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1.
Qual Life Res ; 32(12): 3531-3545, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37522941

RESUMO

PURPOSE: This study aimed to investigate the supportive care needs of Australian melanoma patients and their caregivers to form the basis for improving services. METHODS: General and melanoma-related supportive care needs in melanoma patients were measured using the SCNS-SF34 and SCNS-M12 respectively, whereas caregivers completed the SCNS-P&C. Patients also completed the MCQ-28 and FCRI-9, with all participants completing the QLQ-C30, DASS-21, and questions measuring utilisation and preference for supportive health services. Multivariable stepwise logistic regression was used to identify variables associated with unmet needs in melanoma patients. RESULTS: A total of 56 early-stage patients, 100 advanced-stage patients, and 37 caregivers participated. At least three-quarters ([Formula: see text] 75%) of each participant group reported at least one unmet need. Of the ten most reported unmet needs in each participant group, at least six ([Formula: see text] 60%) were related to psychological and emotional well-being, with access to a psychologist the most desired service (> 25%). Fear of cancer recurrence was equally prevalent in both patient groups at a level indicative of need for intervention. Advanced-stage patients reported significantly (p < 0.05) more unmet psychological, physical and daily living, and sexuality needs, and significantly (p < 0.05) worse functioning than early-stage patients. CONCLUSION: Australian melanoma patients and caregivers report substantial unmet supportive care needs, particularly regarding their psychological and emotional well-being. Psychological and emotional well-being services, such as access to a clinical psychologist or implementation of patient-reported outcome measures, should be incorporated into routine melanoma care to address unmet patient and caregiver needs and improve well-being.


Assuntos
Cuidadores , Melanoma , Humanos , Estudos Transversais , Cuidadores/psicologia , Recidiva Local de Neoplasia , Inquéritos e Questionários , Austrália , Qualidade de Vida/psicologia , Apoio Social , Necessidades e Demandas de Serviços de Saúde
2.
Fertil Steril ; 113(3): 642-652, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32192597

RESUMO

OBJECTIVE: To characterize the sociodemographic and psychological profiles of participant groups involved in altruistic surrogacy in Australia. DESIGN: Cross-sectional study. SETTING: Single psychological practice in Sydney, Australia. PATIENT(S): Six hundred and two individuals involved in 160 altruistic surrogacy arrangements: 143 intended mothers, 175 intended fathers (including 17 same-sex intended father couples), 160 surrogates, and 124 surrogate partners. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Responses to a presurrogacy sociodemographic assessment counseling protocol and the Personality Assessment Inventory (PAI). RESULT(S): The surrogates were primarily sisters, sisters-in-law, mothers (48.6%), or other extended family or friends (46.3%) of the intended parents. Most participants resided in residential postcode areas within the highest socioeconomic status quintile; however, intended mothers were more likely than surrogates to live in the most advantaged residential areas, to be younger and be more educated, and to be employed in professional occupations. Most participant psychological profiles were normal. A statistically significantly elevated PAI Somatic Complaints-Health Concerns subscale for intended mothers was observed compared with other participant groups. The higher PAI Warmth scale scores of intended mothers and surrogates were statistically significantly different from their respective partners, although not different from each other. CONCLUSION(S): Sociodemographic and some psychological differences between participant groups were observed that warrant exploration in pretreatment surrogacy counseling. Importantly, the higher scores on the PAI Warmth scale exhibited by intended mothers and surrogates in the context of close family and friendship relationships are likely to serve as protective mechanisms for the altruistic surrogacy outcome.


Assuntos
Altruísmo , Relações Interpessoais , Pais/psicologia , Parceiros Sexuais/psicologia , Mães Substitutas , Adulto , Austrália/epidemiologia , Estudos Transversais , Relações Pai-Filho , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Determinação da Personalidade , Gravidez , Fatores Socioeconômicos , Mães Substitutas/psicologia , Mães Substitutas/estatística & dados numéricos
3.
BMC Med Inform Decis Mak ; 19(1): 165, 2019 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-31426772

