using this instrument as a PROM, with empowerment as an outcome measure, to evaluate and improve the quality of genetic counselling in various clinical genetics settings.

Health-related quality of life and well-being health state values among Dutch oldest old

Background: Valuing hypothetical health states is a demanding personal process, since it involves the psychological evaluation of hypothetical health states. It seems plausible that elderly individuals will value hypothetical health states differently than the general population. It is, however, important to understand the psychological division that oldest old subgroups construct between acceptable and unacceptable health states. This information can produce important evidence regarding well-being and disability conceptualization. Objective: To investigate how Dutch oldest old, conceptualize health-related quality of life health states when compared to well-being health states. In addition, we aim to compare subgroups, based on dependency classification. Methods: Ninety-nine elderly living in the Groningen, Hoogeveen and Veendam areas of the Netherlands participated in the study. Respondents were classified into three groups based on dependency levels. The respondents were asked to value hypothetical health states, a generic preference-based HRQoL and a well-being instrument, using a visual analog scale. Results: All three groups ranked the same health states, from both questionnaires, below the average across the health states. The health-related quality of life health states was consistently ranked lower than the current well-being health states. Conclusions: Health state valuations performed by the oldest old indicate that conceptually, respondents view below average health-related and well-being health states as undesirable. The results indicated that the oldest old do view deficits in health-related health states as more important than deficits in well-being health states. Since the oldest old performed the valuations, focused interventions to improve below average health-related outcomes might be the most cost-effective way to increase oldest old well-being outcomes.

Benefit finding in renal transplantation and its association with psychological and clinical correlates: A prospective study

Objectives

The identification of positive psychological changes, including benefit finding (BF), in chronic illness has gained substantial interest. However, less is known about BF in the context of a positive medical intervention. End‐stage renal disease (ESRD) can be regarded as a burdensome condition, but transplantation is expected to restore physical and psychological functioning to a large extent after a period of illness. The aim of this study was to examine (1) changes in BF from pre‐ to 12 months post‐transplantation, (2) the concurrent association of disease‐related characteristics and optimism to BF, and (3) the potential causal relations between BF and distress.

Methods

In this longitudinal study, 319 patients completed questionnaires before, 3 months, 6 months, and/or 12 months post‐transplantation. Multilevel models were used for the analyses. Measures included the Illness Cognitions Questionnaire to measure BF, the Life Orientation Test to measure optimism, and the General Health Questionnaire to measure distress.

Results

Benefit finding increased from pre‐ to post‐transplantation. Fewer symptoms and comorbidities, and more optimism, were related to more BF over all time‐points. The direction of the relation between BF and distress changed over time. Before transplantation, distress predicted an increase in BF, whereas post‐transplantation, distress predicted a decrease in BF. The causal relation between BF and distress post‐transplantation appeared to be reciprocal.

Conclusions

A positive medical intervention such as renal transplantation might facilitate the development of BF. This study indicates the need for longitudinal research on the relation between BF and psychological health in the face of positive events.

Impact of a Nurse-Led Health Promotion Intervention in an Aging Population: Results From a Quasi-Experimental Study on the "Community Health Consultation Offices for Seniors"

Objective: The study evaluated the nurse-led intervention "Community Health Consultation Offices for Seniors (CHCO)" on health-related and care needs-related outcomes in community-dwelling older people (⩾60 years). Method: With a quasi-experimental design, the CHCO intervention was evaluated on health-related and care needs-related outcomes after 1-year follow-up. Older people who received the intervention were frail, overweight, or were smoking. The comparison group received care as usual. In both groups, similar data were collected on health status, falls and fractures, and care needs. In the intervention group, additional data were collected on biometric measures and health-related behavior. Results: The intervention group and the care-as-usual group included 403 seniors and 984 seniors, respectively. Health-related outcomes, behaviors, and biometric measures, remained stable. After 1 year, care needs increased for both groups, but at a lower rate for the care-as-usual group. Discussion: The CHCO intervention showed no significant improvement on health-related outcomes or stability in care needs-related outcomes.

Course and predictors of supportive care needs among Mexican breast cancer patients: A longitudinal study

OBJECTIVE

This study examined the course and predictors of supportive care needs among Mexican breast cancer patients for different cancer treatment trajectories.

