Biomedical subjects

K Siegel

Publications and source records attributed to K Siegel.

At least 19 recordsLinked to original sources

PubMed1992

Reducing the prevalence of unmet needs for concrete services of patients with cancer. Evaluation of a computerized telephone outreach system.

A two-stage study was undertaken of outpatients with advanced cancer who were receiving chemotherapy. In Stage 1 of the study, their needs for practical services and the barriers to those needs being met were assessed. Based on these results, an intervention was designed to reduce the prevalence of patients' unmet needs. The intervention was an automated telephone needs assessment coupled with social worker follow-up. The efficacy of this intervention was evaluated using an independent sample in Stage 2 in an experimental trial. Patients in the experimental group (n = 109), who received three automated surveys, reported fewer unmet needs in a subsequent comprehensive assessment than those in the control group (n = 130). The computerized telephone outreach system proved to be a cost-effective and reliable method for the early identification of unmet patient needs soon after they emerge and efficient deployment of limited professional staff.

Aged↗

PubMed1992

The changing needs of patients with cancer at home. A longitudinal view.

Changes in the daily living needs of 629 patients with advanced cancer were investigated (1) during and (2) 3 to 6 months after a course of outpatient chemotherapy and/or radiation treatment. The analytic sample consisted of patients completing both baseline and follow-up interviews (n = 434). At both times, the point prevalence of need and unmet need for assistance with personal care, instrumental activities, transportation, and home health tasks was calculated. In addition, the prevalence of new need and unmet need at follow-up was determined as were the rates of resolution of baseline need. The prevalence of need for assistance with personal care increased from 7% at baseline to 16% at follow-up; the dynamic of need acquisition and resolution resulted in relatively constant prevalence rates in other task areas. Acquisition of need at follow-up was associated primarily with disease and treatment-related characteristics. Approximately one third of patients reporting need for assistance during at least one interview did not have enough help. New unmet need at follow-up was associated most strongly with patients' mobility and the ability of their informal support system to provide care. The apparently rapid fluctuation in patients' experience of need and unmet need suggests the necessity for ongoing appraisal of patients' physical condition and social situation.

Adult↗

PubMed1992

Psychosocial adjustment of children with a terminally ill parent.

Although a substantial number of children experience serious parental illness and death, the adjustment problems attendant to the stress of having a fatally ill parent have not been examined systematically. This paper compares the psychosocial adjustment of 62 school-aged children with a terminally ill parent (study sample) with that of children in a community sample, using several standard rating scales. Study children had significantly higher levels of self-reported depression (Children's Depression Inventory) and anxiety (State-Trait Anxiety Inventory) and lower self-esteem (Self-Esteem Inventory). Parents also reported study children's significantly higher behavior problems and lower social competence (Child Behavior Checklist). Increased professional attention to this vulnerable population is encouraged.

Adaptation, Psychological↗

PubMed1992

Determinants of need and unmet need among cancer patients residing at home.

De-hospitalization of cancer treatment, particularly for those with advanced disease, can complicate adjustment and strain the capacity of caregiver networks to meet patients' daily needs. Outpatient staff should be able to recognize patients who need help to meet their daily needs as well as those who are not getting enough help. This study describes the physiological and social determinants of need and unmet need for assistance among 629 cancer patients with advanced disease initiating a course of outpatient chemotherapy and/or radiation therapy. Areas of needs examined through telephone interviews with participating patients were: personal care, instrumental tasks (housework, shopping, and cooking), and transportation. Physiological factors (metastases, disease stage, and functional status) were associated with need for assistance in all three areas. Also, older age (over 65) and low income predicted need for help with personal care, and women were more likely than men to report illness-related need for assistance with instrumental tasks and transportation. Unmet need was primarily associated with patients' social support system (e.g., children living nearby and perceived resiliency of network helpers). These findings highlight the need for outpatient staff to evaluate patients' informal care resources as well as patients' symptoms and impairments in deciding who should be referred for home care services.

Activities of Daily Living↗

PubMed1992

Factors associated with urban gay men's treatment initiation decisions for HIV infection.

While a public health emphasis on primary prevention of human immunodeficiency virus (HIV) infection continues, it is recognized that large numbers of individuals are already infected. Efforts at secondary prevention focus on early medical intervention and may be effective in slowing progression to a diagnosis of AIDS. Understanding the factors that promote or impede seropositive individuals from receiving prompt medical treatment and complying with treatment regimens is essential to prolonging survival. During unstructured interviews in an ongoing study of sexual decision-making, 55 urban, gay, seropositive men spontaneously offered information about their treatment choices for their HIV infection. Findings regarding their considerations in initiating, delaying, or rejecting medical treatment are presented.

Adult↗

PubMed1991

Caregiver burden and unmet patient needs.

