Recommendations for supporting healthcare workers' psychological well-being: Lessons learned during the COVID-19 pandemic.

Healthcare workers are at risk of adverse mental health outcomes due to occupational stress. Many organizations introduced initiatives to proactively support staff's psychological well-being in the face of the COVID-19 pandemic. One example is the STEADY wellness program, which was implemented in a large trauma centre in Toronto, Canada. Program implementors engaged teams in peer support sessions, psychoeducation workshops, critical incident stress debriefing, and community-building initiatives. As part of a project designed to illuminate the experiences of STEADY program implementors, this article describes recommendations for future hospital wellness programs. Participants described the importance of having the hospital and its leaders engage in supporting staff's psychological well-being. They recommended ways of doing so (e.g., incorporating conversations about wellness in staff onboarding and routine meetings), along with ways to increase program uptake and sustainability (e.g., using technology to increase accessibility). Results may be useful in future efforts to bolster hospital wellness programming.

Understanding compassionate care from the patient perspective: Highlighting the experience of head and neck cancer care.

Objectives: To address the knowledge gap in the practice of compassionate healthcare by elucidating patient perspectives on compassion, empathy, and sympathy. Methods: Semi-structured telephone interviews were conducted at two time points with patients undergoing head and neck cancer treatment. Questions explored participants' understanding of compassion, sympathy, and empathy, as they relate to each other and to healthcare. Interviewers manually recorded responses. Qualitative exploratory methods were used to analyze data; inductive line-by-line coding was conducted to develop primary codes. Themes emerged through categorization of codes. Results: Ninety-five interviews conducted with 63 participants across two time points revealed four major themes - Compassion-vs-Empathy-vs-Sympathy, Coping Methods, Showing Care, and Nature of Interaction - encompassing seven categories, with a total of 24 codes. Codes were consistent across time points, except for two new codes, "positivity" and "personalized" emerging during follow-up interviews. Conclusions: Patient narrative from this study supported the concept that compassion is multidimensional and enabled several dimensions to be identified, highlighting the importance of patient perspectives in improving the provision of compassionate healthcare. Findings should be considered in future training and practice.

Web-Based Psychosocial Interventions for Disaster-Related Distress: What Has Been Trialed in the Past, and What Can We Learn From This?

OBJECTIVES: To summarize reports describing implementation and evaluation of Web-based psychosocial interventions for disaster-related distress with suggestions for future intervention and research, and to determine whether a systematic literature review on the topic is warranted. METHODS: Systematic searches of Embase, PsycINFO, and MEDLINE were conducted. Duplicate entries were removed. Two rounds of inclusion/exclusion were conducted (abstract and full-text review). Relevant data were systematically charted by 2 reviewers. RESULTS: The initial search identified 112 reports. Six reports, describing and evaluating 5 interventions, were included in a data analysis. Four of the 5 interventions were asynchronous and self-guided modular programs, with interactive components. The fifth was a short-term, online supportive group intervention. Studies utilized a variety of evaluation methods, and only 1 of 14 outcome measures used across the studies was utilized in more than 1 project. CONCLUSIONS: Several Web-based psychosocial interventions have been developed to target disaster-related distress, but few programs have been formally evaluated. A systematic review of the topic would not be recommended at this time due to heterogeneity in reported studies. Further research on factors impacting participation, generalizability, and methods of program delivery with consistent outcome measures is needed.

Implementing the STEADY Wellness Program to Support Healthcare Workers throughout the COVID-19 Pandemic.

The COVID-19 pandemic has posed an ongoing threat to the mental wellbeing of countless individuals worldwide, with healthcare workers at particularly high risk. We developed the STEADY staff wellness program prior to the pandemic based on the available literature and input from stakeholders, guided by the Knowledge-to-Action (KTA) Implementation Science Framework. We quickly adapted the STEADY program for implementation in selected high-need units within Canada's largest trauma hospital during the pandemic's first wave. This brief report describes implementation of the STEADY program, retroactively applying the structure of the Knowledge-to-Action Implementation Science Framework to the practical steps taken. We identified the importance of more frequent, shorter contact with HCWs that occurred in-person, with an emphasis on peer support. A flexible approach with strong support from hospital leadership were key facilitators. Our findings suggest that a flexible approach to practical program implementation, theoretically underpinned in best-practices, can result in an acceptable program that promotes increased HCW wellbeing during a pandemic.

Development of an Evidence-Informed Solution to Emotional Distress in Public Safety Personnel and Healthcare Workers: The Social Support, Tracking Distress, Education, and Discussion CommunitY (STEADY) Program.

Public safety personnel (PSP) and healthcare workers (HCWs) are frequently exposed to traumatic events and experience an increased rate of adverse mental health outcomes compared to the public. Some organizations have implemented wellness programming to mitigate this issue. To our knowledge, no programs were developed collaboratively by researchers and knowledge users considering knowledge translation and implementation science frameworks to include all evidence-informed elements of posttraumatic stress prevention. The Social Support, Tracking Distress, Education, and Discussion Community (STEADY) Program was developed to fill this gap. It includes (1) peer partnering; (2) distress tracking; (3) psychoeducation; (4) peer support groups and voluntary psychological debriefing following critical incidents; (5) community-building activities. This paper reports on the narrative literature review that framed the development of the STEADY framework and introduces its key elements. If successful, STEADY has the potential to improve the mental well-being of PSP and HCWs across Canada and internationally.

