Caregiver self-efficacy providing nutritional support for pediatric patients undergoing hematopoietic stem cell transplant is associated with psychosocial factors.

Introduction: Caregiver self-efficacy in providing nutritional support to pediatric hematopoietic stem cell transplantation (HSCT) patients has been little studied despite the increased risk of these children potentially being over- or under-nourished after HSCT, and nutritional status could possibly affect treatment outcomes. The current study aimed to describe caregiver dietary self-efficacy and its associated psychosocial factors and barriers to following dietary recommendations. Methods: Caregivers completed questionnaires pre-HSCT and 30 days, 100 days, and one year post-HSCT. A subset provided a 24-h recall of food intake. Results: Results showed generally high caregiver confidence and low difficulty supporting their child nutritionally. However, lower confidence was associated with higher caregiver depression, anxiety, and stress 30 days post-HSCT. Further, higher difficulty at various time points was correlated with lower income, higher depression and anxiety, stress, and miscarried helping (i.e., negative caregiver-child interactions surrounding eating), as well as child overweight status and failure to meet protein intake guidelines. Nutritional criteria for protein, fiber, added sugar, and saturated fat were met by 65%, 0%, 75%, and 75%, respectively. Caregiver attitudes and child behavior were the most frequently reported barriers to healthy eating. Discussion: Results suggest that directing resources to caregivers struggling emotionally, economically, or transactionally could support pediatric patients undergoing HSCT in maintaining optimal nutritional status.

Activism, Coping, and Hopefulness Among Parents of Children With Cancer.

Background: Coping styles employed by parents of children with cancer have significant implications for parents' and children's well-being. To supplement the minimal literature in this area, activism (participation in activities that serve to benefit children with cancer as a group) was investigated as a potential coping strategy. Method: Parents (N = 67) of children with cancer completed an online survey that included measures of COPE inventory (COPE), hopefulness (Adult Hope Scale), and depression (Patient Health Questionnaire-9-item). Participants retrospectively reported their engagement in activism to benefit children with cancer and to benefit other causes, including actions that were taken before and after their child's cancer diagnosis. Relations between activism, overall styles of coping, hopefulness, and depression were assessed. Results: Activism was positively correlated with hope and active coping, but not associated with depression. Participants reported a significant increase in childhood-cancer-related activism following their own child's diagnosis, with 100% of parents endorsing engagement in such activism. Postdiagnosis childhood-cancer-related activism uniquely explained 17% of the variance in hopefulness after other forms of activism had been accounted for. Discussion: Childhood-cancer-related activism is a common activity among parents of children with cancer that has significant implications for parental hopefulness. Parents who endorse an active, solution-focused approach to coping with the childhood cancer experience may be more likely than others to engage in activism. Further research is needed to clarify the role of activism in the lives of families of children with cancer.

Health Information Technology Utilization by Adolescent and Young Adult Aged Inpatients Undergoing Hematopoietic Cell Transplantation.

This longitudinal study examined feasibility of "Roadmap 1.0," a modular health information application integrated with the electronic medical record, provided to 30 adolescent and young adult (AYA) inpatients 11-24 years of age undergoing hematopoietic stem cell transplantation (HSCT). Feasibility was demonstrated: 70% accessed the application. Utilization was highest the first 2 weeks of hospitalization, with the laboratory results module used most. Users' tension and fatigue were higher than nonusers' at baseline, but not hospital discharge or day 100. Results suggest AYAs utilize health information technology in ways consistent with the HSCT trajectory and Roadmap 1.0 addressed informational and psychological needs.

Impact of a health information technology tool addressing information needs of caregivers of adult and pediatric hematopoietic stem cell transplantation patients.

PURPOSE: We developed BMT Roadmap, a health information technology (HIT) application on a tablet, to address caregivers' unmet needs with patient-specific information from the electronic health record. We conducted a preliminary feasibility study of BMT Roadmap in caregivers of adult and pediatric HSCT patients. The study was registered on ClinicalTrials.gov (NCT03161665; NCT02409121). METHODS: BMT Roadmap was delivered to 39 caregivers of adult and pediatric patients undergoing first-time HSCT at a single study site. We assessed person-reported outcome measures (PROMs) at baseline (hospital admission), discharge, and day 100: usefulness of BMT Roadmap (Perceived Usefulness); activation (Patient Activation Measure-Caregiver version [PAM-C]); mental health ([POMS-2®]: depression, distress, vigor, and fatigue); anxiety (State-Trait Anxiety Inventory); and quality of life (Caregiver Quality of Life Index-Cancer [CQOLC]). To identify determinants of caregiver activation and quality of life, we used linear mixed models. RESULTS: BMT Roadmap was perceived useful and activation increased from baseline to discharge (p = 0.001). Further, burden decreased through discharge (p = 0.007). Overall, a pattern of increasing vigor and decreasing depression, distress, fatigue, and anxiety was apparent from baseline to discharge. However, overall quality of life lowered at discharge after accounting for BMT Roadmap use, depression, anxiety, and fatigue (p = 0.04). CONCLUSIONS: BMT Roadmap was a feasible HIT intervention to implement in HSCT caregivers. BMT Roadmap was associated with increased activation and decreased burden, but quality of life lowered across hospitalization. Findings support the need to further develop caregiver-specific self-directed resources and provide them both inpatient and outpatient across the HSCT trajectory.

