Psychosocial Distress Research Articles

A WeChat-based Intervention, Wellness Enhancement for Caregivers (WECARE), for Chinese American Dementia Caregivers: Pilot Assessment of Feasibility, Acceptability, and Preliminary Efficacy.

Chinese American family caregivers of persons with dementia experience high rates of psychosocial distress and adverse health outcomes. Due to their immigrant and minority status, they face substantial obstacles to care and support, including stigma and misperception of dementia, limited knowledge and use of welfare and services, and poor social support. Few interventions have been developed or tested for this vulnerable population. This study aims to pilot-test the Wellness Enhancement for Caregivers (WECARE) intervention, a culturally tailored program delivered via WeChat, a social media app highly popular in the Chinese population. The 7-week WECARE was designed specifically for Chinese American dementia caregivers to improve their caregiving skills, reduce stress, and enhance psychosocial well-being. Feasibility, acceptability, and preliminary efficacy of the WECARE were assessed in this pilot. A total of 24 Chinese American family caregivers of persons with dementia were recruited for a pre-post 1-arm trial of the WECARE. By subscribing to the WECARE official account, participants received interactive multimedia programs on their WeChat account multiple times a week for 7 weeks. A backend database automatically delivered program components and tracked user activities. Three online group meetings were organized to facilitate social networking. Participants completed a baseline and a follow-up survey. Feasibility was assessed by the follow-up rate and curriculum completion rate; acceptability was assessed by user satisfaction and perceived usefulness of the program; and efficacy was assessed with pre-post differences in 2 primary outcomes of depressive symptoms and caregiving burden. The intervention was completed by 23 participants with a retention rate of 96%. Most of them (n=20, 83%) were older than 50 years and the majority (n=17, 71%) were female. The backend database revealed that the mean curriculum completion rate was 67%. Participants also reported high rates of user satisfaction and perceived usefulness of the intervention and high ratings of weekly programs. The intervention led to significant improvement in participants' psychosocial health outcomes; their depressive symptoms reduced from 5.74 to 3.35 with an effect size of -0.89 and caregiving burden decreased from 25.78 to 21.96 with an effect size of -0.48. This pilot study suggests that WeChat-based WECARE intervention was feasible and acceptable; it also demonstrated initial efficacy in improving psychosocial well-being in Chinese American dementia caregivers. Further research with a control group is needed to assess its efficacy and effectiveness. The study highlights the need for more culturally appropriate mobile health interventions for Chinese American family caregivers of persons with dementia.

Abstract 1932: Evaluation of racial and ethnic psychotropic medication use among patients with colorectal cancer

Abstract Background: Colorectal cancer (CRC) is the 4th most common cancer type in the US. Following CRC treatment, about 37% of CRC survivors experience symptoms associated with anxiety and depression. Additionally, psychosocial distress is especially prevalent among CRC survivors with a stoma, and those reporting CRC-induced sexual dysfunction. Pharmacotherapy is one of the mainstay treatment options for psychological distress among patients with CRC. Research has shown that racial disparities are present with the use of supportive care medications in other cancer types. However, this has not been explored with the use of psychotropic medication for patients with CRC. The purpose of this research is to evaluate the presence of racial disparities in psychotropic medication use among patients with CRC. Methods: Utilizing the National Cancer Institute Surveillance Epidemiology and End Results (NCI SEER)- Medicare linked database, our analysis included all patients with a CRC diagnosis and an active outpatient prescription claims for psychotropic medications from 2009-2018. Prescription claims were specific to patients diagnosed with CRC and stratified by self-identified race and ethnicity. Patients who were on psychotropic medications before CRC diagnosis, or unspecified race or ethnicity were excluded from the analysis. Psychotropic medications consisted of anxiolytics, antidepressants, and antipsychotic medications. Results: 136,014 participants were included in the analysis. The racial and ethnic breakdown comprised of 81.56% White, 11.22% African American (AA), 2.66% Hispanic, 4.27% Asian/Pacific Islander (API), and 0.25% Native American (NA). Results are presented as unadjusted odds ratios (OR) and 95% confidence intervals (CI). Compared to White patients, AA (OR 0.53; 95% CI 0.50-0.56), API (OR 0.50; 95% CI 0.46-0.54), Hispanic (OR 0.64; 95% CI 0.58-0.71), and NA (OR 0.59; 95% CI 0.43-0.81) patients had lower utilization of anxiolytic medications. Regarding antidepressant use, AA (OR 0.55; 95% CI 0.53-0.57), API (OR 0.46; 95% CI 0.43-0.49), Hispanic (OR 0.73; 95% CI 0.68-0.79), and NA (OR 0.78; 95% CI 0.63-0.96) had lower utilization compared to White patients. Differences in antipsychotic medication use was observed with Asian/Pacific Islanders (OR 0.71; 95% CI 0.64-0.78) and Native Americans (OR 0.49; 95% CI 0.31-0.76) compared to White patients. No other racial differences in antipsychotic medications were identified. Conclusion: The study showed that racial and ethnic disparities are present with the use of psychotropic medications among patients with CRC. Racial and ethnic minority patients had lower use for most of the drug classes evaluated. Further research is warranted to assess the potential barriers and facilitators of psychotropic medication use among patients belonging to historically minoritized racial and ethnic groups. Citation Format: MegCholack Awunti, Yi Guo, Sherise Rogers, Lisa Scarton, Diana Wilkie, John Allen. Evaluation of racial and ethnic psychotropic medication use among patients with colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1932.

