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Predicting Decisional Conflict: Anxiety and Depression in Shared Decision Making

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Objectives: Emotional distress can be a potential barrier to shared decision making (SDM), yet affect is typically not systematically assessed in medical consultation. We examined whether urological patients report anxiety or depression prior to a consultation and if emotional distress predicts decisional conflict thereafter. Methods: We recruited a large sample of urological outpatients (N = 397) with a range of different diagnoses (42% oncological). Prior to a medical consultation, patients filled in questionnaires, including the Hospital Anxiety and Depression Scale. After the consultation, patients completed the Decisional Conflict Scale. We scored the rate of anxiety and depression in our sample and conducted multiple regression analysis to examine if emotional distress before the consultation predicts decisional conflict thereafter. Results: About a quarter of patients reported values at or above cut-off for clinically relevant emotional distress. Emotional distress significantly predicted a higher degree of decisional conflict. There were no differences in emotional distress between patients with and without uro-oncological diagnosis. Conclusions: Emotional distress is common in urology patients – oncological as well as non-oncological. It predicts decisional conflict after physician consultation. Practice Implications: Emotional distress should be systematically assessed in clinical consultations. This may improve the process and outcome of SDM.

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... 6 In uro-oncological samples, about 30% of patients typically report elevated anxiety levels. 7 While recent studies have established a link between negative affect and adverse decision outcomes, 7,8 an association between negative affect and participation preference has not been demonstrated. 9 Moreover, the influence of anxiety on treatment preferences has not been examined thoroughly. ...
... 6 In uro-oncological samples, about 30% of patients typically report elevated anxiety levels. 7 While recent studies have established a link between negative affect and adverse decision outcomes, 7,8 an association between negative affect and participation preference has not been demonstrated. 9 Moreover, the influence of anxiety on treatment preferences has not been examined thoroughly. ...
... Several studies have addressed the role of personality traits in the clinical setting, 15,16 and personality traits have previously been linked to uro-oncological treatment and decision making outcomes. 7,17 The most fruitful approach to describe facets of personality is the five-factor model, 18 which defines five global domains of personality: openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism. Individuals with high openness are typically autonomous, physically active, and willing to take risks. ...
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Objective: Patient-centered care and shared decision making (SDM) are generally recognized as the gold standard for medical consultations, especially for preference-sensitive decisions. However, little is known about psychological patient characteristics that influence patient-reported preferences. We set out to explore the role of personality and anxiety for a preference-sensitive decision in bladder cancer patients (choice of urinary diversion, UD) and to determine if anxiety predicts patients' participation preferences. Methods: We recruited a sample of bladder cancer patients (N = 180, primarily male, retired) who awaited a medical consultation on radical cystectomy and their choice of UD. We asked patients to fill in a set of self-report questionnaires before this consultation, including measures of treatment preference, personality (BFI-10), anxiety (STAI), and participation preference (API and API-Uro), as well as sociodemographic characteristics. Results: Most patients (79%) indicated a clear preference for one of the treatment options (44% continent UD, 34% incontinent UD). Patients who reported more conscientiousness were more likely to prefer more complex methods (continent UD). The majority (62%) preferred to delegate decision making to healthcare professionals. A substantial number of patients reported elevated anxiety (32%), and more anxiety was predictive of higher participation preference, specifically for uro-oncological decisions (β = 0.207, p < 0.01). Conclusions: Our findings provide insight into the role of psychological patient characteristics for SDM. Aspects of personality such as conscientiousness influence treatment preferences. Anxiety contributes to patients' motivation to be involved in pertinent decisions. Thus, personality and negative affect should be considered to improve SDM.
... Additional medical data of patients were obtained from electronic files. Data on additional constructs of this survey are reported elsewhere [16]. ...
... According to scoring guidelines of the scale's manual, a HADS total score ≥ 16 was defined as a cutoff value for clinically relevant emotional distress [19]. For more details on this questionnaire and further measures on a different topic, please refer to Köther and colleagues [16]. ...
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PurposeThis study aims to determine the degree of shared decision-making (SDM) from urological patients’ perspective and to identify possible predictors. Methods Overall, 469 urological patients of a university outpatient clinic were recruited for this prospective study. Before a medical consultation, clinical and sociodemographic information, and patients’ emotional distress were assessed by questionnaires. After the consultation, patients completed the SDM-Questionnaire-9 (SDM-Q-9). The SDM-Q-9 scores of relevant subgroups were compared. Logistic regression was used to identify patients at risk for experiencing low involvement (SDM-Q-9 total score ≤ 66) in SDM.ResultsData from 372 patients were available for statistical analyses. The SDM-Q-9 mean total score was 77.8 ± 20.6. The majority of patients (n = 271, 73%) experienced a high degree of involvement (SDM-Q-9 total score > 66). The mean score per SDM-Q-9 item was in the upper range (3.9 ± 1.4 out of 5). The most poorly rated item was “My doctor wanted to know how I want to be involved in decision-making” (3.5 ± 1.6). Immigration status (OR 3.7, p = 0.049), and nonscheduled hospital registration (OR 2.1, p = 0.047) were significant predictors for less perceived involvement. Comorbidity, oncological status, and emotional distress did not significantly predict perceived participation.Conclusion In a university hospital setting, most urological patients feel adequately involved in SDM. Nevertheless, urologists should routinely ask for patients’ participation preference. Patients without a scheduled appointment and patients who immigrated may need more support to feel involved in SDM.
... 14 For instance Kother et al., showed that emotional distress was common in urooncology and could be a predictor of decisional conflict. 15 Xu et al., 16 in his qualitative review on men's perspectives in choosing prostate cancer treatment, advanced the involvement of family and friends, particularly those already diagnosed with prostate cancer, as variables that assisted patients in making their treatment choices. ...
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Background: Decisional conflict (DC) is a psychological construct that an individual experiences in making a decision that involves risk, loss, regret, or challenges to one's values. This study assessed DC in a cohort of South African men undergoing curative treatment for localised prostate cancer (LPC). The objectives were to (1) to examine the association between DC and prostate cancer knowledge (PCK), demographics, state anxiety, prostate cancer anxiety and time to treatment and (2) to compare levels of DC between treatment groups [prostatectomy (RP) and external beam radiation (RT)]. Method: Data, comprising the Decisional Conflict Scale (DCS), Prostate Cancer Knowledge (PCK), State-Trait Anxiety Inventory (STAI-S), the Memorial Anxiety Scale for Prostate Cancer (MAX-PC) and demographic data from 83 participants of a larger prospective longitudinal observational study examining depression, anxiety and health related quality of life (DAHCaP) were analysed. Results: The mean age of participants was 63 years (RP 61yrs and RT 65yrs; p< 0.001). Most were of mixed ancestry (72.3%). The total DCS scores between the treatment groups (RP 25.00 and RT 18.75; p = 0.037) and two DCS sub-scores-uncertainty (p = 0.033), and support (p = 0.048), were significantly higher in the RP group. A statistically significant negative correlation was observed between state anxiety and time between diagnosis and treatment in the RP group (Spearman's rho = -0.368; p = 0.030). There was no correlation between the DCS score and PCK within each treatment group (Spearman's rho RP = -0.249 and RT = -0.001). Conclusion: Decisional conflict was higher in men undergoing RP. Men were more anxious in the RP group regarding the time treatment was received from diagnosis. No correlation was observed between DC and PCK. Pre-surgical management of DC should include shared decision making (SDM) which is cognisant of patients' values facilitated by a customised decision aid.
... 14 For instance Kother et al., showed that emotional distress was common in urooncology and could be a predictor of decisional conflict. 15 Xu et al., 16 in his qualitative review on men's perspectives in choosing prostate cancer treatment, advanced the involvement of family and friends, particularly those already diagnosed with prostate cancer, as variables that assisted patients in making their treatment choices. ...
