What does the answer mean? A qualitative study of how palliative cancer patients interpret and respond to the Edmonton Symptom Assessment System.

The Edmonton Symptom Assessment System (ESAS) is a well-known self-reporting tool for symptom assessment in palliative care. Research has shown that patients experience difficulties in the scoring and interpretation, which may lead to suboptimal treatment. The aims were to examine how palliative care cancer patients interpreted and responded to the ESAS. Eleven patients (3 F/8 M), median age 65 (34-95) with mixed diagnoses were interviewed by means of cognitive interviewing, immediately after having completed the ESAS. The highest mean scores were found with tiredness (6.3) and oral dryness (5.7). The results showed that sources of error were related to interpretation of symptoms and differences in the understanding and use of the response format. The depression and anxiety symptoms were perceived as difficult to interpret, while the appetite item was particularly prone to misunderstandings. Contextual factors, such as mood and time of the day, influenced the answers. Lack of information and feedback from staff influenced the scores. Some patients stated that they scored at random because they did not understand why and how the ESAS was used. The patients' interpretation must be considered in order to minimize errors. The ESAS should always be reviewed with the patients after completion to improve symptom management, thereby strengthening the usability of the ESAS.

Associations between perceived somatic symptoms and mental health after Roux-en-Y gastric bypass: a 3-year prospective cohort study.

BACKGROUND: Attention to and interpretation of symptoms are influenced by psychologic and contextual factors. Preoperative anxiety, and to some extent depression, has been found to predict the perceived impact of somatic symptoms 1 year after Roux-en-Y gastric bypass. Postoperative changes in negative affect may possibly both influence and be influenced by the perception of somatic symptoms. OBJECTIVES: This study aimed to explore whether preoperative anxiety and depressive symptoms correlated with perceived impact of somatic symptoms 3 years after Roux-en-Y gastric bypass. Second, we aimed to examine the 3-year trajectory of depressive and anxiety symptoms, and their interaction with perceived somatic symptoms postoperatively. SETTING: University hospital. METHODS: Presurgery, 1-, and 3-year postsurgery data were collected from 169 participants (62.4% follow-up). Anxiety and depressive symptoms were assessed at all time points. The participants reported the degree of perceived impact of various somatic symptoms 1 and 3 years after surgery. A cross-lagged, autoregressive regression analysis was employed to examine the mutual interaction of trajectories over the follow-up period. RESULTS: Fatigue (30.8%) and dumping (23.7%) were common high-impact symptoms 3 years postoperatively. Higher baseline anxiety was associated with higher impact of fatigue, pain, and diarrhea, while depressive mood was related to higher impact of diarrhea at 3-year follow-up. Higher anxiety/depression symptoms were bidirectionally related to higher perceived total symptom impact at both 1 and 3 years postoperatively, controlling for percent total weight loss. Higher perceived impact of somatic symptom burden at 1 year after surgery predicted a significant increase in depressive symptoms the next 2 years. CONCLUSION: Baseline anxiety was associated with higher perceived impact of several somatic symptoms 3 years after Roux-en-Y gastric bypass. Higher total symptom burden (pain, fatigue, dumping, diarrhea, and vomiting) at 1 year after surgery predicted increase in depression over the next 2 years. The results underscore the importance of managing somatic symptoms after surgery to prevent patients' distress.

Psychosocial characteristics associated with symptom perception 1 year after gastric bypass surgery-a prospective study.

