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Luo HL, Luo HL. Analysis of the effect of multi-channel continuous nursing intervention on patients post-radical gastrectomy. World J Gastrointest Surg 2025; 17:100848. [PMID: 40291863 PMCID: PMC12019047 DOI: 10.4240/wjgs.v17.i4.100848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Revised: 02/08/2025] [Accepted: 03/10/2025] [Indexed: 03/29/2025] Open
Abstract
BACKGROUND Radical gastrectomy (RGE) for gastric carcinoma (GC) has exerted definite therapeutic efficacy in treating patients with GC. However, a notable risk of postoperative complications (POCs) persists among middle-aged and elderly patients with compromised physiological functions. Hence, developing and implementing reliable nursing interventions to optimize the comprehensive management of these patients is deemed imperative. AIM To analyze the association of multi-channel continuous nursing intervention with POCs, negative emotions (NEs), and quality of life (QoL) of patients undergoing RGE for GC. METHODS This retrospective study selected 99 patients who underwent RGE for GC in our hospital from May 2020 to May 2023. Participants were categorized into the control (n = 49 cases) and research groups (n = 50 cases) receiving routine and multi-channel continuous nursing care, respectively. Comparative analysis involved data on postoperative rehabilitation (time to first anal exhaust, oral feeding and ambulation, and hospital stay), complications (nausea and vomiting, delayed gastric emptying, and abdominal distension), NEs [Self-rating Anxiety (SAS)/Depression Scale (SDS)], treatment compliance, self-efficacy, and QoL [World Health Organization QoL Brief Version (WHOQOL-BREF)]. RESULTS Compared to the control group, the research group demonstrated earlier first postoperative anal exhaust, oral feeding, and ambulation, shorter hospital stay, lower POC rate, and more reduced SAS and SDS scores postintervention, which was significantly lower than the baseline. The treatment compliance scores were significantly higher in the research group than in the control group in terms of medication adherence, daily exercise, reasonable diet, and regular review. Further, the research group demonstrated increased self-efficacy scores in terms of positive attitude, self-stress relief, and self-decision-making, as well as the overall score postintervention, which were higher than the control group. Moreover, the research group reported notably higher WHOQOL-BREF scores in domains such as physiology, psychology, social relations, and environment. CONCLUSION Multi-channel continuous nursing intervention prevents POCs in patients undergoing RGE for GC as well as significantly alleviates patients' NEs and boosts their QoL.
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Affiliation(s)
- Huan-Li Luo
- Department of Nursing, Henan Vocational College of Nursing, Anyang 455000, Henan Province, China
| | - Huan-Ling Luo
- Department of International Education, Henan Vocational College of Nursing, Anyang 455000, Henan Province, China
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Daniel NR, Edelstein RS, Salwi SM, Valera JR, Polenick CA. "I Am Not Sure What Else I Could Do to Help Her More": Perceptions of Partner Support in Older Couples Living with Multiple Chronic Conditions. J Appl Gerontol 2025:7334648251316655. [PMID: 40013559 DOI: 10.1177/07334648251316655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2025] Open
Abstract
Spouses are a major support in managing multiple chronic conditions (MCC) in middle and later life, but little is known about perceptions of partner support patterns within couples. We examined perceptions of partner support patterns and satisfaction with partner support among older couples where both partners lived with MCC. Both partners in 51 couples completed separate phone interviews with open-ended questions about managing MCC and partner support. We categorized participating couples as discordant (n = 20) or concordant (n = 31) in their views of partner support. Our qualitative content analysis revealed that discordant couples wanted more mutual partner support, communication about health and support needs, engagement in health-related activities, and no desired changes. Concordant couples wanted more mutual partner support, working together to manage MCC, better partner self-management, and no desired changes. These findings inform targeted interventions for couples with MCC and emphasize exploring perceptions of partner support patterns.
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Affiliation(s)
- Nikita R Daniel
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Robin S Edelstein
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Shreya M Salwi
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Juhi R Valera
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Mosher CE, Lee S, Addington EL, Park S, Lewson AB, Snyder S, Hirsh AT, Bricker JB, Miller KD, Ballinger TJ, Schneider BP, Storniolo AM, Newton EV, Champion VL, Johns SA. Randomized Controlled Trial of Acceptance and Commitment Therapy for Fatigue Interference With Functioning in Metastatic Breast Cancer. J Clin Oncol 2025; 43:662-671. [PMID: 39454125 DOI: 10.1200/jco.24.00965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 09/11/2024] [Accepted: 10/04/2024] [Indexed: 10/27/2024] Open
Abstract
PURPOSE Fatigue is a highly prevalent and disabling symptom for patients with metastatic breast cancer (MBC). Evidence-based interventions for managing fatigue in advanced cancer populations are lacking. This phase II randomized controlled trial tested the effect of acceptance and commitment therapy (ACT) on fatigue interference with functioning in patients with MBC. METHODS Eligible patients were women with stage IV breast cancer who had moderate to severe fatigue interference. Patients completed a baseline assessment that included self-report measures of fatigue interference with activities, mood, and cognition (primary outcome) and sleep interference with functioning, engagement in daily activities, and quality of life (QOL; secondary outcomes). Then patients were randomly assigned to six weekly telephone-delivered sessions of either ACT (n = 116) or education/support (n = 120). Follow-up assessments occurred at 2 weeks, 3 months, and 6 months postintervention (means, 9.69, 20.51, and 33.59 weeks postbaseline, respectively). RESULTS Linear mixed model analyses showed that compared with patients in the education/support condition, patients in the ACT condition reported significantly less fatigue interference (P = .018). These results were significant at 2 weeks and 6 months postintervention. ACT's effect on sleep interference was not statistically significant after the Sidak adjustment for multiple comparisons (P = .037). ACT patients showed a steady decline in sleep interference, a trend that was not found for education/support patients. Engagement in daily activities and QOL did not significantly differ between study groups, except for functional QOL (P = .006). Compared with education/support patients, ACT patients showed significantly better functional QOL at 2 weeks and 6 months postintervention. CONCLUSION Results suggest that a brief, telephone-delivered ACT intervention can reduce fatigue interference with functioning in patients with MBC.
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Affiliation(s)
- Catherine E Mosher
- Department of Psychology, Indiana University Indianapolis, Indianapolis, IN
| | - Shieun Lee
- Indiana University School of Nursing, Indianapolis, IN
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Elizabeth L Addington
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Seho Park
- Department of Industrial and Data Engineering, Hongik University, Seoul, South Korea
| | - Ashley B Lewson
- Department of Psychology, Indiana University Indianapolis, Indianapolis, IN
| | - Stella Snyder
- Department of Psychology, Indiana University Indianapolis, Indianapolis, IN
| | - Adam T Hirsh
- Department of Psychology, Indiana University Indianapolis, Indianapolis, IN
| | - Jonathan B Bricker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Psychology, University of Washington, Seattle, WA
| | - Kathy D Miller
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Tarah J Ballinger
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Bryan P Schneider
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Anna Maria Storniolo
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Erin V Newton
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | | | - Shelley A Johns
- Center for Health Services Research, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN
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Santellano B, Agrawal R, Duchesne G, Sharara M, Agrawal G, Balas EA, Tsai MH, Nayak A, Cortes JE. Social determinants of health and upper gastrointestinal cancer outcomes in the United States: a systematic review. Front Public Health 2024; 12:1477028. [PMID: 39628804 PMCID: PMC11613319 DOI: 10.3389/fpubh.2024.1477028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 11/04/2024] [Indexed: 12/06/2024] Open
Abstract
Introduction Social determinants of health (SDOH) are the conditions in which individuals are born, grow, work, live, and age. Methods We examined the literature on the association between SDOH and survival of patients with gastrointestinal (GI) cancer [esophageal, duodenal and gastric cancer (GC)] in the United States from 2001 to 2022. Results From 38,654 studies across COCHRANE, EMBASE, SCOPUS, WEB OF SCIENCE, and PubMed, we identified 14 relevant studies focusing on GI cancer using the PRISMA flowchart. Eight of the 12 GC studies specifically focused on gastric adenocarcinoma (GAC), the most common histologic subtype. Uninsured patients had a significantly worse overall survival probability. For patients with GI cancer, the highest income level (i.e., in the highest quartile) was associated with improved survival. Being unmarried had a negative impact on overall survival. Overall, people with insurance, higher incomes, and who were married had better overall survival rates. Discussion Our findings suggest a clear association between SDOH and survival for patients with GI cancers. However, there is great variability in the factors studied and how these are measured and reported. A better understanding of SDOH is needed to design strategies with an aim to improve patient outcomes. Systematic review registration https://www.crd.york.ac.uk/prospero/, PROSPERO (CRD42022346854).
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Affiliation(s)
- Brenda Santellano
- Georgia Cancer Center at Augusta University, Augusta, GA, United States
| | - Rashi Agrawal
- Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Gabriela Duchesne
- Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Muhannad Sharara
- Georgia Cancer Center at Augusta University, Augusta, GA, United States
| | - Gagan Agrawal
- School of Computing, University of Georgia, Athens, GA, United States
| | - E. Andrew Balas
- School of Public Health, Augusta University, Augusta, GA, United States
| | - Meng-Han Tsai
- Georgia Cancer Center at Augusta University, Augusta, GA, United States
- Georgia Prevention Institute, Augusta University, Augusta, GA, United States
| | - Asha Nayak
- Georgia Cancer Center at Augusta University, Augusta, GA, United States
| | - Jorge E. Cortes
- Georgia Cancer Center at Augusta University, Augusta, GA, United States
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Zhou Y, Che CC, Chong MC, Hou Y, Xiao X, Liu Y, Zhao H. Understanding the patient-spouse communication experience during chemotherapy for gastric cancer: A qualitative study. J Psychosoc Oncol 2024:1-22. [PMID: 39531412 DOI: 10.1080/07347332.2024.2423350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
PURPOSE This study examines how patients with gastric cancer and their spouses communicate about the illness, assessing the impact of positive or negative communication on their psychological adaptation and the intimacy of their relationship as a couple. METHOD Employing The Relationship Intimacy Model of Couple Adaptation to Cancer, this study used purposive sampling with the principle of maximum variation to select participants. Sixteen pairs of patients with gastric cancer and their spouse caregivers, hospitalized in the oncology department of a tertiary hospital in Jingjiang City, Jiangsu Province, from March to July 2023, were chosen for semi-structured face-to-face interviews. The recorded data were transcribed within 24 h following each interview and supplemented with field notes. Directed content analysis was employed for the qualitative content analysis. RESULTS The interview data revealed three themes and six subthemes. Theme 1: The impact of negative patient-spouse communication, with the subthemes being (i) a decline in couples' relationship intimacy and (ii) reduced psychological adaptation. Theme 2: The impact of positive patient-spouse communication, with the subthemes being (i) enhanced couples' relationship intimacy and (ii) increased psychological adaptation. Theme 3: The impact of protective concealment, with the subthemes being (i) declined couples' relationship intimacy and psychological adaptation, and (ii) increased couples' relationship intimacy and psychological adaptation. Throughout the chemotherapy period, patients with gastric cancer and their spouses experienced both positive and negative forms of patient-spouse communication. This underscores the significance of acknowledging protective concealment within couples. Moreover, the study highlights how the dynamics of couples' relationship intimacy and psychological adaptation are influenced by both positive and negative communication patterns surrounding the illness. CONCLUSIONS For patients with gastric cancer and their spouses, it is crucial for nurses to emphasize the importance of spousal disease communication during chemotherapy. Efforts should be made to mitigate one-sided, conflictual communication and avoidance behaviors, and to adopt appropriate communication strategies in terms of content and timing to deeply promote couple communication. Additionally, there is a need to focus on the physical and psychological stress of protective concealment in couples.
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Affiliation(s)
- Ye Zhou
- Editorial Office of International Journal of Nursing Sciences, Chinese Journal of Nursing Publishing Co., Ltd., Beijing City, China
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chong Chin Che
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Mei Chan Chong
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Yuzhu Hou
- Oncology Department, Jingjiang People's Hospital Affiliated to Yangzhou University, Taizhou City, Jiangsu Province, China
| | - Xiangqun Xiao
- TCM Department, Jingjiang People's Hospital Affiliated to Yangzhou University, Taizhou City, Jiangsu Province, China
| | - Yun Liu
- General Gastroenterology, Jingjiang People's Hospital Affiliated to Yangzhou University, Taizhou City, Jiangsu Province, China
| | - Haiyan Zhao
- TCM Department, Jingjiang People's Hospital Affiliated to Yangzhou University, Taizhou City, Jiangsu Province, China
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Zhou Y, Che CC, Chong MC, Zhao H. Development of a marital self-disclosure programme for alleviating the fear of cancer recurrence in patients with gastric cancer and undergoing chemotherapy: a modified Delphi method. Front Psychol 2024; 15:1340915. [PMID: 39040962 PMCID: PMC11262412 DOI: 10.3389/fpsyg.2024.1340915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 06/21/2024] [Indexed: 07/24/2024] Open
Abstract
Aim This study aimed to develop a marital self-disclosure programme to alleviate the fear of cancer recurrence in patients with gastric cancer who are undergoing chemotherapy. Design Delphi method. Methods Data from available literature and stakeholder interviews were utilised to formulate the initial draft of a marital self-disclosure programme aimed to alleviate the fear of cancer recurring in patients with gastric cancer and undergoing chemotherapy. A panel of experts subsequently conducted a two-round modified Delphi method to finalise the programme. Results A total of 13 experts participated in the first round of consultation, while 11 experts were involved in the second round, as two experts withdrew due to unavailability. The response rates of both rounds of expert consultation were 100 and 84.62%, respectively, and the expert authority coefficients (Cr) of the programme were 0.83 and 0.84, respectively. The coordination coefficients of the expert opinions were 0.124 (χ2 = 61.214, p = 0.010) and 0.167 (χ2 = 69.668, p = 0.001) for each Delphi round. The average score of the second round was (4.545 ± 0.688) to (5.000 ± 0), with a full score ratio of 0.55-1.00. The coefficient of variation (CV) ranged from 0 to 0.031. Outcomes from both rounds of consultations were considered acceptable and credible. The finalised marital self-disclosure programme for alleviating the fear of cancer recurrence in patients with gastric cancer undergoing chemotherapy consists of two parts; disclosure guidance for patients and their spouse with nine items, and the structure and themes of marital self-disclosure with 31 items. Patient or public contribution After two rounds of expert consultations, the marital self-disclosure programme for patients with gastric cancer undergoing chemotherapy is suggested to be scientifically valid and reliable. This programme is anticipated to potentially support patients and their spouses effectively by providing a reliable intervention plan focused on alleviating the fear of cancer recurrence.
