Group support for patients with metastatic cancer. A randomized outcome study.
01 May 1981-Archives of General Psychiatry (American Medical Association)-Vol. 38, Iss: 5, pp 527-533
TL;DR: Objective evidence is provided that a supportive group intervention for patients with metastatic cancer results in psychological benefit and mechanisms underlying the effectiveness of this group intervention are explored.
Abstract: • The effects of weekly supportive group meetings for women with metastatic carcinoma of the breast were systematically evaluated in a one-year, randomized, prospective outcome study. The groups focused on the problems of terminal illness, including improving relationships with family, friends, and physicians and living as fully as possible in the face of death. We hypothesized that this intervention would lead to improved mood, coping strategies, and self-esteem among those in the treatment group. Eighty-six patients were tested at four-month intervals. The treatment group had significantly lower mooddisturbance scores on the Profile of Mood States scale, had fewer maladaptive coping responses, and were less phobic than the control group. This study provides objective evidence that a supportive group intervention for patients with metastatic cancer results in psychological benefit. Mechanisms underlying the effectiveness of this group intervention are explored.
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TL;DR: A clinical effectiveness and cost-effectiveness study of treatment as usual (TAU) plus manualised CBT, delivered by high-level Improving Access to Psychological Therapy (IAPT) practitioners, versus TAU for people with advanced cancer and depression, measured at baseline, 6, 12, 18 and 24 weeks.
Abstract: Background With a prevalence of up to 16.5%, depression is one of the commonest mental disorders in people with advanced cancer. Depression reduces the quality of life (QoL) of patients and those close to them. The National Institute for Health and Care Excellence (NICE) guidelines recommend treating depression using antidepressants and/or psychological treatments, such as cognitive–behavioural therapy (CBT). Although CBT has been shown to be effective for people with cancer, it is unclear whether or not this is the case for people with advanced cancer and depression. Objectives To assess the clinical effectiveness and cost-effectiveness of treatment as usual (TAU) plus manualised CBT, delivered by high-level Improving Access to Psychological Therapy (IAPT) practitioners, versus TAU for people with advanced cancer and depression, measured at baseline, 6, 12, 18 and 24 weeks. Design Parallel-group, single-blind, randomised trial, stratified by whether or not an antidepressant was prescribed, comparing TAU with CBT plus TAU. Setting Recruitment took place in oncology, hospice and primary care settings. CBT was delivered in IAPT centres or/and over the telephone. Participants Patients (N = 230; n = 115 in each arm) with advanced cancer and depression. Inclusion criteria were a diagnosis of cancer not amenable to cure, a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) diagnosis of depressive disorder using the Mini-International Neuropsychiatric Interview, a sufficient understanding of English and eligibility for treatment in an IAPT centre. Exclusion criteria were an estimated survival of < 4 months, being at high risk of suicide and receiving, or having received in the last 2 months, a psychological intervention recommended by NICE for treating depression. Interventions (1) Up to 12 sessions of manualised individual CBT plus TAU delivered within 16 weeks and (2) TAU. Outcome measures The primary outcome was the Beck Depression Inventory, version 2 (BDI-II) score at 6, 12, 18 and 24 weeks. Secondary outcomes included scores on the Patient Health Questionnaire-9, the Eastern Cooperative Oncology Group Performance Status, satisfaction with care, EuroQol-5 Dimensions and the Client Services Receipt Inventory, at 12 and 24 weeks. Results A total of 80% of treatments (185/230) were analysed: CBT (plus TAU) (n = 93) and TAU (n = 92) for the BDI-II score at all time points using multilevel modelling. CBT was not clinically effective [treatment effect –0.84, 95% confidence interval (CI) –2.76 to 1.08; p = 0.39], nor was there any benefit for other measures. A subgroup analysis of those widowed, divorced or separated showed a significant effect of CBT on the BDI-II (treatment effect –7.21, 95% CI –11.15 to –3.28; p < 0.001). Economic analysis revealed that CBT has higher costs but produces more quality-adjusted life-years (QALYs) than TAU. The mean service costs for participants (not including the costs of the interventions) were similar across the two groups. There were no differences in EQ-5D median scores at baseline, nor was there any advantage of CBT over TAU at 12 weeks or 24 weeks. There was no statistically significant improvement in QALYs at 24 weeks. Limitations Although all participants satisfied a diagnosis of depression, for some, this was of less than moderate severity at baseline, which could have attenuated treatment effects. Only 64% (74/115) took up CBT, comparable to the general uptake through IAPT. Conclusions Cognitive–behavioural therapy (delivered through IAPT) does not achieve any clinical benefit in advanced cancer patients with depression. The benefit of CBT for people widowed, divorced or separated is consistent with other studies. Alternative treatment options for people with advanced cancer warrant evaluation. Screening and referring those widowed, divorced or separated to IAPT for CBT may be beneficial. Whether or not improvements in this subgroup are due to non-specific therapeutic effects needs investigation. Trial registration Current Controlled Trials ISRCTN07622709. Funding This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 19. See the NIHR Journals Library website for further project information.
