Suicide Attempt by Pacemaker System Abuse: A Case Report with Comments on the Psychological Adaptation of Pacemaker Patients

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72997/1/j.1540-8159.1980.tb04333.x.pd

Racial/Ethnic Disparities in Knowledge about Risks and Benefits of Breast Cancer Treatment: Does It Matter Where You Go?

To evaluate the association between provider characteristics and treatment location and racial/ethnic minority patients' knowledge of breast cancer treatment risks and benefits. Data Sources/Data Collection . Survey responses and clinical data from breast cancer patients of Detroit and Los Angeles SEER registries were merged with surgeon survey responses ( N =1,132 patients, 277 surgeons). Study Design . Cross-sectional survey. Multivariable regression was used to identify associations between patient, surgeon, and treatment setting factors and accurate knowledge of the survival benefit and recurrence risk related to mastectomy and breast conserving surgery with radiation. Principal Findings . Half (51 percent) of respondents had survival knowledge, while close to half (47.6 percent) were uncertain regarding recurrence knowledge. Minority patients and those with lower education were less likely to have adequate survival knowledge and more likely to be uncertain regarding recurrence risk than their counterparts ( p <.001). Neither surgeon characteristics nor treatment location attenuated racial/ethnic knowledge disparities. Patient–physician communication was significantly ( p <.001) associated with both types of knowledge, but did not influence racial/ethnic differences in knowledge. Conclusions . Interventions to improve patient understanding of the benefits and risks of breast cancer treatments are needed across surgeons and treatment setting, particularly for racial/ethnic minority women with breast cancer.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/71991/1/j.1475-6773.2008.00843.x.pd

Development of a Practical Model for Targeting Patient Decision Support Interventions to Promote Colorectal Cancer Screening in Vulnerable Populations

We sought to develop a practical model for predicting probability of colorectal cancer (CRC) screening completion in a diverse safety-net population and a subsequent framework for targeting screening promotion interventions. Data used to construct the models was prospectively collected from a CRC screening intervention. Models were cross-validated by randomly splitting the data into training and validation samples. The predicted probabilities of screening completion from the final model were trichotomized into framework groups and cross-validated by defining cut-points in the training sample, applying them to the validation sample, and comparing across samples for homogeneity. The final model included demographic and simple psychosocial measures and predicted screening behavior adequately (AUROC=0.63). The framework groups (cut-points 0.62 (low), 0.74 (medium), and 1.0 (high)) were homogeneous across the two samples. The model and framework may be useful for designing and delivering targeted interventions to promote CRC screening. Future research should validate the framework groups

Progression of Symptoms and Functioning Among Female Cardiac Patients With and Without Diabetes

Objective: To determine if older women with both heart disease and diabetes experience worse physical and psychosocial functioning and higher symptom burden over an 18-month period compared with those with heart disease alone. Methods: Data from older women with heart disease (>=60 years, n = 1008, 18% with diabetes) were used to assess the impact of diabetes on physical functioning (Sickness Impact Profile [SIP]-Physical and Six-Minute Walk test [6MWT]), psychosocial functioning (SIP-Psychosocial and depressive symptoms), and physical symptom burden (cardiac and general) at baseline and 4, 12, and 18 months later. Generalized estimating equation models compared trends in outcomes over time between groups with and without diabetes. Results: Across all four time points, women with heart disease and diabetes had greater functional impairment, as indicated by higher SIP scores, than those without diabetes (43%-71% higher SIP-Physical scores and 32%-65% higher SIP-Pyschosocial scores; all p<=-0.002). 6MWT distance was 17%-30% less in the diabetes group across time points (all p<=-0.002). Depressive symptoms were 27%-39% higher in the diabetes group (all p-<-0.03) except at month 4. Women with diabetes scored 15%-29% higher on a physical symptom index across time points (all p-<-0.05) than those without diabetes; no significant differences were observed in cardiac symptoms until month 18 (diabetes group 29% higher, p = 0.02). Subgroups with and without diabetes in this sample experienced significantly different trends over time in SIP-Physical scores (p = 0.02) and 6MWT distance (p = 0.05), such that the disadvantage of the diabetes group at baseline was greater 18 months later. Conclusions: Women with comorbid diabetes and heart disease are vulnerable to poor health-related quality of life, particularly in terms of physical functioning and symptoms, and require special efforts from clinical care providers to ameliorate a potential downward trend in these outcomes over time.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90452/1/jwh-2E2010-2E2123.pd

Meaning‐based coping, chronic conditions and quality of life in advanced cancer & caregiving

