A randomized controlled trial assessing behavioral, cognitive, emotional and physiological changes resulting from a communication skills training in physicians caring for cancer patients.

OBJECTIVE: This randomized study assesses behavioral, cognitive, emotional and physiological changes resulting from a communication skills training (CST) for physicians caring for cancer patients. METHODS: Medical specialists (N = 90) were randomly assigned in groups to complete a manualized 30-h CST or to a waiting list. Assessments included behavioral (communication skills), cognitive (self-efficacy, sense of mastery), emotional (perceived stress) and physiological (heart rate) measures. Assessments were made at baseline (both groups), after CST program (training group), and four months after (waiting list group). All assessments were conducted before, during, and after a complex communication task with an advanced-stage cancer simulated patient (SP). RESULTS: Trained physicians had higher levels of communication skills (from RR=1.32; p = .003 to RR=41.33; p < .001), self-efficacy (F=9.3; p = .003), sense of mastery (F=167.9; p < .001) and heart rate during the SP encounter (from F=7.4; p = .008 to F=4; p = .050) and same levels of perceived stress (F=3.1; p = .080). CONCLUSION: A learner-centered, skills-focused and practice-oriented manualized 30-h CST induced multilevel changes indicating physician engagement in a learning process. PRACTICE IMPLICATIONS: Trainers should consider the CST multilevel benefits (behavioral, cognitive, emotional and physiological) before, during and after a complex communication simulated task as an innovative way to assess the efficacy of a communication skills learning process.

Towards a Vulnerability Model for Major Depressive Episodes.

BACKGROUND: While many studies have investigated depression risk factors, few attempts have been made to weight, and compare them. Therefore, we conducted a prospective comparison of a sample of subjects suffering from major depressive disorder and a group of healthy subjects. We compared classic risk factors with internal elements such as personality, family dynamics and health locus of control. We also looked for prognostic factors. METHODS: Forty people with major depressive disorder (the MDD group) were randomly assigned to different treatment groups and followed for two years. In parallel, we followed a group of 21 healthy subjects (healthy group). At the beginning of the study, sociodemographic data were recorded and all subjects were asked to complete the Multidimensional Health Locus of Control (MHLC) scale, the NEO Five-Factor Inventory (NEO-FFI), and the Family Adaptation and Cohesion Scale (FACES III). During the study, subjects were regularly assessed using the Hamilton Depression Scale (HDS) and the Short Form Health Survey (SF-12). RESULTS: Of the 23 explanatory variables, 13 were statistically different (p≤0.05): age, gender, number of people living together, income, extravert personality and neuroticism, Internal HLC, Powerful others HLC, Adaptability of the current couple and the family of origin, and Cohesion of the ideal and nuclear family and family of origin. The accumulation of risk factors doubles the chances of suffering from MDD (odds ratio 1.905**). Independent of treatment, among the 13 variables, the first nine explain 34.1% of change in depression measured on the HDS scale (p<0.001). CONCLUSION: While the size of our sample limits the robustness of our results, our study suggests that some risk factors are also prognostic. The respective weights of these factors vary as a function of age group. Finally, some, such as health locus of control, family dynamics or extraversion, can be modified as an adjunct to pharmacological treatment.

Screen Time and (Belgian) Teenagers.

