Addressing Death Distress in Caregivers of Patients with Malignant Glioma

The field of psychosocial oncology seeks to improve the quality of life of patients and families affected by cancer. This task becomes increasingly important when there are limited, non-curative treatment options, a high probability of recurrence, and rapid functional decline, such as in the case of a malignant glioma (MG). Indeed, the diagnosis of a MG is associated with negative sequalae that often translates to higher caregiver burden. Caregivers—who must manage the functional decline of the patient, changes within the family, and a complicated medical system—often feel overwhelmed, isolated, and ill-equipped to handle these myriad responsibilities. While they also report significant depression and anxiety, caregivers specifically endorse death distress (i.e., fear, despair, or preoccupation with the patient’s inevitable mortality). Few evidenced-based interventions exist for ameliorating caregiver psychological distress, despite their stated desire for increased professional support., and none targets death distress in caregivers. Managing Cancer and Living Meaningfully (CALM) is a brief, evidence-based, supportive-expressive psychotherapy developed to address the practical and profound issues associated with advanced cancer and may benefit caregivers’ death distress. However, the suitability of CALM has yet to be evaluated in caregivers specifically. Therefore, the overarching purpose of the current study was to evaluate the suitability of CALM in caregivers of patients diagnosed with MG by collecting the foundational data necessary to enhance the intervention to meet the unique needs of this population. To achieve this goal, the current study recruited 22 bereaved caregivers to complete a focus group and subsequent questionnaires. During the focus groups, caregivers learned about the standard CALM intervention and provided feedback/recommendations to improve its suitability, feasibility, and acceptability. Their responses were qualitatively analyzed by a team of coders using thematic, deductive, latent analysis (Kappa = 0.86). The results suggest that the CALM intervention is highly relevant to the caregiving experience and might benefit caregivers emotionally, make them feel more prepared/effective, improve their communication with the patient, and provide a unique opportunity to receive specialized care specific to neuro-oncology. Potential hurdles for caregivers\u27 participation included not having sufficient time and energy, not feeling emotionally ready, fearing they would burden the patient with their emotionality, and believing their loved one would not be emotionally or cognitively capable to participate. Participants also provided recommendations for additional content areas (e.g., caregiver burden and bereavement), how to introduce services, when to initiate treatment, when to participate as an individual versus as a dyad, and how to address logistical concerns. Although CALM might be only one of many necessary interventions to support caregivers’ needs, participants’ feedback was largely positive. Their recommendations will be valuable in developing a final, optimized CALM protocol that addresses the needs of the forgotten patient in cancer care: the caregiver

Structured Poetic Expressions for Emerging Adults Experiencing Bereavement

Previous research has produced heterogeneous findings regarding the effectiveness of expressive writing in reducing grief symptomatology among the bereaved (e.g., Collison, 2016; Lichtenthal & Cruess, 2010; Stroebe et al., 2006). The purpose of this study was to address these mixed results by exploring the effects and linguistic characteristics of a novel writing task (i.e., the acrostic poem) among bereaved undergraduates, using an innovative data analysis technique (i.e., Linguistic Inquiry and Word Count). The current study recruited 68 undergraduates who had lost a loved one. Participants were randomly assigned to write over multiple days using the acrostic poem, emotional disclosure prompt, or a control writing prompt. Consistent with previous research, the results indicated no significant differences in grief between conditions over time; however, there were key group differences in linguistic content. Further, while all participants endorsed improvements in grief one week following the intervention, the participants returned to baseline one month later. Patterns of writing, coping, religiosity/ spirituality, physical symptoms, and grief in bereaved emerging adults were also assessed. The results suggest that while expressive writing might not be an effective intervention for the bereaved, the content of writing might provide clinicians some insight on psychological and spiritual processes at play in bereaved emerging adults

Screening for Cognitive Impairment in Primary Brain Tumor Patients: A Preliminary Investigation with the MMSE and RBANS

Introduction: The prevalence of mild cognition impairment (MCI) among older adults (≥65) is estimated to range between 10-20% (Langa & Levine, 2014). Integrated primary care allows opportunities for interdisciplinary consultation, screening, and intervention. The aim of this study is to explore the percentage of older adults reporting cognitive concerns during their first primary care psychology visits. It is hypothesized that these rates will mirror prevalence rates in other older adult community dwelling samples in primary care settings. Methods: A patient sample of older adults (≥60) was introduced to services following a referral from their primary care physician. Clinicians then identified problems that were discussed in session, including “cognitive concerns.” Descriptive statistics will be used to assess the percentage of older adults with “cognitive concerns” in this sample, compared to other community dwelling samples. Results: 267 older adults were identified within a larger sample of patients who received primary care psychology services. The percentage of older adults who were referred for “cognitive concerns” was 10.5% (n = 28), with 12.7% (n = 34) reporting “cognitive concerns” during their visit. Interestingly of the 28 older adults referred by their provider for “cognitive concerns,” less than 50% (n = 13) of those patients reported “cognitive concerns” as one of their problems in session. Discussion: This sample of older adults reported cognitive concerns in primary care psychology sessions at a rate that falls within the range identified in other community dwelling samples. Future research could further improve upon identification and screening of older adults with cognitive concerns by psychologists in primary care settings, as intervention for MCI can improve quality of life and may delay progression of dementia (Campbell et al., 2018; Eshkoor et al., 2015).https://scholarscompass.vcu.edu/gradposters/1088/thumbnail.jp

