The Basic Documentation for Psycho-Oncology Short Form (PO-Bado SF)--an expert rating scale for distress screening: development and psychometric properties.

BACKGROUND: The aim of this study is to validate the Basic Documentation for Psycho-Oncology Short Form (PO-Bado SF), a six item interview-based expert rating scale for distress screening in cancer patients. METHODS: Using a heterogeneous multicenter study sample (n = 1551), we examined validity, reliability, and dimensionality of the PO-Bado SF. The Hospital Anxiety and Depression Scale (HADS), the Distress Thermometer, the Questionnaire on Stress in Cancer, and the Patient Health Questionnaire were used to investigate convergent validity. Confirmatory factor analysis was applied to address unidimensionality. An optimal cutoff point was determined by ROC analysis and the maximum of Youden's index. An additional study with n = 41 audio recorded PO-Bado SF interviews was carried out to assess inter-rater reliability. RESULTS: Mean age of the study sample was 64.0 (SD = 12.0), 42% were women. About 24% of the patients suffered from metastases. The one-factor solution was confirmed; internal consistency of the PO-Bado SF was high (α = 0.84). The PO-Bado SF total score correlated significantly with all psychosocial measures, the highest correlation was with the HADS total score (r = 0.64). Patients with severe disease conditions (metastases, psychological/psychiatric treatment in the past, low performance status) received higher distress ratings (p < 0.001). Using HADS total score (>13) as external criterion, an optimal PO-Bado SF cutoff score of >9 emerged (sensitivity 0.75; specificity 0.82). Inter-rater reliability was satisfactory for each of the six items (intra class correlation of 0.75 to 0.85). CONCLUSIONS: The PO-Bado SF is a short, reliable and valid expert rating scale to identify distressed cancer patients.

The effect of including a 'psychooncological statement' in the discharge summary on patient-physician communication: a randomized controlled trial.

OBJECTIVE: The objective of this study is to determine whether the inclusion of a 'psychooncological statement' (PO-statement) in the discharge summary enhances patient-physician communication about psychosocial issues across the inpatient and outpatient sector. METHODS: A total of 1416 cancer patients were randomly assigned to the intervention (with PO-statement in the discharge summary) or control group (discharge summary without PO-statement). Shortly before discharge from the hospital (T1), patients from the intervention group were screened for psychosocial distress. Based on the electronic clinical documentation system, screening results were subsequently integrated into the discharge summary, which automatically generated a PO-statement. To determine the effect of the PO-statement, patients as well as their primary care physicians (n = 596) were asked during follow-up care (T2) whether psychosocial distress was discussed during the last consultation. RESULTS: Including a PO-statement in the discharge summary did not result in more frequent discussions about psychosocial issues compared with the control group from the patients' and physicians' perspectives. Instead, discussions about psychosocial well-being were significantly associated with women of the patient (p = <0.001) and the physician (p = 0.011), medical discipline (gynecologists; p = 0.002), cancer diagnosis (gynecological cancer; p = 0.002), metastases (p = <0.001), professional training of patients (none, p = 0.026), and psychosocial qualification of physicians (p = 0.018). CONCLUSION: Written information on psychosocial distress in the discharge summary alone does not affect communication.

Health-related quality of life supersedes other psychosocial predictors of long-term survival in cancer patients undergoing radiotherapy.

BACKGROUND: To investigate the prognostic value of several psychosocial factors for long-term survival in cancer patients. MATERIAL AND METHODS: Baseline data were gathered in routine radiotherapy practice during 44 months. The analysis is based on 938 patients for whom follow-up data were available. Baseline psychosocial distress, depression, health-related quality of life (HRQOL), and life satisfaction were assessed using Questionnaire on Stress in Cancer Patients (QSC-R23), Self-Rating Depression Scale (SDS), Functional Assessment of Therapy - General (FACT-G) questionnaire, and Questions on Life Satisfaction (FLZ(M)). Patients were followed up for 7 to 10 years. Kaplan-Meier plots and Cox proportional hazards models were used to investigate associations between sociodemographic, clinical, psychosocial factors and overall survival (OS). RESULTS: Patients' median survival time was 35 months (95% CI 28.9-41.1). Significant multivariate predictors of OS were age, health insurance type, Karnofsky performance status, cancer site, and cancer stage. Controlling for these variables, HRQOL was the only psychosocial predictor of survival (hazard ratio 0.988, 95% CI 0.979-0.997, p =0.009). The physical well-being and the functional well-being subscales of the FACT-G emerged as the relevant HRQOL facets predictive of survival. CONCLUSION: HRQOL has incremental predictive value for long-term survival in cancer patients.

Determinants of long-term response to group therapy for dysfunctional fear of progression in chronic diseases.

