肿瘤患者心理困扰管理研究现状及本土化思考

心理困扰存在于肿瘤发生、发展的各阶段,是最常见的问题之一,在国外研究日益聚焦的同时,我们从心理困扰起源出发,回顾肿瘤患者心理困扰管理概况、观察性及实验性研究现状,分析心理困扰管理概念内涵、筛查工具、分类标准、干预模式及最佳管理途径等本土化问题,旨在找出困扰管理与我国国情的契合点,探求肿瘤患者心理困扰管理模式的合理化途径。     

The importance of distinguishing between harassment-only and assault military sexual trauma during screening

Extant research demonstrates that a history of military sexual trauma (MST) is associated with PTSD and depression diagnoses as well as heightened risk for suicidal ideation and death by suicide. Past studies of MST and its sequelae typically collapse harassment-only and assault MST screening items into a single response, recorded as positive or negative for a history of MST. It is presently unclear whether assault is associated with poorer mental health outcomes relative to harassment-only MST. Female service members/Veterans (n = 656) completed an online survey assessing history (present, absent) and type (harassment-only, assault) of MST, PTSD, depression, sexual satisfaction and function symptoms, as well as suicidal ideation. Findings revealed that those who reported a history of MST, and assault more specifically, were more likely to report higher PTSD symptoms and probable PTSD diagnosis, higher depression symptoms and probable depression diagnosis, worse sexual function and probable sexual function diagnosis, lower sexual satisfaction, and presence of suicidal ideation. Those who reported harassment-only MST also reported higher PTSD severity and probable PTSD diagnosis, but the magnitude of the association of harassment-only MST and PTSD severity relative to assault MST and PTSD severity was substantially lower. Findings suggest it is critical to distinguish between history and type of MST during screening as a combined screening item loses sensitivity to identify those at heightened risk for distress and dysfunction.     

Patient and Partner Quality of Life and Psychosocial Adjustment Following Radical Prostatectomy

We prospectively examined differences in quality of life and psychosocial adjustment in 80 prostate cancer patients and their partners (n = 65) beginning before radical prostatectomy and proceeding across the first year postsurgery. Both members of the couple experienced significant changes associated with the patient's cancer, however their experiences differed in some regards. Patients experienced reprieve from emotional distress and negative affect immediately following surgery despite worsened physical functioning. Partner quality of life and psychosocial adjustment scores were generally more constant from presurgery to postsurgery, with improvements noted 1 year later. For both patients and partners, cancer-specific stress symptoms declined progressively over the year. We also obtained partial support for the effectiveness of a single-session communication intervention on patient social/family wellbeing and partner general stress. Findings have implications for patient and partner adjustment following radical prostatectomy, and attest to the importance of incorporating partner evaluations into psychosocial oncology research.     

Recruitment Strategies for a Home-Based Physical Activity Intervention for Breast Cancer Patients

Recruiting cancer patients for randomized trials investigating psychosocial interventions presents several unique challenges. This paper describes the challenges and yields for different recruitment methods used in Moving Forward, a randomized trial of a home-based moderate-intensity physical activity program for early-stage breast cancer survivors. Recruitment methods included letters sent to patients by their oncologists, direct referrals from oncologists, in-person recruitment in oncology clinics, referrals from nurses and medical assistants, passive recruitment, other mailings, and community outreach strategies. Of the 424 screenings completed, 86 (20.3%) participants were randomized. Physician letters yielded the greatest number of initial screenings (147; 34.7%) and participants randomized (28; 32.5%). In-person recruitment also proved to be a productive recruitment strategy; 14 (16.3%) of the participants were recruited via this strategy. Community outreach efforts did not provide as great a yield and were labor intensive. We discuss suggestions for recruitment of cancer patients in future trials.     

Development of an Interactive Decision Aid for Female BRCA1/BRCA2 Carriers

Shared decision making between patients and providers is becoming increasingly common, particularly when there is no clear preferred course of action. As a result, decision aids are being adopted with growing frequency and have been applied to many medical decision-making issues. One such issue where there is uncertainty is breast cancer risk management among BRCA1/BRCA2 carriers. We present the development of a CD-ROM decision aid to facilitate risk management decision making in this population. Our decision aid was developed with the intention of providing it through a randomized clinical trial. The CD-ROM is a multimedia, interactive intervention which provides information about breast cancer, risks associated with BRCA1 and BRCA2 mutations, risk management options for hereditary breast cancer, and a breast cancer risk management decision aid. The goal of this CD-ROM, offered as an adjunctive intervention, is to reduce decisional conflict and psychological distress and improve comprehension of risk information, decisional satisfaction, medical adherence, and quality of life for this population of women at increased risk for breast cancer.     

