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Sanders JJ, Temin S, Ghoshal A, Alesi ER, Ali ZV, Chauhan C, Cleary JF, Epstein AS, Firn JI, Jones JA, Litzow MR, Lundquist D, Mardones MA, Nipp RD, Rabow MW, Rosa WE, Zimmermann C, Ferrell BR. Palliative Care for Patients With Cancer: ASCO Guideline Update. J Clin Oncol 2024; 42:2336-2357. [PMID: 38748941 DOI: 10.1200/jco.24.00542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 06/28/2024] Open
Abstract
PURPOSE To provide evidence-based guidance to oncology clinicians, patients, nonprofessional caregivers, and palliative care clinicians to update the 2016 ASCO guideline on the integration of palliative care into standard oncology for all patients diagnosed with cancer. METHODS ASCO convened an Expert Panel of medical, radiation, hematology-oncology, oncology nursing, palliative care, social work, ethics, advocacy, and psycho-oncology experts. The Panel conducted a literature search, including systematic reviews, meta-analyses, and randomized controlled trials published from 2015-2023. Outcomes of interest included quality of life (QOL), patient satisfaction, physical and psychological symptoms, survival, and caregiver burden. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 52 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Evidence-based recommendations address the integration of palliative care in oncology. Oncology clinicians should refer patients with advanced solid tumors and hematologic malignancies to specialized interdisciplinary palliative care teams that provide outpatient and inpatient care beginning early in the course of the disease, alongside active treatment of their cancer. For patients with cancer with unaddressed physical, psychosocial, or spiritual distress, cancer care programs should provide dedicated specialist palliative care services complementing existing or emerging supportive care interventions. Oncology clinicians from across the interdisciplinary cancer care team may refer the caregivers (eg, family, chosen family, and friends) of patients with cancer to palliative care teams for additional support. The Expert Panel suggests early palliative care involvement, especially for patients with uncontrolled symptoms and QOL concerns. Clinicians caring for patients with solid tumors on phase I cancer trials may also refer them to specialist palliative care.Additional information is available at www.asco.org/supportive-care-guidelines.
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Affiliation(s)
| | - Sarah Temin
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | - Arun Ghoshal
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Erin R Alesi
- Virginia Commonwealth University Health System, Massey Cancer Center, Richmond, VA
| | | | | | - James F Cleary
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | | | | | | | | | | | | | - Michael W Rabow
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
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Chow AYM, Zhang AY, Chan IKN, Fordjour GA, Lui JNM, Lou VWQ, Chan CLW. Caregiving Strain Mediates the Relationship Between Terminally Ill Patient's Physical Symptoms and Their Family Caregivers' Wellbeing: A Multicentered Longitudinal Study. J Palliat Care 2023:8258597231215137. [PMID: 38018131 DOI: 10.1177/08258597231215137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Objectives: Research considered patient outcomes primarily over caregivers in end-of-life care settings. The importance of family caregivers (FCs) in end-of-life care draws growing awareness, evidenced by an increasing number of evaluations of caregiver-targeted interventions. Little is known of FCs' collateral benefits in patient-oriented home-based end-of-life care. The study aims to investigate FC outcomes and change mechanisms in patient-oriented care. Methods: A pre-post-test study. We recruited FCs whose patients with a life expectancy ≤ 6 months enrolled in home-based end-of-life care provided by service organizations in Hong Kong. Patients' symptoms, dimensions of caregiving strain (ie, perception of caregiving, empathetic strain, adjustment demands), and aspects of FCs' wellbeing (ie, perceived health, positive mood, life satisfaction, spiritual well-being) were measured at baseline (T0) and 3 months later (T1). Results: Of the 345 FCs at T0, 113 provided T1 measures. Three months after the service commenced, FCs' caregiving strain significantly reduced, and their positive mood improved. Alleviation of the patient's physical symptoms predicted FC better outcomes, including the perception of caregiving, empathetic strain, and wellbeing. Changes in perception of caregiving mediated the effects of changes in patients' physical symptoms on FCs' changes in life satisfaction and spiritual wellbeing. Changes in empathetic strain mediated the changes between patient's physical symptoms and FCs' positive mood. Conclusions: Collateral benefits of patient-oriented home-based end-of-life care were encouraging for FCs. Patient's physical symptom management matters to FCs' caregiving strain and wellbeing. The active ingredients modifying FCs' perception of caregiving and addressing empathetic strain may amplify their benefits in wellbeing.
