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Biomedical subjects

J T Ptacek

Publications and source records attributed to J T Ptacek.

At least 19 recordsLinked to original sources

Physician interactions with families and caregivers after a patient's death: current practices and proposed changes.

There are little objective data concerning physician bereavement or other supportive interactions with the families and caregivers of deceased patients. We surveyed the physician staff of a large tertiary rural referral center in central Pennsylvania. We asked about current practices in attending former patients' funerals, family condolence visits, letter or phone contacts, as well as the desire of physicians to participate in these activities. The database consisted of 143 questionnaires that were returned from 286 physicians initially mailed the survey. Only 119 of the 143 had experienced patient deaths in their practices. Most of these 119 physicians did not participate in any type of planned contact with a former patient's family after the patient's death. Phone calls were used 39.6% after an inpatient death, and condolence notes were sent by about 40% of physicians. There was no correlation between these activities and number of deaths in the practice per year or if death occurred as an inpatient or outpatient. Physicians practicing at the medical center more than 10 years were more likely to contact the grieving family or caregivers. There was significant desire by the physicians to have an easy way to identify deceased patients' caregivers or loved ones, to have condolence notes available for the physicians' use, and to have bereavement service information sent to the families or caregivers.

Attitude to Death↗

Patients' perceptions of receiving bad news about cancer.

PURPOSE: The purpose of this investigation was to document patients' recollections about what transpired during bad news interactions between physicians and themselves. PATIENTS AND METHODS: One hundred twenty cancer patients provided information about the most recent time they received bad cancer-specific news. Using a series of descriptive statements, patients reported on what the physician did while communicating the bad news. Patients also indicated the extent to which they were satisfied with the transaction and whether they believed that the interaction had any long-lasting impact on their adjustment or on their subsequent interactions with the physician who delivered the news. RESULTS: Overall, patients reported having similar experiences, with most physicians behaving in ways that were consistent with advice published in the medical literature. Satisfaction with the bad news transaction was high. Younger patients and women found the transaction to be more stressful, and older patients believed that the transaction was less important for subsequent interactions with the physician. Logistic regression analyses indicated that satisfaction with the transaction was uniquely predicted by factors related to the environment, to what the physician said, and to how the physician said it. CONCLUSION: Despite high levels of self-reported satisfaction by patients, some factors differentiated the most satisfied patients from patients who were less satisfied. The findings suggest that special attention should be given to making the environment comfortable, taking plenty of time with the patient, and attempting to empathize with the patient's experiences.

Adaptation, Psychological↗

"I'm sorry to tell you ..." physicians' reports of breaking bad news.

In this investigation the authors assessed what physicians do when planning for and delivering bad news to patients. Seventy-three physicians responded to a series of statements about the behaviors, thoughts, and feelings they might have had while preparing for and delivering bad medically-related news. Data were also obtained about how well they thought the transaction had gone, how much stress they had experienced, and what they thought the experience was like from the patient's perspective. Physicians reported that these transactions were only moderately stressful, with 18.1% and 18.7% indicating that preparation stress or delivery stress, respectively, were above the midpoint on the scale. Slightly over 42% of the sample indicated that the stress they experienced lasted from several hours to three or more days. Thirty-six delivery-related statements were typical (with endorsement rates of at least 80% in a given direction) for at least one of the two recall groups.

Adult↗

Masking effects of social desirability response set on relations between psychosocial factors and sport injuries: a methodological note.

Social desirability has long been viewed as a potential source of error variance in self-report measures. We suggest that social desirability (whether in the form of impression management or self-deception) has the capacity to mask relations between psychosocial variables and sport-related outcome or criterion measures that are not measured by selfreport. To illustrate what can occur, we present data from a longitudinal study in which life stress and psychological coping skills were studied as predictors of behaviorally-defined athletic injuries. When data from the entire sample of 352 athletes were analyzed, virtually no injury variance was accounted for by life stress, psychological coping skills, or their interaction. In contrast, deletion from the sample of athletes with high social desirability response set scores resulted in significant predictive relations involving both life stress and coping skills, as well as a significant moderator effect for coping skills. We propose that social desirability masking effects can significantly increase the likelihood of Type II errors in sports medicine research that involves self-report measures, and that social desirability responding needs to be controlled or minimized.