BACKGROUND: Parental anxiety about young people's use of media has increased with the advent of Generation Alpha. Excessive consumption is assumed to lead to a sedentary lifestyle, psychiatric disorders, overconsumption of sexual content and suicidal behaviour. But are these assumptions valid? METHODS: We supplemented data from the 2014 Health Behaviour in School-aged Children Study for Belgium with a bibliographical search of online databases (Medline, Scopus, PsycArticles, PsycInfo, PubMed) with the keywords 'adolescent' - 'internet' and 'sedentarity' or 'suicide' or 'family' or 'sex*' or 'porno*' for articles published between 2014 and 2019. We selected 27 original research articles and/ or quantitative or qualitative meta-analyses. RESULTS: Total consumption of different media (television, video games, internet) remained stable until 2010, and significantly increased in 2014. No parallel increase in sedentarity was reported. Controversy continues to surround the quantification of overconsumption, and the definition of 'problematic use'. Nevertheless, it appears that 5% of young people have unusual internet use, and 97.5% of these meet the criteria for a mental disorder. The risk of overconsumption is related to four factors: familial, personality, peer influence and supply. These general factors are supplemented by specific factors related to the abuse of sexual content and suicidal behaviour. For the latter, specific risk factors are the same as for suicidal young people who are not influenced by social media. CONCLUSION: Even if screen time is higher for Generation Alpha, these young people are no more at risk unless they accumulate risk factors. They are also exposed to challenges that researchers have not yet studied in any depth. One question relates to how they can manage their privacy if their parents published, without their consent, photographs of them as children? Another issue is their relationship to knowledge, given that everything they need to know can easily be found online.

From Family Surroundings to Intestinal Flora, A Literature Review Concerning Epigenetic Processes in Psychiatric Disorders.

BACKGROUND: Some behaviors or psychiatric conditions seem to be inherited from parents or explain by family environment. We hypothesized interactions between epigenetic processes, inflammatory response and gut microbiota with family surroundings or environmental characteristics. SUBJECTS AND METHODS: We searched in literature interactions between epigenetic processes and psychiatric disorders with a special interest for environmental factors such as traumatic or stress events, family relationships and also gut microbiota. We searched on Pubmed, PsycINFO, PsycARTICLES and Sciencedirect articles with the keywords psychiatric disorders, epigenome, microbiome and family relationships. RESULTS: Some gene polymorphisms interact with negative environment and lead to psychiatric disorders. Negative environment is correlated with different epigenetic modifications in genes implicated in mental health. Gut microbiota diversity affect host epigenetic. Animal studies showed evidences for a transgenerational transmission of epigenetic characteristics. CONCLUSIONS: Our findings support the hypothesis that epigenetic mediate gene-environment interactions and psychiatric disorders. Several environmental characteristics such as traumatic life events, family adversity, psychological stress or internal environment such as gut microbiota diversity and diet showed an impact on epigenetic. These epigenetic modifications are also correlated with neurophysiological, inflammatory or hypothalamic-pituitary-adrenal axis dysregulations.

How does physicians' decisional conflict influence their ability to address treatment outcomes in a decision-making encounter with an advanced-stage cancer simulated patient? A descriptive study.

OBJECTIVES: This descriptive study assesses how physicians' decisional conflict influences their ability to address treatment outcomes (TOs) in a decision-making encounter with an advanced-stage cancer simulated patient (SP). METHODS: Physicians (N = 138) performed a decision-making encounter with the SP trained to ask for TOs information. The physicians' decisional conflict regarding patients' cancer treatments in general was assessed with the General Decisional Conflict Scale (Gen-DCS). The physicians' decisional conflict regarding the SP's cancer treatments was assessed with the Specific Decisional Conflict Scale (Spe-DCS). Physicians' ability to address TOs during the encounter was assessed with an interaction analysis system: the Multi-Dimensional Analysis of Patient Outcome Predictions (MD.POP). Weekly time spent with cancer patients was assessed with a questionnaire. RESULTS: Physicians' Spe-DCS (ß = -.21 ; p = .014) and weekly time spent with cancer patients (ß = .22 ; p = .008) predicted the number of TOs addressed during the encounter. Spe-DCS scores predicted nearly all MD.POP dimensions (r = -.18 ; p = .040 to r = -.30 to p < .001) whereas Gen-DCS scores predicted nearly none MD.POP dimensions. CONCLUSION: Physicians' specific decisional conflict interferes with their ability to address TOs in a decision-making encounter with an advanced-stage cancer SP. PRACTICE IMPLICATIONS: Physicians should be trained to address TOs according to patient preferences, despite their own decisional conflict.