... Psychological scales were selected according to the few studies that investigated which factors influence the decision to preserve fertility and identified aspects related to the individual desire for a future pregnancy (Baysal et al., 2015;Hershberger et al., 2016;Flink et al., 2017a;Melo et al., 2019). Moreover, we focused on anxiety and depression because they are generally associated with difficulties in decision-making (Bishop and Gagne, 2018;Köther et al., 2021). ...
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Objective: Fertility loss due to cancer treatment can be a devastating experience for women and the couple. Undergoing fertility preservation can be a complex decision from both a medical and emotional point of view. The aim of the present study was to evaluate which socio-demographic and psychological factors predict a high motivation to undergo fertility preservation. Methods: Fifty-eight female cancer patients who accessed an Oncofertility Unit completed: a questionnaire to collect socio-demographic characteristics and the level of motivation, the Beck-Depression Inventory-II, the State-Trait Anxiety Inventory-Y, and the Fertility Problem Inventory. Results: Almost half of the sample (44.8%) declared a high motivation. At multiple logistic regression analysis only the “Need for parenthood” subscale of the FPI predicted a high motivation. We alternatively evaluated as possible predictor the construct “Representations about the importance of parenthood” (i.e., the sum of the “Need for Parenthood” and “Rejection of childfree lifestyle” subscales) in place of the two separate subscales. At multiple logistic regression analysis, only this variable predicted a high motivation to undergo fertility preservation. Conclusion: The most important predictor of a high motivation to undergo fertility preservation is the individual desire for parenthood. This implies that, regardless of socio-demographic characteristics, any woman of childbearing age should receive an appropriate counseling about fertility preservation.
... The prevalence of mental disorders such as depression and anxiety in postacute rehabilitation patients is high [1][2][3][4]. Patients with depression and anxiety are often dissatisfied with treatment decisions [5] and have a worse functional outcome of their rehabilitation than patients without depression and anxiety [2,[6][7][8][9]. Therefore, the consideration and treatment of co-morbid psychological distress and mental disorders is important to improve rehabilitation outcomes. ...
Article
PurposeAlthough psychological distress has a negative impact on functional recovery, institutionalisation and mortality rates, there is typically no established procedure to screen for psychological distress in geriatric rehabilitation. The aim of the study was to evaluate a brief single-item Verbal Numerical Rating Scale (VNRS-PD) as a screening tool for psychological distress in multimorbid geriatric rehabilitation patients.Methods In this cross-sectional study, N = 132 geriatric rehabilitation in-patients (M = 82 years old; 70.5% female) completed a verbal numerical rating scale (VNRS-PD) on satisfaction with their mood as well as the Hospital Anxiety and Depression Scale (HADS) and the short-form of the Geriatric Depression Scale (GDS). Based on the questionnaire data, the rehabilitation patients were classified as high or low in psychopathology. Using receiver-operating characteristic (ROC) curve analysis, optimal cutoff scores of the VNRS-PD were calculated for each questionnaire to detect significant psychological distress.ResultsBetween 28.8% (HADS ≥ 18) and 43.9% (GDS ≥ 6) of the sample had above-cutoff questionnaire scores. The area under the curve (AUC) of the VNRS-PD varied from 0.785 (95%-CI 0.709–0.861) (GDS ≥ 6) and 0.790 (95%-CI 0.716–0.864) (HADS ≥ 18) to 0.807 (95%-CI 0.734–0.880) (GDS ≥ 7). A score of ≤ 5 in the VNRS-PD proved to be the cutoff with an optimal trade-off between sensitivity (0.776–0.867) and specificity (0.638–0.703).Conclusion The VNRS-PD may be a suitable screening instrument to detect patients with psychological distress in inpatient geriatric rehabilitation for and to initiate further diagnostics within a graduated psychodiagnostic scheme. This first step may help to identify older patients with psychological distress and mental disorders, to initiate targeted interventions. Further research is needed to replicate these findings in a larger sample.
... It is recognized that increased levels of anxiety and distress can negatively affect the decision-making process, presenting challenges for obtaining medical information and processing it in a way, that is, consistent with one's values and preferences. 20,21 Studies have shown that pregnant patients frequently experience anxiety and uncertainty during prenatal genetic testing. 13,22,23 Yet, the COVID-19 pandemic has provoked a series of other concerns for pregnant women considering prenatal genetic testing, sources of anxiety that have not been fully identified with past infectious disease threats. ...
Article
Objective: We conducted a study to examine the impact of COVID on patients' access and utilization of prenatal genetic screens and diagnostic tests at the onset of the COVID-19 pandemic in the U.S. Methods: We conducted telephone interviews with 40 patients to examine how the pandemic affected prenatal genetic screening and diagnostic testing decisions during the initial months of the pandemic in the U.S. An interview guide queried experiences with the ability to access information about prenatal genetic testing options and to utilize the tests when desired. Audio-recordings were transcribed and coded using NVivo 12. Analysis was conducted using Grounded Theory. Results: The pandemic did not alter most participants' decisions to undergo prenatal genetic testing. Yet, it did impact how participants viewed the risks and benefits of testing and timing of testing. There was heightened anxiety among those who underwent testing, stemming from the risk of viral exposure and the fear of being alone if pregnancy loss or fetal abnormality was identified at the time of an ultrasound-based procedure. Conclusion: The pandemic may impact patients' access and utilization of prenatal genetic tests. More research is needed to determine how best to meet pregnant patients' decision-making needs during this time. This article is protected by copyright. All rights reserved.
Article
Introduction Shared decision making between patients and clinicians is important to surgical practice and patients’ perceptions of their healthcare experiences. This study aims to measure associations between patients’ perceptions of their shared decision-making process and health-related quality of life among a cohort of patients choosing surgical management of an elective surgical procedure, hemorrhoidectomy. Methods This study is a single site study based in Vancouver, Canada. Consecutive patients of five colorectal surgeons registered for elective hemorrhoidectomy between September 2016 and June 2020 were eligible to participate. Participants completed the CollaboRATE instrument which measures patients’ perceptions of their shared decision-making after the surgical consultation, along with a number of other patient-reported outcomes. Results The participation rate was 45.3%, with 157 patients scheduled for hemorrhoidectomy providing complete information. Unadjusted results found that participants having the most comorbidities reported better communication with their surgeon. The adjusted results show that socioeconomic status and depression were associated with lower CollaboRATE scores. There was no effect of sex, pain interference, anxiety or perceived health status on participants CollaboRATE scores. Conclusion This study found evidence that participants with lower economic status or those reporting depressive symptoms had worse perceptions of their shared decision-making process with their surgeon. These findings suggest that special attention should be paid to the surgical decision-making process for these patient populations.
Article
Context Decision aids (DAs) aim to support patients in the process of shared decision-making for complex treatment decisions. To improve patient-centered care in uro-oncology, it is essential to evaluate the availability and quality of existing DAs. Objective To assess the quality of existing DAs for patients across the most prevalent uro-oncological entities. Evidence acquisition This study was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. A systematic literature search (MedLine, Cochrane Library, Web of Science Core Collection, and CCMed) was conducted to identify DAs for treatment decisions for patients with prostate, renal, or bladder cancer. All studies reporting on the development or evaluation of DAs were included. The DAs were examined based on the International Patient Decision Aid Standards (IPDAS) and the evaluation studies were compared in accordance with Standards for Universal reporting of a patient Decision Aid Evaluations (SUNDAE). Evidence synthesis The literature search identified 1995 potentially relevant publications. Thirty-two studies reporting on 25 DAs met the inclusion criteria. Twenty-two DAs address prostate cancer, two renal tumor, and one bladder cancer. In the majority of DAs (n = 20), patients can enter individual data. A few (n = 6) DAs allow for personalization using a risk-adapted presentation of treatment options. The percentage of IPDAS criteria met in DAs ranged between 50% and 100% (median 87.5%), and the studies’ adherence to the SUNDAE checklist was between 62% and 96% (median 86.6%). Evaluation studies suggest that interventions are likely efficacious. However, a preliminary meta-analysis revealed no significant difference between "DA" and "usual care" for decisional conflict or decisional regret. Conclusions This review highlights that a number of well-developed DAs exist in urology. However, there is a need for specific instruments targeting kidney and bladder cancer. Personalization of tools and adherence to international standards of DAs should be further improved. Patient summary The majority of uro-oncological decision aids target prostate cancer, whereas fewer address kidney or bladder cancer. The quality of the existing instruments is high, but can be increased further to better address specific needs of individual patients.
