Stacie M. Metz

The Effectiveness of the Learning to BREATHE Program on Adolescent Emotion Regulation

This study assessed the effectiveness of a mindfulness-based program, Learning to BREATHE, on adolescent emotion regulation. Participants included 216 regular education public high school students with pretest and posttest data participating in the program or instruction-as-usual comparison condition. Program participants reported statistically lower levels of perceived stress and psychosomatic complaints and higher levels of efficacy in affective regulation. Program participants also evidenced statistically larger gains in emotion regulation skills including emotional awareness, access to regulation strategies, and emotional clarity. These findings provide promising evidence of the effectiveness of Learning to BREATHE on the development of key social-emotional learning skills.

Measuring patient and clinician perspectives to evaluate change in health-related quality of life among patients with chronic obstructive pulmonary disease

ContextMany treatments aim to improve patients’ health-related quality of life (HRQoL), and many care guidelines suggest assessing symptoms and their impact on HRQoL. However, there is a lack of consensus regarding which HRQoL outcome measures are appropriate to assess, and how much change on those measures depict significant HRQoL improvement.ObjectiveWe used triangulation methods to identify and understand clinically important differences (CIDs) for the amount of change in HRQoL that reflects both health professionals and patients’ values, among patients with chronic obstructive pulmonary disease (COPD).Design, Setting, and ParticipantsWe incorporated three perspectives: (1) an expert panel of physicians familiar with the measurement of HRQoL in COPD patients; (2) 610 primary care COPD outpatients who completed baseline and bimonthly follow-up HRQoL interviews over the 12-month study; and (3) the primary care physicians (PCPs; n = 43) of these outpatients who assessed their patients’ disease at baseline and at subsequent PCP visits during the year long study.MeasurementsThe Chronic Respiratory Disease Questionnaire (CRQ), the Medical Outcomes Study Short Form 36-item survey (SF-36, version 2.0), and global assessments of change from each of the three perspectives for all HRQoL domains.ResultsWith few exceptions, the CRQ was able to detect small changes at levels reported by the patients (1–2 points) and their PCPs (1–5 points). These results confirm minimal important difference standards developed in 1989 by Jaeschke et al. anchored on patient-perceived changes in HRQoL. In general, the expert panel and PCP CIDs were larger than the patient CIDs.ConclusionThis triangulation methodology yielded improved interpretation, understanding, and insights on stakeholder perspectives of CIDs for patient-reported outcomes.

Validity of patient-reported health-related quality of life global ratings of change using structural equation modeling

BackgroundPatient-perceived global ratings of change are often used as anchors of health-related quality of life (HRQoL) since they are easy for clinicians to interpret and incorporate the patient’s perception of change as a means to capture clinical significance. Although this approach may be preferred, the validity of the anchor-based approach is currently under scrutiny.ObjectiveTo estimate the explained variation in single-item domain-specific global ratings of change (GRCs) that is accounted for by time 1 (T1) and time 2 (T2) domain-specific summary change scores from the Short-Form 36, V2 (SF-36) Health Survey in asthma primary care patients.MethodsThe baseline and first follow-up enrollment data to be evaluated in this investigation were part of a larger longitudinal HRQoL study conducted from August 2000–December 2002, in which the 356 asthma patients from Midwestern primary care facilities completed telephone interviews for every two consecutive months for a year on multiple HRQoL measures, including the SF-36 and domain-specific GRCs. A structural equation modeling technique was employed to ascertain the explained variability in patient-reported GRCs for each SF-36 domain that is accounted for by the summary change scores at the two time-points for four SF-36 domains (bodily pain, general health perception, mental health, and physical functioning). The model was estimated by the maximum likelihood method with the Satorra-Bentler correction for ordinal variables using equal threshold asymptotic covariance matrices.ResultsMulticollinearity between T1 and T2 latent constructs clouded interpretation of the standardized structural coefficients leading to GRCs. Correlations, however, revealed that all four domain-specific GRCs were more strongly related to T2- than T1-domain summary scores, indicating that patients were not equally relying on T1 and T2 to generate the GRCs. Furthermore, T1-domain summary scores were not of equal magnitude and opposite sign as compared to T2 scores.ConclusionsIn this study, there is insufficient evidence to establish SF-36 domain-specific GRC validity in asthma primary care patients. Therefore, it is recommended to reassess validity before using domain-specific SF-36 GRCs to classify clinically important change over time.

Working on the Inside: Mindfulness for Adolescents

Adolescence is a period of enormous physical, psychological, and social change leading to great opportunity along with some risk. This chapter begins with a brief overview of developmental strengths, vulnerabilities, and neurobiological changes during adolescence when physical and mental health disorders often manifest. Understanding adolescent development can help researchers and educators recognize the importance of prevention for reducing problems while also supporting a skill set that is a foundation for academic success. Social-emotional learning (SEL) interventions, including mindfulness-based programming, can teach adolescents skills such as emotion management, compassion, and purposeful, nonjudgmental attention, which are associated with improvements in academics, behavior, and well-being. These skills are beneficial for all adolescents; hence, school-based universal prevention programs are highlighted. Learning to BREATHE, a mindfulness education program, is presented as an example of a universal prevention program implemented and evaluated in school settings. Finally, the acronym, S.C.H.O.O.L.S., is presented as a framework for researchers and educators considering the implementation and evaluation of evidence-based mindfulness programs in schools.

Predictors of Health Education and Nonmedication Treatment in Adult Outpatients With Diagnosed Cardiac Conditions

The premise of this study was to assess what factors predict the provision of health education and nonmedication treatment for adult cardiac outpatients. A multivariate logistic regression analysis was carried out on 2005 National Hospital Ambulatory Medical Care Survey data to determine the odds of provision of health education or nonmedication treatment in respect to age, sex, ethnicity, body mass index, insurance type, smoking status, diabetes status, and receipt of medication in 278 cardiac patients aged 18 to 64 years who visited outpatient departments in 2005. Approximately 48% of cardiac outpatients were offered health education and 32% nonmedication therapy. Cardiac outpatients who were older, obese, and female were less likely to receive health education or nonmedication treatment during their visits. Eliminating such disparities to comprehensive cardiac outpatient care will elicit favorable outcomes to the patient and health care system.