Psycho‐Oncology最新文献

Objective: Patient trust is fundamental to ensuring optimal cancer care, especially for vulnerable patients who may face additional challenges. However, there is a limited understanding of what it entails for nurses to establish and maintain trust among vulnerable patients. Grounded in the concept of Trust Work, this study explored nurses' efforts to nurture patient trust.

Methods: Drawing on qualitative insights from NAVIGATE, a multicenter randomized controlled trial, we explored the interaction between nurses and vulnerable patients with lung cancer in clinical encounters. We included 16 patients and eight nurses from five Danish hospital sites. Among other sources, data comprised 45 audio-recorded clinical encounters conducted over one year, 15 of which were also observed in clinic settings or patients' homes, as well as semi-structured interviews with all participating patients and nurses. Analyses were based on thematic analysis principles.

Results: We found that nurses were continuously engaged in nurturing trust. This trust work involved three interrelated aspects: (1) 'Recognition' - meticulous preparation to remember individual patients and recognize their lived experiences, (2) 'Witnessing' or 'Guarding' - sustained support, though with varying levels of engagement, and (3) 'Involvement' or 'Detachment'-engaging with affirming resources or disengaging from colleagues' or the broader healthcare system. These aspects were shaped by contextual factors, including nurses' available time and continuity of care, professional affiliations and roles, and collegial and institutional relationships.

Conclusion: This study highlights nurses' critical role in nurturing patient trust and identifies important contextual factors for improving care targeting vulnerable cancer patients.

Objectives: Parents of children with cancer are at increased risk for anxiety, depression, and post-traumatic stress, although wide variability among parents has been documented. This cross-sectional study was designed to examine the individual contributions and simultaneous interaction of three coping constructs-coping strategy, repertoire of coping techniques, and flexibility in applying these techniques-in parental distress related to childhood cancer.

Methods: A sample of 88 mothers and 57 fathers (N = 145) of children undergoing active cancer treatment were recruited from a pediatric hematology-oncology department. Parents' ages ranged from 22 to 58 years. Parents completed standardized measures including the Brief COPE, Coping Flexibility Scale-Revised, the Pediatric Parenting Stress Inventory, and the Profile of Mood States.

Results: Avoidance-focused coping strategy, repertoire of coping techniques, and coping flexibility were individually found to be significantly correlated with parental distress. Bootstrap mediation analysis revealed that the collective model explained 37%-43% of the variance in parental distress, with avoidance-focused coping strategy emerging as the most significant predictor, accounting for approximately 29% of the total variance.

Conclusions: These results suggest that clinical interventions should prioritize identifying and reducing parental reliance on avoidance-focused coping techniques as a primary target. Subsequently, expanding parents' repertoire of problem- and emotion-focused coping techniques and enhancing flexibility in their application could lead to better distress reduction. However, the cross-sectional design limits causal interpretation, and future longitudinal studies employing larger sample sizes are needed to establish the relationships between these constructs.

Objectives: Social participation plays a key role in the rehabilitation process, improving mental health, reducing isolation, and enhancing quality of life. Despite its importance, existing tools for assessing social participation in pediatric cancer patients are limited in comprehensiveness and specificity. The aim of this study was to develop and evaluate the psychometric properties of a Social Participation Scale for Pediatric Cancer Patients (SPS-PC).

Methods: Items were created after an extensive literature review and evaluated through expert consultation and a pilot study. A convenience sampling approach was employed to recruit 420 pediatric cancer patients from pediatric departments of three tertiary grade-A hospitals in Zhengzhou for psychometric testing of the scale. Item selection was based on item analysis, exploratory factor analysis was conducted to extract factors, and confirmatory factor analysis was used to assess structural validity.

Results: The final version of the SPS-PC includes 16 items across four dimensions: school participation, family participation, peer participation, and health management participation. The scale demonstrated excellent content and construct validity, with high internal consistency (Cronbach's α = 0.900) and strong reliability (test-retest reliability = 0.820). Exploratory and confirmatory factor analyses confirmed a robust four-factor structure.

Conclusion: The SPS-PC is a reliable and valid instrument for assessing social participation in pediatric cancer patients. The scale's comprehensive approach makes it an essential tool for clinical practice and research in pediatric oncology, contributing to the social reintegration of these children.

Background: consideRATE is a patient- and care-partner-reported measure of care experience during serious illness. We used consideRATE with patients and care partners at the Dartmouth Cancer Center to assess patient experience, evaluate psychometric properties, and explore scoring approaches.

