What do 1281 distress screeners tell us about cancer patients in a community cancer center?

OBJECTIVE: The 2008 Institute of Medicine's Report, Cancer Care for the Whole Patient (IOM, 2008), recommends screening cancer patients for distress. Cancer programs throughout the United States are struggling to achieve this standard. The IOM report indicates that only 14% of 1000 randomly selected American Society of Clinical Oncology (ASCO) members and eight of 15 National Comprehensive Cancer Network (NCCN) centers reported screening for distress in at least some of their patients [J Natl Compr Cancer Netw 2007;5:99-103]. Without adequate screening, distress often goes unnoticed by cancer professionals and there is little information about the prevalence of distress. The main objective of this article is to present data from 1281 distress screenings completed by patients treated within a community cancer center. Specifically, this article reports the intensity of distress, frequency of problem endorsement, and requests for specific psychosocial providers by cancer patients. METHOD: Medical and radiation oncology patients completed a distress screener before their first physician appointment. The screening instrument included the Distress Thermometer, a symptom checklist, and a list of psychosocial providers that the patient could request to meet. RESULTS: Thirty-two percent of this sample rated distress above the threshold level. Worry was the most common problem endorsed followed by financial issues. Emotional concerns were endorsed by 59% of the sample. The cancer dietitian was the psychosocial professional most frequently requested by patients. CONCLUSION: Distress screening can be accomplished within a community cancer center but the provision of psychosocial services is difficult given the high volume of need.

Affective differentiation in breast cancer patients.

Fifty-three breast cancer patients completed an Internet-based diary measuring daily negative affect and positive affect and daily negative and positive events for seven consecutive evenings shortly after surgery. The authors used Hierarchical Linear Modeling (Raudenbush and Bryk in Hierarchical linear models: applications and data analysis methods. Sage, Thousand Oaks, CA, 2002) to examine moderators of affective differentiation, or the daily relationship between the patients' negative affect and positive affect. Strong affective differentiation is characterized by the relative independence of negative and positive affect. There were no significant Level 1 (within-subject) moderators of affective differentiation. However, at Level 2 (between-subject), as predicted, increased age was associated with stronger affective differentiation, as was greater use of planning to cope with breast cancer. Also as predicted, increased anxiety and greater use of behavioral disengagement and denial coping were associated with weaker affective differentiation. The results suggest the value of the affective differentiation construct, and a daily diary methodology, for research on the daily lives of breast cancer patients.

What do newly diagnosed cancer patients discuss with survivors?

The Cancer Companion Program at the Helen F. Graham Cancer Center is a peer-to-peer telephone-based program that connects a newly diagnosed cancer patient with a previous cancer patient with the same diagnosis. Similar peer support and telephone-based programs have been studied, and many benefits have been found in previous studies. As such, this study focuses not on program efficacy, but rather aims to understand the topics that newly diagnosed cancer patients discuss with cancer survivors. Participants in this study were 41 newly-diagnosed cancer patients who had requested to be matched with a volunteer cancer companion. Content analysis of the phone call logs demonstrated that patients discussed treatment-related, psychological, and day-to-day concerns. These results are discussed in terms of educating physicians, nurses, and psychosocial cancer care practitioners about the issues which are most important to newly diagnosed cancer patients.

Multidisciplinary care for life after cancer: a survivor's center.

This article introduces the most recent definition of cancer survivor and the empirical data demonstrating the barriers that are often faced by patients following cancer treatment. The article then describes a novel use of the oncology multidisciplinary care model to address those issues, which is one of the first of its kind in the nation. The article is closed with a case example.

African Americans' knowledge of cancer genetic counseling: an examination of information delivery.

Two groups totaling 44 African Americans from two community churches were examined to determine the impact of two presentations on the uptake of genetic counseling educational material. Both presentations were developed with adult learning theory principles and offered information about cancer genetic risk assessment. The second presentation was enhanced to include a description, with pictures, of a culturally relevant fictitious family's course through risk assessment. Hypotheses were: a) knowledge would increase for each group and b) culturally relevant pictures and a family description would increase satisfaction with the presentation. A pre- and post-assessment was conducted with pre-assessment including demographic information and a knowledge questionnaire. Post-assessment included the knowledge questionnaire and a presentation satisfaction questionnaire. Independent t tests were used to analyze the gain scores between pre- and post-knowledge questionnaires and the satisfaction scores between groups. These results are discussed in terms of decreasing disparities in African Americans' participation in risk assessment through community outreach educational programs.

The daily moment: a stress reduction program for cancer center staff.

