Randomized clinical trial of a brief and extensive dyadic intervention for advanced cancer patients and their family caregivers

Background Few intervention programs assist patients and their family caregivers to manage advanced cancer and maintain their quality of life (QOL). This study examined (i) whether patient–caregiver dyads (i.e., pairs) randomly assigned to a brief or extensive dyadic intervention (the FOCUS Program) had better outcomes than dyads randomly assigned to usual care and (ii) whether patients' risk for distress and other factors moderated the effect of the brief or extensive program on outcomes. Methods Advanced cancer patients and their caregivers ( N  = 484 dyads) were stratified by patients' baseline risk for distress (high versus low), cancer type (lung, colorectal, breast, or prostate), and research site and then randomly assigned to a brief (three‐session) or extensive (six‐session) intervention or control. The interventions offered dyads information and support. Intermediary outcomes were appraisals (i.e., appraisal of illness/caregiving, uncertainty, and hopelessness) and resources (i.e., coping, interpersonal relationships, and self‐efficacy). The primary outcome was QOL. Data were collected prior to intervention and post‐intervention (3 and 6 months from baseline). The final sample was 302 dyads. Repeated measures MANCOVA was used to evaluate outcomes. Results Significant group by time interactions showed that there was an improvement in dyads' coping ( p  < 0.05), self‐efficacy ( p  < 0.05), and social QOL ( p  < 0.01) and in caregivers' emotional QOL ( p  < 0.05). Effects varied by intervention dose. Most effects were found at 3 months only. Risk for distress accounted for very few moderation effects. Conclusions Both brief and extensive programs had positive outcomes for patient–caregiver dyads, but few sustained effects. Patient–caregiver dyads benefit when viewed as the ‘unit of care’. Copyright © 2012 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/96760/1/pon3036.pd

Molecular mechanisms of cell death: recommendations of the Nomenclature Committee on Cell Death 2018.

Over the past decade, the Nomenclature Committee on Cell Death (NCCD) has formulated guidelines for the definition and interpretation of cell death from morphological, biochemical, and functional perspectives. Since the field continues to expand and novel mechanisms that orchestrate multiple cell death pathways are unveiled, we propose an updated classification of cell death subroutines focusing on mechanistic and essential (as opposed to correlative and dispensable) aspects of the process. As we provide molecularly oriented definitions of terms including intrinsic apoptosis, extrinsic apoptosis, mitochondrial permeability transition (MPT)-driven necrosis, necroptosis, ferroptosis, pyroptosis, parthanatos, entotic cell death, NETotic cell death, lysosome-dependent cell death, autophagy-dependent cell death, immunogenic cell death, cellular senescence, and mitotic catastrophe, we discuss the utility of neologisms that refer to highly specialized instances of these processes. The mission of the NCCD is to provide a widely accepted nomenclature on cell death in support of the continued development of the field

The impact of family presence on the physician-cancer patient interaction

Physician behaviors were studied in 473 interactions between oncologists and adult cancer outpatients. Ninety-nine of these interactions occured when family members were present during the visit. Patients with family members present were likely to be sicker as demonstrated by a poorer performance status. Contrary to earlier reports, age of the patient did not predict whether the patient was likely to be accompanied by a family member. The physician behaviors were factor analyzed to produce six factors and a multivariate analysis of variance was conducted using the presence of family and performance status as independent variables. The time the physician spent in the patient's room, patient satisfaction and quality of life were also examined in separate analyses. The time the physician spent with the patient was greater when family were present. The results showed that, in general, physicians provide more information when patients are accompanied by family members, or if no family are present, when the patient has a worse performance status. Patient satisfaction and quality of life were rated lower for patients with a worse performance status and were not impacted by physician behaviors. Physicians' behavior was affected by both the presence of a family member, and the patient's performance status.family physician-cancer patient relationship

Information and decision-making preferences of hospitalized adult cancer patients

Physician behaviors and patient responses were studied in 439 interactions between hospitalized adult cancer patients and oncologists to investigate patient preferences for a participatory role in the interaction. Patients were asked their preference for information to be given (minimal; only if it is good news; or all information, good or bad) and their preference for participation in decision-making (prefer doctor makes therapeutic decisions or prefer to participate in decisions). The majority (92%) preferred all information be given, but only 69% preferred to participate in therapeutic decisions. Of those wanting all the information, 24.9% preferred the physician to make the therapeutic decisions. This group was comprised primarily of older, sicker males. Those who did not want to participate were also slightly more satisfied (Pdoctor-cancer patient relationship

Information seeking during "bad news" oncology interactions: Question asking by patients and their companions

Previous research has investigated patient question asking in clinical settings as a strategy of information seeking and as an indicator of the level of active patient participation in the interaction. This study investigates questions asked by patients and their companions during stressful encounters in the oncology setting in the USA. We transcribed all questions patients and companions asked the oncologist during 28 outpatient interactions in which "bad news" was discussed (n=705) and analyzed them for frequency and topic. Additionally, we analyzed the extent to which personal and demographic characteristics and independently obtained ratings of the oncologist-patient/companion relationships were related to question asking. Findings demonstrated that at least one companion was present in 24 (86%) of the 28 interactions and companions asked significantly more questions than patients. The most frequently occurring topics for both patients and companions were treatment, diagnostic testing, diagnosis, and prognosis. In general, personal and demographic characteristics were unrelated to question asking, but older patients asked fewer questions, while more educated patients asked more questions. With regard to ratings of the quality of the dyadic relationships, results showed that "trust" between the physician and companions was positively correlated and "conversational dominance by physician" was negatively correlated with the frequency of companion questions. Additionally, positive ratings of the relationship between physicians and companions were correlated with fewer patient questions. This study demonstrates that companions are active participants in stressful oncology interactions. Future research and physician training in communication would benefit from expanding the focus beyond the patient-physician dyad to the roles and influence of multiple participants in medical interactions.Cancer Physician-patient communication Question asking Information-seeking USA