Methods: Patients and care partners who are aged 18+ and English proficient participated in a cross-sectional survey. Participants completed consideRATE (8 items), CANHELP Lite (21 items), and demographic questions. Reliability was assessed using Cronbach's α, and validity was evaluated with Pearson's correlations. Continuous and top-box scoring approaches were used. Psychometric properties were analyzed for patients, care partners, and subgroups with lower educational attainment or income.

Results: 244 participants (114 patients, 128 care-partners, 2 unspecified) completed the survey. consideRATE has internal reliability (α = 0.86); the correlation (r) between consideRATE continuous scoring and CANHELP Lite scores for all participants was 0.5; p < 0.001, for patients 0.5; p < 0.001, for care-partners 0.5; p < 0.001, for patients (n = 71) with lower educational attainment 0.5, p < 0.001, and for patients (n = 50) with lower income 0.7, p < 0.001. We also found correlations between consideRATE top-box scoring and CANHELP Lite scores for all participants (r^pb = 0.4, p < 0.001), with stronger associations among the patient (r^pb = 0.5, p < 0.001) and lower income (r^pb = 0.6, p = 0.005) subgroups. We found discriminant validity between consideRATE and Single-item Health Literacy (SIL) measures for continuous scoring (r = -0.05 to 0.09, p > 0.05) and top-box scoring (r = -0.02 to 0.09, p > 0.05). We found no significant difference in overall experience between patients with solid and hematologic malignancy cancer categories.

Conclusion: We demonstrated in this sample of patients attending a cancer center that consideRATE has good internal reliability and is well correlated with CANHELP Lite.

Background: Fatigue is a common consequence of low-grade gliomas (LGG), but its specific nature has not been extensively studied. In particular, it remains unclear if the prevalence and determinants of mental fatigue differ from those of physical fatigue. Therefore, this study aimed to examine (1) whether the prevalence and severity of mental fatigue differ from physical fatigue in patients with LGG; (2) the specific determinants of mental and physical fatigue, including cognitive impairments, affective symptoms and radiological abnormalities.

Methods: A total of 148 patients with LGG were included and assessed with the Dutch Multifactor Fatigue Scale (DMFS; mental and physical fatigue) and the Hospital Anxiety and Depression Scale (HADS; affective symptoms). Neuropsychological tests were administered to measure cognitive impairments, particularly in basic and complex information processing speed.

Results: Severe mental fatigue affected 38% of patients, a significantly different prevalence than that of severe physical fatigue (22%), with an overlap of 15%. Patients with severe mental fatigue had significantly lower scores on a divided attention task, compared to patients with non-severe mental fatigue. In a hierarchical linear prediction model with demographical, radiological and psychological variables, different sets of determinants were found for mental fatigue (anxiety and depression) and physical fatigue (depression, educational level and tumor volume).

Conclusions: Mental fatigue can be distinguished from physical fatigue in patients with LGG, characterized by a high prevalence and unique determinants. Therefore, mental fatigue should be considered as a distinct construct and presumably requires a different (neuro)psychological therapeutic approach compared to physical fatigue.

Background: Fear of cancer recurrence (FCR) is prevalent among patients with breast cancer, yet those at high risk are not well characterized.

Aims: This study aimed to identify the patient characteristics associated with FCR after diagnosis.

Methods: Between July and September 2023, participants in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort completed the 9-item FCR-Short Form Inventory. A score of 22 or higher indicated clinically significant FCR (csFCR). Logistic and linear regression estimated associations between different risk factors and csFCR and FCR scores, respectively. Missing data were addressed using multiple imputation.

Results: Among 1390 stage I-III patients (mean age 63.1 years and 9.1 [mean] years since diagnosis), 262 (18.8%) reported csFCR. In adjusted models, csFCR was associated with having another cancer excluding non-melanoma skin (adjusted odds ratio [aOR], 2.64; 95% CI, 1.66-4.21), greater levels of stress (aOR, 2.40 per 1-SD increment; 95% CI, 1.98-2.91), having a prior recurrence (aOR, 2.26; 95% CI, 1.14-4.47), and having estrogen receptor-positive tumors (aOR, 1.60; 95% CI, 1.06-2.40). Older age at diagnosis (aOR, 0.64 per 10-year increment; 95% CI, 0.56-0.73) was associated with lower odds of csFCR. Similar associations were observed with continuous FCR scores, along with advanced stage at diagnosis associated with higher FCR scores (p-trend = 0.001).

Conclusions: Nearly 1 in 5 breast cancer patients reported csFCR. Key risk factors included younger age at diagnosis, history of recurrence or other malignancies, greater levels of stress, and estrogen receptor-positive breast cancer, which can inform targeted interventions to support survivorship.

