International collaboration for assessing unmet needs of cancer survivors and family caregivers: Lens of healthcare professionals.

OBJECTIVE: Cancer patients and their family caregivers have reported various needs that are not met. Recognition of the unmet needs by healthcare professionals may be a first step to adequately and systematically addressing them. Thus, the International Psycho-Oncology Society Survivorship Online Survey was developed to measure healthcare professionals' evaluation about the unmet needs of their patients and family caregivers around the globe. METHODS: The survey was developed in English and translated to additional 14 different languages. The survey was distributed on the web-based REDCap application to over 50 psycho-oncology societies and their networking platforms as well as social media and to authors who have published in psycho-oncology journals globally. RESULTS: A total of 1472 participants from 36 countries at least partially completed the survey. Healthcare professionals evaluated needs for managing one's emotional distress and patients' medical care and symptoms as the most common concerns for both patients and their family caregivers across all patient age groups. Less than two-thirds of the participating healthcare professionals reported that their institution had services or programs to address the needs of the patients or caregivers. CONCLUSIONS: Findings suggest several directions for further analyses to provide more specific information that would be readily translated into clinical practices, research, and policy aimed to enhance the quality of life of cancer patients, survivors, and family caregivers around the globe. In addition, this collaborative effort also hints at the importance of establishing international networks to promote equity in care for people touched by cancer worldwide.

Do posttraumatic stress symptoms predict trajectories of sleep disturbance and fatigue in patients with breast cancer? A parallel-process latent growth model.

OBJECTIVE: Using a parallel-process latent growth model (LGM), this study examined whether posttraumatic stress symptoms (PTSS) are associated with the trajectory of sleep disturbance (SD) and fatigue and whether the SD trajectory mediates the PTSS-fatigue relationship. METHODS: Data were from 215 patients with breast cancer recruited from a tertiary hospital in South Korea. A self-report survey was administered at four time points during the course of adjuvant chemotherapy. RESULTS: The mean age of the participants was 46.69 (SD = 9.08) and the majority was at stage I and the average months since diagnosis was 1.33 (SD = 1.43). Unconditional parallel-process LGM indicated that SD and fatigue were positively associated with each other, both in terms of initial status and growth rate. Then, the conditional parallel-process LGM with baseline PTSS (i.e., avoidance, intrusion, and hyperarousal) as predictors were examined and anxiety, depressive symptoms and chronotype were entered as covariates in the model. Results indicated that a higher initial status and faster growth of SD were associated with a faster increase in fatigue. Greater baseline hyperarousal was directly related to a higher initial status and a slower increase in SD, and higher initial fatigue. Furthermore, a higher hyperarousal was associated with a greater initial SD, which was related to a faster increase in fatigue. Additionally, the late chronotype was related to a faster increase in fatigue through its impact on the initial SD. CONCLUSIONS: The detrimental impact of hyperarousal on the SD trajectory and fatigue suggests the need to intervene in PTSS and SD early and throughout the course of cancer treatments to prevent fatigue.

Psychiatric symptoms mediate the effect of resilience on health-related quality of life in patients with breast cancer: Longitudinal examination.

OBJECTIVE: Patients with breast cancer receiving neoadjuvant chemotherapy are at increased risk of poor health-related quality of life (HRQOL). This study examined clinical caseness on depression and anxiety mediate the relationship between resilience and HRQOL in patients with breast cancer. METHODS: A total of 193 patients with breast cancer undergoing neoadjuvant chemotherapy completed questionnaires including the Connor-Davidson Resilience Scale, Hospital Anxiety and Depression Scale (HADS), and Functional Assessment of Cancer Therapy-Breast before the first session (T0), before the start of the last session (T1), and 6 months after the end (T2) of chemotherapy. Mediation analyses using a bootstrapping method was performed. RESULTS: The indirect effect (IE) through T1 depression was significant (IE through depression = 0.043, 95% confidence interval [CI] [0.002-0.090]), while IE through T1 anxiety was not significant (IE through anxiety = 0.037, 95% CI [-0.010-0.097]) in the association between T0 resilience and T2 HRQOL. CONCLUSIONS: Clinical caseness on HADS depression subscale during chemotherapy was a mediating factor of the relationship between resilience before chemotherapy and HRQOL after chemotherapy in patients with breast cancer receiving neoadjuvant chemotherapy. Depression during chemotherapy in patients with breast cancer may be a target symptom of screening and intervention to maintain the HRQOL after chemotherapy. Also, patients with low resilience are more likely to develop depression during chemotherapy, and clinicians should carefully monitor whether depression occurs in these patients with low resilience.

