Psychosocial Distress In Patients Research Articles

Psychosocial distress in patients treated for cancer pain: A prospective observational study

Untreated emotional distress negatively impacts the management of cancer pain. The authors evaluated 64 patients with cancer pain who completed baseline and follow-up measures to identify if (1) measures of psychosocial wellbeing, pain intensity, and pain management were associated with survival time; (2) higher opioid doses were associated with less psychosocial distress; and (3) intrasubject correlations across time altered the relationship between pain, depression, social support, spirituality, and increased desire for hastened death (DHD). The main outcome measures included the Brief Pain Inventory (BPI), Daily Morphine Equivalent Dose (DMED), Beck Depression Inventory-II (BDI-II), DHD scale, Bottomley Social Support Scale, FACIT Spiritual Well-Being Scale (FACIT-Sp), Karnofsky Performance Rating Scale (KPRS), and State-Trait Anxiety Inventory (STAI). There were significant differences between baseline and follow-up DHD (0.84 vs. 1.38, p = 0.021) and BPI scores (6.36 vs. 4.86, p < 0.001). Lower existential wellbeing was associated with reduced survival (HR = 0.78, p = 0.019); improvement in pain was associated with longer survival (HR = 1.33, p = 0.034). Higher religious wellbeing was associated with higher probability of survival to 1 year (HR = 0.41, p = 0.014), as was higher KPRS (HR = 0.97, p = 0.001) but not DMED >300 mg. Higher existential distress and lower Bottomley scores were associated with higher hazard ratios for death at 1 year (HR = 2.78, p = 0.02) and (HR = 14.94, p = 0.002). There were significant diferences in average BDI-J for persons with BPI > 7 versus those with moderate or mild pain (12.12 vs. 6.82, p < 0.0001) and in DHD (1.71 vs. 0.64, p = 0.002). Depression decreased in persons with DMED >300 mg between baseline and follow-up (-1.67 vs. 2.72, p = 0.024). Mean DHD was lower forpersons whose pain improved versus others (0.96 vs. 2.0, p = 0.026). A generalized linear model was conducted with DHD as the dependent variable and the other above variables as predictors. Higher existential wellbeing and KPRS were associated with lower DHD (beta = -0.135, p = 0.049) and (P = -0.79, p = 0.006), respectively. The major findings of this study are that in persons with cancer pain, lower social support and existential wellbeing, but not higher DMED, were associated with shorter survival time. Treatment of cancer pain was associated with lessening of emotional distress. Lower levels of existential wellbeing and physical performance status appear to be associated with greater DHD.

Evaluation of Important Contact Persons and Their Helpfulness in Coping with Metastatic Breast Cancer Induced Psycho-Social Distress. A Prospective Study at a Community-Based Oncology Group Practice in Germany.

Abstract Introduction: Since psycho-social distress is a prevalent condition in metastatic breast cancer patients, it is important to find out which contact persons are called on most frequently to find help in dealing with this situation. In addition to the significance of these contact persons we wanted to find out to what extend they were actually helpful for the patients when contacted.Methods: 57 patients with metastatic breast cancer visiting the practice in April and May 2009 were administered the Distress Thermometer (DT) and Problem List (PL). Thereafter a standardized personal interview was held concerning their important contact persons where patients were asked to name their important contact persons freely. After this additionally a list of possible contact persons was read to the patients to complete the set of persons the patient has contacted. For each contact person the patient was asked to indicate if this contact was helpful or not.Results: The mean distress level observed in this population of 57 metastatic breast cancer patients was 4.9. 36% showed a distress level &amp;gt; 5. Physical problems as a source of distress were stated by 93%, emotional, familial, practical or spiritual problems were causing distress in 72%, 26%, 21% and 4% respectively. 88% of patients named their oncologist as an important person to help them with their distress. Children, partner, friends and general practitioner were important persons for 70%, 65%, 60% and 54% respectively. Regarding only the free answers the order of the most important persons was partner (60%), children (54%), friends (42%), other family members (35%), oncologist (28%), general practitioner (14%). All patients (100%) who sought help from their oncologist described this as helpful. Children, partner, friends and general practitioner were helpful in 90%, 86%, 94% and 94% of cases. 10 patients (18%) had contacted a psychiatrist. This was helpful for 8 (80%) of these patients.There is a positive and statistically significant correlation between distress level and number of persons contacted. (r=.283; p=0.033).Conclusions: Psycho-social distress in patients with metastatic breast cancer is mostly caused by physical and emotional problems. Patients treated in an oncology practice reported a network of care-giving persons as helpful in the coping process. Persons described as being most helpful were oncologists, partner, children, friends an general practitioner. Patients with higher distress levels tend to contact more different persons in trying to find help. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1072.