Article
Objective The COVID-19 pandemic pushed some of the most well-developed health care systems to their limits. In many cases, this has challenged patient-centered care. We set out to examine individuals’ attitudes toward shared decision making (SDM) and to identify predictors of participation preference during the pandemic. Methods We conducted an online survey with a large convenience sample ( N = 1061). Our main measures of interest were participants’ generic and COVID-19–related participation preference as well as their acceptance and distress regarding a triage vignette. We also assessed anxiety, e-health literacy, and aspects of participants’ health. We conducted group comparisons and multiple linear regression analyses on participation preference as well as triage acceptance. Results In generic decision making, most participants expressed a strong need for information and a moderate participation preference. In the hypothetical case of COVID-19 infection, most preferred physician-led decisions. Generic participation preference was the strongest predictor of COVID-19–related participation preference, followed by age, education, and anxiety. Furthermore, both higher generic and COVID-19–related participation preferences predicted lower triage acceptance. Conclusion Our findings demonstrate potential health care recipients’ attitudes toward SDM during a severe health care crisis and emphasize that participation preference varies according to the context.
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Although it is an adaptive mechanism that danger usually elicits fear, it seems that fearful individuals overestimate the danger associated with their feared objects or situations. Previous research has not systematically distinguished between the estimated risk of an encounter with fear-relevant stimuli and the expected unpleasant outcomes of such encounters. Furthermore, it is not clear if biased risk perception is specific to an individual’s fear or generalized to all negative events. In an online-survey (N = 630) we assessed the estimated risk to encounter fear-relevant stimuli and the expectations of negative outcomes of such encounters. Items contained three domains (spiders, snakes, and everyday fear triggers). In regression analyses we examined the specific associations between fear and risk estimations. In addition, we compared subgroups with specific fears and low fearful individuals. While an individual’s fear score was not related to the estimated risk of an encounter with fear-specific stimuli, it was related to an overestimation of negative outcomes in all domains. The perceived risk of aversive outcomes was most pronounced for an individual’s specific fear. Furthermore, an individual’s specific fear was most predictive of the estimated risk of a negative fear-relevant outcome. Highly fearful individuals overestimate the risk of negative outcomes of fear-relevant encounters. Specifically, they dread outcomes of encounters with their feared object. Differentiating fear-relevant components of risk perception provides insights into the cognitions which may motivate maladaptive avoidance behavior.
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Introduction: Despite the attempt to make decisions based on evidence, doctors still have to consider patients' choices which often involve other factors. In particular, emotions seem to influence the way that options and the surrounding information are interpreted and used. Objective: The objective of the present review is to provide a brief overview of research on decision making and cancer with a specific focus on the role of emotions. Method: Thirty-nine studies were identified and analysed. Most of the studies investigated anxiety and fear. Worry was the other psychological factor that, together with anxiety, played a crucial role in cancer-related decision-making. Results: The roles of fear, anxiety and worry were described for detection behaviour, diagnosis, choice about prevention and curative treatments and help-seeking behaviour. Results were inconsistent among the studies. Results stressed that cognitive appraisal and emotional arousal (emotion's intensity level) interact in shaping the decision. Moderate levels of anxiety and worry improved decision-making, while low and high levels tended to have no effect or a hindering effect on decision making. Moderating factors played an under-investigated role. Conclusions: Decision making is a complex non-linear process that is affected by several factors, such as, for example, personal knowledge, past experiences, individual differences and certainly emotions. Research studies should investigate further potential moderators of the effect of emotions on cancer-related choice. Big data and machine learning could be a good opportunity to test the interaction between a large amount of factors that is not feasible in traditional research. New technologies such as eHealth and virtual reality can offer support for the regulation of emotions and decision making.
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Objective The present study aims to examine the relationships between and among cancer treatment-related decisional conflict, quality of life, and comorbidity in older adults with cancer. Methods A convenience sample of 200 older adults was recruited from outpatient medical oncology and radiation oncology practices in the northeastern United States. A cross-sectional, descriptive, correlational study design was used employing a survey method. Survey instruments included the Decisional Conflict scale (DCS) (with five subscales, including informed, values clarity, support, uncertainty, and effective decision); Self-administered comorbidity questionnaire (SCQ); European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (including five function scales, three symptom scales, a global health/quality of life scale, and six single items); and an investigator-developed demographic form. Results The mean total DCS score was 22.1 (±12.5). The uncertainty subscale had the highest mean of the subscales (29.2 ± 18.2). The mean score for global health status/quality of life was 44.2 (±20.7). The mean score of the SCQ was low (9.6 ± 4.1). Significant positive relationships were identified between decisional conflict and quality of life (P = 0.009) and quality of life and comorbidity (P = 0.001). Multiple linear regression analysis found statistically significant relationships for total decisional conflict score and the five decisional conflict scale subscales. Conclusions Results may suggest a relationship between decisional conflict and quality of life, as well as the quality of life and comorbidity. In addition, there are several physical, emotional, and spiritual factors that may positively or negatively impact decisional conflict.
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Background: When bad news about a cancer diagnosis is being delivered, patient-centered communication (PCC) has been considered important for patients' adjustment and well-being. However, few studies have explored how interpersonal skills might help cancer patients cope with anxiety and distress during bad-news encounters. Methods: A prospective, experimental design was used to investigate the impact of the physician communication style during a bad-news encounter. Ninety-eight cancer patients and 92 unaffected subjects of both sexes were randomly assigned to view a video of a clinician delivering a first cancer diagnosis with either an enhanced patient-centered communication (E-PCC) style or a low patient-centered communication (L-PCC) style. Participants rated state anxiety and negative affect before and immediately after the video exposure, whereas trust in the physician was rated after the video exposure only. Main and interaction effects were analyzed with generalized linear models. Results: Viewing the disclosure of a cancer diagnosis resulted in a substantial increase in state anxiety and negative affect among all participants. This emotional response was moderated by the physician's communication style: Participants viewing an oncologist displaying an E-PCC style were significantly less anxious than those watching an oncologist displaying an L-PCC style. They also reported significantly higher trust in the physician. Conclusions: Under a threatening, anxiety-provoking disclosure of bad news, a short sequence of empathic PCC influences subjects' psychological state, insofar that they report feeling less anxious and more trustful of the oncologist. Video exposure appears to be a valuable method for investigating the impact of a physician's communication style during critical encounters. Cancer 2017. © 2017 American Cancer Society.