Network analyses of associations between cancer-related physical and psychological symptoms and quality of life in gastric cancer patients.

OBJECTIVE: This study applied network analyses to illustrate patterns of associations between cancer-related physical and psychological symptoms (CPPS) and quality of life (QOL) before and after surgery. METHODS: Participants consisted of 256 gastric cancer patients admitted for curative section surgery at the surgical department in a teaching hospital in Korea between May 2016 and November 2017. Participants completed the survey, including MD Anderson Symptom Inventory, Hospital Anxiety and Depression Scale, and Functional Assessment of Cancer Therapy-Gastric Cancer before surgery (T0), 1 week after surgery (T1), and 3-6 months after surgery (T2). RESULTS: Three networks featured several salient connections with varying magnitudes between CPPS and QOL across all time points. Particularly, anxiety was tightly connected to emotional wellbeing (EWB) across all time points and physical wellbeing (PWB) at T1. On the other hand, depression was connected to functional wellbeing at T0 and T2, gastric cancer concerns (CS) at T1, and PWB at T2. Distress and sadness were the most central symptoms in the three networks. Other central symptoms included shortness of breath at T0, fatigue at T0 and T1, and PWB and CS at T2. Anxiety, depression, and EWB served as bridges connecting CPPS to QOL across all time points with varying degrees of importance, as did PWB at T1 and T2. CONCLUSIONS: Treating psychological distress and enhancing EWB and PWB can be high impact intervention targets throughout the cancer trajectory.

Association of depression and anxiety disorder with the risk of mortality in breast cancer: A National Health Insurance Service study in Korea.

PURPOSE: To examine whether depression, anxiety disorder, and their co-occurrence would increase the risk of mortality in patients with breast cancer, and whether antidepressant treatment would reduce the same. METHODS: Data were retrieved from the database of the Korean National Health Insurance Service. Of 145,251 patients diagnosed with breast cancer between 2007 and 2014, 20,870 patients diagnosed with depression or anxiety disorder one year before breast cancer diagnosis were excluded. Thus, data of 124,381 patients were included in this study. RESULTS: Depression and anxiety disorder were associated with an increased risk of mortality [Hazard Ratio (HR) 1.26, 95% CI 1.18-1.36; HR 1.14, 95% CI 1.08-1.22, respectively] and their co-occurrence further increased the risk (HR = 1.38, 95% CI 1.24-1.54). Antidepressant treatment was related to a reduced risk of mortality. Compared to patients without any psychiatric comorbidity with no antidepressant treatment, the mortality risk increased in patients with either psychiatric comorbidity or both, but the risk seemed to attenuate with antidepressant treatments. CONCLUSION: The current findings suggest that psychiatric comorbidities are markers of increased mortality risk in patients with breast cancer, and antidepressant treatment may attenuate the risk. This underscores the need for screening and treating depression and anxiety disorders to improve survival in patients with breast cancer.

Trajectory of fear of cancer recurrence and beliefs and rates of medication adherence in patients with breast cancer.

OBJECTIVE: This study examined the growth trajectory of fear of cancer recurrence (FCR) and its predictors, and the association of that trajectory with the beliefs and rates of medication adherence in patients with breast cancer. METHODS: Two hundred and ten patients with breast cancer undergoing adjuvant endocrine therapy in a university hospital in Seoul, Korea, were followed up five times over 18 months following surgery, and data from the final 162 patients were analyzed. RESULTS: Latent class growth analysis identified three classes. Classes 1 (38.31%) and 2 (39.89%) showed low and moderate FCR levels, respectively, with a decreasing trend over time. Class 3 (21.80%) showed a high FCR level with an initially decreasing but increasing trend afterward s. Lower education and unemployed status were associated with the high FCR class. Higher depression was more associated with the moderate FCR class than the low FCR class. Higher emotional representation was more associated with the high FCR class than with low FCR class, and greater illness comprehension was more associated with the moderate FCR class than with the high FCR class. Both necessity and concerns about medication were the highest in the high FCR class. However, self-reported medication adherence rates did not significantly differ between the classes. CONCLUSIONS: A high level of FCR appears to persist over time, and given its association with greater concerns about medication, monitoring and management of FCR throughout the cancer trajectory.