Cardiac Related Psychosocial Distress and Traumatic Distress in Individuals with Advanced Heart Failure

Guided by the Transactional Model of Stress and Coping, this study explored relationships between cardiac related psychosocial distress, traumatic distress, and the number of lifetime traumas in people with advanced heart failure. Utilizing a cross-sectional survey design, a convenience sample of participants with advanced heart failure who received treatment in Washington, DC, completed standardized measures. Bivariate analysis showed a statistically significant difference in mean number of exposures and distress associated with advanced heart failure therapies and linear relationships between exposures and traumatic distress, distress and traumatic distress, and exposures and distress, as well as between the number of exposures and distress and traumatic distress and between the distress and traumatic distress. Multivariate analysis suggested that the higher the number of reported traumatic events, the higher the distress, and the higher the distress, the higher the traumatic distress. Social workers and allied team members should consider how a patient’s distress relates to traumatic distress in the advanced stage heart failure population.

Depressive symptoms, but not moderate-to-vigorous physical activity, impacts sexual well-being and menopause-specific quality of life in middle-aged women

ABSTRACT Inadequate physical activity (PA), unhealthy weight status, prevalence of chronic conditions, and psychosocial distress are common in middle-aged women and are linked to reductions in well-being and quality of life. However, their potential interactive effects, specifically on sexual well-being and menopause-specific quality of life (MENQOL), have not been well characterized in postmenopausal women. PURPOSE: To determine if moderate-to-vigorous physical activity (MVPA) and adiposity (%Fat) influence sexual well-being and MENQOL outcomes, controlling for health status (chronic conditions; medications) and psychosocial well-being (depressive symptoms; perceived stress), in postmenopausal women. Postmenopausal women (n = 68, 58.6 ± 3.4 yr, 80.9 percent married/partnered, 51.5 percent overweight/obese, nonsmoking) were recruited through e-mail advertisements and flyers placed throughout the community. Participants were scheduled for two laboratory visits 7–10 days apart where they were objectively assessed for MVPA with accelerometers (in the interim), adiposity via dual-energy X-ray absorptiometry (DXA), and self-report questionnaires to determine health status, depressive symptoms, perceived stress, sexual well-being, and MENQOL. Lower MVPA and higher %Fat were associated with lower physical domain MENQOL (both r = .27, p < .05); health status and psychosocial well-being were not associated (all p > .05). Hierarchical regression analyses revealed 1) greater number of chronic conditions and medications, and depressive symptoms scores predicted less favorable sexual well-being, independent of MVPA and %Fat (standardized β range =.22–.56, all p < .05), 2) depression was most consistently associated with MENQOL (models p ≤ .001), and 3) greater adiposity augmented the negative influence of depression on the physical domain of MENQOL (β = .40. p = .002). CONCLUSIONS: PA may influence sexual well-being and MENQOL indirectly through positive impacts on adiposity, chronic conditions, and depressive symptoms in middle-aged postmenopausal women, a sector of the population often afflicted with compromised sexual well-being.

LBA02-06 PSYCHO-SOCIAL DISTRESS AND QUALITY OF LIFE IN PATIENTS AFTER RADICAL CYSTECTOMY: ONE YEAR FOLLOW-UP IN 842 GERMAN PATIENTS