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Agency (A) and communion (C) are fundamental content dimensions. We propose a facet-model that differentiates A into assertiveness (AA) and competence (AC) and C into warmth (CW) and morality (CM). We tested the model in a cross-cultural study by comparing data from Asia, Australia, Europe, and the USA (overall N = 1.808). Exploratory and confirmatory factor analyses supported our model. Both the two-factor model and the four-factor model showed good fit indices across countries. Participants answered additional measures intended to demonstrate the fruitfulness of distinguishing the facets. The findings support the model's construct validity by positioning the fundamental dimensions and their facets within a network of self-construal, values, impression management, and the Big Five personality factors: In all countries, A was related to independent self-construal and to agentic values, C was related to interdependent self-construal and to communal values. Regarding the facets, AA was always related to A values, but the association of AC with A values fell below our effect size criterion in four of the five countries. A (both AA and AC) was related to agentic impression management. However, C (both CW and CM) was neither related to communal nor to agentic impression management. Regarding the Big Five personality factors, A was related to emotional stability, to extraversion, and to conscientiousness. C was related to agreeableness and to extraversion. AA was more strongly related to emotional stability and extraversion than AC. CW was more strongly related to extraversion and agreeableness than CM. We could also show that self-esteem was more related to AA than AC; and that it was related to CM, but not to CW. Our research shows that (a) the fundamental dimensions of A and C are stable across cultures; and (b) that the here proposed distinction of facets of A and C is fruitful in analyzing self-perception. The here proposed measure, the AC-IN, may be a useful tool in this research area. Applications of the facet model in social perception research are discussed.
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Objectives Unresolved clinically significant decisional conflict (CSDC) in patients following a consultation with health professionals is often the result of inadequate patient involvement in decision-making and may result in poor outcomes. We sought to identify the prevalence of CSDC in studies on decision-making in primary care and to explore its risk factors. Setting We performed a secondary analysis of existing data sets from studies conducted in Primary Care Practice-Based Research Networks in Québec and Ontario, Canada. Participants Eligible studies included a patient-reported measure on the 16-item Decisional Conflict Scale (DCS) following a decision made with a healthcare professional with no study design restriction. Primary and secondary outcome measures CSDC was defined as a score ≥25/100 on the DCS. The prevalence of CSDC was stratified by sex; and patient-level logistic regression analysis was performed to explore its potential risk factors. Data sets of studies were analysed individually and qualitatively compared. Results 5 projects conducted between 2003 and 2010 were included. They covered a range of decisions: prenatal genetic screening, antibiotics for acute respiratory infections and miscellaneous. Altogether, the 5 projects gathered data from encounters with a total of 1338 primary care patients (69% female; range of age 15–83). The prevalence of CSDC in patients varied across studies and ranged from 10.3% (95% CI 7.2% to 13.4%) to 31.1% (95% CI 26.6% to 35.6%). Across the 5 studies, risk factors of CSDC included being male, living alone and being 45 or older. Conclusions Prevalence of CSDC in patients who had enrolled in studies conducted in primary care contexts was substantial and appeared to vary according to the type of decision as well as to patient characteristics such as sex, living arrangement and age. Patients presenting risk factors of CSDC should be offered tools to increase their involvement in decision-making.
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Objective. We explored whether active patient involvement in decision making and greater patient knowledge are associated with better treatment decision-making experiences and better quality of life (QOL) among men with clinically localized prostate cancer. Localized prostate cancer treatment decision making is an advantageous model for studying patient treatment decision-making dynamics because there are multiple treatment options and a lack of empirical evidence to recommend one over the other; consequently, it is recommended that patients be fully involved in making the decision. Methods. Men with newly diagnosed clinically localized prostate cancer ( N = 1529) completed measures of decisional control, prostate cancer knowledge, and decision-making experiences (decisional conflict and decision-making satisfaction and difficulty) shortly after they made their treatment decision. Prostate cancer–specific QOL was assessed at 6 months after treatment. Results. More active involvement in decision making and greater knowledge were associated with lower decisional conflict and higher decision-making satisfaction but greater decision-making difficulty. An interaction between decisional control and knowledge revealed that greater knowledge was only associated with greater difficulty for men actively involved in making the decision (67% of sample). Greater knowledge, but not decisional control, predicted better QOL 6 months after treatment. Conclusions. Although men who are actively involved in decision making and more knowledgeable may make more informed decisions, they could benefit from decisional support (e.g., decision-making aids, emotional support from providers, strategies for reducing emotional distress) to make the process easier. Men who were more knowledgeable about prostate cancer and treatment side effects at the time that they made their treatment decision may have appraised their QOL as higher because they had realistic expectations about side effects.
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Measuring clinicians' shared decision-making (SDM) performance is a key requirement given the intensity of policy interest in many developed countries - yet it remains one of the most difficult methodological challenges, which is a concern for many stakeholders. In this Viewpoint Article, we investigate the development of existing patient-reported measures (PRMs) of SDM identified in a recent review. We find that patients were involved in the development of only four of the 13 measures. This lack of patient involvement in PRM development is associated with two major threats to content validity, common to all 13 PRMs of SDM: (i) an assumption of patient awareness of 'decision points' and (ii) an assumption that there is only one decision point in each healthcare consultation. We provide detailed examples of these threats and their impact on accurate assessment of SDM processes and outcomes, which may hamper efforts to introduce incentives for SDM implementation. We propose cognitive interviewing as a recommended method of involving patients in the design of PRMs in the field of SDM and provide a practical example of this approach. © 2015 The Authors Health Expectations Published by John Wiley & Sons Ltd.
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Early identification and intervention have been recommended for newly diagnosed prostate cancer patients who experience significant emotional distress; however, there is little empirical basis for designing or selecting interventions for these men. We sought to identify factors that are associated with distress in these men as a basis for identifying suitable intervention strategies. Using cross-sectional data and validated scales, we investigated the extent to which clinical, demographic, belief, and personality characteristics are associated with emotional distress assessed with the Distress Thermometer in 1425 men newly diagnosed with clinically localized prostate cancer (pretreatment). Beliefs potentially amenable to psychoeducational interventions [low self-efficacy for decision-making (B =-0.11, p = 0.02), low confidence in cancer control (B =-0.03, p < 0.001), and masculine identity threat (B =-0.26, p = 0.001)] were associated with higher emotional distress, as well as personality factors [low optimism (B =-0.04, p = 0.052) and low resilience (B =-0.83, p < 0.001)]. Findings provide a framework for the development of interventions for prostate cancer patients with elevated emotional distress. These may include improving provider communication about prostate cancer prognosis for those with low confidence in cancer control, providing decision-making support to increase decision-making self-efficacy, or referral to brief cognitive behavioral interventions to help patients reframe masculine identity threat or for those with low optimism or resilience reframe and adjust to the health threat. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.
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Individuals avoid stimuli which are associated with aversive experience to preserve safety. However, behavioral avoidance also causes impairments and prevents the individual from attaining positive rewards. Little is known about the link between fear acquisition and the development of behavioral avoidance in the presence of potential rewards. Therefore, two experiments investigated the impact of fear conditioning on a subsequent gambling task. In an experimental group (n = 30) advantageous choices (higher reward probability) were linked to a fear-relevant stimulus that was associated with an aversive unconditioned stimulus (US) during fear conditioning (conditioned stimulus, CS+). A disadvantageous choice (lower reward probability) was, however, linked to a safe stimulus that was never associated with the US (CS-). In a control group (n = 25), fear conditioning was followed by a similar gambling task with novel stimuli. A second experiment focused on individual predictors of avoidant decisions (n = 81). Compared with the control group, individuals in the experimental groups avoided the advantageous CS + choice despite fewer gains. The predictor analysis further clarified that avoidant decisions were pronounced in highly trait anxious participants who exhibited higher fear responses. On the other hand, findings also indicated a reduction in absolute avoidance across the task. Combined, these findings demonstrate that fear conditioning can lead to avoidant decision making, especially in vulnerable individuals. The resulting costs parallel impairments caused by behavioral avoidance. Such an emotional decision-making style may be a link between aversive experience and the development of habitual pathological avoidance. Introducing rewards for approach, however, may counteract avoidant decisions. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
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Psychiatric disorders can pose problems in the assessment of decision-making capacity (DMC). This is so particularly where psychopathology is seen as the extreme end of a dimension that includes normality. Depression is an example of such a psychiatric disorder. Four abilities (understanding, appreciating, reasoning and ability to express a choice) are commonly assessed when determining DMC in psychiatry and uncertainty exists about the extent to which depression impacts capacity to make treatment or research participation decisions. A systematic review of the medical ethical and empirical literature concerning depression and DMC was conducted. Medline, EMBASE and PsycInfo databases were searched for studies of depression and consent and DMC. Empirical studies and papers containing ethical analysis were extracted and analysed. 17 publications were identified. The clinical ethics studies highlighted appreciation of information as the ability that can be impaired in depression, indicating that emotional factors can impact on DMC. The empirical studies reporting decision-making ability scores also highlighted impairment of appreciation but without evidence of strong impact. Measurement problems, however, looked likely. The frequency of clinical judgements of lack of DMC in people with depression varied greatly according to acuity of illness and whether judgements are structured or unstructured. Depression can impair DMC especially if severe. Most evidence indicates appreciation as the ability primarily impaired by depressive illness. Understanding and measuring the appreciation ability in depression remains a problem in need of further research.
