1
|
Mayer S, Fuchs S, Fink M, Schäffeler N, Zipfel S, Geiser F, Reichmann H, Falkenburger B, Skardelly M, Teufel M. Hope and Distress Are Not Associated With the Brain Tumor Stage. Front Psychol 2021; 12:642345. [PMID: 34122231 PMCID: PMC8192812 DOI: 10.3389/fpsyg.2021.642345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/26/2021] [Indexed: 11/17/2022] Open
Abstract
Objective Hopelessness and depression are strongly associated with suicidality. Given that physical and psychological outcomes can be altered with hope, hope is a therapeutic goal of increasing importance in the treatment of brain tumor patients. Moreover, it is not yet understood which factors affect the perception of hope in brain tumor patients. In addition, it remains uncertain whether lower-grade brain tumor patients suffer less from psycho-oncological distress than higher-grade brain tumor patients. Methods Neuro-oncological patients were examined perioperatively with the Distress Thermometer (DT) and the Herth Hope Index (HHI). In addition, psychological comorbidities (anxiety GAD-2, depression PHQ-2) and an assessment of general psycho-oncological distress were recorded. Results Sixty-six brain tumor patients were included (median age 53 years, 35% higher-grade brain tumors, i.e., WHO grade III/IV). No differences between higher- and lower-grade brain tumor patients were observed for general psycho-oncological distress and hope. However, higher-grade brain tumor patients showed a significantly higher level of depression (p ≤ 0.001) and more negative expectations regarding therapeutic success (H = 4.873, p ≤ 0.050). The extent of depression correlated negatively with hope. Conclusion Unexpectedly, higher-grade brain tumor patients remained as hopeful as lower-grade brain tumor patients despite the devastating diagnosis, higher levels of depression, and a worse expectation of therapeutic success. Conversely, lower-grade brain tumor patients experience as much psycho-oncological distress as patients with a higher-grade brain tumor, underpinning the imperative need for comprehensive psycho-oncological screening. For all brain tumor patients, considering hope is important to avoid suicides resulting from hopelessness and depression.
Collapse
Affiliation(s)
- Simone Mayer
- Department of Neurology, University Hospital Carl Gustav Carus Dresden, Dresden, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Stefanie Fuchs
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Madeleine Fink
- Department of Psychosomatic Medicine and Psychotherapy, LVR University Hospital Essen, Essen, Germany
| | - Norbert Schäffeler
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Franziska Geiser
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Heinz Reichmann
- Department of Neurology, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Björn Falkenburger
- Department of Neurology, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Marco Skardelly
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Tübingen, Germany.,Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany.,Department of Neurosurgery, District Hospital Reutlingen, Reutlingen, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Department of Psychosomatic Medicine and Psychotherapy, LVR University Hospital Essen, Essen, Germany.,Section of Psycho-Oncology, West German Cancer Center (WTZ), University Hospital Essen, Essen, Germany
| |
Collapse
|
2
|
Quesada O, AlBadri A, Wei J, Shufelt C, Mehta PK, Maughan J, Suppogu N, Aldiwani H, Cook-Wiens G, Nelson MD, Sharif B, Handberg EM, Anderson RD, Petersen J, Berman DS, Thomson LEJ, Pepine CJ, Merz CNB. Design, methodology and baseline characteristics of the Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD). Am Heart J 2020; 220:224-236. [PMID: 31884245 DOI: 10.1016/j.ahj.2019.11.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/30/2019] [Indexed: 12/16/2022]
Abstract
A significant number of women with signs and symptoms of ischemia with no obstructive coronary artery disease (INOCA) have coronary vascular dysfunction detected by invasive coronary reactivity testing (CRT). However, the noninvasive assessment of coronary vascular dysfunction has been limited. METHODS The Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) was a prospective study of women with suspected INOCA aimed to investigate whether (1) cardiac magnetic resonance imaging (CMRI) abnormalities in left ventricular morphology and function and myocardial perfusion predict CRT measured coronary microvascular dysfunction, (2) these persistent CMRI abnormalities at 1-year follow-up predict persistent symptoms of ischemia, and (3) these CMRI abnormalities predict cardiovascular outcomes. By design, a sample size of 375 women undergoing clinically indicated invasive coronary angiography for suspected INOCA was projected to complete baseline CMRI, a priori subgroup of 200 clinically indicated CRTs, and a priori subgroup of 200 repeat 1-year follow-up CMRIs. RESULTS A total of 437 women enrolled between 2008 and 2015, 374 completed baseline CMRI, 279 completed CRT, and 214 completed 1-year follow-up CMRI. Mean age was 55± 11 years, 93% had 20%-50% coronary stenosis, and 7% had <20% stenosis by angiography. CONCLUSIONS The WISE-CVD study investigates the utility of noninvasive CMRI to predict coronary vascular dysfunction in comparison to invasive CRT, and the prognostic value of CMRI abnormalities for persistent symptoms of ischemia and cardiovascular outcomes in women with INOCA. WISE-CVD will provide new understanding of a noninvasive imaging modality for future clinical trials.