You have accessJournal of UrologyCME1 Apr 2023LBA02-06 PSYCHO-SOCIAL DISTRESS AND QUALITY OF LIFE IN PATIENTS AFTER RADICAL CYSTECTOMY: ONE YEAR FOLLOW-UP IN 842 GERMAN PATIENTS Henning Bahlburg, Karl Tully, Florian Roghmann, Joachim Noldus, and Guido Mueller Henning BahlburgHenning Bahlburg More articles by this author , Karl TullyKarl Tully More articles by this author , Florian RoghmannFlorian Roghmann More articles by this author , Joachim NoldusJoachim Noldus More articles by this author , and Guido MuellerGuido Mueller More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003361.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: As both screening and treatment of patients with muscle-invasive bladder cancer improve, the rate of cancer survivors will increase. Therefore, long term medical, psychological and social effects should be investigated. This study aims to investigate psycho-social distress and quality of life in German patients after radical cystectomy (RC). METHODS: This study relied on prospectively collected data for patients, who underwent three weeks of inpatient rehabilitation after RC between April 2018 and December 2019. Data on psycho-social distress and quality of life were collected 4 weeks (T1), 6 months (T2) and 12 months (T3) post-surgery by validated instruments (QLQ-C30, QLQ-BLM, QSC-R10). Uni- and multivariate logistic regression was performed to identify predictors for high psycho-social distress. RESULTS: 842 patients (683 male, 159 female) were included. 447 patients (326 male, 121 female) received an IC, 395 (357 male, 38 female; p<0.001) received an INB. Tumor stage ≥pT3a (41.4% vs 24.1%; p<0.001) and lymph node metastases (19.9% vs 11.8%; p<0.001) were significantly more often present in patients with an IC. Health related quality of life (HRQoL) did not differ between the cohorts and steadily improved during follow-up. At T2, social, emotional and cognitive function as well as future worries and body image worsened in patients only to improve again at T3 in all patients, but especially in patients with an INB. Overall, 34.9% of all patients reported high psycho-social distress (QSC-R10 ≥15) at T1. During follow-up, no significant difference in psychosocial distress between both cohorts was observed. However, at both T2 and T3, over 40% of all patients still reported high psycho-social distress. Univariate regression analysis identified lymph node metastases as a predictor for high psycho-social distress at T3 (OR 2,123; CI 1,194–3,777; p=0,010). Multivariate regression analysis revealed both age ≤ 59 (OR 1,731; CI 1,056–2,838; p=0,030) and lymph node metastases (OR 2,073; CI 1,133–3,793; p=0,018) as predictors for high psycho-social distress at T3. CONCLUSIONS: Overall, HRQoL improves in all patients one year after RC. However, some sub-scales such as future worries, role function and emotional function still bother patients to varying degrees. A significant portion of both patients with an IC and an INB suffer from high psychosocial distress one year after RC. Especially young patients with lymph node metastases should be monitored regularly and undergo psychological counselling if necessary. Source of Funding: This study was funded by the “Nordrhein-Westfalen Association for the Fight Against Cancer, Germany.” The funder had no influence on the study design, data collection and analysis or preparation of the abstract. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1188 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Henning Bahlburg More articles by this author Karl Tully More articles by this author Florian Roghmann More articles by this author Joachim Noldus More articles by this author Guido Mueller More articles by this author Expand All Advertisement PDF downloadLoading ...

MP36-02 SAFETY AND EFFECTIVENESS OF INTRALESIONAL CLOSTRIDIUM HISTOLYTICUM INJECTIONS FOR ATYPICAL PRESENTATIONS OF PEYRONIE'S DISEASE

You have accessJournal of UrologyCME1 Apr 2023MP36-02 SAFETY AND EFFECTIVENESS OF INTRALESIONAL CLOSTRIDIUM HISTOLYTICUM INJECTIONS FOR ATYPICAL PRESENTATIONS OF PEYRONIE'S DISEASE Zhan Wu, Mystie Chen, Jasmine Kashkoush, and Ryan Mori Zhan WuZhan Wu More articles by this author , Mystie ChenMystie Chen More articles by this author , Jasmine KashkoushJasmine Kashkoush More articles by this author , and Ryan MoriRyan Mori More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003270.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Peyronie’s disease (PD) is a common condition that causes sexual dysfunction and significant psychosocial distress. Intralesional injection of Clostridium Histolyticum (CCH) is a safe and effective treatment for well selected patients with PD. Limited data currently address the use of CCH for atypical presentations of PD which include hourglass deformity, ventral curvature, multi-planar curvature, and calcified plaque. We aim to assess the safety and effectiveness of CCH for patients with atypical PD. METHODS: A retrospective review was conducted on patients who received CCH at an integrated health system from October 2016 to September 2022. Patients were split into two groups: typical PD and atypical PD. Atypical PD patients included those with hourglass deformity, ventral curvature, multi-planar curvature, and calcified plaque. Demographics, treatment details, objective outcomes (curvature assessments), patient-reported outcome measures (Peyronie’s Disease Questionnaire), and complications were assessed. RESULTS: 83 men with stable phase PD underwent intralesional CCH injections. The mean age was 55.27 (SD=8.09). This included 44 men (53%) with atypical PD: 25 with hourglass deformity, 16 with multi-planar curvature, 13 with calcified plaque, and 4 with ventral curvature. The mean absolute change in penile curvature for patients with atypical PD was similar to patients with typical PD (18.3 degrees vs. 20.8 degrees, p=0.294). This represented an overall improvement in curvature by 38.9% and 40.8% for atypical and typical PD respectively (p=0.656). CCH was equally well tolerated with both groups with only minor complications. The most common post-procedural complaints were ecchymosis and mild penile pain. Corporal rupture was exceedingly rare with 1 case in each group. The composite psychosocial/physical symptoms score on PDQ assessment decreased by 4.88 and 4.48 for typical and atypical PD respectively (p=0.859). Likewise, the composite symptom bother score of PDQ decreased by 4.13 and 2.76 for typical and atypical PD respectively (p=0.270). CONCLUSIONS: Intralesional CCH has been shown to be safe and effective for treatment of PD presenting as isolated unidirectional dorsal or lateral deformity. These data suggest CCH is safe and effective for atypical presentations of PD including hourglass deformity, ventral curvature, multi-planar curvatures, and calcified plaque. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e479 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zhan Wu More articles by this author Mystie Chen More articles by this author Jasmine Kashkoush More articles by this author Ryan Mori More articles by this author Expand All Advertisement PDF downloadLoading ...