3009 Evaluation of psycho-social distress in patients treated in a community based oncology group practice in Germany

3009 Evaluation of psycho-social distress in patients treated in a community based oncology group practice in Germany

Living with an Unfixable Heart: A Qualitative Study Exploring the Experience of Living with Advanced Heart Failure

Nurses working with patients with advanced heart failure need knowledge that will help us to help patients cope with their situations of chronic illness. However, our knowledge bank is deficient due to the scarcity of inquiry that takes the affected person's point of view as its central focus. The aim of this study was to describe patients' experiences of living with advanced heart failure. The study sample (N=9) consisted of male (N=6) and female (N=3) patients with advanced (NYHA classes III-IV) heart failure. The design was qualitative and open unstructured interviews were audio-taped and transcribed verbatim during 2006. Four main themes emerged: Living in the Shadow of Fear; Running on Empty; Living a Restricted life; and Battling the System. The experience of living with advanced heart failure was described as a fearful and tired sort of living characterised by escalating impotence and dependence. The findings suggest that there may be an illogical but enduring ethos of 'cure' pervading health care worker's attitudes to advanced heart failure care. This mindset might be working to hinder the application of additional or alternative therapies, which might better palliate the physical and psychosocial distress of patients.

Evaluation of psycho-social distress in patients treated in a community-based oncology group practice in Germany

e20577 Background: Systematic evaluation of psycho-social distress in oncology outpatients is an important issue. Therefore we assessed feasibility and benefit of standardized routine screening using the Distress Thermometer (DT) and the Problem List (PL) in daily practice. Methods: All patients attending the practice between July and September 2008 were administered the DT and the PL. Patients were classified into the disease groups solid tumors, hematological neoplasms, benign hematological diseases and other non-malignant diseases. The individual treatment phase was evaluated additionally. Participants in a mammography screening programme were assessed as a control group. 500 randomly selected patients were sent a feedback-form to describe how they experienced the DT's influence on the doctor-patient-communication. Results: The 1,446 patients reported an average distress level of 4.7 with 37% indicating a distress level &gt; 5. Patients with other non-malignant diseases (81% autoimmune diseases or hereditary hemochromatosis) showed the highest average distress level of 5.2. Regarding the treatment phases, the most distressed patients were patients who just learned about their diagnosis of relapsed or metastatic disease (6.4), patients receiving Best Supportive Care (5.4) and patients receiving adjuvant anti-hormonal therapy (5.4). The most frequently indicated problems causing distress were exhaustion/fatigue (49%), pain (44%), impaired mobility (41%) and sleep disorders (39%) respectively. Breast cancer patients stated a distress level of 5.2. The average distress level in 474 mammography screening participants was 3.3. 37% of 190 patients who returned the feedback-form indicated that the DT and PL were useful tools to speak to their doctor about their distress more precisely. 38% felt better than usual after this conversation. Conclusions: The study shows that cancer patients do not necessarily show higher distress than patients with severe non-malignant diseases. The problems patients most frequently indicate as distressing are somatic disorders. DT and PL are applicable for routine screening in an outpatient setting. Physicians as well as patients stated that the use of the DT improved the quality of their communication. No significant financial relationships to disclose.