Collapse
Affiliation(s)
- Odayme Quesada
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
| | - Ahmed AlBadri
- Emory Women's Heart Center & Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
| | - Chrisandra Shufelt
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
| | - Puja K Mehta
- Emory Women's Heart Center & Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Jenna Maughan
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
| | - Nissi Suppogu
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
| | - Haider Aldiwani
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
| | - Galen Cook-Wiens
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michael D Nelson
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
| | - Behzad Sharif
- Mark S. Taper Imaging Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Eileen M Handberg
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL
| | - R David Anderson
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL
| | - John Petersen
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL
| | - Daniel S Berman
- Mark S. Taper Imaging Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Louise E J Thomson
- Mark S. Taper Imaging Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Carl J Pepine
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA.
| |
Collapse
|
3
|
Boals A, Liu K. Illusory Reports of Posttraumatic Growth in Response to a Nontraumatic Event. JOURNAL OF LOSS & TRAUMA 2019. [DOI: 10.1080/15325024.2019.1655988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Keke Liu
- University of North Texas, Denton, Texas, USA
| |
Collapse
|
4
|
Alokozai A, Eppler SL, Lu LY, Sheikholeslami N, Kamal RN. Can Patients Forecast Their Postoperative Disability and Pain? Clin Orthop Relat Res 2019; 477:635-643. [PMID: 30762696 PMCID: PMC6382205 DOI: 10.1097/corr.0000000000000627] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Forecasting is a construct in which experiences and beliefs inform a projection of future outcomes. Current efforts to predict postoperative patient-reported outcome measures such as risk-stratifying models, focus on studying patient, surgeon, or facility variables without considering the mindset of the patient. There is no evidence assessing the association of a patient's forecasted postoperative disability with realized postoperative disability. Patient-forecasted disability could potentially be used as a tool to predict postoperative disability. QUESTIONS/PURPOSES (1) Do patient-forecasted disability and pain correlate with patient-realized disability and pain after hand surgery? (2) What other factors are associated with patient ability to forecast disability and pain? METHODS We completed a prospective, longitudinal study to assess the association between forecasted and realized postoperative pain and disability as a predictive tool. One hundred eighteen patients of one hand/upper extremity surgeon were recruited from November 2016 to February 2018. Inclusion criteria for the study were patients undergoing hand or upper extremity surgery, older than 18 years of age, and English fluency and literacy. We enrolled 118 patients; 32 patients (27%) dropped out as a result of incomplete postoperative questionnaires. The total number of patients eligible was not tracked. Eighty-six patients completed the preoperative and postoperative questionnaires. Exclusion criteria included patients unable to give informed consent, children, patients with dementia, and nonEnglish speakers. Before surgery, patients completed a questionnaire that asked them to forecast their upper extremity disability (DASH [the shortened Disabilities of the Arm, Shoulder and Hand] [QuickDASH]) and pain VAS (pain from 0 to 10) for 2 weeks after their procedure. The questionnaire also queried the following psychologic factors as explanatory variables, in addition to other demographic and socioeconomic variables: the General Self Efficacy Scale, the Pain Catastrophizing Scale, and the Patient Health Questionnaire Depression Scale. At the 2-week followup appointment, patients completed the QuickDASH and pain VAS to assess their realized disability and pain scores. Bivariate analysis was used to test the association of forecasted and realized disability and pain reporting Pearson correlation coefficients. Unpaired t-tests were performed to test the association of demographic variables (for example, men vs women) and the association of forecasted and realized disability and pain levels. One-way analysis of variance was used for variables with multiple groups (for example, annual salary and ethnicity). All p values < 0.05 were considered statistically significant. RESULTS Forecasted postoperative disability was moderately correlated with realized postoperative disability (r = 0.59; p < 0.001). Forecasted pain was weakly correlated with realized postoperative pain (r = 0.28; p = 0.011). A total of 47% of patients (n = 40) were able to predict their disability score within the MCID of their realized disability score. Symptoms of depression also correlated with increased realized postoperative disability (r = 0.37; p < 0.001) and increased realized postoperative pain (r = 0.42; p < 0.001). Catastrophic thinking was correlated with increased realized postoperative pain (r = 0.31; p = 0.004). Patients with symptoms of depression realized greater pain postoperatively than what they forecasted preoperatively (r = -0.24; p = 0.028), but there was no association between symptoms of depression and patients' ability to forecast disability (r = 0.2; p = 0.058). Patient age was associated with a patient's ability to forecast disability (r = .27; p = 0.011). Catastrophic thinking, self-efficacy, and number of prior surgical procedures were not associated with a patient's ability to forecast their postoperative disability or pain. CONCLUSIONS Patients undergoing hand surgery can moderately forecast their postoperative disability. Surgeons can use forecasted disability to identify patients who may experience greater disability compared with benchmarks, for example, forecast and experience high QuickDASH scores after surgery, and inform preoperative discussions and interventions focused on expectation management, resilience, and mindset. LEVEL OF EVIDENCE Level III, prognostic study.
