Developing Effective Cancer Pain Education Programs

Pain is prevalent, burdensome, and undertreated in individuals with cancer across the disease trajectory. Providing patients and family caregivers psychosocial support and education to manage cancer pain is a core component of quality care that can result in significant clinical benefit. In this review, we (1) outline an approach for developing and assessing the effectiveness of education programs for adults with cancer pain; (2) discuss considerations for tailoring programs to the needs of diverse populations and those with limited health literacy skills; (3) describe the resource needs and costs of developing a program; and (4) highlight innovative approaches to cancer pain education. We conclude with recommendations for future research and the next generation of educational interventions

Resolution, Relief, And Resignation:A Qualitative Study Of Responses To Misfit At Work

Research has portrayed person–environment (PE) fit as a pleasant condition resulting from people being attracted to and selected into compatible work environments; yet, our study reveals that creating and maintaining a sense of fit frequently involves an effortful, dynamic set of strategies. We used a two-phase, qualitative design to allow employees to report how they become aware of and experience misfit, and what they do in response. To address these questions, we conducted interviews with 81 individuals sampled from diverse industries and occupations. Through their descriptions, we identified three broad responses to the experience of misfit: resolution, relief, and resignation. Within these approaches, we identified distinct strategies for responding to misfit. We present a model of how participants used these strategies, often in combination, and develop propositions regarding their effectiveness at reducing strain associated with misfit. These results expand PE fit theory by providing new insight into how individuals experience and react to misfit—portraying them as active, motivated creators of their own fit experience at work

SLC6A3 and body mass index in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial

<p>Abstract</p> <p>Background</p> <p>To investigate the contribution of the dopamine transporter to dopaminergic reward-related behaviors and anthropometry, we evaluated associations between polymorphisms at the dopamine transporter gene(<it>SLC6A3</it>) and body mass index (BMI), among participants in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial.</p> <p>Methods</p> <p>Four polymorphisms (rs6350, rs6413429, rs6347 and the 3' variable number of tandem repeat (3' VNTR) polymorphism) at the <it>SLC6A3 </it>gene were genotyped in 2,364 participants selected from the screening arm of PLCO randomly within strata of sex, age and smoking history. Height and weight at ages 20 and 50 years and baseline were assessed by questionnaire. BMI was calculated and categorized as underweight, normal, overweight and obese (<18.5, 18.5–24.9, 25.0–29.9, or ≥ 30 kg/m², respectively). Odds ratios (ORs) and 95% confidence intervals (CIs) of <it>SLC6A3 </it>genotypes and haplotypes were computed using conditional logistic regression.</p> <p>Results</p> <p>Compared with individuals having a normal BMI, obese individuals at the time of the baseline study questionnaire were less likely to possess the <it>3' </it>VNTR variant allele with 9 copies of the repeated sequence in a dose-dependent model (** is referent; OR_*9= 0.80, OR₉₉= 0.47, p_trend= 0.005). Compared with individuals having a normal BMI at age 50, overweight individuals (A-C-G-* is referent; OR_A-C-G-9= 0.80, 95% CI 0.65–0.99, p = 0.04) and obese individuals (A-C-G-* is referent; OR_A-C-G-9= 0.70, 95% CI 0.49–0.99, p = 0.04) were less likely to possess the haplotype with the 3'variant allele (A-C-G-9).</p> <p>Conclusion</p> <p>Our results support a role of genetic variation at the dopamine transporter gene, <it>SLC6A3</it>, as a modifier of BMI.</p

Safety and Benefit of Discontinuing Statin Therapy in the Setting of Advanced, Life-Limiting Illness: A Randomized Clinical Trial

For patients with limited prognosis, some medication risks may outweigh the benefits, particularly when benefits take years to accrue; statins are one example. Data are lacking regarding the risks and benefits of discontinuing statin therapy for patients with limited life expectancy

Determinants of mental health utilization in a palliative care outpatient setting

This study examines the determinants of psychology service utilization among a chronically ill population. Data were combined from an outpatient palliative care clinic using two patient outcome studies for a secondary data analysis. Overall, 149 patients were examined with the majority being middle-aged (M = 55, SD = 14.73), female (n=112; 75.2%) and White (n=123; 82.6%) with a primary diagnosis of cancer (n=117; 78.5%) over a 37 month time period. Using the Behavioral Model of Health Service Use (Andersen, 1995), separate logistic regression analyses were conducted to assess for significant predisposing, enabling and need factor determinants of psychology service utilization in outpatient palliative care. The significant determinants from each of these factors were then modeled together. The total number of visits to see a palliative care physician was found to be the strongest determinant of psychology service utilization (p < .001). Seeing multiple providers was also a statistically significant determinant of psychology service utilization (p = .002) as well as not taking a non-opioid analgesic (p = .024). These findings suggest enabling factors from Andersen's model are most strongly associated with psychology service utilization in outpatient palliative care populations. Of note, many factors associated with need for psychology services, such as emotional distress, psychological symptom burden or having a psychological comorbidity, did not reach significance in determining psychology service use. These findings reinforce previous research that indicates chronically ill individuals are not likely to receive mental health care even though it is documented that they have increased distress related to their mental health. Also, these findings indicate the need for further investigation as to who is receiving referrals for psychology services, as it is noted in the scientific literature that many chronically ill individuals are under-recognized as needing mental health care referrals by their physicians. (Published By University of Alabama Libraries