Unmet supportive needs of cancer patients in an acute care hospital in Japan—a census study

Relationship between posttraumatic growth and help-seeking behavior in use of psychosocial support services among patients with cancer

PURPOSE

Cancer survivors who used psychosocial support services often report posttraumatic growth (PTG). This refers to positive psychological changes that may occur as the five domains as a result of the challenges they face. Opposing relationship also might exist. This study aimed to examine the relationship between PTG and help-seeking behavior (HSB).

METHODS

In total, 710 participants completed an online survey at Time1. Of those, 395 who reported not using any psychosocial support services at Time1 were asked to participate in the Time2 survey and completed a questionnaire. The participants provided demographic information, the experiences of using psychosocial support services, and the overall and five domains of PTG.

RESULTS

Those who experienced HSB at Time1 reported a higher PTG, and two of the PTG domains, Appreciation of Life and New Possibilities, than those who did not used services. Mixed ANOVAs showed the main effects of the HSB on the overall PTG, Appreciation of Life, and New Possibilities. Hierarchical logistic regression analyses showed that Appreciation of Life at Time1 was significantly related to the engaging in HSB at Time2.

CONCLUSION

Those who received psychosocial support services reported a higher PTG. Participants may have also engaged in HSB because they had experienced PTG. People who are likely to seek help and experience PTG may share common characteristics.

IMPLICATIONS FOR CANCER SURVIVORS

Support for those who do not fit the existing PTG and the use of psychosocial support services should also be considered.

Identification of implementation enhancement strategies for national comprehensive care standards using the CFIR-ERIC approach: a qualitative study

BACKGROUND

Comprehensive care is important for ensuring patients receive coordinated delivery of healthcare that aligns with their needs and preferences. While comprehensive care programs are recognised as beneficial, optimal implementation strategies in the real world remain unclear. This study utilises existing implementation theory to investigate barriers and enablers to implementing the Australian National Safety and Quality Health Service Standard 5 - Comprehensive Care Standard in acute care hospitals. The aim is to develop implementation enhancement strategies for work with comprehensive care standards in acute care.

METHODS

Free text data from 256 survey participants, who were care professionals working in acute care hospitals across Australia, were coded using the Consolidated Framework for Implementation Research (CFIR) using deductive content analysis. Codes were then converted to barrier and enabler statements and themes using inductive theme analysis approach. Subsequently, CFIR barriers and enablers were mapped to the Expert Recommendations for Implementing Change (ERIC) using the CFIR-ERIC Matching Tool, facilitating the development of implementation enhancement strategies.

RESULTS

Twelve (n = 12) CFIR barriers and 10 enablers were identified, with 14 barrier statements condensed into 12 themes and 11 enabler statements streamlined into 10 themes. Common themes of barriers include impact of COVID-19 pandemic; heavy workload; staff shortage, lack of skilled staff and high staff turnover; poorly integrated documentation system; staff lacking availability, capability, and motivation; lack of resources; lack of education and training; culture of nursing dependency; competing priorities; absence of tailored straties; insufficient planning and adjustment; and lack of multidisciplinary collaboration. Common themes of enablers include leadership from CCS committees and working groups; integrated documentation systems; established communication channels; access to education, training and information; available resources; culture of patient-centeredness; consumer representation on committees and working groups; engaging consumers in implementation and in care planning and delivery; implementing changes incrementally with a well-defined plan; and regularly collecting and discussing feedback. Following the mapping of CFIR enablers and barriers to the ERIC tool, 15 enhancement strategies were identified.

CONCLUSION

This study identified barriers, enablers, and recommended strategies associated with implementing a national standard for comprehensive care in Australian acute care hospitals. Understanding and addressing these challenges and strategies is not only crucial for the Australian healthcare landscape but also holds significance for the broader international community that is striving to advance comprehensive care.

Understanding help-seeking behaviour in relation to psychosocial support services among Japanese cancer patients

BACKGROUND

There are various psychosocial support services for cancer patients in Japan; however, their utilization rate is lower than in Western countries. The aim of this study was to investigate the actual status of the utilization of such services and the related factors of their use, using the transtheoretical model.

METHODS

We conducted an Internet survey of cancer outpatients. They were asked for information on their demographics, physical status and the usage of and intention to use psychosocial support services, and to answer the Hospital Anxiety and Depression Scale.

RESULTS

Data of 712 participants were analyzed; 111 had made use of psychosocial support services (15.6%). Participants who were younger, female, had breast cancer, experience with hormone therapy and did not have a good performance status (Karnofsky Performance Scale) more often used such services when comparing users/experiencers with non-users/inexperienced. Of the inexperienced, 538 were in the Precontemplation stage (89.5%), 62 were in the Contemplation stage (10.3%) and one was in the Preparation stage (0.2%). Approximately 35% of those in the Precontemplation stage would correspond to adjustment disorders or major depression.

CONCLUSIONS

We showed the degree of cancer patients who have used the psychosocial support services and its contents and revealed the factors related to the utilization of such services in Japan. Our study supports previous reports that cancer patients with high levels of distress do not necessarily seek support, and thus future studies should also examine other modifiable factors considering the medical settings.

