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"Clover, Louise"
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Biofeedback Enabled CALM (BeCALM)—the feasibility of biofeedback on procedural anxiety during radiation therapy: study protocol for a pilot randomised controlled trial
IntroductionPatients undergoing treatment for cancer who require radiation therapy (RT) report anxiety specifically relating to the RT procedure. Procedural anxiety can be detrimental to treatment delivery, causing disruptions to treatment sessions, or treatment avoidance. Acute procedural anxiety is most commonly managed with anxiolytic medication. There is a need for effective, non-pharmacological interventions for patients not suitable for, or who prefer to avoid, anxiolytic medication. The primary objectives of this pilot trial are to evaluate the: (1) feasibility of conducting the Biofeedback Enabled CALM (BeCALM) intervention during RT treatment sessions; (2) acceptability of the BeCALM intervention among patients; and (3) acceptability of the BeCALM intervention among radiation therapists. The secondary objective of this pilot trial is to examine the potential effectiveness of the BeCALM intervention delivered by radiation therapists to reduce procedural anxiety during RT.Methods and analysisThis is a pilot randomised controlled trial. A researcher will recruit adult patients with cancer (3-month recruitment period) scheduled to undergo RT and meeting eligibility criteria for procedural anxiety at the Calvary Mater Hospital, Newcastle (NSW), Australia. Participants will be randomly assigned to receive treatment as usual or the BeCALM intervention (biofeedback plus brief breathing techniques). The primary outcomes are feasibility (measured by recruitment, retention rates and percentage of treatment sessions in which the intervention was successfully delivered); radiation therapists perceived feasibility and acceptability (survey responses); and patient perceived acceptability (survey responses). Secondary outcome is potential effectiveness of the intervention (as measured by the State Trait Anxiety Inventory—State subscale; the Distress Thermometer; and an analysis of treatment duration).Ethics and disseminationThe study protocol has received approval from Hunter New England Health Human Research Ethics Committee (2021/ETH11356). The results will be disseminated via peer-reviewed publications, as well as presentation at relevant conferences.Trial registration numberACTRN12621001742864.
Journal Article
Which items on the distress thermometer problem list are the most distressing?
Purpose
The importance of distress identification and management in oncology has been established. We examined the relationship between distress and unmet bio-psychosocial needs, applying advanced statistical techniques, to identify which needs have the closest relationship to distress.
Methods
Oncology outpatients (
n
= 1066) undergoing QUICATOUCH screening in an Australian cancer centre completed the distress thermometer (DT) and problem list (PL). Principal component analysis (PCA), logistic regression and classification and regression tree (CART) analyses tested the relationship between DT score (at a cut-off point of 4) and PL items.
Results
Sixteen items were reported by <5 % of participants. PCA analysis identified four major components. Logistic regression analysis indicated three of these component scores, and four individual items (20 items in total) demonstrated a significant independent relationship with distress. The best CART model contained only two PL items: ‘worry’ and ‘depression’.
Conclusions
The DT and PL function as intended, quantifying negative emotional experience (distress) and identifying bio-psychosocial sources of distress. We offer two suggestions to minimise PL response time whilst targeting PL items most related to distress, thereby increasing clinical utility. To identify patients who might require specialised psychological services, we suggest the DT followed by a short, case-finding instrument for patients over threshold on the DT. To identify other important sources of distress, we suggest using a modified PL of 14 key items, with the 15th item ‘any other problem’ as a simple safety net question. Shorter times for patient completion and clinician response to endorsed PL items will maximise acceptance and clinical utility.
Journal Article
To be mortal is human: professional consensus around the need for more psychology in palliative care
Nursing and allied health professionals also spend considerable time with patients developing strong therapeutic relationships fundamental to the success of challenging conversations when adjusting to incurable illness.2 3 Nevertheless, White et al’s survey noted considerable variability in the availability of palliative care and end-of-life-related content in UK-based undergraduate nursing and allied health courses. Domain Example End-of-life assessment Distinguishing between normative distress, maladjustment and mental illness Assessing cognitive function and decision-making capacity End-of-life interventions Adjusting to illness and functional limitations Pain management Improving quality-of-life and subjective well-being Interventions addressing death preparedness (eg, existential issues, legacy work and dignity therapy), death anxiety, demoralisation and (anticipatory) grief and supporting patients as they make decisions about their care Team-related and systems related skills Supporting caregivers before and after a person dies Fostering communication between patients, families and the multidisciplinary healthcare team Developing and delivering accessible community and public-facing psychoeducation around end-of-life, advance-care planning and death Supporting health professionals Providing liaison and advocacy for end-of-life care at a higher systems level There is much to be gained through better integration of psychology into end-of-life care and communication—yet currently, discipline-specific end-of-life training for psychologists appears rare. UMS-D’s end-of-life communication research program is supported by grants from the HCF Research Foundation, the Adolescent and Young Adult (AYA) Cancer Global Accord and through a clinical-academic mentoring award from the Palliative Care Clinical Academic Group of the Sydney Partnership for Health, Education, Research and Enterprise.
Journal Article
Taliban at gates of last outpost of resistance
Afghanistan's Taliban militia has stormed its way to the outskirts of Mazar-i-Sharif, the last big city in Afghanistan to withstand its four-year campaign to spread fundamentalist Islam throughout the country. Experts say the city could fall at any time, sealing Taliban rule throughout the country. But the predominance of foreign interests in the Afghan conflict means the consequences of a Taliban victory could reverberate far outside Afghanistan's borders. Foreign experts, many of whom view the Taliban as a creation of the Pakistani army, agree that if it the Taliban do manages to retain control of the city, it would fundamentally alter the balance of power in southern and central Asia, affecting flashpoints in a wide arc from Kashmir to Tajikistan to Iran.
Newspaper Article