Breast/ovarian cancer genetic counseling: Do anxiety, depression, and health care-related fears influence cancer worry and risk perception?

BACKGROUND: The impact of family and personal cancer history and emotional factors, such as depression and anxiety, on disease representation has received limited attention in studies investigating the development of cancer-related worry and risk perception within the context of genetic counseling. The current study endeavors to fill this gap by exploring the extent to which depression and anxiety influence cancer worry and risk perception, and the role of health care-related fear as potential mediator in this relationship. METHODS: A sample of 178 women who underwent their first genetic counseling for breast/ovarian cancer, 52% of whom had previous cancer diagnoses, completed questionnaires assessing sociodemographic and clinical information, emotional distress in terms of anxiety and depression, cancer-related worry, risk perception, and health care-related fears. RESULTS: Results of mediation analyses showed that cancer-related worry and risk perception increased with rising levels of depression and anxiety, with health care-related fears acting as a mediator in the relationship of depression and anxiety with cancer worry and risk perception. Covariate analysis revealed that previous cancer diagnosis increases cancer-related worry but not risk perception, while the number of family members affected by cancer increases both outcomes. CONCLUSION: These findings emphasize the need for a holistic approach in genetic counseling and have implications for the clinical practice.

Moral Distress in Oncology: A Descriptive Study of Healthcare Professionals.

BACKGROUND: The oncology setting is characterized by various complexities, and healthcare professionals may experience stressful conditions associated with ethical decisions during daily clinical practice. Moral distress (MD) is a condition of distress that is generated when an individual would like to take action in line with their ethical beliefs but in conflict with the healthcare facility's customs and/or organization. This study aims to describe the MD of oncology health professionals in different care settings. METHODS: Descriptive quantitative study was conducted in the Operating Units of the Istituti Fisioterapici Ospitalieri in Rome between January and March 2022. The investigated sample consisted of the medical and nursing staff on duty at the facility, who were given a questionnaire through a web survey. Besides a brief sociodemographic form, the MD Scale-Revised questionnaire was used for data collection. RESULTS: The sample consisted of nurses (51%) and physicians (49%), predominantly working in surgeries (48%), and having 20-30 years of service (30%). MD was higher among healthcare professionals, in medicine than that ing in corporate organizations, surgeries, or outpatient clinics (p = 0.007). It was not related to the profession (p = 0.163), gender (p = 0.103), or years of service (p = 0.610). CONCLUSIONS: This paper outlines the prevalence of MD in care settings and describes its relationship with profession, gender, and seniority. There is no patient care without the care of health professionals: knowing and fighting MD improves the safety of the treatments provided and the quality perceived by patients.

The Experience of Oncology Healthcare Providers in the Central Italy during the COVID-19 Lockdown.

While the emotional response of healthcare providers during the COVID-19 pandemic has been extensively investigated in countries in the Far-East, little is known about the psychological impact and the associated emotional distress of healthcare providers in Italy, especially with regard to different regions. The aim of the "VIRARE" survey, which was addressed to all the healthcare providers in the Lazio region (central Italy) and, in particular, to those working in the oncology field, is to analyze their opinion on the impact and management of the pandemic, to better understand the level of their psychological distress. A global good psychological response of healthcare providers to the pandemic has emerged, independently from their different occupations in the oncology field. Healthcare providers show a high degree of resilience, identifying the major causes of distress the difficulty of the management of this situation, the obstacles in their working activity and expressing a high degree of dissatisfaction with how Italian institutions handled this situation. This survey also provides a direct comparison between COVID-19-infected (or directly in contact with COVID-19-infected patients) and uninfected healthcare providers, identifying the sub-category of infected professionals that reported signs of depression as particularly vulnerable.

The Cancer Worry Scale Revised for Breast Cancer Genetic Counseling.

BACKGROUND: The Cancer Worry Scale was revised to be used in breast cancer genetic counseling (CWS-GC). This scale is used to identify dimensions that are relevant in the genetic counseling context, such as worry about developing breast cancer, impact of worries on daily life, and risk perception in women attending a counseling session for BRCA1/2 mutations. OBJECTIVE: The aim of this study was to estimate the psychometric properties of the CWS-GC in a sample of Italian women. METHODS: A total of 304 women aged 19 to 90 years, 58% with history and 42% with no history of breast or ovarian cancer, participated in the study. Validity, reliability, and sensitivity to change of the CWS-GC were assessed. RESULTS: Confirmatory factor analysis suggested a 2-factor structure of the CWS-GC measuring cancer worry and risk perception and with Cronbach's α coefficients of .90 and .70, respectively. Criterion validity was attested by substantial yet not overlapping correlations with anxiety and fear of medical procedures. In a subsample of 50 women, test-retest reliability at a 4-week interval ranged from 0.70 to 0.87, and the CWS-GC was able to detect small to medium changes 1 month after genetic counseling. CONCLUSIONS: Overall, the CWS-GC showed good psychometric characteristics in this population. IMPLICATIONS FOR PRACTICE: The CWS-GC would be appropriate for use by healthcare professionals to better understand how women react and adapt to information on genetic cancer risk to provide them with emotional support and encourage surveillance behaviors.