Examination of factors contributing to help-seeking behavior in accessing psychosocial support services among Japanese cancer patients: An application of the segmentation approach

OBJECTIVE

Various psychosocial support services for cancer patients are available in Japan; however, their utilization rate is low. The present study aimed to examine factors contributing to help-seeking behavior in the use of psychosocial support services among cancer outpatients at three stages: Precontemplation (without adjustment disorder or major depression), Precontemplation (with adjustment disorder or major depression), and Contemplation.

METHODS

We conducted a web-based questionnaire survey at two points with a panel of cancer outpatients. We collected data on demographic information, physical status, the use of and intention to use psychosocial support services, psychological distress, attitude toward using psychosocial support services for cancer patients, and social support.

RESULTS

In total, 395 cancer patients were analyzed. In the Precontemplation (without adjustment disorder or major depression) stage, resistance to help-seeking (OR = 0.726, P = .011) and future prospects of the Brief Cancer-Related Worry Inventory (OR = 1.012, P = .019) were significant. In the Precontemplation (with adjustment disorder or major depression) stage, only recommendation by medical staff or family (OR = 0.000, P = .026) had a significant effect. In the Contemplation stage, only social and interpersonal problems (OR = 0.942, P = .080) showed a significant (negative) trend.

CONCLUSIONS

This study showed that contributing factors differed by stage. To encourage the use of psychosocial support services, it is desirable to recommend the use and to develop interventions for promoting, with responding to patients' conditions and intentions rather than responding to everyone in the same way.

Depression in Cancer Care

Depression is common among cancer patients and their families, and may lead to substantial clinical consequences. Clinicians should routinely screen cancer patients for comorbid depression and should provide appropriate care at both primary and specialized care levels. Good quality care is beneficial not only for cancer patients themselves but also for their family members. It includes good communication between patients and health providers, and addressing of unmet needs of cancer patients. Specialized care comprises pharmacotherapy and psychotherapy. The advancement of psychotherapy for cancer patients parallels the advancement of general psychotherapy. Among the many types of psychotherapies, mindfulness-based interventions have been attracting growing attention. Some relevant studies that have been conducted in Keio University Hospital are described herein.

The use of psychosocial support services among Japanese breast cancer survivors

Background

This study aimed to investigate the use of psychosocial support services, the intention to use these services, and to elucidate the characteristics of survivors most likely to use support services among Japanese breast cancer survivors.

Methods

We invited breast cancer survivors to complete an online questionnaire via an email sent to subscribers of a non-profit organization mailing list. We asked participants questions related to demographics, opinions on the state of psychosocial support services, and their interest in using these services. Participants were also asked to complete the Hospital Anxiety and Depression Scale and the Brief Cancer Worry Inventory (BCWI).

Results

We analyzed the data of 171 participants. Those who used some form of psychosocial support service constituted 50.9% of the participant population. Participants used cancer consulting and support center services (13.5%), hospital and non-hospital support groups (12.9%, respectively), psychiatry (11.1%), hospital and non-hospital cancer salons (8.8%, respectively), psychosomatic medicine (8.2%), therapist counseling (6.4%) and psycho-oncology department services (4.1%). Non-users who suffered from adjustment disorders or major depression (52.1%) reported higher total BCWI and the subscale scores had no concrete plans to use psychosocial support services.

Conclusions

The usage levels of psychiatry, psychosomatic medicine and psycho-oncology services in our study were higher than those reported in any previous Japanese study within the psycho-oncology field. Participants joining a breast cancer survivors' mailing list, or their being female, may have led to a higher use of such services. A high degree of distress does not necessarily lead cancer survivors to seek psychosocial support services.

Prevalence, correlates, and impact of depressive and anxiety disorder in cancer: Findings from a multicenter study

Objective:

Our aim was to examine the prevalence, correlates, and association of depressive and anxiety disorders with quality of life (QoL) and such other outcomes as the need for psychosocial services in cancer patients.

Method:

A total of 400 patients participated in a multicenter survey involving five cancer centers located throughout Korea. The Short-Form Health Survey, the MD Anderson Symptom Inventory, the Mini-Mental Adjustment to Cancer (MINI-MAC), and Mini-International Neuropsychiatric Interview were administered.

Results:

The prevalence rates for depressive and anxiety disorders were 16 and 17.1%, respectively. Younger age and poor Eastern Cooperative Oncology Group performance status, and all physical symptoms, as well as helplessness/hopelessness, anxious preoccupation (AP), and cognitive avoidance (CA) on the MINI-MAC were found to be significantly related to depressive disorder (DD) in a univariate logistic regression analysis. Metastases, the symptoms of disturbed sleep, dry mouth, and numbness or tingling, as well as AP and CA were significantly correlated with anxiety disorder (AD) in the univariate analysis. In the multivariate analyses, only AP was significant for AD (odds ratio = 2.94,p< 0.001), while none reached statistical significance for DD. Psychiatric comorbidity status had a detrimental effect on various dimensions of QoL. Patients with DD or AD reported a significantly higher need for professional psychosocial services.

