Trajectories of personal control in cancer patients receiving psychological care.
Psychooncology. 2015 May;24(5):556-63
Authors: Zhu L, Schroevers MJ, van der Lee M, Garssen B, Stewart RE, Sanderman R, Ranchor AV
OBJECTIVE: This study aimed to (1) identify subgroups of cancer patients with distinct personal control trajectories during psychological care, (2) examine whether socio-demographic, clinical, and psychological care characteristics could distinguish trajectories, and (3) examine differential patterns of psychological symptoms between trajectories.
METHODS: This naturalistic study focused on 241 cancer patients receiving psychological care at psycho-oncology institutions. Data were collected before the initiation of psychological care, and 3 and 9 months thereafter. Latent class growth analysis was applied to identify personal control trajectories.
RESULTS: Three personal control trajectories were identified: enduring improvement (41%), temporary improvement (50%), and deterioration (9%). Education and baseline physical symptoms distinguished these trajectories. In the whole group, improvements in personal control were associated with improvements in psychological symptoms. Patients at distinct trajectories reported different levels of psychological symptoms, but did not differ in their courses of psychological symptoms. Patients in the enduring and temporary control improvement groups experienced significant psychological symptoms reductions over time, whereas patients in the control deterioration group maintained high psychological symptoms.
CONCLUSIONS: Improvements in personal control seem to depend on initial control level: those who start with the highest control levels show subsequent improvements, whereas those with the lowest control levels show subsequent deterioration.
PMID: 25251894 [PubMed - indexed for MEDLINE]
Results of the PACE follow-up study are uninterpretable.
Lancet Psychiatry. 2016 Jan 18;
Authors: Coyne JC, Laws KR
PMID: 26795757 [PubMed - as supplied by publisher]
Online genetic counseling from the providers’ perspective: counselors’ evaluations and a time and cost analysis.
Eur J Hum Genet. 2016 Jan 20;
Authors: Otten E, Birnie E, Ranchor AV, van Langen IM
Telemedicine applications are increasingly being introduced in patient care in various disciplines, including clinical genetics, mainly to increase access to care and to reduce time and costs for patients and professionals. Most telegenetics reports describe applications in large geographical areas, showing positive patients’ and professionals’ satisfaction. One economic analysis published thus far reported lower costs than in-person care. We hypothesized that telegenetics can also be beneficial from the professional’s view in relatively small geographical areas. We performed a pilot study in the Northern Netherlands of 51 home-based online counseling sessions for cardiogenetic and oncogenetic cascade screening, and urgent prenatal counseling. Previously, we showed patient satisfaction, anxiety, and perceived control of online counseling to be comparable to in-person counseling. This study focuses on expectations, satisfaction, and practical evaluations of the involved counselors, and the impact in terms of time and costs. Most counselors expected disadvantages of online counseling for themselves and their patients, mainly concerning insufficient non-verbal communication; few expected advantages for themselves. Afterwards, counselors additionally raised the disadvantage of insufficient verbal communication, and reported frequent technical problems. Their overall mean telemedicine satisfaction itemscore was 3.38 before, and 2.95 afterwards, being afterwards slightly below the minimum level we set for a satisfactory result. We estimated reduced time and costs by online counseling with about 8% and 10-12%, respectively. We showed online genetic counseling to be effective, feasible and cost-efficient, but technical improvements are needed to increase counselors’ satisfaction.European Journal of Human Genetics advance online publication, 20 January 2016; doi:10.1038/ejhg.2015.283.
PMID: 26785833 [PubMed - as supplied by publisher]
Role of patient treatment beliefs and provider characteristics in establishing patient-provider relationships.
Fam Pract. 2015 Apr;32(2):224-31
Authors: Lee King PA, Cederbaum JA, Kurzban S, Norton T, Palmer SC, Coyne JC
BACKGROUND: Positive patient-provider relationships have been associated with improved depression treatment outcomes. Little is known about how patient treatment beliefs influence patient-provider relationships, specifically treatment alliance and shared decision making in primary care (PC).
OBJECTIVE: We evaluated the relationship between patient treatment beliefs and patient-provider relationships by gender, race and current depression.
