Emotional Distress In Patients Research Articles

Порівняльний аналіз субклінічного тривожно-депресивного синдрому в пацієнтів із гострим інфарктом міокарда з елевацією сегмента ST до та під час активних бойових дій у Харківській області

The aim – to assess subclinical emotional distress in patients with ST-Elevation Myocardial Infarction (STEMI) before and during the ongoing conflict in the Kharkiv Region. Materials and methods. The study encompassed 242 patients exhibiting subclinical emotional distress and hospitalized with STEMI at «L.T. Malaya TNI of NAMSU» before active conflict, compared with 65 patients during the conflict. Adherence to ethical standards was ensured, in line with the 1964 Helsinki Declaration, and the protocol received approval from the local ethics committee (Protocol № 8, dated 29.08.2016, and Protocol № 4, dated 12.05.2022). Participants completed the DASS-21 questionnaire, reflecting their emotional state 10–14 days prior, and received STEMI treatment as per current guidelines.Results. We showed that anxiety more frequent appeared during the active hostilities (p=0.0218). Depression had the influence on excessive smoking (p=0.0199), LV EF decrease (p=0.0057), LDL-C increase (p=0.0393). Anxiety and stress intrude into hypertension frequency (p=0.0171, p=0.0489) consequently as well as anxiety – on LDL-C increase (p=0.0068). All data of subclinical emotional distress during active hostilities associate with the frequency of smoking increase: p=0.0422 for depression, p=0.0275 for anxiety and p=0.0199 for stress. Depression associates with LVEF decrease (p=0.0267), the leucocytes count increase (p=0.0467), high frequency of hypertension (p=0.0410). Anxiety associates with higher heart rate (p=0.0277), depression and stress – with younger age (p=0.0369).Conclusions. Our research demonstrates close associations between the data of subclinical emotional distress both in patients with STEMI before and during the active hostilities in Kharkiv Region. Data were assessed with DASS-21 questionnaire on 10 –14 day prior the event. These results should be undertaken during general practitioner’s appointment to prevent further cardiovascular event.

Assessment of Behavioral Disorders in Iranian Children with Functional Constipation

Background: Functional constipation (FC) is a common issue in pediatric healthcare, causing significant physical and emotional distress for patients and their families. Objectives: This study aimed to investigate the prevalence of behavioral issues in children diagnosed with functional constipation, exploring their characteristics and relationship with various factors. Methods: We conducted a case-control study involving 107 children and adolescents (aged 2 to 18 years) with chronic functional constipation as the case group and 107 children without this condition as the control group. The Strengths and Difficulties Questionnaire (SDQ) was employed to evaluate different aspects of behavioral patterns. Results: The comparison of various behavioral components assessed by the SDQ between the case and control groups revealed significantly higher average scores for emotional symptoms (0.85 ± 0.81 vs. 0.55 ± 1.03, P = 0.019), peer relationship problems (1.76 ± 2.23 vs. 0.76 ± 1.18, P = 0.001), and prosocial behavior (8.12 ± 1.87 vs. 7.42 ± 1.64, P = 0.002) in children with chronic functional constipation. Within the chronic constipation group, peer relationship issues were more common in boys, whereas girls exhibited more problems with prosocial behavior. Moreover, issues related to hyperactivity/inattention and prosocial behavior were more frequent in older children with chronic constipation. Conclusions: Chronic functional constipation in children is strongly associated with behavioral changes and problems, which are influenced by the demographic and anthropometric features of the patients.

The Role and Limitations of the Reference Interval Within Clinical Chemistry and Its Reliability for Disease Detection.

