Is implementing screening for distress an efficient means to recruit patients to a psychological intervention trial?

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Is implementing screening for distress an efficient means to recruit patients to a psychological intervention trial?

Psychooncology. 2014 May;23(5):516-23

Authors: van Scheppingen C, Schroevers MJ, Pool G, Smink A, Mul VE, Coyne JC, Sanderman R

Abstract

OBJECTIVES: Psychological interventions show greater efficacy when evaluated with distressed patients. We report on the feasibility of implementing screening for recruiting distressed cancer patients to a randomized controlled trial of problem-solving therapy (PST), characteristics associated with enrolment, and time investment and challenges of implementing screening.

METHODS: Three medical settings implemented screening of patients, directly after cancer treatment (T1) and 2 months later (T2), using Hopkins Symptom Checklist-25 and one question about need for services. Distressed patients indicating need for services were interviewed. Eligible patients were offered the possibility to participate in the trial. Consenting patients were randomized to PST or waitlist.

RESULTS: At T1, 366 of 970 screened patients (37%) scored above the cutoff and at T2, 208 of 689 screened patients (30%). At either or both T1 and T2, 423 patients reported distress, of whom 215 indicated need for services. Only 36 (4% of 970) patients consented to trial participation. Twenty-seven patients needed to be screened to recruit a single patient, with 17 h required for each patient recruited. Barriers to screening were time constraints and negative attitudes of oncology staff towards screening.

CONCLUSIONS: Implementing screening proved inefficient for recruiting distressed cancer patients post-treatment to a randomized controlled trial on PST, with need for services being much less than anticipated. Consecutively screening patients did not result in a sample representative of the larger pool of distressed patients, which may lower generalizability. An adequately powered intervention trial using screening requires a feasibility study establishing recruitment rates and dedicated, funded staff assistance.

PMID: 24829951 [PubMed - indexed for MEDLINE]

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Participation in questionnaire studies among couples affected by breast cancer.

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Participation in questionnaire studies among couples affected by breast cancer.

Support Care Cancer. 2014 Dec 10;

Authors: Terp H, Rottmann N, Larsen PV, Hagedoorn M, Flyger H, Kroman N, Johansen C, Dalton S, Hansen DG

Abstract

OBJECTIVE: Participation bias may be a problem in couple-based psychosocial studies. Therefore, it is important to investigate the characteristics associated with participation. The aim of this study was to analyze whether participation in a longitudinal psychosocial questionnaire study among couples affected by breast cancer was associated with socioeconomic, breast cancer-specific, and other health-related characteristics of the patients and partners.

METHODS: The analyzes are based on 2254 couples who were invited to participate in a nationwide survey on psychosocial adjustment among couples dealing with breast cancer. Participating couples (N = 792) were compared with non-participating couples (N = 1462) with regard to socioeconomic and health-related characteristics obtained from nationwide clinical and administrative registers.

RESULTS: Associations were seen between various socioeconomic variables and couple participation. The patient characteristics older age (OR = 0.15 [95 % CI = 0.07-0.55]), low education (OR = 1.95 [95 % CI = 1.46-2.68]), disability pension (OR = 0.59 [95 % CI = 0.39-0.55]), or non-western ethnicity (OR = 0.36 [95 % CI = 0.15-0.82]) reduced couple participation. The partner characteristics older age (OR = 0.23 [95 % CI = 0.15-0.43]), low education (OR = 1.67 [95 % CI = 1.25-2.22]), receiving disability pension (OR = 0.46 [95 % CI = 0.25-0.82]), non-western ethnicity (OR = 0.17 [95 % CI = 0.06-0.49]), or high morbidity (OR = 0.76 [95 % CI = 0.60-0.96]) also reduced couple participation. Furthermore, couples with low income (OR = 1.49 [95 % CI = 1.16-1.95]) had reduced participation. No associations were found between couple participation and breast cancer-related variables.

CONCLUSIONS: Socioeconomic characteristics of patients and partners, and morbidity of partners may influence participation in couple-based psychosocial breast cancer research. Breast cancer-related characteristics do not seem to influence participation.

PMID: 25487844 [PubMed - as supplied by publisher]

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Changes in cancer patients’ personal goals in the first 6 months after diagnosis: the role of illness variables.

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Changes in cancer patients’ personal goals in the first 6 months after diagnosis: the role of illness variables.

