RESUMEN
BACKGROUND: This study aims to rigorously compare the effectiveness of the educational programs of a new integrated clinical clerkship in medicine (3 months) and surgery (3 months) at a cancer center with the conventional subspecialty-based rotations at a tertiary teaching hospital, by this prospective, pre-post comparative method. METHODS: Between 2013-2016, we compared 69 students who had selected the integrated clerkship that emphasized clinical competency and medical humanities training with 138 matched peers who had completed conventional clerkships during the same period. Outcome measures for medical humanities included empathy, patient-centeredness, and other values and skills related to holistic health care professionalism by introducing prospective propensity score matching (PSM). RESULTS: At baseline, no significant between-group differences existed. At the completion of the core clerkships, students receiving the integrative clerkship had significantly higher scores on the Patient-Practitioner Orientation Scale (PPOS) and the Professionalism Climate in Clinical Teaching Environment (PCI), and similar Jefferson Scale of Physician Empathy Student Version (JSPE) scores, as compared with the comparison group. We also found that the students in this program did not perform worse than those in the traditional internship group in the comprehensive and formative OSCE medical clinical skills test. CONCLUSIONS: Our study develops an empirical basis for rigorous evaluation to design medical education to improve the medical humanities values and skills of interns. Features of the new integrated clerkship program that we developed include substantial participation by the students in patient-centered in-hospital culture, as well as reflection, discussion, and feedback on actual clinical cases.
Asunto(s)
Prácticas Clínicas , Estudiantes de Medicina , Prácticas Clínicas/métodos , Competencia Clínica , Humanidades , Humanos , Puntaje de Propensión , Estudios ProspectivosRESUMEN
This study examined the long-term trajectory patterns of anxiety in breast cancer survivors and identified its predicting variables, especially the type of coping profile. Eighty-one patients who completed all four questionnaires from the 10-year study were included in the analysis. Anxiety scores from the Hospital Anxiety and Depression Scale were used in latent class growth analysis to chart the anxiety trajectory of cancer survivors. Demographic variables, clinical variables, depression level, and coping profiles (adaptive versus maladaptive) were used as predictors. Our study identified a two-class model of long-term anxiety trajectory among breast cancer survivors, with a resistant group (85.2%) and a distress group (14.8%). Demographic and clinical variables were not associated with anxiety trajectory paths. On the other hand, maladaptive coping characterized by higher scores in helplessness/hopelessness, cognitive avoidance, and anxious preoccupation, and lower scores in fighting spirit and fatalism in the Mini-MAC was a significant predictor of distressed anxiety. Coping profiles identified using the Mini-MAC were predictive of long-term anxiety trajectory among breast cancer survivors in our survey. Early interventions on coping with cancer could reduce long-term anxiety problems.
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Adaptación Psicológica , Ansiedad/psicología , Neoplasias de la Mama/psicología , Supervivientes de Cáncer/psicología , Psicometría/métodos , Adulto , Anciano , Trastornos de Ansiedad/psicología , Femenino , Humanos , Persona de Mediana Edad , Autoimagen , Encuestas y CuestionariosRESUMEN
A total of 84 breast cancer survivors completed a package of psychological inventories in 2009 (Time 1), 2012 (Time 2), and 2016 (Time 3). Latent class growth analysis revealed three posttraumatic growth trajectory patterns: distressed posttraumatic growth (n = 5, 6.7%), illusory posttraumatic growth (n = 42, 56.0%), and constructive posttraumatic growth (n = 28, 37.3%). Women with more frequent use of helplessness-hopelessness coping and lower depression levels at Time 1 were more likely to display an illusory than a constructive posttraumatic growth trajectory pattern. Illusory posttraumatic growth might represent a form of coping rather than authentic positive changes. Researchers and clinicians should understand different patterns of posttraumatic growth.