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Patient's trust in their physician is crucial for desirable treatment outcomes such as satisfaction and adherence. In oncology, trust is possibly even more essential, due to the life-threatening nature of cancer. A review was undertaken of the current knowledge of the conceptualization, assessment, correlates, and consequences of cancer patients' trust in their physician. The empirical literature published in peer-reviewed journals between October 1988 and October 2008 was searched, employing all combinations and variations of the following keywords: trust, physician-patient relations, and cancer. The search identified 45 relevant papers, only 11 of which drew attention to the conceptualization of trust, and 5 of which focused on trust as the primary subject of interest. Trust in physicians was strong overall. Patients' trust appeared to be enhanced by the physician's perceived technical competence, honesty, and patient-centred behaviour. A trusting relationship between patient and physician resulted in facilitated communication and medical decision making, a decrease of patient fear, and better treatment adherence. A lack of focus on trust and the conceptualization thereof, strong methodological variations between studies and a possible publication bias lead us to conclude that cancer patients' trust in their physician deserves more systematic, theoretically based, research attention. Consequently, studies are needed aimed at gaining a thorough understanding of the nature and impact of cancer patients' trust in their physician, and how the interaction between physician and patient may contribute to such trust.
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We describe the functioning and well-being of patients with depression, relative to patients with chronic medical conditions or no chronic conditions. Data are from 11,242 outpatients in three health care provision systems in three US sites. Patients with either current depressive disorder or depressive symptoms in the absence of disorder tended to have worse physical, social, and role functioning, worse perceived current health, and greater bodily pain than did patients with no chronic conditions. The poor functioning uniquely associated with depressive symptoms, with or without depressive disorder, was comparable with or worse than that uniquely associated with eight major chronic medical conditions. For example, the unique association of days in bed with depressive symptoms was significantly greater than the comparable association with hypertension, diabetes, and arthritis. Depression and chronic medical conditions had unique and additive effects on patient functioning.
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Background: The Decisional Conflict Scale (DCS) measures 5 dimensions of decision making (feeling: uncertain, uninformed, unclear about values, unsupported; ineffective decision making). We examined the use of the DCS over its initial 20 years (1995 to 2015). Methods: We conducted a scoping review with backward citation search in Google Analytics/Web of Science/PubMed, followed by keyword searches in Cochrane Library, PubMed, Ovid MEDLINE, EMBASE, CINAHL, AMED, PsycINFO, PRO-Quest, and Web of Science. Eligible studies were published between 1995 and March 2015, used an original experimental/observational research design, concerned a health-related decision, and provided DCS data (total/subscales). Author dyads independently screened titles, abstracts, full texts, and extracted data. We performed narrative data synthesis. Results: We included 394 articles. DCS use appeared to increase over time. Three hundred nine studies (76%) used the original DCS, and 29 (7%) used subscales only. Most studies used the DCS to evaluate the impact of decision support interventions ( n = 238, 59%). The DCS was translated into 13 languages. Most decisions were made by people for themselves ( n = 353, 87%), about treatment ( n = 225, 55%), or testing ( n = 91, 23%). The most common decision contexts were oncology ( n = 113, 28%) and primary care ( n = 82, 20%). Conclusions: This is the first study to descriptively synthesize characteristics of DCS data. Use of the DCS as an outcome measure for health decision interventions has increased over its 20-year existence, demonstrating its relevance as a decision-making evaluation measure. Most studies failed to report when decisional conflict was measured during the decision-making process, making scores difficult to interpret. Findings from this study will be used to update the DCS user manual.
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Objective: To evaluate the relationship between personality and emotional distress in prostate cancer. Neuroticism and introversion were hypothesized to be associated with clinically significant symptoms of emotional distress, including depression, anxiety, and suicidal ideation. Methods: Men with a history of prostate cancer (n=212) completed an NIH-funded cross-sectional study using well-validated measures of personality, depression, anxiety, and suicidal ideation. Covariates were age, education, time since diagnosis, comorbidity, and presence of metastases. Results: Emotional distress was reported by 37% of participants, including depression (23%), anxiety (15%), and suicidal ideation (10%). As hypothesized, men who were more neurotic were more likely to report emotional distress (44.5% vs. 26.9%; OR=2.78, p=.004), depression (31.9% vs. 11.8%; OR=4.23, p=.001), and suicidal ideation (29.4% vs. 9.7%; OR=4.15, p=.001). Introverts were more likely to report emotional distress (45.2% vs. 28.7%; OR=2.32, p=.012) and depression (30.8% vs. 15.7%; OR=2.57, p=.014). Men with metastases were more likely to report emotional distress (51.7% vs. 31.2%; OR=4.56, p<.001). Conclusions: Neuroticism and introversion were associated with clinically significant emotional distress in men with prostate cancer. Findings suggest that, in the context of treatment for prostate cancer, patient distress reflects disease characteristics (e.g., metastases presence) as well as stable personality traits. Implications for clinical care are discussed.
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Konzepte zur pflegerischen Begleitung und Betreuung von Krebspatienten durch Lotsen stoßen bereits heute auf ein wachsendes Interesse. Bei der Refinanzierung und flächendeckenden Umsetzung besteht jedoch noch Optimierungsbedarf. Eine kontinuierliche Unterstützung Betroffener und deren Angehöriger kann nachhaltig helfen, mit einer Krebserfahrung besser umzugehen. Onkolotsen unterstützen Betroffene dabei, Gesundheitsinformationen zu finden, zu verstehen und anzuwenden, neue Herausforderungen zu bewältigen und sich besser im Gesundheitswesen zurechtzufinden. Der Zuwachs an Wissen, die Unterstützung bei der Entwicklung oder Bewahrung einer positiven Einstellung und die Vermittlung von Fähigkeiten zur Problembewältigung steigern die individuelle Gesundheitskompetenz und ermöglichen eine aktive, eigenverantwortliche Mitarbeit im Behandlungsprozess. Onkolotsen, wie auch Akteure in anderen Lotsenprojekten, leisten damit einen wichtigen Beitrag zur Verbesserung der Chancengleichheit im Gesundheitswesen.
