Cindy L. Carter

Care at the end of life: Focus on communication and race

Objective: To profile communication and recommendations reported by adults with terminal illness and explore differences by patient and physician characteristics. Method: This pilot was a cross-sectional study sample of 90 patients (39 Caucasian, 51 African American) with advanced heart failure or cancer. Participants completed an in-person, race-matched interview. Results: Participation was high (94%). Discussion about end-of-life topics was low. For example, only 30% reported discussion of advance directives, and 22% reported their physician inquired about spiritual support. Participants with cancer were significantly more likely to be receiving pain and/or symptom management at home, aware of prognosis, and participating in hospice. African American participants who were under the care of African American physicians were less likely to report pain and/or symptom management than other racial matches. Discussion: Although additional research on factors related to communication is important, initiation of patient-centered counseling by all physicians with seriously ill patients is essential.

Genetic testing for alpha1-antitrypsin deficiency.

Purpose: The Alpha Coded Testing Study investigated the risks, benefits, and psychological impact of home genetic testing for α1-antitrypsin deficiency.Methods: In the study, 996 adult individuals requested and returned a home-administered, confidential, fingerstick blood test.Results: Individuals highly rated the benefits of establishing a diagnosis (82%), helping family members (86%), and anticipating peace of mind (79%). 78% of 239 current smokers reported a high likelihood of smoking cessation if diagnosed with AATD. After testing, more than 60% indicated that they would share the results with family and physicians but < 30% would share results with insurance companies.Conclusions: Confidential home testing for genetic disorders requires a comprehensive program of participant support.

Quality of life pilot intervention for breast cancer patients: Use of social cognitive theory

OBJECTIVE The purpose of this article is to evaluate an 8-week pilot intervention based on Social Cognitive Theory to improve quality of life for women with breast cancer. METHODS A total of 32 breast cancer patients were randomized to either the intervention or standard care. Outcome variables included quality of life, mood, self-efficacy, outcome expectations, and self-regulation. RESULTS Effect sizes were calculated to examine the impact of the intervention, with moderate to large effect sizes found for several subscales of the outcome expectations variable: learning about cancer and treatment (d = 0.85), having a positive attitude (d = 0.54), talking about cancer (d = 1.02), engaging in relaxation (d = 0.62), and setting goals (d = 1.58). SIGNIFICANCE OF RESULTS A nonparametric sign test was conducted, indicating that women in the intervention condition either improved more or showed less decline than the women in standard care, p = .034, two-tailed. Implications and suggestions for the content and delivery of future psychosocial interventions with cancer patients are reviewed.

The comparative effectiveness of a team-based versus group-based physical activity intervention for cancer survivors

PurposePhysical activity benefits cancer survivors, but the comparative effectiveness of a team-based delivery approach remains unexplored. The hypothesis tested was that a team-based physical activity intervention delivery approach has added physical and psychological benefits compared to a group-based approach. A team-based sport accessible to survivors is dragon boating, which requires no previous experience and allows for diverse skill levels.MethodsIn a non-randomized trial, cancer survivors chose between two similarly structured 8-week programs, a dragon boat paddling team (n = 68) or group-based walking program (n = 52). Three separate intervention rounds were carried out in 2007–2008. Pre–post testing measured physical and psychosocial outcomes.ResultsCompared to walkers, paddlers had significantly greater (all p < 0.01) team cohesion, program adherence/attendance, and increased upper-body strength. For quality-of-life outcomes, both interventions were associated with pre–post improvements, but with no clear-cut pattern of between-intervention differences.ConclusionsThese hypothesis-generating findings suggest that a short-term, team-based physical activity program (dragon boat paddling) was associated with increased cohesion and adherence/attendance. Improvements in physical fitness and psychosocial benefits were comparable to a traditional, group-based walking program. Compared to a group-based intervention delivery format, the team-based intervention delivery format holds promise for promoting physical activity program adherence/attendance in cancer survivors.

Factors associated with cancer survivors’ selection between two group physical activity programs

IntroductionPhysical activity programs have health benefits for cancer survivors, but little is known about factors that influence cancer survivors’ actual choices between different physical activity programs. To address this knowledge gap, we examined factors associated with selecting between two group physical activity programs.MethodsThe present study is nested in a non-randomized trial. After attending an orientation to learn about the programs offered, cancer survivors (n = 133) selected between a dragon boat paddling team and group walking program. We measured the association between physical activity program chosen and demographic, clinical, physical and psychosocial characteristics.ResultsRoughly equal proportions chose to participate in dragon boat paddling or walking (55% versus 45%). Of the many variables studied, few were associated with program selection. Compared to those who chose the walking program, those who chose the dragon boat paddling team were more likely to be Caucasians (p = .015) and younger (p = .027), and marginally signifantly more like to have cancers other than breast cancer (p = .056) and have greater lower-body strength (.062).Discussions/ConclusionsAmong a cohort of cancer survivors who were interested in physical activity programs who chose between two markedly different group physical activity programs, the two programs attracted groups of approximately the same size and with remarkably similar characteristics overall. The two most notable associations were that Caucasians and younger adults were significantly more likely to choose the dragon boat paddling program.Implications for Cancer SurvivorsTo meet the needs of cancer survivors, a menu of physical activity program options may be optimal.

