ORCID Profile
0000-0002-5930-4573
Current Organisation
University of Notre Dame Australia
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Publisher: Wiley
Date: 03-06-2008
DOI: 10.1002/PON.1371
Publisher: Wiley
Date: 18-12-2008
DOI: 10.1002/PON.1493
Abstract: The psychotherapy and cancer survival debate generated great interest in the psychoneuroimmunological and bio-behavioral mechanisms that might mediate any gain in survival. Recent methodologically-improved cognitive-existential, supportive-expressive and psycho-educational group interventions for patients with breast cancer and melanoma have not extended survival times. Shorter survival has been associated with social disparity and untreated clinical depression, potentially mediated by poorer adherence to anti-cancer treatments. Group therapy both prevents and treats depression. Future research could address these bio-behavioral mechanisms.
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.GENHOSPPSYCH.2017.01.007
Abstract: Demoralization, a state of lowered morale and poor coping, has a prevalence of 13-18% among patients with advanced cancer. We surveyed clinicians' perspectives of the utility of "with demoralization" as a diagnostic specifier for adjustment and depressive disorders. Using comparative clinical vignettes in a field survey, clinicians from a range of disciplines were asked their perception of the utility of diagnosis and treatment options. Response frequencies were compared using Cochran's Q and McNemar's tests, with sensitivity and specificity rated against expert rankings of diagnosis. Analysis of variance and paired t-tests examined significant differences in ratings of utility. Vignettes were assessed by 280 clinicians 77% supported utility of the category 'adjustment disorder with demoralization' compared to 33% supporting 'adjustment disorder with anxiety' (McNemar test, p<0.001), while 83% supported the utility of 'with demoralization' for major depressive episode, matching 83% perceiving utility for 'with melancholia.' Sensitivity and specificity ratings were 77% and 94% for adjustment disorder with demoralization and 83% and 91% for major depression with demoralization. Clinicians perceived the specifier 'with demoralization' to deepen diagnostic understanding, treatment choice, and ability to communicate with clinicians and patients, particularly for the category of adjustment disorder with demoralization.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 11-2001
DOI: 10.1200/JCO.2001.19.21.4117
Abstract: PURPOSE: To determine whether making patient-reported cancer needs, quality-of-life (QOL), and psychosocial information available to the health care team, allowing coordinated specifically targeted psychosocial interventions, resulted in reduced cancer needs, improved QOL, and increased satisfaction with care received. METHODS: Self-reported cancer needs, QOL, and psychosocial information was collected from 450 people with cancer, using standardized questionnaires via a touch-screen computer. For a randomly chosen two thirds, this information was made available to the health care team who coordinated targeted psychosocial interventions. Information from the remaining one third was not seen. Patients were assessed 2 and 6 months after randomization for changes in their cancer needs, QOL, and psychosocial functioning and satisfaction with overall care received. RESULTS: There were no significant differences between the two arms with respect to changes in cancer needs, QOL, or psychosocial functioning between the baseline and follow-up assessments, nor with respect to satisfaction with care. However, for the subgroup of patients who were moderately or severely depressed at baseline, there was a significant reduction in depression for the intervention arm relative to the control arm at the 6-month assessment (P = .001). CONCLUSION: Making patient-reported cancer needs, QOL, and psychosocial data available to the health care team at a single consultation together with coordinated psychosocial interventions does not seem to reduce cancer needs nor improve QOL, psychosocial functioning, or satisfaction with the care received. However, identification of patients with moderate or severe levels of depression may be valuable in reducing subsequent levels of depression.
Publisher: Elsevier BV
Date: 11-2022
DOI: 10.1016/J.JPAINSYMMAN.2022.07.015
Abstract: Personal values are in idual conceptions of the desirable appraisals and actions that guide our attitudes and behaviour. Advance care planning (ACP) now emphasises the consideration of personal life goals and values expressed as a Values Directive (VD) to guide discussions concerning medical treatment. To investigate the ersity of values, experiences and adaptations expressed in cancer patients VDs. Contents of the VDs of ACPs of cancer patients who participated in a randomised control trial comparing a video intervention showing values communication between cancer patient-caregivers with usual care were analysed. Qualitative phenomenological content analysis was used to understand how participants made meaning of their lived experiences. Forty-two participants completed an ACP (37.2% response rate), with 97.6% of these completing a VD (57.1% female, mean age 72 years, 30.1% gastrointestinal cancer). Participants described erse adjustments to frailty and adaptive coping with deteriorating functionality. Emotional and financial concerns were eased through experiencing benevolence and trust established through family and friendship bonds and reciprocation of care. Death anxiety and ambivalence were expressed concurrently with the experiential acceptance of dying. Secular and sacred rituals featured as an affirmation of their faith or beliefs. Cancer patients seek to make meaning of their experiences, concurrently posturing vulnerability and resilience, despite conflicting emotions and experiences. Given that the choices people make as they approach dying relate to their most deeply held values, ACP conversations should explore how patients draw from their values and life goals to optimise their adaptations to illness.
Publisher: Wiley
Date: 04-06-2018
DOI: 10.1002/PON.4761
Abstract: Demoralization as a form of existential distress involves poor coping, low morale, hopelessness, helplessness, and meaninglessness. In a secondary analysis of a cohort of German cancer patients, we aimed to explore latent class structure to assess the contribution that symptoms of demoralization make to anhedonic depression, anxiety, adjustment, and somatic disorders. Measures of demoralization, depression, anxiety, physical symptoms, and functional impairment had been completed cross-sectionally by 1527 patients with early or advanced cancer. Latent class analysis used maximum likelihood techniques to define the unobserved latent constructs that can be predicted as symptom clusters. In idual patients were assigned to the most probable class. Classes were compared on demographics, and logistic regression assessed the odds of in idual items predicting each class. A 4-class model provided the best fit. Class 1 (n = 829, 54.3%) was defined by the absence of distress Classes 2 to 4 all carried functional impairment. Class 2 (n = 333, 21.8%) was differentiated by somatic symptoms (sleep, tiredness, and appetite) Class 3 (n = 163, 10.7%) by anhedonia, anxiety, and severe demoralization and Class 4 (n = 202, 13.2%) by adjustment and moderate demoralization. Members of Class 3 were more likely to be younger, female, anhedonic, depressed, and anxious. In both Classes 3 and 4, functional impairment, physical symptom burden, and suicidal ideation were present. In contrast with the severe symptom cluster carrying anhedonia, anxiety, and demoralization, the moderate symptom cluster was formed by patients with demoralization and impaired functioning, a clinical picture consistent with a unidimensional model of adjustment disorder.
Publisher: Wiley
Date: 30-05-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2015
Publisher: Informa UK Limited
Date: 10-09-2021
Publisher: Elsevier BV
Date: 09-2023
Publisher: Royal College of Psychiatrists
Date: 06-1994
Abstract: As grief is both an in idual and shared experience, adopting a systemic perspective is most appropriate for health-care professionals seeking to assist the bereaved. Within this framework, the family virtually always constitutes the most significant social group in which grief is experienced. In this paper we review the literature on family grief, covering clinical case reports, the observations of family therapists, systematic family bereavement research and family intervention studies. An understanding of patterns of family grief and vulnerability factors for morbid grief is pivotal to both preventive intervention and treatment of an established disorder.
Publisher: Informa UK Limited
Date: 10-03-2017
Publisher: SAGE Publications
Date: 02-2007
DOI: 10.2190/OM.56.1.C
Abstract: Distress reverberates throughout the family during palliative care and bereavement, inviting consideration of a family-centered model of care. Targeting families thought to be “at risk” has merit. The Family Focused Grief Therapy model was tested in a randomized controlled trial of 81 families (353 in iduals) and bereavement outcome is reported here for treatment completers compared to controls. There were no significant baseline differences between treatment completers and non-completers. Significant reduction in distress occurred at 13 months post death for the families completing treatment, with further improvements for the 10% of in iduals most distressed at baseline. A preventive model of family-centered care applied to those at greatest risk is meritorious and in keeping with the aspirations of Cicely Saunders for improving the quality of hospice care.
Publisher: Oxford University Press
Date: 25-03-2011
Publisher: Wiley
Date: 03-1997
DOI: 10.1002/(SICI)1099-1611(199703)6:1<25::AID-PON240>3.0.CO;2-N
Abstract: Lichen planus (LP) is an autoimmune inflammatory disease that affects oral mucosal tissue, leading to complications in patients treated with dental implant therapy. This case report discusses the clinical management of a patient diagnosed with an erosive type of LP. After disease management, the patient was treated with dental implants in the upper and lower jaws with augmentation procedures around the implants. All implants were loaded after a three-month period of healing. Slight bone loss was observed in the upper premolar area following an exaggerated soft tissue response to the augmentation procedure. Within one year of implant placement, no additional complications were encountered.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2009
Publisher: Wiley
Date: 2006
DOI: 10.1002/PON.1031
Abstract: Advances in prostate cancer treatments since the 1990s have led to a growing proportion of patients living with the effects of the cancer. Various challenges face the man and his partner from the point of learning of the diagnosis: deciding among numerous erse treatment options, dealing with side-effects of treatment and possibly facing the terminal phase of the illness. This invariably has an impact on the patient's family and, in view of the older age group of men usually affected, the experience of a partner is particularly relevant. A thorough review of the research literature reporting directly from partners of prostate cancer patients has not been undertaken previously. For this review, five databases were searched for the decade 1994-2005, during which most of the work in this field has been done. Very few evaluations of psychosocial interventions involving the partner were found, but there was a preponderance of qualitative studies involving small numbers of participants and quantitative surveys with little consistency in the measures used. The literature suggests that partners report more distress than patients, yet believe that patients are the more distressed, and the focus of concern of patients on their sexual function is not shared to an equal degree by their partners.
Publisher: Springer Science and Business Media LLC
Date: 13-04-2023
Publisher: Wiley
Date: 03-12-2007
DOI: 10.1002/CNCR.23179
Publisher: Wiley
Date: 12-05-2016
DOI: 10.1002/CNCR.30015
Abstract: The Demoralization Scale (DS) was initially validated in 2004 to enable the measurement of demoralization in patients with advanced cancer. Subsequent shortcomings indicated the need for psychometric strengthening. Here, the authors report on the refinement and revalidation of the DS to form the DS-II, specifically reporting the scale's internal validity. Patients with cancer or other progressive diseases who were receiving palliative care (n = 211) completed a revised version of the 24-item DS and a measure of symptom burden (the Memorial Symptom Assessment Scale). Exploratory factor analysis and Rasch modeling were used to evaluate, modify, and revalidate the scale, providing information about dimensionality, suitability of response format, item fit, item bias, and item difficulty. Test-retest reliability was examined for 58 symptomatically stable patients at a 5-day follow-up. Exploratory factor analysis supported a 22-item, 2-component model. Separate Rasch modeling of each component resulted in collapsing the response option categories and removing 3 items from each component. Both final 8-item subscales met Rasch model expectations and were appropriate to sum as a 16-item total score. The DS-II demonstrated internal consistency and test-retest reliability (Meaning and Purpose subscale: α = .84 intraclass correlation [ICC] = 0.68 Distress and Coping Ability subscale: α = .82 ICC = 0.82 total DS: α = .89 ICC = 0.80). The DS-II is a 3-point response, self-report scale comprising 16 items and 2 subscales. Given its revalidation, psychometric strengthening, and simplification, the DS-II is an improved and more practical measure of demoralization for research and clinical use. External validation of the DS-II will be reported subsequently. Cancer 2016 :2251-9. © 2016 American Cancer Society.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 11-2013
Publisher: Wiley
Date: 02-12-2010
Publisher: Wiley
Date: 27-03-2017
DOI: 10.1002/PON.4413
Abstract: Demoralization is a commonly observed syndrome in cancer patients, deserving to be carefully assessed in cross-cultural contexts. To examine the factor structure and concurrent and ergent validity of the Italian version of the Demoralization Scale (DS-IT) in cancer patients. The s le included 194 Italian cancer outpatients who were assessed by using the DS-IT and the Diagnostic Criteria of Psychosomatic Research-Demoralization module to examine demoralization. The Patient Health Questionnaire-9 (PHQ-9) to explore depression and the Mini-Mental Adjustment-to-Cancer-Hopelessness/Helplessness scale (Mini-MAC-HH) to explore maladaptive coping were also administered. Four factors were extracted by exploratory factor analysis on the DS-IT (disheartenment, α = .87 sense of failure, α = .77 dysphoria, α = .73 loss of meaning urpose, α = .72 total = 0.91), accounting for 57.1% of the variance. The DS-IT factors shared between 17% and 36% of the variance. Patients reporting a diagnosis of demoralization on the Diagnostic Criteria of Psychosomatic Research-Demoralization module (23.7%) had higher scores on DS-IT loss of meaning urpose, sense of failure, dysphoria, and DS-IT total. About half of those who were highly demoralized were not depressed and among those who had moderate or moderately severe demoralization, about 80% were not depressed on the PHQ-9. The DS-IT was significantly associated with PHQ-9 and Mini-MAC-HH. The study presents further evidence that demoralization is a significant clinical condition and that the DS-IT demonstrates satisfactory levels of validity and reliability to support its use in patients in the ambulatory cancer setting.
Publisher: Wiley
Date: 04-2009
DOI: 10.1111/J.1365-2923.2009.03302.X
Abstract: Evidence suggests that the most important component of communication skills training (CST) is experiential learning through role-play sessions that rely on facilitators to guide learners. However, there is little published evidence about processes of assessing facilitator competence in CST. This paper reports on the development and application of procedures to assess facilitator competence in a large-scale CST programme. Thirty-two novice facilitators in a large CST programme were audio-recorded while facilitating small-group CST training sessions in order to explore whether the training they had received had prepared them to competently facilitate. Audio-recordings were assessed using the Comskil facilitator assessment coding system. Facilitators were rated as having achieved basic competence, advanced competence or expert competence. Facilitation tasks that were most frequently coded as being used always included inviting the learner to give feedback first and inviting all group members to give feedback. The facilitation task coded least frequently as being used always was involving group members in solving problems. Of the 32 facilitators, 18 reached at least a basic level of competence. Psychosocially trained facilitators and MD facilitators differed in their use of five facilitation tasks. Modest training and minimal practice does not result in complete facilitator competence. Some facilitation skills appear to be more easily acquired than others. These findings highlight which skills should be prioritised in the further training of novice facilitators. A long-term project currently underway will study whether facilitator competence improves with practice and regular feedback.
Publisher: Cambridge University Press (CUP)
Date: 06-2009
DOI: 10.1017/S1478951509000212
Abstract: Family therapy has developed several approaches to framing questions within family meetings, but few of these techniques have been adapted for palliative care. We focus on the application of questioning techniques from systemic family therapy to palliative care. More specifically, we describe and give ex les of the model of asking questions developed by Karl Tomm (1988) through its application in Family Focused Grief Therapy (FFGT), a preventive intervention delivered to high-risk families during palliative care and bereavement. First, the type of questions used across the course of therapy is explored based on the interventive questioning model. Then, a case ex le is provided to demonstrate the use and adaptation of this model in a palliative care setting. At the beginning of therapy, the most frequent questions were linear and circular, moving around the family to build up a picture of events from everyone's perspective. As for the frequency of reflexive and strategic questions, these increased as the therapy progressed, bringing the family to new perspectives. The case ex le fleshes out the importance of each type of question, all of which have a proper place in the course of therapy. These illustrations highlight the value of having a model of questioning styles to guide the clinician when exploring palliative care issues, such as care provision, coping and grief, intimacy, and discussing death. This framework could be useful in guiding supervisors, trainees, and clinicians seeking to build skills and optimize their interventions in a palliative care setting.
Publisher: SAGE Publications
Date: 06-1996
DOI: 10.3109/00048679609065005
Abstract: Objective: To provide an overview of the work of a consultation-liaison (C-L) psychiatry service to an oncology unit in a university affiliated teaching hospital, with the aid of a comprehensive clinical database. Method: The MICROCARES prospective clinical database system was used to record data on all oncology inpatients referred to C-L psychiatry, and the hospital clinical database was used to compare referred inpatients with all oncology inpatients. Results: Two hundred and seventy-one referrals were made in the 3 years from 1991 to 1993, a referral rate of 10.4%. The referred patients were younger but there was no bias in sex and marital status. The mean length of stay was twice that for all other oncology admissions, day cases excluded. The most frequent reasons for referral were coping problems, depression, terminal illness issues and anxiety. The most common psychiatric diagnoses were Systemic Family Problems (V codes, 24%), Mood Disorders (23%), Adjustment Disorders (16%) and Organic Mental Disorders (10%). Management involved family conferences in half of the patients and antidepressant medication in one-quarter. Concordance with pharmacological recommendations was 98%. Existential issues and family-centred care are discussed. Conclusions: Both in idual and family-centred care is required in an oncology service a dedicated liaison attachment offers considerable staff support. Psycho-oncology is underdeveloped in Australia compared to many overseas services there is scope for substantial growth in preventive and supportive work.