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Neoplasias de la Mama , Supervivientes de Cáncer , Crecimiento Psicológico Postraumático , Trastornos por Estrés Postraumático , Adaptación Psicológica , Neoplasias de la Mama/psicología , Femenino , Humanos , SobrevivientesRESUMEN
PURPOSE: Cancer survivors experience significant psychosocial distress even after completion of cancer treatment. The association between cancer coping and cancer recovery is not well established. The present study investigated the cancer-coping profile and cancer outcomes in breast cancer survivors. METHODS: A three-wave longitudinal study was conducted. In 2009 (wave 1), 248 breast cancer survivors completed a package of psychological inventories to evaluate cancer copying style, psychological distress, anxiety and depression, and quality of life. They received follow-up survey in 2012 (wave 2) and 2016 (wave 3). A latent profile analysis (LPA) was conducted among participants in wave 1 to identify cancer-coping class. Identified cancer-coping class was used to predict psychological and survival outcomes in waves 2 and 3. RESULTS: Two cancer-coping classes were identified through LPA, namely adaptive cancer coping (class I; 52%) and maladaptive cancer coping (class II; 47.8%). Demographic and clinical factors did not differ significantly between the two classes. Subsequent analyses demonstrated that the cancer-coping style in wave 1 predicted the psychological symptoms and quality of life outcomes at the two follow-ups (waves 2 and 3). Survivors in the adaptive group (class I) exhibited lower cancer distress, anxiety and depression scores, and higher quality of life scores than those in the maladaptive group did. Cancer coping were not found to be significantly associated with cancer survival or recurrence. CONCLUSIONS: The identified cancer-coping styles were predictive of the survivors' psychological symptoms, psychological well-being, and health-related quality of life but not cancer survival or recurrence.
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Adaptación Psicológica , Neoplasias de la Mama/psicología , Supervivientes de Cáncer/psicología , Calidad de Vida/psicología , Adulto , Anciano , Anciano de 80 o más Años , Trastornos de Ansiedad/etiología , Trastornos del Conocimiento/psicología , Demografía , Trastorno Depresivo/etiología , Femenino , Humanos , Estudios Longitudinales , Persona de Mediana Edad , Recurrencia Local de Neoplasia/psicología , Estrés Psicológico/etiología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVE: Beginning in 2007, all newly diagnosed cancer patients at the Koo Foundation Sun Yat-Sen Cancer Center (KF-SYSCC) were screened for psychosocial distress. Our social workers, as part of the psychosocial care team (PCT), have engaged in proactive outreach with patients identified as distressed. The goal of the present study was to assess the prevalence of psychosocial distress and the extent of contact between the PCT and distressed patients. METHOD: Newly diagnosed patients who were treated at KF-SYSCC between 2007 and 2010 for cancer were eligible if there were at least 100 patients with the same type of cancer. Before treatment began, they were screened with the Pain Scale and the Distress Thermometer (DT) and had the option to specify a desire for help. The rates of distress were analyzed by cancer type and by probable related factors. Information regarding contact with the PCT was retrieved from computerized databases. RESULTS: Overall, some 5,335 cancer patients representing 12 major cancer types were included in our study. Of these, 1,771 (33.20%) were significantly distressed. By multivariate logistic regression, younger age, female gender, higher pain score, and disease stage, but not cancer type, were found to be associated with higher rates of distress. Among these distressed patients, 628 (36%) had some contact with the PCT. SIGNIFICANCE OF RESULTS: This Taiwanese study with a large sample size revealed a prevalence rate of psychosocial distress similar to rates found in Western countries. Contact with the PCT was established in only 36% of significantly distressed patients, despite a proactive outreach program. It is very important to have screening results made available in a timely fashion to the psycho-oncology team so that appropriate care can be offered promptly.
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Conducta de Búsqueda de Ayuda , Neoplasias/psicología , Prevalencia , Factores de Tiempo , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Instituciones de Atención Ambulatoria/organización & administración , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Distribución de Chi-Cuadrado , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/diagnóstico , Factores de Riesgo , Estrés Psicológico/etiología , Estrés Psicológico/psicología , Encuestas y Cuestionarios , TaiwánRESUMEN
BACKGROUND/PURPOSE: Traditionally, clinical clerkship training in Taiwan does not provide medical students with sufficient patient care responsibilities and often results in inadequate clinical skills. METHODS: We implemented a pilot clerkship program at a comprehensive cancer center that emphasizes core clinical competency through direct patient care and dedicated faculty and mentors. Students were an integral part of the patient care team held accountable for providing coordinated and holistic care. Students' self-assessment of clinical competencies, faculty evaluation, and objective structured clinical examination were compared against their peers trained by traditional clerkship at a main teaching hospital. RESULTS: Fifty medical students completed the clerkship program in the first 3 years. At the end of the clerkship, participants rated themselves significantly higher than their peers in almost all patient care and clinical skill domains. The most significant areas included physical examination, clinical reasoning, developing management plan, holistic approach, handling ethical issues, and time management skills. The students rated their clerkship teachers significantly higher in time spent with students, skills and enthusiasm in teaching, as well as giving students appropriate patient care responsibilities. There was no significant difference in the end-of-clerkship objective structured clinical examination performance, but participants of the program achieved better grades in their subsequent internship. CONCLUSION: This pilot collaborative program presented a successful model for clinical education in the teaching of core clinical competencies through direct patient care responsibilities at the clerkship stage. It is hoped that the project will become a catalyst for medical education reform in Taiwan and regions with similar traditions.