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Affiliation(s)
- Ye Zhou
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chong Chin Che
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Mei Chan Chong
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Haiyan Zhao
- Nursing Department, Jingjiang People's Hospital, Taizhou, Jiangsu Province, China
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Zhao H, Zhou Y, Che CC, Chong MC, Zheng Y, Hou Y, Chen C, Zhu Y. Marital Self-Disclosure Intervention for the Fear of Cancer Recurrence in Chinese Patients With Gastric Cancer: Protocol for a Quasiexperimental Study. JMIR Res Protoc 2024; 13:e55102. [PMID: 38684089 PMCID: PMC11091802 DOI: 10.2196/55102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Patients with gastric cancer experience different degrees of fear of cancer recurrence. The fear of cancer recurrence can cause and worsen many physical and psychological problems. We considered the "intimacy and relationship processes in couples' psychosocial adaptation" model. OBJECTIVE The study aims to examine the effectiveness of a marital self-disclosure intervention for improving the level of fear of cancer recurrence and the dyadic coping ability among gastric cancer survivors and their spouses. METHODS This is a quasiexperimental study with a nonequivalent (pretest-posttest) control group design. The study will be conducted at 2 tertiary hospitals in Taizhou City, Jiangsu Province, China. A total of 42 patients with gastric cancer undergoing chemotherapy and their spouses will be recruited from each hospital. Participants from Jingjiang People's Hospital will be assigned to an experimental group, while participants from Taizhou People's Hospital will be assigned to a control group. The participants in the experimental group will be involved in 4 phases of the marital self-disclosure (different topics, face-to-face) intervention. Patients will be evaluated at baseline after a diagnosis of gastric cancer and reassessed 2 to 4 months after baseline. The primary outcome is the score of the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) for patients. The secondary outcomes are the scores of the FoP-Q-SF for partners and the Dyadic Coping Inventory. RESULTS Research activities began in October 2022. Participant enrollment and data collection began in February 2023 and are expected to be completed in 12 months. The primary results of this study are anticipated to be announced in June 2024. CONCLUSIONS This study aims to assess a marital self-disclosure intervention for improving the fear of cancer recurrence in Chinese patients with gastric cancer and their spouses. The study is likely to yield desirable positive outcomes as marital self-disclosure is formulated based on evidence and inputs obtained through stakeholder interviews and expert consultation. The study process will be carried out by nurses who have received psychological training, and the quality of the intervention will be strictly controlled. TRIAL REGISTRATION ClinicalTrials.gov NCT05606549; https://clinicaltrials.gov/study/NCT05606549. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55102.
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Affiliation(s)
- Haiyan Zhao
- Nursing Department, Jingjiang People's Hospital, Taizhou, China
| | - Ye Zhou
- Chinese Nursing Journals Publishing House Co, Ltd, Beijing, China
| | - Chong Chin Che
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Mei Chan Chong
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Yu Zheng
- Nursing Department, Jingjiang People's Hospital, Taizhou, China
| | - Yuzhu Hou
- Nursing Department, Jingjiang People's Hospital, Taizhou, China
| | - Canjuan Chen
- Nursing Department, Jingjiang People's Hospital, Taizhou, China
| | - Yantao Zhu
- Nursing Department, Jingjiang People's Hospital, Taizhou, China
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Renslo B, Sawaf T, Virgen CG, Farrokhian N, Yu KM, Somani SN, Penn J, Ziegler A, Gan GN, Kakarala K, Shnayder Y, Bur AM, Sykes KJ. Assessing the Risk of Adjuvant Radiotherapy Initiation Delays With Social Support Surveys. Otolaryngol Head Neck Surg 2023; 169:928-937. [PMID: 36939526 PMCID: PMC10688033 DOI: 10.1002/ohn.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVE In patients with head and neck squamous cell carcinoma (HNSCC), initiating postoperative radiotherapy (PORT) greater than 42 days after surgery is associated with a higher risk of poor survival outcomes. Social support has been shown to modulate behaviors related to care-seeking and treatment adherence. In this study, we sought to determine the relationship between social support metrics and PORT delays. STUDY DESIGN Prospective cohort study. SETTING Single tertiary medical center. METHODS Patients with HNSCC who underwent primary surgical excision requiring PORT were prospectively enrolled. Patient-perceived social support metrics were assessed using the Medical Outcomes Study Social Support Survey (MOS-SSS) at initial presurgical evaluation. Associations with PORT delays were evaluated via univariable and multivariable logistic regression analysis. RESULTS A total of 111 patients met the inclusion criteria for the study. An additional 28 patients were recommended to receive PORT but did not initiate treatment and were included for secondary analysis. All four subscales of the MOS-SSS (positive social interaction, affectionate support, tangible support, and emotional/informational support) were significantly associated with PORT initiation delays on univariable analysis. On multivariable analysis, the overall MOS-SSS score (odds ratio [OR] 2.08, 1.15-4.35, p = .028) was significantly associated with PORT initiation delays. On secondary analysis, lower tangible support was associated with a lack of PORT initiation (OR 1.63, 1.05-2.54, p = .028). CONCLUSION Social support metrics were significantly associated with PORT delays, which may help promote tighter scheduling and closer monitoring of high-risk patients.
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Affiliation(s)
- Bryan Renslo
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Tuleen Sawaf
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Celina G. Virgen
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Nathan Farrokhian
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Katherine M. Yu
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Shaan N. Somani
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Joseph Penn
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andrea Ziegler
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Gregory N. Gan
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kiran Kakarala
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Yelizaveta Shnayder
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andrés M. Bur
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kevin J. Sykes
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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Zhou Y, Che CC, Chong MC, Zhao H, Lu Y. Effects of marital self-disclosure on marital relationship and psychological outcome for cancer patients: a systematic review. Support Care Cancer 2023; 31:361. [PMID: 37249639 DOI: 10.1007/s00520-023-07826-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/21/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE Literature on marital self-disclosure interventions for cancer patients lacks consistency in methodology and content. Moreover, the impact of such interventions on physical and psychological health, marital relationships, and self-disclosure ability is controversial. This review aims to systematically analyze the studies of marital self-disclosure intervention, synthesize the structure and topics of marital self-disclosure, and summarize and evaluate its effects on improving physical and psychological outcomes and marital relationships in cancer patients and their spouses. METHOD This systematic review used the preferred reporting items of Systematic Reviews and Meta-Analyses (PRISMA). We conducted a systematic review of randomized controlled and quasi-experimental studies published from the establishment of the database to October 2022. Marital self-disclosure interventions were conducted with both cancer patients and their spouses. Studies published in a language other than English or Chinese, and studies below a quality grade of C were excluded. Data were extracted through a standardized data collection form, and two reviewers independently extracted and evaluated the data. The quality of the included studies was assessed using the Cochrane Handbook of Systematic Reviews of Interventions, and a third reviewer adjudicated in case of disagreement. The data were synthesized by vote counting based on direction of effect according to the Synthesis Without Meta-analysis (SWiM) reporting guideline. RESULTS Thirteen studies were included in the review. Based on quality evaluation, three studies were categorized as grade A (good), and ten studies were grade B (moderate). Seven studies reported moderate rates of participant refusal and attrition. The structure and topics of marital self-disclosure varied across different studies. The five studies had various prespecified disclosure topics, such as fear of cancer recurrence, benefit finding, and emotional distress. The overall results suggest that marital self-disclosure interventions can improve physical and psychological health, enhance marital relationships, and increase self-disclosure ability. CONCLUSION The limited number of studies, small sample sizes, diverse intervention strategies, and methodological heterogeneity weakened the evidence base for the effectiveness of marital self-disclosure interventions. Therefore, further high-quality randomized controlled trials (RCTs) are recommended to confirm the effectiveness of such interventions. These studies should also evaluate the interventions' long-term impact, analyze optional topics and methods, identify key features, and explore the development of the best intervention program.
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Affiliation(s)
- Ye Zhou
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia
| | - Chong Chin Che
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia.
| | - Mei Chan Chong
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia
| | - Haiyan Zhao
- Nursing Department, Jingjiang People's Hospital, Taizhou City, Jiangsu Province, China
| | - Yin Lu
- Nursing Department, Jingjiang People's Hospital, Taizhou City, Jiangsu Province, China
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Zhou J, Chen X, Wang Z, Li Q. Couple-Based Communication Interventions for Cancer Patient-Spousal Caregiver Dyads' Psychosocial Adaptation to Cancer: A Systematic Review. Healthcare (Basel) 2023; 11:healthcare11020236. [PMID: 36673604 PMCID: PMC9858755 DOI: 10.3390/healthcare11020236] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/07/2023] [Accepted: 01/10/2023] [Indexed: 01/14/2023] Open
Abstract
(1) Background: Effective communication among couples in which one has been diagnosed with cancer is critical to improve their psychosocial adaptation to cancer. The objective of this review was to explore the characteristics and measurement outcomes of existing couple-based communication interventions in the cancer context. (2) Methods: Eight electronic databases were searched from database initiation to August 2022 to identify eligible articles. Hand searching was also performed on the included articles' reference lists and authors. (3) Results: A total of 14 intervention studies were eligible to be included in this review. Cancer couples with distress or communication problems before intervention were more likely to benefit from the couple-based communication interventions. Positive outcomes were reported, including an improvement in relationship functioning (including mutual communication, intimacy, and relationship satisfaction) and individual functioning (including a decline of anxiety, depression and cancer-related concerns, and an increase in psychological adjustment and quality of life). (4) Conclusions: These findings supported the importance of improving mutual communication behaviors to promote cancer patient-spousal caregiver dyads' psychosocial adaptation to cancer. While most included studies were conducted in western countries and the sample size was relatively small, more research is warranted to develop more efficacious couple-based communication interventions.
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Burns MF, Secinti E, Johns SA, Wu W, Helft PR, Turk AA, Loehrer PJ, Sehdev A, Al-Hader AA, Mosher CE. Impact of acceptance and commitment therapy on physical and psychological symptoms in advanced gastrointestinal cancer patients and caregivers: Secondary results of a pilot randomized trial. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023; 27:107-115. [PMID: 37064761 PMCID: PMC10100868 DOI: 10.1016/j.jcbs.2023.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Patients with advanced gastrointestinal cancer often experience high symptom burden, which is associated with heightened distress in both patients and their family caregivers. Few interventions have been tested to jointly address patient and caregiver symptoms in advanced gastrointestinal cancer. In a randomized pilot trial, telephone-based, dyadic acceptance and commitment therapy (ACT) was found to be feasible in this population. The present secondary analyses examined the impact of this intervention on patient and caregiver physical and psychological symptoms. Patients and caregivers (N = 40 dyads) were recruited from clinics in Indianapolis, Indiana and randomized to either six weeks of telephone-based ACT or education/support, an attention control condition. Outcomes were assessed at baseline and at 2 weeks and 3 months post-intervention. Study group differences in outcomes were not statistically significant. However, when examining within-group change, only ACT patients experienced moderate reductions in pain severity and interference at 2 weeks post-intervention (effect size [ES]=-0.47; -0.51) as well as moderate reductions in depressive symptoms at 2 weeks (ES=-0.42) and 3 months (ES=-0.41) post-intervention. ACT caregivers experienced moderate reductions in sleep disturbance (ES=-0.56; -0.49) and cognitive concerns (ES=-0.61; -0.85) across follow-ups. Additionally, caregivers in both conditions experienced moderate reductions in fatigue (ES=-0.38 to -0.70) and anxiety (ES=-0.40 to -0.49) across follow-ups. Findings suggest that ACT may improve certain symptoms in dyads coping with advanced gastrointestinal cancer and warrant replication in a larger trial.