The Psychosocial Impact of the COVID-19 Pandemic on Chronic Care Patients.

The COVID-19 pandemic has had a profound and pervasive impact on psychosocial health and disrupted care systems world-wide. Our research aims to assess the psychosocial impact of the pandemic and related changes in chronic care provision on patients with chronic obstructive pulmonary disease (COPD) and heart failure. A qualitative survey using semi-structured interviews was held among patients with COPD and heart failure. Using randomized sampling, 23 patients with COPD, heart failure, or both were recruited to participate in semi-structured interviews. Interviews were held by phone or videocall. The survey was held during the summer of 2021, when strict national containment strategies were widely implemented but gradually loosened and vaccination was ongoing. Inductive coding using Gioia's approach was used to analyze the data in Atlas.Ti 9.1 software. Using an iterative approach, the data were synthesized in a data structure and data table, which was analyzed using an interpretative approach. We found 3 aggregate dimensions in which the COVID-19 pandemic has a negative impact on psychosocial health of patients with chronic disease: (1) perceived vulnerability to disease, (2) influence of health policy, and (3) a mismatch of supply and demand of health care. In these dimensions, the impact of the COVID-19 crisis was found to have a negative impact on psychosocial well-being, compounded by national strategies to contain the pandemic and a disruption of chronic care for patients. Health care providers should be aware of a multidimensional nature of psychosocial distress for chronic disease patients due to the COVID-19 crisis. Future practice and health policy could be improved by increasing awareness among health care providers, promote regular attention for psychosocial well-being of patients, provision of clear information related to the pandemic, and strategies to secure continuity of care. Results of this study might be further explored in larger studies.

Individual and collective contribution of antenatal psychosocial distress conditions and preterm birth in Pakistani women.

We determined whether dimensions of psychosocial distress during pregnancy individually and collectively predicted preterm birth (PTB) in Pakistani women as it may be misleading to extrapolate results from literature predominantly conducted in high-income countries. This cohort study included 1603 women recruited from four Aga Khan Hospital for Women and Children in Sindh, Pakistan. The primary binary outcome of PTB (i.e., livebirth before 37 completed weeks' gestation) was regressed on self-reported symptoms of anxiety (Pregnancy-Related Anxiety (PRA) Scale and Spielberger State-Trait Anxiety Inventory Form Y-1), depression (Edinburgh Perinatal Depression Scale (EPDS)), and covariates such as chronic stress (Perceived Stress Scale) assessed with standardized question and scales with established language equivalency (Sindhi and Urdu). All 1603 births occurred between 24 and 43 completed weeks' gestation. PRA was a stronger predictor of PTB than other types of antenatal psychosocial distress conditions. Chronic stress had no effect on the strength of association between PRA and PTB and a slight but non-significant effect on depression. A planned pregnancy significantly lowered risk of PTB among women who experienced PRA. Aggregate antenatal psychosocial distress did not improve model prediction over PRA. Like studies in high-income countries, PRA became a strong predictor of PTB when considering interactive effects of whether the current pregnancy was planned. Women's resilience and abilities to make sexual and reproductive health decisions are important to integrate in future research. Findings should be generalized with caution as socio-cultural context is a likely effect modifier. We did not consider protective/strength-oriented factors, such as resilience among women.

Психологічна підтримка осіб схильних до соціального тривожного розладу у періоди надзвичайних ситуацій: пілотне дослідження у період пандемії COVID-19

Background: Social restrictions during the COVID-19 pandemic, such as being forced to stay at home, observing social distancing in public places, or having to switch to remote work (study), increased difficulties with social interaction. Although quarantine measures mitigated the "harmful impact of the pandemic" through psychological distancing from the typical stressors of social interaction, for individuals prone to social anxiety disorder, they contributed to the consolidation of avoidance strategies, prevented the disconfirmation of dysfunctional beliefs and unproductive expectations. Psychosocial support programs focused on affordable and flexible interventions will help improve resourcefulness, prevent excessive distress in difficult life circumstances, and relapse of comorbid mental health disorders. The aim: To study changes in symptoms and levels of psychosocial dysfunction in individuals with social anxiety disorder as a result of completing an online psychological support program based on low-intensity CBT. Materials and methods: One hundred thirteen individuals with a social anxiety disorder and/or complaints that meet the diagnostic criteria for this disorder according to DSM-5 were enrolled in an online low-intensity intervention program based on the cognitive-behavioral model during the COVID-19 pandemic. In 6 months after completing the program, 84 people underwent a mental state assessment using the SCL-90-R scale. Also, assessed was the influence of experiential (emotional) avoidance on the severity of symptoms and their reduction. Results. According to the results of the pilot study, it was found that the proposed program of psychosocial support for people suffering from social anxiety disorder contributed to the reduction of psychosocial distress and the severity of mental symptoms in the six months after its completion. Low-intensity techniques based on CBT, offered in an online format, have demonstrated effectiveness and sustainability of effects with regular practice in everyday life. Since the program is focused on reducing avoidance strategies as a pathogenetic mechanism, these changes can be considered preventive factors. Conclusions: The presented results are preliminary and limited by several factors: in particular, adaptation to martial law conditions. Considering the positive feedback from participants, the flexibility of the proposed program, and the prognostically positive results reflected in the moderate experimental effect of exposure on comorbid symptoms and the level of severity of distress, we see the perspective of further research and the implementation of the program for practical use.