RESUMO

BACKGROUND: Most breast cancer patients undergoing mastectomy are candidates for breast reconstruction. Deciding about breast reconstruction is complex and the preference-sensitive nature of this decision requires an approach of shared decision making between patient and doctor. Women considering breast reconstruction have expressed a need for decision support. We developed an online patient decision aid (pDA) to support decision making in women considering immediate breast reconstruction. The primary aim of this study is to assess the impact of the pDA in reducing decisional conflict, and more generally, on the decision-making process and the decision quality. Additionally, we will investigate the pDA's impact on health outcomes, explore predictors, and assess its cost-effectiveness. METHODS: A multicenter, two-armed randomized controlled trial (1:1) will be conducted. Women with breast cancer or ductal carcinoma in situ who will undergo a mastectomy and are eligible for immediate breast reconstruction will be invited to participate. The intervention group will receive access to the online pDA, whereas the control group will receive a widely available free information leaflet on breast reconstruction. Participants will complete online questionnaires at: baseline (T0), 1 week after consultation with a plastic surgeon (T1), and 3 (T2) and 12 months (T3) after surgery. The primary outcome is decisional conflict. Secondary outcomes include other measures reflecting the decision-making process and decision quality (e.g., decision regret), patient-reported health outcomes (e.g., satisfaction with the breasts) and costs. DISCUSSION: This study will provide evidence about the impact of an online pDA for women who will undergo mastectomy and are deciding about breast reconstruction. It will contribute to the knowledge on how to optimally support women in making this difficult decision. TRIAL REGISTRATION: This study is retrospectively registered at ClinicalTrials.gov ( NCT03791138 ).


Assuntos
Neoplasias da Mama/cirurgia , Carcinoma Intraductal não Infiltrante/cirurgia , Técnicas de Apoio para a Decisão , Mamoplastia , Mastectomia , Neoplasias da Mama/psicologia , Carcinoma Intraductal não Infiltrante/psicologia , Protocolos Clínicos , Análise Custo-Benefício , Tomada de Decisões , Feminino , Humanos , Pessoa de Meia-Idade , Participação do Paciente , Encaminhamento e Consulta , Estudos Retrospectivos , Inquéritos e Questionários
4.
BMC Health Serv Res ; 19(1): 120, 2019 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-30764822

RESUMO

BACKGROUND: Collaborative care involves active engagement of primary care and hospital physicians in shared care of patients beyond usual discharge summaries. This enhances community-based care and reduces dependence on specialists and hospitals. The model, successfully implemented in chronic care management, may have utility for treatment of depression in cancer. The aim of this systematic review was to identify components, delivery and roles and responsibilities within collaborative interventions for depression in the context of cancer. METHODS: Medline, PsycINFO, CINAHL, Embase, Cochrane Library and Central Register for Controlled Trials databases were searched to identify studies of randomised controlled trials comparing a treatment intervention that met the definition of collaborative model of depression care with usual care or other control condition. Studies of adult cancer patients with major depression or a non-bipolar depressive disorder published in English between 2005 and January 2018 were included. Cochrane checklist for risk of bias was completed (Study Prospero registration: CRD42018086515). RESULTS: Of 8 studies identified, none adhered to the definition of 'collaborative care'. Interventions delivered were multi-disciplinary, with care co-ordinated by nurses (n = 5) or social workers (n = 2) under the direction of psychiatrists (n = 7). Care was primarily delivered in cancer centres (n = 5). Care co-ordinators advised primary care physicians (GPs) of medication changes (n = 3) but few studies (n = 2) actively involved GPs in medication prescribing and management. CONCLUSIONS: This review highlighted joint participation of GPs and specialist care physicians in collaborative care depression management is promoted but not achieved in cancer care. Current models reflect hospital-based multi-disciplinary models of care. PROTOCOL REGISTRATION: The protocol for this systematic review has been registered with PROSPERO. The registration number is CRD42018086515.


Assuntos
Transtorno Depressivo Maior/terapia , Neoplasias/terapia , Equipe de Assistência ao Paciente/organização & administração , Adulto , Institutos de Câncer/organização & administração , Ensaios Clínicos Controlados como Assunto , Atenção à Saúde/organização & administração , Depressão/terapia , Feminino , Humanos , Masculino , Corpo Clínico Hospitalar/organização & administração , Neoplasias/psicologia , Participação do Paciente , Atenção Primária à Saúde/organização & administração , Psiquiatria/organização & administração , Ensaios Clínicos Controlados Aleatórios como Assunto , Especialização/estatística & dados numéricos
5.
Psychooncology ; 27(6): 1589-1596, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29623676

