Palliative care aims to improve quality of life for people with serious illness and their families. One potential barrier to palliative care uptake is inaccurate knowledge and/or negative beliefs ...among the general population, which may inhibit early interest in, communication about, and integration of palliative care following subsequent illness diagnosis. We explored knowledge and beliefs about palliative care among the general public using nationally-representative data collected in 2018 as part of the cross-sectional Health Information National Trends Survey. Only individuals who had heard of palliative care (n = 1,162, Mage = 51.8, 64% female) were queried on knowledge and beliefs. We examined whether self-assessed level of awareness of palliative care (i.e., knowing a little vs. enough to explain it) was associated with the relative likelihood of having accurate/positive beliefs, inaccurate/negative beliefs, or responding "don't know" to questions about palliative care. Respondents who indicated knowing a lot about palliative care had more accurate versus inaccurate knowledge than those who knew a little on only two of six items and more positive attitudes on only one of three items. In particular, respondents with greater awareness were equally likely to report that palliative care is the same as hospice and requires stopping other treatments, and equally likely to believe that palliative care means giving up and to associate palliative care with death. Those with higher awareness were less likely than those with lower awareness to respond "don't know," but greater awareness was not necessarily associated with having accurate or positive beliefs about palliative care as opposed to inaccurate or negative beliefs. Thus, even members of the general public who perceived themselves to know a lot about palliative care were often no less likely to report inaccurate knowledge or negative beliefs (versus accurate and positive, respectively). Findings suggest a need to improve awareness and attitudes about palliative care.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Judgment and decision‐making research often examines effects of emotion unrelated (i.e., incidental) to the decision when research questions center on emotion related (i.e., integral) to the ...decision, with a theory‐based assumption that the two types of emotion have equivalent influence. Experimentally targeting incidental emotion can overcome practical and ethical challenges that preclude manipulating integral emotion, particularly in medical contexts; however, the validity of the assumption that integral and incidental emotions have interchangeable influences on judgments and decisions, such as risk perceptions and behavioral intentions, has not been systematically examined. In a pre‐registered meta‐analysis of eight experiments (n = 5,336), we examined whether incidental fear and anger influenced risk perceptions and intentions similarly to integral fear and anger. To ensure the quality and intensity of the emotional experience remained constant across conditions, we rendered emotion integral or incidental to the threat by varying the type of outcomes assessed (matched or unmatched to the emotion induction). Results provide preliminary evidence that integral and incidental influences can differ. Most notably, incidental anger decreased risk perceptions, whereas integral anger increased them. Moreover, even when the direction of the effect of integral and incidental emotions was similar, the magnitude of the integral effect was larger. These findings suggest that the common practice of manipulating incidental emotions and generalizing findings to integral emotions may not be advisable, and as such, future work is needed to identify the specific features of the incidental and integral emotional experience that contribute to similarities and differences in their influence.
Palliative care can alleviate symptom burden, reduce psychosocial distress, and improve quality of life for patients suffering from serious or life-threatening illnesses. However, the extent to which ...U.S. adults are aware of or understand the goals and benefits of palliative care is not well understood. Public awareness of palliative care is necessary to change norms and create demand, and as such, limited awareness may be a significant barrier to palliative care uptake. An assessment of current palliative care awareness in the United States is needed to inform the health care sector's improving palliative care communication and delivery.
To examine the prevalence of palliative care awareness among a nationally-representative sample of U.S. adults and to identify sociodemographic and health-related characteristics associated with palliative care awareness.
Weighted data from the Health Information National Trends Survey (HINTS 5, Cycle 2 2018,
= 3445) were used to produce frequencies of the characteristics, and associations with palliative care awareness were determined through multiple logistic regression.
An estimated 71% of U.S. adults reported having never heard of palliative care. Older individuals, those with higher educational attainment, women, and whites (vs. nonwhites) had greater odds of palliative care awareness.
These data suggest there is limited awareness of palliative care in the United States, despite its documented benefits. Addressing this awareness gap is a priority to change norms around using palliative care services. Community- and population-based interventions are necessary to raise awareness and inform the public about palliative care.
