Improving access to cancer information and supportive care services: A systematic review of mechanisms applied to link people with cancer to psychosocial supportive care services.

OBJECTIVE: Previous research has described the low uptake of psychosocial support services in people living with cancer. While characteristics of individuals using services have been examined, mechanisms applied to link individuals to support services are less frequently considered. This review aims to identify the mechanisms used to link people with cancer to support services and assess their impact. METHODS: Systematic searches of Pubmed, CINAHL, EMBASE and PsycINFO were conducted up to May 2020. Studies reporting service use associated with mechanisms to link adults with cancer to support services targeting emotional, informational, practical or social support needs were eligible. Eligible study designs included controlled trials, pre-post designs and observational studies. Study quality was assessed and a narrative synthesis of findings undertaken. RESULTS: A total of 10 papers (from 8,037 unique titles) were eligible. Testing the feasibility of the linkage mechanism was the primary aim in five (50%) studies. Three linkage mechanisms were identified: (a) outreach from the support service; (b) clinician recommendation/referral; (c) mailed invitation. Outreach was the most successful in connecting people with cancer to services (52%-90% use); clinician recommendation/referral was least successful (3%-28%). The impact of different linkage mechanisms for different demographic groups was not assessed. CONCLUSIONS: Outreach from services shows the most potential for increasing access to support services. However, the limited number of studies and limitations in the types of support services people with cancer were linked to, demonstrated the need for further work in this area. Identifying mechanisms that are effective for underserved, high-needs patient groups is also needed.

Combined Smoking Cues Enhance Reactivity and Predict Immediate Subsequent Smoking.

Introduction: Cue reactivity (CR) research has reliably demonstrated robust cue-induced responding among smokers exposed to common proximal smoking cues (eg, cigarettes, lighter). More recent work demonstrates that distal stimuli, most notably the actual environments in which smoking previously occurred, can also gain associative control over craving. In the real world, proximal cues always occur within an environment; thus, a more informative test of how cues affect smokers might be to present these two cue types simultaneously. Methods: Using a combined-cue counterbalanced CR paradigm, the present study tested the impact of proximal (smoking and neutral) + personal environment (smoking and nonsmoking places) pictorial cues, on smokers' subjective and behavioral CR; as well as the extent to which cue-induced craving predicts immediate subsequent smoking in a within-subjects design. Results: As anticipated, the dual smoking cue combination (ProxS + EnvS) led to the greatest cue-induced craving relative to the other three cue combinations (ProxS + EnvN, ProxN + EnvS, and ProxN ± EnvN), ps < .004. Dual smoking cues also led to significantly shorter post-trial latencies to smoke, ps < .01. Overall CR difference score (post-trial craving minus baseline craving) was predictive of subsequent immediate smoking indexed by: post-trial latency to smoke [B = -2.69, SE = 9.02; t(143) = -2.98, p = .003]; total puff volume [B = 2.99, SE = 1.13; t(143) = 2.65, p = .009]; and total number of puffs [B = .053, SE = .027; t(143) = 1.95, p = .05]. Conclusions: The implications of these findings for better understanding the impact of cues on smoking behavior and cessation are discussed. Implications: This novel cue reactivity study examined smokers' reactivity to combined proximal and distal smoking cues. Exposure to a combination of two smoking cues (proximal and environment) led to the greatest increases in cue-induced craving and smoking behavior compared to all other cue combinations. Further, the overall magnitude of cue-induced craving was found to significantly predict immediate subsequent smoking. This work provides new insight on how exposure to various cues and cue combinations directly affect smokers' craving and actual smoking behavior, as well as the relationship between those two indices of reactivity.

Reducing stress and burnout in the public-sector work environment: A mindfulness meditation pilot study.

ISSUE ADDRESSED: Identifying ways to manage the psychological and emotional costs of workplace stress is essential. Mindfulness meditation is reported to support mental well-being; however, findings are limited in Australian business settings. Accordingly, this study explored the efficacy of a mindfulness meditation program tailored for an Australian public-sector workplace. METHODS: A mixed-methods, single-group, pre-/post-test design was used to evaluate a proof-of-concept mindfulness intervention. Quantitative measures included the Perceived Stress Scale and Maslach Burnout Inventory. Survey data were collected to analyse participant experiences. Participants (n = 65) were recruited from a government organisation. The 8-week program ran weekly for 45 minutes and had a 65% retention rate. Resources were provided to support home practice. RESULTS: Statistically significant decreases were obtained for perceived stress (d = 0.8) and emotional exhaustion (d = 0.4). Themes from qualitative findings suggested participants experienced an increased recognition of stress triggers, increased ability to detach from stressors, increased calmness and increased ability to prioritise work. CONCLUSIONS: Qualitative results extend comparable quantitative research by detailing how an appropriately tailored 8-week meditation-based program has the potential to decrease perceived stress in highly stressful work environments. SO WHAT?: Triangulated data suggest that an appropriately adapted mindfulness meditation program can be an effective, efficient and low-cost inclusion within an organisation's health promotion repertoire to help increase mental health among staff.

