Symptom burden in palliative care patients: perspectives of patients, their family caregivers, and their attending physicians

Rationale

The purpose of this study was to prospectively evaluate the perspectives of palliative care patients, their family caregivers, and their attending palliative care specialists on frequency, intensity, distress, and treatment requirement of the patient’s physical and psychological symptoms.

Patients and methods

Forty advanced cancer patients and their family caregivers were recruited through a palliative care inpatient ward within 24 h after admission. Patients, caregivers, and physicians completed a modified version of the Memorial Symptom Assessment Scale (including perceived treatment requirement).

Results

Thirty-nine patients (98 %) suffered from at least one symptom frequently or almost constantly (median number 5; range, 0–9). Most frequent symptoms were lack of energy (95 %), tiredness (88 %), and pain (80 %), which were scored correspondingly by patients, caregivers, and physicians to be the most intensive, distressing, and treatment requiring. Treatment requirement was determined by symptom intensity or distress in patients and physicians, but by distress in caregivers. Significant differences in symptom burden between patients, caregivers, and physicians were found with regard to pain (p?=?.007), tiredness (p?=?.037), lack of energy (p?<?.05), anxiety (p?<?.05), and sadness (p?<?.05). Physicians underestimated 60 % of symptom dimensions, while the caregivers overestimated 77 %; however, overall median scoring differences were limited with ?.10 (range, ?.55 to +.25) between patients and physicians and +.33 (range, ?.78 to +.61) between patients and family caregivers.

Conclusions

While physicians tended to underestimate, family caregivers tended to overestimate the patient’s symptoms. Therefore, adequate symptom treatment can only be successful in a close dialog between patients, their caregivers, and a multidisciplinary team.     

Use of a Direct Observational Measure in a Trial of Risperidone and Parent Training in Children with Pervasive Developmental Disorders

A Structured Observational Analog Procedure (SOAP), an analogue measure of parent-child interactions, was used to assess treatment outcome in children with Autism Spectrum Disorder and serious behavior problems. It served as a secondary outcome measure in a 24-week, randomized trial of risperidone (MED; N?=?49) versus risperidone plus parent training (COMB; n?=?75) (ages 4–13 years). At 24-weeks, there was 28 % reduction in child inappropriate behavior during a Demand Condition (p?=?.0002) and 12 % increase in compliance to parental requests (p?=?.004) for the two treatment conditions combined. Parents displayed 64 % greater use of positive reinforcement (p?=?.001) and fewer repeated requests for compliance (p?<?.0001). In the analysis of covariance (ANCOVA), COMB parents used significantly more positive reinforcement (p?=?.01) and fewer restrictive statements (p?<?.05) than MED parents. The SOAP is sensitive to change in child and parent behavior as a function of risperidone alone and in combination with PMT and can serve as a valuable complement to parent and clinician-based measures.     

“Reading between the lines” of flow sheet data: nurses' optional documentation associated with cardiac arrest outcomes

Historically, short “comments” on paper-based flow sheets conveyed the patient's overall clinical state. We analyzed the content and documentation patterns of electronic health record flow sheets for 201 cardiac arrest patients. Free-text comments were associated with the abnormality of clinical measurements (p < .05). The documentation of 3 or more comments for acute care patients was associated with a greater likelihood of dying by discharge (p < .01). Documentation of intensive care unit vital signs greater than the minimum hourly requirement was associated with increased survival of a cardiac arrest (p < .05). Further analysis of such patterns may be useful for the measurement of nursing knowledge and surveillance activities, interdisciplinary communication tools, and clinical decision making.     

