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Biomedical subjects

C W Given

Publications and source records attributed to C W Given.

At least 73 records · Page 4Linked to original sources
PubMed1977

The design and use of a health status index for family physicians.

This paper describes a Health Status Index (HSI) which is part of a patient encounter form in a family practice center. The Index, which is used to profile a patient's health status longitudinally, combines physical and psychosocial measures of health. Based on its use in the center and through the presentation of data on patient health status, the authors illustrate how the Index can facilitate the evaluation of care and the management of practice. More specifically, they suggest that such data assist physicians in: (1) evaluating the effect of different modes of treatment on the duration and severity of ill-defined symptoms and complaints; (2) identifying high-risk patients for special attention; (3) indicating treatment modalities which produce more desirable outcomes; (4) determining the efficiency of different modes of treatment and of continued care; and (5) addressing chronological, as well as interpersonal and interprofessional, questions of providing continuous care for the chronically ill.

Acute Disease↗
PubMed1977

The use of computer generated patient profiles to evaluate resident performance in patient care.

This paper describes the way in which data from a computer-based health information system are used to review the service experiences of family practice residents. First, it discusses the development of the patient profiles that provide a chronological account of a patient's visits, their purposes, diagnoses, laboratory procedures, treatments, and outcomes. Then, through four cases, it describes the way in which these computer-generated displays are used by faculty to conduct concurrent reviews of residents' performances, to select medical records for review, and to initiate feedback and instruction to residents as they care for their patients.

Child↗
PubMedDate not supplied

Predictors of depressive symptomatology of geriatric patients with lung cancer-a longitudinal analysis.

BACKGROUND: Lung cancer is a major health problem throughout the world. It is the leading cause of cancer-related death in men and women in the USA, with a 5-year survival rate of only 14%. It has been hypothesized that variables such as physical and social functioning, cancer-related symptomatology, comorbid conditions, cell type, and treatment are valid predictors of the psychological response to a diagnosis of lung cancer. METHODS: As part of a larger longitudinal study, 211 patients, 65 years of age or older, with an incident diagnosis of lung cancer, were recruited from 23 sites within a midwestern state. Repeated measures analysis of variance techniques were used to analyse how age, gender, comorbid conditions, stage of disease, cell type, as well as the time-dependent variables symptoms, physical functioning, social functioning, and treatment predict depressive symptomatology at four assessments over the first year following diagnosis. RESULTS: Social functioning (p<0.0001), symptoms severity (p<0.0001) and radiation treatment (p=0.017) were significant predictors of depressive symptomatology, with more symptoms and more restricted social functioning generally corresponding to higher levels of depressive symptomatology. Patients who had not received radiation treatment were more depressed than those who had received treatment at least 40 days prior to the interview. CONCLUSIONS: At a clinical level of patient care, these findings mandate early identification of psychosocial difficulties experienced, an individualized symptom management plan and the application of other interventions, such as information giving, reassurance and referral to other resources.

Activities of Daily Living↗
PubMedDate not supplied

Complementary therapy use among older cancer patients.

PURPOSE: The purpose of this study was to assess the use of complementary therapies among older cancer patients, to report patterns of use, and to understand who is more likely to use complementary therapies. DESCRIPTION OF STUDY: A survey was conducted of 699 older cancer patients at 4 weeks and 6 weeks into cancer treatment. All participants were 64 years of age or older, had received a diagnosis of breast, colorectal, prostate, or lung cancer, and were recruited from community cancer treatment centers throughout Michigan. Measures of interest included self-reported physical symptoms, depressive symptomatology, optimism, spirituality, and use of conventional and complementary health services. RESULTS: Approximately 33% of older cancer patients reported using complementary therapies. These individuals were more likely to be women, to be breast cancer patients, and to have a higher level of education. The three most frequently used therapies were exercise, herbal therapy, and spiritual healing. Complementary therapy users were significantly more optimistic than nonusers. Also, there were significant differences between users and nonusers on types of physical symptoms experienced, but no differences on reported depressive symptomatology or spirituality. CLINICAL IMPLICATIONS: Oncology providers need to be aware that one third of their older patients are likely to supplement conventional care with complementary therapies. Therefore, providers should be knowledgeable about the safety and efficacy, in particular, of various exercise programs, herbal and vitamin therapies, and spiritual healing. It would be beneficial to develop a system within cancer centers by which patients could easily report on their use of complementary therapies, allowing providers to work in partnership with their patients.