Prior work demonstrated that cognitive-behavioral (CBT) and supportive-experiential (SET) group interventions can reduce dysfunctional fear of progression (FoP) in patients with chronic diseases. In this secondary analysis of a randomized controlled study, we investigated determinants of long-term response to group therapy for FoP. Response to therapy after 12 months was assessed using the Reliable Change Index (RCI). Outcome data were available for 129 patients with cancer and 116 patients with chronic arthritis. 37.9% of the patients in the CBT group and 32.7% of those attending the SET group indicated response to therapy (p=.402). Educational level predicted long-term response to therapy (OR 2.53, 95% CI 1.33-4.81; p=.005). Medical patients with lower education may need additional attention in order to gain long-lasting benefit from brief group psychotherapy. However, this investigation needs to be replicated in a study that includes a broader range of psychological predictors.

[Fear of progression in chronic diseases]. / Progredienzangst bei chronischen Erkrankungen.

Chronically physically ill patients frequently suffer from psychological distress. The realistic fear of progression (FOP) of disease is one of the most important causes of distress in these patients. This study investigates the extent of FOP in patients with diverse diagnoses. 863 Patients answered the FOP-questionnaire, medical and sociodemographic items. Group differences were investigated with t- and F-tests. Determinants for FOP were identified by linear multiple regression. Some diagnostic subgroups differ in degree and profile of FOP. Patients with rheumatic diseases and Parkinson's disease score highest, patients with stroke or chronic peripheric vascular disease lowest in FOP total scores. Age, sex, economic situation and employment effect the level of fear of progression. Systematic studies are needed to verify the importance of FOP for patients with chronic disease and to ascertain clinical indication for psychotherapeutic support.

Distress screening in oncology-evaluation of the Questionnaire on Distress in Cancer Patients-short form (QSC-R10) in a German sample.

OBJECTIVE: The aim was to examine the psychometric properties of the Questionnaire on Stress in Cancer Patients (QSC-R10), a 10-item screening instrument for self-assessment of psychosocial distress in cancer patients. METHODS: A total of 1850 cancer patients were assessed with the QSC-R10. Patients were recruited from different inpatient and outpatient settings in Germany between 2007 and 2009. RESULTS: Mean age of the sample was 62.9 (SD=12.4) with breast cancer as the most frequent diagnosis (35.2%). The analysis indicated high reliability (Cronbach's α=0.85) and test-retest reliability (ICC=0.89). Validation scales included the Hospital Anxiety and Depression Scale (HADS), Distress-Thermometer (DT), European Organization for Research and Treatment of Cancer QLQ-C30 (EORTC QLQ-C30) and Karnofsky Performance Status (KPS). Convergent validity was highest for the HADS total score (r=0.74) and the lowest correlation for KPS (r=-0.36). The QSC-R10 significantly distinguished subgroups by their clinical characteristics (metastases, illness duration, previous psychiatric treatment and psycho-oncological support; p<0.001). A cutoff score of >14 demonstrated good sensitivity (81.0%) and specificity (73.2%) and is suitable to determine the need for psychosocial support. CONCLUSION: The QSC-R10 is a valid and reliable questionnaire to detect distress in cancer patients with high acceptance among professionals and patients.

Predicting pain and disability in patients with hand fractures: comparing pain anxiety, anxiety sensitivity and pain catastrophizing.

There is a range of anxiety-related constructs associated with pain and pain-related disability. Those most often examined are pain catastrophizing, pain anxiety and anxiety sensitivity. All three are conceptualized to be important in the development and maintenance of chronic pain, and are included within fear avoidance models. Surprisingly these constructs are not routinely examined together, and when they are, have been investigated in healthy individuals using experimental techniques or patients with chronic conditions. Although these constructs are also thought to be important in acute clinical pain, they tend not to been examined together in the same study. The focus of the current research was therefore to examine these three anxiety-related constructs in an acute pain setting, and examine their relative influence on both pain and pain-related functional disability. Participants were 82 patients with a hand fracture, recruited from a fracture clinic at a general hospital. They completed a battery of measures related to anxiety, pain and disability. Once controlling for injury-related variables, catastrophizing was found to predict current pain, pain-related anxiety predicted task-related pain, whereas anxiety sensitivity was (negatively) associated with disability. These findings are discussed in light of the relative role that these anxiety-related constructs have in pain and disability, as well as implications for future research.

Evaluation of two group therapies to reduce fear of progression in cancer patients.