Collapse
|
5
|
Lewis L, Dolph B, Said M, Feeley TH, Kayler LK. Enabling Conversations: African American Patients' Changing Perceptions of Kidney Transplantation. J Racial Ethn Health Disparities 2018; 6:536-545. [PMID: 30547301 DOI: 10.1007/s40615-018-00552-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/22/2018] [Accepted: 11/27/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND Racial disparities in access to kidney transplantation (KTX) among African Americans (AAs) have been attributed in part to insufficient patient education. Interventions are needed to provide AAs with culturally sensitive, understandable information that increases their capacity to pursue KTX. Research about the factors that activated patients to pursue KTX is necessary to inform such interventions; however, few studies have yielded this type of information. METHODS We conducted focus groups and one-on-one interviews with 26 AA referred, listed, or transplanted patients and 3 nephrologists to explore decisional factors that foster pursuit of KTX. Interviews were recorded and transcribed, and qualitative analytic methods to identify themes and subthemes were applied in an effort to inform message content for a future educational video intervention. RESULTS Three themes emerged from thematic content analysis: (1) healthcare provider communication, (2) exposure to peer transplant success, and (3) family encouragement. Enabling provider communication techniques include repetition about the KTX option, optimistic messaging about KTX access, and comforting conversations about the KTX process. CONCLUSION We identified information based on patient views and experiences to help inspire and develop animated videos designed to activate patients towards KTX. Interventions are needed that address informational gaps and focus on emotion to improve patients' experiences and ability to understand transplant opportunities.
Collapse
Affiliation(s)
- Lauren Lewis
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 462 Grider Street, Buffalo, NY, 14215, USA.
| | - Beth Dolph
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 462 Grider Street, Buffalo, NY, 14215, USA
| | - Meriem Said
- Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, NY, USA
| | - Thomas H Feeley
- Department of Communication, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Liise K Kayler
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 462 Grider Street, Buffalo, NY, 14215, USA.,Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, NY, USA
| |
Collapse
|
6
|
Huffman JC, Albanese AM, Campbell KA, Celano CM, Millstein RA, Mastromauro CA, Healy BC, Chung WJ, Januzzi JL, Collins LM, Park ER. The Positive Emotions after Acute Coronary Events behavioral health intervention: Design, rationale, and preliminary feasibility of a factorial design study. Clin Trials 2017; 14:128-139. [PMID: 28079394 DOI: 10.1177/1740774516673365] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Positive psychological constructs, such as optimism, are associated with greater participation in cardiac health behaviors and improved cardiac outcomes. Positive psychology interventions, which target psychological well-being, may represent a promising approach to improving health behaviors in high-risk cardiac patients. However, no study has assessed whether a positive psychology intervention can promote physical activity following an acute coronary syndrome. OBJECTIVE In this article we will describe the methods of a novel factorial design study to aid the development of a positive psychology-based intervention for acute coronary syndrome patients and aim to provide preliminary feasibility data on study implementation. METHODS The Positive Emotions after Acute Coronary Events III study is an optimization study (planned N = 128), subsumed within a larger multiphase optimization strategy iterative treatment development project. The goal of Positive Emotions after Acute Coronary Events III is to identify the ideal components of a positive psychology-based intervention to improve post-acute coronary syndrome physical activity. Using a 2 × 2 × 2 factorial design, Positive Emotions after Acute Coronary Events III aims to: (1) evaluate the relative merits of using positive psychology exercises alone or combined with motivational interviewing, (2) assess whether weekly or daily positive psychology exercise completion is optimal, and (3) determine the utility of booster sessions. The study's primary outcome measure is moderate-to-vigorous physical activity at 16 weeks, measured via accelerometer. Secondary outcome measures include psychological, functional, and adherence-related behavioral outcomes, along with metrics of feasibility and acceptability. For the primary study outcome, we will use a mixed-effects model with a random intercept (to account for repeated measures) to assess the main effects of each component (inclusion of motivational interviewing in the exercises, duration of the intervention, and inclusion of booster sessions) from a full factorial model controlling for baseline activity. Similar analyses will be performed on self-report measures and objectively-measured medication adherence over 16 weeks. We hypothesize that the combined positive psychology and motivational interviewing intervention, weekly exercises, and booster sessions will be associated with superior physical activity. RESULTS Thus far, 78 participants have enrolled, with 72% of all possible exercises fully completed by participants. CONCLUSION The Positive Emotions after Acute Coronary Events III study will help to determine the optimal content, intensity, and duration of a positive psychology intervention in post-acute coronary syndrome patients prior to testing in a randomized trial. This study is novel in its use of a factorial design within the multiphase optimization strategy framework to optimize a behavioral intervention and the use of a positive psychology intervention to promote physical activity in high-risk cardiac patients.