Reference intervals (RIs) are a range of values that are supplied alongside laboratory measurements for comparison to allow interpretation of this data. Historically, RIs were referred to as the normal range. However, the perception of what is normal can lead to confusion in clinicians and unnecessary emotional distress in patients. RIs can be acquired using several methods. Laboratories may quote published studies or derive their own using established direct or indirect methods. Alternatively, laboratories may verify RIs provided by assay manufacturers using in-house studies. RIs have several limitations that clinicians should be aware of. The statistical methodology associated with establishment of RIs means that approximately 5% of "disease free" individuals will fall outside the RI. Additionally, the higher the number of tests requested, the higher the probability that one will be abnormal, and repeat results in an individual may show regression to the mean. Completion of studies for establishment of RIs can be expensive, difficult, and time consuming. Method bias and differences in populations can greatly influence RIs and prevent them from being transferable between some laboratories. Differences in individual characteristics such as age, ethnicity, and sex can result in large variation in some analytes. Some patients, such as those whose gender differs from that which was presumed for them at birth, may require their own RIs. Alternatively, a decision will need to be made about which to use. Overall, the issue common to these factors lies within interpretation. As such, RIs can be improved with better training in their use, combined with a better understanding of influences that affect them, and more transparent communication from laboratories in how RIs were derived.

When Germline Genetic Testing Results Are Unclear: Highlighting Variants of Uncertain Significance.

With the advent of high-throughput next-generation sequencing (NGS) and multigene panel testing, genetic testing and interpretations have become increasingly complex. Specifically, reports demonstrating "variant of uncertain significance" (VUS) present interpretative challenges. Misinterpretation of a VUS may result in clinical harm, emotional distress for patients and family members, and potential health-care provider liability. The following article and deidentified case study illustrate how a lack of health-care provider and patient understanding of a germline VUS resulted in a negative patient outcome and unnecessary surgery.

Unveiling the silent nemesis: periprosthetic joint infection-the burden and road to recovery

Periprosthetic joint infection (PJI) is a devastating complication of joint replacement surgery that poses significant challenges for patients and healthcare systems. It is associated with increased morbidity, financial burdens, and emotional distress for patients. Understanding the risk factors for PJI and implementing preventive strategies are crucial to reducing its incidence and mitigating its impact on both individuals and healthcare institutions.

Screening for Emotional Distress in Patients with Cardiovascular Disease.

In this article, we discuss the relationship between emotional distress and common cardiovascular disease condition, including coronary artery disease, atrial fibrillation, congestive heart failure, mechanical circulatory support, and heart transplant. We review screening measures that have been studied and used in clinical practice for each condition, as well as priorities for future research. Studies consistently demonstrate failing to identify and treat emotional distress in patients with cardiovascular disease is associated with adverse outcomes. However, routine emotional distress screening is not formally recommended for all cardiovascular disease conditions and is limited to depression screening in select patient populations. Future research should focus on evaluating the validity and reliability of standardized screening measures across the scope of emotional distress in patients with or at risk for cardiovascular disease. Other areas of future research include implementation of evidence-based pharmaceutical treatments and integrated behavioral health approaches and interventions.

Perceived dignity is an unrecognized source of emotional distress in patients with rheumatic diseases: Results from the validation of the Mexican version of the Patient Dignity Inventory.

Dignity has rarely been explored in patients with rheumatic diseases (RMDs), which contrasts with patients´ observations that dignity is a relevant area for research focus. The study's primary objective was to adapt and validate the Mexican version of the Patient Dignity Inventory (PDI-Mx) in patients with RMDs, and to estimate the proportion of patients with distress related to perceived dignity (DPD) assessed with the PDI-Mx. This cross-sectional study was developed in 2 phases. Phase 1 consisted of pilot testing and questionnaire feasibility (n = 50 patients), PDI-Mx content validity (experts' agreement), construct validity (exploratory factor analysis), discriminant validity (Heterotrait-Monotrait correlations' rate [HTMT]), criterion validity (Spearman correlations) and PDI-Mx reliability with internal consistency (Cronbach's alpha) and test-retest (intra-class correlation coefficients [ICC]) in 220 additional outpatients (among whom 30 underwent test-retest). Phase 2 consisted of quantifying DPD (PDI-Mx cut-off ≥54.4) in 290 outpatients with RMDs. Overall, patients were representative of typical outpatients with RMDs from a National tertiary care level center. The 25-item PDI-Mx was found feasible, valid (experts' agreement ≥82%; a 4-factor structure accounted for 68.7% of the total variance; HTMT = 0.608; the strength of the correlations was moderate to high between the PDI-Mx, the Depression, Anxiety, and Stress scale dimensions scores, and the Health Assessment Questionnaire Disability Index score) and reliable (Cronbach's ɑ = 0.962, ICC = 0.939 [95%CI = 0.913-0.961]). DPD was present in 78 patients (26.9%). The PDI-Mx questionnaire showed good psychometric properties for assessing DPD in our population. Perceived dignity in patients with RMDs might be an unrecognized source of emotional distress.