Experimental Low Back Pain Decreased Trunk Muscle Activity in Currently Asymptomatic Recurrent Low Back Pain Patients During Step Tasks

Low back pain (LBP) patients show reorganized trunk muscle activity but if similar changes are manifest in recurrent LBP (R-LBP) patients during asymptomatic periods remains unknown. In 26 healthy and 27 currently asymptomatic R-LBP participants electromyographic activity (EMG) was recorded from trunk and gluteal muscles during series of stepping up and down on a step bench before and during experimentally intramuscular induced unilateral and bilateral LBP. Pain intensity was assessed using numeric rating scale (NRS) scores. Root mean square EMG (RMS-EMG) normalized to maximal voluntary contraction EMG and pain-evoked differences from baseline (ΔRMS-EMG) were analyzed. Step task duration was calculated from foot sensors. R-LBP compared with controls showed higher baseline RMS-EMG and NRS scores of experimental pain (P?<?.05). In both groups, bilateral compared with unilateral experimental NRS scores were higher (P?<?.001) and patients compared with controls reported higher NRS scores during both pain conditions (P?<?.04). In patients, unilateral pain decreased ΔRMS-EMG in the Iliocostalis muscle and bilateral pain decreased ΔRMS-EMG in all back and gluteal muscles during step tasks (P?<?.05) compared with controls. In controls, bilateral versus unilateral experimental pain induced increased step task duration and trunk RMS-EMG whereas both pain conditions decreased step task duration and trunk RMS-EMG in R-LBP patients compared with controls (P?<?.05).

Concurrent neuromechanical and functional gains following upper-extremity power training post-stroke

Background

Repetitive task practice is argued to drive neural plasticity following stroke. However, current evidence reveals that hemiparetic weakness impairs the capacity to perform, and practice, movements appropriately. Here we investigated how power training (i.e., high-intensity, dynamic resistance training) affects recovery of upper-extremity motor function post-stroke. We hypothesized that power training, as a component of upper-extremity rehabilitation, would promote greater functional gains than functional task practice without deleterious consequences.

Method

Nineteen chronic hemiparetic individuals were studied using a crossover design. All participants received both functional task practice (FTP) and HYBRID (combined FTP and power training) in random order. Blinded evaluations performed at baseline, following each intervention block and 6-months post-intervention included: Wolf Motor Function Test (WMFT-FAS, Primary Outcome), upper-extremity Fugl-Meyer Motor Assessment, Ashworth Scale, and Functional Independence Measure. Neuromechanical function was evaluated using isometric and dynamic joint torques and concurrent agonist EMG. Biceps stretch reflex responses were evaluated using passive elbow stretches ranging from 60 to 180º/s and determining: EMG onset position threshold, burst duration, burst intensity and passive torque at each speed.

Results

Primary outcome: Improvements in WMFT-FAS were significantly greater following HYBRID vs. FTP (p?=?.049), regardless of treatment order. These functional improvements were retained 6-months post-intervention (p?=?.03). Secondary outcomes: A greater proportion of participants achieved minimally important differences (MID) following HYBRID vs. FTP (p?=?.03). MIDs were retained 6-months post-intervention. Ashworth scores were unchanged (p?>?.05). Increased maximal isometric joint torque, agonist EMG and peak power were significantly greater following HYBRID vs. FTP (p < .05) and effects were retained 6-months post-intervention (p’s?<?.05). EMG position threshold and burst duration were significantly reduced at fast speeds (≥120º/s) (p’s < 0.05) and passive torque was reduced post-washout (p < .05) following HYBRID.

Conclusions

Functional and neuromechanical gains were greater following HYBRID vs. FPT. Improved stretch reflex modulation and increased neuromuscular activation indicate potent neural adaptations. Importantly, no deleterious consequences, including exacerbation of spasticity or musculoskeletal complaints, were associated with HYBRID. These results contribute to an evolving body of contemporary evidence regarding the efficacy of high-intensity training in neurorehabilitation and the physiological mechanisms that mediate neural recovery.     

Effectiveness of an optional breastfeeding course for multidisciplinary undergraduate healthcare students: A quasi-experimental study

