RESUMO
PURPOSE OF REVIEW: The evidence regarding the effectiveness of interventions aiming to improve ACP uptake appears mixed. The purpose of this scoping review is to summarize findings from recent RCTs assessing the efficacy of interventions designed to increase ACP uptake in cancer care. RECENT FINDINGS: The PubMed database was searched for studies published between 2021 and 2023. Ten RCTs were identified that evaluated a wide range of interventions aimed at encouraging or facilitating ACP communication among patients with advanced cancer, caregivers, and HCPs. Three RCTs developed ACP facilitation tools for patients and sometimes caregivers. Six RCTs involved integrating trained ACP facilitators into patient care, and one RCT used nudges to encourage oncologists trained in ACP discussions to initiate discussions with patients at highest risk of short-term mortality. Most of the reviewed interventions were based on previously tested intervention approaches or tools. SUMMARY: The key effects identified in this review are the facilitation of ACP discussions among patients, caregivers, and HCPs, and the documentation of patient preferences in the medical record. The direct involvement of facilitators in ACP document drafting and inclusion in patient files, as well as interventions prompting end-of-life discussions, contributed to this effect.
Assuntos
Planejamento Antecipado de Cuidados , Neoplasias , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Neoplasias/terapia , Oncologia/métodos , Preferência do Paciente , CuidadoresRESUMO
PURPOSE OF REVIEW: Cancer patients' communication with their relatives and healthcare professionals (HCPs) is essential for advance care planning (ACP). The purpose of this scoping review was to synthesize recent research findings about factors enabling cancer patients', their relatives', and physicians' communication about ACP, and to propose recommendations for future ACP implementation in cancer care. RECENT FINDINGS: This review confirmed the importance of aspects of the cancer care context (i.e., culture) as ACP uptake-predisposing and -enabling factors. It highlighted the difficulty of determining who should initiate ACP discussion, with which patients and at what time-points. It also highlighted a lack of consideration for socioemotional processes in the study of ACP uptake despite evidence that cancer patients', relatives' and physicians' discomforts that arise from communication about end-of-life and the wish to safeguard each other are main obstacles to ACP implementation. SUMMARY: Based on these recent findings, we propose an ACP communication model, developed with the consideration of factors reported to influence ACP uptake and communication in healthcare, and integrating socioemotional processes. The testing of the model may yield suggestions for innovative interventions that can support communication about ACP and promote a better uptake in clinical practice.
Assuntos
Planejamento Antecipado de Cuidados , Neoplasias , Humanos , Oncologia , Neoplasias/terapiaRESUMO
PURPOSE: This study reports the short- and mid-term benefits of an eight-session emotion and self-regulation group intervention ecologically boosted through daily app-based prompts. The intervention was designed for breast cancer patients in the early survivorship period meeting criteria for clinical levels of psychological symptoms. METHODS: Patients were randomly assigned to the immediate intervention arm (n = 61; intervention received immediately) or to the delayed intervention arm (n = 59; intervention received 5 months later). Psychological symptoms, including anxiety, depressive symptoms, emotional distress, fear of cancer recurrence (FCR), worry, and intrusive thoughts were assessed through questionnaires. Emotion regulation was assessed in a dynamic emotion regulation task and in everyday life. Assessments were completed at baseline (T1), 5 months (T2) and 10 months (T3) later. RESULTS: Treated patients reported lower levels of worry and intrusive thoughts. They improved their ability to down-regulate the intensity of their negative emotions when exposed to cancer-related triggers in the dynamic emotion regulation task. They reported fewer and less intense negative emotions and more positive emotions in their everyday life. Benefits were maintained 5 months later, except for positive emotions in everyday life. CONCLUSIONS: The results showed that focusing on emotion regulation is a relevant approach in the treatment of psychological symptoms for breast cancer patients in the early survivorship period meeting criteria for clinical levels of psychological symptoms. The intervention led to changes in patients' dynamic and everyday life emotion regulation. Consolidation sessions may be needed to sustain benefits in positive emotions and to increase the effect sizes.
