Browsing by Subject "Advanced cancer"

Now showing 1 - 5 of 5
  • Thumbnail Image
    Item
    Intensive Treatment Near the End of Life in Advanced Cancer Patients
    (2016-04-07) Touza, Kaitlin Kyna; Rand, Kevin L.; Stewart, Jesse; Mosher, Catherine Esther; Grahame, Nicholas J.
    Many advanced cancer patients receive intensive treatment near the end of life (EOL). Intensive treatment near the EOL is often associated with worse outcomes, such as worse quality of life (QOL), greater distress in patients and caregivers, and higher health care costs. For cancers typically unresponsive to chemotherapy such as lung and gastro-intestinal (GI), the side effects of intensive treatment are endured without increasing survival time. To date, research on EOL care in advanced cancer patients has focused on patient prognostic understanding, physician communication, and patient distress. These factors do not fully explain why many patients receive intensive treatment near the EOL when there is no hope for cure. Hence, there is a need to better understand the factors that influence EOL treatment in order to improve patient and caregiver outcomes. Self-Regulation Theory (SRT) provides a framework that may help explain motivations and care decisions in this population. This study had two aims: 1) to examine the associations between EOL clinical encounters (i.e., EOL conversations with a physician) and treatment intensity in advanced cancer patients near the EOL; and 2) to examine the associations between important SRT constructs (i.e., goal flexibility, hope, and optimism) and treatment intensity in advanced cancer patients near the EOL. A sample of 76 advanced lung and GI cancer patients was recruited from Indiana University Simon Cancer Center. Hope predicted receiving chemotherapy closer to death (β = -.41, t (66) = -2.31, p = .025), indicating more intensive treatment near EOL. Other predictor variables were not significantly associated with intensive treatment. Implications and methodological limitations are discussed.
  • Thumbnail Image
    Item
    Narrative review of prognosis related communication in advanced cancer patients
    (AME, 2021) Al-Issa, Karam; Helft, Paul R.; Medicine, School of Medicine
    Objective: In this review we will focus on doctor-patient communication as one of the most important modifiable factors which may have a significant impact especially on the important transition between the ambulatory and terminal phases of cancer. Background: High quality communication about prognosis for cancer patients is a critical component of advance care planning, and it plays a critical role among all the complex factors that affect end of life care decisions. In this review we focus on doctor-patient communication as the most important modifiable factor impacting the transitional period between the ambulatory phase and the terminal phase of cancer. We also discuss how prognostic understanding among advanced cancer patients influences decisions in regard to their cancer care. Methods: We investigated studies that examined advanced cancer patients and prognosis-related communication. Conclusions: We believe that oncologists' skills, experience, and comfort level in managing patients' reactions to negative information is a principal barrier that contributes substantially to the deficit of high-quality prognosis-related communication described in the literature. We also believe that it is useful to categorize oncologists with regard to their ability to engage in high quality communication, and we suggest category-specific strategies to improve oncologists' skills to conduct more effective prognosis related communication with their patients.
  • Thumbnail Image
    Item
    Preliminary Validation of the Injustice Experience Questionnaire in Patients with Advanced Cancer
    (Elsevier, 2023) Secinti, Ekin; Snyder, Stella; Wu, Wei; Mosher, Catherine E.; Psychology, School of Science
    Context: When diagnosed with advanced cancer, patients may perceive their situation as an injustice. The Injustice Experience Questionnaire (IEQ) is a 12-item measure of perceived unfairness originally developed for patients with chronic pain. The factor structure, reliability, and validity of the IEQ in patients with cancer have not been assessed. Objectives: To examine the factor structure, internal consistency, and construct validity of the IEQ in patients with advanced cancer. Methods: Patients with advanced lung or prostate cancer (N = 201) were recruited from academic and public clinics in Indianapolis, IN. Patients completed the 12-item IEQ and other measures of psychological processes and distress. IEQ instructions were modified to focus on cancer-related perceived injustice. Confirmatory factor analysis (CFA) was used to examine the dimensionality of the measure. Internal consistency reliability and construct validity were examined. Results: CFA showed that the original IEQ's 2-factor structure had an adequate fit (RMSEA = 0.07, CFI = 0.96, SRMR = 0.05). The factors included Severity/irreparability and Blame/unfairness. Internal consistency was excellent (α = 0.92, ω = 0.94). The IEQ showed significant positive associations with physical and psychological symptoms (rs = 0.20 - 0.65, Ps < 0.05). The IEQ also showed significant negative associations with quality of life and acceptance of cancer (rs=-0.51 - -0.46, Ps < 0.05). Conclusion: Findings provide preliminary support for using the IEQ in patients with advanced cancer. Future research should assess the sensitivity of the IEQ to change in an interventional context.
