Physician preferences for an electronic lung cancer screening decision aid.

OBJECTIVE: To present primary care physician (PCP) suggestions for design and implementation of a decision aid (DA) tool to support patient-provider shared decision-making on lung cancer screening (LCS). STUDY DESIGN: Semistructured interviews were conducted with 15 PCPs at an academic medical center. METHODS: The deidentified transcripts were independently coded by 2 study interviewers and jointly reviewed every 5 interviews until we determined that data saturation had been achieved. We then identified themes in the data and selected illustrative quotes. RESULTS: Three main themes were identified: (1) make it brief and familiar (make the tool user-friendly and implement a similar format to other widely used DAs); (2) bring me to automation station (limit busywork; focus on the patient and on the decision); and (3) involve the patient (facilitate patient involvement in the DA with simple language, visual aids, and bullet-point takeaways). CONCLUSIONS: Findings contain concrete suggestions by PCPs to inform usable and acceptable LCS DA tool design and implementation. For an LCS DA to be most successful, PCPs emphasized that the tool must be easy to use and incorporate autopopulation functions to limit redundant patient charting.

Psychosocial interventions to improve sexual functioning in women with cancer: a systematic review of randomized controlled trials.

INTRODUCTION: Many women with cancer struggle with sexual side effects during and after treatment. Although preliminary evidence indicates that psychosocial interventions may be efficacious in improving sexual functioning for women with cancer, no systematic review has summarized the state of the science in this area. OBJECTIVES: The primary goal of this review was to narratively synthesize the results of randomized controlled trials (RCTs) testing the efficacy of psychosocial interventions to address sexual dysfunction in women with cancer. A secondary goal was to describe the diversity of the included samples (ie, racial/ethnic and sexual minority). METHODS: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic review was conducted examining RCTs of psychosocial interventions to improve sexual functioning for women with cancer. Articles were identified using MEDLINE, Embase, PsycINFO, and Cochrane CENTRAL. Two reviewers independently assessed each article for inclusion, with a third to resolve discrepancies. RESULTS: Seventeen studies were included in the review, 12 of which provided sufficient information to calculate effect sizes. Ten of the 12 studies primarily aimed to improve sexual functioning, all of which demonstrated positive effects on at least 1 outcome of sexual functioning. In the 2 RCTs of psychosocial interventions in which sexual function was a secondary aim, effects were negligible (ds = -0.04 and -0.15). Commonalities among the studies with large effect sizes were that they included education, mindfulness/acceptance, and communication/relationship skills as intervention components. Of note, there was an overall lack of sample diversity across studies, and most studies failed to report the race/ethnicity or sexual orientation of the participants. CONCLUSION: Results support interventions targeting sexual functioning outcomes for women with cancer and suggest that multimodal interventions including education, mindfulness/acceptance, and communication/relationship skills may be most effective. Future research should also focus on examining the efficacy and potential adaptations of extant sexual functioning interventions for underrepresented groups.

Effects of trauma history on cancer-related screening, diagnosis, and treatment.

Trauma has substantial effects on human health and is recognised as a potential barrier to seeking or receiving cancer care. The evidence that exists regarding the effect of trauma on seeking cancer screening, diagnosis, and treatment and the gaps therein can define this emerging research area and guide the development of interventions intended to improve the cancer care continuum for trauma survivors. This Review summarises current literature on the effects of trauma history on screening, diagnosis, and treatment among adult patients at risk for or diagnosed with cancer. We discuss a complex relationship between trauma history and seeking cancer-related services, the nature of which is influenced by the necessity of care, perceived or measured health status, and potential triggers associated with the similarity of cancer care to the original trauma. Collaborative scientific investigations by multidisciplinary teams are needed to generate further clinical evidence and develop mitigation strategies to provide trauma-informed cancer care for this patient population.

Identifying radiation therapists' perceptions of potentially triggering aspects of care for survivors of sexual violence undergoing radiotherapy.