Hostile mood and social strain during daily life: a test of the transactional model.

BACKGROUND: Hostility is a multidimensional construct related to cardiovascular (CV) disease risk. Daily hostile mood and social interactions may precipitate stress-related CV responses in hostile individuals. PURPOSE: Determine whether trait cognitive hostility best predicts daily hostile mood and social interactions relative to other trait hostility factors and explore the temporal links between these daily measures. METHODS: One hundred seventy-one participants completed assessments of four trait hostility scales. Participants completed an electronic diary across 3 days, assessing current hostile mood and social interaction quality. RESULTS: Multiple regression analyses revealed both affective and cognitive hostility to be significant predictors of daily hostile mood, and cognitive hostility alone to predict daily social strain. Additional analyses revealed previous social strain to predict elevated subsequent hostile mood. CONCLUSIONS: Episodes of social strain may give rise to elevated hostile mood. Trait cognitive hostility may be an important factor in predicting daily social strain.

Does cultural competence training for health professionals impact culturally and linguistically diverse patient outcomes? A systematic review of the literature.

OBJECTIVE: To assess the impact of cultural competence training for health professionals on patient outcomes. METHOD: A systematic review of cultural competence training interventions for healthcare workers including papers published January 2010 to January 2021, identified through MEDLINE, CINAHL, ERIC and APA PsychINFO. Health conditions were not specified, however, only studies reporting patient outcomes were included. Training frameworks and delivery, measures of health professional cultural competence, and patient outcomes were reviewed. RESULTS: Of 7879 unique studies identified, five met inclusion criteria including two randomised control trials, two mixed method and one multi-method pre/post study. Professionals reported the training was beneficial, and some improvements in patient perceptions of health providers' cultural competence were found. However, patient health outcomes did not improve significantly in any study. CONCLUSION: Cultural competence training is promoted to improve outcomes of patients from culturally diverse backgrounds; however, few studies assess outcomes when examining training impact. Inconsistencies in theoretical frameworks and training makes it difficult to assess the efficacy of training on patient outcomes. RESULTS: Of 7879 unique studies identified, five met inclusion criteria including two randomised control trials, two mixed method and one multi-method pre/post study. Professionals reported the training was beneficial, and some improvements in patient perceptions of health providers' cultural competence were found. However, patient health outcomes did not improve significantly in any study. CONCLUSION: Cultural competence training is promoted to improve outcomes of patients from culturally diverse backgrounds; however, few studies assess outcomes when examining training impact. Inconsistencies in theoretical frameworks and training makes it difficult to assess the efficacy of training on patient outcomes. PRACTICE IMPLICATIONS: To ascertain the benefits of health professional cultural competence training on patient outcomes, research needs to address the issues of definition, theoretical frameworks and implementation approaches to training.

Can exercise alleviate sleep disturbances during acute nicotine withdrawal in cigarette smokers?

Sleep disturbances, including insomnia (difficulty falling or staying asleep), are common nicotine withdrawal symptoms particularly during the initial stage of nicotine abstinence, and increase the likelihood of relapse within the first 4 weeks of quitting. Although clinically recognized as a key symptom of nicotine withdrawal, sleep disturbances are not addressed in the clinical guidelines for nicotine dependence treatment. Unfortunately, Nicotine Replacement Therapy (NRT) and other pharmacologic interventions do not attenuate withdrawal-provoked sleep disturbances, with several even exacerbating sleep disruption. The present study tested the impact of 30-min of daily moderate exercise, morning versus evening, on key polysomnographic indicators of sleep disturbances during initial 3 days (72 hr) of nicotine withdrawal. Forty-nine daily smokers (53% male) completed 3 separate abstinence periods, during which they completed either morning exercise, evening exercise, or a nonexercising magazine reading control condition. Order of condition was counterbalanced across subjects with a 1-week wash out in between each 3-day abstinence period. Exercise engagement mitigated several changes in sleep architecture associated with acute nicotine deprivation and other time-related effects on sleep, specifically frequency of arousals (B = -2.8, SE = .95; t(1271) = -3.0, p = .003) and reductions in sleep maintenance (B = .58, SE = .21; t(1270) = 2.8, p = .005). Additionally, smokers who reported greater perceived withdrawal severity had the longest latency to fall asleep but experienced the greatest attenuation of this effect following PM exercise. Overall, results suggest a role for exercise as an adjunct smoking cessation treatment to specifically target sleep disturbances during early acute nicotine withdrawal. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Autonomic characteristics of defensive hostility: reactivity and recovery to active and passive stressors.

