Effects and moderators of psychosocial interventions on quality of life, and emotional and social function in patients with cancer: An individual patient data meta-analysis of 22 RCTs.

OBJECTIVE: This individual patient data (IPD) meta-analysis aimed to evaluate the effects of psychosocial interventions (PSI) on quality of life (QoL), emotional function (EF), and social function (SF) in patients with cancer, and to study moderator effects of demographic, clinical, personal, and intervention-related characteristics. METHODS: Relevant studies were identified via literature searches in 4 databases. We pooled IPD from 22 (n = 4217) of 61 eligible randomized controlled trials. Linear mixed-effect model analyses were used to study intervention effects on the post-intervention values of QoL, EF, and SF (z-scores), adjusting for baseline values, age, and cancer type. We studied moderator effects by testing interactions with the intervention for demographic, clinical, personal, and intervention-related characteristics, and conducted subsequent stratified analyses for significant moderator variables. RESULTS: PSI significantly improved QoL (ß = 0.14,95%CI = 0.06;0.21), EF (ß = 0.13,95%CI = 0.05;0.20), and SF (ß = 0.10,95%CI = 0.03;0.18). Significant differences in effects of different types of PSI were found, with largest effects of psychotherapy. The effects of coping skills training were moderated by age, treatment type, and targeted interventions. Effects of psychotherapy on EF may be moderated by cancer type, but these analyses were based on 2 randomized controlled trials with small sample sizes of some cancer types. CONCLUSIONS: PSI significantly improved QoL, EF, and SF, with small overall effects. However, the effects differed by several demographic, clinical, personal, and intervention-related characteristics. Our study highlights the beneficial effects of coping skills training in patients treated with chemotherapy, the importance of targeted interventions, and the need of developing interventions tailored to the specific needs of elderly patients.

Social networks, social support and coping with serious illness: the family connection.

Selected social support and family research is reviewed to highlight potential problems in social support exchange as patients and families collectively cope with illness and disability. Results indicate that family support is a primary source of patient support and that the impact of illness on families is substantial, underscoring their need for support. Results also indicate that there are numerous opportunities for problematic supportive exchange within families. The case is made that future studies of social support are needed to answer a series of questions about social support process within families coping with serious illness.

Longitudinal analysis of psychological adaptation among family members of patients with cancer.

A growing body of research suggests that a cancer diagnosis reverberates throughout the family system. The majority of studies provide evidence of the psychological distress experienced by family members at the time of diagnosis and during terminal and early bereavement stages. Increasingly, however, patients survive a cancer diagnosis. Therefore, their experience and that of family members more closely approximates living with a chronic illness. In this longitudinal study of 143 pairs of patients and significant others it was found that a substantial minority of significant others experienced psychological distress up to one year after the patient's initial diagnosis. The psychologically vulnerable group of significant others included an initially poor functioning group who remained so over time as well as a group whose mental health status declined over time. Personal and social resources were more important factors in declining mental health than illness-related factors.

Social relations, social support and survival among patients with cancer.

This study examined the relationship between social relationships and social support and survival following a first diagnosis of breast, colorectal, or lung cancer. Findings showed different factors related to survival for those with breast vs lung or colorectal cancer and for those with localized vs non-localized cancers. Results provide important evidence that social relations and social support may operate differently depending on cancer site and extent of disease.

Rose Questionnaire responses among black, Latino, and white subjects in two socioeconomic strata.

We administered the Rose Questionnaire to 1442 black, white, and Latino patients (approximately equal numbers) who sought care for acute chest pain at two medical centers. Of these, 718 subjects were enrolled at a large public hospital serving a low-socioeconomic status population and 724 at a large health maintenance organization hospital serving a middle-class clientele. Using the standard definition of Rose angina, multivariate logistic regression analysis identified five factors that contributed to the relative risk of a positive response: family history of myocardial infarction (2.48), history of peripheral vascular disease (1.41), history of high blood pressure (1.29), history of high cholesterol (1.26), and low-socioeconomic status hospital (0.78). Inquiring about shortness of breath as a substitute for chest pain or an alternative complaint in set one of the Rose Questionnaire did not increase the number of positive responses or differentiate between the socioeconomic groups or race-ethnic subgroups. Having a prior history of self-reported risk factors clearly defined a group with greater likelihood of a positive response to the Rose Questionnaire. Receiving care at a large public hospital (ie, being in a low-socioeconomic status group) was associated with reduced likelihood of having "typical" angina in comparison to receiving care at a health maintenance organization (middle socioeconomic status) for white subjects but not for Latinos and blacks.