Support Care Cancer. 2014 Dec 6;

Authors: Janse M, Ranchor AV, Smink A, Sprangers MA, Fleer J

Abstract

PURPOSE: Setting and pursuing personal goals is a vital aspect of our identity and purpose in life. Cancer can put pressure on these goals and may be a reason for people to adjust them. Therefore, this paper investigates (1) changes in cancer patients’ goals over time and (2) the extent to which illness characteristics relate to goal changes.

METHODS: At both assessment points (1 and 7 months post-diagnosis), colorectal cancer patients (n = 198) were asked to list their current goals and rate them on hindrance of illness, attainability, likelihood of success, temporal range and importance. All goals were coded by two independent raters on content (i.e. physical, psychological, social, achievement and leisure). Patients’ medical data were obtained from the national cancer registry.

RESULTS: Over time, patients reported a decrease in illness-related hindrance, higher attainability and likelihood of success, a decrease in total number of goals, goals with a shorter temporal range, and more physical and fewer social goals. At both assessments, patients with more advanced stages of cancer, rectal cancer, a stoma, and receiving additional chemotherapy and/or radiotherapy reported more illness-related hindrance in goal attainment, but only patients with a stoma additionally reported lower attainability, likelihood of success and more short-term goals.

CONCLUSIONS: The results of this study support the assumption that cancer patients adjust their goals to changing circumstances and additionally show how patients adjust their goals to their illness. Moreover, we demonstrate that illness variables impact on goal change.

PMID: 25479825 [PubMed - as supplied by publisher]

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Goal adjustment strategies operationalised and empirically examined in adolescents with cancer.

Goal adjustment strategies operationalised and empirically examined in adolescents with cancer.

J Health Psychol. 2014 Dec 4;

Authors: Janse M, Sulkers E, Tissing WJ, Sanderman R, Sprangers MA, Ranchor AV, Fleer J

Abstract

Adolescents facing cancer may need to adjust their personal life goals. Theories identified several goal adjustment strategies, but their use has not been tested. Therefore, this study operationalises goal adjustment strategies and examines their use. Adolescent cancer patients listed their goals 3 and 12 months post-diagnosis. Goals received scores on five goal characteristics: life domain, level of abstraction, importance, attainability and effort. Results showed that adolescents with cancer (N = 30, mean age: 14.2 years, 60% female) used four of five strategies described in theory, while one additional strategy was found. These findings suggest that adolescents with cancer use goal adjustment strategies as measured by goal characteristics over time.

PMID: 25476574 [PubMed - as supplied by publisher]

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Body image in cancer survivors: a systematic review of case-control studies.

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Body image in cancer survivors: a systematic review of case-control studies.

J Cancer Surviv. 2014 Dec 2;

Authors: Lehmann V, Hagedoorn M, Tuinman MA

Abstract

PURPOSE: There is common consensus that cancer and its treatment can impair the body, but combined evidence of the previous literature in cancer survivors is missing. Therefore, we reviewed body image in cancer survivors and focused on case-control studies, in order to draw conclusions as to whether body image might be altered due to cancer.

METHODS: Medline, Cinahl, Embase, and PsycInfo were searched and after duplicate extraction, 1932 hits were retrieved and screened for eligibility. Included studies were rated on selection, measurement, and reporting bias.

RESULTS: Twenty-five studies were identified using 19 different scales to measure body image. Ten studies reported a more negative body image in survivors, nine found no differences, three reported mixed findings, and three reported a more positive body image in survivors. Potential bias was common and 16 studies had at least three sources of potential bias. Less-biased studies (i.e., ≤2 sources of bias) hinted to weak differences between survivors and controls, favoring healthy controls. A meta-analysis could not be performed.

CONCLUSIONS: This review was long overdue and indicates a somewhat more negative body image in cancer survivors than healthy controls. However, numerous problems potentially biasing study results have been detected and firm conclusions cannot be drawn.

IMPLICATIONS FOR CANCER SURVIVORS: Future studies should recruit larger samples, match samples, and pay attention to how body image is conceptualized and measured in order to draw reliable conclusions as to whether body image is impaired in cancer survivors.

PMID: 25446910 [PubMed - as supplied by publisher]

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Valuation of depression co-occurring with a somatic condition: feasibility of the time trade-off task.

Valuation of depression co-occurring with a somatic condition: feasibility of the time trade-off task.