Publisher: SAGE Publications
Date: 21-04-2019
Abstract: Objective: This study aimed to identify the biopsychosocial factors associated with anxiety among a residential aged care s le. Method: A total of 178 residents ( M age = 85.4 years, SD = 7.4 years) with mild cognitive impairment or normal cognition participated. Participants completed the Geriatric Anxiety Inventory (GAI) and a set of measures assessing cognition, depression, self-perceived health, mastery, attachment, perceived social support, social engagement, functional status, the experience of a fall, and other negative life events. Results: Unique correlates of GAI scores were depression, a preoccupied attachment style, lower mastery, cognitive impairment, and lower self-perceived health. Discussion: Most correlates that were uniquely associated with anxiety had little to do with the current environment. More variance was accounted for by stable and lifelong factors. This provides new insights into the characteristics of anxiety within aged care populations, and although preliminary, provides possible targets to prevent and treat anxiety within this setting.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 08-2005
Publisher: Oxford University Press
Date: 25-03-2011
Publisher: Oxford University Press
Date: 25-03-2010
Publisher: Oxford University Press
Date: 25-03-2011
Publisher: Elsevier BV
Date: 06-2004
Publisher: Wiley
Date: 12-05-2016
DOI: 10.1002/CNCR.30012
Abstract: The recently refined Demoralization Scale-II (DS-II) is a 16-item, self-report measure of demoralization. Its 2 factors-Meaning and Purpose and Distress and Coping Ability-demonstrate sound internal validity, including item fit, unidimensionality, internal consistency, and test-retest reliability. The convergent and discriminant validity of the DS-II with various measures is reported here. Patients who had cancer or other progressive diseases and were receiving palliative care (n = 211) completed a battery of questionnaires, including the DS-II and measures of symptom burden, quality of life, depression, and attitudes toward the end of life. Spearman ρ correlations were determined to assess convergent validity. Mann-Whitney U tests with calculated effect sizes were used to examine discriminant validity and establish the minimal clinically important difference (MCID). Cross-tabulation frequencies with chi-square analyses were used to examine discriminant validity with major depression. The DS-II demonstrated convergent validity with measures of psychological distress, quality of life, and attitudes toward the end of life. It also demonstrated discriminant validity, as the DS-II differentiated patients who had different functional performance levels and high/low symptoms, with a difference of 2 points between groups on the DS-II considered clinically meaningful. Furthermore, discriminant validity was demonstrated, as comorbidity with depression was not observed at moderate levels of demoralization. The DS-II has sound psychometric properties and is an appropriate measure of demoralization. Given its structural simplicity and brevity, it is likely to be a useful tool in meaning-centered therapies. Cancer 2016 :2260-7. © 2016 American Cancer Society.
Publisher: Oxford University Press
Date: 25-03-2011
Publisher: AME Publishing Company
Date: 10-2016
Publisher: Wiley
Date: 1998
DOI: 10.1002/(SICI)1099-1611(199801/02)7:1<14::AID-PON313>3.0.CO;2-D
Abstract: Endoscopic submucosal dissection (ESD) has been widely used in the treatment of early gastric cancer (EGC). A personalized and effective prediction method for ESD with EGC is urgently needed. To construct a risk prediction model for ulcers after ESD for EGC based on LASSO regression. A total of 196 patients with EGC who received ESD treatment were prospectively selected as the research subjects and followed up for one month. They were ided into an ulcer group and a non-ulcer group according to whether ulcers occurred. The general data, pathology, and endoscopic characteristics of the groups were compared, and the best risk predictor subsets were screened by LASSO regression and tenfold cross-validation. Multivariate logistic regression was applied to analyze the risk factors for ulcers after ESD in patients with EGC. A receiver operating characteristic (ROC) curve was used to estimate the predictive model performance. One month after the operation, no patient was lost to follow-up. The incidence of ulcers was 20.41% (40/196) (ulcer group), and the incidence of no ulcers was 79.59% (156/196) (non-ulcer group). There were statistically significant differences in the course of disease, Clopidogrel medication history, lesion diameter, convergent folds, and mucosal discoloration can predict the occurrence of ulcers after ESD in patients with EGC.
Publisher: Elsevier BV
Date: 02-2017
Publisher: Cambridge University Press (CUP)
Date: 06-2013
DOI: 10.1017/S1478951513000618
Abstract: Cognitive therapy (CT) has considerable utility for psychosomatic medicine (PM) in acute medical settings but, to date, no such cohesive adaptation has been developed. Part I delineated a CT model for acute medical settings focusing on assessment and formulation. In Part II, we review how CT can be applied to common PM clinical challenges. A pragmatic approach is helpful because this review targets PM trainees and educators. Narrative review is used to discuss the application of CT strategies to common challenges in acute medical settings. Treatment complexities and limitations associated with the PM setting are detailed. Exemplary dialogues are used to model techniques. We present CT approaches to eight common scenarios: (1) distressed or hopeless patients (2) patients expressing pivotal distorted cognitions/images (3) patients who catastrophize (4) patients who benefit from distraction and activation strategies (5) panic and anxiety (6) suicidal patients (7) patients who are stuck and helpless (8) inhibited patients. Limitations are discussed. A CT informed PM assessment, formulation and early intervention with specific techniques offers a novel integrative framework for psychotherapy with the acutely medically ill. Future efforts should focus on dissemination, education of fellows and building research efficacy data.
Publisher: Springer International Publishing
Date: 19-09-2017
DOI: 10.1007/978-3-319-64310-6_12
Abstract: Medical communication is a skill which can be learned and taught and which can substantially improve treatment outcomes, especially if patients' communication preferences are taken into account. Here, we give an overview of communication training research and outline the COMSKIL program as a state-of-the-art communication skills training in oncology. COMSKIL has a solid theoretical foundation and teaches core elements of medical communication in up to ten fully operationalized modules. These address typical situations ranging from breaking bad news to responding to difficult emotions, shared decision-making, and communicating via interpreters.
Publisher: Routledge
Date: 04-10-2016
DOI: 10.4324/781315672861
Publisher: Elsevier BV
Date: 10-2014
Publisher: Elsevier BV
Date: 11-2017
Publisher: BMJ
Date: 06-2016
Publisher: American Society of Clinical Oncology (ASCO)
Date: 20-11-2007
Abstract: Shared decision making is a tenet of contemporary medicine and oncology practice. How involved elderly patients want to be in making treatment decisions and how physicians perceive patient preferences for such involvement are uncertain. In structured interviews about multiple facets of chemotherapy treatment decision making, we asked patients age 70 years and older with a recent diagnosis of metastatic colorectal cancer (CRC) about their preferences for prognostic information and for involvement in treatment decision making. We also asked treating oncologists (n = 19) to describe their perceptions of patient preferences. Information and decision-making preferences were evaluated in relation to sociodemographic and clinical characteristics. Seventy-three patients age 70 to 89 years completed the study interview within 16 weeks of metastatic CRC diagnosis. Most patients (n = 70 96%) had decided to receive chemotherapy and 61 had initiated treatment. Relatively few (n = 32 44%) wanted information about expected survival when they made a treatment decision. Preference for prognostic information was more common among men than women (56% v 29% P .05). About half of the patients (n = 38 52%) preferred a passive role in the treatment decision-making process. Physician perceptions were concordant with patient preferences for information in 44% of patient-physician pairs and for decision control in 41% of patient-physician pairs. For older patients with advanced CRC, preferences for prognostic information and for an active role in treatment decision making are not easily predictable. Physicians' perceptions are often inconsistent with patients' stated preferences. Explicit discussion of preferred decision-making styles may improve patient-physician encounters.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 10-07-2015
Abstract: To examine bereavement mental health service use, barriers to use, and factors associated with use in parents bereaved by cancer. A multicenter, cross-sectional study of 120 parents bereaved by cancer between 6 months and 6 years after their loss was performed. Parents completed self-report assessments of mental health service use and barriers, prolonged grief, depression, anxiety, attachment styles, and sense of meaning by phone, in person, or on their own. Forty-one percent of bereaved parents were currently using mental health services (talk therapy, psychotropic medication, and/or a support group), most commonly within the first 2 years after their loss. Talk therapy was the most frequently used service, although 36% of parents who discontinued therapy did so because it was not helpful. Forty percent of parents who wanted bereavement support reported they were not receiving services. The most common barriers to service use were that it was too painful to speak about the loss (64%) and too difficult to find help (60%). Factors associated with current mental health service use included more recent loss, prior mental health service use, subclinical/increased depression, insecure attachment styles, and a decreased sense of meaning. Minority parents were more likely to have unmet needs than nonminority parents. Parents appear to need, want, and often access bereavement mental health services, which could be offered in oncology settings. However, barriers to service use must be addressed, particularly for those with more debilitating grief symptoms and for minorities. High treatment dropout rates suggest the importance of improving retention, training providers, and developing effective grief interventions.
Publisher: Cambridge University Press (CUP)
Date: 22-03-2012
DOI: 10.1017/S147895151100085X
Abstract: The objective of this study was to describe the experience of undertaking meaning and purpose (MaP) therapy for patients with advanced cancer, with an aim of refining therapeutic processes involved prior to pilot testing. Specifically, we were interested in examining the themes arising from participation in the intervention in relation to our therapeutic goals, and how acceptable both the number of sessions and processes used were. A convenience s le of people living with advanced cancer was recruited to participate in this process, resulting in 24 therapy sessions for analysis. A thematic analysis of each session illustrated that the process of MaP therapy is one that encourages reflection, offers insights, and can be confrontational, but can also allow participants to “shift” their perspective and focus onto meaningful goals. Results illustrate how the therapist creates a therapeutic frame that holds up a poignant portrayal of the meaning of life lived, and mirrors this to the patient, such that they grasp its rich texture. Participants' descriptions showed how they were buoyed forward as a result, with renewed vigor and enthusiasm, despite their illness and any physical restrictions that it imposed. A planned pilot test of this intervention will enable us to determine potential effect sizes of this therapy in reducing distress and increasing meaning prior to a full randomized controlled trial. Understanding the processes involved and the experiences of participation in meaning-based therapies is crucial to the future strength of this area of psychotherapy.
Publisher: SAGE Publications
Date: 08-2015
Abstract: Mental health clinicians can experience problems communicating distressing diagnostic information to patients and their families, especially about severe mental illnesses such as schizophrenia. Evidence suggests that interpersonal communication skills can be effectively taught, as has been demonstrated in the specialty of oncology. However, very little literature exists with respect to interpersonal communication skills training for psychiatry. This paper provides an overview of the communication skills training literature. The report reveals significant gaps exist and highlights the need for advanced communication skills training for mental health clinicians, particularly about communicating a diagnosis and/or prognosis of schizophrenia. A new communication skills training framework for psychiatry is described, based on that used in oncology as a model. This model promotes applied skills and processes that are easily adapted for use in psychiatry, providing an effective platform for the development of similar training programs for psychiatric clinical practice.
Publisher: Cambridge University Press (CUP)
Date: 22-11-2012
DOI: 10.1017/S147895151200082X
Abstract: Although cognitive therapy (CT) has established outpatient utility, there is no integrative framework for using CT in acute medical settings where most psychosomatic medicine (P-M) clinicians practice. Biopsychosocial complexity challenges P-M clinicians who want to use CT as the a priori psychotherapeutic modality. For ex le, how should clinicians modify the data gathering and formulation process to support CT in acute settings? Narrative review methodology is used to describe the framework for a CT informed interview, formulation, and assessment in acute medical settings. Because this review is aimed largely at P-M trainees and educators, exemplary dialogues model the approach (specific CT strategies for common P-M scenarios appear in the companion article.) Structured data gathering needs to be tailored by focusing on cognitive processes informed by the cognitive hypothesis. Agenda setting, Socratic questioning, and adaptations to the mental state examination are necessary. Specific attention is paid to the CT formulation, Folkman's Cognitive Coping Model, self-report measures, data-driven evaluations, and collaboration (e.g., sharing the formulation with the patient.) Integrative CT-psychopharmacological approaches and the importance of empathy are emphasized. The value of implementing psychotherapy in parallel with data gathering because of time urgency is advocated, but this is a significant departure from usual outpatient approaches in which psychotherapy follows evaluation. This conceptual approach offers a novel integrative framework for using CT in acute medical settings, but future challenges include demonstrating clinical outcomes and training P-M clinicians so as to demonstrate fidelity.
Publisher: Elsevier BV
Date: 06-2000
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-1993
Publisher: American Society of Clinical Oncology (ASCO)
Date: 10-04-2012
Abstract: To provide a state-of-the-art review of communication skills training (CST) that will guide the establishment of a universal curriculum for fellows of all cancer specialties undertaking training as oncology professionals today. Extensive literature review including meta-analyses of trials, conceptual models, techniques, and potential curricula provides evidence for the development of an appropriate curriculum and CST approach. Ex les from the Memorial Sloan-Kettering Cancer Center CST program are incorporated. A core curriculum embraces CST modules in breaking bad news and discussing unanticipated adverse events, discussing prognosis, reaching a shared treatment decision, responding to difficult emotions, coping with survivorship, running a family meeting, and transitioning to palliative care and end of life. Achievable outcomes are growth in clinician's self-efficacy, uptake of new communication strategies and skills, and transfer of these strategies and skills into the clinic. Outcomes impacting patient satisfaction, improved adaptation, and enhanced quality of life are still lacking. Future communication challenges include genetic risk communication, concepts like watchful waiting, cumulative radiation risk, late effects of treatment, discussing Internet information and unproven therapies, phase I trial enrollment, and working as a multidisciplinary team. Patient benefits, such as increased treatment adherence and enhanced adaptation, need to be demonstrated from CST.
Publisher: SAGE Publications
Date: 05-1997
DOI: 10.1177/026921639701100303
Abstract: Using a three-phase longitudinal design, the bereavement of 115 adult Australian families following the death of a parent from cancer was studied. The cohort comprised 115 spouses and 153 offspring 670 in idual responses were obtained. A range of psychosocial variables was studied through a semistructured interview covering the experience of the deceased's illness, death and funeral, spousal health, family coping, sources of support, use of ritual and completion of estate duties. Bereavement outcome was measured by standardized questionnaires of the intensity of grief (Bereavement Phenomenology Questionnaire), depression (Beck Depression Inventory), psychological distress (Brief Symptom Inventory) and social adjustment (Social Adjustment Scale). Those psychosocial variables found to be significantly correlated with bereavement outcome were entered into best sub-set regression analyses. Family coping was the most consis tent correlate of bereavement outcome in these regression analyses, which accounted for up to 38% of the variance in grief, 64% in distress, 53% in depression and 46% in social adjustment. The nature of family functioning is a key aspect of social support in influencing the outcome of bereavement.
Publisher: Elsevier BV
Date: 2014
Publisher: Elsevier BV
Date: 03-2008
DOI: 10.1016/J.PEC.2007.11.024
Abstract: To develop a workshop for training faculty to facilitate small group role play sessions for a communication skills training program and assess the impact of that workshop on the trainees' self-efficacy about facilitation skills. A multi-specialty group of 33 attending physicians at a Comprehensive Cancer Center were trained in a Facilitating Communication Skills Training workshop in order to prepare them to facilitate small group role play with fellows and residents. The workshop curriculum was based on theory and literature on teaching communication skills. The workshop had a significant effect on participants' self-efficacy in facilitating communication skills training. At least 75% of participants reported feeling comfortable facilitating communication skills training small groups. This facilitation workshop was successful in providing participants with confidence to successfully facilitate small group role play sessions in communication skills training. In order to evaluate the effectiveness of communication skills training programs, it is important to have trained facilitators who adhere to a set of facilitation guidelines. Workshops on facilitation skills provide the background and practice time necessary as a first step in the training process.
Publisher: Wiley
Date: 11-08-2011
DOI: 10.1007/S10897-011-9400-Y
Abstract: Uncertainty is central to the experience of genetic decision making and counseling about cancer risk. Women seeking genetic counseling about their breast cancer risk may experience a great deal of uncertainty about issues related to their daughters. We used a theory of Communication and Uncertainty Management to guide analysis of sources of uncertainty about daughters that emerged during 16 video-recorded and transcribed conversations between mothers at risk for a BRCA 1/2 mutation and their genetic healthcare practitioners. An interpretive design and constant comparative method revealed three dominant patterns or themes representing sources of uncertainty mothers have relating to their daughters: disease risk, future cancer screening, and communication of related information to daughters. Both practitioners and mothers discussed these aspects of uncertainty. The findings identify the significant role uncertainty and familial concerns play in mothers' genetic testing decision making process. To assist genetic practitioners, we highlight daughter-related concerns that mothers are uncertain about and which are vital to their genetic counseling needs.
Publisher: Informa UK Limited
Date: 19-06-2003
Publisher: Cambridge University Press (CUP)
Date: 11-1999
DOI: 10.1017/S0033291799001142
Abstract: Background. Assessment of adjustment of patients in cancer treatment trials is becoming more common and increasingly regarded as a useful outcome measure. The widely used Mental Adjustment to Cancer (MAC) Scale was designed to measure Fighting Spirit (FS), Anxious Preoccupation (AP), Helpless–hopelessness (HH) and Fatalism. Methods. Questionnaire responses from 632 breast cancer patients were randomly ided into two groups, one for exploratory analyses and possible scale refinement, and the other for validation purposes. Results. Estimates of reliability (Cronbach's α) were satisfactory for two scales, FS (α = 0·85) and HH (α = 0·81), but lower for AP (α = 0·65) and Fatalism (α = 0·64). Exploratory factor analysis suggested that the MAC Scale might be measuring six independent constructs including two related to Fighting Spirit (Positive Orientation to the Illness, Minimizing the Illness), two related to Fatalism (Fatalism-revised, Loss of Control), a construct we have named Angst, and an unchanged HH construct. Scales developed to measure these constructs were satisfactorily replicated in confirmatory analyses but some reliabilities were lower than desirable. The general structure of the MAC Scale remained little changed despite the ision of two scales and the suggested removal of six items. The refined scales correlated with the Hospital Anxiety and Depression scale and the Medical Coping Modes Questionnaire, indicating good concurrent validity. Conclusions. While reasonable reliability of the original scales persists through analyses of the MAC Scale, the original factor structure could not be reproduced. Six refined constructs with strong construct validity were identified within the overall domain of mental adjustment to cancer.