Family relationships and health locus of control as covariables in the evolution of major depressive disorder.

BACKGROUND: In a two-year study, we compared the efficacy of noradrenergic and serotonergic antidepressants with and without the addition of 100 mg acetylsalicylic acid (ASA) in subjects suffering from major depressive disorder (MDD). In this article we examine the influence of the health locus of control, family relationships and personality traits on the progress of MDD. SUBJECTS AND METHODS: 40 people with MDD (MDD group) were randomly assigned to the different treatment groups. They were followed in parallel with a group of 20 'healthy' subjects (HG). At the beginning of the study, sociodemographic data were collected, and patients were asked to complete the Multidimensional Health Locus of Control (MHLC) scale, the NEO Five-Factor Inventory (NEO-FFI), and the Family Adaptation and Cohesion Scale (FACES III). During the study subjects were regularly assessed using the Hamilton Depression Scale (HDS), the Short Form Health Survey (SF-12) and the Clinical Global Impression scale (CGI). RESULTS: Regardless of the type of treatment, physical health is the best predictor of variation at two years in the MDD group; 45% of variance is explained by a linear regression model that includes three variables from the MHLC, FACES III and NEO-FFI scales. Similarly, 40% of CGI and 24% of HDS variance is predicted. These explanatory variables are statistically less powerful in the MDD group than the HG group. CONCLUSION: While drug treatment is a determinant in changes on the HDS, CGI and SF12 scales, factors such as family relationships, MHLC or personality are important covariates of these changes. The question remains whether we can influence these covariates to improve the response to antidepressants.

Role of gut microbiota in the interaction between immunity and psychiatry: a literature review.

BACKGROUND: Psychiatric disorders may be correlated with a low-grade systemic inflammation but the origin of this inflammatory response remains unclear and both genetics and environmental factors seems to be concerned. Recent researches observed that gut microbiota seems to have an impact on the brain and immune processes. METHOD: We review recent literature to a better understanding of how microbiota interacts with brain, immunity and psychiatric disorders. We search on Pubmed, PsycINFO, PsycARTICLES and Sciencedirect articles with the keywords "gastrointestinal microbiota" and "mental disorders" or "psychological stress". RESULTS: We showed links between gut microbiota and brain-gut axis regulation, immune and endocrine system activity, neurophysiological changes, behavior variations and neuropsychiatric disorders. Communications between brain and gut are bidirectional via neural, endocrine and immune pathway. Microbiota dysbiosis and increase gut permeability with subsequent immune challenges seems to be the source of the chronic mild inflammation associated with neuropsychiatric disorders. Repeated immune or stress events early in life may lead to neurodevelopmental disorders or sickness behavior later in life. CONCLUSIONS: Psychological stress impact gut microbiota with subsequent immune activation leading to neurodevelopmental disorders or sickness behavior and altering neurophysiology and reactivity to stress or lifestyle.

Depression and physical health, the therapeutic alliance and antidepressants.

BACKGROUND: In a two-year study we compared the efficacy of noradrenergic (duloxetine D) and serotonergic (escitalopram E) antidepressants with and without the addition of 100 mg acetylsalicylic acid (ASA) in subjects suffering from a major depressive episode (MDE). The results showed that the D + ASA (DASA) group improved more rapidly than the E + placebo (EP) subgroup. In particular, Hamilton Depression Scale (HDS) scores improved as early as two months, Clinical Global Impression (CGI) scores improved at five months, and remission rates were better. In the course of this study, we also investigated the role of the therapeutic relationship (alliance) on both the progress of the MDE, and patients' mental and physical health. SUBJECTS AND METHODS: 40 people suffering from an MDE were randomly assigned to treatment groups. At the beginning of the study sociodemographic data were collected, and the Helping Alliance Questionnaire (HAQ) was completed. During the study, patients were regularly assessed using the HDS, CGI and the Short Form Health Survey (SF-12). RESULTS: Subgroup comparisons revealed that HAQ scores are not correlated with HAD scores, but a correlation was found with remission rates (r=0.316*). Similarly, at all times, HAQ scores were correlated with physical health (p<0.05), which is in turn correlated with HDS and CGI scores. CONCLUSION: Physical health is linked to the level of depression. While the alliance with the patient is not directly correlated with the intensity of depression, is it correlated with their physical condition and its improvement. For patients, improving their physical health appears to be more important than improving their mental health. These observations must be confirmed.

