Purpose
We aimed to assess the impact of implementing Edmonton Symptom Assessment System (ESAS) screening on health-related quality of life (HRQoL) and patient satisfaction with care (PSC) in ...ambulatory oncology patients. ESAS is now a standard of care in Ontario cancer centers, with the goal of improving symptom management in cancer patients, yet few studies examine impact of ESAS on patient outcomes.
Methods
We compared ambulatory oncology patients who were not screened prior to ESAS site implementation (2011–2012), to a similar group who were screened using ESAS after site implementation (2012–2013), to examine between-group differences in patient HRQoL, PSC outcomes, and supportive care needs (Supportive Care Service Survey). Both no-ESAS (
n
= 160) and ESAS (
n
= 108) groups completed these measures: the latter completing them, along with ESAS, at baseline and 2 weeks later.
Results
After assessing the impact of implementing ESAS, by matching for potentially confounding variables and conducting univariate analyses, no significant between-group differences were found in HRQoL or PSC. There was significant improvement in symptoms of nausea/vomiting and constipation, after 2 weeks. Lower symptom burden with decreased ESAS scores was significantly correlated with increased HRQoL. There were no between-group differences in knowledge of/access to supportive care.
Conclusions
Significant correlation between change in ESAS and HRQoL implies ESAS could usefully inform healthcare providers about need to respond to changes in symptom and functioning between visits. This study showed no impact of early-ESAS screening on HRQoL or PSC. Further research should explore how to better utilize ESAS screening, to improve communication, symptom management, and HRQoL.
Summary Wernicke-Korsakoff syndrome in patients with cancer is understudied. Much of what is known—that significant under-recognition and delays in treatment exist—comes from studies of alcohol ...misuse disorders or non-alcohol-related Wernicke-Korsakoff syndrome in patients. We investigated the frequency and associated features of cancer-related Wernicke-Korsakoff syndrome in the published literature. We included 90 articles reporting on 129 patients. Only 38 (30%) of 128 patients with data available exhibited the entire triad of classic features of Wernicke-Korsakoff syndrome: confusion, ataxia, and ophthalmoplegia or nystagmus. Diagnosis during life was missed altogether in 22 (17%) of 128 patients. The operational diagnostic criteria (at least two of the following: nutritional deficiency, ocular signs, cerebellar signs, and either altered mental status or mild memory impairment), which are considered more reliable than the classical triad, were used in only nine (7%) cases, yet 120 (94%) met the operational criteria for diagnosis at the time of presentation when applied retroactively. Complete recovery was reported in only 47 (36%) cases. Given that oncologists or haematologists accounted for only 17 (19%) first authors among the articles included, it is important that oncologists are aware of the risk factors for cancer-related Wernicke-Korsakoff syndrome, and that they are vigilant about diagnosing and treating the disease especially in the absence of alcohol misuse disorders.
Public safety personnel (PSP) and healthcare workers (HCWs) are frequently exposed to traumatic events and experience an increased rate of adverse mental health outcomes compared to the public. Some ...organizations have implemented wellness programming to mitigate this issue. To our knowledge, no programs were developed collaboratively by researchers and knowledge users considering knowledge translation and implementation science frameworks to include all evidence-informed elements of posttraumatic stress prevention. The Social Support, Tracking Distress, Education, and Discussion Community (STEADY) Program was developed to fill this gap. It includes (1) peer partnering; (2) distress tracking; (3) psychoeducation; (4) peer support groups and voluntary psychological debriefing following critical incidents; (5) community-building activities. This paper reports on the narrative literature review that framed the development of the STEADY framework and introduces its key elements. If successful, STEADY has the potential to improve the mental well-being of PSP and HCWs across Canada and internationally.
This study examines the rate and prediction of referral for specialized psychosocial oncology care in 326 patients with metastatic GI or lung cancer.
Referral information was abstracted from medical ...records and hospital databases. Patients completed measures of psychosocial and physical distress and functioning.