INTRODUCTION: Research shows that for survivors of sexual violence (SV), cancer procedures can be retraumatizing due to perceived similarities to the original SV. To date, there is no training program designed specifically for the radiation therapist (RTT) on how to deliver care sensitively to survivors of SV. A key component of sensitive practice is working with patients to identify and develop strategies to manage situations that could be triggering. The goal of this study was to understand the RTT recognition of potential sensory/environmental, relational, and mixed triggers in radiation oncology settings. METHODS: This quantitative research study conducted a secondary analysis on RTT responses to a learning activity from an online cancer education training program. The first section of the activity asked trainees to identify two potential triggers in a brachytherapy video, and the second portion of the activity asked trainees to describe two potential triggers in their own work. RESULTS: Descriptive statistics, χ2 tests, and t tests were used to analyze 50 RTT responses. RTTs tended to identify different types of triggers depending on the question (brachytherapy video vs. self-reflection). Data indicated that despite a lack of formal didactic training in trigger management, RTTs could identify triggers, and were most likely to recognize "mixed" type triggers. DISCUSSION: Triggers identified are consistent with past research on childhood sexual abuse survivors' healthcare retraumatization in obstetrics and gynecology, and cancer care. As in past research, invasive techniques, and situations where the patient was in a submissive position were identified as triggering aspects of care. It is interesting to note when reflecting on their own practice, the least identified triggers all fell under the environmental/sensory trigger category. RTTs may not fully appreciate a variety of potential triggers such as sounds of treatment or silence because they are outside of the room administering the beam when the machine is delivering treatment. Thus, they may not hear certain sounds or silence during their daily routine. CONCLUSIONS: Relatively few trainees identified sensory/ environmental triggers (e.g., restricted visibility and sounds of treatment, including silence) when reflecting on their own practice, which could potentially reduce their likelihood of helping patients minimize the impact of (or avoid) such triggers. Future research should identify a comprehensive list of triggers and then develop a training specific to the RTT focused on identifying environmental/sensory triggers from the perspective of the patient in the often unfamiliar and frightening radiotherapy suite.

Qualitative similarities and distinctions between participants' experiences with a yoga intervention and an attention control.

PURPOSE: This manuscript aims to compare and contrast acceptability and perceived benefits of yoga-skills training (YST) and an empathic listening attention control (AC) in the Pro-You study, a randomized pilot trial of YST vs. AC for adults receiving chemotherapy infusions for gastrointestinal cancer. METHODS: Participants were invited for a one-on-one interview at week 14 follow-up, after completing all intervention procedures and quantitative assessments. Staff used a semi-structured guide to elicit participants' views on study processes, the intervention they received, and its effects. Qualitative data analysis followed an inductive/deductive approach, inductively identifying themes and deductively guided by social cognitive theory. RESULTS: Some barriers (e.g., competing demands, symptoms), facilitators (e.g., interventionist support, the convenience of clinic-based delivery), and benefits (e.g., decreased distress and rumination) were common across groups. YST participants uniquely described the importance of privacy, social support, and self-efficacy for increasing engagement in yoga. Benefits specific to YST included positive emotions and greater improvement in fatigue and other physical symptoms. Both groups described some self-regulatory processes, but through different mechanisms: self-monitoring in AC and the mind-body connection in YST. CONCLUSIONS: This qualitative analysis demonstrates that participant experiences in a yoga-based intervention or an AC condition reflect social cognitive and mind-body frameworks of self-regulation. Findings can be used to develop yoga interventions that maximize acceptability and effectiveness and to design future research that elucidates the mechanisms by which yoga is efficacious.

Trauma-Informed Radiation Therapy: Implementation and Evaluation of a Sensitive Practice Tool for Female Patients Undergoing Radiotherapy for Breast Cancer.