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Affiliation(s)
- Marcia F. Burns
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Ekin Secinti
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Shelley A. Johns
- Indiana University School of Medicine, Center for Health Services Research, Regenstrief Institute, 1101 W. 10th Street, Indianapolis, IN, 46202, USA
| | - Wei Wu
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Paul R. Helft
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN, 46202, USA
| | - Anita A. Turk
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN, 46202, USA
| | - Patrick J. Loehrer
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN, 46202, USA
| | - Amikar Sehdev
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN, 46202, USA
| | - Ahmad A. Al-Hader
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN, 46202, USA
| | - Catherine E. Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
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12
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Al-Azri M, Al-Awaisi H. Exploring causes of delays in help-seeking behaviours among symptomatic Omani women diagnosed with late-stage breast cancer - A qualitative study. Eur J Oncol Nurs 2022; 61:102229. [DOI: 10.1016/j.ejon.2022.102229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/29/2022] [Accepted: 10/13/2022] [Indexed: 11/29/2022]
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Snippen NC, de Vries HJ, Bosma AR, van der Burg-Vermeulen SJ, Hagedoorn M, Brouwer S. Workers' views on involving significant others in occupational health care: a focus group study among workers with a chronic disease. Disabil Rehabil 2022; 44:8252-8263. [PMID: 34904485 DOI: 10.1080/09638288.2021.2011435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To explore workers' views and considerations on involving their significant others (SOs) in occupational health care. METHODS Four focus group interviews in the Netherlands, with 21 workers who had visited an occupational health physician (OHP) due to work absence caused by a chronic disease. Data was analyzed using thematic analysis. RESULTS We distinguished four main themes: (i) attitudes towards involving SOs, (ii) preferences on how to involve SOs, (iii) benefits of involving SOs, and (iv) concerns with regard to involving SOs. Workers expressed both positive and critical opinions about involving SOs in occupational health care. Benefits mentioned included provision of emotional and informational support by SOs before, during, and after consultations. According to workers, support from SOs can be enhanced by informing SOs about re-integration plans and involving them in decision making. However, workers were concerned about overburdening SOs, and receiving unwanted support from them. CONCLUSIONS According to interviewed workers, engagement of SOs in occupational health care can help workers with a chronic disease in their recovery and return to work. However, they felt it is important to take SO characteristics and the worker's circumstances and preferences into account, and to balance the potential benefits and drawbacks of involving SOs.Implications for rehabilitationThis study suggests that the worker's re-integration process could benefit from informing significant others about the return to work plans, involving them in decision-making, and explicitly discussing how the significant other can support the worker.Occupational health physicians have an important role in informing workers about the possibility and potential benefits of involving their significant others in the re-integration process.The involvement of a significant other in the re-integration process needs to be tailored to the specific situation of the individual worker, taking into account the preferences of both the worker and significant other.Findings suggest that it is important that occupational health physicians, workers and significant others are not only aware of the possible benefits of significant other involvement, but also of potential drawbacks such as interference during consultations, overburdening significant others, and significant others providing unwanted support.
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Affiliation(s)
- Nicole C Snippen
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Haitze J de Vries
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Astrid R Bosma
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - Sylvia J van der Burg-Vermeulen
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mariët Hagedoorn
- Department of Health Sciences, Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sandra Brouwer
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Porter LS, Ramos K, Baucom DH, Steinhauser K, Erkanli A, Strauman TJ, Zafar SY, Check DK, Leo K, Liu E, Keefe FJ. Evaluating a couple communication skills training (CCST) intervention for advanced cancer: study protocol for a randomized controlled trial. Trials 2022; 23:712. [PMID: 36028908 PMCID: PMC9419413 DOI: 10.1186/s13063-022-06656-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For patients and their intimate partners, advanced cancer poses significant challenges that can negatively impact both individuals and their relationship. Prior studies have found evidence that couple-based communication skills interventions can to be beneficial for patients and partners. However, these studies have been limited by reliance on in-person treatment delivery and have not targeted couples at high risk for poor outcomes. This study tests the efficacy of a Couples Communication Skills Training (CCST) intervention delivered via videoconference for couples reporting high levels of holding back from discussing cancer-related concerns, a variable associated with poorer psychological and relationship functioning. METHODS This RCT is designed to evaluate the efficacy of CCST in improving patient and partner relationship functioning (primary outcome). Secondary outcomes include patient and partner psychological functioning and patient symptoms and health care use. We also examine the role of objective and self-reported communication behaviors as mediators of treatment effects. Two hundred thirty patients with advanced lung, gastrointestinal, genitourinary, and breast cancer and their partners will be randomized to CCST or an education control intervention. Participants in both conditions complete self-reported outcome measures at baseline, mid-treatment, post-treatment, and 3 months post-treatment. Objective measures of communication are derived from video-recorded couple conversations collected at baseline and post-treatment. An implementation-related process evaluation (assessing implementation outcomes and potential barriers to/facilitators of implementation) will be conducted to inform future efforts to implement CCST in real-world settings. DISCUSSION This trial can yield important new knowledge about effective ways to improve patient and partner adjustment to advanced cancer. TRIAL REGISTRATION This study trial is registered at clinicaltrials.gov (Trial # NCT04590885); registration date: October 19, 2020.
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Affiliation(s)
- Laura S Porter
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, DUMC 102506, Durham, NC, 27710, USA.
| | - Katherine Ramos
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, DUMC 102506, Durham, NC, 27710, USA
| | - Donald H Baucom
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karen Steinhauser
- Population Health Sciences Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Alaattin Erkanli
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | | | - S Yousuf Zafar
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Devon K Check
- Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Karena Leo
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, DUMC 102506, Durham, NC, 27710, USA
| | - Evan Liu
- Trinity College of Arts & Sciences, Duke University, Durham, NC, USA
| | - Francis J Keefe
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, DUMC 102506, Durham, NC, 27710, USA
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15
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Mosher CE, Secinti E, Wu W, Kashy DA, Kroenke K, Bricker JB, Helft PR, Turk AA, Loehrer PJ, Sehdev A, Al-Hader AA, Champion VL, Johns SA. Acceptance and commitment therapy for patient fatigue interference and caregiver burden in advanced gastrointestinal cancer: Results of a pilot randomized trial. Palliat Med 2022; 36:1104-1117. [PMID: 35637615 PMCID: PMC9396957 DOI: 10.1177/02692163221099610] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Fatigue often interferes with functioning in patients with advanced cancer, resulting in increased family caregiver burden. Acceptance and commitment therapy, a promising intervention for cancer-related suffering, has rarely been applied to dyads coping with advanced cancer. AIM To examine the feasibility, acceptability, and preliminary efficacy of acceptance and commitment therapy for patient-caregiver dyads coping with advanced gastrointestinal cancer. Primary outcomes were patient fatigue interference and caregiver burden. DESIGN In this pilot trial, dyads were randomized to six weekly sessions of telephone-delivered acceptance and commitment therapy or education/support, an attention control. Outcomes were assessed at baseline and at 2 weeks and 3 months post-intervention. SETTING/PARTICIPANTS Forty patients with stage III-IV gastrointestinal cancer and fatigue interference and family caregivers with burden or distress were recruited from two oncology clinics and randomized. RESULTS The eligibility screening rate (54%) and retention rate (81% at 2 weeks post-intervention) demonstrated feasibility. At 2 weeks post-intervention, acceptance and commitment therapy participants reported high intervention helpfulness (mean = 4.25/5.00). Group differences in outcomes were not statistically significant. However, when examining within-group change, acceptance and commitment therapy patients showed moderate decline in fatigue interference at both follow-ups, whereas education/support patients did not show improvement at either follow-up. Acceptance and commitment therapy caregivers showed medium decline in burden at 2 weeks that was not sustained at 3 months, whereas education/support caregivers showed little change in burden. CONCLUSIONS Acceptance and commitment therapy showed strong feasibility, acceptability, and promise and warrants further testing. TRIAL REGISTRATION ClinicalTrials.gov NCT04010227. Registered 8 July 2019, https://clinicaltrials.gov/ct2/show/NCT04010227?term=catherine+mosher&draw=2&rank=1.
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Affiliation(s)
- Catherine E Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Ekin Secinti
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Wei Wu
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | | | - Kurt Kroenke
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jonathan B Bricker
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Paul R Helft
- Indiana University School of Medicine, Indiana Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Anita A Turk
- Indiana University School of Medicine, Indiana Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Patrick J Loehrer
- Indiana University School of Medicine, Indiana Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Amikar Sehdev
- Indiana University School of Medicine, Indiana Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Ahmad A Al-Hader
- Indiana University School of Medicine, Indiana Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | | | - Shelley A Johns
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Regenstrief Institute Center for Health Services Research, Indianapolis, IN, USA
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16
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Torres Blasco N, Costas Muñiz R, Zamore C, Porter L, Claros M, Bernal G, Shen MJ, Breitbart W, Castro EM. Cultural adaptation of meaning-centered psychotherapy for latino families: a protocol. BMJ Open 2022; 12:e045487. [PMID: 35379609 PMCID: PMC8981324 DOI: 10.1136/bmjopen-2020-045487] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Literature suggests couple-based interventions that target quality of life and communication can lead to positive outcomes for patients with cancer and their partners. Nevertheless, to date, an intervention to address the needs of Latino families coping with advanced cancer has not been developed. Meta-analytic evidence suggests that culturally adapted evidenced-based intervention targeting a specific cultural group is four times more effective. Our goal is to culturally adapt a novel psychosocial intervention protocol entitled 'Caregivers-Patients Support to Latinx coping advanced-cancer' (CASA). We hypothesised that combine two evidence-based interventions and adapting them, we will sustain a sense of meaning and improving communication as patients approach the end of life among the patient-caregiver dyad. METHODS AND ANALYSIS To culturally adapt CASA, we will follow an innovative hybrid research framework that combines elements of an efficacy model and best practices from the ecological validity model, adaptation process model and intervention mapping. As a first step, we adapt a novel psychosocial intervention protocol entitled protocol entitled 'Caregivers-Patients Support to Latinx coping advanced-cancer' (CASA). The initial CASA protocol integrates two empirically based interventions, meaning-centred psychotherapy and couple communication skills training. This is an exploratory and prepilot study, and it is not necessary for a size calculation. However, based on recommendations for exploratory studies of this nature, a priori size of 114 is selected. We will receive CASA protocol feedback (phase 1b: refine) by conducting 114 questionnaires and 15 semistructured interviews with patients with advanced cancer and their caregivers. The primary outcomes of this study will be identifying the foundational information needed to further the develop the CASA (phase IIa: proof-of-concept and phase IIb: pilot study). ETHICS AND DISSEMINATION The Institutional Review Board of Ponce Research Institute approved the study protocol #1907017527A002. Results will be disseminated through peer-reviewed publications.
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Affiliation(s)
| | - Rosario Costas Muñiz
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Carolina Zamore
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Laura Porter
- Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | - Maria Claros
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Guillermo Bernal
- Professor of Psychology (Retired), Universidad de Puerto Rico, San Juan, Puerto Rico
| | | | - William Breitbart
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - E M Castro
- SBBS, Ponce Health Sciences University, Ponce, Puerto Rico
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Yagil D, Goldblatt H, Cohen M. Family members' experiences of the return to work of cancer survivors. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:184-192. [PMID: 33852745 DOI: 10.1111/hsc.13388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 02/14/2021] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
Although family members play an important role in various aspects of coping with cancer and are significantly affected by it, little is known about their perspectives regarding return to work (RTW). This study explored attitudes and experiences of cancer survivors' family members related to cancer survivors' RTW. The present study consists of a qualitative research design, employing in-depth semistructured interviews with first-degree family members (N = 21) of cancer survivors who were approached through online social networks: spouses, children, parents and siblings. Grounded theory techniques were used for data analysis. Four themes emerged from the interviews: (a) the family's cautious voice in return-to-work decision making; (b) work-home imbalance; (c) inhibiting or promoting the effect of work on the recovery process and (d) expectations and appreciation of unconditional workplace support. The findings suggest that psychosocial and health care professionals should help family members play an active role in the decision of RTW. Professionals should also prepare family members for potential costs of RTW for the family and help them develop realistic expectations regarding workplace support of the cancer survivor.
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Affiliation(s)
- Dana Yagil
- Department of Human Services, University of Haifa, Haifa, Israel
| | - Hadass Goldblatt
- Department of Human Services, University of Haifa, Haifa, Israel
| | - Miri Cohen
- Department of Human Services, University of Haifa, Haifa, Israel
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Samuelsson M, Wennick A, Jakobsson J, Bengtsson M. Models of support to family members during the trajectory of cancer: A scoping review. J Clin Nurs 2021; 30:3072-3098. [PMID: 33973285 DOI: 10.1111/jocn.15832] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/31/2021] [Accepted: 04/19/2021] [Indexed: 12/15/2022]
Abstract
AIMS AND OBJECTIVES To map the existing literature on support models provided to family members during the cancer trajectory. BACKGROUND Cancer diagnosis, treatment and survivorship have a profound influence on the surrounding family members. This scoping review is part of the development of a support model for family members of persons diagnosed with colorectal cancer. DESIGN The method was guided by the Arksey and O'Malley framework, described in the Joanna Briggs Institute guidelines, and the reporting is compliant with PRISMA-ScR Checklist. Searches were conducted in PubMed, CINAHL and PsycINFO from November 2019-February 2020 with no limitation in publication year or study design. Complementing searches were conducted in reference lists and for grey literature, followed by an additional search in September 2020. Inclusion criteria were primary research about support provided by health care, to family members, during cancer, of an adult person, in Swedish or English, of moderate or high methodological quality. Quality was assessed using the Joanna Briggs Institute critical appraisal tools. Data were extracted using a charting form. RESULT A total of 32 studies were included in the review describing 39 support models. CONCLUSION The mapping of the existing literature resulted in the identification of three themes of support models: psychoeducation, caregiver training and psychological support. In addition, that future research should target a specific diagnosis and trajectory phase as well as include family members and intervention providers in model development. RELEVANCE FOR CLINICAL PRACTICE Knowledge from the literature on both the needs of the family members and existing support models should be incorporated with the prerequisites of clinical practice. Clinical practice should also be complemented with structured assessments of family members' needs conducted regularly.
