TRAIT ANXIETY AS A PREDICTOR OF PSYCHOLOGICAL AND PHYSIOLOGICAL DISTRESS OVER TIME IN PATIENTS RECENTLYDIAGNOSED WITH BREAST CANCER

Breast cancer has an unpredictable course, can be fatal, and many breast cancer treatments and prevention strategies are unpleasant and have aversive side effects. Anxiety is a normal reaction to a breast cancer diagnosis and may promote adaptive responses to new demands. However, anxiety can also have negative psychological and physiological consequences. Past research has suggested that trait anxiety may be an important determinant of psychological adjustment as well as physiological disease outcomes. The specific effects of trait anxiety on the course of psychological functioning during the initial period of adjustment to disease and on disease course following diagnosis are not well understood. The primary aim of this study was to evaluate the course and influence of trait and acute anxiety in patients diagnosed with breast cancer. This study included 58 women with a new diagnosis of breast cancer. Anxiety measures, psychosocial distress measures, and salivary cortisol measurements were collected at diagnosis, and 3 and 6 months post-diagnosis. Overall, anxiety at diagnosis was related to poorer psychosocial outcomes during the first six months following a diagnosis of breast cancer. Specifically, trait anxiety was more predictive of long-term distress than was state anxiety

Risk Reducing Behaviors in a Community Sample of Women with a Family History of Breast Cancer

This study was designed to examine and explain the use of risk-reducing behaviors in a group of women recruited from the community who had a family history of breast cancer. An empirically derived model was developed that included variables hypothesized to influence adherence intentions, early detection behaviors, and high-risk clinic contact intentions. The model included the background variables of age, objective risk, education, income, and healthcare communication and the proximal variables of perceived risk, cancer specific distress, and attitude. This study also prospectively examined the use of high-risk services. Participants included women (N = 187) with a family history of breast cancer who had no prior contact with a high-risk or familial breast cancer clinic or program. Study hypotheses were tested with correlational analyses, structural equation modeling (SEM), and logistic regression. Results of SEM found that the proposed variables accounted for 42% of the variance in adherence intentions, and 23% of the variance in both early detection behaviors and clinic contact intentions. Approximately 24% of the women who participated in this study contacted the high-risk clinic to receive additional information about their risk. Predictors of clinic contact included higher objective risk, higher clinic contact intentions, lower perceived risk, and higher cancer distress. Implications of these findings are discussed

Aging in the Right Place

Background: This project builds upon a pilot study that documented innovative shelter/housing solutions that have not undergone rigorous evaluation but hold the promise of supporting “aging in the right place” for older persons (50+) with experiences of homelessness (OPEH) in Montreal, Calgary, and Vancouver. “Aging in the right place” means older adults remain in their homes and communities supported by housing, health, social services responsive to their unique lifestyles and needs. While our pilot study identified innovative shelter/housing solutions that support OPEH to establish and maintain a home and work towards aging in the right place, there remains a knowledge gap regarding what works, why it works, and for whom it works. Methods/Design: Through a community-based participatory research approach, we will conduct evaluations of 11 different promising shelter/housing practices to determine the types of practices that appear most useful in supporting aging in the right place, and the groups of OPEH for whom the promising practices work based on intersections of risk (e.g., age, gender, sexual orientation, race/ethnicity, disability, Indigenous status, and immigrant status). Our overall goal is to improve the shelter/housing options to meet the unique and complex health and social needs of OPEH across Canada. Discussion: Program evaluations will offer practice-based evidence of ways in which promising practices of shelter/housing might serve as best practices for supporting OPEH to establish and maintain a home and work towards aging in the right place. Project findings will inform housing, homelessness, health, and social service providers’ design and delivery of programs for OPEH to improve the sustainability of community housing, build provider capacity, and ensure supports that promote aging in the right place are sustained