Assuntos
Neoplasias da Mama , Regulação Emocional , Humanos , Feminino , Neoplasias da Mama/terapia , Neoplasias da Mama/psicologia , Sobrevivência , Emoções/fisiologia , Ansiedade/terapia , Ansiedade/psicologiaRESUMO
PURPOSE OF REVIEW: When a parent is diagnosed with cancer, the entire family is impacted. Patients with cancer and co-parents may no longer feel able to fulfill their parenting roles. The aims of this article are to describe interventions designed to support parenting in the oncological context and to make suggestions for the development and assessment of such interventions. RECENT FINDINGS: Ten parenting support interventions published in the last 10âyears in oncology were identified, among which four randomized controlled trials (RCTs). The therapeutic aims, techniques, and modalities of these interventions were heterogeneous. Five main therapeutic aims were addressed to: increase parents' knowledge, promote parents' emotion regulation, enhance parents' self-efficacy related to parenting, promote parents' support of their children's reactions and coping strategies, and promote open and appropriate parent-child communication. Few studies have combined informational resources with experiential techniques. SUMMARY: Very few studies examining the efficacy of parenting support interventions have been published. There is still a need to develop, test, and compare interventions that meet the many needs of parents and their children. Suggestions are made about the contents and formats of parenting support interventions in oncology.
Assuntos
Neoplasias , Poder Familiar , Humanos , Neoplasias/terapia , Relações Pais-Filho , Poder Familiar/psicologia , Pais/psicologiaRESUMO
PURPOSE OF REVIEW: The purpose of this article is to review the formats and techniques of psychological interventions designed for patients with metastatic cancer and prolonged survival expectancies. RECENT FINDINGS: Fifteen interventional studies were selected for this article. One group of psychological interventions focused primarily on patients' adaptation by increasing their knowledge, developing patients' stress management skills, promoting their open communication with healthcare providers, and helping them deal with existential concerns. Another group of interventions focused on patients with moderate and high levels of distress. These interventions provided specific techniques to manage anxiety, depression, fear of cancer progression, and existential distress. Interestingly, interventions targeting distressed patients are not necessarily longer or more intensive than interventions targeting adaptation. The interventions were examined in few randomized controlled trials, and incorporated a broad range of techniques, making comparison of their efficacy difficult. No intervention specifically targeted patients newly diagnosed with metastatic cancer. SUMMARY: On the basis of this review, we proposed suggestions according to patients' levels of distress, which differ in intensity, format, techniques, and tools offered. These suggestions may be relevant for the future development and assessment of interventions targeting patients with newly diagnosed metastatic cancer and prolonged survival expectancies.
Assuntos
Segunda Neoplasia Primária , Neoplasias , Ansiedade/psicologia , Ansiedade/terapia , Humanos , Neoplasias/psicologia , Intervenção Psicossocial , Qualidade de Vida , Estresse Psicológico/terapiaRESUMO
OBJECTIVES: Clinical fear of cancer recurrence (FCR) is highly prevalent among breast cancer patients and appears early in the disease trajectory. A better understanding of psychological factors associated with clinical FCR is essential to guide screening and intervention development. This cross-sectional study aimed to assess the contribution of attentional bias, intrusive thoughts, metacognitive beliefs, intolerance of uncertainty, thought suppression, and worry to clinical FCR in breast cancer patients in the early survivorship period. METHODS: Seventy-four patients treated for non-metastatic breast cancer were enrolled at the end of their treatment. The FCR Inventory-Short Form (FCRI-SF) was used to discriminate between the patients with clinical versus nonclinical FCR. Attentional bias to negative and positive cancer-related and non-cancer-related emotional words was assessed with a dot-probe task. Words were presented for 17, 500, and 1500 ms. Intrusive thoughts and thought suppression were assessed with the White Bear Suppression Inventory, metacognitive beliefs with the Metacognitions Questionnaire-30, intolerance of uncertainty with the Intolerance of Uncertainty Inventory-Part A, and worry with the Penn State Worry Questionnaire. RESULTS: According to univariate analyses, the patients with clinical FCR (FCRI-SF ≥13) significantly differed from those with nonclinical FCR in terms of intrusive thoughts (p = 0.002), metacognitive beliefs (p = 0.029), intolerance of uncertainty (p < 0.001), and worry (p < 0.001). Intolerance of uncertainty (odds ratio, OR = 1.06; p = 0.040) and worry (OR = 1.09; p = 0.013) remained in the final logistic regression models. All the patients showed vigilance to cancer-related words, whether with negative or positive valence, at automatic stages of processing (17 ms). CONCLUSIONS: Intolerance of uncertainty and worry were the two psychological factors contributing directly to clinical FCR in our cross-sectional study. In addition, attentional bias did not differentiate breast cancer patients with clinical versus nonclinical FCR. Treatment approaches for clinical FCR in early survivorship care may need to integrate uncertainty and worry management intervention strategies.