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Affiliation(s)
- Maria Samuelsson
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden
- Department of Pediatrics, Skåne University Hospital, Malmö, Sweden
| | - Anne Wennick
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden
| | - Jenny Jakobsson
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden
| | - Mariette Bengtsson
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden
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Song L, Qan'ir Y, Guan T, Guo P, Xu S, Jung A, Idiagbonya E, Song F, Kent EE. The Challenges of Enrollment and Retention: A Systematic Review of Psychosocial Behavioral Interventions for Patients With Cancer and Their Family Caregivers. J Pain Symptom Manage 2021; 62:e279-e304. [PMID: 33933618 PMCID: PMC8419067 DOI: 10.1016/j.jpainsymman.2021.04.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023]
Abstract
CONTEXT Psychosocial behavioral interventions (PBIs) that target patients with cancer and their caregivers face challenges in participant enrollment and retention. OBJECTIVES 1) Describe characteristics of the patient-caregiver PBI studies; 2) examine participant enrollment and retention rates; 3) identify factors influencing participant enrollment and retention rates; and 4) explore the strategies to promote enrollment and retention rates. METHODS We identified randomized controlled trials that tested PBIs among adult patients with cancer and caregivers in five electronic databases. We conducted narrative and quantitative analyses to synthesize our findings. RESULTS Among 55 qualified studies reviewed, most tested the efficacy of PBIs (n = 42) and used two study arms (n = 48). In-person meeting was the most common PBI delivery mode. The primary outcomes included quality of life, physical health, and symptoms. The average of enrollment rates of patient-caregiver dyads was 33% across studies (range 8%-100%; median = 23%). The average retention rate at the end of follow-ups was 69% (range 16%-100%; median = 70%). The number of study arms, recruitment method, type of patient-caregiver relationship, and intervention duration influenced enrollment rates. Study design (efficacy vs. pilot), follow-up duration, mode of delivery, type of relationship, and intervention duration influenced retention rates. Sixteen studies reported retention strategies, including providing money/gift cards upon study completion and/or after follow-up survey, and excluding patients with advanced cancer. CONCLUSION Researchers need to incorporate effective strategies to optimize enrollment and retention in patient-caregiver PBI trials. Researchers need to report detailed study processes and PBI information to improve research transparency and increase consistency.
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Affiliation(s)
- Lixin Song
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina, USA; University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA.
| | - Yousef Qan'ir
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina, USA
| | - Ting Guan
- University of North Carolina at Chapel Hill, School of Social Work, Chapel Hill, North Carolina, USA
| | - Peiran Guo
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina, USA
| | - Shenmeng Xu
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina, USA
| | - Ahrang Jung
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina, USA
| | - Eno Idiagbonya
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina, USA
| | - Fengyu Song
- West Coast University, General Education, Anaheim, California, USA
| | - Erin Elizabeth Kent
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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McInnerney D, Kupeli N, Stone P, Anantapong K, Chan J, Flemming K, Troop N, Candy B. Emotional disclosure in palliative care: A scoping review of intervention characteristics and implementation factors. Palliat Med 2021; 35:1323-1343. [PMID: 34053341 PMCID: PMC8267079 DOI: 10.1177/02692163211013248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Emotional disclosure is the therapeutic expression of emotion. It holds potential as a means of providing psychological support. However, evidence of its efficacy in palliative settings is mixed. This may be due to variation in intervention characteristics. AIM To derive a greater understanding of the characteristics of potentially effective emotional disclosure-based interventions in palliative care by:(1) Developing a taxonomy of emotional disclosure-based interventions tested in people with advanced disease and(2) Mapping and linking objectives, outcomes, underlying mechanisms, and implementation factors. DESIGN A scoping review drawing on Intervention Component Analysis to combine evidence from studies' methods, results, and discussion sections. DATA SOURCES Six databases were searched to May 2020 including CINAHL, PsycINFO, and MEDLINE. Studies of emotional disclosure in adults with advanced disease were included. Study quality was appraised using an established tool. RESULTS Seven thousand seven hundred ninety-two unique records were screened, of which 25 primary studies were included. Intervention characteristics were grouped into classes within three domains: topic of disclosure, format, and dose. Evidence was not available to determine which, if any, of the characteristics is most effective. Thematic synthesis of evidence from methods and discussion sections identified factors to consider in tailoring an emotional disclosure-based intervention to this setting, including: population characteristics (e.g. time since diagnosis), providing a safe environment, and flexibility in format. CONCLUSIONS This review approach facilitated a clearer understanding of factors that may be key in developing emotional disclosure-based interventions for palliative populations. Intervention Component Analysis has potential for application elsewhere to help develop evidence-based interventions.
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Affiliation(s)
- Daisy McInnerney
- Division of Psychiatry, Marie Curie Palliative Care Research Department, UCL, London, UK
| | - Nuriye Kupeli
- Division of Psychiatry, Marie Curie Palliative Care Research Department, UCL, London, UK
| | - Paddy Stone
- Division of Psychiatry, Marie Curie Palliative Care Research Department, UCL, London, UK
| | - Kanthee Anantapong
- Division of Psychiatry, Marie Curie Palliative Care Research Department, UCL, London, UK
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Justin Chan
- Division of Psychiatry, Marie Curie Palliative Care Research Department, UCL, London, UK
| | - Kate Flemming
- Department of Health Sciences, University of York, York, UK
| | - Nicholas Troop
- Department of Psychology, Sports and Geography, University of Hertfordshire, Hertfordshire, UK
| | - Bridget Candy
- Division of Psychiatry, Marie Curie Palliative Care Research Department, UCL, London, UK
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21
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Gesselman AN, Wion RK, Garcia JR, Miller WR. Relationship and sexual satisfaction are associated with better disease self-management in persons with epilepsy. Epilepsy Behav 2021; 119:107937. [PMID: 33892288 PMCID: PMC8154732 DOI: 10.1016/j.yebeh.2021.107937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 01/23/2023]
Abstract
Prior research has demonstrated that PWEs view intimate interpersonal relationships as personally important and as a substantive challenge in their lives. This is significant as high-quality intimate relationships have been linked with greater well-being and better healthcare self-management in other disease contexts. For persons with epilepsy (PWEs), self-management is critical for seizure control, lower mortality, and better quality of life. In the current study, we conducted the first known investigation into the quality of PWEs' intimate relationships and their self-management abilities. In a sample of 88 PWEs, using the Adult Epilepsy Self-Management Instrument, results demonstrate links between greater relationship satisfaction and sexual satisfaction with better self-management on seven of the eleven subscales: health communication, coping skills, social support, seizure tracking, seizure response, stress management, and wellness; satisfaction was unrelated to the treatment, safety, medical adherence, and proactivity subscales. Importantly, these results held while controlling for age, gender, social support, and presence of comorbidities. These findings provide some evidence of the importance of intimate relationships in understanding PWEs' healthcare management abilities. Given that intimate relationship dynamics have been shown to be highly amenable to intervention, this is an area of potential interest for improving self-management in PWEs.
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Affiliation(s)
| | - Rachel K Wion
- School of Nursing, Indiana University, United States
| | - Justin R Garcia
- The Kinsey Institute, Indiana University, United States; Department of Gender Studies, Indiana University, United States
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Mosher CE, Secinti E, Kroenke K, Helft PR, Turk AA, Loehrer PJ, Sehdev A, Al-Hader AA, Champion VL, Johns SA. Acceptance and commitment therapy for fatigue interference in advanced gastrointestinal cancer and caregiver burden: protocol of a pilot randomized controlled trial. Pilot Feasibility Stud 2021; 7:99. [PMID: 33879253 PMCID: PMC8056101 DOI: 10.1186/s40814-021-00837-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 04/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fatigue interference with activities, mood, and cognition is one of the most prevalent and bothersome concerns of advanced gastrointestinal (GI) cancer patients. As fatigue interferes with patient functioning, family caregivers often report feeling burdened by increasing responsibilities. Evidence-based interventions jointly addressing cancer patient fatigue interference and caregiver burden are lacking. In pilot studies, acceptance and commitment therapy (ACT) has shown promise for addressing symptom-related suffering in cancer patients. The current pilot trial seeks to test a novel, dyadic ACT intervention for both advanced GI cancer patients with moderate-to-severe fatigue interference and their family caregivers with significant caregiving burden or distress. METHODS A minimum of 40 patient-caregiver dyads will be randomly assigned to either the ACT intervention or an education/support control condition. Dyads in both conditions attend six weekly 50-min telephone sessions. Outcomes are assessed at baseline as well as 2 weeks and 3 months post-intervention. We will evaluate the feasibility, acceptability, and preliminary efficacy of ACT for improving patient fatigue interference and caregiver burden. Secondary outcomes include patient sleep interference and patient and caregiver engagement in daily activities, psychological flexibility, and quality of life. We will also explore the effects of ACT on patient and caregiver physical and mental health service use. DISCUSSION Findings will inform a large-scale trial of intervention efficacy. Results will also lay the groundwork for further novel applications of ACT to symptom interference with functioning and caregiver burden in advanced cancer. TRIAL REGISTRATION ClinicalTrials.gov , NCT04010227 . Registered 8 July 2019.
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Affiliation(s)
- Catherine E. Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN 46202 USA
| | - Ekin Secinti
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN 46202 USA
| | - Kurt Kroenke
- Indiana University School of Medicine, Center for Health Services Research, Regenstrief Institute, 1101 W. 10th Street, Indianapolis, IN 46202 USA
| | - Paul R. Helft
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN 46202 USA
| | - Anita A. Turk
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN 46202 USA
| | - Patrick J. Loehrer
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN 46202 USA
| | - Amikar Sehdev
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN 46202 USA
| | - Ahmad A. Al-Hader
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN 46202 USA
| | - Victoria L. Champion
- Indiana University School of Nursing, 1111 Middle Drive, NU 340G, Indianapolis, IN 46202 USA
| | - Shelley A. Johns
- Indiana University School of Medicine, Center for Health Services Research, Regenstrief Institute, 1101 W. 10th Street, Indianapolis, IN 46202 USA
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23
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Tiete J, Delvaux N, Liénard A, Razavi D. Efficacy of a dyadic intervention to improve communication between patients with cancer and their caregivers: A randomized pilot trial. PATIENT EDUCATION AND COUNSELING 2021; 104:563-570. [PMID: 33129628 DOI: 10.1016/j.pec.2020.08.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 07/27/2020] [Accepted: 08/19/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Cancer-related communication is critical for patients' and caregivers' adaptation to illness. This randomized pilot study was conducted to test the feasibility, acceptability, and efficacy of a specific dyadic intervention to improve communication. METHODS A four weekly-session intervention was developed to reinforce cancer-related patient-caregiver communication. Patients receiving treatment for any diagnosed cancer, and their caregivers, were recruited from two oncology clinics in Belgium. Sixty-four patient-caregiver dyads were assigned randomly to intervention and waitlist groups. Cancer-related dyadic communication, dyadic coping and emotional distress were assessed at baseline and post-intervention. RESULTS The intervention attrition rate was 6 %. Linear mixed models were performed on 60 dyads. Significant two-way group × time interaction indicated improvement in participants' cancer-related dyadic communication frequency (β = -1.30; SE = 0.31; p = .004), self-efficacy (β = -10.03; SE = 3.90; p = .011) and dyadic coping (β = -5.93; SE = 2.73; p = .046) after the intervention. CONCLUSION These results indicate that the brief dyadic communication intervention is feasible and acceptable, and show preliminary evidence of efficacy. PRACTICE IMPLICATIONS Encouraging patients and caregivers to discuss personal cancer-related concerns may improve their ability to cope with the illness together.
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Affiliation(s)
- Julien Tiete
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Education, 50 Avenue Franklin Roosevelt, Brussels, Belgium; Hôpital Erasme, Service de Psychologie, 808 Route de Lennik, Brussels, Belgium.
| | - Nicole Delvaux
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Education, 50 Avenue Franklin Roosevelt, Brussels, Belgium; Hôpital Erasme, Service de Psychologie, 808 Route de Lennik, Brussels, Belgium
| | - Aurore Liénard
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Education, 50 Avenue Franklin Roosevelt, Brussels, Belgium; Institut Jules Bordet, Clinique de Psycho-oncologie, 121 Boulevard de Waterloo, Brussels, Belgium
| | - Darius Razavi
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Education, 50 Avenue Franklin Roosevelt, Brussels, Belgium; Institut Jules Bordet, Clinique de Psycho-oncologie, 121 Boulevard de Waterloo, Brussels, Belgium
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Mosher CE, Krueger E, Hirsh AT, Miller KD, Ballinger TJ, Storniolo AM, Schneider BP, Newton EV, Champion VL, Johns SA. Protocol of a randomized trial of acceptance and commitment therapy for fatigue interference in metastatic breast cancer. Contemp Clin Trials 2020; 98:106168. [PMID: 33038501 DOI: 10.1016/j.cct.2020.106168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 11/28/2022]
Abstract
Fatigue interference with activities, mood, and cognition is one of the most prevalent and distressing concerns of metastatic breast cancer patients. To date, there are no evidence-based interventions for reducing fatigue interference in metastatic breast cancer and other advanced cancer populations. In pilot studies, Acceptance and Commitment Therapy (ACT) has shown potential for reducing symptom-related suffering in cancer patients. The current Phase II trial seeks to more definitively examine the efficacy of telephone-based ACT for women with metastatic breast cancer who are experiencing fatigue interference. In this trial, 250 women are randomly assigned to either the ACT intervention or an education/support control condition. Women in both conditions attend six weekly 50-min telephone sessions. The primary aim of this study is to test the effect of telephone-based ACT on fatigue interference. Secondary outcomes include sleep interference, engagement in daily activities, and quality of life. Outcomes are assessed at baseline, 2 weeks post-intervention, and 3 and 6 months post-intervention. This trial also examines whether increases in psychological flexibility, defined as full awareness of the present moment while persisting in behaviors aligned with personal values, account for the beneficial effect of ACT on fatigue interference. After demonstrating ACT's efficacy, the intervention can be widely disseminated to clinicians who care for metastatic breast cancer patients. Our findings will also inform future ACT trials with various cancer populations and functional outcomes.
