Sarah Quinton

Negative Aspects of Close Relationships are More Strongly Associated than Supportive Personal Relationships with Illness Burden of Irritable Bowel Syndrome

OBJECTIVE This study assessed the relative magnitude of associations between IBS outcomes and different aspects of social relationships (social support, negative interactions). METHOD Subjects included 235 Rome III diagnosed IBS patients (M age=41yrs, F=78%) without comorbid GI disease. Subjects completed a testing battery that included the Interpersonal Support Evaluation List (Social Support or SS), Negative Interaction (NI) Scale, IBS Symptom Severity Scale (IBS-SSS), IBS-QOL, BSI Depression, STAI Trait Anxiety, SOMS-7 (somatization), Perceived Stress Scale, and a medical comorbidity checklist. RESULTS After controlling for demographic variables, both SS and NI were significantly correlated with all of the clinical variables (SS rs=.20 to .36; NI rs=.17 to .53, respectively; ps<.05) save for IBS symptom severity (IBS-SSS). NI, but not SS, was positively correlated with IBS-SSS. After performing r-to-z transformations on the correlation coefficients and then comparing z-scores, the correlation between perceived stress, and NI was significantly stronger than with SS. There was no significant difference between the strength of correlations between NI and SS for depression, somatization, trait anxiety, and IBSQOL. A hierarchical linear regression identified both SS and NI as significant predictors of IBS-QOL. CONCLUSIONS Different aspects of social relationships - support and negative interactions - are associated with multiple aspects of IBS experience (e.g. stress, QOL impairment). Negative social relationships marked by conflict and adverse exchanges are more consistently and strongly related to IBS outcomes than social support.

Inflammatory Bowel Disease Patient Experiences with Psychotherapy in the Community

This study aimed to characterize patient expectations for integrating mental health into IBD treatment, describe experiences with psychotherapy, and evaluate therapy access and quality. Adults with IBD were recruited online and via a gastroenterology practice. Participants, 162 adults with IBD, completed online questionnaires. The sample was primarily middle-aged, White, and female. Sixty percent had Crohn’s Disease. Disease severity was mild to moderate; 38% reported utilizing therapy for IBD-specific issues. The greatest endorsed barrier to psychotherapy was its cost. Psychotherapy was perceived as leading to modest gains in quality of life, emotional well-being, and stress reduction. Participants reported a disparity between their desire for mental health discussions and their actual interactions with providers. The majority of participants (81%) stated there are insufficient knowledgeable therapists. A significant number of patients with IBD endorsed the desire for mental health integration into care. Disparities exist in reported provider–patient communication on these topics. There appears to be a dearth of IBD-knowledgeable therapists in the community.

Endosonographers’ approach to delivering a diagnosis of pancreatic cancer: obligated but undertrained

Background and study aims: No data are available on the practice patterns of endosonographers as they pertain to the disclosure of a pancreatic cancer diagnosis. We sought to understand the current practice and coping strategies of physicians who perform endoscopic ultrasound (EUS) procedures in patients with suspected pancreatic cancer. Methods: This study used a nonexperimental, cross-sectional survey design. A total of 707 endosonographers were contacted and asked to complete an online survey encompassing both demographic and practice data. In addition, participants had the option to complete a second survey assessing common coping strategies. Results: A total of 152 physicians (22 %) participated in the study. The sample was split between community (47 %) and academic centers (53 %). A total of 92 % of the respondents felt an obligation to share a cancer diagnosis when it was available to them; however, only 45 % felt they were adequately trained to do so. Comfort levels were higher in those who performed more than 200 EUS procedures annually and in those practicing for longer than 5 years (P = 0.044). A total of 98 physicians (64.5 %) also completed the Brief COPE questionnaire, and the results indicated that the more experienced endosonographers were less likely to experience emotional distress when disclosing a cancer diagnosis. Conclusion: The comfort level for disclosing a pancreatic cancer diagnosis after EUS appears to be higher in experienced endosonographers (> 5 years in practice) and in those who conduct a higher volume of procedures. Although the majority of endosonographers feel obligated to disclose a cancer diagnosis, the lack of time and proper training is limiting. Formal communication skills training within a gastrointestinal fellowship should be considered.