BACKGROUND: The experience of symptoms after bariatric surgery, such as pain, dumping, and fatigue, may affect behavior, quality of life, and the need for healthcare consultations. Attention to and interpretation of symptoms are influenced by psychological and contextual factors. Prospective studies of psychological factors predicting physical symptom perception after bariatric surgery are scarce. OBJECTIVES: To explore associations of preoperative negative affect and history of stressful and traumatic events with frequency and intensity of self-reported symptoms 1 year after Roux-en-Y gastric bypass (RYGB). SETTING: University hospital. METHODS: Questionnaire data were collected before and 1 year after RYGB from 230 patients. Negative affect and stressful events were measured preoperatively. The participants reported the number and impact of various physical symptoms postoperatively. RESULTS: The most common symptoms reported to have a high impact on behavior were fatigue (32.8%) and dumping (28.4%). Reporting more symptoms was associated with preoperative anxiety (r = .22, P = .001) and the number of stressful life events (r = .21, P = .002). Participants with a probable preoperative anxiety disorder reported a higher impact of fatigue, pain, dumping, and diarrhea after surgery, while those with a probable mood disorder and a history of traumatic sexual/violent events reported a higher impact of dumping. CONCLUSION: Preoperative anxiety symptoms and stressful experiences were associated with a higher perceived impact of symptoms, such as dumping, fatigue, and pain after RYGB. The evaluation of psychological characteristics associated with symptom perception may be relevant when managing symptoms that are not responsive to other treatment measures.

Predictors of Physical Activity After Gastric Bypass-a Prospective Study.

BACKGROUND: Most patients do not meet the recommended level of physical activity after bariatric surgery, and psychological factors underlying postoperative physical activity remain poorly understood. This study aimed at identifying self-regulatory predictors of physical activity after bariatric surgery. METHODS: Questionnaire data including self-regulation variables and the short-version of the International Physical Activity Questionnaire were obtained in a prospective cohort of 230 patients 1 year after Roux-en-Y gastric bypass. The study sample consisted of participants consenting to wear an ActiGraph GT3X+ accelerometer for seven consecutive days, 18-24 months after surgery (n = 120). RESULTS: A total of 112 participants with complete self-report data provided valid accelerometer data. Mean age was 46.8 years (SD = 9.3), and 81.3% was women. Preoperative and postoperative BMI was 44.8 ± 5.5 and 30.6 ± 5.0 kg/m2, respectively. Total weight loss was 28.9% (SD = 7.5). By objective measures, 17.9% of the participants met the recommended level of moderate-to-vigorous-intensity of physical activity of ≥150 min/week, whereas 80.2% met the recommended level according to self-reported measures. Being single, higher education level, and greater self-regulation predicted objective physical activity in multivariate regression analysis. Greater self-regulation also predicted self-reported physical activity. Weight loss 1 year after surgery was not associated with self-reported or objectively measured physical activity. CONCLUSIONS: Despite large differences between accelerometer-based and subjective estimates of physical activity, the associations of self-regulatory factors and weight loss with postoperative physical activity did not vary depending on mode of measurement. Self-regulation predicted both objective and self-reported physical activity. Targeting patients' self-regulatory ability may enhance physical activity after gastric bypass.

Preoperative predictors of adherence to dietary and physical activity recommendations and weight loss one year after surgery.

BACKGROUND: Weight loss and weight loss maintenance vary considerably between patients after bariatric surgery. Postoperative weight gain has partially been explained by lack of adherence to postoperative dietary and physical activity recommendations. However, little is known about factors related to postoperative adherence. OBJECTIVES: The aim of this study was to examine psychological, behavioral, and demographic predictors of adherence to behavior recommendations and weight loss 1 year after bariatric surgery. SETTING: Oslo University Hospital. METHODS: In a prospective cohort study, 230 patients who underwent Roux-en-Y gastric bypass were recruited from Oslo University hospital from 2011 to 2013. They completed a comprehensive questionnaire before and 1 year after surgery. Weight was measured preoperatively, on the day of surgery, and 1-year postoperatively. RESULTS: Mean body mass index was 44.9 kg/m(2) (standard deviation [SD] = 6.0) preoperatively and 30.6 kg/m(2) (SD = 5.2) 1 year after surgery. Patients lost on average 29.2 % (SD = 8.2) of their initial weight. Predictors of dietary adherence were years with dieting experience, readiness to limit food intake, and night eating tendency. Preoperative physical activity and planning predicted postoperative physical activity whereas predictors of weight loss were higher frequency of snacking preoperatively, greater past weight loss, and lower age. CONCLUSION: Several preoperative psychological predictors were related to postoperative adherence to dietary and physical activity recommendations but were not associated with weight loss. Interventions targeting psychological factors facilitating behavior change during the initial postoperative phase are recommended as this might improve long-term outcomes.