Predictive value of prior Rose angina for myocardial infarction confirmation after emergency admissions.

The Rose Questionnaire, developed to facilitate screening for the presence of coronary artery disease, has shown good utility for white men and more variable utility among Latino, African-American, and female subjects. This study investigated its utility for prediction of outcome in patients with suspected myocardial infarction. A total of 1428 white, Latino, and African-American subjects completed questionnaires after emergency admission, which were correlated with diagnoses at the time of discharge from a public hospital and private hospital. Results indicated that subjects with positive questionnaires were less likely to have infarction confirmed at discharge, except for those with a prior history of myocardial infarction, than those with a negative response. These data are important in evaluating the overall utility of the Rose Questionnaire and the significance of angina.

Chest pain admissions: characteristics of black, Latino, and white patients in low- and mid-socioeconomic strata.

To assess the potential impact of socioeconomic status (SES) factors on health-care seeking behavior for suspected acute coronary artery disease symptoms, equal numbers of black, Latino, and white patients seeking care for chest pain at two large hospital emergency rooms were studied. Differences between low and middle SES groups with respect to pre-attack health, health history, ethnicity, gender, and modes of transportation to the hospital were explored. Highly significant self-reported differences between low SES and middle SES patients were found as follows: low SES subjects were more likely to describe themselves as being in fair to poor general health (68% versus 18%), had more frequent chest pain, reported other types of heart disease, were more often current smokers, more likely to be black or Latino, and to be younger. Members of the low SES group also were less [corrected] likely to have known cholesterol levels, to have used estrogen, to have had a prior ECG or cardiac surgery, to be nonsmokers, to have had a stress test, and to have typical angina. Middle SES subjects more often described typical angina, prior use of estrogen (females), congenital, rheumatic, or family history of heart disease, prior knowledge of high cholesterol, were more likely to be of the male gender, and to be older than the low SES cohort. The data reveal that low SES subjects, with markedly less health-care resources compared with middle SES subjects, have a worse general health and cardiac risk profile despite the fact that they were significantly younger (mean age 53.4 versus 60.7, P < .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Coping with serious illness: on integrating constructs to enhance clinical research, assessment and intervention.

Empirical research suggests that given relatively similar illness contingencies, patients who cope successfully with serious illness have access to and use effectively social network support, believe events are to some extent within their control, perceive themselves to be effective, and employ an array of flexible coping strategies. Based on a selective literature review, the argument is made that more integrative conceptual frameworks are needed to advance theory and to enhance the applied value of research data. Clinical implications for assessment, intervention, and evaluation are set forth.

Hospice volunteer programs: a proposed agenda.

With the expansion of hospice services, volunteers are being increasingly used to provide emotional, spiritual, and tangible support to the terminally ill and their significant others. Unfortunately, little has been published about the experiences of hospice volunteers. In this paper, we (1) propose a timely agenda for the development and refinement of hospice volunteer programs; (2) outline basic program criteria about which there is emerging consensus; (3) delineate pertinent issues in the screening, training, and job performance of hospice volunteers; and (4) indicate how the implementation of formal program regulations and operations and program evaluation may benefit service recipients and institutional providers.

Psychosocial care for the chronically ill adolescent: challenges and opportunities.

Rapid advances in medical technology have resulted in increased survival of children with chronic illness. As a result, growing numbers of adolescents and their families need psychosocial services. This article calls for further efforts by social workers to address the needs of chronically ill adolescents. Psychosocial interventions to aid adolescents are described, and the potential application of communication technologies such as computers and videos to traditional therapeutic and educational services is discussed.