Novel Health Information Technology Tool Use by Adult Patients Undergoing Allogeneic Hematopoietic Cell Transplantation: Longitudinal Quantitative and Qualitative Patient-Reported Outcomes.

PURPOSE: Health information technology (IT) is an ideal medium to improve the delivery of patient-centered care and increase patient engagement. Health IT interventions should be designed with the end user in mind and be specific to the needs of a given population. Hematopoietic cell transplantation (HCT), commonly referred to as blood and marrow transplantation (BMT), is a prime example of a complex medical procedure where patient-caregiver-provider engagement is central to a safe and successful outcome. We have previously reported on the design and development of an HCT-specific health IT tool, BMT Roadmap. METHODS: This study highlights longitudinal quantitative and qualitative patient-reported outcomes (PROs) in 20 adult patients undergoing allogeneic HCT. Patients completed PROs at three time points (baseline, day 30 post-HTC, and day 100 post-HCT) and provided weekly qualitative data through semistructured interviews while using BMT Roadmap. RESULTS: The mean hospital stay was 23.3 days (range, 17 to 37 days), and patients had access to BMT Roadmap for a mean of 21.3 days (range, 15 to 37 days). The total time spent on BMT Roadmap ranged from 0 to 139 minutes per patient, with a mean of 55 minutes (standard deviation, 47.6 minutes). We found that patients readily engaged with the tool and completed qualitative interviews and quantitative PROs. The Patient Activation Measure, a validated measure of patient engagement, increased for patients from baseline to discharge and day 100. Activation was significantly and negatively correlated with depression and anxiety PROs at discharge, suggesting that this may be an important time point for intervention. CONCLUSION: Given the feasibility and promising results reported in this study, next steps include expanding our current health IT platform and implementing a randomized trial to assess the impact of BMT Roadmap on critical PROs.

Practicing what we know: Multicultural counseling competence among clinical psychology trainees and experienced multicultural psychologists.

Multicultural (MC) competence is considered a necessary skill for clinical and counseling psychologists; however, there is little to no research on the assessment of demonstrated multicultural counseling competence (DMCCC) of clinical psychology graduate students. In this study, we developed a MC assessment instrument to assess DMCCC of clinical psychology graduate students compared with MC-experienced psychologists. In addition, we assessed for differences between the endorsement of MC-appropriate strategies and actual use of these strategies in clinical practice, both by MC-experienced psychologists and clinical psychology students. Results revealed significant differences between the DMCCC of clinical psychology graduate students and MC-experienced psychologists. Significant differences also emerged between endorsement of strategies as multiculturally appropriate and likelihood of actual use of these strategies. Findings suggest that future training and competence models should incorporate participants' ability to not only identify multiculturally appropriate strategies but also use these strategies in therapy.

Web-based treatment for infertility-related psychological distress.

Infertility has been associated with stigma and negative psychosocial functioning. However, only a small proportion of this population actually receives care. Fertility patients predominantly use the Internet for information gathering, social support, and assistance with decision-making; yet, available web resources are unreliable sources of mental health care. Web-based alternatives also have the potential to assist with intervention access difficulties and may be of significant lower cost. This study evaluated the efficacy of a web-based approach to providing a cognitive behavioral intervention with 31 infertile women seeking medical reproductive technologies. Following randomized assignment, participants using the web-based intervention were compared with those in a wait-list control condition on general and infertility-related psychological stress measures. Results were mixed regarding intervention efficacy. Significant declines in general stress were evidenced in the experimental group compared with a wait-list control group. However, website access did not result in statistically significant improvements on a measure of infertility-specific stress. These findings add to the literature on psychological interventions for women experiencing fertility problems. Moreover, despite the widespread use of the Internet by this population, the present study is one of the first to investigate the usefulness of the Internet to attenuate stress in this population. Preliminary results suggest general stress may be significantly reduced in infertile women using an online cognitive behavioral approach.

Measuring resilience in women experiencing infertility using the CD-RISC: examining infertility-related stress, general distress, and coping styles.

