Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 20.306
Filtrar
1.
Epidemiol Psychiatr Sci ; 29: e85, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31915097

RESUMO

Given the high prevalence (30-35%) of psychosocial and psychiatric morbidity amongst cancer patients in any phase of the disease trajectory, screening for emotional problems and disorders has become mandatory in oncology. As a process, screening begins at the entry to the cancer care system and continues at clinically meaningful times, periodically during active cancer care, or when clinically indicated. The goal is to facilitate proper referral to psychosocial oncology specialists for more specific assessment and care, as well as treatment and evaluation of the response, according to the implementation of distress management guidelines. In this editorial, we will provide a non-exhaustive overview of relevant protocols, with particular reference to the National Comprehensive Cancer Network (NCCN) Distress Management in Oncology Guidelines, and review the challenges and the problems in implementing screening, and the assessment and management of psychosocial and psychiatric problems in cancer centres and community care.


Assuntos
Programas de Rastreamento/métodos , Neoplasias/psicologia , Estresse Psicológico/diagnóstico , Humanos , Saúde Mental , Neoplasias/complicações , Guias de Prática Clínica como Assunto , Qualidade de Vida/psicologia , Estresse Psicológico/etiologia , Estresse Psicológico/terapia
2.
Epidemiol Psychiatr Sci ; 29: e86, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31915100

RESUMO

With cancer incidence increasing over time worldwide, attention to the burden of psychiatric and psychosocial consequences of the disease is now mandatory for both cancer and mental health care professionals. Psychiatric disorders have been shown to affect at least 30-35% of cancer patients during all phases of the disease trajectory, and differ in nature according to stage and type of cancer. Other clinically relevant distressing psychosocial and existential conditions (e.g. demoralisation, health anxiety, loss of meaning and existential distress) not included as 'disorders' in the usual diagnostic and nosological systems (i.e. meta-diagnostic conditions) have also been shown to be present in another 15-20% of cancer patients. In this editorial, we will present a summary of the extensive literature regarding the epidemiology of the several psychosocial disorders affecting cancer patients as a cause of distress and burden to be taken into consideration and addressed in cancer care through evidence-based intervention.


Assuntos
Transtornos Mentais/complicações , Saúde Mental , Neoplasias/psicologia , Estresse Psicológico/psicologia , Ansiedade/etiologia , Disfunção Cognitiva/etiologia , Efeitos Psicossociais da Doença , Depressão/etiologia , Humanos , Transtornos Mentais/psicologia , Neoplasias/complicações , Neoplasias/diagnóstico , Psico-Oncologia , Qualidade de Vida , Estresse Psicológico/diagnóstico , Estresse Psicológico/etiologia
3.
Epidemiol Psychiatr Sci ; 29: e89, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31915101

RESUMO

Because of the increasing global cancer burden and the WHO epidemiological estimation in terms of number of new cases, deaths and long-survivors worldwide, an interdisciplinary approach, including psychiatric and psychoncology care is mandatory in oncology. About 50% of cancer patients have in fact been shown to have psychiatric disorders, including clinically significant emotional distress and/or unrecognised or untreated psychosocial conditions as a consequence of cancer at some point during the cancer trajectory. These problems are associated with the patient's reduction of quality of life, impairment in social relationships, longer rehabilitation time, poor adherence to treatment and abnormal illness behaviour. Because of these reasons, the internationally recognised IPOS Standards of Quality Cancer Care underline that psychosocial cancer care should be recognised as a universal human right; that quality cancer care must integrate the psychosocial domain into routine care and that distress should be measured as the sixth vital sign after temperature, blood pressure, pulse, respiratory rate and pain. In spite of social inequalities still existing between countries in the organisation and implementation of psychosocial oncology, recommendations and guidelines are available regarding screening, assessment and intervention to psychiatric and psychosocial disorders across the trajectory of cancer. The clinical and political agenda of psychoncology as a mandatory component of a whole comprehensive person-centred approach to cancer should therefore be acknowledged in psychiatry.


