Search

This randomized study assesses behavioral, cognitive, emotional and physiological changes resulting from a communication skills training (CST) for physicians caring for cancer patients.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).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).A learner-centered, skills-focused and practice-oriented manualized 30-h CST induced multilevel changes indicating physician engagement in a learning process.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.

Background: Cariprazine is a new atypical antipsychotic drug approved for the treatment of schizophrenia and bipolar disorders. Methods: we searched the published randomized controlled-trials (RCT) to review cariprazine efficacy and tolerability using the databases (PubMed, EUDRACT, ClinicalTrials.gov and Cochrane Central Register of Controlled Trials) for cariprazine role in managing the following psychiatric conditions (schizophrenia, bipolar mania, bipolar depression and major depressive disorder). A meta-analysis was conducted using the identified 13 clinical trials to assess efficacy using with the outcomes: positive and negative syndrome scale (PANSS), clinical global impressions - severity of Illness (CGI-S), young mania rating scales (YMRS), Montgomery Asberg depression rating scale (MADRS) and Hamilton rating scale for depression (HAM-D). The risk of discontinuation due to adverse effects and common side effects were examined. Results: The mean difference in change from baseline for PANSS was -6.23 (95% Confidence Interval (CI) -7.18, -5.28) favoring cariprazine treatment (p

Physicians' characteristics that influence their communication performance (CP) in decision-making encounters have been rarely studied. In this longitudinal study, predictors of physicians' CP were investigated with a simulated advanced-stage cancer patient.Physicians (n=85) performed a decision-making encounter with a simulated patient (SP). Their CP was calculated by analyzing encounter transcripts with validated interaction analysis systems. Potential specific psychological predictors were physicians' empathy towards the SP (Jefferson Scale of Physician Empathy, JSPE) and their decisional conflict about the treatment (Decisional Conflict Scale, DCS). Potential general psychological predictors were physicians' empathy towards cancer patients (JSPE), their decisional conflict about cancer patients' treatments (DCS), and their affective reactions to uncertainty (Physicians' Reactions to Uncertainty, PRU).Physicians' CP was predicted by their decisional conflict about the SP's treatment (DCS) (β=0.41; p0.001) and their affective reactions to uncertainty regarding cancer treatments (PRU) (β=-0.31; p=0.003).During encounters with advanced-stage cancer patients, physicians' awareness of uncertainty about which treatments to consider may facilitate their communication performance, whereas physicians' affective reactions to uncertainty may inhibit their performance.Physicians' decisional conflict and reactions to uncertainty should be addressed in communication skills training programs.

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 (β = -.21 ;p = .014) and weekly time spent with cancer patients (β = .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., SCOPUS: ar.j, info:eu-repo/semantics/published

Les progres medicaux entrainent des prises de decision complexes en oncologie. Le doute inherent a ces decisions peut provoquer des reactions negatives chez les patients et chez les medecins. Une etude internationale a recemment montre les difficultes des medecins a appliquer des competences en communication susceptibles de reduire ces reactions negatives. Les medecins travaillant en oncologie pourraient beneficier de programmes de formation a la communication specifiques aux contextes de haute incertitude pour ameliorer la qualite de leurs prises de decision therapeutique.

Objective Although cancer patients frequently experience self-perceived burden to others, this perception has not been enough studied. The aim of this study was to investigate the prevalence of self-perceived burden to the primary caregiver (SPB-PC) and associated factors in an older patient population with hematologic malignancies at the time of chemotherapy initiation. Methods In total, 166 consecutive patients with hematologic malignancies aged ≥65 years were recruited at the time of chemotherapy initiation. Patients' SPB-PC was assessed using a 100-mm visual analogue scale (VAS). Characteristics potentially associated with SPB-PC, including sociodemographic and medical characteristics, physical functioning status (Karnofsky performance score, activities of daily living (ADL)/instrumental ADL), symptoms (fatigue, pain, nausea, quality of life), psychological distress (Hospital Anxiety and Depression Scale (HADS)), perceived cognitive function (Functional Assessment of Cancer Therapy Cognitive (FACT-Cog) Scale), and patients'/primary caregivers' personal relationship characteristics (family tie, support), were assessed. Results Thirty-five percent of patients reported moderate to severe SPB-PC (VAS ≥ 50 mm). Patients' SPB-PC was associated with lower Karnofsky performance (β = −0.135, p = 0.058) and ADL (β = −0.148, p = 0.037) scores, and higher HADS (β = 0.283, p

In previous studies we showed the interaction between depression and immunity. We observed that psychological stress seems to be important in this association. In this review we try to understand if psychological stress and immunity have similar or specific impact on the other psychiatric disorders. More generally we review literature to understand if specific immune alterations exist between the main psychiatric diagnoses.We studied the literature in search of variabilities between the different psychiatric disorders in terms of immunity especially inflammation. We search on Pubmed, PsycINFO, PsycARTICLES and Sciencedirect articles with the keywords immunity or inflammation and depression, anxious disorders and schizophrenia.Prevalence of inflammation in psychiatric disorders seems to be between 21 to 42%. Psychiatric disorders are correlated with elevated levels of CRP, pro-inflammatory cytokines (IL-6, IL-1β and TNFα) and anti-inflammatory factors (TGF β, IL-10, sIL-2, IL-1RA). IL-6 in childhood were associated with subsequent risk of depression or psychotic disorders in early adulthood and in a dose dependent manner.We found similar immune processes through the different disorders. Variations in cytokines levels seem paralleling various stages of the illness and treatment. Inflammatory markers are linked with severity and resistance to treatment and with subsequent risk of disorders.Some inflammatory parameters could be considered as risk factor, severity, resistance, trait or state markers of a psychiatric disorder. Other studies are necessary to a better understanding of clinical implications of this heterogeneity.

