Associations of parent-adolescent relationship quality with type 1 diabetes management and depressive symptoms in Latino and Caucasian youth.

OBJECTIVE: To examine associations of parent-adolescent relationship quality (parental acceptance and parent-adolescent conflict) with adolescent type 1 diabetes management (adherence and metabolic control) and depressive symptoms in Latinos and Caucasians. METHODS: In all, 118 adolescents and their mothers (56 = Latino, 62 = Caucasian) completed survey measures of parental acceptance, diabetes conflict, adolescent adherence, and adolescent depressive symptoms. Glycemic control was obtained from medical records. RESULTS: Across ethnic groups, adolescent-reported mother and father acceptance were associated with better diabetes management, whereas mother-reported conflict was associated with poorer diabetes management and more depressive symptoms. Independent of socioeconomic status, Latinos reported lower parental acceptance and higher diabetes conflict with mothers than Caucasians. Ethnicity moderated some associations between relationship quality and outcomes. Specifically, diabetes conflicts with mothers (mother and adolescent report) and fathers (adolescent report) were associated with poorer mother-reported adherence among Caucasians, but not among Latinos. CONCLUSIONS: Parent-adolescent relationship quality differs and may have different relations with diabetes management across Latinos and Caucasians.

Illness perceptions matter: understanding quality of life and advanced illness behaviors in female patients with late-stage cancer.

BACKGROUND: Patients with late-stage cancer are living longer, making it important to understand factors that contribute to maintaining quality of life (QOL) and completing advanced illness behaviors (eg, advance directives). OBJECTIVE: To examine whether illness perceptions-the cognitive beliefs that patients form about their cancer-may be more important guides to adjustment than clinical characteristics of the cancer. METHODS: In a cross-sectional study, 105 female patients diagnosed with stage III (n = 66) or IV (n = 39) breast (n = 44), gynecological (n = 38), or lung (n = 23) cancer completed self-report measures of illness perceptions, QOL, and advanced illness behaviors. Clinical data was obtained from medical records. RESULTS: Despite modest associations, patients' beliefs about the cancer were clearly unique from the clinical characteristics of the cancer. Illness perception variables accounted for a large portion of the variance (PS < .01) for QOL and advanced illness behaviors, whereas clinical characteristics did not. QOL scores were predicted by patients' reports of experiencing more cancer related symptoms (ie, illness identity), believing that their cancer is central to their self-identity, and higher income. Higher completion of advanced illness behaviors was predicted by higher income, the cancer being recurrent, and participants perceiving their cancer as more severe but also more understandable. LIMITATIONS: This study was limited by a cross-sectional design, small sample size, and focus on female patients. CONCLUSION: Addressing patients' beliefs about their cancer diagnosis may provide important targets for intervention to improve QOL and illness behaviors in patients with late-stage cancer.

Current state of psychiatric involvement on palliative care consult services: results of a national survey.

CONTEXT: Palliative care consult services have emerged as an excellent resource for physicians seeking help with patients' symptoms. Symptoms include those of a psychiatric nature (e.g., depression, anxiety, delirium); however, little information is known about whether palliative care services include psychiatric input as part of multidisciplinary teams. OBJECTIVES: To explore 1) the current level of collaboration between psychiatrists and palliative care consult services across the U.S. and 2) the factors that support or restrict such involvement. METHODS: A national survey was developed and distributed electronically to program directors identified in the National Palliative Care Registry maintained by the Center to Advance Palliative Care. Analyses examined trends in psychiatry involvement with hospital-based palliative care teams. RESULTS: The survey had a 59% response rate, with final analyses including surveys completed by 260 palliative care program directors (67% inclusion rate from total respondents). Seventy-two percent of respondents reported some form of involvement with a psychiatrist on their palliative care service, with only 10% of those identifying a psychiatrist as a full- or part-time member of the team. Most respondents reported that they would like psychiatrists to be more involved with the palliative care services (71%). Secondary analyses of qualitative responses identified common impediments to increased psychiatry involvement, which included financial constraints, provider interest, and perceived disciplinary disconnect. CONCLUSION: There are shared objectives between psychiatry and palliative care; however, currently, co-involvement on treatment teams is quite limited. Future research is needed to identify ways to facilitate the interface of palliative care and psychiatry.