Assuntos
Neoplasias da Mama , Humanos , Feminino , Neoplasias da Mama/terapia , Neoplasias da Mama/psicologia , Medo/psicologia , Sobrevivência , Recidiva Local de Neoplasia/psicologia , Estudos TransversaisRESUMO
OBJECTIVE: Cancer-related communication is critical for parents' and children's adaptation to the disease. This randomized pilot study was conducted to test the feasibility, acceptability, and efficacy of a 4-session intervention designed to improve parents' communication. METHODS: A 4-session intervention was developed to aid parents to support their children through more open/adapted communication. Sixty-six parents were assigned randomly to informational booklet with and without 4-session support intervention arms. Parents' communication self-efficacy, communication behaviors, communication difficulties, knowledge about age-appropriate communication, theoretical knowledge about concerns of children, parenting concerns, and distress were assessed by questionnaires at baseline and post-interventions. Multivariate analyses of variance were performed to compare data between and within groups over time. RESULTS: The intervention attrition rate was 6%. Data from 60 participants were included in analyses. Parents in the informational booklet with 4-session support group increased their communication self-efficacy (F = 4.5, p = 0.04), reduced communication difficulties (F = 4.0, p = 0.05), and increased their knowledge about how to communicate (F = 4.8, p = 0.03). CONCLUSION: The results indicate that the 4-session intervention is acceptable, and shows preliminary evidence of efficacy. PRACTICE IMPLICATIONS: A short support intervention associated with an informational booklet may be useful for parents wishing to improve their communication with their children.
Assuntos
Neoplasias , Pais , Criança , Humanos , Projetos Piloto , Poder Familiar , Comunicação , Neoplasias/terapiaRESUMO
BACKGROUND: Although previous studies have reported the efficacy of communication skills training (CST) programs, specific training addressing communication about uncertainty and hope in oncology has not yet been studied. This paper describes the study protocol of a randomized controlled trial assessing the efficacy of a CST program aimed at improving physician ability to communicate about uncertainty and hope in encounters with cancer patients. METHODS/DESIGN: Physician participants will be randomly assigned in groups (n = 3/group) to a 30-h CST program (experimental group) or to a waiting list (control group). The training program will include learner-centered, skills-focused, practice-oriented techniques. Training efficacy is assessed in the context of an encounter with a simulated advanced stage cancer patient at baseline and after the CST for the experimental group, and after four months for the waiting-list group. Efficacy assessments will include communicational, psychological and physiological measures. Group-by-time effects will be analyzed using a generalized estimating equation (GEE). A power analysis indicated that a sample size of 60 (30 experimental and 30 control) participants will be sufficient to detect effects. DISCUSSION: The current study will aid in the development of effective CST programs to improve physician ability to communicate about uncertainty and hope in encounters with cancer patients. TRIAL REGISTRATION: US Clinical Trials Register NCT02836197 .