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Affiliation(s)
- Amy Y M Chow
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
- Jockey Club End-of-life Community Care Project, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Anna Y Zhang
- Jockey Club End-of-life Community Care Project, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Iris K N Chan
- Jockey Club End-of-life Community Care Project, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Genevieve A Fordjour
- Jockey Club End-of-life Community Care Project, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Julianna N M Lui
- Jockey Club End-of-life Community Care Project, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Vivian W Q Lou
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
- Jockey Club End-of-life Community Care Project, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong SAR, China
| | - Cecilia L W Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
- Jockey Club End-of-life Community Care Project, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
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Horgas AL, Bruckenthal P, Chen S, Herr KA, Young HM, Fishman S. Assessing Pain in Older Adults: Caregivers play a key role in recognizing and documenting pain at home. Home Healthc Now 2023; 41:128-134. [PMID: 37144927 DOI: 10.1097/nhh.0000000000001166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. This new group of articles provides practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. Cite this article as: Horgas, A.L., et al. Assessing Pain in Older Adults. Am J Nurs 2022; 122 (12): 42-48.
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Affiliation(s)
- Ann L Horgas
- Ann L. Horgas is an associate professor and chair of the Department of Biobehavioral Nursing Science at the University of Florida College of Nursing in Gainesville. Patricia Bruckenthal is a professor, associate dean for nursing research and innovation, and chair of doctoral studies in the School of Nursing at Stony Brook University in Stony Brook, NY. Shaoshuai Chen is a doctoral student in the College of Nursing at the University of Iowa in Iowa City, where Keela A. Herr is the Kelting Professor in Nursing, associate dean for faculty, and codirector of the Csomay Center for Gerontological Excellence. Heather M. Young is a professor and founding dean emerita in the Betty Irene Moore School of Nursing at the University of California Davis in Sacramento, and national director of the Betty Irene Moore Fellowship for Nurse Leaders and Innovators. Scott Fishman is a professor, the Fullerton Endowed Chair in Pain Medicine, and executive vice chair in the Department of Anesthesiology and Pain Medicine at the University of California Davis School of Medicine in Sacramento, where he is also director of the Center for Advancing Pain Relief. This article was funded by the Mayday Fund and the Ralph C. Wilson, Jr. Foundation. Contact author: Ann L. Horgas, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Mayhew M, Balderson BH, Cook AJ, Dickerson JF, Elder CR, Firemark AJ, Haller IV, Justice M, Keefe FJ, McMullen CK, O'Keeffe-Rosetti MC, Owen-Smith AA, Rini C, Schneider JL, Von Korff M, Wandner LD, DeBar LL. Comparing the clinical and cost-effectiveness of remote (telehealth and online) cognitive behavioral therapy-based treatments for high-impact chronic pain relative to usual care: study protocol for the RESOLVE multisite randomized control trial. Trials 2023; 24:196. [PMID: 36927459 PMCID: PMC10018633 DOI: 10.1186/s13063-023-07165-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/13/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Cognitive behavioral therapy for chronic pain (CBT-CP) is an effective but underused treatment for high-impact chronic pain. Increased access to CBT-CP services for pain is of critical public health importance, particularly for rural and medically underserved populations who have limited access due to these services being concentrated in urban and high income areas. Making CBT-CP widely available and more affordable could reduce barriers to CBT-CP use. METHODS As part of the National Institutes of Health Helping to End Addiction Long-term® (NIH HEAL) initiative, we designed and implemented a comparative effectiveness, 3-arm randomized control trial comparing remotely delivered telephonic/video and online CBT-CP-based services to usual care for patients with high-impact chronic pain. The RESOLVE trial is being conducted in 4 large integrated healthcare systems located in Minnesota, Georgia, Oregon, and Washington state and includes demographically diverse populations residing in urban and rural areas. The trial compares (1) an 8-session, one-on-one, professionally delivered telephonic/video CBT-CP program; and (2) a previously developed and tested 8-session online CBT-CP-based program (painTRAINER) to (3) usual care augmented by a written guide for chronic pain management. Participants are followed for 1 year post-allocation and are assessed at baseline, and 3, 6, and 12 months post-allocation. The primary outcome is minimal clinically important difference (MCID; ≥ 30% reduction) in pain severity (composite of pain intensity and pain-related interference) assessed by a modified 11-item version of the Brief Pain Inventory-Short Form at 3 months. Secondary outcomes include pain severity, pain intensity, and pain-related interference scores, quality of life measures, and patient global impression of change at 3, 6, and 12 months. Cost-effectiveness is assessed by incremental cost per additional patient with MCID in primary outcome and by cost per quality-adjusted life year achieved. Outcome assessment is blinded to group assignment. DISCUSSION This large-scale trial provides a unique opportunity to rigorously evaluate and compare the clinical and cost-effectiveness of 2 relatively low-cost and scalable modalities for providing CBT-CP-based treatments to persons with high-impact chronic pain, including those residing in rural and other medically underserved areas with limited access to these services. TRIAL REGISTRATION ClinicalTrials.gov NCT04523714. This trial was registered on 24 August 2020.
