Stress Matters: A Case Report in Occupational Therapy for Cancer-Related Cognitive Impairment

Background: This case report details occupational therapy (OT) for a woman with breast cancer experiencing cancer-related cognitive impairment (CRCI), referred to OT for memory strategies. Method: Preliminary subjective and cognitive screenings were completed with further/finer assessment diarized. Results: While the cognitive aspect of CRCI is often addressed via OT, in this case, stress was the most prevalent barrier to function reported. Stress was identified as: impacting occupational engagement, CRCI presentation, interfering with return-to-work goals, and accentuated given the COVID-19 pandemic. A common cancer-specific stress screening tool appeared inadequate in identifying the impact and interplay of stress on function, necessitating a more narrative exploration around these themes. Intervention details, clinical reasoning, and outcomes are profiled in this case report. Conclusion: Current published literature showcases the multi-factorial nature of CRCI, highlighting stress as an important, though often overlooked, factor, and thus an area for OT practice growth. Developing the OT approach to functional management of CRCI involves further exploration and appreciation of the relationship between stress and function. Clinical case studies offer a foundation and serve as a first step for expanding the value of OT in approaching CRCI and stress from a functional perspective, particularly considering the stressors of the current pandemic

Stress Matters: A Case Report in Occupational Therapy for Cancer-Related Cognitive Impairment

Background: This case report details occupational therapy (OT) for a woman with breast cancer experiencing cancer-related cognitive impairment (CRCI), referred to OT for memory strategies. Method: Preliminary subjective and cognitive screenings were completed with further/finer assessment diarized. Results: While the cognitive aspect of CRCI is often addressed via OT, in this case, stress was the most prevalent barrier to function reported. Stress was identified as: impacting occupational engagement, CRCI presentation, interfering with return-to-work goals, and accentuated given the COVID-19 pandemic. A common cancer-specific stress screening tool appeared inadequate in identifying the impact and interplay of stress on function, necessitating a more narrative exploration around these themes. Intervention details, clinical reasoning, and outcomes are profiled in this case report. Conclusion: Current published literature showcases the multi-factorial nature of CRCI, highlighting stress as an important, though often overlooked, factor, and thus an area for OT practice growth. Developing the OT approach to functional management of CRCI involves further exploration and appreciation of the relationship between stress and function. Clinical case studies offer a foundation and serve as a first step for expanding the value of OT in approaching CRCI and stress from a functional perspective, particularly considering the stressors of the current pandemic

Exploring adherence to daytime compression in women with breast cancer related lymphedema: a multi-methods study

Aim: The objective of this follow-up study was to explore the barriers and facilitators to use of daytime compression among women with breast cancer related lymphedema who previously took part in a trial examining the efficacy of night compression.Methods: We used a multi-methods approach involving a survey and subsequent focus group sessions. The survey questions were developed based on clinical experience and findings from the literature. Questions were framed to align with the Theoretical Domains Framework. For the focus group data, we applied an interpretive description qualitative methodology to understand participants’ experiences and views on use of daytime compression. Qualitative findings were mapped to the Theoretical Domains Framework.Results: Questionnaires were completed by 48 of 52 participants. Only 15 participants (31%) reported adhering to wearing the garment for greater than 12 h each day. Better adherence was positively associated with perceived control of lymphedema (r = 0.304; 95%CI: 0.051-0.564 ; P = 0.021). Survey findings suggest that participants have good knowledge about the rationale for, and the benefits of, wearing the compression sleeve. Twenty-three survey respondents took part in one of the five subsequent focus group sessions. Five key themes were identified representing the primary barriers to regular use of daytime compression: discomfort, negative emotions, interference with function, social situations and visibility, and use of alternative management strategies.Conclusion: The findings suggest less than optimal adherence to daytime compression sleeve use. Further research is needed to explore the relative benefit of daytime compression, optimal wear times, and implementable strategies to improve adherence

Examining Patient Engagement in Chatbot Development Approaches for Healthy Lifestyle and Mental Wellness Interventions: Scoping Review