Objective: Patient-centered decision making requires cancer patients be actively involved and feel sufficiently informed about their care, but patients' preferences for information are often ...unrecognized or unmet by their oncologist, particularly for more distressing topics. This study examined cancer patients' preferences for information about three care-related topics: (1) diagnostic information, (2) treatment costs, and (3) prognosis. We tested whether factors known to influence information preferences (psychological distress, control preferences, and financial distress) were differently associated with information preferences for each topic. Methods: Cancer patients (N = 176) receiving ongoing treatment completed a questionnaire that assessed their out-of-pocket treatment costs, psychological distress, preferences for control over their medical decisions, and the amount of information they desired and received from their oncologists about the three topics. Results: Patients' preferences were less often met for treatment cost information than for the other topics, p < 0.001, with half wanting more cost information than they received. One-third of patients also wanted more prognostic information than they received. Patients' preferences for diagnostic information did not differ as a function of financial burden, distress, or control preferences, ps > 0.05. Preferences for cost information were greater among patients who preferred more control over their medical decisions, p = 0.016. Patients' preferences for prognostic information were greater among those desiring more control and with lower distress, ps < 0.05. Financial burden was not associated with information preferences. Conclusion: Appreciating the variability in information preferences across topics and patients may aid efforts to meet patients' information needs and improve outcomes.
Across 38 studies, interventions that changed people’s predictions about how a health choice or behavior would make them feel led to small, but consistent changes in behavioral outcomes
Abstract
...Background
People often use affective forecasts, or predictions about how a decision will make them feel, to guide medical and health decision making. However, these forecasts are susceptible to biases and inaccuracies that can have consequential effects on decision making and health.
Purpose
A meta-analysis was performed to determine the effectiveness of intervening to address affective forecasting as a means of helping patients make better health-related choices.
Methods
We included between-subjects experimental and intervention studies that targeted variables related to affective forecasting (e.g., anticipated regret, anticipated affect) as a means of changing health behaviors or decisions. We determined the overall effect of these interventions on targeted affective constructs and behavioral outcomes, and whether conceptual and methodological factors moderated these effects.
Results
A total of 133 independent effect sizes were identified from 37 publications (N = 72,020). Overall, affective forecasting interventions changed anticipated regret, d = 0.24, 95% confidence interval (CI) (0.15, 0.32), p < .001, behavior, d = 0.29, 95% CI (0.13, 0.45), p < .001, and behavioral intentions, d = 0.19, 95% CI (0.11, 0.28), p < .001, all measured immediately postintervention. Interventions did not change anticipated positive and negative affect, and effects on intentions and regret did not extend to follow-up time points, ps > .05. Generally, effects were not moderated by conceptual model, intervention intensity, or behavioral context.
Conclusions
Affective forecasting interventions had a small consistent effect on behavioral outcomes regardless of intervention intensity and conceptual framework, suggesting such constructs are promising intervention targets across several health domains.
The U.S. Preventive Services Task Force (USPSTF) issues “Insufficient Evidence” (I) statements when scientific evidence is inadequate for making recommendations about clinical preventive services. ...Insufficient Evidence statements may be changed to definitive recommendations if new research closes evidence gaps. This study examines the characteristics of evidence that informed changes from I statements to definitive recommendations, including NIH's role as a funder.
A total of 11 USPSTF Insufficient Evidence statements that were changed between 2010 and 2019 were assessed. Study designs, bibliometric influence, and funding sources for scientific articles cited in USPSTF evidence reviews were characterized for each I statement. Data were analyzed in 2019–2020.
Most I statements (82%) changed to a B grade; an average of 8.4 years elapsed between issuing the I statement and releasing the definitive recommendation. An average of 63 (range=19−253) articles were included in each USPSTF evidence review. NIH support was cited in 28.8% of articles, on average. The proportion of NIH-funded articles reporting RCT designs was similar to that of non–NIH-funded articles (64.5% vs 59.5%). A higher proportion of NIH-funded articles were rated good quality for study design (39.0%) than the proportion of non–NIH-funded articles (24.4%). Bibliometric influence measured by relative citation ratios was higher for NIH-funded (mean=14.78) than for non–NIH-funded (mean=5.07) articles.
Study designs and funding supports varied widely across topics, but overall, NIH was the largest single funder of evidence informing 11 changed USPSTF I statements. Enhanced efforts by NIH and other stakeholders to address I statement evidence gaps are needed.
Objective: Health behaviors, including smoking and fruit and vegetable consumption, are both associated with psychological distress and vary by race/ethnicity. The relation of global psychological ...distress to behavior also varies by race/ethnicity, but the specific negative affective states responsible for this effect are not known. This study examined how the relation of feelings of depression and anxiety to health behaviors differs by race/ethnicity. Method: Secondary data analysis of the HINTS nationally representative population survey was conducted. Survey participants reported their current symptoms of depression and anxiety, as well as smoking status and fruit and vegetable consumption. Survey weighted linear and logistic regression analyses were used to assess whether race/ethnicity moderated the relation of symptoms of depression and anxiety to smoking and fruit and vegetable consumption. Results: For symptoms of depression, but not anxiety, there was a significant interaction between race/ethnicity and psychological distress in predicting both smoking status and fruit and vegetable consumption. Greater depressive symptoms were related to a greater likelihood of smoking and lower fruit and vegetable consumption for White, but not Black respondents. For Hispanic respondents, depressive symptoms were associated with a greater likelihood of currently smoking, but were not associated with fruit and vegetable consumption. Conclusion: The association between depressive symptoms and both smoking and fruit and vegetable consumption differs as a function of race/ethnicity. These findings have implications for understanding the extent to which negative affective states influence health behaviors across different racial/ethnic groups, and for developing interventions that effectively target smoking and fruit and vegetable consumption among different racial/ethnic subgroups.