PURPOSE: For childhood sexual abuse survivors, cancer care can be retraumatizing because of perceived similarities to the original sexual violence. The authors' group designed and implemented a sensitive practice tool (SPT) and evaluated the feasibility of the tool in female patients receiving breast radiation. METHODS: The SPT was offered as a "universal precaution" to patients with breast cancer as part of standard clinical care. Patients were given the SPT, which included an instructional video about radiotherapy and a survey about triggers and preferences. The survey results were provided to radiation therapists and used to personalize patients' care. A retrospective chart review and quality improvement survey of therapists were performed. RESULTS: Of 739 eligible patients, 493 (66.7%) completed the SPT from November 2013 to June 2019. Among respondents, 281 (57.0%) reported potential triggers, 395 (80.1%) reported distress management preferences, and 59 (12.0%) requested psychosocial referrals. Mean patient satisfaction was high, and a majority of patients were likely to recommend the SPT to other patients (85.3%). Among radiation therapists (n = 13), 100% reported that the SPT made it easier to customize or individualize patient care. Trauma disclosure was not significantly associated with increased frequency of trigger endorsement (P = .07) but was associated with increased endorsement of distress management preferences (P = .02) and psychosocial referral requests (P < .001). CONCLUSIONS: The reported experience with the SPT in the breast radiotherapy setting demonstrated that potential triggers and distress management preferences among patients are common and that patient satisfaction with the SPT is high, yielding clinically meaningful and actionable sensitive practice information.

BI-RADS-0 Screening Mammography: Risk Factors That Prevent or Delay Follow-Up Time to Diagnostic Evaluation.

OBJECTIVE: BI-RADS 0 screening mammograms require follow-up diagnostic imaging, optimally within 60 days. Our study aims to identify risk factors for delayed follow-up. METHODS: We conducted a retrospective case-control study of individuals who had a nondiagnostic BI-RADS 0 screening mammogram between March 19, 2018, and March 19, 2020. Sociodemographic information was collected from a self-reported questionnaire. We aimed to identify factors associated with <60-day follow-up, >60-day follow-up, or no follow-up outcomes. The χ2 test and univariate logistic regressions were performed. Significant variables were included in multinomial logistic regression. We also aimed to identify risk factors that lead to delayed follow-up times among individuals with follow-up. Spearman's correlation and Mann-Whitney Wilcoxon tests and Kruskal-Wallis tests were performed. RESULTS: Review returned 5,034 screening mammograms. Of 4,552 individuals included, 904 (19.9%) had no follow-up. Of the 3,648 (80.1%) with follow-up, 2,797 (76.7%) had a follow-up <60 days (median 20 days) and 851 (23.3%) had follow-up >60 days (median 176 days). Multinomial regression found that Asian (P = .022), Black (P < .0001), and individuals who identified their race as other (P < .0001) were independently more likely to have no or >60-day follow-up. Individuals who did not report their race (P = .001) or completed the questionnaire in Spanish (P = .025) were more likely to have no or >60-day follow-up. Among individuals with follow-up, Black individuals (P < .0001), those who identified their race as other (P < .0001), Hispanic individuals (P = .04), and those who completed the questionnaire in Spanish (P < .0001) had follow-up delays. BRCA-positive individuals had shorter follow-up times (P = .021). DISCUSSION: Follow-up time is affected by cancer risk factors such as BRCA status in addition to race, preferred language, and Hispanic ethnicity.

Breast arterial calcification rates in a diverse, urban group of screening mammography patients.

PURPOSE: Breast arterial calcifications (BAC), detected by digital mammography are a potential marker of coronary artery disease (CAD). Past BAC research has been limited by having primarily racially and ethnically homogeneous samples, samples at higher risk for CAD, and neglecting to explore the influence of women's health factors. The purpose of this study was to evaluate the prevalence of, and factors associated with, BAC in an ethnically and racially diverse group. METHODS: We conducted a retrospective chart review on 17,237 screening mammography patients. Mammography results and patient responses to a demographic and medical history questionnaire were abstracted. Logistic regression was used. RESULTS: BAC prevalence was 12.3%. Age was a significant risk factor, with the odds of BAC approximately doubling every decade. Age-adjusted analyses showed: 1) higher BAC prevalence among Hispanic and Black women; 2) lower BAC prevalence among Ashkenazi women, nulliparous and pre-menopausal women, those with dense breasts and breast implants, and those currently using HRT; and, 3) no association between BAC prevalence and BMI or age at menarche. CONCLUSIONS: BAC prevalence differs according to age, ethnicity, race, women's health, and breast-specific factors. Communication of BAC information in clinical settings could potentially prompt women to engage in preventive care.

Systematic Review of Comparisons Between Plastic and Silicone Dilators: Revealing a Knowledge Gap.