COVID-19: Psychological distress, fear, and coping strategies among community members across the United Arab Emirates.

The COVID-19 pandemic impacted the psychosocial well-being of the United Arab Emirates [UAE] population like other communities internationally. We aimed to identify the factors associated with psychological distress, fear, and coping amongst community members across the UAE. We conducted a cross-sectional online survey across the UAE during November 2020. Adults aged ≥18 years, living in the UAE who were able to respond to an online questionnaire in English or Arabic were considered eligible to participate in the study. We used standard validated tools to measure psychological distress, fear and coping. Kessler Psychological Distress Scale [K10] was used to assess psychological distress, Fear of COVID-19 Scale [FCV-19S] was used to assess the level of fear, and Brief Resilient Coping Scale [BRCS] was used to assess the coping strategies. A total of 417 individuals participated in this study with a mean age of 29 [± 10.7] years. More than half of the participants experienced high to very high levels of psychological distress [55%] and a quarter experienced high levels of fear of COVID-19 [23.3%] with almost a third of them [36.2%] having low resilient coping. About 37.4% of the participants had work-related mental health impacts and 32.4% were perceived to have moderate to a great deal of distress due to a change of employment status during the pandemic. One in ten participants [9.4%] reported increased smoking. Increased smoking [AOR 8.66, 95% CIs 1.08-69.1,], increased alcohol drinking [AOR 2.39, 95% CIs 1.05-5.47] and higher levels of fear of COVID-19 [AOR 2.93, 95% CIs 1.83-4.67] were associated with moderate to very high levels of psychological distress. Being female [AOR 1.82, p = 0.030], having a pre-existing mental health condition [AOR 9.88, 95% p = 0.027], engaging in high-risk behaviors such as increased smoking [AOR 21.14, p = 0.003], increased alcohol drinking [AOR 1.48, p = 0.359] in the previous four weeks, and higher levels of fear of COVID-19 [AOR 4.18, p <0.001] were associated with moderate to very high levels of psychological distress. Also, being a smoker [AOR, 0.840, p = 0.011], and having a high level of fear [AOR 0.372, p = 0.001] were found to be associated with low resilient coping. Community members in the UAE are at a higher risk of psychosocial distress and fear during the COVID-19 pandemic. Thus, healthcare providers and policymakers would need to be more alert to provide specific mental health support strategies for their wellbeing.

The unmet need of psycho-oncology services for integrated cancer care in India: a review

Cancer has varied effects on mental health of the patients, their family and friends as well as the caregivers. The emotional, social, interpersonal, rehabilitative and psychological effects of cancer on all of them can contribute to psycho-social distress. Appropriately addressing psychological, social and behavioral issues through psycho-oncology services improves the physician-patient relationship, increase satisfaction to the ongoing treatment, create a positive attitude towards treatment and outcomes and improve the quality of life. It also has a role in preventive oncology as well as in cancer rehabilitation. Global recognition of the need of psycho-oncology services has led to establishment of a lot of international organizations and societies in the developed countries. On the other hand, there are no societies or standard guidelines for psychosocial care in India. Also, due to lack of awareness and cancer education, the stigma associated with this care compounded by the stigma associated with cancer is a major hindrance to availing mental health care in India. Identifying this unmet need, creating awareness about the need of distress management during key transitions in cancer care pathway and providing training and research opportunities in this field in India will pave the way to improve the outcomes of cancer treatment delivery and patient compliance as well as satisfaction to the provided care. Psycho-oncology services need to be integrated into the existing cancer care pathways in a structured manner so as to enable ease of availability of these services for the patients and their families when in need.

The Revised PENIS Score and proposal of the PACKAGE Checklist: a meta-epidemiologic study on penile amputation and replantation.

