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1.
BMJ Open ; 13(11): e073138, 2023 11 19.
Artículo en Inglés | MEDLINE | ID: mdl-37984961

RESUMEN

OBJECTIVES: Little research exists on how risk scores are used in counselling. We examined (a) how Breast Cancer Risk Assessment Tool (BCRAT) scores are presented during counselling; (b) how women react and (c) discuss them afterwards. DESIGN: Consultations were video-recorded and participants were interviewed after the consultation as part of the NRG Oncology/National Surgical Adjuvant Breast and Bowel Project Decision-Making Project 1 (NSABP DMP-1). SETTING: Two NSABP DMP-1 breast cancer care centres in the USA: one large comprehensive cancer centre serving a high-risk population and an academic safety-net medical centre in an urban setting. PARTICIPANTS: Thirty women evaluated for breast cancer risk and their counselling providers were included. METHODS: Participants who were identified as at increased risk of breast cancer were recruited to participate in qualitative study with a video-recorded consultation and subsequent semi-structured interview that included giving feedback and input after viewing their own consultation. Consultation videos were summarised jointly and inductively as a team.tThe interview material was searched deductively for text segments that contained the inductively derived themes related to risk assessment. Subgroup analysis according to demographic variables such as age and Gail score were conducted, investigating reactions to risk scores and contrasting and comparing them with the pertinent video analysis data. From this, four descriptive categories of reactions to risk scores emerged. The descriptive categories were clearly defined after 19 interviews; all 30 interviews fit principally into one of the four descriptive categories. RESULTS: Risk scores were individualised and given meaning by providers through: (a) presenting thresholds, (b) making comparisons and (c) emphasising or minimising the calculated risk. The risk score information elicited little reaction from participants during consultations, though some added to, agreed with or qualified the provider's information. During interviews, participants reacted to the numbers in four primary ways: (a) engaging easily with numbers; (b) expressing greater anxiety after discussing the risk score; (c) accepting the risk score and (d) not talking about the risk score. CONCLUSIONS: Our study highlights the necessity that patients' experiences must be understood and put into relation to risk assessment information to become a meaningful treatment decision-making tool, for instance by categorising patients' information engagement into types. TRIAL REGISTRATION NUMBER: NCT01399359.


Asunto(s)
Neoplasias de la Mama , Femenino , Humanos , Ansiedad , Consejo , Medición de Riesgo , Factores de Riesgo
2.
Support Care Cancer ; 31(10): 566, 2023 Sep 08.
Artículo en Inglés | MEDLINE | ID: mdl-37682354

RESUMEN

PURPOSE: The global incidence of cancer and available cancer-directed therapy options is increasing rapidly, presenting patients and clinicians with more complex treatment decisions than ever before. Despite the dissemination of evidence-based communication training tools and programs, clinicians cite barriers to employing effective communication in cancer care (e.g., discomfort of sharing serious news, concern about resource constraints to meet stated needs). We present two composite cases with significant communication challenges to guide clinicians through an application of evidence-based approaches to achieve quality communication. METHODS: Composite cases, communication skills blueprint, and visual conceptualization. RESULTS: High-stakes circumstances in each case are described, including end-of-life planning, advanced pediatric illness, strong emotions, and health inequities. Three overarching communication approaches are discussed: (1) content selection and delivery; (2) rapport development; and (3) empathic connection. The key takeaways following each case provide succinct summaries of challenges encountered and approaches used. A communication blueprint from the Memorial Sloan Kettering Cancer Center Communication Skills Training Program and Research Laboratory has been adapted and is comprised of strategies, skills, process tasks, and sample talking points. A visually concise tool - the Communication Blueprint Traffic Circle - illustrates these concepts and demonstrates the iterative, holistic, and agile considerations inherent to effective communication. CONCLUSION: Evidence-based communication is foundational to person-centeredness, associated with improved clinician and patient/caregiver outcomes, and can be integrated throughout routine oncology care. When used by clinicians, evidence-based communication can improve patient and caregiver experiences and assist in ensuring goal-concordant cancer care delivery.


