Breaking bad news to cancer patients and their families: Attitudes toward death among Turkish physicians and their communication styles.

To investigate how Turkish oncologists' attitudes toward death influence their emotional states, outlooks, and communication styles when breaking bad news to cancer patients and/or their families.Cross-sectional study using self-completed questionnaires.The study sample consisted of 35 physicians working at an oncology department. Physicians completed a quantitative one-time survey developed by the authors and the Death Attitude Profile-Revised (DAP-R).Thirty-one physicians completed the survey and the DAP-R. A mean of 13.39 ± 8.82 minutes was allocated for breaking bad news; 87.1% of the participants avoided using the word "cancer" and 42% avoided using the word "death". The attitudes characterized by "death avoidance" and "fear of death" were found to be related to the emotional difficulty experienced by the physicians, and were also associated with less eye contact with the patient, and less attention paid to the language used while breaking bad news.It is important for physicians to be aware of how their attitudes toward death affect their communication with patients during bad news. They should be provided in-service professional education, and therapeutic support.

Burnout Syndrome Among Hemodialysis and Peritoneal Dialysis Nurses.

INTRODUCTION: Burnout, a syndrome with 3 dimensions of emotional exhaustion, depersonalization, and reduction of personal accomplishment, is very common among hemodialysis nurses, while data are scarce regarding the prevalence of burnout syndrome (BS) among peritoneal dialysis (PD) nurses. This study aimed to assess and compare demographic and professional characteristics and burnout levels in hemodialysis and PD nurses, and to investigate factors that increase the level of burnout in dialysis nurses. MATERIALS AND METHODS: A total of 171 nurses from 44 dialysis centers in Turkey were included in a cross-sectional survey study. Data were collected using a questionnaire defining the social and demographic characteristics and working conditions of the nurses as well as the Maslach Burnout Inventory for assessment of burnout level. RESULTS: There was no significant difference in the level of burnout between the hemodialysis and PD nurses groups. Emotional exhaustion and depersonalization scores were higher among the shift workers, nurses who had problems in interactions with the other team members, and those who wanted to leave the unit, as well as the nurses who would not attend training programs. In addition, male sex, younger age, limited working experience, more than 50 hours of working per week, and working in dialysis not by choice were associated with higher depersonalization scores. Personal accomplishment score was lower among the younger nurses who had problems in their interactions with the doctors, who would not regularly attend training programs, and who felt being medically inadequate. CONCLUSIONS: Improving working conditions and relations among colleagues, and also providing further dialysis education are necessary for minimizing burnout syndrome. Burnout reduction programs should mainly focus on younger professionals.

Impact of exercise on quality of life and body-self perception of patients with acromegaly.

In acromegaly the impact of therapy on well-being and self-perception of patients is not clearly defined. The data existing on the effect of treatment on health-related quality of life in patients with acromegaly is inconclusive. In this study we addressed the effect of exercise on health-related quality of life, symptoms of depression and perception of body image in patients with acromegaly. Patients with acromegaly were stratified into two groups according to their participation in a prescheduled program of exercise. Participants in the study group performed exercise for 75 min a day for 3 days a week during cosecutive 3 months. Warming, cardio, strength, balance and stretching moves applied in every course. Both the exercise group and control group were asked to complete a questionnaire on quality of life, symptoms of depression and self-perception of body image. Each questionnaire was answered by both groups before the beginning of the exercise program (at month-0) and after the completion of the program (at month-3). In exercise group after the completion of exercise period there was a tendency towards decreament in body mass index and IGF-I, although not statistically significant (p = 0.08 and p = 0.09). Self-assessment of body image improved significantly after participation in the exercise program (p = 0.01). Present findings support that exercise may be an adjunctive method for patients with acromegaly to improve self esteem and perception.

Evaluation of depression, quality of life and body image in patients with Cushing's disease.

