A train the trainer program for healthcare professionals tasked with providing psychosocial support to breast cancer survivors.

BACKGROUND: The objective of this study is to develop, implement, and evaluate a training program for healthcare providers to improve ability to provide psychosocial support to breast cancer survivors in Korea. METHODS: Based on a needs assessment survey and in-depth interviews with breast cancer survivors, a multidisciplinary team developed two-day intensive training program as well as education materials and counseling notes. Participants' overall satisfaction was evaluated after the training. RESULTS: The training program included a total of 16 lectures held over the course of seven sessions. Forty-one nurses and 3 social workers participated in the training program. Mean age was 37.5(± 6.4) years, and on average, they had 11.1 (± 5.6) years of experience. Participants' overall satisfaction was good as following: program contents (4.04), trainee guidebook (3.82), location and environment (4.10), and program organization (4.19). Among the participants, 31 (70.4%) received certification after submitting real consultation cases after the training. CONCLUSION: Two day intensive training can provide a comprehensive and coordinated education to healthcare professionals for implementing survivorship care with an emphasis on psychosocial support. Furthermore, the program should resume as a periodic continuing education course for healthcare providers. Similar education for graduate students in oncology nursing would be beneficial.

[Therapeutic education coordination function and skills]. / Fonction et compétences de coordination en éducation thérapeutique.

INTRODUCTION: Therapeutic Patient Education (TPE) coordination function has been developed worldwide for several decades. In France, this function is an integral part of authorization of TPE programs. However, both in France and in other European countries, situations, activities and qualifications common to TPE coordinators are becoming progressively more structured, regardless of the disease and/or the type of practice concerned. METHODS: The French National Institutefor Prevention and Health Education (INPES) conducted a project based on an innovative method comprising formalization of practices as perceived by professionals themselves (91 professionals in France and about thirty in five other European countries were interviewed) and consultation of a taskforce composed of national and international TPE experts, in a perspective of repeated construction with successive phases of consultation. RESULTS: The analysis conducted in the course of this project demonstrated the pivotal role of TPE coordinators at the interface with the various TPE actors. The TPE coordinator function was defined by guidelines comprising six symbolic situations, 20 activities and 26 key skills in three domains. DISCUSSION: This work constituted the basis for the elaboration of a new skill-based regulatory framework for TPE coordination. The TPE coordinator guidelines provide a relevant tool to organize training and validation of the experience acquired in thisfield and also open up new research perspectives.

Stress management training for breast cancer surgery patients.

OBJECTIVE: This study evaluated the psychological effects of a pre-surgical stress management training (SMT) in cancer patients. METHODS: Stress management training comprised four sessions in total: on 5 days and 1 day pre-surgery and on 2 days and 1 month post-surgery. Patients also received audio CDs with relaxation and coping skills exercises. Patients were randomly assigned to the SMT (N = 34) or a regular care condition (N = 36). Depression, anxiety, quality of life, perception of control, fatigue, pain, sleep problems, and surgery-related somatic symptoms were measured at Day 6 and Day 1 pre-surgery, and Day 2, 5, 30 and 90 post-surgery. RESULTS: Depression and fatigue decreased in the intervention group and increased in the control group, leading to significant group differences at Day 2 (fatigue) and Day 5 post-surgery (fatigue and depression). It also appeared that surgery-related symptoms had increased more in the control group 3 months post-surgery than in the SMT group. No intervention effects were observed for anxiety, pain, and sleep problems. CONCLUSION: The use of a short psychological intervention is effective in reducing depression and fatigue in the post-surgical period, although the effects are of short duration.

A longitudinal study of changes in provider-patient interaction in treatment of localized prostate cancer.

