Internet interventions for improving psychological well‐being in psycho‐oncology: review and recommendations

Objective Too few cancer patients and survivors receive evidence‐based interventions for mental health symptoms. This review examines the potential for Internet interventions to help fill treatment gaps in psychosocial oncology and presents evidence regarding the likely utility of Internet interventions for cancer patients. Methods The authors examined available literature regarding Internet interventions tailored to cancer patients' mental health needs and reviewed elements of Internet interventions for mental health relevant to advancing psycho‐oncology Internet intervention research. Results Few rigorous studies focusing on mental health of cancer patients have been conducted online. A growing body of evidence supports the efficacy, accessibility, and acceptability of mental health Internet interventions for a variety of general and medical patient populations. The authors present recommendations and guidelines to assist researchers in developing, testing, and disseminating Internet interventions for cancer patients and survivors, to manage and improve their mental health. Issues unique to Internet interventions—including intervention structure, customization, provider interaction, and privacy and confidentiality issues—are discussed. These guidelines are offered as a step toward establishing a set of “best practices” for Internet interventions in psycho‐oncology and to generate further discussion regarding the goals of such interventions and their place in cancer care. Conclusions Internet interventions have the potential to fill an important gap in quality cancer care by augmenting limited available mental health services. These interventions should be developed in a manner consistent with best practices and must be empirically tested and validated. Copyright © 2011 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93546/1/pon1993.pd

Decision-Making and Depressive Symptomatology

Difficulty making decisions is a core symptom of depressive illness, but the nature of these difficulties has not been well characterized. The two studies presented herein use the same hypothetical scenarios that call for a decision. In Study 1, participants were asked to make and explain their decisions in a free-response format, as well as to describe their prior experiences with similar situations. The results suggest that those with more depressive symptoms make decisions that are less likely to further their interests. We also identified several interesting associations between features of decision-making and the presence of depressive symptoms. In Study 2, participants were guided through their decisions with simple decision tools to investigate whether the association between depressive symptoms and poor decisions is better accounted for by failure to use of good decision-making strategies, or by other factors, such as differences in priorities or goals. With this minimal intervention the quality of decisions no longer declined significantly as a function of depressive symptom severity. Moreover, few associations between depressive symptom severity and decision-related goals and priorities were evident, suggesting that the previously-exposed difficulties of depressed individuals with decision-making were largely the result of their failure to use effective decision-making techniques

A Cross-Sectional Study of Barriers to Personal Health Record Use among Patients Attending a Safety-Net Clinic

BACKGROUND: Personal health records (PHR) may improve patients' health by providing access to and context for health information. Among patients receiving care at a safety-net HIV/AIDS clinic, we examined the hypothesis that a mental health (MH) or substance use (SU) condition represents a barrier to engagement with web-based health information, as measured by consent to participate in a trial that provided access to personal (PHR) or general (non-PHR) health information portals and by completion of baseline study surveys posted there. METHODS: Participants were individually trained to access and navigate individualized online accounts and to complete study surveys. In response to need, during accrual months 4 to 12 we enhanced participant training to encourage survey completion with the help of staff. Using logistic regression models, we estimated odds ratios for study participation and for survey completion by combined MH/SU status, adjusted for levels of computer competency, on-study training, and demographics. RESULTS: Among 2,871 clinic patients, 70% had MH/SU conditions, with depression (38%) and methamphetamine use (17%) most commonly documented. Middle-aged patients and those with a MH/SU condition were over-represented among study participants (N = 338). Survey completion was statistically independent of MH/SU status (OR, 1.85 [95% CI, 0.93-3.66]) but tended to be higher among those with MH/SU conditions. Completion rates were low among beginner computer users, regardless of training level (<50%), but adequate among advanced users (>70%). CONCLUSIONS: Among patients attending a safety-net clinic, MH/SU conditions were not barriers to engagement with web-based health information. Instead, level of computer competency was useful for identifying individuals requiring substantial computer training in order to fully participate in the study. Intensive on-study training was insufficient to enable beginner computer users to complete study surveys

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Decision-making and depressive symptomatology

