Biomedical subjects
Publications and source records attributed to R L Heinrich.
The case is made for the integration of primary care and behavioral health services in the HMO. Key features of a successfully integrated behavioral health service are offered, along with brief reports of integration efforts at a number of HMOs across the United States. The author believes that better value and cost efficiencies result from integration.
The CAncer Rehabilitation Evaluation System (CARES) (CARES Consultants, Santa Monica, CA) a rehabilitation and quality of life instrument with well-documented reliability and validity, has been shortened. This report describes the development and psychometric properties of the new instrument, the CAncer Rehabilitation Evaluation System--Short Form (CARES-SF). The data from four existing samples of cancer patients demonstrate that the CARES-SF is highly related to the CARES (r = 0.98), has excellent test-retest reliability (86% agreement), concurrent validity with related measures, and acceptable internal consistency of summary scales (alpha = 0.85 to 0.61). In a new sample of breast cancer patients evaluated at three points in time (1 month, 7 months, and 13 months after diagnosis) the instrument appears to be sensitive to change and is highly related to the Functional Living Index--Cancer (FLIC), an existing quality of life instrument. The authors conclude that the CARES-SF has excellent potential as a quality of life instrument for use in clinical trials.
Evaluated the psychometric properties of the Cancer Inventory of Problem Situations (CIPS), a cancer-specific survey instrument designed to assess day-to-day problems and rehabilitation needs of cancer patients. A heterogeneous group of 479 cancer patients participated in the research. The substructure of the CIPS was investigated using factor-analytic techniques. The CIPS was factored into 31 clinically useful subscales. Further analyses led to five higher order factors representing the physical, psychosocial, medical interaction, marital, and sexual problem areas characteristic of cancer and its treatment. Internal consistency of all the scales was high (mean alpha = .81). The test-retest reliability and validity of the instrument were also studied in a sample of 120 patients. Analyses of items, subscales, higher order factors, and total CIPS scores suggest excellent reliability. The pattern of correlations of the CIPS with other measures (psychological distress; physical, marital, and sexual functioning; and quality of life) provided preliminary evidence of concurrent, discriminant, and convergent validity. The CIPS appears to have sound psychometric properties and fills an important gap in the assessment of cancer patients for both clinical and research purposes.
The authors present a cancer specific rehabilitation and treatment planning questionnaire and a computer scoring and reporting evaluation system, the CARES. CARES stands for CAncer Rehabilitation Evaluation System. It is a unique instrument and research to date suggests that it is comprehensive, reliable, valid, and pertinent to patients' quality of life, as they live with cancer. The CARES provides a cost-efficient method of evaluating patients' needs and can serve as a valuable adjunct to medical care. The CARES has been adapted for research settings as well, and has a short form for multiple administrations. Finally, a computer scoring and professional reporting system is available to clinicians with access to IBM compatible personal computers.
Anxiety associated with medical situations was studied in a heterogeneous sample of 320 adult cancer patients. Patients completed the Cancer Inventory of Problem Situations, which identifies anxiety in a variety of medical situations. On the average, 44% of patients reported some anxiety in medical situations; 23% reported significant anxiety. Anxiety was somewhat situation dependent. Females were more likely to report anxiety and with greater intensity than males in situations such as watching other patients receive treatments, waiting to see the doctor, waiting to find out the results of tests, going to the hospital, and receiving chemotherapy. Multiple regression techniques were used to identify the correlates of anxiety. Age, sex, problems communicating with the health team, and global adjustment to the illness all accounted for a significant amount of the variance. The results suggest important areas for mental health professionals to be involved in the care of individuals with cancer if comprehensive care is to be provided.
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Oncologists and oncology nurses are in a unique and important position to help patients cope with the many stressful aspects of cancer. Oncology professionals can provide tremendous help to patients and their families by: 1. Being aware of the emotional, cognitive, behavioral, and social problems that patients and their families commonly experience as they adjust to cancer; 2. Encouraging patients to communicate freely about their current problems and their fears for the future; 3. Listening to these concerns and providing information about the normalcy of these reactions; 4. Providing specific suggestions for coping, when needed, based on knowledge of the successful coping efforts of others; 5. Making referrals to mental health professionals when these more limited interventions fail to provide sufficient help. We summarize reactions and difficulties that are common among cancer patients at six stages of the disease and we suggest interventions that may be helpful to patients as they cope with and adjust to these difficulties.
Breast cancer is the most common neoplasm in occidental women, yet very little information is available about the rehabilitation needs of these patients. This report reviews in detail the physical, psychological, social, and financial problems identified by fifty women during the first month after primary surgical treatment. The most frequently reported problems were physical and psychological. Patients undergoing modified radical mastectomy (MRM) are compared with patients receiving segmental mastectomy and primary radiotherapy (SM). There were few differences between the two surgical treatment groups; however, patients in the MRM group reported more difficulty with clothing and body image, while the SM group had more disruption of recreation and social activities. Information about the rehabilitation problems of patients with this common neoplasm should be helpful to patients and to the members of the health care team who are helping them recover.
