Psychosocial rehabilitation: a new challenge for oncology.
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Adaptation, Psychological↗
Biomedical subjects
D Razavi
Publications and source records attributed to D Razavi.
Prevention of adjustment disorders and anticipatory nausea secondary to adjuvant chemotherapy: a double-blind, placebo-controlled study assessing the usefulness of alprazolam.
PURPOSE AND METHODS: Although a high prevalence of adjustment disorders and anticipatory nausea secondary to adjuvant chemotherapy (CT) has been reported, little has been done to develop strategies to prevent these problems. A double-blind, placebo-controlled study was therefore designed to assess the usefulness of adding low-dose alprazolam (0.5 mg to 2 mg per day) to a psychologic support program including progressive relaxation training designed to prevent the aforementioned conditions. Fifty-seven women undergoing adjuvant CT for stage II primary breast cancer agreed to participate in the assessment, which was conducted at four time points: before starting CT, 6 weeks after CT, before the fourth CT, and after the fourth CT. The Hospital Anxiety and Depression Scale (HADS), Montgomery and Asberg Depression Rating Scale (MADRS), Hamilton Anxiety Scale (HAS), Revised Symptom Checklist (SCL-90-R), Morrow Assessment of Nausea and Emesis (MANE), and World Health Organization (WHO) grading of acute and subacute toxicities were used to compare the alprazolam (AA) and placebo (PA) arms of the study. RESULTS: At the second evaluation, the results showed a higher rate of anticipatory nausea (18% v 0%) in the PA compared with the AA arm (P = .038). These differences were no more significant at each of the further assessments. Significant differences were found for the intake of hypnotics at each assessment visit, with the rate of hypnotic users being significantly higher in the PA (19%) compared with the AA (0%) arm at the fourth assessment (P < .05). Anxiety and depression scores of self- and observer-report were similar in the two arms. A significant relationship was found between the development of anticipatory nausea and the self-report of anxiety and depression score measured by HADS at baseline. The average HADS total score at baseline was 15.33 (SD = 6.56) for patients who developed anticipatory nausea and 11.23 (SD = 6.67) for other patients. CONCLUSION: The adjunct of alprazolam to a psychologic support program delays the occurrence of anticipatory nausea and controls sleeping problems secondary to adjunct CT. Although studies are needed to improve the efficacy reported here, physicians may already consider the use of alprazolam for cancer patients undergoing CT.
Adjustment Disorders↗
Screening for psychiatric disorders in a lymphoma out-patient population.
The Hospital Anxiety and Depression Scale (HADS), a four-point, 14-item self-assessment questionnaire, was tested as a screening method for psychiatric disorders in a sample of 117 Hodgkin's lymphoma and non-Hodgkin lymphoma consecutive out-patients. A receiver operating characteristic (ROC) analysis was performed, giving the relationship between the true positive rate (sensitivity) and the false positive rate (1--specificity). This makes it possible to choose an optimal cut-off score that takes into account the costs and benefits of treatment of psychiatric disorders (mainly adjustment, depressive and anxiety disorders) in a lymphoma out-patient population. A cut-off point of 10 gave 84% sensitivity and 66% specificity. HADS appears in this study to be a well accepted, simple, sensitive and specific tool.
Adjustment Disorders↗
Brief psychological training for health care professionals dealing with cancer patients: a one-year assessment.
The usefulness of psychological training for health professionals dealing with terminally ill cancer patients is becoming more widely recognized, but little has been done to elaborate its content and form. Of special interest is the study of the effectiveness of brief psychological training groups and the quality of treatment to be achieved. The principal aim of the training group assessed here was to develop a better understanding of death and dying issues and ways to cope with them. The present study reports the attitudes of participants, assessed 1 year after the end of training in order to investigate the possible consolidation of the immediate posttraining effectiveness reported previously. Subjects (n = 78) who attended the training groups were compared to a control group (n = 42). Attitudes about oneself, illness and death, occupation, personal growth, and professional relationships were assessed with a semantic differential questionnaire before training, after training, and 1 year later. Results show a significant reduction of the positive effect assessed just after the training. While attitudes moved significantly to the positive pole immediately after the end of the training, 1 year later the reverse phenomenon is noted. These data suggest the necessity for improving the effectiveness of short psychological training proposed to help health care professionals dealing with terminally ill cancer patients.
Adult↗
Psychosocial correlates of oestrogen and progesterone receptors in breast cancer.
Psychosocial correlates of hormone receptor status in primary breast cancers were investigated in 93 consecutive patients. Life event, coping style, and psychological adjustment self-report scales were completed. The 75 patients with receptor-positive (oestrogen and/or progesterone) tumours were better adjusted psychologically than the 18 patients with receptor-negative lesions. These findings may explain the relations that have been found between psychosocial variables and survival.
