Introduction: Building an evaluation model that derives from oncology pediatric patients' perspective is essential for effectively meeting their needs. Current standards of pediatric psychosocial-oncology care are mainly determined by medical providers and the child's relatives. There is a recognized need to develop a holistic model that is driven by patients themselves, with a central focus on utilizing art as a tool to facilitate the expression of their inner world. Objective: To propose an integrative model for the biopsychosocial assessment of oncology pediatric patients. Material and Methods: Qualitative grounded theory design based on the analysis of observations, interviews, and art projects. The initial study included twenty children aged 6-17 years diagnosed with cancer from the Hospital de Especialidades Pediátricas in Maracaibo, Venezuela. Results: An integrative model for the biopsychosocial assessment consisting of six dimensions—physical, cognitive, emotional, behavioral, family, and social—represented as concentric and interacting circles, is proposed. This model depicts factors that promote well-being and health, as well as obstacles that impede them in pediatric oncology. Conclusions: This model establishes a foundational framework for cancer centers to delineate the essential components of comprehensive biopsychosocial care from pediatric patients’ perspective.

Purpose of review Cancer patients’ communication with their relatives and healthcare professionals (HCPs) is essential for advance care planning (ACP). The purpose of this scoping review was to synthesize recent research findings about factors enabling cancer patients’, their relatives’, and physicians’ communication about ACP, and to propose recommendations for future ACP implementation in cancer care. Recent findings This review confirmed the importance of aspects of the cancer care context (i.e., culture) as ACP uptake-predisposing and -enabling factors. It highlighted the difficulty of determining who should initiate ACP discussion, with which patients and at what time-points. It also highlighted a lack of consideration for socioemotional processes in the study of ACP uptake despite evidence that cancer patients’, relatives’ and physicians’ discomforts that arise from communication about end-of-life and the wish to safeguard each other are main obstacles to ACP implementation. Summary Based on these recent findings, we propose an ACP communication model, developed with the consideration of factors reported to influence ACP uptake and communication in healthcare, and integrating socioemotional processes. The testing of the model may yield suggestions for innovative interventions that can support communication about ACP and promote a better uptake in clinical practice.

PurposeThis study reports the short- and mid-term benefits of an eight-session emotion and self-regulation group intervention ecologically boosted through daily app-based prompts. The intervention was designed for breast cancer patients in the early survivorship period meeting criteria for clinical levels of psychological symptoms. MethodsPatients were randomly assigned to the immediate intervention arm (n = 61; intervention received immediately) or to the delayed intervention arm (n = 59; intervention received 5 months later). Psychological symptoms, including anxiety, depressive symptoms, emotional distress, fear of cancer recurrence (FCR), worry, and intrusive thoughts were assessed through questionnaires. Emotion regulation was assessed in a dynamic emotion regulation task and in everyday life. Assessments were completed at baseline (T1), 5 months (T2) and 10 months (T3) later. ResultsTreated patients reported lower levels of worry and intrusive thoughts. They improved their ability to down-regulate the intensity of their negative emotions when exposed to cancer-related triggers in the dynamic emotion regulation task. They reported fewer and less intense negative emotions and more positive emotions in their everyday life. Benefits were maintained 5 months later, except for positive emotions in everyday life. ConclusionsThe results showed that focusing on emotion regulation is a relevant approach in the treatment of psychological symptoms for breast cancer patients in the early survivorship period meeting criteria for clinical levels of psychological symptoms. The intervention led to changes in patients' dynamic and everyday life emotion regulation. Consolidation sessions may be needed to sustain benefits in positive emotions and to increase the effect sizes.

Objective Cancer-related communication is critical for parents' and children's adaptation to the disease. This randomized pilot study was conducted to test the feasibility, acceptability, and efficacy of a 4-session intervention designed to improve parents' communication. Methods A 4-session intervention was developed to aid parents to support their children through more open/adapted communication. Sixty-six parents were assigned randomly to informational booklet with and without 4-session support intervention arms. Parents' communication self-efficacy, communication behaviors, communication difficulties, knowledge about age-appropriate communication, theoretical knowledge about concerns of children, parenting concerns, and distress were assessed by questionnaires at baseline and post-interventions. Multivariate analyses of variance were performed to compare data between and within groups over time. Results The intervention attrition rate was 6%. Data from 60 participants were included in analyses. Parents in the informational booklet with 4-session support group increased their communication self-efficacy (F = 4.5, p = 0.04), reduced communication difficulties (F = 4.0, p = 0.05), and increased their knowledge about how to communicate (F = 4.8, p = 0.03). Conclusion The results indicate that the 4-session intervention is acceptable, and shows preliminary evidence of efficacy. Practice implications A short support intervention associated with an informational booklet may be useful for parents wishing to improve their communication with their children.

Objectives Clinical fear of cancer recurrence (FCR) is highly prevalent among breast cancer patients and appears early in the disease trajectory. A better understanding of psychological factors associated with clinical FCR is essential to guide screening and intervention development. This cross-sectional study aimed to assess the contribution of attentional bias, intrusive thoughts, metacognitive beliefs, intolerance of uncertainty, thought suppression, and worry to clinical FCR in breast cancer patients in the early survivorship period. Methods Seventy-four patients treated for non-metastatic breast cancer were enrolled at the end of their treatment. The FCR Inventory-Short Form (FCRI-SF) was used to discriminate between the patients with clinical versus nonclinical FCR. Attentional bias to negative and positive cancer-related and non-cancer-related emotional words was assessed with a dot-probe task. Words were presented for 17, 500, and 1500 ms. Intrusive thoughts and thought suppression were assessed with the White Bear Suppression Inventory, metacognitive beliefs with the Metacognitions Questionnaire-30, intolerance of uncertainty with the Intolerance of Uncertainty Inventory-Part A, and worry with the Penn State Worry Questionnaire. Results According to univariate analyses, the patients with clinical FCR (FCRI-SF >= 13) significantly differed from those with nonclinical FCR in terms of intrusive thoughts (p = 0.002), metacognitive beliefs (p = 0.029), intolerance of uncertainty (p < 0.001), and worry (p < 0.001). Intolerance of uncertainty (odds ratio, OR = 1.06; p = 0.040) and worry (OR = 1.09; p = 0.013) remained in the final logistic regression models. All the patients showed vigilance to cancer-related words, whether with negative or positive valence, at automatic stages of processing (17 ms). Conclusions Intolerance of uncertainty and worry were the two psychological factors contributing directly to clinical FCR in our cross-sectional study. In addition, attentional bias did not differentiate breast cancer patients with clinical versus nonclinical FCR. Treatment approaches for clinical FCR in early survivorship care may need to integrate uncertainty and worry management intervention strategies.