Penile amputation causes severe physical and psychosocial distress. Microsurgical implementation in penile replantation is presumed to be superior to surgical repair. This assumption has been difficult to verify. The purpose of this study was threefold: (1) to produce an updated review of penile replantation, substantiated by the largest sample size to date; (2) to appraise the comparative value of the novel PENIS Score and propose the PACKAGE Checklist, a guide for standardization of future case reports and reviews; and (3) to improve confusing terminology and recommend the standardization of vocabulary. A literature review assessed 432 full-text case reports in 20 languages and identified 123 microsurgical and 40 surgical cases of penile replantation. The novel PENIS Score stratified penile amputations based on 5 criteria: position along the shaft, extension through the penis, neurovascular repair, ischemia time and type, and severed edge condition and contamination. For the outcome measurements, a Kendall tau coefficient evaluated the association between each PENIS criterion for short-term postoperative complications and 3 outcome measures: erection, urination, and sensation. Less than half of surgical reports on penile replantation are sufficiently detailed to complete all PENIS Score criteria. The viability of microsurgical and surgical replantation was equivalent at 92% and 94%, respectively. A statistically significant correlation was found between microsurgical repair and the return of sensation but not with nerve repair. Return of sensation with nerve repair was 51%, and microsurgical replantation without nerve repair was 42%; both were significantly higher than the 14% for surgical replantation. Preservation of a skin bridge was associated with a 40% reduction in severe postoperative complications. Microsurgical replantation is superior in return of sensation, with or without nerve repair. Implementing the PACKAGE Checklist and PENIS Score will help inform case reports and reviews.

Willingness toward psychosocial support during cancer treatment: a critical yet challenging construct in psychosocial care.

Psychosocial distress screening, mandated by the American College Surgeons' Commission on Cancer, continues to be implemented across cancer centers nationwide. Although measuring distress is critical to identifying patients who may benefit from additional support, several studies suggest that distress screening may not actually increase patients' utilization of psychosocial services. While various investigators have identified barriers that may impede effective implementation of distress screening, we posit that patients' intrinsic motivation, which we term patients' willingness, may be the biggest predictor for whether cancer patients choose to engage with psychosocial services. In this commentary, we define patient willingness towards psychosocial services as a novel construct, distinct from the intention toward a certain behavior described across pre-existing models of health behavior change. Further, we offer a critical perspective of models of intervention design that focus on acceptability and feasibility as preliminary outcomes thought to encompass the willingness construct described herein. Finally, we summarize several health service models that successfully integrate psychosocial services alongside routine oncology care. Overall, we present an innovative model that acknowledges barriers and facilitators and underscores the critical role of willingness in health behavior change. Consideration of patients' willingness toward psychosocial care will move the field of psychosocial oncology forward in clinical practice, policy initiatives, and study design.

Building the foundation for a community-generated national research blueprint for inherited bleeding disorders: research priorities for ultra-rare inherited bleeding disorders

ABSTRACT Background Ultra-rare inherited bleeding disorders (BDs) present important challenges for generating a strong evidence foundation for optimal diagnosis and management. Without disorder-appropriate treatment, affected individuals potentially face life-threatening bleeding, delayed diagnosis, suboptimal management of invasive procedures, psychosocial distress, pain, and decreased quality-of-life. Research design and methods The National Hemophilia Foundation (NHF) and the American Thrombosis and Hemostasis Network identified the priorities of people with inherited BDs and their caregivers, through extensive inclusive community consultations, to inform a blueprint for future decades of research. Multidisciplinary expert Working Group (WG) 3 distilled highly feasible transformative ultra-rare inherited BD research opportunities from the community-identified priorities. Results WG3 identified three focus areas with the potential to advance the needs of all people with ultra-rare inherited BDs and scored the feasibility, impact, and risk of priority initiatives, including 13 in systems biology and mechanistic science; 2 in clinical research, data collection, and research infrastructure; and 5 in the regulatory process for novel therapeutics and required data collection. Conclusions Centralization and expansion of expertise and resources, flexible innovative research and regulatory approaches, and inclusion of all people with ultra-rare inherited BDs and their health care professionals will be essential to capitalize on the opportunities outlined herein.

Development, validation and psychometric evaluation of the Chinese version of the biopsychosocial impact scale in orofacial pain patients.

The objective of this study was to develop the Chinese version of the biopsychosocial impact scale (BPIm-S) to assess functional limitation and psychosocial distress in orofacial pain (OFP) patients in mainland China, and investigate the factor structure, reliability and validity, measurement invariance, as well as scores differences across genders, age and educational status among OFP patients. The BPIm-S was developed and evaluated in four stages: (1) concept selection and item generation; (2) a pilot study assessing face and content validity; (3) the factors structure, reliability, convergent validity, and measurement invariance; and (4) concurrent validity and clinical responsiveness. Exploratory (EFA) and confirmatory factor analyses (CFA) were performed on data gathered from 406 OFP patients to assess construct validity. Composite Reliability (CR) and the Average Variance Extracted (AVE) were used to assess internal convergent validity. CR, internal consistency, and split-half reliability were also performed to determine the reliability. Multigroup CFA (MGCFA) was used to assess measurement invariance across genders, age and educational status. Mann-Whitney test compared scores across different genders, age and educational status. Participants completed the BPIm-S, visual analog scale (VAS), brief pain inventory facial (BPI-F), General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9), and spearman's correlation coefficient was used to evaluate the concurrent validity and item-total correlations. A total of 12 patients with OFP completed the BPIm-S twice to test clinical responsiveness. To conduct the CFA and measurement invariance analysis, Mplus 8.4 was used. IBM SPSS Statistics 21 software and SPSSAU, a web-based data science algorithm platform tool, were used for all additional studies. For the preliminary version, 17 items were chosen. A total of four items were removed following the pilot research. The remaining 13 items of the BPIm-S comprised an overall summary scale. Excellent reliability (Item-to-total correlations ranged from 0.763 to 0.912) and strong internal consistency (Cronbach's α = 0.970, functional limitation, 0.962, and psychosocial distress, 0.977) were discovered. CFA also validated the structural validity of the 13-item scale. EFA was performed and a two-factor structure was investigated. In addition, MGCFA corroborated the measurement invariance of the BPIm-S across gender, age, and educational status. Patients over the age of 30, those with a medium level of education, and those with a low level of education showed substantially greater levels of functional limitation and psychological distress (Wilcoxon test, p < 0.001). Both concurrent validity and clinical responsiveness were assessed to be of good quality. The BPIm-S demonstrated good psychometric qualities and is a reliable tool that can now be used by clinicians to evaluate functional limitation and psychosocial distress among OFP patient.