INTRODUCTION: Vaginal stenosis is a distressing side effect of radiation therapy that can impair quality of life. Dilator therapy is an option for patients undergoing pelvic radiotherapy to mitigate vaginal stenosis. Currently, the dilators given to patients by most hospitals are made of plastic, compared to silicone dilators which are available on the market for purchase. OBJECTIVES: We conducted a systematic literature review to find information to guide clinical recommendations to pelvic radiotherapy patients on potential differences regarding the use of plastic vs silicone dilators with regard to efficacy, cost, and patient preferences. METHODS: A systematic literature review was conducted in Embase, MEDLINE, and PubMed using Emtree terms. To be included in the review, papers needed to: focus on female patients undergoing radiation therapy, assess a vaginal dilator, measure any dilator intervention outcome, and specifically compare plastic vs silicone dilators for any measured outcome (either qualitative or quantitative). RESULTS: The initial search yielded 195 articles. Two area experts, with a third expert for arbitration, read each article and found that none met all review inclusion criteria. No studies were found that compared silicone to plastic dilators with regard to efficacy in treating vaginal stenosis due to radiation therapy, no studies were found that compared cost or cost-effectiveness of the 2 dilator types, and no studies were found comparing patient preferences or experiences (eg, comfort, adherence, ease of use) between the 2 dilator types. CONCLUSION: The materials used to create dilators have never been rigorously compared in the context of radiotherapy-related vaginal stenosis. Institutions and patients have no data to guide their choice. Significantly more research at the patient and institutional level is needed to explore the potential long-term quality of life and cost benefits of improved adherence with silicone dilator use, and to guide shared decision-making regarding dilator choice. Morgan O, Lopez MD, Martinez AJC, et al. Systematic Review of Comparisons Between Plastic and Silicone Dilators: Revealing a Knowledge Gap. Sex Med Rev 2022;10:513-519.

Affective mechanisms of stress-induced cigarette craving: Considerations of gender and race/ethnicity.

OBJECTIVE: Among the major impediments to successful smoking cessation are strong cravings, especially during times of heightened stress. Affective responses to stress (e.g., acute anxious and depressed mood) may serve as important mediators of cigarette cravings that are amenable to intervention. Experimental models have been developed to reliably induce cravings during stress under laboratory conditions, permitting a closer examination of possible changes in affect that may be driving cigarette cravings. A key limitation of the extant research is its reliance on samples of predominantly White males who smoke. Although several recent studies suggest possible gender- and race/ethnicity-based differences in affective responses to acute stress, no studies have explored how such differences may contribute to cigarette cravings. METHOD: To address this gap, we conducted an experimental study in which a diverse sample of healthy volunteer female (n = 163) and male (n = 139) nicotine-dependent individuals who smoked were exposed to a stressor (guided imagery of painful dental work). We assessed negative affect and cigarette craving immediately before and after the imaginal dental stressor. RESULTS: Path analyses revealed that the acute stressor induced increases in negative affect, which, in turn, increased cigarette craving (significant direct and indirect effects, p's < 0.05; R2indirect = 0.5). Interestingly, effects were more pronounced in women and in non-White individuals who smoked. CONCLUSIONS: Results highlight the important roles of stress and affect in craving, and the need to consider gender and race/ethnicity when developing interventions to manage stress-induced cigarette cravings among individuals attempting to quit.

Examining gain- and loss-framed messages in a novel breast cancer screening/cardiovascular context: Does framing matter?

Objective: Digital mammography can reveal not only breast cancer but also breast arterial calcification (BAC), which can indicate potential coronary artery disease. To explore ways to inform women of their BAC status in the context of a standard mammography results letter, we conducted a preliminary study comparing gain- and loss-framed messages to encourage follow-up cardiovascular care. Methods: U.S. women over age 40 with no heart disease history (N = 227) were randomly assigned to view a mammography letter including BAC information in one of seven ways (three gain-framed messages, three loss-framed messages, one comparison message). Results: Post-test measures indicated no significant differences on BAC knowledge, recall of test results and recommendations, perceived message effectiveness, or behavioral intentions for follow-up. Conclusion: Despite showing no significant differences between message conditions, results supported the messages' ability to clearly convey BAC information and encourage intention for follow-up cardiovascular care. Innovation: This experimental study represents the first published report examining the inclusion of BAC screening results within the mammography letter. It also explored the use of message framing in a dual detection-prevention context and suggests that future work should test the effects of including both framing tactics in messages designed to target dual-focus contexts.

