Risk For Premature Termination Research Articles

Clinical predictors of premature radiotherapy terminations in senior adults with oral cavity and laryngeal carcinoma.

The underlying factors that contribute to early radiotherapy (RT) termination are understudied, especially in the era of hypofractionated treatment regimens. In this retrospective investigation, we examined the characteristics and causes of premature RT terminations in senior adults (>70 years old) with oral cavity (OC) and laryngeal carcinomas. Hundred and eighty-eight patients treated with RT ± systemic therapy for OC and laryngeal cancer from 2017 to 2022 were identified. Premature termination was defined as completion of less than 95% of the prescribed RT. Logistic regression analysis was performed to examine factors predictive of premature termination, and survival was determined using the Kaplan-Meier method. Twenty patients (10.6%) experienced premature RT terminations. On regression analysis, ECOG score at initiation of RT was the only covariate studied to be independently associated with premature termination (OR 2.00, 95%CI: [1.21, 3.30], p = 0.007). Three-year overall survival (49.1% vs. 77.3%) was significantly reduced in the termination cohort (p < 0.0001). This analysis demonstrated over 1 in 10 patients had premature RT termination, which prognosticated inferior survival outcomes. Poor performance status may highlight patients at risk for premature termination and thus identify good candidates for hypofractionated protocols.

Characteristics of Premature Radiotherapy Terminations in Patients with Oral Cavity and Laryngeal Carcinomas

Premature radiation therapy (RT) terminations in patients with head and neck cancer result in poor outcomes. However, the underlying factors that contribute to early RT termination are understudied, especially in the era of hypofractionated treatment. In this retrospective single institution study, we examined causes and clinical characteristics of premature terminations in oral cavity (OC) and laryngeal carcinomas. We reviewed charts of 188 patients treated with RT ± systemic therapy for OC and laryngeal cancer from 2017-2022. Patients were typically prescribed standard 1.8-2.0 Gy fractionation regimens, though patients deemed unlikely to complete conventional RT upon initial evaluation were given SBRT. Premature termination was defined as completion of less than 95% prescribed RT. We collected pertinent demographic, clinicopathological data on this termination cohort, which was compared to a matched cohort of patients with RT completion. We used logistic regression analysis to examine factors predictive of premature termination. Of the patients included in this analysis, 72.7% were prescribed adjuvant RT [9.1% OC, 45.5% larynx] vs. 27.3% primary RT [90.9% OC, 45.5% larynx]. 84.6% received conventional IMRT, while 15.4% received SBRT. 17 patients (9.0%) had premature RT (all IMRT) terminations- 9 OC and 8 laryngeal primaries. Mean age of those who had premature termination was 79.5 years (range: 70-98). 70.6% were male, 58.8% were white, and 23.5% were single/widowed. Majority received concurrent systemic therapy (58.8%), had AJCC (8th Ed.) Stage ≥ III (76.5%), Charlson-Comorbidity Index ≥6 (64.7%), ECOG score ≥2 (70.6%), smoked >10 pack-years (76.5%), and lived >10 miles from RT facility (58.8%). The most common documented reasons for premature termination were: subjective intolerance (29.4%), death (23.5%), objective RT toxicity (23.5%), and inpatient admission (17.6%). The mean time on treatment for IMRT was 27.8 days for termination cohort vs. 47.7 days for completion cohort. The percentage of patients reporting RT toxicity (CTCAE v5.0 mucositis, severe weight loss, oral infection, e.g.) was 88.2% for termination cohort vs. 29.6% for completion cohort. On regression analysis, ECOG score at the time of initiation of RT was independently associated with premature termination (OR: 2.438, 95% CI: 1.155-5.146, p = .019). This retrospective analysis of patients undergoing RT for OC and laryngeal cancers at our tertiary care center demonstrated nearly 1 in 10 patients are at risk for premature termination. Poor performance status was independently associated with premature termination. There was a 100% completion rate in hypofractionated treatment with SBRT. Taken together, poor performance status may identify patients at risk for premature termination and thus identify good candidates for SBRT protocols.