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Affiliation(s)
- Catherine E Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN 46202, USA.
| | - Ellen Krueger
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN 46202, USA.
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN 46202, USA.
| | - Kathy D Miller
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN 46202, USA.
| | - Tarah J Ballinger
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN 46202, USA.
| | - Anna Maria Storniolo
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN 46202, USA.
| | - Bryan P Schneider
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN 46202, USA.
| | - Erin V Newton
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN 46202, USA.
| | - Victoria L Champion
- Indiana University School of Nursing, 1111 Middle Drive, NU 340G, Indianapolis, IN 46202, USA.
| | - Shelley A Johns
- Indiana University School of Medicine, Center for Health Services Research, Regenstrief Institute, 1101 W. 10(th) Street, Indianapolis, IN 46202, USA.
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25
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Milbury K, Li Y, Durrani S, Liao Z, Tsao AS, Carmack C, Cohen L, Bruera E. A Mindfulness-Based Intervention as a Supportive Care Strategy for Patients with Metastatic Non-Small Cell Lung Cancer and Their Spouses: Results of a Three-Arm Pilot Randomized Controlled Trial. Oncologist 2020; 25:e1794-e1802. [PMID: 32621630 DOI: 10.1634/theoncologist.2020-0125] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/12/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Although mindfulness-based interventions have been widely examined in patients with nonmetastatic cancer, the feasibility and efficacy of these types of programs are largely unknown for those with advanced disease. We pilot-tested a couple-based meditation (CBM) relative to a supportive-expressive (SE) and a usual care (UC) arm targeting psychospiritual distress in patients with metastatic lung cancer and their spousal caregivers. PATIENTS AND METHODS Seventy-five patient-caregiver dyads completed baseline self-report measures and were then randomized to one of the three arms. Couples in the CBM and SE groups attended four 60-minute sessions that were delivered via videoconference. All dyads were reassessed 1 and 3 months later. RESULTS A priori feasibility benchmarks were met. Although attendance was high in both groups, dyads in the CBM group indicated greater benefit of the sessions than those in the SE group (patients, CBM mean = 2.63, SE mean = 2.20, p = .003; spouses, CBM mean = 2.71, SE mean = 2.00, p = .005). Compared with the UC group, patients in the CBM group reported significantly lower depressive symptoms (p = .05; d = 0.53) and marginally reduced cancer-related stress (p = .07; d = 0.68). Medium effect sizes in favor of the CBM compared with the SE group for depressive symptoms (d = 0.59) and cancer-related stress (d = 0.54) were found. Spouses in the CBM group reported significantly lower depressive symptoms (p < .01; d = 0.74) compared with those in the UC group. CONCLUSION It seems feasible and possibly efficacious to deliver dyadic interventions via videoconference to couples coping with metastatic lung cancer. Mindfulness-based interventions may be of value to managing psychological symptoms in the palliative care setting. Clinical trial identification number. NCT02596490 IMPLICATIONS FOR PRACTICE: The current randomized controlled trial has established that a mindfulness approach to the management of patients' and spouses' psychospiritual concerns is acceptable and subjectively deemed more beneficial than a supportive-expressive treatment for patients with metastatic non-small cell lung cancer (NSCLC). We also revealed that videoconference delivery, here FaceTime, is an acceptable approach even for geriatric patients with metastatic NSCLC and that patients and their spousal caregivers prefer a dyadic delivery of this type of supportive care strategy. Lastly, this trial has laid the foundation for the role of mindfulness-based interventions in the palliative care setting supporting patients with advanced NSCLC and their spousal caregivers.
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Affiliation(s)
- Kathrin Milbury
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yisheng Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sania Durrani
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anne S Tsao
- Department of Head and Neck/Thoracic Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cindy Carmack
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lorenzo Cohen
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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26
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Milbury K, Weathers SP, Durrani S, Li Y, Whisenant M, Li J, Lim B, Weinberg JS, Kesler SR, Cohen L, Bruera E. Online Couple-Based Meditation Intervention for Patients With Primary or Metastatic Brain Tumors and Their Partners: Results of a Pilot Randomized Controlled Trial. J Pain Symptom Manage 2020; 59:1260-1267. [PMID: 32061834 PMCID: PMC11816621 DOI: 10.1016/j.jpainsymman.2020.02.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Although patients with primary and metastatic brain tumors and their partners are at risk of experiencing high symptom burden, they are often excluded from psychosocial intervention studies. Thus, we sought to examine the feasibility and preliminary efficacy of a couple-based meditation (CBM) program targeting symptom and well-being outcomes. METHODS Couples completed baseline measures assessing symptom and well-being outcomes and were randomized to the CBM or a usual care control group. Couples in the CBM groups attended four weekly (60 minutes each) therapist-led sessions that were delivered via FaceTime (Apple Inc, Cupertino, CA). The CBM program focused on cultivating mindfulness, compassion, gratitude and purpose, and integrated emotional disclosure exercises. Both groups were reassessed six and 12 weeks after baseline. RESULTS We approached 60 eligible dyads, of which 37 (62%) consented, 35 (95%) were randomized, and 22 (63%) completed all assessments. Couples in the CBM group attended a mean of 3.33 sessions (SD 1.09). For patients, significant group differences in favor of the CBM group were found for cognitive (d = 1.05) and general disease symptoms (d = 0.93), and relationship well-being (d = 0.68) and compassion (d = 0.96). No significant group differences were revealed for partners. CONCLUSION It seems to be feasible, acceptable, and possibly efficacious to deliver a dyadic intervention via FaceTime to brain tumor couples. Although both patients and partners in the CBM group rated the intervention as beneficial, significant group differences with medium-to-large effect sizes were only found for patients.
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Affiliation(s)
- Kathrin Milbury
- Department of Behavioral Science, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA.
| | - Shiao-Pei Weathers
- Department of Neuro-Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Sania Durrani
- Department of Behavioral Science, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Yisheng Li
- Department of Biostatistics, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Meagan Whisenant
- Department of Symptom Research, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Jing Li
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Bora Lim
- Department of Breast Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Shelli R Kesler
- Department of Oncology, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Lorenzo Cohen
- Department of Palliative, Rehabilitation & Integrative Medicine, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation & Integrative Medicine, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
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Bosisio M, Pâquet M, Bois K, Rosen NO, Bergeron S. Are Depressive Symptoms and Attachment Styles Associated with Observed and Perceived Partner Responsiveness in Couples Coping With Genito-Pelvic Pain ? JOURNAL OF SEX RESEARCH 2020; 57:534-544. [PMID: 31090447 DOI: 10.1080/00224499.2019.1610691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Partner responsiveness is thought to facilitate relationship adjustment in couples coping with genito-pelvic pain, such as provoked vestibulodynia (PVD). Recent studies suggest that attachment and depressive symptoms may act as a filter in the perception of partner responsiveness, and a barrier to the capacity of being responsive to a partner. Given studies suggesting higher depressive symptoms and relationship insecurities in women experiencing genito-pelvic pain compared to controls, investigating the role of these factors in partner responsiveness may help couples improve their wellbeing in the challenging context of PVD. The aim of this study was to examine the associations between depressive symptoms, attachment, and perceived and observed partner responsiveness in 50 couples coping with PVD. Participants took part in a videotaped discussion and completed self-report measures of depressive symptoms, attachment, and perceived partner responsiveness. Based on the actor-partner interdependence model, results indicated that when women and partners reported greater depressive symptoms and anxious attachment, they perceived each other as being less responsive. When partners experienced greater depressive symptoms, women and partners were rated, by a trained observer, as being less responsive to each other. Targeting depressive symptoms and relationship insecurity in couple therapy could increase responsiveness in couples coping with PVD.
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Affiliation(s)
| | | | - Katy Bois
- Department of Psychology, Université de Montréal
| | - Natalie O Rosen
- Departments of Psychology and Neuroscience, Dalhousie University
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28
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Reese JB, Zimmaro LA, Lepore SJ, Sorice KA, Handorf E, Daly MB, Schover LR, Kashy D, Westbrook K, Porter LS. Evaluating a couple-based intervention addressing sexual concerns for breast cancer survivors: study protocol for a randomized controlled trial. Trials 2020; 21:173. [PMID: 32051002 PMCID: PMC7014745 DOI: 10.1186/s13063-019-3975-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/09/2019] [Indexed: 12/11/2022] Open
Abstract
Background Sexual concerns are distressing for breast cancer survivors and interfere with their intimate relationships. This study evaluates the efficacy of a four-session couple-based intervention delivered via telephone, called Intimacy Enhancement (IE). The IE intervention is grounded in social cognitive theory and integrates evidence-based techniques from cognitive behavioral couple therapy and sex therapy to address survivors’ sexual concerns and enhance their and their partners’ sexual, relationship, and psychological outcomes. Methods This trial is designed to evaluate the efficacy of the IE intervention in improving survivors’ sexual function, the primary study outcome. Secondary outcomes include survivors’ sexual distress, partners’ sexual function, and survivors’ and partners’ relationship intimacy and quality as well as psychological distress (depressive symptoms and anxiety symptoms). Additional aims are to examine whether treatment effects on patient sexual function are mediated by sexual communication and self-efficacy for coping with sexual concerns and to explore whether survivor age and race/ethnicity moderate intervention effects on survivors’ sexual function. Eligible adult female breast cancer survivors reporting sexual concerns and their intimate partners are recruited from two academic sites in the USA and are randomized to either the IE intervention or to a control condition of equal length offering education and support around breast cancer-related health topics (Living Healthy Together). The target sample size is 120 couples. Self-report outcome measures are administered to participants in both conditions at baseline (T1), post-treatment (T2), 3 months post-treatment (T3), and 6 months post-treatment (T4). Discussion Evidence-based interventions are needed to address sexual concerns for breast cancer survivors and to enhance their and their intimate partners’ sexual, relationship, and psychological well-being. This randomized controlled trial will allow us to examine the efficacy of a novel couple-based intervention delivered via telephone for breast cancer survivors experiencing sexual concerns and their intimate partners, in comparison with an attention control. Findings of this study could influence clinical care for women with breast cancer and inform theory guiding cancer-related sexual rehabilitation. Trial registration ClinicalTrials.gov, NCT03930797. Registered on 24 April 2019.
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Affiliation(s)
- Jennifer Barsky Reese
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA.
| | - Lauren A Zimmaro
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Stephen J Lepore
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA.,Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Avenue, Ritter Annex, Philadelphia, PA, 19122, USA
| | - Kristen A Sorice
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Elizabeth Handorf
- Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Mary B Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Leslie R Schover
- Will2Love LLC, 1333 Old Spanish Trail, Suite G, #134, Houston, TX, 77054, USA
| | - Deborah Kashy
- Department of Psychology, Michigan State University, 316 Physics Road, Room 262, East Lansing, MI, 48824, USA
| | - Kelly Westbrook
- Department of Medicine-Oncology, Duke University Medical Center, DUMC 3459, Durham, NC, 27710, USA
| | - Laura S Porter
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, DUMC 90399, Durham, NC, 27708, USA
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Abstract
Because relationship discord and dissolution are common and costly, interventions are needed to treat distressed couples and to prevent distress among vulnerable couples. We review meta-analytic evidence showing that 60-80% of distressed couples benefit from behavioral and emotion-focused approaches to couple therapy, but we also note that treatment effects are weaker in actual clinical practice than in controlled studies, dissipate following treatment for about half of all couples, and may be explained by factors that are common across models. Meta-analyses of prevention programs reveal reliable but smaller effects, reflecting a need to know more about whether and how communication mediates effects, about how risk and diversity moderate effects, and about how technology-enabled interventions can reduce attrition in vulnerable populations. Interventions for couples are improving and expanding, but critical questions remain about how and for whom they work.
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Affiliation(s)
- Thomas N Bradbury
- Department of Psychology, University of California, Los Angeles, California 90095-1563, USA;
| | - Guy Bodenmann
- Department of Psychology, University of Zurich, CH-8050 Zurich, Switzerland;
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30
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Rodin G, An E, Shnall J, Malfitano C. Psychological Interventions for Patients With Advanced Disease: Implications for Oncology and Palliative Care. J Clin Oncol 2020; 38:885-904. [PMID: 32023159 DOI: 10.1200/jco.19.00058] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
A growing body of research demonstrates the feasibility and efficacy of psychological interventions for adult patients with advanced cancer. Findings from quantitative studies of psychotherapeutic interventions with primary psychological outcomes for such patients are reviewed here and recommendations for best practice are made. We consider these interventions according to three broad phases in which they are most commonly applied: soon after diagnosis of advanced cancer, when living with the disease, and at or near the end of life. Cumulative evidence from well-designed studies demonstrates the efficacy of psychosocial interventions for patients with advanced disease to relieve and prevent depression, anxiety, and distress related to dying and death, as well as to enhance the sense of meaning and preparation for end of life. Individual and couple-based interventions have been proven to be most feasible, and the development and use of tailored and validated measures has enhanced the rigor of research and clinical care. Palliative care nurses and physicians can be trained to deliver many such interventions, but a core of psychosocial clinicians, including social workers, psychologists, and psychiatrists, is usually required to train other health professionals in their delivery and to ensure their quality. Few of the interventions for which there is evidence of effectiveness have been routinely incorporated into oncology or palliative care. Advocacy on the basis of this evidence is required to build psychosocial resources in cancer treatment settings and to ensure that psychological care receives the same priority as other aspects of palliative care in oncology.