METHODS

Data from 172 (66.4% response rate) patients were considered in this observational longitudinal study. Participants were measured after diagnosis, neoadjuvant treatment, surgery, adjuvant treatment, and the first post-treatment follow-up visit. Psychological, Health System and Information, Physical and Daily Living, Patient Care and Support, Sexual, and Additional care needs were measured with the Supportive Care Needs Survey (SCNS-SF34). Linear mixed models with maximum-likelihood estimation were computed.

RESULTS

The course of supportive care needs was similar across the different cancer treatment trajectories. Supportive care needs declined significantly from diagnosis to the first post-treatment follow-up visit. Health System and Information care needs were the highest needs over time. Depressive symptoms and time since diagnosis were the most consistent predictors of changes in course of supportive care needs of these patients.

CONCLUSIONS

Health system and information care needs of Mexican breast cancer patients need to be addressed with priority because these needs are the least met. Furthermore, patients with high depressive symptoms at the start of the disease trajectory have greater needs for supportive care throughout the disease trajectory.

Work-specific cognitive symptoms and the role of work characteristics, fatigue, and depressive symptoms in cancer patients during 18 months post return to work

OBJECTIVE

Cancer patients can experience work-specific cognitive symptoms post return to work. The study aims to (1) describe the course of work-specific cognitive symptoms in the first 18 months post return to work and (2) examine the associations of work characteristics, fatigue and depressive symptoms with work-specific cognitive symptoms over time.

METHODS

This study used data from the 18-month longitudinal "Work Life after Cancer" cohort. The Cognitive Symptom Checklist-Work Dutch Version (CSC-W DV) was used to measure work-specific cognitive symptoms. Linear mixed models were performed to examine the course of work-specific cognitive symptoms during 18-month follow-up; linear regression analyses with generalized estimating equations were used to examine associations over time.

RESULTS

Working cancer patients examined with different cancer types were included (n = 378). Work-specific cognitive symptoms were stable over 18 months. At baseline, cancer patients reported more working memory symptoms (M = 32.0; CI, 30.0-34.0) compared with executive function symptoms (M = 19.3; CI, 17.6-20.9). Cancer patients holding a job with both manual and nonmanual tasks reported less work-specific cognitive symptoms (unstandardized regression coefficient b = -4.80; CI, -7.76 to -1.83) over time, compared with cancer patients with a nonmanual job. Over time, higher depressive symptoms were related to experiencing more overall work-specific cognitive symptoms (b = 1.27; CI, 1.00-1.55) and a higher fatigue score was related to more working memory symptoms (b = 0.13; CI, 0.04-0.23).

CONCLUSIONS

Job type should be considered when looking at work-specific cognitive symptoms over time in working cancer patients. To reduce work-specific cognitive symptoms, interventions targeted at fatigue and depressive symptoms might be promising.

Fatigue and depressive symptoms improve but remain negatively related to work functioning over 18 months after return to work in cancer patients

Purpose

The aims of this study are to investigate the course of work functioning, health status, and work-related factors among cancer patients during 18 months after return to work (RTW) and to examine the associations between these variables and work functioning over time.

Methods

Data were used from the 18-month longitudinal “Work Life after Cancer” (WOLICA) cohort, among 384 cancer patients who resumed work. Linear mixed models were performed to examine the different courses during 18-month follow-up. Linear regression analyses with generalized estimating equations (GEE) were used to examine the associations and interactions.

Results

Cancer patients reported an increase of work functioning and a decrease of fatigue and depressive symptoms in the first 12 months, followed by a stable course between 12 and 18 months. Cognitive symptoms were stable during the first 18 months. Working hours increased and social support decreased during the first 6 months; both remained stable between 6 and 18 months. Fatigue, depressive, and cognitive symptoms were negatively associated with work functioning over time; working hours and supervisor social support were positively associated.

Conclusions

Interventions to improve cancer patients’ work functioning over time might be promising if they are aimed at reducing fatigue, depressive symptoms, cognitive symptoms, and encouraging supervisor social support.

