Parental resilience: A neglected construct in resilience research

The substantial focus of resilience research on childhood well‐being has resulted in limited knowledge regarding other aspects of resilience in families, such as that of parents. Informed by literature in childhood and family resilience, in this review, we progress conceptual understanding by focusing on parental resilience. The definition of parental resilience, as the capacity of parents to deliver a competent and quality level of parenting to children despite the presence of risk factors, is offered here as a worthwhile framework through which to explore variables thought to contribute to resilience among parents. A conceptual model is proposed whereby parental psychological well‐being and self‐efficacy, family functioning, and social connectedness are specifically addressed, with each posited as playing an important role in parents’ ability to deliver high‐quality parenting. In addition to these factors, how parents accommodate adversity and find meaning in their everyday lives within their families is hypothesised to be an important process in understanding parental resilience.     

Small bowel sarcoma: A rare case report

Sarcoma of the small bowel is an extremely rare type of small bowel malignancy and represents around 10 per cent of small bowel cancers. Usually asymptomatic, patients can present with chronic abdominal distention with pain and/or weight loss. Most pathologists now refer to small bowel sarcomas (SBS) as gastrointestinal stromal tumours as they are mesenchymal neoplasms believed to be derived from the interstitial cells of Cajal in the gastrointestinal tract. SBS can be highly vascular and commonly ulcerate and/or bleed. They tend to be aggressive and have a poor prognosis. Surgery is the treatment of choice for SBS, with definitive diagnosis usually made postoperatively with the aid of histopathology. We would like to highlight the importance of careful intra-operative examination of an unknown small bowel (SB) mass, which can give the surgeon clues to the type of tumour present. This case report aims to demonstrate this important process: recognising SBS intra-operatively will aid the surgeon with performing the appropriate resection as minute omental metastasis can be present with SBS; in such cases an omentectomy during the laparotomy is recommended. In institutions where available, intra-operative radiotherapy is ideal.     

Characterizing patient-oncologist communication in genomic tumor testing: The 21-gene recurrence score as an exemplar

ObjectiveWomen with early-stage, ER + breast cancer are recommend to receive genomic profiling tests, such as the 21-gene Recurrence Score (RS) test, to guide treatment decisions. We examined test- and treatment-related information discussed and the associations between RS categories and aspects of communication during patient-oncologist clinical encounters.MethodsAs part of a larger trial, clinical encounters (N = 46) were audiorecorded and coded for 1) RS- and treatment-related information, 2) shared decision making, 3) patient active participation, and 4) oncologist patient-centered communication. We examined differences by RS category using mixed models, adjusting for nesting within oncologist.ResultsPatients with a high RS were more likely to receive a chemotherapy recommendation (p < .01), hear about the risks/side effects of chemotherapy (p < .01), and offer their preferences (p = .02) than those with intermediate or low RS. Elements of shared decision making increased with RS. Oncologist patient-centered communication (M = 4.09/5, SD = .25) and patient active participation (M = 3.5/4, SD = 1.0) were high across RS.ConclusionFindings suggest that disease severity, rather than clinical uncertainty, impact treatment recommendations and shared decision making.Practice implicationsOncologists adjust test- and treatment-related information and shared decision making by disease severity. This information provides a framework to inform decision making in complex cancer and genomics settings.