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Marshall KH, Pincus HA, Tesson S, Lingam R, Woolfenden SR, Kasparian NA. Integrated psychological care in pediatric hospital settings for children with complex chronic illness and their families: a systematic review. Psychol Health 2024; 39:452-478. [PMID: 35635028 DOI: 10.1080/08870446.2022.2072843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 03/07/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To synthesize and critically evaluate evidence on the effectiveness of integrated psychological care models for children with complex chronic illness within pediatric hospital settings and provide recommendations for successful implementation. DESIGN Six electronic databases (Medline, Cochrane, Embase, PsycINFO, Scopus, CINAHL) were systematically searched for English language studies including families of children aged 0-17 years with complex chronic illness. Eligible studies reported on psychology or neuropsychology screening, assessment, intervention, or services provided within a pediatric hospital setting. RESULTS Fifteen studies were identified for review; nine assessed a psychological service, five examined psychosocial screening, and one examined a neuropsychology service. Three studies demonstrated the effectiveness of integrated psychological services in improving child or parent physical, psychological, or behavioral health outcomes. Uptake of psychosocial screening was high (84-96%), but only 25-37% of children or families identified as 'at-risk' engaged with on-site psychology services. Integrated psychological services offering consultations at the same time and location as the child's medical visit reported the highest rates of uptake (77-100%). CONCLUSIONS The available evidence supports co-location of child medical and psychological services. A more consistent and comprehensive approach to the assessment of patient- and caregiver-reported outcomes and implementation effectiveness is recommended.
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Affiliation(s)
- Kate H Marshall
- Heart Centre for Children, The Sydney Children's Hospitals Network, Sydney, NSW, Australia
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Harold A Pincus
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, NY, USA
- Irving Institute for Clinical and Translational Research, Columbia University and New York‑Presbyterian Hospital, New York, NY, USA
| | - Stephanie Tesson
- Heart Centre for Children, The Sydney Children's Hospitals Network, Sydney, NSW, Australia
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Raghu Lingam
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Susan R Woolfenden
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
- Sydney Institute for Women, Children and their Families, Sydney local health District, Sydney, NSW, Australia
| | - Nadine A Kasparian
- Cincinnati Children's Center for Heart Disease and Mental Health, Heart Institute and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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2
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Tesson S, Swinsburg D, Nielson-Jones C, Costa DSJ, Winlaw DS, Badawi N, Sholler GF, Butow PN, Kasparian NA. Mother-Infant Dyadic Synchrony and Interaction Patterns After Infant Cardiac Surgery. J Pediatr Psychol 2024; 49:13-26. [PMID: 37873696 DOI: 10.1093/jpepsy/jsad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/19/2023] [Accepted: 09/19/2023] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVE Parents and their infants with complex congenital heart disease (CHD) face relational challenges, including marked distress, early separations, and infant hospitalizations and medical procedures, yet the prevalence of parent-infant interaction difficulties remains unclear. Using a standardized observational paradigm, this study investigated mother-infant dyadic synchrony, interactional patterns, and associated predictors in mother-infant pairs affected by CHD, compared with typically-developing pairs. METHODS In this prospective, longitudinal cohort study, mothers and their infants requiring cardiac surgery before age 6-months (n=110 pairs) and an age- and sex-matched Australian community sample (n=85 pairs) participated in a filmed, free-play interaction at 6.9±1.0 months. Mother-infant dyadic synchrony, maternal and infant interactional patterns, and relational risk were assessed using the Child-Adult Relationship Experimental (CARE) Index. Maternal and infant predictors were assessed at 32 weeks gestation, 3- and 6-months postpartum. RESULTS Most mother-infant interactions were classified as "high risk" or "inept" (cardiac: 94%, control: 81%; p=.007). Dyadic synchrony (p<.001), maternal sensitivity (p=.001), and infant cooperativeness (p=.001) were lower for cardiac than control pairs. Higher maternal traumatic stress at 6-months postpartum predicted lower dyadic synchrony for mother-infant pairs affected by CHD (B=-.04, p=.03). Dyadic synchrony was higher among older infants in the total (B=.40, p=.003) but not cardiac sample (B=.24, p=.06). CONCLUSIONS Relational difficulties were almost universal among mother-infant pairs affected by CHD and were also high in the Australian community sample. Widespread education initiatives are recommended to increase awareness of heightened mother-infant relational risk in congenital heart care and well-child settings, alongside relationally-focused prevention and early intervention programs.
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Affiliation(s)
- Stephanie Tesson
- Heart Centre for Children, The Sydney Children's Hospitals Network, Australia
- School of Psychology, The University of Sydney, Australia
- Faculty of Medicine and Health, The University of New South Wales, Australia
| | - Dianne Swinsburg
- Heart Centre for Children, The Sydney Children's Hospitals Network, Australia
- Faculty of Medicine and Health, The University of New South Wales, Australia
| | - Claudia Nielson-Jones
- Heart Centre for Children, The Sydney Children's Hospitals Network, Australia
- Faculty of Medicine and Health, The University of New South Wales, Australia
| | - Daniel S J Costa
- School of Psychology, The University of Sydney, Australia
- Pain Management Research Institute, Royal North Shore Hospital, Australia
| | - David S Winlaw
- Heart Institute, Cincinnati Children's Hospital Medical Center, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, USA
| | - Nadia Badawi
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Australia
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Australia
| | - Gary F Sholler
- Heart Centre for Children, The Sydney Children's Hospitals Network, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Australia
| | - Phyllis N Butow
- School of Psychology, The University of Sydney, Australia
- Psycho-Oncology Co-operative Research Group, The University of Sydney, Australia
| | - Nadine A Kasparian
- Heart Institute, Cincinnati Children's Hospital Medical Center, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, USA
- Heart and Mind Wellbeing Center, Heart Institute and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, USA
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Turner S, Tesson S, Butow P, Vachan B, Chan MK, Shaw T. Integrating leadership development into radiation oncology training: A qualitative analysis of resident interviews. Int J Radiat Oncol Biol Phys 2021; 113:26-36. [PMID: 34634439 DOI: 10.1016/j.ijrobp.2021.09.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Radiation oncologists need to have more than sound clinical and technical competencies. To optimize care for patients and advance all aspects of radiation oncology (RO), radiation oncologists must also be effective leaders. Embedding systematic leadership education into RO training programs is challenging. This study examined RO residents' perspectives and preferences relating to leadership education. Such data informs the integration of universal leadership learning into RO training in Australian and New Zealand, and identifies priority areas to facilitate successful leadership development initiatives in RO training programs worldwide. METHODS AND MATERIALS Semi-structured telephone interviews were conducted with 13 RO residents across eight Australian training departments and all stages of training. Data from transcriptions of taped interviews were coded by ≥ 2 researchers and collected to saturation. Qualitative thematic analysis was conducted employing an iterative inductive process to develop codes into themes and subthemes. Representative quotes were collated to illustrate subthemes. RESULTS Four key themes related to leadership education were identified and labelled: (1) Recognition, credibility and value of education, (2) Logistics of formal learning, (3) Real-world opportunities: 'seeing and doing', and (4) One size does not fit all. Residents unanimously felt formal leadership education was important and that aspects of becoming a good leader could be learned. Organisational and cultural factors emerged as either barriers or facilitators to learning. There was strong support for interactive methods of learning, and role-modelling by senior colleagues was identified as having a major impact on junior learners. CONCLUSIONS This study offers insight into RO residents' perspectives and preferences around their own leadership development. Findings have practical implications for the design of effective RO leadership programs and bring us one step closer to the ultimate goal of enhancing leadership capability for all RO professionals.