Systematic Review of Comparisons Between Plastic and Silicone Dilators: Revealing a Knowledge Gap.

INTRODUCTION: Vaginal stenosis is a distressing side effect of radiation therapy that can impair quality of life. Dilator therapy is an option for patients undergoing pelvic radiotherapy to mitigate vaginal stenosis. Currently, the dilators given to patients by most hospitals are made of plastic, compared to silicone dilators which are available on the market for purchase. OBJECTIVES: We conducted a systematic literature review to find information to guide clinical recommendations to pelvic radiotherapy patients on potential differences regarding the use of plastic vs silicone dilators with regard to efficacy, cost, and patient preferences. METHODS: A systematic literature review was conducted in Embase, MEDLINE, and PubMed using Emtree terms. To be included in the review, papers needed to: focus on female patients undergoing radiation therapy, assess a vaginal dilator, measure any dilator intervention outcome, and specifically compare plastic vs silicone dilators for any measured outcome (either qualitative or quantitative). RESULTS: The initial search yielded 195 articles. Two area experts, with a third expert for arbitration, read each article and found that none met all review inclusion criteria. No studies were found that compared silicone to plastic dilators with regard to efficacy in treating vaginal stenosis due to radiation therapy, no studies were found that compared cost or cost-effectiveness of the 2 dilator types, and no studies were found comparing patient preferences or experiences (eg, comfort, adherence, ease of use) between the 2 dilator types. CONCLUSION: The materials used to create dilators have never been rigorously compared in the context of radiotherapy-related vaginal stenosis. Institutions and patients have no data to guide their choice. Significantly more research at the patient and institutional level is needed to explore the potential long-term quality of life and cost benefits of improved adherence with silicone dilator use, and to guide shared decision-making regarding dilator choice.

Pilot randomized controlled trial of a hypnosis intervention for women with bladder pain syndrome.

AIMS: To evaluate the feasibility and acceptability of a randomized controlled trial of a hypnosis intervention for the treatment of bladder pain syndrome/interstitial cystitis (BPS/IC) in women. METHODS: We conducted a parallel arm, non-blinded, pilot randomized controlled trial of standardized hypnosis sessions including a hypnosis web tool versus usual care in adult women with BPS/IC. Pilot study outcomes included feasibility domains: process, resources and management, safety, and acceptability. Clinical outcomes of lower urinary tract symptoms and quality of life were measured using validated questionnaires at baseline and at the end of the 4-week intervention. RESULTS: We randomized 29 out of 30 (96.7%) eligible women. In the hypnosis group, 12 of 15 (80.0%) subjects completed the 4-week intervention and follow up, and 13 of 14 (92.9%) in the usual care group. In the hypnosis group, adherence to the standardized sessions was 80% and participants used the web-based tool for an average of 5.6 ± 2.7 times per week. Scores for emotional distress, relaxation, pain severity and expected bladder symptoms significantly improved during the first two of three planned hypnosis sessions (all p < 0.05). Improvement in quality of life scores was greater in the hypnosis group than the usual care group (-2.6 ± 2.3 vs. -0.9 ± 1.1, p = 0.04). There were no significant between-group differences in urinary symptoms or bladder pain. No adverse events were reported. CONCLUSIONS: A hypnosis intervention for the treatment of bladder pain syndrome/interstitial cystitis is feasible, acceptable, safe, and may improve quality of life.

Common paraverbal errors during hypnosis intervention training.

There is growing literature to support the use of hypnosis as an evidence-based behavioral medicine intervention to manage a wide variety of symptoms and side effects associated with cancer and its treatment (e.g., pain, nausea, fatigue). However, formal training in hypnosis is often lacking among cancer care providers. The purpose of this study is to identify common paraverbal errors among hypnosis trainees in order to inform future training efforts. In a sample of 196 hypnosis trainees, paraverbal errors (i.e., tone, pacing, and phrasing) were tracked across hypnotic intervention components. Results revealed that trainees had most difficulty with hypnotic tone, particularly during the Induction, Deepening, and Alerting components. Individual trainee characteristics were unrelated to paraverbal errors.