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.EJON.2016.12.001
Abstract: Oncology health professionals (HPs) are increasingly required to care for patients from minority backgrounds. Yet many HPs have not had formal training in how to communicate effectively in culturally erse settings. More information is needed about the challenges that oncology HPs face in communicating with minority patients to inform the content of formal training programs. This qualitative study aimed to identify oncology nurses' and oncologists' in idual experiences and challenges in communicating with patients from minority backgrounds. Thirty-eight oncology HPs (21 oncology nurses, 12 medical oncologists, and 5 radiation oncologists) were interviewed in idually or in focus groups about their experiences communicating with patients from minority backgrounds. The interviews were audio taped and analysed thematically. The majority of participants (82%) reported varying degrees of uncertainty and discomfort regarding working with minority patients, with many barriers to communication encountered. Participants perceived that minority patients received less emotional support than majority group patients. They experienced challenges in balancing beliefs about patient autonomy with cultural differences regarding the role of the family. Strategies employed by participants to facilitate interactions included: modifying speech, taking more time in consultations, rapport building, and using nonverbal techniques. Oncology HPs encounter many linguistic and cultural barriers when communicating with minority patients. They need formal training tailored to developing culturally competent communication. Oncology nurses and oncologists could benefit from formal communication skills training focused upon cultural competence during their career development programs.
Publisher: Elsevier BV
Date: 07-2009
DOI: 10.1176/APPI.PSY.50.4.383
Abstract: Mixed anxiety/depression is associated with poorer psychosocial and treatment outcomes, worse quality of life, pooreradherence to treatment, slower recovery, greater suicide risk, and highercost-utilization. This study aimed to examine the cancer-specific prevalence of these symptoms. Cross-sectional anxiety and depression symptom data were collected with the Brief Symptom Inventory from adult outpatients presenting to a tertiary cancer center (N=8,265). Mixed anxiety/depression symptoms were seen in 12.4% of patients overall depression symptoms in 18.3%, overall anxiety symptoms in 24.0%, pure anxiety symptoms in 11.7%, and pure depression symptoms in 6.0% 70% had neither. Higher rates of mixed anxiety/depression symptoms were seen with stomach, pancreatic, head and neck, and lung cancers, but lower rates were seen in those with breast cancers. The mixed anxiety/depression phenotype occurs in two-thirds of depressed cancer patients. The fact that 70% of patients did not meet thresholds for depression or anxiety symptoms can be interpreted as a reflection of the resistance to developing a significant level of these symptoms. However, because stomach, pancreatic, head and neck, and lung cancers have higher levels of mixed anxiety/depression symptoms, the question can be raised as to whether these are associated with a more biological type of anxiety/depression (e.g., due to cytokine release) and whether this phenotype should be actively targeted because of its frequent occurrence in these cancers.
Publisher: Elsevier BV
Date: 07-2010
DOI: 10.1016/J.GENHOSPPSYCH.2010.04.007
Abstract: Because one in five Americans die in the intensive care unit (ICU), the potential role of palliative care is considerable. End-of-life (EOL) communication is essential for the implementation of ICU palliative care. The objective of this review was to summarize current research and recommendations for ICU EOL communication. For this qualitative, critical review, we searched PubMed, Embase, Cochrane, Ovid Medline, Cinahl and Psychinfo databases for ICU EOL communication clinical trials, systematic reviews, consensus statements and expert opinions. We also hand searched pertinent bibliographies and cross-referenced known EOL ICU communication researchers. Family-centered communication is a key component of implementing EOL ICU palliative care. The main forum for this is the family meeting, which is an essential platform for implementing shared decision making, e.g., transitioning from curative to EOL palliative goals of care. Better communication can improve patient outcomes such as reducing psychological trauma symptoms, depression and anxiety shortening ICU length of stay and improving the quality of death and dying. Communication strategies for EOL discussions focus on addressing family emotions empathically and discussing death and dying in an open and meaningful way. Central to this is viewing ICU EOL palliative care and withdrawal of life-extending treatment as predictable and not an unexpected emergency. Because the ICU is now a well-established site for death, ICU physicians should be trained with EOL communication skills so as to facilitate palliative care more hospitably in this challenging setting. Patient/family outcomes are important ways of measuring the quality of ICU palliative care and EOL communication.
Publisher: Wiley
Date: 22-12-2016
DOI: 10.1002/PON.4310
Publisher: Informa UK Limited
Date: 09-08-2006
Publisher: Royal College of Psychiatrists
Date: 08-2000
Abstract: There is le scope to devise forms of psychotherapy in consultation–liaison psychiatry, including the newly evolving area of psycho-oncology. To highlight the development of psychotherapy in psycho-oncology, providing two illustrations. We report on conceptual and clinical research in the context of oncology and palliative care, focusing on (a) an approach for families at risk of maladaptive bereavement and (b) a group programme for women newly diagnosed with early-stage breast cancer. We were able to introduce new forms of psychological treatment for specific clinical groups, and anecdotal evidence points to useful benefits for participants. Psychotherapists should grasp the opportunity to bring their skills to the medical arena, but need to subject newly devised interventions to well-designed and methodologically rigorous research.
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.JPAINSYMMAN.2016.08.013
Abstract: The risk of suicide is elevated in palliative care patients compared with the general population. Various psychological factors, including depression, demoralization, loss of control, and low self-worth, have been associated with a desire to hasten death. The aim of this study was to investigate whether depression, demoralization, loss of control, and low self-worth mediated the relationship between global quality of life and desire to hasten death. A s le of 162 palliative care patients completed measures of global quality of life, depression, demoralization, perceived control, self-worth, and desire to hasten death. A multiple mediation model with bootstrapping s ling tested the total (combined) indirect effect and in idual indirect effects of depression, the two subscales of demoralization (Meaning and Purpose, and Distress and Coping Ability), perceived control, and self-worth. Depressive symptoms, loss of meaning and purpose, loss of control, and low self-worth mediated the direct effect of global quality of life on desire to hasten death. The Distress and Coping Ability component of demoralization was not a significant mediator. Depression, loss of meaning and purpose, loss of control, and low self-worth are strong clinical markers for desire to hasten death. Targeting these symptoms through existentially oriented therapies, such as meaning-centered therapy, may ameliorate suicidal thinking.
Publisher: Hindawi Limited
Date: 14-02-2021
DOI: 10.1111/ECC.13401
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2008
Publisher: MDPI AG
Date: 19-09-2022
DOI: 10.3390/CURRONCOL29090527
Abstract: Patients with head and neck cancer face important life-altering effects in appearance and function, affecting distress and quality of life and requiring the involvement of a multidisciplinary team. Psycho-oncology makes an important contribution to the field, as head and neck cancers carry a huge adaptational toll. To illustrate the value of this discipline, we report two cases of patients with advanced head and neck cancer for which the treatment-related body changes were of major significance. A commentary by the treating surgeons and psycho-oncologists precedes a general discussion about the clinical management of such patients. The article outlines strategies to address health literacy, doctor–patient communication, treatment decision-making, and emotional distress placing the person at the center of oncological care. It calls for the broad application of principles of psychological first aid by healthcare professionals in oncology.
Publisher: Springer Science and Business Media LLC
Date: 04-05-2011
DOI: 10.1007/S13187-011-0226-Y
Abstract: Cancer patients report significant levels of unmet needs in the realm of communication. Communication skills training programs have been shown to improve clinical communication. However, advanced communication skills training programs in oncology have lacked institutional integration, and thus have not attended to institutional norms and cultures that may counteract explicit communication skills training. We developed and implemented an advanced communication skills training program made up of nine teaching modules for faculty, fellows, and residents. Training included didactic and experiential small group work. Self-efficacy and behavior change were assessed for in idual participants. Since 2006, 515 clinicians have participated in this training program. Participants have shown significant gains in self-efficacy regarding communicating with patients in various contexts. Our initial work in this area demonstrates the implementation of such a program at a major cancer center to be feasible, to be acceptable, and to have a significant impact on participants' self-efficacy.
Publisher: Wiley
Date: 08-1988
DOI: 10.1111/J.1479-828X.1988.TB01665.X
Abstract: The experience of a Mother and Baby Unit in a General Hospital Psychiatry Department in managing postnatal depression and puerperal psychosis over a 2-year period is reviewed. In our community severe depressive illness will more often be referred to a Public General Hospital with a psychiatric service. The mean admission duration of 26 days for depressive illness was significantly lower than that previously reported by a Psychiatric Hospital. A significant delay in presentation appeared in half the cases, which could be reduced by attention to the family and past psychiatric history, especially the patient's relationship to her own mother indicating risk of puerperal mental disturbance.
Publisher: Informa UK Limited
Date: 07-2012
Publisher: SAGE Publications
Date: 17-11-2011
Abstract: Clinicians meet people from different ethnic backgrounds, yet need to respond in culturally sensitive ways. This article focuses on Asian American families. Within a randomized controlled trial of family therapy commenced during palliative care and continued into bereavement, 3 families of Asian American background were examined qualitatively from a cultural perspective by listening to recordings of 26 therapy sessions and reviewing detailed supervision notes compiled by each therapist. A synopsis of each family's therapy narrative is presented. Prominent themes include family closeness, respect for hierarchy within the family, gender-determined roles, intergenerational tensions, preoccupation with shame and limited emotional expressiveness. Family therapists working with culturally erse families need to pay thoughtful attention to ethnic issues as they strive to support them during palliative care and bereavement.
Publisher: Elsevier BV
Date: 07-2009
DOI: 10.1176/APPI.PSY.50.4.375
Abstract: With medical advances since the 1990s, a growing proportion of patients are living for many years with prostate cancer (PCA) and the consequences of its treatment. The authors investigated the experience of being diagnosed with cancer and the effects of its treatment on patients' partners. The authors conducted an observational, longitudinal study of 103 couples facing the diagnosis of either localized (potentially curable) or metastatic (incurable) PCA at Time 1 and then 6 months later (Time 2). At both Time 1 and Time 2, psychological distress, marital satisfaction, and family functioning were measured in patients and partners coping was measured in partners only. Partner maladaptive coping patterns of avoidance and self-blame at Time 1 predicted greater partner psychological distress at Time 2, as did "wishful thinking" at Time 2. Psychosocial interventions designed to promote adaptive coping in couples facing PCA warrant systematic study.
Publisher: Elsevier BV
Date: 06-2000
Publisher: Wiley
Date: 24-09-2020
DOI: 10.1002/PON.5519
Publisher: Cambridge University Press (CUP)
Date: 06-2009
DOI: 10.1017/S1478951509000224
Abstract: To develop a communication skills training module for health care professionals about how to conduct a family meeting in palliative care and to evaluate the module in terms of participant self-efficacy and satisfaction. Forty multispecialty health care professionals from the New York metropolitan area attended a communication skills training module at a Comprehensive Cancer Center about how to conduct a family meeting in oncology. The modular content was based on the Comskil model and current literature in the field. Based on a retrospective pre–post measure, participants reported a significant increase in self-efficacy about their ability to conduct a family meeting. Furthermore, at least 93% of participants expressed their satisfaction with various aspects of the module by agreeing or strongly agreeing with statements on the course evaluation form. Family meetings play a significant role in the palliative care setting, where family support for planning and continuing care is vital to optimize patient care. Although these meetings can be challenging, this communication skills module is effective in increasing the confidence of participants in conducting a family meeting.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-1999
Publisher: Elsevier BV
Date: 11-2014
Publisher: Elsevier BV
Date: 2009
Abstract: To develop a communication skills training (CST) module for health care professionals, particularly in the area of oncology, on how to conduct interviews using interpreters and to evaluate the module in terms of participant's self-efficacy and satisfaction. Forty-seven multi-specialty health care providers from the New York Metropolitan Area attended a communication skills module at a Comprehensive Cancer Care Center about how to conduct clinical interviews utilizing interpreters. The development of this module was on the basis of current literature and followed the Comskil model previously utilized for other doctor-patient CSTs. Participants were given pre- and post-surveys to evaluate their own confidence as well as the helpfulness of the module. On the basis of a retrospective pre-post measure, participants reported an increase in their confidence about interviewing patients via translators. In addition, at least 80% of participants reported their satisfaction with the various components of the module by either agreeing or strongly agreeing with the different statements. We have developed a module that trains clinicians in effective collaboration with professional medical interpreters and shown its ability to increase the confidence of clinician's to work with limited English proficiency patients. Our approach intends to minimize not only the language barrier but also the cultural barriers that could potentially interfere with patients' care. This work has important practice implications in the oncology setting, where cultural sensitivity is paramount and empathic exchange with the patient optimizes their sense of being well supported by their health care team. We believe that this model is generalizable to many other medical settings where use needs to be made of a professional interpreter.
Publisher: Cambridge University Press (CUP)
Date: 13-05-2016
DOI: 10.1017/S1478951516000341
Abstract: Family caregivers of people with motor neurone disease (MND) experience adverse health outcomes as a result of their caregiving experience. This may be alleviated if their support needs are identified and addressed in a systematic and timely manner. The objective of the present study was to assess the feasibility and relevance of the Carer Support Needs Assessment Tool (CSNAT) in home-based care during the period of caregiving from the perspectives of the family caregivers of people with MND and their service providers. The study was conducted during 2014 in Western Australia. Some 30 family caregivers and 4 care advisors participated in trialing the CSNAT intervention, which involved two visits from care advisors (6–8 weeks apart) to identify and address support needs. The feedback from family caregivers was obtained via telephone interviews and that of care advisors via a self-administered questionnaire. A total of 24 caregivers completed the study (80% completion rate) and identified the highest support priorities as “knowing what to expect in the future,” “knowing who to contact if concerned,” and “equipment to help care.” The majority found that this assessment process adequately addressed their needs and gave them a sense of validation, reassurance, and empowerment. Care advisors advocated the CSNAT approach as an improvement over standard practice, allowing them to more clearly assess needs, to offer a more structured follow-up, and to focus on the caregiver and family. The CSNAT approach for identifying and addressing family caregivers' support needs was found to be relevant and feasible by MND family caregivers and care advisors. The tool provided a formal structure to facilitate discussions with family caregivers and thus enable needs to be addressed. Such discussions can also inform an evidence base for the ongoing development of services, ensuring that new and improved services are designed to meet the explicit needs of the family caregivers of people with a motor neurone disease.
Publisher: Wiley
Date: 09-08-2016
DOI: 10.1002/PON.4223
Publisher: Cruse Bereavement Care
Date: 12-2013
Publisher: American Psychological Association (APA)
Date: 10-2015
DOI: 10.1037/FAM0000096
Publisher: Wiley
Date: 06-09-2001
Publisher: SAGE Publications
Date: 07-10-2016
Abstract: Demoralization has been the subject of discussion in relation to end-of-life care. It is characterized by hopelessness and helplessness due to a loss of purpose and meaning. The purpose of this review was to consolidate the conceptual understanding of demoralization and argue for its existence as a psychiatric syndrome. The history of the construct is explored, including the nature of existential distress and related psychological conditions that precipitate demoralization. Recent definitions of demoralization are described and differentiated from similar constructs. Future directions are highlighted, specifically in relation to the assessment, diagnosis, and treatment of demoralization in palliative care. Overall, demoralization is a clinically useful construct for those facing existential threat, guiding the clinician toward efforts to restore morale, meaning, and purpose.
Publisher: Informa UK Limited
Date: 16-10-2019
Publisher: American Psychological Association (APA)
Date: 08-2018
DOI: 10.1037/FAM0000404
Publisher: American Society of Clinical Oncology (ASCO)
Date: 06-2016
Abstract: Systematic family-centered cancer care is needed. We conducted a randomized controlled trial of family therapy, delivered to families identified by screening to be at risk from dysfunctional relationships when one of their relatives has advanced cancer. Eligible patients with advanced cancer and their family members screened above the cut-off on the Family Relationships Index. After screening 1,488 patients or relatives at Memorial Sloan Kettering Cancer Center or three related community hospice programs, 620 patients (42%) were recruited, which represented 170 families. Families were stratified by three levels of family dysfunction (low communicating, low involvement, and high conflict) and randomly assigned to one of three arms: standard care or 6 or 10 sessions of a manualized family intervention. Primary outcomes were the Complicated Grief Inventory-Abbreviated (CGI) and Beck Depression Inventory-II (BDI-II). Generalized estimating equations allowed for clustered data in an intention-to-treat analysis. On the CGI, a significant treatment effect (Wald χ 2 = 6.88 df = 2 P = .032) and treatment by family-type interaction was found (Wald χ 2 = 20.64 df = 4 P .001), and better outcomes resulted from 10 sessions compared with standard care for low-communicating and high-conflict groups compared with low-involvement families. Low-communicating families improved by 6 months of bereavement. In the standard care arm, 15.5% of the bereaved developed a prolonged grief disorder at 13 months of bereavement compared with 3.3% of those who received 10 sessions of intervention (Wald χ 2 = 8.31 df = 2 P =.048). No significant treatment effects were found on the BDI-II. Family-focused therapy delivered to high-risk families during palliative care and continued into bereavement reduced the severity of complicated grief and the development of prolonged grief disorder.