Patients' communication preferences for receiving a cancer diagnosis: Differences depending on cancer stage.

OBJECTIVE: This study aimed to identify communication preferences for receiving a cancer diagnosis in South Korean patients and explore differences depending on cancer stage-with or without recurrence/metastasis. METHODS: A total of 312 patients from five cancer centers in South Korea completed the Korean version of the Measure of Patients' Preferences questionnaire, Mini-Mental Adjustment to Cancer scale, Insomnia Severity Index, and Hospital Anxiety and Depression Scale. RESULTS: Among patients without recurrence/metastasis, four factors were indicated: "additional information," "medical information," "emotional support," and "supportive environment." Among patients with recurrence/metastasis, five factors were indicated: "medical information and explanation," "emotional support," "supportive environment," "additional information," and "informing family." In the group without recurrence/metastasis, a positive attitude was a significant predictor of the preference for all four factors and a lower anxiety level was a predictor of the preference for additional information. Patients who reported a high level of anxious preoccupation preferred supportive environments. In the group with recurrence/metastasis, patients who showed a high level of cognitive avoidance preferred to receive medical and additional information and emotional support. CONCLUSIONS: Cancer patients' preferences for communication when receiving bad news differ whether recurrence/metastasis or not in South Korea. Especially, patients with recurrence/metastasis preferred a clear explanation of medical information, and physicians informing patients' families about their diagnosis and prognosis. Thus, physicians should take patients' medical and psychological characteristics into consideration when delivering the news regarding their condition.

Profiles of depressive symptoms and the association with anxiety and quality of life in breast cancer survivors: a latent profile analysis.

PURPOSE: The aim of this study was to examine profiles of depressive symptoms and the association with anxiety and quality of life (QOL) in breast cancer survivors. METHODS: A cross-sectional multicenter survey involving 5 hospitals in Korea was implemented between February 2015 and January 2017. A self-report survey included the Patient Health Questionnaire-9, Short Form 36, and State and Trait Anxiety Scale. Data from 347 patients were analyzed. RESULTS: Latent profile analysis identified five profiles of depressive symptoms: (1) "no depression" (63.98%); (2) "mild depression with sleep problems" (16.43%); (3) "mild depression" (8.65%); (4) "moderate depression with anhedonia" (7.78%); and (5) "moderately severe depression" (3.17%). Results from Fisher's exact test and analysis of variance (ANOVA) to examine whether sociodemographic and clinical characteristics distinguish the classes indicated that marital status, income and education as well as C-reactive protein distinguished a few classes. Multivariate analysis of covariance and analysis of covariance results indicated that both types of anxiety as well as several dimensions of QOL differed between the identified classes. CONCLUSIONS: The current results suggest that although identified classes were characterized overall by severity of depression, a few classes also reflected pronounced individual symptom patterns, warranting tailored interventions for these symptom patterns, along with overall severity of depression.

Phenomenological examinations of delirium in advanced cancer patients: exploratory structural equation modelling and latent profile analysis.

BACKGROUND: This study examined phenomenological manifestations of delirium in advanced cancer patients by examining the factor structure of the Delirium Rating Scale-Revised-98 (DRS-R-98) and profiles of delirium symptoms. METHODS: Ninety-three patients with advanced cancer admitted to inpatient palliative care units in South Korea were examined by psychiatrists using the DRS-R-98 and the Confusion Assessment Method (CAM). The factor structure of the DRS-R-98 was examined by exploratory structural equation modelling analysis (ESEM) and profiles of delirium were examined by latent profile analysis (LPA). RESULTS: CAM-defined delirium was present in 66.6% (n = 62) of patients. Results from the ESEM analysis confirmed applicability of the core and noncore symptom factors of the DRS-R-98 to advanced cancer patients. LPA identified three distinct profiles of delirium characterizing the overall severity of delirium and its core and noncore symptoms. Class 1 (n = 55, 59.1%) showed low levels of all delirium symptoms. Class 2 (n = 17, 18.3%) showed high levels of core symptoms only, whereas Class 3 (n = 21, 22.6%) showed high levels of both core and noncore symptoms except motor retardation. CONCLUSIONS: Clinical care for delirium in advanced cancer patients may benefit from consideration of the core and noncore symptom factor structure and the three distinct phenomenological profiles of delirium observed in the present study.