Alternative model of personality disorders traits predict residential addictions treatment completion

BackgroundAmong people receiving residential treatment for a substance use disorder (SUD), premature treatment termination predicts poor post-treatment outcomes. We examined the utility of the alternative model for personality disorders (AMPD) for predicting premature residential SUD treatment termination, including interactions with age and gender. MethodsParticipants (N = 374) were receiving residential treatment for SUD and enrolled in a clinical trial with two conditions: Skills for Improving Distress Intolerance (SIDI) and Supportive Counseling (NCT01741415). Participants were assessed at intake on AMPD traits using the Personality Inventory for DSM-5 (PID-5) and tracked longitudinally. After establishing gender and age measurement invariance, we used competing risk models to predict treatment completion versus premature termination using interactions of PID-5 scores with age and gender. FindingsDisinhibition and Negative Emotionality domains and facets predicted premature treatment termination, particularly among younger, male participants. There were positive effects of SIDI on treatment completion for participants with high levels of domain and facet Negative Emotionality. A small proportion (≈ 12 %) of the PID-5 items showed differential item functioning by age or gender; however, the aggregate impact on test-level total scores was negligible. ConclusionsParticipants (particularly young men) displaying poor self-control and emotional regulation are at risk for premature termination. These findings, together with minimal aggregate differential item functioning at the scale level, suggest that the PID-5 is a practically useful, construct-valid, non-proprietary measure, aspects of which can be used for screening in residential SUD treatment. Furthermore, among those with high negative emotionality, SIDI may be effective in preventing premature treatment termination.

Maternal Support and Attrition from Child Trauma-Focused Therapy.

Many children prematurely terminate from trauma-focused therapy (TFT), and attrition is a critical barrier in addressing the impacts of childhood sexual abuse (CSA). The field's knowledge of risk factors for dropout is growing; however, one aspect of the child's environment that remains unexamined is maternal support following the CSA disclosure/discovery. Maternal support has been theorized to play a valuable role in influencing children's outcomes after CSA and may be relevant in understanding attrition. The objective of the current study was to investigate the associations between children's symptoms, relationship to the perpetrator, and maternal support in relation to premature termination from TFT among 186 sexually abused children (Mage = 9.24 years, SD = 3.72, 67.3% female). Two operational definitions of attrition were used: (a) clinician-rated dropout (i.e., clinician's ratings of whether the child completed treatment) and (b) whether the child received an adequate treatment dose treatment (i.e., ≥12 sessions). Maternal marital status was the only factor associated with clinician-rated treatment dropout, OR = 2.35, whereas maternal support and blame/doubt were unrelated. Living farther from the clinic was tied to an increased risk of receiving an inadequate treatment dose, OR = 0.96. Replication of these findings is needed, particularly using a clinician-administered measure of caregiver support; yet, maternal emotional support and blame/doubt may not evince strong ties to dropout from TFT among sexually abused children. Additional work is needed to discern if there are key subgroups for whom support is more strongly related to the risk of premature termination following CSA.

Factors related to attrition from trauma-focused cognitive behavioral therapy

Attrition from child trauma-focused treatments such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is common; yet, the factors of children who prematurely terminate are unknown. The aim of the current study was to identify risk factors for attrition from TF-CBT. One hundred and twenty-two children (ages 3–18; M=9.97, SD=3.56; 67.2% females; 50.8% Caucasian) who received TF-CBT were included in the study. Demographic and family variables, characteristics of the trauma, and caregiver- and child-reported pretreatment symptoms levels were assessed in relation to two operational definitions of attrition: 1) clinician-rated dropout, and 2) whether the child received an adequate dose of treatment (i.e., 12 or more sessions). Several demographic factors, number of traumatic events, and children’s caregiver-rated pretreatment symptoms were related to clinician-rated dropout. Fewer factors were associated with the adequate dose definition. Child Protective Services involvement, complex trauma exposure, and child-reported pretreatment trauma symptoms were unrelated to either attrition definition. Demographics, trauma characteristics, and level of caregiver-reported symptoms may help to identify clients at risk for premature termination from TF-CBT. Clinical and research implications for different operational definitions and suggestions for future work will be presented.

Characteristics of attrition among children receiving trauma-focused treatment.