Immunity and psychiatric disorders: variabilities of immunity biomarkers are they specific?

BACKGROUND: In previous studies we showed the interaction between depression and immunity. We observed that psychological stress seems to be important in this association. In this review we try to understand if psychological stress and immunity have similar or specific impact on the other psychiatric disorders. More generally we review literature to understand if specific immune alterations exist between the main psychiatric diagnoses. METHOD: We studied the literature in search of variabilities between the different psychiatric disorders in terms of immunity especially inflammation. We search on Pubmed, PsycINFO, PsycARTICLES and Sciencedirect articles with the keywords immunity or inflammation and depression, anxious disorders and schizophrenia. RESULTS: Prevalence of inflammation in psychiatric disorders seems to be between 21 to 42%. Psychiatric disorders are correlated with elevated levels of CRP, pro-inflammatory cytokines (IL-6, IL-1ß and TNFα) and anti-inflammatory factors (TGF ß, IL-10, sIL-2, IL-1RA). IL-6 in childhood were associated with subsequent risk of depression or psychotic disorders in early adulthood and in a dose dependent manner. DISCUSSIONS: We found similar immune processes through the different disorders. Variations in cytokines levels seem paralleling various stages of the illness and treatment. Inflammatory markers are linked with severity and resistance to treatment and with subsequent risk of disorders. CONCLUSIONS: Some inflammatory parameters could be considered as risk factor, severity, resistance, trait or state markers of a psychiatric disorder. Other studies are necessary to a better understanding of clinical implications of this heterogeneity.

Correlations between event-related potentials and NK cells, B and T lymphocytes.

BACKGROUND: The links between psychiatry and immune dysfunctions are well known. By contrast, there are few studies that evaluate the link between neuroelectrophysiology and immune system disturbances. SUBJECTS AND METHODS: We retrospectively included 31 patients hospitalized between 2011 and 2012. They completed a sociodemographic questionnaire and were assessed using DSM IV TR on Axis 1. Event-related potentials were performed. Lymphocyte subtypes were quantified using flow cytometry. RESULTS: In terms of P300 latency, there are correlations with the absolute value of leukocytes: for P3a component, we find a correlation in frontal derivation Fz (r=0.405*), in central derivation Cz (r=0.438*), in parietal derivation Pz (r=0.403*) and for P3b component, there is a correlation in Fz (r=0.414*), in Cz (r=0.402*) and in Pz (r=0.425*). In terms of P300 amplitude, for P3b component, there are correlations with CD3 lymphocytes percentage in all derivations (Fz (r=-0.621**); Cz (r=-0.567**); Pz (r=-0.499**)) and with CD19 lymphocytes percentage in all derivations (Fz (r=0.469*); Cz (r=0.466*); Pz (r=0.430*)). For P3a, it is correlated with CD3 percentage (in Fz (r=-0.539**); Cz (r=-0.406*)) and with CD19 percentage (Fz (r=0.364*); Pz (r=0.357*)). With respect to the relationship between mismatch negativity (MMN) amplitude and natural killer (NK) cells percentage, there are correlations in left temporal derivation T3 (r=-0.426*), in Cz (r=-0.401*) and in right temporal derivation T4 (r=-0.427*). A correlation is found between the contingent negative variation (CNV) amplitude and the lymphocytes percentage in Fz (r=-0.471**). CONCLUSIONS: There is a link between lymphocyte-related immunity and electrophysiological disturbances in psychiatric patients. Further studies would be needed to evaluate this relationship more specifically, particularly prospectively and by pathology.