Collapse
Affiliation(s)
- Jeffery C Huffman
- 1 Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Ariana M Albanese
- 1 Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Kirsti A Campbell
- 1 Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Rachel A Millstein
- 1 Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Brian C Healy
- 2 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Wei-Jean Chung
- 1 Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - James L Januzzi
- 3 Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Linda M Collins
- 4 The Methodology Center, Penn State, University Park, PA, USA
| | - Elyse R Park
- 1 Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
7
|
Duggal D, Sacks-Zimmerman A, Liberta T. The Impact of Hope and Resilience on Multiple Factors in Neurosurgical Patients. Cureus 2016; 8:e849. [PMID: 27909637 PMCID: PMC5120968 DOI: 10.7759/cureus.849] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The purpose of the present article is to outline and review the impact of stable psychological characteristics on the emotional and functional outcomes of neurosurgical patients. Neurosurgical patients face adversity as inherent to their diagnoses and, consequently, experience emotional distress. Despite commonalities in diagnoses, diverse outcomes are seen post-neurosurgery, which are influenced by psychological factors. Therefore, an understanding of neurosurgical patients’ behavior, thoughts, and feelings surrounding their diagnoses, informed by psychological concepts, is important for both neuropsychology and neurosurgery.
Collapse
|
8
|
Breast Augmentation and Breast Reconstruction Demonstrate Equivalent Aesthetic Outcomes. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e811. [PMID: 27536490 PMCID: PMC4977139 DOI: 10.1097/gox.0000000000000824] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 05/20/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is a perception that cosmetic breast surgery has more favorable aesthetic outcomes than reconstructive breast surgery. We tested this hypothesis by comparing aesthetic outcomes after breast augmentation and reconstruction. METHODS Postoperative images of 10 patients (cosmetic, n = 4; reconstructive, n = 6; mean follow-up, 27 months) were presented anonymously to participants who were blinded to clinical details. Participants were asked if they believed cosmetic or reconstructive surgery had been performed. Aesthetic outcome measures were quantified: (1) natural appearance, (2) size, (3) contour, (4) symmetry, (5) position of breasts, (6) position of nipples, (7) scars (1 = poor and 4 = excellent). Images were ranked from 1 (most aesthetic) to 10 (least aesthetic). Analyses included two-tailed t tests, Mann-Whitney U tests, and χ(2) tests. RESULTS One thousand eighty-five images were quantified from 110 surveys (99% response rate). The accuracy of identifying cosmetic or reconstructive surgery was 55% and 59%, respectively (P = 0.18). Significantly more of the top 3 aesthetic cases were reconstructive (51% vs 49%; P = 0.03). Despite this, cases perceived to be reconstructive were ranked significantly lower (5.9 vs 5.0; P < 0.0001). Mean aesthetic outcomes were equivalent regardless of surgery for 5 categories (P > 0.05), with the exception of breast position that improved after reconstruction (2.9 vs 2.7; P = 0.009) and scars that were more favorable after augmentation (2.9 vs 3.1; P < 0.0001). Age and nipple position (R (2) = 0.04; P = 0.03) was the only association between a demographic factor and aesthetic outcome. CONCLUSIONS Aesthetic outcomes after cosmetic and reconstructive breast surgery are broadly equivalent, though preconceptions influence aesthetic opinion. Plastic surgeons' mutually inclusive-reconstructive and aesthetic skill set maximizes aesthetic outcomes.
Collapse
|
9
|
Relationship between Patient Expectations and Clinical Measures in Patients Undergoing Rheumatoid Hand Surgery from the Silicone Arthroplasty in Rheumatoid Arthritis (SARA) Study. Plast Reconstr Surg 2016; 136:775e-781e. [PMID: 26595031 DOI: 10.1097/prs.0000000000001778] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the relationship between preoperative patient expectations and clinical measures in patients undergoing rheumatoid hand surgery. METHODS Patients were recruited as a part of a larger prospective multicenter study to evaluate outcomes of silicone metacarpophalangeal joint arthroplasty (SMPA). Patients in the surgical cohort completed a baseline expectation questionnaire asking about expectations for function, work, pain, and aesthetics after SMPA. Responses were categorized into groups of low, middle, and high expectations for each domain and for cumulative expectations across all domains. Other study measurements were taken at baseline and 1 year, including the Michigan Hand Outcomes Questionnaire (MHQ) and objective clinical measurements (i.e., grip strength, pinch strength, the Jebsen-Taylor Hand Function Test, ulnar drift, and extensor lag). RESULTS Preoperative expectations and clinical measures were complete for 59 patients at baseline and 45 patients at 1-year follow-up. Preoperative expectation level was related to baseline patient-reported domains of activities of daily living and hand satisfaction measured by the MHQ (p = 0.04 and p = 0.07, respectively). Patients had relatively similar satisfaction with hand function postoperatively regardless of preoperative expectation level. No consistent relationship was seen between preoperative expectations and objective measures at baseline and 1-year follow-up. CONCLUSIONS High preoperative expectations were not a risk factor for dissatisfaction postoperatively. Preoperative expectation level may be considered for stratifying baseline patient-reported hand function in patients with similar objective hand function.
