Serge Sultan

Prevalence, intensity, and predictors of the supportive care needs of women diagnosed with breast cancer: a systematic review

The assessment of supportive care needs is a crucial step in the development of appropriate interventions that may improve the quality of life of cancer patients. This review describes and analyzes the prevalence and predictors of the unmet supportive care needs of breast cancer (BC) patients and survivors and suggests paths for further research.

To be or not to be empathic: the combined role of empathic concern and perspective taking in understanding burnout in general practice.

BackgroundGeneral practice is stressful and burnout is common among family physicians. A growing body of evidence suggests that the way physicians relate to their patients could be linked to burnout. The goal of this study was to examine how patterns of empathy explained physicians’ burnout.MethodsWe surveyed 294 French general practitioners (response rate 39%), measured burnout, empathic concern (EC) and perspective taking (PT) using self-reported questionnaires, and modeled burnout levels and frequencies with EC, PT and their interaction in linear and logistic regression analyses.ResultsMultivariate linear models for burnout prediction were associated with lower PT (β = −0.21, p < 0.001) and lower EC (β = −0.17, p < 0.05). Interestingly, the interaction (EC x PT) also predicted burnout levels (β = 0.11, p < 0.05). The investigation of interactions revealed that high scores on PT predicted lower levels of burnout independent from EC (odd ratios (OR) 0.37; 95% confidence interval (95% CI) 0.21–0.65 p < 0.001), and high scores on both EC and PT were protective against burnout: OR 0.31; 95% CI 0.15–0.63, p < 0.001).ConclusionsDeficits in PT alone might be a risk factor for burnout, whereas higher PT and EC might be protective. Educators should take into account how the various components of empathy are potentially associated with emotional outcomes in physicians.

Depression in patients with mastocytosis: prevalence, features and effects of masitinib therapy.

Depression in patients with mastocytosis is often reported but its prevalence and characteristics are not precisely described. In addition, the impact of therapies targeting mast cells proliferation, differentiation and degranulation on psychic symptoms of depression have never been investigated. Our objective was to determine the prevalence and to describe features of depression in a large cohort of mastocytosis patients (n = 288) and to investigate the therapeutic impact of the protein kinase inhibitor masitinib in depression symptoms. The description of depression was based on the analysis of a database with Hamilton scores using Principal Component Analysis (PCA). Efficacy of masitinib therapy was evaluated using non parametric Wilcoxon test for paired data within a three months period (n = 35). Our results show that patients with indolent mastocytosis present an elevated prevalence of depression (64%). Depression was moderate in 56% but severe in 8% of cases. Core symptoms (such as psychic anxiety, depressed mood, work and interests) characterized depression in mastocytosis patients. Masitinib therapy was associated with significant improvement (67% of the cases) of overall depression, with 75% of recovery cases. Global Quality of Life slightly improved after masitinib therapy and did not predicted depression improvement. In conclusion, depression is very frequent in mastocytosis patients and masitinib therapy is associated with the reduction its psychic experiences. We conclude that depression in mastocytosis may originate from processes related to mast cells activation. Masitinib could therefore be a useful treatment for mastocytosis patients with depression and anxiety symptoms.

Burnout and empathy in primary care: three hypotheses

In the last 10 years, a growing literature about empathy in primary care indicates that, for both patient and clinician, empathy helps to improve many aspects of health care practice and patient satisfaction. Wensing et al 1 indicated that humaneness, exploring the needs of patients, and good communication skills are some of the high priorities that patients expect from their GP. Cape et al 2 showed that doctor empathy coded by external observers was positively correlated with listening interactions and patient involvement. Vedsted and Heje3 found that patients tended to recommend their GP to others if they judged them as ‘empathic’. Mercer et al 4 showed a positive relationship both between GP empathy and patient enablement at the consultation, and between patient enablement and changes in the main symptom and well-being evaluated 3 months after the consultation. Finally, Verheul et al 5 investigated the impact of a warm and empathic consultation compared to a cold and formal consultation on the certainty of the outcome. The greatest beneficial effects of empathic communication on stress reduction and expectancies were observed when it was combined with a positive expectations style. To preserve effective empathy in care, the health provider must be in a positive frame of mind and not affected by stress or burnout. Burnout occurs when individuals feel emotionally overwhelmed by the …

Evidence for cognitive impairment in mastocytosis: prevalence, features and correlations to depression.

Mastocytosis is a heterogeneous disease characterized by mast cells accumulation in one or more organs. We have reported that depression is frequent in mastocytosis, but although it was already described, little is known about the prevalence and features of cognitive impairment. Our objective was to describe the prevalence and features of cognitive impairment in a large cohort of patients with this rare disease (n = 57; mean age = 45) and to explore the relations between memory impairment and depression. Objective memory impairment was evaluated using the 3rd edition of the Clinical Memory scale of Wechsler. Depression symptoms were evaluated using the Hamilton Depression Rating Scale. Age and education levels were controlled for all patients. Patients with mastocytosis presented high levels of cognitive impairment (memory and/or attention) (n = 22; 38.6%). Cognitive impairment was moderate in 59% of the cases, concerned immediate auditory (41%) and working memory (73%) and was not associated to depression (p≥0.717). In conclusion, immediate auditory memory and attention impairment in mastocytosis are frequent, even in young individuals, and are not consecutive to depression. In mastocytosis, cognitive complaints call for complex neuropsychological assessment. Mild-moderate cognitive impairment and depression constitute two specific but somewhat independent syndromes in mastocytosis. These results suggest differential effects of mast-cell activity in the brain, on systems involved in emotionality and in cognition.