Development of the Multi-Dimensional Analysis of Patient Outcome Predictions (MD.POP) during medical encounters.

OBJECTIVE: Our first objective was to develop the Multi-Dimensional analysis of Patient Outcome Predictions (MD.POP), an interaction analysis system that assesses how HCPs discuss precisely and exclusively patient outcomes during medical encounters. The second objective was to study its interrater reliability. METHOD: The MD.POP was developed by consensus meetings. Forty simulated medical encounters between physicians and an actress portraying a patient were analysed. Interrater reliability analysis was conducted on 20 of those simulated encounters. RESULTS: The MD.POP includes six dimensions: object, framing, value, domain, probability and form of POP. The coding method includes four steps: 1) transcription of the encounter, 2) POP identification, 3) POP dimension coding and 4) POP scoring. Descriptive analyses show that the MD.POP is able to describe verbal expressions addressing the patient's outcomes. Statistical analyses show excellent interrater reliability (Cohen's Kappa ranging from 0.92 to 0.94). CONCLUSION: The MD.POP is a reliable interaction analysis system that assesses how HCPs discuss patient medical, psychological or social outcomes during medical encounters. PRACTICAL IMPLICATION: The MD.POP provides a measure for researchers to study how HCPs communicate with patients about potential outcomes. Results of such studies will allow to provide recommendations to improve HCP's communication about patients' outcomes.

The Psycho-Immunological Model As a Psychosomatic Entity: a Literature Review of Interactions between Depression and Immunity.

BACKGROUND: A large amount of evidence has already shown associations between depression and immunity, a bi-directional relationship seems to be increasingly evident. We showed in several precedent studies that family dynamics (Dubois et al. 2016, Zdanowicz et al. 2015), some coping skills (Manceaux et al. 2016) or gender (Fagniart et al. 2016) are correlated with depression and/or immunity and change the way depression and immunity interact together. METHOD: The objective of this review is to study the literature in search of older and recent evidence about how immunity and depression interact and which determinants influence this relationship. We searched on PubMed, PsycINFO, PsycARTICLES and Sciencedirect articles with the keywords immunity and depression and with coping, gender and family. RESULTS AND DISCUSSIONS: Surprisingly we observed in the literature that depression is mostly correlated with both inflammatory and impaired immunity mainly for cell-mediated immunity. Recent studies showed that gender differences in immunity seems to explain in part some variabilities concerning depression and acute/chronic stress among men and women. There is evidence for a sexual dimorphism of the immune system. Coping style, perceived control or personality impact the immune system. There is evidence that childhood maltreatment or stress occurring early in life can exert persistent effects over a long period of time like a "biological scar". CONCLUSIONS: There seems to be an individual and biological heterogeneity behind the label of major depressive disorder. We demonstrated the role of several modulators on immunity and depression such as gender, coping, personality, early-life stress or relationships. Many other modulators could exist and should be considered for further investigations.

Selective Serotonergic (SSRI) Versus Noradrenergic (SNRI) Reuptake Inhibitors with and without Acetylsalicylic Acid in Major Depressive Disorder.