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Affiliation(s)
- Sandra Turner
- University of Sydney, Camperdown, NSW, Australia; Sydney West Radiation Oncology Network, NSW, Australia.
| | | | | | - Burcu Vachan
- NHMRC Clinical Trials Centre, University of Sydney, NSW, Australia
| | - Ming-Ka Chan
- Department of Pediatrics and Child Health, University of Manitoba and The Children's Hospital of Winnipeg, Canada
| | - Timothy Shaw
- University of Sydney, Camperdown, NSW, Australia
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Tesson S, Butow PN, Marshall K, Fonagy P, Kasparian NA. Parent-child bonding and attachment during pregnancy and early childhood following congenital heart disease diagnosis. Health Psychol Rev 2021; 16:378-411. [PMID: 33955329 DOI: 10.1080/17437199.2021.1927136] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Diagnosis and treatment of congenital heart disease (CHD) can present challenges to the developing parent-child relationship due to periods of infant hospitalization and intensive medical care, parent-infant separations, child neurodevelopmental delay and feeding problems, and significant parent and child distress and trauma. Yet, the ways in which CHD may affect the parent-child relationship are not well-understood. We systematically reviewed the evidence on parental bonding, parent-child interaction, and child attachment following CHD diagnosis, according to a pre-registered protocol (CRD42019135687). Six electronic databases were searched for English-language studies comparing a cardiac sample (i.e., expectant parents or parents and their child aged 0-5 years with CHD) with a healthy comparison group on relational outcomes. Of 22 unique studies, most used parent-report measures (73%) and yielded mixed results for parental bonding and parent-child interaction quality. Observational results also varied, although most studies (4 of 6) found difficulties in parent-child interaction on one or more affective or behavioural domains (e.g., lower maternal sensitivity, lower infant responsiveness). Research on parental-fetal bonding, father-child relationships, and child attachment behaviour was lacking. Stronger evidence is needed to determine the nature, prevalence, and predictors of relational disruptions following CHD diagnosis, and to inform targeted screening, prevention, and early intervention programs for at-risk dyads.
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Affiliation(s)
- Stephanie Tesson
- School of Psychology, The University of Sydney, Sydney, Australia.,Heart Centre for Children, The Sydney Children's Hospitals Network, Sydney, Australia
| | - Phyllis N Butow
- School of Psychology, The University of Sydney, Sydney, Australia.,Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, Australia
| | - Kate Marshall
- Heart Centre for Children, The Sydney Children's Hospitals Network, Sydney, Australia.,Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, Australia
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nadine A Kasparian
- Heart Centre for Children, The Sydney Children's Hospitals Network, Sydney, Australia.,Cincinnati Children's Center for Heart Disease and Mental Health, Heart Institute and the Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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5
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Kan JM, Dieng M, Butow PN, Mireskandari S, Tesson S, Menzies SW, Costa DSJ, Morton RL, Mann GJ, Cust AE, Kasparian NA. Identifying the 'Active Ingredients' of an Effective Psychological Intervention to Reduce Fear of Cancer Recurrence: A Process Evaluation. Front Psychol 2021; 12:661190. [PMID: 34163405 PMCID: PMC8215538 DOI: 10.3389/fpsyg.2021.661190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 05/06/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Psychological interventions targeting fear of cancer recurrence (FCR) are effective in reducing fear and distress. Process evaluations are an important, yet scarce adjunct to published intervention trials, despite their utility in guiding the interpretation of study outcomes and optimizing intervention design for broader implementation. Accordingly, this paper reports the findings of a process evaluation conducted alongside a randomized controlled trial of a psychological intervention for melanoma patients. Methods: Men and women with a history of Stage 0-II melanoma at high-risk of developing new primary disease were recruited via High Risk Melanoma Clinics across Sydney, Australia and randomly allocated to receive the psychological intervention (n = 80) or usual care (n = 84). Intervention participants received a tailored psycho-educational resource and three individual psychotherapeutic sessions delivered via telehealth. Qualitative and quantitative data on intervention context, processes, and delivery (reach, dose, and fidelity), and mechanisms of impact (participant responses, moderators of outcome) were collected from a range of sources, including participant surveys, psychotherapeutic session audio-recordings, and clinical records. Results: Almost all participants reported using the psycho-educational resource (97%), received all intended psychotherapy sessions (96%), and reported high satisfaction with both intervention components. Over 80% of participants would recommend the intervention to others, and a small proportion (4%) found discussion of melanoma-related experiences confronting. Perceived benefits included enhanced doctor-patient communication, talking more openly with family members about melanoma, and improved coping. Of potential moderators, only higher FCR severity at baseline (pre-intervention) was associated with greater reductions in FCR severity (primary outcome) at 6-month follow-up (primary endpoint). Conclusions: Findings support the acceptability and feasibility of a psychological intervention to reduce FCR amongst individuals at high risk of developing another melanoma. Implementation into routine melanoma care is an imperative next step, with FCR screening recommended to identify those most likely to derive the greatest psychological benefit.