Implications for Cancer Survivors

It is important to monitor cancer patients not only in the period directly after RTW but up to 18 months after RTW, allowing for timely interventions when needed.

Functional health state description and valuation by people aged 65 and over: a pilot study

Background

Assessing quality of life among the elderly is a complex and multifaceted issue. Elderly people might find valuing and describing their personal experience of quality of life (QoL) demanding and cumbersome. This study therefore sought to determine the feasibility of administering two questionnaires in two samples of elderly people.

Methods

A preference-based instrument (EQ-5D + C) and a currently achieved functioning questionnaire (CAF) were utilized. Two pilot studies were performed. The first was performed in South Africa (n = 30), designed to test whether elderly respondents could complete and understand the two questionnaires and also to indicate which valuation method, visual analogue scale or time trade off they preferred. A second pilot study was performed in the Netherlands (n = 30), designed to investigate the use of both questionnaires in determining quality of life and health state valuations in a Dutch sample of elderly.

Results

Seventy percent of the South African respondents indicated that they preferred the visual analogue scale (VAS) method, when compared to the time trade-off (TTO). In both the South African and the Dutch pilot studies, the respondents, with different dependency levels, were able to use both questionnaires to determine health state descriptions and valuations. When ranking the profiles from fewer to more problems, the EQ-5D + C exhibits a gradual downwards trend, with a maximum of 100 and minimum VAS value of 41. The CAF also exhibits a gradual downwards trend, with a maximum of 1.00 and minimum VAS value of 36.

Conclusions

The results indicate that individuals from different parts of the world are able to complete, describe, and value the questionnaires. It is our recommendation that a comprehensive study should be done, which includes both the EQ-5D + C questionnaire and the CAF questionnaire, since the two questionnaires have proven to be feasible in providing information on quality of life and well-being of elderly people.

Electronic supplementary material

The online version of this article (10.1186/s12877-018-0711-9) contains supplementary material, which is available to authorized users.

Functioning and quality of life in Dutch oldest old with diverse levels of dependency

BACKGROUND

Frequently, a questionnaire like the EQ-5D is applied to investigate elderly health-related quality of life (HRQoL), but current literature suggests that inputs that go beyond these traditional health aspects might be of importance. The capability approach is a different method, which integrates several non-health-related factors to define the well-being of the oldest old.

OBJECTIVE

We propose to investigate the differences in oldest old functionings and quality of life (QoL), given different levels of dependency, using both a utility-based (EQ-5D+C) and capability-based (Currently Achieved Functioning) questionnaire.

METHODS

We interviewed 99 Dutch elderly, living in the Groningen, Veendam, and Hoogeveen areas. The average age of the elderly was 80 years, who were living independently, still looking after themselves; living semi-dependently with moderate care; or living in a nursing home requiring consistent care.

RESULTS

The utility score for the dependent group is the lowest of all three groups, across the diseases investigated in this study. The respective average utility scores calculated for the dependent, semi-dependent, and independent subgroups were 0.56 (SD ±0.10); 0.84 (SD ±0.11), and 0.69 (SD ±0.13). Mobility and pain were reported to be the major domains where problems appeared across the three groups. Additionally, dependent elderly experience deficits in the role and control functionings while the other two subgroups experience deficits in pleasure and security.

CONCLUSION

The results suggest that it is important to take note of the achievability of functionings and HRQoL, in addition to care dependency, to obtain QoL and well-being outcomes of the oldest old.

Patterns of unmet supportive needs and relationship to quality of life in Chinese cancer patients

OBJECTIVE

This study aimed to (1) identify distinct patterns of unmet needs in Chinese cancer patients; (2) examine whether sociodemographic and medical characteristics distinguished these patterns; and (3) examine whether people with distinct patterns reported differential quality of life (QoL).

METHODS

This cross-sectional study recruited 301 cancer patients from 2 hospitals in China. The 34-item Supportive Care Needs Survey Short-Form was used to measure unmet needs across 5 domains: physical and daily living, psychological, patient care and support, health systems and information, and sexuality. Latent class analysis was performed to identify patterns of unmet needs across these domains.