Psychological morbidity concurrent with fertility problems has been the focus of substantial scientific inquiry. However, researchers have largely overlooked psychological resilience within this population. This study explored the associations between resilience, infertility-related and general distress, and coping behaviors in forty women from nine fertility clinics throughout the United States. Participants completed the Connor-Davidson Resilience Scale (CD-RISC), Symptom Checklist-90 (SCL-90), Beck-Depression Inventory-II (BDI-II), Fertility Problem Inventory (FPI), and Ways of Coping Questionnaire (WCQ). Women with fertility problems evidenced significantly lower resilience scores than published norms. This study established evidence for the reliability and convergent validity of the CD-RISC with infertile populations. However, similar to other studies using this instrument, the factor structure reported by Connor and Davidson [Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson resilience scale (CD-RISC). Depression and Anxiety 2003;18:76-82] was not well supported. Resilience was negatively associated with infertility-specific and general distress. Engagement in action-focused coping skills was positively correlated with resilience. Implications for enhancing resilience with this population as are discussed.

Rapid assessment for psychopathology in a college health clinic: utility of college student specific questions.

OBJECTIVE: The purpose of this study was to determine the utility and unique benefits of employing the College Health Questionnaire (CHQ) in a college health care setting. The CHQ is a newly designed measure to assess psychosocial issues commonly problematic among college students. PARTICIPANTS: One hundred nine patients participated in the study during their medical appointments. METHODS: Participants completed the study questionnaires (CHQ and Patient Health Questionnaire) in the waiting room. Their provider had the opportunity to use the responses in treatment decision making. RESULTS: A majority (66.1%) endorsed at least one CHQ item. Patients who indicated traditional mental health problems were more likely to be prescribed psychotropic medications, whereas patients who endorsed psychosocial issues commonly problematic among college students were more likely to be referred for behavioral treatment. CONCLUSIONS: Screening for behavioral problems in college primary care settings without the use of college-related questions would result in missing numerous important psychosocial problems.

Cognitive behavioral treatment to improve adherence to hemodialysis fluid restrictions: a case report.

This case report describes outpatient psychological treatment targeting adherence to fluid restrictions in a hemodialysis patient. The consequences of nonadherence to fluid restrictions in hemodialysis patients range from minor discomfort to increased hospitalizations and mortality rates. In addition, when patients chronically fail to adhere, they may no longer be candidates for kidney transplant. The interventions focused on polydipsia, characterized by excessive fluid intake. The methods involved 11-sessions of individual psychotherapy incorporating strategies including increasing awareness, decreasing motivation, increasing effort, engaging in competing events, conducting thought stopping, breaking repetitive routines, eliciting social support, and receiving reinforcement. Results demonstrated that the patient successfully restricted his fluid intake at or below recommended levels 83% of days after fading of treatment began. This case report demonstrates the success of cognitive behavioral treatment strategies with a nonpsychiatric hemodialysis patient.

The need for integrating behavioral care in a college health center.

OBJECTIVE: A trend toward the integrated care model is evident in community primary medical care settings, where behavioral services are provided alongside medical services. The present study explored the potential need for implementing an integrated care model at a Midwest University Health Center by investigating whether the use of two behavioral questionnaires influenced providers' prescription of psychotropic medications and referrals for behavioral intervention. DESIGN: Participants were randomly assigned to condition. The 109 participants in the experimental condition completed two behavioral questionnaires and the 91 control participants received treatment as usual. MAIN OUTCOME MEASURES: The behavioral questionnaires were the mental health-oriented Patient Health Questionnaire and the college-adjustment-oriented College Health Questionnaire. Postvisit, all participants rated their satisfaction with treatment; providers documented psychotropic medication prescriptions, and behavioral treatment referrals. RESULTS: The experimental condition displayed significantly higher rates of discussion of behavioral problems and prescription of psychotropic medications but not referrals for behavioral treatment. Patients in the experimental condition and all providers indicated a desire to use the questionnaires in future visits. CONCLUSION: The findings suggest that increased awareness of behavioral problems influences treatment-decision making at a university health service, and therefore this setting would be fertile ground for implementation of an integrated care model.

Treatment of early onset hair pulling as a simple habit.

The authors evaluated the effects of response prevention, a treatment previously shown to be effective for routine thumb sucking and suggested to be effective for early onset trichotillomania, applied to hair pulling in a 2-year-old. Response prevention was used alone in two settings (bedtime and naptime) and combined with a brief time out in another (daytime). The authors also used a novel assessment, weight of hairs pulled, and the results indicated complete cessation of hair pulling. Corresponding photographic evidence indicated complete regrowth of hair lost to pulling. These results add to a growing literature suggesting early onset hair pulling may be more appropriately classified as a benign habit than as trichotillomania.