Publisher: Hindawi Limited
Date: 07-03-2017
DOI: 10.1111/ECC.12474
Abstract: People with head and neck cancer (HNC) experience elevated symptom toxicity and co-morbidity as a result of treatment, which is associated with poorer psychosocial and quality-of-life (QoL) outcomes. This Phase I study examined whether an in idualised mindfulness-based stress reduction (IMBSR) programme could be successfully used with HNC patients undergoing curative treatment. Primary aims were to explore feasibility, compliance, acceptability and fidelity. Secondary aims were to determine whether (1) participation in the intervention was associated with changes in post-intervention mindfulness and (2) post-intervention mindfulness was associated with post-intervention distress and QoL. Nineteen HNC patients participated in a seven-session IMBSR programme with pre- and post-test outcome measures of psychological distress, depression, anxiety and QoL. Primary aims were assessed by therapists or participants. Mindfulness, distress and QoL were assessed using self-report questionnaires at pre- and post-intervention. Longer time spent meditating daily was associated with higher post-intervention mindfulness. After controlling for pre-intervention mindfulness, there was an association between higher post-intervention mindfulness and lower psychological distress and higher total, social and emotional QoL. This study offers important preliminary evidence than an IMBSR intervention can be administered to HNC patients during active cancer treatment. A randomised controlled trial is warranted to confirm these findings.
Publisher: Elsevier BV
Date: 10-1998
DOI: 10.1016/S0140-6736(98)05406-3
Abstract: During the 9 months between July, 1996, and March, 1997, the provision of euthanasia for the terminally ill was legal in the Northern Territory of Australia. Seven patients made formal use of the Rights of the Terminally Ill (ROTI) Act four died under the Act. We report their clinical details and the decision-making process required by the Act. We taped in-depth interviews with the general practitioner who provided euthanasia. Further information was available from public texts created by patients, the media, and the coroner. All seven patients had cancer, most at advanced stages. Three were socially isolated. Symptoms of depression were common. Having met criteria of the Act, some patients deferred their decision for a time before proceeding with euthanasia. Medical opinions about the terminal nature of illness differed. Provision of opinions about the terminal nature of illness and the mental health of the patient, as required by the ROTI Act, created problematic gatekeeping roles for the doctors involved.
Publisher: Springer Science and Business Media LLC
Date: 30-08-2023
Publisher: Wiley
Date: 05-2018
DOI: 10.1002/PON.4693
Publisher: Wiley
Date: 2007
DOI: 10.1002/PON.1185
Abstract: Mixed reports exist about the impact of supportive-expressive group therapy (SEGT) on survival. From 485 women with advanced breast cancer recruited between 1996-2002, 227 (47%) consented and were randomized within an average 10 months of cancer recurrence in a 2:1 ratio to intervention with 1 year or more of weekly SEGT plus three classes of relaxation therapy (147 women) or to control receiving three classes of relaxation therapy (80 women). The primary outcome was survival psychosocial well-being was appraised secondarily. Analysis was by intention-to-treat. SEGT did not prolong survival (median survival 24.0 months in SEGT and 18.3 in controls univariate hazard ratio for death 0.92 [95% CI, 0.69-1.26] multivariate hazard ratio, 1.06 [95% CI, 0.74-1.51]). Significant predictors of survival were treatment with chemotherapy and hormone therapy (p<0.001), visceral metastases (p<0.001) and advanced disease at first diagnosis (p<0.05). SEGT ameliorated and prevented new DSM-IV depressive disorders (p = 0.002), reduced hopeless-helplessness (p = 0.004), trauma symptoms (p = 0.04) and improved social functioning (p = 0.03). SEGT did not prolong survival. It improved quality of life, including treatment of and protection against depression.
Publisher: SAGE Publications
Date: 09-2003
DOI: 10.1191/0269216303PM808OA
Abstract: Family Focused Grief Therapy (FFGT) is a new model of brief intervention, which is commenced during palliative care for those families shown to be at high risk of poor adaptation, and continued preventively into bereavement with the aim of improving family functioning and reducing the morbid consequences of grief. In this paper, baseline data on 81 families (363 in iduals) selected by screening from a palliative care population are explored to confirm our previously reported observation that high levels of psychosocial morbidity are positively associated with worsening family dysfunction. The Family Relationships Index (FRI) was used for screening and the Family Assessment Device (FAD) as an independent family outcome measure. The Beck Depression Inventory (BDI), Brief Symptom Inventory (BSI) and Social Adjustment Scale (SAS) were the psychosocial measures. Families were classified according to their functioning based on the FRI. To allow for correlated family data, statistical analyses employed the generalized estimating equation (GEE) method, controlling for gender and depression (BDI). Screening of 257 families (701 in iduals) revealed 74 (29%) well-functioning families and 183 (71%) at some risk of morbid outcome. Of the latter, 81 (44%) gave informed consent to enter a randomized controlled trial of FFGT. Patients had a mean age of 57 years, 51% were male and they suffered from cancer, with a median length of illness from diagnosis to death of 25 months. In accordance with the FFGT model, their family types were identified as Intermediate 51%, Sullen 26% and Hostile 23%. These were significantly associated with steadily increasing levels of distress (BSI) and poor social adjustment (SAS). The FAD confirmed the concurrent accuracy of the FRI. As significantly greater levels of psychosocial morbidity were present in families whose functioning as a group was poorer, support was generated for a clinical approach that screens for families rather than in iduals at high risk. The predictive validity of the FRI as a screening measure was confirmed. Overall, these baseline data point to the importance of a family-centred model of care.
Publisher: Royal College of Psychiatrists
Date: 07-2015
DOI: 10.1192/APT.BP.114.012724
Abstract: At a time when patients are challenged to cope adaptively with both the diagnosis and treatment of cancer, clinicians need to respond appropriately to the many inevitable questions about the causes of cancer and contributing factors, including ‘Is this my fault?’. The evidence guiding answers to such questions has been confounded by many methodological challenges, but personality, stress and life events are no longer considered causes of cancer. However, social isolation, untreated depression and social deprivation continue to influence quality of life and reduce cancer survival times. Psychiatry might play a role in promoting lifestyle changes that reduce the risk of cancer, but more importantly it can influence disease progression by optimising patients' adaptation to the many challenges that cancer brings.
Publisher: Cambridge University Press (CUP)
Date: 10-12-2018
DOI: 10.1017/S1041610217002599
Abstract: Assessing anxiety among residential aged care facility (RACF) residents is challenging, and it cannot be assumed that valid and reliable measures used within the community are also appropriate for this setting. This review systematically examined the literature to identify which anxiety measures were most commonly used with older adults in RACFs, and determine whether psychometric data support their use within this population. Using the PRISMA guidelines, five electronic databases were searched using key terms and subject headings. The search was limited to literature published in English. Eligible studies utilized an anxiety measure to assess anxiety symptoms among RACF residents. Based on the findings of this search, a critical review of the research into the reliability, validity, and administrative and respondent burden of the most commonly used measures (i.e. used in four or more studies) was conducted. In total, 1,771 articles were identified, with 50 studies included in this review. Overall, 22 measures were used, with the majority of studies utilizing a clinician-administered or self-report measure. The RAID, HADS, STAI, and GAI were the most commonly used measures. While overall there is a lack of research and consensus into the psychometric properties of these measures within RACFs, strongest evidence of reliability and validity was found for the GAI. Commonly used measures of anxiety within aged care populations are not well validated for this complex subs le of older adults. Strengths and weaknesses of each measure with regards to their usefulness in aged care settings are discussed, with future research areas highlighted.
Publisher: SAGE Publications
Date: 10-11-2012
Abstract: Supporting the family-as-a-whole presents challenges in palliative care, although family meetings are increasingly used in routine practice. The Family Focused Grief Therapy (FFGT) Model guides clinicians in using a range of intervention strategies. To examine the therapists’ techniques used in assessing ‘at risk’ families in palliative care to better illuminate what helps and what remains challenging. Recorded sessions 1 and 2 were coded using the FFGT fidelity coding measure, with its glossary of definitions. Inter-rater reliability between three coders was satisfactory at 88%. Frequencies of strategy utilization were computed, with extraction of ex les of both successful and problematic approaches. From within a larger study of family therapy during palliative care at a comprehensive cancer center, the first two sessions ( n = 144) delivered to 74 families (299 in iduals) by 32 therapists were coded and analyzed. Therapists readily explored the story of illness and families’ ways of coping (97%) and assessed communication and cohesiveness in the majority. Exploration of relational patterns occurred in 89% of sessions, use of a genogram in 80%, understanding members’ roles in 65% and family values and beliefs in 62%. Less use was made of summaries (39%), family mottos (34%), exploration of family conflict (35%) and the formalization of a comprehensive family treatment plan (20%). Challenges exist in therapy with difficult families. Therapy in the home brings special issues. Therapists can apply most of the interventions prescribed by the FFGT model.
Publisher: Springer Science and Business Media LLC
Date: 19-10-2016
Publisher: Mark Allen Group
Date: 02-10-2015
DOI: 10.12968/IJPN.2015.21.10.504
Abstract: Despite the losses experienced by nurses in their role in palliative care, they wish to continue working in this environment. This is described as resilience, which enhances coping in dealing with death and grief. To explore the nature of nurses' resilience and the way it is developed. A qualitative research design using grounded theory methods was employed. With theoretical s ling, 18 interviews were conducted and theoretical saturation was achieved. Self-nurturing was evident as the way nurses developed resilience, which included knowledge of self, coping adaptively, valuing care and accepting limitations. All participants spoke of the characteristics of resilience from the blend of in idual responsibility for self and the support provided by others. However, none had educational pathways to build greater resilience. Integrating support and education to foster nurses' resilience is important to enable self-protection, as well as the provision of high quality care.
Publisher: Wiley
Date: 17-10-2017
DOI: 10.1002/GPS.4604
Abstract: To synthesize and summarize the studies examining the correlates and predictors of anxiety in older adults living in residential aged care. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, five electronic databases were searched using key terms and subject headings, as well as reference lists of relevant papers. The search was limited to peer-reviewed literature published in English. Eligible studies examined the association between at least one correlate/factor and anxiety disorders or symptoms in aged care residents aged 50+ years. A total of 3741 articles were identified, of which 34 studies (with a total of 1 543 554 participants) were included in this review. Correlates associated with anxiety included pain, use of anti-depressants/lithium, depression, and lower perceived quality of life. Less consistent and/or less studied variables included younger age, female gender, higher educational level, functional dependence, subjective health status, more prescribed medications, impaired vision, insomnia, external locus of control, fear of falling, attachment, hope, meaning in life, and the influence of social, environmental, and staff olicy correlates. While several variables were found to have strong associations with anxiety in aged care residents, a number of factors have been examined by only one or two studies. Further research (preferably prospective studies) is therefore needed to reliably confirm findings and to help plan and develop preventative and intervention strategies. Copyright © 2016 John Wiley & Sons, Ltd.
Publisher: Wiley
Date: 20-04-2011
Publisher: Wiley
Date: 04-1994
Publisher: SAGE Publications
Date: 06-1997
DOI: 10.3109/00048679709073846
Abstract: Objective: To review the psychometric properties and factor structure of the Bereavement Phenomenology Questionnaire (BPQ). Method: Continuous data were compared using two tailed t-tests and analysis of variance. A confirmatory factor analysis was carried out. Results: Good internal consistency (Cronbach's alpha = 0.93) with a single factor has been found. The BPQ discriminates the intensity of grief between widows and widowers, spouses and offspring, and temporally between acute and later phases of bereavement. Conclusion: Although on the BPQ items are highly correlated and only a single factor has emerged, it remains nonetheless a valid and reliable scale for the measurement of grief.
Publisher: Cambridge University Press (CUP)
Date: 11-02-2015
DOI: 10.1017/S1478951515000231
Abstract: Caregiving partners constitute a unique group, who provide both physical and emotional care for patients. There has been extensive research conducted on caregivers during either the caregiving or bereavement phase however, these phases are often treated as separate entities rather than as part of a continuum. In this paper, utilizing relevant literature and clinical observations, we map the emotional journey and lived experience of caregivers moving from disease progression, to the end of life, to the dying process itself, and then through life after the death of a partner. Along this journey, we identify the links between pre-death caregiving and bereavement. Our illustration raises awareness regarding the unmet needs experienced by caregiving partners across the continuum and provides an alternative framework through which clinicians can view this course. of Results We bolster arguments for improved palliative care services and early interventions with distressed caregiving partners by emphasizing continuity of care both before and after a patient's death.
Publisher: Wiley
Date: 09-2001
DOI: 10.1046/J.1440-1800.2001.00110.X
Abstract: This theoretical paper is derived from a discourse analysis of the textual material from a study of the seven deaths associated with legalised euthanasia in the Northern Territory, Australia. The textual analysis utilises evidence from interviews, letters written by people seeking euthanasia, medical reports, coroner's records and media reports concerning the social experiment of legalised euthanasia in Australia. The paper does not discuss the euthanasia debate. It argues that the body is a neglected concern in the debates and offers a construction of the discourses of the body as symptomatic, dependent, shameful and temporal. Medical discourses frame the body as symptomatic but these people were also concerned with the loss of autonomy associated with dependence, with shame connected with loss of bodily functions and the embodied experience of determining a 'time to die'.
Publisher: Cambridge University Press (CUP)
Date: 22-11-2011
DOI: 10.1017/S147895151100037X
Abstract: The purpose of this study was to develop a communication skills training (CST) module for oncology healthcare professionals on how to more effectively respond to patient anger. We also sought to evaluate the module in terms of participant self-efficacy and satisfaction. The development of this module was based on a systematic review of the literature and followed the Comskil model previously used for other doctor–patient CST. Using an anonymous 5-point Likert scale, participants rated their pre-post self-efficacy in responding to patient anger as well as their satisfaction with the course. Data were analyzed using a paired s le t test. During the academic years 2006–2009, 275 oncology healthcare professionals participated in a CST that focused on responding to patient anger. Participants' confidence in responding to patient anger increased significantly ( p 0.001) after attending the workshop. They also agreed or strongly agreed to five out of six items assessing course satisfaction 92–97% of the time. We have developed a CST module on how to respond to patient anger, which is both effective and useful. Training healthcare professionals to respond more effectively to patient anger may have a positive impact on the patient–physician relationship.
Publisher: SAGE Publications
Date: 04-2002
DOI: 10.1046/J.1440-1614.2002.01014.X
Abstract: Objective: To investigate the diagnostic efficiency of the Hospital Anxiety and Depression Scale (HADS) in patients with breast cancer. Methods: Women (303) recently diagnosed with stage I or II breast cancer completed the HADS and were psychiatrically assessed. Recommended cut-off scores for Depression (D) and Anxiety (A) Scales identified probable caseness and the accuracy was compared with DSM-IV diagnoses. Cut-off scores were varied to establish optimal accuracy. Results: One hundred and eleven (36.6%) met criteria for depressive disorders and 25 (8.3%) met criteria for anxiety disorders. At the recommended cut-off score of 11 for the D scale, positive and negative predictive values were.75 and.64, respectively, while sensitivity and specificity were.05 and.99, respectively. For the A scale, positive predictive value (PPV) was.15 negative predictive value (NPV),.90 sensitivity,.08 and specificity,.87. Reducing the cut-off score to 5 produced PPV of.63, NPV of.74, sensitivity of.49 and specificity of.83 for the D scale .14,.94,.75 and.45, respectively, for the A scale. Composite scores (cut-off of 22) had a PPV of.92, NPV of.57, sensitivity of.09 and specificity of.99. Conclusions: Recommended cut-off scores for the HADS may result in under-reporting of psychiatric morbidity among women with early stage breast cancer. These results are consistent with other recent studies of the HADS. The type of constructs measured by the scale is the likely explanation for its limited utility when screening for psychiatric morbidity in early stage breast cancer.
Publisher: American Medical Association (AMA)
Date: 10-01-2000
Publisher: Informa UK Limited
Date: 22-02-2019
DOI: 10.1080/13607863.2018.1439882
Abstract: Limited research has been conducted into the identification of a valid and reliable screening measure for anxiety in aged care settings, despite it being one of the most common psychological conditions. This study aimed to determine an appropriate anxiety screening tool for aged care by comparing the reliability and validity of three commonly used measures and identifying specific cut-offs for the identification of generalized anxiety disorder (GAD). One-hundred and eighty nursing home residents (M age = 85.39 years) completed the GAI, HADS-A, and RAID, along with a structured diagnostic interview. Twenty participants (11.1%) met DSM-5 criteria for GAD. All measures had good psychometric properties , although reliability estimates for the HADS-A were sub-optimal. Privileging sensitivity , the GAI cut-off score of 9 gave sensitivity of 90.0% and specificity of 86.3% HADS-A cut-off of 6 gave sensitivity of 90.0% and specificity of 80.6% and RAID cut-off of 11 gave sensitivity of 85.0% and specificity of 72.5%. While all three measures had adequate reliability, validity, and cut-scores with high levels of sensitivity and specificity to detect anxiety within aged care, the GAI was the most consistently reliable and valid measure for screening for GAD.