Subjective and Objective Risks of Carrying a BRCA1/2 Mutation in Individuals of Ashkenazi Jewish Descent

This repeated measures study examines (1) the change in subjective risk of mutations pre- to postcounseling, (2) the accuracy of BRCAPRO estimates of mutations, and (3) the discrepancy between subjective risk and BRCAPRO estimates of mutations before and after genetic counseling. Ninety-nine Ashkenazi Jewish individuals pursued testing for BRCA1/2 mutations. Most had a personal cancer history (N = 51; family only: N = 48); and received uninformative negative results (N = 66; positives: N = 23; informative negative: N = 10). The coping strategy of defensive pessimism predicts that individuals will believe the worst case scenario to better cope with a potential negative outcome. Consistent with this, most felt they would have a mutation, if not mutations in both genes. The BRCAPRO model appeared to overestimate risk of having a mutation in this sample (p < .001). BRCAPRO overestimates notwithstanding, genetic counseling increased accuracy of subjective risk (p < .01). Individuals with a family-only cancer history had the least accurate estimates of risk (p < .05) and may need further intervention to either manage anxiety or improve knowledge.     

An efficient cervical disease diagnosis approach using segmented images and cytology reporting

Cervical cancer is the second most common cancer in women globally. A computer aided cervical disease diagnosis system that can relieve pressure on medical experts and save the cost is proposed. To implement our approach in the reality of cervical diseases diagnosis, a multi-modal framework is designed for three kinds of cervical diseases diagnosis that integrates uterine cervix images, Thinprep Cytology Test, human papillomavirus test, and patients’ age. However, too many features increase memory storage costs and computational costs, and it affects the spread of this system in poor areas. Feature selection not only eliminates redundant or irrelevant features but also finds the factors that influence the disease most first is performed in multi-modal frameworks for cervical diseases diagnosis. The detailed process of the method is as follows: first, according the representative color, an efficient image segmentation algorithm is developed; then from three different types of segmented images, we extract color features and texture features for interpreting uterine cervix images; next, Boruta algorithm is applied to feature selection; finally, the performance of Random Forests that utilizes selected features for cervical disease diagnosis is investigated. In the experiment, the proposed multi-modal diagnostic approach gives the final diagnosis for three different kinds of cervical diseases with 83.1% accuracy, which significantly outperforms methods using any single source of information alone. The validation cohort is applied to validate the efficiency of our method, and the performance of random forest obtained by using only 1.2% of features is like or even better than using 100% of features.     

A randomised trial of the effect of appearance versus health-framed messages on engagement with an online brief screening and alcohol reduction intervention

Objectives: To compare the impact of appearance versus health-framed messages on engagement in a brief web-based risk screening and alcohol reduction intervention.

Design: Randomised trial delivered via Drinkaware’s website. Visitors were exposed to appearance (n?=?51,588) or health-framed messages (n?=?52,639) directing them towards an AUDIT-C risk screening questionnaire. Users completing this questionnaire were given feedback on their risk level and extended frame-congruent information.

Outcomes: The primary outcome is completion of the AUDIT-C questionnaire. The secondary outcome is whether the participant accessed any of four further resources.

Results: The appearance-framed message led to a small but significant increase in the number of users completing the AUDIT-C compared to the health-framed message (n?=?3,537, 6.86% versus n?=?3,355, 6.37%, p?<?0.01). Conversely, following subsequent risk feedback, users exposed to extended health-framed information were more likely to access further resources (n?=?1,146, 2.17% versus n?=?942, 1.83%, p?<?0.01).

Conclusions: Physical appearance-framed messages increased the likelihood of engagement with an online alcohol screening and brief intervention tool, whereas health-framed messages increased the likelihood of accessing further resources. This highlights the potential for the use of multi-level approaches in alcohol reduction interventions.