  • Thumbnail Image
    Item
    Spiritual Care Assessment and Intervention (SCAI) for Adult Outpatients With Advanced Cancer and Caregivers: A Pilot Trial to Assess Feasibility, Acceptability, and Preliminary Effects
    (Sage, 2022) Varner Perez, Shelley E.; Maiko, Saneta; Burke, Emily S.; Slaven, James E.; Johns, Shelley A.; Smith, Olivia J.; Helft, Paul R.; Kozinski, Kathryn; Torke, Alexia M.; Biostatistics and Health Data Science, School of Medicine
    Background: Although religion and spirituality are important to adults with cancer and their family caregivers, few studies have tested spiritual care interventions in the outpatient setting. Aim: To determine the feasibility, acceptability, and preliminary effects of chaplain-delivered, semi-structured spiritual care to adult outpatients with advanced cancer and their caregivers. Design: In this pre/post pilot intervention study, board-certified chaplains utilized the Spiritual Care Assessment and Intervention (SCAI) framework during 4 individual sessions. Surveys at baseline and at 1, 6, and 12 weeks post-intervention assessed spiritual well-being, quality of life, depression, anxiety, and religious coping. Setting/participants: We enrolled U.S. adult outpatients with or without an eligible family caregiver. Eligible patients were at least 18 years old and at least 2 weeks post-diagnosis of incurable and advanced-stage lung or gastrointestinal (GI) cancer. Results: Of 82 eligible patients, 24 enrolled (29.3%); of 22 eligible caregivers, 18 enrolled (81.8%). Four planned chaplain visits were completed by 87.5% of patients and 77.8% of caregivers. All enrolled participants completed baseline surveys, and more than 75% completed follow-up surveys at 2 of 3 time points. More than 80% of patients and caregivers reported they would recommend the sessions to a friend or family member. Patients' spiritual well-being improved significantly at all timepoints compared to baseline: 1-week post (p < .006), 6-weeks post (p < .001), and 12-weeks post (p < .004). Conclusions: Spiritual care through SCAI is feasible, acceptable, and shows promise in improving spiritual well-being and other important outcomes in advanced-stage cancer patients and family caregivers. Further investigation is warranted.
  • Thumbnail Image
    Item
    Symptom experiences in advanced cancer: Relationships to acceptance and commitment therapy constructs
    (Wiley, 2021) Mosher, Catherine E.; Krueger, Ellen; Secinti, Ekin; Johns, Shelley A.; Psychology, School of Science
    Objective: This study examined relations between acceptance and commitment therapy (ACT) constructs and symptom-based subgroups of advanced cancer patients. Methods: Patients with advanced breast, gastrointestinal, lung, and prostate cancer (N = 201) completed questionnaires assessing five common symptoms and ACT variables (i.e., psychological inflexibility, cognitive fusion, values obstruction and progress, peaceful acceptance, mindfulness, and activity engagement) on one occasion. Results: Latent profile analysis showed three patient classes: (1) normal levels of all symptoms (32%); (2) normal levels of all symptoms except for mild sleep problems and moderate fatigue (19%); and (3) normal pain, mild levels of sleep problems, anxiety, and depressive symptoms, and moderate fatigue (48%). Controlling for demographic covariates, lower psychological inflexibility, cognitive fusion, and values obstruction were associated with a higher likelihood of being in classes 1 or 2 than class 3. In addition, greater values progress, peaceful acceptance, mindfulness, and activity engagement were associated with a higher likelihood of being in class 1 than class 3. Of these four factors, only greater mindfulness and activity engagement were associated with a higher likelihood of being in class 2 than class 3. Conclusions: Advanced cancer patients show heterogeneous symptom profiles, and even mild to moderate symptom levels are related to greater withdrawal from personally meaningful activities and less acceptance of cancer and internal experiences (e.g., symptoms, thoughts, feelings). Findings are consistent with the ACT model and support further testing of ACT to address symptom interference with functioning in advanced cancer patients.