Objective: This randomized study assesses behavioral, cognitive, emotional and physiological changes resulting from a communication skills training (CST) for physicians caring for cancer patients. Methods: Medical specialists (N = 90) were randomly assigned in groups to complete a manualized 30-h CST or to a waiting list. Assessments included behavioral (communication skills), cognitive (self-efficacy, sense of mastery), emotional (perceived stress) and physiological (heart rate) measures. Assessments were made at baseline (both groups), after CST program (training group), and four months after (waiting list group). All assessments were conducted before, during, and after a complex communication task with an advanced-stage cancer simulated patient (SP). Results: Trained physicians had higher levels of communication skills (from RR=1.32; p = .003 to RR=41.33; p < .001), self-efficacy (F=9.3; p = .003), sense of mastery (F=167.9; p < .001) and heart rate during the SP encounter (from F=7.4; p = .008 to F=4; p = .050) and same levels of perceived stress (F=3.1; p = .080). Conclusion: A learner-centered, skills-focused and practice-oriented manualized 30-h CST induced multilevel changes indicating physician engagement in a learning process.Practice implications: Trainers should consider the CST multilevel benefits (behavioral, cognitive, emotional and physiological) before, during and after a complex communication simulated task as an innovative way to assess the efficacy of a communication skills learning process.

In 1980, in an effort to bridge the gap between physicians and behavioral scientists working in the cancer field in Europe, the European Organization for Research and Treatment of Cancer (EORTC) created a Study Group on Quality of Life. A principal function of this group was to serve as a liaison to the various EORTC clinical cooperative groups, providing advice on the design, implementation, and analysis of quality-of-life substudies within selective phase III clinical trials. Much of the early discussion in the EORTC Study Group focused on the relative merits of employing a generic vs. disease-specific approach to quality of life assessment. Given the paucity of well-validated cancer-specific questionnaires, the Study Group elected to embark on the long-term process of instrument development. In order to investigate the psychometric properties and cross-cultural performance of the core questionnaire, a field study was initiated with participants from 15 countries, including most of the Western European countries as well as Australia, Canada, and Japan.

Objective: Cancer-related communication is critical for patients' and caregivers' adaptation to illness. This randomized pilot study was conducted to test the feasibility, acceptability, and efficacy of a specific dyadic intervention to improve communication. Methods: A four weekly-session intervention was developed to reinforce cancer-related patient-caregiver communication. Patients receiving treatment for any diagnosed cancer, and their caregivers, were recruited from two oncology clinics in Belgium. Sixty-four patient-caregiver dyads were assigned randomly to intervention and waitlist groups. Cancer-related dyadic communication, dyadic coping and emotional distress were assessed at baseline and post-intervention. Results: The intervention attrition rate was 6 %. Linear mixed models were performed on 60 dyads. Significant two-way group x time interaction indicated improvement in participants' cancer-related dyadic communication frequency (beta = -1.30; SE = 0.31; p =.004), self-efficacy (beta = -10.03; SE = 3.90; p =.011) and dyadic coping (beta = -5.93; SE = 2.73; p =.046) after the intervention. Conclusion: These results indicate that the brief dyadic communication intervention is feasible and acceptable, and show preliminary evidence of efficacy. Practice implications: Encouraging patients and caregivers to discuss personal cancer-related concerns may improve their ability to cope with the illness together. (C) 2020 Elsevier B.V. All rights reserved.

Objectives: This descriptive study assesses how physicians' decisional conflict influences their ability to address treatment outcomes (TOs) in a decision-making encounter with an advanced-stage cancer simulated patient (SP). Methods: Physicians (N = 138) performed a decision-making encounter with the SP trained to ask for TOs information. The physicians' decisional conflict regarding patients' cancer treatments in general was assessed with the General Decisional Conflict Scale (Gen-DCS). The physicians' decisional conflict regarding the SP's cancer treatments was assessed with the Specific Decisional Conflict Scale (Spe-DCS). Physicians' ability to address TOs during the encounter was assessed with an interaction analysis system: the Multi-Dimensional Analysis of Patient Outcome Predictions (MD.POP). Weekly time spent with cancer patients was assessed with a questionnaire. Results: Physicians' Spe-DCS (beta = -.21 ; p = .014) and weekly time spent with cancer patients (beta = .22 ; p = .008) predicted the number of TOs addressed during the encounter. Spe-DCS scores predicted nearly all MD.POP dimensions (r = -.18 ; p = .040 to r = -.30 to p < .001) whereas Gen-DCS scores predicted nearly none MD.POP dimensions. Conclusion: Physicians' specific decisional conflict interferes with their ability to address TOs in a decision-making encounter with an advanced-stage cancer SP. Practice implications: Physicians should be trained to address TOs according to patient preferences, despite their own decisional conflict. (C) 2020 Elsevier B.V. All rights reserved.