Acute Stress Symptoms, Intolerance of Uncertainty and Coping Strategies in Reaction to the October 7 War.

BACKGROUND: On 7 October 2023, hundreds of armed Hamas fighters breached the security border fence and entered Israel from the Gaza Strip. More than 1400 Israeli citizens were murdered, and 239 individuals were kidnapped. Many Israeli citizens experienced these occurrences as psychologically traumatic events that caused stress and uncertainty. OBJECTIVES: The present study aimed to examine the relationship between exposure to war (in more distant circles), intolerance of uncertainty (IU) and disengaged coping on acute stress symptoms (ASS). First, we examined whether exposure to war and IU were directly associated with ASS. Second, we tested the mediating role of disengaged coping in the relationship among war exposure, IU and ASS. METHODS: This cross-sectional study involved 393 Israeli citizens. Participants answered questionnaires on exposure to war, IU, coping strategies and ASS. RESULTS: The study results indicate that higher exposure and higher levels of IU were directly associated with more intensive ASS, and this association was partially mediated by higher use of disengaged coping strategies. CONCLUSIONS: Individuals during wartime are at risk of experiencing high levels of ASS and developing ASD. However, degree of exposure to war alone was not associated with ASS, but it was related to personal resources and coping strategies.

Some differences between social work, spiritual care, and psychology: Content variance in end-of-life conversations.

OBJECTIVES: Within the multidisciplinary team, there can sometimes be lack of clarity as to the specific different contributions of each of the psycho-social-spiritual professionals: social workers, psychologist, and spiritual caregivers. This study examined the content of their end-of-life conversations with patients. METHODS: A total of 180 patients with terminal cancer received standard multidisciplinary care, including conversations with a social worker, psychologist, and spiritual caregiver. After each patient's death, these professionals reported using a structured tool which content areas had arisen in their conversations with that patient. RESULTS: Across all content areas, there were significant differences between social work and spiritual care. The difference between social work and psychology was slightly smaller but still quite large. Psychology and spiritual care were the most similar, though they still significantly differed in half the content areas. The differences persisted even among patients who spoke with more than 1 kind of professional. The 6 content areas examined proved to subdivide into 2 linked groups, where patients speaking about 1 were more likely to speak about the others. One group, "reflective" topics (inner and transpersonal resources, interpersonal relationships, one's past, and end of life), included all those topics which arose more often with spiritual caregivers or psychologists. The second group, "decision-making" topics (medical coping and life changes), was comprised of those topics which arose most commonly with social workers, bridging between the medical and personal aspects of care and helping patients navigate their new physical, psychological, and social worlds. SIGNIFICANCE OF RESULTS: These findings help shed light on the differences, in practice, between patients' conversations with social workers, psychologists, and spiritual caregivers and the roles these professionals are playing; can aid in formulating individualized care plans; and strengthen the working assumption that all 3 professions contribute in unique, complementary ways to improving patients' and families' well-being.

Longitudinal trajectories of depression and quality of life in a cohort of cancer survivors and individuals without cancer in Europe.

BACKGROUND: The long-term effects of cancer on psychological symptoms and quality of life (QoL) have been widely reported, but they were seldom examined over time compared to the general population. AIMS: To investigate trajectories of depression and QoL over time among cancer survivors compared to individuals without cancer throughout Europe and identify associated factors. METHODS: Data from five waves of the Survey of Health, Ageing and Retirement in Europe study were used. The study sample featured 1066 cancer survivors and 9655 individuals without cancer from 13 European countries. Group-based trajectory modeling was used to identify depression and QoL trajectories, and a linear mixed-effects model was used to characterize their correlates. RESULTS: Four depression trajectories-stable low, stable high, increasing, and decreasing-and four QoL trajectories were identified. All QoL trajectories were stable over time, but differed in their levels: low, low-medium, medium-high, and high. Depression and QoL trajectories were similar between cancer survivors and individuals without cancer. However, significantly more cancer survivors had high-depression and low-QoL trajectories. Further, better perceived health, activities of daily living, physical activity, and income adequacy levels were significantly associated with changes in depression and QoL levels over time. CONCLUSIONS: Although depression and QoL trajectories did not differ between cancer survivors and individuals without cancer, more cancer survivors were characterized by high-depression and low-QoL life trajectories. IMPLICATIONS FOR CANCER SURVIVORS: Providers should be aware and screen for cancer survivors with elevated depression and low QoL, and promote relevant psychosocial interventions. Modifiable factors associated with depression and QoL can be targets for cancer survivors' long-term care plans.

Associations Between Psycho-Social-Spiritual Interventions, Fewer Aggressive End-of-Life Measures, and Increased Time After Final Oncologic Treatment.