BACKGROUND: Antidepressant medication efficacy remains a major research challenge. Here, we explored four questions: whether noradrenergic antidepressants are more effective than serotonergic antidepressants; whether the addition of 100 mg acetylsalicylic acid (ASA) changes antidepressant efficacy; whether the long-term efficacy differs depending on the antidepressant and the addition of ASA; and whether serum levels of brain-derived neurotrophic factor (BDNF) are clinically informative. SUBJECTS AND METHODS: In a two-year study, forty people with major depressive disorder were randomly assigned to groups that received an SSRI (escitalopram) or an SNRI (duloxetine), each group received concomitant ASA (100 mg) or a placebo. Sociodemographic data were recorded and patients under went regular assessments with the Hamilton depression scale (HDS) and clinical global impression (CGI) scale. Serum levels of BDNF were measured four times per year. RESULTS: There was no significant difference in efficacy between the two antidepressants or between antidepressant treatment with and without ASA. However, subgroup comparisons revealed that the duloxetine + ASA (DASA) subgroup showed a more rapid improvement in HDS score as early as 2 months (t=-3.114, p=0.01), in CGI score at 5 months (t=-2.119, p=0.05), and a better remission rate (χ2=6.296, p 0.012) than the escitalopram + placebo (EP) subgroup. Serum BDNF before treatment was also higher in the DASA subgroup than in the EP subgroup (t=3.713; p=0.002). CONCLUSION: This suggest two hypotheses: either a noradrenergic agent combined with ASA is more effective in treating depression than a serotonergic agent alone, or the level of serum BDNF before treatment is a precursor marker of the response to antidepressants. Further research is needed to test these hypotheses.

Depression and Immunity: a Psychosomatic Unit.

BACKGROUND: The effects of depression on the immune system are well known. Recently, depression as a consequence of an immune disorder has received increased research attention. Here, we test the hypothesis that the depression-immunity association is a buffer zone between external stimuli, defence mechanisms, and intrinsic determinants. SUBJECTS AND METHODS: Five hundred and forty-nine patients presenting with a major depressive episode completed the Beck Depression Inventory (BDI), Lazarus and Folkman's coping inventory, and the Family Adaptability and Cohesion Scale (FACES III). Lymphocyte subtypes were quantified using flow cytometry. RESULTS: Links between immunity and depression were confirmed: levels of CD3, CD4 and CD8 cells accounted for 12.7% of the variance in the BDI (p<0.001, linear regression; LR). The depression-immunity pairing interacted with family dynamics, coping mechanisms, and gender. Dynamics in the family of origin explained 11.4% of the BDI score (LR) and 1% of CD3 and CD4 levels (p<0.001, Pearson's r). Coping mechanisms were associated with 12% of the BDI score (p<0.001, LR), and the capacity of distancing oneself from one's problems was associated with 10.3% of CD3, CD8, and CD16/56 levels (p<0.01, LR). BDI scores in women were 2.9 points higher than in men (p<0.01, t=2.379) and associated with a greater risk of immune depression (p<0.001, odds ratio=0.5). CONCLUSIONS: External determinants (family), coping mechanisms, and internal determinants (such as gender) simultaneously influence a depression-immunity pairing. Sometimes these factors act more on the mood component, sometimes more on the immune component. The two components also interact closely with each other.

Returning to Work after a Common Mental Health Disorder: a New Preoccupation for Mental Health Professionals?

BACKGROUND: Since 2010, the Belgian mental healthcare system has been involved in a structural reform: the main objective of this reorganisation is to foster the reintegration in the community of patients suffering from a mental health disorder. In parallel, the role of mental health professionals has evolved these last years: from a strictly clinical role, to the preoccupation with the rehabilitation of social competencies such as enhancing patients' abilities to return to work. The aim of this paper is to explore, specifically for patients hospitalized for a common mental health disorder, the predictive variables of returning to work within 6 months after hospitalization (RTW6). SUBJECTS AND METHODS: Our sample was extracted from routinely collected data during the patients' hospital stay (10 days) at the Psychosomatic Rehabilitation Day Centre of CHU Godinne. A sample of 134 patients participated in our study. Those patients were contacted 6 months after their hospitalization to assess resumption of work. RESULTS: We found that a patient's sociodemographicand socioeconomic variables, and depressive symptoms at the beginning of hospitalization were not predictive of return to work within 6 months (RTW6). On the other hand, duration of absence from work before hospitalization and the diagnosis of a major depression in particular were negatively associated with RTW6, whereas improvement of depressive symptoms during hospitalization stay was positively associated to RTW6. CONCLUSION: Our study identified the diagnosis of major depression and the duration of absence from work before hospitalization as two important risk factors impeding a fast return to work for patients hospitalised for a common mental health disorder. As the preoccupation with patients' abilities to return to work is now on the agenda of mental health professionals, special support and supervision should be dedicated to the more vulnerable patients.