A treatment-outcome study was conducted to study the impact of behavior and physical therapy on components of the chronic low back pain syndrome. Eighteen patients received behavior therapy and 15 patients received physical therapy. All patients had at least a 6-month history of seeking treatment for chronic low back pain. Prior to treatment patients were assessed in four principal areas of functioning: (1) physical abilities; (2) current physical functioning; (3) psychological and psychosocial functioning; and (4) pain intensity and pain perception. Treatments were conducted in a group (five to eight patients) outpatient setting. Both behavior therapy and physical therapy groups met for 10-weekly sessions, each lasting 2 hr. Behavior therapy was designed to address the environmental, social, and emotional components of the low back pain syndrome as well as the depression and decreased activity that result from chronic low back pain. Physical therapy was based upon traditional rehabilitation theory and was designed to improve low back function. Patients were reevaluated at posttreatment, 6 months, and 1 year. The results showed a general improvement for patients in both groups and a few treatment-specific differences in outcome measures.
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This report examines the psychosocial impact of cancer in 240 men according to age using a recently developed cancer-specific survey instrument. Overall, younger patients experienced more frequent or severe psychosocial and treatment-related problems than the older patients, especially in relation to work and chemotherapy. In addition, younger patients experienced more difficulty dealing with the health care setting. The authors conclude that the elderly cancer patient experiences less psychosocial disruption from cancer than do younger individuals.
With the recent improvement in cancer therapy, patients are living for extended periods of time. There is little information on the day-to-day problems that these patients experience. The paucity of such information is due to the absence of instruments specifically designed to document these problems. The authors have developed an instrument, The Cancer Inventory of Problem Situations (CIPS), and present a study of 84 cancer patients using the CIPS. Preliminary evaluation of the instrument in this small and heterogeneous group of patients demonstrates that cancer has a significant, extensive impact on psychosocial and physical functioning. Cancer patients have moderate to severe problems in personal care, activity management, involvement with the health care system, work, and interpersonal interactions.
Little research has been conducted documenting the reliability and validity of the Karnofsky Performance Status (KPS) scale, and guidelines based on empirical data do not exist to govern its use. Two hundred ninety-three cancer patients completed a questionnaire that assesses their physical and psychosocial difficulties. Physicians rated patients on the KPS and a subsample of 75 patients was used to evaluate interrater reliability. Analyses were conducted to evaluate the interrater reliability and construct validity of the KPS. The KPS was shown to have good reliability and validity. Detailed examination of the reliability data suggested areas in which physicians err in their judgments. Multiple regression techniques were used to empirically identify seven behaviorally based questions that would be helpful in predicting KPS scores. The seven variables included weight loss, weight gain, reduced energy, difficulty walking, driving, grooming, and working part time. An interview approach with behaviorally based guidelines is presented using these variables to obtain relevant data and make more accurate KPS ratings. With the approach suggested and the guidelines presented, oncologists may train themselves to use the KPS in a standard way, which should increase reliability and validity of the KPS and has implications for patients and research studies that use KPS as a stratifying variable.
Two studies are presented which describe the development of a problem-oriented psychosocial screening instrument for use in health care settings. Reliability and validity data are presented on the Chronic Illness Problem Inventory (CIPI) which demonstrate its ability to document accurately patient's specific problems in areas of physical limitations, psychosocial functioning, health care behaviors and marital adjustment. A study is also presented which compares the problems of patients with three distinct chronic illnesses: pain, obesity, and respiratory ailments. Results indicate a significantly greater severity of problems for pain patients and especially patients with multiple pain complaints. Problem areas common to all three illness groups are discussed in the context of providing better comprehensive treatment for chronically ill patients.
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Conducted a treatment-outcome study to investigate the effectiveness of behavioral (BT) or physical therapy (PT) for treating chronic low back pain (CLBP). Thirteen patients received BT; 12 patients received PT. All patients had at least a 6-month history of seeking treatment of CLBP. Prior to treatment patients were assessed in four principal areas of functioning: (1) physical abilities; (2) current physical functioning; (3) psychological and psychosocial functioning; and (4) pain intensity and pain perception. Treatments were conducted in a group (5-8 patients) outpatient setting. Both BT and PT met for 10 weekly 2-hour sessions. BT was designed to address the environmental, social, and emotional influences of the pain experience, depression, and decreased activity from CLBP. PT was based upon traditional rehabilitation theory and was designed to improve low back function. The posttreatment results showed general improvement for patients in both groups, but few treatment-specific differences in outcome measures.
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Explore the source record for details and available documents.