How impaired is too impaired? Exploring futile neuropsychological test patterns as a function of dementia severity and cognitive screening scores

Some older adults cannot meaningfully participate in the testing portion of a neuropsychological evaluation due to significant cognitive impairments. There are limited empirical data on this topic. Thus, the current study sought to provide an operational definition for a futile testing profile and examine cognitive severity status and cognitive screening scores as predictors of testing futility at both baseline and first follow-up evaluations. We analysed data from 9,263 older adults from the National Alzheimer’s Coordinating Center Uniform Data Set. Futile testing profiles occurred rarely at baseline (7.40%). There was a strong relationship between cognitive severity status and the prevalence of futile testing profiles, χ²(4) = 3559.77, p < .001. Over 90% of individuals with severe dementia were unable to participate meaningfully in testing. Severity range on the Montreal Cognitive Assessment (MoCA) also demonstrated a strong relationship with testing futility, χ²(3) = 3962.35, p < .001. The rate of futile testing profiles was similar at follow-up (7.90%). There was a strong association between baseline dementia severity and likelihood of demonstrating a futile testing profile at follow-up, χ²(4) = 1513.40, p < .001. Over 90% of individuals with severe dementia, who were initially able to participate meaningfully testing, no longer could at follow-up. Similarly, there was a strong relationship between baseline MoCA score band and likelihood of demonstrating a futile testing profile at follow-up, χ²(3) = 1627.37, p < .001. Results can help to guide decisions about optimizing use of limited neuropsychological assessment resources.     

The role of social support in women’s health and recovery processes

The aim of this study was to assess the psychological state of women who have undergone surgery for breast cancer or cardiac surgery, including examination of the role of social support in both groups. The study included 48 women (mean age: 66.04?±?8.3 years). They were divided into two groups according to diagnosis: 23 women (mean age: 69.2?±?8.6 years) who underwent heart surgery (cardiac group, CG) and 25 women (mean age: 63.2?±?7.0 years) treated for breast cancer and associated with the Women After Mastectomy Club (oncology group, OG). In addition to the assessment of socio-demographic variables, the following self-report questionnaires were administered: Satisfaction with Life Scale, Acceptance of Illness Scale, Beck Depression Inventory, Spielberger State-Trait Anxiety Inventory as well as Berlin Social Support Scale. In the CG, the severity of depressive symptoms was two times higher than in OG (p?=?.003). In both groups, there was a high percentage (80%) of women with severe symptoms of anxiety (p?=?.37). In both groups, the level of life satisfaction was similar (p?=?.58), but OG was characterized by a higher level of acceptance of the disease (p?=?.003). The correlation analysis showed that in both groups, social support was related differently to the parameters of emotional state. Women treated for breast cancer were in a better mental condition than women treated for heart disease. The support coming from other women in similar circumstances (Women After Mastectomy Club) seems to be more effective than the support coming from the patient’s immediate environment. The results for social support ought to be interpreted not only through the prism of mean values of received support, but also with regard to the information on the sources of support.     

Suffering for others as religious meaning-making: varieties,prerequisites, and functions in the coping process of a sample of practising Christians living with cancer

The coping method suffering for others as religious meaning-making (SORM) is analysed regarding its varieties, prerequisites, and functions in a group (n?=?10) of practising Christians living with cancer. In-depth interviews are featured in this qualitative, longitudinal study of the interdependence of religiosity and coping. A common feature of the analysed narratives is the idea that the informant's suffering would have – or at least had the potential to have – a positive effect on other individuals. This idea is identified as the “coping tool” of the coping method. Three different variants of SORM are identified, with a variety of prerequisites. The function in all cases is to conserve the significant object sense of meaning and, in some cases: survival. A case study is presented that shows how the coping method can be maintained over time by changing the coping tools of the method when they lose their efficacy in the coping process.     