Trajectory analysis of microwave ablation treatment effect on the quality of life and emotional distress in patients with papillary thyroid cancer.

Trajectory changes of quality of life (QOL) and psychological status in patients with T1N0M0 papillary thyroid cancer (PTC) after microwave ablation (MWA) treatment. Patients with T1N0M0 PTC who underwent MWA from March to August 2021 were included in this study. Patients completed the European Organisation for Research and Treatment of Cancer questionnaire (QLQ-C30), Thyroid Cancer-Specific Quality of Life Questionnaire (THYCA-QOL) and Hospital Anxiety and Depression Scale (HADS) at baseline, 3 months, 6 months, 9 months and 12 months after MWA. 181 patients were enrolled in this study. All patients met a minimum of 12 months of follow-up. The QOL at baseline and 12 months after MWA were 14.95 ± 1.78 and 14.19 ± 1.73 (P < 0.01), respectively. Patients' anxiety was 3.33 ± 1.81 and 1.49 ± 2.14 (P < 0.01), respectively. Patients' depression was 2.14 ± 2.10 and 1.40 ± 2.22 (P < 0.01), respectively. In the trajectory analysis, 73%, 19% and 8% of patients achieved significant improvement, slight improvement and stable in QOL, respectively, with older, female, lower education and lower monthly income as the risk factors of QOL. 63%, 31% and 6% of patients achieved significant improvement, slight improvement and stable in anxiety, respectively, with younger, female, lower education, lower monthly income, unmarried or divorced and higher T3, T4 levels as the risk factors of anxiety. 72%, 21% and 7% of patients achieved significant improvement, slight improvement and stable in depression, respectively, with younger, lower monthly income and unmarried or divorced as the risk factors of depression. MWA can effectively improve the QOL and emotional distress of patients with T1N0M0 PTC.

Concurrent and Prospective Associations Between Communicated Emotional Arousal and Adjustment Among Couples Coping With Cancer.

The experience of cancer can create considerable emotional distress for patients and their committed partners. How couples communicate about cancer-related concerns can have important implications for adjustment. However, past research has primarily utilized cross-sectional designs and retrospective self-reports of couple communication. While informative, little is known about how patients and partners express emotion during conversations about cancer, and how these emotional patterns predict individual and relational adjustment. The current investigation examined how patterns of emotional arousal within couples' communication about cancer was associated with concurrent and prospective individual psychological and relational adjustment. At baseline, 133 patients with stage II- breast, lung, or colorectal cancer and their partners completed a conversation about a cancer-related concern. Vocally expressed emotional arousal (f0) was extracted from recorded conversations. Couples completed self-report measures of individual psychological and relational adjustment at baseline and at 4, 8, and 12 months later. Couples who started the conversation higher in f0 (i.e., greater emotional arousal) reported better individual and relational adjustment at baseline. If the non-cancer partner had lower f0 relative to patients, this predicted worse individual adjustment across follow-up. Additionally, couples who maintained their level of f0 rather than decreasing later in the conversation reported improvements in individual adjustment across follow-up. Elevated emotional arousal within a cancer-related conversation may be adaptive for adjustment, as it may reflect greater emotional engagement and processing of an important topic. These results may suggest ways for therapists to guide emotional engagement to enhance resilience in couples experiencing cancer.

Pre-treatment Emotional Distress in Patients Receiving Radiotherapy for Gynecologic Cancers.