Health Expect. 2014 Nov 13;

Authors: Papageorgiou K, Vermeulen KM, Leijten FR, Buskens E, Ranchor AV, Schroevers MJ

Abstract

BACKGROUND: Health state valuations obtained from the general population are used for cost-utility analyses of health-care interventions. Currently, most studies have focused on valuations of somatic conditions, to a much lesser extent of mental states, that is, depression and even less on valuations of depression co-occurring with somatic conditions.

OBJECTIVE: We tested the feasibility of the time trade-off (TTO) task to elicit valuations for depression solitary or co-occurring with a somatic condition. Moreover, we explored person- and state-related factors that may affect valuations.

DESIGN: During semi-structured interviews, 10 individuals (five women, mean age: 36 years) used a TTO task to value vignettes describing mild and severe depression; and mild depression co-occurring with moderate and severe states of cancer, diabetes or heart disease. During valuations, participants were thinking aloud. Feasibility criteria were successful completion and difficulty/concentration (1-10); logical consistency of values; and comprehension of the TTO, based on qualitative analysis of think aloud data. Factors influencing valuations were generated from think aloud data.

RESULTS: Participants reported satisfactory levels of difficulty (mean: 1.9) and concentration (mean: 8.3) and assigned consistent values. Qualitative analysis revealed difficulties with imagining: living with depression for lifetime (n = 4); reaching the age of 80 (n = 6); and living with a somatic condition and mentally healthy (n = 6). Person- and state-related factors, for example perceived susceptibility to depression (n = 4), appeared to affect valuations.

CONCLUSION: Quantitative findings supported feasibility of the valuation protocol, yet qualitative findings indicated that certain task aspects should be readdressed. Factors influencing valuations can be explored to better understand valuations.

PMID: 25393599 [PubMed - as supplied by publisher]

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A critical reanalysis of the relationship between genomics and well-being.

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A critical reanalysis of the relationship between genomics and well-being.

Proc Natl Acad Sci U S A. 2014 Sep 2;111(35):12705-9

Authors: Brown NJ, MacDonald DA, Samanta MP, Friedman HL, Coyne JC

Abstract

Fredrickson et al. [Fredrickson BL, et al. (2013) Proc Natl Acad Sci USA 110(33):13684-13689] claimed to have observed significant differences in gene expression related to hedonic and eudaimonic dimensions of well-being. Having closely examined both their claims and their data, we draw substantially different conclusions. After identifying some important conceptual and methodological flaws in their argument, we report the results of a series of reanalyses of their dataset. We first applied a variety of exploratory and confirmatory factor analysis techniques to their self-reported well-being data. A number of plausible factor solutions emerged, but none of these corresponded to Fredrickson et al.’s claimed hedonic and eudaimonic dimensions. We next examined the regression analyses that purportedly yielded distinct differential profiles of gene expression associated with the two well-being dimensions. Using the best-fitting two-factor solution that we identified, we obtained effects almost twice as large as those found by Fredrickson et al. using their questionable hedonic and eudaimonic factors. Next, we conducted regression analyses for all possible two-factor solutions of the psychometric data; we found that 69.2% of these gave statistically significant results for both factors, whereas only 0.25% would be expected to do so if the regression process was really able to identify independent differential gene expression effects. Finally, we replaced Fredrickson et al.’s psychometric data with random numbers and continued to find very large numbers of apparently statistically significant effects. We conclude that Fredrickson et al.’s widely publicized claims about the effects of different dimensions of well-being on health-related gene expression are merely artifacts of dubious analyses and erroneous methodology.

PMID: 25157145 [PubMed - indexed for MEDLINE]

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Weight and height in children newly diagnosed with cancer.

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Weight and height in children newly diagnosed with cancer.

Pediatr Blood Cancer. 2014 Oct 30;

Authors: Brinksma A, Roodbol PF, Sulkers E, Hooimeijer HL, Sauer PJ, van Sonderen E, de Bont ES, Tissing WJ

Abstract

BACKGROUND: Although weight loss and lack of linear growth occur in children with cancer, growth history is not included in research that aims to determine nutritional status in children newly diagnosed with cancer. Therefore, this study aimed to determine weight loss and lack of linear growth in this patient group.

PROCEDURE: Weight and height were recorded in 95 children (ages 1.5-10 years) at diagnosis and compared with data predicted from growth curves. Age, gender, type of malignancy, extent of disease, and prior weight and height were tested for their potential relation to differences between actual and predicted data.