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Affiliation(s)
- Janice M Kan
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Mbathio Dieng
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Phyllis N Butow
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, The University of Sydney, Sydney, NSW, Australia.,Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Shab Mireskandari
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Stephanie Tesson
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Scott W Menzies
- Discipline of Dermatology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,The Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Daniel S J Costa
- Pain Management Research Institute, The University of Sydney at Royal North Shore Hospital, Sydney, NSW, Australia.,School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Graham J Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,John Curtin School of Medical Research, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Anne E Cust
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Nadine A Kasparian
- Cincinnati Children's Center for Heart Disease and Mental Health, Heart Institute and the Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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6
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Tesson S, Swinsburg D, Kasparian NA. Maintaining Momentum in Infant Mental Health Research During COVID-19: Adapting Observational Assessments. J Pediatr Psychol 2021; 46:254-263. [PMID: 33738487 PMCID: PMC7989424 DOI: 10.1093/jpepsy/jsab020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 12/19/2022] Open
Abstract
Understanding the potential effects of the COVID-19 pandemic on the developing parent-infant relationship is a priority, especially for medically-fragile infants and their caregivers who face distinct challenges and stressors. Observational assessments can provide important insights into parent-child behaviors and relational risk; however, stay-at-home directives and physical distancing measures associated with COVID-19 have significantly limited opportunities for in-person observational parent-infant assessment. To maintain momentum in our research program during the pandemic, we rapidly pivoted to remote, technology-assisted parent-infant observational assessments. In this commentary, we offer a series of strategies and recommendations to assist researchers in adapting observational parent-infant paradigms. We also discuss the benefits, challenges, and limitations of distance-delivered assessments, and offer considerations for clinical service provision and future research during and post the COVID-19 pandemic. .
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Affiliation(s)
- Stephanie Tesson
- Heart Centre for Children, The Sydney Children’s Hospitals Network
- School of Psychology, The University of Sydney
| | - Dianne Swinsburg
- Heart Centre for Children, The Sydney Children’s Hospitals Network
- Discipline of Paediatrics, School of Women’s and Children’s Health, UNSW Medicine, The University of New South Wales
| | - Nadine A Kasparian
- Heart Centre for Children, The Sydney Children’s Hospitals Network
- Cincinnati Children’s Center for Heart Disease and Mental Health, Heart Institute and the Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital
- Department of Pediatrics, University of Cincinnati College of Medicine
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Sharpe L, Turner J, Fardell JE, Thewes B, Smith AB, Gilchrist J, Beith J, Girgis A, Tesson S, Day S, Grunewald K, Butow P. Psychological intervention (ConquerFear) for treating fear of cancer recurrence: mediators and moderators of treatment efficacy. J Cancer Surviv 2019; 13:695-702. [PMID: 31347010 DOI: 10.1007/s11764-019-00788-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 07/05/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE ConquerFear is an efficacious intervention for fear of cancer recurrence (FCR) that demonstrated greater improvements than an attention control (relaxation training) in a randomized controlled trial. This study aimed to determine mediators and moderators of the relative treatment efficacy of ConquerFear versus relaxation. METHODS One hundred and fifty-two cancer survivors completed 5 therapy sessions and outcome measures before and after intervention and at 6 months' follow-up. We examined theoretically relevant variables as potential mediators and moderators of treatment outcome. We hypothesized that metacognitions and intrusions would moderate and mediate the relationship between treatment group and FCR level at follow-up. RESULTS Only total FCR score at baseline moderated treatment outcome. Participants with higher levels of FCR benefited more from ConquerFear relative to relaxation on the primary outcome. Changes in metacognitions and intrusive thoughts about cancer during treatment partially mediated the relationship between treatment group and FCR. CONCLUSIONS These results show that ConquerFear is relatively more effective than relaxation for those with overall higher levels of FCR. The mediation analyses confirmed that the most likely mechanism of treatment efficacy was the reduction in unhelpful metacognitions and intrusive thoughts during treatment, consistent with the theoretical framework underpinning ConquerFear. IMPLICATIONS FOR CANCER SURVIVORS ConquerFear is a brief, effective treatment for FCR in cancer survivors with early-stage disease. The treatment works by reducing intrusive thoughts about cancer and changing beliefs about worry and is particularly helpful for people with moderate to severe FCR.
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Affiliation(s)
- Louise Sharpe
- School of Psychology, University of Sydney, Brennan MacCallum (A18), Camperdown, NSW, 2006, Australia.
| | - J Turner
- Mental Health Centre, Faculty of Medicine, University of Queensland, Saint Lucia, Australia
| | - J E Fardell
- Kids Cancer Centre, Sydney Children's Hospital and School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Saint Lucia, Australia
| | - B Thewes
- School of Psychology, University of Sydney, Brennan MacCallum (A18), Camperdown, NSW, 2006, Australia.,Department Medical Psychology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - A B Smith
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - J Gilchrist
- Crown Princess Mary Cancer Centre, Breast Cancer Institute, Westmead Hospital, Westmead, Australia
| | - J Beith
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Camperdown, Australia.,Department of Medical Oncology, Chris O'Brien Lifehouse, Missenden Rd., Camperdown, Australia
| | - A Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - S Tesson
- School of Psychology, University of Sydney, Brennan MacCallum (A18), Camperdown, NSW, 2006, Australia
| | - S Day
- School of Psychology, University of Sydney, Brennan MacCallum (A18), Camperdown, NSW, 2006, Australia
| | - K Grunewald
- School of Psychology, University of Sydney, Brennan MacCallum (A18), Camperdown, NSW, 2006, Australia
| | - P Butow
- School of Psychology, University of Sydney, Brennan MacCallum (A18), Camperdown, NSW, 2006, Australia.,Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Camperdown, Australia
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Costa DSJ, Mercieca-Bebber R, Tesson S, Seidler Z, Lopez AL. Patient, client, consumer, survivor or other alternatives? A scoping review of preferred terms for labelling individuals who access healthcare across settings. BMJ Open 2019; 9:e025166. [PMID: 30850410 PMCID: PMC6429876 DOI: 10.1136/bmjopen-2018-025166] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Use of the term 'patient' has been recently debated, compared with alternatives including 'consumer' and 'client'. This scoping study aimed to provide an integrated view of preferred labels across healthcare contexts and countries to clarify labelling preferences of individuals accessing healthcare. DESIGN Scoping study. DATA SOURCES A preliminary literature search using GoogleScholar, Medline, Embase and PsycINFO found 43 key papers discussing terminology for labelling individuals accessing healthcare services. We then used citation chaining with PubMed and GoogleScholar to identify studies discussing term preferences among healthcare recipients. ELIGIBILITY CRITERIA No date limits were applied, and all healthcare settings were considered. Primary research studies examining terminology preferences of individuals accessing healthcare, published in peer-reviewed journals were eligible. DATA EXTRACTION AND SYNTHESIS All authors extracted data regarding preferred term and study characteristics, and assessed reporting quality of the studies using criteria relevant to our design. RESULTS We identified 1565 articles, of which 47 met inclusion criteria. Six articles that examined preference for personal address (eg, first name) were excluded. Of the remaining 41 studies, 33 examined generic terms ('patient', 'client', 'consumer') and 8 focused on cancer survivorship. Of the 33 examining generic terms, 27 reported a preference for 'patient' and four for 'client'. Samples preferring 'client' were typically based in mental health settings and conducted in the USA. Of the eight cancer survivorship studies, five found a preference for 'survivor', and three 'someone who had had cancer'. CONCLUSIONS Overall, healthcare recipients appear to prefer the term 'patient', with few preferring 'consumer'. Within general clinical and research contexts, it therefore seems appropriate to continue using the label 'patient' in the absence of knowledge about an individual's preferences. Reasons for preferences (eg, familiarity, social identity) and the implications of labelling for healthcare have not been investigated adequately, necessitating future empirical (including qualitative) research.