Trajectory of severity of postoperative delirium symptoms and its prospective association with cognitive function in patients with gastric cancer: results from a prospective observational study.

PURPOSE: Delirium is a common neurocognitive complication in cancer. Despite this, the studies examining the trajectory of the severity of delirium symptoms and its impact on health outcome in gastric cancer is rather limited. This study examined the trajectory of delirium symptom severity (DSS) following resection surgery for gastric cancer and its prospective association with cognitive function. METHODS: A three-wave prospective observational study was conducted with 242 gastric cancer patients admitted for resection surgery at a teaching hospital in South Korea from May 2016 to November 2017. DSS was assessed by the clinical staff before and 1, 2, 3, and 7 days after surgery using the Delirium Rating Scale-Revised-98. A survey including the Functional Assessment of Cancer Therapy-Cognitive Scale (FACT-Cog) and Mini-Mental State Examination (MMSE) was administered before surgery (T0), 7 days after (T1), and 3 to 6 months after surgery (T2). RESULTS: Out of 242 participants, 48.8% (118) completed the survey at all three time points, 43.4% (105) did so for two time points, and 7.9% (19) for one time point. No cases of full delirium were observed over four postoperative time points. Latent growth curve modeling analyses indicated that DSS declined over 3 days after surgery. Age and anesthesia time were positively associated with the initial level of DSS. A medication history for memory complaints was related to a slower recovery from delirium symptoms. While the use of propofol as an anesthetic agent was associated with lower initial DSS, it predicted a slower recovery from DSS. A higher initial DSS predicted a lower T1 MMSE score. CONCLUSIONS: Severity of postoperative delirium symptoms predicts a short-term and objective cognitive function post-surgery. Monitoring and timely treatment of postoperative delirium symptoms is needed to diminish cognitive consequences in gastric cancer patients.

Suicide Risk in Persons with HIV/AIDS in South Korea: a Partial Test of the Interpersonal Theory of Suicide.

PURPOSE: The high disease burden associated with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is linked to the elevated suicide risk in this population. Informed by the interpersonal theory of suicide, this study examined how and under which conditions depression is related to suicide risk in people living with HIV/AIDS. METHODS: A total of 202 outpatients with HIV/AIDS participated in a cross-sectional and multi-center survey involving four university hospitals in South Korea. This self-reported survey included the Hospital Anxiety and Depression Scale, Interpersonal Needs Questionnaire, and Mini-International Neuropsychiatric Interview suicidality module. RESULTS: Participants' mean age was 48.6 (SD = 13.4) and the majority was male (89.1%). The proportions of those at high, medium, and low suicide risk were 18.5%, 20%, and 15.4%, respectively. Depression was associated with suicide risk directly and indirectly by increasing perceived burdensomeness (PB) and the indirect effect of depression on suicide risk mediated by PB was contingent on the level of thwarted belongingness (TB). PB was associated with suicide risk even after controlling for depression, suggesting its independent effect on suicide risk. CONCLUSIONS: PB and TB are potential mechanisms through which depression is associated with suicide risk, supporting the applicability of the interpersonal theory of suicide to understanding a complex interplay of risk factors in people with HIV/AIDS. Moreover, given the independent association of PB with suicide risk, as well as a protective effect of TB in suicide risk, monitoring and management of these factors should be included in the care of people with HIV/AIDS.

Does depression decrease the moderating effect of self-efficacy in the relationship between illness perception and fear of progression in breast cancer?