Publisher: Cambridge University Press (CUP)
Date: 14-12-2016
DOI: 10.1017/S1478951516000845
Abstract: Our aim was to compare changes in emotional processing by women newly diagnosed with gynecological cancer enrolled in either a coping and communication skills intervention (CCI) or a supportive counseling (SC) intervention. We examined the association between in-session emotional processing and patient-rated therapeutic progress. Three therapy sessions with 201 patients were rated for the depth of emotional processing (peak and mode) during emotion episodes (EEs) using the Experiencing Rating Scale (EXP). Participants completed measures of dispositional emotional expressivity, depressive symptoms, and cancer-related distress before treatment began, as well as ratings of perceived progress in therapy after each session. Peak EXP ratings averaged between 2.7 and 3.1, indicating that women discussed events, their emotional reactions, and their private experiences in sessions. A small proportion of patients had high levels of processing, indicating deeper exploration of the meaning of their feelings and experiences. Women in SC were able to achieve a higher level of emotional processing during the middle and later sessions, and during cancer-related EEs in the later session. However, emotional processing was not significantly associated with a patient's perceived therapeutic progress with SC. In the CCI group, higher levels of emotional processing were associated with greater session progress, suggesting that it may play an important role in patient-rated treatment outcomes. Newly diagnosed gynecological cancer patients are able to attend to their emotions and personal experiences, particularly when discussing cancer-related issues during both short-term SC and prescriptive coping skills interventions.
Publisher: Cambridge University Press (CUP)
Date: 03-2006
DOI: 10.1017/S1478951506060068
Abstract: Objective: Our purpose was to determine the frequency of psychiatric morbidity and to assess the quality of life of women with advanced breast cancer. Methods: The 227 women in the s le were recruited in Melbourne, Australia, and were interviewed (prior to intervention) for a randomized controlled trial of supportive-expressive group therapy. The main outcome measures were DSM–IV psychiatric diagnoses plus quality of life data based on the EORTC QLQ-C30 (core) and QLQ-BR23 (breast module) instruments. Results: Forty-two percent of the women (97/227) had a psychiatric disorder 35.7% (81) of these had depression or anxiety or both. Specific diagnoses were minor depression in 58 women (25.6%), major depression in 16 (7%), anxiety disorder in 14 (6.2%), and phobic disorder in 9 (4%). Seventeen (7.5%) women had more than one disorder. In terms of quality of life, one-third felt less attractive, one-quarter were dissatisfied with their body image, and, in most, sexual interest had waned. Menopausal symptoms such as hot flashes affected less than one-third, whereas symptoms of lymphedema were experienced by 26 (11.5%). Significance: Women with advanced breast cancer have high rates of psychiatric and psychological disturbance. Quality of life is substantially affected. Clinicians need to be vigilant in monitoring psychological adjustment as part of a comprehensive biopsychosocial approach.
Publisher: Informa UK Limited
Date: 16-07-2020
Publisher: Oxford University Press (OUP)
Date: 10-2012
Publisher: American Society of Clinical Oncology (ASCO)
Date: 20-02-2017
Publisher: Elsevier BV
Date: 08-2014
Publisher: SAGE Publications
Date: 14-03-2014
Abstract: A hereditary cancer predisposition can rattle families, creating dysfunctional interactions. Families need assistance navigating conversations about risk. Because mothers and daughters uniquely share breast cancer experiences and risk, there is a particular need for practitioners to assist them with communication. Three focus groups were conducted with 11 mothers with an elevated cancer risk (with adolescent daughters) receiving genetic counseling. We explored three inquiries to capture mother–daughter communication: emergent challenging topics (e.g., health-promotion behavior, daughter’s risk, mother’s risk of death), factors complicating discussions (e.g., balancing what to share and when, guilt and blaming, confusion about risk and prevention), and strategies enhancing conversations initiated by mothers (e.g., paying attention to daughter’s cues) or practitioners (e.g., inviting daughters to appointments). Findings suggested that mothers struggle to balance eliciting daughters’ concerns, providing them with support, and imparting knowledge without overwhelming them. We offer mothers and practitioners guidance to help facilitate these conversations.
Publisher: Elsevier BV
Date: 03-1999
Publisher: Hindawi Limited
Date: 03-2010
DOI: 10.1111/J.1365-2354.2008.01012.X
Abstract: The objective was to explore the psychosocial adaptation of female partners living with men with a diagnosis of either localized or metastatic prostate cancer. Semi-structured qualitative interviews were conducted with 50 women at two time points (baseline and 6 months later). The interviews examined emotions, experiences, attitudes to sexual and continence issues and treatment decision making. As part of a larger prospective observational study, demographic data and scores for depression and anxiety were collected. Initial analysis demonstrated that the group of 11 women assessed as distressed on the anxiety and depression measures described reduced coping skills and poorer adaptation after 6 months. In contrast, the 39 women in the non-distressed group reported emotional adaptation that fitted the Lazarus and Folkman pattern of coping through appraisal of the impact of the diagnosis on their partner and themselves, appraisal of coping strategies and reappraisal of the situation. A surprise finding was the high level of resilience displayed by majority of these women. Results suggest that a psychosocial intervention could strengthen healthy adaptation and provide better coping skills for distressed couples.
Publisher: Elsevier BV
Date: 03-2015
DOI: 10.1016/J.JPAINSYMMAN.2014.07.008
Abstract: Demoralization can be understood as a condition that results from existential conflict. It presents with symptoms of hopelessness and helplessness caused by a loss of purpose and meaning in life. It is a significant mental health concern given there can be an associated desire for hastened death. The aim of this systematic review was to synthesize the recent empirical evidence on demoralization in patients with progressive disease or cancer, including prevalence rates the relationships between demoralization and sociodemographic, disease- and treatment-related, and psychological factors and the psychometric properties of demoralization measures. A comprehensive literature search using key words and subject headings was performed following PRISMA guidelines with nine electronic bibliographic databases, resulting in 25 studies (33 articles) with a total of 4545 participants reviewed. Full articles underwent methodological quality assessment, and correlational information was synthesized according to the strength of evidence. The findings suggest that demoralization is prevalent in patients with progressive disease or cancer and clinically significant in 13%-18%. A range of factors were consistently associated with demoralization: poorly controlled physical symptoms, inadequately treated depression and anxiety, reduced social functioning, unemployment, and single status. The Demoralization Scale has demonstrated good psychometric properties across five studies. Overall, this systematic review was limited by the extent of variability in the characteristics of studies. Patients who are single, isolated or jobless, have poorly controlled physical symptoms, or have inadequately treated anxiety and depressive disorders are at increased risk for demoralization. Clinical recognition of demoralization can trigger more focused interventions.
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1016/J.PSYCHRES.2017.12.023
Abstract: Dramatic mental shifts in young patients with borderline personality disorder (BPD) can be understood to occur via dissociative processes found in immature schema modes. A schema mode is an organized pattern of thought, affect and behaviour based on a set of core beliefs. These maladaptive modes are not integrated into a united personality structure and can function in a dissociated form. The aim of this study was to empirically assess the relationship between dysfunctional schema modes and dissociation in BPD. Forty-two young patients with BPD confirmed by the structured clinical interview for DSM-IV Axis-II personality disorders (SCID-II) were further assessed by the Psychiatric Diagnostic Screening Questionnaire (PDSQ), DSM-IV/ICD-10 Personality Questionnaire (DIP-Q), Schema Mode Inventory (SMI) and Wessex Dissociation Scale (WDS). Pearson correlations assessed associations and stepwise regression explored the extent of these associations. The strongest correlations were found between dissociation and the following modes: Detached Protector, Angry Child, Impulsive Child, Punitive Parent, Demanding Parent, and Vulnerable Child. Stepwise regression analysis indicated that schema modes explained 58% of the variance in dissociation. The schema modes that significantly predicted dissociation were the Detached Protector and Impulsive Child modes. Key therapeutic targets in treating adolescents with BPD include detachment and impulsivity.
Publisher: SAGE Publications
Date: 04-2000
DOI: 10.1080/J.1440-1614.2000.00692.X
Abstract: Objective: Given the recent publication of Dutch guidelines for euthanasia of the mentally ill, our aim in this paper is to review the clinical role of the psychiatrist in assessing patients who seek euthanasia or physician-assisted suicide. Method: Three areas are examined that are informative of the role of the psychiatrist in assessing patients who desire death: recent surveys of psychiatrists' attitudes, empirical and clinical studies, and treatment issues. Results: Demoralisation and depression emerge as pertinent clinical issues worthy of psychiatric intervention. The role of the psychiatrist is complex and includes issues of assessment, systems, countertransference and treatment. Conclusions: Dutch guidelines for physician-assisted suicide in the mentally ill generate serious concern given the uncertainty of prognosis, potential range and variability of outcome of treatments of suicidality and the boundary violations that are involved for the psychiatrist. The guidelines have the potential to dangerously alter the practice of psychiatry and should be condemned.
Publisher: SAGE Publications
Date: 05-06-2012
Abstract: Clinicians meet a variety of ethnicities among patients and families in hospice programs. This article focuses on Latino families. Within a controlled trial of family therapy in the context of palliative care, 17 families identified as Hispanic. Five were examined qualitatively herein. A synopsis of each family’s narrative is presented here. Patterns of strong family loyalty ( Familismo), the gender roles of Machismo and Marianismo, the importance of family tradition, expectations about caregiving, and the place of faith and religion emerged as prominent and able potentially to impact on the therapy. Family therapists need to be thoughtful about cultural issues as they strive to support families.
Publisher: Oxford University Press
Date: 06-09-2011
Publisher: Elsevier
Date: 2011
Publisher: Elsevier BV
Date: 05-2016
Publisher: IEEE
Date: 11-2016
Publisher: American Medical Association (AMA)
Date: 22-10-2012
DOI: 10.1001/ARCHINTERNMED.2012.3633
Abstract: Advanced and progressive illnesses bring existential suffering to patients as an inevitable consequence of the disease and its treatment. Physicians need a typology of existential distress to aid its recognition and improved management. The major forms of existential challenge include (1) death anxiety, (2) loss and change, (3) freedom with choice or loss of control, (4) dignity of the self, (5) fundamental aloneness, (6) altered quality of relationships, (7) our search for meaning, and (8) mystery about what seems unknowable. An adaptive response to each challenge promotes equanimity, peace, and fulfillment while sustaining engagement with life, creativity, and joy. Physicians can do much to nurture courage and maintain each person's sense of meaning, value, and purpose.
Publisher: Springer Science and Business Media LLC
Date: 2007
Publisher: Springer Science and Business Media LLC
Date: 02-05-2016
DOI: 10.1007/S40596-016-0560-9
Abstract: Mental health clinicians can experience difficulties communicating diagnostic information to patients and their families/carers, especially about distressing psychiatric disorders such as schizophrenia. There is evidence for the effectiveness of communication skills training (CST) for improving diagnostic discussions, particularly in specialties such as oncology, but only limited evidence exists about CST for psychiatry. This study evaluated a CST program specifically developed for psychiatry residents called ComPsych that focuses on conveying diagnostic and prognostic information about schizophrenia. The ComPsych program consists of an introductory lecture, module booklets for trainees, and exemplary skills videos, followed by small group role-plays with simulated patients (SPs) led by a trained facilitator. A standardized patient assessment (SPA) was digitally recorded pre- and post-training with a SP using a standardized scenario in a time-limited (15 min) period. Recorded SPAs were independently rated using a validated coding system (ComSkil) to identify frequency of skills used in five skills categories (agenda setting, checking, questioning, information organization, and empathic communication). Thirty trainees (15 males and 15 females median age = 32) undertaking their vocational specialty training in psychiatry participated in ComPsych training and pre- and post-ComPsych SPAs. Skills increased post-training for agenda setting (d = -0.82), while questioning skills (d = 0.56) decreased. There were no significant differences in any other skills grouping, although checking, information organization, and empathic communication skills tended to increase post-training. A dose effect was observed for agenda setting, with trainees who attended more CST sessions outperforming those attending fewer. Findings support the generalization and translation of ComPsych CST to psychiatry.
Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.CONCOG.2016.08.017
Abstract: Mindfulness is theorised to improve attention regulation and other cognitive processes. This systematic review examines whether 8-week standardised and manualised mindfulness training programs such as Mindfulness Based Cognitive Therapy (MBCT) and Mindfulness Based Stress Reduction (MBSR) enhances attention, memory and executive function abilities measured by objective neuropsychological tests. Seven databases were searched resulting in 18 studies meeting inclusion criteria for review. Overall studies did not support attention or executive function improvements. We found preliminary evidence for improvements in working memory and autobiographical memory as well as cognitive flexibility and meta-awareness. Short-term mindfulness meditation training did not enhance theorised attentional pathways. Results call into question the theoretical underpinnings of mindfulness, further highlighting the need for a comprehensive theoretical framework.
Publisher: Oxford University Press (OUP)
Date: 04-2011
Publisher: American Psychiatric Association Publishing
Date: 05-1996
Abstract: The aim of this study was to identify patterns of family functioning in adult families after the death of a parent. One hundred fifteen families completed measures of family functioning, grief, psychological state, and social adjustment 6 weeks (time 1), 6 months (time 2), and 13 months (time 3) after the death of a parent (a total of 670 in idual responses). Cluster analytic methods were applied to develop a typology of perceptions of family functioning during bereavement. Five types of families emerged from dimensions of cohesiveness, conflict, and expressiveness on the Family Environment Scale. Thirty-six percent of the families were considered supportive because of their high cohesiveness, and another 23% resolved conflict effectively. Two types were dysfunctional: hostile families, distinguished by high conflict, low cohesiveness, and poor expressiveness, and sullen families, who had more moderate limitations in these three areas they declined in frequency from 30% at time 1 to 15% at time 3. The remaining type (26%), termed intermediate, exhibited midrange cohesiveness, low control, and low achievement orientation. The typology at time 1 predicted typologies at time 2 and time 3. There were no age or gender differences among the family types, but offspring, as compared with spouses, were overrepresented in the hostile families. Family types can be identified, allowing at-risk families to be helped to prevent complications of grief. Screening with the family relationship index of the Family Environment Scale would facilitate such a family-centered approach.
Publisher: Wiley
Date: 2004
DOI: 10.1002/CNCR.20180
Publisher: Hindawi Limited
Date: 26-03-2015
DOI: 10.1111/ECC.12316
Publisher: SAGE Publications
Date: 07-2004
DOI: 10.1080/J.1440-1614.2004.01385.X
Abstract: Objective: To compare two self-report questionnaires for identifying possible depression in women with metastatic breast cancer. Method: We conducted structured psychiatric interviews and administered the Beck Depression Inventory Short Form (BDI-SF) and Hospital Anxiety and Depression Scale (HADS) to 227 women with stage IV breast cancer. The accuracy for identifying DSM-IVdefined major and minor depression was examined. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were calculated and receiver operating characteristic curves plotted. Results: Seventy-four (32.6%) patients satisfied DSM-IV criteria for a depressive disorder. With a cut-off of 4, the BDI-SF had a sensitivity of 0.84, specificity of 0.63, and PPV of 0.52. A cut-off of 11 on the HADS-Depression scale (HADS-D) resulted in sensitivity, specificity, and PPV of 0.16, 0.97, and 0.75, respectively. For major depression alone, the BDI-SF with a cut-off of 5 had excellent sensitivity but poor PPV the HADS, with a cut-off of 7, had weak sensitivity and PPV. Conclusions: Overall, the two scales perform similarly in identifying major depression, while the BDI-SF is the more useful in screening for DSM-IV major or minor depression categories in this clinical group.
Publisher: JSTOR
Date: 07-2004
DOI: 10.2307/3528690
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2014
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.JAD.2017.11.029
Abstract: Little is known about anxiety in aged care populations, despite its increase in this frail population. This study investigated the prevalence, recording, and treatment rate of anxiety disorders among aged care residents. A cross-sectional, observational design was used to assess 180 elderly residents from 12 aged care facilities in Melbourne, Australia. Participants were assessed for threshold and subthreshold anxiety disorders and comorbid depression using the MINI for DSM-5. Medical files were also reviewed to determine whether there was any indication that anxiety had previously been detected, and what treatment those with a threshold/subthreshold diagnosis were receiving. Overall prevalence of threshold and subthreshold anxiety disorders was 19.4% and 11.7%, respectively. Generalized anxiety disorder was the most common threshold disorder and agoraphobia was the most prevalent subthreshold anxiety disorder. While less than half of those with a threshold or subthreshold anxiety disorder had an indication of anxiety in their file, the majority received psychotropic medication. Cognitive impairment was not significantly associated with the prevalence or treatment of anxiety. The prevalence of threshold and subthreshold anxiety in aged care settings is high, but remains under-reported by staff and GPs. Facility staff and GPs should ensure they are aware of how anxiety presents in elderly residents and routinely screen for this common mental health issue. This cohort had poor access to psychological treatments for their condition.
