Breaking bad news to cancer patients in times of COVID-19

Breaking bad news is a mandatory provision in the professional life of nearly every physician. One of its most frequent occasions is the diagnosis of malignancy. Responding to the recipients’ emotions is a critical issue in the delivery of unsettling information, and has an impact on the patient’s trust in the treating physician, adjustment to illness and ultimately treatment. Since the World Health Organization (WHO) declared COVID-19 a pandemic on March 11, 2020, several measures of social distancing and isolation have been introduced to our clinical setting. In the wake of these restrictions, it is important to reexamine existing communication guidelines to determine their applicability to face-to-face counseling in the context of social distancing, as well as to new communication technologies, such as telemedicine. We address these issues and discuss strategies to convey bad news the most empathetic and comprehensible way possible.

The Assessment of Pain and Barriers to Pain Management: A Content Analysis From a National Sample of Hospice Psychosocial Assessments Completed by Social Workers

Pain is a multidimensional symptom frequently experienced by hospice patients that is physical, psychological, social, emotional, and spiritual. Medicare regulations require hospices to complete a psychosocial assessment with content such as patient/family adjustment to illness. Furthermore, pain barriers such as concerns about addiction, and fatalism are recognized impediments to high quality pain management. National data concerning whether hospice social workers are paying attention to issues related to patient pain is minimal. Addressing this gap, we randomly sampled 248 hospices nationally and requested a blank copy of their social work psychosocial assessment and reviewed its pain-related content. A total of 105 hospices (response rate 42.3%) provided an assessment for review. Descriptive statistics summarize agency characteristics and whether pain assessment content and pain barrier content were present. Analyses examined whether pain assessment content was included based on agency characteristics. Of the 105 participating agencies, most were non-profit (60%) and located in the South (30.5%). Less than half (47.6%) of the agencies included pain assessment content in their assessment. No associations were observed between having pain assessment content and agency characteristics. None of the assessments included content about 3 barriers to pain management: tolerance, overdose, stigma, and fatalism. Few agencies included other barriers to pain management: addiction (1%), burden (1%), non-adherence (3.8%) and stoicism (18.1%). Agencies which had pain assessment content mostly included other dimensions of pain: psychological (80%), emotional (74%), and social (78%). Hospice social workers can do more to assess and address pain concerns—especially psychological, social, and emotional dimensions.

Psychosocial Adjustment to Illness and Its Relationship with Spiritual Wellbeing in Iranian Cancer Patients

Background. The aim of this study was to investigate the psychosocial adjustment to illness and its relation with spiritual health in cancer patients. Methods. This study was conducted in 2019 in Iran. It was a descriptive study with a sample of 124 cancer patients. Data were collected using two questionnaires of the psychosocial adjustment to illness scale (PAIS) with 46 questions and the Paloutzian and Ellison spiritual health scale with 20 questions. Results. The mean age of the participants in this study was 52.4±13.2 (range 18 to 87 years). The mean months of life with cancer were 16.5 months. The mean score of psychosocial adjustment to illness was 30.7±15.5. The mean score of spiritual wellbeing in the studied patients was 71.4±17.1. The results of the Pearson correlation test showed a significant inverse relationship between the mean score of psychosocial adjustment to illness and the mean score of spiritual wellbeing (p>0.001, rr=−.355). Conclusion. Cancer patients in this study had relatively good psychosocial adjustment with their illness. Spiritual wellbeing can increase psychosocial adjustment to illness in this group of patients.

Psychosocial Adjustment of In-Home Caregivers of Family Members with Dementia and Parkinson’s Disease: A Comparative Study

Neurodegenerative diseases such as Parkinson’s and dementia are highly prevalent worldwide. People who suffer from these disorders often receive in-home care and assistance from family members, who must dedicate a considerable amount of time to the care recipient. The study of family caregivers’ psychosocial adjustment to the degenerative processes of both conditions is of interest due to the implications for the quality of life of both the care receiver and the caregiver, as well as other family members. This study compares the psychosocial adjustment of family members who care for people with dementia and Parkinson’s disease and identifies the main sociodemographic variables that affect the processes of adjustment to both conditions. To this end, the Psychosocial Adjustment to Illness Scale (PAIS-SR) and a sociodemographic form were administered to 157 family caregivers in Navarre, Spain. The results show that adjustment to the disease in family caregivers of people with Parkinson’s disease and dementia is, in general, satisfactory and related to variables such as place of residence, income, and employment status. The illness itself (Parkinson’s or dementia), however, is found to be the most influential variable in the level of psychosocial adjustment.