Aging in the Right Place

Background: This project builds upon a pilot study that documented innovative shelter/housing solutions that have not undergone rigorous evaluation but hold the promise of supporting “aging in the right place” for older persons (50+) with experiences of homelessness (OPEH) in Montreal, Calgary, and Vancouver. “Aging in the right place” means older adults remain in their homes and communities supported by housing, health, social services responsive to their unique lifestyles and needs. While our pilot study identified innovative shelter/housing solutions that support OPEH to establish and maintain a home and work towards aging in the right place, there remains a knowledge gap regarding what works, why it works, and for whom it works. Methods/Design: Through a community-based participatory research approach, we will conduct evaluations of 11 different promising shelter/housing practices to determine the types of practices that appear most useful in supporting aging in the right place, and the groups of OPEH for whom the promising practices work based on intersections of risk (e.g., age, gender, sexual orientation, race/ethnicity, disability, Indigenous status, and immigrant status). Our overall goal is to improve the shelter/housing options to meet the unique and complex health and social needs of OPEH across Canada. Discussion: Program evaluations will offer practice-based evidence of ways in which promising practices of shelter/housing might serve as best practices for supporting OPEH to establish and maintain a home and work towards aging in the right place. Project findings will inform housing, homelessness, health, and social service providers’ design and delivery of programs for OPEH to improve the sustainability of community housing, build provider capacity, and ensure supports that promote aging in the right place are sustained

Brief fear of movement scale for osteoarthritis

Fear of movement has important clinical implications for individuals with osteoarthritis. This study aimed to establish a brief fear of movement scale for use in osteoarthritis. Items from the Tampa Scale for Kinesiophobia (TSK) were examined

Patterns of patient-reported symptoms and association with sociodemographic and systemic sclerosis disease characteristics: a scleroderma Patient-centered Intervention Network (SPIN) Cohort cross-sectional study

Background Systemic sclerosis is a heterogenous disease in which little is known about patterns of patient-reported symptom clusters. We aimed to identify classes of individuals with similar anxiety, depression, fatigue, sleep disturbance, and pain symptoms and to evaluate associated sociodemographic and disease-related characteristics. Methods This multi-centre cross-sectional study used baseline data from Scleroderma Patient-centered Intervention Network Cohort participants enrolled from 2014 to 2020. Eligible participants completed the PROMIS-29 v2.0 measure. Latent profile analysis was used to identify homogeneous classes of participants based on patterns of anxiety, depression, fatigue, sleep disturbance, and pain scores. Sociodemographic and disease-related characteristics were compared across classes. Findings Among 2212 participants, we identified five classes, including four classes with “Low” (565 participants, 26%), “Normal” (651 participants, 29%), “High” (569 participants, 26%), or “Very High” (193 participants, 9%) symptom levels across all symptoms. Participants in a fifth class, “High Fatigue/Sleep/Pain and Low Anxiety/Depression” (234 participants, 11%) had similar levels of fatigue, sleep disturbance, and pain as in the “High” class but low anxiety and depression symptoms. There were significant and substantive trends in sociodemographic characteristics (age, education, race or ethnicity, marital or partner status) and increasing disease severity (diffuse disease, tendon friction rubs, joint contractures, gastrointestinal symptoms) across severity-based classes. Disease severity and sociodemographic characteristics of “High Fatigue/Sleep/Pain and Low Anxiety/Depression” class participants were similar to the “High” severity class. Interpretation Most people with systemic sclerosis can be classified by levels of patient-reported symptoms, which are consistent across symptoms and highly associated with sociodemographic and disease-related variables, except for one group which reports low mental health symptoms despite high levels of other symptoms and substantial disease burden. Studies are needed to better understand resilience in systemic sclerosis and to identify and facilitate implementation of cognitive and behavioural strategies to improve coping and overall quality of life

Domain Specific Self-Efficacy Mediates the Impact of Pain Catastrophizing on Pain and Disability in Overweight and Obese Osteoarthritis Patients

This study examined whether self-efficacy mediated the relationship between pain catastrophizing and pain and disability. Participants were 192 individuals diagnosed with osteoarthritis (OA) of the knees who were overweight or obese. Multiple mediator analyses were conducted to simultaneously test self-efficacy for pain control, physical function, and emotional symptoms as mediators while controlling for demographic and medical status variables. Higher pain catastrophizing was associated with lower self-efficacy in all three domains (ps< .05). Self-efficacy for pain control fully mediated the relationship between pain catastrophizing and pain (Beta=.08, Sobel test Z=1.97, p<.05). The relationship between pain catastrophizing and physical disability was fully mediated by self-efficacy for physical function (Beta=.06, Sobel test Z=1.95, p=.05). Self-efficacy for emotional symptoms partially mediated the relationship between pain catastrophizing and psychological disability (Beta=. 12, Sobel test Z=2.92, p<.05). These results indicate that higher pain catastrophizing contributed to greater pain and disability via lower domain-specific self-efficacy. Efforts to reduce pain and improve functioning in OA patients should consider addressing pain catastrophizing and domain specific selfefficacy. Pain catastrophizing may be addressed through cognitive therapy techniques and selfefficacy may be enhanced through practice of relevant skills and personal accomplishments. Perspective- This paper found that higher pain catastrophizing contributed to great pain and disability via domain specific self-efficacy. These results suggest that treatment efforts to reduce pain and improve functioning in OA patients who are overweight or obese should consider addressing both pain catastrophizing and self-efficacy. Originally published Journal of Pain, Vol. 9, No. 10, Oct 200