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Affiliation(s)
- Daniel S J Costa
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Pain Management Research Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Rebecca Mercieca-Bebber
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
- Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
- Psycho-OncologyCo-operative Group, University of Sydney, Sydney, New South Wales, Australia
| | - Stephanie Tesson
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
- Psycho-OncologyCo-operative Group, University of Sydney, Sydney, New South Wales, Australia
| | - Zac Seidler
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
- Psycho-OncologyCo-operative Group, University of Sydney, Sydney, New South Wales, Australia
| | - Anna-Lena Lopez
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
- Psycho-OncologyCo-operative Group, University of Sydney, Sydney, New South Wales, Australia
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9
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Butow P, Williams D, Thewes B, Tesson S, Sharpe L, Smith AB, Fardell JE, Turner J, Gilchrist J, Girgis A, Beith J. A psychological intervention (ConquerFear) for treating fear of cancer recurrence: Views of study therapists regarding sustainability. Psychooncology 2019; 28:533-539. [PMID: 30597658 DOI: 10.1002/pon.4971] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/16/2018] [Accepted: 12/23/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE ConquerFear is a metacognitive intervention for fear of cancer recurrence (FCR) with proven efficacy immmediately and 6 months post-treatment. This qualitative study documented barriers and facilitators to the sustainability of ConquerFear from the perspective of study therapists. METHODS Fourteen therapists who had delivered ConquerFear in a randomised controlled trial completed a semi-structured phone interview, reaching theoretical saturation. Themes from thematic analysis were mapped to the Promoting Action on Research Implementation in Health Services (PARiHS) implementation framework. RESULTS Participants were 13 males and one female with, on average, 14 years psycho-oncology experience. Nine over-arching themes were identified, falling into three domains, which when present, were facilitators, and if absent, were barriers: evidence (intervention credibility, experienced efficacy, perceived need for intervention); context (positive attitude to and capacity for survivorship/FCR care, favourable therapist orientation and flexibility, strong referral pathways); and facilitation of implementation (intervention/service fit, intervention/patient fit, and training, support, and provided resources). CONCLUSIONS ConquerFear is a sustainable intervention in routine clinical practise. Facilitators included a sound evidence base; a receptive context; good fit between the intervention, therapist orientation, and patient need; and flexibility of delivery. Where absent, these factors served as barriers. These results have implications for enhancing uptake of psycho-oncology interventions in routine care.
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Affiliation(s)
- Phyllis Butow
- Psycho-Oncology Co-operative Research Group, The University of Sydney, Sydney, Australia.,School of Psychology, The University of Sydney, Sydney, Australia
| | - Douglas Williams
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Belinda Thewes
- Psycho-Oncology Co-operative Research Group, The University of Sydney, Sydney, Australia
| | - Stephanie Tesson
- Psycho-Oncology Co-operative Research Group, The University of Sydney, Sydney, Australia.,School of Psychology, The University of Sydney, Sydney, Australia
| | - Louise Sharpe
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Allan Ben Smith
- Psycho-Oncology Co-operative Research Group, The University of Sydney, Sydney, Australia.,Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Kensington, Australia
| | - Joanna E Fardell
- Psycho-Oncology Co-operative Research Group, The University of Sydney, Sydney, Australia.,Kids Cancer Centre, Sydney Children's Hospital and School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - Jane Turner
- Mental Health Centre, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Jemma Gilchrist
- Crown Princess Mary Cancer Centre, Breast Cancer Institute, Westmead Hospital, Sydney, Australia
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Kensington, Australia
| | - Jane Beith
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, Australia
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Smith A'B, Sharpe L, Thewes B, Turner J, Gilchrist J, Fardell JE, Girgis A, Tesson S, Descallar J, Bell ML, Beith J, Butow P. Medical, demographic and psychological correlates of fear of cancer recurrence (FCR) morbidity in breast, colorectal and melanoma cancer survivors with probable clinically significant FCR seeking psychological treatment through the ConquerFear study. Support Care Cancer 2018; 26:4207-4216. [PMID: 29882025 DOI: 10.1007/s00520-018-4294-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 05/27/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE Despite the prevalence of fear of cancer recurrence (FCR), understanding of factors underlying clinically significant FCR is limited. This study examined factors associated with greater FCR morbidity, according to a cognitive processing model, in cancer survivors who screened positively for clinically significant FCR seeking psychological treatment through the ConquerFear trial. METHODS Participants had completed treatment for breast, colorectal or melanoma cancer 2 months to 5 years previously and scored ≥ 13/36 on the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF). Hierarchical regression analyses examined associations between demographic, medical and psychological variables, namely metacognitions (MCQ-30), post-traumatic stress symptoms (IES-R) and FCR (FCRI total score). RESULTS Two hundred and ten (95%) of the 222 cancer survivors who consented to the ConquerFear trial completed the baseline questionnaire. Participants were predominantly (89%) breast cancer survivors. The final regression model accounted for 68% of the variance in FCR (demographic and medical variables 13%, metacognitions 26%, post-traumatic stress symptoms 28%). Negative metacognitive beliefs about worry and intrusive post-traumatic stress symptoms were significant individual correlates of FCR, but negative beliefs about worry did not significantly moderate the impact of intrusions on FCR morbidity. CONCLUSIONS Results provide partial support for the cognitive processing model of FCR. Psychological factors were found to play an important role in FCR morbidity after controlling for demographic/medical factors. More intrusive thoughts and negative beliefs about worry were strong independent predictors of FCR morbidity. Cancer survivors with clinically significant FCR may benefit from assessment for intrusive thoughts and metacognitions and delivery of trauma- and/or metacognitive-based interventions accordingly.