Collapse
|
10
|
Laferton JAC, Auer CJ, Shedden-Mora MC, Moosdorf R, Rief W. Factors associated with disability expectations in patients undergoing heart surgery. Int J Behav Med 2015; 22:85-91. [PMID: 25187112 DOI: 10.1007/s12529-014-9434-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Heart surgery patients' expectations have been shown to be related to surgery outcome, independent of medical status. However, it is unclear which factors determine patients' expectations about disability following heart surgery. PURPOSE Investigating the associations of patients' disability expectations with demographic, medical, and psychosocial factors as well as other aspects of patients' expectations might help to tailor psychological interventions more specifically to optimize patient's expectations. METHODS Eighty-three patients were invited to a psycho-educational intervention to optimize expectations prior to elective coronary artery bypass graft (CABG). Before the psychological intervention and before surgery, disability expectations, demographical, medical, psychosocial variables as well as patient and treatment related expectations were collected via questionnaires and patients' files. Associations with disability expectations were assessed using hierarchical linear multiple regression analysis. RESULTS Patients self-rated disability (β = 0.50; p < 0.001) and beliefs about treatment efficacy (β = -0.42; p < 0.001) was independently associated with disability expectations. Expectations about the efficacy of patients' own health behavior as well as demographical variables, psychological distress, perceived social support, and measures of medical morbidity did not explain any additional variance in patients' disability expectations. CONCLUSION CABG patients seem to form their disability expectations upon their perceptions about their current disability and their expectations about the efficacy of treatment. Patients' disability expectations appear to be independent from scientifically established risk factors and other psychosocial patient characteristics in heart surgery. Future research is necessary to further determine what factors psychological interventions should focus on to modify patients' disability expectations.
Collapse
Affiliation(s)
- Johannes A C Laferton
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany,
| | | | | | | | | |
Collapse
|
11
|
Waight CA, Strodl E, Sheridan J, Tesar P. Posttraumatic growth in post-surgical coronary artery bypass graft patients. Health Psychol Open 2015; 2:2055102915571370. [PMID: 28070351 PMCID: PMC5193300 DOI: 10.1177/2055102915571370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Recent research in posttraumatic growth has been applied to people with life-threatening illnesses to optimise recovery. There is a lack of research exploring posttraumatic growth in coronary artery bypass graft patients. This article describes the recovery experience of 14 coronary artery bypass graft patients (13 males and 1 female) at their first outpatient review post-surgery. Grounded theory analysis was used to develop a model of distinct and shared pathways to growth depending on whether patients were symptomatic or asymptomatic pre-coronary artery bypass graft. Outcomes of posttraumatic growth in this sample included action-based healthy lifestyle growth and two forms of cognitive growth: appreciation of life and new possibilities. The model of posttraumatic growth developed in this study may be helpful in guiding future research into promoting posttraumatic growth and behaviour change in coronary artery bypass graft patients.
Collapse
|
12
|
Ozcakir A, Oflu Dogan F, Cakir YT, Bayram N, Bilgel N. Subjective well-being among primary health care patients. PLoS One 2014; 9:e114496. [PMID: 25486293 PMCID: PMC4259359 DOI: 10.1371/journal.pone.0114496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 11/08/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The psychological importance of subjective well-being for a healthy life has been well recognized. It is also well known that depressive and anxiety disorders have a negative effect on subjective well-being. The aim of this cross-sectional, descriptive study was to assess the subjective well-being status of a group of primary healthcare patients in relation to socio-demographic characteristics, personal health and mood-status. METHODS A total of 284 patients participated in the study. The Oxford Happiness Scale, Life Satisfaction Scale, DASS-42 (Depression, Anxiety and Stress Scales-42) and a questionnaire about socio-demographic characteristics were completed by the participants. RESULTS In general, the participants were found to be moderately happy and satisfied with their lives. They had mild levels of depression, anxiety and stress. In terms of happiness, an older age (≥40 years), educated to secondary level or higher and not having depression or anxiety were found to be factors increasing happiness. In terms of life satisfaction, female gender, an older age (≥40 years), educated to secondary level or higher, being single and not having depression were found to increase life satisfaction. CONCLUSION Primary healthcare providers should give more importance to the mood status of their patients. Screening for depression and anxiety should be applied at the primary healthcare level because negative mood status is more important than some socio-demographic characteristics in respect of unhappiness and dissatisfaction.