PURPOSE: Whilst much is known as to the met and unmet communication needs of prostate cancer patients, few studies have been conducted on the changes in communication between provider and patient over time. Therefore, the aim of our study is to examine (a) whether there are changes over time in the quality of psychosocial care in long-term treatment of localized prostate cancer and (b) whether those changes are associated with the treatment decision. METHODS: HAROW is a prospective, observational study designed to collect clinical data and patient reported outcomes (PROs) of different treatment options (hormonal therapy, active surveillance, radiation, operation, watchful waiting) for newly diagnosed patients with localized prostate cancer under real conditions. At 6-month intervals, general clinical data, PROs (e.g. quality of life, quality of physician-patient interaction) and individual costs are documented. We analysed data of N = 1,216 patients at the time of initial diagnosis (T1) and after 6 months (T2). RESULTS: There is a significant decline in shared decision-making behaviour of physicians for the group of patients undergoing a prostatectomy and for the hormonal therapy group at the time of initial diagnosis and after 6 months. In terms of emotional support by physicians, there is a significant difference between the treatment groups at the time of initial diagnosis with patients undergoing a prostatectomy reporting significantly less support than the hormonal therapy group. CONCLUSION: Future research from both, the providers' and the patients' perspective, will have to clarify if we can interpret our results as change in the communication behaviour once the treatment decision for prostatectomy or hormonal therapy is made.

Measuring spirituality as a universal human experience: development of the Spiritual Attitude and Involvement List (SAIL).

Many cancer patients experience spirituality as highly supportive while coping with their disease. Most research as well as most questionnaires in this field is religious orientated. The Spiritual Attitude and Involvement List was developed to enable research on spirituality among religious and nonreligious people. It consists of seven subscales that measure connectedness with oneself, with others and nature, and with the transcendent. Among a student, a healthy population, a healthy interested, a curative cancer, and a palliative cancer sample factorial, convergent and discriminant validity were demonstrated, as well as adequate internal consistency and test-retest reliability.

Measuring spirituality as a universal human experience: a review of spirituality questionnaires.

Spirituality is an important theme in health research, since a spiritual orientation can help people to cope with the consequences of a serious disease. Knowledge on the role of spirituality is, however, limited, as most research is based on measures of religiosity rather than spirituality. A questionnaire that transcends specific beliefs is a prerequisite for quantifying the importance of spirituality among people who adhere to a religion or none at all. In this review, we discuss ten questionnaires that address spirituality as a universal human experience. Questionnaires are evaluated with regard to psychometric properties, item formulation and confusion with well-being and distress. Although none of the questionnaires fulfilled all the criteria, the multidimensional Spiritual Well-Being Questionnaire is promising.

Breast cancer surgery-induced immunomodulation.

BACKGROUND AND OBJECTIVES: Surgical procedures can cause tumor cells to disseminate into the circulatory system. Although this spread of metastatic cells will be limited by immune activity, immunosuppression tends to be the main effect resulting from surgery. The objective of this study is to assess hormonal and immunological changes induced by breast cancer surgery. METHODS: Endocrine and immune responses to surgery were determined in 27 breast cancer patients. Blood samples were taken at 6 days and 1 day before surgery and 2 hr, 1 day, and 5 days after surgery. Changes in endocrine function, number of leucocytes and their subpopulations, enumerative immune expression, functional activity, and cytokine levels were determined. RESULTS: Breast cancer surgery induces a pro-inflammatory response and leucocytosis. Immunosuppression is indicated by decreased HLA-DR expression, decreased NKCA, and a Th2 response. A delayed Th1 response was also found 5 days after surgery. As no cortisol level change was observed, this hormone can be excluded as the mediator of surgery-related immunomodulation in breast cancer. CONCLUSION: Although breast cancer surgery is classified as minor surgery the surgical procedure produces substantial immunomodulation.

Barriers to using psycho-oncology services: a qualitative research into the perspectives of users, their relatives, non-users, physicians, and nurses.

PURPOSE: The present explorative study was designed as a qualitative evaluation of the psycho-oncology services (POS) available at a psycho-oncology institution (POI) in Germany. The study focused on barriers to using these services. METHODS: Seven focus groups and five complementary individual interviews were conducted with POS users, their relatives, and POS non-users from a German POI, as well as with oncology physicians and nurses from an affiliated hospital. The focus groups and individual interviews were audiotaped and fully transcribed. Data were analyzed using the documentary method. RESULTS: Four utilization barriers were identified: (1) patients' and physicians' information deficits about POI and POS, (2) patients' and physicians' subjective norms regarding POS, (3) lack of organizational and therapeutic integration of POI and POS into routine oncology care on the ward, and (4) specific characteristics of cancer patients. The most important finding was that lack of organizational and therapeutic integration of POS in routine oncology care on the ward might have a lasting, negative effect on patients' and physicians' information deficits and subjective norms. Furthermore, the identified utilization barriers seem to be a multi-causal problem with complex interdependencies. CONCLUSION: Based on these results, the organizational and therapeutic integration of POS in routine oncology care on the POI ward appears to be a useful tool in offering widely accessible therapies and providing patients with concise, straightforward information via different channels, such as personnel, brochures, and the Internet. Nevertheless, the results should be interpreted tentatively, due to the explorative character of this study.