METHODS: We used a deductive parallel convergent mixed method design with cross-sectional data. Participants were 227 Black and White patients presenting with depression symptoms in PC settings. Individuals were randomized into either a quantitative survey (n = 198) or qualitative interview (n = 29) group. We used multiple ordinary least squares regression to evaluate the association between patient beliefs, as measured by the Treatment Beliefs Scale and the Medication Beliefs Scale, and treatment alliance or shared decision making. We concurrently conducted thematic analyses of qualitative semistructured interview data to explicate the nature of patient-provider relationships.
RESULTS: We found that patients who believed their provider would respectfully facilitate depression treatment reported greater bond, openness and shared decision making with their provider. We also identified qualitative themes of physicians listening to, caring about and respecting patients. Empathy and emotive expression increased patient trust in PC providers as facilitators of depression treatment.
CONCLUSIONS: This work systematically demonstrated what many providers anecdotally believe: PC environments in which individuals feel safe sharing psychological distress are essential to early identification and treatment of depression. Interprofessional skills-based training in attentiveness and active listening may influence the effectiveness of depression intervention.
PMID: 25556196 [PubMed - indexed for MEDLINE]
Prevalence of psychological problems and associated transplant-related variables at different time periods after liver transplantation.
Liver Transpl. 2015 Apr;21(4):524-38
Authors: Annema C, Roodbol PF, Stewart RE, Porte RJ, Ranchor AV
After liver transplantation, recipients often experience psychological problems that are influenced by demographic, personal, and transplant-related variables. However, because previous studies have mostly reported on psychological problems and their influencing factors in the first years after transplantation, less is known about their prevalence and influence in the long run. The aims of this study were to examine point-prevalence rates of symptoms of anxiety, depression, and posttraumatic stress (PTS) at different time periods after transplantation and to examine the transplant-related variables associated with these problems. A cross-sectional survey was performed among 373 liver transplant recipients who received transplants between 1979 and 2009 at our center. Five clinically relevant time periods were identified: 0.5 to <2 years, 2 to <5 years, 5 to <10 years, 10 to <15 years, and ≥15 years after transplantation. The response rate was 75% (n=281). Overall, 33.4% of the respondents experienced clinically relevant symptom levels of anxiety (28.7%), depression (16.5%), or PTS (10.0%). Symptoms of anxiety and depression were more prevalent in the first 2 years and in the long term after transplantation. PTS symptoms were more prevalent in the first 5 years after transplantation. However, the prevalence rates did not differ significantly between time periods. Viral hepatitis and the number of side effects of the immunosuppressive (IS) medication were found to be associated with all psychological problems. Alcoholic liver disease was associated with anxiety and depression in the short term after transplantation. In conclusion, a significant subset of transplant recipients experience psychological problems, both shortly after transplantation and in the long run. These problems are often associated with side effects from the IS medication. Therefore, the monitoring of psychological problems, the offering of psychological counseling, and the management of the medication’s side effects should be part of the routine care of transplant recipients.
PMID: 25556775 [PubMed - indexed for MEDLINE]
The Cognitive Symptom Checklist-Work in cancer patients is related with work functioning, fatigue and depressive symptoms: a validation study.
J Cancer Surviv. 2015 Nov 30;
Authors: Dorland HF, Abma FI, Roelen CA, Smink A, Feuerstein M, Amick BC, Ranchor AV, Bültmann U
PURPOSE: The study objectives are to translate the 21-item Cognitive Symptom Checklist-Work (CSC-W21) to Dutch (CSC-W DV) and to validate the CSC-W DV in working cancer patients.
METHODS: The CSC-W21 was cross-culturally translated and adapted to a Dutch version. In this 19-item version, the dichotomous response option was changed to an ordinal five-point scale. A validation study of the CSC-W DV was conducted among cancer patients who had returned to work during or following cancer treatment. Internal consistency (Cronbach’s α), structural validity (exploratory factor analysis) and construct validity (hypothesis testing) were evaluated.
RESULTS: In a cohort of 364 cancer patients, 341 (94 %) completed the CSC-W DV (aged 50.6 ± 8.6 years, 60 % women). Exploratory factor analysis revealed two subscales ‘working memory’ and ‘executive function’. The internal consistency of the total scale and subscales was high (Cronbach’s α = 0.93-0.95). Hypothesis testing showed that self-reported cognitive limitations at work were related to work functioning (P < 0.001), fatigue (P = 0.001) and depressive symptoms (P < 0.001), but not to self-rated health (P = 0.14).