Assuntos
Comunicação , Educação Médica Continuada , Oncologia , Relações Médico-Paciente , Médicos , Incerteza , Humanos , Estudos Longitudinais , Oncologia/métodos , Oncologia/normasRESUMO
OBJECTIVE: To compare in a multicenter randomized controlled trial the benefits in terms of anxiety regulation of a 15-session single-component group intervention (SGI) based on support with those of a 15-session multiple-component structured manualized group intervention (MGI) combining support with cognitive-behavioral and hypnosis components. METHODS: Patients with nonmetastatic breast cancer were randomly assigned at the beginning of the survivorship period to the SGI (n = 83) or MGI (n = 87). Anxiety regulation was assessed, before and after group interventions, through an anxiety regulation task designed to assess their ability to regulate anxiety psychologically (anxiety levels) and physiologically (heart rates). Questionnaires were used to assess psychological distress, everyday anxiety regulation, and fear of recurrence. Group allocation was computer generated and concealed till baseline completion. RESULTS: Compared with patients in the SGI group (n = 77), patients attending the MGI group (n = 82) showed significantly reduced anxiety after a self-relaxation exercise (P = .006) and after exposure to anxiety triggers (P = .013) and reduced heart rates at different time points throughout the task (P = .001 to P = .047). The MGI participants also reported better everyday anxiety regulation (P = .005), greater use of fear of recurrence-related coping strategies (P = .022), and greater reduction in fear of recurrence-related psychological distress (P = .017) compared with the SGI group. CONCLUSIONS: This study shows that an MGI combining support with cognitive-behavioral techniques and hypnosis is more effective than an SGI based only on support in improving anxiety regulation in patients with breast cancer.
Assuntos
Ansiedade/prevenção & controle , Neoplasias da Mama/psicologia , Sobreviventes de Câncer/psicologia , Grupos de Autoajuda , Sobrevivência , Adaptação Psicológica , Adulto , Ansiedade/etiologia , Ansiedade/psicologia , Atitude Frente a Saúde , Neoplasias da Mama/complicações , Medo/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: Despite the well-known negative impacts of cancer and anticancer therapies on cognitive performance, little is known about the cognitive compensatory processes of older patients with cancer. This study was designed to investigate the cognitive compensatory processes of older, clinically fit patients with hematologic malignancies undergoing chemotherapy. METHODS: We assessed 89 consecutive patients (age ≥ 65 y) without severe cognitive impairment and 89 age-, sex-, and education level-matched healthy controls. Cognitive compensatory processes were investigated by (1) comparing cognitive performance of patients and healthy controls in novel (first exposure to cognitive tasks) and non-novel (second exposure to the same cognitive tasks) contexts, and (2) assessing psychological factors that may facilitate or inhibit cognitive performance, such as motivation, psychological distress, and perceived cognitive performance. We assessed cognitive performance with the Trail-Making, Digit Span and FCSR-IR tests, psychological distress with the Hospital Anxiety and Depression Scale, and perceived cognitive performance with the FACT-Cog questionnaire. RESULTS: In novel and non-novel contexts, average cognitive performances of healthy controls were higher than those of patients and were associated with motivation. Cognitive performance of patients was not associated with investigated psychological factors in the novel context but was associated with motivation and psychological distress in the non-novel context. CONCLUSIONS: Older, clinically fit patients with hematologic malignancies undergoing chemotherapy demonstrated lower cognitive compensatory processes compared to healthy controls. Reducing distress and increasing motivation may improve cognitive compensatory processes of patients in non-novel contexts.
Assuntos
Antineoplásicos/uso terapêutico , Cognição/efeitos dos fármacos , Disfunção Cognitiva/etiologia , Neoplasias Hematológicas/tratamento farmacológico , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/efeitos adversos , Bélgica , Estudos de Casos e Controles , Disfunção Cognitiva/epidemiologia , Estudos de Coortes , Feminino , Neoplasias Hematológicas/diagnóstico , Neoplasias Hematológicas/psicologia , Humanos , Estudos Longitudinais , Masculino , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: Although cancer patients frequently experience self-perceived burden to others, this perception has not been enough studied. The aim of this study was to investigate the prevalence of self-perceived burden to the primary caregiver (SPB-PC) and associated factors in an older patient population with hematologic malignancies at the time of chemotherapy initiation. METHODS: In total, 166 consecutive patients with hematologic malignancies aged ≥65 years were recruited at the time of chemotherapy initiation. Patients' SPB-PC was assessed using a 100-mm visual analogue scale (VAS). Characteristics potentially associated with SPB-PC, including sociodemographic and medical characteristics, physical functioning status (Karnofsky performance score, activities of daily living (ADL)/instrumental ADL), symptoms (fatigue, pain, nausea, quality of life), psychological distress (Hospital Anxiety and Depression Scale (HADS)), perceived cognitive function (Functional Assessment of Cancer Therapy Cognitive (FACT-Cog) Scale), and patients'/primary caregivers' personal relationship characteristics (family tie, support), were assessed. RESULTS: Thirty-five percent of patients reported moderate to severe SPB-PC (VAS ≥ 50 mm). Patients' SPB-PC was associated with lower Karnofsky performance (ß = -0.135, p = 0.058) and ADL (ß = -0.148, p = 0.037) scores, and higher HADS (ß = 0.283, p < 0.001) and FACT-Cog perceived cognitive impairments subscale (ß = 0.211, p = 0.004) scores. The proportion of explained variance was 23.5%. CONCLUSIONS: Health care professionals should be aware that about one third of older cancer patients experience moderate to severe SPB-PC at the time of chemotherapy initiation. They should adapt their support of patients who report such a feeling. Copyright © 2016 John Wiley & Sons, Ltd.