23 citations
TL;DR: Psychoneuroimmunological research in HIV-1 seropositives is a rapidly developing field, yielding contradictory findings so far, but which in the long run could provide important knowledge for psychoimmunologic interventions, targeted at improving or preserving immune status and retarding disease progression, as well as optimizing psychosocial functioning.
Abstract: Behavioral factors may have an effect on the course of infection in HIV-1 infected individuals. These effects can be mediated by the immune system of the host, which, based on psychoneuroimmunologic findings, can be affected by some psychosocial factors. We present a short review of some putative psychoneuroimmunologic pathways and their possible implications for HIV-1 infected individuals. We next summarize the findings of recent psychoimmunological work with HIV-1 seropositives and discuss the methodological problems in studying the psychoneuroimmunologic aspects of HIV-1 infection. Psychoneuroimmunologic research in HIV-1 seropositives is a rapidly developing field, yielding contradictory findings so far, but which in the long run could provide important knowledge for psychoimmunologic interventions, targeted at improving or preserving immune status and retarding disease progression, as well as optimizing psychosocial functioning.
23 citations
TL;DR: Group psycho-education played a significant role in improving the well-being status and reducing depression of breast cancer survivors.
Abstract: Background: The psychological stress after diagnosis of breast cancer is often severe. Most of the women with breast cancer and their families suffer from emotional, social, financial and psychological disturbances. Materials and Methods: A cluster non-randomized trial was conducted at a Cancer Society in Melaka, Malaysia to assess the effectiveness of psycho-education on well-being status and depression among breast cancer patients. The study period was for one month (11 th June 2011 and 16 th July 2011). Participants in this study were 34 adult women suffering from non-metastatic breast cancer and on appropriate allopathic medication. The WHO-five Well-being Index (1998 version) was used as the screening instrument for the assessment of well-being and depression. The data collected were tabulated and analyzed by using the Statistical Package for Social Sciences (SPSS) version 11.0. Wilcoxon Signed-rank Test was applied for comparison between pre-test and post-test scores. A P value Results: This study revealed that majority of the participants was in the state of adequate well-being after the psycho-education 33 (97.1%). The proportion of depressed individuals had also reduced from 8 (23.5%) to 1 (2.9%) after the psychological intervention. The post-test results significantly improved after the intervention for the items related to I have felt calm and relaxed, I woke up feeling fresh and rested and my daily life has been filled with things that interest me along with the overall impression in the WHO-5 Well-being Index. Conclusion: Group psycho-education played a significant role in improving the well-being status and reducing depression of breast cancer survivors.
23 citations
TL;DR: In this article, the authors investigated the process, outcome and satisfaction in three types of cancer support groups: patients with cancer, bereaved spouses and other relatives, which followed a model similar to that of Spiegel and Spira's supportive expressive groupwork.