Pain Coping Skills Training for African Americans With Osteoarthritis Study: Baseline Participant Characteristics and Comparison to Prior Studies

Background: The Pain Coping Skills Training for African Americans with OsteoaRTthritis (STAART) trial is examining the effectiveness of a culturally enhanced pain coping skills training (CST) program for African Americans with osteoarthritis (OA). This disparities-focused trial aimed to reach a population with greater symptom severity and risk factors for poor pain-related outcomes than previous studies. This paper compares characteristics of STAART participants with prior studies of CST or cognitive behavioral therapy (CBT)-informed training in pain coping strategies for OA. Methods: A literature search identified 10 prior trials of pain CST or CBT-informed pain coping training among individuals with OA. We descriptively compared characteristics of STAART participants with other studies, in 3 domains of the National Institutes of Minority Health and Health Disparities' Research Framework: Sociocultural Environment (e.g., age, education, marital status), Biological Vulnerability and Mechanisms (e.g, pain and function, body mass index), and Health Behaviors and Coping (e.g., pain catastrophizing). Means and standard deviations (SDs) or proportions were calculated for STAART participants and extracted from published manuscripts for comparator studies. Results: The mean age of STAART participants, 59 years (SD = 10.3), was lower than 9 of 10 comparator studies; the proportion of individuals with some education beyond high school, 75%, was comparable to comparator studies (61-86%); and the proportion of individuals who are married or living with a partner, 42%, was lower than comparator studies (62-66%). Comparator studies had less than about 1/3 African American participants. Mean scores on the Western Ontario and McMaster Universities Osteoarthritis Index pain and function scales were higher (worse) for STAART participants than for other studies, and mean body mass index of STAART participants, 35.2 kg/m2 (SD = 8.2), was higher than all other studies (30-34 kg/m2). STAART participants' mean score on the Pain Catastrophizing scale, 19.8 (SD = 12.3), was higher (worse) than other studies reporting this measure (7-17). Conclusions: Compared with prior studies with predominantly white samples, STAART participants have worse pain and function and more risk factors for negative pain-related outcomes across several domains. Given STAART participants' high mean pain catastrophizing scores, this sample may particularly benefit from the CST intervention approach

Automated Internet-based pain coping skills training to manage osteoarthritis pain: a randomized controlled trial

Osteoarthritis (OA) places a significant burden on worldwide public health because of the large and growing number of people affected by OA and its associated pain and disability. Pain coping skills training (PCST) is an evidence-based intervention targeting OA pain and disability. To reduce barriers that currently limit access to PCST, we developed an 8-week, automated, Internet-based PCST program called PainCOACH and evaluated its potential efficacy and acceptability in a small-scale, 2-arm randomized controlled feasibility trial. Participants were 113 men and women with clinically confirmed hip or knee OA and associated pain. They were randomized to a group completing PainCOACH or an assessment-only control group. Osteoarthritis pain, pain-related interference with functioning, pain-related anxiety, self-efficacy for pain management, and positive and negative affect were measured before intervention, midway through the intervention, and after intervention. Findings indicated high acceptability and adherence: 91% of participants randomized to complete PainCOACH finished all 8 modules over 8 to 10 weeks. Linear mixed models showed that, after treatment, women who received the PainCOACH intervention reported significantly lower pain than that in women in the control group (Cohen d = 0.33). Intervention effects could not be tested in men because of their low pain and small sample size. Additionally, both men and women demonstrated increases in self-efficacy from baseline to after intervention compared with the control group (d = 0.43). Smaller effects were observed for pain-related anxiety (d = 0.20), pain-related interference with functioning (d = 0.13), negative affect (d = 0.10), and positive affect (d = 0.24). Findings underscore the value of continuing to develop an automated Internet-based approach to disseminate this empirically supported intervention