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Individual psychosocial support for breast cancer patients: Quality of life, psychological effects, patient satisfaction, health care utilization and costs
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A randomized intervention study, with the aim to compare the effects of individual psychosocial support provided by (1) oncology nurses specially trained in psychological techniques (INS), or (2) psychologists (IPS), to (3) standard care (SC). Breast cancer patients, living in Uppsala County, and about to start adjuvant treatment at the Department of Oncology, Uppsala, were consecutively included between 1998 and 2000. The patients were assessed seven times during two years by self-administered questionnaires. Study I revealed positive effects of both INS and IPS as compared to SC on global quality of life, side effects, and post-traumatic distress. A lower proportion of patients in the intervention groups had psychosocial support provided in routine care compared with the SC group. In study II the patients reported being highly satisfied with the intervention, irrespective of profession providing the support. However, patients in the INS group reported higher levels of benefit regarding disease-related problems than those in the IPS group. In study III total Health Care costs were lower in the intervention groups and since a gain in quality-adjusted life years (QALY) was seen (mean .1 QALY), the interventions dominated. The costs for the interventions were 44 291- 48 978 SEK. In study IV, daily reporting of anxiety, depression and activity on Visual Analogue Scales (VAS) were completed during two weeks before and after the Hospital Anxiety and Depression Scale (HADS) assessments. A point assessment with the HADS captured the situation better than four weeks assessment on three VAS in the diary. The HADS was considered preferable to the diary. The conclusion is that psychosocial support is beneficial for breast cancer patients and that the intervention delivered by nurses was as effective as that given by psychologists. The costs for the interventions were limited.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2007. , p. 73
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 268
Keywords [en]
Oncology nursing, Breast cancer patients, Individual psychosocial support, Intervention study, Randomized, Quality of life, Psychological effects, Patient satisfaction, Health care utilization and costs
Keywords [sv]
Onkologisk vård
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-7929ISBN: 978-91-554-6922-1 (print)OAI: oai:DiVA.org:uu-7929DiVA, id: diva2:170427
Public defence
2007-09-07, Auditorium Minus, Gustavianum, Uppsala, 09:00
Opponent
Supervisors
Available from: 2007-05-24 Created: 2007-05-24 Last updated: 2013-08-29Bibliographically approved
List of papers
1. Individual psychosocial support for breast cancer patients: A randomized study of nurse vs. psychologist interventions and standard care
Open this publication in new window or tab >>Individual psychosocial support for breast cancer patients: A randomized study of nurse vs. psychologist interventions and standard care
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2007 (English)In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 30, no 3, p. E10-E19Article in journal (Refereed) Published
Abstract [en]

In a prospective, randomized study, an individual psychosocial support intervention performed by specially trained oncology nurses, or psychologists, were compared with standard care. Consecutive primary breast cancer patients about to start adjuvant therapy (n = 179) were included. Data were supplied by the questionnaires European Organisation for Research and Treatment of Cancer Quality of Life Study Group Core Quality of life questionnaire with 30 questions (EORTC QLQ-C30) and Breast Cancer Module with 23 questions (BR23), the Hospital Anxiety and Depression Scale, Spielberger's State-Trait Anxiety Inventory, and the Impact of Event Scale before randomization and 1, 3, and 6 months later. Patient files provided data on utilization of psychosocial support offered in routine care. Global quality of life/health status, nausea and vomiting, and systemic therapy side effects were the subscales showing significant Group by Time interactions, favoring the interventions. Intervention groups improved statistically significantly more than the standard care group regarding insomnia, dyspnea, and financial difficulties. Nurse patients experienced less intrusion compared with the standard care group. All groups showed statistically and clinically significant improvements with time on several subscales. The intervention groups, however, improved to a greater extent. Fewer patients in the intervention groups used psychosocial hospital support compared with the standard care group. In conclusion, psychosocial support by specially trained nurses using techniques derived from cognitive behavioral therapy is beneficial for breast cancer patients and may be a realistic alternative in routine cancer care.

Keywords
Breast cancer patients, Individual psychosocial support, Intervention study, Randomized
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-96017 (URN)10.1097/01.NCC.0000270709.64790.05 (DOI)
Available from: 2007-05-24 Created: 2007-05-24 Last updated: 2017-12-14Bibliographically approved
2. Satisfaction, utilisation and perceived benefit of individual psychosocial support for breast cancer patients: A randomised study of nurse versus psychologist interventions
Open this publication in new window or tab >>Satisfaction, utilisation and perceived benefit of individual psychosocial support for breast cancer patients: A randomised study of nurse versus psychologist interventions
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2006 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 62, no 2, p. 235-243Article in journal (Refereed) Published
Abstract [en]

Objective: In a prospective, randomised study, individual psychosocial support performed by: (1) specially trained oncology nurses (INS) or (2) psychologists (IPS) were compared with respect to utilisation, satisfaction and perceived benefit.