Financial toxicity in cancer patients undergoing radiotherapy in a universal health care system – A prospective multicenter study of 1075 patients

PurposeTo establish and confirm prevalence as well as risk factors of financial toxicity in a large national cohort of cancer patients undergoing radiotherapy in a universal health care system. MethodsWe conducted a prospective cross-sectional study offering a patient-reported questionnaire to all eligible cancer patients treated with radiotherapy in 11 centers in Germany during 60 consecutive days. The four-point subjective financial distress question of the EORTC QLQ-C30 was used as a surrogate for financial toxicity. Confirmatory hypothesis testing evaluated the primary study outcomes: overall prevalence of financial toxicity and its association with predefined risk factors. P-values < 0.05 were considered statistically significant. ResultsOf 2341 eligible patients, 1075 (46%) participated. The prevalence of subjective financial distress (=any grade higher than not present) was 41% (438/1075) exceeding the hypothesized range of 26.04–36.31%. Subjective financial distress was felt “A little” by 26% (280/1075), “Quite a bit” by 11% (113/1075) and “Very much” by 4% (45/1075) of the patients. Lower household income, lower global health status/ quality of life, higher direct costs and higher loss of income significantly predicted higher subjective financial distress per ordinal regression and confirmed these risk factors. Higher psychosocial distress and lower patient satisfaction were significantly associated with higher subjective financial distress in an exploratory ordinal regression model. ConclusionThe overall prevalence of financial toxicity was higher than anticipated, although reported at low or moderate degrees by most affected patients. As we confirmed risk factors associated with financial toxicity, patients at risk should be addressed early for potential support.

Keys to Successful Education for Patients with Genital Warts with Emphasis on the Presenting Male Patient

Genital warts (condyloma acuminatum) are the clinical manifestations of the Human papillomavirus (HPV) type 6 and 11. HPV is the most common sexually transmitted infection in the United States and genital warts are sexually acquired low-risk strains of HPV. Although genital warts are not a life-threatening condition, they can be a cause of morbidity and psychosocial distress for patients and their sexual partners. Since genital warts are common in clinical practice with men predominantly presenting to the dermatology clinic, providers are given an important window for treatment, compassionate education with the possibility of vaccination discussion. This article will provide comprehensive guidance and a patient question/answer template to better assist these visits in order to facilitate broader conversations around HPV and destigmatize genital warts.

Economic and Psychosocial Impact of COVID-19 in the Hispanic Community Health Study/Study of Latinos.

To examine the prevalence and correlates of economic hardship and psychosocial distress experienced during the initial phase of the coronavirus disease 2019 (COVID-19) pandemic in a large cohort of Hispanic/Latino adults. The Hispanic Community Health Study/Study of Latinos (HCHS/SOL), an ongoing multicenter study of Hispanic/Latino adults, collected information about COVID-19 illness and psychosocial and economic distress that occurred during the pandemic (N=11,283). We estimated the prevalence of these experiences during the initial phase of the pandemic (May 2020 to May 2021) and examined the prepandemic factors associated with pandemic-related economic hardship and emotional distress using multivariable log linear models with binomial distributions to estimate prevalence ratios. Almost half of the households reported job losses and a third reported economic hardship during the first year of the pandemic. Pandemic-related household job losses and economic hardship were more pronounced among noncitizens who are likely to be undocumented. Pandemic-related economic hardship and psychosocial distress varied by age group and sex. Contrary to the economic hardship findings, noncitizens were less likely to report pandemic-related psychosocial distress. Prepandemic social resources were inversely related to psychosocial distress. The study findings underscore the economic vulnerability that the pandemic has brought to ethnic minoritized and immigrant populations in the United States, in particular noncitizens. The study also highlights the need to incorporate documentation status as a social determinant of health. Characterizing the initial economic and mental health impact of the pandemic is important for understanding the pandemic consequences on future health. Clinical Trial Registration Number: NCT02060344.