RESULTS

Four patterns of unmet needs were identified, differing in levels and nature of unmet needs. Participants in class 1 (47%) reported few unmet needs. Patients in class 2 (15%) had moderate levels of unmet needs, displaying similar levels across 5 domains. People in class 3 (25%) and class 4 (13%) reported similarly high levels on "psychological," "health care system and information," "physical and daily living," and "patient care," but differing in "sexuality," with class 3 reporting low levels while class 4 high on "sexuality." None of sociodemographic and medical characteristics distinguished these patterns significantly. Compared to other classes, people in class 1 reported highest levels of QoL.

CONCLUSIONS

This study demonstrates the existence of 4 patterns of unmet supportive needs in Chinese cancer patients. Patients with few unmet needs reported the best QoL.

Prevalence and factors associated with supportive care needs among newly diagnosed Mexican breast cancer patients

PURPOSE

Mexican breast cancer patients are generally diagnosed in advanced stages of the disease and often experience delays in cancer treatment delivery. Currently, little is known about these patients' psychological care needs. This study assessed levels and correlates of supportive care needs of Mexican breast cancer patients around the time of cancer diagnosis.

METHODS

One hundred seventy-three newly diagnosed Mexican breast cancer patients participated in the study. Supportive care needs, anxiety, depression, and patients' sociodemographic and clinical characteristics were assessed. Multiple regression analyses were used to examine factors associated with care needs.

RESULTS

Up to 44% of patients showed unmet care needs. Health system/information needs were the most prevalent (68%), while physical/daily living needs the least (19%). Level of depressive symptoms was most consistently related to care needs. Patients with higher levels of depressive symptoms had higher psychological (β = 0.38), physical/daily living (β = 0.43), patient care/support (β = 0.17), and additional unmet care needs (β = 0.30), than patients with lower levels of depressive symptoms.

CONCLUSIONS

This study suggests that mainly health system/information needs arise at the time of cancer diagnosis among Mexican breast cancer patients. Patients suffering high levels of depressive symptoms reported the highest levels of unmet needs. Future studies should be conducted to elucidate the care needs throughout the disease trajectory, as such information can inform health care professionals and policy makers and lead to improvements in the organization and provision of health care services for Mexican breast cancer patients.

Reducing discrepancies of personal goals in the context of cancer: A longitudinal study on the relation with well-being, psychological characteristics, and goal progress

OBJECTIVES

To (1) examine whether reducing discrepancies between goal importance and goal attainability is an adaptive predictor of well-being, (2) investigate intrusion, awareness, optimism, and pessimism as determinants of reducing discrepancies between goal importance and goal attainability, and (3) explore how goal progress is involved in reducing discrepancies between goal importance and goal attainability during two major periods after a colorectal cancer diagnosis.

DESIGN

Prospective design.

METHODS

Newly diagnosed colorectal cancer patients (n = 120) were interviewed three times: within a month, 7 months (treatment period), and 18 months (follow-up period) post-diagnosis. Data were analysed using multiple regressions.

RESULTS

Results showed that (1) reducing discrepancies enhances well-being, (2) optimism and pessimism are predictors of reducing discrepancies during the treatment period but not during the follow-up period, while intrusion and awareness do not predict reducing discrepancies in either period, and (3) goal progress is a predictor of reducing discrepancies during the follow-up period, but no evidence for a moderating or mediating role of goal progress in the relation between psychological characteristics and reducing discrepancies was found.

CONCLUSIONS

Reducing discrepancies between goal importance and goal attainability could benefit colorectal cancer patients' well-being. Optimism, pessimism, and goal progress appear to influence cancer patients' ability to reduce discrepancies. Providing assistance in improving goal progress to those who are less optimistic and highly pessimistic may be a suitable training for cancer patients to prevent deterioration in well-being. Statement of contribution What is already known on this subject? More discrepancy between goal importance and goal attainability is associated with lower levels of well-being. People are able to change evaluations of importance and attainability, but it is unknown whether this positively impacts well-being. Underlying causes of differences in the extent to which discrepancies between goal importance and goal attainability are reduced are unknown. What does this study add? This is the first study to show that reducing discrepancies between goal importance and goal attainability is beneficial for well-being. This is the first study to show that optimism and pessimism are determinants of reducing discrepancies between goal importance and goal attainability. Goal progress might be an effective target for interventions that aim to facilitate one's ability to reduce discrepancies between goal importance and goal attainability.