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Affiliation(s)
- Allan 'Ben' Smith
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, Australia. .,Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.
| | - Louise Sharpe
- School of Psychology, University of Sydney, Sydney, Australia
| | - Belinda Thewes
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, Australia.,Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jane Turner
- Mental Health Centre, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Jemma Gilchrist
- Crown Princess Mary Cancer Centre, Breast Cancer Institute, Westmead Hospital, Sydney, Australia
| | - Joanna E Fardell
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, Australia.,Kids Cancer Centre, Sydney Children's Hospital and School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Stephanie Tesson
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, Australia
| | - Joseph Descallar
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Melanie L Bell
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, Australia.,Epidemiology & Biostatistics, University of Arizona, Tucson, AZ, USA
| | - Jane Beith
- Department of Medical Oncology, Chris O'Brien Lifehouse, Missenden Rd, Camperdown, NSW, Australia
| | - Phyllis Butow
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, Australia
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11
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Butow PN, Turner J, Gilchrist J, Sharpe L, Smith AB, Fardell JE, Tesson S, O’Connell R, Girgis A, Gebski VJ, Asher R, Mihalopoulos C, Bell ML, Zola KG, Beith J, Thewes B. Randomized Trial of ConquerFear: A Novel, Theoretically Based Psychosocial Intervention for Fear of Cancer Recurrence. J Clin Oncol 2017; 35:4066-4077. [DOI: 10.1200/jco.2017.73.1257] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Purpose Fear of cancer recurrence (FCR) is prevalent, distressing, and long lasting. This study evaluated the impact of a theoretically/empirically based intervention (ConquerFear) on FCR. Methods Eligible survivors had curable breast or colorectal cancer or melanoma, had completed treatment (not including endocrine therapy) 2 months to 5 years previously, were age > 18 years, and had scores above the clinical cutoff on the FCR Inventory (FCRI) severity subscale at screening. Participants were randomly assigned at a one-to-one ratio to either five face-to-face sessions of ConquerFear (attention training, metacognitions, acceptance/mindfulness, screening behavior, and values-based goal setting) or an attention control (Taking-it-Easy relaxation therapy). Participants completed questionnaires at baseline (T0), immediately post-therapy (T1), and 3 (T2) and 6 months (T3) later. The primary outcome was FCRI total score. Results Of 704 potentially eligible survivors from 17 sites and two online databases, 533 were contactable, of whom 222 (42%) consented; 121 were randomly assigned to intervention and 101 to control. Study arms were equivalent at baseline on all measured characteristics. ConquerFear participants had clinically and statistically greater improvements than control participants from T0 to T1 on FCRI total ( P < .001) and severity subscale scores ( P = .001), which were maintained at T2 ( P = .017 and P = .023, respectively) and, for FCRI total only, at T3 ( P = .018), and from T0 to T1 on three FCRI subscales (coping, psychological distress, and triggers) as well as in general anxiety, cancer-specific distress (total), and mental quality of life and metacognitions (total). Differences in FCRI psychological distress and cancer-specific distress (total) remained significantly different at T3. Conclusion This randomized trial demonstrated efficacy of ConquerFear compared with attention control (Taking-it-Easy) in reduction of FCRI total scores immediately post-therapy and 3 and 6 months later and in many secondary outcomes immediately post-therapy. Cancer-specific distress (total) remained more improved at 3- and 6-month follow-up.
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Affiliation(s)
- Phyllis N. Butow
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Jane Turner
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Jemma Gilchrist
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Louise Sharpe
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Allan Ben Smith
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Joanna E. Fardell
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Stephanie Tesson
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Rachel O’Connell
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Afaf Girgis
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Val J. Gebski
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Rebecca Asher
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Cathrine Mihalopoulos
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Melanie L. Bell
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Karina Grunewald Zola
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Jane Beith
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Belinda Thewes
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
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Sundaresan P, Ager B, Turner S, Costa D, Kneebone A, Pearse M, Woo H, Tesson S, Juraskova I, Butow P. A Randomized Controlled Trial Evaluating the Utility of a Patient Decision Aid to Improve Clinical Trial (RAVES 08.03) Related Decision-Making. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sundaresan P, Ager B, Turner S, Costa D, Kneebone A, Pearse M, Woo H, Tesson S, Juraskova I, Butow P. A randomised controlled trial evaluating the utility of a patient Decision Aid to improve clinical trial (RAVES 08.03) related decision-making. Radiother Oncol 2017; 125:124-129. [PMID: 28844330 DOI: 10.1016/j.radonc.2017.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE Randomised controlled trials (RCTs) are considered the 'gold-standard' for evaluating medical treatments. However, patients and clinicians report difficulties with informed consent and recruitment. We evaluated the utility of a Decision Aid (DA) in reducing RCT-related decisional conflict, and improving RCT knowledge and recruitment. MATERIALS AND METHODS Potential participants for a radiotherapy RCT were invited to participate in the current study. Participants were randomised to receive the RCT's participant information sheet with or without a DA. Questionnaires were administered at baseline, one and six months. The primary outcome measure was decisional conflict. Secondary outcome measures included knowledge regarding and recruitment to the RCT. RESULTS 129 men were randomised to the DA (63) and control (66) arms. Decisional conflict was significantly lower over 6-months (p=0.048) in the DA arm. Knowledge regarding the RCT was significantly higher at 6months (p=0.033) in the DA arm. 20.6% of the DA arm (13 of 63) and 9% of the control arm (6 of 66) entered the RCT. CONCLUSIONS This study demonstrates the utility of a DA in reducing decisional conflict and improving trial knowledge in men with cancer who are making decisions regarding RCT participation.