Adaptation, Psychological↗
Psychologic support and psychotropic medications.
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Antidepressive Agents↗
Screening for adjustment disorders and major depressive disorders in cancer in-patients.
The Hospital Anxiety and Depression Scale (HADS), a four-point, 14-item questionnaire, was tested as a screening method for adjustment disorders and major depressive disorders in a sample of 210 cancer in-patients. A receiver operating characteristic (ROC) analysis was performed, giving the relationship between the true positive rate (sensitivity) and the false positive rate (1-specificity). This makes it possible to choose an optimal cut-off point that takes into account the costs and benefits of treatment of psychological distress. For screening for major depressive disorders only, a cut-off score of 19 gave 70% sensitivity and 75% specificity. For screening for adjustment disorders and major depressive disorders taken together, a cut-off score of 13 gave 75% sensitivity and 75% specificity. HADS appears in this study to be a simple, sensitive and specific tool for screening for psychiatric disorders in an oncology in-patient population.
Adaptation, Psychological↗
[Factors limiting and favoring communication and information in oncology].
The authors discuss actual concepts about the transmission of information to the patient and his family in oncology. After the discussion of problems related to the emission and reception of information, they introduce the useful strategies designed in order to achieve an optimal transmission of information, and to improve doctor-patient communication.
Attitude↗
Immediate effectiveness of brief psychological training for health professionals dealing with terminally ill cancer patients: a controlled study.
The usefulness of a psychological training for health professionals dealing with terminally ill cancer patients is beginning to be widely recognized, but little has been done to elaborate its content and form. The study of the effectiveness of brief psychological training groups is of special interest for the quality of treatment to be achieved. The principal aim of the training group, assessed here, was to develop a better understanding of death and dying issues and ways to cope with them. Subjects (n = 122) who attended the training groups were compared to a control group (n = 43). Attitudes about oneself, toward illness and death, occupation, personal growth, and professional relationship were assessed with a semantic differential questionnaire before and after training. Results show a significant change in attitudes for the trained subjects. Subjects reporting more negative attitudes at the beginning of the training were those which benefit the most. The attitude change is a first step aimed at assessing the effectiveness of psychological training; it will be completed by the assessment of long term attitudes and behavior modifications of the health care professionals trained.
Attitude to Health↗
Cancer care--a stress for health professionals.
Literature related to health care professionals dealing with stress of cancer care is still in its infancy. The authors distinguish papers of general interest (the most frequent), papers identifying stressors, and papers about stress consequences. Most of them recognize death of the patients as a major stressor for health care professionals. There are also additional stressors specific to health care and work. Consequences of stressors have another important dimension: working with cancer patients is often a chronic stress which may lead to the development of burnout and poor quality of care. Little also is actually known about how coping strategies and/or support are influencing adaptation and stress consequences. The authors suggest that an important effort should be made to evaluate stress, and its consequences on poor staff communication with cancer patients and their families. Training interventions aimed at a better quality of care should be designed and their usefulness investigated. The effectiveness of training for health care professionals dealing with cancer patients is reviewed.
Attitude to Death↗
[The psychosocial impact of illness and death in children: current concepts].
The authors review actual concepts about the psychosocial impact of the fatal illness and the death of a child. The conceptualization of death and the psychological consequences of illness with a fatal prognosis--particularly those affecting the children themselves, their parents, and health care professionals--are developed and discussed.
Child↗
[Caregivers faced with informing the cancerous patient and his family: an inquiry].
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Humans↗
[Euthanasia: interaction of bioethical and psychological aspects].
The authors develop the interactions of psychological and ethical issues of euthanasia. After a brief recall of the historical background, they discuss the concept of euthanasia and analyse the distinction between active and passive euthanasia focusing either on patient-doctor relationship and ethics.
Bioethics↗
[Psychological and psychiatric aspects in cancerology].
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Adaptation, Psychological↗
Tricyclic antidepressant plasma levels: the state of the art and clinical prospects.
The authors review the main pharmacological factors playing a role in the kinetics of tricyclic antidepressant plasma levels. The current data concerning the relationship between tricyclic plasma levels and their clinical responses indicate that there is a therapeutic window at 50-150 ng/ml for the secondary derivatives (nortriptyline and desipramine). The lower limit of efficiency for the primary derivatives (imipramine and amitriptyline) is estimated at 200 ng/ml. The boundaries and prospects of the clinical use of antidepressant plasma levels are discussed in their various methodological aspects.
Amitriptyline↗
Testing health care professionals' communication skills: the usefulness of highly emotional standardized role-playing sessions with simulators.