Religious and spiritual struggle: prevalence and correlates among older adults with depression in the BRIGHTEN Program

Older adults (OA) are more religious and/or spiritual (R/S) than younger adults, but some experience R/S struggle which is associated with poorer quality of life. Little is known about R/S struggle in community dwelling OA. This study examines prevalence, correlates, the association with depression for R/S struggle, and a desire for spiritual care in community dwelling OA with depression. In a programme for integrating care for these OA, 188 participants provided demographic information along with the Geriatric Depression Scale and a tool screening for potential R/S struggle. Prevalence of potential R/S struggle was 50%. The younger OA and Caucasian individuals vs. Hispanic individuals were more likely to experience potential R/S struggle. A relationship of potential R/S struggle with depression persisted with the inclusion of controls. Of those with potential struggle, 52% wanted to see a chaplain. Screening for potential R/S struggle can play an important role in choosing specific interventions for OA with depression.     

Peer support for women with breast cancer: the role of empathy and self‐disclosure

This study examined how women with breast cancer perceived different styles of peer helping. Forty recently diagnosed breast cancer patients evaluated three audiotaped conversations between a breast cancer patient and an (ex‐patient) volunteer helper; the conversations differed in terms of the empathy and self‐disclosure offered by the helper. The findings supported the first hypothesis, that a helping style involving high self‐disclosure would be positively evaluated only in the presence of high empathy. However, the findings did not support the second hypothesis, that in conversations where high empathy is present, a helping style involving high self‐disclosure would be evaluated more positively than one involving low self‐disclosure. Qualitative data suggested that the helper's ability to listen to the patient and the helper's appropriate sharing of her own experience of breast cancer were both perceived as important components of effective helping. Implications for the training and practice of volunteer helpers are discussed. Copyright © 1999 John Wiley & Sons, Ltd.     

L’expertise médicale au temps des pandémies : l’exemple des cancers

Medical law suits were interrupted during the COVID-19 pandemia and judicial process will come shortly back to the normal. Pandemia induced delays in the cancer diagnosis and treatment. These modifications were validated by expert consensus from the medical societies. However in the coming years it is highly possible that patients think they were victims of a “loss of chance” and ask for a compensation. The various situations in which physicians can be involved are described and recommendations for the management of medical charts are discussed.     

Patient Motivation, Satisfaction, and Coping in Genetic Counseling and Testing for BRCA1 and BRCA2

Women with a strong family history of breast and/or ovarian cancer can now have genetic testing, that may identify mutations associated with increased cancer predisposition. Within the context of a clinical trial evaluating printed educational materials, we examined motivation, satisfaction, coping, and perceptions of genetic counseling and testing among 159 women who underwent pretest counseling and made a testing decision. Ninety-six percent of the participants elected to have BRCA1/2 testing. When making a decision about genetic testing, study participants were concerned less about the potential negative effects that could result from testing than the potential benefits. After counseling, participants said that they felt better able to make decisions that were right for them and that their questions and concerns were adequately addressed during the session. Ninety-five percent of the women were satisfied with their test decision. Participants used a range of strategies to cope with thoughts and feelings about cancer and/or genetic testing immediately following test decision. Results suggest that the genetic counseling session helped women make decisions about testing for BRCA1 and BRCA2, even in the setting of a trial in which all women also received detailed educational materials. Further, the results indicate that future research focusing on perceptions of risks and benefits of testing and of coping strategies immediately following test decision may be warranted.     

Posttraumatic Stress Symptoms and Stressful Life Events Predict the Long-term Adjustment of Survivors of Childhood Cancer and Their Mothers

Objectives: To examine prospectively the impact of posttraumatic stress symptoms (PTSS) in response to childhood cancer and treatment on general adjustment while accounting for the role of other stressful life events and appraisal of life threat and treatment intensity. Methods: As part of a larger study assessing PTSS, 56 childhood cancer survivors, aged 8 to 18, and 65 mothers completed self-report measures of PTSS and appraisal of the intensity and life threat associated with cancer treatment at time 1 and self-report measures of stressful life events and general adjustment at time 2 (approximately 18 months after time 1). Results: For child survivors and their mothers, posttraumatic stress at time 1 significantly predicted general adjustment at time 2, over and above the significant contribution of lifetime stressful events. The life events variable did not function as a mediator in the association of PTSS and general adjustment. Conclusions: Trauma responses to childhood cancer and its treatment have implications for the long-term adaptation of children and their families. Early signs and symptoms of posttraumatic stress and stressful life experiences require early assessment and intervention.