Predictors of Preoperative Weight Loss in Morbidly Obese Adults Waiting for Bariatric Surgery: A Prospective Cohort Study.

BACKGROUND: Preoperative weight loss is encouraged before bariatric surgery, as it is associated with improved surgical conditions. It has also been related to better postoperative outcomes, but this relationship is less clear. However, little is known about what predicts weight loss preoperatively, so the aim was to identify psychosocial and clinical predictors of preoperative weight loss. METHODS: Weight was measured at the first visit, the time of surgery approval, and on the day of surgery in 286 bariatric surgery patients (227 women). A questionnaire consisting of multiple psychosocial measures was completed before surgery. RESULTS: Preoperatively, patients experienced a mean weight loss of 3.8 %. Men lost significantly more weight than women (mean = 5.4, SD = 6.0 vs. mean = 3.4, SD = 5.8, t = -2.3, p < 0.05), and 43.2 % of the patients lost ≥ 5% of their body weight. A high weight loss goal (ß = 0.20, p < 0.001), frequent self-weighing (ß = 0.18, p < 0.002), and being close to or at highest lifetime weight when applying for surgery (ß = -0.30, p < 0.0001) were identified as predictors of weight loss, after controlling for body mass index (BMI), gender, and length of preoperative time period. CONCLUSIONS: A relatively low proportion of patients lost the recommended weight preoperatively. Our results indicate that patients benefit from monitoring weight preoperatively and that allowing patients to keep their high weight loss goals may contribute to higher weight loss. Further investigation of these predictors could provide valuable knowledge regarding how to support and motivate patients to lose weight preoperatively.

A comparison of behavioral and psychological characteristics of patients opting for surgical and conservative treatment for morbid obesity.

BACKGROUND: Little is known about the psychological prerequisites for weight loss maintenance after bariatric surgery. A first step in investigating whether existing knowledge of conservative weight loss treatment is applicable for lifestyle interventions postoperatively is to compare specific psychological characteristics at baseline. The aim of this study was to compare patients scheduled for bariatric surgery with patients receiving conservative treatment for morbid obesity on measures of behavioral and psychosocial characteristics considered predictors of their adoption of and adherence to long-term lifestyle recommendations. METHODS: Baseline clinical and questionnaire data from the prospective "Oslo Bariatric Surgery Study" were used to examine potential differences between bariatric surgery patients (n = 301) and patients receiving conservative weight loss treatment (n = 261). RESULTS: The surgical group was characterized by their younger age (43.8 vs. 46.2 years, p <0.01), higher percentage of women (79.1 vs. 70.1 %, p <0.05), and higher Body Mass Index (BMI; 45.0 vs. 41.9 kg/m(2), p <0.001). A multiple logistic regression analysis, adjusting for group differences in BMI, gender, and age, showed that the surgical group had higher self-efficacy (Odds ratio; OR = 3.44, 95 % Confidence interval; CI 1.65, 7.14), more positive outcome expectations (OR = 1.53, 95 % CI 1.23, 1.89), and plans that were more explicit for changing their eating behaviors (OR = 1.80, 95 % CI 1.06, 1.93). The surgical patients were also less ready to change physical activity levels (OR = 0.59, 95 % CI 0.48, 0.73), had tried more types of unhealthy weight loss methods in the past (OR = 1.16, 95 % CI 1.01, 1.33), drank soda more frequently (OR = 1.24, 95 % CI 1.02, 1.50), had fewer binge eating episodes (OR = 0.38, 95 % CI 0.20, 0.71), and had more depressive symptoms (OR = 1.19, 95 % CI 1.09, 1.29). CONCLUSIONS: Patients opting for bariatric surgery had more positive expectations of the treatment outcomes and stronger beliefs in their ability to achieve these outcomes. Those starting conservative treatment had stronger beliefs in readiness to change physical activity levels. Future studies should explore the effect of interventions for bariatric surgery patients, promoting postoperative physical activity and stress realistic outcome expectations. The potential effects of incorporating this knowledge in intervention strategies remain to be explored.