Publisher: American Psychiatric Association Publishing
Date: 05-1996
Abstract: The aim of this study was to describe the intensity of grief, the psychosocial morbidity, and the coping patterns in members of families classified according to a typology of family functioning comprising supportive, conflict-resolving, intermediate, sullen, and hostile classes. One hundred fifteen families were assessed longitudinally 6 weeks (time 1), 6 months (time 2), and 13 months (time 3) after the death of a parent (constituting 670 in idual responses) on measures of grief intensity, psychological state, social adjustment, and family coping. A previously described typology of perceptions of family functioning was applied. Repeated measures multivariate analysis of variance based on both in iduals and families and post hoc comparisons of significant results were undertaken. Sullen families displayed the most intense grief and the most severe psychosocial morbidity. Well-functioning families (supportive and conflict-resolving) resolved their grief and adjusted more adaptively than their dysfunctional counterparts (intermediate, sullen, and hostile families). There were no cluster-by-time interactions. The clusters accounted for 15.7% of the variance in depression (Beck Depression Inventory) and 27.9% of the variance in social functioning (Social Adjustment Scale). Well-functioning families used more family coping strategies (Family Crisis Oriented Personal Evaluation Scales). More intense grief and greater psychosocial morbidity are found in sullen, hostile, and intermediate bereaved families than in the more adaptive supportive and conflict-resolving types. At-risk families are identifiable and could be treated preventively to reduce morbidity.
Publisher: Wiley
Date: 09-11-2016
DOI: 10.1002/GPS.4378
Abstract: To synthesize and summarize the studies examining the prevalence rate of anxiety disorders and symptoms in older adults living in residential aged care. Using the PRISMA guidelines, five electronic databases were searched using key terms and subject headings, as well as reference lists of relevant papers. The search was limited to literature published in English. Eligible studies examined the prevalence of anxiety disorders or symptoms in aged care residents aged 50+ years. A total of 2249 articles were identified, of which 18 studies (with a total of 5927 participants) were included in this review. The rate of overall anxiety disorders ranged from 3.2% to 20%, with the highest quality studies estimating a prevalence rate of 5% to 5.7%. Generalized anxiety disorder and specific phobias were found to be the most common anxiety disorders among aged care residents, while clinically significant anxiety symptoms were found to be more frequent (6.5% to 58.4%) than threshold disorders. Anxiety disorders and anxiety symptoms are common in older aged care residents. Given the paucity and overall quality of research examining anxiety within this population and the heterogeneity found in studies, further research is needed to help clarify this issue.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 20-12-2007
Publisher: Elsevier BV
Date: 05-2008
DOI: 10.1016/J.EJCA.2008.02.032
Abstract: It is widely recognised by clinicians that depression is a difficult symptom to identify amongst patients with advanced illness. Many of the symptoms of depression are difficult to elicit in patients who are approaching the end of life. Additionally, many believe that a 'degree' of depression is almost normal as patients approach life's end. More recently the concept of demoralization as a separate entity to depression has been described which can be briefly described as a disorder of meaning and hope. In this paper, we review these diagnoses together with the latest screening tools which can help clinicians to recognise better such pathologies in their patients and discuss interventions that can be utilised to help patients with depression or demoralization to have a better quality of life.
Publisher: Oxford University Press (OUP)
Date: 02-06-2015
Publisher: SAGE Publications
Date: 12-2002
DOI: 10.1046/J.1440-1614.2002.01086.X
Abstract: Objective: Demoralization, as described by Jerome Frank, is experienced as a persistent inability to cope, together with associated feelings of helplessness, hopelessness, meaninglessness, subjective incompetence and diminished self-esteem. It is arguably the main reason people seek psychiatric treatment, yet is a concept largely ignored in psychiatry. The aim here is to review and summarize the literature pertaining to demoralization in order to examine the validity of the construct. Method: A narrative review of demoralization and the related concepts of hope, hopelessness, and meaning is presented, drawing on a range of empirical and observational studies in the medical and psychiatric literature. Results: An examination of the concepts of the ‘Giving Up–Given Up’ syndrome (George Engel), ‘suffering’ (Eric Cassell), and demoralization (Jerome Frank), demonstrate considerable convergence of ideas. Demoralization has been commonly observed in the medically and psychiatrically ill and is experienced as existential despair, hopelessness, helplessness, and loss of meaning and purpose in life. Although sharing symptoms of distress, demoralization is distinguished from depression by subjective incompetence in the former and anhedonia in the latter. Demoralization can occur in people who are depressed, cancer patients who are not depressed and those with schizophrenia. Hopelessness, the hallmark of demoralization, is associated with poor outcomes in physical and psychiatric illness, and importantly, with suicidal ideation and the wish to die. Conclusions: Demoralization is an important construct with established descriptive and predictive validity. A place needs to be found for it in psychiatric nomenclature.
Publisher: SAGE Publications
Date: 08-08-2018
Abstract: Death anxiety is a common issue in adult patients with advanced cancer and can have a large impact on quality of life and end-of-life care. Interventions are available to assist but are scarcely used in everyday practice. To assess quantitative studies on interventions for adult patients with advanced cancer suffering from death anxiety. MEDLINE, PsycINFO, Embase and CINAHL were searched to identify quantitative or mixed studies on death anxiety or relatable existential intervention studies in advanced cancer patients published from 1990 to December 2016. Two reviewers independently screened titles and abstracts and assessed relevant studies for eligibility. Data were then extracted from included studies for analysis. Nine unique quantitative studies were identified, including five randomised controlled trials, involving a total overall of 1179 advanced cancer patients. All studies were psychotherapeutic in nature and centred on existential themes such as meaning, dignity, relationships and spiritual well-being. The therapies investigated shared overlapping themes but varied in duration, therapist experience, training required and burden on patient. Heterogeneity of studies and measures prevented determination of an overall effect size. Interventions were identified for this clinical scenario of death anxiety in patients with advanced cancer. Therapies of short duration incorporating spiritual well-being and those evoking a sense of meaning were claimed to be the most beneficial, despite lacking rigorous statistical analysis. More high-quality studies with tailored outcome measures are required to fully evaluate the most effective interventions for death anxiety in patients with advanced cancer.
Publisher: Oxford University Press (OUP)
Date: 08-1999
Publisher: Informa UK Limited
Date: 31-12-2003
Publisher: BMJ
Date: 2014
DOI: 10.1097/IGC.0000000000000010
Abstract: The study aimed to characterize cancer-related concerns among women with a new diagnosis of gynecological cancer from a developmental life stage perspective. The study compared the degree of cancer-related concern between young women (45 years or younger), middle age women (46–64 years), and older women (65 years or older). Data from women (N = 243) with a condition diagnosed as primary gynecological cancer who were participating in a randomized control trial were analyzed. Women completed a measure that assessed the degree of concern in 12 cancer-related domains (physical functioning, cancer treatment, emotional functioning, sexual functioning, disease progression/death, own well-being, partner well-being, relationship with spouse artner, body image, relationship with others, employment, and finances). Multivariate comparisons were made between the 3 age groups on the cancer-related concerns. There were age group differences in overall cancer-related concern and specific cancer-related domains. Young women reported the greatest cancer-related concern ( P 0.001). They reported greater concern over emotional functioning ( P 0.001) and sexual functioning ( P 0.001) compared to the middle- and older-age groups. Older women reported less concern over the impact of cancer on finances ( P = 007). There were no differences between age groups in concern over physical impairment, cancer treatment, disease progression/death, own well-being, partner well-being, relationship with spouse artner, body image, and relationship with others. Age may play an important role in the impact of a gynecological cancer diagnosis in domains of functioning, specifically emotional functioning, sexual functioning, and finances. Other cancer-related areas may represent more universal degree of impact. Professionals may benefit from considering the impact of cancer from a developmental life stage perspective.
Publisher: Elsevier BV
Date: 11-2022
DOI: 10.1016/J.JPAINSYMMAN.2022.08.002
Abstract: Psycho-existential symptoms are common yet often missed or neglected in palliative care. Screening can be an effective way to recognize and respond to this need. We aimed to implement routine use of the Psycho-existential Symptom Assessment Scale (PeSAS) as a screening tool in Australian palliative care services and discern the symptom prevalence identified. In a multi-site rolling design, we established implementation site committees and embarked on experiential workshops to train clinicians in the tool's efficient use. Patient symptom prevalence data were collected to compare uptake across sites. Descriptive statistics were applied. Over one year, we trained 216 clinicians across six palliative care services in the use of the PeSAS as a screening tool and collected data from 1405 patients. Clinicians reported significant growth in their sense of efficacy in assessing psycho-existential wellness. Services using electronic records implemented most easily. Psycho-existential symptoms with clinically significant prevalence (scores ≥ 4/10) included anxiety 41.1%, discouragement 37.6%, hopelessness 35.8%, pointlessness 26.9%, depression 30.3%, and the wish to die 17%. The precision of measurement within 3% was found for severe ratings (score ≥ 8/10) including anxiety 10.6%, depression 10.2%, the wish to die 7.6%, and confusion 3.6%. Clinicians can be trained to screen with the Psycho-existential Symptom Assessment Scale, which serves as a valuable measure to better recognize symptoms of psycho-existential distress among palliative care patients. Implementation barriers included the prior ethos of the service, confidence in talking about these themes, electronic data entry, and perceived time pressures.
Publisher: Informa UK Limited
Date: 04-02-2015
DOI: 10.1080/07481187.2014.985406
Abstract: The authors examined psychosocial outcomes following the first year of bereavement, for 51 family caregivers, including both spouses and offspring. Researchers assessed caregivers during palliative care and again during the second year of bereavement, for social functioning, depression, and distress. For all family caregivers, only depression scores declined significantly between T1 and T2 (p < 0.05). Caregiver relationship and gender did not make a difference in recovery. Results demonstrate that poor psychosocial health outcomes exist beyond the first year of bereavement. Early identification of these caregivers is necessary to provide mental health professionals the opportunity to intervene proactively.
Publisher: SAGE Publications
Date: 05-2004
DOI: 10.1080/J.1440-1614.2004.01358.X
Abstract: Objective: To assess psychosocial morbidity in women with breast cancer and to compare the differential rates between women with early stage and advanced disease. Method: In this report, 303 women with early stage breast cancer, psychiatrically assessed at baseline (as part of a study of cognitive-existential group therapy during adjuvant chemotherapy), are compared with 200 women with advanced breast cancer (similarly assessed in a trial of supportive-expressive group therapy). A structured psychiatric interview plus self-report measures were used to assess psychiatric morbidity, quality of life and cognitive attitude to cancer. Results: The early stage patients, whose mean age was 46 years, were on average 3 months post-surgery and had an overall prevalence of DSM-IV psychiatric diagnosis of 45%. The metastatic patients, whose mean age was 51 years, were on average 63 months post-primary diagnosis and had an overall prevalence of DSM-IV diagnosis of 42% the difference between the two rates was not statistically significant. Of women with early stage breast cancer, 36.7% had mood disorders, 9.6% suffering from major depression and 27.1% from minor depression. In the metastatic s le 31% had mood disorders, 6.5% having major depression and 24.5% with minor depression. Anxiety disorders were present in 8.6% of the early stage group and 6% of women with advanced disease. Fatigue, a past history of depression, and cognitive attitudes of helplessness, hopelessness or resignation were significantly associated with depression in both groups. The women from the metastatic s le were significantly less distressed by hair loss but more dissatisfied with body image, and had higher rates of lymphoedema and hot flushes than the early stage women. Conclusions: The rates of psychosocial distress are high, and similar, across patients with both early and advanced stage breast cancer, although the illness related causes of distress are different. These data present a challenge to clinical services to provide a comprehensive range of support services to ameliorate this distress.
Publisher: Informa UK Limited
Date: 27-01-2017
DOI: 10.1080/15504263.2017.1287457
Abstract: In recent years, treatment of substance use disorder has rekindled emphasis on recovery which, being a gradual process, starts with remoralization. In this study, we examine the level of demoralization throughout the treatment process for patients with comorbid substance dependence and psychiatric disorders. 217 patients with co-occurring disorders and 179 community-based in iduals participated in this study. Demoralization was measured twice over one month as inpatient treatment happened. In contrast with the community s le, we found high levels of demoralization in the clinical cohort, with 86% of patients having demoralization scores above threshold. During the first month there was a statistically significant reduction in demoralization scores. However, clinically relevant change appeared limited, with only 3% of patients moving from dysfunctional to functional status in this naturalistic setting without targeted intervention aimed at remoralization. Although the level of demoralization is significantly improved during the first month of treatment, patients still remain strongly demoralized. Clinically relevant improvement is limited. It could be worthwhile to set up targeted interventions aimed at remoralization. Furthermore, we advocate for the assessment of demoralization in the clinical setting to monitor patients' treatment outcomes.
Publisher: Wiley
Date: 17-01-2016
DOI: 10.1002/PON.4048
Abstract: Antidepressants are commonly used for the pharmacological treatment of depression. We aimed to summarise the prevalence of antidepressant prescription to cancer patients, and differences by study or patient characteristics. PubMed, Embase, Web of Science, Scopus and psychINFO were searched using keywords 'psychotropic', 'antidepressants', 'prescription' and 'cancer'. Prevalence of antidepressants, type, dose and follow-up of antidepressants and prescriber details were extracted. Overall, 1537 articles between 1979 and February 2015 were found, 38 met the inclusion criteria and were reviewed according to PRISMA guidelines. The prevalence rate of prescribing antidepressants to cancer patients was 15.6% (95% CI = 13.3-18.3). Prescription was significantly less common in studies from Asia (7.4% 95% CI = 4.3-12.5), more common in female (22.6% 95% CI = 16.0-31.0) or breast cancer patients (22.6% 95% CI = 16.0-30.9). Selective serotonin reuptake inhibitors were the most frequently prescribed antidepressants. General practitioners and psychiatrists, followed by oncologists, were identified as the major providers of antidepressant prescriptions to cancer patients. Few studies reported the exact dose, length of time drugs were prescribed for or follow-up regimens. There is considerable variation in the prescribing patterns of antidepressants across the world, with few studies reporting robust data on exact dose or follow-up regimens. Prospective studies that monitor antidepressant prescribing, including details of reasons for prescribing and the healthcare providers involved, dose, change in dose or type of medication and follow-up are needed to ascertain whether patients are being treated optimally and if side effects or drug-drug interactions are identified and managed. Copyright © 2016 John Wiley & Sons, Ltd.
Publisher: Wiley
Date: 11-2004
DOI: 10.1002/PON.798
Abstract: Supportive-Expressive Group Therapy (SEGT) has been developed and manualised in the research setting, but there have been few clinical accounts of its utility. In this qualitative review of its application in the Melbourne-based randomised control trial (RCT) for women with advanced breast cancer, SEGT is considered from the perspective of the structure and framework of therapy, its therapists, the issues that develop in exploring its common themes and what constitutes a well functioning group. Groups move through identifiable developmental phases. The mature group process transforms existential ambivalence into creative living, evidenced by humour, celebration, assertiveness, altruism, new creative pursuits and eventually courageous acceptance of dying. Challenges and pitfalls include avoidance, non-containment of ambivalence, intolerance of difference, anti-group phenomena and splitting. A key element is the medicalization of the group culture whereby members and co-therapists explore health beliefs and attitudes about care. This promotes compliance with anti-cancer treatments, including both the initiation of and perseverance with chemotherapy. This mechanism could prove to be a potentially important pathway in promoting longer survival.
Publisher: Cambridge University Press (CUP)
Date: 25-10-2007
DOI: 10.1017/S1478951507000570
Abstract: This study builds on previous work that explored the lived experience of meaning in advanced cancer. The aims were to explore the associations of suffering (physical and existential distress) and coping (via social support) with psychological distress and global meaning using a battery of instruments among adults attending an Australian metropolitan cancer service ( n = 100). The contribution of suffering and coping via social support to psychological distress and meaning were examined using a variety of statistical methods. Multiple regression analyses were conducted to further examine relative contributions to both psychological distress and global meaning. Physical and existential distress were found to be positively associated with psychological distress whereas high social support and personal meaning are related to lower levels of psychological distress. Social support was the strongest correlate of global meaning whereas high levels of existential distress were related to lower levels of global meaning. On the basis of this study, it is concluded that the factors related to suffering clearly promote psychological distress, and the reverse is true for global meaning for those living with cancer. This study speaks to the clinical complexity of the dynamic experience of suffering and meaning in cancer. We need to better understand the impact of physical suffering and meaning in the lives of this population and to actively work toward the enhancement of social support and connection with others for this group. Optimal palliative and family-centered care blended with therapies that promote a sense of meaning of life lived appear crucial to ameliorate suffering.
Publisher: Springer Science and Business Media LLC
Date: 19-09-2017
DOI: 10.1007/S00520-017-3876-4
Abstract: Cancer patients are often prescribed antidepressants, but little data is available about whether the type and dose are similar to prescriptions to patients with other chronic diseases. This study compared the prescription practices of antidepressants to cancer and non-cancer inpatients at a major Australian tertiary hospital and assessed side effects and potential drug-drug interactions. Inpatients diagnosed with cancer within the past 12 months and prescribed antidepressants were age and gender matched to inpatients with other chronic disease conditions. Data from 75 cancer and 75 non-cancer inpatients were extracted. Antidepressants were prescribed to cancer and non-cancer patients, respectively, for the treatment of depression (n = 50 vs n = 59), other mental health problems (n = 8 vs n = 11, p < 0.67) or unspecified reasons (n = 17 vs n = 5, p < 0.02). Mirtazapine (n = 11/75) was most commonly prescribed to cancer patients followed by duloxetine (n = 9/75). Desvenlafaxine (n = 15/75) was prescribed most commonly to non-cancer inpatients, followed by mirtazapine (n = 11/75). Four cancer patients and three non-cancer patients had documented adverse side effects from antidepressants. About one-third of cancer patients (n = 23/75) and about a quarter of non-cancer patients (n = 18/75) were prescribed other medicines with the potential for drug-drug interactions with antidepressants. Antidepressants were prescribed for a range of indications in all patients, but more commonly for unspecified reasons among the cancer patients. Future prospective studies that monitor antidepressant prescribing to cancer patients should ascertain details of the indication, pathways to prescription and differences in type, dose or schedule depending on prescribing medical practitioner.