Patients with gynecologic cancers selected for external-beam radiotherapy or brachytherapy may experience emotional distress. We aimed to identify patients who may benefit from early psycho-oncological intervention. We investigated 10 potential risk factors of emotional distress in a retrospective series of 122 patients planned for radiotherapy of gynecologic cancers. Factors included COVID-19 pandemic, number of physical problems, age, performance status, tumor site/stage, surgery, chemotherapy, brachytherapy, and history of another tumor. p-Values <0.005 indicated significance, and p-values <0.06 trends. Frequencies of worry, fear, sadness, depression, nervousness, and loss of interest were 41%, 57%, 39%, 16%, 38%, and 20%, respectively. Significant associations with at least one of these symptoms were found for ≥5 physical problems and no upfront surgery. Trends were observed for chemoradiotherapy, history of another tumor, worse performance status, and younger age. The prevalence of pre-radiotherapy emotional distress was remarkable in patients with gynecologic cancers. Patients with risk factors may benefit from immediate psycho-oncological assistance.

Prevalence of and Risk Factors for Emotional Distress in Patients Undergoing Radiotherapy for Lung Cancer.

Quality of life of patients with lung cancer can be impaired by psychological distress. This study evaluated prevalence of and risk factors for emotional distress in patients undergoing radiotherapy or chemoradiotherapy. Fourteen potential risk factors were retrospectively investigated in 144 patients. Emotional distress was evaluated with the National Comprehensive Cancer Network Distress Thermometer. Values of p<0.0036 (Bonferroni correction) were considered significant. At least one emotional problem (worry, fear, sadness, depression, nervousness, loss of interest) was reported by the majority of patients (N=93, 65%). Prevalence of these problems was 37%, 38%, 31%, 15%, 32% and 23%, respectively. Physical problems were significantly associated with worry (p=0.0029), fear (p=0.0030), sadness (p<0.0001), depression (p=0.0008), nervousness (p<0.0001), and loss of interest (p<0.0001). Age ≤69 years was associated with worry (p=0.0003), and female sex with fear (p=0.0002) and sadness (p=0.0026). Trends were found for associations of age with sadness (p=0.045), female sex with nervousness (p=0.034), and chemoradiotherapy with worry (p=0.027). Many patients with lung cancer experience emotional distress. Early psycho-oncological assistance may be important, particularly for high-risk patients.

Prevalence and Risk Factors of Emotional Distress in Patients With Prostate Cancer Assigned to External-beam Radiotherapy With or Without High-dose Rate Brachytherapy.

Upcoming radiotherapy for prostate cancer may lead to emotional distress. This study aimed to identify the prevalence and risk factors in a retrospective cohort of 102 patients. Thirteen characteristics were evaluated for six emotional problems. To account for multiple comparisons, Bonferroni correction was used; p-values <0.0038 were significant (alpha level <0.05). Prevalence of worry, fears, sadness, depression, nervousness, and loss of interest in usual activities was 25%, 27%, 11%, 11%, 18%, and 5%, respectively. A greater number of physical problems was significantly associated with worry (p=0.0037) and fears (p<0.0001) and showed trends regarding sadness (p=0.011) and depression (p=0.011). Trends were also found for associations between younger age and worry (p=0.021), advanced primary tumor stage and fears (p=0.025), patient's history of another malignancy and nervousness (p=0.035), and between external-beam radiotherapy alone and fears (p=0.042) or nervousness (p=0.037). Although the prevalence of emotional distress was comparably low, patients with risk factors may benefit from early psychological support.

Emotional Distress in a Patients Following Polytrauma.

Emotional affectivity can be described under two general dimensions: positive affectivity and negative affectivity. It is often assessed by means of questionnaires completed retrospectively by the subjects. The most common scales used are PANAS, DES, and PANA-X. All these scales are based on the concept of two dimensions, negative and positive affective emotions, respectively. Both dimensions mentioned, positive and negative affectivity, can be associated with a bipolar dimensional entity called pleasant-unpleasant. Specifically, a high level of positive emotions and a low level of negative emotions are associated with pleasant/positive feelings (happiness, well-being, satisfaction, cheerfulness, etc.), while a low level of positive emotions and a high level of negative emotions are associated with negative feelings (sadness, anger, nervousness, depression, anxiety, etc.). This study is an observational and cross-sectional study. The elements that led to the production of the final database were collected by means of a questionnaire, which included 43 items, 39 of which were specific questions found in the affective distress profile. The questionnaire was administered to 145 patients who had suffered polytrauma and were admitted to the Emergency Hospital of Galati in October 2022. The final centralizing tables included the characteristics of 145 patients, aged between 14 and 64 years. The aim of this study is to identify the level of emotional distress in patients who have suffered polytrauma, so the following scores were evaluated, obtained after the application of PDA: STD, ENF, END. The total distress score was obtained by summing all the negative items found in the PDA questionnaire. Men show a high level of emotional distress compared to women. Polytrauma has a negative effect on patients' emotional status, with a worrying prevalence of negative functional and dysfunctional emotions. The level of distress in polytrauma patients is high.