OBJECTIVE: Fear of progression (FOP) is a prevalent concern among breast cancer patients that affect their adjustment to disease. This study examined whether self-efficacy moderates the effect of illness perception (IP) on FOP and whether the moderating effect of self-efficacy depends on the level of depressive symptoms. METHODS: A cross-sectional survey including brief illness perception questionnaire (BIPQ), FOP short form, general self-efficacy scale, and the center for epidemiologic studies depression scale were administered to 245 patients with breast cancer in Korea. RESULTS: Self-efficacy moderated the negative impact of the patients' perception of chronic timeline and a greater emotional impact of the illness on FOP. However, the moderating effect of self-efficacy of the BIPQ timeline and emotions on FOP depended on level of depressive symptoms. CONCLUSIONS: The findings underscore the importance of considering the IP as determinants of FOP, as well as of self-efficacy and depression as the moderating factors in the relationship between IP and FOP, suggesting the need to enhance self-efficacy and depressive symptoms in order to compensate the negative impact of IP on FOP in breast cancer patients.

Psychometric properties of the Korean version of the medical outcomes study HIV health survey: results from a multicenter survey in Korea.

BACKGROUND: Precise assessment of health-related quality of life (HRQOL) with a reliable and valid measure is a prerequisite to the enhancement of HRQOL. This study examined the psychometric properties of the Korean version of the Medical Outcomes Study HIV Health Survey (K-MOS-HIV). METHODS: The reliability and validity of the K-MOS-HIV were examined in a multicenter survey involving 201 outpatients with human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS) from four teaching hospitals throughout Korea. RESULTS: Ceiling effects were observed in six subscales scores, particularly, for the role functioning (71.1%), social functioning (63.2%), and pain (48.8%) scores. The Cronbach's α for the physical health summary and mental health summary were 0.90 and 0.94, respectively, and it ranged from 0.78 to 0.95 for the subscales. The results of the exploratory structural equation modeling supported the two-factor structure of the K-MOS-HIV (physical health summary and mental health summary). An examination of the mean square statistics values from the Rasch analysis showed that the information-weighted fit and outlier-sensitive fit statistics were within the acceptable ranges of 0.6-1.4 except for two items in the mental health summary. The convergent validity of the K-MOS-HIV was supported by its significant positive correlations with the World Health Organization Quality of Life-HIV-BREF subscale scores. Its known-group validity was proven with its ability to detect significant differences in several K-MOS-HIV subscale scores among participants with different sociodemographic and clinical characteristics. CONCLUSIONS: The K-MOS-HIV health survey appears to be a reliable and valid measure of HRQOL.

The relationship between alexithymia and headache impact: the role of somatization and pain catastrophizing.

PURPOSE: The present study compared psychological factors (i.e., alexithymia, somatization, pain catastrophizing (PC), anxiety, and depression) and QOL for headache patients and headache-free individuals, and examined whether somatization and PC mediate the relationship between alexithymia and headache impact in headache patients. METHODS: Study participants consisted of 123 headache patients from an outpatient clinic at a university hospital and 124 headache-free individuals in Daegu, Korea. The survey employed the somatization and anxiety subscales of the Symptom Checklist-90-revised, the Patient Health Questionnaire-9, Pain Catastrophizing Scale, Toronto Alexithymia Scale, Short-Form Health survey-8 (SF-8), and the Headache Impact Test-6. RESULTS: Headache patients showed a higher level of all psychological factors and lower level of two summary scores (physical and mental health) as well as the seven dimensions of the SF-8 compared with headache-free individuals. Examination employing the SPSS Process macro found that the direct effect of alexithymia on headache impact was not significant after controlling for somatization and PC. The total indirect effects of alexithymia on headache impact were significant without anxiety and depression as covariates with the significant indirect effects of alexithymia on headache impact via somatization or via PC as well as via somatization and PC. However, after controlling for anxiety and depression, PC was the only significant pathway through which alexithymia was related to headache impact. CONCLUSIONS: Headache patients may benefit from interventions aiming at improving psychological factors in order to improve the functioning and QOL of headache patients.

Cross-Cultural Validation of the Korean Version of the Chalder Fatigue Scale.