The autonomic characteristics of hostility and defensiveness were assessed in 55 male undergraduates based on composite Cook Medley Hostility (Chost) and Marlowe Crowne Social Desirability (MC) scores to create 4 groups: Defensive Hostile (DH; high MC, high Chost), High Hostile (HH; low MC, high Chost), Defensive (Def; high MC, low Chost) and Low Hostile (LH; low MC, low Chost). All subjects engaged in a video game (VG) and hand cold pressor (CP) task. Cardiovascular responses in DH subjects were predicted to show enhanced sympathetic alpha and beta-adrenergic activity and the least vagal control compared to others across tasks. DH and LH men showed significant heart rate reactivity to the CP task compared to HH men. LH men showed significant reductions in high frequency power (vagal assessment) to the tasks compared to HH men. Future studies may employ harassment techniques and include the factors of gender and ethnicity in their assessments.

Examining the relationship between cue-induced craving and actual smoking.

Smoking cue-reactivity studies have consistently demonstrated heightened self-report craving, as well as moderate autonomic reactivity, among smokers exposed to salient drug-related cues. However, significantly fewer studies have examined whether exposure to smoking cues affects smokers' actual smoking, or examined the predictive relationship between cue-induced craving and smoking behavior. Using our well-tested pictorial cues in a cue-reactivity paradigm, we investigated the impact of smoking-related cues relative to neutral cues on subjective craving and smoking behavior (assessed via CReSS; Plowshare Technologies, Baltimore, MD) measures of latency to smoke, puff volume, and number of puffs). Further, we examined the predictive value of cue-induced craving on subsequent smoking behavior. Sixty nondeprived daily smokers completed 2 experimental sessions involving exposure to either smoking-related or neutral pictorial cues. Following initial exposure to cues, smokers rated their craving and were then allowed to smoke freely if they chose to during a subsequent 6-min cue exposure period. Result showed that exposure to smoking cues relative to neutral predicted significantly greater craving and increases in smoking behavior. Likewise, the magnitude of the difference in cue-induced craving when exposed to smoking cues relative to neutral cues (i.e., the cue-reactivity effect) was highly predictive of shorter latency to smoke, as well as increased number of puffs and puff volume.

Participation in outdoor recreation program predicts improved psychosocial well-being among veterans with post-traumatic stress disorder: a pilot study.

PURPOSE: Evaluate the effectiveness of a 2-day, 3-night outdoor recreation intervention involving fly-fishing in reducing the psychological concomitants of stress among 74 veterans (M = 47.27, SD = 14.55 years) with post-traumatic stress disorder (PTSD). METHODS: Participants completed repeated assessments of attentiveness, mood, depression, anxiety, and somatic stress across 3 time periods, corresponding to 2 weeks before the trip (baseline), the last day of the trip, and a 6-week follow-up. Assessments of perceptual stress, PTSD symptoms, and sleep quality were also administered during the baseline and follow-up periods. RESULTS: Acute effects were observed for improvements in attentiveness and positive mood states, coupled with significant and sustained reductions in negative mood states, anxiety, depression, and somatic symptoms of stress. Comparisons between the baseline and follow-up periods revealed significant improvements in sleep quality and reductions in perceptual stress and PTSD symptoms. CONCLUSIONS: The current findings suggest that combat veterans with PTSD may benefit from participation in group-based outdoor recreation as a means to improve psychosocial well-being.

A retrospective comparison of water birth and conventional vaginal birth among women deemed to be low risk in a secondary level hospital in Australia.

BACKGROUND: Water birth involves the complete birth of the baby under warm water. There is a lack of consensus regarding the safety of water birth. AIM: This study aimed to describe the maternal and neonatal outcomes associated with water birth among labouring women deemed at low risk for obstetric complications and compare these outcomes against women of similar risk who had a standard land birth. METHOD: A retrospective audit and comparison of women giving birth in water with a matched cohort who birthed on land at Bankstown hospital over a 10 year period (2000-2009). RESULTS: In total 438 childbearing women were selected for this study (N=219 in each arm). Primigravida women represented 42% of the study population. There was no significant difference in mean duration of both first and second stages of labour or postpartum blood loss between the two birth groups. There were no episiotomies performed in the water birth arm which was significantly different to the comparison group (N=33, p<0.001). There were more babies in the water birth group with an Apgar score of 7 or less at 1min (compared to land births). However, at 5min there was no difference in Apgar scores between the groups. Three of eight special care nursery admissions in the water birth group were related to feeding difficulties. CONCLUSION: This is the largest study on water birth in an Australian setting. Despite the limitations of a retrospective audit the findings make a contribution to the growing body of knowledge on water birth.