Routine referral occurred in 33% of patients, and in 42% and 44%, respectively, of those scoring high on measures of depression (Beck Depression Inventory BDI-II >or= 15) and hopelessness (Beck Hopelessness Scale >or= 8). Univariate analyses indicated that referral was associated with younger age, unmarried status, living alone, presence of more depressive symptoms, hopelessness, and attachment anxiety, and with less social support, self-esteem, and spiritual well-being (all P < .05). Among the significantly depressed (BDI-II >or= 15), 100% of those less than 40 years of age, but only 22% of those age 70 years or older were referred. Multivariate analyses indicated that referral was associated with younger age, unmarried status, and presence of more depressive symptoms. Moreover, increasing age was associated with a progressively lower likelihood of referral independent of the level of distress.
Routine referral of patients with metastatic cancer for psychosocial oncology care was predicted by presence of more severe depressive symptoms, younger age, and unmarried status. The rate of referral progressively declined with each decade of age, even among those with significant distress. These findings are consistent with some aspects of Andersen's model of health care utilization. The extent to which referred patients represent those who are most likely to benefit deserves further investigation.
Self-harm (SH) is one of the strongest predictors of eventual death by suicide. This study examines the potential protective role of reasons for living (RFL) and hope in youth with a history of ...self-harm using data from a randomized control trial (RCT) of brief cognitive behavioural therapy (BCBT). A single-blind, pilot RCT examined the efficacy of BCBT for suicide prevention versus an attentional control in youth aged 15-25 admitted to hospital following self-harm. Subjects’ reasons for living and hope were measured weekly by the Reasons for Living Scale (RFL) and Adult Hope Scale (AHS), respectively, for 10 weeks of acute treatment. Logistic regression was performed to evaluate whether baseline RFL and AHS scores predicted repeat self-harm. Mann-Whitney U tests were used to compare median RFL and AHS scores. Our study did not find associations between reasons for living or hope and repeat self-harm in youth. Treatment with BCBT was also not associated with improved scores on either measure.
•There was no association between baseline RFL or AHS scores and repeat self-harm.•Reasons for living and hope did not protect against repeat self-harm.•There were no differences in RFL or AHS scores across treatment conditions at Week 10.•BCBT did not improve reasons for living or hope compared to an attentional control.
Prostate cancer is the most common cancer diagnosis among men. Family caregivers (often female spouses) play a key role in ensuring patients' needs are met, frequently assuming their role with no ...formal training, which can contribute to a high burden. The purpose of this study was to pilot
-the first dyadic, Tailored, wEb-based, psychosocial and physical activity self-Management PrOgram for men with prostate cancer and their caregivers.
49 men with prostate cancer and their caregivers were randomized to
or usual care. Baseline and follow-up questionnaires were completed to assess feasibility, acceptability, and clinical significance. A priori benchmarks for these outcomes were set. Thirteen exit interviews were conducted to further explore acceptability.
Feasibility benchmarks were met with the exception for recruitment with on average 6.1 dyads recruited/month (benchmark: 8 dyads/month). Benchmarks of acceptability focused on attrition (<25%) and system usability, which were met. Using the strict criteria for adherence of 100% of the module viewed and participants spending at least 15 min on the module, 45% of participants were adherent. The clinical significance on anxiety and quality of life was supported for caregivers, and mostly supported for the men with prostate cancer.
This pilot trial was successful, with minor modifications needed prior to a large trial.
Objectifs : Améliorer les connaissances sur la pratique des soins compatissants en mettant en lumière le point de vue des patients sur la compassion, l’empathie et la sympathie.
Méthodes : Des ...entretiens téléphoniques semi-structurés ont été menés à deux moments précis avec des patients suivant un traitement contre le cancer de la tête et du cou. Les questions visaient à explorer la compréhension qu’ont les participants de la compassion, de la sympathie, de l’empathie et des relations mutuelles entre ces notions dans un contexte de soins de santé. Les chercheurs ont consigné manuellement les réponses. Des méthodes exploratoires qualitatives ont été utilisées pour analyser les données et un codage inductif ligne par ligne a été effectué pour développer des codes primaires. Une catégorisation des codes a ensuite permis de faire ressortir des thèmes récurrents.