AimsThis study aimed to examine and quantify the effectiveness of an optional breastfeeding course for multidisciplinary undergraduate healthcare students and to provide advice for education improvement based on students’ characteristics and learning feedback.BackgroundBreastfeeding has received global awareness and educating undergraduate healthcare students is a prospective way to promote breastfeeding. This is the first report from mainland China to verify the education effects and formulate a proposal for improvement.DesignA quasi-experimental study with a one-group pretest-posttest design.MethodsAn optional breastfeeding course covering eight topics based on the Health Belief Model was conducted for multidisciplinary students in a medical college. The Breastfeeding Knowledge Questionnaire, Iowa Infant Feeding Attitude Scale and Breastfeeding Promotion Intention Scale were completed for pre- and post-education comparison. The Wilcoxon signed-rank test, MannWhitney U test, KruskalWallis test and chi-square test were used for statistical analysis. The class average normalized gain and individual students’ normalized gain were calculated to quantify the effectiveness from the perspective of learning gain.ResultsFrom March to November 2021, 102 students specialized mainly in nursing, clinical medicine, medical imaging technology and midwifery took the course. Knowledge, attitudes and intention scores improved significantly (Z = 8.70, 8.72, 7.64, respectively, p < .001) and the class average normalized gains were 81.0%, 52.3% and 70.6%, respectively. Insignificant differences were found for students of different genders and categories of specialties (p > .05). Students of first year had significantly higher individual normalized gains (p < .05). In learning feedback, the top-ranked advice for course improvement was to increase practice and experience (75.5%).ConclusionsThis optional breastfeeding course produced medium to high learning gains for multidisciplinary healthcare undergraduates. Independent breastfeeding education based on behavioral theory for multidisciplinary students is recommended to be conducted in medical colleges. The addition of practice and experience may add value to such education.     

The impact of radiotherapy on quality of life for cancer patients: a longitudinal study

Purpose

The aim of this study was to assess for changes in quality of life (QOL) among cancer patients who undergo radiotherapy (RT) and to identify factors that influence QOL in this group.

Materials and methods

Three hundred sixty-seven cancer patients who received curative RT were investigated using the EORTC QLQ-C30 questionnaire at the start of RT, end of RT, and 1 and 6 months post-RT.

Results

The patients were 49 % women, 51 % men, and median age at diagnosis was 57 years (range, 16–86 years). Compared to pre-RT, at the end of RT, the global health status score (p?<?0.001), nausea/vomiting (p?<?0.001), and apetite loss scores (p?<?0.001) were significantly poorer. Compared to the end of RT, at 1 and 6 months post-RT, global health status, all functional, and all symptom scores were significantly improved (p?<?0.001). Patient sex influenced scores for pain (p?=?0.036), appetite loss (p?=?0.027), and financial difficulty (p?=?0.003). Performance status influenced scores for global health status (p?=?0.006), physical functioning (p?<?0.001), cognitive functioning (p?=?0.001), and role functioning (p?=?0.021). Comorbidity influenced fatigue score (p?<?0.001). Cancer stage influenced scores for physical functioning (p?=?0.001), role functioning (p?=?0.010), and fatigue (p?<?0.001). Treatment modality (chemoRT vs. RT alone) influenced scores for physical functioning (p?=?0.016), fatigue (p?<?0.001), nausea/vomiting (p?=?0.009), and appetite loss (p?<?0.001); and RT field influenced scores for nausea/vomiting (p?=?0.001), appetite loss (p?=?0.003), and diarrhea (p?=?0.037). Radiotherapy dose functioning (p?<?0.001), cognitive functioning (p?<?0.001), social functioning (p?<?0.001), fatigue (p?<?0.001), and pain (<60 vs ≥60 Gy) had an effect on scores for physical functioning (p?<?0.001), role functioning (p?<?0.001), emotional (p?<?0.001), insomnia (p?<?0.001), constipation (p?<?0.001).

Conclusion

While RT negatively affects cancer patients’ QOL, restoration tends to be rapid and patients report significant improvement by 1 month post-RT. Various patient- and disease-specific factors and RT modality affect QOL in this patient group. We advocate measuring cancer patients’ QOL regularly as part of routine patient management.     

Peptide hormones and risk for future cardiovascular events among prediabetics: a 20-year follow-up in the OPERA study

Abstract

Background: Prediabetes has proven to have many unfavourable impacts on the cardiovascular system.

Methods: The OPERA (Oulu Project Elucidating Risk of Atherosclerosis) study included 1045 middle-aged subjects followed from the years 1990–1993 to 2014. The focus was on peptide hormones.