Asunto(s)
Comunicación , Neoplasias , Humanos , Niño , Formación de Concepto , Muerte , Emociones , Empatía , Neoplasias/terapia
3.
Am J Hosp Palliat Care ; 40(2): 235-243, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-35574961

RESUMEN

BACKGROUND: The COVID-19 pandemic has led to the rapid expansion of telehealth service delivery. We explored the experiences of a multidisciplinary palliative care team delivering telepalliative care for oncology inpatients during a 10-weeks COVID-19 surge in New York City. METHODS/PARTICIPANTS: We conducted semi-structured qualitative interviews with a targeted sample, employing a phenomenological approach with applied thematic text analysis. An interdisciplinary coding team iteratively coded data using a mix of a priori and inductive codes. Team members first independently reviewed each category, then met to reach consensus on recurring themes. The sample (n = 11) included a chaplain (n = 1), social worker (n = 1), pharmacist (n = 1), physicians (n = 3), physician assistant (n = 1), and nurse practitioners (n = 4). RESULTS: Participants described multidimensional clinician distress as a primary experience in delivering telepalliative care during the COVD-19 surge, characterized by competing loyalties (e.g., institutional obligations, ethical obligations to patients, resentment and distrust of leadership) and feelings of disempowerment (e.g., guilt in providing subpar support, decisional regret, loss of identity as a provider). Participants provided explicit recommendations to improve telepalliative care delivery for acute oncology inpatients in the future. CONCLUSION: Palliative care clinicians experienced personal and professional distress providing inpatient telepalliative care during this COVID-19 surge. Clinician strain providing telehealth services must be explored further as the pandemic and utilization of telehealth evolves. Telepalliative care planning must include attention to clinician wellbeing to sustain the workforce and promote team cohesion, and a focus on infrastructure needed to deliver high-quality, holistic care for oncology patients and their families when in-person consultation is impossible.


Asunto(s)
COVID-19 , Neoplasias , Telemedicina , Humanos , Pandemias , Atención a la Salud , Cuidados Paliativos/métodos , Telemedicina/métodos , Neoplasias/terapia
4.
Transl Behav Med ; 12(7): 816-824, 2022 07 18.
Artículo en Inglés | MEDLINE | ID: mdl-35716077

RESUMEN

New York City was a "global COVID-19 hotspot" in spring 2020. Many health teams rapidly transitioned to telehealth platforms. Little is known about the experiences of inpatient palliative care services who delivered telehealth services during the pandemic. This study was aimed to explore the experiences of an interdisciplinary palliative care team in meeting the holistic needs of oncology inpatients via telehealth over a 10-week period during the first COVID-19 surge. A targeted sample of interdisciplinary palliative specialists at an urban comprehensive cancer center participated in in-depth interviews that explored participants' experiences delivering physical, psychosocial, and spiritual care via telehealth. An interdisciplinary coding team followed a rigorous thematic text analysis approach and met regularly to reach consensus on emerging themes. Eleven palliative specialists from six disciplines (chaplaincy, medicine, nursing, pharmacy, physician assistant, and social work) participated. Seventy-three percent reported not receiving telehealth training prior to COVID-19 and 64% were "not at all" or "somewhat comfortable" delivering telepalliative care. Several themes were identified, including the barriers related to telehealth, the impact of telehealth on the quality of relationships with patients, their families, and coworkers, and the changes in perceived self-efficacy of fulfilling job responsibilities. Telehealth use has increased significantly during COVID-19, requiring further evaluation of its utility. Participants reported both positive and negative inpatient telepalliative care experiences associated with various domains of professional functioning, such as communication, relationships with key stakeholders, and self-efficacy. Enhanced telehealth training and support must be improved to sustain the palliative workforce and promote high-quality patient and family care in the future.


In spring 2020, New York City was a COVID-19 global hotspot. The palliative care team at a major cancer center rapidly transitioned to a "virtual service" (i.e., telehealth) without any physical contact with oncology inpatients for a 10-week period. No infrastructure for inpatient telehealth had been established prior to the transition. We wanted to explore how effective the interdisciplinary palliative care team felt in meeting the psychosocial, spiritual, and physical needs of patients and their families via telehealth. The palliative care team consisted of advanced practice providers, physicians, a chaplain, pharmacist, and social worker. Through participant interviews, our research team identified common themes related to the barriers and facilitators of telehealth; various effects on the quality of relationships with patients, their families, and coworkers; and diverse experiences related to the team's perceived effectiveness in delivering telepalliative care. There are several implications to consider. Inpatient practice settings must design telehealth infrastructures to ensure both patient and provider protections when in-person care is not possible. Multilevel policies must direct investments in telehealth training for health professionals to support high-quality care during future public health crises. Research should be directed toward developing and measuring enhanced telehealth interventions to support effective and holistic virtual palliative care delivery for inpatient settings.