Assuntos
Transtornos Mentais/etiologia , Neoplasias/psicologia , Qualidade de Vida , Humanos , Oncologia , Transtornos Mentais/psicologia , Neoplasias/complicações , Psico-Oncologia , Encaminhamento e Consulta
4.
BMJ ; 368: l6669, 2020 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-31915124

RESUMO

OBJECTIVE: To examine how a healthy lifestyle is related to life expectancy that is free from major chronic diseases. DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: The Nurses' Health Study (1980-2014; n=73 196) and the Health Professionals Follow-Up Study (1986-2014; n=38 366). MAIN EXPOSURES: Five low risk lifestyle factors: never smoking, body mass index 18.5-24.9, moderate to vigorous physical activity (≥30 minutes/day), moderate alcohol intake (women: 5-15 g/day; men 5-30 g/day), and a higher diet quality score (upper 40%). MAIN OUTCOME: Life expectancy free of diabetes, cardiovascular diseases, and cancer. RESULTS: The life expectancy free of diabetes, cardiovascular diseases, and cancer at age 50 was 23.7 years (95% confidence interval 22.6 to 24.7) for women who adopted no low risk lifestyle factors, in contrast to 34.4 years (33.1 to 35.5) for women who adopted four or five low risk factors. At age 50, the life expectancy free of any of these chronic diseases was 23.5 (22.3 to 24.7) years among men who adopted no low risk lifestyle factors and 31.1 (29.5 to 32.5) years in men who adopted four or five low risk lifestyle factors. For current male smokers who smoked heavily (≥15 cigarettes/day) or obese men and women (body mass index ≥30), their disease-free life expectancies accounted for the lowest proportion (≤75%) of total life expectancy at age 50. CONCLUSION: Adherence to a healthy lifestyle at mid-life is associated with a longer life expectancy free of major chronic diseases.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Estilo de Vida Saudável/fisiologia , Expectativa de Vida , Neoplasias , Comportamento de Redução do Risco , Adulto , Consumo de Bebidas Alcoólicas , Índice de Massa Corporal , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/psicologia , Diabetes Mellitus Tipo 2/prevenção & controle , Diabetes Mellitus Tipo 2/psicologia , Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/prevenção & controle , Neoplasias/psicologia , Pesquisa em Enfermagem , Estudos Prospectivos , Fumar
5.
Ann Agric Environ Med ; 26(4): 636-643, 2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31885239

RESUMO

OBJECTIVE: The aim of the study is to compare the hope of rural and urban inhabitants in the terminal stage of a neoplastic disease covered by stationary hospice care. MATERIAL AND METHODS: The study was carried out among patients in the terminal phase of a neoplastic disease. They were patients of both 24-hour and daily palliative and hospice care units throughout the country. The study group consisted of 246 patients, average age - 59.5, the youngest respondent was 18 and the oldest - 90. The B. L. Block (NCN-36) test, prepared for people struggling with serious life-threatening diseases, was used. Comparison of the results with regard to the place of residence was based on the test Friedman ANOVA and Kendall compatibility factor. The general comparison of hope in individual dimensions and globally with the division into the degree of urbanization, was based on the Kruskal-Wallis test. RESULTS: On the basis of factor analysis, 4 scales constructed from 8 items branch were distinguished. The following scales are used to study hope in the situational dimension - health, the telek-temporal dimension - goals, the spiritual dimension - religious beliefs and in the emotional-affective (affective) dimension - motivations. CONCLUSIONS: The strength of hope in people in the terminal phase of cancer, residing in villages, settlements, small, medium and large cities, was similar and depended on its magnitude. Of all the manifestations of hope, the greatest variation in results occurred in the subjects when they encountered serious problems and difficulties. The inhabitants of medium-sized cities were characterized by a higher hope at that time.


Assuntos
Neoplasias/psicologia , Adolescente , Adulto , Idoso , Feminino , Esperança , Habitação , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes/psicologia , Adulto Jovem
7.
Bull Cancer ; 106(12): 1124-1131, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31759513