Mindfulness-based stress reduction training for oncology patients: patients' appraisal and changes in well-being.

OBJECTIVE: This study explores satisfaction and changes in well-being in cancer patients following mindfulness-based stress reduction training. METHOD: Data were collected in 47 cancer patients before and after the training, and also 1 year later. Standardized questionnaires were used to measure quality of life, joy in life, mood disturbances (depression, anger, vigor, fatigue, and tension), meaning in life and physical symptoms. RESULTS: Participants were highly satisfied and said they had reached their goals with the training. The results show that directly after the training patients reported a better quality of life, more joy in life, less tension, and fewer physical symptoms. These effects appeared even stronger at follow-up. A year after the training a decrease was also found in depression, anger, vigor and total mood disturbance. No changes could be established for meaning in life and fatigue. Effect sizes varied between 0.28 and 0.60, indicating small-to-moderate changes. CONCLUSION: Mindfulness training potentially supports cancer patients in handling the stress due to their life-threatening disease and increases their well-being. Several suggestions for further research are discussed. PRACTICE IMPLICATIONS: Mindfulness training provides cancer patients with tools to deal with their limitations and worries, both during and after their treatment.

Presence, communication and treatment of fatigue and pain complaints in incurable cancer patients.

OBJECTIVE: This study describes the experiences of fatigue and pain in incurable cancer patients and the treatment they receive. METHODS: Patients were recruited via medical specialists from hospitals in the South and Southwest of the Netherlands. Hundred and twenty-five incurable cancer patients filled out a written questionnaire and were also interviewed at home. RESULTS: Ninety percent reported to suffer from fatigue and 48% had pain. Forty-five percent had discussed fatigue with a healthcare professional and 55% had discussed pain. Fifteen percent reported to receive medical treatment for their fatigue and 29% received pain treatment. Treatment for fatigue and pain treatment had been recently adjusted in 4% of the patients with fatigue complaints and 21% of the patients with pain complaints. CONCLUSION: Although fatigue is a more common problem than pain in patients with incurable cancer, less attention in the care is paid to fatigue and its treatment than to pain. PRACTICE IMPLICATIONS: Fatigue deserves more attention in the care policy for incurable cancer patients and more research should be focused on interventions to address fatigue in this group of cancer patients.

Education of creative art therapy to cancer patients: evaluation and effects.

BACKGROUND: The course Cancer and Creative Art offers cancer patients the possibility to cope with their illness through creativity and self-expression. METHODS: Five groups of 35 participants, predominantly composed of women with breast cancer, participated in an explorative evaluation and effect study; premeasures and postmeasures were applied. RESULTS: The course met the needs of participants that included personal growth and contact with fellow sufferers as well as exploration and expressing their emotions and coping with their feelings. The participants were satisfied with the organization of the course, but most felt that the sessions were too short and asked for more time for follow-up discussions. They indicated positive changes in coping with their emotions, the awakening of a process of "conscious living," and the development of creativity. Many of the participants felt the intake interview with a psychiatrist was not necessary. Measures taken before and after showed that the activities of daily living deteriorated due the course of the disease. However, the participants indicated that their quest for meaning in life increased after the course. Their mood did not change. The course also improved the general quality of life. CONCLUSIONS: Creative art therapy benefits the quality of life of cancer patients. Follow-up studies should provide more insight into the change process during creative art therapy and its long-term effect on the quality of life for people with cancer.

Patient education in Western European hospitals: a comparison of the Netherlands, Flanders and England.

