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Objective Despite its four decade history, the multidisciplinary specialty of psychosocial oncology (PSO) has no official consensus on core content. In 2014, the American Psychosocial Oncology Society (APOS) Board charged the APOS Professional Education Committee with outlining curricular content needed for core competence. Methods Content validation was completed using a four-phase modified Delphi Method. During Phase I, a Professional Education Committee subgroup proposed domains and items, which were rated by the APOS Fellows and Board via online survey. During Phase II, Fellows completed a second, revised survey. Phase III incorporated early career members. Developmental and diversity items were integrated into each domain. In Phase IV, a larger group of subject matter experts were surveyed, with feedback incorporated. Validation across phases involved average rating thresholds, intraclass correlations, and final percent agreement. Results The Delphi Method supported 12 content domains: Cancer Basics, Psychosocial Oncology, Professional Development, Ethics, Emotional/Psychological Concerns, Sexuality and Relationship Concerns, Spiritual/Religious Concerns, Healthcare Communication and Decision Making, Social/Practical Problems, Caregiver Concerns, Cognitive Concerns, Physical Symptoms and Psychosocial Assessment/Treatment. High levels of agreement were achieved across domains (86%-100%) and items, with no significant rating differences by discipline. Conclusions This proposed core content can enhance and standardize education and training in PSO including APOS' Virtual Psychosocial Oncology Core Curriculum, focused on broadly expanding the PSO workforce, particularly in underserved areas. Next steps include development of core competencies and establishment of online training modules based on this content validation.

Objective Burnout in academic medicine has been widely studied, but most work has been conducted among physicians. Psychologists in academic medicine have unique burnout factors. Therefore, investigating the prevalence and predictors of burnout among psychologists in academic medicine during the COVID-19 pandemic represents an important addition to the literature. Methods Sixty-two psychologists responded to burnout-related items in a larger, 40-item Psychiatry Department climate survey conducted from October to November 2020. Five items from the MINI-Z survey were administered to examine control over workload and sufficiency of documentation time as predictors of both continuous and dichotomously defined burnout. Linear and logistic regression was employed with years as a faculty member entered as a covariate. Results Slightly less than half (48.4%) of respondents met dichotomous criteria for burnout. Faculty with fewer years of experience scored higher on their level of continuous burnout. Both control over workload and sufficiency of time for documentation were independent predictors of continuous burnout, but only control over workload remained a statistically significant predictor in a simultaneous model. Control over workload was a significant predictor in dichotomous models but did not remain so once sufficiency of documentation time was also added. Conclusion Burnout prevalence among psychologists was comparable to rates among physicians at other institutions, even when examined during the COVID-19 pandemic. Academic medicine administrators and organizational leaders should consider policies and programming to increase control over workload, especially among junior psychologist faculty.

Absence of formal and systematic screening for mood and anxiety disorders among patients with sickle cell disease (SCD) can result in under-recognized psychological problems. This study examined the prevalence of psychological symptoms using a systematic screening process. Patients with SCD completed four self-report screening tools for measurement of depressive and anxiety symptoms, self-efficacy, and pain. The goal was to detect patients with psychological symptoms and identify predictors of follow-up treatment attendance. A total of 336 adult patients (57% female, mean age 33 years) completed validated screening instruments for major depressive disorder and generalized anxiety disorder. Patients recommended for mental health follow-up included higher proportions of women. Patients who accepted the mental health follow up had higher levels of education compared to groups that did not accept nor attend the follow-up appointment. Overall, 34% of patients who endorsed elevated distress scores and were referred for mental health care attended the follow-up appointment. Findings suggest patients with SCD and elevated psychological distress are likely to use mental health treatment resources, which notes this program's success in identifying needs and responding to them. However, further research is needed to understand ways to engage this population in mental health care.

OBJECTIVES:Perceived stress is associated with sickle cell disease (SCD) pain; however, little is known about psychological mechanisms that may clarify this link among adult patients. This study explored whether anxiety and depression symptoms explained the relation between perceived stress and SCD pain episode frequency among 70 African-American adults (51.4% women, mean age 35.6 years).METHODS:Participants completed measures of perceived stress, pain, and psychological symptoms in an outpatient clinical setting.RESULTS:A serial multiple mediation model showed that psychological symptoms collectively reduced the association between perceived stress and SCD pain frequency (b = 0.116, P = 0.141). However, only the indirect effect of stress on pain frequency through anxiety symptoms was significant (b = 0.089).CONCLUSIONS:Anxiety but not depression symptoms best explain the association between stress and SCD pain. Further research is needed to identify the specific components of negative affect that drive the experience of SCD pain.