Measurement in Group Interventions for Women with Breast Cancer

Abstract Instrumentation is a critical component of intervention research. This article discusses a review of measurement tools used in research on group interventions for women with breast cancer. The wide variety of instruments used in research studies is listed. The criteria for instrument selection are compared with the most commonly used instrument, the Profile of Mood States. The authors summarize directions for future research related to instrumentation use.

Barriers to Genetic Testing Among Persons at Risk for Alpha-1 Antitrypsin Deficiency

The alpha coded testing (ACT) study offers free and confidential testing for alpha-1 antitrypsin deficiency (AATD) and includes surveys to provide data to study the psychosocial correlates of genetic testing. The purpose of the current study is to better understand reasons why some individuals complete genetic testing while others do not. Survey measures were compared between participants who requested and returned a genetic test for AATD (n = 703), and a random sample of individuals who requested a test kit, but did not return it within 3 months of their request (n = 83). Increasing decile of age (odds ratio [OR] = 0.74 [95% confidence interval = 0.60-0.82]) and fingerstick fear (OR = 0.74 [0.60-0.93]) were associated with a decreased likelihood of returning the test, while assurance of confidentiality was associated with an increased likelihood (OR = 1.26 [1.01-1.57]) of returning the genetic test. General anxiety as measured by the Beck Anxiety Inventory, family functioning as measured by the general functioning subscale of the Family Assessment Device, and stress induced by genetic testing as measured by the Impact of Events Scale did not significantly differ between responder groups (p = not significant). Results of this study help characterize factors driving genetic testing in AATD and may offer insight into population responses with other genetic tests.

Abstract A118: The impact of participating in a team sport versus a group physical activity program on group cohesion in cancer survivors

Objectives: Being a member of a cohesive group could provide a source of high‐quality social support that could positively impact the quality of life in cancer survivors. In a nonrandomized trial, we compared group cohesion in a team‐oriented (dragon boat paddling team) and non‐team‐oriented (group walking program) group physical activity intervention. We hypothesized that group cohesion would be stronger among those who participated in the team‐oriented dragon boat paddling team compared to the group walking program. Participants and Methods: 122/134 (91%) of participants who enrolled in the study completed the eight‐week physical activity programs, dragon boat paddling team (n=68) or group walking program (n=54). Group cohesion was measured post‐intervention using a modified 11 item version of the Group Environment Questionnaire. We tested differences in median cohesion scores between paddlers and walkers using the Wilcoxon Rank Sum test, a nonparametric equivalent of the t‐test which is robust to deviations from the normality assumption. Results: Following completion of the group physical activity program, the median group cohesion score for paddlers was statistically significantly higher than for walkers (paddlers=4.36, walkers=3.73, p=0.004). Conclusions: Participating in a team sport was associated with significantly higher group cohesion even in comparison to a group physical activity program that was not team oriented. These novel findings suggest that team‐oriented physical activity programs such as dragon boat paddling may provide a greater opportunity for social support through increased group cohesion than a group‐based walking program. Future studies should examine the mechanisms underlying these differences and the outcomes associated with increased cohesion. Among cancer survivors, team membership may provide a natural source of social support. Citation Information: Cancer Prev Res 2010;3(1 Suppl):A118.

Abstract B21: Cancer-related quality of life following physical activity interventions for cancer survivors

B21 Objectives We carried out a nonrandomized trial to determine how participation in physical activity interventions (dragon boat paddling team versus a group walking program) impacted on physical and psychological outcomes. We report preliminary findings comparing the pre-post intervention differences on cancer-related quality-of-life (QoL). Participants and Methods 83/92 (90%) of participants who enrolled in the study completed an eight-week paddling (n=46) or walking (n=37) intervention. The 27-item FACT-G Scale was administered both pre- and post-intervention. We examined pre-post test differences in mean scores for the total FACT-G scale and four subscales. Results In the total study population, participation in a physical activity intervention was associated with significant post-intervention improvements in overall FACT-G QoL scores (post-test mean 84.5 vs. pretest mean 82.5; p=0.03). This included significant gains on the physical (p=0.02) and functional (p=0.01) QoL FACT-G subscales. These overall findings were consistent within both the paddling and walking interventions; no significant between-group differences were observed. However, the increase in the functional subscale mean score was statistically significant for the paddling (p=0.02) but not the walking (p=0.19) intervention. Conclusions Participation in a physical activity program, regardless of the type of program, increased overall cancer-related QoL in cancer survivors. This impact was most notable for QoL related to the physical and functional domains. These preliminary findings indicate that participating in a short-term physical activity program can lead to significant improvements in cancer-related QoL. Supported by NCI R03CA128482. Citation Information: Cancer Prev Res 2008;1(7 Suppl):B21.