Four-hundred eighty-three patients with cancer and their informal caregivers were studied. Patients reported on met and unmet needs in personal care activities (bathing and dressing), instrumental activities (heavy and light housekeeping, cooking, shopping), transportation (medical and general), and home health care (health/treatment assistance). A minority (18.9%) experienced an unmet need. Hierarchical logistic regression was used to identify significant predictors of any unmet need. Patients were more likely to report any unmet needs when their illness/treatment resulted in restricted activity days, when their financial resources were reduced enough for them to apply for Medicaid or Public Assistance, or when their caregivers were not their spouses. Although in general, the likelihood of an unmet need decreased as the number of domains of assistance provided by the caregiver increased, if that care was associated with a high level of burden, the odds of a patient reporting an unmet need actually increased.

Adult↗

PubMed1991

Social environment and social support.

Research on the relevance of social support to cancer has been plentiful since the first American Cancer Society workshop on methodological issues in behavioral and psychosocial science. Nonetheless, critical shortcomings continue to characterize the attempt empirically to establish such things as the extent to which social support predicts adjustment to cancer diagnosis and treatment. Prominent among these is the failure to adequately address large elements of the social structure, such as social class and urbanization, and to investigate how they shape the well being of persons with or at risk for cancer and their caregivers. We recommend that more psychosocial research on the link between social support and cancer be conducted within populations beset by poverty and without adequate access to health care. Funding is needed for the training and maintenance of multidisciplinary and multicultural teams of researchers working within community-based organizations and hospitals serving the underserved.

Humans↗

PubMed1991

Parental death: a preventive intervention.

The untimely death of a spouse and parent is extraordinarily painful and difficult. Whether a brief intervention such as the one we are exploring is enough to make a significant difference in the mourning process and future optimum survival has yet to be seen. To date we are gratified that the immediate response of most of the surviving spouses and children is that the intervention is a helpful experience.

Adaptation, Psychological↗

PubMed1991

A preventive intervention program for bereaved children: problems of implementation.

A brief, standardized intervention program to facilitate children's adjustment to the terminal illness and death of a parent posed the following implementation problems: estimation of patient life expectancy; engagement of the family in crisis; adhesion to the parental guidance model; and termination of formal clinical intervention. Resolution of these issues is described, and adaptation of such programs to other high-risk populations is considered.

Acquired Immunodeficiency Syndrome↗

PubMed1991

The relationship of spousal caregiver burden to patient disease and treatment-related conditions.

The prevalence and intensity of different caregiving burdens experienced by spousal caregivers and the association of these burdens with various patient illness and treatment-related conditions were examined in a sample of 295 married cancer patients and their spouses. The spousal caregivers were confronted with a wide range of burdens associated with their caregiving responsibilities. Objective, as compared to subjective, caregiver burdens were more strongly associated with patient disease and treatment-related conditions. Compared to husbands, wives experienced more burden and these burdens were more strongly associated with the various disease and treatment conditions.

Adult↗

PubMed1991

Living with HIV infection: adaptive tasks of seropositive gay men.

With improved understanding of the natural history of HIV/AIDS and the availability of effective early intervention, HIV infection recently has come to be conceptualized as a chronic illness. As we enter the next phase of the epidemic, insights into the challenges of daily living faced by seropositive persons will aid in designing appropriate interventions to educate for adaptive success and to ameliorate adaptive difficulties. In our analysis of focused interviews with 55 seropositive gay men, we identified three major adaptive challenges: dealing with the possibility of a curtailed life span, dealing with reactions to a stigmatizing illness, and developing strategies for maintaining physical and emotional health. The men's descriptions of these adaptive challenges are discussed in the context of adaptation to other chronic illnesses.

Adaptation, Psychological↗

PubMed1990

Monitoring quality-of-life needs of cancer patients.

The advent of prepayment systems in hospitals has greatly shortened the length of stay of patients who are therefore increasingly treated and cared for in outpatient settings while living at home with family or other caretakers. This shift in the locus of treatment has created a critical need for the development of organized systems of follow-up that monitor a patient's needs while he or she is undergoing active treatment but living at home. Over time, failure to develop such systems of care is likely to result in major gaps in the continuity of care, a decrease in the quality of patients' lives while on treatment, tremendous stress on caretakers, and a general decrease in the quality of services provided to patients. This article reports on a study of one such system of monitoring i.e., a computer-automated telephone outreach system that would routinely assess the concrete needs of chemotherapy outpatients (e.g., transportation to the hospital and need for assistance with activities of daily living). This automated intervention was designed in response to previous findings that 62% of chemotherapy outpatients had at least one unmet need within the month before assessment and 39% had two or more; clinical knowledge that cancer patients' needs vary considerably over time as a consequence of both the disease and its treatment; and that, because of limited professional staff, patients' needs cannot be routinely assessed without the aid of automation, particularly as the proportion of cancer patients treated as outpatients continues to increase. These conditions suggested the need to develop a cost-efficient strategy for the universal assessment of patients' need on a periodic basis, so that emerging needs could be identified in a timely way. For the feasibility study, 97 chemotherapy outpatients were surveyed at least once over the telephone by a computer in a high quality digitally-stored voice asking 12 questions regarding the patients' concrete needs. The data suggested that our computer-automated telephone outreach system is reliable and valid and has the potential for relatively broad-based acceptance. In addition, the intervention frequently allows for timely social work assistance for identified needs. It further serves as a form of outreach that can compensate for patients' reluctance to identify themselves as needing help and for passivity that may be associated with depression or physical illness. This intervention appears to have the potential to be a time- and labor-efficient strategy for ongoing assessment of the changing needs of large numbers of cancer or other chronic diseased outpatients, insuring timely professional intervention as needs arise.