BACKGROUND: Little is known about the impact of spiritual caregivers, psychologists, and social workers on desired end-of-life (EoL) medical outcomes, such as reduced use of aggressive care in the final 2 weeks of life, having more time between the last active oncological treatment and death, and increased hospice use. PATIENTS AND METHODS: We conducted a prospective study of 180 patients with cancer and their families, their interactions with social work, psychology, and spiritual care, and the above three treatment outcomes. RESULTS: We found that having one or more spiritual care visits (adjusted odds ratio (AOR) = 2.02; P = .04), having more quality visits with the psychologist (P = .01), and speaking with someone about one's inner resources (AOR = 2.25; P = .03) all correlated with reduced EoL aggressive care. The key interventions correlating with increased time after final treatment were more visits with the spiritual caregiver or the social worker (AOR = 1.30; P < .001), and speaking about the medical treatment (AOR = 1.54; P < .001) and about interpersonal relationships (AOR = 2.28; P < .001). A subjectively good-quality connection with the spiritual caregiver correlated with increased hospice use (AOR = 10.00; P = .01). CONCLUSIONS: Patients with cancer who availed themselves of the spiritual care, psychology, and social work services, each profession in distinct ways, had significantly different outcomes in their EoL medical treatment, including undergoing fewer futile aggressive measures, having more time after their last active treatment, and using hospice services more. These outcomes directly bear on improved quality of life and reduced costs.

The perception and attitudes of Israeli cancer patients regarding advance care planning.

OBJECTIVES: Advance care planning (ACP) allows patients to acknowledge and document their preferences regarding end-of-life care and to ensure their fulfilment. Several factors were found to be related to patients' motivation regarding this process, such as their fear of being a burden on family members; however, the completion rate of the ACP forms is partial. The current study aimed to evaluate the barriers and motives among Israeli cancer patients regarding ACP, including many older adults. SETTING AND MEASUREMENTS: Advanced cancer patients participated in the study. All completed an initial questionnaire to evaluate their basic knowledge regarding the issue. Participants who agreed to talk with a social worker completed a semi open-ended questionnaire which investigated their main motives and barriers regarding the issue. RESULTS: Most of the patients who completed the ACP forms were older and had lung cancer. They mentioned information and open communication with family and staff members as the main enabling factors. Their main motives were to ensure that the best medical decisions would be made and to avoid unnecessary medical procedures. The main reasons for not completing the forms was no close relative who would agree to take the responsibility as well as timing. Most of the participants did not hear about the issue from sources outside the oncology division. CONCLUSIONS: Despite several limitations, the current findings may have important implications regarding ways to establish a more suitable ACP process, adjusted to older patients' needs. This may assist in promoting patients' cooperation with ACP and its implementation in the medical system, including older adults.

Post-treatment Psychological Distress Among Colorectal Cancer Survivors: Relation to Emotion Regulation Patterns and Personal Resources.

BACKGROUND: Post-treatment psychological distress among colorectal cancer (CRC) survivors is common, but changes over time. However, data on the effects of emotional factors on changes in psychological distress over time remain limited. The study sought to describe the patterns of change in psychological distress among CRC survivors in the short-term after treatment completion and to identify predictors of the change in psychological distress experienced by CRC survivors. METHODS: A total of 153 CRC survivors, stages II-III at diagnosis, who were 4-24 months post-diagnosis (participation rate 89.5%) completed the Emotion Regulation Questionnaire, Acceptance and Action Questionnaire, Resilience Scale-14, Self-Compassion Scale-Short Form, and Brief Symptom Inventory-18 (psychological distress scale) at Time 1 (T1). Psychological distress was assessed again at Time 2 (T2), 6 months later. RESULTS: Two patterns of change in post-treatment psychological distress among CRC survivors were identified: One group of patients experienced higher psychological distress at T1, which decreased at T2. A second group experienced lower psychological distress at T1, which increased at T2. Self-compassion and personal resilience predicted higher psychological distress at T2. Lower suppression and self-compassion and higher personal resilience increased the likelihood of being in the increased psychological distress group. CONCLUSIONS: Psychological distress evaluation of CRC survivors at different time-points post-treatment is warranted. In addition, awareness is needed that self-compassion may be individually related to psychological distress among participants.

Emotion Regulation Patterns among Colorectal Cancer Survivors: Clustering and Associations with Personal Coping Resources.