Collapse
Affiliation(s)
- Alis Ozcakir
- Uludag University Faculty of Medicine, Department of Family Medicine, Bursa, Turkey
| | - Fatma Oflu Dogan
- Uludag University Faculty of Medicine, Department of Family Medicine, Bursa, Turkey
| | - Yakup Tolga Cakir
- Uludag University Faculty of Medicine, Department of Family Medicine, Bursa, Turkey
| | - Nuran Bayram
- Uludag University Faculty of Economics and Administrative Sciences, Department of Econometrics, Bursa, Turkey
| | - Nazan Bilgel
- Uludag University Faculty of Medicine, Department of Family Medicine, Bursa, Turkey
| |
Collapse
|
13
|
Huffman JC, DuBois CM, Mastromauro CA, Moore SV, Suarez L, Park ER. Positive psychological states and health behaviors in acute coronary syndrome patients: A qualitative study. J Health Psychol 2014; 21:1026-36. [PMID: 25114026 DOI: 10.1177/1359105314544135] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Positive psychological states are linked to superior cardiac outcomes, possibly mediated through increased participation in health behaviors. Trained study staff conducted in-depth semi-structured interviews in the hospital and 3 months later for 34 patients diagnosed with an acute coronary syndrome. These interviews focused on positive psychological states, cardiac health behaviors, and their connection; the interviews were transcribed and independently coded using directed content analysis. Both optimism and positive affect were associated with completion of physical activity and healthy eating in a bidirectional manner. In contrast, gratitude, while common, was infrequently linked to completion of health behaviors.
Collapse
Affiliation(s)
- Jeff C Huffman
- Massachusetts General Hospital, USA Harvard Medical School, USA
| | | | | | | | - Laura Suarez
- Massachusetts General Hospital, USA Harvard Medical School, USA
| | - Elyse R Park
- Massachusetts General Hospital, USA Harvard Medical School, USA Benson-Henry Institute for Mind Body Medicine, USA
| |
Collapse
|
14
|
Predicting quality of life with a pretransplantation assessment battery: A prospective study of cardiac recipients. J Clin Psychol Med Settings 2013; 2:335-55. [PMID: 24226414 DOI: 10.1007/bf01991681] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study provides descriptive data on the prevalence of symptoms and quality of life of cardiac transplantation recipients and tests the predictive validity of a pre-cardiac transplantation psychological assessment battery on posttransplantation quality of life. Following the formation of four cluster groups of pretransplantation MMPI profiles based on previous research, frequency analysis found that the cluster groups were not equally represented among cardiac recipients, such that the "Distressed/Confused" cluster had only one recipient member. Tests of significance among the three remaining cluster groups on the posttransplantation quality of life variables found no significant differences. Regression analyses to test the predictive validity of other pretransplantation medical and psychological variables indicated that trait anxiety was a significant predictor of increased symptom frequency and symptom problems and decreased mental health among recipients. Collectively, modest support was found for the use of pretransplantation psychological variables as predictors of posttransplantation quality of life. Interpretation of psychological test data in the context of other psychosocial variables is discussed.
Collapse
|
15
|
Dew MA, Roth LH, Switzer GE, Schulberg HC, Simmons RG, Kormos RL, Griffith BP. Gender differences in patterns of emotional distress following heart transplantation. J Clin Psychol Med Settings 2013; 3:367-86. [PMID: 24226846 DOI: 10.1007/bf01994020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The study provides the first empirical evaluation of gender differences in psychological symptomatology and DSM-III-R major depressive disorder (MDD) across the first year following heart transplantation. An important goal was to identify physical health-related and psychosocial factors that could account for, or mediate, any association between gender and psychological distress. The sample for the present analyses was drawn from a larger cohort of 172 heart recipients and included all 28 women in the cohort plus 118 men who were matched demographically with the group of women. Detailed patient assessments were completed at 2, 7, and 12 months posttransplant. As expected, women's symptom levels were consistently higher than men's. However, while men's symptom levels in all areas declined with time posttransplant, women's distress in the area of depression initially improved but then worsened by the 12-month assessment. The distribution of episodes of MDD showed a temporal pattern of gender differences similar to that of depressive symptoms. The most important mediators of the gender-depression relationship were factors related to early posttransplant daily functional limitations: women reported more impairments in daily activities. Higher levels of such impairments, in turn, predicted subsequently higher depression levels by 12 months posttransplant. Several additional variables pertaining to transplant-related concerns and a low sense of personal mastery-while not serving as mediators-exerted their own independent effects on 12-month depression levels. The findings are relevant to the tailoring of educational and clinical interventions to the individual needs of women and men who receive heart transplants.
