Errol J. Philip

Psychological distress in patients with pancreatic cancer—an understudied group

Background: Pancreatic cancer is the fourth leading cause of cancer‐related death in the United States, unsuccessful in significantly improving 5‐year survival. A diagnosis of pancreatic cancer may be associated with increased psychological distress, yet remarkably little is known about the degree of psychological distress experienced by these patients at the time of diagnosis and treatment.

Relationship of illness perceptions with depression among individuals diagnosed with lupus.

Background: The purpose of this study was to investigate the relationship of illness perceptions, as outlined in the Self‐Regulatory Model of illness, with depression among individuals diagnosed with lupus. Methods: A mail‐out questionnaire was completed by 154 members of the Australia Lupus Foundation and Lupus Foundation of New South Wales. Each questionnaire consisted of a Lupus Medical and Symptoms Questionnaire, the Illness Perceptions Questionnaire‐Revised and the Cardiac Depression Scale. Results: Hierarchical regression analysis revealed that individuals who reported a perception of their illness as having negative life consequences, an unpredictable nature and themselves possessing little understanding of lupus, reported high levels of depression. Conclusions: This study indicated the existence of a high level of depressive symptoms among individuals diagnosed with lupus, and reinforces the need for screening procedures in chronic illness, and treatment interventions that target maladaptive illness perceptions. Depression and Anxiety, 2009.

Assessment of self-efficacy for caregiving: the critical role of self-care in caregiver stress and burden.

OBJECTIVEnLittle attention has been given to assessing the importance of self-care and communication in the caregiving setting, especially caregiving for those who are terminally ill. The Caregiver Inventory (CGI), a measure of self-efficacy for caregiving that includes these two dimensions, was subjected to psychometric analyses.nnnMETHODnOne hundred and thirty-three primary caregivers completed the CGI; of those, 81 also completed the Perceived Stress Scale (PSS), Caregiver Burden Inventory (CBI), and a measure of caregiver tasks (ADLR-CG). Based on home visits, social workers also rated the caregiver tasks required (ADLR-SW). Exploratory Factor Analysis, as well as reliability and validity analyses were conducted.nnnRESULTSnFit indices in M + I (V. 5.1) indicated a four factors solution: Managing Medical Information (α = 0.64), Caring for Care Recipient (α = 0.78), Caring for Oneself (α = 0.88), and Managing Difficult Interactions/Emotions (α = 0.76). The CGI was highly negatively related to stress (PSS, r = -0.54, p = 0.001) and burden (CBI, p = -0.37, p = 0.001); ADLR-CG was related to burden (r = 0.43, p = 0.001) but not stress. In regression and relative importance analyses, Care of Oneself and Managing Difficult Interactions/Emotions emerged as equal in terms of having the strongest and most robust negative relationships with stress and burden.nnnSIGNIFICANCE OF RESULTSnResults suggest that the CGI is a reliable and valid measure of self-efficacy for caregiving, and indicate the importance of self-efficacy for self-care and for managing difficult communication in successfully navigating the demands of caregiving for terminally ill persons.

Evaluating the impact of an educational intervention to increase CRC screening rates in the African American community: a preliminary study

BackgroundDespite the acknowledged importance of colorectal cancer (CRC) screening and its proven prognostic benefit, African American men and women simultaneously possess the highest rates of CRC-related incidence and mortality (Swan et al. in Cancer 97(6):1528–1540, 2003) and lowest screening rates in the United States (Polite et al. in Med Clin N Am 89(4):771–793, 2005). Effective, targeted interventions that promote CRC screening for this community are therefore critical. The current study evaluated the impact of a print-based educational intervention on screening behavior and associated patient-based factors, including cancer-related knowledge, fatalism, worry, and decisional balance (pros–cons).MethodsOne hundred and eighteen individuals (mean agexa0=xa056.08, SDxa0=xa05.58) who had not undergone screening were recruited from two health clinics in New York City. Each participant received educational print materials regarding the need for screening, the process of undergoing screening, and the benefits of regular CRC screening.ResultsOne in four individuals had undergone post-intervention screening at a three-month follow-up. Whereas all participants reported a decrease in cancer-related worry (pxa0<xa0.05), it was a decrease in fatalism (pxa0<xa0.05) and an increase in decisional balance (pxa0<xa0.05) that was associated with post-intervention screening behavior.DiscussionThese preliminary results suggest that fatalistic beliefs and an individual’s assessment of the benefits and barriers of screening may be critical in the decision to undergo CRC screening. Future interventions to increase CRC-screening rates for this community may be improved by focusing on these patient-based factors.