Results: Plasma resistin levels were higher among prediabetics (p?=?.001), particularly impaired glucose tolerance (IGT) (p?<?.001), but not impaired fasting glucose (IFG) patients than among normal glucose tolerance (NGT) or diabetes groups. Diabetics showed lower resistin levels than IGT subjects (p?<?.001). IGT or diabetes groups showed lower adiponectin and higher leptin levels compared to the NGT group (p?<?.001). The IFG group had the highest blood pressure and left ventricular mass index, even higher than the diabetic group. Diabetics had the highest, prediabetics (IFG?+?IGT) intermediate and NGT the lowest risk for CVD events during follow-up (p?<?.001). Among prediabetics, high plasma ghrelin was an independent predictor of CVD events (p?<?.05) in the Cox regression analysis although it did not significantly improve either classification or discrimination of the patients.

Conclusions: Among glucose tolerance groups, patients with IGT had the highest resistin, but equally high leptin and low adiponectin levels as diabetics. Among prediabetics, ghrelin seems to predict independently cardiovascular events in the long term.

• KEY MESSAGE

• Among glucose tolerance groups, patients with IGT had the highest resistin, but equally high leptin and low adiponectin levels as diabetics.

• Among prediabetics, ghrelin seems to predict independently cardiovascular events in the long term.

     

The initial psychometric properties for the Total Body Developmental Sequences for youth with visual impairments

Youth with visual impairments often show difficulties with gross motor skills regardless of age or sex. Gross motor skills support positive developmental trajectories for health warranting the need for assessment. The Total Body Developmental Sequences (TBDS) are fast, easy-to-use, indices of gross motor development with relatively unknown psychometric properties for youth with visual impairments. The primary purpose of this study was to assess the psychometric properties of the TBDS with a secondary purpose to evaluate differential effects of biological sex, age, and degree of vision on gross motor skills. Youth with visual impairments (N?=?57, ages 9 – 19 years, Boys?=?23, Girls?=?34) completed the TBDS and the Test of Gross Motor Development (TGMD-3). Results showed good initial psychometric properties (r?=?.89, α?=?.84, p?<?.001). Furthermore, the participants in this sample showed significant differences in gross motor skills based upon degree of vision (p?<?.05) but not sex or age (p?>?.05). The TBDS may now be used as an initial gross motor screening tool for youth with visual impairments. This initial screen (TBDS) is warranted as youth with visual impairments may show arrested development which may be exacerbated with more severe visual impairments.

     

Ethnic differentials in mental health needs and service utilization among persons with cancer

Purpose

Improving the assessment of and access to appropriate care for mental health problems among persons with cancer is essential, particularly for population groups that are at high risk for psychopathology. This study characterized ethnic differentials regarding needs and service utilization by Jewish (n?=?1,430) and Arab-Israeli (n?=?141) persons with cancer.

Methods

We reviewed 284 randomly selected active medical charts in an oncology clinic in a large public hospital (November 2010–April 2011).

Results

While 12?% of the charts of the Jewish-Israeli sample included a record of psychiatric disorders or symptoms, only 5?% of the charts of the Arab-Israeli sample had a similar record (χ2?=?4.4, p?χ2?=?6.7; p?χ2?=?3.6; p?χ2?=?6.3; p?χ2?=?5.35; p?Conclusions Despite methodological limitations, findings confirm past research showing that disadvantaged ethnic minorities may receive differential recommendations for mental health problems among persons with cancer. This may contribute to the differential treatment gap in mental health care among persons with cancer of contrasting ethnic groups.     