Purpose This study assessed the efficacy of a 38-hour communication skills training program designed to train a multidisciplinary radiotherapy team. Methods Four radiotherapy teams were randomly assigned to a training program or a waiting list. Assessments were scheduled at baseline and after training for the training group and at baseline and 4 months later for the waiting list group. Assessments included an audio recording of a radiotherapy planning session to assess team members' communication skills and expression of concerns of patients with breast cancer (analyzed with content analysis software) and an adapted European Organisation for Research and Treatment of Cancer satisfaction with care questionnaire completed by patients at the end of radiotherapy. Results Two hundred thirty-seven radiotherapy planning sessions were recorded. Compared with members of the untrained teams, members of the trained teams acquired, over time, more assessment skills (P = .003) and more supportive skills (P = .050) and provided more setting information (P = .010). Over time, patients interacting with members of the trained teams asked more open questions (P = .022), expressed more emotional words (P = .025), and exhibited a higher satisfaction level regarding nurses' interventions (P = .028). Conclusion The 38-hour training program facilitated transfer of team member learned communication skills to the clinical practice and improved patients' satisfaction with care.

Since 2010, the Belgian mental healthcare system has been involved in a structural reform: the main objective of this reorganisation is to foster the reintegration in the community of patients suffering from a mental health disorder. In parallel, the role of mental health professionals has evolved these last years: from a strictly clinical role, to the preoccupation with the rehabilitation of social competencies such as enhancing patients' abilities to return to work. The aim of this paper is to explore, specifically for patients hospitalized for a common mental health disorder, the predictive variables of returning to work within 6 months after hospitalization (RTW6).Our sample was extracted from routinely collected data during the patients' hospital stay (10 days) at the Psychosomatic Rehabilitation Day Centre of CHU Godinne. A sample of 134 patients participated in our study. Those patients were contacted 6 months after their hospitalization to assess resumption of work.We found that a patient's sociodemographicand socioeconomic variables, and depressive symptoms at the beginning of hospitalization were not predictive of return to work within 6 months (RTW6). On the other hand, duration of absence from work before hospitalization and the diagnosis of a major depression in particular were negatively associated with RTW6, whereas improvement of depressive symptoms during hospitalization stay was positively associated to RTW6.Our study identified the diagnosis of major depression and the duration of absence from work before hospitalization as two important risk factors impeding a fast return to work for patients hospitalised for a common mental health disorder. As the preoccupation with patients' abilities to return to work is now on the agenda of mental health professionals, special support and supervision should be dedicated to the more vulnerable patients.

The effects of depression on the immune system are well known. Recently, depression as a consequence of an immune disorder has received increased research attention. Here, we test the hypothesis that the depression-immunity association is a buffer zone between external stimuli, defence mechanisms, and intrinsic determinants.Five hundred and forty-nine patients presenting with a major depressive episode completed the Beck Depression Inventory (BDI), Lazarus and Folkman's coping inventory, and the Family Adaptability and Cohesion Scale (FACES III). Lymphocyte subtypes were quantified using flow cytometry.Links between immunity and depression were confirmed: levels of CD3, CD4 and CD8 cells accounted for 12.7% of the variance in the BDI (p0.001, linear regression; LR). The depression-immunity pairing interacted with family dynamics, coping mechanisms, and gender. Dynamics in the family of origin explained 11.4% of the BDI score (LR) and 1% of CD3 and CD4 levels (p0.001, Pearson's r). Coping mechanisms were associated with 12% of the BDI score (p0.001, LR), and the capacity of distancing oneself from one's problems was associated with 10.3% of CD3, CD8, and CD16/56 levels (p0.01, LR). BDI scores in women were 2.9 points higher than in men (p0.01, t=2.379) and associated with a greater risk of immune depression (p0.001, odds ratio=0.5).External determinants (family), coping mechanisms, and internal determinants (such as gender) simultaneously influence a depression-immunity pairing. Sometimes these factors act more on the mood component, sometimes more on the immune component. The two components also interact closely with each other.

Antidepressant medication efficacy remains a major research challenge. Here, we explored four questions: whether noradrenergic antidepressants are more effective than serotonergic antidepressants; whether the addition of 100 mg acetylsalicylic acid (ASA) changes antidepressant efficacy; whether the long-term efficacy differs depending on the antidepressant and the addition of ASA; and whether serum levels of brain-derived neurotrophic factor (BDNF) are clinically informative.In a two-year study, forty people with major depressive disorder were randomly assigned to groups that received an SSRI (escitalopram) or an SNRI (duloxetine), each group received concomitant ASA (100 mg) or a placebo. Sociodemographic data were recorded and patients under went regular assessments with the Hamilton depression scale (HDS) and clinical global impression (CGI) scale. Serum levels of BDNF were measured four times per year.There was no significant difference in efficacy between the two antidepressants or between antidepressant treatment with and without ASA. However, subgroup comparisons revealed that the duloxetine + ASA (DASA) subgroup showed a more rapid improvement in HDS score as early as 2 months (t=-3.114, p=0.01), in CGI score at 5 months (t=-2.119, p=0.05), and a better remission rate (χThis suggest two hypotheses: either a noradrenergic agent combined with ASA is more effective in treating depression than a serotonergic agent alone, or the level of serum BDNF before treatment is a precursor marker of the response to antidepressants. Further research is needed to test these hypotheses.

Background: Although previous studies have reported the efficacy of communication skills training (CST) programs, specific training addressing communication about uncertainty and hope in oncology has not yet been studied. This paper describes the study protocol of a randomized controlled trial assessing the efficacy of a CST program aimed at improving physician ability to communicate about uncertainty and hope in encounters with cancer patients. Methods/design: Physician participants will be randomly assigned in groups (n = 3/group) to a 30-h CST program (experimental group) or to a waiting list (control group). The training program will include learner-centered, skills-focused, practice-oriented techniques. Training efficacy is assessed in the context of an encounter with a simulated advanced stage cancer patient at baseline and after the CST for the experimental group, and after four months for the waiting-list group. Efficacy assessments will include communicational, psychological and physiological measures. Group-by-time effects will be analyzed using a generalized estimating equation (GEE). A power analysis indicated that a sample size of 60 (30 experimental and 30 control) participants will be sufficient to detect effects. Discussion: The current study will aid in the development of effective CST programs to improve physician ability to communicate about uncertainty and hope in encounters with cancer patients. Trial registration: US Clinical Trials Register NCT02836197., SCOPUS: ar.j, info:eu-repo/semantics/published