Résultats : Quatre-vingt-quinze entretiens menés avec 63 participants à deux moments différents ont fait ressortir quatre thèmes principaux : 1) manifestations de bienveillance; 2) nature des interactions; 3) compassion, empathie et sympathie; 4) méthodes d’adaptation. Ces thèmes se subdivisaient en sept catégories, conduisant à un total de 24 codes. Les codes étaient cohérents d’un point de vue temporel, à l’exception de deux nouveaux codes, « positivité » et « personnalisé », apparus lors des entretiens de suivi.
Conclusions : Les témoignages des patients de cette étude ont conforté le concept selon lequel la compassion est multidimensionnelle et ont permis de définir plusieurs dimensions de ce sentiment, soulignant l’importance de tenir compte du point de vue des patients pour améliorer la prestation de soins compatissants. Les conclusions devraient être intégrées dans les formations et les pratiques futures.
To address the knowledge gap in the practice of compassionate healthcare by elucidating patient perspectives on compassion, empathy, and sympathy.
Semi-structured telephone interviews were conducted ...at two time points with patients undergoing head and neck cancer treatment. Questions explored participants' understanding of compassion, sympathy, and empathy, as they relate to each other and to healthcare. Interviewers manually recorded responses. Qualitative exploratory methods were used to analyze data; inductive line-by-line coding was conducted to develop primary codes. Themes emerged through categorization of codes.
Ninety-five interviews conducted with 63 participants across two time points revealed four major themes - Compassion-vs-Empathy-vs-Sympathy, Coping Methods, Showing Care, and Nature of Interaction - encompassing seven categories, with a total of 24 codes. Codes were consistent across time points, except for two new codes, "positivity" and "personalized" emerging during follow-up interviews.
Patient narrative from this study supported the concept that compassion is multidimensional and enabled several dimensions to be identified, highlighting the importance of patient perspectives in improving the provision of compassionate healthcare. Findings should be considered in future training and practice.
The COVID-19 pandemic has posed an ongoing threat to the mental wellbeing of countless individuals worldwide, with healthcare workers at particularly high risk. We developed the STEADY staff wellness ...program prior to the pandemic based on the available literature and input from stakeholders, guided by the Knowledge-to-Action (KTA) Implementation Science Framework. We quickly adapted the STEADY program for implementation in selected high-need units within Canada’s largest trauma hospital during the pandemic’s first wave. This brief report describes implementation of the STEADY program, retroactively applying the structure of the Knowledge-to-Action Implementation Science Framework to the practical steps taken. We identified the importance of more frequent, shorter contact with HCWs that occurred in-person, with an emphasis on peer support. A flexible approach with strong support from hospital leadership were key facilitators. Our findings suggest that a flexible approach to practical program implementation, theoretically underpinned in best-practices, can result in an acceptable program that promotes increased HCW wellbeing during a pandemic.
Posttraumatic Stress Disorder (PTSD) can be defined by the inability to recover from a traumatic event. A common misconception is that PTSD can only develop in circumstances of war or acute physical ...trauma. However, the diagnostic criteria of PTSD were adjusted in the Diagnostic Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) to include the diagnosis and treatment of a life-threatening illness, such as cancer, as a traumatic stressor that can result in PTSD. The word 'cancer' is so strongly linked to fear, stigma, and mortality, that some patients are fearful to even say 'the C word'. Therefore, it is not surprising that patients may experience a diagnosis of cancer as sudden, catastrophic, and/or life-threatening. Cancer-related PTSD (CR-PTSD) can negatively affect a patient's psychosocial and physical well-being during treatment and into survivorship. Unfortunately, CR-PTSD often goes undiagnosed and, consequentially, untreated. This article provides a general overview of PTSD with cancer as the traumatic event in order to define CR-PTSD, and reviews the growing pool of literature on this topic, including prevalence, risk factors, characterization, and treatment of CR-PTSD. The purpose of this article is to spread awareness of this relatively newly defined and commonly missed disorder among patients with cancer to clinicians and patients alike.
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