PURPOSE: University students are vulnerable to fatigue. If not adequately dealt with, fatigue might develop into various health problems and negatively affect quality of life (QOL). The present study examined psychometric properties of the Korean version of the Chalder Fatigue Scale (K-CFQ) in university students. METHOD: Data were obtained from two samples of undergraduate students in Korea. The first dataset (N = 557) was collected in a cross-sectional survey in 2015 and the second dataset (N = 338) from a longitudinal survey with three time points over a semester period in 2016. Participants completed measures of fatigue, QOL, depression, anxiety, and sleep quality. RESULTS: Three-factor model (physical fatigue, low energy, and mental fatigue) rather than the original two-factor model (physical and mental fatigue) provided a better goodness of fit indices to the data. Internal consistency of the K-CFQ was satisfactory, with Cronbach's α value of 0.88 for the total scale and those of subscales ranging from 0.73 to 0.87. Its convergent validity was supported by its significant association with anxiety, depression, sleep quality, and QOL. Significant association between T1 K-CFQ with physical QOL at T2 and T3 supported its predictive validity. Its known-group validity was proven with higher K-CFQ scores observed in the participants with depression and those with poor sleep quality. CONCLUSIONS: Current results suggest that K-CFQ is a valid and reliable measure of fatigue, and a better model fit of the three-factor structure of the K-CFQ implies potential cross-cultural differences in the dimensionality of fatigue.

Prevalence, correlates, and impact of depressive and anxiety disorder in cancer: Findings from a multicenter study.

ABSTRACTObjective:Our aim was to examine the prevalence, correlates, and association of depressive and anxiety disorders with quality of life (QoL) and such other outcomes as the need for psychosocial services in cancer patients. METHOD: A total of 400 patients participated in a multicenter survey involving five cancer centers located throughout Korea. The Short-Form Health Survey, the MD Anderson Symptom Inventory, the Mini-Mental Adjustment to Cancer (MINI-MAC), and Mini-International Neuropsychiatric Interview were administered. RESULTS: The prevalence rates for depressive and anxiety disorders were 16 and 17.1%, respectively. Younger age and poor Eastern Cooperative Oncology Group performance status, and all physical symptoms, as well as helplessness/hopelessness, anxious preoccupation (AP), and cognitive avoidance (CA) on the MINI-MAC were found to be significantly related to depressive disorder (DD) in a univariate logistic regression analysis. Metastases, the symptoms of disturbed sleep, dry mouth, and numbness or tingling, as well as AP and CA were significantly correlated with anxiety disorder (AD) in the univariate analysis. In the multivariate analyses, only AP was significant for AD (odds ratio = 2.94, p < 0.001), while none reached statistical significance for DD. Psychiatric comorbidity status had a detrimental effect on various dimensions of QoL. Patients with DD or AD reported a significantly higher need for professional psychosocial services. SIGNIFICANCE OF RESULTS: Given the substantial prevalence and pervasive impact of DD and AD on various aspects of QoL, its assessment and care should be integrated as a regular part of oncological care throughout the cancer continuum.

Development and validation of the National Cancer Center Psychological Symptom Inventory.

OBJECTIVE: To report the development and validation of the National Cancer Center Psychological Symptom Inventory (NCC-PSI). METHODS: Psychometric properties of the NCC-PSI were examined by using multicenter surveys involving 400 patients with cancer in 5 cancer-treatment hospitals throughout Korea. Related measures including the Mini-International Neuropsychiatric Interview were administered. RESULTS: Convergent validity was supported by NCC-PSI's significant associations with related measures. Known-group validity was proven with higher scores of helplessness/hopelessness and anxious preoccupation on the Mini-Mental Adjustment to Cancer in the depression and anxiety diagnosis group, defined by the NCC-PSI. Cutoff scores for insomnia, anxiety, and depression were identified. Overall, the screening performance of the NCC-PSI was comparable to that of the distress thermometer and Patient Health Questionnare-2. CONCLUSIONS: The NCC-PSI represents a meaningful effort to develop a distress screening tool that addresses specific psychological symptoms common in cancer, which are tailored to the local oncology care system with varying degrees of psychosocial care resources.

Examining the Relationship Between Pain Catastrophizing and Suicide Risk in Patients with Rheumatic Disease: the Mediating Role of Depression, Perceived Social Support, and Perceived Burdensomeness.

