Sharing bad news of a lung cancer diagnosis: understanding through communication privacy management theory.

BACKGROUND: The aim of this paper is to understand the process of information disclosure and privacy as patients share their news of lung cancer with significant others. METHODS: Twenty patients with lung cancer and 17 family members/friends accompanying them at diagnosis-giving completed either individual or dyad semi-structured interviews. Initial thematic analysis, then Petronio's Communication Privacy Management theory was used to inform interpretation. RESULTS: Patients described a sense of ownership of the news of their cancer and sought control of how, when and with whom it was shared. Family members expressed a need to follow the patients' rules in sharing this news, which limited their own support systems. Patients and family members had to live within the relational communication boundaries in order to maintain their trusting relationship and avoid potential disruptions. CONCLUSION: Patients as individuals are strongly interlinked with significant others, which impacts on their experience of disclosing private information. This shapes their psychological processes and outcomes impacting on their illness experience. This should be considered when developing interventions to support patients with sharing bad news. Copyright © 2015 John Wiley & Sons, Ltd.This project was funded by Dimbleby Cancer Care Research FundThis is the author accepted manuscript. The final version is available from Wiley via http://dx.doi.org/10.1002/pon.402

How do women at increased breast cancer risk perceive and decide between risks of cancer and risk-reducing treatments? A synthesis of qualitative research

Objective: Risk‐reducing procedures can be offered to people at increased cancer risk, but many procedures can have iatrogenic effects. People therefore need to weigh risks associated with both cancer and the risk‐reduction procedure in their decisions. By reviewing relevant literature on breast cancer (BC) risk reduction, we aimed to understand how women at relatively high risk of BC perceive their risk and how their risk perceptions influence their decisions about risk reduction. Methods: Synthesis of 15 qualitative studies obtained from systematic searches of SCOPUS, Web of Knowledge, PsychINFO, and Medline electronic databases (inception‐June 2015). Results: Women did not think about risk probabilistically. Instead, they allocated themselves to broad risk categories, typically influenced by their own or familial experiences of BC. In deciding about risk‐reduction procedures, some women reported weighing the risks and benefits, but papers did not describe how they did so. For many women, however, an overriding wish to reduce intense worry about BC led them to choose aggressive risk‐reducing procedures without such deliberation. Conclusions: Reasoning that categorisation is a fundamental aspect of risk perception, we argue that patients can be encouraged to develop more nuanced and accurate categorisations of their own risk through their interactions with clinicians. Empirically‐based ethical reflection is required to determine whether and when it is appropriate to provide risk‐reduction procedures to alleviate worry

Acquiring a pet dog significantly reduces stress of primary carers for children with autism spectrum disorder: a prospective case control study

This study describes the impact of pet dogs on stress of primary carers of children with Autism Spectrum Disorder (ASD). Stress levels of 38 primary carers acquiring a dog and 24 controls not acquiring a dog were sampled at: Pre-intervention (17 weeks before acquiring a dog), post-intervention (3–10 weeks after acquisition) and follow-up (25–40 weeks after acquisition), using the Parenting Stress Index. Analysis revealed significant improvements in the intervention compared to the control group for Total Stress, Parental Distress and Difficult Child. A significant number of parents in the intervention group moved from clinically high to normal levels of Parental Distress. The results highlight the potential of pet dogs to reduce stress in primary carers of children with an ASD

Mono- versus polydrug abuse patterns among publicly funded clients

To examine patterns of mono- versus polydrug abuse, data were obtained from intake records of 69,891 admissions to publicly funded treatment programs in Tennessee between 1998 and 2004. While descriptive statistics were employed to report frequency and patterns of mono- and polydrug abuse by demographic variables and by study years, bivariate logistic regression was applied to assess the probability of being a mono- or polydrug abuser for a number of demographic variables. The researchers found that during the study period 51.3% of admissions reported monodrug abuse and 48.7% reported polydrug abuse. Alcohol, cocaine, and marijuana were the most commonly abused substances, both alone and in combination. Odds ratio favored polydrug abuse for all but one drug category–other drugs. Gender did not affect drug abuse patterns; however, admissions for African Americans and those living in urban areas exhibited higher probabilities of polydrug abuse. Age group also appeared to affect drug abuse patterns, with higher odds of monodrug abuse among minors and adults over 45 years old. The discernable prevalence of polydrug abuse suggests a need for developing effective prevention strategies and treatment plans specific to polydrug abuse