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Affiliation(s)
- Gary Rodin
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Ekaterina An
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Joanna Shnall
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Carmine Malfitano
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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31
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Porter LS, Baucom DH, Bonner M, Linardic C, Kazak AE. Parenting a child with cancer: a couple-based approach. Transl Behav Med 2020; 9:504-513. [PMID: 31094434 DOI: 10.1093/tbm/ibz016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Couples co-parenting a child with cancer face significant stressors that can adversely affect their couple relationship. How parents respond as a couple may affect the psychological adjustment of each parent and the child, as well as the ability of the family to cope with the child's illness. The purpose of this study was to assess the feasibility and acceptability of a couple-based intervention for parents of children with cancer. We conducted a randomized pilot intervention study (N = 21 couples randomized with a 2:1 allocation to the couple-based intervention or education control) testing a six-session, telephone-based intervention that trained couples in relationship skills to help them care for their child, strengthen their relationship, and support each other. We examined feasibility and acceptability of the intervention to the parents. In this study, 56% of eligible couples agreed to participate; 82% of randomized couples completed post-intervention surveys, and 62% completed all six sessions. Satisfaction with the intervention was high (mean = 3.3 on a 4-point scale). Changes in both groups were small in magnitude and mixed in direction, with some outcomes favoring the couple-based intervention and other favoring the education condition. Supporting couples is important to optimize individual and parental functioning when a child has cancer. However, there are significant challenges to delivering couple-based interventions to these parents. More research is needed to establish optimal timing and content of couple-based interventions for these parents as well as feasible methods of delivery.
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Affiliation(s)
- Laura S Porter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Donald H Baucom
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Melanie Bonner
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Corinne Linardic
- Department of Pediatrics-Hematology/Oncology, Duke University Medical Center, Durham, NC, USA
| | - Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children's Health System, Sidney Kimmel Medical College of Thomas Jefferson University, Wilmington, DE, USA
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Meier C, Taubenheim S, Lordick F, Mehnert-Theuerkauf A, Götze H. Depression and anxiety in older patients with hematological cancer (70+) - Geriatric, social, cancer- and treatment-related associations. J Geriatr Oncol 2019; 11:828-835. [PMID: 31831361 DOI: 10.1016/j.jgo.2019.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 08/09/2019] [Accepted: 11/26/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Older patients are often underrepresented in clinical and epidemiological studies and the knowledge of the effect of hematologic cancer on mental health in the elderly is sparse. Objectives of our study are to provide information on depression and anxiety in older patients with hematological cancer (HCP), compared to a community sample (CS), and to investigate factors associated with depression and anxiety. MATERIALS AND METHODS We conducted a prospective study with interview assessments of HCP (ICD: C81 - C96) age ≥ 70 years to assess depressive symptoms (PHQ-9) and anxiety (GAD-7) in comparison to a CS matched by age and sex. Hierarchical Regression analysis was used to determine the association of depression and anxiety with quality of life (QoL) as well as geriatric, social, cancer- and treatment-related factors. RESULTS 200 patients (response rate 50.5%, Mean age = 76 years, 64% male) and 225 citizens (response rate 44.5%) were interviewed. Compared to the CS, HCP showed significantly higher levels of depression. There was no difference in levels of anxiety between the two groups. Geriatric characteristics including limited mobility, need for care, comorbidity, as well as ongoing chemotherapy, lack of partnership, and low QoL were associated with depression. Anxiety in HCP was associated with detrimental social interaction, cognitive and emotional functioning, poor nutrition, and comorbidity. CONCLUSIONS Older patients with hematologic cancer are at high risk to experience depressive symptoms and low QoL. Health care professionals should assess geriatric symptoms and screen for depression to allow for early interventions and improve treatment outcomes.
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Affiliation(s)
- Cora Meier
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Sabine Taubenheim
- Clinical Cancer Registry Leipzig, University Medical Center Leipzig, Leipzig, Germany
| | - Florian Lordick
- University Cancer Center Leipzig (UCCL), University Medical Center Leipzig, Leipzig, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Heide Götze
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany.
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Effectiveness of couple psycho-oncological interventions in increasing patients and their partners’ adaptation to disease: A systematic review and a meta-analysis. CURRENT PSYCHOLOGY 2019. [DOI: 10.1007/s12144-019-00543-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mosher CE, Secinti E, Hirsh AT, Hanna N, Einhorn LH, Jalal SI, Durm G, Champion VL, Johns SA. Acceptance and Commitment Therapy for Symptom Interference in Advanced Lung Cancer and Caregiver Distress: A Pilot Randomized Trial. J Pain Symptom Manage 2019; 58:632-644. [PMID: 31255586 PMCID: PMC6754796 DOI: 10.1016/j.jpainsymman.2019.06.021] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/20/2019] [Accepted: 06/21/2019] [Indexed: 11/24/2022]
Abstract
CONTEXT Advanced lung cancer patients typically have a poor prognosis and many symptoms that interfere with functioning, contributing to high rates of emotional distress in both patients and family caregivers. There remains a need for evidence-based interventions to improve functional outcomes and distress in this population. OBJECTIVES This pilot trial examined the feasibility and preliminary efficacy of telephone-based Acceptance and Commitment Therapy (ACT) for symptomatic, advanced lung cancer patients and their distressed family caregivers. Primary outcomes were patient symptom interference with functioning and patient and caregiver distress. METHODS Symptomatic, advanced lung cancer patients and distressed caregivers (n = 50 dyads) were randomly assigned to six sessions of ACT or an education/support condition. Patients completed measures of symptom interference and measures assessing the severity of fatigue, pain, sleep disturbance, and breathlessness. Patients and caregivers completed measures of distress and illness acceptance and struggle. RESULTS The eligibility screening rate (51%) and retention rate (76% at six weeks postintervention) demonstrated feasibility. No group differences were found with respect to patient and caregiver outcomes. Both groups showed a small, significant decrease in struggle with the illness over the study period, but did not show meaningful change in other outcomes. CONCLUSION Findings suggest that telephone-based ACT is feasible for many advanced lung cancer patients and caregivers, but may not substantially reduce symptom interference and distress. Low baseline levels of certain symptoms may have contributed to null findings. Next steps include applying ACT to specific, clinically meaningful symptom interference and varying intervention dose and modality.
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Affiliation(s)
- Catherine E Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA.
| | - Ekin Secinti
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Nasser Hanna
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Lawrence H Einhorn
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Shadia I Jalal
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA; Richard L. Roudebush VAMC, Indianapolis, Indiana, USA
| | - Gregory Durm
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Shelley A Johns
- Indiana University School of Medicine, Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana, USA
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Oh S, Ryu E. Does Holding Back Cancer-Related Concern Affect Couples' Marital Relationship and Quality of Life of Patients with Lung Cancer? An Actor–Partner Interdependence Mediation Modeling Approach. Asian Nurs Res (Korean Soc Nurs Sci) 2019; 13:277-285. [PMID: 31605768 DOI: 10.1016/j.anr.2019.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 10/01/2019] [Accepted: 10/01/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Soonyoung Oh
- Department of Nursing, Kyungbok University, Pochun, Republic of Korea
| | - Eunjung Ryu
- Department of Nursing, Chung-Ang University, Seoul, Republic of Korea.
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Relationship intimacy processes during treatment for couple-focused interventions for prostate cancer patients and their spouses. JOURNAL OF PSYCHOSOCIAL ONCOLOGY RESEARCH & PRACTICE 2019; 1. [PMID: 36237825 PMCID: PMC9554946 DOI: 10.1097/or9.0000000000000007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective: In a previously published trial, we compared the effect of an
intimacy-enhancing therapy (IET) and a General Health and Wellness
intervention (GHW) on psychological and relationship outcomes among men
diagnosed with localized prostate cancer and their partners. Results
suggested partial effects of IET on psychological adjustment and
relationship satisfaction. To understand these partial effects, the first
aim of this study was to evaluate self-disclosure, perceived partner
disclosure, perceived partner responsiveness, and levels of intimacy rated
after sessions, and the second aim of this study was to examine the role of
pre-treatment holding back on these intimacy processes. Methods: A total of 156 couples who participated in treatment reported on
self- and perceived partner disclosure, responsiveness, and intimacy during
sessions. Participants rated levels of holding back before treatment. Linear
growth models were estimated using multilevel modeling. Each intimacy
process variable was predicted to be a function of time, role, condition,
and all interactions among these variables. The effects of own and partner
pretreatment holding back on average intimacy process and change in intimacy
process were tested in moderated growth models. Results: Self- and perceived partner disclosure were significantly higher
during IET sessions than GHW sessions. Self-disclosure, perceived partner
disclosure, and perceived partner responsiveness increased in both IET and
GHW. Intimacy was not higher and did not increase more in IET compared with
GHW. Participants who held back reported that their partner disclosed less
to them during sessions, perceived that their partner was less responsive to
them during sessions, and reported less intimacy during sessions. Partners
of participants who held back were seen as less responsive and their
interactions were seen as less intimate. Conclusions: Although IET focused on enhancing couples’ responsiveness and
intimacy, it did not have a stronger effect on these processes during
sessions than GHW. The lack of an effect may, in part, be because of the
fact that IET did not help those couples who may have been in the greatest
need for it because they held back more.
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Milbury K, Li J, Weathers SP, Shih T, Malliaha S, Li Y, Cohen L. A research protocol for a pilot, randomized controlled trial designed to examine the feasibility of a dyadic versus individual yoga program for family caregivers of glioma patients undergoing radiotherapy. Pilot Feasibility Stud 2019; 5:95. [PMID: 31367462 PMCID: PMC6657047 DOI: 10.1186/s40814-019-0479-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 07/09/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Although the diagnosis and treatment of a primary brain tumor present unique challenges to patients and their family caregivers, evidence-based supportive care interventions are generally lacking. The primary aim of this research protocol is to determine the feasibility of implementing a dyadic yoga (DY) versus a caregiver yoga (CY) intervention or a wait-list control (WLC) group using a randomized controlled trial design. METHODS Seventy-five glioma patients undergoing radiotherapy and their family caregivers are randomized to the DY, CY, or a WLC group. Patient-caregiver dyads in the DY group and caregivers in the CY group receive 15 sessions (45 min each) over the course of patients' standard radiotherapy (6 weeks). Patients and caregivers in all groups complete baseline assessments of symptoms, quality of life (QOL), and health utilization outcomes prior to randomization. Follow-up assessments are performed 6 weeks and then again 3 months later. The primary outcome is feasibility (i.e., ≥ 50% of eligible dyads consent, ≥ 70% of enrolled dyads complete all assessments, and ≥ 50% of all practice sessions are attended). We will also perform primarily descriptive analyses of the self-reported outcomes (e.g., fatigue, overall QOL) and explore potential intervention moderators (e.g., performance status) to inform a larger future trial. CONCLUSION This trial will provide important information regarding the feasibility of a dyadic versus a caregiver yoga intervention regarding symptom, QOL, and health utilization outcomes in glioma patients and their caregivers. TRIAL REGISTRATION ClinicalTrials.gov NCT02481349.
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Affiliation(s)
- Kathrin Milbury
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Houston, TX 77030 USA
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Shiao-Pei Weathers
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Tina Shih
- Department of Health Services, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Smitha Malliaha
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Houston, TX 77030 USA
| | - Yisheng Li
- Department of Biostatics, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Lorenzo Cohen
- Department of Palliative, Rehabilitation & Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX USA
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Badr H, Bakhshaie J, Chhabria K. Dyadic Interventions for Cancer Survivors and Caregivers: State of the Science and New Directions. Semin Oncol Nurs 2019; 35:337-341. [PMID: 31248677 DOI: 10.1016/j.soncn.2019.06.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To describe caregiving and relationship challenges in cancer and the state of the science of dyadic interventions that target survivors and caregivers. DATA SOURCES Narrative review. CONCLUSION Viewing the survivor-caregiver dyad as the unit of care may improve multiple aspects of survivor and caregiver quality of life. However, several questions remain regarding how, why, and for whom dyadic interventions are effective. IMPLICATIONS FOR NURSING PRACTICE Nurses should consider survivor, caregiver, and relationship needs when formulating supportive care protocols. Screening for survivor distress and extending distress screening to caregivers is an important first step in providing comprehensive psychosocial care.