Objective: Habitual use of emotion regulation strategies may influence physical health. We examined whether the tendencies to employ cognitive reappraisal and suppression were associated with health ...biomarkers, and whether stress and sleep quality mediated these associations. Design & main outcome measures: Using data from the Biomarkers substudy (n = 1255) of the national Midlife in the U.S. Study, we tested the hypothesis that there would be indirect, but not direct, associations of cognitive reappraisal and suppression to biomarker indicators of multisystem physiological dysregulation, that is, allostatic load (AL). We computed the proportion of biomarkers in the highest risk quartile within seven biological systems, and summed these scores to compute AL. Associations with the biological systems were also examined separately.Results: Neither reappraisal nor suppression was directly associated with AL or biomarker function in the seven biological systems. Suppression was indirectly associated with higher AL and greater dysregulation in the inflammatory, metabolic, and hypothalamic-pituitary-adrenal systems via its relations to stress and sleep, p < 0.05. Reappraisal was indirectly associated with lower AL and less metabolic and inflammatory dysregulation, ps<0.05.Conclusions: Suppression and reappraisal may have different downstream health effects via stress, sleep, and biomarker expression, suggesting malleable emotion regulation strategies may be an important intervention target.
Objective
To define risk factors for meningioma-related seizures and predictors of successful weaning of antiseizure medications following meningioma resection.
Methods
This is a retrospective study ...of 95 patients who underwent meningioma resection at a single institution. Primary outcome analyzed was ability to achieve seizure freedom without the use of anti-seizure medication at 6-months, 1-year, and last known follow up. Secondary outcome was postoperative seizure freedom.
Results
Preoperative seizures (OR: 11.63, 95% CI 3.64, 37.17, p < 0.0001), non-skull base tumor location (OR: 3.01, 95% CI 1.29, 7.02, p = 0.0128), and modified STAMPE score of 3–5 (OR: 5.42, 95% CI 2.18, 13.52, p = 0.0003) were associated with greater likelihood of remaining on antiseizure medication at 6-month follow up. Preoperative seizures (OR: 4.93, 95% CI: 2.00, 12.16 , p = 0.0008), intratumoral calcifications (OR: 4.19, 95% CI: 1.61, 14.46, p = 0.0055), modified STAMPE score of 3–5 (OR: 5.42, CI 2.18, 13.52, p = 0.0003), and Ki67 greater than 7% (OR: 5.68, CI 1.61, 20.10, p = 0.0060) were significant risk factors for inability to discontinue ASMs by last follow up. Preoperative seizures (OR: 4.33, 95% CI 1.59, 11.85, p = 0.0050) and modified STAMPE score of 3–5 (OR: 6.09, 95% CI 2.16, 17.20, p = 0.0007) were significant risk factors for postoperative seizures.
Conclusions
Preoperative seizures, modified STAMPE2 score of 3–5, non-skull base tumor location, intratumoral calcifications, and Ki67 > 7% were significant risk factors for inability to achieve seizure freedom without ASMs. In addition, the modified STAMPE2 score successfully predicted increased seizure risk following meningioma resection for patients with a score of 3 or higher.
Objective: Goal-concordant care is an important feature of high quality medical treatment. Patients' care goals may focus on curative and/or palliative outcomes. Patients rarely communicate their ...care goals, and providers' predictions of patient goals are often inaccurate, corresponding most closely to their own treatment goals. This projection of own goals onto patients introduces the potential for bias, leading to goal-discordant care.
Design and Main Outcomes: We examined goal discordance using data from a U.S. sample of healthcare providers (N = 492) recruited online in 2017 using GfK Knowledge Panel. Providers reported their perceptions of their patients' care goals (curative relative to palliative), their own care goals if they were to become ill, and their willingness to deliver palliative care.
Results: For 28% of providers, their own care goals differed from their patients'. Providers were more likely to prioritise palliative care (relative to curative) in their own goals than in their predictions about patients' goals. Providers were more willing to deliver palliative care when their own goals prioritised more palliative relative to curative care, but their perceptions of patient goals were unassociated with willingness to provide it.
Conclusions: Efforts to improve goal communication and reduce projection biases among providers may facilitate goal-concordant care.
PDF