Adaptation, Psychological↗

Health care providers' perspectives on breaking bad news to patients.

This article reports the results of an investigation designed to obtain descriptive information about what typically transpires in bad news transactions between patients and physicians. A sample of 115 health care providers who were attending a 1-day workshop on palliative care issues responded to questions regarding bad news transactions between physicians and patients. Results indicated that giving the news in person, giving the news in a private place, having patient support providers present, and using a warm and caring tone are highly typical of bad news transactions, whereas exploring patient emotional reactions, relying on touch, delivering the news at the patient's pace, and providing written information are less typical. Nurses and physicians diverged in the perceptions about what typically transpires, suggesting that studies focusing only on physician reports or recommendations may be misleading. These data also point to the need to obtain other views of bad news transactions, and they argue for research designed to assess the relation between actual patient-physician encounters and subsequent patient-related outcomes.

Adult↗

Breaking bad news to patients: physicians' perceptions of the process.

The goal of this investigation was to gain a better understanding of the processes associated with communicating bad news to patients. A convenience sample of 38 physicians recalled a time when they delivered bad news and then answered a series of questions about what transpired. Data were also obtained about how well they thought the transaction had proceeded, how much stress they had experienced, and what they thought the experience was like from the patient's perspective. The majority of physicians reported following most of the published recommendations for delivering bad news. However, the number of recommendations followed was not correlated with self-reported stress and effectiveness in news delivery or with physicians' estimates of patients' distress. The number of recommendations followed could not be accounted for by the closeness of the relationship between physician and patient or by the gender composition of the bad news encounter. Overall, physicians reported that the transaction was moderately stressful for themselves, that the stress lasted beyond the recalled transaction, and that they were effective in delivering the news in a way that reduced patient distress. These findings suggest that the sampled physicians are generally following a substantial number of published recommendations when delivering very stressful news to patients. The primary weaknesses in the delivery process occur while preparing for the encounter. The fact that many of the physicians reported that their stress lasted beyond the transaction itself suggests that training in the delivery of bad news should include guidance on cognitive and behavioral coping strategies to help physicians deal with their own discomfort.

Adaptation, Psychological↗

The role of dispositional and situational factors in cognitive interference.

Two studies investigated the cross-temporal stability and cross-situational consistency of cognitive interference. In Study 1, 70 college students reported on the intrusive thoughts they experienced during 2 course examinations and a self-reflective task. In Study 2, 55 college athletes reported on intrusive thoughts following 2 course examinations and 2 regular season football games. Major findings were (a) cognitive interference showed both cross-temporal stability and cross-situational consistency, (b) it was predicted by a measure of dispositional intrusive thinking, (c) the link between cognitive interference and dispositional intrusive thinking was not accounted for by indices of depressive symptomatology and trait anxiety, and (d) the degree of cross-situational consistency of cognitive interference and the content of these intrusive thoughts were influenced by situational factors.

Adult↗

Lorazepam as an adjunct to opioid analgesics in the treatment of burn pain.

Benzodiazepines are commonly used to supplement opioid analgesics in treating procedural pain during the treatment of major burn injuries. To date, no study has investigated whether benzodiazepines actually have an analgesic or anxiolytic effect in such circumstances. Seventy-nine patients admitted to a major regional burn center were randomly assigned to groups that received 1 mg of lorazepam or a placebo in addition to their standard opioid analgesics. A strong analgesic effect of lorazepam was not observed when treatment groups were compared independent of their baseline pain ratings. However when patients who had high baseline pain were compared, lorazepam resulted in a significant reduction in pain ratings (adjusted post-treatment VAS mean score = 54.28; adjusted control VAS mean score = 69.06). Trait anxiety did not predict those patients who had an analgesic effect with lorazepam, but state anxiety did prove to be a covariate with visual analogue score decreases in pain reports.

