Dissociation among individuals receiving cancer care: A scoping review.

PROBLEM IDENTIFICATION: Dissociation is a common presentation of trauma, distinguishable from classic post-traumatic stress disorder (PTSD) symptoms. While pre-cancer and cancer-related traumatic experiences are prevalent among cancer-affected individuals, the specific impact of traumatic dissociation is unclear. LITERATURE SEARCH: This scoping review includes a search of English articles published between 1980 and 2019 referencing dissociation in the context of cancer-affected adults. DATA EVALUATION/SYNTHESIS: Articles assessed how dissociation was addressed in relation to pre-cancer and cancer-related trauma exposure and treatment. Out of 1,265 articles, 71 met inclusion criteria, and 15 underwent a full review. Two studies addressed dissociation related to pre-cancer trauma, nine in regard to cancer-related trauma only, and four in relation to both trauma types. No studies included experimental designs or described interventions. CONCLUSIONS: Despite high rates of trauma exposure among cancer-affected adults, limited studies specifically address the impact of dissociation. Further inquiry on this topic is needed, especially on treatment implications.

Patient reported outcomes affecting quality of life in socioeconomically disadvantaged cancer patients.

PURPOSE: The aim of this study was to identify correlates of quality of life (QOL) for socioeconomically disadvantaged cancer patients receiving care in the "safety net" health system. DESIGN: This cross-sectional study used linear regressions to determine the effect of patient reported outcome measures (PRO) on QOL.Sample/Methods: Cancer patients (n = 115) receiving drug therapy completed a series of PROs including: Functional Assessment of Cancer Therapy (FACT-G), PROMIS (Anxiety, Depression, Fatigue, Pain Interference, and Physical Function), and the Comprehensive Score for Financial Toxicity. FINDINGS: More than 60% of patients reported an annual income below $24,999. Forty-five percent of patients were either uninsured or county-funded. Depression, pain, and financial toxicity were found to be consistently significant correlates of QOL.Implications: Cancer patients with existing financial strain have unique psychosocial stressors. This study provides insight into the relationship between these stressors, and the need for targeted screening and intervention that address such aspects of care.

Social workers' perspectives about advance directives: A qualitative study.

OBJECTIVES: The study explores medical social workers' perceptions on the importance of and purpose for documenting Advance Directives (ADs) in the United States and their views of the benefits for engaging patients and families in dialogue about ADs and Advance Care Planning (ACP). METHODS: We conducted a qualitative study using free-text responses from a survey of 142 social workers who work in the medical field in various in-patient hospital and out-patient medical/healthcare settings. Participants were asked, "What is the purpose of documenting an advance directive?" and "Why do you think advance directives are important?" and "What benefits have you experienced in educating patients about advance directives?" Thematic analysis informed themes about the purpose, importance, and benefits of supporting patients in completing an AD. RESULTS: Four themes emerged: 1) The purpose of documenting an AD, 2) Facilitating communication, 3) Creating a plan involves relationship building, and 4) Having an AD reduces suffering and uncertainty. CONCLUSION: Social workers have expertise in relationship building which is an essential element of the partnering process with patients and their support systems towards AD completion. PRACTICE IMPLICATIONS: Social workers who work in medical settings provide ACP education for patients and families and create interprofessional linkages to support patient care. It is clear that social workers add value to care provision to improve communication and provide assistance towards AD completion.

Dying for a change: a systematic review of compassionate release policies.

PURPOSE: The purpose of this study was to systematically review literature to investigate trends in compassionate release policies, facility implementation, barriers at both the incarcerated individual and institutional levels, as well as gaps in the literature. The absence of uniform and appropriate policies to address suitable interventions at the end-of-life has aggravated the challenges and issues facing health-care systems within a correctional facility. A response to address and alleviate these barriers is policies related to compassionate release, a complex route that grants eligible inmates the opportunity to die in their community. Despite the existence of compassionate release policies, only 4% of requests to the Federal Bureau of Prisons are granted, with evidence demonstrating similarly low rates among numerous state prison systems, signifying the underuse of these procedures as a vital approach to decarceration. DESIGN/METHODOLOGY/APPROACH: A systematic review was completed using preferred reporting items for systematic reviews and meta-analyses guidelines. Centre for Agriculture and Biosciences International Abstracts, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Education Resources Information Center, Google Scholar, MEDLINE, PsycINFO, PubMed, Social Services Abstracts and Social Work Abstracts were searched from inception to March 2021. Inclusion criteria included: the compassionate release policy (or related policy) is implemented in the USA; reported qualitative and/or quantitative outcomes; and reported original data. FINDINGS: Twenty studies formed the final data set. Data analysis revealed four main themes: language barriers, complexities of eligibility criteria, over-reliance on prognostication and social stigma. Barriers to inmates' access to compassionate release policies include unclear or technical language used in policy documents. Eligibility criteria appear to vary across the country, including disease prognoses and the ability to predict terminal declines in health, creating confusion amongst inmates, lawyers and review boards. Stigmas surrounding the rights of incarcerated individuals frequently influence policymakers who experience pressure to maintain a punitive stance to appease constituents, thus discouraging policies and interventions that promote the release of incarcerated individuals. RESEARCH LIMITATIONS/IMPLICATIONS: Further research is vital to strengthen the understanding of compassionate release policies and related barriers associated with accessing various types of early parole. To promote social justice for this marginalized population, end-of-life interventions in corrections need to be consistently evaluated with outcomes that improve care for dying inmates. PRACTICAL IMPLICATIONS: Within correctional facilities, correctional health-care workers should play an integral role in influencing prison and medical staff attitudes toward dying inmates by providing an understanding of how to effectively support this vulnerable population. Social workers should participate in research that focuses on effective guidelines for correctional facilities to provide compassionate end-of-life care for inmates. SOCIAL IMPLICATIONS: Racial disparities in the US criminal justice system are prevalent and well documented, as individuals of color are arrested far out of proportion to their share of all individuals in the USA. This particular population is thus challenged with poor access to and quality of health care in corrections. Correctional health-care workers can play an integral role in influencing policymakers, as well as prison and medical staff attitudes toward dying inmates by providing an understanding of how to effectively support this vulnerable population. ORIGINALITY/VALUE: Currently, there are no published research articles that provide a systematic review of compassionate release policies in the USA.