Unmet needs in breast cancer survivors are common, and multidisciplinary care is underutilised: the Survivorship Needs Assessment Project.

PURPOSE: The transition from a breast cancer patient to a survivor can be associated with significant physical, psychological, and social challenges. Development of multidisciplinary evidence-based care during the post-treatment period is a key area of cancer research. This study examined survivorship issues, unmet needs and perceptions about care among a cohort of breast cancer survivors. METHODS: Participants were 130 women diagnosed with breast cancer for at least one year, and attending a hospital breast or oncology outpatient clinic. They completed a series of self-report questionnaires assessing demographic and clinical characteristics, unmet needs, severity of survivorship issues, use of multidisciplinary services, clinical benchmarks, survivorship care satisfaction, and suggestions for service improvements. RESULTS: There was an average of 4.9 unmet survivorship needs, with 67% of participants reporting at least one unmet need. Fear of cancer recurrence, stress, coordination of medical care and negative iatrogenic impacts of hormonal treatments were key concerns. The cancer support team typically consisted of medical and nursing staff, and family/friends, and most were satisfied with their survivorship care. There was minimal use of other multidisciplinary clinicians and support groups. Provision of additional dietary and cancer recurrence education, and a written treatment plan were identified as key areas of service improvement. CONCLUSION: Despite high satisfaction ratings, survivorship issues and unmet needs were relatively common, particularly among younger participants. Use of multidisciplinary care was inconsistent and overall underutilised. IMPLICATIONS FOR CANCER SURVIVORS: Ongoing specific evaluation and optimisation of existing models of multidisciplinary survivorship care are essential in meeting the complex needs of breast cancer survivors.

Dignity Therapy and Life Review for Palliative Care Patients: A Qualitative Study.

CONTEXT: Dignity therapy (DT) is a psychotherapeutic intervention whose aim was to bolster the sense of purpose, meaning, and sense of dignity in patients with terminal disease. OBJECTIVES: The aim of this study was to explore, compare, and better understand the content of standard DT, waitlist DT (WDT), and Life Review (LR) that used the DT interview protocol but omitted the creation of legacy documents. METHODS: Efficacy of these interventions was previously documented in a sample of 56 participants. In this study, DT and WDT legacy documents and LR session transcripts were qualitatively analyzed using the Framework approach, both deductively and inductively. RESULTS: All participants expressed a diverse set of beliefs, values, memories, and important relationships with the majority also indicating at least some sense of meaning and acceptance despite disappointments, regrets, and the impacts of illness. Sense of legacy, fighting spirit, and hope were particularly prevalent in legacy documents (DT and WDT groups), whereas relationship regrets, self-blame, unfinished business, and aftermath concerns were more likely to be expressed during the LR process. Themes of spirituality, illness impacts, and unfinished business were relatively less common in WDT participants. CONCLUSION: This study provides further insight into what palliative care patients consider to be most important and meaningful to them when taking part in DT and LR. Creating legacy documents is likely to result in session content that is different in several key areas compared with LR, even when controlling for interview questions, therapist influences, and session length. Consideration of the above is essential in optimizing psychotherapeutic outcomes near end of life.

Dignity Therapy and Life Review for Palliative Care Patients: A Randomized Controlled Trial.

CONTEXT: Dignity therapy (DT) is a psychotherapeutic intervention with increasing evidence of acceptability and utility in palliative care settings. OBJECTIVES: The aim of this study was to evaluate the legacy creation component of DT by comparing this intervention with life review (LR) and waitlist control (WC) groups. METHODS: Seventy adults with advanced terminal disease were randomly allocated to DT, LR, or WC followed by DT, of which 56 completed the study protocol. LR followed an identical protocol to DT except that no legacy document was created in LR. Primary outcome measures were the Brief Generativity and Ego-Integrity Questionnaire, Patient Dignity Inventory, Functional Assessment of Cancer Therapy-General, version 4, and treatment evaluation questionnaires. RESULTS: Unlike LR and WC groups, DT recipients demonstrated significantly increased generativity and ego-integrity scores at study completion. There were no significant changes for dignity-related distress or physical, social, emotional, and functional well-being among the three groups. There were also no significant changes in primary outcomes after the provision of DT after the waiting period in the WC group. High acceptability and satisfaction with interventions were noted for recipients of both DT and LR and family/carers of DT participants. CONCLUSION: This study provides initial evidence that the specific process of legacy creation is able to positively affect sense of generativity, meaning, and acceptance near end of life. High acceptability and satisfaction rates for both DT and LR and positive impacts on families/carers of DT participants provide additional support for clinical utility of these interventions. Further evaluation of specific mechanisms of change post-intervention is required given DT's uncertain efficacy on other primary outcomes.

Development of a brief measure of generativity and ego-integrity for use in palliative care settings.

OBJECTIVE: Our aim was to develop and test a brief measure of generativity and ego-integrity that is suitable for use in palliative care settings. METHOD: Two measures of generativity and ego-integrity were modified and combined to create a new 11-item questionnaire, which was then administered to 143 adults. A principal-component analysis with oblique rotation was performed in order to identify underlying components that can best account for variation in the 11 questionnaire items. RESULTS: The two-component solution was consistent with the items that, on conceptual grounds, were intended to comprise the two constructs assessed by the questionnaire. SIGNIFICANCE OF RESULTS: Results suggest that the selected 11 items were good representatives of the larger scales from which they were selected, and they are expected to provide a useful means of measuring these concepts near the end of life.

Deteriorating memory confidence, responsibility perceptions and repeated checking: comparisons in OCD and control samples.

Repeated checking has been repeatedly associated with memory distrust. We sought to extend previous research using a computer-based checking task by incorporating a group of 15 individuals with OCD, and examining the effect of increased perceived responsibility. Participants were asked to repeatedly check a virtual stovetop, with half the participants also placed under a condition of high-perceived responsibility. Our observations replicated previous research showing that the act of repeatedly checking leads to reductions in memory vividness, detail and confidence, without accompanying reductions in memory accuracy. Furthermore, while a sense of increased personal responsibility had little effect on a student control sample, it led to a significant further deterioration in memory confidence in individuals with OCD. These results suggest that in people with OCD, normal reductions in memory confidence over repeated trials are exacerbated and intensified by inflated responsibility perceptions.