Adult↗

Baseline pain as a moderator of hypnotic analgesia for burn injury treatment.

Sixty-one patients hospitalized for severe burns were randomly assigned to conditions in which they received either hypnosis or a control condition in which they received attention, information, and brief relaxation instructions from a psychologist. The posttreatment pain scores of the 2 groups did not differ significantly when all patients were considered. However, when a subset of patients who reported high levels of baseline pain were examined, it was found that patients in the hypnosis group reported less posttreatment pain than did patients in the control group. The findings are used to replicate earlier studies of burn pain hypnoanalgesia, explain discrepancies in the literature, and highlight the potential importance of motivation with this population.

Adult↗

Facilitating and debilitating trait anxiety, situational anxiety, and coping with an anticipated stressor: a process analysis.

Participants completed anxiety and coping diaries during 10 periods that began 7 days before an academic stressor and continued through the evening after the stressor. Profile analysis was used to examine the anxiety and coping processes in relation to 2 trait anxiety grouping variables: debilitating and facilitating test anxiety (D-TA and F-TA). Anxiety and coping changed over time, and high and low levels of D-TA and F-TA were associated with different daily patterns of anxiety and coping. Participants with a debilitative, as opposed to facilitative, trait anxiety style had lower examination scores, higher anxiety, and less problem-solving coping. Covarying F-TA, high D-TA was associated with a pattern of higher levels of tension, worry, distraction, and avoidant coping, as well as lower levels of proactive coping. Covarying D-TA, high F-TA was associated with higher levels of tension (but not worry or distraction), support seeking, proactive and problem-solving coping.

Adaptation, Psychological↗

Breaking bad news. A review of the literature.

OBJECTIVE: To review the literature on breaking bad news while highlighting its limitations and describing a theoretical model from which the bad news process can be understood and studied. DATA SOURCES: Sources were obtained through the MEDLINE database, using "bad news" as the primary descriptor and limiting the sources to English-language articles published since 1985. STUDY SELECTION AND EXTRACTION: All articles dealing specifically with bad news were examined. These works included letters, opinions, reviews, and empirical studies. Recommendations from these articles were examined, sorted into discrete categories, and summarized. DATA SYNTHESIS: The 13 most consistently mentioned recommendations (eg, delivering the news at the patient's pace, conveying some hope, and giving the news with empathy) were examined. CONCLUSION: Although much has been written on the topic of breaking bad news, the literature is in need of empirical work. Research should begin with the simple question of whether how the news is conveyed accounts for variance in adjustment before moving to more specific questions about which aspects of conveying bad news are most beneficial. It is suggested that the bad news process can be understood from the transactional approach to stress and coping.

Adaptation, Psychological↗

Pain, coping, and adjustment in patients with burns: preliminary findings from a prospective study.

We prospectively examined the associations between procedural pain during hospitalization and coping and adjustment 1 month postdischarge in 43 patients treated at a major regional burn center for burns extensive enough to require at least 5 days of daily wound debridement procedures. Both patients and nurses provided ratings of patient pain, which were summarized and aggregated across a 5-day period. Results indicated that those subjects with higher pain scores also reported poorer adjustment as measured by scores on the Brief Symptoms Inventory and the Sickness Impact Profile. Moreover, these associations remained significant after partialling out the effects of preburn adjustment. Hierarchical regression analyses revealed evidence that seeking social support had a moderating effect on the association between pain and scores on a measure of posttraumatic stress disorder.

Adaptation, Psychological↗

Sensation seeking, stress, and adolescent injuries: a test of stress-buffering, risk-taking, and coping skills hypotheses.

The potential stress-buffering effects of sensation seeking were assessed in a prospective study involving high school athletes. A significant positive relation between major negative sport-specific life events and subsequent injury time-loss occurred only for athletes low in sensation seeking. No evidence was obtained for a competing hypothesis that high sensation seeking would constitute an injury vulnerability factor by increasing risk-taking behaviors. Although low sensation seekers reported poorer stress management coping skills, there was no evidence that differences in coping efficacy mediated the injury vulnerability difference. Results indicate that sensation seeking is a stress-resiliency factor and suggest the utility of assessing relations between life stressors and outcomes that occur within the same environmental context.