ObjectiveThis study examined the relationship between the number of co‐existing health problems (patient comorbidities and caregiver chronic conditions) and quality of life (QOL) among patients with advanced cancer and their caregivers and assessed the mediating and moderating role of meaning‐based coping on that relationship.MethodsData came from patients with advanced cancers (breast, colorectal, lung, and prostate) and their family caregivers (N = 484 dyads). Study hypotheses were examined with structural equation modeling using the actor‐partner interdependence mediation model. Bootstrapping and model constraints were used to test indirect effects suggested by the mediation models. An interaction term was added to the standard actor‐partner interdependence model to test for moderation effects.ResultsMore patient comorbidities were associated with lower patient QOL. More caregiver chronic conditions were associated with lower patient and caregiver QOL. Patient comorbidities and caregiver chronic conditions had a negative influence on caregiver meaning‐based coping but no significant influence on patient meaning based coping. Caregiver meaning‐based coping mediated relationships between patient comorbidities and caregiver health conditions and patient and caregiver QOL. No significant moderating effects were observed.ConclusionsDespite the severity of advanced cancer for patients and caregivers, the co‐existing health problems of one member of the dyad have the potential to directly or indirectly affect the wellbeing of the other. Future research should consider how the number of patient comorbidities and caregiver chronic conditions, as well as the ability of patients and caregivers to manage those conditions, influences their meaning‐based coping and wellbeing. Copyright © 2016 John Wiley & Sons, Ltd.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138410/1/pon4146_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138410/2/pon4146.pd

The influence of dyadic symptom distress on threat appraisals and self-efficacy in advanced cancer and caregiving

Physical and psychological symptoms experienced by patients with advanced cancer influence their wellbeing; how patient and family caregivers' symptom distress influence each other's wellbeing is less understood. This study examined the influence of patient and caregiver symptom distress on their threat appraisals and self-efficacy to cope with cancer

Contingency contracting to enhance patient compliance: A review

Researchers and practitioners have expressed considerable interest in contingency contracting as a promising intervention strategy for enlisting patient cooperation, particularly with regard to long-term treatment regimens. After brief examination of the theoretical background, the authors summarize advantages of contracting, describe elements essential to the development of a contract, and enumerate those ingredients in the contracting process thought to be critical for achieving optimal results. They review relevant research efforts in terms of their designs, methods, target and contracted health-related behaviors, contingencies employed, and initial and follow-up results. On the basis of this review, current issues regarding contingency contracting are raised, and practical considerations for large-scale application are noted along with recommendations for future research.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24976/1/0000403.pd

Self-management of the health care regimen: a comparison of nurses' and cardiac patients' perceptions

This study compared perceptions of 129 elderly cardiac patients regarding their health status and self-management skills with corresponding assessments by outpatient nursing staff members. Nurse-patient perceptions were most congruent on general questions regarding the heart condition. Differences were most apparent regarding how aware patients were of being asked to follow a regimen for managing their heart problems; what specific components comprised the regimens the patients were to follow; and how much confidence patients had in their ability to comply with specific components of the regimen. Congruence in perceptions of nurses and patients varied by the sex of the patient. Findings suggest that careful and continuous assessment of patients' perceptions about their condition and ongoing instruction regarding specifics of the therapeutic regimen are key elements in efforts to enhance elderly patients' selfmanagement skills.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31512/1/0000434.pd

Understanding the engagement of key decision support persons in patient decision making around breast cancer treatment

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149329/1/cncr31956.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149329/2/cncr31956_am.pd

Racial/ethnic differences in adequacy of information and support for women with breast cancer

BACKGROUND. Providing breast cancer patients with needed information and support is an essential component of quality care. This study investigated racial/ethnic variations in the information received and in the availability of peer support. METHODS. In total, 1766 women who were diagnosed with nonmetastatic breast cancer and reported to the Los Angeles County Surveillance, Epidemiology, and End Results registry from June 2005 to May 2006 were mailed a survey after initial treatment. Among accrued cases, 96.2% met eligibility criteria (n = 1698), and 72% completed the survey. Race/ethnicity categories were white, African American, and Latinas (2 categories indicating low or high acculturation, which was determined by using the Short Acculturation Scale for Hispanics). Outcomes included receipt and need for treatment-related and survivorship-related information, difficulty understanding information, and support from women with breast cancer. RESULTS. More women reported receiving treatment-related information than survivorship-related information. After adjusting for sociodemographic, clinical, and treatment factors, a higher percentage of low acculturated Latina women desired more information on treatment-related and survivorship-related issues ( P < .001). Significantly more Latina low acculturated women than white women reported difficulty understanding written materials, with 74.5% requiring help from others. A higher percentage of all minority groups compared with whites reported no contact with other women with breast cancer ( P < .05) and reported less contact through family/friends ( P < .05). Women rated the benefit of talking to other women high, particularly with emotional issues. CONCLUSIONS. Continued efforts to provide culturally appropriate information and support needs to women with breast cancer are necessary to achieve quality care. Latinas with low acculturation reported more unmet information and care support needs than women in other racial/ethnic groups. Cancer 2008. © 2008 American Cancer Society.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/60993/1/23660_ftp.pd