Aged↗
PubMedDate not supplied

Physical functioning and depression among older persons with cancer.

PURPOSE: The purpose of this study was to help identify factors to assess which elderly patients are likely to experience problems with physical and psychological functioning in association with cancer or its treatment. DESCRIPTION OF STUDY: A study was undertaken with a sample of 420 patients with cancer who were between the ages of 65 and 98 years and had received an incident diagnosis of breast, colon, lung, or prostate cancer. An analysis of covariance technique was used to determine how cancer site, treatment type, stage of disease, gender, age, comorbidity, symptom severity, and pre-diagnosis levels of physical functioning were related to physical functioning deficit, and how all of these in turn influenced patient depressive symptomatology. RESULTS: Pre-diagnosis physical functioning, symptom severity, and days since surgery were significant predictors of physical functioning deficit. Patients who had been treated only with surgery experienced greater physical functioning deficits than did patients who had received both surgery and adjuvant therapy. This apparent anomaly was partly explained by the time interval from surgery to interview. Higher levels of symptom severity, lower levels of prior physical functioning, and greater physical functioning deficits all predicted higher levels of depressive symptomatology. CLINICAL IMPLICATIONS: In the care of elderly patients with cancer, it is important for healthcare providers to consider the pre-diagnosis levels of physical functioning of patients with cancer to understand and anticipate the physical and psychological consequences of cancer and its treatment. Equally important is the proper management of patient symptoms in maximizing both the physical and psychological quality of life.

Aged↗
PubMedDate not supplied

Social vulnerability and reactions to caregiving in daughters and daughters-in-law caring for disabled aging parents.

Variables that have been conceptually linked with social vulnerability--income, educational level, employment, cessation of work to provide care, marital status, social support, and health--were used to predict four categories of reaction to caregiving in 159 daughters and daughters-in-law caring for their disabled aging parents. Social support, income, and health best predicted negative reactions to caregiving; social support alone best predicted negative reactions to caregiving; social support alone best predicted feelings of family abandonment, impact on health, and impact on schedule. Compared with daughters and daughters-in-law who had not quit work to provide care, those who had quit work were significantly older, had lower incomes and fewer social supports, and were more involved in care. The results suggest that quitting work may be a precursor to social isolation that places the caregiver at increased risk for social vulnerability and negative reaction to caregiving. The implications of the findings for health care policy are discussed.

Aged↗
PubMedDate not supplied

Research design and subject characteristics predicting nonparticipation in a panel survey of older families with cancer.

BACKGROUND: While recognized that loss of subjects over time may introduce bias and complicate statistical analysis in panel studies, it is seldom acknowledged that sampling bias starts with subjects who are eligible but do not participate. OBJECTIVES: Community-based recruiters identified 1,948 subjects as eligible to participate in a descriptive panel survey of older families with cancer. Focusing on the time between identification of eligible subjects until contact for the first interview for consenting subjects, the purpose of this study was to determine if subject or research design factors predicted who was more prone to nonparticipation. METHOD: A multivariate model explored the simultaneous effects of subject and research design characteristics on nonparticipation. Demographic and cancer characteristics, as well as features of the study protocol, were used as predictors in a multinomial logit regression model to enable a three-way comparison between nonconsenters (n = 748), consenters who dropped out prior to data collection (n = 208), and consenters who participated in the intake interview (n = 992). RESULTS: Age and cancer diagnosis played roles in whether consent was obtained, whereas race did not affect consent but raised odds of drop out after consent. Powerful evidence emerged that design features, such as if a caregiver participated, recruitment staff roles, and payment to recruiters, affected the probability of subjects not participating or dropping out before being interviewed. CONCLUSIONS: Findings suggest that both subject and research design characteristics affect the likelihood of nonparticipation in a panel study of older cancer patients and family caregivers. Future research involving testing of strategies addressing access and accrual issues, research staff roles, reimbursements, and responsiveness to the needs of research personnel, ill participants, and family members is warranted.

Age Factors↗
PubMedDate not supplied

Family support in advanced cancer.