Measurement accuracy in assessing patient’s quality of life: to weight or not to weight domains of quality of life

PurposeHealth-related quality of life (HRQOL) measures typically do not incorporate patients’ preferences for domains such as physical, emotional, functional and social/family well-being, which may compromise precision.MethodA forced-choice domain-preference measure was developed to assess the importance of HRQOL domains. About 194 cancer patients completed the domain-preference measure, along with measures of HRQOL, coping, adjustment, and life satisfaction.ResultsPatients ranked emotional well-being as most important and the loss of social-family well-being as the most difficult to do without. A weighting algorithm revealed no advantage to incorporating individuals’ domain preferences in HRQOL assessment; however, preliminary evidence suggested that HRQOL measurement may be more accurate in predicting outcomes for individuals with no distinct domain preferences than those with distinct preference profiles.ConclusionThis study provides preliminary evidence for the validity of current measures of HRQOL, which may inherently take into account patients’ domain preferences.

Depression and pain in night time and daytime functioning of individuals with lupus

The purpose of this study was to investigate the role of pain and depression in night time and daytime functioning of individuals with lupus. A cross-sectional research design was used. Participants were recruited via a mail-out to members of the Lupus Australia Foundation and the Lupus Association of New South Wales. One hundred and fifty-four participants completed a questionnaire package consisting of a Lupus Medical and Symptoms Questionnaire designed by the researchers, the Cardiac Depression Scale and the Pittsburgh Sleep Quality Index. Hierarchical regression analyses revealed that pain principally predicted levels of sleep disturbance, whilst depression and pain (to a lesser extent) together predicted daytime dysfunction. The present results suggested the need for more adequate pain management, particularly at night and psychological interventions to decrease levels of depression that interfere with daily functioning in individuals with lupus.

Psychosocial issues in post-treatment cancer survivors: Desire for support and challenges in identifying individuals in need

ABSTRACT Purpose: The ongoing and late effects of cancer treatment can interfere with quality of life and adoption of healthy behaviors, thus potentially impairing recovery and survival. Developing effective methods to identify individuals in need of support is crucial in providing comprehensive, ongoing care and ensuring optimal use of limited resources. The current study provides an examination of long-term survivors’ reports of psychosocial issues, their desire for follow-up, and the role of widely used distress-screening measures for identifying survivors who desire help. Method: 317 cancer survivors (M age = 62.98 years, female = 70%, Md years since treatment = 7.5 years, mixed diagnoses) completed measures of psychosocial adjustment and quality of life as well as a checklist of psychosocial issues on which they indicated whether they would like to speak with a health professional regarding each issue. Results: Participants reported an average of 1.7 psychosocial issues. Only a minority desired to speak to a health professional; however, those desiring follow-up reported significant impairments in adjustment and quality of life. Though far from adequate as a stand-alone measure, area under the curve and regression analysis suggested a combination of the distress thermometer and number of psychosocial issues may be the best assessment of those desiring follow-up assistance. Conclusion: These results indicate that there is a need for a more sophisticated system of assisting survivors that takes into account issues, symptoms, and motivation for help. The present study is important in guiding the development of effective survivorship care and contributing to the growing literature describing the adjustment and care needs of survivors.

Examining the Impact of Latino Nativity, Migration, and Acculturation Factors on Colonoscopy Screening

AbstractLatinos are a diverse population comprised of multiple countries of origin with varying cultural profiles. This study examines differences in colonoscopy completion across place of birth and migration-related factors in a sample of predominantly Dominican and Puerto Rican Latinos living in New York City after receiving a recommendation for colonoscopy screening and navigation services. The sample included 702 Latinos recruited for two cancer screening projects targeting Latinos eligible for colonoscopy who seek healthcare in New York City. Participants completed a survey that included sociodemographic, health-related questions, psychosocial assessments and cancer screening practices, in Spanish or English. Migration, acculturation, and language factors were found to predict colonoscopy completion. The results indicated that Latinos born in the Dominican Republic and Central America were more likely to complete a screening colonoscopy than their counterparts born in the US. Further, those who emigrated at an older age, who have resided in the US for less than 20xa0years, preferred Spanish and those with lower US acculturation levels were also more likely to complete a screening colonoscopy. The findings suggest that Latinos who are less acculturated to the US are more likely to complete a screening colonoscopy after receiving a physician recommendation for colonoscopy screening. The results provide important information that can inform clinical practice and public health interventions. Continued attention to cultural and migration influences are important areas for cancer screening intervention development.n

Social Relationship Coping Efficacy: A New Construct in Understanding Social Support and Close Personal Relationships in Persons with Cancer

Social relationship coping efficacy (SRCE) is the confidence to engage in behaviors that can maintain or enhance close social relationships in the context of illness. This study focused on psychometric analyses of the SRCE scale and its role in maintaining or enhancing personal relationships, social support, and quality of life (QOL).

Assessment of distress and quality of life in rare cancers

Rare cancers are a heterogeneous group of conditions that can be associated with emotional and physical impairments. In view of the dearth of research in this area, we investigated the quality of life and prevalence of distress in a cohort of patients diagnosed with a rare cancer, classified by the RARECARE definition.