Death Anxiety, Religious Doubt, and Depressive Symptoms across Race in Older Adults

The purpose of this study is to investigate the direct and indirect relationships among death anxiety, religious doubt, and depressive symptoms in older adults. This study also investigates race as a moderator for these relationships. This study used data from the Religion, Aging, and Health Survey. Participants identified as Christian, identified as Black or White, lived in a non-institutionalized household within the U.S., were retired, and spoke English. Using PROCESS, results revealed that religious doubt partially mediated the relationship between death anxiety and depressive symptoms. Furthermore, moderated mediation models revealed that race moderated the relationship between religious doubt and depressive symptoms. Specifically, there was significant, positive relationship between religious doubt and depressive symptoms for participants who identified as Black but not White. Results highlight how religious doubt can influence depressive outcomes among the geriatric communities of color. Limitations and future directions are also discussed

The Relationship Between Optimism, Coping, and Depressive Symptoms in Hispanic Mothers and Fathers of Children with Autism Spectrum Disorder

This study examined gender differences in the relationship between dispositional optimism, coping, and depressive symptoms of Hispanic mothers (n = 46) and fathers (n = 43) of children with autism spectrum disorder. Coping was hypothesized to mediate the relationship between optimism and depressive symptoms. The results revealed that mothers reported greater depressive symptoms and greater use of positive and support coping than fathers; however, both mothers and fathers reported similar levels of optimism and use of avoidant coping. In addition, positive and avoidant coping strategies mediated the association between optimism and depressive symptoms for both mothers and fathers. Clinical implications for this study include interventions for improving optimistic outlooks as well as interventions that improve parents' coping skills and therefore reduce negative outcomes

Study protocol for Cognitive Behavioral Therapy for Insomnia in patients with primary brain tumor: A single-arm phase 2a proof-of-concept trial

Background: Sleep disturbance is among the most common symptoms endorsed by patients with primary brain tumor (PwPBT), with many reporting clinically elevated insomnia and poor management of their sleep-related symptoms by their medical team. Though Cognitive Behavioral Therapy for Insomnia (CBT-I) remains the front-line treatment for sleep disturbance, CBT-I has yet to be evaluated in PwPBT. Thus, it is unknown whether CBT-I is feasible, acceptable, or safe for patients with primary brain tumors. Methods: PwPBT (N = 44) will enroll and participate in a six-week group-based CBT-I intervention delivered via telehealth. Feasibility will be based on pre-determined metrics of eligibility, rates and reasons for ineligibility, enrollment, and questionnaire completion. Acceptability will be measured by participant retention, session attendance, satisfaction ratings, and recommendation to others. Safety will be assessed by adverse event reporting. Sleep will be measured both objectively via wrist-worn actigraphy and subjectively via self-report. Participants will also complete psychosocial questionnaires at baseline, post-intervention, and three-month follow-up. Conclusion: CBT-I, a non-pharmacological treatment option for insomnia, has the potential to be beneficial for an at-risk, underserved population: PwPBT. This trial will be the first to assess feasibility, acceptability, and safety of CBT-I in PwPBT. If successful, this protocol will be implemented in a more rigorous phase 2b randomized feasibility pilot with the aim of widespread implementation of CBT-I in neuro-oncology clinics

Effects of Adjuvant Endocrine Therapy–Specific Perceptions on Response to a Behavioral Intervention for Adjuvant Endocrine Therapy Adherence in Patients With Breast Cancer

PURPOSE Adjuvant endocrine therapy (AET) is a life-saving medication for patients with hormone-sensitive breast cancer, yet many struggle with adherence, warranting behavioral intervention. In our recent trial, participation in a group cognitive behavioral intervention (STRIDE) for symptom management and adherence was associated with improvements in symptom distress, coping, quality of life, and mood. We now explore whether baseline patient- and medication-specific factors—which may be modifiable by clinician-led discussions—moderated the effect of STRIDE on adherence rates. METHODS From October 2019 to June 2021, 100 patients with early-stage breast cancer reporting AET-related distress were enrolled and randomly assigned to STRIDE or a medication monitoring (MM) control group. All patients stored their AET in electronic pill bottles to track objective adherence. Patients also self-reported their adherence on the Medication Adherence Report Scale-5 and their perceptions of AET on the Cancer Therapy Satisfaction Questionnaire at baseline. We conducted hierarchical linear modeling to test moderators of intervention effects on objective adherence rates. We report the time × group × moderator effects. RESULTS Among patients reporting greater perceived difficulties with AET adherence at baseline, STRIDE participants had higher adherence rates over time compared with MM ( b = –13.80; SE = 4.56; P < .01). Patients with greater expectations of therapeutic benefit from AET also had improved adherence rates if they were assigned to STRIDE, versus MM ( b = 0.25; SE = 0.10; P = .01). Patients who perceived taking AET as convenient and had been taking their AET for less time had higher adherence rates in STRIDE, versus MM. CONCLUSION The current study identified patient- and medication-specific factors that may augment AET adherence interventions and may be modifiable through clinician-led discussions, such as perceptions of adherence problems, therapeutic efficacy, and convenience of AET. Patients’ AET perceptions moderate the effect of a behavioral intervention (STRIDE) on AET adherence in breast cance