RESUMO

INTRODUCTION: Home healthcare can be totally different depending on the route of treatment: intravenous anticancer drugs involve regular contact with the health caregiver while the oral route leaves the patient completely autonomous. This cross-sectional research has a comparative purpose between the representations of disease and treatments, the self-efficacy and the quality of life of patients treated with oral anticancer drugs and those treated by intravenous route. METHODS: The sample include 130 patients with cancer. Seventy-two are treated with intravenous chemotherapy and 48 by oral route. The protocol includes a questionnaire of disease representations (IPQ-r), treatment representations (BMQ), self-efficacy (GSES 10) and quality of life (QLQ-C30). RESULTS: The administration route of anticancer treatment impacts the illness representations with the normalization of cancer. The intravenous route, by its invasive and time-consuming nature, increases difficulties in fulfilling family and professional roles. Moreover, side effects are correlated with the perceived dangerousness of the treatment and self-efficacy. Age and the length of time since the diagnosis affect respectively the understanding of the disease and the cognitive dimension of quality of life. DISCUSSION: More than a difference in form of treatment, the whole pathway of healthcare has to be taken into account since it involves different psychological consequences, in particular about therapeutic choices or in terms of patient support.


Assuntos
Antineoplásicos/administração & dosagem , Neoplasias/tratamento farmacológico , Qualidade de Vida , Autoeficácia , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/efeitos adversos , Estudos Transversais , Feminino , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Autocuidado , Inquéritos e Questionários
9.
Pathologe ; 40(Suppl 3): 347-349, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31705241

RESUMO

The label cancer in itself leads to complex psychological reactions in patients that are closely related to previous experiences and self-image. A cancer diagnosis can lead to increased distress and subsequent mental comorbidity such as depression or anxiety disorders. The responsibility of the pathologist, as the person who first uses the label cancer, is high. The pathologist must be conscious and focus not only on the accuracy of the anatomical pathology, but also on the potential influences the wording may have on the mental health of the patient. The word "carcinoma" should only be used in the case of tumors with the respective biological behavior. The example of non-invasive follicular thyroid neoplasm with papillary-like nuclear features shows that changing a label can lead to an improvement in distress and quality of life.


Assuntos
Adaptação Psicológica , Saúde Mental , Neoplasias/psicologia , Estresse Psicológico , Humanos , Patologistas/psicologia , Relações Profissional-Paciente , Psico-Oncologia/métodos , Qualidade de Vida
10.
Rev Prat ; 69(4): 449-453, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-31626505

RESUMO

Given the chronicity of cancer, its related treatments and sequalae, more attention has been paid to questioning the living conditions of cancer survivors. In the early 2000s, research have highlighted the occupational difficulties faced by cancer survivors in the first two years after diagnosis. In the line of these, this article aims to provide clinicians with information on the situation within the five years following cancer diagnosis, based on results of the VICAN5 survey. We explored three main themes: the differences between salaried and self-employed workers, the main sequelae related to the disease or the treatments, having an impact on the working lives of people concerned, and finally, the workstation layouts and their effect on job retention. The main objective is to make clinicians, who may be involved in supporting professionally active patients, aware of the difficulties that these later may encounter. Clinicians need to keep in mind the specific constraint faced by self-employed individuals since they are more likely to reduce their sick leave for financial reasons or for the functioning of their company. They also need to pay more attention to the patient-reported sequalae in order to ensure an adequate care, especially for fatigue and chronic neuropathic pain that can strongly affect his/her professional life. Finally, the clinician who is aware of the effectiveness of workstation layouts will be able to inform and to support his/her patient more precisely.


Assuntos
Sobreviventes de Câncer , Neoplasias , Retorno ao Trabalho , Sobreviventes de Câncer/psicologia , Sobreviventes de Câncer/estatística & dados numéricos , Emprego/estatística & dados numéricos , Fadiga , Feminino , Humanos , Masculino , Neoplasias/psicologia , Inquéritos e Questionários
11.
BMC Public Health ; 19(1): 1402, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31664966

RESUMO

BACKGROUND: The Cancer Attitude inventory (CAI) was developed to measure attitudes toward cancer. The aim of the present study was to describe the development of the Persian version of the CAI and to evaluate its psychometric properties in an Iranian sample. METHODS: The forward-backward method was used to translate the CAI scale from English into Persian. After linguistic validation and a pilot check, a cross-sectional study was performed and psychometric properties of the Iranian version of the questionnaire were assessed. The scale validation was conducted with a convenience sample of 820 laypeople. Construct validity was assessed through both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Internal consistency was assessed through Cronbach's alpha analysis and test-retest analysis. RESULTS: Five factors were identified in CAI: isolation, helplessness, fear of consequence, belief of control and independence, and fear of death. The results achieved from the CFA displayed that the data fit the model: the relative chi-square (× 2/df) = 2.98 (p < .001), and the root mean square error of approximation (RMSEA) = .07 (90% CI = .06-.07). All comparative indices of the model had scores greater than .80, demonstrating a good fit to the data. Cronbach's Alpha and the intra-class correlation coefficient (ICC) were .97, which is well above the acceptable threshold. CONCLUSIONS: The results indicate that the Persian version of the CAI is practical, reliable and valid. Consequently, the instrument could be used in plans to create positive attitudes about cancer control and treatment among Persian people.