Although standardized role-playing sessions (SRPS) with simulators are increasingly used to assess health care professionals' (HCPs) communication skills (CS) and the effectiveness of training workshops (TWs), nothing has been done to date to define the optimal emotional content of SRPS. Three emotionally different SRPS contexts-weakly emotional (WE-), moderately emotional (ME-), and highly emotional (HE-SRPS)-were, therefore, tested in order to assess induced CS and sensitivity to TW-related changes. The study included 25 HCPs. Tape-recorded SRPS, scheduled before and after the TW, were retranscribed, and assessed according to the Cancer Research Campaign Workshop Evaluation Manual (CRCWEM), which provides a rating of form, function and structure for each utterance. Results show that induced CS are different in WE-, ME-, and HE-SRPS, regarding form (HE-SRPS induced more 'directing', 'leading' or 'multiple' questions; WE: 20.7%; ME: 19.7%; HE: 33.7% (p<0.001)); function (HE-SRPS induced more 'inappropriate' information; WE: 6. 5%; ME: 8.2%; HE: 15.6% (p<0.001)); and blocking (HE-SRPS induced more 'blocking' utterances; WE: 7.2%; ME: 13.8%; HE: 30.2% (p<0. 0001)). Finally, CS changes induced by TWs are the highest in HE-SRPS (14.8% increase of 'open' questions for the HE- versus 1.0% for the WE-SRPS; 11.6% decrease of 'inappropriate' information for the HE- versus 3.3% for the WE-SRPS; and 17.5% decrease of 'blocking' for the HE- versus 2.6% for the WE-SRPS). In conclusion, SRPS, with a HE content, induce more inappropriate CS. Moreover, they are more sensitive to TW effects. SRPS with a HE content should, thus, be recommended for the assessment of TW effectiveness.
Adult↗
Patients' satisfaction ratings and their desire for care improvement across oncology settings from France, Italy, Poland and Sweden.
There has been an increasing interest in patient satisfaction assessment across nations recently. This paper reports on a cross-cultural comparison of the comprehensive assessment of satisfaction with care (CASC) response scales. We investigated what proportion of patients wanted care improvement for the same level of satisfaction across samples from oncology settings in France, Italy, Poland and Sweden, and whether age, gender, education level and type of items affected the relationships found. The CASC addresses patient's satisfaction with the care received in oncology hospitals. Patients are invited to rate aspects of care and to mention for each of these aspects, whether they would want improvement.One hundred and forty, 395, 186 and 133 consecutive patients were approached in oncology settings from France, Italy, Poland and Sweden, respectively. Across country settings, an increasing percentage of patients wanted care improvement for decreasing levels of satisfaction. However, in France a higher percentage of patients wanted care improvement for high-satisfaction ratings whereas in Poland a lower percentage of patients wanted care improvement for low-satisfaction ratings. Age and education level had a similar effect across countries. Confronting levels of satisfaction with desire for care improvement appeared useful in comprehending the meaning of response choice labels for the CASC across oncology settings from different linguistic and cultural background. Linguistic or socio-cultural differences were suggested for explaining discrepancies between countries.
Adult↗
[Medico-psychosocial rehabilitation of patients with cancer].
The important prevalence of psychosocial problems and psychiatric disturbances that have been reported in Oncology, underlines the need for a comprehensive psychosocial support of cancer patients and their families. Psychosocial interventions designed for this purpose should be divided in five categories: prevention, early detection, restoration, support and palliation. Firstly, preventive interventions are designed to avoid the development of predictable morbidity secondary to treatment and/or disease. Secondly, early detection of patients needs or problems refers to the assumption that early interventions could have therapeutic results superior to those of delayed support, both for quality of life and survival. Thirdly, restorative interventions refer to actions used when a cure is likely, the aim being the control or elimination of residual cancer disability. Fourthly, supportive rehabilitation is planned to lessen disability related to chronic disease characterized by numerous cancer illness remission, progression and active treatment. Fifthly, palliation is required when curative treatments are likely to be no more effective, and when maintaining or improving comfort becomes the main goal. Psychosocial interventions are often multidisciplinary with a variety of content. The content of psychosocial interventions range from information and education to more sophisticated support programs including directive (behavioral or cognitive) therapies, or non directive (dynamic or supportive) therapies. Social interventions include usually financial, household, equipment, and transport assistance depending on individual and family needs and resources. These interventions may be combined with the prescription of pharmacological (psychotropic, analgesic,...), physical, speech or occupational therapies, especially in rehabilitation programs.(ABSTRACT TRUNCATED AT 250 WORDS)
Combined Modality Therapy↗