The effect of an online lecture on psychosocial cancer care providers' attitudes about hypnosis.

Hypnosis has been shown to be efficacious in the control of the symptoms and side effects of cancer and its treatment across all stages of the cancer continuum. Yet, hypnosis has generally failed to widely disseminate to clinical cancer settings, potentially due in part to provider attitudes about hypnosis. In a sample of 340 trainees (psychosocial cancer care providers), we tested the effects of a 12-minute online video hypnosis lecture on provider attitudes (using the Attitudes Toward Hypnosis Questionnaire). We hypothesized that viewing the online video would improve attitudes about hypnosis. Using a repeated measures design, total attitudes toward hypnosis improved following the lecture [F(1,339) = 321.97, p < .0001], as did all hypnosis attitude subscales. Older age and ethnicity (Latino/a) were associated with more positive attitudes across assessment points (ps < .05). Those trainees without prior hypnosis experience had the most attitude improvement (p < .05). The results support the use of a brief, online hypnosis lecture to improve cancer care provider attitudes about hypnosis, and suggest a path forward to facilitate more widespread dissemination of hypnosis to cancer care.

Cancer treatment experiences among survivors of childhood sexual abuse: A qualitative investigation of triggers and reactions to cumulative trauma.

ABSTRACTObjective:Some 25% of women and 8% of men in the United States have experienced childhood sexual abuse (CSA) before the age of 18. For these individuals, healthcare visits and interactions can be retraumatizing due to perceived similarities to past abuse (e.g., pain, undressing, lack of control). However, no prior studies have provided formal qualitative analyses regarding CSA survivors' reactions to cancer treatment. Therefore, our study's objective was to identify key themes pertaining to CSA survivors' cancer treatment experiences. METHOD: Male and female members of the Amazon Mechanical Turk (N = 159, mean age = 44.27 years, SD = 10.02) participated in an anonymous online survey study. The inclusion criteria included reporting: history of CSA; a diagnosis of colorectal, gynecological, breast, or skin cancer; and experience of triggers and/or difficulties during cancer treatment. Participants' responses to open-ended questions were analyzed using inductive thematic analysis. RESULTS: We identified two primary themes describing CSA survivors' experiences: Theme 1: treatment-related triggers (key subthemes: procedure-related, provider-related, and emotional triggers); and Theme 2: questioning the meaning of cumulative trauma (e.g., "Why me again?"). SIGNIFICANCE OF RESULTS: For CSA survivors, cancer and its treatment can trigger thoughts and emotions associated with the original abuse as well as negative evaluations of themselves, the world, and their future. Our findings are consistent with past research on CSA survivors' experiences in non-cancer healthcare settings and add to the literature by highlighting their struggles during cancer treatment. The present results can inform further research on trauma survivors' reactions to cancer treatment and give cancer care providers the context they need to understand and sensitively serve a substantial yet often overlooked patient group.

Cancer Victim Identity for Individuals with Histories of Cancer and Childhood Sexual Abuse.

Identifying as a 'cancer victim' has been linked to adverse psychosocial sequelae in individuals who have been diagnosed with cancer. Being a childhood sexual abuse (CSA) survivor may predispose individuals towards a "victim" identity in general. The aim of this study was to determine the prevalence of identifying as a 'cancer victim' among CSA survivors who were diagnosed with cancer as adults, and to explore psychological factors associated with identification as a cancer victim. 105 adults reporting both a history of CSA and of having been diagnosed with cancer as an adult were recruited through Amazon Mechanical Turk. Variables assessed included CSA severity, abuse-related powerlessness, general mastery, and cancer victim identity. Fifty-one percent of the sample endorsed a cancer victim identity. Path analysis revealed that abuse-related powerlessness was related to decreased feelings of general mastery, which was in turn associated with cancer victim identification (x2 = .12, DF = 1, p < .73; RMSEA = .00; SRMR = .01: Bentler CFI = 1.0). From a clinical perspective, the results suggest that increasing general mastery in CSA survivors in the cancer setting may be an important mechanism for attenuating the risk for developing a cancer victim identity and, presumably, for downstream adverse psychosocial sequelae.