Assuntos
Atitude Frente a Saúde , Neoplasias/psicologia , Inquéritos e Questionários , Adulto , Estudos Transversais , Análise Fatorial , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos Testes , Tradução , Adulto Jovem
12.
Nihon Koshu Eisei Zasshi ; 66(9): 574-581, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31588093

RESUMO

Objective This study aimed (1) to clarify sick leave-related factors in Japanese working cancer patients receiving outpatient treatment and (2) to assess quality of life (QOL) in this group of patients.Methods A survey was conducted using a questionnaire designed for adult cancer patients aged 20 to 64 years who were currently receiving outpatient treatment and living in Hokkaido. The questionnaire was used to collect data on basic characteristics, cancer-related factors, and QOL (SF-12v2, Japanese edition). To clarify the factors related to sick leave, we first calculated the propensity score using logistic regression analysis. The presence or absence of sick leave was the dependent variable, and the basic attributes were the covariates. We then analyzed each variable with significant differences in basic and cancer-related attributes as an independent variable using binomial logistic regression analysis. Quality of life was evaluated by comparing scores on the eight subscales and three component summaries of the SF-12v2.Results There were a total of 147 respondents, of which 79 were included in this study. They were classified into two groups: the leave group (29, 36.7%) and the work continuation group (50, 63.3%). The logistic regression analysis with propensity score adjustment showed that taking leave were associated with patients who were less than 6 months since cancer diagnosis (odds ratio=17.9, P<0.001) and patients who had not undergone surgery (odds ratio=3.9, P=0.011). The QOL scores of the leave group were lower than those of the Japanese national sample in seven out of the eight subscales, and there was a significant decrease in the six items for the work continuation group. In particular, two role functioning dimensions-physical and emotional-were remarkably decreased. In the analysis of component summary scores, it was found that QOL scores of cancer patients were lower for the role component summary (RCS) and physical component summary (PCS) compared with the national samples; however, mental component summary scores showed an increasing trend. The leave group had significantly lower RCS and PCS scores compared with the work continuation group.Conclusion We surveyed Japanese working cancer patients and analyzed sick leave-related factors and QOL in that population. We found that having less than 6 months since cancer diagnosis and not having undergone surgery were highly related to leave, and QOL scores (RCS and PCS) were low. The results of this study indicate that Japanese working cancer patients need to be provided with support that is based on their specific characteristics.


Assuntos
Assistência Ambulatorial , Neoplasias/psicologia , Saúde do Trabalhador , Qualidade de Vida , Licença Médica , Adulto , Grupo com Ancestrais do Continente Asiático , Feminino , Humanos , Japão , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Pacientes Ambulatoriais , Pontuação de Propensão , Apoio Social , Inquéritos e Questionários , Adulto Jovem
13.
East Asian Arch Psychiatry ; 29(3): 91-94, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31566185

RESUMO

OBJECTIVE: We aimed to evaluate the prevalence of depressive and anxiety symptoms and mental health literacy (MHL) in outpatients with or without cancer in Singapore. METHODS: Oncology outpatients and outpatients without cancer (controls) were assessed for severity of anxiety and depressive symptoms (using the Hospital Anxiety and Depression Scale) and MHL regarding major depressive disorder and generalised anxiety disorder in terms of diagnosis, aetiology, treatment, and attitudes toward mental health services. RESULTS: A total of 89 oncology outpatients and 61 controls were recruited. Those with primary and secondary education had significantly lower MHL scores than those with university education (p = 0.001). Oncology outpatients and controls were comparable in terms of anxiety (13.5% vs 9.8%, p = 0.5), depression (2.2% vs 1.6%, p > 0.99), and total MHL score (7.94 vs 9.13, p = 0.102). CONCLUSIONS: MHL is comparable between oncology outpatients and controls and is positively associated with education level.


Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Alfabetização em Saúde , Serviços de Saúde Mental , Saúde Mental , Neoplasias/psicologia , Pacientes Ambulatoriais/psicologia , Adulto , Estudos de Casos e Controles , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Singapura/epidemiologia , Adulto Jovem
14.
BMC Health Serv Res ; 19(1): 754, 2019 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-31655598

RESUMO

BACKGROUND: Cancer patients experience psychological and social distress due to their medical treatment and social issues. However, continuous and specialized social support is still lacking. In Germany, a group of company health insurance funds has developed an approach to support cancer patients with monthly structured interviews conducted by specially trained Social Care Nurses. The nurses will identify patient needs in order to provide help with medical, personal, and social matters. One aim of the scientific evaluation is to analyze the effect of the consultations on various patient-reported outcomes, especially quality of life. The evaluation concept will be described in this study protocol. METHODS/DESIGN: The evaluation is a non-randomized, controlled, multi-center intervention study with a mixed-method design. It consists of three research modules which include primary data from questionnaires, and claims data from the health insurance funds. In Module 1, cancer patients will be recruited to form an intervention group (OSCAR, n = 150) and a control group (n = 200) in four study centers for a period of 1 year. One baseline and three follow-up questionnaires will be conducted to survey the patient-reported outcomes. Relevant secondary outcomes are health literacy, participation, and physician-patient communication. In Module 2, claims data will be used to analyze cost effects and thereby assess effectivity and hospitalization. Module 3 will involve a qualitative analysis of project diaries kept by the Social Care Nurses. The diaries will record the nurses' practical experiences and the benefits of deploying OSCAR across the German healthcare system. DISCUSSION: OSCAR is an innovative way of providing cancer patients with continuous support to improve their quality of life. The evaluation concept aims to assess the effects of the monthly consultations by the Social Care Nurses on the patients, and will use a mixed-method design. The results are important for assessing the transferability of OSCAR to the healthcare system as a whole. TRIAL REGISTRATION: German Clinical Trials Register (DRKS-ID: DRKS00013640 ). Registered 29 December 2017.


Assuntos
Alfabetização em Saúde/estatística & dados numéricos , Neoplasias/terapia , Participação do Paciente/estatística & dados numéricos , Qualidade de Vida , Apoio Social , Alemanha , Pesquisa sobre Serviços de Saúde , Humanos , Neoplasias/psicologia , Relações Enfermeiro-Paciente , Encaminhamento e Consulta , Projetos de Pesquisa , Inquéritos e Questionários
15.
Medicine (Baltimore) ; 98(38): e17228, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567984

RESUMO

OBJECTIVE: To determine whether psychological intervention (PI) changes the levels of immune indicators in cancer patients. METHODS: We conducted a systematic search published up to July 2018, followed by a manual search. Randomized controlled trials were included. Two reviewers independently screened and extracted data, which were analyzed using Review manager 5.3. RESULTS: Twenty-nine studies were included including four kinds of PI. Only stress management didn't result in immune changes; only cognitive behavior therapy affect NK cell activity. PI did not change immune indicators on cancer patients who completed therapy. Compared to patients not receiving PI, those received PI had significantly higher NK cell count and activity in whole blood; and serum levels of IL-2, IL-4, IFN-γ, lgA, and lgG. However, the differences in the serum levels of IL-6, IL-10, TNF-α, and IgM were not significant (P > .05), and the changes recorded for the CD3, CD4, and CD8 cell count, and CD4/CD8 ratios were inconsistent. CONCLUSIONS: Although there are considerable evidences of PI's immune effect, but its magnitude was moderate. Therefore, it may be premature to conclude whether PI affects immunity of cancer patients. Further research is warranted, with special focus on the PI types and treatment methods.