Keeping members of the oncology team from being overwhelmed by the stress of their jobs is a major concern at the Helen E. Graham Cancer Center and every cancer center around the country. The impact of stressors experienced as a result of caring for people is felt heavily not only by physicians and nurses, but also by each staff member in a cancer center. In addition to caregiving stressors, all cancer center staff experience corporation-style stressors such as staffing shortages, long hours, tight schedules, and limited resources. Therefore, the importance of finding innovative mechanisms for all staff to reduce their stress levels and develop stronger bonds with their coworkers is paramount. Given the stressors mentioned above, the Daily Moment program was developed. This involves staff gathering before morning rounds to listen to a staff member read an inspirational quote or an appropriate joke. The Daily Moment was developed with the following goals: (1) occur daily but not require much time, (2) energize staff for the day, (3) be effective for all levels of staffing, and (4) improve coworker relationships and interactions. Participation in the Daily Moment was voluntary. After 6 weeks of implementation, a survey was administered to all staff. Results indicated that all goals for the program were accomplished, and they demonstrated that innovative stress reduction programs may require little time and still generate positive influences on a cancer center staff. Finally, the simplicity of this program allows it to be instituted at any facility at any time with no cost.

Priorities in behavioral science education: views of practicing family physicians.

BACKGROUND AND OBJECTIVES: The behavioral science curriculum in family practice residency programs consists of a wide range of diverse topics. Because of time limitations, not all topics receive equal emphasis. The goal of the present study was to replicate a previous study with family physicians practicing in a different geographical area. METHODS: Questionnaires were mailed to a sample of 543 family physicians in Mississippi. Respondents were asked to rate each of 28 behavioral science topics according to the priority to be given in residency education. RESULTS: One hundred eighty-five surveys were returned for a 34% response rate. The rank order of topics in the present study was highly similar to the rank order in the original study. Female physicians had higher overall mean ratings. CONCLUSIONS: This sample of family physicians in Mississippi provided similar ratings to those in a previous study of family physicians trained and/or practicing in Colorado. The results support that, regardless of geographic location and practice characteristics, family physicians hold similar opinions about which behavioral science topics should receive highest priority in residency training. The behavioral science curriculum in family practice residency programs consists of a wide range of diverse topics. Because of time limitations, not all topics receive equal emphasis. Published resources provide helpful lists of topics and teaching strategies but do not specify which areas should be given priority. Consequently, behavioral science teachers may have difficulty prioritizing the topics because there is no agreement on the core competencies to be given highest priority in residency education. In a previous study, investigators sent a survey to practicing family physicians to determine the topics of behavioral science considered to be most important in residency education. The physicians were able to identify specific topics to be given higher priority. While these previous results were useful, the study was limited by the homogeneity of the sample. All the family physicians had trained or were currently practicing in the state of Colorado. The goal of the present study was to replicate the original study with family physicians practicing in a different geographical area.

Psychosocial oncology in Delaware: advances in treating cancer-related distress.

This article introduces the field of psychosocial oncology, which is a subspecialty within the larger field of oncology. Data from randomized, controlled clinical trials are presented to support the use of behavioral therapeutic methodologies in the management of affective distress in Delaware's cancer patient population. The article is completed with a description of two innovative psychosocial programs that are new to Delaware.

Using adult learning theory concepts to address barriers to cancer genetic risk assessment in the African American community.

Utilization of cancer genetic risk assessment can be profoundly influenced by an individuals' knowledge of risk assessment, attitudes regarding illness and healthcare, and affective reactions derived from social norms. Race and ethnicity play a powerful role in the development of an individual's attitudes and should be considered when attempting to understand a person's openness to cancer genetic risk assessment (Lannin et al., 1998). Until recently, however, cancer screening and prevention programs have been primarily based on data from studies conducted with the Caucasian population, yielding data that are not fully applicable to the African American community. In the last several years, research findings regarding African American's knowledge, attitudes, and feelings about genetic counseling and testing have grown (Matthews et al., 2000; Singer et al., 2004; Thompson et al., 2003). However, to the authors' knowledge, these data have yet to be presented in a manner that both summarizes the barriers that African Americans have reported regarding cancer genetic risk assessment, while at the same time suggesting methods individual genetic counselors can utilize during community presentations to help address these barriers. This article will first summarize previous empirical findings regarding African Americans' knowledge, attitudes, and feelings about cancer genetic risk assessment. The article will then apply adult learning theory to those findings to provide genetic counselors with practical, theory based techniques to apply toward community based educational programs with African American groups.