Collapse
Affiliation(s)
- M A Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania
| | | | | | | | | | | | | |
Collapse
|
16
|
Pusic AL, Klassen AF, Snell L, Cano SJ, McCarthy C, Scott A, Cemal Y, Rubin LR, Cordeiro PG. Measuring and managing patient expectations for breast reconstruction: impact on quality of life and patient satisfaction. Expert Rev Pharmacoecon Outcomes Res 2012; 12:149-58. [PMID: 22458616 DOI: 10.1586/erp.11.105] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The goal of postmastectomy breast reconstruction is to restore a woman's body image and to satisfy her personal expectations regarding the results of surgery. Studies in other surgical areas have shown that unrecognized or unfulfilled expectations may predict dissatisfaction more strongly than even the technical success of the surgery. Patient expectations play an especially critical role in elective procedures, such as cancer reconstruction, where the patient's primary motivation is improved health-related quality of life. In breast reconstruction, assessment of patient expectations is therefore vital to optimal patient care. This report summarizes the existing literature on patient expectations regarding breast reconstruction, and provides a viewpoint on how this field can evolve. Specifically, we consider how systematic measurement and management of patient expectations may improve patient education, shared medical decision-making and patient perception of outcomes.
Collapse
Affiliation(s)
- Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Detweiler-Bedell JB, Friedman MA, Leventhal H, Miller IW, Leventhal EA. Integrating co-morbid depression and chronic physical disease management: identifying and resolving failures in self-regulation. Clin Psychol Rev 2008; 28:1426-46. [PMID: 18848740 PMCID: PMC2669084 DOI: 10.1016/j.cpr.2008.09.002] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Revised: 08/15/2008] [Accepted: 09/02/2008] [Indexed: 11/22/2022]
Abstract
Research suggests that treatments for depression among individuals with chronic physical disease do not improve disease outcomes significantly, and chronic disease management programs do not necessarily improve mood. For individuals experiencing co-morbid depression and chronic physical disease, demands on the self-regulation system are compounded, leading to a rapid depletion of self-regulatory resources. Because disease and depression management are not integrated, patients lack the understanding needed to prioritize self-regulatory goals in a way that makes disease and depression management synergistic. A framework in which the management of co-morbidity is considered alongside the management of either condition alone offers benefits to researchers and practitioners and may help improve clinical outcomes.
Collapse
|
18
|
|
19
|
Patient expectations as predictors of outcome in patients with acute low back pain. J Gen Intern Med 2008; 23:148-53. [PMID: 18066631 PMCID: PMC2359167 DOI: 10.1007/s11606-007-0460-5] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 10/23/2007] [Accepted: 10/30/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Few studies have evaluated the association between patient expectations for recovery and clinical outcomes, and no study has evaluated whether asking patients to choose their therapy modifies such an association. OBJECTIVE To evaluate the association between patients' expectations and functional recovery in patients with acute low back pain (LBP), and to determine whether that association is affected by giving patients choice of therapy. DESIGN AND PARTICIPANTS A secondary analysis of a randomized controlled trial comparing usual care alone to usual care plus choice of chiropractic, acupuncture, or massage in 444 adults with acute LBP, lasting less than 21 days. MEASUREMENTS AND MAIN RESULTS Primary outcome was functional disability (Roland score) at 5 and 12 weeks. Patients' general expectations for improvement were associated with improvement in functional status (beta = 0.96, 95% CI = 0.56, 1.36). A 1-point increase in general expectations was associated with a 0.96-point improvement in Roland score. The association of expectation with outcome was 2-3 times greater in the usual care group than the choice group. However, these differences did not reach statistical significance. CONCLUSIONS In patients with acute LBP, higher expectations for recovery are associated with greater functional improvement. Eliciting patient expectations for improvement may be a simple way to identify patients with the highest (or lowest) likelihood of experiencing functional improvement. Incorporating questions about patient expectations in future trials may clarify the role of this important correlate of clinical outcomes.