Methods: Between December 1997 and December 1999, consecutive breast cancer patients (n = 120) were included at start of adjuvant therapy (chemo-, endocrine and/or loco-regional radiotherapy). Data were collected by an extended version of the 'IPS-patient satisfaction questionnaire' within I week after termination of the support intervention. Questionnaires were also mailed to all patients 6, 12 and 18-24 months after inclusion. Levels of distress were collected with the Hospital Anxiety and Depression Scale (HADS) and Impact of Event Scale (IES) questionnaires.

Results: The patients were highly satisfied with the individual psychosocial support intervention they received, irrespective of which profession provided the support. However, the patients in the INS group reported higher levels of benefit regarding disease-related problems, regardless if the patients at baseline reported low or high levels of distress.

Conclusions: Patients were highly satisfied with an individual psychosocial support intervention. In areas dealing with somatic aspects, the group intervened by nurses were more satisfied than the one by psychologists.

Practice implications: Individual psychosocial support by specially trained nurses is a realistic alternative in routine cancer care.

Keywords
Cancer, Breast cancer, Patient satisfaction, Psychotherapy
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-96018 (URN)10.1016/j.pec.2005.07.008 (DOI)000239475300012 ()16500071 (PubMedID)
Available from: 2007-05-24 Created: 2007-05-24 Last updated: 2017-12-14Bibliographically approved
3. Cost-utility analysis of individual psychosocial support interventions for breast cancer patients in a randomized controlled study
Open this publication in new window or tab >>Cost-utility analysis of individual psychosocial support interventions for breast cancer patients in a randomized controlled study
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2014 (English)In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 23, no 3, p. 251-258Article in journal (Refereed) Published
Abstract [en]

Background The Distress Thermometer (DT) has been used in psycho-oncology research across the globe and has been recommended as a clinical tool to be used routinely in cancer settings to detect clinically significant distress. We sought to characterize the translation and validation of the DT in cancer patients in different countries and cultures and summarize how the translated versions function to detect clinically significant distress. Methods An electronic mail survey was sent to the members of the International Psychosocial Oncology Society Federation of Psycho-Oncology Societies and electronic searches of English language databases were conducted to identify translations of the DT and studies designed to validate these translations. Results Our efforts yielded a total of 21 non-English translations of the DT; 18 of these were validated in studies designed for that purpose. A variety of instruments were used in receiver operating characteristic curve analysis to derive an optimal cut-off score indicative of clinically significant distress. Cut-off scores varied by language, country, and clinical setting and to sample characteristics. In the majority of studies, a score of 4 maximized sensitivity and specificity relative to an established criterion. Conclusions These findings provide a broad, international perspective on the current state of psychosocial screening using the DT. Findings also demonstrate widespread awareness of the need for psychological and social support of persons diagnosed with and treated for cancer.

Keywords
validity; cancer; screening; distress; Distress Thermometer
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-206096 (URN)10.1002/pon.3411 (DOI)000332952500002 ()24115469 (PubMedID)
Funder
Swedish Cancer Society
Available from: 2013-08-27 Created: 2013-08-27 Last updated: 2017-12-06Bibliographically approved
4. Four weeks of daily assessments of anxiety, depression and activity compared to a point assessment with the Hospital Anxiety and Depression Scale
Open this publication in new window or tab >>Four weeks of daily assessments of anxiety, depression and activity compared to a point assessment with the Hospital Anxiety and Depression Scale
2008 (English)In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 17, no 1, p. 95-104Article in journal (Refereed) Published
Abstract [en]

Objectives To explore to what extent the daily reporting of anxiety, depression and activity in a diary mirrors scores on point assessments with the Hospital Anxiety and Depression scale ( HADS). Methods In a randomized intervention study consecutive breast cancer patients ( n = 179) about to start adjuvant therapy were included. The HADS questionnaires were sent to patients 3 and 12 months after inclusion. Daily reporting of anxiety, depression and activity on Visual Analogue Scales ( VAS) were completed during 4 weeks surrounding the HADS assessments. Results The results showed moderate correlations ( r = -0.36 to -0.67, P < 0.01) at both assessments. The daily reports were consistent over 4 weeks and did not differ between assessments. Mean scores on the HAD-Anxiety were 4.00 at the 3 months and 5.07 at the 12 months assessment. For the HAD-Depression the mean scores at the same assessment points were 3.61 and 3.23, respectively. The daily reports put more strain on the respondents and produced a larger attrition rate than the HADS. Conclusion A point assessment with the HADS captures the situation of breast cancer patients' equivalent to 4 weeks assessment in a diary, but is easier to complete and is therefore preferable to the diary.

Keywords
Breast cancer, Cancer, Diary, Hospital Anxiety and Depression Scale, Psychology, Oncology
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-96020 (URN)10.1007/s11136-007-9275-4 (DOI)000251995900010 ()18026852 (PubMedID)
Available from: 2007-05-24 Created: 2007-05-24 Last updated: 2017-12-14Bibliographically approved

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