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Houston, TX, United States

Rhondali W.,University of Houston | Rhondali W.,Center Hospitalier Of Lyon Sud | Yennurajalingam S.,University of Houston | Ferrer J.,Lyndon Baines Johnson General Hospital | And 3 more authors.
Supportive Care in Cancer | Year: 2014

Purpose: Advanced cancer patients often experience moderate to severe physical and emotional distress. One of the main components of emotional distress is depression. The objective of this study was to examine the association between supportive care interventions and patient self-reported depression (PSRD) among advanced cancer outpatients. Methods: We included consecutive patients seen in the outpatient Supportive Care Center between February 2008 and February 2010 with at least one follow-up visit. We used the Edmonton Symptom Assessment Scale (ESAS) to assess their symptom intensity. Clinical improvement of PSRD was defined as an improvement of at least 30 % between the initial visit and the first follow-up. We used logistic regression models to assess possible predictors of improvement in PSRD. Results: We included 444 patients with a median age of 59 years (Q1-Q3; 51-65). The most common type of cancer was gastrointestinal (98, 22 %). Out of the 444 patients, 160 (36 %) reported moderate/severe depression at baseline (ESAS item score≥4/10). Higher baseline depression intensity was significantly associated to anxiety (r=0.568, p=0.046), total symptom distress score (TSDS; r=0.550, p<0.001) and personal history of depression (r=0.242, p=0.001). Of the 160 patients, 90 (56 %) with moderate/severe PSRD at baseline showed a significant improvement at the follow-up visit (p=0.038). Improvement in anxiety, sedation, and feeling of well-being were associated with higher depression improvement (OR 7.93, CI 3.74-16.80 and OR 2.44, CI 1.09-5.46, respectively). Conclusions: More than 50 % patients with moderate/severe PSRD significantly improved after one single supportive/palliative care consultation. Improvements of anxiety and sedation were independently associated with PSRD improvement. © 2013 Springer-Verlag.

Johnson O.,Lyndon Baines Johnson General Hospital | Langford R.W.,Texas Womans University
Critical Care Nursing Quarterly | Year: 2010

One in 6 pregnancies is lost before the 20th week of gestation and the psychological impacts of this loss are frequently unaddressed while attention is focused on immediate physiological needs. To improve the comprehensive care provided to women experiencing pre-20-week loss, an evidence-based intervention protocol was developed to provide emotional support to these women in the immediate aftermath of the loss. The protocol was tested using a sample of 40 women who experienced a pre-20-week perinatal loss and were being treated in a large county emergency center. Twenty randomly selected women received the intervention protocol while another 20 women received the usual standard of care. Both groups completed the Perinatal Grief Scale during a routine 2-week follow-up visit. The results indicated that the intervention was effective in ameliorating the degree of despair in women experiencing an early pregnancy loss. Women receiving the protocol expressed feelings of being supported and cared for by the staff. Secondary benefits were an increased collaboration among health care professionals, development of an environment of empathy, and a change in the culture of belief that these women needed only physical care. Results indicate a need for a support protocol for all women experiencing loss regardless of gestational age. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

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