Emotional Distress Prior to Chemoradiation for Rectal or Anal Cancer.

Anticipation of chemoradiation has been reported to cause psychosocial distress in patients with rectal cancer. This study provides additional data regarding prevalence and risk factors of emotional distress in patients who received chemoradiation for rectal or anal cancer. Sixty-four patients were analyzed for emotional distress utilizing 12 factors. When applying the Bonferroni correction, p-values <0.0042 were considered significant. Worry, fears, sadness, depression, nervousness, and loss of interest in usual activities were reported by 31%, 47%, 33%, 11%, 47%, and 19% of patients, respectively. More physical problems were associated with fears (p=0.0030) and loss of interest (p=0.0021). Strong trends were observed for associations between female sex and sadness (p=0.0098) and between lower performance score and worry (p=0.0068) or fears (p=0.0064). A considerable proportion of patients reported emotional distress prior to chemoradiation for rectal or anal cancer. High-risk patients may benefit from early psycho-oncological support.

Pre-treatment Emotional Distress in Patients Irradiated for Malignant Glioma.

A recommendation of radiotherapy for patients with malignant gliomas may trigger emotional distress. Frequency and risk factors of this complication were investigated. Prevalence of six emotional problems and 11 potential risk factors were evaluated in 103 patients irradiated for grade II-IV gliomas. p-Values <0.0045 were considered significant. Seventy-six patients (74%) had ≥1 emotional problem. Prevalence of specific emotional problems ranged between 23% and 63%. Associations were found between ≥5 physical problems and worry (p=0.0010), fear (p=0.0001), sadness (p=0.0023), depression (p=0.0006), and loss of interest (p=0.0006), and Karnofsky performance score ≤80 and depression (p=0.0002). Trends were found for physical problems and nervousness (p=0.040), age ≥60 years and depression (p=0.043) or loss of interest (p=0.045), grade IV glioma and sadness (p=0.042), and ≥2 involved sites and loss of interest (p=0.022). Three-fourths of glioma patients had pre-radiotherapy emotional distress. Psychological support should be offered very soon, particularly for high-risk patients.

Cancer Fear, Emotion Regulation, and Emotional Distress in Patients With Newly Diagnosed Lung Cancer.

Research related to newly diagnosed lung cancer patients' emotional regulation strategies and how these strategies influence their emotional distress is scarce. The aim of this study was to investigate the relationship between cancer fear, emotion regulation, and emotional distress in patients with newly diagnosed lung cancer. A cross-sectional, correlation research design was conducted, using self-report questionnaires: the Cancer Fear Scale, the Emotion Regulation Questionnaire, and the Hospital Anxiety and Depression Scale. A total of 117 newly diagnosed lung cancer patients were sampled. Nearly 70% of newly diagnosed lung cancer patients had a high level of cancer fear; 56.4%, depression; and 45.3%, anxiety. Depression was positively associated with cancer fear ( r = 0.239, P < .01) and expressive suppression ( r = 0.185, P < .05), but negatively associated with cognitive reappraisal ( r = -0.323, P < .01). Anxiety was positively associated with cancer fear ( r = 0.488, P < .01) but negatively associated with cognitive reappraisal ( r = -0.214, P < .05). Cancer fear and cognitive reappraisal were significant explanatory factors and explained 25.2% of variance in anxiety. Cancer fear, expressive suppression, and cognitive reappraisal were significant explanatory factors and explained 16.7% of variance in depression. Newly diagnosed lung cancer patients with cancer fear and who used fewer cognitive reappraisal strategies or more expressive suppression had more emotional distress. Clinicians should be attentive to patients' cancer fears and emotion regulation strategies as early as possible to prevent their emotional distress.

