A randomized trial of a nurse-led decision aid to inform patients with advanced cancer about palliative chemotherapy.

e20583 Background: There is a lack of decision aids (DAs) for patients with advanced cancer considering palliative treatment. In this randomized study, we evaluated nurse-led DAs about second-line palliative chemotherapy for patients with advanced breast (BC) or colorectal cancer (CRC). Methods: Patients with advanced BC or CRC considering second-line treatment were randomized to receive only usual care (control group) or usual care plus a DA from a nurse (intervention group) (1:2 ratio). Using the DA, a nurse offered information on adverse events, tumor response, and survival. Patients completed a baseline questionnaire and two follow-up questionnaires 1 week and 8 weeks after the treatment-related information was provided. Outcome measures were well-being, coping, knowledge, and information and decision-related outcomes. Intent-to-treat analyses were performed using Chi Square tests, independent samples t-tests, and linear mixed models to examine differences between groups over time. Results: In all,128 patients participated in the study; median age 62 years (range 32-81), 37% male, 73% CRC. Of the 83 patients assigned to the intervention group, 77 received a DA. At the first follow-up, more patients receiving a DA preferred chemotherapy (96% vs. 84%; p=0.067). Seven weeks later, 88% of patients in the intervention group and 84% of patients in the control group had started chemotherapy (p=0.746). The only statistically significant effect was the stronger treatment preference of patients in the intervention group (3.0 vs. 2.5; p=0.030). The DAs did not negatively impact anxiety, depression, cancer worries, and hopelessness. Conclusions: It is possible to offer a DA with explicit information to patients with advanced cancer without negative impact on patients' well-being. Unexpectedly, this study did not show consistent effectiveness of the DAs. Our interpretation is that most patients receiving the DA had already decided to start chemotherapy. Clinical trial information: NTR1113.

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Abstract 225: A Depression Quality Program and Cardiovascular Disease: Assessing the Impact on Care

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.225 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Linda Gordon ◽

Amanda Malecky ◽

Andrew Althouse ◽

Nicole Ansani

Keyword(s):

Usual Care ◽

Goal Attainment ◽

Intervention Group ◽

Phone Call ◽

Categorical Variables ◽

Care Group ◽

Control Group ◽

Surrogate Outcome ◽

The Impact

Background: Data demonstrate an adverse association between depression and coronary artery disease prognosis. Therefore, a depression screening program was initiated in the catheterization (cath) lab. The goals were to improve HEDIS depression compliance rates and determine the impact on clinical outcomes. Methods: Adult patients in an inpatient cath lab from 3 cardiology practices were screened for enrollment in a randomized controlled trial. All cath lab patients received a PHQ-9 depression screener. Those who screened positive for depression (score ≥ 10) were randomized to intervention or usual care. The usual care group received a follow-up phone call to re-administer the PHQ-9 at 6-8 weeks and within 210 days of discharge. The intervention group was administered the PHQ-9 and received intensive education at baseline, 6-8 weeks, and within 210 days of discharge. Education included targeted depression information with a mental health care provider and comprehensive disease management education with a cardiovascular nurse practitioner. Outcomes included: differences in HEDIS depression goal attainment; depression response/remission rates; and cardiovascular goals. Differences between groups were tested using chi-squared tests (categorical variables) and t-tests (continuous variables). Results: Baseline characteristics were similar between control (N=43) and intervention (N=40) groups, with the exception of significantly fewer African American patients in the control group (N=2, 4.7%) vs intervention (N=9, 22.5%). Changes in HEDIS goal attainment show that patients in the intervention group were slightly more likely to be referred to a provider to address depression (95.0% vs 86.0%, p=0.314), or receive meds for depression (65.0% vs 51.2%, p=0.219), but these differences are not statistically significant. More patients in the intervention group refused meds for depression compared to control (15.0% vs. 2.3%, p=0.041); have received blood work (65.0% vs 41.9%, p=0.030); and have received follow-up within 210 days (82.5% vs 46.5%, p<0.001). Treatment adjustment rate was higher in the intervention group compared to control (85.0% vs. 65.1%, p=0.037). Hospital readmission rate was similar between groups (p=0.896) and there was no difference in depression remission or response rates (p=0.426). Further, no differences were seen in cardiovascular surrogate outcome parameters, including cholesterol, A1c, CRP, or BNP between groups; except SGOT was significantly different between groups (-5.0 intervention vs 2.0 control p=0.045). Conclusions: These data demonstrate improvements in attaining a surrogate outcome measure of quality (HEDIS goals); however, this does not appear to translate to a significant clinical impact. Quality measures may need to be continuously reassessed to ensure efficiency and effectiveness of care.