Background: There are 18 million cancer survivors in the United States; 10% have gastrointestinal (GI) cancer. Psychosocial risk factors (PSRF) and perceived health (PH) are important to their well-being.

Aims: This study examines PSRF among survivors of GI cancer and evaluates their association with PH.

Methods: A cross-sectional analysis of the All of Us Research Program included survivors of GI cancer who completed Social Determinants of Health and Overall Health surveys. PSRF were assessed using validated scales. Regression models evaluated associations between PSRF and PH.

Results: 13,813 patients with GI cancer were included. Female patients were more likely to perceive good physical health (OR 1.52 [95% CI: 1.30-1.79]) than male patients. Black patients reported higher discrimination (β 0.25 [95% CI: 0.20-0.31]) compared to white patients. Increased loneliness and stress decreased the odds of reporting good mental health by 53% (OR 0.47 [95% CI: 0.39-0.56]) and 39% (OR 0.61 [95% CI: 0.50-0.74]), respectively. Increased spirituality was associated with improved perceived mental health (OR 1.12 [95% CI: 1.06-1.17]). Healthcare discrimination (OR 0.87 [95% CI: 0.79-0.97]) and loneliness (OR 0.84 [95% CI: 0.73-0.97]) were negatively associated with perceived physical health. Social support (OR 1.16 [95% CI: 1.06-1.26]) and spirituality (OR 1.08 [95% CI: 1.02-1.14]) were positively associated with quality of life.

Conclusion: Protective PSRF such as social support and spirituality are correlated with better perceived health in survivors of GI cancer. Tailoring supportive services based on patient-reported experience may help improve quality of life in cancer survivorship.

Background: Poems related to cancer offer a rich perspective on the clinical reality of living with cancer. Therefore, in this paper, poems written by poets about their own cancer and about the cancer of loved ones are examined in the context of communal coping.

Methods: We analyzed 123 poems by 14 poets writing about their own cancer, and 72 poems by 8 poets writing about the cancer of their loved ones, with Linguistic Inquiry and Word Count software (LIWC).

Results: LIWC-scores drawn from poems about one's own cancer exhibited a limited use of "third-person singular", social words ("family", "female", "male"), and time orientation ("focus past"), and an increased focus on the present. Support for this observation comes from significant correlations between words related to the present, body, and health, with strong, negative emotions. Poems about loved ones who suffer cancer tend to focus on grief and mourning, and to exhibit melancholy and represent paternal, maternal, spousal, and filial elegies.

Conclusions: The linguistic characteristics and content of poems by poets writing about their cancer or about the cancer of their loved ones provides rich insights. This linguistic analysis of poems regarding cancer can be used in the further development of theory and clinical application of self-management approaches for persons with cancer, in support of expressive writing interventions, bibliotherapy, photovoice, art therapy, and health humanities.

Background: Although depression is prevalent and has significant consequences among individuals living with likely incurable cancer (ILLIC), optimal methods of identifying and treating depression in this population remain unknown.

Aims: To evaluate a paradigm of (1) proactive identification (ID) (i.e., remotely and asynchronously from clinical encounters) of depression among ILLIC and (2) digital mental health intervention (DMHI) for depression treatment.

Methods: In this decentralized randomized clinical trial, ILLIC with elevated depressive symptoms were proactively identified using electronic health record data and randomized 2:1 to a DMHI-based Behavioral Activation treatment or usual care (UC) depression treatment. Measures of feasibility (accrual, retention) and acceptability (engagement) were described; depression severity (change in PHQ-9 scores through 4 weeks post-randomization) was modeled with a generalized estimating equation.

Results: Among 88 ILLIC who completed screening, 30 were eligible and randomized to the trial. No patients were lost to follow-up or withdrew; 80% of patients randomized to proactive ID + DMHI used the app through 4 weeks. Proactive ID + DMHI improved depression from baseline to 4 weeks relative to proactive ID + UC (mean difference in change from baseline to week 4 = -2.7; 90% CI: -4.9 to -0.4). At 4 weeks, the odds of a clinical response (PHQ-9 decrease of ≥ 5 points) was 9.0-fold higher for patients in proactive ID + DMHI relative to proactive ID + UC (OR 9.0; 90% CI: 1.1-74.2).

Conclusions: A proactive ID + DMHI approach to identifying and treating depression among ILLIC is feasible, acceptable, and potentially efficacious. These promising data support conducting a large efficacy trial evaluating this approach.

Trial registration: ClinicalTrials.gov identifier: NCT05932810.