Implementing patient question-prompt lists into routine cancer care

OBJECTIVE

To examine the feasibility and acceptability of routine provision of patient question prompt lists (QPLs) to promote patient participation and patient-clinician communication in medical consultations.

METHODS

Four cancer centres across NSW, Australia (two rural, two urban) were invited to participate, involving distribution of QPLs to patients seeing a medical or radiation oncologist, or palliative care clinician. Patients rated their satisfaction after their next consultation. Cancer specialists provided their views at the end of the study.

RESULTS

Sixty-four percent (389/606) of patients attending consultations received a QPL. Of patients offered a QPL (426), 91% accepted. Of 139 patients surveyed post-consultation, 89% reported reading the QPL and, of these, 44% referred to the QPL during the consultation at least once. All of 10 cancer specialists providing their views post-implementation reported that QPL implementation in routine practice was feasible and did not strain resources.

CONCLUSIONS

Cancer patients and cancer specialists showed support for routine dissemination of the QPL.

PRACTICE IMPLICATIONS

For successful implementation of evidence-based tools we recommend promotion by local clinical champions, negotiation with clinic staff about dissemination methods, raised patient awareness through on-site project facilitators, media, consumer and support groups, and availability of resources in hard copy and via online sources.

Understanding deficits in empathy after traumatic brain injury: The role of affective responsivity

People with traumatic brain injury (TBI) often find social situations challenging because they can no longer respond to the emotional state of the people they are with. Many also lack emotional empathy in their social interactions. But are these problems related? The present study addressed this question by examining psychophysiological indices of emotional responding, including facial electromyography (EMG) and skin conductance during exposure to happy and angry facial expressions, in addition to self-rated emotional empathy in 21 adults with severe TBI and 22 control participants. In comparison to control participants, those in the TBI group displayed a reduction in the ability to empathize emotionally, and showed reduced physiological responding to the emotional expression of anger. By contrast, the control group spontaneously mimicked the emotional expressions they were exposed to, regardless of affective valence, and also demonstrated higher skin conductance responsivity to angry faces. The data further suggested that a loss of emotional empathy plays a role in the emotional response deficits to angry facial expressions following TBI. The results have implications for understanding the impaired social functioning and poor quality of interpersonal relationships commonly seen as a consequence of TBI.

An examination of the initial cancer consultation of medical and radiation oncologists using the Cancode interaction analysis system

This study provides an analysis of the structure of the initial cancer consultation, the consultation styles of medical and radiation oncologists, and their effect on patient outcomes. One hundred and fifty-five cancer patients attending their first consultation with either a medical or radiation oncologist were audiotaped and the transcripts were analysed using the Cancode computer interaction analysis system. Findings revealed that medical oncologists allowed patients and their families more input into the consultation and were rated as warmer and more patient-centred compared with radiation oncologists. However, radiation oncologists spent a longer period discussing, and were more likely to bring up, social support issues with patients. Both medical and radiation oncologists varied their consultation style according to the patient's gender, age, anxiety levels, prognosis, and education. Patients seeing an oncologist who was rated as warmer and discussed a greater number of psychosocial issues had better psychological adjustment and reduced anxiety after consultation. These findings provide current evidence that may be used to inform improvements of communication skills training for oncologists and highlight the need for future communication research to separately consider oncologists from different disciplines.

Neural mechanisms underlying trait impulsivity in non-clinical adults: stop-signal performance and event-related potentials

Impaired inhibitory processing has been implicated in clinical expressions of impulsivity, but it is unknown whether the same deficit underlies the personality trait in healthy, non-clinical populations. The present study examined performance and event-related potentials (ERPs) during a stop-signal task in non-clinical adults who scored in the top ("Low" n=20) and bottom 15% ("High" n=20) on Eysenck's Impulsiveness Questionnaire from a sample of 200 subjects. The stop-signal task consisted of a visual choice-RT task and auditory stop-signals presented on 30% of trials. While performance findings revealed no differences between groups, underlying ERPs revealed a number of quantitative differences. Lateralised readiness potential (LRP) amplitude on stop-signal trials was larger in the High than Low group, indicating greater response side-specific motor preparation in the primary motor cortex (PMC), while an N1/P3 complex was evoked on successful stop-signal trials and was also enhanced in the High than Low group. The centrally-maximal successful-stop P3 has previously been implicated as an index of inhibition in the PMC, suggesting enhanced inhibitory processing in the High group. Together these findings indicate that the High impulsivity group was able to counteract an impulsive response style on stop-signal trials with enhanced inhibitory activation, resulting in comparable overt performance to the Low group. These results provide a unique insight into the neural mechanisms underlying trait impulsivity in non-clinical adults.