RESUMO

OBJECTIVE: To report on the cost-effectiveness of BRECONDA (Breast RECONstruction Decision Aid), a web-based decision aid to facilitate decisions regarding breast reconstruction surgery, with usual care for women with breast cancer. METHODS: The economic evaluation was conducted alongside a randomized controlled trial. Women diagnosed with breast cancer or ductal carcinoma in situ and eligible for breast reconstruction following mastectomy were randomized to access BRECONDA for 6 months + usual care (n = 106) or usual care (n = 116) and were assessed at baseline preintervention, and then 1-month and 6-months post-randomization. Decisional conflict, satisfaction with information, decisional regret, and utilities were assessed by using maximum-likelihood linear mixed effects models. Costs included the fixed costs of BRECONDA, health care provider time, and health care resource use. Nonparametric bootstrapping was used to estimate incremental cost-effectiveness ratios. RESULTS: BRECONDA resulted in significantly less decisional conflict and greater satisfaction with information over time. Quality-adjusted life years did not differ between participants who received the decision aid compared with usual care. The cost of BRECONDA was estimated to be small (AUD$10) relative to other health care interventions and resulted in decreased health care costs overall (AUD$764). Based on the point estimates, the decision aid was more effective and less costly (dominant) for all measures of effectiveness. It was estimated that the decision aid has an 87% probability of being cost-effective at $60 000 per quality-adjusted life year gained. CONCLUSIONS: The BRECONDA web-based intervention designed to facilitate decisions regarding breast reconstruction surgery is likely to be cost-effective compared with usual care for women with breast cancer.


Assuntos
Neoplasias da Mama/economia , Mamoplastia/psicologia , Participação do Paciente/psicologia , Satisfação do Paciente/estatística & dados numéricos , Adulto , Idoso , Neoplasias da Mama/cirurgia , Conflito Psicológico , Análise Custo-Benefício , Tomada de Decisões , Técnicas de Apoio para a Decisão , Feminino , Custos de Cuidados de Saúde , Humanos , Mamoplastia/economia , Pessoa de Meia-Idade , Participação do Paciente/economia , Anos de Vida Ajustados por Qualidade de Vida , Método Simples-Cego
6.
J Immigr Minor Health ; 17(1): 165-71, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24072515

RESUMO

Fatalism has been associated with non-adherence to health behavior in the past. This study compared fatalism of Chinese and Korean immigrants with native-born Caucasians (N = 309) and examined whether the relationship between fatalism and exercise, nutrition and medical screening would be moderated by ethnicity. Chinese reported higher fatalism than Caucasians and Koreans. Higher fatalism was associated with greater exercise among Chinese and Koreans, but less reported exercise among Caucasians. Caucasian participants had higher scores for nutrition and medical screening compared with Chinese and Korean immigrants. These findings indicate that fatalism is more prevalent among Chinese immigrants; however, there is no evidence of a detrimental effect of fatalism on exercise, nutrition or medical screening among the Asian immigrants. Caucasians with higher fatalism may be at greater risk of future illnesses, given the association between fatalism and sedentary behavior in this group. Differences between cultural groups in the adoption of health behavior justify the development and assessment of targeted interventions to optimize health promoting behaviors.


Assuntos
Atitude Frente a Morte , Emigrantes e Imigrantes/psicologia , Comportamentos Relacionados com a Saúde , População Branca , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , China/etnologia , Características Culturais , Feminino , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Prevalência , República da Coreia/etnologia , Inquéritos e Questionários , Estados Unidos
7.
Ann Behav Med ; 48(2): 205-14, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24500081

RESUMO

BACKGROUND: Increasing life expectancies, burgeoning healthcare costs and an emphasis on the management of multiple health-risk behaviours point to a need to delineate health lifestyles in older adults. PURPOSE: The aims of this study were to delineate health lifestyles of a cohort of older adults and to examine the association of these lifestyles with biological and psychological states and socio-economic indices. METHODS: Cluster analysis was applied to data derived from the self-reported 45 and Up cohort study (N = 96,276) of Australians over 45 years, regarding exercise, smoking, alcohol consumption, diet and cancer screening behaviours. RESULTS: Six lifestyle clusters emerged delineated by smoking, screening and physical activity levels. Individuals within health-risk dominant clusters were more likely to be male, living alone, low-income earners, living in a deprived neighbourhood, psychologically distressed and experiencing low quality of life. CONCLUSIONS: Health lifestyle cluster membership can be used to identify older adults at greatest risk for physical and psychological health morbidity.