Objectif : Diverses etudes rapportent la presence d’alterations cognitives chez les patients atteints d’un cancer. Le but de cet article est de proposer une revue des etudes longitudinales controlees ayant evalue l’efficacite d’interventions visant a prendre en charge ces alterations cognitives. Methode : Les etudes longitudinales controlees ayant evalue l’efficacite d’interventions visant a prendre en charge les alterations cognitives chez les patients adultes atteints d’un cancer et publiees entre 1993 et 2013 ont ete identifiees, a l’exception des etudes impliquant des patients atteints de tumeurs ou de metastases cerebrales. Resultats : Parmi les interventions pharmacologiques (n = 11), certaines suggerent l’impact positif du modafinil notamment au niveau mnesique et executif. Les interventions non pharmacologiques (n = 10) demontrent l’impact positif de programmes de revalidation cognitive et de stimulation, de psycho-education et de la meditation sur plusieurs fonctions mnesiques, attentionnelles et executives, objectives et subjectives. Les interventions non pharmacologiques entrainent des ameliorations cognitives plus importantes que les interventions pharmacologiques. Conclusions : Certaines etudes longitudinales controlees semblent demontrer l’interet de prendre en charge les alterations cognitives observees chez les patients atteints d’un cancer. De nouvelles etudes evaluant l’efficacite d’interventions combinant prise en charge des alterations cognitives et soutien psychotherapeutique a l’adaptation psychologique des patients devraient etre menees.

INTRODUCTION: Little is known about elderly cancer inpatients' desire for psychological help. PURPOSE: The aim of this study was to investigate whether elderly cancer inpatients well informed about their diagnosis expressed a desire to receive formal psychological help at the start of their cancer treatment. The characteristics of the patients that sought help were examined. METHODS: This cross-sectional study assessed 650 consecutive cancer inpatients that were 65 years of age and older when they started treatment for breast, colorectal, ovarian, lung, prostate or haematological cancers. Disease-related, medical and psychological characteristics of these patients were assessed using validated tools. RESULTS: Distress and cognitive impairment were experienced by 37% and 46% of elderly cancer inpatients, respectively. However, only 12% of patients reported a desire for formal psychological help (14% of women vs 9% of men). The patient characteristics examined were found to be weakly associated with this desire (this explained 16% of the variance for women and 14% for men). For the female subgroup, this desire was associated with age [

Purpose: To our knowledge, no study has specifically assessed the time course of anxiety during radiotherapy (RT). The objective of this study was to assess anxiety time courses in patients with nonmetastatic breast cancer. Material and methods: This multicenter, descriptive longitudinal study included 213 consecutive patients with breast cancer who completed visual analog scales (VASs) assessing state anxiety before and after the RT simulation and the first and last five RT sessions. Results: Pre- and post-session anxiety mean levels were highest at the RT simulation (respectively, 2.9 ± 2.9 and 1.6 ± 2.5) and first RT session (respectively, 3.4 ± 2.9 and 2.0 ± 2.4), then declined rapidly. Clinically relevant mean differences (P1 cm on the VAS) between pre- and post-simulation/session VAS scores were found only for the RT simulation (1.3 ± 2.7; p < 0.001) and first RT session (1.4 ± 2.4; p < 0.001). Five percent to 16% of patients presented clinically relevant anxiety (pre- and post-simulation/session VAS scores P 4 cm) throughout treatment. Conclusions: To optimize care, RT team members should offer all patients appropriate information about treatment at the simulation, check patients’ understanding, and identify patients with clinically relevant anxiety requiring appropriate support throughout RT.

Breaking bad news (BBN) is a complex task which involves dealing cognitively with different relevant dimensions and a challenging task which involves dealing with intense emotional contents. No study however has yet assessed in a randomized controlled trial design the effect of a communication skills training on residents' physiological arousal during a BBN task.Residents' physiological arousal was measured, in a randomized controlled trial design, by heart rate and salivary cortisol before, during and after a BBN simulated task.Ninety-eight residents were included. MANOVA showed significant group-by-time effects. Trained residents' mean heart rate levels remained elevated after training and cortisol areas under the curve increased after training compared to untrained residents.Communication skills training has an effect on residents' physiological arousal. Residents' self-efficacy and communication skills improvements in a BBN simulated task are associated with an elevated physiological arousal, which becomes proportional to the complexity of the task and reflects a better engagement and performance.Residents should be informed that, to perform a task, they need to engage in the task with a physiological arousal proportional to the complexity of this task. Communication skills training should be adapted.

Objectif Chez les patients âges atteints d’un cancer, plusieurs etudes evaluent l’etat des fonctions cognitives pendant le traitement. L’objectif de cet article est d’approfondir l’evaluation de la presence ou non de troubles cognitifs au commencement d’un traitement anticancereux, chez les patients âges de plus de 65 ans atteints d’une affection hemato-oncologique.

Previous study shows that cellular immunity and family relationships are each correlated with the severity of depression and suggests that the psycho-immunological theory should look at the relation between immunity and family life. The aim of the present study based on the same sample is to investigate if similar correlations exist with humoral immunity.498 inpatients with major depressive disorder were enrolled in an open-label trial. In addition to a socio- demographic questionnaire, they completed Olsen's FACES III and the Beck Depression Inventory (BDI). We performed a classic blood test, a plasma cortisol assay at 8 a.m., 4 p.m. and 8 p.m. and a dexamethasone suppression test (Carroll test). Electrophoresis is used for separation and quantification of serum proteins.There is no correlation between humoral immunity and the severity of depression. We found a correlation between cohesion of the family of the origin and beta-globulins (r=-0.147; p=0.016), and C4 (r=0.124; p=0.039). Between adaptability of the family of the origin and cortisol levels at 8 a.m. (r=0.122; p=0.008). We showed a correlation between both C4 (r=-0.263; p=0.000) and beta-globulins (r=-0.148; p=0.013) with CD8. There is a correlation between cortisol at 8 a.m. and CD4 (r=-0.095; p=0.033).Humoral immunity has no correlation with depression but has multiple interactions with cellular immunity which is correlate with the severity of the depression. The psycho-immunological theory is reinforced. It is quite original to find correlation between the family functioning and C4 or beta-globulins while the link with cortisol strengthens some studies about psychological stress, cortisol and immunity. Future studies should examine which kind of family or relation are implicated and how the family functioning and immunity could be connected.