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A Children’s Asthma Education Program: Roaring Adventures of Puff (RAP), Improves Quality of Life

Canadian Respiratory Journal ◽

10.1155/2010/327650 ◽

2010 ◽

Vol 17 (2) ◽

pp. 67-73 ◽

Cited By ~ 27

Author(s):

Shawna L McGhan ◽

Eric Wong ◽

Heather M Sharpe ◽

Patrick A Hessel ◽

Puish Mandhane ◽

...

Keyword(s):

Quality Of Life ◽

Usual Care ◽

Education Program ◽

Intervention Group ◽

Asthma Management ◽

Control Group ◽

Asthma Education ◽

Children With Asthma

BACKGROUND: It is postulated that children with asthma who receive an interactive, comprehensive education program would improve their quality of life, asthma management and asthma control compared with children receiving usual care.OBJECTIVE: To assess the feasibility and impact of ‘Roaring Adventures of Puff’ (RAP), a six-week childhood asthma education program administered by health professionals in schools.METHODS: Thirty-four schools from three health regions in Alberta were randomly assigned to receive either the RAP asthma program (intervention group) or usual care (control group). Baseline measurements from parent and child were taken before the intervention, and at six and 12 months.RESULTS: The intervention group had more smoke exposure at baseline. Participants lost to follow-up had more asthma symptoms. Improvements were significantly greater in the RAP intervention group from baseline to six months than in the control group in terms of parent’s perceived understanding and ability to cope with and control asthma, and overall quality of life (P<0.05). On follow-up, doctor visits were reduced in the control group.CONCLUSION: A multilevel, comprehensive, school-based asthma program is feasible, and modestly improved asthma management and quality of life outcomes. An interactive group education program offered to children with asthma at their school has merit as a practical, cost-effective, peer-supportive approach to improve health outcomes.

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Early rehabilitation after hospital admission for road trauma using an in-reach multidisciplinary team: a randomised controlled trial

Clinical Rehabilitation ◽

10.1177/0269215517694462 ◽

2017 ◽

Vol 31 (9) ◽

pp. 1189-1200 ◽

Cited By ~ 4

Author(s):

Jane Wu ◽

Steven G Faux ◽

John Estell ◽

Stephen Wilson ◽

Ian Harris ◽

...

Keyword(s):

Length Of Stay ◽

Usual Care ◽

Intervention Group ◽

Psychological Status ◽

Randomised Control Trial ◽

Control Group ◽

Rehabilitation Team ◽

Secondary Outcomes ◽

The Impact

Objective: To investigate the impact of an in-reach rehabilitation team for patients admitted after road trauma. Design: Randomised control trial of usual care versus early involvement of in-reach rehabilitation team. Telephone follow-up was conducted by a blind assessor at three months for those with minor/moderate injuries and six months for serious/severe injuries. Setting: Four participating trauma services in New South Wales, Australia. Subjects: A total of 214 patients admitted during 2012-2015 with a length of stay of at least five days. Intervention: Provision of rehabilitation services in parallel with ward based therapy using an in-reach team for the intervention group. The control group could still access the ward based therapy (usual care). Main measures: The primary outcome was acute length of stay. Secondary outcomes included percentage requiring inpatient rehabilitation, function (Functional Independence Measure and Timed Up and Go Test), psychological status (Depression Anxiety and Stress Score 21), pain (Orebro Musculoskeletal Pain Questionnaire) and quality of life (Short Form-12 v2). Results: Median length of stay in acute care was 13 days (IQR 8-21). The intervention group, compared to the control group, received more physiotherapy and occupational therapy sessions (median number of sessions 16.0 versus 11.5, P=0.003). However, acute length of stay did not differ between the intervention and control groups (median 15 vs 12 days, P=0.37). There were no significant differences observed in the secondary outcomes at hospital discharge and follow-up. Conclusion: No additional benefit was found from the routine use of acute rehabilitation teams for trauma patients over and above usual care.