Assuntos
Comportamentos Relacionados com a Saúde , Adaptação Psicológica , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Austrália/epidemiologia , Análise por Conglomerados , Dieta/estatística & dados numéricos , Detecção Precoce de Câncer/estatística & dados numéricos , Exercício Físico , Feminino , Nível de Saúde , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Psicologia , Qualidade de Vida/psicologia , Fumar/epidemiologia , Fatores Socioeconômicos , Estresse Psicológico/epidemiologia
8.
J Community Genet ; 5(2): 89-98, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23934762

RESUMO

Breast cancer is a significant health concern for African American women. Nonetheless, uptake of genetic risk assessment (including both genetic counseling and testing) for breast cancer gene mutations among these populations remains low. This paper systematically reviews cognitive (i.e., beliefs) and affective (i.e., emotions) factors influencing BRCA1/2 genetic risk assessment among African American women as well as psychosocial interventions to facilitate informed decision making in this population. A systematic search of CINAHL, PubMed, and PsycINFO was undertaken, yielding 112 published studies. Of these, 18 met the eligibility criteria. African American woman are likely to participate in genetic risk assessment if they are knowledgeable about cancer genetics, perceive a high risk of developing breast cancer, have low expectancies of stigmatization from medical professionals, view themselves as independent from family, and have fatalistic beliefs and a future temporal orientation. Anticipated negative affective responses, such as an inability to "handle" the results of testing, are barriers to uptake. Specific perceptions, beliefs, and emotional factors are associated with genetic risk assessment among African American women. Understanding these factors is key in the development of interventions to facilitate informed decision making in this population.

9.
Med J Aust ; 199(9): 599-603, 2013 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-24182225

RESUMO

OBJECTIVES: To establish whether altered protocol characteristics of streamlined StepDown breast assessment clinics heightened or reduced the psychological distress of women in attendance compared with standard assessment. Willingness to attend future screening was also compared between the assessment groups. DESIGN: Observational, prospective study of women attending either a mammogram-only StepDown or a standard breast assessment clinic. Women completed questionnaires on the day of assessment and 1 month later. PARTICIPANTS AND SETTING: Women attending StepDown (136 women) or standard assessment clinics (148 women) at a BreastScreen centre between 10 November 2009 and 7 August 2010. MAIN OUTCOME MEASURES: Breast cancer worries; positive and negative psychological consequences of assessment (Psychological Consequences Questionnaire); breast cancer-related intrusion and avoidance (Impact of Event Scale); and willingness to attend, and uneasiness about, future screening. RESULTS: At 1-month follow-up, no group differences were evident between those attending standard and StepDown clinics on breast cancer worries (P= 0.44), positive (P= 0.88) and negative (P = 0.65) consequences, intrusion (P = 0.64), and avoidance (P = 0.87). Willingness to return for future mammograms was high, and did not differ between groups (P = 0.16), although higher levels of unease were associated with lessened willingness to rescreen (P = 0.04). CONCLUSIONS: There was no evidence that attending streamlined StepDown assessments had different outcomes in terms of distress than attending standard assessment clinics for women with a BreastScreen-detected abnormality. However, unease about attending future screening was generally associated with less willingness to do so in both groups; thus, there is a role for psycho-educational intervention to address these concerns.


Assuntos
Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/psicologia , Mamografia/psicologia , Estresse Psicológico/etiologia , Neoplasias da Mama/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Inquéritos e Questionários
10.
Psychooncology ; 15(2): 96-108, 2006 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-15880639

RESUMO

This exploratory study investigates the experience of partners of women at high risk of developing breast/ovarian cancer and reports on the partners' views concerning their relationship, communication, future planning, children and childbearing, involvement in decision-making regarding screening and prophylactic measures, and information and support needs. In-depth interviews were conducted with 15 partners. Of these, seven were partners of women who were BRCA1/2 mutation carriers, five were partners of women with unknown mutation status, and three were partners of women who were non-carriers. None of the women had a previous diagnosis of breast or ovarian cancer. Partners of carriers and women with unknown mutation status were found to be more distressed than partners of non-carriers, with partners of mutation carriers reporting the most difficulties. Factors associated with better adjustment and coping for partners included dealing with this situation as a team with their wife, greater involvement in decision-making, satisfaction with their supportive roles and being optimistic. Decision-making difficulties in relation to prophylactic measures, concerns about their children possibly being at increased cancer risk, as well as the need to receive information directly from health professionals and the wish to meet other partners were also discussed.


Assuntos
Neoplasias da Mama/psicologia , Necessidades e Demandas de Serviços de Saúde , Avaliação das Necessidades , Neoplasias Ovarianas/psicologia , Adaptação Psicológica , Adulto , Austrália/epidemiologia , Neoplasias da Mama/epidemiologia , Área Programática de Saúde , Tomada de Decisões , Demografia , Características da Família , Feminino , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Neoplasias Ovarianas/epidemiologia , Fatores de Risco , Inquéritos e Questionários
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