scholarly journals Role of Patient Coping Strategies in Understanding the Effects of Early Palliative Care on Quality of Life and Mood

2018 ◽  
Vol 36 (1) ◽  
pp. 53-60 ◽  
Author(s):  
Joseph A. Greer ◽  
Jamie M. Jacobs ◽  
Areej El-Jawahri ◽  
Ryan D. Nipp ◽  
Emily R. Gallagher ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Depressive Symptoms ◽  
Coping Strategies ◽  
Indirect Effect ◽  
Avoidant Coping ◽  
Intervention Effects ◽  
Early Palliative Care ◽  
Patient Reported

Purpose The early integration of oncology and palliative care (EIPC) improves quality of life (QOL) and mood for patients with advanced cancer. However, the mechanisms by which EIPC benefits these outcomes remain unclear. We therefore examined whether EIPC improved patients’ coping strategies and if changes in coping accounted for intervention effects on QOL and depressive symptoms. Patients and Methods For this secondary analysis of an EIPC trial, we examined data from 350 patients with newly diagnosed incurable lung or GI cancer. Participants completed assessments of QOL (Functional Assessment of Cancer Therapy–General), depressive symptoms (Patient Health Questionnaire–9), and coping (Brief COPE) at baseline and 24 weeks. We used linear regression to test intervention effects on use of coping strategies and mediation regression models with bias-corrected bootstrapping to examine whether improvements in coping mediated the effects of early palliative care on patient-reported outcomes. Results Compared with usual oncology care, EIPC significantly increased patient use of approach-oriented coping strategies ( B = 1.09; SE = 0.44; P = .01) and slightly reduced use of avoidant strategies ( B = −0.44; SE = 0.23; P = .06) from baseline to 24 weeks. Also, the increased use of approach-oriented coping and reduction in avoidant coping were associated with higher QOL and lower depressive symptoms at 24 weeks. The positive changes in approach-oriented coping, but not avoidant coping, significantly mediated the effects of EIPC on QOL (indirect effect, 1.27; 95% CI, 0.33 to 2.86) and depressive symptoms (indirect effect, −0.39; 95% CI, −0.87 to −0.08). Conclusion Patients with incurable cancer who received EIPC showed increased use of approach-oriented coping, which was associated with higher QOL and reduced depressive symptoms. Palliative care may improve these outcomes by providing patients with the skills to cope effectively with life-threatening illness.

The positive effects of early integrated palliative care on patient coping strategies, quality of life, and depression.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 92-92 ◽  
Author(s):  
Jamie M. Jacobs ◽  
Joseph Greer ◽  
Areej El-Jawahri ◽  
Ryan David Nipp ◽  
Emily R. Gallagher ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Depressive Symptoms ◽  
Coping Strategies ◽  
Indirect Effect ◽  
Active Coping ◽  
Avoidant Coping ◽  
Newly Diagnosed ◽  
Oncology Care

92 Background: In a recent trial, early integrated palliative care (PC) improved quality of life (QOL) and reduced depressive symptoms in patients with newly-diagnosed incurable lung and gastrointestinal (GI) cancer. The mechanisms by which PC benefits these outcomes are unclear. We examined whether early integrated PC improved patients’ coping strategies and the degree to which changes in coping mediated intervention effects on QOL and depressive symptoms. Methods: From 5/2011 to 7/2015, we enrolled 350 patients with newly diagnosed incurable lung or non-colorectal GI cancer in a randomized trial of early PC integrated with oncology care vs. oncology care alone at Massachusetts General Hospital. Patients completed self-report measures of QOL (Functional Assessment of Cancer Therapy-General), depressive symptoms (Patient Health Questionnaire-9), and use of active and avoidant coping strategies (Brief Cope) at baseline, 12, and 24 weeks. Linear regression was used to assess the effects of the early PC intervention on active and avoidant coping strategies. A multiple mediation regression was modeled to examine whether changes in use of coping strategies mediated intervention effects on QOL and depressive symptoms. Results: Compared to oncology care, early integrated PC improved patients’ use of active coping ( B= 1.09, SE= 0.44, p= .01, 95% CI: 0.23, 1.96) and slightly reduced use of avoidant coping strategies ( B= -0.44, SE= 0.23, p= .06, 95% CI:-0.90, 0.02). Improvements in 24-week QOL in patients assigned to PC were mediated by increased use of active coping strategies (indirect effect = 1.27, 95% CI: 0.31, 2.86), but not by decreased use of avoidant coping. Similarly, PC-related reductions in 24-week depressive symptoms were mediated by increased use of active coping strategies (indirect effect = -0.39, 95% CI:-0.89, -0.08) but not by decreased use of avoidant coping. Conclusions: Patients with newly diagnosed incurable cancer who received early integrated PC showed increased use of active coping strategies, which was associated with improved QOL and depressive symptoms. PC may improve QOL and mood by providing patients with the skills to cope effectively with life-threatening illness. Clinical trial information: NCT01401907.