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Prácticas Clínicas , Competencia Clínica/normas , Educación de Pregrado en Medicina/métodos , Atención al Paciente/normas , Centros Médicos Académicos , Femenino , Humanos , Masculino , Autoevaluación (Psicología) , Taiwán , Adulto JovenRESUMEN
OBJECTIVE: Cancer patients in Hong Kong and Taiwan share traditional Chinese as a written form of language, but each region has its own sociocultural background. This study examined if the four-factor model (self, spiritual, life orientation, and interpersonal) of the Chinese version of the Posttraumatic Growth Inventory (PTGI-C), developed for Hong Kong cancer survivors, could be applied to cancer survivors in Taiwan. METHODS: Multisample confirmatory factor analyses (MS-CFA) were used to examine the factorial invariance of the PTGI-C among cancer survivors in Taiwan (n = 217) and Hong Kong (n = 223). RESULTS: The goodness-of-fit of the four-factor model was satisfactory, χ²(180) = 372.36 (χ²/df = 2.07), goodness-of-fit index (GFI) = 0.90, adjusted GFI (AGFI) = 0.87, comparative fit index (CFI) = 0.92, Tucker-Lewis index (TLI) = 0.91, root mean square error of approximation (RMSEA) = 0.05, Akaike information criterion (AIC) = 492.36. This result suggests that the factor structure of the PTGI-C developed in Hong Kong could be applied to cancer survivors in Taiwan. The internal reliabilities of the 15-item whole scale, as well as all the subscales, were good and similar to those reported previously. Interregion comparison revealed that the Taiwan sample had higher mean 'spiritual' and 'interpersonal' posttraumatic growth subscale scores than the Hong Kong sample. CONCLUSIONS: The four-factor model of the PTGI-C is invariant among cancer survivors using traditional Chinese as a written form of the language. The differences in the degree of some posttraumatic growth dimensions may be because of differences in cultural factors and in psychosocial support for cancer patients between the two regions.
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Adaptación Psicológica , Neoplasias/psicología , Adulto , Comparación Transcultural , Análisis Factorial , Femenino , Hong Kong , Humanos , Masculino , Persona de Mediana Edad , Psicometría/instrumentación , Autoimagen , Espiritualidad , Encuestas y Cuestionarios , Sobrevivientes/psicología , TaiwánRESUMEN
PURPOSE: This study assesses the sensitivity and specificity of Mandarin versions of two psychosocial screening tools for adjustment, anxiety and depressive disorders: the Hospital Anxiety and Depression Scale (HADS), and the Distress Thermometer (DT). METHODS: The two scales were used to screen 103 consecutive cancer patients seen for psychiatric evaluation at KF-SYSCC between May and November 2004 prior to their psychiatric interviews. Each scale was tested against clinical psychiatric diagnoses based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition for their sensitivity and specificity. RESULTS: For the Mandarin version of the DT, receiver operating characteristic (ROC) analyses identified a DT score of 4 as the optimal cut-off, with sensitivity and specificity of 98 and 73%, respectively. For the Mandarin version of the HADS, ROC identified a score of 9 and 8 as the optimal cutoffs for the respective anxiety and depression subscales (HADS-a and HADS-d), with sensitivities and specificities of 84 and 73, 72 and 86%, respectively. For the full scale of the HADS (HADS-t), 15 was identified as the optimal cutoff, which yielded sensitivity and specificity of 84 and 68%, respectively. Using the frequency table, the concordance rate of the two scales was found to be 72-80% based on the above optimal cut-offs. CONCLUSION: The Mandarin versions of the HADS and the DT are efficacious for screening anxiety and depression for our population. Compared with the HADS-t, the DT appears to have not only higher sensitivity, but also higher specificity.