Asunto(s)
COVID-19 , Telemedicina , Humanos , Pacientes Internos/psicología , Cuidados Paliativos/psicología , Pandemias
5.
Nurse Educ Pract ; 50: 102928, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33310509

RESUMEN

Nurses must demonstrate effective communication across complex interpersonal domains, as emphasized by numerous professional healthcare organizations. However, formal communication skills training has been only modestly integrated into baccalaureate nursing programs, and of those studied systematically, there are notable methodological concerns. The current study focused on application of a well-researched communication program (Comskil) to student nurses completing summer internships at a comprehensive cancer center as part of their clinical education. The Comskil training program for student nurses is an in-person, day-long training that includes three sections: responding empathically to patients; discussing death, dying, and end-of-life goals of care; and responding to challenging family interactions. Student nurse participants provided strongly favorable perceptions of the program, with 90% indicating that they agreed or strongly agreed with all perception items. A significant pre-to post-training improvement in self-reported confidence was observed (p < .01). Additionally, pre- and post-training observational coding of standardized patient assessments indicated significant improvements in usage of the following skill categories: total skill use, information organization, and empathic communication (p < .001). Overall, these results suggest that communication skills training for student nurses is a feasible, acceptable, and effective way of increasing confidence and skills usage in complex clinical scenarios.


Asunto(s)
Empatía , Estudiantes de Enfermería , Competencia Clínica , Comunicación , Humanos , Capacitación en Servicio
6.
Palliat Support Care ; 18(4): 419-424, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32295656

RESUMEN

OBJECTIVE: Effective communication is an essential part of patient-centered care. The complexity of cancer care in older adults makes communication challenging, particularly when older patients have cognitive deficits and lose their autonomy. This paper describes the development, implementation, and evaluation of a communication skills training module for health care providers (HCPs) who work with older adults with cancer, with or at risk of developing cognitive deficits. METHOD: Using a pre-post single arm study design, 99 HCPs from a comprehensive cancer center in North-East USA, who worked primarily with geriatric patients, participated in the study. Participants included Advance Practice Providers (including Nurse Practitioners and Physician Assistants; n = 24, 24.2%); nurses (n = 23, 23.2%), social workers (n = 14, 14.1%), physicians (n = 13, 13.1%), and "other" HCPs (including occupational therapists, physical therapists, and psychologists; n = 20, 20.2%). The HCPs participated in a one-day geriatric communication skills training program in groups of 12-15 over a 2-year period. Participants complete pre-post surveys on module evaluation and perception of self-efficacy as well as pre-post video-recorded Standardized Patient Assessment (SPA) to evaluate communication skill uptake. RESULTS: Most participants evaluated the module positively; over 90% indicated that they agreed or strongly agreed with five of the six module evaluation items. HCPs' self-efficacy in communicating with cancer patients with cognitive deficits significantly increased from pre- to post-module training. There was a significant increase in the following communication skill use from pre- to post-training: checking patient preferences, declaring agenda, and inviting agenda. SIGNIFICANCE OF RESULTS: Results demonstrated a successful implementation of the program as evidenced through favorable program evaluation, significant gains in self-efficacy, as well as significant improvement in several communication skills.


Asunto(s)
Disfunción Cognitiva/terapia , Neoplasias/psicología , Relaciones Profesional-Paciente , Enseñanza/normas , Anciano , Anciano de 80 o más Años , Instituciones Oncológicas/organización & administración , Instituciones Oncológicas/estadística & datos numéricos , Disfunción Cognitiva/psicología , Comunicación , Competencia Cultural/psicología , Femenino , Humanos , Masculino , Oncología Médica/educación , Neoplasias/terapia , Enfermería Oncológica/educación , Desarrollo de Programa , Autoeficacia , Encuestas y Cuestionarios , Enseñanza/psicología , Enseñanza/estadística & datos numéricos
7.
Transl Behav Med ; 10(4): 918-927, 2020 10 08.
Artículo en Inglés | MEDLINE | ID: mdl-30476333