Publisher: Cambridge University Press (CUP)
Date: 13-11-2008
DOI: 10.1017/S1478951508000540
Abstract: End-of-life communication is crucial because most U.S. hospitals implement cardiopulmonary resuscitation (CPR) in the absence of do-not-resuscitate directives (DNRs). Despite this, there is little DNR utilization data to guide the design of communication-training programs. The objective of this study was to determine DNR utilization patterns and whether their use is increasing. A retrospective database analysis (2000–2005) of DNR data for 206,437 patients, the entire patient population at Memorial Sloan-Kettering Cancer Center (MSKCC), was performed. The hospital recorded, on average, 4,167 deaths/year. In 2005, 86% of inpatient deaths had a DNR, a 3% increase since 2000 ( p .01). For patients who died outside the institution (e.g., hospice), 52% had a DNR, a 24% increase over 6 years ( p .00001). Adult inpatients signed 53% of DNRs but 34% were signed by surrogates. The median time between signing and death was 0 days, that is, the day of death. Only 5.5% of inpatient deaths had previously signed an outpatient DNR. Here, the median time between signing and death was 30 days. Although DNR directives are commonly utilized and their use has increased significantly over the past 6 years, most cancer patients/surrogates sign the directives on the day of death. The proximity between signing and death may be a marker of delayed end-of-life palliative care and suboptimal doctor–patient communication. These data underscore the importance of communication-training research tailored to improve end-of-life decision making.
Publisher: Springer Science and Business Media LLC
Date: 06-12-2009
Publisher: Wiley
Date: 04-2022
DOI: 10.1002/PON.5925
Abstract: This issue celebrates the 30th anniversary of Psycho‐Oncology as a journal, a home for scholarship integrating the psychological, social and behavioural dimensions of cancer. Psycho‐oncology developed as an evidence‐based discipline to offer an alternative to unproven therapies and to optimise coping and support for patients with cancer and their families. A review of key articles was undertaken for this editorial. Empirical studies have defined the prevalence of morbidity arising from cancer and the acute, longer‐term and late effects of its varied treatments. Interventions have been adapted to respond to existential challenges, death anxiety, fear of recurrence, disease progression, palliative care and have been continued into bereavement. Mixed modality treatments have combined psychotropic and psychotherapeutic interventions. Survivorship studies have examined rehabilitation, fertility, sexuality, body image and relational impacts of illness. This journal has helped the discipline to flourish by publishing the innovative outputs of its community of researchers.
Publisher: Cambridge University Press (CUP)
Date: 04-11-2013
DOI: 10.1017/S1478951513000527
Abstract: The aim of this study was to explore the type of relationship and the process of developing these relationships between nurses and patients in palliative care units in Japan. The special contribution that culture makes was examined to better understand the intensity of nurses’ grief after the death of their patient. Thirteen Japanese registered nurses currently practicing in palliative care units were interviewed between July 2006 to June 2009. Theoretical s ling was utilised and the data were analysed using grounded theory methodology. Constant comparison was undertaken during coding processes until data saturation was achieved. Significant cultural influences emerged both in the type of relationship nurses formed with patients and in the way they developed relationships. The type of relationship was termed ‘human-to-human’, meaning truly interpersonal. The cultural values of ‘Uchi (inside) and Soto (outside)’ have particular implications for the relationship. Four actions Being open , Trying to understand , Devoting time and energy , and Applying a primary nurse role , were identified as strategies for nurses to develop such relationships. The quality of this deeply committed encounter with patients caused nurses to grieve following patients’ death. Culture is a major influence upon the reasons, complexities, and impact that lie behind nurses’ behaviours. Attention is needed to support nurses to sustain a fundamental caring quality in their relationships with patients.
Publisher: Korean Neuropsychiatric Association
Date: 2022
Publisher: Springer Science and Business Media LLC
Date: 12-03-2011
DOI: 10.1245/S10434-011-1623-5
Abstract: We showed in a companion paper that the prevalence of burnout among surgical oncologists at a comprehensive cancer center was 42% and psychiatric morbidity 27%, and high quality of life (QOL) was absent for 54% of surgeons. Here we examine modifiable workplace factors and other stressors associated with burnout, psychiatric morbidity, and low QOL, together with interest in interventions to reduce distress and improve wellness. Study-specific questions important for morale, QOL, and stressors associated with burnout were included in an anonymous Internet-based survey distributed to the surgical faculty at Memorial Sloan-Kettering Cancer Center. Among the 72 surgeons who responded (response rate of 73%), surgeons identified high stress from medical lawsuits, pressure to succeed in research, financial worries, negative attitudes to gender, and ability to cope with patients' suffering and death. Workplace features requiring greatest change were the reimbursement system, administrative support, and schedule. Work-life balance and relationship issues with spouse or partner caused high stress. Strongest correlations with distress were a desire to change communication with patients and the tension between the time devoted to work versus time available to be with family. Surgeons' preferences for interventions favored a fitness program, nutrition consultation, and increased socialization with colleagues, with less interest in interventions conventionally used to address psychological distress. Several opportunities to intervene at the organizational level permit efforts to reduce burnout and improve QOL.
Publisher: Wiley
Date: 30-08-2022
DOI: 10.1002/PON.5802
Abstract: Identifying modifiable factors affecting work ability among cancer survivors is important. The primary aim of the present study was to examine the effects of depression and related psychological factors on work ability among breast cancer survivors in Australia. In this cross‐sectional electronic and postal survey, Australian breast cancer survivors were investigated. Work status and conditions before and after cancer treatment were analysed. Work ability was measured using the Work Limitation Questionnaire©‐Short Form (WLQ‐SF) with its four domains (time management, physical tasks, mental‐interpersonal tasks, and output tasks). Three psychological factors were investigated: depression, fear of cancer recurrence, and demoralisation. Sociodemographic and clinical data were also collected. Multivariate regression analysis was used to identify the associations of psychological factors with WLQ‐SF. Among eligible survivors, 310 (50%) responded to the survey and were analysed. Nearly one third reported their work conditions had changed after cancer treatment. The depressed group reported limited work ability in 35%–44% of the four domains of WLQ‐SF, while the non‐depressed group reported limited work ability in only 8%–13%. At‐work productivity loss was approximately fourfold higher in the depressed group than in the non‐depressed group. In multivariate analysis, at‐work productivity loss was associated with depression, demoralisation, and past history of anxiety. After breast cancer treatment, work conditions changed toward lower wages and working hours. Depression, demoralisation, and past history of anxiety were associated with lower work ability. Further evaluations of work rehabilitation in breast cancer survivors are warranted.
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.JPAINSYMMAN.2017.03.016
Abstract: Screening and baseline data on 170 American families (620 in iduals), selected by screening from a palliative care population for inclusion in a randomized controlled trial of family-focused grief therapy, were examined to determine whether family dysfunction conferred higher levels of psychosocial morbidity. We hypothesized that greater family dysfunction would, indeed, be associated with poorer psychosocial outcomes among palliative care patients and their family members. Screened families were classified according to their functioning on the Family Relationships Index (FRI) and consented families completed baseline assessments. Mixed-effects modeling with post hoc tests compared in iduals' baseline psychosocial outcomes (psychological distress, social functioning, and family functioning on a different measure) according to the classification of their family on the FRI. Covariates were included in all models as appropriate. For those who completed baseline measures, 191 (30.0%) in iduals were in low-communicating families, 313 (50.5%) in uninvolved families, and 116 (18.7%) in conflictual families. Family class was significantly associated (at ps ≤ 0.05) with increased psychological distress (Beck Depression Inventory and Brief Symptom Inventory) and poorer social adjustment (Social Adjustment Scale) for in idual family members. The family assessment device supported the concurrent accuracy of the FRI. As predicted, significantly greater levels of in idual psychosocial morbidity were present in American families whose functioning as a group was poorer. Support was generated for a clinical approach that screens families to identify those at high risk. Overall, these baseline data point to the importance of a family-centered model of care.
Publisher: SAGE Publications
Date: 02-1999
DOI: 10.2190/JB07-5GCR-BH81-J2QN
Abstract: A qualitative case study was conducted to explore the clinical decision making processes that underpinned the practice of euthanasia under the Rights of the Terminally Ill (ROTI) Act. The key informant for this research was Philip Nitschke, the general practitioner responsible for the legal cases of euthanasia. His information was supported by extensive document analysis based on the public texts created by patients in the form of letters and documentaries. Further collaborating sources were those texts generated by the media, rights groups, politicians, the coroner's court, and the literature on euthanasia and assisted suicide. A key study finding was that the ROTI legislation did not adequately provide for the specific medical situation in the Northern Territory, Australia. The medical roles, as proscribed by the legislation, carried many inherent assumptions about the health care context and the availability of appropriately qualified medical staff committed to providing euthanasia. These assumptions translated into difficulties in establishing clinical practices for the provision of euthanasia. A further finding concerned the motivations of those who requested euthanasia. This article addresses the medical roles and the motivations of those seeking euthanasia.
Publisher: Wiley
Date: 2003
DOI: 10.1002/PON.683
Abstract: We conducted a randomised, controlled trial of cognitive-existential group therapy (CEGT) for women with early stage breast cancer receiving adjuvant chemotherapy with the aim of improving mood and mental attitude to cancer. Women were randomised to 20 sessions of weekly group therapy plus 3 relaxation classes or to a control arm receiving 3 relaxation classes. Assessments, independently done at baseline, 6 and 12 months, included a structured psychiatric interview and validated questionnaires covering mood, attitudes to cancer, family relationships, and satisfaction with therapy. Three hundred and three of 491 (62%) eligible patients participated over 3 years. Distress was high pre-intervention: 10% were diagnosed as suffering from major depression, 27% from minor depression and 9% from anxiety disorders. On an intention-to-treat analysis, there was a trend for those receiving group therapy (n=154) to have reduced anxiety (p=0.05, 2-sided) compared to controls (n=149). Women in group therapy also showed a trend towards improved family functioning compared to controls (p=0.07, 2-sided). The women in the groups reported greater satisfaction with their therapy (p<0.001, 2-sided), appreciating the support and citing better coping, self-growth and increased knowledge about cancer and its treatment. They valued the CEGT therapy. Overall effect size for the group intervention was small (d=0.25), with cancer recurrence having a deleterious effect in three of the 19 therapy groups. Psychologists as a discipline achieved a moderate mean effect size (d=0.52). CEGT is a useful adjuvant psychological therapy for women with early stage breast cancer. Interaction effects between group members and therapists are relevant to outcome. Group-as-a-whole effects are powerful, but the training and experience of the therapist is especially critical to an efficacious outcome.
Publisher: Public Library of Science (PLoS)
Date: 04-08-2009
Publisher: SAGE Publications
Date: 03-2017
Publisher: Cambridge University Press (CUP)
Date: 11-04-2023
DOI: 10.1017/S1478951523000378
Abstract: To investigate the prevalence and current approaches to clinical management of chronic nonmalignant pain in patients referred to palliative care services. A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with PROSPERO (CRD42021205432). Six databases were searched on 25 August 2020 and again on 11 July 2022: PubMed and Ovid MEDLINE, Elsevier Scopus, PsychINFO, the Cochrane Library, and CINAHL. Search included prevalence or intervention studies with patients who had chronic nonmalignant pain and were referred to palliative care services. Screening was undertaken independently by 2 reviewers. The searches returned 417 titles subsequent screening identified 5 eligible studies, 4 from the USA and 1 from Hong Kong, including 2 cohort and 3 cross-sectional studies. S le sizes ranged from 137 to 323, with a total of 1,056 patients. The prevalence of chronic nonmalignant pain ranged from 14% to 34% across different palliative care settings. There was significant crossover of pain types 54% of patients with chronic no-malignant pain had additional cancer-related pain or cancer treatment–related pain. Opioids were used to manage stand-alone chronic nonmalignant pain for 39% of patients compared to 58% with mixed chronic nonmalignant pain and other pain diagnoses. Five studies have documented the prevalence of chronic nonmalignant pain of 14–34% in palliative care. Further research including prevalence and treatment studies would provide clearer evidence for best practice management of chronic nonmalignant pain in the palliative care setting.
Publisher: Springer Science and Business Media LLC
Date: 25-04-2022
Publisher: Elsevier BV
Date: 10-2010
DOI: 10.1016/J.PEC.2009.12.009
Abstract: To document cases of adverse or near adverse events in communication skills training (CST) and to identify risk factors and strategies to reduce the likelihood of their occurrence. Six physician CST cases meeting criteria for an adverse or near adverse collected from experienced facilitators are analyzed and discussed. Three types of adverse CST events are described: traumatic personal experiences or losses evoked by training perception that feedback is not empathic and where trainees are referred for remedial CST as a risk management strategy. Early identification of risk factors and emotional cues of trainees is a key first step that facilitates implementation of remedial strategies to avert potential adverse events. Consideration of ways that physicians' personal experiences impact communication and good feedback techniques are vital. The implications of physicians sent to CST for risk management purposes is a new scenario that deserves special consideration. To make CST safer and to optimize learning, early recognition of potential adverse events is essential. Specific feedback techniques should be mastered by all CST facilitators.
Publisher: SAGE Publications
Date: 2008
DOI: 10.1080/00048670801961081
Abstract: Objective: To examine the psychological and social adjustment of men with early or advanced stage prostate cancer and to compare them with a matched group of cancer-free community volunteers. Methods: A longitudinal observational study in which 367 men recently diagnosed with early (n=211) or advanced stage (n=156) prostate cancer were compared to 169 cancer-free men from the community, of similar age and residential area, using self-report measures of psychosocial adjustment. Results: On the mental health subscales of the Short-Form 36-item Health Survey, men with advanced disease had lower vitality and social functioning than the other two groups, and lower mental health scores than the comparison group. Both patient groups had lower role-emotional scores than the comparison group. With regard to the Brief Symptom Inventory, the advanced disease group had higher somatization scores, and lower interpersonal sensitivity and paranoid ideation scores than the early stage group and the community comparison group. In terms of psychiatric morbidity, there were higher rates of anxiety disorders but not depressive disorders in both patient groups although overall diagnosis rates were low. No differences were found in terms of couple or family functioning. Conclusions: There is impairment in psychosocial function in men with prostate cancer, particularly those with advanced disease, but no increase in the rate of formal psychiatric disorder or adverse effects on the couples and families. This suggests directions for psychosocial interventions with these patient groups.
Publisher: Wiley
Date: 08-06-2015
DOI: 10.1002/PON.3854
Abstract: A diagnosis of cancer and subsequent treatment are distressing not only for the person directly affected, but also for their intimate partner. The aim of this review is to (a) identify the main theoretical frameworks underpinning research addressing dyadic coping among couples affected by cancer, (b) summarise the evidence supporting the concepts described in these theoretical frameworks, and (c) examine the similarities and differences between these theoretical perspectives. A literature search was undertaken to identify descriptive studies published between 1990 and 2013 (English and French) that examined the interdependence of patients' and partners' coping, and the impact of coping on psychosocial outcomes. Data were extracted using a standardised form and reviewed by three of the authors. Twenty-three peer-reviewed manuscripts were identified, from which seven theoretical perspectives were derived: Relationship-Focused Coping, Transactional Model of Stress and Coping, Systemic-Transactional Model (STM) of dyadic coping, Collaborative Coping, Relationship Intimacy model, Communication models, and Coping Congruence. Although these theoretical perspectives emphasised different aspects of coping, a number of conceptual commonalities were noted. This review identified key theoretical frameworks of dyadic coping used in cancer. Evidence indicates that responses within the couple that inhibit open communication between partner and patient are likely to have an adverse impact on psychosocial outcomes. Models that incorporate the interdependence of emotional responses and coping behaviours within couples have an emerging evidence base in psycho-oncology and may have greatest validity and clinical utility in this setting.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 10-07-2014
Publisher: Wiley
Date: 12-1994
Publisher: Wiley
Date: 17-12-2014
DOI: 10.1002/PON.3737
Publisher: Wiley
Date: 04-05-2017
DOI: 10.1002/CNCR.30749
Abstract: Demoralization refers to a state in which there is a perceived inability to cope, that is associated with a sense of disheartenment and a loss of hope and meaning. This study investigated the co-occurrence versus independence of demoralization with mental disorders and suicidal ideation to evaluate its features as a concept of distress in the context of severe illness. In a cross-sectional s le of 430 mixed cancer patients, we assessed demoralization with the Demoralization Scale (DS) the 4-week prevalence of mood, anxiety, and adjustment disorders and suicidal ideation with the standardized Composite International Diagnostic Interview-Oncology (CIDI-O) and depressive symptoms with the Patient Health Questionnaire-9 (PHQ-9). We compared the relative risk (RR) for mental disorders associated with demoralization to that associated with self-reported depression. Clinically relevant levels of demoralization were present in 21% of the patients. Demoralization co-occurred with a mood/anxiety disorder in 7% 14% were demoralized in absence of any mood/anxiety disorder. Demoralization and adjustment disorders co-occurred in 2%. The RR for any mood/anxiety disorder was 4.0 in patients with demoralization (95% confidence interval [CI], 2.5-6.2) and 3.0 in those with depression (95% CI, 1.9-4.6). Demoralization, but not depression, was associated with a significantly increased risk for suicidal ideation after controlling for mental disorders (RR, 2.0 95% CI, 1.1-3.5). Clinically relevant demoralization frequently occurs independently of a mental disorder in patients with cancer and has a unique contribution to suicidal ideation. Demoralization is a useful concept to identify profiles of psychological distress symptoms amenable to interventions improving psychological well-being in this population. Cancer 2017 :3394-401. © 2017 American Cancer Society.