To the Editor: Vitiligo may significantly impair quality of life, particularly in social functioning and interpersonal interactions.1Ongenae K. Van Geel N. De Schepper S. Naeyaert J.M. Effect of vitiligo on self-reported health-related quality of life.Br J Dermatol. 2005; 152: 1165-1172Crossref PubMed Scopus (150) Google Scholar Psychosocial interventions remain scarce, however. Social Interaction Skills Training (SIST) has been shown to significantly reduce social anxiety and avoidance and improve confidence in patients with visible differences.2Robinson E. Rumsey N. Partridge J. An evaluation of the impact of social interaction skills training for facially disfigured people.Br J Plast Surg. 1996; 49: 281-289Abstract Full Text PDF PubMed Scopus (184) Google Scholar SIST incorporates cognitive behavioral therapy principles, using coping mechanisms to retrain maladaptive thinking patterns and communication techniques to reframe interactions. Common techniques include social dynamic exploration, behavioral modeling, role playing, feedback, and coaching. We developed a SIST workshop for vitiligo patients (Supplemental Table I, available at https://doi.org/10.17632/rcw37kjcrp.1), based on principles emphasized by Robinson et al and the British charity Changing Faces.2Robinson E. Rumsey N. Partridge J. An evaluation of the impact of social interaction skills training for facially disfigured people.Br J Plast Surg. 1996; 49: 281-289Abstract Full Text PDF PubMed Scopus (184) Google Scholar Primary end points included the Social Avoidance and Distress (SAD) Scale.3Watson D. Friend R. Measurement of social-evaluative anxiety.J Consult Clin Psychol. 1969; 33: 448-457Crossref PubMed Scopus (2114) Google Scholar Secondary end points included the Brief Fear of Negative Evaluation-II (BFNE-II) Scale,3Watson D. Friend R. Measurement of social-evaluative anxiety.J Consult Clin Psychol. 1969; 33: 448-457Crossref PubMed Scopus (2114) Google Scholar,4Carleton R.N. Collimore K.C. Asmundson G.J. Social anxiety and fear of negative evaluation: construct validity of the BFNE-II.J Anxiety Disord. 2007; 21: 131-141Crossref PubMed Scopus (117) Google Scholar 2 visual analog scales5Salman A. Kurt E. Topcuoglu V. Demircay Z. Social anxiety and quality of life in vitiligo and acne patients with facial involvement: a cross-sectional controlled study.Am J Clin Dermatol. 2016; 17: 305-311Crossref PubMed Scopus (32) Google Scholar assessing comfort levels in social situations, and open-ended workshop-specific questionnaires. The SAD, BFNE-II, and visual analog scales are standardized instruments validated in measuring social avoidance and anxiety. This prospective pilot study, which was approved by the University of Texas Southwestern Medical Center Institutional Review Board, recruited 17 patients with vitiligo from the University of Texas Southwestern Medical Center Pigmentary Disorders Clinic (Table I). All were 18 years or older, fluent in English, had no significant neuropsychiatric history, and attended one of two 6-hour SIST workshops facilitated by clinical psychologists. Participants completed the outcome measures at 4 separate times: immediately before and after the workshop and again 3 and 8 weeks afterwards.Table IParticipant demographicsDemographic factorsParticipants (n = 17)NumberPercentageSex Male16 Female1694Age, y 15-29318 30-44847 45-59318 ≥60318Race/ethnicity African American424 White318 Hispanic741 South Asian318Body surface area involvement, % 0-10847 10-25741 25-5016 50-7516 75-10000 Open table in a new tab A repeated-measures analyses of variance was performed to assess quantitative scores (Table II), using imputation with the last-observation-carried-forward method to address any missing data. An inductive thematic analysis was conducted to interpret qualitative data and generate overarching themes/subthemes.Table IISummary of mean scoresAssessment scalePreworkshopPostworkshopWeek 0Week 3Week 8SAD11.767.53∗Significantly lower than preworkshop level (P < .01).8.47∗Significantly lower than preworkshop level (P < .01).7.65∗Significantly lower than preworkshop level (P < .01).BFNE-II36.9430.18∗Significantly lower than preworkshop level (P < .01).33.4132.29Visual analog scale Company of strangers52.7671.94†Significantly higher than preworkshop level (P < .01).63.65†Significantly higher than preworkshop level (P < .01).63.35†Significantly higher than preworkshop level (P < .01). Meeting new people54.8874.24†Significantly higher than preworkshop level (P < .01).67.76†Significantly higher than preworkshop level (P < .01).67.35†Significantly higher than preworkshop level (P < .01).BFNE-II, Brief Fear of Negative Evaluation-II; SAD, Social Avoidance and Distress.∗ Significantly lower than preworkshop level (P < .01).† Significantly higher than preworkshop level (P < .01). Open table in a new tab BFNE-II, Brief Fear of Negative Evaluation-II; SAD, Social Avoidance and Distress. SAD scores showed a significant decrease immediately after the workshop compared with preworkshop baselines at α = 0.05, which was also observed at the 3- and 8-week follow-up assessments. BFNE-II scores showed a significant decrease immediately after the workshop. Although scores were still decreased at 3 and 8 weeks compared with baseline, statistical significance was not reached at these time points. Scores on the visual analog scales showed significant increases for both items immediately after the workshop and at the 3- and 8-week follow-up assessments. Themes commonly reported before the workshop included low self-esteem and body acceptance, self-consciousness, social stigmatization, and a lack of adaptive coping strategies. Themes reported after the workshop included empowerment from new coping techniques, sense of community, and increased social confidence. These preliminary results suggest that although patients might still fear anticipated negative evaluations, the strategies and coping mechanisms learned from SIST may help reframe social interactions. Measurable improvements from this pilot study correlated to decreases in clinically significant social anxiety and avoidance, which Robinson et al2Robinson E. Rumsey N. Partridge J. An evaluation of the impact of social interaction skills training for facially disfigured people.Br J Plast Surg. 1996; 49: 281-289Abstract Full Text PDF PubMed Scopus (184) Google Scholar also observed. Study limitations include uneven sex distribution (possibly related to sex differences in perceived societal expectations), small sample size, and lack of controls. Future larger randomized controlled trials are needed to confirm findings. Vitiligo can be detrimental to the quality of life, psychological well-being, and social functioning of affected individuals. SIST may be useful for patients with vitiligo and warrants further exploration as a therapeutic intervention. More detailed information on how to conduct a SIST workshop can be obtained by contacting the corresponding author. We thank Changing Faces and the North Texas Burn Rehabilitation Model System (funded by National Institute on Disability, Independent Living, and Rehabilitation Research ) for providing the study concept and resources to develop our workshop, as well as Brandon Oscarson, at Children's Medical Center Dallas, for statistical assistance.