Abstract: This paper presents an investigation into the process, outcome and satisfaction in three types of cancer support groups: patients with cancer, bereaved spouses and other relatives. The groups followed a model similar to that of Spiegel and Spira's supportive- expressive groupwork (1991). At post-test 392 clients completed a group process and consumer satisfaction questionnaire. In addition, 77 clients also completed the Brief Symptom Inventory (Derogatis & Melisaratos, 1983) as a pre- and post-test. The Brief Symptom Inventory data indicated clients were able to achieve more optimal emotional functioning following support group participation Patients were the least satisfied of the three conditions and bereaved spouses the most satisfied. Recommendations are offered for screening, group composition, and future research.
23 citations
TL;DR: The Life Tape Project (LTP) as mentioned in this paper helps bring families closer together, increases communication, and acts as an existential intervention leading to greater sense of legacy, meaning, self-awareness, identity, and connection.
Abstract: Cancer poses a powerful threat to the emotional equilibrium of patients and their families. A key role of the family and medical team is to provide a supportive environment as the patient confronts the reality of death. Few interventions have been developed to help families support patients in dealing with fears of death and dying. We present one such approach, the Life Tape Project (LTP), that helps bring families closer together, increases communication, and acts as an existential intervention leading to greater sense of legacy, meaning, self-awareness, identity, and connection. Additionally, the results of a pilot study exploring the benefits of the LTP are presented, and we describe symbolic immortality, an aspect of existential coping, to illuminate how existential and social support factors can work together to benefit patients and their families.
22 citations
Cites background from "Group support for patients with met..."
...We have already suggested that the experience of existential isolation is one distressing aspect of existential anxiety that is effectively countered by social support (Spiegel, 1993; Spiegel et al., 1981)....
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References
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TL;DR: In this paper, the effects of reward or reinforcement on preceding behavior depend in part on whether the person perceives the reward as contingent on his own behavior or independent of it, and individuals may also differ in generalized expectancies for internal versus external control of reinforcement.
Abstract: The effects of reward or reinforcement on preceding behavior depend in part on whether the person perceives the reward as contingent on his own behavior or independent of it. Acquisition and performance differ in situations perceived as determined by skill versus chance. Persons may also differ in generalized expectancies for internal versus external control of reinforcement. This report summarizes several experiments which define group differences in behavior when Ss perceive reinforcement as contingent on their behavior versus chance or experimenter control. The report also describes the development of tests of individual differences in a generalized belief in internal-external control and provides reliability, discriminant validity and normative data for 1 test, along with a description of the results of several studies of construct validity.
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01 Jan 1969
TL;DR: In this article, the implications of terminal illness for patients and for those involved in their care were discussed, and patients invited to talk about their experience found great relief in expressing their fear and anger and were able to move towards a state of acceptance and peace.
Abstract: Although most areas of human experience are nowadays discussed freely and openly, the subject of death is still surrounded by conventional attitudes and reticence that offer only fragile comfort because they evade the real issues. The dying may thus be denied the opportunity of sharing their feelings and discussing their needs with family, friends, or hospital staff. Although receiving devoted medical care, a dying patient is often socially isolated and avoided, since professional staff and students can find contact painful and embarrasing.
Aware of the strains imposed on all sides by this situation, Dr Kubler-Ross established a seminar at the University of Chicago to consider the implications of terminal illness for patients and for those involved in their care. Patients invited to talk about their experience often found great relief in expressing their fear and anger and were able to move towards a state of acceptance and peace. The seminar, initially composed of students of medicine, sociology, psychology, and theology, but later joined by hospital staff and relatives of patients, enabled many members to come to terms with their own feelings and to respond constructi to what the patients had to teach them.
5,220 citations
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TL;DR: A study of 800 outpatient visits to Children's Hospital of Los Angeles as discussed by the authors explored the effect of verbal interaction between doctor and patient on patient satisfaction and follow-through on follow-up.
Abstract: Study of 800 outpatient visits to Childrens Hospital of Los Angeles to explore the effect of the verbal interaction between doctor and patient on patient satisfaction and follow-through on...
947 citations