Improving physicians' communication skills and reducing cancer patients' anxiety: a quasi-experimental study.

AIMS AND BACKGROUND: This study is aimed at evaluating the effectiveness of a physician-centered communication skills training program on cancer patient anxiety levels. METHODS AND STUDY DESIGN: In this quasi-experimental study, physicians from 9 units of 5 general hospitals and 1 cancer research institute were recruited. The unit heads chose which physicians would attend the training program (treatment group) and which would not (control group). The effectiveness of the course was evaluated by assessing the evolution of state anxiety in a sample of cancer patients before and after clinical consultations. RESULTS: Thirty-eight physicians and 339 outpatients were assessed. Patients from the treatment and control groups did not differ in pre-examination anxiety or psychological distress levels. Patients examined by physicians from the treatment group displayed a higher decrease in state-anxiety levels compared with those examined by physicians from the control group. A higher proportion of high anxiety levels was found in women, in less educated patients, and in those with a high distress level. CONCLUSIONS: Our findings suggest the effectiveness of the communication skills training program with reference to patient anxiety levels. Given the potential gap between training and clinical impact, further studies investigating the effect of communication training on patient outcomes are needed.

Burnout among physicians and nurses working in oncology.

BACKGROUND: The phenomenon of Burnout is an important occupational problem which affects those working in the "helping professions" to a greater degree since they have continuous and constant contact with suffering patients. AIMS: We aimed to assess the Burnout level and its correlation with organizational stressors. METHODS: The aim was achieved through administration of a questionnaire, the organizational check-up survey (OCS) among 80 physicians and 102 nurses working in a cancer institute. RESULTS: The results showed significant levels of Burnout (Exhaustion and Cynicism) associated with perceived discrepancy between the worker's values and those promoted by the hospital management, mainly among longer serving staff work overload reported by staff working in the intensive care and medical oncology departments; lack of recognition reported by permanent staff and also those who had no contact with the patients. CONCLUSIONS: The study confirmed the multiple factors involved in the phenomenon of Burnout and the usefulness of the OCS tool for the diagnosis and management of Burnout via appropriate intervention programmes. Furthermore, it also seemed to confirm the need to pay particular attention to the wellbeing of health professionals working in care and treatment of cancer patients via individual measures associated with other organizational measures.

National Cancer Information Service in Italy: an information points network as a new model for providing information for cancer patients.

The international literature data report that good information and communication are fundamental components of a therapeutic process. They contribute to improve the patient-health care professional relationship, to facilitate doctor-patient relationships, therapeutic compliance and adherence, and to the informed consent in innovative clinical trials. We report the results of a multicentric national initiative that developed a 17-information-structure network: 16 Information Points located in the major state-funded certified cancer centers and general hospitals across Italy and a national Help-line at the nonprofit organization AIMaC (the Italian oncologic patients, families and friends association), and updated the already existing services with the aim to create the National Cancer Information Service (SION). The project is the result of a series of pilot and research projects funded by the Italian Ministry of Health. The Information Service model proposed is based on some fundamental elements: 1) human interaction with experienced operators, adequately trained in communication and information, complemented with 2) virtual interaction (Help line, Internet, blog, forum and social network); 3) informative material adequate for both scientific accuracy and communicative style; 4) adequate locations for appropriate positioning and privacy (adequate visibility); 5) appropriate advertising. First results coming from these initiatives contributed to introduce issues related to "Communication and Information to patients" as a "Public Health Instrument" to the National Cancer Plan approved by the Ministry of Health for the years 2010-2012.

Factors associated with an individuals' decision to withdraw from genetic counseling for BRCA1 and BRCA2 genes mutations: are personality traits involved?