RESULTS: The incidence of undernutrition, based on z-scores for weight-for-age (WFA), height-for-age (HFA), and weight-for-height (WFH), was 2%, 4%, and 7%, respectively. Actual z-scores were lower than predicted z-scores. Differences between actual and predicted z-scores of <-0.5 standard deviation score (SDS) in WFA, HFA, or WFH were found in 25%, 23%, and 29% of the children, respectively. Children with advanced cancer had the highest risk of significant weight loss (<-0.5 SDS in WFA) (ORWFA  = 3.45, P = 0.012) prior to diagnosis. Differences were unrelated to type of malignancy, age, gender, and weight and height prior to diagnosis.

CONCLUSIONS: At diagnosis, approximately 25% of the children showed a significant reduction in z-scores for weight-for-age, height-for-age, and weight-for-height. This reduction may indicate a deteriorated nutritional status. Therefore, assessment of growth history should be standard of care to ensure appropriate nutritional interventions and should be included in research that aims to evaluate nutritional status in children newly diagnosed with cancer. Pediatr Blood Cancer © 2014 Wiley Periodicals, Inc.

PMID: 25359660 [PubMed - as supplied by publisher]

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Distress, problems and referral wish of cancer patients: differences according to relationship status and life phase.

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Distress, problems and referral wish of cancer patients: differences according to relationship status and life phase.

Psychooncology. 2014 Oct 24;

Authors: Tuinman MA, Van Nuenen FM, Hagedoorn M, Hoekstra-Weebers JE

Abstract

OBJECTIVE: The aim of this study is to examine differences in distress, problems and referral wish in cancer patients according to relationship status and life phase.

METHODS: A cross-sectional group of 1340 patients (response = 51%) completed socio-demographic and illness-related questions, and the Dutch version of the Distress Thermometer and Problem List that also assesses desire for additional care (yes, maybe and no). Relationship status was categorized into six groups (married, cohabiting, LAT (=living-apart-together: have a partner but live alone), divorced, widowed or single) and age into young (18-50), middle aged (51-65) and older (65+) cohorts.

RESULTS: Relationship status and life phase were independently related to high distress, referral wish and accordance between the latter two. Single and LAT patients were around two times more likely than married patients to be highly distressed, and wanting additional care. The same was found for younger patients as compared to 65+ patients. Whereas high distress is usually not a strong indication for additional care needs, single, LAT and younger patients most often wanted care when they were highly distressed.

CONCLUSION: Health care professionals who implement distress screening in practice can expect a higher need for additional care in single and LAT patients, but only when they are younger or middle aged. The benefit of having a partner around on a daily basis seems less important in dealing with cancer-related problems when patients are older. Copyright © 2014 John Wiley & Sons, Ltd.

PMID: 25345693 [PubMed - as supplied by publisher]

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[Teleradiology in a family practice on the Dutch island of Ameland: a cost-benefit analysis].

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[Teleradiology in a family practice on the Dutch island of Ameland: a cost-benefit analysis].

Ned Tijdschr Geneeskd. 2013;156(51):A5428

Authors: Jacobs JJ, Jacobs JP, Wiersma D, Sanderman R

Abstract

OBJECTIVE: To calculate the costs and benefits of the introduction of teleradiology at a general practice on the Dutch island of Ameland from the perspectives of three different entities: (a) the family doctor (investor); (b) patients; and (c) health insurance companies.

DESIGN: Descriptive, cost-benefit analysis.

METHOD: For the year 2009, one and a half years after the introduction of a teleradiology facility at a general practice in Ameland, the operational and financing costs, the patient’s saved travel time and expenses and the teleradiology costs for health insurance companies were compared with the costs that would have been made without teleradiology.

RESULTS: In 2009, 426 X-rays had been taken at the general practice of which 241 for trauma and 185 for non-traumatic cases. With a reimbursement of € 100 per X-ray taken during normal working hours and € 200 for those taken during evenings and weekends, benefits for the family doctor (investor) were € 46,698 and the costs amounted to € 45,710, or a positive balance of € 980. Patients’ savings in travel time and expenses were calculated at € 111,068. Health insurance companies reimbursed a minimum of € 89,265 less on diagnosis and treatment.

CONCLUSION: The introduction of teleradiology a general practice in Ameland resulted in a considerable cost reduction for patients as well as for health insurance companies. In the future, diagnosing in this manner could be expanded in particular to regions in which the distances to hospitals are greater: a part of secondary healthcare could be conducted at a reduced cost.

PMID: 24472309 [PubMed - indexed for MEDLINE]

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