Identifying the factors related to premature termination from trauma-focused child therapy is an important first step in ultimately preventing attrition in at-risk families. The primary aim of the present study was to investigate whether demographic factors and pretreatment symptom levels were associated with premature termination among children who received trauma-focused treatment. Because different definitions of attrition may influence results, candidate factors were examined in relation to 2 operational definitions of attrition. Four hundred and sixty-six children (ages 2-18 years; M = 9.23, SD = 3.78; 66.1% females) who were referred to a Child Advocacy Center (CAC) for trauma-focused therapy were included in the study. Demographic and family variables, characteristics of the traumatic event, and caregiver- and child-reported pretreatment symptoms levels were assessed in relation to both clinician-rated treatment status and whether the child received an adequate dose of treatment (i.e., ≥12 sessions). Several demographic factors (e.g., child's age, minority status, household income, maternal years of education), Child Protective Services (CPS) involvement, type of treatment received, number of traumatic events, and caregiver-rated pretreatment symptom levels were related to clinician-rated treatment status. Relatively fewer factors were associated with the adequate dose operationalization of attrition. Children's symptom reports were unrelated to either attrition definition. Demographic and family factors, trauma characteristics, and level of caregiver-reported symptoms may help identify families at risk for premature termination. Efforts to understand the interactions between attrition factors, as well the use of different operational definitions in relation to premature termination, are warranted. (PsycINFO Database Record

Predictors of treatment dropout in depressed outpatients

Premature termination is common among patients treated for depression with psychotherapy.This study examines predictors of dropout from treatment in adult depressed outpatients. Fifty depressed outpatients completed a socio-demographic questionnaire. Severity of depressive symptoms, with the BDI-II (Beck et al., 1996) and expectation of change with The Scale of Expectation of Change (Echeburua & Corral, 1987) were assessed. All patients attended a group-based CBT program for depression. Patients were categorized in groups: completers vs. dropouts. Student’s t-test and a logistic regression analyses were performed. Comparing treatment completers vs. dropouts, the dropout group had significantly higher age of onset and severity of depression than the completer group. The dropout group had lower expectation of change. Age of onset and scores on expectation of change emerged as significant predictors of dropout. Depressed outpatients with higher age of onset and lower expectation of change seem to be at higher risk of premature termination.

2758 – Personality and treatment dropout in depressed outpatients

Introduction Premature termination is common among patients treated for depression with either pharmacotherapy or psychotherapy. Yet little is known about factors associated with premature treatment termination among depressed patients. In other hand, there is conflicting evidence about the influence of personality disorder on outcome in depressive disorders. Aims The present study assesses whether personality may predict the dropout of a psychotherapy group for patients with depressive disorder. Methods A personality disorders (PDs) self-report questionnaire based on the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) was completed by 39 depressed outpatients. All patients attended a group-based CBT program for depression consisted of 10 weekly 90 minutes sessions. Patients were categorized in groups as completers vs. dropouts. Dropout was defined as attendance at less than 7 sessions. Differences between groups were tested using Student's t -test and in order to measure the specific contribution of personality on dropout a logistic regression analyses were performed. Results Comparing treatment completers (67%) vs. dropouts (33%), groups differed significantly on number of items in schizotypal, narcissistic and borderline PDs. The dropout group scored significantly higher on these PDs than the completer group. Scores on borderline personality disorder emerged as a significant predictor of dropout. Conclusions Depressed outpatients with comorbid borderline traits are at higher risk of premature termination and may require modified treatment strategies.

Risk factors for premature termination of treatment at a child and family mental health clinic

Objective: Premature termination of treatment amongst children and families attending mental health services is a significant problem for both outcomes research and clinical practice in South Africa and elsewhere. This study investigated factors that are associated with premature termination of treatment at a public service child and family clinic in Cape Town. Method: A retrospective archival analysis of clinic files from 2002–2009 was conducted. Administrative, child and family factors, and type of treatment were explored as risk factors for premature termination. Results: A single-parent household and the presence of a child or oppositional defiant disorder were risk factors for premature termination of treatment, while the presence of a maternal psychiatric diagnosis was associated with a lower likelihood of terminating treatment prematurely. Conducting a scholastic assessment with the child was associated with a lower risk of premature termination, while there was a trend towards a higher risk of premature termination when individual child therapy was the recommended treatment. Conclusions: This study offers recommendations for how these findings could assist South African clinicians to enhance client retention in child and family mental health services, and suggestions for future research.