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Affiliation(s)
- Meghan Mayhew
- Kaiser Permanente Center for Health Research, Portland, USA.
| | | | - Andrea J Cook
- Kaiser Permanente Washington Health Research Institute, Seattle, USA
| | | | | | | | | | - Morgan Justice
- Kaiser Permanente Washington Health Research Institute, Seattle, USA
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, USA
| | | | | | - Ashli A Owen-Smith
- Georgia State University and Center for Health Research and Evaluation Kaiser Permanente Georgia, Atlanta, USA
| | - Christine Rini
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine and Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, USA
| | | | - Michael Von Korff
- Kaiser Permanente Washington Health Research Institute, Seattle, USA
| | - Laura D Wandner
- National Institute of Neurological Disorders and Stroke, Bethesda, USA
| | - Lynn L DeBar
- Kaiser Permanente Center for Health Research, Portland, USA
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Chang VT, Sandifer C, Zhong F. GI Symptoms in Pancreatic Cancer. Clin Colorectal Cancer 2023; 22:24-33. [PMID: 36623952 DOI: 10.1016/j.clcc.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/21/2022] [Indexed: 12/31/2022]
Abstract
This review will apply a multidisciplinary approach to GI symptoms with attention to symptom assessment (instruments and qualitative aspects), differential diagnosis, and recent findings relevant to management of symptoms and underlying diseases. We conclude that further development of supportive interventions for GI symptoms for both patient and caregivers has the potential to reduce distress from GI symptoms, and anticipate better symptom control with advances in scientific knowledge and improvement of the evidence base.
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Affiliation(s)
- Victor T Chang
- Section Hematology Oncology (111), VA New Jersey Health Care System, East Orange, NJ; Department of Medicine, Rutgers - New Jersey Medical School, Newark, NJ.
| | | | - Fengming Zhong
- Section Hematology Oncology (111), VA New Jersey Health Care System, East Orange, NJ; Department of Medicine, Rutgers - New Jersey Medical School, Newark, NJ
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Semere W, Althouse AD, Arnold R, White D, Smith TJ, Chu E, Rosenzweig MQ, Schenker Y. Examining Caregiver Outcomes in the CONNECT Intervention for Patients With Advanced Cancer. J Pain Symptom Manage 2023; 65:173-182. [PMID: 36503155 DOI: 10.1016/j.jpainsymman.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
CONTEXT Palliative care offers patient and family centered approaches that may mitigate risk of caregiver burden and poor mood. OBJECTIVES To determine whether a palliative care intervention (CONNECT) improved burden, mood, and self-efficacy among caregivers of patients with advanced cancer. METHODS In this cluster randomized trial, patients and their caregivers were recruited from 17 Oncology clinics in Pennsylvania. Participants attended nurse-led monthly visits, addressing patient symptoms, goals of care, and advance care planning. At baseline and three months, we measured caregiver burden using Zarit Burden Interview (ZBI-12; range 0-48), caregiver anxiety and depression using Hospital Anxiety and Depression Scales (HADS-A, range 0-21; HADS-D, range 0-21). We measured caregiver self-efficacy at three months using Caregiver Inventory (CGI; range 0-189). RESULTS We enrolled 441 caregivers and 381 completed three-month assessments. We found no significant differences in caregiver burden (adjusted mean difference -0.39; 95% CI -1.07-0.29, P = 0.90), depression (adjusted mean difference -0.22, 95% CI -0.97-0.55, P = 0.26), or anxiety (adjusted mean difference 0.09; 95% CI -1.25-1.43, P = 0.58), between the intervention and standard care at three months. Caregiver self-efficacy was higher at three months in the intervention compared to standard care (adjusted mean difference 9.36; 95% CI 0.95-17.77, P = 0.030). CONCLUSION Caregivers in CONNECT did not experience improved burden or mood, however, they reported higher self-efficacy compared to caregivers receiving standard care. This study highlights the need for strategies to optimize caregiver outcomes in palliative care interventions.