CONCLUSIONS: The CSC-W DV showed high internal consistency and reasonable construct validity for measuring work-specific cognitive symptoms in cancer patients. The CSC-W DV was associated in expected ways with work functioning, fatigue and depressive symptoms.
IMPLICATIONS FOR CANCER SURVIVORS: It is important to enhance knowledge about cognitive symptoms at work in cancer patients, to guide and support cancer patients as good as possible when they are back at work and to improve their work functioning over time.
PMID: 26620817 [PubMed - as supplied by publisher]
Delay in Diagnosis of Testicular Cancer; A Need for Awareness Programs.
PLoS One. 2015;10(11):e0141244
Authors: Öztürk Ç, Fleer J, Hoekstra HJ, Hoekstra-Weebers JE
BACKGROUND AIM: To gain insight into patient and doctor delay in testicular cancer (TC) and factors associated with delay.
MATERIALS AND METHODS: Sixty of the 66 eligible men; median age 26 (range 17-45) years, diagnosed with TC at the University Medical Center Groningen completed a questionnaire on patients’ delay: interval from symptom onset to first consultation with a general practitioner (GP) and doctors’ delay: interval between GP and specialist visit.
RESULTS: Median patient reported delay was 30 (range 1-365) days. Patient delay and TC tumor stage were associated (p = .01). Lower educated men and men embarrassed about their scrotal change reported longer patient delay (r = -.25, r = .79 respectively). Age, marital status, TC awareness, warning signals, nor perceived limitations were associated with patient delay. Median patient reported time from GP to specialist (doctors’ delay) was 7 (range 0-240) days. Referral time and disease stage were associated (p = .04). Six patients never reported a scrotal change. Of the 54 patients reporting a testicular change, 29 (54%) patients were initially ‘misdiagnosed’, leading to a median doctors’ delay of 14 (1-240) days, which was longer (p< .001) than in the 25 (46%) patients whose GP suspected TC (median doctors’ delay 1(0-7 days).
CONCLUSIONS: High variation in patients’ and doctors’ delay was found. Most important risk variables for longer patient delay were embarrassment and lower education. Most important risk variable in GP’s was ‘misdiagnosis’. TC awareness programs for men and physicians are required to decrease delay in the diagnosis of TC and improve disease free survival.
PMID: 26606249 [PubMed - as supplied by publisher]
Posted in PLoS One
Tagged J. Fleer
Using Marital Status and Continuous Marital Satisfaction Ratings to Predict Depressive Symptoms in Married and Unmarried Women with Systemic Sclerosis: A Canadian Scleroderma Research Group Study.
Arthritis Care Res (Hoboken). 2015 Nov 25;
Authors: Levis B, Rice DB, Kwakkenbos L, Steele RJ, Hagedoorn M, Hudson M, Baron M, Thombs BD, Canadian Scleroderma Research Group
BACKGROUND: Married persons have, on average, better mental health than non-married persons. Among married persons, marital satisfaction is associated with better mental health. Studies that have compared mental health among married and non-married persons and considered marital satisfaction have categorized patients as satisfied versus unsatisfied, which reduces statistical power and does not generate clinically useful information on mental health across the marital satisfaction spectrum.
OBJECTIVE: To demonstrate a novel regression approach to evaluate mental health in women with systemic sclerosis (SSc), comparing married and unmarried women, accounting for continuously measured marital satisfaction.
METHODS: Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) and marital satisfaction with the Dyadic Adjustment Scale-7. A single multiple linear regression model was used to predict CES-D scores from marital status and, among married women, continuously measured marital satisfaction, controlling for demographic and clinical characteristics.
RESULTS: Of 725 women, 494 (68%) were married or living as married. On average, married women had CES-D scores 2.0 points (0.19 standard deviations [SDs]) lower than unmarried women (p=0.013). Among married women, 1.0 SD increases in marital satisfaction were associated with 2.2 point (0.21 SDs) decreases in CES-D scores (p<0.001). Married women below the 19th percentile of marital satisfaction had greater predicted depressive symptoms than unmarried women. Married women’s predicted CES-D scores ranged from 6.7 points lower to 6.9 points higher than unmarried women, depending on marital satisfaction.