Psycho-social distress in patients with chronic somatic diseases

Abstract. Research activities of the Department of Rehabilitation Psychology and Psychotherapy, University of Freiburg, mainly focus on psycho-social distress of patients with chronic somatic diseases. Examples of current or recent research projects are: 1. Meta-analysis on quality of life and health care costs in patients with somatic diseases and comorbid mental disorders: Preliminary results indicate a substantial negative effect of comorbid mental disorders on somatic and psychosocial aspects as well as health care costs. 2. Communication in cancer care from the patients’ perspective: Breast cancer patients who were more satisfied with the received information at baseline showed better psychological adjustment after three and six months. 3. Patients’ experiences as empowerment. German version of the website DIPEx with the modules diabetes and chronic pain: it is a free multimedia website with a database of patients’ experiences of their illnesses, linked with evidence-based information on these diseases, treatment options and facilities of support.

Predictors of Access to Palliative Care Services among Patients Who Died at a Comprehensive Cancer Center

Palliative care services can decrease physical and psychosocial distress in patients with advanced cancer. However, most patients with cancer die without access to palliative care services (APCS), and patterns of referral are not well understood. The purpose of this study was to determine predictors of patients' access to palliative care. We reviewed patient records from the computerized database at UT M. D. Anderson Cancer Center over 2 (2003 and 2004) to determine differences in characteristics and outcomes between patients with and without APCS. APCS was defined as a palliative care consultation and follow-up or transfer to the palliative care unit. A total of 499 of 1453 (34%) inpatients who died at our cancer center had APCS. There were no significant differences in race, age, or insurance status between the APCS groups. The two major predictors of a low rate of APCS were hematologic malignancies (20% rate of APCS versus 44% for solid tumors, p < 0.0001) and intensive care unit (ICU) admission (15% versus 52% for non-ICU admission, p < 0.0001). Patients with hematologic malignancies who were admitted to the ICU had the lowest APCS rate (10%, p < 0.0001). The median relative cost of care per patient for decedents with APCS was 0.62 compared to non-referred patients (p < 0.0001). APCS was lower among patients with hematologic malignancies and those admitted to the ICU. APCS resulted in a lower cost of care. Mortality in comprehensive cancer centers is quite variable among different primary malignancies. More research is needed to better define patterns of referral.

Psychosocial factors and 2-year outcome following bariatric surgery for weight loss.

How psychosocial factors may impact on weight loss after bariatric surgery is not well understood. This lack of knowledge is problematic, because there is a high prevalence of psychosocial distress in patients seeking treatment for obesity in hospital-based programs. The purpose of this study was to examine the relationship between preoperative psychosocial factors and eventual weight loss. Between 1987 and 1998, all individuals undergoing Roux-en-Y gastric bypass for weight loss in our institution had psychologic preoperative evaluations. Patients who were followed prospectively were studied. The relation of having received mental health treatment to percentage of excess weight loss at 2 years is examined using t-tests. 62 women and 18 men completed a 2-year follow-up. Patients who had received treatment for either substance abuse (n=10) or psychiatric co-morbidity (n=39) lost more weight compared with those without such histories (P<0.05, P <0.001 respectively). Given these results, it is plausible that a history of having received either psychiatric treatment for a disorder or counseling for substance abuse should not be a contraindication to bariatric surgery, and, in fact, may be prognostic of favorable outcome. Further research examining psychosocial factors and outcome from bariatric surgery is clearly warranted.

Adjustment to illness and dropout of chemotherapy

The study compares the adjustment to illness of a group of 53 cancer patients who dropped out of chemotherapy with a matched group of 53 cancer patients who completed their treatment. The patients were treated in five oncological institutes in Israel. We found differences both in the Psychosocial Adjustment to Illness Scale (PAIS) and Brief Symptom Inventory Scale (BSI). In both scales we found significant differences indicating that the degree of adjustment and the psychosocial distress of patients who dropped out of treatment was worse than that of patients who completed treatment.