Turkish Translation of the Patterns of Activity Measure-Pain in Patients with Chronic Low Back and Neck Pain: Validity and Reliability

ObjectiveTo translate the Patterns of Activity Measure-Pain (POAM-P) into Turkish and test its validity and reliability.MethodsA total of 252 patients with chronic low back and neck pain were included. The Turkish translation of the POAM-P (POAMP/T), which has subgroups of Avoidance, Overdoing, and Pacing, was performed in accordance with international recommendations. The POAMP/T was administered twice. Physical activity level was assessed with the International Physical Activity Questionnaire-7 (IPAQ-7), and psychologic status was assessed with the Hospital Anxiety (HADS-A) and Depression Scales (HADS-D). The internal and external construct validity, internal consistency, and test-retest reliability were analyzed.ResultsThree related factorial structures were defined in Confirmatory Factor Analysis. Indexes and factor loads were found to be sufficient. A negative relationship was observed between avoidance and IPAQ-7 (rho = –0.328, p < .001), HADS-D (ρ = ?0.163, p = .009), and HADS-A scores (ρ = ?0.164, p = .009); whereas, a positive relationship was observed between overdoing and IPAQ-7 (ρ = 0.362, p < .001), HADS-D (ρ = 0.309, p < .001), and HADS-A scores (ρ = 0.325, p < .001). A negative correlation was found between pacing and IPAQ-7 (ρ = ?0.200, p = .001), HADS-D (ρ = ?0.507, p < .001), and HADS-A scores (ρ = ?0.509, p < .001). The Cronbach alpha values for avoidance, overdoing, and pacing were obtained as 0.941, 0.917, and 0.940, respectively. The intraclass correlation coefficient for avoidance, overdoing, and pacing was found as 0.972, 0.973, and 0.972, respectively. Test and retest scores were similar (p > .05).ConclusionsThe Turkish version of the POAM-P is a valid and reliable scale for the assessment of pain-related activity patterns in patients with chronic low back or neck pain.     

Sleep and other correlates of high-level health in older adults

A large sample (N?=?1139) of adults ≥75 years from the 2011–2014 NHANES cohorts was used to examine predictors of high-level health. Analyses were done with SAS to control for sample weights and allow results to be reported as population parameters. The majority of participants described their health as high-level (73.6%). Logistic regression found a longer sleep duration, minority status, decreased income, multiple medications, low physical activity, and late stage memory impairment were significant predictors of low-level health (p?<?.05) while sex, education level, marital status, body mass index, and depression symptoms were not. The assessment of sleep should be expanded to cover dimensions such as sleep quality and sleep disorders to help maintain wellness in older adults. This study supports that the majority of older adults have high-level health and identifies several modifiable factors to maintain wellness.     

Appraising the impact of left ventricular ejection fraction on outcomes of percutaneous drug-eluting stenting for unprotected left main disease: insights from a multicenter registry of 975 patients

Background

Despite the well-known prognostic impact of systolic dysfunction in unselected patients undergoing percutaneous coronary intervention (PCI), limited data are available on its current predictive role after PCI for unprotected left main disease (ULM). We thus appraised the prognostic role of left ventricular ejection fraction (LVEF) in patients undergoing PCI for ULM with drug-eluting stents (DES).

Methods

Consecutive eligible subjects were retrospectively enrolled in a national registry. Patients were divided into three groups: LVEF?<?30%, LVEF 30?C45%, and LVEF?>?45%. Relevant baseline and outcome data were compared with bivariate and multivariable tests.

Results

A total of 975 subjects was included (LVEF?<?30%: 46, LVEF 30?C45%: 208, LVEF?>?45%: 721). Patients with LVEF?<?30% had several other unfavorable clinical features, including older age and higher EuroSCORE. Adverse event rates were different already at 7?days (p?=?0.012 for all-cause death and p?=?0.015 for major adverse cardiac events [MACE]), with even more significant trends up to 30?days and at long-term (p?<?0.001 for death, and p?<?0.001 for MACE). After a median of 18?months, risk of death totaled 39 versus 13 versus 8% (p?<?0.001) and risk of MACE 44 versus 24 versus 22% (p?=?0.003). Multivariable analyses showed however that reduced LVEF was not an independent predictor of adverse events at any time-point.

Conclusions

Whereas reduced LVEF is apparently a significant predictor of adverse events after PCI with DES for ULM, its prognostic impact is mostly due to clustering with other adverse features.     