The Relationship Between Perceived Burdensomeness and Psychosocial Adjustment to Illness in Patients with Chronic Pain: A Mediating Role of Pain Self-Efficacy

Background: The majority of patients living with chronic pain faces several challenges; therefore, factors affecting their adaptation to the disease to provide appropriate therapeutic methods and meditation and relaxation therapy should be identified. Objectives: The present study aimed at investigating the relationship between perceived burdensomeness and psychosocial adjustment, and the mediating role of pain self-efficacy. Methods: This descriptive correlational study was conducted on 240 patients with chronic pain referred to the orthopedic centers in Ardabil in 2019 selected by convenience sampling. Psychosocial Adjustment to Illness Scale, Pain Self-efficacy Questionnaire, and Interpersonal Needs Questionnaire were used for data collection. Also, Pearson correlation and multiple regressions were used for data analysis. Data were analyzed using SPSS V. 19 and AMOS V. 21. Results: The findings confirmed the negative and direct effect of perceived burdensomeness (β = -0.11 and P < 0.01), as well as the positive and direct effect of pain self-efficacy (β = 0.86 and P < 0.01) on psychosocial adjustment. On the other hand, perceived burdensomeness (β = -0.32, P < 0.01) had a negative and direct effect on pain self-efficacy. The indirect effect of perceived burdensomeness and pain self-efficacy on psychosocial adjustment to illness was also confirmed. Conclusions: According to the findings of the present study, it can be concluded that the feelings of pain self-efficacy mediate the relationship between perceived burdensomeness and psychosocial adjustment in patients with chronic pain. That can also be important for the patient and their caregivers in relation to other chronic illnesses. Chronic diseases can also affect patients and their caregivers.

Psychometric properties of the questionnaire on threat perception of chronic illnesses in pediatric patients

Objective: the objective of the study was to assess the psychometric properties of the Brief Illness Perception Questionnaire in a sample of adolescents with chronic endocrine or pneumological conditions and to analyze the dimensionality and reduce the scale elaborating scales by sex and medical diagnosis. Method: we evaluated 510 patients aged 9-16 years using the Brief Illness Perception Questionnaire and the Hospital Anxiety and Depression Scale. We carried out tests of reliability, construct and criterion validity and a comparison of means based on the diagnosis and socio-demographic variables. The reliability and validity analyses showed adequate psychometric properties for this scale, with better results obtained for a single dimension after eliminating 3 items. Results: adolescents with type 1 diabetes and girls were found to have an increased threat perception of their illness. Anxiety/depression was positively associated with the perception of illness. Conclusion: this questionnaire is a useful and practical tool for evaluating adjustment to illness in pediatric patients.

Literature Review: Psychological Resilience Factors in People with Neurodegenerative Diseases

Background Psychological distress is frequently observed in neurodegenerative diseases (NDDs) having a significant impact on function, quality of life (QOL), caregiver burden, and illness cost. As higher psychological resilience can protect against negative outcomes and aid in the successful adjustment to illness, identifying resilience factors is important. Understanding what enhances or lowers psychological resilience allows us to offer support/interventions to people with NDDs and their carers starting early in the disease process. Objective To investigate factors associated with psychological resilience in NDDs by completing a systematic review of relevant studies. Method Five electronic databases were searched for studies relating to psychological resilience in NDDs. Eighteen articles were reviewed using a narrative synthesis approach. Results Studies with varied aims and methodologies were found. The identified factors were categorized into core, internal, and external resilience. Regarding core factors contradicting evidence was found about the relationship between resilience and physical function. Fatigue, however, appears to be associated with less resilience. A limited number of studies focused on pain and demographics. Of internal resilience factors, studies found positive associations between higher resilience and improved mental health, even over time. Resilience appears to correlate positively with various psychological and QOL factors. Importantly, external resilience factors (e.g., social connectedness and intervention) were discovered to be linked to resilience. The evidence for resilience-enhancing intervention suggests that resilience can be modified. Conclusion Various factors were identified to be associated with psychological resilience in NDDs. As resilience appears to be modifiable, it is important to focus on resilience-enhancing interventions for people with NDDs.