In the context of health care in Belgium, the psychological or psychiatric opinion of a multidisciplinary team is required in the assessment of bariatric surgery candidates. In clinical practice, a wide variety of liaison psychiatry assessment methods exist.On the basis of a post-operative psychiatric comorbidity case report and a literature review on "liaison psychiatry and bariatric surgery" we aim to identify opportunities for the systematization of bariatric pre-surgery psychiatric evaluation.The bariatric pre-surgery evaluation must be rigorous and founded on evidence-based medicine. On this basis, specific psychiatric criteria may be defined and researched in assessments. The issue remains for psychiatric comorbidities that develop after surgery and for which a preventive framework should be sustained in the liaison psychiatry approach.The aim of the research is to support an improved systematization of the psychological assessments of pre-operative bariatric surgery candidates. We believe that systematic evaluation tools should be defined for the identification of possible absolute or relative contra-indications and that a preventive approach to post-operative psychiatric disorders should be included in this assessment.

Exposure to stress modifies the humoral and cellular immunity by the activation of the hypothalamic-pituitary-adrenal axis. On one hand, this psycho-immunological theory allows the analyse of links between immunity and depression. On the other hand, the correlation between the immune response, the clinical expression in major depressive disorder (MDD) and the gender was proven. Our analysis evaluates the influence of the gender and the level of depression severity on the cellular immune response associated with it.549 patients with MDD were enrolled in an open-ended survey. In addition to a socio-demographic questionnaire, they completed the Beck Depression Scale (BDS). Flow cytometry was used to assess lymphocyte subsets.On average, the intensity of the depression (ID) among women is higher by 2.9 points (t=2.379*). In terms of immunity, there are correlations between this ID and absolute values of CD3 (r=-0.127***), CD4 (r=-0.189***), CD8 (r=0.089*) and CD16 and 56 (r=0.129*). In terms of gender, there are significant differences for the percentage of total lymphocytes (m=37.84, w=35.59; t=2.646***), CD3 (m=2.08, w=1.9; t=2.676*), CD4 (m=1.44, w=1.3; t =2.522*), CD8 (m=0.62, w=0.57; t=2.182*). A linear regression model including both variables supports the existence of these differences in the percentage of total lymphocytes (Adjusted R2=0.025***) and CD8 (Adjusted R2=0.012*).If the link between depression and the cellular immune response is a known fact, our study proves that women have a stronger immune response than men in terms of percentage of total lymphocytes mobilized and cytotoxic lymphocytes. The volume of natural killer lymphocytes is independent of the gender but connected to the ID. Based on those results, psycho-immunological theories could potentially be rethought in the light of immunity being at least partially dependent of the gender.

In a previous study, we compared the family relationships of patients hospitalized in a psychiatry unit from either psychiatric consultations or after passing emergency room (E.R.). The intensity of depression was statistically comparable in both groups. What distinguishes patients transiting emergencies is that their families and couples are more cohesive and adaptable. In this study, we compare both groups in terms of coping mechanisms and multidimensional health locus of control (MHLC).All patients (N=2172) with a major depressive disorder admitted to our department between 01/01/2010 and 31/12/2012 are included in an open study. They completed the Beck's Depression Inventory, the Olson's Family Adaptability and Cohesion Scale, visual analogue scales of stress, the ways of coping checklist, and the MHLC scale.Patients admitted through emergencies are found to have less belief in chance (CHLC) (t=2.488; p=0.014), distance themselves more from their problems (t=-2.187; p=0.03), but reappropriate them less positively (t=2.355; p=0.019) than those admitted through consultations. A logistic regression model including variables identified in the previous study (adaptability in the original family and the couple's lived stress) gives a risk factor (odds ratio) of 14.7 which means that a patient who would combine the different risk factors would be 14.7 times more likely to go through emergency.How to explain that depressive patients with more favorable factors considered: to believe less in chance, distancing from their problems, and having a better family support, are more likely to go to the E.R.? We make the suggestion that those factors exactly slowed down patients in their care application at first, allowing the depression to worsen. It is only once they would have depleted their reserves that they would reach the emergency room on their own initiative or encouraged by their families, themselves overwhelmed by the situation. Further study should take into account the duration of the episode before arrival at the hospital.

In a previous study, we investigated the risk of admission to emergency (ER) of depressed patients prior to their hospitalization in psychiatry in comparison with hospitalized patients transferred from the consultations department (Cdpt). In the present study, we compare among the same patients variables affecting the intensity of depression in each group.All patients with Major depressive disorder admitted in our department through emergencies (N=146) or consultations (N=2172) between January 1, 2010 and December 31, 2012 were included in an open study. They completed the Beck Depression Inventory (BDI), analogical visual scales about stress levels (in professional, social, family, married life, over the past year and the past month), the Multidimensional Health Locus of Control and the Olson Family Adaptation and Cohesion Scale and the Ways of coping.The depression (t=1.438; p=0.90) is similar in both samples. Although some variables such as gender, internality, coping mechanisms and stress factors influence the intensity of depression in both groups of patients (linear regression p0.000, r=0.593), other factors play a role only in either one or the other group. The factors of patients' age, number of children, elements of family dynamics, couple life, and the belief in luck do influence the intensity of depression only in patients hospitalized through Cdpt (linear regression p0.000, r=0.366). The intensity of depression of patients admitted through ER, is specifically dependent on the number of collateral factors (p=0.045, r=0.304), the number of living relatives (p=0.036, r=0.276) and the belief in the power of others (p=0.022, r=-0.16).Although Both samples are comparable in terms of intensity of depression, patients admitted through the Cdpt are more dependent on the quality of family relationships whereas those coming from emergencies are most influenced by their concrete social and family situation. Alongside these specific variables it remains that stress and coping mechanisms account for the largest percentage of variance of the intensity of depression.