A Developmental Investigation of Stop-Signal Inhibition

Abstract. The present study examined the development of response inhibition in the stop-signal task across child (8-13 years), young-adult (18-22 years), and middle-aged adult (29-47 years) groups through a dissociation of low- and higher-frequency ERP activity. Fifty-one subjects (n = 17 in each group) performed the stop-signal task, which consisted of a visual choice reaction time (RT) task and auditory stop-signals, while EEG was recorded. The original EEG data (0.01-30 Hz) was subsequently filtered to separate slow-wave (0.01-2 Hz) and residual (2-30 Hz) activity. Performance findings revealed that stop-signal reaction time (SSRT) decreased from the child to young-adult group and then showed a small increase in the middle-aged adult group. Original ERPs revealed decreasing N1 and N2 amplitudes and increasing P2 and P3 amplitudes across the scalp with increasing age for successful-stop trials. These developmental effects did not occur in the residual waveforms after removal of slow-wave activity. For failed-stop trials, a response-locked negative component, identified as the error-negativity (Ne), showed an age-related decrease in amplitude across the scalp in the residual, but not the original, waveform. The error-positivity (Pe) increased in amplitude with age in the original data, but this was accounted for by a positive slow-wave (PSW). Together, the findings suggest that underlying slow-wave activity accounts for a large number of developmental effects in the traditionally quantified ERP components, but may also obscure effects occurring in residual activity. These findings highlight the importance of dissociating low- and higher-frequency ERP activity in developmental research.

The development of stop-signal and Go/Nogo response inhibition in children aged 7–12 years: Performance and event-related potential indices

The present study examined the development of response inhibition during the Stop-signal and Go/Nogo tasks in children using performance and ERP measures. Twenty-four children aged 7 to 12 years completed both tasks, each with an auditory Nogo/Stop-signal presented on 30% of trials. On average, response inhibition was more difficult in the Stop-signal than Go/Nogo task. Response inhibition performance did not develop significantly across the age range, while response execution varied significantly in a task dependent manner (Go/Nogo: increasing accuracy and reducing response variability with age; Stop-signal: reducing Go mean reaction time and response variability with age). The N1, P2, N2 and P3 components showed different scalp distributions, with N1 and P2 peaking earlier, and P3 later, in Nogo compared to Stop stimuli. N2 and P3 amplitude were positively correlated with successful inhibition probability in the Go/Nogo task only. N2 amplitude and latency to both Nogo and successful Stop stimuli decreased linearly with age, but not in the frontal regions. N1 and P3 amplitude in the parietal region increased with age for Stop-signals. An age-related reduction in P3 latency to Nogo stimuli correlated significantly with reduced RT and variability in Go responding, indicating a relationship between efficient Nogo and Go processing. Together the behavioural and ERP results suggest little development of the response inhibition process as measured via the Stop-signal and Go/Nogo tasks across the 7 to 12 year age range, while response execution processes develop substantially.

The auditory-evoked N2 and P3 components in the stop-signal task: indices of inhibition, response-conflict or error-detection?

The N2 and P3 components have been separately associated with response inhibition in the stop-signal task, and more recently, the N2 has been implicated in the detection of response-conflict. To isolate response inhibition activity from early sensory processing, the present study compared processing of the stop-signal with that of a task-irrelevant tone, which subjects were instructed to ignore. Stop-signals elicited a larger N2 on failed-stop trials and a larger P3 on successful-stop trials, relative to ignore-signal trials, likely reflecting activity related to failed and successful stopping, respectively. ERPs between fast and slow reaction-time (RT) groups were also examined as it was hypothesised that greater inhibitory activation to stop faster responses would manifest in the component reflecting this process. Successful-stop P3 showed the anticipated effect (globally larger amplitude in the fast than slow RT group), supporting its association with the stopping of an ongoing response. In contrast, N2 was larger in the slow than fast RT group, and in contrast to the predictions of the response-conflict hypothesis, successful-stop N2 and the response-locked error-negativity (Ne) differed in scalp distribution. These findings indicate that the successful-stop N2 may be better explained as a deliberate form of response control or selection, which the slow RT group employed as a means of increasing the likelihood of a successful-stop. Finally, a comparison of stimulus and response-locked ERPs revealed that the failed-stop N2 and P3 appeared to reflect error-related activity, best observed in the response-locked Ne and error-positivity (Pe). Together these findings indicate that the successful-stop N2 and P3 reflect functionally distinct aspects of response control that are dependent upon performance strategies, while failed-stop N2 and P3 reflect error-related activity.

