Inge Henselmans

Identification and prediction of distress trajectories in the first year after a breast cancer diagnosis

OBJECTIVEnIn this article, we aim to (a) identify distinct trajectories of psychological distress in the first year after a breast cancer diagnosis in women treated with adjuvant therapy and (b) explore possible predictors of these trajectories, that is, demographic, medical, and personal characteristics.nnnMETHODnThe 171 patients were assessed after diagnosis, after surgery, after adjuvant treatment, in the reentry phase, and in the (short-term) survivorship phase (2 and 6 months after the end of treatment, respectively).nnnMAIN OUTCOME MEASUREnPsychological distress was assessed with the 12-item General Health Questionnaire.nnnRESULTSnThere were four trajectories of distress: a group that experienced no distress (36.3%), a group that experienced distress only in the active treatment phase (33.3%), a group that experienced distress in the reentry and survivorship phase (15.2%), and a group that experienced chronic distress (15.2%). Personality and physical complaints resulting from adjuvant treatment could distinguish the distress trajectories. Mastery was the only unique predictor.nnnCONCLUSIONnMost patients were not distressed in response to breast cancer or only temporarily so. Yet, a minority of patients became or remained distressed after the end of treatment.

The adaptive role of perceived control before and after cancer diagnosis: A prospective study

Cancer is generally considered a low-control situation. Stability of perceptions of control before and after cancer was examined, as well as the adaptive value of maintenance versus relinquishment of control in the psychological adjustment to cancer. This study, conducted in the northern Netherlands, was carried out in a prospective design with four assessment points (one pre-morbid and three post-morbid assessments) involving semi-structured interviews and self-report questionnaires. Ninety-nine newly diagnosed cancer patients all aged over 57 years completed all four assessment points. We found that perceptions of control declined before and after disease, possibly as a consequence of the diagnosis of cancer. Further, maintenance of control after cancer diagnosis was related to lower levels of psychological distress 6 and 12 months after diagnosis. These results suggest that maintenance of perceptions of control is beneficial to the psychological adjustment to cancer.

Personal control after a breast cancer diagnosis : stability and adaptive value

Objective: This longitudinal study aims to gain more insight in both the changes in personal control due to a breast cancer diagnosis, as well as in the stress‐buffering effect of personal control.

The adaptive effect of personal control when facing breast cancer: Cognitive and behavioural mediators

This prospective study examines the cognitive and behavioural mediators of the relation between personal control and the initial response to a breast cancer diagnosis as well as subsequent psychological adjustment. A total of 143 patients participated immediately after diagnosis (T1), after surgery (T2) and 2 months after the end of treatment (T3), of whom 92 also completed a questionnaire pre-diagnosis (T0). The buffering effect of personal control on psychological distress shortly after diagnosis was mediated by cancer-specific cognitions, i.e. threat appraisal and coping self-efficacy. Moreover, a strong sense of personal control predicted lower levels of anxiety 2 months after the end of treatment, but was unrelated to distress at T3. The adaptive effect on anxiety was mediated by threat appraisal and active engagement in social life after surgery, but not by active patient participation or coping self-efficacy. These results confirm and explain the adaptive effect of control. Apparently, women with a low sense of control appraise cancer and their personal coping skills more negatively, which makes them vulnerable to distress in response to diagnosis. Furthermore, women with a strong sense of control might regulate anxiety by remaining engaged in social life.

Personal control over the cure of breast cancer: adaptiveness, underlying beliefs and correlates

Objectives: Although cognitive adaptation theory suggests that personal control acts as a stress buffer when facing adversity, maladaptive outcomes might occur when control is disconfirmed. The moderating effect of disappointing news on the adaptiveness of personal control over cure in women with breast cancer was examined and contrasted with the effect on the adaptiveness of general control over life. Additionally, the underlying beliefs and correlates of control over cure were explored.

The Tenacious Goal Pursuit and Flexible Goal Adjustment Scales: A Validation Study

The flexible goal adjustment (FLEX) and tenacious goal pursuit (TEN) scales are used regularly in aging research. The current study examined their validity in a sample of 517 women (30-75 years) in multiple ways. Overall, the findings show that the scales do not clearly distinguish between FLEX and TEN. The direction in which the items were formulated was just as important as what was being measured. Moreover, face validity of the inversely phrased items in particular appeared to be weak. On the basis of these findings, the authors recommend a revision of the concept definitions as well as of the items.

Complementary and alternative medicine use of women with breast cancer: Self-help CAM attracts other women than guided CAM therapies

OBJECTIVEnExamine stability of use of complementary and alternative medicine (CAM) of breast cancer patients, reasons for CAM use, and sociodemographic, clinical, and psychological predictors of CAM use.nnnMETHODSnCAM use was assessed after adjuvant therapy and six months later. Following the CAM Healthcare Model, CAM use was divided into use of provider-directed (guided) and self-directed (self-help) CAM. Stability and reasons for CAM use were examined with McNemars tests and descriptive statistics. Cross-sectional and longitudinal associations between predictors and CAM use were examined with univariate and multivariate logistical analyses.nnnRESULTSnUse of provider-directed and self-directed CAM was stable over time (N=176). Self-directed CAM was more often used to influence the course of cancer than provider-directed CAM. Both were used to influence well-being. Openness to experience predicted use of provider-directed CAM, while clinical distress predicted use of self-directed CAM, after adjusting for other predictors. Perceived control did not predict CAM use.nnnCONCLUSIONnCAM use is stable over time. It is meaningful to distinguish provider-directed from self-directed CAM.nnnPRACTICE IMPLICATIONSnProviders are advised to plan a CAM-talk before adjuvant therapy, and discuss patients expectations about influence of CAM on the course of cancer. Distressed patients most likely need information about self-directed CAM.

