Perspectives of patients with multiple myeloma on accepting their prognosis-A qualitative interview study.

OBJECTIVE: Prognostic awareness is essential for making treatment decisions in malignant diseases. Being confronted with a poor prognosis, however, can affect patients' mental health. Therefore, it is important to study coping in the context of malignant diseases. Acceptance is an adaptive coping strategy associated with less psychological distress. This study sought to explore the facilitators and barriers for prognostic acceptance in a sample in which both hope and uncertainty regarding prognosis are pronounced: multiple myeloma patients. METHODS: In a German university hospital, 20 multiple myeloma patients participated in semistructured interviews. Following thematic content analysis by Kuckartz, the interview transcripts were coded for facilitators and barriers for prognostic acceptance. Additionally, patients completed questionnaires on prognostic awareness and sociodemographic characteristics. RESULTS: Patients described the following facilitators for prognostic acceptance: social support, positive thinking, focusing on the Here and Now, proactive confrontation, having little to no symptoms, and being there for others. The indicated barriers were distressing physical symptoms and restricted functioning, social distress, and additional distress from other areas of life. CONCLUSIONS: Patients reported a variety of factors-related to the social realm, symptom burden, and specific attitudes-that help or hinder them in accepting their prognosis. Oncologists and psycho-oncologists may support prognostic acceptance by encouraging patients to both actively deal with realistic information as well as enjoy pleasant and meaningful moments in the present during which the disease and its prognosis recedes into the background.

Early palliative care for those who care: A qualitative exploration of cancer caregivers' information needs during hospital stays.

BACKGROUND: The supporting role of caregivers is crucial to cancer patients' care and well-being. Periods of inpatient hospital treatment are common in the cancer trajectory. There is insufficient systematic knowledge of caregivers' experiences and information needs in hospital context. AIM: Aim of this study is to identify information needs and factors contributing to unmet information needs of caregivers in hospital. DESIGN: A qualitative approach was used to identify major themes and specific types of information needs. Interviews with caregivers were conducted and analysed using a qualitative three-step process. SETTING/PARTICIPANTS: The study was conducted in a hospital oncology department. Seventeen caregivers of patients with advanced cancer were interviewed. RESULTS: Caregivers' needs during inpatient treatment vary and are largely unmet. Four major themes emerged from the analysis, revealing information needs of caregivers related to the cancer disease, patient, caregivers themselves and hospital context. The most mentioned issues were appropriate treatment, treatment outcomes and the related consequences for caregivers' life, hospital processes and transition back home. CONCLUSION: Caregivers have a variety of specific information needs which often remain unmet. Based on our findings, we provide recommendations for integrating caregivers into oncology care, which should be implemented in clinical practice, policy decisions and research.

Early integration of palliative cancer care: patients' and caregivers' challenges, treatment preferences, and knowledge of illness and treatment throughout the cancer trajectory.

PURPOSE: Early integration of palliative care (EIPC) into oncology is beneficial for cancer patients and their caregivers. Best practice models of EIPC throughout the course of cancer treatment aim to support patients and caregivers in meeting their individual needs. So far, we know little about whether EIPC offers should be phase-specific or patient-centered. This study investigated patients' and caregivers' needs considering individual challenges, treatment preferences, and knowledge over the cancer trajectory. METHODS: Semi-structured qualitative interviews and pre-interview questionnaires were conducted with 11 cancer patients and 9 caregivers. A modified grounded theory approach was used to analyze the interview data applying thematic analysis and reflective principles by using MAXQDA. RESULTS: Our data showed no clearly distinct pattern of illness-phase-specific needs of patients and caregivers. Support needs were dependent on the significance and interpretation of events by patients and caregivers. Mastering challenges was highly individual and influenced by personal and contextual factors. Our results showed that subjective theories of illness significantly influenced experience, information requirements, treatment preferences, and the feeling of patients and caregivers "to be in good hands." The physician-patient relationship was of central relevance and has a major gatekeeper function for EIPC. Access to the medical care system, resources, and information appeared to be based on chance. CONCLUSIONS: For optimal EIPC, it is necessary to improve structural conditions such as more structured information about resources and procedures. Subjective theories of illness need to be continuously considered by practitioners in order to recognize the individual need for support.

