A realist synthesis of interprofessional patient safety activities and healthcare student attitudes towards patient safety.

Interprofessional education (IPE) has been used for instilling a positive safety culture within healthcare, yet what interventions work to change healthcare student attitudes and how improved patient safety outcomes are best achieved with this intervention, is unclear and challenging to evaluate. A realist synthesis was undertaken to ascertain how, why, and in what circumstances IPE activities result in a positive change to student attitudes to patient safety. Database searches of CINAHL, MEDLINE, Scopus, and Eric were undertaken in April 2022 to identify relevant studies. Synthesis with a realist framework of analysis, coupled with the development of a program theory was conducted to identify interactions among contexts, intervention, mechanisms, and outcomes (CIMO). Twenty-three articles eligible for inclusion articulated environments in which varied contexts, interventions, and mechanisms were activated to influence student attitudes to patient safety. Findings from this realist synthesis informs awareness into the methods of delivering and evaluating IPE activities and offers new perspectives for educators in planning and evaluating future IPE from a collaborative and positive safety culture perspective.

Quality of Life in Patients With Pancreatic Cancer and Their Caregivers: A Systematic Review.

Little is known about quality of life (QOL) of patients with pancreatic cancer and their caregivers compared with adults with other cancers. This systematic review summarizes the available evidence base, identifies its limitations, and recommends directions for research and clinical application. A systematic review was conducted of research on QOL in adults with pancreatic cancer and their caregivers. Quality of life was examined in the following specific domains: psychological, physical, social, sexual, spiritual, and general. Of the 7130 articles reviewed, 36 studies met criteria for inclusion. Compared with healthy adults or population norms, adults with pancreatic cancer had worse QOL across all domains. Compared with patients with other cancer types, patients with pancreatic cancer evidenced worse psychological QOL. Physical and social QOL were either similar or more compromised than in patients with other cancers. Limited data preclude conclusions about sexual, spiritual, and caregiver QOL. Patients with pancreatic cancer evidence decrements in multiple QOL domains, with particular strain on psychological well-being. Methodological limitations of available studies restrict definitive conclusions. Future research with well-defined samples, appropriate statistical analyses, and longitudinal designs is needed. Findings from this review support the merits of distress screening, integration of mental health professionals into medical teams, and attention to caregiver burden.

Disease controllability moderates the effect of coping efficacy on positive affect.

OBJECTIVE: This study aims to test experimentally whether coping strategies (approach- vs. avoidance-oriented coping) have differential effects under conditions of high or low stressor controllability. DESIGN: Undergraduates (62 women, 30 men) participated in a 2 × 2 experimental study where they were introduced to a fictitious disease (tisomerase enzyme deficiency) said to be either controllable or uncontrollable and an approach- or avoidance-oriented coping behaviour induction. MAIN OUTCOME MEASURES: Changes in positive and negative affect. RESULTS: A significant disease control x coping interaction on positive affect (f(2) = .07, p = .011) revealed that approach-coping condition participants had higher positive affect than avoidance-coping condition participants when disease control was high (d = .94, p = .003), but not when it was low (d = .11, p = .93). The experimental conditions did not significantly influence negative affect. CONCLUSION: Results demonstrate that disease control moderates the salubrious effects of approach-oriented coping on positive affect. For controllable, but not uncontrollable, health stressors, promoting problem-focused approach-oriented coping strategies may be recommended.

Mediators of an Internet-based psychosocial intervention for women with breast cancer.

OBJECTIVE: Many interventions have been designed to promote psychological adjustment in cancer survivors; however, notably few studies have specified the mediating processes through which these interventions work. The primary aim of this research is to examine theoretically and empirically grounded mediators of an Internet-based psychosocial intervention for women with breast cancer. METHOD: Women (N = 88) diagnosed with breast cancer were randomly assigned to participate in a 3-hr workshop for creation of personal websites or a waitlist control. Mediating variables and dependent variables were assessed at baseline, 1 month, and 6 months following workshop participation. Indirect effects were tested using single and multiple mediator models. RESULTS: Relative to control participants, women randomized to Project Connect Online (PCO) evidenced statistically significant benefit 6 months after the workshop on depressive symptoms, positive mood, and life appreciation, as well as on hypothesized mediators (i.e., coping self-confidence, loneliness, social support from friends, but not emotional processing and expression). Change over 6 months in coping self-confidence, loneliness, and social support from friends mediated the relationship between the intervention and improvement in depressive symptoms. Coping self-confidence mediated the relationship between PCO and enhanced positive mood, and social support from friends mediated the relationship between PCO and increased life appreciation. CONCLUSIONS: Findings indicate how PCO promoted adaptive change and highlighted modifiable factors, including coping self-confidence, loneliness, and social support from friends, which contributed to positive adjustment to breast cancer. Additional potential mediators and ways in which the intervention can be enhanced are addressed.

Project connect online: user and visitor experiences of an Internet-based intervention for women with breast cancer.

OBJECTIVE: This study's purpose was to characterize the experience of patients with breast cancer randomly assigned to the intervention arm of Project Connect Online (PCO), a randomized controlled trial of an Internet-based intervention, and to examine relationships between website use variables and psychosocial outcomes. METHODS: In the larger PCO trial, patients with breast cancer (n = 88) were randomly assigned to an intervention or a waiting-list control. This report pertains to the 46 women in the intervention arm, a 3-h workshop for creation of personal websites with a blog function to communicate with their interpersonal network and chronicle their breast cancer experience. Participants completed assessments at 1 and 6 months. Visitors to the websites (n = 66) completed an online questionnaire. RESULTS: Reactions to website use were positive, although lack of time was a barrier for some. Women with advanced cancer were more likely to use their websites. Women found the websites useful for telling the story of their experience and expressing emotions. Positive word use was associated with heightened positive mood at 6 months; negative word use was associated with improved depressive symptoms. Visitors were most commonly female friends of participants who valued the websites as a way to connect emotionally with participants and receive information about their health. CONCLUSIONS: Specific aspects of patients' blogs predicted improvements in psychosocial functioning. Personal websites can help women with breast cancer construct a narrative of their experience, express emotions, and receive the social support they need, particularly from friends and extended family.