Rates of Depression and Anxiety in Cancer Patients: A Review of Cross-National Findings

Cancer is the leading cause of death worldwide. In this paper, we examine the similarities and differences between the United States (US) and the European Union (EU-27) in the incidences, deaths, types of screening, and screening rates for breast, cervical, colorectal, prostate, and lung cancers. We highlight the differences between the health care, economic, and sociopolitical systems in the US and EU-27 that result in different types of coverage, access to health care, and cancer screening. Finally, we discuss patient-directed, provider-directed, community-directed, and system-directed interventions and the outcomes of these approaches

Self vs. Parent: Factors Influencing Likelihood of Hiring a Healthcare Advocate

Objective: To determine how the factors that may lead an individual to hire a healthcare advocate to aid him/herself in navigating the healthcare system when dealing with chronic or complex health issues differ from the factors that are considered when deciding to hire a healthcare advocate for one’s parent.Methods: 1,740 randomly selected participants completed a brief vignette-based questionnaire that indicated their likelihood of hiring an HCA for oneself or a parent. Confirmatory factor analysis and structural equation modeling were used to test the effects of predisposing, enabling, and illness factors on the predicted likelihood.Results: Although neither model fit well statistically, both fit well descriptively. The direct path from predisposing to enabling factors and the indirect path from predisposing factors to illness level were significant in both models. Discussion: Understanding the factors that influence the decision to hire an HCA could help health providers target patients who are most likely to use HCA services, thereby reducing the burden on the healthcare system and improving quality of care

Sleep Disturbances in Fibromyalgia Syndrome: Relationship to Pain and Depression

Objective This study is an examination of sleep, pain, depression, and physical functioning at baseline and 1-year followup among patients with fibromyalgia syndrome (FMS). Although it is clear that these symptoms are prevalent among FMS patients and that they are related, the direction of the relationship is unclear. We sought to identify and report sleep problems in this population and to examine their relationship to pain, depression, and physical functioning. Methods Patients diagnosed with fibromyalgia were recruited from a Southern California health maintenance organization and evaluated according to American College of Rheumatology criteria in the research laboratory. Six hundred patients completed the baseline assessment and 492 completed the 1-year assessment. Measures included the Center for Epidemiologic Studies Depression Scale, the McGill Pain Questionnaire, the Pittsburgh Sleep Quality Index, and the Fibromyalgia Impact Questionnaire. Results The majority of the sample (96% at baseline and 94.7% at 1 year) scored within the range of problem sleepers. Path analyses examined the impact of baseline values on 1-year values for each of the 4 variables. No variable of interest predicted sleep, sleep predicted pain (β = 0.13), pain predicted physical functioning (β = −0.13), and physical functioning predicted depression (β = −0.10). Conclusion These findings highlight the high prevalence of sleep problems in this population and suggest that they play a critical role in exacerbating FMS symptoms. Furthermore, they support limited existing findings that sleep predicts subsequent pain in this population, but also extend the literature, suggesting that sleep may be related to depression through pain and physical functioning

Ethnic Differences in Perceptions of Alzheimer’s Disease: Implications for Seeking Assistance in Caring for an Ill Parent

Purpose: To examine ethnic differences in ratings of 1) condition severity, 2) need for medical assistance, and 3) likelihood of hiring a Healthcare Advocate (HCA) for an ill, elderly parent as a function of 1) parent’s cognitive state (Alzheimer’s disease [AD] or cognitively healthy), 2) parent’s physical malady (hip fracture or heart attack), and 3) distance (near or far from the parent), with an emphasis on the interaction between ethnicity and cognitive state. Method: Nine-hundred-seventy-four individuals who identified as White, Black, Hispanic, or Asian/Pacific Islander read a hypothetical vignette about an older man. The man’s physical malady (heart attack or hip fracture), cognitive state (AD or no AD), and physical distance from a close family member were manipulated in the vignette. Participants rated the severity of the medical condition and their likelihood of hiring an HCA. Results: Black and Asian/Pacific Islander participants did not differ from White participants on any outcomes. Unlike White participants, Hispanic participants did not rate the older man’s condition as more severe and were not more likely to seek assistance when he had AD than when he was cognitively healthy. Conclusion: Ethnic differences in perceptions of AD may be less extensive than previously thought. The medical severity of AD did not appear to be recognized among the Hispanic participants in our sample, suggesting that culturallysensitive AD education may be particularly important in this subgroup