Different patterns of emotion regulation have been proposed for dealing with the intense emotions elicited while coping with cancer. The relationships between these different emotion regulation patterns have not yet been studied. This study examined the usage levels of different emotion regulation patterns (repression, suppression, experiential avoidance and cognitive reappraisal), the intercorrelations and clustering of these patterns and their associations with personal coping resources (personal resilience and self-compassion) in a sample of colorectal cancer survivors. This was a cross-sectional study in which 153 colorectal cancer survivors, stages II-III, (47% female, 53% male), aged 26-87, completed the Marlowe-Crowne Social Desirability Scale, the State-Trait Anxiety Inventory-6, the Emotion Regulation Questionnaire, the Acceptance and Action Questionnaire, the Resilience Scale-14 and the Self-Compassion Scale-Short Form. The four emotion regulation patterns were found to be distinct from each other (i.e., low to moderate correlations). Cognitive reappraisal was negatively related to suppression and experiential avoidance and positively associated with self-compassion. Two-step cluster analysis revealed three distinct clusters: Cluster 1-the suppression-avoidance dominant cluster; Cluster 2-the cognitive reappraisal dominant cluster; and Cluster 3-the repression dominant cluster. Repression, suppression, experiential avoidance and cognitive reappraisal were found to differ from each other but able to be organized into distinct clusters of survivors. Healthcare professionals should be aware of these different emotion regulation patterns and the need to identify the patterns used by each survivor.

Emotion regulation and psychological distress in cancer survivors: A systematic review and meta-analysis.

Emotion regulation may affect the levels of psychological distress of cancer survivors, but inconsistencies exist among studies regarding the direction of this effect. The systematic review and meta-analysis sought to estimate the associations between emotion regulation patterns (repression, suppression, experiential avoidance and cognitive reappraisal) and psychological distress among cancer survivors. Fifteen studies met inclusion criteria for systematic review, and seven studies focussing on suppression were included in the meta-analysis. The systematic review pointed to a marked variability in associations among the emotion regulation patterns and psychological distress. The three meta-regressions of the relationships between suppression and psychological distress found significant fixed- and random-effect sizes (except marginal significance of a random-effect model for partial correlation). Subgroup analysis showed no moderation effect of time since diagnosis or study quality, but a significant difference (fixed-effect model only, p = 0.005) was found between correlative studies and those controlling for confounders. The current study suggests that suppression is related to elevated levels of psychological distress among cancer survivors, although large inconsistencies exist among studies and publication bias could not be ruled out. Further studies with large samples and a consistent approach are thus required to evaluate the associations of emotion regulation patterns and psychological distress.

The perception of Israeli oncology staff members regarding advance care planning.

BACKGROUND: Advance care planning (ACP) defines end-of-life care in accordance with the patients' preferences. It is highly important during mental and/or physical deterioration, which prevents patients from expressing their wishes. Despite various attempts worldwide to promote the issue, it is not well established, suggesting various challenges in the implementation of the process in the medical system. The current study aimed to evaluate the perception of Israeli oncology staff members regarding the process. METHODS: Physicians and nurses from a division of oncology participated in the study. They completed the study's questionnaires, which included quantitative items regarding staff and patients' motives and barriers, as well as qualitative questions to better evaluate their understanding regarding the process. RESULTS: According to staff members, the optimal time to complete the forms is during the final stages of the disease. Making the right medical decisions and avoiding unnecessary medical procedures were rated as the main motives for patients in the process. The communication factor was perceived as the main barrier for patients, as well as the main motive and barrier for staff. The central role of communication was demonstrated in the qualitative section as well. Various differences were demonstrated between staff members who talked with patients about ACP and those who did not. CONCLUSION: The study demonstrated the central role of communication in the process of ACP from the staff's perception. This highlights the need to further promote training programs for staff members to establish better interactions and communication skills when dealing with end-of-life issues.

The association of resilience and age in individuals with colorectal cancer: an exploratory cross-sectional study.

BACKGROUND: Studies generally report lower emotional distress in older patients with cancer than in younger patients with cancer. The personality construct of resilience was previously found to be higher with age, but has not been assessed in relation to emotional distress in older patients with cancer. OBJECTIVE: To assess the mediating effect of resilience on the associations between age and emotional distress in patients with colorectal cancer (CRC). PATIENTS AND METHODS: An exploratory cross-sectional study of 92 individuals, aged 27-87 years, diagnosed with CRC stage II-III, 1-5 years prior to enrollment in the study. They completed the Wagnild and Young's resilience scale and Brief Symptoms Inventory-18, cancer-related problem list, and demographic and disease-related details. RESULTS: Older age, male gender, and less cancer-related problems were associated with higher resilience and lower emotional distress. A Structural Equation Modeling (SEM) analysis and mediation tests showed that, while controlling for cancer-related problems, resilience mediated the effects of age and gender on emotional distress. CONCLUSIONS: The study enlarges the explanation for the consistent previous findings on the better adjustment of older patients with cancer. Increased professional support should be provided for patients with low resilience levels.