Does palliative care improve outcomes for patients with HIV/AIDS? A systematic review of the evidence

Background: The need for palliative care in HIV management is underlined by the high prevalence of pain and symptoms, the toxicity, side effects, and virological failure associated with antiretroviral therapy, emergence of co-morbidities, continued high incidence of malignancies, late presentation of people with HIV disease, and the comparatively higher death rates among the infected individuals. Methods: A systematic review was undertaken to appraise the effect of models of palliative care on patient outcomes. A detailed search strategy was devised and biomedical databases searched using specific terms relevant to models of palliative care. Data from papers that met the inclusion criteria were extracted into common tables, and evidence independently graded using well described hierarchy of evidence. Results: 34 services met the inclusion criteria. Of these, 22 had been evaluated, and the evidence was graded as follows: grade 1 (n = 1); grade 2 (n = 2); grade 3 (n = 7); grade 4 (n = 1); qualitative (n = 6). Services were grouped as: home based care (n = 15); home palliative care/hospice at home (n = 7); hospice inpatient (n = 4); hospital inpatient palliative care (n = 4); specialist AIDS inpatient unit (n = 2); and hospital inpatient and outpatient care (n = 2). The evidence largely demonstrated that home palliative care and inpatient hospice care significantly improved patient outcomes in the domains of pain and symptom control, anxiety, insight, and spiritual wellbeing. Conclusions: Although the appraisal of evidence found improvements across domains, the current body of evidence suffers from a lack of (quasi) experimental methods and standardised measures. The specialism of palliative care is responding to the clinical evidence that integration into earlier disease stages is necessary. Further studies are needed to both identify feasible methods and evaluate the apparent beneficial effect of palliative care on patient outcomes in the post-HAART era

Psychosocial Influences on Disaster Preparedness in San Francisco Recipients of Home Care.

Disasters disproportionately impact certain segments of the population, including children, pregnant women, people living with disabilities and chronic conditions and those who are underserved and under-resourced. One of the most vulnerable groups includes the community-dwelling elderly. Post-disaster analyses indicate that these individuals have higher risk of disaster-related morbidity and mortality. They also have suboptimal levels of disaster preparedness in terms of their ability to shelter-in-place or evacuate to a shelter. The reasons for this have not been well characterized, although impaired health, financial limitations, and social isolation are believed to act as barriers to preparedness as well as to adaptability to changes in the environment both during and in the immediate aftermath of disasters. In order to identify strategies that address barriers to preparedness, we recently conducted a qualitative study of 50 elderly home care recipients living in San Francisco. Data were collected during in-home, in-person interviews using a semi-structured interview guide that included psychosocial constructs based on the social cognitive preparedness model and a new 13-item preparedness checklist. The mean preparedness score was 4.74 (max 13, range 1-11, SD. 2.11). Over 60 % of the participants reported that they had not made back-up plans for caregiver assistance during times of crisis, 74 % had not made plans for transportation to a shelter, 56 % lacked a back-up plan for electrical equipment in case of power outages, and 44 % had not prepared an emergency contacts list-the most basic element of preparedness. Impairments, disabilities, and resource limitations served as barriers to preparedness. Cognitive processes that underlie motivation and intentions for preparedness behaviors were lacking. There were limitations with respect to critical awareness of hazards (saliency), self-efficacy, outcome expectancy, and perceived responsibility. There was also a lack of trust in response agencies and authorities and a limited sense of community. Participants wanted to be prepared and welcomed training, but physical limitations kept many of them home bound. Training of home care aides, the provision of needed resources, and improved community outreach may be helpful in improving disaster outcomes in this vulnerable segment of the population