Changes in psychological adjustment over the course of treatment for breast cancer: the predictive role of social sharing and social support.

Although research on social sharing suggests it could be an important factor in subsequent adjustment, it has rarely been examined in combination with the nature of the support received by patients. The goal of this study was to determine whether and to what extent social sharing concerning the disease and perceived social support after breast surgery explain psychological adjustment at the end of the treatment.

Physicians’ understanding of patients’ personal representations of their diabetes: Accuracy and association with self-care

The degree of accuracy with which physicians understand their patients’ views may be of central importance for promoting self-care in the majority of chronic illnesses and in type 2 diabetes in particular. The objectives of this study were to measure the accuracy of the general practitioners’ understanding of the patients’ views and relate it to health behavioural outcomes in patients with non-complicated type 2 diabetes. The participants in this cross-sectional study consisted of 14 clinicians and 78 of their patients from Paris, France. The predictors were levels of accuracy in understanding the patients’ views derived from the illness perception questionnaire-revised (IPQ-R). The outcomes were patient-reported self-care measures. In regression models controlling for clinical and personal variables, higher accuracy on chronicity beliefs was associated with an improved diet and increased blood glucose self-testing and higher accuracy in identifying treatment control beliefs was associated with better dietary self-care. Accuracy was higher with regard to beliefs about causes, treatment control and consequences. These results suggest that accuracy may impact self-care in specific domains of illness perception but not others. The results may help identify useful avenues of communication training designed for professionals.

A longitudinal study of coping, anxiety and glycemic control in adults with type 1 diabetes

Diabetes is a unique disorder in how much it requires a high degree of individual self management strategies. Anxiety and stress can affect glycemic control, and thus management of emotions may be key to good glycemic control. This study is the first to examine how anxiety and coping style, and their interaction, can affect long-term glycemic control. We measured anxiety, coping, and HbA1C, a measure for mean blood glucose levels in the previous 6–8 weeks, in 115 patients with Type 1 diabetes at baseline and roughly 5 years later. We found that coping predicted outcomes, especially for those high in trait anxiety. Trait anxiety predicted limited increases in HbA1C (mean increase = 0.02%). Lower levels of emotion-oriented coping predicted clinically significant increases in HbA1C, but only for those high on baseline trait anxiety (mean increase = 0.92%). Task-oriented coping predicted decreases in state anxiety. Use of task- and emotion-oriented coping appears especially important for highly anxious patients, both for emotional regulation and glycemic control. So, coping styles, basal anxiety and their interactions should be considered in designing follow-up and interventions with diabetic patients.

Cognitive and anxiety symptoms in screening for clinical depression in diabetes A systematic examination of diagnostic performances of the HADS and BDI-SF

BACKGROUND Little systematic research into the diagnostic performance of instruments used to screen for clinical depression is available for people with diabetes. The objective of this study was to compare performances of the HADS and BDI-SF and their components in association with a standard diagnostic interview. METHODS In a sample of 298 French outpatients from a diabetes clinic (165 men, aged 59.4 + or - 10.7 years), we assessed diagnoses of clinical depression (CD, n=42) and major depression (MD, n=30) using the MINI and administered the HADS and BDI-SF. RESULTS Cognitive symptoms from the BDI-SF (BDIcog) were more closely associated with MD than CD. BDIcog and HADS total scores performed best overall in identifying clinical depression (AUCs under ROC curve 85%). For identification of CD, the sensitivity/specificity of BDI cognitive symptoms was 88/71% (cutoff 3+) and for the HADS 83/65% (cutoff 13+). For identification of MD, BDIcog scored 83/80% (cutoff 4+) and HAD-A 80/76% (cutoff 9+). Logistic regression analyses further suggested that BDIcog and HAD-A discriminated between depressed and non-depressed patients better than the somatic and anhedonia items present in the same scales. The depression subscale of the HADS performed poorly. LIMITATIONS The consecutive nature of the sample may limit the generalizability of our findings. CONCLUSION Results suggest that, in addition to depressed mood, both negative thoughts and anxiety are core elements for the correct identification of clinical depression in chronic illnesses such as diabetes. It may be more appropriate to use the total score when applying the HADS and distinguish non-somatic symptoms within the BDI.

Empathic concern and professional characteristics associated with clinical empathy in French general practitioners

ABSTRACT Objective: Clinical empathy, i.e. the ability of physicians to adopt patient perspective, is an essential component of care, which depends in part on empathic concern, i.e. compassionate emotions felt for others. However, too much empathic concern can be challenging for physicians. Aim of this study was to examine physician practice characteristics that could explain clinical empathy beyond empathic concern. We were also interested in testing whether professional reflective activities, such as Balint group attendance or clinical supervision, might make clinical empathy less dependent on empathic concern. Methods: A total of 295 French general practitioners (response rate of 37%) completed self-reported questionnaires on empathic concern and clinical empathy, using the Toronto empathy questionnaire (TEQ) and the Jefferson scale of physician empathy (JSPE), respectively. We also recorded information on their professional practice: professional experience, duration of consultations, and participation in Balint groups or being a clinical supervisor. Hierarchical regression analyses were carried out with clinical empathy as dependent variable. Results: Empathic concern was an important component of clinical empathy variance. The physician practice characteristics ‘consultation length’ and ‘being a Balint attendee or a supervisor,’ but not ‘clinical experience’ made a significant and unique contribution to clinical empathy beyond that of empathic concern. Participating to one reflective activity (either Balint group attendance or clinical supervision) made clinical empathy less dependent on empathic concern. Conclusion: Working conditions such as having enough consultation time and having the opportunity to attend a professional reflective activity support the maintenance of clinical empathy without the burden of too much empathic concern.