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Background: Decision aids are interventions that support patients by making their decisions explicit, providing information about options and associated benefits/harms, and helping clarify congruence between decisions and personal values. Objectives: To assess the effects of decision aids in people facing treatment or screening decisions. Search methods: Updated search (2012 to April 2015) in CENTRAL; MEDLINE; Embase; PsycINFO; and grey literature; includes CINAHL to September 2008. Selection criteria: We included published randomized controlled trials comparing decision aids to usual care and/or alternative interventions. For this update, we excluded studies comparing detailed versus simple decision aids. Data collection and analysis: Two reviewers independently screened citations for inclusion, extracted data, and assessed risk of bias. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made and the decision-making process.Secondary outcomes were behavioural, health, and health system effects.We pooled results using mean differences (MDs) and risk ratios (RRs), applying a random-effects model. We conducted a subgroup analysis of studies that used the patient decision aid to prepare for the consultation and of those that used it in the consultation. We used GRADE to assess the strength of the evidence. Main results: We included 105 studies involving 31,043 participants. This update added 18 studies and removed 28 previously included studies comparing detailed versus simple decision aids. During the 'Risk of bias' assessment, we rated two items (selective reporting and blinding of participants/personnel) as mostly unclear due to inadequate reporting. Twelve of 105 studies were at high risk of bias.With regard to the attributes of the choice made, decision aids increased participants' knowledge (MD 13.27/100; 95% confidence interval (CI) 11.32 to 15.23; 52 studies; N = 13,316; high-quality evidence), accuracy of risk perceptions (RR 2.10; 95% CI 1.66 to 2.66; 17 studies; N = 5096; moderate-quality evidence), and congruency between informed values and care choices (RR 2.06; 95% CI 1.46 to 2.91; 10 studies; N = 4626; low-quality evidence) compared to usual care.Regarding attributes related to the decision-making process and compared to usual care, decision aids decreased decisional conflict related to feeling uninformed (MD -9.28/100; 95% CI -12.20 to -6.36; 27 studies; N = 5707; high-quality evidence), indecision about personal values (MD -8.81/100; 95% CI -11.99 to -5.63; 23 studies; N = 5068; high-quality evidence), and the proportion of people who were passive in decision making (RR 0.68; 95% CI 0.55 to 0.83; 16 studies; N = 3180; moderate-quality evidence).Decision aids reduced the proportion of undecided participants and appeared to have a positive effect on patient-clinician communication. Moreover, those exposed to a decision aid were either equally or more satisfied with their decision, the decision-making process, and/or the preparation for decision making compared to usual care.Decision aids also reduced the number of people choosing major elective invasive surgery in favour of more conservative options (RR 0.86; 95% CI 0.75 to 1.00; 18 studies; N = 3844), but this reduction reached statistical significance only after removing the study on prophylactic mastectomy for breast cancer gene carriers (RR 0.84; 95% CI 0.73 to 0.97; 17 studies; N = 3108). Compared to usual care, decision aids reduced the number of people choosing prostate-specific antigen screening (RR 0.88; 95% CI 0.80 to 0.98; 10 studies; N = 3996) and increased those choosing to start new medications for diabetes (RR 1.65; 95% CI 1.06 to 2.56; 4 studies; N = 447). For other testing and screening choices, mostly there were no differences between decision aids and usual care.The median effect of decision aids on length of consultation was 2.6 minutes longer (24 versus 21; 7.5% increase). The costs of the decision aid group were lower in two studies and similar to usual care in four studies. People receiving decision aids do not appear to differ from those receiving usual care in terms of anxiety, general health outcomes, and condition-specific health outcomes. Studies did not report adverse events associated with the use of decision aids.In subgroup analysis, we compared results for decision aids used in preparation for the consultation versus during the consultation, finding similar improvements in pooled analysis for knowledge and accurate risk perception. For other outcomes, we could not conduct formal subgroup analyses because there were too few studies in each subgroup. Authors' conclusions: Compared to usual care across a wide variety of decision contexts, people exposed to decision aids feel more knowledgeable, better informed, and clearer about their values, and they probably have a more active role in decision making and more accurate risk perceptions. There is growing evidence that decision aids may improve values-congruent choices. There are no adverse effects on health outcomes or satisfaction. New for this updated is evidence indicating improved knowledge and accurate risk perceptions when decision aids are used either within or in preparation for the consultation. Further research is needed on the effects on adherence with the chosen option, cost-effectiveness, and use with lower literacy populations.
Article
Purpose: Women with a BRCA1 or BRCA2 mutation are at high risk for breast cancer and must make important decisions about breast cancer prevention and screening. In the current study, we report a multisite, randomized, controlled trial evaluating the effectiveness of a decision aid for breast cancer prevention in women with a BRCA mutation with no previous diagnosis of cancer. Methods: Within 1 month of receiving a positive BRCA result, women were randomized to receive either usual care (control group) or decision aid (intervention group). Participants were followed at 3, 6, and 12 months; were asked about preventive measures; and completed standardized questionnaires assessing decision making and psychosocial functioning. Results: One hundred fifty women were randomized. Mean cancer-related distress scores were significantly lower in the intervention group compared with the control group at 6 months (P = 0.01) and at 12 months postrandomization (P = 0.05). Decisional conflict scores declined over time for both groups and at no time were there statistical differences between the two groups. Conclusion: The decision aid for breast cancer prevention in women with a BRCA1 or BRCA2 mutation is effective in significantly decreasing cancer-related distress within the year following receipt of positive genetic test results.Genet Med advance online publication 01 September 2016Genetics in Medicine (2016); doi:10.1038/gim.2016.108.
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Helgeson proposed a comprehensive model of agency, communion, and well-being that was based on a review of the literature on agentic and communal personality traits, power and intimacy motivation, and self-critical and dependent depressive styles. The present study empirically examined the overlap among these personality dimensions as well as their relations to positive and negative affect, life satisfaction, and social adjustment. A factor analysis of the various personality measures yielded two factors, labeled communion and agency. Power motivation loaded negatively with four communal qualities: communal traits, communal role behaviors, intimacy motivation, and dependency. Self-criticism loaded negatively with two other agentic qualities: agentic traits and agentic role behaviors. Both agency and communion were significantly positively associated with positive affect and social adjustment. Agency also was sig nificantly associated with higher life satisfaction and lower negative affect. The positive adjustment outcomes related to agency were confirmed by peer reports.
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There are pervasive sex differences in psychological and physical well-being, many of which can be linked to the differential socialization of men and women. Numerous studies have linked psychological masculinity and femininity to well-being. In the present article, this literature is explained by focusing on the specific personality traits captured by conventional measures of masculinity and femininity: agency (focus on self and forming separations) and communion (focus on others and forming connections), respectively. Both agency and communion are required for optimal well-being (D. Bakan, 1966); when one exists in the absence of the other (unmitigated communion or unmitigated agency), however, negative health outcomes occur. Research that is consistent with this idea is presented, and the processes by which unmitigated agency and unmitigated communion affect well-being are explored. These processes involve control, social support, and health behavior. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Emotion processing and decision-making are integral aspects of daily life. However, our understanding of the interaction between these constructs is limited. In this review, we summarize theoretical approaches that link emotion and decision-making, and focus on research with anxious or depressed individuals to show how emotions can interfere with decision-making. We integrate the emotional framework based on valence and arousal with a Bayesian approach to decision-making in terms of probability and value processing. We discuss how studies of individuals with emotional dysfunctions provide evidence that alterations of decision-making can be viewed in terms of altered probability and value computation. We argue that the probabilistic representation of belief states in the context of partially observable Markov decision processes provides a useful approach to examine alterations in probability and value representation in individuals with anxiety and depression, and outline the broader implications of this approach.
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Most theories of affective influences on judgement and choice take a valence-based approach, contrasting the effects of positive versus negative feeling states. These approaches have not specified if and when distinct emotions of the same valence have different effects on judgement. In this article, we propose a model of emotion-specific influences on judgement and choice. We posit that each emotion is defined by a tendency to perceive new events and objects in ways that are consistent with the original cognitive-appraisal dimensions of the emotion. To pit the valence and appraisal-tendency approaches against one another, we present a study that addresses whether two emotions of the same valence but differing appraisals—anger and fear—relate in different ways to risk perception. Consistent with the appraisal-tendency hypothesis, fearful people made pessimistic judgements of future events whereas angry people made optimistic judgements. In the Discussion we expand the proposed model and review evidence supporting two social moderators of appraisal-tendency processes.