Assuntos
Cuidadores/psicologia , Efeitos Psicossociais da Doença , Neoplasias Hematológicas/psicologia , Doente Terminal/psicologia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Feminino , Neoplasias Hematológicas/terapia , Humanos , Masculino , Prevalência , Qualidade de Vida/psicologia , Autoimagem , Índice de Gravidade de DoençaRESUMO
INTRODUCTION: Little is known about elderly cancer inpatients' desire for psychological help. PURPOSE: The aim of this study was to investigate whether elderly cancer inpatients well informed about their diagnosis expressed a desire to receive formal psychological help at the start of their cancer treatment. The characteristics of the patients that sought help were examined. METHODS: This cross-sectional study assessed 650 consecutive cancer inpatients that were 65 years of age and older when they started treatment for breast, colorectal, ovarian, lung, prostate or haematological cancers. Disease-related, medical and psychological characteristics of these patients were assessed using validated tools. RESULTS: Distress and cognitive impairment were experienced by 37% and 46% of elderly cancer inpatients, respectively. However, only 12% of patients reported a desire for formal psychological help (14% of women vs 9% of men). The patient characteristics examined were found to be weakly associated with this desire (this explained 16% of the variance for women and 14% for men). For the female subgroup, this desire was associated with age [<75 years vs ≥75 years; odds ratio (OR) = 2.57], marital status (without a partner vs with a partner; OR = 2.26) and distress (OR = 1.13). For the male subgroup, loss of functional autonomy (OR = 1.41) and pain (OR = 1.22) were relevant characteristics. CONCLUSIONS: Although more than about four out of 10 elderly cancer inpatients in this study experience distress or cognitive impairment, only about one out of 10 expresses a desire for formal psychological help. Therefore, an appropriate sequence of interventions should be scheduled in order to offer them an optimal formal psychological help.
Assuntos
Pacientes Internados/psicologia , Neoplasias/psicologia , Estresse Psicológico/psicologia , Adaptação Psicológica , Idoso , Idoso de 80 Anos ou mais , Bélgica/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Neoplasias/epidemiologia , Neoplasias/terapia , Prevalência , Estresse Psicológico/epidemiologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: In cancer care, informal primary caregivers provide healthcare professionals with key information regarding patient difficulties. The aim of this study was to assess their ability to report cancer patients' physical, psychological, and social difficulties. METHODS: We recruited 208 consecutive patients and their informal primary caregivers in 10 oncology units. Patients reported their difficulties on the CAncer Rehabilitation Evaluation System (CARES-P), whereas caregivers reported their perception of patient difficulties on an adapted CARES questionnaire (CARES-C). On the basis of CARES-P and CARES-C questionnaire answers, correct report rates were defined by the percentage of difficulties reported at least 'a little' by patients and by caregivers. False report rates were defined by the percentage of difficulties not reported at least 'a little' by patients and reported by caregivers. Patients and their caregivers also provided their distress levels (Hospital Anxiety and Depression Scale) and coping strategies. RESULTS: Caregivers correctly reported 67% of physical, 69% of psychological, and 40% of social difficulties experienced in patients. Caregivers falsely reported 28% of physical, 37% of psychological, and 22% of social difficulties not experienced by patients. Significant correlations were found between all correct and false reported rates. Patient and caregiver characteristics were weakly associated with caregivers' correct and false reports. CONCLUSIONS: Family primary caregivers correctly reported approximately two thirds of physical and psychological patients' difficulties; however, they had less accurate reports of patients' social difficulties. Correct report rates increased the probability of false report rates. Healthcare professionals should carefully evaluate the accuracy of a primary informal caregiver's report in regards to patient experiences.