Questioning Style and Pimping in Clinical Education: A Quantitative Score Derived from a Survey of Internal Medicine Teaching Faculty

Construct: Pimping is a controversial pedagogical technique in medicine, and there is a tension between pimping being considered as “value adding” in some circumstances versus always unacceptable. Consequently, faculty differ in their attitudes toward pimping, and such differences may be measurable and used to inform future research regarding the impact of pimping on learner outcomes. Background: Despite renewed attention in medical education on creating a supportive learning environment, there is a dearth of prior research on pimping. We sought to characterize faculty who are more aggressive in their questioning style (i.e., those with a “pimper” phenotype) from those who are less threatening. Approach: This study was conducted between December 2015 and September 2016 at Johns Hopkins University. We created a 13-item questionnaire assessing faculty perceptions on pimping as a pedagogical technique. We surveyed all medicine faculty (n?=?150) who had attended on inpatient teaching services at two university-affiliated hospitals over the prior 2?years. Then, using responses to the faculty survey, we developed a numeric “pimping score” designed to characterize faculty into “pimper” (those with scores in the upper quartile of the range) and “nonpimper” phenotypes. Results: The response rate was 84%. Although almost half of the faculty reported that being pimped helped them in their own learning (45%), fewer reported that pimping was effective in their own teaching practice (20%). The pimping score was normally distributed across a range of 13–42, with a mean of 24 and a 75th percentile cutoff of 28 or greater. Younger faculty, male participants, specialists, and those reporting lower quality of life had higher pimping score values, all p?<?.05. Faculty who openly endorsed favorable views about the educational value of pimping had sevenfold higher odds of being characterized as “pimpers” using our numeric pimping score (p?≤?.001). Conclusions: The establishment of a quantitative pimping score may have relevance for training programs concerned about the learning environment in clinical settings and may inform future research on the impact of pimping on learning outcomes.     

Urine liver fatty acid binding protein and chronic kidney disease progression

Excretion of the tubular protein liver fatty acid binding protein (L-FABP) is a potential novel biomarker of renal dysfunction. We examined whether urine L-FABP excretion adds prognostic information to the well-established risk markers, blood pressure (BP), albumin excretion and baseline GFR, regarding progression of chronic kidney disease (CKD). In a prospective study design a cohort of 74 stage 3-4 CKD patients (age 61?±?13 years) were included. Glomerular filtration ratio (GFR, ⁵¹Cr-EDTA-clearance), 24-hour ambulatory BP, 24-hour urinary albumin/creatinine ratio (UAC) and urinary L-FABP/creatinine ratio (U-L-FABP/C) were determined at baseline and after 18 months of follow-up. For comparison 25 age-matched healthy controls were included. The U-L-FABP/C was elevated in CKD patients when compared to controls (mean U-L-FABP/C 2.3 [95% CI 1.7–2.9] μg/mmol vs 0.6 [0.5–0.7] μg/mmol, p?<?.001). In CKD patients, log U-L-FABP/C at baseline and at follow-up were positively associated (Pearson correlation coefficient r?=?0.74, p?<?.001). Baseline log U-L-FABP/C was negatively correlated with baseline GFR (r?=??0.32, p?<?.001) and directly correlated with UAC (r?=?0.67, p?<?.001). The relative change in GFR from baseline to follow-up correlated with baseline UAC (p?<?.001), 24-hour systolic BP (p?=?0.05) and log U-L-FABP/C (p?<?.001). Using multiple regression analysis adjusting for baseline GFR, UAC, BP, age and gender, baseline log U-L-FABP/C was associated with a decline in GFR only in patients with UAC <3?mg/mmol (n?=?29, p?=?0.001) and not in patients with UAC ≥3?mg/mmol (n?=?44, p?=?0.21). In conclusion urine L-FABP/C is permanently elevated in CKD patients, but only associated with GFR decline in those without albuminuria.     

Gastrointestinal ostomies and sexual outcomes: a comparison of colorectal cancer patients by ostomy status

Purpose

Research examining effects of ostomy use on sexual outcomes is limited. Patients with colorectal cancer were compared on sexual outcomes and body image based on ostomy status (never, past, and current ostomy). Differences in depression were also examined.