RESUMEN

A compelling touted strategy for reducing discrimination towards lesbian, gay, bisexual, and transgender (LGBT) patients is improving communicative competence of health care providers (HCPs); however, evidence base for describing communication practices between HCPs and LGBT patients is scarce. The purpose of this study was to qualitatively examine HCP experiences and perspectives as they relate to patient sexual orientation and gender identity (SOGI) disclosure, perceived communication and structural/administrative challenges in interactions with LGBT patients, and suggestions for improving care of LGBT patients. The sample consisted of 1,253 HCPs, who provided open-ended responses to an online cross-sectional survey conducted at a Comprehensive Cancer Center in the Northeastern United States. The open-ended responses were inductively and deductively coded for key themes and sub-themes. The results demonstrated an array of useful communication strategies employed by oncology HCPs to encourage LGBT patients' SOGI disclosure (direct questions regarding sexual orientation, use of the term "partner," and using correct pronouns), communication and structural/administrative challenges faced by HCPs in providing care (HCP own fears and biases, transgender patient care, insurance issues, and procedural challenges for LGBT patients), and suggested recommendations from oncology HCPs to improve their care delivery for LGBT patients (more provider-based training, improving awareness of LGBT-friendly resources, establishing trusting relationships, and not assuming sexuality or gender identity). These findings have implications for developing and evaluating training programs to improve LGBT sensitivity and communication among HCPs, and encourage SOGI disclosure in an open and judgment-free health care environment.


Asunto(s)
Minorías Sexuales y de Género , Personas Transgénero , Estudios Transversales , Femenino , Identidad de Género , Personal de Salud , Humanos , Masculino , Conducta Sexual
8.
J Health Commun ; 23(4): 329-339, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29521575

RESUMEN

Delivery of culturally competent care toward lesbian, gay, bisexual, and transgender (LGBT) patients depends on how health-care providers (HCPs) communicate with them; however, research about knowledge, attitude, and behavior of HCPs toward LGBT patients is scant. The objectives of our study were to describe oncology HCPs' knowledge and examine if beliefs about LGB and transgender patients mediate the effects of LGBT health-care knowledge on open communication behaviors with LGB and transgender patients, respectively. A total of 1253 HCPs (187 physicians, 153 advance practice professionals (APPs), 828 nurses, and 41 others) at a Comprehensive Cancer Center completed an online survey that included the following measures: LGBT health-care knowledge, beliefs, communication behaviors, willingness to treat LGBT patients, encouraging LGBT disclosure, and perceived importance of LGBT sensitivity training. Only 50 participants (5%) correctly answered all 7 knowledge items, and about half the respondents answered 3 (out of 7) items correctly. Favorable beliefs about LGBT health care mediated the effect of higher LGBT health-care knowledge on open communication behaviors with transgender patients, controlling for effects of type of profession, religious orientation, gender identity, sexual orientation, and having LGBT friends/family. The results of this study demonstrated an overall lack of medical knowledge and the need for more education about LGBT health care among oncology HCPs.


Asunto(s)
Comunicación , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/psicología , Neoplasias/terapia , Minorías Sexuales y de Género , Adolescente , Adulto , Anciano , Femenino , Personal de Salud/estadística & datos numéricos , Humanos , Masculino , Oncología Médica , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto Joven
9.
Patient Educ Couns ; 100(12): 2346-2354, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-28734560

RESUMEN

OBJECTIVES: The presentation of risks and benefits in clinical practice is common particularly in situations in which treatment recommendations involve trade-offs. The treatment of breast cancer risk with selective estrogen receptor modulators (SERMs) is such a decision. We investigated the influence of health care provider (HCP) counseling on women's decision-making. METHODS: Thirty breast cancer risk counseling sessions were recorded from April 2012-August 2013 at a comprehensive cancer center and at a safety-net, community hospital in the US. Participating women and HCPs were interviewed. A cross-case synthesis was used for analysis. RESULTS: Of 30 participants 21 received a SERM-recommendation, 11 decided to take SERMs. Counseling impacted decision-making, but did not determine it. Three categories emerged: 1.) ability to change the decision anytime, 2.) perceptions on medications, and 3.) proximity of cancer. CONCLUSION: Decision-making under conditions of a risk diagnosis such as increased breast cancer risk is a continuous process in which risk information is transformed into practical and experiential considerations. PRACTICE IMPLICATIONS: Individuals' health care decision-making is only marginally dependent on the interactions in the clinic. Accepting patients' experiences and beliefs in their own right and letting them guide the discussion may be important for a satisfying decision-making process.