Assuntos
Cuidadores , Coleta de Dados/normas , Relações Interpessoais , Neoplasias/enfermagem , Estresse Psicológico/psicologia , Atividades Cotidianas , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Autorrelato/normas , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To investigate the prevalence of desire for formal psychological support of primary caregivers of patients with cancer and to identify caregivers' and patients' socio-demographic and psychological characteristics as well as patients' disease-related characteristics associated with this desire. METHODS: This is a multicenter, cross-sectional study assessing desire for formal psychological support among consecutive primary caregivers of patients with cancer. Patients and caregivers completed the Hospital Anxiety and Depression Scale and reported their desire for formal psychological support. RESULTS: Two-hundred and eighty-two patient-caregiver dyads were assessed. Forty percent of patients had breast cancer, 16% had a hematologic cancer, 12% had a gastrointestinal cancer, and 32% had another solid tumor. Nineteen percent of caregivers reported desiring formal support, and 54% experienced moderate to high levels of distress. Regression analysis showed that caregivers' desire for formal support was negatively associated with caregivers' age (Exp(B) = 0.95; p < 0.001) and education levels (Exp(B) = 0.35; p = 0.032) and positively with caregivers' level of distress (Exp(B) = 1.08; p < 0.001) and with patients' desire for formal psychological support (Exp(B) = 2.54; p = 0.008). These variables only predicted 25% of caregivers who desire formal support. CONCLUSIONS: One out of five caregivers desires formal psychological support although one out of two caregivers experiences significant levels of distress. The weak association between caregivers' desire for formal support and distress emphasizes the need to implement systematic screenings of both their distress and their desire for formal psychological support in oncology.
Assuntos
Cuidadores/psicologia , Aconselhamento , Necessidades e Demandas de Serviços de Saúde , Neoplasias/psicologia , Apoio Social , Adaptação Psicológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/epidemiologia , Ansiedade/psicologia , Bélgica/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Depressão/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Escalas de Graduação Psiquiátrica , Estresse Psicológico/psicologia , Inquéritos e QuestionáriosRESUMO
PURPOSE OF REVIEW: Decision-making in oncology is associated with uncertainty and potential decisional conflict. The purpose of this paper is to review strategies suggested to improve treatment decision-making, discuss their limits and describe recommendations that have been made to improve the decision-making process. RECENT FINDINGS: To improve the decision-making process, uncertainty reduction, shared decision-making and multidisciplinary teamwork have been initially proposed. Due to their limits, alternative approaches such as uncertainty management, collaborative decision-making and collaborative multidisciplinary teamwork have been recommended. Uncertainty management considers uncertainty as a multilevel concept. It may be achieved through collaborative decision-making and collaborative multidisciplinary teamwork. Collaborative decision-making is an in-depth personalized iterative assessment of patient medical, psychological and social status. It promotes the patient's proactive role as a key stakeholder of decision-making and the physician's proactive role as a key support to patient decision-making. Collaborative multidisciplinary teamwork promotes an optimal environment for collaborative decision-making in which patients are key stakeholders and all relevant healthcare professionals are actively involved. These approaches require developing interventions for patients, and trainings for physicians and multidisciplinary teams. SUMMARY: On the basis of these recent approaches, we propose a 'three-step model of multidisciplinary collaborative treatment decision-making' in oncology. This model should be tested for its validity.