OBJECTIVE Despite the well-known negative impacts of cancer and anticancer therapies on cognitive performance, little is known about the cognitive compensatory processes of older patients with cancer. This study was designed to investigate the cognitive compensatory processes of older, clinically fit patients with hematologic malignancies undergoing chemotherapy. METHODS We assessed 89 consecutive patients (age ≥ 65 y) without severe cognitive impairment and 89 age-, sex-, and education level-matched healthy controls. Cognitive compensatory processes were investigated by (1) comparing cognitive performance of patients and healthy controls in novel (first exposure to cognitive tasks) and non-novel (second exposure to the same cognitive tasks) contexts, and (2) assessing psychological factors that may facilitate or inhibit cognitive performance, such as motivation, psychological distress, and perceived cognitive performance. We assessed cognitive performance with the Trail-Making, Digit Span and FCSR-IR tests, psychological distress with the Hospital Anxiety and Depression Scale, and perceived cognitive performance with the FACT-Cog questionnaire. RESULTS In novel and non-novel contexts, average cognitive performances of healthy controls were higher than those of patients and were associated with motivation. Cognitive performance of patients was not associated with investigated psychological factors in the novel context but was associated with motivation and psychological distress in the non-novel context. CONCLUSIONS Older, clinically fit patients with hematologic malignancies undergoing chemotherapy demonstrated lower cognitive compensatory processes compared to healthy controls. Reducing distress and increasing motivation may improve cognitive compensatory processes of patients in non-novel contexts.

Introduction : Il n’est aujourd’hui plus a demontrer que l’activite et l’exercice physique ont des effets positifs sur l’humeur et l’anxiete. Les etudes experimentales decrivent des effets anxiolytiques et antidepressifs tant sur les sujets sains que sur les patients. L’objectif de cet article est de montrer que l’exercice physique au sein d’un service de psychiatrie contribue a l’amelioration de la sante mentale des patients hospitalises. Methodes : Les informations sociodemographiques, le diagnostic et l’activite physique (duree, distance, type et frequence) de 283 patients hospitalises au sein d’un service de psychiatrie ont ete repertories. Les membres de l’equipe soignante (20 personnes) ont evalue les patients sur une echelle visuelle analogique de 1 a 10 en fonction de l’amelioration de leur sante mentale. Aucune manipulation experimentale n’a ete effectuee. Sujets : Cent vingt-huit hommes et 155 femmes presentent les troubles suivants : trouble depressif majeur, troubles anxieux, dependance alcoolique, toxicomanie, decompensation psychotique et trouble bipolaire. Resultats : Les correlations entre l’amelioration de la sante mentale et la participation aux exercices physiques sont toutes significatives (frequence : r=0,228 ; p

Objectif : Cet article a pour ambition de proposer aux cliniciens un modèle permettant le repérage des éléments dysfonctionnels responsables de l’apparition ou du maintien du Désir Sexuel Hypoactif. Méthodologie En nous appuyant sur une large recension des écrits cliniques et empiriques, nous suggérons une vision globale dont les fondements théoriques viennent de la sexofonctionnelle. Résultats : Ce modèle souligne le caractère multifactoriel du Désir Sexuel Hypoactif et nous conduit vers une structuration didactique en cinq axes. Discussion : De cette manière, les facteurs (1) cognitifs, (2) physiologiques, (3) comportementaux, (4) émotionnels et (5) environnementaux sont discutés. Conclusions : Cette étiologie en cinq axes facilitera l’évaluation de l’ensemble des éléments responsables du Désir Sexuel Hypoactif et permettra aux cliniciens une adaptation de leur traitement en fonction d’une anamnèse attentive au caractère multifactoriel du Désir Sexuel Hypoactif.

Object : The purpose of this article is to propose a model to clinicians designed to highlight the dysfunctional elements responsible for the appearance and continuation of Hypoactive Sexual Desire Disorder. Methodology : Supported by a broad analysis of clinical and empirical accounts, we suggest a global vision whose theoretical foundations come from “sexofonctionnelle”. Results :This model underlines the multi-factor aspect of Hypoactive Sexual Desire Disorder and leads us to a didactical structuration comprising five axes. Discussion : Thereby, the cognitive, physiological, behavioural, emotional and environmental factors are discussed. Conclusion : This etiology with its five axes will facilitate the assessment of all the elements responsible for Hypoactive Sexual Desire Disorder and will enable clinicians to adapt their treatment by being aware of the multi-factor nature of Hypoactive Sexual Desire Disorder when taking a medical history.

Object Bibliotherapy is a concept which leads us to consider the wide range of actual therapeutic approaches. The originality of bibliotherapy lies in the fact that the use of a writing (brochure, manual, book…) constitutes the central element of the help intervention. Methodology A review of the literature about the different types of bibliotherapeutic books, about the way these books are used, as well as about the levels of contact with the therapist will be presented. The reflection will thereafter focus on scientifically validated books dealing with female sexual dysfunctions. Results Bibliotherapy as treatment for sexual dysfunctions does not equal traditional sex therapies, but it offers an interesting and effective alternative for a specific target audience and a complementary tool to traditional methods. Discussion Different factors influencing the effectiveness of the bibliotherapeutic tool are discussed. Some reflections are also proposed to try to determine the profile of the women to whom the bibliotherapeutic tool may be advised. Conclusions It is noticed that there exists only a few bibliotherapeutic tools which have been validated for sex therapy. The promotion of further research in this field would therefore be highly pertinent in view of the positive results of previous studies.

Objectif La bibliotherapie est un concept qui nous amene a considerer la grande diversite des approches therapeutiques actuelles. L’originalite de celle-ci reside dans le fait qu’au centre de l’intervention d’aide, on retrouve l’utilisation d’un ecrit (brochure, manuel, livre…). Methodologie Une revue de la litterature des differents types d’ouvrages bibliotherapeutiques, leurs modes d’utilisation et les niveaux de contact avec le therapeute est presentee. La reflexion est ensuite focalisee sur les ouvrages valides scientifiquement traitant des dysfonctions sexuelles feminines. Resultats La bibliotherapie pour les dysfonctions sexuelles n’egale pas les sexotherapies traditionnelles mais elle offre une alternative interessante et efficace pour un public cible ou un outil complementaire a celles-ci. Discussion Differents facteurs influencant l’efficacite de l’ouvrage bibliotherapeutique sont discutes. Quelques pistes sont egalement proposees pour tenter de determiner le profil de femmes auxquelles l’ouvrage bibliotherapeutique peut etre conseille. Conclusions Il est identifiable qu’il existe peu d’outils bibliotherapeutiques valides en sexotherapie. Promouvoir la recherche dans ce domaine aurait donc toute sa pertinence au vu des rapports positifs des precedentes etudes.