Developing a core set of patient-reported outcomes in pancreatic cancer: A Delphi survey

BACKGROUNDnPatient-reported outcomes (PROs) are amongst the most relevant outcome measures in pancreatic cancer care and research. However, it is unknown which out of the numerous PROs are most important to patients and health care professionals (HCPs) in this setting. The aim of this study was to identify a core set of PROs to be incorporated in a nationwide prospective multidisciplinary pancreatic cancer registry.nnnPATIENTS AND METHODSnWe performed a two-round Delphi survey among 150 patients diagnosed with pancreatic or periampullary cancer (treated either with curative intent or in palliative setting) and 78 HCPs (surgeons, medical oncologists, gastroenterologists, radiotherapists, nurses, and dietitians) in The Netherlands. In round 1, participants were invited to rate the importance of 53 PROs, which were extracted from 17 different PRO measures and grouped into global domains, on a 1-9 Likert scale. PROs rated as very important (score 7-9) by the majority (≥ 80%) of curative and/or palliative patients as well as HCPs were considered sufficiently important to be incorporated in the core set. PROs not fulfilling these criteria in round 1 were presented again to the participants in round 2 along with individual and group feedback.nnnRESULTSnA total of 97 patients (94%) in curative-intent setting, 38 patients (81%) in palliative setting and 73 HCPs (94%) completed both rounds 1 and 2. After the first round, 7 PROs were included in the core set: general quality of life, general health, physical ability, satisfaction with caregivers, satisfaction with services and care organisation, coping and defecation. After the second round, 10 additional PROs were added: appetite, ability to work/do usual activities, medication use, weight changes, fatigue, negative feelings, positive feelings, fear of recurrence, relationship with partner/family, and pancreatic enzyme replacement therapy use.nnnCONCLUSIONnThis study provides a core set of PROs selected by patients and HCPs, which may be incorporated in pancreatic cancer care and research. Validation outside the Dutch context is recommended for generalisation and use in international studies.

Relationship between physicians’ death anxiety and medical communication and decision-making: A systematic review

OBJECTIVEnTo examine the relationship between physicians death anxiety and medical communication and decision-making. It was hypothesized that physicians death anxiety may lead to the avoidance of end-of-life conversations and a preference for life-prolonging treatments.nnnMETHODSnPubMed and PsycInfo were systematically searched for empirical studies on the relation between physicians death anxiety and medical communication and decision-making.nnnRESULTSnThis review included five quantitative and two qualitative studies (Nu2009=u20097). Over 38 relations between death anxiety and communication were investigated, five were in line with and one contradicted our hypothesis. Physicians death anxiety seemes to make end-of-life communication more difficult. Over 40 relations between death anxiety and decision-making were investigated, three were in line with and two contradicted the hypothesis. Death anxiety seemes related to physicians guilt or doubt after a patients death.nnnCONCLUSIONSnThere was insufficient evidence to confirm that death anxiety is related to more avoidant communication or decision-making. However, death anxiety does seem to make end-of-life communication and decision-making more difficult for physicians.nnnPRACTICE IMPLICATIONSnEducation focused on death and dying and physicians emotions in medical practice may improve the perceived ease with which physicians care for patients at the end of life.

Training for Medical Oncologists on Shared Decision‐Making About Palliative Chemotherapy: A Randomized Controlled Trial

BACKGROUNDnSystemic treatment for advanced cancer offers uncertain and sometimes limited benefit, while the burden can be high. This study examines the effect of shared decision-making (SDM) training for medical oncologists on observed SDM in standardized patient assessments.nnnMATERIALS AND METHODSnA randomized controlled trial comparing training with standard practice was conducted. Medical oncologists and oncologists-in-training (nu2009=u200931) participated in a video-recorded, standardized patient assessment at baseline (T0) and after 4 months (T1, after training). The training was based on a four-stage SDM model and consisted of a reader, two group sessions (3.5 hours each), a booster session (1.5 hours), and a consultation card. The primary outcome was observed SDM as assessed with the Observing Patient Involvement scale (OPTION12) coded by observers blinded for arm. Secondary outcomes were observed SDM per stage, communication skills, and oncologists satisfaction with communication.nnnRESULTSnThe training had a significant and large effect on observed SDM in the simulated consultations (Cohens fu2009=u20090.62) and improved observed SDM behavior in all four SDM stages (fu2009=u20090.39-0.72). The training improved oncologists information provision skills (fu2009=u20090.77), skills related to anticipating/responding to emotions (fu2009=u20090.42), and their satisfaction with the consultation (fu2009=u20090.53).nnnCONCLUSIONnTraining medical oncologists in SDM about palliative systemic treatment improves their performance in simulated consultations. The next step is to examine the effect of such training on SDM in clinical practice and on patient outcomes.nnnIMPLICATIONS FOR PRACTICEnSystemic treatment for advanced cancer offers uncertain and sometimes limited benefit, while the burden can be high. Hence, applying the premises of shared decision-making (SDM) is recommended. SDM is increasingly advocated based on the ethical imperative to provide patient-centered care and the increasing evidence for beneficial patient outcomes. Few studies examined the effectiveness of SDM training in robust designs. This randomized controlled trial demonstrated that SDM training (10 hours) improves oncologists performance in consultations with standardized patients. The next step is to examine the effect of training on oncologists performance and patient outcomes in clinical practice.