Suppression of P50 evoked potential component, schizotypal beliefs and smoking

Suppression of the P50 component of the evoked potential is an electrophysiological index of sensory gating that is blunted in schizophrenia spectrum disorders. Although P50 suppression is thought to be related to symptomatology, this is yet to be shown. The failure to demonstrate this relation has led some to argue that P50 suppression and symptomatology are not related. However, a possible confound has recently been corroborated [i.e., chronic smoking is related to superior P50 suppression [Crawford et al., Neuroscience Letters 317 (2002) 151]], and a relation has been found in questionnaire-defined individuals with indications of schizotypy [i.e., psychometric schizotypy is related to poor P50 suppression [Croft et al., Biological Psychiatry 50 (2001) 441]]. The present study attempted to replicate and extend both studies by examining P50 suppression, smoking histories, psychometric schizotypy and NEO Five-Factor Inventory (NEO-V) scores in 37 healthy participants. Replicating Crawford et al., P50 suppression was better in the heavier smokers. Providing a partial replication of Croft et al., P50 suppression was inversely related to schizotypy scores in participants who smoked little or not at all; however, P50 suppression was positively related to schizotypy in heavier smokers. Covarying for age and NEO-V scale scores had little effect on these relations. The findings provide evidence of important confounds that would limit our ability to detect P50 suppression/symptom relations in schizophrenia.

Inhibitory motor control in children with attention-deficit/hyperactivity disorder: event-related potentials in the stop-signal paradigm

BACKGROUND

The aim of the study was to investigate the inhibitory control of an ongoing motor response and to identify underlying neural deficiencies, manifested in event-related potentials, that cause poorer inhibitory performance in children with attention-deficit/hyperactivity disorder.

METHODS

A stop-signal paradigm with a primary visual task and auditory stop signal was used to compare performance in 13 children with attention-deficit/hyperactivity disorder and 13 control children, while event-related potentials were recorded simultaneously.

RESULTS

Children with attention-deficit/hyperactivity disorder showed poorer inhibitory performance through a slower inhibitory process. Inhibitory processing of auditory stop signals was marked by a frontal N2 component that was reduced in the attention-deficit/hyperactivity disorder group relative to controls. A central positive component (P3) was associated with the success of inhibiting a response, but there were no group differences in its amplitude or latency.

CONCLUSIONS

Findings support the hypothesis of deficient inhibitory control in children with attention-deficit/hyperactivity disorder. Slower inhibitory processing appears to be due to a specific neural deficiency that manifests in the processing of the stop signal as attenuated negativity in the N2 latency range.

Event-related slow-wave activity in two subtypes of attention-deficit/hyperactivity disorder

OBJECTIVE

Previous time-frequency studies have indicated that event-related low-frequency activity has important effects on component topography and developmental effects in auditory event-related potentials (ERPs) of children and adolescents. This study investigated the influence of event-related slow-wave (SW) (0.01-2 Hz) activity in the group differences seen between children with and without attention-deficit/hyperactivity disorder (AD/HD) of different subtypes.

METHODS

Time-frequency analysis techniques were applied to auditory ERP data derived from children with AD/HD predominantly inattentive type (n = 30), AD/HD combined type (n = 30) and age-matched control subjects (n = 30).

RESULTS

Event-related early frontal negative and late posterior positive SW components were reduced in the AD/HD combined type group, but not AD/HD inattentive type group, relative to controls. The RESIDUAL ERPs, which represented event-related 2-12 Hz activity, showed clinical vs. control group differences in components that were similar in both AD/HD subtype groups.

CONCLUSIONS

The time-frequency results showed that event-related SW (0.1-2 Hz) activity contributes importantly to group differences between AD/HD and control children, and the pattern of group differences from controls for each of the AD/HD subtype groups, which are evident in raw ERPs. These results emphasise both the clinical and developmental importance of this form of analysis.

SIGNIFICANCE

This novel approach revealed additional specific information about stimulus processing and regional inhibition/activation in two AD/HD subtypes, relative to control subjects.