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Affiliation(s)
- Wagahta Semere
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California, San Francisco (W.S.), San Francisco, California, USA.
| | - Andrew D Althouse
- University of Pittsburgh School of Medicine (A.D.A., Y.S.), Pittsburgh, Pennsylvania, USA
| | - Robert Arnold
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics (R.A.), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Douglas White
- Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine (D.W.), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Thomas J Smith
- Palliative Medicine Program (T.J.S.), The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Edward Chu
- Albert Einstein Cancer Center (E.C.), New York, New York
| | | | - Yael Schenker
- University of Pittsburgh School of Medicine (A.D.A., Y.S.), Pittsburgh, Pennsylvania, USA; Palliative Research Center (PaRC) (Y.S.), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Chi NC, Nakad L, Han S, Washington K, Hagiwara Y, Riffin C, Oliver DP, Demiris G. Family Caregivers' Challenges in Cancer Pain Management for Patients Receiving Palliative Care. Am J Hosp Palliat Care 2023; 40:43-51. [PMID: 35503240 PMCID: PMC10201988 DOI: 10.1177/10499091221094564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
CONTEXT Family caregivers (FCs) of cancer patients play a crucial role in managing their care partner's pain, but little research has examined FCs' specific challenges regarding the provision of pain management (PM) to cancer patients receiving palliative care. OBJECTIVES To determine the demographic and clinical characteristics of FCs who encounter challenges in PM and to elucidate the specific challenges that FCs face when managing pain for their care partner with cancer. METHODS We conducted a secondary analysis of 40 interview transcripts of FCs who were caring for persons with cancer. Interviews were audio-recorded, transcribed verbatim, and analyzed using deductive thematic analysis. RESULTS The three major identified challenges to PM for FCs of persons with cancer were: (1) communication and teamwork issues, (2) caregiver-related issues, and (3) patient-related issues. Communication and teamwork issues encompassed caregivers' receipt of inadequate information regarding PM, and inappropriate and ineffective communication from the healthcare team. Caregiver issues pertained to caregivers' fear and beliefs, concurrent responsibilities, and lack of pain-related knowledge and skills. Patient issues related to their own fear and beliefs, psychological and physiological well-being, adherence to medications, and reluctance to report pain. CONCLUSION Findings of this study have implications for future research and practice related to cancer PM in palliative care. Results suggest the need for FC training in PM as well as clear clinical practice guidelines and resources to help providers prepare, educate, and communicate with FCs regarding PM.