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Affiliation(s)
- Puma Sundaresan
- Sydney Medical School, University of Sydney, Australia; Radiation Oncology Network, Westmead Hospital, NSW, Australia.
| | - Brittany Ager
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Australia
| | - Sandra Turner
- Sydney Medical School, University of Sydney, Australia; Radiation Oncology Network, Westmead Hospital, NSW, Australia
| | - Dan Costa
- Sydney Medical School, University of Sydney, Australia; Pain Management Research Institute, Royal North Shore Hospital, Australia
| | - Andrew Kneebone
- Sydney Medical School, University of Sydney, Australia; Northern Sydney Cancer Centre, Australia
| | - Maria Pearse
- Department of Radiation Oncology, Auckland City Hospital, New Zealand
| | - Henry Woo
- Sydney Medical School, University of Sydney, Australia
| | - Stephanie Tesson
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Australia
| | - Ilona Juraskova
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Australia; Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Australia
| | - Phyllis Butow
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Australia; Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Australia
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Beith JM, Thewes B, Turner J, Gilchrist J, Sharpe L, Girgis A, Smith A'B, Fardell J, Tesson S, O'Connell R, Asher R, Butow P. Long-term results of a phase II randomized controlled trial (RCT) of a psychological intervention (Conquer Fear) to reduce clinical levels of fear of cancer recurrence in breast, colorectal, and melanoma cancer survivors. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.18_suppl.lba10000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA10000 Background: Up to 70% of cancer survivors report clinically significant fear of cancer recurrence (FCR). This parallel RCT evaluated the impact of a psychological intervention, Conquer Fear (CF), on FCR in cancer survivors. Methods: Participants were disease-free stage I-III breast, colorectal or melanoma cancer survivors, 2 months to 5 years post-treatment, who scored above the clinical cut-off (≥13) on the FCR Inventory (FCRI) severity subscale. CF included 5 sessions incorporating attention training, detached mindfulness, challenging unhelpful metacognitions, values clarification and psycho-education. Participants were randomised to the intervention ( n= 121) or a relaxation training (RT) control arm ( n= 101) (target n= 260). The primary end-point was reduction in FCR (FCRI total) immediately after intervention completion. Follow-up assessments occurred immediately, 3- and 6-months post-treatment. Data analysis was by intention to treat. The differences in change in FCR from baseline between CF and RT and secondary outcomes were tested using independent t-tests. A difference of 14.5 points in FCR was considered clinically significant. Long-term changes in FCR and secondary outcomes were evaluated using linear regression models fitted with generalized estimating equations (GEE), adjusted for baseline FCR. Results: Reduction in FCR between baseline and immediately post-treatment was significantly more in CF participants compared to RT. (Difference in change (95% CI): -10.5 (-16.1, -4.9); p < 0.001). Greater FCR reductions were also observed amongst CF participants at 3 months (-7.6 (-13.9, -1.4), p = 0.02) and 6 months (-7.8 (-14.2, -1.4), p = 0.02) compared with RT. The pattern of change in outcomes over time was consistent between treatment groups as no significant linear trends in treatment effects over time were observed. Conclusions: Conquer Fear is a theoretically-grounded intervention to reduce FCR and its associated psychological morbidity which leads to significantly greater reductions in FCR in the first 6 months following treatment than relaxation training. Clinical trial information: ACTRN12612000404820.
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Affiliation(s)
| | - Belinda Thewes
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Jane Turner
- Mental Health Centre, School of Medicine, University of Queensland, Brisbane, Australia
| | - Jemma Gilchrist
- Crown Princess Mary Cancer Centre Westmead, Westmead, Australia
| | - Louise Sharpe
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Sydney, Australia
| | - Allan 'Ben' Smith
- Centre for Oncology Education and Research Translation (CONCERT), Sydney, Australia
| | - Joanna Fardell
- Behavioural Sciences Unit, School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Stephanie Tesson
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, Australia
| | - Rachel O'Connell
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Rebecca Asher
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Phyllis Butow
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, Australia
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Beith JM, Thewes B, Turner J, Gilchrist J, Sharpe L, Girgis A, Smith A'B, Fardell J, Tesson S, O'Connell R, Asher R, Butow P. Long-term results of a phase II randomized controlled trial (RCT) of a psychological intervention (Conquer Fear) to reduce clinical levels of fear of cancer recurrence in breast, colorectal, and melanoma cancer survivors. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.lba10000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA10000 The full, final text of this abstract will be available at abstracts.asco.org at 2:00 PM (EDT) on Friday, June 2, 2017, and in the Annual Meeting Proceedings online supplement to the June 20, 2017, issue of the Journal of Clinical Oncology. Onsite at the Meeting, this abstract will be printed in the Saturday edition of ASCO Daily News.
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Affiliation(s)
| | - Belinda Thewes
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Jane Turner
- Mental Health Centre, School of Medicine, University of Queensland, Brisbane, Australia
| | - Jemma Gilchrist
- Crown Princess Mary Cancer Centre Westmead, Westmead, Australia
| | - Louise Sharpe
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Sydney, Australia
| | - Allan 'Ben' Smith
- Centre for Oncology Education and Research Translation (CONCERT), Sydney, Australia
| | - Joanna Fardell
- Behavioural Sciences Unit, School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Stephanie Tesson
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, Australia
| | - Rachel O'Connell
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Rebecca Asher
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Phyllis Butow
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, Australia
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Sundaresan P, Ager B, Butow P, Tesson S, Kneebone A, Costa D, Woo H, Pearse M, Juraskova I, Turner S. PV-0050: A randomised controlled study of decision aids to improve clinical trial decisions & recruitment. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30494-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zdenkowski N, Tesson S, Lombard J, Lovell M, Hayes S, Francis PA, Dhillon HM, Boyle FM. Supportive care of women with breast cancer: key concerns and practical solutions. Med J Aust 2017; 205:471-475. [PMID: 27852186 DOI: 10.5694/mja16.00947] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients diagnosed with breast cancer may have supportive care needs for many years after diagnosis. High quality multidisciplinary care can help address these needs and reduce the physical and psychological effects of breast cancer and its treatment. Ovarian suppression and extended endocrine therapy benefits are associated with vasomotor, musculoskeletal, sexual and bone density-related side effects. Aromatase inhibitor musculoskeletal syndrome is a common reason for treatment discontinuation. Treatment strategies include education, exercise, simple analgesia and a change to tamoxifen or another aromatase inhibitor. Chemotherapy-induced alopecia may be a constant reminder of breast cancer to the patient, family, friends, acquaintances and even strangers. Alopecia can be prevented in some patients using scalp-cooling technology applied at the time of chemotherapy infusion. The adverse impact of breast cancer diagnosis and treatment on sexual wellbeing is under-reported. Identification of physical and psychological impacts is needed for implementation of treatment strategies. Fear of cancer recurrence reduces quality of life and increases distress, with subsequent impact on role functioning. Identification and multidisciplinary management are key, with referral to psychosocial services recommended where indicated. The benefits of exercise include reduced fatigue, better mental health and reduced musculoskeletal symptoms, and may also include reduced incidence of breast cancer recurrence. Identification and management of unmet supportive care needs are key aspects of breast cancer care, to maximise quality of life and minimise breast cancer recurrence.