Total number of MMPI-2 clinical scale elevations predicts premature termination after controlling for intake symptom severity and personality disorder diagnosis

Premature termination of therapy by patients is a common phenomenon that can be deleterious to treatment outcome for patients and also negatively affect therapists, treatment centers, and research programs. Therefore, a method of identifying patients at risk for premature termination could have widespread benefits. This study investigated whether patients’ MMPI-2 profiles, including clinical scale elevations and Negative Treatment Indicator (TRT) scores, could predict premature termination in an outpatient sample, controlling for personality disorder diagnosis and symptom severity at intake. Results indicated that while TRT scores were not incrementally predictive of premature termination, the total number of clinical scale elevations was significantly incrementally predictive of dropout. Clinical implications are discussed.

Personality, Levels of Psychological Distress and Premature Termination of Psychodynamic Group Therapy: Results from a Prospective Longitudinal Study

This study investigated personality factors and type of psychological distress associated with an increased risk of premature termination of psychodynamic group therapy. Data was part of a larger ongoing longitudinal project. Subjects who had completed the group therapy (n = 53) were compared to subjects who had terminated the therapy prematurely (n = 41) with respect to their pre-therapy personality profiles (as measured with KAPP) and self-reported symptoms (as measured with the SCL–90). Overall, differences between the groups were modest but subjects that dropped out of therapy showed more difficulties with handling frustration, had a more distorted body image, felt more needed and reported higher levels of phobic anxiety.

Predicting Premature Termination from Counseling Using the Butcher Treatment Planning Inventory

This investigation examined the extent to which premature termination from counseling could be predicted from selected scales on the Butcher Treatment Planning Inventory (BTPI). Ninety-five new clients at a university counseling center agreed to participate in the study and completed the BTPI as part of the intake evaluation. Premature termination occurred when a participant missed a scheduled appointment and unilaterally dropped out of counseling. Higher scores on Closed-Mindedness, Problems in Relationship Formation, Somatization of Conflict, Self-Oriented/Narcissism, Perceived Lack of Environmental Support, and the Treatment Difficulty Composite were associated with premature termination. The General Pathology Composite, a general index of symptomatic distress, also enhanced the prediction of premature termination by suppressing irrelevant variance in other BTPI scales. The results provide support for the validity of the BTPI in identifying clients at risk for premature termination from counseling.

Parent Expectancies for Child Therapy: Assessment and Relation to Participation in Treatment

Two studies examined parents' pre-treatment expectancies for their child's psychotherapy among children (N = 405, ages 2–15) referred for oppositional, aggressive, and antisocial behavior. Study I focused on the development of a measure to assess expectancies. The results indicated that the measure was internally consistent. Moreover, socioeconomic disadvantage and ethnic minority status, severity of child dysfunction, child age, and parental stress and depression were significant predictors of lower parent expectancies for child therapy. Study II examined the relation of parent expectancies and participation in therapy. The results indicated that parent expectancies predicted subsequent barriers to treatment participation, treatment attendance, and premature termination from therapy. Overall, these findings have implications for the study of expectancies for therapy, for identifying families at risk for premature termination from treatment, and for the development of interventions designed to increase parent participation in child therapy.

Serum Levels of Elam-1, But not Cd44, Predict the Clinical Outcome of Patients with Preeclampsia

Objective: Preeclampsia is a severe complication in pregnancy, causing considerable maternal and fetal morbidity and mortality. Experimental evidence indicates that adhesion molecules are key factors of endothelial activation in preeclampsia. The aim of our study was to evaluate if serum levels of adhesion molecules CD44 and ELAM-1 provide clinically useful information as prognostic markers for preeclampsia.Methods: A matched-pair study including 43 women with preeclampsia and 43 women with uncomplicated pregnancies was performed. Enzyme-linked immunosorbent assay (ELISA) was used to determine serum levels of CD44 and ELAM-1. Results were correlated with clinical data.Results: Median serum levels of ELAM-1 in controls and in women with preeclampsia were 8.9 ng/mL (minimum 0, maximum 20.0) and 12.0 ng/mL (minimum 4.0, maximum 27.0), respectively (Kruskal-Wallis test, p= 0.01). In a univariate logistic regression model, ELAM-1 did reveal a significant influence on the odds of presenting with preeclampsia as well as on the odds of premature termination of the pregnancy due to preeclampsia (univariate logistic regression, p- 0.03 and p = 0.01, respectively). The risk of premature termination of the pregnancy was 0.5%, 15.3%, and 80.5% at ELAM-1 serum levels of 0 ng/mL, 10 ng/mL, and 20 ng/mL, respectively. No significant correlation between CD44 serum levels and clinicopathological parameters due to preeclampsia was observed.Conclusions: If these results are confirmed in a larger series, ELAM-1 could be used as a prognostic factor in preeclamptic women, allowing early identification and appropriate management of high-risk patients with preeclampsia. It is unlikely that measurement of ELAM-1 will be of value as a screening test.