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Affiliation(s)
- Nai-Ching Chi
- College of Nursing, University of Iowa, Iowa City, IA, USA
| | - Lynn Nakad
- College of Nursing, University of Iowa, Iowa City, IA, USA
| | - Soojeong Han
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Karla Washington
- School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Yuya Hagiwara
- College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Catherine Riffin
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - George Demiris
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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Fisher HM, Stalls J, Winger JG, Miller SN, Plumb Vilardaga JC, Majestic C, Kelleher SA, Somers TJ. Role of self-efficacy for pain management and pain catastrophizing in the relationship between pain severity and depressive symptoms in women with breast cancer and pain. J Psychosoc Oncol 2023; 41:87-103. [PMID: 35311481 PMCID: PMC9489816 DOI: 10.1080/07347332.2022.2046676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE This study evaluated the relationship between pain and depressive symptoms through pain self-efficacy and pain catastrophizing in breast cancer patients with pain. DESIGN Secondary analysis of a randomized trial investigating a cognitive-behavioral pain management protocol. SAMPLE Females (N = 327) with stage I-III breast cancer and report of at least moderate pain. METHODS Pain severity, pain self-efficacy, pain catastrophizing, and depressive symptoms were measured. The proposed model was assessed using structural equation modeling. RESULTS Higher pain severity was significantly related to lower pain self-efficacy and higher pain catastrophizing. Lower pain self-efficacy and higher pain catastrophizing were significantly related to more depressive symptoms. Higher pain severity was significantly associated with more depressive symptoms through lower pain self-efficacy and higher pain catastrophizing. The association between pain severity and depressive symptoms was not significant when specified as a direct effect. CONCLUSION Pain severity related to depressive symptoms in breast cancer patients via pain self-efficacy and pain catastrophizing. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS Measurement of pain self-efficacy and pain catastrophizing should be incorporated into comprehensive pain assessments for women with breast cancer, as these variables may be relevant therapeutic targets. Psychosocial symptom management interventions should include strategies that increase pain self-efficacy and decrease pain catastrophizing because these pain-related cognitive variables appear to drive the relationship between pain severity and depressive symptoms.
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Affiliation(s)
- Hannah M. Fisher
- Pain Prevention and Treatment Research Program, Duke University Medical Center, Durham, North Carolina, USA
| | - Juliann Stalls
- Pain Prevention and Treatment Research Program, Duke University Medical Center, Durham, North Carolina, USA
| | - Joseph G. Winger
- Pain Prevention and Treatment Research Program, Duke University Medical Center, Durham, North Carolina, USA
| | - Shannon N. Miller
- Pain Prevention and Treatment Research Program, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Catherine Majestic
- Pain Prevention and Treatment Research Program, Duke University Medical Center, Durham, North Carolina, USA
| | - Sarah A. Kelleher
- Pain Prevention and Treatment Research Program, Duke University Medical Center, Durham, North Carolina, USA
| | - Tamara J. Somers
- Pain Prevention and Treatment Research Program, Duke University Medical Center, Durham, North Carolina, USA
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Horgas AL, Bruckenthal P, Chen S, Herr KA, Young HM, Fishman S. Assessing Pain in Older Adults. Am J Nurs 2022; 122:42-48. [PMID: 36384795 DOI: 10.1097/01.naj.0000904092.01070.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. This new group of articles provides practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.
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Affiliation(s)
- Ann L Horgas
- Ann L. Horgas is an associate professor and chair of the Department of Biobehavioral Nursing Science at the University of Florida College of Nursing in Gainesville. Patricia Bruckenthal is a professor, associate dean for nursing research and innovation, and chair of doctoral studies in the School of Nursing at Stony Brook University in Stony Brook, NY. Shaoshuai Chen is a doctoral student in the College of Nursing at the University of Iowa in Iowa City, where Keela A. Herr is the Kelting Professor in Nursing, associate dean for faculty, and codirector of the Csomay Center for Gerontological Excellence. Heather M. Young is a professor and founding dean emerita in the Betty Irene Moore School of Nursing at the University of California Davis in Sacramento, and national director of the Betty Irene Moore Fellowship for Nurse Leaders and Innovators. Scott Fishman is a professor, the Fullerton Endowed Chair in Pain Medicine, and executive vice chair in the Department of Anesthesiology and Pain Medicine at the University of California Davis School of Medicine in Sacramento, where he is also director of the Center for Advancing Pain Relief. This article was funded by the Mayday Fund and the Ralph C. Wilson, Jr. Foundation. Contact author: Ann L. Horgas, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Stalls JM, Bovbjerg DH, Somers TJ, Plumb Vilardaga JC, Kimmick GG, McAuliffe PF, Keefe FJ, Posluszny DM, Sullivan MJL, Erkanli A, Reed SD, Sutton L, Owen L, Massa L, Shelby RA. Improving well-being for individuals with persistent pain after surgery for breast cancer, lobular carcinoma in situ, or ductal carcinoma in situ: A randomized clinical trial. Contemp Clin Trials 2022; 122:106934. [PMID: 36152791 PMCID: PMC10001426 DOI: 10.1016/j.cct.2022.106934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 01/27/2023]
Abstract