A Dual Perspective of Psycho-Social Barriers and Challenges Experienced by Drug-Resistant TB Patients and Their Caregivers through the Course of Diagnosis and Treatment: Findings from a Qualitative Study in Bengaluru and Hyderabad Districts of South India.

Qualitative insights regarding psycho-social barriers and challenges experienced by drug-resistant tuberculosis (DR-TB) patients and their caregivers are understudied in India. We conducted a qualitative study using semi-structured qualitative interviews among treatment-completed DR-TB patients (n = 20) and caregivers (n = 20) in Bengaluru and Hyderabad districts, which represented two different socio-cultural settings in South India. Criterion sampling was used for recruiting the eligible participants who completed treatment with adherence. "Emotional issues and social barriers" were identified to represent a major challenge for patients and caregivers, which occurred acutely after disease diagnosis, characterized by fear and emotional distress due to their perceived loss of life prospects, severity of symptoms, discomfort, and disease denial. Medication intolerance, chronic symptoms, lack of visible signs of treatment progress, loss of weight, and physical concerns caused subsequent fear and distress during the treatment phases for patients along with experiences of stigma. External triggers generated "decisive moments" of hopelessness and life-ending thoughts for patients at the diagnosis and early treatment phase. Medication related challenges included the perceived burden and power of pills which caused emotional distress for patients and intolerance towards caregivers. Pill burden was found as consequential as the side effects of injections. Challenges related to lack of support were another major theme, in which caregivers lacked resources for treatment support and nutrition. Throughout treatment, caregivers and patients expressed concern about a lack of supportive care from family members, sympathy, and intangible social support. Challenges during hospital admission in terms of lack of privacy, quality of services, individual attention, and empathy from health care workers were reported by patients and caregivers. Despite better adherence, DR-TB patients and caregivers experienced considerable emotional and social consequences. Differentiating DR-TB patients and caregivers' issues at different stages of diagnosis and treatment could help improve patient-centered outcomes in India and other high-burden nations.

Screening diagnostics of emotional distress in patients with facial neuropathy

Patients with facial nerve neuropathy (NLN) are often emotionally labile, inadequately assess the severity of symptoms and prognosis of the disease, have low compliance and motivation for treatment and rehabilitation.The purpose of the study: to develop a screening method for assessing the attitude of a patient with NLN to the disease in order to determine his need for psychological assistance and identify factors affecting compliance and motivation for treatment and rehabilitation.Material and methods: the study included 80 patients with NLN of various genesis who applied during the first 3 months (group 1, n = 37) and 3 months after the onset of symptoms (group 2, n = 43). All patients underwent a neurological examination, an assessment of the severity of NLN on the House–Brackmann scale and were asked to fill out a questionnaire on screening diagnostics of indicators of emotional well-being.Results. In Group 1, the severity of the disease was due to weakness of facial muscles and lagophthalmos, in Group 2 — mainly complications in the form of muscle hypertonia (88.4% of patients) and synkinesias on the affected side (89.2%), while strength partially recovered from 6 [3; 6] to 3 [3; 4] points according to According to the House– Brackmann scale, and the frequency of lagophthalmos decreased by 2 times (from 78.4% to 32.6%). The severity of paresis was not correlated with the severity of emotional disorders (p = 0.607) and the presence of lagophthalmos — 3 [2; 6] versus 4 [2; 8] (p = 0.412). The total score of negative questionnaire responses was higher in patients with complications: muscle hypertonicity — 5 [3; 7] versus 3 [1; 5] (p = 0.033) and synkinesia — 6 [3.5; 7.5] versus 3 [2: 6] (p = 0.010). Moreover, the severity of emotional disorders was associated with the number of complications (p = 0.006). Patients believed that the disease made them less attractive (72.5%), others pay too much attention to the face (46.3%) and changed their attitude (18.8%). Since the acute period of NLN, the mood has changed in 65% of patients. Every second patient believed that the disease divided his life into “before” and “after”, every third answered: “this is the worst thing that happened to me in my life.” In three cases, statements of suicidal thoughts were noted. Patients who sought help in the chronic period of NLN are more dysfunctional in terms of emotional state — the total score of negative responses was 6 [3.5; 3] versus 3 [1; 5] (p = 0.001). A third of the patients were convinced that the main responsibility for recovery lies with doctors, so they are at risk of refusing treatment.Conclusion: in the debut of NLN, every second patient worries about appearance and notes a decrease in mood. Negative thoughts and feelings in patients in the chronic stage of the disease occur in 90% of cases. The developed screening method of psychological assessment of the patient’s attitude to the disease allows to determine the patient’s need for psychological help, to identify indications for consultation with a psychologist or psychiatrist.