The aim of this study was to evaluate patients with Cushing's disease (CD) who had undergone transsphenoidal surgery in terms of depression, quality of life (QoL), and perception of body image in comparison to healthy controls. Forty patients with CD and 40 healthy controls matched for demographic characteristics were included in the study. The subjects were evaluated with the Beck depression inventory (BDI), the health survey-short form (SF-36) and the multidimensional body-self relations questionnaire (MBSRQ). Subgroups of the patients with CD were formed on the basis of remission status and BDI scores. In this study, QoL in the general health category and body image were lower in the patients with CD than in the healthy subjects. However, no differences in depression scores were found between the two groups. When the CD group was evaluated according to remission rate, the mean BDI score was significantly higher in the CD patients without remission than in both the CD patients with remission and the healthy subjects (p = 0.04). However, the physical functioning, bodily pain and general health scores of the CD patients without remission on the SF-36 questionnaire were lower than in the CD patients in remission and the healthy subjects (p = 0.002, p = 0.04, p = 0.002, respectively). Fitness evaluation, health evaluation and body areas satisfaction scores of the MBSRQ were significantly different in the three groups (p = 0.003, p = 0.009 and p = 0.001, respectively). In this study, patients with CD were found to have lower QoL, lower body image perception and higher levels of depression compared to healthy controls, particularly if the disease is persistant despite surgery.

Association of coping style, cognitive errors and cancer-related variables with depression in women treated for breast cancer.

OBJECTIVE: The purpose of this study was to examine the correlation between depression levels with coping styles and cognitive errors in women treated for breast cancer. METHODS: A total of 110 breast cancer outpatients who had had surgery at least 6 months previously, had completed adjuvant cancer treatment and had not experienced metastasis or recurrent lesions were evaluated. The Automatic Thoughts Questionnaire, Cognitive Errors Questionnaire, Mental Adjustment to Cancer Scale and Beck Depression Inventory were administered to all patients. Semi-structured interview forms were used to obtain medical and demographic data. All patients were categorized into depression and non-depression groups according to their Beck Depression Inventory scores. The study protocol was approved by the Medical Ethics Committee of Istanbul University Oncology Institute. RESULTS: Higher cognitive errors and automatic thought scores were found in the depression group. Fighting spirit was found to be the primary coping style used in the non-depression group, while helplessness/hopelessness, anxious/preoccupation and fatalism were the coping styles used the most in the depression group. No association between depression and socio-demographic (except for educational level) and cancer-related variables was detected. However, it was found that automatic thoughts, cognitive errors, education level, fighting spirit and anxious/preoccupation are important indicators of depression in our sample. CONCLUSIONS: A causal relationship exists between depression and a patient's cognitive patterns and accompanying anxiety. The degree of depression is inversely related to both fighting spirit coping type and educational level. If clinicians take this into consideration, diagnosing and treating depression will be more effective.

Depression, automatic thoughts, alexithymia, and assertiveness in patients with tension-type headache.

OBJECTIVE: The role of psychological factors related to headache has long been a focus of investigation. The aim of this study was to evaluate depression, automatic thoughts, alexithymia, and assertiveness in persons with tension-type headache and to compare the results with those from healthy controls. METHODS: One hundred five subjects with tension-type headache (according to the criteria of the International Headache Society classification) and 70 controls were studied. The Beck Depression Inventory, Automatic Thoughts Scale, Toronto Alexithymia Scale, and Rathus Assertiveness Schedule were administered to both groups. Sociodemographic variables and headache features were evaluated via a semistructured scale. RESULTS: Compared with healthy controls, the subjects with headache had significantly higher scores on measures of depression, automatic thoughts, and alexithymia and lower scores on assertiveness. Subjects with chronic tension-type headache had higher depression and automatic thoughts scores than those with episodic tension-type headache. CONCLUSIONS: These findings suggested that persons with tension-type headache have high depression scores and also may have difficulty with expression of their emotions. Headache frequency appears to influence the likelihood of coexisting depression.