Improved coping to mediate the positive effects of integrated palliative care on quality of life and depression.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10023-10023 ◽  
Author(s):  
Jamie M. Jacobs ◽  
Joseph A. Greer ◽  
Areej El-Jawahri ◽  
Ryan David Nipp ◽  
Emily R. Gallagher ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Coping Strategies ◽  
Indirect Effect ◽  
Active Coping ◽  
Avoidant Coping ◽  
Depression Symptoms ◽  
Newly Diagnosed ◽  
Oncology Care

10023 Background: In a recent trial, early integrated palliative care (PC) improved quality of life (QOL) and reduced depression symptoms in patients with newly-diagnosed incurable lung and gastrointestinal (GI) cancer. The mechanisms by which PC benefits these outcomes are unclear. Therefore, we examined whether early integrated PC improved patients’ coping strategies and the degree to which changes in coping mediated intervention effects on patient-reported QOL and depression symptoms. Methods: From 5/2011 to 7/2015, we enrolled 350 patients with newly diagnosed incurable lung or non-colorectal GI cancer in a randomized trial of early PC integrated with oncology care vs. oncology care alone at Massachusetts General Hospital. Patients completed self-report measures of QOL (Functional Assessment of Cancer Therapy-General), depression symptoms (Patient Health Questionnaire-9), and use of active and avoidant coping strategies (Brief Cope) at baseline, 12, and 24 weeks. Linear regression was used to assess the effects of the early PC intervention on active and avoidant coping strategies. A multiple mediation regression with bias-corrected bootstrapping was modeled to examine whether changes in use of coping strategies mediated intervention effects on QOL and depression symptoms. Results: Compared to oncology care, early integrated PC improved patients’ use of active coping and reduced use of avoidant coping strategies. Improvements in 24-week QOL in patients assigned to PC were mediated by increased use of active coping strategies (indirect effect = 1.27, bootstrapped SE = 0.65, 95% CI [0.31, 2.86]), but not by decreased use of avoidant coping. Similarly, PC-related reductions in 24-week depression symptoms were mediated by increased use of active coping strategies (indirect effect = -0.39, bootstrapped SE = 0.20, 95% CI [-0.89, -0.08] but not by decreased use of avoidant coping. Conclusions: Patients with newly diagnosed incurable cancer who received early integrated PC showed increased use of active coping strategies, which led to improved QOL and depression symptoms. PC may improve QOL and mood by providing patients with the skills to cope effectively with life-threatening illness. Clinical trial information: NCT01401907.

scholarly journals Fatigue in patients on oral targeted or chemotherapy for cancer and associations with anxiety, depression, and quality of life

2019 ◽  
Vol 18 (2) ◽  
pp. 141-147
Author(s):  
Hanneke Poort ◽  
Jamie M. Jacobs ◽  
William F. Pirl ◽  
Jennifer S. Temel ◽  
Joseph A. Greer
Keyword(s):  
Quality Of Life ◽  
Depressive Symptoms ◽  
Oral Treatment ◽  
Depression Scale ◽  
Well Being ◽  
Anxiety Symptoms ◽  
Severe Fatigue ◽  
Patient Reported ◽  
The Impact

AbstractObjectivesOral treatment (targeted or chemotherapy) for cancer is being increasingly used. While fatigue is a known side effect of intravenous chemotherapy, the rate of fatigue and the impact of fatigue on other patient-reported outcomes are not well described.MethodAt Massachusetts General Hospital Cancer Center, 180 adult patients prescribed oral targeted or chemotherapy for various malignancies enrolled in a randomized controlled trial of adherence and symptom management. Patients completed baseline self-reported measures of fatigue (Brief Fatigue Inventory; BFI), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale; HADS), and quality of life, including subscales for physical, social, emotional, and functional well-being ([QOL] Functional Assessment of Cancer Therapy — General; FACT-G). We examined clinically relevant fatigue using a validated cut-off score for moderate-severe fatigue (BFI global fatigue ≥4) and tested the associations with anxiety symptoms, depressive symptoms, and QOL with independent samples t-tests.ResultsAt baseline, 45 of 180 participants (25.0%) reported moderate-severe fatigue. Fatigued patients experienced more anxiety symptoms (mean diff. 3.73, P < 0.001), more depressive symptoms (mean diff. 4.14, P < 0.001), and worse QOL on the total FACT-G score (mean diff. −19.58, P < 0.001) and all subscales of the FACT-G compared to patients without moderate-severe fatigue.Significance of resultsOne in four patients on oral treatment for cancer experienced clinically relevant fatigue that is associated with greater anxiety and depressive symptoms and worse QOL.