Psychological effects of the intensified follow-up of the CEAwatch trial after treatment for colorectal cancer

BACKGROUND

The aim of the study was to evaluate psychological effects of the state-of-art intensified follow-up protocol for colorectal cancer patients in the CEAwatch trial.

METHOD

At two time points during the CEAwatch trial questionnaires regarding patients' attitude towards follow-up, patients' psychological functioning and patients' experiences and expectations were sent to participants by post. Linear mixed models were fitted to assess the influences and secular trends of the intensified follow-up on patients' attitude towards follow-up and psychological functioning. As secondary outcome, odds ratios were calculated using ordinal logistic mixed model to compare patients' experiences to their expectations, as well as their experiences at two different time points.

RESULTS

No statistical significant effects of the intensified follow-up were found on patients' attitude towards the follow-up and psychological functioning variables. Patients had high expectations of the intensified follow-up and their experiences at the second time point were more positive compared to the scores at the first time point.

CONCLUSION

The intensified follow-up protocol posed no adverse effects on patients' attitude towards follow-up and psychological functioning. In general, patients were more nervous and anxious at the start of the new follow-up protocol, had high expectations of the new follow-up protocol and were troubled by the nuisances of the blood sample testing. As they spent more time in the follow-up and became more adapted to it, the nervousness and anxiety decreased and the preference for the frequent blood test became high in replacement of conversations with the doctors.

Work functioning trajectories in cancer patients: Results from the longitudinal Work Life after Cancer (WOLICA) study

More than 60% of cancer patients are able to work after cancer diagnosis. However, little is known about their functioning at work. Therefore, the aims of this study were to (1) identify work functioning trajectories in the year following return to work (RTW) in cancer patients and (2) examine baseline sociodemographic, health-related and work-related variables associated with work functioning trajectories. This longitudinal cohort study included 384 cancer patients who have returned to work after cancer diagnosis. Work functioning was measured at baseline, 3, 6, 9 and 12 months follow-up. Latent class growth modeling (LCGM) was used to identify work functioning trajectories. Associations of baseline variables with work functioning trajectories were examined using univariate and multivariate analyses. LCGM analyses with cancer patients who completed on at least three time points the Work Role Functioning Questionnaire (n = 324) identified three work functioning trajectories: "persistently high" (16% of the sample), "moderate to high" (54%) and "persistently low" work functioning (32%). Cancer patients with persistently high work functioning had less time between diagnosis and RTW and had less often a changed meaning of work, while cancer patients with persistently low work functioning reported more baseline cognitive symptoms compared to cancer patients in the other trajectories. This knowledge has implications for cancer care and guidance of cancer patients at work.

Expanded carrier screening: what determines intended participation and can this be influenced by message framing and narrative information?

Next-generation sequencing enabled us to create a population-based expanded carrier screening (ECS) test that simultaneously tests for 50 serious autosomal recessive diseases. Before offering this test universally, we wanted to know what factors are related to intended participation and how the general public can be informed about the test without being influenced in their intention to participate. We studied this by measuring to what extent 'message framing' and 'narrative information' can influence people's intended participation. Data were collected by means of an online survey of 504 potential users, and the factors examined were based on the Theory of Planned Behaviour and on previous research on intended participation in preconception carrier screening. Message framing was manipulated by explaining the risk of couple carriership in different ways, while narrative information was provided to only half of the respondents. The factors most positively related to intended participation were perceiving benefits of the screening, having a positive attitude towards the screening, having no religion, having an actual child wish and experiencing the choice to participate as easy. Perceived benefits and a positive attitude were most influential factors by far. Message framing and narrative information had no significant effect on intended participation, reinforcing that message framing and narrative information can help to inform the general public about ECS without influencing their intended participation. Future research should study if the importance of perceived benefits and a positive attitude can be replicated when other factors are included and when actual participation is measured instead of intended participation.

