The cancer Support Person's Unmet Needs Survey

BACKGROUND:

A rigorous psychometric methodology was used to develop a measure of unmet needs for cancer survivors' principal support persons. Principal support person was defined as “someone you can count on and who helps you with your needs.”

METHODS:

Development of the domains and the items followed an extensive literature review, iterative input from support persons, and consultation with health professionals and front‐line staff working with cancer survivors and their supports. Cognitive interviews helped clarify item wording, and the draft questionnaire was reappraised by a group of support persons. The questionnaire was reduced to 90 items and sent to a stratified, random sample of cancer survivors selected from a provincial population‐based cancer registry. They were asked to give the survey to their support person.

RESULTS:

The resulting 78‐item Support Person Unmet Needs Survey has high acceptability, item test‐retest reliability, internal consistency (Chronbach alpha = .990), and face, content, and construct validity. It captures 6 domains of unmet needs and accounts for 73.5% of total variance: Information and Relationship Needs (27 items, 22.1% of variance), Emotional Needs (16 items, 15.2%), Personal Needs (14 items, 14.0%), Work and Finance (8 items, 8.8%), Health Care Access and Continuity (9 items, 8.6%), and Worries About Future (4 items, 4.8%).

CONCLUSIONS:

This instrument will be of use where there is an interest in examining the impact of cancer not only on cancer survivors but also on their identified principal support persons. Cancer 2009. © 2009 American Cancer Society.     

Cancer treatment adherence among low‐income women with breast or gynecologic cancer

BACKGROUND:

The authors implemented a controlled, randomized trial that compared 2 interventions: the provision of written resource navigation information (enhanced usual care [EUC]) versus written information plus patient navigation (TPN) aimed at improving adjuvant treatment adherence and follow‐up among 487 low‐income, predominantly Hispanic women with breast cancer or gynecologic cancer.

METHODS:

Women were randomized to receive either TPN or EUC; and chemotherapy, radiation therapy, hormone therapy, and follow‐up were assessed over 12 months. Patients with breast cancer were analyzed separately from patients with gynecologic cancer.

RESULTS:

Overall adherence rates ranged from 87% to 94%, and there were no significant differences between the TPN group and the EUC group. Among women with breast cancer, 90% of the EUC group and 88% of the TPN group completed chemotherapy (14% of the EUC group and 26% of the TPN group delayed the completion of chemotherapy), 2% of the EUC group and 4% of the TPN group failed to complete chemotherapy, and 8% of the EUC group and 7% of the TPN group refused chemotherapy. Radiation treatment adherence was similar between the groups: Ninety percent of patients completed radiation (40% of the EUC group and 42% of the TPN group delayed the completion of radiation); in both groups, 2% failed to complete radiation, and 8% refused radiation. Among gynecologic patients, 87% of the EUC group and 94% of the TPN group completed chemotherapy (41% of the EUC group and 31% of the TPN group completed it with delays), 7% of the EUC group and 6% of the TPN group failed to complete chemotherapy, 6% of the EUC refused chemotherapy, 87% of the EUC group and 84% of the TPN group completed radiation (51% of the EUC group and 42% of the TPN with delays), 5% of the EUC group and 8% of the TPN group failed to complete radiation, and 8% of the EUC group and 5% of the TPN group refused radiation.

CONCLUSIONS:

Treatment adherence across randomized groups was notably higher than reported in previous studies, suggesting that active telephone patient navigation or written resource informational materials may facilitate adherence among low‐income, predominantly Hispanic women. Adherence also may have be facilitated by federal‐state breast and cervical cancer treatment funding. Cancer 2009. © 2009 American Cancer Society.     

Parental reactions to children with congenital heart disease

Informal discussions with 260 families of children with congenital heart disease are reported. Parents raised questions concerning etiology, timing of the diagnosis, pathophysiology and symptomatology, and need for restriction. Depending upon the stage and seriousness of the disease, common parental behavior was observed. A psychological process similar to mourning is required at the time of diagnosis and at the time of corrective surgery in order to promote the family's adaptation to the child with congenital heart disease. Management suggestions are included.This study was supported in part by Grant #3990530 from the Mary Duke Biddle Fund and Grant #MH 08045-13 Psychiatry G.P. Special Training.     

Characteristics of children and their families at entry into foster care

This study provides an overview of children, their families, and their circumstances at the time that the child entered foster care in Israel. Data regarding a representative sample of 800 children were collected as part of the ongoing operation of a clinical information system set up for Israel's foster care service in 1988. Implications of our findings for interventions are discussed.     

The Solution Method: 2-year trends in Weight, Blood Pressure, Exercise, Depression, and Functioning of Adults trained in Development Skills

This study describes changes observed during a 2-year period in participants enrolled in The Solution Method, a developmental skills training program for adult weight management. This Intervention is the adult application of a model of treatment previously used only in the management of pediatric obesity (The Shapedown Program). Developmental skills training integrates understandings and methods from developmental, family systems, biomedical, genetic, and behavioral theories of the etiology of obesity. Twenty-two subjects (mean age=43.4±8.5 years and mean body mass index=33.1+5.3) completed a group intervention based on this method, which was conducted by a registered dietitian and a mental health professional. Questionnaire responses indicated the extent to which their weight was a medical and/ or psychosocial risk. Subjects attended 2-hour weekly sessions for an average of 18 weeks during which they were trained in six developmental skills: strong nurturing, effective limits, body pride, good health, balanced eating, and mastery living. Data, which were collected at the beginning of treatment and at 3, 6, 12, and 24 months, included weight, blood pressure, 7-day exercise recalls, and responses to depression and functioning (psychosocial, vocational, and economic) questionnaires. Participants’ weights decreased throughout the 2-year period of the study: mean weight change was −4.2 kg (3 months), −6.0 kg (6 months), −7.0 kg (12 months), and −7.9 kg (24 months). In addition, compared with baseline values, systolic and diastolic blood pressure, exercise, and depression improved throughout the study period. These improvements were statistically significant at 24 months for weight (p<.01), systolic blood pressure (p<.02), diastolic blood pressure (p<.001), and exercise (p<.001); the results were not statistically significant for depression. Most participants reported improvement in a broad range of aspects of functioning. We conclude that this application of developmental skills training for adult weight management may produce significant long-term beneficial effects. J Am Diet Assoc. 1997;97:1133–1138.     

Pilot study of abuse of asthma inhalers by middle and high school students

During a school-based survey, middle and high school students (n = 1536) reported on their nonprescribed, lifetime use of asthma inhalers. Approximately 15% of 8th and 9th graders reported using nonprescribed asthma inhalers; the odds for this behavior were significantly higher for these students (2.25 and 2.30, respectively) and the nonprescribed use of asthma inhalers was significantly associated with higher rates of other drug use.