Pilot study: retreat intervention predicts improved quality of life and reduced psychological distress among breast cancer patients.

PURPOSE: Evaluate the effectiveness of a week-long residential retreat intervention incorporating photographic art therapy in concert with psychoanalytically oriented group therapy and mind-body practices in reducing psychological distress and improving quality of life (QoL) and spiritual well-being for breast cancer patients. METHODS: 28 female breast cancer patients completed self report assessments of psychological distress, QoL, and spiritual well-being on the first day of the retreat, the last day of the retreat, and a 6 week follow up assessment. RESULTS: Repeated measures MANOVA with Bonferroni post-hoc comparisons revealed the retreat experience to predict significant and sustained reductions in depression, anxiety, and somatic stress, coupled with sustained improvements in QoL and spiritual well-being. CONCLUSIONS: The current findings suggest that breast cancer patients may benefit from participation in a week-long multi-modal retreat center experience involving photographic art therapy and structured group therapy as a means to explore personal strain.

Citalopram improves metabolic risk factors among high hostile adults: results of a placebo-controlled intervention.

Hostility is associated with a number of metabolic risk factors for cardiovascular disease, including waist-hip ratio, glucose, and triglycerides. Along with hostility, many of these measures have also been shown to be associated with reduced central serotonergic function. We have previously reported that a citalopram intervention was successful in reducing hostility by self-report assessment (Kamarck et al., 2009). Here we examine the effects of this serotonergic intervention on metabolic risk factors in the same sample. 159 healthy adults with elevated hostility scores were randomized to citalopram or placebo for a 2-month period. Citalopram favorably changed metabolic risk factors, including waist circumference (p=.003), glucose (p=.02), HDL cholesterol (p=.04), triglycerides (p=.03), insulin sensitivity (p=.045) and diastolic blood pressure by automated assessment (p=.0021). All of these metabolic changes were significantly mediated by treatment-related changes in body mass index (in most cases, p<.01). In addition, the changes in blood glucose were significantly mediated by treatment-related changes in hostility (p<.05). Mechanisms accounting for these associations remain to be explored.

Hostility and anger in: cardiovascular reactivity and recovery to mental arithmetic stress.

BACKGROUND: Hostility and anger have been attributed as psychosocial risk factors for coronary heart disease. Heightened cardiovascular reactivity (CVR), and poor recovery, to provocative stressors are thought to hasten this risk. PURPOSE: To examine the relationship between hostility and anger inhibition (AI), and the moderating situational influences of harassment and evaluation, in predicting CVR and recovery to mental arithmetic (MA) stress using a multiple regression approach. METHODS: 48 male undergraduate students engaged in the following 3 minute tasks during recording of the electrocardiogram, impedance cardiography, and blood pressure: baseline, MA, and evaluation. Hostility and AI were assessed with the Cook-Medley Hostility Scale and the Speilberger Anger In subscale, respectively. RESULTS: An interaction between hostility and AI showed high diastolic blood pressure reactivity to the MA task among hostile anger inhibitors. Harassment did not modify this effect. However, harasser evaluation predicted prolonged systolic blood pressure (SBP) responding among men scoring high in AI, and facilitated SBP recovery among those scoring low on AI. CONCLUSIONS: The findings highlight the interactive influences of AI and hostility in predicting CVR to stress and underscore the importance of recovery assessments in understanding the potentially pathogenic associations of these constructs.

Hostility moderates the effects of social support and intimacy on blood pressure in daily social interactions.

OBJECTIVE: This study sought to determine the role of hostility in moderating the effects of positive social interactions on ambulatory blood pressure (ABP). DESIGN: Participants (341 adults) completed the Cook-Medley Hostility Scale and underwent ABP monitoring, assessed every 45 min during waking hours across 6 days. An electronic diary measuring mood and social interactions was completed at each ABP assessment. MAIN OUTCOME MEASURES: The dependent variables from the ABP monitor included systolic blood pressure, diastolic blood pressure, and heart rate. RESULTS: Different patterns of ambulatory diastolic blood pressure (ADBP) responding to social interactions perceived as intimate or supportive among high- versus low-hostile individuals were observed. Higher intimacy ratings were linked to reductions in ADBP among low-hostile but not high-hostile individuals. Conversely, high-hostile, but not low-hostile, individuals showed increases in ADBP to situations rated high in social support. Although findings for ambulatory systolic blood pressure were nonsignificant, the pattern of results was similar to ADBP. CONCLUSION: Hostile individuals may find offers of support stressful and may fail to benefit from intimacy during daily life. The pathogenic effects of hostility may be mediated in part by responses to social interactions, both positive and negative.