Health Care Advocacy: The Relationships between Age, Chronicity, Comorbidity, and Perceived Need for Assistance

Background and Purpose: The U.S. population is living longer; therefore, a relatively large proportion of the population is likely to experience chronic illnesses within their lifetime. An experimental study was conducted to examine factors influencing the likelihood of hiring a Health Care Advocate (HCA). Methods: Survey data were collected from a randomly selected community sample of participants (N = 470) over the age of 18 who were provided with a description of an HCA and a written vignette describing a medical scenario. Participants read one of eight vignettes in which they were asked to imagine they were in a car accident and required medical care. Age, injury (chronic vs. acute), and presence of comorbid chronic condition were manipulated. Results: A significant interaction indicated that when there was no pre-existing chronic health condition, sustaining a chronic injury increased the likelihood of hiring an HCA. In addition, younger adults with comorbid conditions were perceived as having greater need for an HCA than younger adults without comorbid conditions. Older adults were perceived as benefiting from HCAs regardless of comorbid conditions. Conclusion: This study demonstrates the need for patient-centered support for older adults following an injury, and for younger adults when a pre-existing chronic condition exists. Efforts should be made to target services to these populations of interest

Effects of Age, Mental Health, and Comorbidity on the Perceived Likelihood of Hiring a Healthcare Advocate

Background and Purpose: The projected increase in chronically ill older adults may overburden the healthcare system and compromise the receipt of quality and coordinated health care services. Healthcare advocates (HCAs) may help to alleviate the burden associated with seeking and receiving appropriate health care. We examined whether having dementia or depression, along with hypertension and arthritis, or having no comorbid medical conditions, and being an older adult, affected the perceived likelihood of hiring an HCA to navigate the health care system. Method: Participants (N = 1,134), age 18 or older, read a vignette and imagined themselves as an older adult with either a mood or cognitive disorder, and comorbid medical conditions or as otherwise being physically healthy. They were then asked to complete a questionnaire assessing their perceived likelihood of hiring an HCA. Results: Participants who imagined themselves as having dementia reported a greater likelihood of hiring an HCA than participants who imagined themselves as having depression (p < .001). Conclusion: It is imperative that health care professionals attend to the growing and ongoing needs of older adults living with chronic conditions, and HCAs could play an important role in meeting those needs

Demographic Predictors of the Perceived Likelihood of Hiring a Health Care Advocate

Background and Significance: The field of health care advocacy developed in response to the growing complexity of the health care system. A Health Care Advocate (HCA) is a trained professional who can help patients navigate the health care system. In the present study we investigated the effects of social support, number of people with whom individuals reside, gender, age, income, and race on the perceived likelihood of hiring an HCA for oneself. Method: Nine hundred and eighty-seven adults (Mage = 45.48 years, SD = 17.33 years, 55.4% female) were randomly selected and asked to complete a questionnaire. To explore the relationships of the perceived likelihood of hiring an HCA, path-analytic models using full-information maximum likelihood (FIML) estimation were tested, using Stata 12.1. Results: The model fit well statistically, ? 2 (5, N = 987) = 8.50, p = 0.131, and descriptively, CFI = 0.999, RMSEA = 0.027, pclose = 0.891, CD = 0.205. Conclusion: Overall, the model accounted for 4.30% of the variance in Hire HCA. More research is needed to better understand the role of an HCA in our complex and everchanging health care system

Predictors of Quality of Life Among Breast Cancer Patients

Over 3.1 million women living in the U.S. have been diagnosed with breast cancer. The purpose of the present study was to determine whether stage of cancer, psychological distress, cognitive fusion (fusion of one’s thoughts and emotions), mindfulness, and resilience were related to quality of life among breast cancer patients. Participants were 24 women, aged 41-71, diagnosed with stage 0-3 breast cancer, recruited to participate in a pilot intervention study. All data for this study were collected at the baseline assessment. A multiple linear regression analysis explained 79.1% of the total variance in quality of life, F(5, 14) = 15.400, p < .001, Adjusted R2 = .791. Higher resilience significantly predicted higher quality of life (b = 2.392, p = .002), whereas higher stage of cancer (b = -8.068, p = .030) and higher levels of psychological distress (b = -1.737, p < .001) significantly predicted lower quality of life. Contrary to the hypotheses, higher levels of mindfulness significantly predicted lower quality of life (b = -0.612, p = .022). Cognitive fusion did not significantly predict quality of life (p > .05). More research is needed to determine how various factors predict quality of life among breast cancer patients