Goal disturbance changes pre/post-renal transplantation are related to changes in distress

OBJECTIVE

Renal transplantation (RTx) is considered the treatment of choice for end-stage renal disease (ESRD) given its association with lower mortality, and improved overall quality of life and psychological functioning compared to dialysis. However, much less is known about which factors underlie these psychological improvements across RTx. Goal theory suggests that experienced disturbances in important goals are related to lower psychological functioning. This study aimed to (1) identify the most disturbed and most important goals for patients before RTx, (2) to examine changes in goal disturbance and goal importance pre/post-RTx, and (3) to examine whether changes in goal disturbance are associated with changes in psychological distress over time, and whether this relationship is mediated by changes in perceived control.

METHODS

In this longitudinal study, 220 patients completed questionnaires before and after RTx, including questionnaires to assess goals (GOALS questionnaire), psychological distress (GHQ-12), and perceived control (Mastery scale).

RESULTS

End-stage renal disease affected both general and disease-specific goals. Approximately 30% of the patients indicated to experience high or very high disturbance before transplantation. Goal disturbance generally decreased significantly pre- to post-RTx, whereas goal importance did not change significantly pre- to post-RTx. No mediation effect of perceived control was found. Instead, both changes in goal disturbance and perceived control showed independent effects on changes in distress.

CONCLUSIONS

Intervention strategies targeting attainable and realistic goal setting, and perceived control in RTx recipients who do not benefit optimally from RTx, might enhance psychological functioning in this population. Statement of contribution What is already known on this subject? Kidney transplantation improves patients' psychological functioning. Experienced disturbances in important life goals are related to lower psychological functioning in chronic illness. What does this study add? Goal disturbance decreases after renal transplantation, and this is related to a decrease in distress over time. Perceived control does not mediate the relationship between goal disturbance and distress pre/post-transplantation. Changes in perceived control have an additional main effect on changes in distress.

Trajectories of anxiety and depression in liver transplant candidates during the waiting-list period

OBJECTIVES

To explore whether distinct trajectories of anxiety and depression exist among liver transplant candidates, and to gain insight into demographic, clinical, and individual characteristics related with these trajectories.

DESIGN

A multicentre, prospective cohort study among 216 liver transplant candidates. Respondents filled out a questionnaire at study entrance and subsequently every 6 months until transplantation or removal from the waiting list.

METHODS

Anxiety (STAI6), depression (CES-D), demographic, and individual variables were assessed by questionnaire. Clinical variables were retrieved by medical record review. The SAS PROC TRAJ procedure was used to identify distinct trajectories. Univariate and multiple ordinal logistic regression analyses were used to explore related variables.

RESULTS

Regarding anxiety, three stable trajectories were identified as follows: below clinical level (51%), slightly above clinical level (34%), and high above clinical level (15%). Regarding depression, four stable trajectories were identified as follows: below clinical level (23%), slightly below clinical level (34%), slightly above clinical level (28%), and high above clinical level (6%). For anxiety as well as for depression, experiencing more liver disease symptoms, a lower level of personal control, making more use of emotional coping, and making less use of task-oriented coping increased the likelihood of membership in those trajectories with higher symptom levels.

CONCLUSION

Distinct, but stable, trajectories of anxiety and depression were present in liver transplant candidates. The trajectories with symptom levels above clinical relevant levels for anxiety or depression comprised, respectively, 49% and 34% of the respondents. Therefore, psychological screening and subsequently providing appropriate interventions are warranted early in the transplant process. Statement of contribution What is already known on this subject For transplant candidates, the waiting-list period is a period of uncertainty and unpredictability. Psychological problems, such as anxiety and depression, are common among liver transplant candidates. Several demographic, clinical, and individual characteristics are associated with anxiety and depression, but these results remain inconclusive. What does this study add Distinct trajectories of symptoms of anxiety and depression are present among liver transplant candidates. Given the stability of the trajectories over time, the symptom level at baseline is indicative of the symptom level during the waiting-list period. Experiencing more liver disease symptoms, low mastery, more use of emotional coping, and less use of task-oriented coping are associated with trajectories of high symptom levels.