CONCLUSION: Comparisons of mental health in married and unmarried rheumatic disease patients should include continuously measured marital satisfaction. This article is protected by copyright. All rights reserved.
PMID: 26605870 [PubMed - as supplied by publisher]
Feasibility and effectiveness of an asthma/COPD service for primary care: a cross-sectional baseline description and longitudinal results.
NPJ Prim Care Respir Med. 2015;25:14101
Authors: Metting EI, Riemersma RA, Kocks JH, Piersma-Wichers MG, Sanderman R, van der Molen T
BACKGROUND: In 2007, an Asthma/chronic obstructive pulmonary disease (COPD) (AC) service was implemented in the North of the Netherlands to support General Practitioners (GPs) by providing advice from pulmonologists on a systematic basis.
AIMS: To evaluate the feasibility and effectiveness of this service on patient-related outcomes.
METHODS: We report baseline data on 11,401 patients and follow-up data from 2,556 patients. GPs can refer all patients with possible obstructive airway disease (OAD) to the service, which is conducted by the local laboratory. Patients are assessed in the laboratory using questionnaires and spirometry. Pulmonologists inspect the data through the internet and send the GP diagnosis and management advice.
RESULTS: A total of 11,401 patients were assessed by the service, covering almost 60% of all adult patients with projected asthma or COPD in the area. In all, 46% (n = 5,268) of the patients were diagnosed with asthma, 18% (n = 2,019) with COPD and 7% (n = 788) with the overlap syndrome. A total of 740 (7%) patients were followed up after 3 months because the GP advised them to change medication. In this group, the proportion of unstable COPD patients (Clinical COPD Questionnaire (CCQ) ⩾ 1) decreased from 63% (n = 92) at baseline to 49% (n = 72). The proportion of patients with uncontrolled asthma (Asthma Control Questionnaire (ACQ) ⩾ 1.5) decreased from 41% (n = 204) to 23% (n = 115). In all, 938 (8%) patients were followed up after 12 months. From these patients, the proportion of unstable COPD patients (CCQ ⩾ 1) decreased from 47% (n = 115) to 44% (n = 107). The proportion of patients with uncontrolled asthma (ACQ⩾1.5) decreased from 16% (n = 95) to 14% (n = 85).
CONCLUSION: The AC service assessed a considerable proportion of patients with OAD in the area, improved patients’ outcomes, and is considered to be feasible and effective.
PMID: 25569634 [PubMed - indexed for MEDLINE]
A randomized controlled trial of web-based cognitive behavioral therapy for severely fatigued breast cancer survivors (CHANGE-study): study protocol.
BMC Cancer. 2015;15(1):765
Authors: Abrahams HJ, Gielissen MF, Goedendorp MM, Berends T, Peters ME, Poort H, Verhagen CA, Knoop H
BACKGROUND: About one third of breast cancer survivors suffer from persistent severe fatigue after completion of curative cancer treatment. Face-to-face cognitive behavioral therapy (F2F CBT), especially designed for fatigue in cancer survivors, was found effective in reducing fatigue. However, this intervention is intensive and treatment capacity is limited. To extend treatment options, a web-based version of CBT requiring less therapist time was developed. This intervention is aimed at changing fatigue-perpetuating cognitions and behaviors. The efficacy of web-based CBT will be examined in a multicenter randomized controlled trial.
METHODS: In total, 132 severely fatigued breast cancer survivors will be recruited and randomized to either an intervention condition or care as usual (ratio 1:1). Participants will be assessed at baseline and 6 months thereafter. The intervention group will receive web-based CBT, consisting of three F2F sessions and maximally eight web-based modules over a period of 6 months. The care as usual group will be on a waiting list for regular F2F CBT. The total duration of the waiting list is 6 months. The primary outcome of the study is fatigue severity. Secondary outcomes are functional impairments, psychological distress and quality of life.
DISCUSSION: If web-based CBT is effective, it will provide an additional treatment option for fatigue in breast cancer survivors. Web-based CBT is expected to be less time-consuming for therapists than regular F2F CBT, which would result in an increased treatment capacity. Moreover, the intervention would become more easily accessible for a larger number of patients, and patients can save travel time and costs.
TRIAL REGISTRATION: Dutch Trial Registry – NTR4309.
PMID: 26500019 [PubMed - as supplied by publisher]