PURPOSE: Little research has examined the role of pain catastrophizing (PC) in predicting suicide among patients with rheumatic disease or the mechanisms through which it works. This study examines whether depression, perceived social support (PSS), and perceived burdensomeness (PB) mediate the relationship between PC and suicide risk. It also examines the relative importance of sociodemographic, clinical, and psychological factors in predicting suicide risk. METHODS: Three hundred sixty patients from a rheumatology clinic in Korea completed measures of pain catastrophizing, social support, depression, and perceived burdensomeness. RESULTS: In hierarchical multiple regression analysis, the PC magnification, PB, physical disability, and PSS were significantly related to suicide risk. Results of the serial multiple mediation analysis indicated that the total indirect effect of PC magnification on suicide risk was significant while the direct effect was not. Four specific indirect effects of PC magnification were found to be statistically significant. First of all, PC magnification was associated with suicide risk through PB and through depression and PB. PC magnification was also associated with suicide risk through depression and PSS. Lastly, PC magnification was associated with suicide risk through depression, PSS, and PB. CONCLUSIONS: The identified pathways through which PC affects suicide risk suggest the importance of depression, PSS, and PB. Evaluation and intervention targeted at physical disability and the psychological factors of PC magnification, depression, PSS, and PB may be integrated into the management of suicide risk in patients with rheumatic disease.

Tailoring communications to the evolving needs of patients throughout the cancer care trajectory: a qualitative exploration with breast cancer patients.

BACKGROUND: Doctor-patient communication is a crucial aspect of patient care. This study explored the communication experience of patients in a cancer consultation over the course of the cancer continuum. METHODS: In-depth interviews with seven breast cancer patients were carried out. RESULTS: Themes related to communication experiences across the five phases of cancer consultation, from diagnosis to recurrence, were identified. The most salient issue is that patients also perceived cancer as 'a disease of the mind', which is not adequately cared for in consultation. This highlights the notion that cancer care providers should provide appropriate care for the psychological dimensions of the cancer experience with an empathic and sincere attitude during consultations. To this end, non-verbal aspects of communication that convey caring, support, and respect seem important. Furthermore, patients perceived that the consultation time was far shorter then they needed and reported that they felt pressured for time. Moreover, the stance taken by patients and the needs and preferences of patients varied across the phases of the cancer trajectory. As patients progressed through the phases of their treatment, they assumed more active roles in the course of their care and the need for more detailed information and questioning increased. Thus, ensuring that patients have opportunities to ask questions in the consultation is important. CONCLUSION: Current findings suggest that the efficacy of communication varies depending on which phase patients are in and that effective communication should be tailored to these evolving needs and preferences of breast cancer patients. Also, patients perceived that the consultation did not adequately address their need for information related to their care or their emotional issues associated with the cancer experience. It is therefore important to address their needs by paying particular attention to non-verbal aspects of communication that convey empathy and respect toward patients, as well as allowing patients to ask questions.

Measuring stress in medical education: validation of the Korean version of the higher education stress inventory with medical students.

BACKGROUND: Medical students face a variety of stressors associated with their education; if not promptly identified and adequately dealt with, it may bring about several negative consequences in terms of mental health and academic performance. This study examined psychometric properties of the Korean version of the Higher Education Stress Inventory (K-HESI). METHODS: The reliability and validity of the K-HESI were examined in a large scale multi-site survey involving 7110 medical students. The K-HESI, Beck Depression Inventory (BDI) and questions regarding quality of life (QOL) and self-rated physical health (SPH) were administered. RESULTS: Exploratory factor analysis of the K-HESI identified seven factors: Low commitment; financial concerns; teacher-student relationship; worries about future profession; non-supportive climate; workload; and dissatisfaction with education. A subsequent confirmatory factor analysis supported the 7-factor model. Internal consistency of the K-HESI was satisfactory (Cronbach's α = .78). Convergent validity was demonstrated by its positive association with the BDI. Known group validity was supported by the K-HESI's ability to detect significant differences on the overall and subscale scores of K-HESI according to different levels of QOL and SPH. CONCLUSIONS: The K-HESI is a psychometrically valid tool that comprehensively assesses various relevant stressors related to medical education. Evidence-based stress management in medical education empirically guided by the regular assessment of stress using reliable and valid measure is warranted.