Significance of results:

Given the substantial prevalence and pervasive impact of DD and AD on various aspects of QoL, its assessment and care should be integrated as a regular part of oncological care throughout the cancer continuum.

Prevalence, associated factors and source of support concerning supportive care needs among Japanese cancer survivors

BACKGROUND

The current study aimed to describe cancer survivors' supportive care needs in Japan, to identify associated factors of unmet needs, and to describe the source of support that are preferred and actually used by cancer survivors.

METHODS

Using a web-based questionnaire, we examined unmet supportive needs and its associated factors among 628 adult Japanese cancer survivors. The questionnaire comprised 16 items representing five domains (medical-psychological, financial, social-spiritual, sexual, and physical needs).

RESULTS

Prevalence of unmet need ranged from 5 to 18%, depending on different domains. The prevalence was high in medical-psychological and financial domains and relatively low in physical and sexual domains. Poor performance status, psychiatric morbidity and low income status were associated with unmet needs of most domains. Most cancer survivors preferred and actually sought support from their family and friends. Financial needs were preferred to be provided by non-medical professionals. Call for peer support was intense, especially for medical-psychological, social-spiritual, and sexual needs; however, peer support was not well-provided.

CONCLUSIONS

This study illustrated characteristics of Japanese cancer survivors who are likely to have unmet needs. The study demonstrated need for expanded involvement of non-medical professionals and peer support, especially in the domains of medical-psychological, social-spiritual, financial and sexual needs.

Supportive care needs of Iranian cancer patients

Background:

A supportive needs assessment is an essential component of any care program. There is no research evidence regarding the supportive care needs of cancer patients in Iran or other Middle Eastern countries.

Aims:

The aim of this study was to determine the supportive care needs of Iranian cancer patients.

Materials and Methods:

This descriptive study was conducted in a referral medical center in the northwest of Iran. A total of 274 cancer patients completed the Supportive Care Needs Survey (SCNS-59). Descriptive statistics were used for data analysis.

Results:

In 18 items of the SCNS, more than 50% of the participants reported that their needs were unmet. Most frequently, unmet needs were related to the health system, information, physical, and daily living domains, and most met needs were related to sexuality, patient care, and support domains.

Conclusions:

Iranian cancer patients experience many unmet needs and there is an urgent need for establishing additional supportive care services in Iran.

Sleep problems and psychological distress in family members of patients with hematological malignancies in the Japanese population

Patients with cancer frequently suffer from insomnia symptoms, and additionally, their family members also often experience these symptoms. The aim of this study was to investigate the prevalence of insomnia symptoms in both family members and patients with hematological malignancies. We conducted an observational cross-sectional study using a clinical self-reported questionnaire for sleep conditions, depressive symptoms (two-question method), and worries (five items that originated from the Brief Cancer Worry Inventory). One hundred twelve family members and 153 patients were investigated. A t test and Chi-square test were used to compare the prevalence of insomnia and depressive symptoms between family members and patients. Logistic regression was used to determine whether insomnia symptoms or worries related to patients' disease had an impact on depressive symptoms. The presence of insomnia symptoms in family members (87 %) was significantly higher than that in patients (60 %, p < 0.001). The prevalence of depressive mood and anhedonia in family members were 55 and 34 %, respectively, and these values were higher than those in patients (43 and 28 %, respectively). Insomnia symptoms and worries about present/prospective disease conditions were significantly associated with depressive mood (insomnia symptoms, odds ratios (OR) 4.3, confidence intervals (CI) 1.2-15.2, p = 0.025; worries, OR 4.4, CI 1.0-19.3, p = 0.048). Taken together, our results demonstrated that insomnia symptoms and depressive symptoms are highly prevalent in family members as well as in patients with hematological malignancies.

Unmet psychosocial needs among cancer patients undergoing ambulatory care in Singapore

PURPOSE

Previous studies have demonstrated high prevalence of unmet psychosocial needs among cancer patients, but few were conducted among Asians. In this cross-sectional study, we investigated the prevalence of and factors associated with unmet psychosocial needs among cancer patients undergoing ambulatory care at a cancer centre in Singapore.

METHOD

We conducted a cross-sectional study among 535 breast, gynaecological and colorectal cancer patients (response rate, 76%) using a modified version of the Cancer Survivors' Unmet Needs measure questionnaire, to assess the prevalence of patients' needs for disease information and social support, physical needs, financial needs and psychological needs, and the extent to which needs were met. Logistic regression analysis was used to identify demographic or disease characteristics associated with unmet needs.

RESULTS

Seventy-five per cent of patients reported having any unmet needs, with disease information needs being most prevalent (61.5%) followed by financial (40.2%), social support (39.7%), psychological (27.3%) and physical (26.1%) needs. Factors independently associated with having high level of unmet needs were age below 60 years, ethnic minority, advanced disease and recent diagnosis.

CONCLUSION

The prevalence of unmet psychosocial needs among cancer patients in ambulatory care is generally high. Young patients with disease recently diagnosed at advanced stage will benefit from additional support.