Paternal Perinatal Experiences during the COVID-19 Pandemic: A Framework Analysis of the Reddit Forum Predaddit.

During the COVID-19 pandemic, new parents were disproportionately affected by public health restrictions changing service accessibility and increasing stressors. However, minimal research has examined pandemic-related stressors and experiences of perinatal fathers in naturalistic anonymous settings. An important and novel way parents seek connection and information is through online forums, which increased during COVID-19. The current study qualitatively analyzed the experiences of perinatal fathers from September to December 2020 through the Framework Analytic Approach to identify unmet support needs during COVID-19 using the online forum predaddit on reddit. Five main themes in the thematic framework included forum use, COVID-19, psychosocial distress, family functioning, and child health and development, each with related subthemes. Findings highlight the utility of predaddit as a source of information for, and interactions of, fathers to inform mental health services. Overall, fathers used the forum to engage with other fathers during a time of social isolation and for support during the transition to parenthood. This manuscript highlights the unmet support needs of fathers during the perinatal period and the importance of including fathers in perinatal care, implementing routine perinatal mood screening for both parents, and developing programs to support fathers during this transition to promote family wellbeing.

Abstract P6-05-29: Experience of Financial Toxicity and Distress Among Individuals Diagnosed with Triple Negative Breast Cancer: Findings from the Cancer Experience Registry

Abstract Background: Financial toxicity associated with cancer and its treatment can negatively impact treatment adherence and quality of life. Individuals with triple negative breast cancer (TNBC) may be at increased risk for financial toxicity due to the aggressive nature of the disease and high rate of recurrence. The objective of this study was to characterize financial experiences of TNBC survivors, their descriptions of communication with providers concerning treatment costs, and correlations between financial toxicity and psychosocial distress. Methods: From July 2017 to August 2021, 94 individuals with TNBC took part in Cancer Support Community’s Cancer Experience Registry® (CER). Participants completed items related to financial distress, including COmprehensive Score for Financial Toxicity (COST), an 11-item (0=Not at all, 4=Very much) measure of financial well-being (range 0-44; lower scores indicate worse financial well-being), dichotomous (yes or no) items assessing patient-provider communication, and Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29 v2.0). Bivariate relations were assessed using Pearson’s correlation. Results: Participants were 81% non-Hispanic White, 6% Black, and 6% Hispanic. Mean age was 52 years (SD=11.3); 14 (15%) reported household income &amp;lt;$40K. Median time since diagnosis was 2 years; 15% (n=14) reported metastatic breast cancer and 36% were currently receiving treatment. Concerning out-of-pocket cancer-related costs, 56% of our sample reported spending &amp;gt;$250 per month; 32% &amp;gt;$500; 13% &amp;gt;$1000. To reduce costs, 23% sometimes, often, or always postponed seeking psychological support, 19% delayed follow-up on recommendations, 6% postponed doctor’s appointments, and 5% skipped medication. The mean COST score was 23.0 (SD=12.3), indicating mild financial distress overall. Less than half of the sample (46%) indicated no financial toxicity (scores &amp;gt;25), 29% mild financial toxicity (scores 14-25), 22% moderate (score 1-13), and 3% severe (score of 0). The frequency of individual COST items showed 61% reported (somewhat, quite a bit, or very much) worry about future financial problems due to treatment costs; 14% were unable to meet monthly expenses; 49% reported concern about keeping their job or income; 47% reported frustration that they could not work or contribute as usual. COST scores were inversely correlated to PROMIS anxiety (r=-.45, p&amp;lt;.001), depression (r=-.44, p&amp;lt;.001), and sleep disturbance subscales (r=-.48, p&amp;lt;.001), such that lower financial well-being related to more symptomology. COST scores were positively associated with the social function subscale (r=.46, p&amp;lt;.001), so that better financial well-being related to higher social functioning. Regarding patient-provider communication, 70% reported their health care team did not discuss costs, 62% did not discuss impact of TNBC and treatment on work, and 59% did not discuss financial concerns. One-third (34%) wished they received more financial advice and assistance. Conclusion: In this sample of TNBC patients, average levels of financial toxicity were in the mild range. However, many reported moderate to severe toxicity (25%). Greater financial toxicity related to increased symptoms of anxiety, depression, sleep disturbance, and worse social functioning. Despite this, results indicate there is little patient-provider discussion about financial burden, with more than half of our sample reporting their health care team did not discuss costs, impact on work, or financial distress. One-third of participants indicated desire for more financial advice and assistance highlighting an opportunity to better serve TNBC patients, who may be at an increased risk of financial toxicity. Citation Format: Kara Doughtie, Erica E. Fortune, Heather Badt, Caroline Lawrence, Madyson L. Popalis, Melissa F. Miller. Experience of Financial Toxicity and Distress Among Individuals Diagnosed with Triple Negative Breast Cancer: Findings from the Cancer Experience Registry [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-29.