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Affiliation(s)
- Hoda Badr
- Department of Medicine, Baylor College of Medicine, Houston, TX.
| | - Jafar Bakhshaie
- Department of Medicine, Baylor College of Medicine, Houston, TX
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Treanor CJ, Santin O, Prue G, Coleman H, Cardwell CR, O'Halloran P, Donnelly M. Psychosocial interventions for informal caregivers of people living with cancer. Cochrane Database Syst Rev 2019; 6:CD009912. [PMID: 31204791 PMCID: PMC6573123 DOI: 10.1002/14651858.cd009912.pub2] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Increasingly, cancer is recognised as a chronic condition with a growing population of informal caregivers providing care for cancer patients. Informal caregiving can negatively affect the health and well-being of caregivers. We need a synthesised account of best evidence to aid decision-making about effective ways to support caregivers for individuals 'living with cancer'. OBJECTIVES To assess the effectiveness of psychosocial interventions designed to improve the quality of life (QoL), physical health and well-being of informal caregivers of people living with cancer compared with usual care. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, ProQuest, Open SIGLE, Web of Science from inception up to January 2018, trial registries and citation lists of included studies. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials comparing psychosocial interventions delivered to adult informal caregivers of adults affected by cancer on a group or individual basis with usual care. Psychosocial interventions included non-pharmacological interventions that involved an interpersonal relationship between caregivers and healthcare professionals. We included interventions delivered also to caregiver-patient dyads. Interventions delivered to caregivers of individuals receiving palliative or inpatient care were excluded. Our primary outcome was caregiver QoL. Secondary outcomes included patient QoL, caregiver and patient depression, anxiety, psychological distress, physical health status and intervention satisfaction and adverse effects. DATA COLLECTION AND ANALYSIS Pairs of review authors independently screened studies for eligibility, extracted data and conducted 'Risk of bias' assessments. We synthesised findings using meta-analysis, where possible, and reported remaining results in a narrative synthesis. MAIN RESULTS Nineteen trials (n = 3, 725) were included in the review. All trials were reported in English and were undertaken in high-income countries. Trials targeted caregivers of patients affected by a number of cancers spanning newly diagnosed patients, patients awaiting treatment, patients who were being treated currently and individuals post-treatment. Most trials delivered interventions to caregiver-patient dyads (predominantly spousal dyads) and there was variation in intervention delivery to groups or individual participants. There was much heterogeneity across interventions though the majority were defined as psycho-educational. All trials were rated as being at 'high risk of bias'.Compared to usual care, psychosocial interventions may improve slightly caregiver QoL immediately post intervention (standardised mean difference (SMD) 0.29, 95% confidence interval (CI) 0.04 to 0.53; studies = 2, 265 participants) and may have little to no effect on caregiver QoL at 12 months (SMD 0.14, 95% CI - 0.11 to 0.40; studies = 2, 239 participants) post-intervention (both low-quality evidence).Psychosocial interventions probably have little to no effect on caregiver depression immediately to one-month post-intervention (SMD 0.01, 95% CI -0.14 to 0.15; studies = 9, 702 participants) (moderate-quality evidence). Psychosocial interventions may have little to no effect on caregiver anxiety immediately post-intervention (SMD -0.12, 95 % CI -0.33 to 0.10; studies = 5, 329 participants), depression three-to-six months (SMD 0.03, 95% CI -0.33 to 0.38; studies = 5. 379 participants) post-intervention and patient QoL six to 12 months (SMD -0.05, 95% CI -0.37 to 0.26; studies = 3, 294 participants) post-intervention (all low-quality evidence). There was uncertainty whether psychosocial interventions improve patient QoL immediately (SMD -0.03, 95 %CI -0.50 to 0.44; studies = 2, 292 participants) or caregiver anxiety three-to-six months (SMD-0.25, 95% CI -0.64 to 0.13; studies = 4, 272 participants) post-intervention (both very low-quality evidence). Two studies which could not be pooled in a meta-analysis for caregiver physical health status found little to no effect immediately post-intervention and a small intervention effect 12 months post-intervention. Caregiver or patient satisfaction or cost-effectiveness of interventions were not assessed in any studies. Interventions demonstrated good feasibility and acceptability.Psychosocial interventions probably have little to no effect on patient physical health status immediately post-intervention (SMD 0.17, 95 % CI -0.07 to 0.41; studies = 4, 461 participants) and patient depression three to six months post-intervention (SMD-0.11, 95% CI -0.33 to 0.12; studies = 6, 534 participants) (both moderate-quality evidence).Psychosocial interventions may have little to no effect on caregiver psychological distress immediately to one-month (SMD -0.08, 95% CI -0.42 to 0.26; studies = 3, 134 participants), and seven to 12 months (SMD 0.08, 95% CI -0.42 to 0.58; studies = 2, 62 participants) post-intervention; patient depression immediately (SMD -0.12, 95% CI -0.31 to 0.07; studies = 9, 852 participants); anxiety immediately (SMD -0.13, 95% CI -0.41 to 0.15;studies = 4, 422 participants), and three to six months (SMD -0.22, 95% CI -0.45 to 0.02; studies = 4, 370 participants); psychological distress immediately (SMD -0.02, 95% CI -0.47 to 0.44; studies = 2, 74 participants) and seven to 12 months (SMD -0.27, 95% CI -0.78 to 0.24; studies = 2, 61 participants); and physical health status six to 12 months (SMD 0.06, 95% CI -0.18 to 0.30; studies = 2, 275 participants) post-intervention (all low-quality evidence).Three trials reported adverse effects associated with the interventions, compared with usual care, including higher distress, sexual function-related distress and lower relationship satisfaction levels for caregivers, higher distress levels for patients, and that some content was perceived as insensitive to some participants.Trials not able to be pooled in a meta-analysis did not tend to report effect size and it was difficult to discern intervention effectiveness. Variable intervention effects were reported for patient and caregiver outcomes. AUTHORS' CONCLUSIONS Heterogeneity across studies makes it difficult to draw firm conclusions regarding the effectiveness of psychosocial interventions for this population. There is an immediate need for rigorous trials with process evaluations and clearer, detailed intervention descriptions. Cost-effectiveness studies should be conducted alongside future trials.
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Affiliation(s)
- Charlene J Treanor
- Queen's University BelfastCentre for Public HealthInstitute of Clinical Sciences Block B, Royal Victoria Hospital SiteGrosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
| | - Olinda Santin
- Queen's University BelfastSchool of Nursing and Midwifery97 Lisburn RoadBelfastUKBT9 7BL
| | - Gillian Prue
- Queen's University BelfastSchool of Nursing and Midwifery97 Lisburn RoadBelfastUKBT9 7BL
| | - Helen Coleman
- Queen's University BelfastCentre for Public HealthInstitute of Clinical Sciences Block B, Royal Victoria Hospital SiteGrosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
| | - Chris R Cardwell
- Queen's University BelfastCentre for Public HealthInstitute of Clinical Sciences Block B, Royal Victoria Hospital SiteGrosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
| | - Peter O'Halloran
- Queen's University BelfastSchool of Nursing and Midwifery97 Lisburn RoadBelfastUKBT9 7BL
| | - Michael Donnelly
- Queen's University BelfastCentre for Public HealthInstitute of Clinical Sciences Block B, Royal Victoria Hospital SiteGrosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
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Lee MK, Suh SR. Effects of Peer-Led Interventions for Patients With Cancer: A Meta-Analysis. Oncol Nurs Forum 2019; 45:217-236. [PMID: 29466347 DOI: 10.1188/18.onf.217-236] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION To evaluate the effects of peer-led supportive interventions for patients with cancer.
. LITERATURE SEARCH Six electronic databases (EMBASE, MEDLINE®, Google Scholar, Cochrane Library, ProQuest Medical Library, and CINAHL®) were searched for articles published from 1997 to May 2017.
. DATA EVALUATION A total of 159 studies were identified. Eighteen (16 randomized, controlled trials [RCTs] and 2 non-RCTs) were eligible for systematic review and 16 for meta-analysis. The Cochrane risk of bias tool and Comprehensive Meta-Analysis software were used for analysis.
. SYNTHESIS The authors synthesized the results of the effect size of each trial according to cancer symptoms, coping, emotional health, quality of life, self-efficacy, sexuality, social support, and health-related behaviors.
. IMPLICATIONS FOR RESEARCH The findings from this study suggest that an additional tiered evaluation that has a theoretical underpinning and high-quality methodology is required to confirm the efficacy of peer-led supportive interventions within cancer care models.
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Porter LS, Samsa G, Steel JL, Hanson LC, LeBlanc TW, Bull J, Fischer S, Keefe FJ. Caregiver-guided pain coping skills training for patients with advanced cancer: Background, design, and challenges for the CaringPals study. Clin Trials 2019; 16:263-272. [PMID: 30782014 PMCID: PMC6533140 DOI: 10.1177/1740774519829695] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND/AIMS Pain is a major concern of patients with advanced cancer and their caregivers. There is strong evidence that pain coping skills training interventions based on cognitive-behavioral principles can reduce pain severity and pain interference. However, few such interventions have been tested for patients with advanced cancer and their family caregivers. This study aims to test the efficacy of a caregiver-guided pain coping skills training protocol on patient and caregiver outcomes. METHODS A total of 214 patients age ≥18 with Stage III-Stage IV cancer and moderate to severe pain, along with their family caregivers, are being identified and randomized with a 1:1 allocation to the caregiver-guided pain coping skills training intervention or enhanced treatment-as-usual. Dyads in both conditions receive educational resources on pain management, and the caregiver-guided pain coping skills training intervention includes three weekly 60-min sessions conducted with the patient-caregiver dyad via videoconference. Measures of caregiver outcomes (self-efficacy for helping the patient manage pain, caregiver strain, caregiving satisfaction, psychological distress) and patient outcomes (self-efficacy for pain management, pain intensity and interference, psychological distress) are collected at baseline and post-intervention. Caregiver outcomes are also collected 3 and 6 months following the patient's death. The study is enrolling patients from four tertiary care academic medical centers and one free-standing hospice and palliative care organization. The primary outcome is caregiver self-efficacy for helping the patient manage pain. RESULTS This article describes challenges in the design and implementation of the CaringPals trial. Key issues for trial design include the identification and recruitment of patients with advanced cancer and pain, and the follow-up and collection of data from caregivers following the patient's death. CONCLUSION The CaringPals trial addresses a gap in research in pain coping skills training interventions by addressing the unique needs of patients with advanced cancer and their caregivers. Findings from this study may lead to advances in the clinical care of patients with advanced cancer and pain, as well as a better understanding of the effects of training family caregivers to help patients cope with pain.
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Affiliation(s)
| | - Gregory Samsa
- 1 Duke University School of Medicine, Durham, NC, USA
| | | | - Laura C Hanson
- 3 Division of Geriatric Medicine & Palliative Care Program, University of North Carolina, Chapel Hill, NC, USA
| | | | - Janet Bull
- 4 Four Seasons Compassion for Life, Hendersonville, NC, USA
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Milbury K, Liao Z, Shannon V, Mallaiah S, Nagarathna R, Li Y, Yang C, Carmack C, Bruera E, Cohen L. Dyadic yoga program for patients undergoing thoracic radiotherapy and their family caregivers: Results of a pilot randomized controlled trial. Psychooncology 2019; 28:615-621. [PMID: 30659739 DOI: 10.1002/pon.4991] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 01/08/2019] [Accepted: 01/11/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Thoracic radiotherapy (TRT) may result in toxicities that are associated with performance declines and poor quality of life (QOL) for patients and their family caregivers. The purpose of this randomized controlled trial was to establish feasibility and preliminary efficacy of a dyadic yoga (DY) intervention as a supportive care strategy. METHODS Patients with stage I to III non-small cell lung or esophageal cancer undergoing TRT and their caregivers (N = 26 dyads) were randomized to a 15-session DY or a waitlist control (WLC) group. Prior to TRT and randomization, both groups completed measures of QOL (SF-36) and depressive symptoms (CES-D). Patients also completed the 6-minute walk test (6MWT). Dyads were reassessed on the last day of TRT and 3 months later. RESULTS A priori feasibility criteria were met regarding consent (68%), adherence (80%), and retention (81%) rates. Controlling for relevant covariates, multilevel modeling analyses revealed significant clinical improvements for patients in the DY group compared with the WLC group for the 6MWT (means: DY = 473 m vs WLC = 397 m, d = 1.19) and SF-36 physical function (means: DY = 38.77 vs WLC = 30.88; d = .66) and social function (means: DY = 45.24 vs WLC = 39.09; d = .44) across the follow-up period. Caregivers in the DY group reported marginally clinically significant improvements in SF-36 vitality (means: DY = 53.05 vs WLC = 48.84; d = .39) and role performance (means: DY = 52.78 vs WLC = 48.59; d = .51) relative to those in the WLC group. CONCLUSIONS This novel supportive care program appears to be feasible and beneficial for patients undergoing TRT and their caregivers. A larger efficacy trial with a more stringent control group is warranted.
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Affiliation(s)
- Kathrin Milbury
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Zhongxing Liao
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vickie Shannon
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Smitha Mallaiah
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Yisheng Li
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chunyi Yang
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cindy Carmack
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lorenzo Cohen
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Raque-Bogdan TL, Lamphere B, Kostiuk M, Gissen M, Beranek M. Unpacking the layers: a meta-ethnography of cancer survivors' loneliness. J Cancer Surviv 2019; 13:21-33. [PMID: 30414079 DOI: 10.1007/s11764-018-0724-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 10/20/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To review the empirical qualitative literature on cancer survivor's experiences with loneliness to inform assessments and interventions for improving cancer survivors' social well-being. METHODS A rigorous systematic review of qualitative studies published in five databases between 1993 and 2016 was conducted. Three coders reviewed 285 titles and abstracts and, after applying a critical review process, 20 manuscripts were synthesized using meta-ethnography. RESULTS The synthesis of the 20 studies provided a framework for understanding survivors' layers of loneliness at the level of the individual, their social support system, the healthcare system, and society. Internally, survivors described loneliness resulting from feelings of inauthenticity, of being alone in their cancer experience, and of lack of control. In their social networks, survivors attributed loneliness to others' avoidance, misperceptions of cancer, and others' failure to recognize the effects of cancer after active treatment. Unmet needs after treatment contributed to feelings of loneliness within the healthcare system. Further, societal stigma around cancer and pressures to experience growth after cancer created another layer of loneliness. The results suggest the need to move beyond an individual level perspective in assessing and treating loneliness in cancer survivors. CONCLUSIONS This meta-ethnography presents an integrated framework of loneliness in cancer survivors as a multi-layered experience. Implications for Cancer Survivors Conceptualizing loneliness from a systemic perspective adds missing pieces to the loneliness puzzle by encouraging assessment and intervention at interacting levels of functioning; considering how individuals respond to and are affected by their social systems can deepen our understanding of cancer survivorship.