Changes in the health care system have resulted in a shift of cancer care from the in-patient arena to ambulatory and home settings. This shift has likewise translated into increased family involvement in the day-to-day care of the person with cancer. Cancer patients have multifaceted needs, including disease and treatment monitoring, symptom management, medication administration, emotional support, assistance with personal care, and assistance with instrument care. Family caregivers may be ill prepared to assume these tasks, requiring information on the disease and treatment, as well as instruction in technical and care skills. Moreover, caregiving must be balanced against already established roles and role responsibilities. In addition, family caregivers have their own emotional responses to the patients' diagnosis and prognosis, and may require coaching and emotional support themselves. The health care system can facilitate positive outcomes by embracing the family caregiver as a partner in the health care team, providing instruction and guidance to the caregiver as he/she assumes this role, and evaluating the home care situation. Research to date has only scratched the surface of testing interventions that meet the needs of the cancer caregiver. A research agenda is proposed to more fully elucidate the cancer caregiver's experience throughout the illness and treatment trajectory, and identify the means to effecting positive outcomes for the person with cancer, their family caregiver, and the health care system.

Caregivers↗
PubMedDate not supplied

Patient and family caregiver reaction to new and recurrent breast cancer.

Exploratory data on the mental health (depression), symptoms, and functional status of breast cancer patients and the mental health (depression) and reaction to care of their caregivers are examined in this paper. How both are influenced by new and recurrent disease is also reported. Patients and family caregivers were followed over a six-month period to determine whether new or recurrent disease status altered their reaction to the cancer experience. The data suggest that psychological distress may be more marked in the family member than in the patient. Differences in caregiver reaction were not due to new or recurrent disease status, health status of the patient, or the care process of the caregiver. Future research is needed to isolate the cause of variations in mental health of women and their family caregivers experiencing new or recurrent breast cancer.

Breast Neoplasms↗
PubMedDate not supplied

Relationships of processes of care to patient outcomes.

This study examined relationships between process and outcome components of patient care. Relationships were determined between independent process variables--diagnostic approach, therapeutic approach, and patient compliance--and dependent outcome variables--functional status, clinical health status, perception of health and care, and knowledge and understanding of disease and therapy. Criteria for process and outcome dimensions were developed, based on a literature review. Data on 103 patients, followed for a five-month period, were collected by use of patient record audit and beginning- and end-of-study patient interviews. Cross-tabulations and multiple regression analysis were used to determine relationships between independent and dependent variables. Analysis of variance was used to determine difference in provider and patient process dimensions according to patient severity groups. Significant relationships were found between all independent variables and the dependent variables of clinical health status and knowledge and understanding of disease and therapy. Patient compliance level was found to be the most significant process variable.

Adult↗
PubMedDate not supplied

Compliance among patients with cancer.

Although there has been substantial progress in the effectiveness of cancer treatment and more patients experience longer-lasting remissions or cure, a substantial number of individuals still fail to respond to treatment. Healthcare professionals now are investigating patient behaviors which may result in ineffective response to potentially curative regimens. Patient perceptions, disease and treatment factors, sociodemographic characteristics, and social support systems influence the patient's decision to comply with a treatment regimen.

Humans↗
PubMedDate not supplied

Prediction of patient attrition from experimental behavioral interventions.

Attrition of patients in treatment and control was compared for loss from the study and loss from care. Previously diagnosed hypertensive patients who were under treatment but out of control (diastolic blood pressure greater than 90 and systolic blood pressure greater than 140 mm Hg) were assigned to conventional care or to an experimental nursing intervention group. The intervention involved eight visits covering a 6-month period. Attrition from the study for the experimental group was defined as completion of four or fewer experimental sessions; for the control group it was defined as making no visits to a treatment center during a 6-month posttest observation period. Attrition from care by the facilities where the study was conducted was defined as no visits to these sources of care during a 1 1/2-year follow-up period. More controls than experimentals were lost from the study. No differences could be found between patients lost from the study and those lost from both the study and care. A logistic regression was used to predict attrition. The four significant predictor variables were: perceived difficulty in following a diet, knowledge of disease, perceived severity of symptoms, and the experimental condition. The study showed: social psychological variables, important predictors of attrition, should be used to identify patients at risk of leaving care for their chronic diseases.

Adolescent↗
PubMedDate not supplied

Analysis of the impact of mother-daughter relationships on the commitment to caregiving.

Path analysis was used to test a model to examine the impact of mother-daughter relationships on the commitment to caregiving by 98 adult daughters during the first three months. Findings generally supported the model. Although significant, magnitude of mothers' limitations did not solely explain commitment, either instrumental or affective. Mother-daughter relationships were powerful predictors of commitment, especially affective commitment. Although predicted, employment status did not function as a mediator in this model, while living arrangements did.

Adult↗