CancerSupportSourceTM -Caregiver: Development of a distress screening measure for cancer caregivers.

OBJECTIVE: Given the substantial demands of cancer caregiving, practical and psychometrically sound tools to evaluate distress among cancer caregivers are needed. CancerSupportSourceTM -Caregiver is a distress screening, referral, and support program designed to identify the unmet needs of cancer caregivers and link caregivers to desired resources and support. This study refined and finalized the CancerSupportSource-Caregiver screening measure and examined its psychometric properties. METHODS: Using an analytic sample of 400 caregivers to people with cancer, we first performed item reduction by assessing exploratory factor analysis, external/internal item quality, and judging theoretical and practical implications of items. Confirmatory factor analysis along with reliability and validity analyses were then conducted to corroborate dimensionality and psychometric properties of the final measure. Nonparametric receiver operating characteristic curve analyses determined scoring thresholds for depression and anxiety risk subscales. RESULTS: Scale refinement resulted in an 18-item measure plus one screening item assessing tobacco and substance use. Items represented five domains of caregiver concerns: emotional well-being, patient well-being, caregiving tasks, finances, and healthy lifestyle. Our analyses showed strong internal consistency and test-retest reliability, a replicable factor structure, and adequate convergent, discriminant, and known groups validity. Sensitivity of 2-item depression and 2-item anxiety risk subscales were 0.95 and 0.87, respectively. CONCLUSIONS: CancerSupportSource-Caregiver is a reliable and valid multidimensional measure of caregiver distress that also screens for risk for clinically significant depression and anxiety. It can be implemented within a distress screening, referral, and follow-up program to rapidly assess caregivers' unmet needs and enhance caregiver well-being across the care continuum.

A group positive psychology intervention for cancer survivors and caregivers: A pilot study of Activating Happiness©.

The purpose of this study was to examine the feasibility and potential concept of a 4-week positive psychology group intervention (Activating Happiness©) for cancer survivors and caregivers that emphasized mindfulness, self-compassion, and gratitude. Nine facilitators led 6 intervention groups for 49 participants (35 cancer survivors, 14 caregivers). Of eligible participants, 63% enrolled and of those, 89% completed all study activities. Participants completed self-report measures at baseline, after the second and final sessions, and 3-month post-intervention, and provided qualitative feedback after the final session. Qualitative data demonstrated that participants found the intervention acceptable. The intervention's potential proof-of-concept was supported by benchmarking outcomes against those reported in randomized controlled trials, with effect sizes for mindfulness, self-compassion, anxiety, and depression for caregivers and survivors, and for pain for survivors comparable to size estimates for efficacy in clinical trials.

If We Don't Ask, Our Patients Might Never Tell: The Impact of the Routine Use of a Patient Values Assessment.

PURPOSE: Good communication can be associated with better end-of-life outcomes. The US Oncology Network developed and tested a Values Assessment (VA) for facilitating advance care planning (ACP). The results of the first 1,268 patients are reported. METHODS: The VA consists of 10 questions of the format "How valuable is it to me to…" (eg, "...know that I am not a burden to my family, friends, or helpers?"). Responses were on a four-point scale from unsure to very valuable. VA data on 1,286 patients with metastatic cancer from April 1, 2013, to July 31, 2015, were extracted from the electronic health record, including demographics, diagnosis, stage, chemotherapy, and outcomes (hospice enrollment, place of death). These demographics were compared by using the χ2 or Fisher's exact test or the Wilcoxon rank sum test for continuous variables. RESULTS: A total of 1,268 patients completed the VA (56.7% were ≥ 65 years of age, 57.8% completed advance directives [ADs]). There were 438 deaths of which 308 had a place of death or a hospice enrollment recorded. Of these, 78% died at home or inpatient hospice; 14.6% died in the hospital. Hospice enrollment with ADs was 76.1% and without, 60.9%. Median length of stay in hospice was 21 days with ADs versus 12.5 days without. Chemotherapy in the last 14 days of life was 8.8% with ADs and 15.5% without. The VA was well accepted by patients. CONCLUSION: A VA as a routine part of practice is feasible and scalable. It facilitates ACP discussions that lead to ADs. The results suggest that VA and ACP lead to less-aggressive care at the end of life.

Posttraumatic growth after cancer: The role of perceived threat and cognitive processing.

This study examines the relation between perceived cognitive and physical threat after a cancer diagnosis and posttraumatic growth (PTG). In total, 169 breast, prostate, and colorectal cancer survivors completed questionnaires. Hierarchical regression models found after controlling for demographic and medical variables, depression, anxiety, and perceived threat account for 41.8% of the variance of positive cognitive processing, and these variables along with positive cognitive processing accounted for 42.7% of the variance of PTG. Positive cognitive processing mediated the pathways between perceived physical threat and PTG. Cognitive processing appears to play a key role in the emergence of PTG following cancer. By exploring survivors' cognitions and perceived threat, psychosocial providers may help cancer survivors cultivate PTG.