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Reported prevalence of emotional distress in cancer patients varies widely across studies. The present study determined prevalence of anxiety and depression (separated for presence of symptoms versus clinical levels) in a large, representative sample of cancer patients after diagnosis. During the years 2004-2009, 10,153 consecutive patients were routinely screened with the Psychosocial Screen for Cancer questionnaire at two major cancer centers. Patients' mean age was 59years and 45% were men. Across cancer types, 19.0% of patients showed clinical levels of anxiety and another 22.6% had subclinical symptoms. Further, 12.9% of patients reported clinical symptoms of depression and an additional 16.5% described subclinical symptoms. Analyses by cancer type revealed significant differences such that patients with lung, gynecological, or hematological cancer reported the highest levels of distress at the time point of cancer diagnosis. As expected, women showed higher rates of anxiety and depression, and for some cancer types the prevalence was two to three times higher than that seen for men. In some cancer types emotional distress was inversely related to age. Patients younger than 50 and women across all cancer types revealed either subclinical or clinical levels of anxiety in over 50% of cases. Findings describe levels of emotional distress after diagnosis but cannot inform about trajectories of anxiety and depression over time. Given that levels of anxiety and depression varied widely by cancer type, gender, and age, these results inform which cancer patients are most likely in need of psychosocial support.
Article
Objective To identify variables within the patient-oncologist communication pattern that impact overall patient comprehension and satisfaction within the breast cancer adjuvant therapy (AT) setting. Setting and participants Fifty patients were recruited from a number of academic and community-based oncology practices. Fifteen oncologists participated. Main variables Three communication variables were identified: percentage of total utterances spoken by the patient, percentage of total physician utterances that were coded as affective (i.e. emotional), and total number of questions asked by the patient during the consultation. Knowledge and satisfaction were assessed by a variety of outcome measures, including knowledge items and satisfaction as measured by VASs, the satisfaction with decision scale and the decisional conflict scale. Results The level of patient knowledge about breast cancer and satisfaction with the clinical encounter showed a tendency to correlate with the variables measuring aspects of patient-physician communication style. Patients who spoke more or asked more questions tended to be more knowledgeable whilst patients whose physicians used more affective language tended to know less but to be more satisfied with their clinical encounter. Conclusions In order to optimize patients’ degree of comprehension and satisfaction with their breast cancer adjuvant therapy, physicians need to increase their affective participation in clinical encounters whilst encouraging patients to ask questions and to actively participate in the decision-making process.
Article
We propose that two psychological dimensions, one relevant to relationships and group life (communion, C) and the other to skill acquisition, talent, and accomplishment (agency, A), aid people in interpreting their social worlds. Moreover, our analysis demonstrates the privileged nature of the C dimension and its relative stability compared to the A dimension across contexts and cultures. In Study 1 we use a standard compilation of culturally universal practices and show that the C dimension accounts for the majority of these universals, implying that the meaning of A traits varies more across cultures than that of C traits. In Studies 2 and 3, we provide evidence for this proposal using different judgment paradigms and cultural groups. The findings indicate that there is greater similarity and consensus in how people make sense of and judge information from the C than A dimension. We discuss the findings in terms of the recurring challenges people face over time as a result of living in groups. Copyright © 2008 John Wiley & Sons, Ltd.
Article
Although support groups are widely available on the Internet, little is known about the conversations in them. We hypothesized that automatic text analysis may be a powerful tool helping to understand what is communicated in these groups. In an exploratory study, the postings of nine women participating in a semi-structured breast cancer support group program were analyzed with a human rater and with Pennebaker and Francis' text analysis software (LIWC). The computer scores on most of the selected word categories and human ratings were moderately correlated. This indicates concurrent validity of the LIWC. An indication for construct validity was found by comparing the LIWC scores of the on-line group with those of other texts. Automated text analysis should be further developed for on-line discussions where they may serve as a useful tool for group moderators and researchers.
Article
Despite a recent growth in our understanding of the impact of psychosocial factors on the outcome of patients with cancer there is still relatively little known about the effect of these issues on patients with genitourinary malignancies. We determined the prevalence of psychological distress in patients with bladder cancer prior to and following radical cystectomy. A total of 74 consecutive patients with clinically organ confined bladder cancer were prospectively surveyed preoperatively using the Basic Symptom Inventory-18, a validated instrument that measures the psychological domains of general distress, anxiety, depression and somatization. Of the initial 74 patients 62 were available for postoperative assessment 1 month following cystectomy. Preoperative and postoperative distress scores were evaluated with respect to age, sex, marital status, type of surgical reconstruction and tumor stage. The preoperative prevalence of psychological distress in patients diagnosed with bladder cancer was 45% and it remained somewhat increased at 34% approximately 4 weeks after cystectomy. Demographic factors such as gender, age, and marital status were not significantly associated with the overall prevalence of distress. In the entire study group there was a statistically significant decrease in general distress (p = 0.028), depression (p = 0.034) and anxiety (p = 0.0004) from the preoperative to the postoperative assessments. Pathological stage was significantly associated with post-cystectomy anxiety (p = 0.040) and general distress (p = 0.042). Our findings indicate that a large proportion of patients with bladder cancer undergoing radical cystectomy experience psychological distress during the perioperative period. The identification of psychological distress in this population has the potential to influence health related quality of life as well as recovery in all individuals with bladder cancer.
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Shared decision-making is increasingly advocated as an ideal model of treatment decision-making in the medical encounter. To date, the concept has been rather poorly and loosely defined. This paper attempts to provide greater conceptual clarity about shared treatment decision-making, identify some key characteristics of this model, and discuss measurement issues. The particular decision-making context that we focus on is potentially life threatening illnesses, where there are important decisions to be made at key points in the disease process, and several treatment options exist with different possible outcomes and substantial uncertainty. We suggest as key characteristics of shared decision-making (1) that at least two participants--physician and patient be involved; (2) that both parties share information; (3) that both parties take steps to build a consensus about the preferred treatment; and (4) that an agreement is reached on the treatment to implement. Some challenges to measuring shared decision-making are discussed as well as potential benefits of a shared decision-making model for both physicians and patients.
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Distress has been defined as a multidimensional construct that extends along a continuum, ranging from common normal feelings of vulnerability, sadness and fears to problems that can become disabling, such as depression, anxiety, panic, social isolation and existential and spiritual crisis. Several studies have pointed out the need to screen for distress in the cancer. Emotional distress has been found as a core indicator of a patient's health and well-being and has installed it as the sixth vital sign. The aim of the present study was to identify the predictors of distress in cancer patients. For the present study, a total of 760 patients with cancer in a tertiary cancer centre were assessed using the Distress Inventory for Cancer Version 2 (DIC V2). A multivariate logistic regression was carried out to identify the predictors of distress and six subscales. Female patients under the age of 44 years scheduled to undergo surgery or those who had undergone surgery predicted significantly higher levels of overall distress. Composite disease stage other than stage IV metastatic disease and being a daily wage employee predicted significantly lower levels of overall distress. Higher distress among women undergoing surgery could imply distress associated with significant cosmetic disfigurement and feeling of loss of womanhood especially in those with breast or cervix cancer. The study once again demonstrate gender and age differences in distress and also highlights the importance of knowing that cancer is confined to one organ and has not spread.
Article
This study investigated differences in the emergence of decisional conflict in healthy and depressed participants. The two groups of interest were questioned about their experience of decisional conflict and ongoing thoughts and impressions during decision making. As predicted, depressed participants experienced more decisional conflict than healthy participants. Furthermore, the diverse processes hypothesis was supported: In healthy participants, preoccupation with the task was the only predictor of decisional conflict. In depressed participants, decisional conflict was predicted by a combination of depression-related processes (e.g., low self-efficacy, lack of concentration, rumination, etc.). This research reduces the gap between the relevance of the symptom of indecisiveness (e.g., for diagnostic purposes) and the lack of knowledge in this realm of psychopathology.