Self-Hypnosis for Phantom Limb Pain: A Multiple-Case Study

Phantom limb pain occurs in more than half of the people who have undergone an amputation. Hypnosis can alleviate pain effectively in experimental, procedural, and chronic pain. Thus, in this multiple-case study, we determined whether hypnosis might be a successful complementary approach to help patients with phantom limb pain in alleviating their pain quality (i.e., sensitive and affective), intensity, fatigue, and emotional distress (i.e., anxiety and depression). Seven patients experiencing phantom limb pain were trained to perform self-hypnosis in five sessions over two and a half months. The patients were encouraged to practice at home daily throughout the study. Measures of the intensity of pain and fatigue, the severity of insomnia, anxiety, depression, and the quality of pain (i.e., sensitive and affective) were performed before and after self-hypnosis training. Six years after the completion of the study, the patients were contacted over the telephone to follow up on their practice of self-hypnosis. All patients reported a reduction in the intensity of pain, severity of insomnia, anxiety, and quality of pain. They also reported a positive change in their behaviors and the sensation of pain after performing hypnosis. At the six-year follow-up, three patients were still practicing hypnosis and reported better control over pain and being more relaxed. The main reason for most patients to stop practicing self-hypnosis was that they failed to find the time. Self-hypnosis can effectively ameliorate pain, fatigue, and emotional distress in patients suffering from phantom limb pain. Large-sample clinical trials with a mixed design are needed to confirm these results.

Patient efficacy in telehealth is moderated by distress among patients with cancer: A cross-sectional survey study.

1590 Background: The COVID-19 pandemic increased the use of telehealth to reduce exposure, which was critical for patients with cancer. The extent to which patients with cancer view telehealth visits as meeting their medical needs was investigated using a cross-sectional survey. Methods: Patients currently receiving cancer treatment at a single cancer institute who had had at least one telehealth visit were emailed an online survey. Response rate was 5% (94/1944). The survey measured patients’: 1) Emotional Thermometer (i.e. distress, anger, depression, anxiety, and need for help on a 0-10 scale); 2) Telehealth usability questionnaire (TUQ; 21-items with various subscales, like interaction quality; α=0.98).); and 3) Perceived Efficacy in Patient-Physician Interactions (PEPPI-5) scale (five items, e.g., “How confident are you in your ability to make the most of your visits with your doctors?”). Respondents completed the PEPPI-5 for in-person visits and for telehealth visits. Descriptive statistics were calculated for all measures. A generalized linear model was estimated predicting PEPPI-5 for telehealth visits from emotional thermometer and TUQ scores. The interaction between emotional thermometer and TUQ scores was estimated to test the hypothesis that emotional distress moderated the relationship between TUQ and efficacy in patient-provider interactions during telehealth visits. Results: Across all five thermometers, 30.8% (28/91) reported a high score on at least one metric. The most frequently reported high score was for anxiety, 23.3% (21/90) and least frequently reported high score was for anger, 12.2% (11/90). The mean TUQ score was 5.5 (SD=1.5) and mean PEPPI-5 score for telehealth visits was 8.1 (SD=2.4). As shown in Table, emotional thermometer scores did moderate the relation between TUQ and patient self-efficacy during telehealth visits. For high emotional thermometer scores, self-efficacy decreased as TUQ scores decreased. Conclusions: For patients experiencing high emotional distress, low comfort and ability with telehealth usability resulted in low patient self-efficacy in communicating with providers and getting medical needs met. Telehealth is a convenient and effective modality; however, in times of emotional distress for patients who are not familiar with telehealth, in-person clinic visits may result in greater patient self-efficacy.[Table: see text]