>276,000 Americans will be diagnosed with invasive breast cancer, lobular carcinoma in situ, or ductal carcinoma in situ this year and most will undergo breast surgery as part of their care. Although prognosis is excellent, many patients experience persistent post-surgical pain (PSP), which has no satisfactory pharmacological treatment. The causal contributions of pain-associated psychological factors (e.g., catastrophic thoughts about pain, psychological flexibility, self-efficacy) to the continuing burden of PSP have not yet been determined and may be opportune intervention targets. The randomized trial described here will compare the benefits of three manualized behavioral interventions for individuals with PSP. Participants will receive either: 1) self-guided health education (SGHE); 2) interventionist-guided health education (IGHE); or 3) interventionist-guided pain coping skills training with elements of acceptance and commitment therapy that specially target catastrophic thoughts about pain, self-efficacy, and psychological flexibility (CST-PSP). Participants will prospectively complete validated assessments of primary outcomes (PSP severity and interference) at baseline (pre-intervention) and 3-, 6-, and 12-months later. Validated measures of emotional distress and cancer-specific distress will be assessed as secondary outcomes. To test their roles as drivers of PSP, catastrophic thoughts about pain, self-efficacy, and psychological flexibility, will be assessed and statistically analyzed as mediators of hypothesized beneficial effects. The interventions' impacts on pain sensitivity and central sensitization will be investigated to test these physiological pathways as proximal drivers of PSP. To better characterize the patient experience, additional validated measures will be explored for associations with PSP, along with demographic and clinical factors. Trial registration: https://clinicaltrials.gov/ct2/show/NCT04225585, registered January 13, 2020.
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Affiliation(s)
- Juliann M Stalls
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States of America.
| | - Dana H Bovbjerg
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States of America
| | | | - Gretchen G Kimmick
- Division of Medical Oncology, Duke University Medical Center, Durham, NC, United States of America
| | - Priscilla F McAuliffe
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States of America
| | - Donna M Posluszny
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, United States of America
| | | | - Alaattin Erkanli
- Department of Biostatistics, Duke University, Durham, NC, United States of America
| | - Shelby D Reed
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Linda Sutton
- Duke Cancer Network, Duke University, Durham, NC, United States of America
| | - Lynda Owen
- Duke Cancer Network, Duke University, Durham, NC, United States of America
| | - Lisa Massa
- Department of Physical and Occupational Therapy, Duke University, Durham, NC, United States of America
| | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States of America
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Changes of Intestinal Flora and Its Relationship with Nutritional Status for Patients with Cancer Pain. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:5188202. [PMID: 36035282 PMCID: PMC9402348 DOI: 10.1155/2022/5188202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/13/2022] [Accepted: 07/16/2022] [Indexed: 11/18/2022]
Abstract
Objective. To study the changes in the intestinal flora and its relationship with nutritional status for patients with cancer pain. Methods. A prospective research method was adopted. One hundred twenty cancer patients with cancer pain were selected as the research objects, who were treated in our hospital from June 2019 to June 2020, and 120 cancer patients without cancer pain were selected as the control group, who were treated in the same period. The differences of the intestinal flora and nutritional status of patients with different severity between the observation group and the control group were compared to analyze the changes of intestinal flora in patients with cancer pain and its correlation with nutritional status. Results. Hemoglobin (HB) (
,
), albumin (ALB) (
,
), prealbumin (PAB) (
,
), and total protein (TP) (
,
) in the observation group were significantly lower than those in the control group. There were statistically significant differences in HB (
,
), ALB (
,
), PAB (
,
), and TP (
,
) among patients with cancer pain of different severity. Through these two comparisons, their nutritional indicators showed a significant downward trend with the increase in the severity for cancer pain patients; the levels of Lactobacillus (
,
), Bifidobacterium (
,
), Enterococcus (
,
), and Eubacterium (
,
) in the observation group were significantly lower than those in the control group. There were statistically significant differences in the levels of Lactobacillus (
,
), Bifidobacterium (
,
), Enterococcus (
,
), and Eubacterium (
,
) among patients with cancer pain of different severity. After pairwise comparison, their beneficial intestinal bacteria were significantly lower than those in the control group with the increase in pain in cancer pain patients. Nitric oxide (NO) (
,
), galectin-3 (
,
), occludin (OCLN) (
,
), galectin-1 (
,
), zonula occludens protein 1 (ZO-1) (
,
), and cingulin (
,
) in the observation group were significantly lower than those in the control group. There were statistically significant differences in NO, galectin-3, OCLN, galectin-1, ZO-1, and cingulin for patients with cancer pain of different severity. By comparison, the NO, galectin-3, OCLN, galectin-1, ZO-1, and cingulin of the patients showed a significant downward trend with the aggravation of cancer pain symptoms. Through correlation analysis, the nutritional indicators of patients were positively correlated with intestinal microorganisms and intestinal barrier function. Conclusion. There was a significant correlation between the changes in intestinal flora and nutritional status for patients with cancer pain, which could be used as an important basis for improving the treatment of cancer pain.