Difficulty with making decisions is one of the features of depressive illness. However, the particulars of decision-making in individuals suffering from depression are poorly understood. In this thesis, the relationship between depression and decision-making was explored in three studies, conducted both on the Internet, with participants recruited from the Internet community, and in person, using college undergraduates. The studies focused on two aspects of decision-making: (1) general approach to decisions, including initial reactions to decision, styles of decision-making, and self-perception as a decision-maker, and (2) decisional effectiveness, or the ability to make use of good decision-making strategies to arrive at a choice that is in the decider\u27s best interest. When participants were prompted to examine decisions carefully, the productivity of decisions was unrelated to the level of depressive symptoms; depressed individuals were also not more likely to have any particular decision-related goals. However, when prompts for careful consideration of decisions were not present, depressed individuals made inferior choices. They were found to use fewer productive decision-making strategies, and were less likely to learn from their past experiences in similar situations. Level of depressive symptoms was also related to approaches to decisions and styles of decision-making. Depressed individuals became more anxious when faced with a decision, and preferred to remain passive, procrastinating or avoiding decisions. Finally, they were more likely to think poorly of their abilities as decision-makers and to not trust their intuitions. The results suggest that the failure to use adaptive decision-making strategies spontaneously is an important factor in determining the poor quality of the choices made by depressed individuals, and that prompting the use of such strategies improves decision-making considerably

Decision-making and depressive symptomatology

Difficulty with making decisions is one of the features of depressive illness. However, the particulars of decision-making in individuals suffering from depression are poorly understood. In this thesis, the relationship between depression and decision-making was explored in three studies, conducted both on the Internet, with participants recruited from the Internet community, and in person, using college undergraduates. The studies focused on two aspects of decision-making: (1) general approach to decisions, including initial reactions to decision, styles of decision-making, and self-perception as a decision-maker, and (2) decisional effectiveness, or the ability to make use of good decision-making strategies to arrive at a choice that is in the decider\u27s best interest. When participants were prompted to examine decisions carefully, the productivity of decisions was unrelated to the level of depressive symptoms; depressed individuals were also not more likely to have any particular decision-related goals. However, when prompts for careful consideration of decisions were not present, depressed individuals made inferior choices. They were found to use fewer productive decision-making strategies, and were less likely to learn from their past experiences in similar situations. Level of depressive symptoms was also related to approaches to decisions and styles of decision-making. Depressed individuals became more anxious when faced with a decision, and preferred to remain passive, procrastinating or avoiding decisions. Finally, they were more likely to think poorly of their abilities as decision-makers and to not trust their intuitions. The results suggest that the failure to use adaptive decision-making strategies spontaneously is an important factor in determining the poor quality of the choices made by depressed individuals, and that prompting the use of such strategies improves decision-making considerably

Decision-making and depressive symptomatology

Difficulty with making decisions is one of the features of depressive illness. However, the particulars of decision-making in individuals suffering from depression are poorly understood. In this thesis, the relationship between depression and decision-making was explored in three studies, conducted both on the Internet, with participants recruited from the Internet community, and in person, using college undergraduates. The studies focused on two aspects of decision-making: (1) general approach to decisions, including initial reactions to decision, styles of decision-making, and self-perception as a decision-maker, and (2) decisional effectiveness, or the ability to make use of good decision-making strategies to arrive at a choice that is in the decider\u27s best interest. When participants were prompted to examine decisions carefully, the productivity of decisions was unrelated to the level of depressive symptoms; depressed individuals were also not more likely to have any particular decision-related goals. However, when prompts for careful consideration of decisions were not present, depressed individuals made inferior choices. They were found to use fewer productive decision-making strategies, and were less likely to learn from their past experiences in similar situations. Level of depressive symptoms was also related to approaches to decisions and styles of decision-making. Depressed individuals became more anxious when faced with a decision, and preferred to remain passive, procrastinating or avoiding decisions. Finally, they were more likely to think poorly of their abilities as decision-makers and to not trust their intuitions. The results suggest that the failure to use adaptive decision-making strategies spontaneously is an important factor in determining the poor quality of the choices made by depressed individuals, and that prompting the use of such strategies improves decision-making considerably