Article
The study objective was to evaluate the psychometric properties of a decisional conflict scale (DCS) that elicits: 1) health-care consumers' uncertainty in making a health-related decision; 2) the factors contributing to the uncertainty; and 3) health-care consumers' perceived effective decision making. The DCS was developed in response to the lack of instruments available to evaluate health-care-consumer decision aids and to tailor decision-supporting interventions to particular consumer needs. The scale was evaluated with 909 individuals deciding about influenza immunization or breast cancer screening. A subsample of respondents was retested two weeks later. The test-retest reliability coefficient was 0.81. Internal consistency coefficients ranged from 0.78 to 0.92. The DCS discriminated significantly (p < 0.0002) between those who had strong intentions either to accept or to decline invitations to receive influenza vaccine or breast cancer screening and those whose intentions were uncertain. The scale also discriminated significantly (p < 0.0002) between those who accepted or rejected immunization and those who delayed their decisions to be immunized. There was a weak inverse correlation (r = -0.16, p < 0.05) between the DCS and knowledge test scores. The psychometric properties of the scale are acceptable. It is feasible and easy to administer. Evaluations of responsiveness to change and validation with more difficult decisions are warranted.
Article
To use a standardized videotape stimulus to assess the effect of physician compassion on viewers' anxiety, information recall, treatment decisions, and assessment of physician characteristics. One hundred twenty-three healthy female breast cancer survivors and 87 women without cancer were recruited for this study. A randomized pretest/posttest control group design with a standardized videotape intervention was used. Participants completed the State-Trait Anxiety Inventory (STAI), an information recall test, a compassion rating, and physician attribute rating scales. Women who saw an "enhanced compassion" videotape rated the physician as warmer and more caring, sensitive, and compassionate than did women who watched the "standard" videotape. Women who saw the enhanced compassion videotape were significantly less anxious after watching it than the women in the other group. Nevertheless, information recall was relatively low for both groups, and enhanced compassion did not influence patient decisions. Those who saw the enhanced compassion videotape rated the doctor significantly higher on other positive attributes, such as wanting what was best for the patient and encouraging the patient's questions and involvement in decisions. The enhanced compassion segment was short, simple, and effective in decreasing viewers' anxiety. Further research is needed to translate these findings to the clinical setting, where reducing patient anxiety is a therapeutic goal.
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Anxiety is common in cancer patient populations, and must often initially be recognized and managed by cancer care professionals. This article reviews the recent oncology and mental health literature on anxiety. The aim is to help those involved in cancer patient care who are not specialists in mental health to understand the nature of anxiety, and discriminate morbid from normal anxiety. We review recent research into the association of anxiety with events during diagnosis and management of cancer, highlighting the importance of the meaning of events to an individual as an important factor in making people anxious. Lastly we review management strategies which might be used by cancer care professionals, in particular the importance of an awareness of specific patterns of communication which may alleviate or maintain anxiety for some cancer patients.
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An interaction between psychological attitude and outcome in early-stage breast cancer has been postulated, with a possible explanation related to the presumed tendency of depressed patients to be less proactive in obtaining health care. We report on the degree of acceptance of adjuvant chemotherapy in patients with breast cancer who have concomitant depression. Only 20 (51.3%) of the study group accepted and received the proposed chemotherapy compared with 75 (92.2%) of the control group (p<0.0001). Treatment of depression might be essential for tailoring adjuvant treatments with chemotherapy.
Article
Women with breast carcinoma commonly experience psychologic distress following their diagnosis. Women who participate in breast cancer support groups have reported significant reduction in their psychologic distress and pain and improvement in the quality of their lives. Web-based breast cancer social support groups are widely used, but little is known of their effectiveness. Preliminary evidence suggests that women benefit from their participation in web-based support groups. Seventy-two women with primary breast carcinoma were assigned randomly to a 12-week, web-based, social support group (Bosom Buddies). The group was semistructured, moderated by a health care professional, and delivered in an asynchronous newsgroup format. The results indicate that a web-based support group can be useful in reducing depression and cancer-related trauma, as well as perceived stress, among women with primary breast carcinoma. The effect sizes ranged from 0.38 to 0.54. Participants perceived a variety of benefits and high satisfaction from their participation in the intervention This study demonstrated that the web-based program, Bosom Buddies, was effective in reducing participants' scores on depression, perceived stress, and cancer-related trauma measures. The effect size of the intervention was in the moderate range. Although web-based social support groups offer many advantages, this delivery mechanism presents a number of ethical issues that need to be addressed.
Article
The incidence of prostate cancer has risen sharply in the last decade, yet knowledge about the psychological health of men with this disease is still limited. A study was therefore undertaken to identify (1) the prevalence of psychological distress in these males, and (2) factors predicting psychological distress. Retrospective cross-sectional survey design by means of a self-administered questionnaire. A sample of 94 men with various stages of prostate cancer completed the Functional Assessment of Cancer Therapy-Prostate Instrument (FACT-P), the Hospital Anxiety Depression Scale (HADS) and items measuring satisfaction with medical care. We detected a prevalence rate of 38% of participants reporting psychological distress corresponding to a HADS cut-off score at or above 15. A standard multivariate regression analysis revealed social/family well-being, physical well-being and functional well-being as significant inverse predictors of psychological distress. Health professionals should be aware of the potential for psychological distress in patients exhibiting poor physical functioning and those with apparent deficits in social or family support in this under-studied group of patients. Strategies for psychosocial intervention are implied.
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A diagnosis of cancer typically results in patients experiencing uncertainty about and loss of control over their situation, which in turn has a negative influence on their health outcomes. Cancer treatment further disrupts patients' quality of life. Throughout their cancer journey patients often rely on their physicians to provide them with social/interpersonal, informational, and decisional support. A growing body of research shows that physicians' communication behavior does indeed have a positive impact on patient health outcomes. Thus, the patient-physician interaction assumes great significance in the cancer care delivery process. It is encouraging to note that research in this area, largely dominated by studies conducted in primary care, is attracting the attention of cancer researchers. In an attempt to encourage and aid future research on patient-physician communication in cancer care, this paper presents a critical evaluation of existing literature on key elements of physicians' communication behavior (i.e., interpersonal communication, information exchange, and facilitation of patient involvement in decision-making). Different approaches to assessing physician behavior are discussed followed by a review of key findings linking physician behavior with cancer patient health outcomes. Finally, potential limitations of existing research are highlighted and areas for future research are identified.
Article
To document anxiety and depression from pretreatment till 5-year follow-up in 299 men with localized prostate cancer. To assess, if baseline scores were predictive for anxiety and depression at 1-year follow-up. Respondents completed four assessments (pretreatment, at 6 and 12 months, and at 5-year follow-up) on anxiety, depression and mental health. Respondents were subdivided according to therapy (prostatectomy or radiotherapy) and high vs low-anxiety. Pretreatment 28% of all patients were classified as 'high-anxiety'; their average anxiety scores decreased significantly post-treatment, that is towards less anxiety. At all assessments, high-anxiety men treated by prostatectomy reported less depression than high-anxiety men treated by radiotherapy. Of men treated by radiotherapy, 27% reported clinical significant levels of depression while 20% is expected in a general population. The improvement in mental health at 6-months follow-up was statistically significant and clinically meaningful in all respondent groups. Sensitivity of anxiety at baseline as a screening tool was 71% for anxiety and 60% for symptoms of depression. We recommend clinicians to attempt early detection of patients at risk of high levels of anxiety and depression after prostate cancer diagnosis since prevalence is high. STAI-State can be a useful screening tool but needs further development.
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