Activities of Daily Living↗

PubMed1990

A prevention program for bereaved children.

The death of a parent seriously threatens children's social and emotional development. When the death can be anticipated, early intervention may facilitate children's adjustment. A prevention program designed to enable parents to foster their children's necessary grief work and resolution of the loss is described.

Adaptation, Psychological↗

PubMed1990

Perceptions of parental competence while facing the death of a spouse.

Healthy parents' perceptions of their competence to meet children's needs during the terminal illness of the other parent were measured on five major domains of parent-child relationships and parental functioning central to children's healthy development. Significant declines from pre-illness competence were perceived, of which the greatest were in emotional sensitivity and responsiveness, and ability to set limits and impose discipline. Implications for the development of preventive intervention strategies are discussed.

Adolescent↗

PubMed1990

Psychosocial oncology research.

In recent years, increased attention has been paid to psychosocial aspects of cancer treatment, recovery and survivorship because oncology health professionals have observed that psychological and social variables can influence the medical outcomes and quality of life of cancer patients. A number of theoretical and conceptual frameworks which might guide research in this field are suggested. Next, several methodological issues of concern to psychosocial; oncology researchers are examined. This is followed by a discussion of recent important findings from psychosocial oncology research and of their implications for social work practice. Finally, recommendations for future research in the field are offered.

Adaptation, Psychological↗

PubMed1990

Social workers' comfort in providing services to AIDS patients.

With the steadily increasing number of people infected with the human immunodeficiency virus, social workers are being called on to play a key role in meeting the complex psychosocial needs of infected individuals and their significant others. To understand more about social workers' levels of comfort in providing services to individuals with acquired immune deficiency syndrome (AIDS) and their family and friends, a survey of social workers in 12 hospital centers was carried out. The majority of social workers were found to be compassionate and sensitive to the needs of this patient population. Several factors were found to be associated with comfort, including various background characteristics, knowledge about the disease, homophobia, negative moral attitudes toward people with AIDS, and the reactions of family and friends. In this article, the authors review these findings and discuss their implications for social work education and practice.

Acquired Immunodeficiency Syndrome↗

PubMed1989

Individual and aggregate level change in sexual behavior among gay men at risk for AIDS.

Until an effective vaccine or treatment for AIDS is developed, the rate of spread of the epidemic will be determined primarily by the willingness of infected and at-risk individuals to refrain from behaviors implicated in the spread of the disease. Consequently, public health efforts have focused on educating these populations about the dangers inherent in certain practices. To date, the impact of these educational activities has been most extensively studied with regard to gay and bisexual men. Researchers, however, seem not always to appreciate the necessity to examine change at two levels of analysis--the individual and the aggregate because it is possible to draw different but valid conclusions about the nature of change, depending upon the level of analysis used. A series of models for examining individual and aggregate level change are described. These models are then used to examine whether there is evidence of change over a 6-month period in the sexual behavior of a sample of gay men from New York City. The data reveal evidence of a significant trend in the direction of safer sexual behavior at both the individual and aggregate level.

Acquired Immunodeficiency Syndrome↗

PubMed1989

Factors distinguishing homosexual males practicing risky and safer sex.

A longitudinal study of patterns of sexual behavior among asymptomatic, homosexual males in New York City was conducted. Participants were interviewed at two time points, 6 months apart. Based on their reports of sexual behavior during a recent 'typical' month, respondents were classified at each time point as engaging in safer (or low-risk) sexual practices versus high-risk sexual behaviors. Discriminant analysis was employed to distinguish the 53 males classified as risky at both time 1 and time 2 from the 47 males classified as safer in both periods. Statistically significant discrimination was achieved with 10 psychosocial predictor variables, four of which were significant while controlling for all other variables in the model. Of these predictors, drug use within sexual contexts was particularly noteworthy, since it provided the greatest relative contribution to the discriminant function and appears to be an important candidate for educational intervention. Other significant variables included perceived adequacy of emotional support, number of years engaged in regular sexual intercourse with other males, and perceived difficulty in modifying sexual behavior. Self-esteem and alcohol consumption approached significance.

Acquired Immunodeficiency Syndrome↗