Sociocultural factors in MI recovery: an exploratory study.

The reported study examines the influence of socioeconomic status (SES) and ethnicity in coping with a first acute myocardial infarction (MI). The study employed a panel design in which seventy-five patients were interviewed during acute hospitalization and six months later, and sixty of those were interviewed again at one year post-MI. Using the analysis of variance test, gradients in anxiety, functional status, and self-reported health status were found among lower SES Blacks, Hispanics, Anglos and upper SES Anglos as well as statistically significant differences in personal sense of control, beliefs about recovery, coping responses, and social support systems. More important, analysis of covariance documents that associations between coping variables and post-MI recovery outcomes vary among the different sociocultural groups.

Pressure-independent baroreflex resetting produced by chronic infusion of angiotensin II in rabbits.

The purpose of this study was to test the hypothesis that chronic infusion of angiotensin II (ANG II) in rabbits shifts or resets baroreflex control of heart rate to a higher pressure level via a mechanism that is independent of the hypertension that is produced. The baroreflex relationship between arterial pressure and heart rate was assessed by first infusing progressively increasing doses of nitroprusside (3, 6, 12, 24, and 48 micrograms.kg-1 x min-1) to lower pressure and then increasing doses of phenylephrine (0.5, 1, 2, 4, and 8 micrograms.kg-1 x min-1) to raise pressure. Two weeks of intravenous ANG II infusion (20 ng.kg-1 x min-1) increased plasma ANG II levels from 9 +/- 1 to 146 +/- 24 pg/ml (P < 0.05), increased arterial pressure from 62 +/- 2 to 95 +/- 2 mmHg (P < 0.05), and transiently increased heart rate. The baroreflex was shifted to a higher pressure level after 30 min and 1, 3, 7, 9, and 14 days of ANG II infusion. Thirty minutes after the ANG II infusion on days 1, 7, and 14 was stopped, arterial pressure decreased, and the baroreflex shifted back to control, indicating that ANG II was required for the resetting that was produced. However, when the ANG II infusion was continued and arterial pressure was instead reduced for 30 min by infusing nitroprusside on days 3 and 9, the baroreflex relationship between arterial pressure and heart rate remained positioned at a higher pressure level.(ABSTRACT TRUNCATED AT 250 WORDS)

Stressful life events: a predictor in recovery from heart attacks.

Early identification of cardiac patients at risk for problems in recovery can be of help to social workers who work in crowded inpatient services. The study described here found preonset stress, measured by a stressful life events questionnaire, to be associated with the level of recovery from a heart attack. The questionnaire may be a valuable tool for social workers working with cardiac patients.

Mental health services among ambulatory patients with human immunodeficiency syndrome infections.

A retrospective study of 463 medical and social service records of patients with AIDS, ARC and minimally symptomatic individuals was conducted to examine mental health services delivered by primary medical care providers. A substantial minority of patients in all three groups had a psychiatric diagnosis and were prescribed psychotropic medications. Recognition of psychiatric complications varied by ethnicity and socioeconomic status.

Acute chest pain in African Americans: factors in the delay in seeking emergency care.

OBJECTIVES: African Americans have been shown to have longer delay times than the majority population in seeking care for acute cardiac problems. The purpose of this study was to determine whether socioeconomic factors affect delay times. METHODS: Structured interviews were administered to 254 African Americans admitted to a public hospital and 194 African Americans admitted to a private hospital for suspected acute myocardial infarction. RESULTS: Patient characteristics found by multiple regression analysis to affect decision-making and travel time for care-seeking were structural access to care, persistence of symptoms, degree of incapacitation, consultation with a layperson, consultation with medical professionals, and mode of transportation. CONCLUSIONS: Within-group differences were found to be related to socioeconomic status. Strategies to increase knowledge about heart attack symptoms, improve access to care, and improve the socioeconomic status of at-risk African Americans are indicated.

The relationship between psychosocial status of immigrant Latino mothers and use of emergency pediatric services.