Communication about uncertainty and hope: A randomized controlled trial assessing the efficacy of a communication skills training program for physicians caring for cancer patients.

BACKGROUND: Although previous studies have reported the efficacy of communication skills training (CST) programs, specific training addressing communication about uncertainty and hope in oncology has not yet been studied. This paper describes the study protocol of a randomized controlled trial assessing the efficacy of a CST program aimed at improving physician ability to communicate about uncertainty and hope in encounters with cancer patients. METHODS/DESIGN: Physician participants will be randomly assigned in groups (n = 3/group) to a 30-h CST program (experimental group) or to a waiting list (control group). The training program will include learner-centered, skills-focused, practice-oriented techniques. Training efficacy is assessed in the context of an encounter with a simulated advanced stage cancer patient at baseline and after the CST for the experimental group, and after four months for the waiting-list group. Efficacy assessments will include communicational, psychological and physiological measures. Group-by-time effects will be analyzed using a generalized estimating equation (GEE). A power analysis indicated that a sample size of 60 (30 experimental and 30 control) participants will be sufficient to detect effects. DISCUSSION: The current study will aid in the development of effective CST programs to improve physician ability to communicate about uncertainty and hope in encounters with cancer patients. TRIAL REGISTRATION: US Clinical Trials Register NCT02836197 .

Predictors of physicians' communication performance in a decision-making encounter with a simulated advanced-stage cancer patient: A longitudinal study.

OBJECTIVES: Physicians' characteristics that influence their communication performance (CP) in decision-making encounters have been rarely studied. In this longitudinal study, predictors of physicians' CP were investigated with a simulated advanced-stage cancer patient. METHODS: Physicians (n=85) performed a decision-making encounter with a simulated patient (SP). Their CP was calculated by analyzing encounter transcripts with validated interaction analysis systems. Potential specific psychological predictors were physicians' empathy towards the SP (Jefferson Scale of Physician Empathy, JSPE) and their decisional conflict about the treatment (Decisional Conflict Scale, DCS). Potential general psychological predictors were physicians' empathy towards cancer patients (JSPE), their decisional conflict about cancer patients' treatments (DCS), and their affective reactions to uncertainty (Physicians' Reactions to Uncertainty, PRU). RESULTS: Physicians' CP was predicted by their decisional conflict about the SP's treatment (DCS) (ß=0.41; p< 0.001) and their affective reactions to uncertainty regarding cancer treatments (PRU) (ß=-0.31; p=0.003). CONCLUSION: During encounters with advanced-stage cancer patients, physicians' awareness of uncertainty about which treatments to consider may facilitate their communication performance, whereas physicians' affective reactions to uncertainty may inhibit their performance. PRACTICE IMPLICATIONS: Physicians' decisional conflict and reactions to uncertainty should be addressed in communication skills training programs.

Cognitive compensatory processes of older, clinically fit patients with hematologic malignancies undergoing chemotherapy: A longitudinal cohort study.