Asunto(s)
Neoplasias de la Mama/prevención & control , Consejo , Toma de Decisiones , Participación del Paciente , Moduladores Selectivos de los Receptores de Estrógeno/administración & dosificación , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Percepción , Investigación Cualitativa , Riesgo
10.
Integr Cancer Ther ; 16(1): 3-20, 2017 03.
Artículo en Inglés | MEDLINE | ID: mdl-27903842

RESUMEN

BACKGROUND: Although epidemiological research demonstrates that there is an association between lifestyle factors and risk of breast cancer recurrence, progression of disease, and mortality, no comprehensive lifestyle change clinical trials have been conducted to determine if changing multiple risk factors leads to changes in biobehavioral processes and clinical outcomes in women with breast cancer. This article describes the design, feasibility, adherence to the intervention and data collection, and patient experience of a comprehensive lifestyle change clinical trial (CompLife). METHODS: CompLife is a randomized, controlled trial of a multiple-behavior intervention focusing on diet, exercise, and mind-body practice along with behavioral counseling to support change. The initial exposure to the intervention takes place during the 4 to 6 weeks of radiotherapy (XRT) for women with stage III breast cancer and then across the subsequent 12 months. The intervention group will have 42 hours of in-person lifestyle counseling during XRT (7-10 hours a week) followed by up to 30 hours of counseling via video connection for the subsequent 12 months (weekly sessions for 6 months and then monthly for 6 months). The primary outcome is disease-free survival. Multiple secondary outcomes are being evaluated, including: (1) biological pathways; (2) overall survival; (3) patient-reported outcomes; (4) dietary patterns/fitness levels, anthropometrics, and body composition; and (5) economic outcomes. Qualitative data of the patient experience in the trial is collected from exit interviews, concluding remarks, direct email correspondences, and web postings from patients. RESULTS: Fifty-five patients have been recruited and randomized to the trial to date. Accrual of eligible patients is high (72%) and dropout rates extremely low (5%). Attendance to the in-person sessions is high (95% attending greater than 80% of sessions) as well as to the 30 hours of video counseling (88% attending more than 70% of sessions). Adherence to components of the behavior change intervention is high and compliance with the intensive amount of data collection is exceptional. Qualitative data collected from the participants reveals testimonials supporting the importance of the comprehensive nature of intervention, especially the mind-body/mindfulness component and social support, and meaningful lifestyle transformations. CONCLUSION: Conducting a comprehensive, multicomponent, lifestyle change clinical trial for women with breast was feasible and collection of biobehavioral outcomes successful. Adherence to behavior change was high and patient experience was overwhelmingly positive.


Asunto(s)
Neoplasias de la Mama/psicología , Consejo/métodos , Dieta/psicología , Supervivencia sin Enfermedad , Ejercicio Físico/psicología , Femenino , Humanos , Estilo de Vida , Persona de Mediana Edad , Recurrencia Local de Neoplasia/psicología , Cooperación del Paciente/psicología
11.
Cancer ; 122(10): 1552-9, 2016 05 15.
Artículo en Inglés | MEDLINE | ID: mdl-26991683