PURPOSE: This paper aims to evaluate the effects of two psychotherapeutic interventions on dysfunctional fear of progression (FoP) in cancer patients and to investigate illness-specific influences. METHODS: One hundred seventy-four cancer patients were recruited from two rehabilitation clinics and randomly assigned to either a four-session cognitive-behavioral group therapy or a supportive-experiential group therapy. The main outcome criterion was FoP that was assessed with the Fear of Progression Questionnaire (FoP-Q) directly before (T1) and after (T2) the intervention, as well as 3 (T3) and 12 months (T4) after discharge. Secondary outcomes were anxiety, depression, and quality of life that were assessed with the following questionnaires: Questions on Life Satisfaction, Questionnaire for General Health Status, and the Hospital Anxiety and Depression Scale. Patients from the control group (n = 91) who received treatment as usual were recruited 1 year later with the same inclusion criteria and assessed with the FoP-Q at T1, T2, and T4. RESULTS: Analyses showed a significant main effect for time and a significant interaction for group x time for the main outcome variable. FoP decreased significantly over time in both intervention groups in contrast to the control group that showed only short-term improvements. The interventions were also effective in improving secondary outcomes except general life satisfaction. Analyses of cancer specific influences on FoP indicated a significant influence of disease status, i.e., patients with metastases and recurrence of cancer gained most from the interventions. CONCLUSIONS: Fear of progression, one of the main sources of distress for cancer patients, can be reduced with short psychotherapeutic interventions.

Group psychotherapy of dysfunctional fear of progression in patients with chronic arthritis or cancer.

BACKGROUND: This study investigated the effectiveness of brief psychotherapeutic group interventions in reducing dysfunctional fear of disease progression (FoP). The interventions comprised either cognitive-behavioral group therapy or supportive-experiential group therapy. We tested whether these generic interventions would prove effective in different illness types. METHODS: Chronic arthritis in- patients (n = 174) and cancer in-patients (n = 174), respectively, were randomized to receive one of the two interventions. The patients provided data before intervention, at discharge, and at 3 and 12 months of follow-up. FoP was the primary outcome, secondary outcomes were anxiety, depression and quality of life. A treatment-as-usual control group provided data on the primary outcome. RESULTS: Patients with chronic arthritis indicated higher levels of FoP than cancer patients. The results revealed that, compared with no specialized intervention, both group therapies were effective in reducing dysfunctional FoP, but only among cancer patients. The effect sizes were 0.54 (cognitive-behavioral therapy) and 0.50 (supportive experiential therapy). The interventions were not differently effective in reducing the secondary outcomes. CONCLUSIONS: Dysfunctional FoP can be effectively targeted with brief group interventions. Psychotherapeutic interventions for reducing FoP should focus on specific illness characteristics.

Reduction of chemotherapy-induced anorexia, nausea, and emesis through a structured nursing intervention: a cluster-randomized multicenter trial.

OBJECTIVES: The purpose of this present study was to evaluate Self-care Improvement through Oncology Nursing (SCION) program to reduce distressing anorexia, nausea, and emesis (ANE) in cancer patients undergoing chemotherapy. METHODS: Two hundred eight patients receiving chemotherapy with moderate to high emetogenic potential participated in a cluster randomized trial on 14 wards in two German university hospitals. Additionally to standard antiemetic treatment, patients from the intervention wards received the SCION program consisting of four modules: advisory consultation, optimizing emesis prophylaxis, nutrition counseling, and relaxation. Patients from the control group received standard antiemetic treatment and standard care. Primary outcome was the group difference in ANE intensity assessed by Common Terminology Criteria for adverse events (CTCAE). MAIN RESULTS: The SCION program did not result in a significant difference in the incidence of ANE symptoms as compared to standard care: mean difference on CTCAE scale was 0.24 pts (95%CI, -1.17 to 1.66 pts; P = 0.733). No difference could be found regarding patients' knowledge of side effects, self-care interventions, and agency. Health-related quality of life was significantly better for patients in the control group (mean difference 10.2 pts; 95%CI, 1.9 to 18.5; P = 0.017). CONCLUSIONS: Contrary to our expectations, the groups did not differ in ANE intensity caused by the overall low acute or delayed symptom intensity. Symptom hierarchy in cancer patients alters and challenges nursing interventions targeting the patients' self-care strategies.

The Basic Documentation for Psycho-Oncology (PO-Bado): an expert rating scale for the psychosocial experience of cancer patients.

BACKGROUND: The integration of psycho-oncology into the medical care of cancer patients requires a transparent, reliable, and valid assessment of psychosocial stress. The Basic Documentation for Psycho-Oncology (PO-Bado), including a short version and a breast cancer-specific version, is such an instrument. The purpose of this article is to present the current stage of development of the 3 versions. PATIENTS AND METHODS: All versions of the PO-Bado were developed and psychometrically evaluated based on the empirical analysis of multiple oncological samples. External criteria for the validation and determination of cut-off scores were the Hospital Anxiety and Depression Scale, the Questionnaire on Stress in Cancer Patients, and the EORTC Quality of Life Questionnaire. Inter-rater reliability was examined by different psycho-oncologists who independently rated PO-Bado interviews. RESULTS: Three versions of the PO-Bado are presented: the standard version (PO-Bado, 17 items), the short form (PO-Bado SF, 7 items), and the breast cancer-specific version (PO-Bado BC, 21 items). A manual and interview guideline are provided for all versions. By now, the standard version has been implemented throughout Germany and includes data of 6,365 patients. CONCLUSION: A consistent nationwide implementation of the PO-Bado for the assessment of psychosocial stress in cancer patients would contribute to the improvement of medical care.