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The Effect of Cyberspace-based Education on the Well-Being of Caregivers of Elderly People with Dementia

Current Aging Science ◽

10.2174/1874609814666210208180051 ◽

2021 ◽

Vol 14 ◽

Author(s):

Yadollah Abolfathi Momtaz ◽

Parisa Mollaei ◽

Parisa Taheri-Tanjani

Keyword(s):

Elderly People ◽

Negative Impact ◽

Intervention Group ◽

Well Being ◽

World Health ◽

Control Group ◽

People With Dementia ◽

Age Related ◽

Significant Difference ◽

The Impact

Introduction: One of the consequences of aging is the prevalence of chronic and age-related diseases, such as dementia. Caring for patients with dementia has a negative impact on the caregiver's well-being. This study aimed to examine the impact of cyberspace-based education on the well-being of caregivers of demented elderly people. Methods: This experimental study was done on a sample of 86 caregivers of elderly with dementia in 2018. The study sample was selected from memory clinic of Taleghani Hospital and randomly assigned into groups (intervention n = 43, control n = 43 groups). The well-being was measured using the World Health Organization - Five Well-Being Index (WHO-5), before and two months after the intervention. Cyberspace-based educational intervention was conducted for one month. The SPSS software version 23 was employed in data analysis. Results: The mean age of the caregivers in the intervention and control groups were (M = 51.95, SD = 10.90) and (M = 51.36, SD = 15.12) respectively. No significant difference was found between two groups in terms of age, gender and level of education. The results of analysis showed that while the well-being of the intervention group was significantly increased (t (38) = -11.38, P<0.001) the well-being in the control group was significantly reduced ( t(36) =4.71 , P<0.001). Conclusion: The findings showed that cyberspace-based education can improve the well-being of caregivers of the elderly with dementia.

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Effects on cognitive and clinical insight with the use of Guided Self-Determination in outpatients with schizophrenia: A randomized open trial

European Psychiatry ◽

10.1016/j.eurpsy.2014.12.007 ◽

2015 ◽

Vol 30 (5) ◽

pp. 655-663 ◽

Cited By ~ 15

Author(s):

R. Jørgensen ◽

R.W. Licht ◽

P.H. Lysaker ◽

P. Munk-Jørgensen ◽

K.D. Buck ◽

...

Keyword(s):