RESUMEN

BACKGROUND: The aim of this study was to identify nurse factors (eg, knowledge, practices, and clinical habits regarding complementary and alternative medicine [CAM] as well as demographic factors) and patient characteristics (eg, age, sex, and treatment status) associated with nurses' CAM inquiry and referral patterns. METHODS: Baseline data were collected with nurse/patient questionnaires about CAM use and knowledge as part of a multicenter CAM educational clinical trial. Frequencies and nested regression models were used to assess predictors of nurses' inquiries about and referral to CAM therapies. RESULTS: Six hundred ninety-nine patients participated in the study. For patients, female sex (odds ratio [OR], 1.50; P = .019) and cancer recurrence (OR, 1.45; P = .05) were predictive of nurses' inquiries about and referral to CAM therapies. A total of 175 nurses with a mean age of 45 years and a mean experience of 20 years participated; 79% were staff nurses, and 11% were nurse practitioners. Fifty-three percent asked at least 1 of their last 5 patients about CAM use; 42% referred patients to CAM therapy. Nurses who reported being "somewhat comfortable" (OR, 2.70; P = .0001) or "very comfortable" (OR, 3.88; P < .0001) about discussing CAM, self-reported use of massage (OR, 2.20; P < .0001), and had formal CAM education (OR, 4.14; P = .0001) were more likely to ask about CAM use. Nurses who reported being "somewhat comfortable" (OR, 2.54; 95% confidence interval, 1.47-4.41; P = .0008) or "very comfortable" (OR, 7.46; P < .00001) and had formal CAM education (OR, 2.96; P < .0001) were also more likely to refer patients to CAM therapies. CONCLUSIONS: Both patient and nurse characteristics were associated with discussions about CAM. Oncology institutions that prioritize evidence-based medicine should consider introducing CAM education to their nursing staff. Cancer 2016;122:1552-9. © 2016 American Cancer Society.


Asunto(s)
Comunicación , Terapias Complementarias/enfermería , Neoplasias/enfermería , Neoplasias/terapia , Relaciones Enfermero-Paciente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto
12.
Cancer ; 119(19): 3514-22, 2013 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-23824945

RESUMEN

BACKGROUND: The use of complementary and alternative medicine (CAM) is widespread, yet there is relatively little discussion regarding its use between oncology patients and their health care practitioners. METHODS: This multisite randomized trial examined the efficacy of an educational intervention designed to encourage oncology nurses to discuss CAM use with their patients. A total of 175 nurses completed questionnaires about discussing CAM use with patients at baseline and 2 months after the intervention. Patients at baseline (N = 699) and different patients at follow-up (N = 650) completed questionnaires regarding CAM. RESULTS: At the 2-month follow-up, nurses in the intervention reported they were more likely to ask about CAM use than those in the control group (odds ratio, 4.2; P = .005). However, no significant effect was found for the percentage of patients who indicated that they were asked about CAM use (odds ratio, 2.1; P > .10). Approximately 40% of patients reported using CAM after their cancer diagnosis, yet the majority of nurses estimated that < 25% of their patients were using CAM. CONCLUSIONS: CAM use in community-based oncology patients is common and is underestimated by oncology nurses. The brief, low-intensity intervention presented herein was found to be sufficiently powerful to change nurses' perceptions of their behavior but may not have been intensive enough to yield changes that were evident to patients.


Asunto(s)
Comunicación , Terapias Complementarias/educación , Terapias Complementarias/enfermería , Neoplasias/terapia , Enfermería Oncológica/educación , Adulto , Actitud del Personal de Salud , Instituciones Oncológicas , Terapias Complementarias/tendencias , Femenino , Humanos , Masculino , Persona de Mediana Edad
13.
Psychosom Med ; 73(3): 218-25, 2011 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-21257977

RESUMEN

OBJECTIVE: To assess whether stress management (SM) improved immune outcomes in men undergoing surgery for prostate cancer. METHODS: A total of 159 men were assigned randomly to a two-session presurgical SM intervention, a two-session supportive attention (SA) group, or a standard care (SC) group. Men in the SM group discussed their concerns about the upcoming surgery and were taught diaphragmatic breathing, guided imagery; they had an imaginal exposure to the day of surgery and learned adaptive coping skills. Men in the SA group discussed their concerns about the upcoming surgery and had a semistructured medical interview. Blood samples were collected at baseline (1 month before surgery) and 48 hours after surgery. Measures of mood (Profile of Mood States) were collected at baseline, 1 week pre surgery, and the morning of surgery. RESULTS: Men in the SM group had significantly higher levels of natural killer cell cytotoxicity (p = .04) and higher levels of circulating proinflammatory cytokines (interleukin [IL]-12p70, p = .02; IL-1ß, p = .02; tumor necrosis factor-α, p = .05) 48 hours post surgery than men in the SA group and higher levels of natural killer cell cytotoxicity (p = 0.02) and IL-1ß (p = .05) than men in the SC group. Immune parameters increased for the SM group and decreased or stayed the same for the SA and SC groups. The SM group had significantly lower Profile of Mood States scores than the SC group (p = .006), with no other group differences between SA and SC groups. Changes in mood were not associated with immune outcomes. CONCLUSIONS: The finding that SM leads to decreased presurgical mood-disturbance and increased immune parameters after surgery reveals the potential psychological and biological benefits of presurgical SM.