BackgroundChatbots are growing in popularity as they offer a range of potential benefits to end users and service providers. ObjectiveOur scoping review aimed to explore studies that used 2-way chatbots to support healthy eating, physical activity, and mental wellness interventions. Our objectives were to report the nontechnical (eg, unrelated to software development) approaches for chatbot development and to examine the level of patient engagement in these reported approaches. MethodsOur team conducted a scoping review following the framework proposed by Arksey and O’Malley. Nine electronic databases were searched in July 2022. Studies were selected based on our inclusion and exclusion criteria. Data were then extracted and patient involvement was assessed. Results16 studies were included in this review. We report several approaches to chatbot development, assess patient involvement where possible, and reveal the limited detail available on reporting of patient involvement in the chatbot implementation process. The reported approaches for development included: collaboration with knowledge experts, co-design workshops, patient interviews, prototype testing, the Wizard of Oz (WoZ) procedure, and literature review. Reporting of patient involvement in development was limited; only 3 of the 16 included studies contained sufficient information to evaluate patient engagement using the Guidance for Reporting Involvement of Patients and Public (GRIPP2). ConclusionsThe approaches reported in this review and the identified limitations can guide the inclusion of patient engagement and the improved documentation of engagement in the chatbot development process for future health care research. Given the importance of end user involvement in chatbot development, we hope that future research will more systematically report on chatbot development and more consistently and actively engage patients in the codevelopment process

Virtual or In-Person: A Mixed Methods Survey to Determine Exercise Programming Preferences during COVID-19

A survey was conducted to identify barriers and facilitators to engaging in virtual and in-person cancer-specific exercise during COVID-19. A theory-informed, multi-method, cross-sectional survey was electronically distributed to 192 individuals with cancer investigating preferences towards exercise programming during COVID-19. Respondents had previously participated in an exercise program and comprised two groups: those who had experience with virtual exercise programming (‘Virtual’) and those who had only taken part in in-person exercise (‘In-Person’). Quantitative data were summarized descriptively. Qualitative data were thematically categorized using framework analysis and findings were mapped to an implementation model. The survey completion response rate was 66% (N = 127). All respondents identified barriers to attending in-person exercise programming during COVID-19 with concerns over the increased risk of viral exposure. Virtual respondents (n = 39) reported: (1) feeling confident in engaging in virtual exercise; and (2) enhanced motivation, accessibility and effectiveness as facilitators to virtual exercise. In-Person respondents (n = 88) identified: (1) technology as a barrier to virtual exercise; and (2) low motivation, accessibility and exercise effectiveness as barriers towards virtual exercise. Sixty-six percent (n = 58) of In-Person respondents reported that technology support would increase their willingness to exercise virtually. With appropriately targeted support, perceived barriers to accessing virtual exercise—including motivation, accessibility and effectiveness—may become facilitators. The availability of technology support may increase the engagement of individuals with cancer towards virtual exercise programming

Risk of Bias.

This review summarizes the effectiveness of scalable mind-body internet and mobile-based interventions (IMIs) on depression and anxiety symptoms in adults living with chronic physical conditions. Six databases (MEDLINE, PsycINFO, SCOPUS, EMBASE, CINAHL, and CENTRAL) were searched for randomized controlled trials published from database inception to March 2023. Mind-body IMIs included cognitive behavioral therapy, breathwork, meditation, mindfulness, yoga or Tai-chi. To focus on interventions with a greater potential for scale, the intervention delivery needed to be online with no or limited facilitation by study personnel. The primary outcome was mean change scores for anxiety and depression (Hedges’ g). In subgroup analyses, random-effects models were used to calculate pooled effect size estimates based on personnel support level, intervention techniques, chronic physical condition, and survey type. Meta-regression was conducted on age and intervention length. Fifty-six studies met inclusion criteria (sample size 7691, mean age of participants 43 years, 58% female): 30% (n = 17) neurological conditions, 12% (n = 7) cardiovascular conditions, 11% cancer (n = 6), 43% other chronic physical conditions (n = 24), and 4% (n = 2) multiple chronic conditions. Mind-body IMIs demonstrated statistically significant pooled reductions in depression (SMD = -0.33 [-0.40, -0.26], pSMD = -0.26 [-0.36, -0.17], pRegistration: The study is registered with PROSPERO ID #CRD42022375606.</div

Depression subgroup analyses by chronic condition groupings.

Depression subgroup analyses by chronic condition groupings.</p

Depression subgroup analyses by delivery modality.

Depression subgroup analyses by delivery modality.</p