The Impact of Optimism on Cancer-Related and Postsurgical Cancer Pain: A Systematic Review.

BACKGROUND: The impact of psychological factors on pain levels continues to be of interest throughout a cancer patient's journey. The relationship between pain and optimism has been described previously in patients with various diseases. OBJECTIVES: We further investigated the effect of optimism on pain levels felt by patients diagnosed and living with cancer before and after surgery. MATERIALS AND METHODS: The search strategy for relevant articles from inception through June 2020 included five databases. The main outcome of interest was the effect of optimism on cancer-related pain. RESULTS: We identified 482 studies. After the full-text screening, seven articles meeting the inclusion criteria were included. Seven studies were analyzed and are included in the data table. Of the seven included articles, four articles described the association of optimism with cancer pain; four articles studied the relationship between optimism and chronic postsurgical pain (CPSP), and one article investigated optimism's relationship with acute postsurgical pain (APSP). All articles observed a negative correlation between optimism and pain levels. CONCLUSION: Despite the differences in the pathophysiology of pain types investigated, and which stage of the patient's journey pain was experienced, all studies reported a negative association with the level of optimism and pain described by patients. Therefore, promoting and supporting psychological coping techniques, including optimism for cancer patients may decrease patients' suffering, increase their quality of life at different cancer stages, and reduce opioid use.

Medical Cannabis State and Federal Regulations: Implications for United States Health Care Entities.

Thirty-six states and four territories in the United States have legalized cannabis for medical and/or recreational use. Marijuana, however, continues to be classified as a schedule I substance under the Federal Controlled Substance Act and remains illegal under US federal law. The incongruity between state and federal legislation creates various challenges for stakeholders: patients, medical trainees, providers, and health care institutions. This communication provides an overview of the major policies impacting Cannabis sativa use within the United States, various state and federal regulations, and highlights potential implications for health care institutions moving forward. Existing literature, regulations, and policies on medical marijuana (MMJ) use in health care settings were searched, reviewed, analyzed, and distilled. As a consequence of legislative inconsistencies, there is insufficient clarity and resultant challenges regarding MMJ usage, prescription, possession, education, and research-related policies for health care stakeholders across the United States. Coupled with limited scientific evidence on the clinical efficacy of MMJ, the needs of the patient and the quality of health care delivery may be affected as hospitals balance the competing risks of being legislatively compliant while protecting the rights of patients and health care employees. There is a recognized need to better define acceptable MMJ policies and regulations in health care settings that are evidence-based, legally compliant, and adequately address the needs of both patients and providers. Given the complexity of the legal and policy landscape, there are potential opportunities for improvement, including in medical education and training, research, and usage oversight of MMJ for stakeholders in the United States.

Bridging Intention and Action for Employee Well-Being Using the Intentional Action (InAct) Process: Workshop-Lecture Series.

BACKGROUND: Employee wellness programs can help manage stress and alleviate burnout. OBJECTIVE: To pilot and disseminate the Intentional Action(InAct) concept for employee wellbeing. METHODS: Five independent interactive workshop-lectures with an automated audience response system. Descriptive analysis of participant response data. RESULTS: Participants (n = 275): rated spirituality, physical environment and nutrition the most highly in contributing to their present well-being. Ninety-eight percent (n = 269) of participants identified a focus area to work on. The well-being area most selected was Exercise, (35% n = 95), however, other non-traditional areas, including Personal and Professional Development (18% n = 48), Relationships and Communication (17% n = 47), were selected, along with mind-body connection and mindful awareness (6% n = 15 and n = 16). CONCLUSION: The pilot engaged employees to reflect and set goals for their future well-being. Healthcare institutions implementing programs should consider a broad range of whole person strategies addressing employee well-being, which go beyond the traditional focus on exercise and nutrition.

Seeing what works: identifying and enhancing successful interprofessional collaboration between pathology and surgery.

Utilising frozen section technologies, Mayo Clinic has one of the lowest reoperation rates for breast lumpectomy in the United States. The research reported on sought to understand the successful teamwork between the Breast Surgery Team and the Frozen Section Laboratory at Mayo Clinic. Researchers worked collaboratively with healthcare staff from breast surgery and the frozen section pathology laboratory to identify communication styles and strategies that contribute to the timely and accurate intraoperative evaluation of breast cancer specimens. Using the video-reflexive ethnography (VRE) methodology underpinned by a positive theoretical approach to researching quality and safety in healthcare, the researchers video-recorded the communications associated with specimen resections in surgery and the subsequent pathology diagnoses. Then, 57 staff from the breast surgery and frozen section laboratory teams attended video-reflexivity sessions to collaboratively analyse their communication practices and identify opportunities to optimize interprofessional communication. In this article, we focus on how the flexible, interdisciplinary, and cross-hierarchical communication within the frozen section laboratory supports a rapid and accurate intraoperative evaluation and communication, previously conceptualized by staff as being performed in a linear fashion. Moreover, we detail how the VRE methodology led surgeons and pathologists to implement new strategies and optimize their interprofessional communication.

A systematic review of shared decision making interventions in chronic conditions: a review protocol.

BACKGROUND: Chronic conditions are a major source of morbidity, mortality and cost worldwide. Shared decision making is one way to improve care for patients with chronic conditions. Although it has been widely studied, the effect of shared decision making in the context of chronic conditions is unknown. METHODS/DESIGN: We will perform a systematic review with the objective of determining the effectiveness of shared decision making interventions for persons diagnosed with chronic conditions. We will search the following databases for relevant articles: PubMed, Scopus, Ovid MEDLINE, Ovid EMBASE, Ovid EBM Reviews CENTRAL, CINAHL, and Ovid PsycInfo. We will also search clinical trial registries and contact experts in the field to identify additional studies. We will include randomized controlled trials studying shared decision making interventions in patients with chronic conditions who are facing an actual decision. Shared decision making interventions will be defined as any intervention aiming to facilitate or improve patient and/or clinician engagement in a decision making process. We will describe all studies and assess their quality. After adjusting for missing data, we will analyze the effect of shared decision making interventions on outcomes in chronic conditions overall and stratified by condition. We will evaluate outcomes according to an importance ranking informed by a variety of stakeholders. We will perform several exploratory analyses including the effect of author contact on the estimates of effect. DISCUSSION: We anticipate that this systematic review may have some limitations such as heterogeneity and imprecision; however, the results will contribute to improving the quality of care for individuals with chronic conditions and facilitate a process that allows decision making that is most consistent with their own values and preferences. TRIAL REGISTRATION: PROSPERO Registration Number: CRD42013005784.