A prospective cohort study on posttraumatic stress disorder in liver transplantation recipients before and after transplantation: Prevalence, symptom occurrence, and intrusive memories

OBJECTIVE

This study aimed at increasing the understanding of posttraumatic stress disorder (PTSD) in liver transplant patients by describing the course of PTSD, symptom occurrence, psychological co-morbidity, and the nature of re-experiencing symptoms.

METHODS

A prospective cohort study was performed among 95 liver transplant recipients from before transplantation up until one year post-transplantation. Respondents filled out a questionnaire regarding psychological functioning (PTSD, anxiety, and depression) before, and at 3, 6, and 12months post-transplantation. Both quantitative and qualitative methods were used to analyze the data.

RESULTS

Before transplantation, respectively 10.5% and 6.3% of the respondents were identified as possible cases of full or partial PTSD. In all cases, co-morbid conditions of anxiety and/or depression were present. After transplantation, no new onset of full PTSD was found. New onset of possible partial PTSD was found in six respondents. Arousal symptoms were the most frequently reported symptoms, but may not be distinctive for PTSD in transplant patients because of the overlap with disease- and treatment-related symptoms. Re-experiencing symptoms before transplantation were mostly related to waiting for a donor organ and the upcoming surgery; after transplantation this was related to aspects of the hospital stay.

CONCLUSIONS

In our group of liver transplant patients, PTSD symptomatology was more present before transplantation than after transplantation. Being diagnosed with a life-threatening disease seemed to be the main stressor. However, when a diagnosis of PTSD is suspected, assessment by a clinician is warranted because of the overlap with mood and anxiety disorders, and disease- and treatment-related symptoms.

Changes of perceived control after kidney transplantation: a prospective study

AIMS

The aim of this study was to determine if kidney transplantation is associated with increases of perceived control and how changes of perceived control affect the course of psychological distress until 1 year after transplantation.

BACKGROUND

Low levels of perceived control are associated with reduced well-being among dialysis patients.

DESIGN

Prospective longitudinal cohort study.

METHODS

Perceived control (Mastery Scale) and psychological distress (GHQ-12) were prospectively assessed before (T0; n = 470) and three (T1; n = 197), six (T2; n = 210) and twelve (T3; n = 183) months after transplantation. Differences between T1 and T0 perceived control were used to stratify the sample into three groups (control gain, stable control and control loss). Socio-demographic and clinical variables, including complications, were examined as potential correlates and the course of psychological was distress compared across groups. Data were collected between July 2008 - July 2013.

RESULTS

Perceived control showed a small increase overall, with 35·1%, 50·0% and 14·9% reporting gain, stable level and loss respectively. Patients with secondary schooling were overrepresented in the control loss group. The course of psychological distress varied across perceived control change groups, with patients in the control gain group experiencing a significant reduction in psychological distress.

CONCLUSION

A considerable number of patients report increased levels of perceived control after transplantation that are associated with a subsequent decrease in psychological distress. Results emphasize the importance of perceived control and could inform interventions to facilitate well-being after kidney transplantation.

Population-based preconception carrier screening: how potential users from the general population view a test for 50 serious diseases

With the increased international focus on personalized health care and preventive medicine, next-generation sequencing (NGS) has substantially expanded the options for carrier screening of serious, recessively inherited diseases. NGS screening tests not only offer reproductive options not previously available to couples, but they may also ultimately reduce the number of children born with devastating disorders. To date, preconception carrier screening (PCS) has largely targeted single diseases such as cystic fibrosis, but NGS allows the testing of many genes or diseases simultaneously. We have developed an expanded NGS PCS test for couples; simultaneously it covers 50 very serious, early-onset, autosomal recessive diseases that are untreatable. This is the first, noncommercial, population-based, expanded PCS test to be offered prospectively to couples in a health-care setting in Europe. So far, little is known about how potential users view such a PCS test. We therefore performed an online survey in 2014 among 500 people from the target population in the Netherlands. We enquired about their intention to take an expanded PCS test if one was offered, and through which provider they would like to see it offered. One-third of the respondents said they would take such a test were it to be offered. The majority (44%) preferred the test to be offered via their general practitioner (GP) and 58% would be willing to pay for the test, with a median cost of [euro ]75. Our next step is to perform an implementation study in which this PCS test will be provided via selected GPs in the Northern Netherlands.