Assuntos
Neoplasias/psicologia , Psicoterapia , Humanos , Imunidade , Neoplasias/imunologia , Neoplasias/terapia , Psicoterapia/métodos
16.
Eur J Oncol Nurs ; 42: 153-161, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31557665

RESUMO

PURPOSE: Caring for cancer patients can be highly stressful for both family caregivers and oncology professionals. These high levels of stress can lead to poorer patient outcomes and increased risk of health problems for the caregivers themselves. Art therapy may help these caregivers as art-making can be a relaxing and enjoyable form of self-expression and art therapists can support individuals in expressing and processing challenging emotions. Research on art-making or art therapy with caregivers of cancer patients has shown some positive results, but its interpretation is limited by the use of multifaceted interventions. METHOD: In this mixed-methods study we compared two brief arts-based approaches for both professional and informal caregivers: single sessions of coloring or open-studio art therapy, with a 45-minute session each. Assessments imcluded self-reports of affect, stress, self-efficacy, anxiety, burnout arnd creative agency alongside salivary biomarkers before and after the session. Open-ended questions, field notes and observations formed the qualitative part of the study. RESULTS: Thirty-four professional (n=25) and informal (n=9) caregivers participated. Participants in both conditions showed increases in positive affect, creative agency, and self-efficacy and decreases in negative affect, anxiety, perceived stress, and burnout. Participants in both conditions expressed enjoyment, relaxation, appreciation of time away from stressors, creative problem solving, a sense of flow, and personal and existential insight. The two approaches also elicited distinct experiences with participants reporting that they found improved focus in coloring and appreciated the support and freedom of expression in open studio art therapy. CONCLUSIONS: These findings suggest that even brief art-making interventions can be beneficial for stressed caregivers of cancer patients. As experience with art-making increased the impact, repeated sessions may be even more useful. We recommend that oncology units have dedicated studio spaces with therapeutic support and different forms of art-making available to meet individual caregiver needs.


Assuntos
Terapia pela Arte , Cuidadores/psicologia , Neoplasias/psicologia , Neoplasias/terapia , Radioterapia (Especialidade) , Adulto , Ansiedade/prevenção & controle , Esgotamento Profissional/prevenção & controle , Emoções , Empatia , Existencialismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto
17.
J Cancer Res Clin Oncol ; 145(11): 2845-2854, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31506739

RESUMO

PURPOSE: We examined whether multi-disciplinary stepped psychosocial care for cancer patients improves quality of care from the patient perspective. METHODS: In a university hospital, wards were randomly allocated to either stepped or standard care. Stepped care comprised screening for distress, consultation between doctor and patient, and the provision of psychosocial services. Quality of care was measured with the Quality of Care from the Patient Perspective questionnaire. The analysis employed mixed-effects multivariate regression, adjusting for age and gender. RESULTS: Thirteen wards were randomized, and 1012 patients participated (n = 570 in stepped care and n = 442 in standard care). Patients who were highly distressed at baseline had 2.3 times the odds of saying they had had the possibility to converse in private with doctors and/or psychologists/social workers when they were in stepped care compared to standard care, 1.3 times the odds of reporting having experienced shared decision-making, 1.1 times the odds of experiencing their doctors as empathic and personal, and 0.6 times the odds of experiencing the care at the ward to be patient oriented. There was no evidence for an effect of stepped care on perceived quality of care in patients with moderate or low distress. CONCLUSIONS: Stepped care can improve some aspects of perceived quality of care in highly distressed patients. TRIAL REGISTRATION: http://www.clinicaltrials.gov . NCT01859429.


Assuntos
Saúde Mental/normas , Neoplasias/psicologia , Neoplasias/terapia , Participação do Paciente/psicologia , Psicoterapia , Qualidade da Assistência à Saúde/normas , Serviço Social em Psiquiatria/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Relações Médico-Paciente , Prognóstico , Psicometria , Melhoria de Qualidade , Encaminhamento e Consulta , Adulto Jovem
18.
Tijdschr Psychiatr ; 61(9): 605-616, 2019.
Artigo em Holandês | MEDLINE | ID: mdl-31560780

RESUMO

BACKGROUND: Cancer patients may experience psychological distress, like anxiety and depressive symptoms. Mindfulness-based cognitive therapy (MBCT) has been shown to alleviate this psychological distress. However, patients experience barriers in participating in face-to-face MBCT. Individual internet-based MBCT (eMBCT) could be an alternative.
AIM: To compare MBCT and eMBCT to treatment as usual (TAU) for psychological distress in cancer patients.
METHOD: 245 cancer patients with psychological distress were randomly allocated to MBCT (n = 77), eMBCT (n = 90) or TAU (n = 78). Patients completed baseline (T0) and post-intervention (T1) assessments. The primary outcome was psychological distress on the Hospital Anxiety and Depression Scale. Outcomes were analyzed using linear mixed modeling on the intention-to-treat sample. Since both interventions were compared to TAU, the type I error rate was set to p < 0.025.
RESULTS: Compared to TAU, patients reported significantly less psychological distress after both MBCT (Cohen's d = 0.43, p < 0.001) and eMBCT (Cohen's d = 0.63, p < 0.001).
CONCLUSION: Compared to TAU, MBCT and eMBCT were similarly effective in reducing psychological distress in a sample of distressed heterogeneous cancer patients.