Prevalence and Predictors of Distress, Anxiety, Depression, and Quality of Life in Bereaved Family Caregivers of Patients With Advanced Cancer

2019 ◽  
Vol 37 (3) ◽  
pp. 201-213 ◽  
Author(s):  
Karin Oechsle ◽  
Anneke Ullrich ◽  
Gabriella Marx ◽  
Gesine Benze ◽  
Feline Wowretzko ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Depressive Symptoms ◽  
Family Caregivers ◽  
Advanced Cancer ◽  
Anxiety Symptoms ◽  
Bereaved Family ◽  
Severe Anxiety ◽  
Item Scale

Objective: To investigate prevalence and predictors of postloss distress, depressive and anxiety symptoms, and quality of life among bereaved family caregivers of patients with advanced cancer. Methods: Prospective multicenter study. Family caregivers (N = 160, mean age 56.8 years, 66% female) completed validated outcome measures (Distress Thermometer, Generalized Anxiety Disorder 7-item scale, Patient Health Questionnaire depression module 9-item scale, SF-8 Health Survey Questionnaire) 6 months after patient’s discharge or death at specialist inpatient palliative care ward. Results: Clinically relevant distress was observed in 82% with sadness (89%), exhaustion (74%), sleeping problems (68%), loneliness (53%), and sorrows (52%) being the most common distress-causing problems. Moderate/severe anxiety and depressive symptoms were observed in 27% and 35%, respectively. Compared to an adjusted norm sample, quality of life was significantly impaired with exception of “bodily pain” and physical component score. Preloss caregiving (odds ratio [OR] 2.195) and higher preloss distress (OR 1.345) predicted high postloss distress. Utilization of psychosocial support services (OR 2.936) and higher preloss anxiety symptoms (OR 1.292) predicted moderate/severe anxiety symptoms, lower preloss physical quality of life (OR 0.952), and higher preloss depressive symptoms (OR 1.115) predicted moderate/severe depressive symptoms. Conclusion: Preloss mental burden showed to be a consistent predictor for postloss burden and should be addressed during palliative care. Future research should examine specific caregiver-directed interventions during specialist palliative care.

Assessment tools for palliative care.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 66-66
Author(s):  
Sarina Isenberg ◽  
Rebecca Aslakson ◽  
Sydney Morss Dy ◽  
Renee Wilson ◽  
Julie Waldfogel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Clinical Practice ◽  
Quality Indicators ◽  
Systematic Reviews ◽  
Grey Literature ◽  
Care Quality ◽  
Assessment Tools ◽  
Patient Reported

66 Background: Recent reviews have not comprehensively addressed palliative care (PC) assessment tools. This project summarizes the extent of evidence about PC assessment tools for patients and families, and how tools have been used for clinical care, quality indicators, and evaluation of interventions. Methods: We searched MEDLINE, CINAHL, and Cochrane Database of Systematic Reviews for systematic reviews of assessment tools for PC, from January 2007 to March 2016. We searched the grey literature for domains without systematic reviews, and for domains with systematic reviews > three years old. Paired investigators independently screened search results and grey literature to determine eligibility, and assessed risk of bias of systematic reviews. The team selected the most recent and highest-quality systematic reviews for each domain. One investigator abstracted information, and a second investigator checked the information. Results: Using the National Consensus Project Palliative Care Guidelines domains, we included nine systematic reviews with 167 tools, and six tools from grey literature. Most tools were in physical, psychological, psychiatric, and social aspects of care, care at the end of life, and tools that cross domains (quality of life and caregiver-reported experience). Only two tools directly addressed spiritual aspects and none addressed cultural or patient-reported experience. Internal consistency reliability was evaluated for almost all tools; most reported construct validity; and few reported responsiveness (sensitivity to change). Few studies evaluated the use of assessment tools in quality indicators or clinical practice. A systematic review of 38 PC interventions and the assessment tools used found that at least 25 interventions included physical, psychosocial and psychiatric, and quality of life tools, but the tools varied extensively, and only nine included patient experience tools. Conclusions: Although assessment tools exist in many PC domains, tools are needed to assess spiritual and cultural aspects of care, and patient-reported experience. Research is needed concerning: tools in clinical practice and quality of care; comparison of existing tools; and evaluation and dissemination tools with evidence of responsiveness.

scholarly journals UK Medical Cannabis Registry palliative care patients cohort: initial experience and outcomes

2022 ◽  
Vol 4 (1) ◽  
Author(s):  
Devaki Nimalan ◽  
Michal Kawka ◽  
Simon Erridge ◽  
Mehmet Ergisi ◽  
Michael Harris ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Adverse Events ◽  
Symptom Control ◽  
Case Series ◽  
Nausea And Vomiting ◽  
Medical Cannabis ◽  
Patient Reported ◽  
The Uk