Publisher: Wiley
Date: 24-02-2012
DOI: 10.1002/HED.22943
Abstract: Facial disfigurement from head and neck cancer can lead to the development of shame and a perception of stigma. We sought to develop the Shame and Stigma Scale (SSS) to measure this. Items were administered to 104 patients with squamous cell carcinoma of the oral cavity, together with measures of quality of life and adaptation. Exploratory factor analysis and item response theory (IRT) models assessed its psychometric properties. A 20-item SSS had a Cronbach's alpha of 0.94 and 4 factors: shame with appearance, sense of stigma, regret, and speech/social concerns. These factors show satisfactory internal validity, convergent validity with the Functional Assessment of Cancer Therapy-General (FACT-G) and Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N), Demoralization Scale and Patient Health Questionnaire (PHQ) Depression, and ergent validity with the Social Desirability Scale. The items displayed desirable properties in factor-specific (IRT) models. Further validation studies are worthwhile to confirm this factor structure, reliability, and validity, and generalizability to all head and neck cancers.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-1995
DOI: 10.1097/00004714-199510000-00010
Abstract: The published case reports of clozapine-induced neuroleptic malignant syndrome (NMS) are reviewed, to which the authors add three, and possibly four, new cases seen in Australia, occurring in and estimated 1,250 patients exposed to the drug. The review suggests that typical NMS does occur with clozapine and that its incidence may be as common as with the classic neuroleptics. The features of clozapine-induced NMS may be somewhat different, with fewer extrapyramidal side effects and a lower rise in creatine kinase levels. The occurrence of NMS with clozapine raises important issues with regard to our understanding of the pathophysiology of the syndrome.
Publisher: Hindawi Limited
Date: 11-09-2017
DOI: 10.1111/ECC.12758
Abstract: This study aimed to ascertain the systemic barriers encountered by oncology health professionals (HPs) working with patients from ethnic minorities to guide the development of a communication skills training programme. Twelve medical and five radiation oncologists and 21 oncology nurses were invited to participate in this qualitative study. Participants were interviewed in idually or in a focus group about their experiences working with people from minority backgrounds. All interviews were transcribed verbatim and analysed thematically. HPs encountered language and communication barriers in their interactions with patients and their families, which were perceived to impact negatively on the quality and amount of information and support provided. There was a shortage of, and poor processes for engaging, interpreters and some HPs were concerned about the accuracy of interpretation. HPs expressed a need for training in cultural awareness and communication skills with a preference for face-to-face delivery. A lack of funding, a culture of "learning on the job", and time constraints were systemic barriers to training. Oncologists and oncology nurses encounter complex challenges in clinical interactions with minority patients and their families, including difficulties working with interpreters. Formal training programmes targeted to the development of culturally competent communication skills are required.
Publisher: Wiley
Date: 20-04-2011
Publisher: American Society of Clinical Oncology (ASCO)
Date: 11-2004
Abstract: Cognitive-existential group therapy (CEGT) was developed to improve mood and mental attitude toward cancer in women with early-stage breast cancer receiving adjuvant chemotherapy. Given the debate about group therapy's association with increased survival in women with metastatic breast cancer, we were curious to check its effect at a much earlier stage in the cancer journey. We randomly assigned 303 women with early-stage breast cancer who were receiving adjuvant chemotherapy to either 20 sessions of weekly group therapy plus three relaxation classes (n = 154) or to a control condition of three relaxation classes alone (n = 149). The primary outcome was survival. CEGT did not extend survival the median survival time was 81.9 months (95% CI, 64.8 to 99.0 months) in the group-therapy women and 85.5 months (95% CI, 67.5 to 103.6 months) in the control arm. The hazard ratio for death was 1.35 (95% CI, 0.76 to 2.39 P = .31). In contrast, histology and axillary lymph node status were significant predictors of survival. Low-grade histology yielded a hazard ratio of 0.342 (95% CI, 0.17 to 0.69), and axillary lymph node–negative status yielded a hazard ratio of 0.397 (95% CI, 0.20 to 0.78). CEGT does not prolong survival in women with early-stage breast cancer.
Publisher: American Psychiatric Association Publishing
Date: 07-2006
DOI: 10.1176/AJP.2006.163.7.1208
Abstract: The aim of family focused grief therapy is to reduce the morbid effects of grief among families at risk of poor psychosocial outcome. It commences during palliative care of terminally ill patients and continues into bereavement. The authors report a randomized, controlled trial. Using the Family Relationships Index, the authors screened 257 families of patients dying from cancer: 183 (71%) were at risk, and 81 of those (44%) participated in the trial. They were randomly assigned (in a 2:1 ratio) to family focused grief therapy (53 families, 233 in iduals) or a control condition (28 families, 130 in iduals). Assessments occurred at baseline and 6 and 13 months after the patient's death. The primary outcome measures were the Brief Symptom Inventory, Beck Depression Inventory, and Social Adjustment Scale. The Family Assessment Device was a secondary outcome measure. Analyses allowed for correlated family data and employed generalized estimating equations based on intention to treat and controlling for site. The overall impact of family focused grief therapy was modest, with a reduction in distress at 13 months. Significant improvements in distress and depression occurred among in iduals with high baseline scores on the Brief Symptom Inventory and Beck Depression Inventory. Global family functioning did not change. Sullen families and those with intermediate functioning tended to improve overall, whereas depression was unchanged in hostile families. Family focused grief therapy has the potential to prevent pathological grief. Benefit is clear for intermediate and sullen families. Care is needed to avoid increasing conflict in hostile families.
Publisher: Wiley
Date: 20-04-2011
Publisher: Elsevier BV
Date: 2013
Publisher: Informa UK Limited
Date: 07-2010
Publisher: Informa UK Limited
Date: 30-03-2017
Publisher: Informa UK Limited
Date: 02-2008
Publisher: Elsevier BV
Date: 10-1995
DOI: 10.1016/S0140-6736(95)91794-2
Abstract: Due to widespread use of low-dose computed tomography (LDCT) screening, increasing number of patients are found to have subsolid nodules (SSNs). The management of SSNs is a clinical challenge and primarily depends on CT imaging. We seek to identify risk factors that may help clinicians determine an optimal course of management. We retrospectively reviewed the characteristics of 83 SSN lesions, including 48 pure ground-glass nodules and 35 part-solid nodules, collected from 83 patients who underwent surgical resection. Of the 83 SSNs, 16 (19.28%) were benign and 67 (80.72%) were malignant, including 23 adenocarcinomas in situ (AIS), 16 minimally invasive adenocarcinomas (MIA), and 28 invasive adenocarcinomas (IA). Malignant lesions were found to have significantly larger diameters (P<0.05) with an optimal cut-off point of 9.24 mm. Significant indicators of malignancy include female sex (P<0.05), air bronchograms (P<0.001), spiculation (P<0.05), pleural tail sign (P<0.05), and lobulation (P<0.05). When compared with AIS/MIA combined, IA lesions were found to be larger (P<0.05) with an optimal cut-off of 12 mm, and have a higher percentage of part-solid nodules (P<0.001), pleural tail sign (P<0.001), air bronchograms (P<0.05), and lobulation (P<0.05). Further multivariate analysis found that lesion size and spiculation were independent factors for malignancy while part-solid nodules were associated with IA histology. East Asian females are at risk of presenting with a malignant lesion even without history of heavy smoking or old age. Nodule features associated with malignancy include larger size, air bronchograms, lobulation, pleural tail sign, spiculation, and solid components. A combination of patient characteristic and LDCT features can be effectively used to guide management of patients with SSNs.
Publisher: Cambridge University Press (CUP)
Date: 13-07-2021
DOI: 10.1017/S1478951521001024
Abstract: The aim was to to establish core components of spiritual care training for healthcare professionals in Australia. This study used the Delphi technique to undertake a consensus exercise with spiritual care experts in the field of healthcare. Participant opinion was sought on (i) the most important components of spiritual care training (ii) preferred teaching methods (iii) clinical scenarios to address in spiritual care training and (iv) current spiritual assessment and referral procedures. Of the 107 participants who responded in the first round, 67 (62.6%) were female, 55 (51.4%) worked in pastoral care, and 84 (78.5%) selected Christian as their religious affiliation. The most highly ranked components of spiritual care training were “relationship between health and spirituality,” followed by “definitions of spirituality and spiritual care.” Consensus was not achieved on the item “comparative religions study/alternative spiritual beliefs.” Preferred teaching methods include case studies, group discussion, role-plays and/or simulated learning, videos of personal stories, and self-directed learning. The most highly ranked clinical scenario to be addressed in spiritual care training was “screening for spiritual concerns for any patient or resident.” When asked who should conduct an initial spiritual review with patients, consensus was achieved regarding all members of the healthcare team, with most nominating a chaplain or “whoever the patient feels comfortable with.” It was considered important for spiritual care training to address one's own spirituality and self-care. Consensus was not achieved on which spiritual care assessment tools to incorporate in training. This Delphi study revealed that spiritual care training for Australian healthcare professionals should emphasize the understanding of the role of spirituality and spiritual care in healthcare, include a range of delivery methods, and focus upon the incorporation of spiritual screening. Further work is required to identify how spiritual care screening should be conducted within an Australian healthcare setting.
Publisher: Springer Science and Business Media LLC
Date: 12-03-2011
DOI: 10.1245/S10434-011-1622-6
Abstract: Burnout is a prevalent and important occupational hazard among surgical oncologists. The well-being or distress experienced can have a significant effect on clinicians and their families, the quality of care provided to patients, and the success of the health care organization. We aimed to measure the prevalence of burnout, psychiatric morbidity, and quality of life using standardized measures characterize associated features and ascertain the surgical faculty's views on potential interventions and obstacles to change. Additional questions about service commitment to well-being, use of annual leave, and attitudes about weekend surgical practice were constructed to guide future targeted interventions. Among the 72 surgeons who responded (response rate of 73%), we found that 42% of surgeons reported burnout and 27% psychiatric levels of distress, while 30% used alcohol and 13% used sleep medications as a possible means to cope. Only one third of surgeons reported high quality of life across physical, emotional, spiritual, and intellectual domains. Compared to general surgical practices, cancer surgeons achieved more personal fulfillment and made less use of distancing methods to cope with their patients. Institutional culture contributes to the nonuse of available annual leave, attitudes about weekend operating schedules, and missed opportunities for the leadership to attend to surgeons' well-being.
Publisher: Wiley
Date: 13-05-2009
DOI: 10.1002/PON.1580
Abstract: Although cancer patients from Western countries have high needs for prognostic information, the frequency of such discussions in oncology consultations is variable. Prognosis is a difficult discussion area for both physicians and patients. Physician focused Communication Skills Training (CST) has been suggested as a means to aid these discussions. We developed and tested a CST module about discussing prognosis. Training consisted of didactic teaching, exemplary video and role-play sessions. The study aim was to develop the module and evaluate the effectiveness of the training. One hundred and forty-two clinicians from Memorial Sloan-Kettering Cancer Center and the New York City area voluntarily participated in the training module over a two-year period. The module was based on current literature and followed the Comskil model previously utilized for other doctor-patient CSTs. Participants completed pre and post surveys to evaluate their own confidence as well as the helpfulness of the module. Based on a retrospective pre-post measure, participants reported an increase in their confidence about discussing prognosis (t(141)=-9.331, p<0.001). At least 92% of participants reported their satisfaction with components of the module by either agreeing or strongly agreeing with 5/6 different statements included in their evaluation forms. This short training program demonstrated success in improving physician confidence to discuss prognosis and self-efficacy. This result, coupled with the participant's intent to utilize new skills in clinical encounters, suggests that this is a useful module. Future research will target changes in patient outcomes as a result of the physician training.
Publisher: Wiley
Date: 07-01-2020
DOI: 10.1002/PON.5268
Abstract: A goal of family-focused therapies in oncology is to help families communicate effectively about illness and its management. Yet there has been no examination of whether and how conjoint sessions are conducive to this process. In this study, we (a) described the extent of cancer-specific communication during family sessions at the end of life (b) identified characteristics associated with SC and (c) determined the association between SC and longer-term family bereavement outcomes. Data were collected as part of a randomized controlled trial of Family Focused Grief Therapy (FFGT) for advanced cancer patients and their families. Demographics, depressive symptoms, and family functioning were assessed at baseline. Cancer-specific communication, perceived responsiveness to communication, and therapeutic alliances were reported after each session. At 13-month bereavement, surviving families were assessed for symptoms of depression and prolonged grief disorder (PGD). Participants were 257 advanced cancer patients and family members receiving FFGT at the end of life. On average, participants perceived significantly more cancer-related communication in session (SC) than at baseline. Both therapist-family and within-family alliances were associated with SC, especially for those with more severe depressive symptoms at baseline. Long-term outcomes were moderated by perceived responsiveness to in-session communication: for those who perceived high responsiveness, SC was associated with fewer depressive and PGD symptoms in bereavement. Conjoint family sessions can effectively increase communication about cancer at the end of life. Clinicians should consider key contextual factors in their effort to facilitate this process: perceived responsiveness, family role, alliances with therapist, and within-family.
Publisher: Wiley
Date: 06-2000
Publisher: Wiley
Date: 29-05-2009
DOI: 10.1002/PON.1585
Abstract: The objective of this paper is to report the implementation and assessment of the Comskil Training Curriculum at Memorial Sloan-Kettering Cancer Center. Twenty-eight attending physicians and surgeons participated in communication skills training modules as part of a train-the-trainer program. Doctors were video recorded in clinical consultations with patients two times before training and two times after training, resulting in 112 video recordings for analysis. Recordings were coded using the Comskil Coding System. Communication skills related to two of the six major skill sets, Establishing the Consultation Framework and Checking, increased following training. Limited changes emerged in three skill sets, while one skill set, Shared Decision Making, did not change. Doctors who attended more training modules had higher levels of change. Female participants demonstrated three skills more frequently than males post-training. The intervention produced significant communication skills uptake in a group of experienced attending clinicians, mediated by the amount of training. Future research should focus on the dose of training necessary to achieve skills uptake and the effect of skills training on patient outcomes.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2009
Publisher: Wiley
Date: 30-07-2016
DOI: 10.1007/S10897-016-9998-X
Abstract: Families who face genetic disease risk must learn how to grapple with complicated uncertainties about their health and future on a long-term basis. Women who undergo BRCA 1/2 genetic testing describe uncertainty related to personal risk as well as their loved ones', particularly daughters', risk. The genetic counseling setting is a prime opportunity for practitioners to help mothers manage uncertainty in the moment but also once they leave a session. Uncertainty Management Theory (UMT) helps to illuminate the various types of uncertainty women encounter and the important role of communication in uncertainty management. Informed by UMT, we conducted a thematic analysis of 16 genetic counseling sessions between practitioners and mothers at risk for, or carriers of, a BRCA1/2 mutation. Five themes emerged that represent communication strategies used to manage uncertainty: 1) addresses myths, misunderstandings, or misconceptions 2) introduces uncertainty related to science 3) encourages information seeking or sharing about family medical history 4) reaffirms or validates previous behavior or decisions and 5) minimizes the probability of personal risk or family members' risk. Findings illustrate the critical role of genetic counseling for families in managing emotionally challenging risk-related uncertainty. The analysis may prove beneficial to not only genetic counseling practice but generations of families at high risk for cancer who must learn strategic approaches to managing a complex web of uncertainty that can challenge them for a lifetime.
Publisher: Cambridge University Press (CUP)
Date: 19-02-2008
DOI: 10.1017/S1478951508000096
Abstract: In the clinical setting of cancer, meaning may well have a central role in the life changes the illness experience brings about. As health care professionals working with people with life-threatening illness, we are exposed to one of the major turning points in life and the ways people confront this transition. Meaning can assist coping by offering a framework, perspective, and counterbalance to the challenge of illness. However, the absence of meaning can be a precursor to profound despair. This article brings together the clinical implications of two studies conducted by the authors that explored the role of meaning in adjustment to cancer, presenting a theoretical understanding of the experience of meaning in cancer and identifying some potential approaches to intervention. Our findings point to some specific goals of care as well as a number of therapeutic modalities aimed to meet these goals. We examine four goals of care—acknowledging suffering, encouraging a search for meaning, strengthening connection with others, and ensuring optimal physical care—as foundational in any clinical approach and then examine the key models of therapy that assist the clinician in pursuing these goals. Our aim is to create an integrated approach to care provision that locates meaning centrally in any patient's adaptation.
Publisher: Oxford University PressOxford
Date: 06-09-2011
DOI: 10.1093/ACPROF:OSO/9780199206414.003.0005
Abstract: This chapter examines a model of family resilience it applies to the setting of palliative care. It attempts to address a question about the characteristics of resilience in families and describes a recently developed model for understanding families in palliative care. It explains the concept and the underlying principles of so-called Family Focused Grief Therapy. It also suggests that the developmental life cycle of the family and its functioning as a group are key parameters in the conceptualization of family resilience.
Publisher: SAGE Publications
Date: 05-2005
Location: United States of America
No related grants have been discovered for David Kissane.