Using the Delphi Method to Elucidate Patient and Caregiver Experiences of Cancer Care.

Objective: Identify the most salient elements of the head and neck cancer (HNC) care experience described by patients and caregivers in focus group interviews. Methods: Three focus groups of patients and caregivers were facilitated by research assistants and clinicians. Open-ended guiding questions captured/elicited aspects of care that were appreciated, warranted improvement, or enhanced communication and information. A four-step Delphi process derived consensus among focus group facilitators (n = 5) regarding salient discussion points from focus group conversations. Results: Seven salient themes were identified: (1) information provision, (2) burden related to symptoms and treatment side effects, (3) importance of social support, (4) quality of care at both hospital and provider levels, (5) caring for the person, not just treating cancer, (6) social and emotional impact of HNC, and (7) stigma and insufficient information regarding human papillomavirus-related HNC. Conclusion: Participants reported varying needs and support preferences, a desire for individualized communication, and to feel cared for as both a person and a patient. Findings illuminate the intricate details underlying high-quality, compassionate, person-centered HNC cancer care.

Feasibility, Acceptability, and Clinical Significance of a Dyadic, Web-Based, Psychosocial and Physical Activity Self-Management Program (TEMPO) Tailored to the Needs of Men with Prostate Cancer and Their Caregivers: A Multi-Center Randomized Pilot Trial.

BACKGROUND: Prostate cancer is the most common cancer diagnosis among men. Family caregivers (often female spouses) play a key role in ensuring patients' needs are met, frequently assuming their role with no formal training, which can contribute to a high burden. The purpose of this study was to pilot TEMPO-the first dyadic, Tailored, wEb-based, psychosocial and physical activity self-Management PrOgram for men with prostate cancer and their caregivers. METHODS: 49 men with prostate cancer and their caregivers were randomized to TEMPO or usual care. Baseline and follow-up questionnaires were completed to assess feasibility, acceptability, and clinical significance. A priori benchmarks for these outcomes were set. Thirteen exit interviews were conducted to further explore acceptability. RESULTS: Feasibility benchmarks were met with the exception for recruitment with on average 6.1 dyads recruited/month (benchmark: 8 dyads/month). Benchmarks of acceptability focused on attrition (<25%) and system usability, which were met. Using the strict criteria for adherence of 100% of the module viewed and participants spending at least 15 min on the module, 45% of participants were adherent. The clinical significance on anxiety and quality of life was supported for caregivers, and mostly supported for the men with prostate cancer. CONCLUSION: This pilot trial was successful, with minor modifications needed prior to a large trial.

Stumblers and Tumblers: Two Pathways to "Unintentional" Fall-Related Traumatic Brain Injury.

Traumatic brain injury (TBI), including concussion, is the commonest neurological condition in high-income countries and is the second commonest condition next to migraines. Although most of these injuries are unintentional, substance abuse and age-related physiological factors have been implicated as causal factors of fall-related TBIs. Our study used qualitative methods and a life course perspective to examine whether life events and psychosocial antecedents, such as early adverse childhood experiences, play a role in the occurrence of non-intentional fall-related TBI. In-depth interviews were conducted with 27 patients who sustained a TBI due to unintentional falls. Transcripts were qualitatively analyzed to explore factors related to their prior life experiences that may have been related to the reasons that led to their falls. The results reveal that childhood family conflict and peer-influenced risky behaviors may have contributed to poorer mental and physical health in adulthood, which in turn contributed to injuries. Respondents whose behaviors did not play a direct role in their injury event were labeled "Stumblers." These patients' falls were seen as being related to unfortunate unique environmental and situational factors and could colloquially be described as "accidental falls." We also identified a distinct group of patients who had a cumulative life experience starting in early childhood that contributed to a pattern of riskier behaviors, ultimately culminating in a fall-related TBI. The second group of patients were labeled "Tumblers" as they chose to participate in risky activities, regardless of whether they considered them to be risky, which ultimately led to the fall-related TBI. This group was identified by a purposeful volitional state that sought out the "opportunity for accidental fall." Childhood family conflict and peer-influenced risky behaviors were important precursors to mental and physical health states in this group.

The Temporal Relations of Traumatic Brain Injury, Victimization, Aggression, and Homelessness: A Developmental Trajectory.