Dropping Out of Child Psychotherapy: Issues for Research and Implications for Practice

Dropping out of psychotherapy among children and adolescents is a significant problem affecting 40-60 percent of the cases receiving outpatient care. I review research on premature termination from treatment and current issues raised by that work. Our research work on dropping out of treatment among children referred for conduct disorder is highlighted to convey a risk factor and burden-of-treatment model to identify and explain who drops out of treatment and why. Factors that predict dropping out of treatment, the clinical outcomes of children who drop out and influences that moderate the impact of risk factors are discussed. A risk-factor model can aid clinical practice. Those in practice can readily test a variety of factors to determine whether such factors predict premature termination. Once at-risk cases are identified, interventions can be used early in treatment to retain cases. Efforts to establish a therapeutic alliance at the earliest points of contact within families is one such strategy. Some factors that place families at risk (e.g. high stress) may guide foci of treatment or initial clinic contacts. Clinical practice is an excellent venue for testing hypotheses about factors that place families at risk for premature termination and for intervening to improve participation in treatment.

The transtheoretical model's stages and processes of change and their relation to premature termination.

This study explored the issue of premature termination by using the client readiness variables reflected in the stages of change and processes of change proposed in J. O. Prochaska and C. C. DiClemente's (1982) transtheoretical model. This study used these variables in an attempt to distinguish between premature and nonpremature terminators in a college counseling center. Results indicated that the two termination groups were distinguishable on stages and processes of change, though some results were not predicted by the transtheoretical theory or model. Recommendations are made for future research to identify and predict clients at risk for premature termination and to determine how to avert such termination

Factors associated with premature termination from outpatient treatment.

A variety of demographic and clinical data collected on 142 new patients treated in an adult psychiatric outpatient clinic were analyzed to determine factors that discriminated between patients who terminated treatment prematurely during the first eight months of therapy and those who did not. High levels of paranoid ideation, lack of health insurance, and living less than 15 miles from the clinic were significantly associated with premature termination. Those factors were combined with three others--substance abuse, divorced marital status, and absence of fee reduction--in a probit regression model that correctly predicted the incidence of premature termination in 75 percent of the patients. The results suggest that patients who may be at risk for premature termination of outpatient therapy can be identified early in the course of their treatment.

Differences in psychological need hierarchy between program completers and dropouts from a drug abuse treatment program.

Psychological need patterns among 116 drug addicts in treatment were measured with the Adjective Checklist. Compared to program completers, program dropouts had higher needs for autonomy and aggression and lower needs for deference, nurturance, and affiliation. This personality style may form the basis of dropping out, among certain types of addicts in certain types of programs, when faced with situational, environmental, or interactional stress. Results also suggest that we may be able to identify a personality pattern at risk for premature termination before the person experiences the impulse to leave.

The MMPI as a predictor of early termination from polydrug abuse treatment.

The MMPI protocols obtained upon admission to an inpatient program for treatment of polydrug abuse were studied to determine if they could identify abusers who terminated prematurely from treatment. Individual scale T scores, profile code types and discriminant scores were evaluated for 104 patients who completed treatment ("stayers") and 72 patients who left prematurely ("quitters"). Although quitters and stayers did not differentiate on primary drug of abuse, age, sex, race, or IQ, quitters were less likely to obtain normal limits or neurotic code profiles, Univariate analyses revealed that quitters obtained higher mean elevations on 6 of the 15 scales studied (F, 4/Pd, 6/Pa, 8/Sc, 9/Ma, A). Discriminant scores based on a stepwise discriminant analysis correctly identified 71% of the study sample, representing a 13.7% improvement over base rate prediction. The probable importance of initial level of psychological discomfort and ability to delay gratification, and the need to examine varied treatment modalities for polydrug abusers identified as at risk for premature termination from treatment were explored.