Cognitive-Behavioral Therapy Plus Hypnosis for Distress During Breast Radiotherapy: A Randomized Trial.

Radiotherapy is a common and effective treatment for women with breast cancer. However, radiotherapy has also been shown to adversely affect patients' emotional well-being. Currently, few mind-body interventions are designed to improve patients' quality of life during radiotherapy. One intervention which has demonstrated clinical efficacy in the breast cancer radiotherapy setting is Cognitive-Behavioral Therapy plus Hypnosis. The goal of this study was to investigate the impact of Cognitive-Behavioral Therapy plus Hypnosis on emotional distress in women with breast cancer undergoing radiotherapy. One hundred patients were randomly assigned to either the Cognitive-Behavioral Therapy plus Hypnosis (n = 50) or Attention Control (n = 50) group. Results revealed significant benefits of Cognitive-Behavioral Therapy plus Hypnosis on emotional distress at the mid-point (d = 0.54), the conclusion (d = 0.64), and 4 weeks following the conclusion (d = 0.65) of radiotherapy (all ps < 0.05). In summary, results support further study of Cognitive-Behavioral Therapy plus Hypnosis as an evidence-based intervention to reduce emotional distress in women with breast cancer. Cognitive-Behavioral Therapy plus Hypnosis has the benefits of being brief, noninvasive, lacking side-effects, and producing beneficial effects which last beyond the conclusion of radiotherapy. Given these strengths, we propose that Cognitive-Behavioral Therapy plus Hypnosis is a strong candidate for greater dissemination and implementation in cancer populations.

Hypnosis for Symptom Control in Cancer Patients at the End-of-Life: A Systematic Review.

Hypnosis has been shown to alleviate symptoms and side effects of cancer and its treatment. However, less is known about the use of hypnosis at the end of life in individuals with cancer. Our goal was to systematically review the literature on the use of hypnosis to manage the most common symptoms of end-of-life cancer patients: fatigue, sleep disturbances, pain, appetite loss, and dyspnea. EMBASE, MEDLINE, COCHRANE, PsychINFO, and SCOPUS databases were searched from inception through November 7, 2016. No studies met the inclusion criteria. It appears that hypnosis has never been rigorously tested as a means to ameliorate the most common symptoms in individuals with cancer at the end of their lives. This finding is troubling, as it strongly implies that a population most in need has been largely neglected. However, a clear future research direction is revealed that may have significant clinical impact.

The Use of a Brief 5-Item Measure of Family Satisfaction as a Critical Quality Indicator in Advanced Cancer Care: A Multisite Comparison.

BACKGROUND: Although family satisfaction is recognized as a critical indicator of quality for patients with advanced cancer, it is rarely assessed as part of routine clinical care. Measurement burden may be one barrier to widespread use of family satisfaction measures. OBJECTIVE: The goal of this study was to test the ability of a new, brief 5-item measure of family satisfaction with care to accurately capture differences across hospital settings. DESIGN: Using data from the Palliative Care for Cancer Patients study, a prospective study of 1979 patients and caregivers, we used multivariate regression analysis to detect significant differences across five sites. SETTINGS: Hospitalized patients with advanced cancer and their caregivers Methods: We used both the shortened 5-item version of the FAMCARE scale (previously developed using Item Response Theory) and the original 20-item FAMCARE to measure family satisfaction. RESULTS: On the 5-item FAMCARE, sites ranged from mean scores of 5.5-6.9 out of a possible high score of 10. Family members at one care site (n = 783) were significantly (p < 0.05) less satisfied with their care than family members at four other care sites. The original 20-item measure failed to differentiate satisfaction levels between all hospital sites. DISCUSSION: Variability in family satisfaction with advanced cancer care across hospital settings can be more sensitively detected using a brief 5-item questionnaire versus longer measures. The development of less lengthy and burdensome measures for monitoring family satisfaction, which are still valid, can facilitate routine assessments to maintain and promote high-quality care across care settings.