Family-focused practice and policy recommendations to improve the inpatient experience for patients undergoing a stem cell transplant.

INTRODUCTION: Hematopoietic stem cell transplantation (HCT) greatly impacts the social, emotional, and physical well-being of the patient and their family. The transplant process imposes significant lifestyle restrictions that result in patient and family isolation, which has been further amplified during the COVID-19 pandemic era. While hospital systems recognize the importance of family engagement, the pandemic underscored the need to translate this philosophy more fully into practice. METHOD: We discuss the importance of engaging the family throughout the transplant experience to improve patient outcomes and overall family health and well-being. RESULTS: We present the HCT family resilience model, a synthesis of multiple family and nursing theories and HCT concepts to better guide HCT family care. The theories and frameworks that inform our model address family functioning and growth in times of stress, coping strategies that promote positive family outcomes and resilience, and multicultural factors that may affect family experiences. A key contribution of our model is highlighting the role of family engagement in improving HCT family outcomes. DISCUSSION: Application of a family systems lens highlights the essential role families play in the care of HCT patients and can foster family well-being. We offer the HCT family resilience conceptual model as a guide for practice and policy improvements to optimize care delivery for this patient and family population, as well as direction for future research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Existential distress in family caregivers: scoping review of meaning-making interventions.

OBJECTIVES: Family and friend caregivers often feel overwhelmed by and ill-prepared for their responsibilities. Many feel helpless living with uncertainty about the outcome of the patient's illness, which leads to existential distress. Supportive care interventions that address existential distress by promoting meaning and purpose buffer the negative effects of caregiver burden and promote resilience and growth. The purpose of this scoping review is to describe the depth and breadth of available interventions targeting caregiver existential distress. METHODS: We followed the Joanna Briggs Institute's scoping review methods and applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension checklist. SCOPUS, Ovid MEDLINE and PsycINFO databases were searched for interventions that targeted existential distress by promoting meaning-making, spiritual well-being, post-traumatic growth and/or benefit finding for caregivers of seriously ill adult patients. RESULTS: We screened 1377 titles/abstracts and 42 full-text articles. Thirty-one articles (28 unique studies) met inclusion criteria. Most interventions were designed for caregivers supporting patients with cancer (n=14) or patients receiving palliative care (n=9). Promising interventions included Meaning-Centered Psychotherapy for Cancer Caregivers, Meaning-Based Intervention for Patients and their Partners, Legacy Intervention for Family Enactment, Family Participatory Dignity Therapy and Existential Behavioural Therapy. More than half of the studies (n=20, 64%) were in the feasibility/acceptability/pilot stage of intervention testing. CONCLUSION: Large randomised controlled trials with more diverse samples of caregivers are needed. Future research should explore the impact of delivering meaning-making interventions to caregivers throughout the illness trajectory. Developing strategies for scaling up and conducting cost analyses will narrow the research and practice gap for meaning-making interventions.

A Mixed-Methods Feasibility Study: Eliciting ICU Experiences and Measuring Outcomes of Family Caregivers of Patients Who Have Undergone Hematopoietic Stem Cell Transplantation.

The impact of an intensive care unit (ICU) admission on family caregivers of patients who have undergone hematopoietic stem cell transplantation (HSCT) has not been well described. Aims of this study were to determine the feasibility of conducting research with family caregivers of HSCT patients during an ICU admission and generate preliminary data about their experiences and engagement in care. Using a mixed-methods, repeated measures design, we collected data from family caregivers after 48 hr in the ICU (T1) and at 48 hr after transferring out of ICU (T2). Enrolling HSCT caregivers in research while in the ICU was feasible (10/13 consented; 9/10 completed data collection at T1); however, data collection at T2 was not possible for most caregivers. Caregiver distress levels were high, and engagement in care was moderate. The three themes that emerged from interviews (n = 5) highlighted that although HSCT family caregivers faced many challenges and received limited support during their ICU experience, they were able to access their own personal resources and demonstrated resilience.

Reducing distress and depression in cancer patients during survivorship.

OBJECTIVE: Distress and depression are prevalent in cancer patients throughout survivorship and are associated with adverse outcomes. This study examines the association between outpatient psycho-oncology treatment and distress and depression in cancer patients. METHODS: This is a prospective observational study of adult patients with a primary diagnosis of cancer referred for psycho-oncology services. Patients were seen for two psycho-oncology visits in a single clinical setting with various qualified providers. Patients completed the distress thermometer and problem checklist (DT + PL) and the Patient Health Questionnaire (PHQ-9) at the beginning of their first and second visits and repeated the DT at the end of these visits. RESULTS: The analysis included 174 patients seen once and 69 patients seen twice. Patients were seen on average 2.5 years after diagnosis. Both visits were associated with significant reductions in distress (5.56 before and 3.85 after for visit 1, p < 0.001; 4.92 before and 3.43 after for visit 2, p < 0.001). There was a significant reduction in distress from baseline to after visit 2 (p < 0.001). Depression scores significantly decreased from the first to second visits (8.79-7.57; p = 0.002). CONCLUSIONS: Psycho-oncology services were associated with significant reductions in distress and depression, with scores after services no longer meeting criteria for clinically significant distress (DT scores ≥ 4) and depression (PHQ-9 scores ≥ 8) as they did at baseline. Reductions in distress and depression were not significantly associated with provider type, intervention or timing of diagnosis. These findings support the use of psycho-oncology services in cancer patients throughout survivorship.

Buyer's remorse: what predicts post-decision dissonance after bariatric surgery?

BACKGROUND: Bariatric surgery continues to be the most effective long-term treatment for obesity and its associated co-morbidities. Despite the benefits, not all patients may repeat the decision to undergo bariatric surgery based on their postoperative experience (postdecision dissonance). OBJECTIVES: In this study, we explore the predictors of postdecision dissonance following bariatric surgery. SETTING: Accredited bariatric center at an academic medical center. METHODS: Patients at an accredited Bariatric Center who underwent bariatric surgery between 2011 and 2017 were surveyed to determine factors predictive of postdecision dissonance, as well as expectations, well-being, and overall satisfaction. RESULTS: A total of 591 patients were sent surveys, of whom 184 (31.1%) responded. Of the 184 responders, 20 (10.9%) patients would not choose to undergo bariatric surgery if they had it do to over again (postdecision dissonance). There was no difference in the time since surgery, age, sex, or type of bariatric surgery among groups. Dissonant patients were less likely to be married and privately insured. Dissonant patients were more likely to feel they had inadequate preoperative education on postoperative expectations (P < .001). These patients also had significantly greater postoperative weight regain, failed weight loss expectations, depression, and dissatisfied body image. CONCLUSION: Postdecision dissonance is driven in part by a patient's perceived inadequacy of preoperative preparation for postoperative outcomes coupled with postoperative weight regain, depression, dissatisfied body image, and failed weight loss expectations. This highlights the importance of preoperative counseling on managing expectations and outcomes after surgery, as well as the need for continued postoperative engagement with a bariatric program to address weight regain and provide mental health support.

'Speaking Truth' Protects Underrepresented Minorities' Intellectual Performance and Safety in STEM.

We offer and test a brief psychosocial intervention, Speaking Truth to EmPower (STEP), designed to protect underrepresented minorities' (URMs) intellectual performance and safety in science, technology, engineering, and math (STEM). STEP takes a 'knowledge as power' approach by: (a) providing a tutorial on stereotype threat (i.e., a social contextual phenomenon, implicated in underperformance and early exit) and (b) encouraging URMs to use lived experiences for generating be-prepared coping strategies. Participants were 670 STEM undergraduates [URMs (Black/African American and Latina/o) and non-URMs (White/European American and Asian/Asian American)]. STEP protected URMs' abstract reasoning and class grades (adjusted for grade point average [GPA]) as well as decreased URMs' worries about confirming ethnic/racial stereotypes. STEP's two-pronged approach-explicating the effects of structural 'isms' while harnessing URMs' existing assets-shows promise in increasing diversification and equity in STEM.

'I'm Black and I'm Proud': A Majority Ecological Context Protects Affective Aspects of Black Identity Under Stereotype Threat.

We provide evidence that stereotype threat, a phenomenon that causes stigmatized individuals to experience group-based evaluative concerns (Steele in Am Psychol 52:613-629, 1997; Whistling Vivaldi and other clues to how stereotypes affect us, W.W. Norton, New York, 2010), impacts affective aspects of Black identity as a function of majority versus minority ecological contexts. Black/African-American students, enrolled in either Africana Studies (Black ecological majority) or Psychology (Black ecological minority), completed private and public regard subscales from the Multidimensional Inventory of Black Identity (Sellers et al. in Pers Soc Psychol Rev 2:18-39, 1998) at baseline (Time 1) and after being randomly assigned to a stereotype threat or no-threat/control condition (Time 2). In threat, participants were introduced to a 'puzzle' task as diagnostic of intellectual abilities, whereas in no-threat the same task was introduced as culture fair, such that people from different racial/ethnic groups had performed similarly on this task in the past. In Psychology, students under threat exhibited a simultaneous decrease and increase in private and public regard, respectively, a pattern shown in the literature to be associated with discrimination-based distress and lesser well-being in Black ecological minority environments. In contrast, Africana Studies students' racial identity under threat remained intact. We discuss the protective effects of Africana Studies on racial identity and implications for educational reform.