Social Functioning ◽

Symptom Severity ◽

Negative Impact ◽

Intervention Group ◽

Psychosocial Interventions ◽

Self Determination ◽

Control Group ◽

Treatment As Usual ◽

Cognitive Insight

AbstractPoor insight has a negative impact on the outcome in schizophrenia; consequently, poor insight is a logical target for treatment. However, neither medication nor psychosocial interventions have been demonstrated to improve poor insight. A method originally designed for diabetes patients to improve their illness management, Guided Self-Determination (GSD), has been adapted for use in patients with schizophrenia (GSD-SZ). The purpose of this study was to investigate the effect on insight of GSD-SZ as a supplement to treatment as usual (TAU) as compared to TAU alone in outpatients diagnosed with schizophrenia. The design was an open randomized trial. The primary hypothesis was cognitive insight would improve in those patients who received GSD-SZ + TAU as assessed by the BCIS. We additionally explored whether the intervention led to changes in clinical insight, self-perceived recovery, self-esteem, social functioning and symptom severity. Assessments were conducted at baseline, and at 3-, 6- and 12-month follow-up. Analysis was based on the principles of intention to treat and potential confounders were taken into account through applying a multivariate approach. A total of 101 participants were randomized to GSD-SZ + TAU (n = 50) or to TAU alone (n = 51). No statistically significant differences were found on the cognitive insight. However, at 12-month follow-up, clinical insight (measured by G12 from the Positive and Negative Syndrome Scale), symptom severity, and social functioning had statistically significantly improved in the intervention group as compared to the control group. “Improving insight in patients diagnosed with schizophrenia”, NCT01282307, http://clinicaltrials.gov/.

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Development and implementation of a multifaceted well-being intervention

Journal of Organizational Effectiveness People and Performance ◽

10.1108/joepp-02-2016-0013 ◽

2016 ◽

Vol 3 (4) ◽

pp. 360-375 ◽

Cited By ~ 3

Author(s):

Maura J. Mills ◽

Clive J. Fullagar ◽

Satoris S. Culbertson

Keyword(s):

Personal Growth ◽

Professional Growth ◽

Intervention Group ◽

Well Being ◽

Control Group ◽

Extension Agents ◽

Content Type ◽

Cognitive Reframing ◽

The One

Purpose The purpose of this paper is to develop and implement an intervention to increase individuals’ hedonic well-being (HWB) and/or eudaimonic well-being (EWB) via cognitive reframing and action-based behaviors. Design/methodology/approach Time 1 and Time 2 data were collected two weeks apart from 76 participants (comprised of city employees, extension agents, and students) in an intervention group (23) and a characteristically similar control group (53). The intervention included an in-person facilitated meeting with a series of follow-up e-mails designed to focus participants on well-being improvement strategies and provide them resources for continued well-being development. Findings Intervention participants evidenced a significant increase in EWB after two weeks, particularly the personal growth dimension. No significant increase resulted for HWB. Research limitations/implications The present intervention indicates the importance of targeting well-being at a facet level, including a focus on multidimensional EWB. The intervention also serves to guide the informed development of future well-being programs. Practical implications These findings have important implications for organizations in light of increased employee desire for personal and professional growth opportunities supported by their employer. Group interventions such as the one reported herein are an important way for organizations to develop and invest in employees. Originality/value This paper traces the development of prior well-being interventions, evaluating their successes and failures and using those to guide the informed development of the present intervention. By utilizing both in-person and follow-up components, and incorporating both hedonic and multidimensional eudaimonic components, the proposed intervention serves as an important step toward a feasible organizational intervention that can benefit many.

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Effectiveness of a health literacy intervention based on transformative learning and incorporating positive psychology on health behavior and well-being of Thai families with NCDs risk

Journal of Public Health Research ◽

10.4081/jphr.2021.1935 ◽

2021 ◽

Author(s):

Ungsinun Intarakamhang ◽

Ann Macaskill

Keyword(s):

Health Literacy ◽

Positive Psychology ◽

Health Behavior ◽

Transformative Learning ◽

Intervention Group ◽

Well Being ◽

Control Group ◽

Post Intervention ◽

Physiological Measurement

Background: Thailand has a higher global NCD mortality rate in comparison to the rest of the world, accounting for 75% and 71% of all deaths. WHO focused increasingly on health literacy (HL) in order to decrease NCDs. This study aimed to assess the effectiveness of an HL intervention utilizing transformative learning and positive psychology with mindfulness training in terms of changing levels of HL, health behavior (HB), and health outcomes. Design and Methods: The study was a randomized control trial from May to September 2019. The participants were a rural Thai population with low levels of HL, living in an area with high levels of NCDs. The 200 participants were cluster randomly allocated to an eight-week intervention, and the control group. The data were collected by Likert questionnaires and physical exams, and analyzed via ANOVA. Results: The intervention group mean scores for HL, psychological capital, HB, and family well-being increased from baseline to post-intervention, but decreased during the follow-up but were still significantly higher than the control group and baseline scores. The increases in HL and HB were matched by improvements in physiological measurement. The BMI scores of the intervention group decreased in each phase, while the control group scores remained largely unchanged. An intervention group had significantly lower fasting blood sugar than the controls at the intervention and in the follow-up. There was no interaction between social support and any other variables.Conclusion: This program demonstrated improvements in HL, HB and the well-being of Thai families at risk of NCDs in rural communities.