Traumatic brain injury (TBI) occurs more frequently in homeless persons than the general public. Both homelessness and TBI have been linked to experiences of violence (e.g., aggression and victimization). This study aimed to understand the temporal occurrences of events over the life course that contribute to vulnerabilities to TBI, victimization, aggression, and homelessness. A life-course perspective was used in this thematic analysis of in-person interviews with homeless persons. A total of 33 homeless persons met the inclusion criteria. Twenty-five of 33 (76%) participants had a self-reported history of TBI. Seventy-six percent of TBI events occurred before the onset of homelessness. Assault was the most common mechanism of TBI. During childhood, TBI was a frequently reported event, and parent- or guardian-related physical and sexual abuse were also accentuated with peer abuse, which may have contributed to a unique developmental trajectory. Aggressive behaviors were reported more commonly in persons who previously endured physical, sexual, and emotional victimization early in childhood. The cumulative effect of early adverse events, including TBI and other forms of victimization, subsequent aggression, and further TBI occurring later in life, may create an "at-risk" or vulnerable state preceding homelessness. Precipitating events during adulthood may contribute to a state of homelessness. Homelessness itself may facilitate the context for recurring physical and emotional injury, some of which may be preventable. Future studies should examine the temporality of events related to victimization by physical trauma, such as TBI, aggression, and homelessness.

Dignity therapy for patients with brain tumours: qualitative reports from patients, caregivers and practitioners.

BACKGROUND: Most individuals with brain tumours experience distress or cognitive impairment during the illness trajectory, potentially causing decreased quality of life, strain on interpersonal relationships and altered sense of self or of the world. Symptoms of brain tumour and treatment can cause increased reliance on others and decreased in sense of dignity. Dignity is an important consideration when caring for patients, as it can influence decisions at end-of-life. Dignity therapy (DT) is a therapeutic intervention that was developed for patients near the end of life. DT encourages the patient to reflect on the life lived, including important roles and sources of pride, resulting in the development of a 'Legacy Document'. DT has been shown to enhance quality of life and dignity, and reduce psychological and existential distress for patients at the end-of-life. There is little literature on the effectiveness of DT, or other quality of life interventions, in brain tumour populations; This paper reports on the feasibility of conducting DT with this population, and presents qualitative data gathered from patients with brain tumours who participated in DT, their caregivers, and their Dignity Therapists. METHODS: Participants were recruited from the Odette Cancer Centre in Toronto. One of five Dignity Therapists conducted the intervention; time data was logged. Immediately after the intervention, patient participants, their caregivers, and Dignity Therapists were sent an open-ended, self-report survey about their experience with DT. Qualitative content analysis was conducted by an impartial reviewer. Average time taken to conduct the intervention was determined. RESULTS: Fifteen out of the 17 recruited participants (88%) completed the intervention; 2 were unable to complete the intervention due to progressing disease. Qualitative data was categorized according to two main areas of interest: Acceptability and Impact. Four participants, 5 caregivers and 4 care providers completed the qualitative surveys. All 4 patient participants reported benefits of DT that related to communication and/or advanced care planning (ACP). Dignity therapists felt that the impact on their patients was positive, and reported satisfaction as a clinician. CONCLUSIONS: The low attrition rate for the intervention suggests that DT is feasible in this population, though the required time to complete DT might be difficult for healthcare practitioners to provide within the recommended timeframe for this therapy. Positive qualitative reports on the effect of DT from patients, caregivers and dignity therapists alike indicate that DT is a promising intervention for this demographic.

Are we missing PTSD in our patients with cancer? Part I.

Posttraumatic Stress Disorder (PTSD) can be defined by the inability to recover from a traumatic event. A common misconception is that PTSD can only develop in circumstances of war or acute physical trauma. However, the diagnostic criteria of PTSD were adjusted in the Diagnostic Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) to include the diagnosis and treatment of a life-threatening illness, such as cancer, as a traumatic stressor that can result in PTSD. The word 'cancer' is so strongly linked to fear, stigma, and mortality, that some patients are fearful to even say 'the C word'. Therefore, it is not surprising that patients may experience a diagnosis of cancer as sudden, catastrophic, and/or life-threatening. Cancer-related PTSD (CR-PTSD) can negatively affect a patient's psychosocial and physical well-being during treatment and into survivorship. Unfortunately, CR-PTSD often goes undiagnosed and, consequentially, untreated. This article provides a general overview of PTSD with cancer as the traumatic event in order to define CR-PTSD, and reviews the growing pool of literature on this topic, including prevalence, risk factors, characterization, and treatment of CR-PTSD. The purpose of this article is to spread awareness of this relatively newly defined and commonly missed disorder among patients with cancer to clinicians and patients alike.

Oncology nursing role in cancer-related PTSD-Part II.

Cancer-related posttraumatic stress disorder (CR-PTSD) is relatively newly defined, lacks clinician awareness and, therefore, often goes undiagnosed. Untreated CR-PTSD can be debilitating; negatively impacting all aspects of a patient's life throughout diagnosis, treatment, and into survivorship. Oncology nurses' frontline role, which includes caring for both patients' physical and psychosocial needs, and commonly forming a trusting relationship with patients, makes them ideal candidates for providing emotional support and assessing patients for risk or symptoms of CR-PTSD. In addition to a brief summary on the current nursing role in assessing and treating mental health disorders such as CR-PTSD, this article provides recommendations for how nurses can identify vulnerable patients, assess these patients for CR-PTSD and provide psychosocial support to those in need, as well as how hospitals can better equip oncology nurses to do so through training, education and supportive resources.