Adaptation, Psychological↗

Conjunctive moderator variables in vulnerability and resiliency research: life stress, social support and coping skills, and adolescent sport injuries.

In life event research relating to vulnerability and resilience factors, single moderator variables have typically been the focus of study. Little is known about the ways in which moderator variables may interact with one another to increase vulnerability or resilience. We propose a distinction between conjunctive moderation, in which multiple moderators must co-occur in a specific combination or pattern to maximize a relation between a predictor and an outcome variable, and disjunctive moderation, in which any one of a number of moderators maximizes the predictor-criterion relation. Our results indicate that social support and psychological coping skills are statistically independent psychosocial resources and that they operate in a conjunctive manner to influence the relation between life stress and subsequent athletic injury in adolescents. Only athletes low in both coping skills and social support exhibited a significant stress-injury relation, and in that vulnerable subgroup, negative major life events accounted for up to 30% of the injury variance. Methodological considerations in the assessment of conjunctive moderator effects are discussed.

Adaptation, Psychological↗

Describing and predicting the nature of procedural pain after thermal injuries: implications for research.

A prerequisite for studying and treating burn-related pain is the establishment of a good understanding of the nature of burn-related pain. However, in most investigations of pain, researchers have failed to examine pain over time or to create summary scores that capture differences in the nature of the pain experiences of individual patients. For 10 consecutive days, 47 patients treated for burn injuries reported on three aspects of procedural pain: worst pain, sensory pain, and affective pain. Three summary pain scores were constructed for each pain dimension: average pain, variability in pain, and linear change in pain. The authors found considerable variability in pain reports from the same patient and from different patients. Analyses indicated that pain reports decreased over time and that patients who had more trait anxiety reported more pain. Patients with larger burn injuries tended to report more affective pain and tended to have a pattern of high and low pain reports that differed from patients with less severe burn injuries. These findings suggest that adequate assessment of burn pain must occur frequently over the course of a single day, as well as for the duration of each patient's care.

Adult↗

Community integration after burn injuries.

Evaluation of community integration is a meaningful outcome criterion after major burn injury. The Community Integration Questionnaire (CIQ) was administered to 463 individuals with major burn injuries. The CIQ results in Total, Home Integration, Social Integration, and Productivity scores. The purposes of this study were to determine change in CIQ scores over time and what burn injury and demographic factors predict CIQ scores. The CIQ scores did not change significantly from 6 to 12 to 24 months postburn injury. Home integration scores were best predicted by sex and living situation; Social Integration scores by marital status; and Productivity scores by functional outcome, burn severity, age, and preburn work factors. The data demonstrate that individuals with burn injuries have significant difficulties with community integration due to burn and nonburn related factors. CIQ scores did not improve over time but improvement may have occurred before the initial 6-month postburn injury follow-up in this study.

Adult↗

Time off work and return to work rates after burns: systematic review of the literature and a large two-center series.

The literature on time off work and return to work after burns is incomplete. This study addresses this and includes a systematic literature review and two-center series. The literature was searched from 1966 through October 2000. Two-center data were collected on 363 adults employed outside of the home at injury. Data on employment, general demographics, and burn demographics were collected. The literature search found only 10 manuscripts with objective data, with a mean time off work of 10 weeks and %TBSA as the most important predictor of time off work. The mean time off work for those who returned to work by 24 months was 17 weeks and correlated with %TBSA. The probability of returning to work was reduced by a psychiatric history and extremity burns and was inversely related to %TBSA. In the two-center study, 66% and 90% of survivors had returned to work at 6 and 24 months post-burn. However, in the University of Washington subset of the data, only 37% had returned to the same job with the same employer without accommodations at 24 months, indicating that job disruption is considerable. The impact of burns on work is significant.

Absenteeism↗