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Dyadic psychosocial interventions for patients with cancer and their caregivers: an update. Curr Opin Oncol 2022; 34:304-312. [PMID: 35730497 DOI: 10.1097/cco.0000000000000835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Cancer causes significant impacts on patients and their caregivers. Cancer is also associated with multiple physical and emotional challenges for the patient-caregiver dyad. This patient-caregiver dyad should be considered as a unit of care by healthcare providers and supported through dedicated psychological interventions. RECENT FINDINGS Twelve studies that tested dyadic interventions aiming to support patient-caregiver dyads were identified from the period April 2020 to December 2021. Studies were predominantly randomized controlled trials (RCTs) and single-arm pilot studies. Half of the interventions were online. Interventions were mostly focused on dyadic adjustment and appeared to be acceptable, feasible and globally effective. However, effects were evident predominantly on individual rather than dyadic outcomes. The interventions targeted either individual psychological outcomes, such as depression and anxiety, and are reported to be effective or various individual outcomes and also appeared to be effective. However, there was a large heterogeneity in quality and sample sizes across all intervention types. SUMMARY Dyadic psychological interventions may be an effective support for patient-caregiver dyads dealing with multiple physical and emotional challenges. Online interventions and the variability of intervention types may respond to dyads specific needs, but though need to be rigorously evaluated through powered RCTs.
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Interventions to Improve Self-Efficacy in Colorectal Cancer Patients and/or Caregivers: A Systematic Review and Meta-Analysis. JOURNAL OF ONCOLOGY 2021; 2021:4553613. [PMID: 34707659 PMCID: PMC8545593 DOI: 10.1155/2021/4553613] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 09/28/2021] [Indexed: 01/30/2023]
Abstract
Objective High levels of self-efficacy (SE) in colorectal cancer (CRC) patients and/or caregivers enable patients to cope with cancer, reduce caregiver burden, and promote quality of life (QOL) in patients and caregivers alike. This review aims to (a) identify the SE theory sources covered by SE interventions or interventions, including targeting improved SE for CRC patients and/or caregivers, to guide future development of SE interventions; and (b) explore intervention effects based on SE theory through meta-analysis. Methods Using five electronic databases—CINAHL, Cochrane Library, Embase, PsycINFO, and PubMed—a systematic search was performed in April 2021 to identify English or Chinese literature that studied improving SE interventions for CRC patients and/or caregivers. Manual screening of the articles' references list was also performed. Results A total of 18 studies were found to be suitable and included in this review. Of the 18 studies that were included, 10 randomized controlled trials (RCTs) studies with 917 participants were eligible for meta-analysis. Interventions provide support for SE drawing on different sources of information. Performance accomplishment (PA) is the key source, with vicarious experience (VE) and verbal persuasion (VP) assisting in improving PA. Reducing negative emotional arousal (NEA) and improving positive emotional arousal (PEA) are also indispensable factors in improving SE. The meta-analysis results show that interventions based on the SE theory can bring about positive effects for CRC patients and/or caregivers. Conclusions Different sources of information aimed at improving SE, covered by the interventions, including PA, VE, VP, NEA, and PEA, have been explored. Positive intervention outcomes that focused on improving SE for CRC patients and/or caregivers were identified and highlighted. For future SE interventions, we advocate choosing combination sources of SE information to design interventions. It is recommended that future SE improvement interventions should focus on improving PA, supplemented by increasing VE, while reducing NEA and providing useful VP.
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