Aim: Until the 1980s, due largely to prejudice, post-menopausal women were believed to experience significantly less sexual desire and thus to have sexual intercourse less often than before menopause. Since the 1990s, this type of prejudices seems to have decreased. The aim of our study is to examine the sexuality of post-menopausal women by comparing it to same aged men’s sexual behaviour and the importance of sexuality in their life. Methods: A sample of 1,526 women and 1,151 men aged 55 and over. Results: Female subjects reported having sexual intercourse as often as women in the general population (once a week for 64% of them). The same proportion of women as men consider that a successful sexual life: is essential for a successful couple life (90%), needs continuous creativity (80%), has a deep positive impact on their well-being (87%). For most of them (82%), a satisfying sex life is possible only if there is a deep love relationship. 55% say they have never met sexual problems. The main complaints cited are vaginal dryness (45%) and a lack of desire (42%). Only 20% of those who had sexual problems report that age and time passing by are responsible for their troubles. In second place, they mention stress (19%), followed by relationship problems, and nervous breakdown (13%). Conclusion: Our study suggests that nowadays, there is no marked difference between post-menopausal women and men’s sexuality either in terms of frequency, or in terms of its importance in their life. Whenever physical problems linked to sexuality arise, they are more often attributed to stress added to relationship problems rather than to ageing. This study shows once again how sexuality is influenced by prejudices.

Objectif : Cette etude vise a determiner, a six mois, des predicteurs de la sante physique et mentale a partir de caracteristiques de personnalite et de la dynamique familiale. Methodes : Vingt sujets dits « sains » ont complete differents questionnaires (MINI, FACES III Olson, Neo-FFI, SF-12 et HAD). Resultats : Apres six mois, la cohesion et l’adaptabilite de la famille nucleaire sont de bons predicteurs influencant positivement la sante ; en revanche, le « nevrotisme » et l’adaptabilite de la famille d’origine jouent en defaveur de la sante. Conclusion : Nos donnees demontrent que, en plus de certaines caracteristiques de personnalite, grandir au sein d’une famille ou les echanges affectifs sont frequents permet de maintenir une bonne sante physique et mentale.

There are few studies which have investigated variables associated with the development of burnout among residents working with cancer patients. The aim of this study is to identify variables leading to residents' burnout in order to develop effective interventions. Burnout was assessed with Maslach Burnout Inventory. Person- (i.e., emotional-focused coping) and work-related (i.e., changes in lack of organizational support index) variables explain 28% of the variance in changes in emotional exhaustion. Training programs may be improved by adding specific modules for residents, about problem-focused coping in interviewing patients, and for supervisors, about effective team management.

Resume : Les strates de l’intime conjugal. Essai de formalisation technique de l’etude de l’intimite dans les couples au moyen de l’inventaire systemique des strates de l’intimite conjugale (ISSIC) – Les problematiques cliniques alentour de l’intimite sont legion dans notre pratique clinique. Il n’empeche toutefois que nous ne disposons que de peu de references techniques pour les apprehender, laissant donc place a notre positionnement subjectif dans la plupart des cas. Le but du present travail est de proposer un moyen d’investigation de differentes formes de l’intimite base sur la theorie de l’information de Shannon et sa reformulation selon Bateson, dans le decours duquel les couples sont amenes a s’hetero-evaluer dans leur fonctionnement, ce qui suppose la mise en place d’un processus auto-reflexif du couple en lieu et place d’interventions evaluatives du therapeute.

The aim of this paper is to remind that medicine is both an objective and a subjective interpersonal human science. Every scientific and medical progress as regards a disease diagnosis, treatment or prognosis has to be in the service of the patient in the frame of his relationship with his physician. Today, we know that this relationship is underlain by an effective and coherent reciprocal communication that acknowledges the subjectivity of both the patient and the physician, in their cognitive and emotional perception of the physiological problem. From this general point of view, arises the question of the best way to improve communication between physicians and patients suffering from cancer. This is crucial because we know today that an effective and a high-performance communication that implies assessments using both open and open directive questions, listening to and acknowledging patient's emotional reactions and expectations could have numerous positive effects. For physicians, this communication allows having an effective assessment of patient's state and breaking the diagnosis more appropriately. Moreover, this communication allows establishing a climate of trust able to promote patient adherence to treatment and to reduce health care professional stress. The question of predicting the acquisition of such effective communication skills by physicians has been the heart of empirical studies. Through the concept of "locus of control" (LOC), this paper shows that physicians are different when they learn communication skills. Results of this paper highlight that physicians' acknowledgement of their own psychological characteristics could improve communication skills training programs' effectiveness.

Objective: To show how the interaction of the medical preventive discourse with the changes of children's position relatively to the adult environment and the discourse on equal opportunities puts young people in a situation of lack of differentiation. This lack of differentiation causes violence. Means: From epidemiologic data on the health of young people, a certain number of behaviors in disfavor of health were put forward. Through techniques either of risk prevention or of health promotion, the medical profession models young people behaviors in terms of "safe" and standard. Unfortunately, this modeling proves relatively ineffective and generates at risk behaviors, for example, in sport. On the other hand, the loss of legitimacy of adults in regard to the rights of children leads the latter to meet difficulties in building their own identity. In these contexts, speaking of equal opportunity of access to goods sets up a series of objects of consumption as signs of the identity (PC, laptops MP3, Ipod, cell phone...). Not to have them is not to exist and this becomes a source of violence. Results: The increase of behaviors at risk and delinquent behaviors is the result of a whole mechanisms which does not any more allow young people to build differences between them. It is these interindividual differences that is at the base of the psychic identity. Conclusion: Promoting health through educating to pleasures, increasing between adults' coherence and establishing groups of young citizens seem to us as the elements that would make possible the re-establishment of a truly human dimension. © 2008 Elsevier Masson SAS. All rights reserved.