OBJECTIVE: This research describes the organization of patient education in hospitals and the conditions that influence this in the Netherlands, Flanders and England. METHODS: The research consists of document analysis and interviews. RESULTS: On the organizational level, there can be a patient information desk (England and the Netherlands) and/or a specialized officer on patient education (the Netherlands and England). In the three countries/regions, the organization of patient education on the program level, for patient groups, is characterized by consultations of specialized nurses, patient information materials and patient education policy. Expert centers stimulate patient education through training and quality projects. Lobbying by patient organizations is important for the setting up of patient education. Both expert centers and patient organizations are financially dependent on and respond to policy of the government. CONCLUSION: Patient education is mostly organized on the organizational level or the program level, or both. Patient organizations and expert centers are conditions that are dependent on the government. Government policy and subsidies are considered as the most important conditions for the organization of patient education in hospitals. PRACTICE IMPLICATIONS: Commitment of officers working in patient education to the Health Promoting Hospital project and the European Association for Communication in Healthcare could stimulate patient education.

Reasons for early interventions by gynaecologists in a clinical follow-up study on cervical intraepithelial neoplasia.

OBJECTIVE: In a previous clinical follow-up study on psychosocial factors and cervical intraepithelial neoplasia (CIN), we had noticed a high percentage of early interventions to the cervix by gynaecologists, in discordance with the research protocol. The aim of the current study was to investigate the reasons for these interventions. STUDY DESIGN: We retrospectively analysed the study records of the clinical study, concerning the follow-up of 98 patients with a CIN 1 or 2 lesion for 2.25 years by colposcopy and cervical smears. We recorded the number of early interventions that had occurred in the clinical study as well as the reasons for these interventions. A distinction was made between acceptable and unacceptable reasons for early intervention. RESULTS: During follow-up, 39 out of 98 women (40%) had undergone intervention in discordance with the protocol. No acceptable reason for these interventions was found for 67% of these patients (26/39). In the majority of these cases either no reason for the intervention had been given, or the gynaecologist had feared for progression of the CIN lesion. CONCLUSION: Gynaecologists tend to intervene during follow-up of CIN, partly out of fear for progression. This tendency may complicate follow-up studies on CIN.

Attitudes of patients with incurable cancer toward medical treatment in the last phase of life.

PURPOSE: When cancer has advanced to a stage in which cure becomes unlikely, patients may have to consider the aim of further treatment. We studied the relationship of patients' attitudes toward treatment with advance care planning and the development of these attitudes after diagnosis of incurable cancer. PATIENTS AND METHODS: Patients with incurable cancer were interviewed and asked to fill out a written questionnaire about their attitudes concerning life-prolonging treatment and end-of-life decision making. These questions were repeated after 6 and 12 months. RESULTS: One hundred twenty-two patients (mean age, 64 years; standard deviation, 10.5 years; 53% women) participated in the study. Patients' attitudes toward treatment could be categorized into the following three different profiles: striving for quality of life, striving for length of life, and no clear preference. Patients who were older, more tired, or had less positive feelings and patients who had more often taken initiatives to engage in advance care planning were more inclined to strive for quality of life than others. Patients with a history of cancer of less than 6 months were more inclined to prefer life prolongation than patients with a longer history of cancer. During follow-up, no changes in attitudes toward treatment were found, except for patients with a short history of cancer in whom the inclination to strive for length decreased. CONCLUSION: Patients who appreciate advance care planning were more inclined to strive for quality of life than other patients. Shortly after the diagnosis of cancer, patients typically seem to prefer life-prolonging treatment, whereas quality of life becomes more important when death is nearing.

Evaluation of haptotherapy for patients with cancer treated with chemotherapy at a day clinic.

