Understanding the Factors Related to Trauma-Induced Stress in Cancer Patients: A National Study of 17 Cancer Centers.

OBJECTIVE: Posttraumatic stress symptoms (PTSS), defined as continued trauma, has been found to negatively impact mental and physical health. Many cancer centers routinely assess level of psychological distress but assessment of symptoms related to PTSS is less routine. Understanding the mechanisms by which psychological distress results in, or influences, PTSS will aid in developing protocols to more effectively identify PTSS in cancer patients. METHODS: Survey data were analyzed from intake data at 17 cancer centers across the U.S. Patients reported distress ratings on the National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT), responded to questions related to intrusive cognitive symptoms of PTSS and provided information about current symptoms and social support systems. Hypotheses were tested using a conditional process model, and paths were provided for direct and indirect effects, including moderation and mediated moderation. RESULTS: Findings indicated that, while distress scores were influential in the total model, the direct effect of distress on intrusive cognitive symptoms of PTSS was negated by the model's indirect effects. The effects of social support and older age were independent protective factors, and there was a moderation effect that varied across groups. Lastly, physical cancer symptoms as a mediating variable further explained the relationship between psychological distress and intrusive cognitive symptoms of PTSS. CONCLUSIONS: Study results provide evidence for a potential mechanism by which distress relates to intrusive cognitive symptoms of PTSS. Furthermore, findings suggest that older age and social support may be protective factors for certain groups and risk factors for others. This study provides formative data for potential next steps that could lead to improvements in routine psychosocial screenings in cancer treatment settings.

The Polaris Oncology Survivorship Transition (POST) System: A Patient- and Provider-Driven Cancer Survivorship Planning Program.

BACKGROUND: It is strongly recommended that individuals ending treatment for cancer have a "survivorship plan," and new standards require survivorship planning for accreditation, However, a comprehensive plan is often neglected. OBJECTIVE: To present the development and field test results of a web-based, breast cancer survivorship care planning system. METHODS: The Polaris Oncology Survivorship Transition (POST) blends input from the electronic health record (EHR), oncology care providers (OCPs), and patients to create a survivorship care plan (SCP). The content of the POST program was created with the assistance of end-user input (patients, oncologists, and primary care providers (PCPs)) and the full program was piloted on women ending treatment for breast cancer. This paper presents the pilot study that field-tested the POST In a clinical setting. Patients were recruited from outpatient care clinics and chemotherapy units in a comprehensive care center. The study included 25 women ending treatment for breast cancer in the past year, 4 OCPs, and PCPs. Patients received the POST computeπzed assessment and a tailored SCP. RESULTS: The POST assists providers in crafting efficient and comprehensive SCPs and was rated highly satisfactory by all end-users. DISCUSSION: The POST program can be used as a cancer survivorship planning program to assist OCPs in care planning for their patients ending treatment for breast cancer. CONCLUSION: This study provides support for Incorporating computerized SCP programs into clinical practice. Use of the POST in clinical practice has the potential to improve survivorship planning.

Are two voices better than one? Predicting permanency in minority youth using multi-informant mental health and strength data.

Among youth in child welfare ages 6-17 years, 40 % meet the criteria for one or more DSM diagnoses. For minority youth in child welfare, poor mental health is compounded by limited access to care and racial disparity bias, leading to poorer outcomes. This paper uses data collected and analyzed by an automated behavioral health assessment system for a multiyear study that focused on ways to improve case planning in child welfare. Youth, their caseworkers, and, in some cases, parents completed assessments that measured and monitored the youths' needs and strengths. More than 60 % of youth participating in the study were African-American; permanency rates after six months of case planning were found to be only one third. Predictive factors related to better behavioral health and permanency outcomes are identified and discussed, as well as the implications for improving case planning by incorporating the views of multiple informants, including the youth.

Revolutionizing child welfare with outcomes management.

Outcomes management technology holds great promise for improving the quality of services provided to youth in the child welfare system. Advantages include better detection of behavioral health and trauma-related issues, early indicators of case progress or risk of failure, and program- and system-level learning. Yet organizational barriers to implementation persist. Attention is spent in this paper on addressing these barriers so the use of outcomes management technology becomes a common practice. A model for predicting resiliency is presented, along with case examples demonstrating its potential use for treatment planning and monitoring progress.

Randomized controlled trial to test a computerized psychosocial cancer assessment and referral program: methods and research design.

The National Cancer Coalition Network, National Cancer Institute, and American College of Surgeons all emphasize the need for oncology providers to identify, address, and monitor psychosocial needs of their patients. The Mental Health Assessment and Dynamic Referral for Oncology (MHADRO) is a patient-driven, computerized, psychosocial assessment that identifies, addresses, and monitors physical, psychological, and social issues faced by oncology patients. This paper presents the methodology of a randomized controlled trial (RCT) that tested the impact of the MHADRO on patient outcomes at 2, 6, and 12 months. Patient outcomes including overall psychological distress, depression, anxiety, functional disability, and use of psychosocial resources will be presented in future publications after all follow-up data is gathered. Eight hundred and thirty six cancer patients with heterogeneous diagnoses, across three comprehensive cancer centers in different parts of the United States, were randomized to the MHADRO (intervention) or an assessment-only control group. Patients in the intervention group were provided detailed, personalized reports and, when needed, referrals to mental health services; their oncology provider received detailed reports designed to foster clinical decision making. Those patients who demonstrated high levels of psychosocial problems were given the option to authorize that a copy of their report be sent electronically to a "best match" mental health professional. Demographic and patient cancer-related data as well as comparisons between patients who were enrolled and those who declined enrollment are presented. Challenges encountered during the RCT and strategies used to address them are discussed.

Economic benefit of chemical dependency treatment to employers.

Using assessment data from the Substance Abuse Treatment Support System, we estimated the economic benefit of chemical dependency treatment to employers. A cohort of individuals (N = 498) treated at Kaiser Permanente's Addiction Medicine programs in Southern California completed assessments before and at least 30 days after treatment began. Compared to intake, subsequent assessments indicated substantial reduction in the number of patients who missed work, were late for work, were less productive than usual at work, and/or had conflict with coworkers or management. The net economic value of these improvements to their employers depended upon the utilization rate of the benefit and the salary level of the employees receiving treatment. For a utilization rate of 0.9% and a mean annual salary of US$45,000, the net benefit of treatment was US$1,538 for > or = 61 days of treatment. Based solely upon these employment-related measures, without factoring in the medical cost offset or indirect benefits of treatment that may help employees to maintain higher levels of productivity, employers break even on an investment of US$30 per member per year for a chemical dependency treatment benefit if the mean annual salary of the employees participating in treatment is US$36,565.