Consistent empirical evidence has shown that low-income Latino populations tend to underutilize health care services and do not have a usual source of care. This article identifies and describes the sociodemographic and psychosocial characteristics of Latino immigrant mothers who use emergency pediatric services, assesses the association of maternal characteristics with perceived barriers to care, and examines key predictors of total number of pediatric visits in a year. A survey was carried out to obtain data on reason for emergency room visit, usual sources of care, child's health, and mother's physical and psychosocial health. The results revealed a clear pattern of delayed care for acute problems in the children, a high number of reported barriers to pediatric care, and high mental distress reported by mothers.

A longitudinal analysis of psychological adaptation among survivors of cancer.

This longitudinal study examined the psychological adaptation of newly diagnosed cancer patients. Findings showed a decline in patient's mental health status over time. Initial psychological status and other psychosocial factors, and not illness-related factors, were predictive of subsequent adaptation. Two psychologically vulnerable patient groups were identified: those who remained distressed over time and those whose mental health status declined over time.

Differential perceptions, behaviors, and motivations among African Americans, Latinos, and whites suspected of heart attacks in two hospital populations.

To evaluate the hypothesis that socioeconomic status would exert greater influence on patients' care-seeking behavior than racial/ethnic group status, we undertook a sequential study of African-American, Latino, and white patients hospitalized for acute chest pain from August 1988 through July 1990 at two sites. The study took place in an urban public medical center and an urban private health maintenance organization medical center, which provide care to mixed racial/ethnic groups of lower and middle socioeconomic status, respectively, in Los Angeles. Three concurrent case series of African-American, Latino, and white patients hospitalized for acute chest pain were recruited. The racial/ethnic distribution of the total group was African Americans, 448; Latinos, 487; and whites, 499. The main outcome measure was the length of time patients spent in deciding to seek emergency medical care for acute chest pain and the associated perceptions, behaviors, and motivations involved in deciding to seek care. For the total group, public hospital site and lack of health insurance were the strongest significant predictors of a longer decision phase, whereas differential symptom perceptions, consultation with medical professionals, and use of paramedic transport were significant predictors of shorter duration. Multiple regression results were similar in separate analyses demonstrated significant differences in patients' perceptions of symptom intensity and incapacitation within racial/ethnic groups related to socioeconomic status, as well as in specific behavior and motivation in seeking care. The study concluded that socioeconomic status as determined by hospital site exerted a stronger influence on patients' care-seeking behavior for acute chest pain than racial/ethnic status. Specific care-seeking behaviors of minority and lower-socioeconomic-status patients in the use of medications and paramedics in the face of acute symptoms should be targeted in future educational programs.

Inadequate adherence to radiotherapy in Latina immigrants with carcinoma of the cervix. Potential impact on disease free survival.

BACKGROUND: Radiation therapy plays an important role in the loco-regional control of carcinoma of the cervix. Strict adherence to the radiation protocol, without the introduction of time breaks, has been shown to favorably affect loco-regional control and survival, making adherence a crucial variable for optimal outcome. Because carcinoma of the cervix is a common disease among Latinas, with survival rates worse than those of other ethnic groups in this country, the pattern of adherence to the prescribed radiation treatment among Latina patients seen at Los Angeles County Hospital were studied. METHODS: The records of 69 consecutive Latina patients with cervical cancer who received radiation therapy at Los Angeles County Hospital were reviewed. Semi-structured interviews in a successive group of 30 similar patients were conducted to acquire preliminary information about their psychosocial characteristics. RESULTS: The results demonstrate inferior rates of optimal adherence to radiation treatment among Latina immigrant patients when compared with the rates reported in the literature for the general population of cervical cancer patients in United States (16 vs. 63%). Furthermore, a large subset of patients (20%) in the series elected to discontinue treatment without a medical reason. When a comparable group of Latina patients was interviewed, potential practical, psychologic, and cultural barriers to optimal care were identified. CONCLUSIONS: The results from this exploratory study support the need for further studies to document the pattern of adherence to radiotherapy in the rest of the country among this minority population. The results suggest that an intervention to improve information and adherence to radiation therapy may be necessary to assure Latinas a chance for rates of cure comparable with the national standards.