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Affiliation(s)
| | | | | | | | - Sandra Hayes
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD
| | | | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-based Decision-making, University of Sydney, Sydney, NSW
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Sundaresan P, Ager B, Butow P, Tesson S, Costa D, Kneebone A, Pearse M, Woo H, Juraskova I, Turner S. PD06-05 A RANDOMISED CONTROLLED TRIAL EVALUATING THE UTILITY OF A PATIENT DECISION AID TO IMPROVE A PROSTATE CANCER CLINICAL TRIAL RELATED DECISION-MAKING AND RECRUITMENT. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Dieng M, Butow PN, Costa DS, Morton RL, Menzies SW, Mireskandari S, Tesson S, Mann GJ, Cust AE, Kasparian NA. Psychoeducational Intervention to Reduce Fear of Cancer Recurrence in People at High Risk of Developing Another Primary Melanoma: Results of a Randomized Controlled Trial. J Clin Oncol 2016; 34:4405-4414. [DOI: 10.1200/jco.2016.68.2278] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose People with a history of melanoma commonly report a fear of cancer recurrence (FCR), yet psychologic support is not routinely offered as part of ongoing melanoma care. This randomized controlled trial examined the efficacy of a psychoeducational intervention to reduce FCR and improve psychologic adjustment in this patient group compared with usual care. Methods The intervention comprised a newly developed psychoeducational resource and three telephone-based psychotherapeutic sessions over a 1-month period timed in accordance with dermatologic appointments. Participants were randomly assigned to intervention (n = 80) or usual care (n = 84). Assessments were completed at baseline, 1 month, and 6 months after dermatologic appointments. Linear mixed models were used to examine differences between treatment and control groups for patient-reported outcomes, including FCR, anxiety, stress, depression, melanoma-related knowledge, health behaviors, satisfaction with melanoma care, unmet needs, and health-related quality of life. Results At 6 months, the intervention group reported lower FCR severity, trigger, and distress scores than the control group in the baseline-adjusted models; the between-group mean difference was −1.9 for FCR severity (95% CI, −3.1 to −0.7; P = .002), −2.0 for FCR triggers (95% CI, −3.3 to −0.7; P = .003), and −0.7 for FCR distress (95% CI, −1.3 to −0.1; P = .03). The decrease in FCR severity (but not triggers or distress) remained statistically significant after adjustment for other covariates ( P = .04). At 6 months, the intervention group also reported lower stress (−1.6; 95% CI, −3.1 to −0.2; P = .03) and improved melanoma-related knowledge (1.7; 95% CI, 0.8 to 2.6; P < .001) compared with the control group. No differences were found between groups for other secondary outcomes. Conclusion This newly developed evidence-based psychoeducational intervention was effective in reducing FCR and stress and increasing melanoma-related knowledge in people at high risk for another melanoma.
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Affiliation(s)
- Mbathio Dieng
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
| | - Phyllis N. Butow
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
| | - Daniel S.J. Costa
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
| | - Rachael L. Morton
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
| | - Scott W. Menzies
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
| | - Shab Mireskandari
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
| | - Stephanie Tesson
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
| | - Graham J. Mann
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
| | - Anne E. Cust
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
| | - Nadine A. Kasparian
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
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Porzio F, Cuierrier É, Wespiser C, Tesson S, Underhill RS, Soldera A. Mechanical equilibrium, a prerequisite to unveil auxetic properties in molecular compounds. Molecular Simulation 2016. [DOI: 10.1080/08927022.2016.1241397] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- F. Porzio
- Centre Québécois sur les Matériaux Fonctionnels (CQMF), Département de Chimie, Université de Sherbrooke, Sherbrooke, Canada
| | - É. Cuierrier
- Centre Québécois sur les Matériaux Fonctionnels (CQMF), Département de Chimie, Université de Sherbrooke, Sherbrooke, Canada
| | - C. Wespiser
- Centre Québécois sur les Matériaux Fonctionnels (CQMF), Département de Chimie, Université de Sherbrooke, Sherbrooke, Canada
| | - S. Tesson
- Centre Québécois sur les Matériaux Fonctionnels (CQMF), Département de Chimie, Université de Sherbrooke, Sherbrooke, Canada
| | - R. S. Underhill
- Defence R&D Canada, Atlantic Research Centre, Dartmouth, Canada
| | - A. Soldera
- Centre Québécois sur les Matériaux Fonctionnels (CQMF), Département de Chimie, Université de Sherbrooke, Sherbrooke, Canada
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Cust AE, Dieng M, Butow P, Costa DSJ, Morton RL, Menzies S, Mireskandari S, Tesson S, Mann GJ, Kasparian N. Randomised controlled trial of a psycho-educational intervention to reduce fear of cancer recurrence in people at high risk of developing another primary melanoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Anne E. Cust
- Sydney School of Public Health, and Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Mbathio Dieng
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Phyllis Butow
- Psycho-oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia
| | | | - Rachael L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Scott Menzies
- Discipline of Dermatology, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Shab Mireskandari
- Centre for Medical Psychology & Evidence-based Decision-making, The University of Sydney, Sydney, Australia
| | - Stephanie Tesson
- Psycho-oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia
| | - Graham J Mann
- Centre for Cancer Research, Westmead Institute for Medical Research, and Melanoma Institute Australia, University of Sydney, Sydney, Australia
| | - Nadine Kasparian
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, Australia
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Tesson S, Richards I, Porter D, Phillips KA, Rankin N, Musiello T, Marven M, Butow P. Women's preferences for contralateral prophylactic mastectomy: An investigation using protection motivation theory. Patient Educ Couns 2016; 99:814-822. [PMID: 27529090 DOI: 10.1016/j.pec.2015.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Most women diagnosed with unilateral breast cancer without BRCA1 or BRCA2 mutations are at low risk of contralateral breast cancer. Contralateral Prophylactic Mastectomy (CPM) decreases the relative risk of contralateral breast cancer, but may not increase life expectancy; yet international uptake is increasing. This study applied protection motivation theory (PMT) to determine factors associated with women's intentions to undergo CPM. METHODS Three hundred eighty-eight women previously diagnosed with unilateral breast cancer and of negative or unknown BRCA1 or BRCA2 status were recruited from an advocacy group's research database. Participants completed measures of PMT constructs based on a common hypothetical CPM decision-making scenario. RESULTS PMT constructs explained 16% of variance in intentions to undergo CPM. Response efficacy (CPM's advantages) and response costs (CPM's disadvantages) were unique individual predictors of intentions. CONCLUSION Decision-making appears driven by considerations of the psychological, cosmetic and emotional advantages and disadvantages of CPM. Overestimations of threat to life from contralateral breast cancer and survival benefit from CPM also appear influential factors. PRACTICE IMPLICATIONS Patients require balanced and medically accurate information regarding the pros and cons of CPM, survival rates, and recurrence risks to ensure realistic and informed decision-making.