Background: No study has yet assessed the impact of physicians' skills acquisition after a communication skills training program on changes in patients' and relatives' anxiety following a three-person medical consultation. This study aimed at comparing, in a randomized study, the impact, on patients' and relatives' anxiety, of a basic communication skills training program and the same program consolidated by consolidation workshops and at investigating physicians' communication variables associated with patients' and relatives' anxiety. Methods: Consultations with a cancer patient and a relative were recorded and analyzed by the Cancer Research Campaign Workshop Evaluation Manual. Patients' and relatives' anxiety were assessed with the State-Trait Anxiety Inventory - State. Results: No statistically significant change over time and between groups was observed. Mixed-effects modeling of changes in patients' and relatives' anxiety showed that decreases in both patients' and relatives' anxiety were linked with patients' and relatives' self-reported distress (p = 0.031 and 0.005), and that increases in both patients' and relatives' anxiety were linked with physicians' breaking bad news (p = 0.028 and 0.005). Conclusion: No impact of the training program was observed. Results indicate the need to further study communication skills which may help reduce patients' and relatives' anxiety especially when breaking bad news. Copyright (C) 2007 John Wiley & Sons, Ltd.

Introduction: Dementia is a known predictor of shorter survival times in older cancer patients. However, no empirical evidence is available to determine how much a cognitive impairment shortens survival in older patients when cancer treatment is initiated. Purpose: To longitudinally investigate how much a cognitive impairment detected at the initiation of cancer treatment influences survival of older patients during a two-year follow-up duration and to compare the predictive value of a cognitive impairment on patients survival with the predictive value of other vulnerabilities associated with older age. Methods: Three hundred and fifty-seven consecutive patients (≥65 years old) admitted for breast, prostate, or colorectal cancer surgeries were prospectively recruited. A cognitive impairment was assessed with the Montreal Cognitive Assessment (MoCA, SCOPUS: ar.j, info:eu-repo/semantics/published

Dans le cadre d’une etude belge multicentrique, cet article rapporte l’evaluation qualitative et quantitative des besoins psychosociaux des proches aidants principaux des patients atteints d’un cancer, ainsi que les difficultes vecues par ces proches a faire face aux besoins psychosociaux des malades. De janvier a novembre 2004, l’ensemble des proches aidants principaux des patients atteints d’un cancer et hospitalises au sein de sept unites de soins en oncologie, ainsi que le proche aidant principal d’un patient sur deux consultant au sein de ces memes unites ont eteinvites a prendre part a l’etude. Les proches aidants principaux ont rempli une adaptation du questionnaire Cancer Rehabilitation Evaluation System (CARES) permettant l’investigation de 24 types de difficultes ayant pu etre rencontrees au cours du dernier mois, ainsi qu’une seconde adaptation du CARES permettant d’evaluer leur perception de 38 types de difficultes potentielles chez leur proche malade au cours du dernier mois. Les sujets ont egalement eteinvites a indiquer s’ils avaient eu des difficultes a faire face a chaque difficulte percue chez leur proche malade. Les informations medicales relatives aux patients ont eterecoltees aupres de leurs oncologues. Parmi les 284 proches aidants principaux inclus, une grande majoritea rencontre au cours du dernier mois une a plusieurs difficultes physiques, psychosociales, sexuelles de meme que des difficultes de communication avec leur partenaire. La majorite des proches aidants principaux percoit de nombreuses difficultes chez leur proche malade et 20 a 60 % d’entre eux rapportent eprouver au moins un peu de difficulte a faire face a ces difficultes. A cotede leurs nombreuses difficultes personnelles, les proches aidants principaux des patients atteints d’un cancer percoivent donc de nombreuses difficultes psychosociales chez leur proche malade. Les proches aidants principaux eprouvent egalement de nombreuses difficultes a gerer ces difficultes percues. Le nombre et l’importante variete des difficultes rapporteesdans cette etude refletent une « toxicite » sous-estimee : celle liee aux impacts et consequences psychosociaux des traitements sur les proches aidants principaux.

[Revisiting the «Tanguy» phenomenon: about retarded self-sufficiency in our post-adolescent population.] Financial, affective and health retarded autonomisation is now increasing in our post-adolescent population. Parents as well as parents-in-law are often disappointed with such a stagnation-process. The aim of the present paper is to propose - from an etymological standpoint - a provocative (pro-vocare) high lightening of such a phenomenon, which is clearly family-determined, even if sociologic and economic aspects are also co-existing. © Medecine et Hygiene. Tous droits reserves pour tous pays.

Complexity theory, as conveyed by systemic analysis to psychotherapy, allowed (health) care teams to deviate from an analytic approach to an interdisciplinary model. "And" took the place of "or". The disciplines are confronted with a situation where they share their knowledge and propose common solutions. However, the proposed treatments are in juxtaposition without any link among them. The patient is then confronted with various therapeutic means which are supposed to bring him/her a plus. This article aims at showing importance of complexity in mental health. The individual, by his emergent, auto-levelling and auto-organisational qualities must understand himself in his complexity and not only through an analytic multidisciplinary caring approach. The autopoietic approach considers that the resources are found inside and not outside of the individual. This approach should be regarded as essential and preliminary to any proposal and therapeutic discussion.