Methods

Patients were prospectively recruited during clinic visits and by tumor registry mailings. Patients with colorectal cancer (N?=?141; 18 past ostomy; 25 current ostomy; and 98 no ostomy history) completed surveys assessing sexual outcomes (medical impact on sexual function, Female Sexual Function Index, International Index of Erectile Function), body image distress (Body Image Scale), and depressive symptoms (Center for Epidemiologic Studies Depression Scale—Short Form). Clinical information was obtained through patient validated self-report measures and medical records.

Results

Most participants reported sexual function in the dysfunctional range using established cut-off scores. In analyses adjusting for demographic and medical covariates and depression, significant group differences were found for ostomy status on impact on sexual function (p?<?.001), female sexual function (p?=?.01), and body image (p?<?.001). The current and past ostomy groups reported worse impact on sexual function than those who never had an ostomy (p?<?.001); similar differences were found for female sexual function. The current ostomy group reported worse body image distress than those who never had an ostomy (p?<?.001). No differences were found across the groups for depressive symptoms (p?=?.33) or male sexual or erectile function (p values?≥?.59).

Conclusions

Colorectal cancer treatment puts patients at risk for sexual difficulties and some difficulties may be more pronounced for patients with ostomies as part of their treatment. Clinical information and support should be offered.     

Homework Completion via Telephone and In-Person Cognitive Behavioral Therapy Among Latinos

Homework completion in cognitive behavioral therapy (CBT) for depression is an integral ingredient in treatment that often goes unreported. Furthermore, many studies of homework completion focus on patient adherence without considering the therapists’ role in reviewing and reinforcing this behavior. No studies to date have assessed the relationship between homework variables and outcomes among Latinos receiving CBT for depression. Since this population has often been difficult to engage in CBT, this study aims to assess whether homework completion and therapist review of homework are related to improved outcomes in a CBT intervention (telephone or in person) for Latinos with depression. We found that higher homework completion was significantly related to lower depression scores at the end of final treatment (as measured by PHQ-9) (B?=???1.38, p?<?.01). However, the significant association of homework with depression went away when clinician review of homework was included in a subsequent step of the model (B?=???0.42, p?=?.45). The number of times a clinician actively reviewed homework was still significantly related to a decrease in PHQ-9 when controlling for demographic factors (B?=???1.23, p?<?.01). This study found that homework is a predictor of improved outcomes in CBT for depression but highlights the role of therapists reviewing homework as a predictor of lower depression symptoms among Spanish speaking Latinos from low socioeconomic backgrounds.     

Determinants of quality of life in advanced cancer patients with bone metastases undergoing palliative radiation treatment

Purpose

Assessment of health-related quality of life (HRQOL) is critical to effective delivery of palliative care in patients with advanced cancer. The current study analyzes relationships between baseline social determinants of health and medical factors, and self-reported HRQOL in patients with bone metastases receiving palliative radiotherapy.

Methods and materials

Advanced cancer patients referred for radiotherapy treatment of bone metastases completed the EORTC QLQ-C30 questionnaire in multiple outpatient clinics internationally. Demographics and social determinants were collected as baseline information. Univariate and Bonferroni-adjusted multivariate linear regression analyses were used to detect significant correlations between baseline determinants and different HRQOL domains.

Results

Karnofsky Performance Status (KPS) was correlated with better physical (p?=?0.0002), role (p?<?0.0001), emotional (p?<?0.0001), and social (p?<?0.0001) functioning, and global health scores (p?=?0.0015) and predicted lower symptom scores for fatigue (p?<?0.0001), pain (p?<?0.0001), appetite loss (p?<?0.0001), and constipation (p?<?0.0001). Increased age was predictive of better social functioning (p?<?0.0001) and less insomnia (p?=?0.0036), higher education correlated with better global health status (p?=?0.0043), and patients who were employed or retired had improved physical functioning (p?=?0.0004 and p?=?0.0030, respectively) and less financial challenges compared to patients who were unemployed (p?=?0.0005).

Conclusions

Baseline KPS had the greatest influence on EORTC QLQ-C30 domain scores. Age, education level, and employment status had significant impacts, although on fewer domains. Further studies that investigate baseline determinants are worthwhile to clarify relationships in order to care for patients more effectively at the end of life.