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Sundaresan P, Tesson S, Ager B, Butow P, Juraskova I, Costa D, Kneebone A, Woo H, Pearse M, Turner S. EP-1460: Knowledge, attitudes and decision-making preferences of men considering clinical trial participation. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32710-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tesson S, Sundaresan P, Ager B, Butow P, Kneebone A, Costa D, Woo H, Pearse M, Juraskova I, Turner S. Knowledge, attitudes and decision-making preferences of men considering participation in the TROG RAVES Prostate Cancer Trial (TROG 08.03). Radiother Oncol 2016; 119:84-90. [PMID: 26867970 DOI: 10.1016/j.radonc.2016.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 01/01/2016] [Accepted: 01/09/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The RAVES (Trans-Tasman Radiation Oncology Group 08.03) randomised controlled trial (RCT), compares adjuvant radiotherapy with early salvage radiotherapy in men with high risk histopathological features at prostatectomy. The RAVES Decision Aid study evaluates the utility of a decision aid for men considering participation in the RAVES RCT. We report the RAVES Decision Aid study participants' attitudes and knowledge regarding RCTs, decision-making preferences and decisional-conflict. MATERIALS AND METHODS Baseline questionnaires assessed knowledge and attitudes towards RCTs and RAVES RCT. Sociodemographic and clinical predictors of knowledge were examined. Involvement in decision-making and difficulties with the decision-making process were assessed using validated tools. RESULTS 127 men (median age=63years) were recruited through urologists (n=91) and radiation oncologists (n=36). Men preferred collaborative (35%) or semi-active (35%) decision-making roles. Most (>75%) felt the RAVES RCT was worthwhile and important with participation being wise. However, nearly half had high decisional-conflict regarding participation. Scores of objective knowledge regarding RCTs and RAVES RCT were low. CONCLUSIONS Most men with high-risk histopathological features at prostatectomy desire active involvement in decision-making regarding further management. Despite positive attitudes towards RCTs and the RAVES RCT, there were gaps in knowledge and high decisional-conflict surrounding participation.
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Affiliation(s)
- Stephanie Tesson
- Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Australia
| | - Puma Sundaresan
- Sydney Medical School, The University of Sydney, Australia; Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Australia.
| | - Brittany Ager
- Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Australia
| | - Phyllis Butow
- Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Australia
| | - Andrew Kneebone
- Sydney Medical School, The University of Sydney, Australia; Northern Sydney Cancer Centre, Australia
| | - Daniel Costa
- Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, Australia
| | - Henry Woo
- Sydney Adventist Hospital Clinical School, The University of Sydney, Australia
| | | | - Ilona Juraskova
- Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Australia; Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Australia
| | - Sandra Turner
- Sydney Medical School, The University of Sydney, Australia; Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Australia
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Butow P, Tesson S, Boyle F. A systematic review of decision aids for patients making a decision about treatment for early breast cancer. Breast 2016; 26:31-45. [PMID: 27017240 DOI: 10.1016/j.breast.2015.12.007] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 12/12/2015] [Accepted: 12/15/2015] [Indexed: 01/11/2023] Open
Abstract
Several complex treatment decisions may be offered to women with early stage breast cancer, about a range of treatments from different modalities including surgery, radiotherapy, and endocrine and chemotherapy. Decision aids can facilitate shared decision-making and improve decision-related outcomes. We aimed to systematically identify, describe and appraise the literature on treatment decision aids for women with early breast cancer, synthesise the data and identify breast cancer decisions that lack a decision aid. A prospectively developed search strategy was applied to MEDLINE, the Cochrane databases, EMBASE, PsycINFO, Web of Science and abstract databases from major conferences. Data were extracted into a pre-piloted form. Quality and risk of bias were measured using Qualsyst criteria. Results were synthesised into narrative format. Thirty-three eligible articles were identified, evaluating 23 individual treatment decision aids, comprising 13 randomised controlled trial reports, seven non-randomised comparative studies, eight single-arm pre-post studies and five cross-sectional studies. The decisions addressed by these decision aids were: breast conserving surgery versus mastectomy (+/- reconstruction); use of chemotherapy and/or endocrine therapy; radiotherapy; and fertility preservation. Outcome measures were heterogeneous, precluding meta-analysis. Decisional conflict decreased, and knowledge and satisfaction increased, without any change in anxiety or depression, in most studies. No studies were identified that evaluated decision aids for neoadjuvant systemic therapy, or contralateral prophylactic mastectomy. Decision aids are available and improved decision-related outcomes for many breast cancer treatment decisions including surgery, radiotherapy, and endocrine and chemotherapy. Decision aids for neoadjuvant systemic therapy and contralateral prophylactic mastectomy could not be found, and may be warranted.
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Affiliation(s)
- Phyllis Butow
- Psycho-oncology Co-operative Research Group (PoCoG) and Centre for Medical Psychology and Evidence-based Medicine (CeMPED), School of Psychology, University of Sydney, NSW, Australia
| | - Stephanie Tesson
- Psycho-oncology Co-operative Research Group (PoCoG) and Centre for Medical Psychology and Evidence-based Medicine (CeMPED), School of Psychology, University of Sydney, NSW, Australia
| | - Frances Boyle
- Faculty of Medicine, University of Sydney, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia; Patricia Ritchie Centre for Cancer Care and Research, Mater Hospital, Sydney, NSW, Australia
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