The aim of the study was to evaluate factors associated with early withdrawal from oncogenetic counseling. A comparison of psycho-social and personality characteristics of two samples of subjects, attendees and withdrawers was carried out. Self-report questionnaires were completed by 112 individuals who had completed counseling and to 56 individuals who withdrew from it. Individuals with few children (OR. 1,724; p = 0,017; CI = 1,101-2,700), a lower number of cancer affected relatives (OR. 1,301; p = 0,000; CI = 1,145-1,479), and with a lower hypomanic scale score (OR. 1,070; p = 0,004; CI = 1,022-1,121), were more likely to withdraw from counseling. It is important for the counselees to draw more attention to the fact that their cancer risk management and prevention is as fundamental as that of their children. Also, it is important to highlight the fact that having less cancer affected relatives does not necessarily mean being at lower risk. In conclusion, that subjects with low levels of psychological and emotional energy are those who probably need greater psychological support during the decision making process. We deem necessary that psychologists, involved in genetic counseling, investigate these aspects during their sessions in order to implement suitable interventions of psychological support during the entire counseling process.

Evaluation of a screening programme for psychological distress in cancer survivors.

PURPOSE: This study is aimed at evaluating the feasibility of a screening procedure for psychological distress in cancer survivors. METHODS: Consecutive series of 339 cancer patients from three centres were requested to fill in two questionnaires measuring psychological distress (PDI) and social support (MOSS). Psychological intervention was offered to patients with significant degree of distress. RESULTS: Most patients accepted to be screened (72.0%; n = 244), and a subgroup (16.0%) showed high psychological distress. A higher ratio of distressed patients was observed among those with lower social support (P = 0.017). A significant (P < 0.01) negative correlation between psychological distress and social support was observed. A psychological intervention was offered to patients with high psychological distress, but only 15.6% completed it. CONCLUSIONS: Results from this study provide both some insights into the characteristics of psychological distress and some input on issues that may arise when implementing a screening procedure for psychological distress in cancer survivors. Further research is needed to assess both the clinical significance of distress and the most appropriate tools to carry out screening procedures within the target population.

Subjective versus objective risk in genetic counseling for hereditary breast and/or ovarian cancers.

BACKGROUND: Despite the fact that genetic counseling in oncology provides information regarding objective risks, it can be found a contrast between the subjective and objective risk. The aims of this study were to evaluate the accuracy of the perceived risk compared to the objective risk estimated by the BRCApro computer model and to evaluate any associations between medical, demographic and psychological variables and the accuracy of risk perception. METHODS: 130 subjects were given medical-demographic file, Cancer and Genetic Risk Perception, Hospital Anxiety-Depression Scale. It was also computed an objective evaluation of the risk by the BRCApro model. RESULTS: The subjective risk was significantly higher than objective risk. The risk of tumour was overestimated by 56%, and the genetic risk by 67%. The subjects with less cancer affected relatives significantly overestimated their risk of being mutation carriers and made a more inaccurate estimation than high risk subjects. CONCLUSION: The description of this sample shows: general overestimation of the risk, inaccurate perception compared to BRCApro calculation and a more accurate estimation in those subjects with more cancer affected relatives (high risk subjects). No correlation was found between the levels of perception of risk and anxiety and depression. Based on our findings, it is worth pursuing improved communication strategies about the actual cancer and genetic risk, especially for subjects at "intermediate and slightly increased risk" of developing an hereditary breast and/or ovarian cancer or of being mutation carrier.

The withdrawal from oncogenetic counselling and testing for hereditary and familial breast and ovarian cancer. A descriptive study of an Italian sample.

BACKGROUND: Oncogenetic counselling is seldom followed through, even when individuals are eligible according to the test criteria. The basic variables which influence the decision to undergo the genetic counselling process are: risk perception, expected benefit or limitations of genetic testing, general psychological distress or cancer-specific distress, lack of trust in one's emotional reactions when faced with negative events, expected level of family support and communications within the family. The aim of this study was to describe the psychosocial variables of an Italian sample that forgoes genetic counselling. METHODS: From May 2002 to December 2006 a psychological questionnaire was sent out to one hundred and six subjects, who freely requested a first genetic informative consultation, and never asked to have a second visit and the family tree drawn up in order to inquire about their eligibility for genetic testing. Statistical analysis was performed by Pearson chi-square test, t-test and Spearman RHO coefficient. RESULTS: The survey presents a lack of emotional cohesion and structured roles and rules within the family system and a positive correlation between the number of children, anxiety and risk perception. The main reasons for giving up on counselling were a sense that testing was a waste of time and the inability to emotionally handle the negative consequences of the test outcome. The subjects who maintained that test and an early diagnosis were a "waste of time" experienced more anxiety. CONCLUSION: The study revealed the importance to ac knowledging the whole persona and their family system as well as provide information highlighting usefulness of early diagnosis.