Assuntos
Terapia Cognitivo-Comportamental , Atenção Plena , Neoplasias/psicologia , Estresse Psicológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Psicológico/prevenção & controle , Resultado do Tratamento
19.
BMC Complement Altern Med ; 19(1): 259, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533782

RESUMO

BACKGROUND: Traditional and complementary medicines (T&CM) are any form of medicine, practice, treatment, product, technology, knowledge system or ceremony outside of conventional medical practice that aims to prevent and/or treat illness and/or promote well-being. Alongside conventional cancer treatments, T&CM usage is increasing; with 19% of indigenous Australians with cancer reporting using T&CM. There is limited evidence surrounding T&CM use and disclosure by indigenous patients. Our aim was to explore healthcare providers' views about usage, disclosure/non-disclosure of T&CM by Indigenous cancer patients. METHODS: Semi-structured, in-depth interviews with 18 healthcare providers, including three indigenous providers, at a large urban hospital providing care to Indigenous cancer patients were conducted to explore providers' experiences and attitudes towards T&CM use by Indigenous cancer patients. An interpretive phenomenological approach was used to thematically analyse the data. RESULTS: Analysis revealed six themes: concern about risk; no 'real' benefits; perception of T&CM and conventional medicine as antithetical; barriers to disclosure; 'patients' choice' a double-edged sword; and providers' lack of knowledge about T&CM. Healthcare providers perceived discord between T&CM and conventional medicine. Most lacked knowledge of T&CM, and had concerns around negative-interactions with conventional treatments. They considered T&CM outside their role, citing this as reasoning for their lack of knowledge. Indigenous healthcare providers had greater understanding and openness towards T&CM. CONCLUSIONS: Given the potential usage of T&CM by Indigenous cancer patients, providers need a more comprehensive understanding of T&CM in order to inform discussion and facilitate effective disclosure on this topic. If indigenous Australians with cancer feel that cancer care providers are unreceptive to discussing T&CM, patient care risks being compromised; particularly given the potential for negative interactions between T&CM and conventional cancer treatments. Fostering health care interactions where indigenous patients feel comfortable to discuss T&CM usage should be a priority for all cancer care services.


Assuntos
Terapias Complementares/psicologia , Pessoal de Saúde/psicologia , Medicina Tradicional/psicologia , Neoplasias/terapia , Adulto , Atitude do Pessoal de Saúde , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia
20.
Crit Rev Oncol Hematol ; 143: 117-123, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31563078

RESUMO

Advanced cancer patients with cachexia and their families can suffer from eating-related distress. This complex entity encompasses patients' struggle to nourish themselves, emotional and social consequences of their inability to maintain food intake, and profound disturbance in family relationships. With evidence-based nutritional care, as well as symptom management to enable food intake, cachexia can be mitigated to some degree. In addition, patients and families require psychosocial support and education to understand and cope with this condition. Only by taking an integrated approach can health care teams alleviate eating-related distress, improve quality of life (QOL), reduce interpersonal conflicts, and alter perceptions of nutritional neglect for patients and families. However, few studies have investigated eating-related distress among patients and families. The aim of this narrative review is to describe what is known about eating-related distress and the roles of integrated palliative, supportive, and nutritional care in improving QOL of patients and families.


Assuntos
Caquexia/terapia , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Neoplasias/terapia , Apoio Nutricional/métodos , Cuidados Paliativos/métodos , Estresse Psicológico/terapia , Caquexia/psicologia , Família/psicologia , Humanos , Neoplasias/metabolismo , Neoplasias/psicologia , Equipe de Assistência ao Paciente , Qualidade de Vida , Estresse Psicológico/psicologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA