Applications of turning point analysis in behavioral medicine research: A systematic scoping review.

BACKGROUND: Turning Point Analysis (TPA) is a methodological approach that allows scholars to retrospectively capture change over time by identifying instances of critical change (i.e., turning points) encountered across a given time period. While TPA has been used to examine time as a variable in health and illness experiences, the use of the method in behavioral medicine scholarship may be limited by the lack of understanding of TPA procedures and applicability. OBJECTIVE: To describe how TPA has been used and enhance its accessibility by identifying and synthesizing methods of TPA data collection and analysis. METHODS: A systematic search of electronic databases, including Academic Source Premier, Psychology and Behavioral Sciences Collection, APA PsycInfo, and ProQuest Dissertation and Theses Database, was conducted in May 2020. In July 2020, we used hand searching to identify additional articles, including forward and back tracking seminal articles on TPA. Studies were screened in duplicate. RESULTS: Of the 1184 studies screened for this review, we included 52. Studies used TPA to examine relational (k = 40), organizational (k = 6), and individual (k = 6) variables and included an analysis of either turning points (k = 28), the trajectories of change over time created by the turning points (k = 3), or both (k = 21). Turning points and trajectories were captured and analyzed using qualitative and quantitative analytic approaches, with most studies using either purely qualitative (k = 26) or mixed methods (k = 21). CONCLUSIONS: The findings of this review provide insight into the varied applications of TPA and suggest the potential value of this methodological approach in better understanding health experiences across time. By synthesizing the procedural and analytic steps to conducting a TPA, this review could also increase the accessibility and use of TPA in behavioral medicine research.

Meaning-centered psychotherapy training program for cancer care clinicians: Efficacy and impact of the first 5 years.

Meaning-Centered Psychotherapy (MCP) is a manualized, evidence-based intervention designed to help cancer patients to find meaning and alleviate distress. Meaning-Centered Psychotherapy Training (MCPT) is a multicomponent program for cancer care clinicians that consists of didactics, group experiential learning, and role-plays with simulated patients to learn MCP and acquire skills to deliver it in real-world oncology settings. The efficacy and impact of MCPT for multidisciplinary cancer care clinicians to learn and disseminate MCP is described and evaluated. A multilevel evaluation based on the RE-AIM framework was utilized to assess the efficacy of the MCPT program over the initial 5 years of the program. The outcomes of the evaluation supported MCPT goals. Three hundred forty-two participants attended MCPT. Overall satisfaction measured in the post-training assessment was high. Significant increases in MCP skills were demonstrated by participants over the course of the role-play sessions, and participants showed significant improvements in pre/post-training MCP knowledge assessment scores, as well as significant increases in self-reported overall MCP skills and core competencies. Follow-up survey responses indicate that MCP trainees were utilizing MCP, had made changes to their clinical practice, and progressed on individual implementation goals. During the first 5 years, the MCPT program was successfully developed, established, implemented, and shown to be effective in the dissemination of MCP across the RE-AIM domains. Future directions for training and implementation research include increasing diversity of providers and investigating the impact of the program on patient outcomes.

Meaning-Centered Psychotherapy (MCP) is a manualized brief intervention designed to help cancer patients to find meaning and alleviate distress. Meaning-Centered Psychotherapy Training (MCPT) is a program for cancer care clinicians, consisting of lectures, group exercises, and practice with simulated patients to learn MCP and the skills to deliver it in real-world oncology settings. Participants were evaluated with a multi-assessment approach to establish the efficacy and impact of the program over the initial 5 years. Results demonstrated that the MCPT program met its goals. In total, 342 clinicians from diverse clinical and geographic cancer settings attended. Overall satisfaction with the training after participation in MCPT was high. Significant increases in MCP skills were demonstrated by participants over the course of the practice sessions, participants showed significant improvements in MCP knowledge assessment scores, as well as in self-reported overall MCP skills and core competencies. Surveys sent at 3, 6, and 12 months after participation indicated that most trainees were utilizing MCP, changed their clinical practice, and made progress on their training goals. During the first 5 years, the MCPT program was successfully developed, implemented, and shown to be effective to facilitate the dissemination of MCP for wider use in clinical settings.

A randomized controlled trial of a distress screening, consultation, and targeted referral system for family caregivers in oncologic care.

OBJECTIVE: Distress screening is standard practice among oncology patients, yet few routine distress screening programs exist for cancer caregivers. The objective of this study was to demonstrate the feasibility, acceptability, and preliminary efficacy of Cancer Support Source-CaregiverTM (CSS-CG, 33-item), an electronic distress screening and automated referral program with a consultation (S + C) to improve caregiver unmet needs, quality of life, anxiety, depression, and distress relative to Enhanced Usual Care (EUC; access to educational materials). METHOD: 150 caregivers of patients with varying sites/stages of cancer were randomized to S + C or EUC and completed assessments at baseline, 3-months post-baseline, and 6-months post-baseline. A subset of participants (n = 10) completed in-depth qualitative interviews. RESULTS: S + C was feasible: among 75 caregivers randomized to S + C, 66 (88%) completed CSS-CG and consultation. Top concerns reported were: (1) patient's pain and/or physical discomfort; (2) patient's cancer progressing/recurring; and (3) feeling nervous or afraid. Differences between groups in improvements on outcomes by T2 and T3 were modest (ds < 0.53) in favor of S + C. Qualitative data underscored the helpfulness of S + C in connecting caregivers to support and helping them feel cared for and integrated into cancer care. CONCLUSIONS: S + C is feasible, acceptable, and yields more positive impact on emotional well-being than usual care. Future studies will examine programmatic impact among caregivers experiencing higher acuity of needs, and benefits of earlier integration of S + C on caregiver, patient, and healthcare system outcomes.

Development and feasibility of a communication training to assist caregivers with advanced care planning.

OBJECTIVE: Caregivers are critical in advanced care planning (ACP) discussions, which are difficult but necessary to carry out patients' goals of care. We developed and evaluated the feasibility and acceptability of a communication training to equip caregivers of patients with malignant brain tumors with skills to navigate ACP conversations. METHOD: Caregivers completed a 2-h virtual training addressing ACP Discussions with Your Loved One and ACP Discussions with the Medical Team. A pre-training assessment was completed at baseline and a training evaluation was completed one day post-training. A subset of participants completed semi-structured interviews 2 months post-training. RESULTS: Of 15 caregivers recruited, 9 attended the training and 4 completed qualitative interviews. Post-training, 40% felt confident in discussing ACP with loved ones and 67% felt confident doing so with healthcare professionals; 100% reported feeling confident in using skills learned in the training to facilitate these conversations. Data from qualitative interviews highlighted additional benefits of the training in empathic communication skills and fostering social support. SIGNIFICANCE OF RESULTS: Our communication skills training shows promise in supporting caregivers' skills and confidence in engaging in ACP discussions with patients and healthcare providers. A future randomized controlled trial with a larger and more diverse caregiving sample is needed to determine training efficacy.