Asunto(s)
Formación de Anticuerpos/fisiología , Cuidados Preoperatorios/métodos , Prostatectomía/métodos , Neoplasias de la Próstata/cirugía , Estrés Psicológico/prevención & control , Adulto , Citocinas/sangre , Humanos , Células Asesinas Naturales/inmunología , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/psicología , Nivel de Atención , Resultado del Tratamiento
14.
Plast Reconstr Surg ; 122(3): 717-724, 2008 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-18766034

RESUMEN

BACKGROUND: An interactive digital education aid for breast reconstruction patients was developed because of a perceived need to provide patients with more education regarding the treatment so that they can make better informed treatment decisions. A prospective randomized study was conducted to assess its effectiveness. METHODS: Breast cancer patients who were candidates for breast reconstruction were recruited and randomized into a control group and a study group. Both groups received routine assessment and education in the plastic surgery clinic, but the study group also watched the interactive digital education aid. Questionnaires assessing knowledge, anxiety, and satisfaction were administered (1) before the initial plastic surgery consultation, (2) immediately before surgery, and (3) 1 month after surgery. RESULTS: A total of 133 women participated, 66 in the control group and 67 in the study group. Women in both groups showed decreased anxiety, increased knowledge, and enhanced satisfaction with their decision-making ability associated with preoperative instructions about reconstructive surgery. However, the study group was significantly more satisfied than the control group with the method of receiving information and showed a less steep learning curve regarding the different techniques of breast reconstruction. They also tended to have a reduced mean level of anxiety and increased satisfaction with the treatment choice compared with the control group. CONCLUSIONS: An interactive digital education aid is a beneficial educational adjunct for patients contemplating breast reconstruction. Patients who use an interactive digital education aid demonstrate greater factual knowledge, reduced anxiety, and increased postoperative satisfaction compared with patients given preoperative instructions using standard methods alone. The benefit of an interactive digital education aid is expected to be higher in a broad-based practice setting outside of a comprehensive cancer center.


Asunto(s)
Mamoplastia , Educación del Paciente como Asunto/métodos , Ansiedad/prevención & control , DC-I , Toma de Decisiones , Femenino , Humanos , Persona de Mediana Edad , Satisfacción del Paciente , Pacientes/psicología , Estudios Prospectivos
15.
Gynecol Oncol ; 101(1): 102-7, 2006 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-16256181

RESUMEN

OBJECTIVES: This study investigated the role of religion/spirituality (R/S) and coping in quality of life (QOL) in 129 women immediately prior to a course of adjuvant chemotherapy for ovarian cancer. METHODS: Participants completed the COPE, the Functional Assessment of Cancer Therapy-Ovarian (FACT-O), and the Systems of Belief Inventory-15R (SBI-15R). Women averaged 58.9 years of age (SD = 11.5) and were primarily Caucasian (86%), married (74%), and had received at least some college education (67%). Eighty-five percent of the participants had stage III or IV ovarian cancer at study entry. RESULTS: Correlational analyses revealed that R/S was associated with active coping (r = 0.23, P = 0.022), overall QOL (r = 0.25, P = 0.012), emotional and functional well-being (r = 0.24, P = 0.014 and r = 0.28, P = 0.004), and fewer ovarian cancer-specific concerns (r = 0.27, P = 0.006). In addition, active coping was related to overall QOL (r = 0.22, P = 0.029) and social and functional well-being (r = 0.20, P = 0.042 and r = 0.33, P = 0.001). Tests of mediation between these variables suggested that the positive associations between R/S and functional well-being and R/S and overall QOL were mediated through the use of active coping. CONCLUSION: Future studies are needed to better understand the complex relationships between R/S, coping, and QOL throughout the ovarian cancer treatment experience.


Asunto(s)
Adaptación Psicológica , Neoplasias Ováricas/psicología , Espiritualidad , Adulto , Anciano , Anciano de 80 o más Años , Quimioterapia Adyuvante , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/tratamiento farmacológico , Calidad de Vida , Encuestas y Cuestionarios , Resultado del Tratamiento
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