Collapse
|
20
|
Spaderna H, Smits JMA, Rahmel AO, Weidner G. Psychosocial and behavioural factors in heart transplant candidates – an overview. Transpl Int 2007; 20:909-20. [PMID: 17543024 DOI: 10.1111/j.1432-2277.2007.00503.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Mortality among heart transplant (HTX) candidates remains high. This review of the literature shows that psychosocial characteristics like depression, social isolation and coping strategies contribute to morbidity and mortality in heart failure (HF) patients, and may also be relevant to the prognosis of HTX candidates. Based on the research to date, physical activity favourably affects subjective and objective parameters not only in HF patients, but also in HTX candidates. Depression is prevalent among HTX candidates, especially in ischaemic patients, and seems to be related to earlier transplantation. Findings on the effects of depression on pretransplant mortality are conflicting. Not much is known concerning social isolation, coping, nutrition, or weight loss in this patient group. Identification of modifiable psychosocial and behavioural variables related to clinical status in this patient group is clearly needed and will aid the development of behavioural interventions to supplement medical therapies.
Collapse
Affiliation(s)
- Heike Spaderna
- Psychological Institute, Johannes Gutenberg-University, Mainz, Germany.
| | | | | | | |
Collapse
|
21
|
Grady KL, Naftel DC, Young JB, Pelegrin D, Czerr J, Higgins R, Heroux A, Rybarczyk B, McLeod M, Kobashigawa J, Chait J, White-Williams C, Myers S, Kirklin JK. Patterns and predictors of physical functional disability at 5 to 10 years after heart transplantation. J Heart Lung Transplant 2007; 26:1182-91. [PMID: 18022086 DOI: 10.1016/j.healun.2007.08.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Revised: 08/01/2007] [Accepted: 08/02/2007] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Researchers have not examined relationships between perception of physical functional disability and demographic, clinical, and psychological variables at 5 to 10 years after heart transplantation. Therefore, the purposes of this study were to describe physical functional disability over time and identify predictors of physical functional disability from 5 to 10 years after heart transplantation. METHODS The study enrolled 555 patients who were between 5 and 10 years post-heart transplant (age, 54 +/- 9 years; 78% male, 88% white, 79% married). Patients completed 6 instruments that measure physical functional disability and factors that may impact physical functional disability. Statistical analyses included calculation of frequencies, means +/- standard deviation (plotted over time), Pearson correlation coefficients, and multiple regression coupled with repeated measures. RESULTS Between 5 and 10 years after heart transplantation, physical functional disability was low, and 34% to 45% of patients reported having no functional disability. More physical functional disability was associated with having more symptoms, having depression/mood/negative affect and lower use of negative coping strategies, having more comorbidities and more specific comorbidities (e.g., more orthopedic problems and diabetes); higher New York Heart Association functional class; having more acute rejection, infection, or cardiac allograft vasculopathy; being female, older, less educated, and unemployed; higher body mass index; and more hospital readmissions (explaining 46% of variance [F = 84.75, p < 0.0001]). CONCLUSIONS Demographic, clinical, and psychological factors were significantly related to physical functional disability. Knowledge of these factors provides the basis for development of therapeutic plans of care.
Collapse
|
22
|
DiClementi JD, Berrenberg JL, Giese L. Association Between Hypnotizability, Perceived Self-Efficacy, and Provider Contact in a Healthy College Student Sample: An Analogue Adherence Study. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2007. [DOI: 10.1111/j.0021-9029.2007.00164.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
23
|
Stone DA, Kerr CE, Jacobson E, Conboy LA, Kaptchuk TJ. Patient expectations in placebo-controlled randomized clinical trials. J Eval Clin Pract 2005; 11:77-84. [PMID: 15660541 DOI: 10.1111/j.1365-2753.2004.00512.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore participants' experience in placebo-controlled randomized clinical trials (RCTs) specifically in relationship to their expectations. BACKGROUND Aspects of being in RCTs, such as informed consent, perception of benefit and understanding of randomization, have been examined. In contrast, little is known concerning the formation of patient expectations before and during trials. METHODS Qualitative methods using in-depth interviews with a semi-structured interview guide of nine patients from four different RCTs. Data analysis was conducted using a codebook format arranging participant responses under broad analytical headings. The interviewer used a semi-structured interview guide to direct the conversation from one broad topic to the next within the context of the ongoing conversation. A checklist of topics encouraged participants to describe their experiences in RCTs. Narratives concerning expectation, blinding and placebo were compared to identify common themes. RESULTS Patient anticipatory processes were influenced and modified both before and during the trial from multiple inputs. Such factors as past experiences in RCTs, past experiences of ineffective treatment, stress of being off regular medications, fear of being a 'placebo responder', input of non-study doctors or other health professionals, the experience of other participants, measurements of health parameters made during the trial and the presence or absence of side-effects all affected patient expectation. CONCLUSION Expectations in RCTs are not fixed and instead may be viewed as continuously shaped by multiple inputs that include experience and information received both before and during the trial. Variability in placebo response observed in previous studies may be related to the fluid nature of expectations. Trying to control and equalize expectations in RCTs may be more difficult than previously assumed.
Collapse
Affiliation(s)
- David A Stone
- South-East European Research Centre, City College, Greece
| | | | | | | | | |
Collapse
|