Early integration of palliative/supportive cancer care-healthcare professionals' perspectives on the support needs of cancer patients and their caregivers across the cancer treatment trajectory.

PURPOSE: Delivering palliative/supportive cancer care (PSCC) early in the course of cancer care can enhance patients' and caregivers' quality of life, reduce anxiety and depression, and prolong patients' lives. However, their support needs are analyzed insufficiently from viewpoints other than their own. The goal of this study was to explore the perspectives of healthcare professionals on desirable standards of support for tumor patients and caregivers across the cancer treatment trajectory. It further aimed at identifying starting points for PSCC to address these needs. METHODS: Nine healthcare professionals of varying disciplines in a large German university hospital each participated in one of two focus groups. The qualitative data was analyzed following the grounded theory methodology. RESULTS: The healthcare professionals described it as desirable standards that tumor patients and caregivers receive support coping with tasks, accepting the situation, generating strength, feeling trust, and gaining clarity, thus increasing their sense of control. These support needs were seen as important throughout the whole cancer treatment trajectory of tumor patients and their caregivers. CONCLUSIONS: Team meetings, supervision, tailored education, and structural improvements may aid healthcare professionals to develop and implement ways to further support patients and caregivers. Also, patients' and caregivers' support needs should be screened regularly, e.g., when treatment phases change. This would complement healthcare professionals' subjective theories of relevant needs during a specific treatment phase.

ChatGPT: Can You Prepare My Patients for [18F]FDG PET/CT and Explain My Reports?

We evaluated whether the artificial intelligence chatbot ChatGPT can adequately answer patient questions related to [18F]FDG PET/CT in common clinical indications before and after scanning. Methods: Thirteen questions regarding [18F]FDG PET/CT were submitted to ChatGPT. ChatGPT was also asked to explain 6 PET/CT reports (lung cancer, Hodgkin lymphoma) and answer 6 follow-up questions (e.g., on tumor stage or recommended treatment). To be rated "useful" or "appropriate," a response had to be adequate by the standards of the nuclear medicine staff. Inconsistency was assessed by regenerating responses. Results: Responses were rated "appropriate" for 92% of 25 tasks and "useful" for 96%. Considerable inconsistencies were found between regenerated responses for 16% of tasks. Responses to 83% of sensitive questions (e.g., staging/treatment options) were rated "empathetic." Conclusion: ChatGPT might adequately substitute for advice given to patients by nuclear medicine staff in the investigated settings. Improving the consistency of ChatGPT would further increase reliability.

Prognostic Awareness in Advanced Disease: A Review Update and Concept Analysis.

PURPOSE: Although subjective knowledge about the prognosis of an advanced disease is extremely important for coping and treatment planning, the concept of prognostic awareness (PA) remains inconsistently defined. The aims of the scoping review were to synthesize a definition of PA from the most recent literature, describe preconditions, correlates and consequences, and suggest a conceptual model. METHODS: By using scoping review methodology, we searched the Web of Science and PubMed databases, and included publications, reviews, meta-analyses or guidelines on all physical diagnoses, as well as publications offering a conceptual or an operational definition of PA. The data were analyzed by means of content analysis techniques. RESULTS: Of the 24 included publications, 21 referred exclusively to cancer, one to patients with hip fractures and two to palliative care in general. The deduced definition of PA comprised the following facets: adequate estimation of chances for recovery, knowledge of limited time to live, adequate estimation of life expectancy, knowledge of therapy goals, and knowledge of the course of the disease. Further content analysis results were mapped graphically and in a detailed table. CONCLUSION: There appears to be a lack of theoretical embedding of PA that in turn influences the methods used for empirical investigation. Drawing on a clear conceptual definition, longitudinal or experimental studies would be desirable.