OBJECTIVE: The purpose of this study was to evaluate a haptotherapeutic treatment and its effects on the perceived well-being of patients with cancer treated with chemotherapy in day care. METHODS: The study had a pre-test-post-test semi-experimental design, with 31 patients in the intervention group and 26 in the control group. Patients in the control group were matched with patients in the experimental condition with respect to age, gender, type of cancer, type of chemotherapy, prognosis and the period between pre- and post-test. Standardized questionnaires were used measuring perceived well-being and satisfaction with care (haptotherapy). Indicators of well-being measured were quality of life, mood, meaning in life, general functioning, physical and psychological symptoms, sleep quality and body awareness. The intervention consisted of five haptotherapy sessions of 45 minutes each. Patients in the control condition received standard medical care. RESULTS: Patients were highly satisfied with the haptotherapy treatment, and especially valued the personal attention and the relaxation they experienced. The haptotherapy treatment improved both the perceived general quality of life and the perceived cognitive and social functioning of patients. No improvement was found for mood, meaning in life, general functioning, physical symptoms, sleep quality and body awareness. CONCLUSION: It may be concluded that haptotherapy positively contributes to several indicators of perceived well-being of patients with cancer during the period they receive chemotherapy. More rigorous experimental studies are necessary in this field, especially concerning randomization, number of participants and homogeneity of the sample. PRACTICE IMPLICATIONS: Haptotherapy as a type of complementary medicine is a potentially valuable and effective intervention to raise the well-being of patients with cancer undergoing invasive treatments like chemotherapy.

Treatment decision making in prostate cancer: patients' participation in complex decisions.

OBJECTIVE: (1) To explore to what degree prostate cancer (PC) patients felt they had participated in treatment decision making (TDM). (2) To determine whether perceived roles during TDM were associated with medical and sociodemographic variables. (3) To examine to what extent satisfaction with TDM was related to perceived role or medical and sociodemographic variables. METHODS: Patients (n=126) were recruited in hospitals and from the Dutch PC patient organization. The relationship between patients' role and stage of disease, treatment modality, age, social status and education was determined, as well as patients' satisfaction with TDM. RESULTS: Most patients felt they had participated in TDM (autonomous 18%, collaborative 60%). Older patients and those with advanced disease more frequently reported not having been involved in decision making. Satisfaction with TDM was related to age and role in TDM but not to stage of disease or treatment modality. Younger men were least content when they had not been involved in decision making. CONCLUSION: Patients' level of participation and satisfaction with TDM appears to be related to medical and sociodemographic variables. PRACTICE IMPLICATIONS: Satisfaction with TDM may be related to patients' age and assumed role. It is recommended to take this into account when planning treatment for prostate cancer patients.

Five years of EACH (European Association for Communication in Healthcare).

Five years after launching EACH (European Association for Communication in Healthcare) we look back at what EACH achieved so far and announce new ideas and activities EACH plans to carry out in the near future. During the past five years several scientific, educational as well as societal changes have taken place in the area of communication in healthcare that all underline the need for continued international collaboration in line with the activities employed by EACH so far. Within communication research the focus has shifted from counting communication utterances to unraveling sequences of patient cues and provider responses. In the field of teaching it is becoming more and more common to attend to the training of trainers as well. Within these developments, new areas of interest arise and need attention. To comply with these increasing demands, EACH invites new persons to become a member of one of the recently launched committees in the area of research, teaching and publishing.

Effects of delayed psychosocial interventions versus early psychosocial interventions for women with early stage breast cancer.

OBJECTIVE: The importance of psychosocial counselling after a diagnosis of cancer has been acknowledged and many intervention studies have been carried out, with the aim to find out which types of intervention are most effective in enhancing quality of life in cancer patients. A factor which could be part of effective counselling could be the time of offering psychosocial counselling. The aim of this study was to research the effect of time of enrolment in a psychosocial group intervention on psychosocial adjustment. METHODS: In the present study, 67 women with early stage breast cancer were randomised in a psychosocial group intervention program starting within 4 months after surgery or in the same intervention program starting at least 3 months later. RESULTS: The main conclusion of this study is that women who started with their intervention early were less distressed at 6 months follow-up than women who were in the delayed condition. Medical and demographic variables were predictive for some psychosocial adjustment indicators, but were not associated with time of enrolment. Regardless of time of enrolment, women improved in distress, body image and recreational activities, but showed a decrease in social interaction. CONCLUSION: Though results are limited, based on these results we suggest that psychosocial counselling should be offered as soon after diagnosis or surgery for breast cancer. PRACTICE IMPLICATIONS: Women diagnosed with primary breast cancer should be able to start with psychological counselling soon after being diagnosed, to prevent them from becoming distressed at long term.