Assuntos
Tomada de Decisões , Oncologia/métodos , Neoplasias/terapia , HumanosRESUMO
OBJECTIVES: To investigate cancer patients' desire for psychological support and to identify patients' sociodemographic, disease-related and psychological factors associated with this desire. METHODS: The study is part of a multicenter, cross-sectional study assessing cancer patients' needs and desire for psychological support. Patients completed the Hospital Anxiety and Depression Scale, the Ways of Coping Checklist, the Cancer Rehabilitation Evaluation System and reported their desire for psychological support. RESULTS: Among the 381 included patients, women (26%) desired psychological support significantly more often than men (11%) (p<0.001). Patients' desire for psychological support was associated with being younger (OR=0.94; p<0.001 for women and OR=0.93; p=0.007 for men) and having a support-seeking coping (OR=1.10; p=0.010 for women and OR=1.36; p=0.003 for men). Other contextual factors such as difficulties encountered and treatment modalities were diversely associated with women and men's desire for psychological support. Neither women's, nor men's psychological distress was associated with their desire for psychological support. CONCLUSIONS: One female cancer patient out of four and one male cancer patient out of ten desire psychological support. Results emphasize the need to screen not only for cancer patients' distress but also for their desire for psychological support. This will allow implementing psychological interventions according to patients' needs and desire.
Assuntos
Adaptação Psicológica , Atitude Frente a Saúde , Transtorno Depressivo Maior , Necessidades e Demandas de Serviços de Saúde , Avaliação das Necessidades , Neoplasias/epidemiologia , Neoplasias/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Apoio Social , Inquéritos e Questionários , Estudos Transversais , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/etiologia , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Prevalência , Fatores SexuaisRESUMO
Although communication skills training programs have been recommended to reduce physicians' burnout, few studies have investigated their efficacy. This study assessed the impact of two training programs on cancer physicians' burnout. Especially, it identified some variables leading to burnout in order to develop effective interventions. Burnout was assessed with the Maslach Burnout Inventory. No statistically significant impact of training programs on burnout was observed. The amount of clinical workload and the overuse of some facilitative communication skills were associated with cancer physicians' burnout. The content of such programs must be redefined to reduce burnout.
Assuntos
Esgotamento Profissional/prevenção & controle , Comunicação , Capacitação em Serviço/organização & administração , Oncologia , Feminino , Humanos , Masculino , Estresse PsicológicoRESUMO
There are few studies which have investigated variables associated with the development of burnout among residents working with cancer patients. The aim of this study is to identify variables leading to residents' burnout in order to develop effective interventions. Burnout was assessed with Maslach Burnout Inventory. Person- (i.e., emotional-focused coping) and work-related (i.e., changes in lack of organizational support index) variables explain 28% of the variance in changes in emotional exhaustion. Training programs may be improved by adding specific modules for residents, about problem-focused coping in interviewing patients, and for supervisors, about effective team management.
Assuntos
Esgotamento Profissional/epidemiologia , Internato e Residência , Oncologia , Feminino , Humanos , Masculino , Fatores de Risco , Autoeficácia , Fatores SocioeconômicosRESUMO
OBJECTIVES: This descriptive study assesses how physicians' decisional conflict influences their ability to address treatment outcomes (TOs) in a decision-making encounter with an advanced-stage cancer simulated patient (SP). METHODS: Physicians (N = 138) performed a decision-making encounter with the SP trained to ask for TOs information. The physicians' decisional conflict regarding patients' cancer treatments in general was assessed with the General Decisional Conflict Scale (Gen-DCS). The physicians' decisional conflict regarding the SP's cancer treatments was assessed with the Specific Decisional Conflict Scale (Spe-DCS). Physicians' ability to address TOs during the encounter was assessed with an interaction analysis system: the Multi-Dimensional Analysis of Patient Outcome Predictions (MD.POP). Weekly time spent with cancer patients was assessed with a questionnaire. RESULTS: Physicians' Spe-DCS (ß = -.21 ; p = .014) and weekly time spent with cancer patients (ß = .22 ; p = .008) predicted the number of TOs addressed during the encounter. Spe-DCS scores predicted nearly all MD.POP dimensions (r = -.18 ; p = .040 to r = -.30 to p < .001) whereas Gen-DCS scores predicted nearly none MD.POP dimensions. CONCLUSION: Physicians' specific decisional conflict interferes with their ability to address TOs in a decision-making encounter with an advanced-stage cancer SP. PRACTICE IMPLICATIONS: Physicians should be trained to address TOs according to patient preferences, despite their own decisional conflict.