OBJECTIVE: Despite the well-known negative impacts of cancer and anticancer therapies on cognitive performance, little is known about the cognitive compensatory processes of older patients with cancer. This study was designed to investigate the cognitive compensatory processes of older, clinically fit patients with hematologic malignancies undergoing chemotherapy. METHODS: We assessed 89 consecutive patients (age ≥ 65 y) without severe cognitive impairment and 89 age-, sex-, and education level-matched healthy controls. Cognitive compensatory processes were investigated by (1) comparing cognitive performance of patients and healthy controls in novel (first exposure to cognitive tasks) and non-novel (second exposure to the same cognitive tasks) contexts, and (2) assessing psychological factors that may facilitate or inhibit cognitive performance, such as motivation, psychological distress, and perceived cognitive performance. We assessed cognitive performance with the Trail-Making, Digit Span and FCSR-IR tests, psychological distress with the Hospital Anxiety and Depression Scale, and perceived cognitive performance with the FACT-Cog questionnaire. RESULTS: In novel and non-novel contexts, average cognitive performances of healthy controls were higher than those of patients and were associated with motivation. Cognitive performance of patients was not associated with investigated psychological factors in the novel context but was associated with motivation and psychological distress in the non-novel context. CONCLUSIONS: Older, clinically fit patients with hematologic malignancies undergoing chemotherapy demonstrated lower cognitive compensatory processes compared to healthy controls. Reducing distress and increasing motivation may improve cognitive compensatory processes of patients in non-novel contexts.

Factors associated with self-perceived burden to the primary caregiver in older patients with hematologic malignancies: an exploratory study.

OBJECTIVE: Although cancer patients frequently experience self-perceived burden to others, this perception has not been enough studied. The aim of this study was to investigate the prevalence of self-perceived burden to the primary caregiver (SPB-PC) and associated factors in an older patient population with hematologic malignancies at the time of chemotherapy initiation. METHODS: In total, 166 consecutive patients with hematologic malignancies aged ≥65 years were recruited at the time of chemotherapy initiation. Patients' SPB-PC was assessed using a 100-mm visual analogue scale (VAS). Characteristics potentially associated with SPB-PC, including sociodemographic and medical characteristics, physical functioning status (Karnofsky performance score, activities of daily living (ADL)/instrumental ADL), symptoms (fatigue, pain, nausea, quality of life), psychological distress (Hospital Anxiety and Depression Scale (HADS)), perceived cognitive function (Functional Assessment of Cancer Therapy Cognitive (FACT-Cog) Scale), and patients'/primary caregivers' personal relationship characteristics (family tie, support), were assessed. RESULTS: Thirty-five percent of patients reported moderate to severe SPB-PC (VAS ≥ 50 mm). Patients' SPB-PC was associated with lower Karnofsky performance (ß = -0.135, p = 0.058) and ADL (ß = -0.148, p = 0.037) scores, and higher HADS (ß = 0.283, p < 0.001) and FACT-Cog perceived cognitive impairments subscale (ß = 0.211, p = 0.004) scores. The proportion of explained variance was 23.5%. CONCLUSIONS: Health care professionals should be aware that about one third of older cancer patients experience moderate to severe SPB-PC at the time of chemotherapy initiation. They should adapt their support of patients who report such a feeling. Copyright © 2016 John Wiley & Sons, Ltd.

Liaison psychiatry and bariatric surgery: double standards. What are the possibilities for the systematization of the pre-operative psychiatric assessment in Belgium?

BACKGROUND: In the context of health care in Belgium, the psychological or psychiatric opinion of a multidisciplinary team is required in the assessment of bariatric surgery candidates. In clinical practice, a wide variety of liaison psychiatry assessment methods exist. SUBJECTS AND METHODS: On the basis of a post-operative psychiatric comorbidity case report and a literature review on "liaison psychiatry and bariatric surgery" we aim to identify opportunities for the systematization of bariatric pre-surgery psychiatric evaluation. RESULTS: The bariatric pre-surgery evaluation must be rigorous and founded on evidence-based medicine. On this basis, specific psychiatric criteria may be defined and researched in assessments. The issue remains for psychiatric comorbidities that develop after surgery and for which a preventive framework should be sustained in the liaison psychiatry approach. CONCLUSIONS: The aim of the research is to support an improved systematization of the psychological assessments of pre-operative bariatric surgery candidates. We believe that systematic evaluation tools should be defined for the identification of possible absolute or relative contra-indications and that a preventive approach to post-operative psychiatric disorders should be included in this assessment.