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Affiliation(s)
- Trisha L Raque-Bogdan
- Department of Counseling Psychology, Morgridge College of Education, University of Denver, 1999 E. Evans Avenue, Denver, CO, USA.
| | - Brooke Lamphere
- Department of Counseling Psychology, Morgridge College of Education, University of Denver, 1999 E. Evans Avenue, Denver, CO, USA
| | - Marisa Kostiuk
- Department of Counseling Psychology, Morgridge College of Education, University of Denver, 1999 E. Evans Avenue, Denver, CO, USA
| | - Maura Gissen
- Department of Counseling Psychology, Morgridge College of Education, University of Denver, 1999 E. Evans Avenue, Denver, CO, USA
| | - Megan Beranek
- Department of Counseling Psychology, Morgridge College of Education, University of Denver, 1999 E. Evans Avenue, Denver, CO, USA
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Heckel L, Gunn KM, Livingston PM. The challenges of recruiting cancer patient/caregiver dyads: informing randomized controlled trials. BMC Med Res Methodol 2018; 18:146. [PMID: 30463520 PMCID: PMC6249774 DOI: 10.1186/s12874-018-0614-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 11/12/2018] [Indexed: 11/30/2022] Open
Abstract
Background Family members are increasingly involved in the care of cancer patients, however many are not prepared for this challenging role. Intervention-based studies are valuable to inform the most appropriate and effective support for caregivers. Barriers in the recruitment of patient/caregiver dyads exist but the reasons for non-participation are less well understood. This analysis determined the factors associated with participation in a randomized controlled trial involving patient/caregiver dyads, reasons for non-participation and factors associated with these reasons. Methods Patients with any type of cancer (other than non-melanoma skin cancer), and their caregiver were recruited at four Australian health services. Eligible patients were invited to participate together with their caregiver (N = 737). Non-participation data were collected from non-participants. Bivariate and binary logistic regression analyses were conducted to examine factors associated with participation. Results Of the 737 eligible dyads, 521 (71%) declined participation. Dyad characteristics associated with participation were caregiver gender, patient treatment modality and hospital type. The odds for participating were almost two times greater for female than male caregivers (p = 0.005); 13 times greater for patients receiving chemoradiotherapy compared to radiotherapy alone (p < 0.001); and three times greater for dyads attending a private versus public hospital (p < 0.001). Reasons for non-participation were lack of interest (33%), lack of time (29%), not requiring support (23%), too burdensome (15%); factors significantly associated with these reasons were treatment modality, patient age, cancer type, and hospital type. Patients diagnosed with prostate cancer and receiving chemotherapy alone were less likely to decline due to a lack of interest. Patients more likely to decline due to lack of time were those aged 40–59 years and receiving chemotherapy alone. Patients who were more likely to decline because they felt participation was too burdensome were those attending a private hospital for treatment. Conclusions To optimize recruitment, it is recommended that special attention is given to different cancer types and treatment modalities, gender and age. Approaching dyads at varied time points when their need for support is high is recommended. This analysis provides important information for researchers undertaking randomized controlled trials involving people diagnosed with cancer and their caregivers.
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Affiliation(s)
- Leila Heckel
- Faculty of Health, School of Nursing and Midwifery, Deakin University, Geelong, Victoria, 3220, Australia.
| | - Kate M Gunn
- Cancer Council SA, 202 Greenhill Road, Eastwood, South Australia, 5063, Australia.,Flinders Centre for Innovation in Cancer, School of Medicine, Flinders University, Sturt Road, Bedford Park, South Australia, 5042, Australia.,University of South Australia Cancer Research Institute, North Terrace, Adelaide, 5000, South Australia
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Reblin M, Sutton SK, Vadaparampil ST, Heyman RE, Ellington L. Behind closed doors: How advanced cancer couples communicate at home. J Psychosoc Oncol 2018; 37:228-241. [PMID: 30372376 DOI: 10.1080/07347332.2018.1508535] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Describe communication between patients with advanced cancer and their spouse/partner caregivers. DESIGN Prospective observational study. SAMPLE 83 advanced cancer patient-spouse caregiver couples. METHODS Couples completed surveys and recorded naturalistic communication for one day. Descriptive analysis was performed on self-report and observational communication data. FINDINGS Both patients and caregivers self-reported high likelihood of engaging in positive interactions. The majority of observed communication was logistical or social small-talk. Cancer and relationship talk was highly skewed; many couples had no talk in these domains. CONCLUSION This study is one of the first to assess continuous naturalistic observation of communication in the homes of couples coping with advanced cancer. We found that routine aspects of daily life continue even when couples are facing important challenges. Implications for Psychosocial Providers: There appear to be few naturalistic cues encouraging couples to discuss potentially difficult topics. More work is needed to determine appropriate levels of communication.
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Affiliation(s)
- Maija Reblin
- a Department of Health Outcomes & Behavior; Moffitt Cancer Center , Tampa , Florida , USA
| | - Steven K Sutton
- a Department of Health Outcomes & Behavior; Moffitt Cancer Center , Tampa , Florida , USA
| | - Susan T Vadaparampil
- b Department of Biostatistics and Bioinformatics, Moffitt Cancer Center , Tampa , Florida , USA
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Langer SL, Romano JM, Todd M, Strauman TJ, Keefe FJ, Syrjala KL, Bricker JB, Ghosh N, Burns JW, Bolger N, Puleo BK, Gralow JR, Shankaran V, Westbrook K, Zafar SY, Porter LS. Links Between Communication and Relationship Satisfaction Among Patients With Cancer and Their Spouses: Results of a Fourteen-Day Smartphone-Based Ecological Momentary Assessment Study. Front Psychol 2018; 9:1843. [PMID: 30364167 PMCID: PMC6191515 DOI: 10.3389/fpsyg.2018.01843] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/10/2018] [Indexed: 11/13/2022] Open
Abstract
Cancer treatment poses significant challenges not just for those diagnosed with the disease but also for their intimate partners. Evidence suggests that couples' communication plays a major role in the adjustment of both individuals and in the quality of their relationship. Most descriptive studies linking communication to adjustment have relied on traditional questionnaire methodologies and cross-sectional designs, limiting external validity and discernment of temporal patterns. Using the systemic-transactional model of dyadic coping as a framework, we examined intra- and inter-personal associations between communication (both enacted and perceived) and relationship satisfaction (RS) among patients with stage II-IV breast or colorectal cancer and their spouses (N = 107 couples). Participants (mean age = 51, 64.5% female patients, and 37.4% female spouses) independently completed twice-daily ecological momentary assessments (EMA) via smartphone for 14 consecutive days. Items assessed RS and communication (expression of feelings, holding back from expression, support and criticism of partner, and parallel ratings of partner behavior). Linear mixed models employing an Actor Partner Interdependence Model were used to examine concurrent, time-lagged, and cross-lagged associations between communication and RS. Expressing one's feelings was unassociated with RS. Holding back from doing so, in contrast, was associated with lower RS for both patients and spouses in concurrent models. These effects were both intrapersonal and interpersonal, meaning that when individuals held back from expressing their feelings, they reported lower RS and so too did their partner. Giving and receiving support were associated with one's own higher RS for both patients and spouses in concurrent models, and for patients in lagged models. Conversely, criticizing one's partner and feeling criticized were maladaptive, associated with lower RS (own and in some cases, partner's). Cross-lagged analyses (evening RS to next-day afternoon communication) yielded virtually no effects, suggesting that communication may have a stronger influence on short-term RS than the reverse. Findings underscore the importance of responsive communication, more so than expression per se, in explaining both concurrent and later relationship adjustment. In addition, a focus on holding back from expressing feelings may enhance the understanding of RS for couples coping with cancer.
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Affiliation(s)
- Shelby L Langer
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Joan M Romano
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Michael Todd
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | | | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Jonathan B Bricker
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Neeta Ghosh
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - John W Burns
- Department of Behavioral Sciences, Rush Medical College, Rush University, Chicago, IL, United States
| | - Niall Bolger
- Department of Psychology, Columbia University, New York, NY, United States
| | - Blair K Puleo
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Julie R Gralow
- Medical Oncology, University of Washington School of Medicine, Seattle, WA, United States
| | - Veena Shankaran
- Medical Oncology, University of Washington School of Medicine, Seattle, WA, United States
| | - Kelly Westbrook
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - S Yousuf Zafar
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Laura S Porter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
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Porter LS, Gao X, Lyna P, Kraus W, Olsen M, Patterson E, Puleo B, Pollak KI. Pilot randomized trial of a couple-based physical activity videoconference intervention for sedentary cancer survivors. Psychol Health 2018; 37:861-865. [PMID: 30138021 PMCID: PMC9840846 DOI: 10.1037/hea0000608] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Including partners in interventions to increase physical activity (PA) could promote better adherence and longer-term effects. In preparation for a future large-scale randomized controlled trial (RCT), this randomized pilot trial tested the acceptability of a novel couple-based PA intervention for breast and prostate cancer survivors and the feasibility of conducting an RCT testing the intervention. METHOD Twenty cancer survivors (70% female; mean age = 63.0 years, SD = 8.9) and their partners (35% female; mean age = 62.8 years, SD = 7.7) were randomized to either the intervention or waitlist control. Couples in the intervention received four videoconference sessions including training in communication and support skills and behavior change techniques. Measures of PA and partner support for exercise were collected from survivors and partners before randomization and postintervention. Survivors also completed a physical well-being measure, and intervention participants completed a treatment acceptability measure. RESULTS Recruitment was challenging; approximately 18% of eligible survivors and their partners agreed to participate. Ninety-two percent of randomized participants completed postintervention surveys, and 78% of dyads randomized to the intervention arm completed all 4 sessions. Mean acceptability ratings were moderate to high. Mean difference scores suggested that participants in the intervention arm tended to report greater improvements in PA, partner support, and physical well-being than those in the control arm. CONCLUSIONS These preliminary findings suggest that the couple-based PA intervention was acceptable to survivors and their partners and that a large-scale RCT is likely to be feasible with modified recruitment strategies. Recommendations for improving recruitment and conducting a larger study are presented. (PsycINFO Database Record
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Affiliation(s)
- Laura S Porter
- Cancer Control and Population Sciences, Duke Cancer Institute
| | - Xiaomei Gao
- Cancer Control and Population Sciences, Duke Cancer Institute
| | - Pauline Lyna
- Cancer Control and Population Sciences, Duke Cancer Institute
| | | | - Maren Olsen
- Department of Biostatistics and Bioinformatics
| | | | - Blair Puleo
- Department of Psychiatry and Behavioral Sciences
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Porter LS, Fish L, Steinhauser K. Themes Addressed by Couples With Advanced Cancer During a Communication Skills Training Intervention. J Pain Symptom Manage 2018; 56:252-258. [PMID: 29704618 PMCID: PMC6082423 DOI: 10.1016/j.jpainsymman.2018.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 04/16/2018] [Accepted: 04/18/2018] [Indexed: 11/26/2022]
Abstract
CONTEXT Couple-based communication interventions have beneficial effects for patients with cancer and their partners. However, few studies have targeted patients with advanced stages of disease, and little is known about how best to assist couples in discussing issues related to life-limiting illness. OBJECTIVES The purpose of the present study was to identify themes addressed by couples during a Couples Communication Skills Training intervention and the frequency with which they discussed issues related to end of life. METHODS Content analyses were conducted on recordings of 72 sessions from 12 couples facing advanced gastrointestinal cancer. Coding was based on six themes identified a priori from the framework for understanding what patients and family value at end of life. The percent of couples addressing each theme was calculated to gauge level of importance and acceptability of these topics. RESULTS The majority of couples addressed topics previously identified as salient at end of life, including clear decision making, affirmation of the whole person, pain and symptom management, contributing to others, and preparation for death. In addition, novel aspects to these themes emerged in the context of couples' conversations, illustrating the importance of the couple relationship in adjusting to life with a life-limiting illness and anticipating the transition to end of life. CONCLUSION Findings suggest that couples likely would be receptive to an intervention that combines training in communication skills with guidance in focusing on issues related to life completion to assist with transitions at end of life. Such interventions might enhance both individuals' abilities to cope with illness-related symptoms and demands, enjoy the time they have together, and derive meaning from the experience.
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Affiliation(s)
| | | | - Karen Steinhauser
- Duke University Medical Center; Durham VA Medical Center, Durham, North Carolina, USA
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Langer SL, Porter LS, Romano JM, Todd MW, Lee SJ. A Couple-Based Communication Intervention for Hematopoietic Cell Transplantation Survivors and Their Caregiving Partners: Feasibility, Acceptability, and Change in Process Measures. Biol Blood Marrow Transplant 2018; 24:1888-1895. [PMID: 29772351 DOI: 10.1016/j.bbmt.2018.05.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022]
Abstract
Hematopoietic cell transplantation (HCT) poses significant challenges for recipients and their caregiving partners. Couples may refrain from talking about treatment-related fears and concerns to minimize distress. This single-group, pre-post study examined feasibility and acceptability of an intervention designed to optimize communication between HCT patients and partners; it also assessed change in process measures. Couples met with a therapist 5 times to learn skills for disclosing illness-related thoughts and feelings and responding supportively to one another. The extent to which participants disclosed thoughts, feelings, and information during the session and felt supported was assessed at the close of each session. Forty of 89 eligible couples consented (45%). Thirty couples commenced intervention 1-month post-transplant; 26 of these completed all sessions (87%) and 27 completed follow-up (90%). Ratings of self-disclosure and feeling supported by one's partner increased linearly across intervention sessions among both patients and caregivers (all P ≥ .01). Ratings of satisfaction with the intervention were high. HCT couples can be recruited and retained for this intervention. They found it acceptable and were amenable to skills training. A randomized trial is needed to test efficacy and to identify moderators of treatment response.
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Affiliation(s)
- Shelby L Langer
- College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona.
| | - Laura S Porter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Joan M Romano
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Michael W Todd
- College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Porter LS, Keefe FJ. Couple-based communication interventions for cancer: moving beyond a 'one size fits all' approach. Acta Oncol 2018; 57:693-695. [PMID: 29219014 DOI: 10.1080/0284186x.2017.1400687] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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