Abstract Introduction Palliative care aims to improve quality of life through optimal symptom control and pain management. Cannabis-based medicinal products (CBMPs) have a proven role in the treatment of chemotherapy-induced nausea and vomiting. However, there is a paucity of high-quality evidence with regards to the optimal therapeutic regimen, safety, and effectiveness of CBMPs in palliative care, as existing clinical trials are limited by methodological heterogeneity. The aim of this study is to summarise the outcomes of the initial subgroup of patients from the UK Medical Cannabis Registry who were prescribed CBMPs for a primary indication of palliative care, cancer pain and chemotherapy-induced nausea and vomiting, including effects on health-related quality of life and clinical safety. Methods A case series from the UK Medical Cannabis Registry of patients, who were receiving CBMPs for the indication of palliative care was undertaken. The primary outcome consisted of changes in patient-reported outcome measures including EQ-5D-5L, General Anxiety Disorder-7 (GAD-7), Single-Item Sleep Quality Scale (SQS), Pain Visual Analog Scale (VAS) and the Australia-Modified Karnofsky Performance Scale at 1 and 3 months compared to baseline. Secondary outcomes included the incidence and characteristics of adverse events. Statistical significance was defined by p-value< 0.050. Results Sixteen patients were included in the analysis, with a mean age of 63.25 years. Patients were predominantly prescribed CBMPs for cancer-related palliative care (n = 15, 94%). The median initial CBD and THC daily doses were 32.0 mg (Range: 20.0–384.0 mg) and 1.3 mg (Range: 1.0–16.0 mg) respectively. Improvements in patient reported health outcomes were observed according to SQS, EQ-5D-5L mobility, pain and discomfort, and anxiety and depression subdomains, EQ-5D-5L index, EQ-VAS and Pain VAS validated scales at both 1-month and 3-months, however, the changes were not statistically significant. Three adverse events (18.75%) were reported, all of which were either mild or moderate in severity. Conclusion This small study provides an exploratory analysis of the role of CBMPs in palliative care in the first cohort of patients since CBMPs legalisation in the UK. CBMPs were tolerated with few adverse events, all of which were mild or moderate and resolved spontaneously. Further long-term safety and efficacy studies involving larger cohorts are needed to establish CBMPs role in palliative care, including comparisons with standard treatments.

scholarly journals Coping Strategies Mediate the Association Between Stigma and Fertility Quality of Life in Infertile Women Undergoing in Vitro Fertilization-Embryo Transfer.

2021 ◽  
Author(s):  
Xiaoyu JING ◽  
Wei GU ◽  
Lu ZHANG ◽  
Runna MIAO ◽  
Xiuli XU ◽  
...  
Keyword(s):  
Quality Of Life ◽  
In Vitro Fertilization ◽  
Coping Strategies ◽  
Embryo Transfer ◽  
Indirect Effect ◽  
Vitro Fertilization ◽  
Infertile Women ◽  
Ivf Et

Abstract Background The mediating role of coping strategies and its relationship with psychological well-being and quality of life has been considered in the literature. However, there is little research to explore the mechanism of coping strategies on stigma and fertility quality of life (FertiQoL) in infertile women undergoing In Vitro Fertilization Embryo Transfer (IVF-ET). The aim of this study was to examine the mediating effect of coping strategies on the relationship between stigma and fertility quality of life (FertiQoL) in Chinese infertile women undergoing In Vitro Fertilization Embryo Transfer (IVF-ET).Methods: In this cross-sectional study, a total of 768 infertile women undergoing IVF-ET were recruited from Assisted Reproductive Center of Shaanxi Province, China. The personal information, infertility stigma scale, coping strategy scale and FertiQoL scale were measured using a set of questionnaires. The multiple mediator model was performed using AMOS 21.0.Results: The model showed a significant negative direct effect between stigma on FertiQoL (direct effect= -2.375, BC 95% CI= -2.764, -1.987). There were significantly negative indirect effects of stigma on FertiQoL through active-avoidance (indirect effect = -0.706; BC 95% CI = -0.950, -0.497), active-confronting (indirect effect = -0.267; BC 95% CI= -0.414, -0.136) and passive-avoidance (indirect effect= -0.244; BC 95% CI = -0.368, -0.142), respectively. The meaning-based coping played a positive intermediary role (indirect effect=0.105; BC 95% CI = 0.046, 0.190). The model explained 69.4% of the variance in FertiQoL.Conclusion: Active-avoidance coping strategy is the most important mediator factor between stigma and FertiQoL in infertile women undergoing IVF-ET treatment. Meaning-based coping strategy plays a positive mediating role between stigma and FertiQoL.

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