Mental health, treatment preferences, advance care planning, and location and quality of death in advanced cancer patients with dependent children

2008 ◽  
Vol 26 (15_suppl) ◽  
pp. 9517-9517
Author(s):  
M. E. Nilsson ◽  
P. K. Maciejewski ◽  
B. Zhang ◽  
A. A. Wright ◽  
E. D. Trice ◽  
...  
Cancer ◽  
2008 ◽  
Vol 115 (2) ◽  
pp. 399-409 ◽  
Author(s):  
Matthew E. Nilsson ◽  
Paul K. Maciejewski ◽  
Baohui Zhang ◽  
Alexi A. Wright ◽  
Elizabeth D. Trice ◽  
...  

2007 ◽  
Vol 25 (5) ◽  
pp. 555-560 ◽  
Author(s):  
Tracy A. Balboni ◽  
Lauren C. Vanderwerker ◽  
Susan D. Block ◽  
M. Elizabeth Paulk ◽  
Christopher S. Lathan ◽  
...  

Purpose Religion and spirituality play a role in coping with illness for many cancer patients. This study examined religiousness and spiritual support in advanced cancer patients of diverse racial/ethnic backgrounds and associations with quality of life (QOL), treatment preferences, and advance care planning. Methods The Coping With Cancer study is a federally funded, multi-institutional investigation examining factors associated with advanced cancer patient and caregiver well-being. Patients with an advanced cancer diagnosis and failure of first-line chemotherapy were interviewed at baseline regarding religiousness, spiritual support, QOL, treatment preferences, and advance care planning. Results Most (88%) of the study population (N = 230) considered religion to be at least somewhat important. Nearly half (47%) reported that their spiritual needs were minimally or not at all supported by a religious community, and 72% reported that their spiritual needs were supported minimally or not at all by the medical system. Spiritual support by religious communities or the medical system was significantly associated with patient QOL (P = .0003). Religiousness was significantly associated with wanting all measures to extend life (odds ratio, 1.96; 95% CI, 1.08 to 3.57). Conclusion Many advanced cancer patients’ spiritual needs are not supported by religious communities or the medical system, and spiritual support is associated with better QOL. Religious individuals more frequently want aggressive measures to extend life.


Author(s):  
Masanori Mori

Physicians and advanced cancer patients are often reluctant to talk about death. They frequently avoid end-of-life discussions (EOLds), although such conversations are essential to initiate advance care planning. In this prospective, a longitudinal multisite cohort study of advanced cancer patients and their informal caregivers, the authors suggested cascading benefits of EOLds between patients and their physicians. In total, 123 of 332 (37.0%) patients reported having EOLds with their physicians at baseline. EOLds were not associated with higher rates of emotional distress or psychiatric disorders. Instead, after propensity-score weighted adjustment, EOLds were associated with less aggressive medical care near death and earlier hospice referrals. Aggressive care was associated with worse patient quality of life and worse bereavement adjustment. These findings may help destigmatize EOLds and assist physicians and patients in initiating such conversations and engaging in advance care planning.


2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21501-e21501 ◽  
Author(s):  
Lea Jasmina Jabbarian ◽  
Renee Maciejewski ◽  
Paul K Maciejewski ◽  
Holly Gwen Prigerson

e21501 Background: The stability of patient treatment preferences has important implications for the optimal timing of advance care planning. Nevertheless, longitudinal data on cancer patients in real-life settings have not examined stability of treatment preferences over time. This study examines the stability of treatment preferences of advanced cancer patients over time and the potential influence of changes in physical functioning. Methods: The patient sample (N = 104) was drawn from a multi-institutional, longitudinal cohort study of patients recruited between 2010 and 2015. Patients with metastatic solid tumor cancer that had progressed on prior chemotherapy regimens were interviewed after an initial clinic meeting in which their most recent scan results were discussed (baseline) and, subsequently, completed monthly follow-ups. Patients reported their treatment preferences (i.e., comfort versus life-extending care) and physical functioning at each assessment. Results: The treatment preferences of the majority of patients (80.8%) remained stable within the first month of follow-up. Patient characteristics, such as age or type of cancer, were not significantly associated with treatment preference stability. The proportion of patients whose preferences changed in favor of comfort care (10.6%) was only slightly higher than the proportion of patients whose preferences changed in favor of life-extending care (8.7%). The same pattern held for the two- and three-month follow-up assessments. Improvement in physical functioning was significantly associated with change in treatment preferences. However, the vast majority of patients (72.2%) had stable or declining physical functioning. Conclusions: Most advanced cancer patients have stable treatment preferences regarding comfort versus life-extending care in the months leading up to their death. Thus, advance care planning earlier in the course of illness may not be premature for the vast majority of patients. As physical functioning changes, treatment preferences should be re-evaluated.


2005 ◽  
Vol 30 (2) ◽  
pp. 174-179 ◽  
Author(s):  
Gala True ◽  
Etienne J. Phipps ◽  
Leonard E. Braitman ◽  
Tina Harralson ◽  
Diana Harris ◽  
...  

2004 ◽  
Vol 34 (3) ◽  
pp. 219-233 ◽  
Author(s):  
Julie Loebach Wetherell ◽  
Robert M. Kaplan ◽  
Gene Kallenberg ◽  
Timothy R. Dresselhaus ◽  
William J. Sieber ◽  
...  

Author(s):  
Nancy Wolff

Research in mental health issues in prisoner populations essentially stopped in the mid 1970’s. It is now re-emerging as a critical component of improving mental health care and helping toward recovery for the incarcerated mentally ill. Mental illness, ranging from acute anxiety to schizophrenia, is endemic within prisons and jails. Unlike their free world counterparts, however, incarcerated people have a constitutional right to mental health treatment. Yet, despite the need for and right to mental health treatment, remarkably little reliable and valid evidence is available on the nature and level of mental illness among incarcerated people, the effects of incarceration on symptomatology, the availability and quality of medication, cognitive, and psychosocial treatment for disorders, and how context impacts the effectiveness of the treatment that is available. Evidence is absent because corrections-based research is constrained by regulation, financing, and inexperience. In this chapter, the history of prisoner research and the evolution of federal regulations to protect prisoners as human subjects will be reviewed and then discussed in terms of how regulation has impacted correctional mental health research, after first defining what is meant by research and why research is needed to inform policy and practice decisions. This will be followed by recommendations for building the correctional mental health research evidence base. The intent here is to help researchers, in collaboration with stakeholders, develop, design, and implement research studies, and disseminate evidence to advance science and the quality of care available to incarcerated people with mental illnesses within the current regulatory environment.


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