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Resilience@Work Mindfulness Program: Results From a Cluster Randomized Controlled Trial With First Responders (Preprint)

10.2196/preprints.12894 ◽

2018 ◽

Author(s):

Sadhbh Joyce ◽

Fiona Shand ◽

Tara J Lal ◽

Brendan Mott ◽

Richard A Bryant ◽

...

Keyword(s):

High Risk ◽

Controlled Trial ◽

Intervention Group ◽

First Responders ◽

Well Being ◽

Control Group ◽

Resilience Training ◽

Cluster Randomized ◽

Adaptive Resilience

BACKGROUND A growing body of research suggests that resilience training can play a pivotal role in creating mentally healthy workplaces, particularly with regard to protecting the long-term well-being of workers. Emerging research describes positive outcomes from various types of resilience training programs (RTPs) among different occupational groups. One specific group of workers that may benefit from this form of proactive resilience training is first responders. Given the nature of their work, first responders are frequently exposed to stressful circumstances and potentially traumatic events, which may impact their overall resilience and well-being over time. OBJECTIVE This study aimed to examine whether a mindfulness-based RTP (the Resilience@Work [RAW] Mindfulness Program) delivered via the internet can effectively enhance resilience among a group of high-risk workers. METHODS We conducted a cluster randomized controlled trial (RCT) comprising 24 Primary Fire and Rescue and Hazmat stations within New South Wales. Overall, 12 stations were assigned to the 6-session RAW Mindfulness Program and 12 stations were assigned to the control condition. A total of 143 active full-time firefighters enrolled in the study. Questionnaires were administered at baseline, immediately post training, and at 6-month follow-up. Measurements examined change in both adaptive and bounce-back resilience as well as several secondary outcomes examining resilience resources and acceptance and mindfulness skills. RESULTS Mixed-model repeated measures analysis found that the overall test of group-by-time interaction was significant (P=.008), with the intervention group increasing in adaptive resilience over time. However, no significant differences were found between the intervention group and the control group in terms of change in bounce-back resilience (P=.09). At 6-month follow-up, the group receiving the RAW intervention had an average increase in their resilience score of 1.3, equating to a moderate-to-large effect size compared with the control group of 0.73 (95% CI 0.38-1.06). Per-protocol analysis found that compared with the control group, the greatest improvements in adaptive resilience were observed among those who completed most of the RAW program, that is, 5 to 6 sessions (P=.002). CONCLUSIONS The results of this RCT suggest that mindfulness-based resilience training delivered in an internet format can create improvements in adaptive resilience and related resources among high-risk workers, such as first responders. Despite a number of limitations, the results of this study suggest that the RAW Mindfulness Program is an effective, scalable, and practical means of delivering online resilience training in high-risk workplace settings. To the best of our knowledge, this is the first time a mindfulness-based RTP delivered entirely via the internet has been tested in the workplace. CLINICALTRIAL Australian New Zealand Clinical Trials Registry ACTRN12615000574549; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368296 (Archived by WebCite at http://www.webcitation.org/75w4xtrpw).

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Efficacy of a Smartphone App Intervention for Reducing Caregiver Stress: Randomized Controlled Trial (Preprint)

10.2196/preprints.17541 ◽

2019 ◽

Author(s):

Matthew Fuller-Tyszkiewicz ◽

Ben Richardson ◽

Keriann Little ◽

Samantha Teague ◽

Linda Hartley-Clark ◽

...

Keyword(s):

Active Control ◽

Psychological Intervention ◽

Controlled Trial ◽

Intervention Group ◽

Well Being ◽

Self Esteem ◽

Mobile App ◽

Control Group ◽

Self Monitoring

BACKGROUND Caregivers play a pivotal role in maintaining an economically viable health care system, yet they are characterized by low levels of psychological well-being and consistently report unmet needs for psychological support. Mobile app–based (mobile health [mHealth]) interventions present a novel approach to both reducing stress and improving well-being. OBJECTIVE This study aims to evaluate the effectiveness of a self-guided mobile app–based psychological intervention for people providing care to family or friends with a physical or mental disability. METHODS In a randomized, single-blind, controlled trial, 183 caregivers recruited through the web were randomly allocated to either an intervention (n=73) or active control (n=110) condition. The intervention app contained treatment modules combining daily self-monitoring with third-wave (mindfulness-based) cognitive-behavioral therapies, whereas the active control app contained only self-monitoring features. Both programs were completed over a 5-week period. It was hypothesized that intervention app exposure would be associated with decreases in depression, anxiety, and stress, and increases in well-being, self-esteem, optimism, primary and secondary control, and social support. Outcomes were assessed at baseline, postintervention, and 3-4 months postintervention. App quality was also assessed. RESULTS In total, 25% (18/73) of the intervention participants were lost to follow-up at 3 months, and 30.9% (34/110) of the participants from the wait-list control group dropped out before the postintervention survey. The intervention group experienced reductions in stress (b=−2.07; P=.04) and depressive symptoms (b=−1.36; P=.05) from baseline to postintervention. These changes were further enhanced from postintervention to follow-up, with the intervention group continuing to report lower levels of depression (b=−1.82; P=.03) and higher levels of emotional well-being (b=6.13; P<.001), optimism (b=0.78; P=.007), self-esteem (b=−0.84; P=.005), support from family (b=2.15; P=.001), support from significant others (b=2.66; P<.001), and subjective well-being (b=4.82; P<.001). On average, participants completed 2.5 (SD 1.05) out of 5 treatment modules. The overall quality of the app was also rated highly, with a mean score of 3.94 out of a maximum score of 5 (SD 0.58). CONCLUSIONS This study demonstrates that mHealth psychological interventions are an effective treatment option for caregivers experiencing high levels of stress. Recommendations for improving mHealth interventions for caregivers include offering flexibility and customization in the treatment design. CLINICALTRIAL Australian New Zealand Clinical Trial Registry ACTRN12616000996460; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371170

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Prevention of Depressive Symptoms and Promotion of Well-being in Adolescents: A Randomized Controlled Trial of the Smile Program

Anales de Psicología ◽

10.6018/analesps.35.2.342591 ◽

2019 ◽

Vol 35 (2) ◽

pp. 300-313

Author(s):

Óscar Sánchez-Hernández ◽

Francisco X. Méndez ◽

Manuel Ato ◽

Judy Garber

Keyword(s):

Depressive Symptoms ◽

Controlled Trial ◽

Intervention Group ◽

Well Being ◽

Behavioral Approach ◽

Control Group ◽

Post Intervention ◽

Post Test ◽

Intervention Condition

This study addressed the development and evaluation of the Smile Program whose main objective was the prevention of depression and the promotion of well-being in adolescents. The program is based on interventions that have been shown to be efficacious (a cognitive-behavioral approach). Participants were 89 adolescents (mean age = 13.88 years; SD = 0.95) recruited from a sample of 1212 students from seven schools. Results showed a significant reduction in self-reported depressive symptoms in the intervention group (n= 51) as compared to youth in the control group (n= 38). Based on parents’ report (n=56), youth in the intervention group had significantly better self-esteem at post-test as compared to youth in the control group. At four months post intervention, youth in the intervention group had higher psychological well-being than those in the control group; at the 8-month follow-up, youth in the intervention condition reported better family self-concept.

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