BACKGROUND AND PURPOSE: The aim of this study was to assess the efficacy of a 38-h communication skills training program designed for multidisciplinary radiotherapy teams. MATERIALS AND METHODS: Four radiotherapy teams were randomly assigned to a training program or to a waiting list. Assessments were scheduled at baseline (T1) and then after the training was completed or four months later (T2), respectively. Communication around radiotherapy delivery was assessed based on audio recordings of the first and last radiotherapy sessions in order to assess team members' communication skills and the expression of concerns by breast cancer patients (analyzed with content analysis software LaComm). RESULTS: 198 radiotherapy sessions were recorded. During the first radiotherapy sessions, members of the trained teams exhibited more assessment skills (p=0.048), provided more setting information (p

Social inequality as a social and economic phenomenon has become an issue of common interest in Europe and other societies worldwide, mainly after the recent global financial and economic crisis that occurred in 2008. The increasing gap observed between socioeconomically advantaged and disadvantaged people has caused intensive debates in politics, social sciences and in the field of public health. Today, poverty is considered as a major variable adversely influencing health. In this paper we will discuss the link between poverty and mental health.We conducted a literature search focusing on three main objectives: (I) to investigate the definition of "poverty"; (II) to determine the association between poverty and major mental health problems; and (III) to discuss the extent to which poverty could be both a cause and a consequence of mental health.We identified a total of 142 relevant papers, published between 1995 and 2014, only 32 were retained. Main findings are summarised in this paper.Poverty can be considered as a risk factor for mental illness. Yet the relation between poverty and mental health is complex, without direct causation, and bidirectional. As poverty has severe consequences not only on health but also on the whole society, combating poverty should be placed high on the political agenda.

Teen suicide is an alarming public health issue. The purpose of this paper is to better understand the reasons behind attempting/committing suicide. Our research focuses on adolescent psychopathology and on pathologies that are considered as adolescent suicide risk factors.We conducted literature-based research. The first part of this research was based on adolescent psychopathological traits, whilst the second concentrated on the most frequently made diagnoses in the case of adolescents who had attempted suicide.Adolescence is a period of life characterized by great instability, where everything is called into question. We can observe a high propensity towards taking action, which allows the adolescent to bypass certain questions that they cannot answer. This takes place against a background where the body, which is undergoing change, becomes the scene, the means and the purpose to answer these questions, once and for all, through suicide. Notwithstanding, the studies also show that, setting aside these psychopathological considerations that characterize every adolescent, certain diagnoses are commonly related to adolescent suicide and, as such, constitute risk factors. These pathologies are as follows: depression, adjustment disorder and personality disorder. We can, however, include some precisions as regards the frequency of these diagnoses, given that adolescence is inherently a period of life characterized by depression and that the future adult is obliged to adjust.Teen suicide is, therefore, conditioned by pathological behaviour, which is part of a necessary and normal transition, but one which is occasionally stimulated by certain pathological instabilities.

Exposure to stress activates the hypothalamic-pituitary-adrenal axis through the release of catecholamines, which modify humoral and cellular immunity. On the one hand, this psycho-immunological theory makes it possible to forge links between immunity and depression. On the other hand, we know that family determinants are an important variable in the model of vulnerability to depression. Our study weighs the influence of cellular immunity and family relations on the severity of depression.498 inpatients with major depressive disorder were enrolled in an open-label trial. In addition to a socio-demographic questionnaire, they completed Olsen's FACES III and the Beck Depression Inventory (BDI). Flow cytometry was used to assess lymphocyte subsets.In terms of immunity, there are correlations between the BDI and percentages of CD3 (p=0.015; r=-0.112), CD4 (p0.000; r=-0.175), CD4/CD8 (p=0.045; r=-0.093) and CD16 and 56 (p=0.014; r=0.113). In terms of family relationships, there is a correlation between the BDI and family of origin, both for cohesion (p=0.007; r=-0.169) and adaptability (p=0.035; r=-0.133) measures. With respect to the relationship between family dynamics and immunity, there are correlations between adaptability in the family of origin and CD3 (p=0.04; r=0.094) and CD4 (p=0.044; r=0.093). A logistic regression model for family variables explained 11.4% of the BDI, compared to 12.7% for immune variables, while a model including the two explained 16%.While both the family and immunity can explain the BDI, it is surprising they have a greater effect in combination than individually. This suggests that the psycho-immunological theory should look at the relation between immunity and family life, notably in relation to the family of origin.

In this article we propose a model for caring for a group focusing on psychoeducation for stress management and learning relaxation designed for patients experiencing somatization and who were recruited during organic medicine consultations. We are developing an interest for this kind of group from a clinical and practical point of view and have sought to demonstrate the impact that this kind of care can have on health representations among these patients through using the MHLC (Multidimensional Health Locus of Control) questionnaire.Participants in the stress management and relaxation groups completed the questionnaire at the beginning of the first session and at the end of the second and last session. We collected 94 usable questionnaires between January 2008 and December 2014 and processed the data using Student's t-test on paired samples.The results tend to demonstrate that psychoeducation for stress management and relaxation reduces internality scores in patients with high scores and the opposite for patients whose internality scores are low.Our research protocol does not enable us to distinguish between the respective influences of the psychoeducation group and the relaxation group.The psychoeducation groups for stress management and relaxation have an impact on health representations in patients experiencing somatization who would not have spontaneously sought out psychiatric consultations.

Objective Our first objective was to develop the Multi-Dimensional analysis of Patient Outcome Predictions (MD.POP), an interaction analysis system that assesses how HCPs discuss precisely and exclusively patient outcomes during medical encounters. The second objective was to study its interrater reliability. Method The MD.POP was developed by consensus meetings. Forty simulated medical encounters between physicians and an actress portraying a patient were analysed. Interrater reliability analysis was conducted on 20 of those simulated encounters. Results The MD.POP includes six dimensions: object, framing, value, domain, probability and form of POP. The coding method includes four steps: 1) transcription of the encounter, 2) POP identification, 3) POP dimension coding and 4) POP scoring. Descriptive analyses show that the MD.POP is able to describe verbal expressions addressing the patient’s outcomes. Statistical analyses show excellent interrater reliability (Cohen’s Kappa ranging from 0.92 to 0.94). Conclusion The MD.POP is a reliable interaction analysis system that assesses how HCPs discuss patient medical, psychological or social outcomes during medical encounters. Practical implication The MD.POP provides a measure for researchers to study how HCPs communicate with patients about potential outcomes. Results of such studies will allow to provide recommendations to improve HCP’s communication about patients’ outcomes.

To optimize their training, predictors of physicians' satisfaction with their management of uncertainty should be examined. This study investigated these predictors by using a simulated advanced stage cancer patient.Physicians (n=85) rated their satisfaction with their management of uncertainty (Visual Analog Scale-100mm) after a decision-making encounter. Communication predictors were examined with the: Observing Patient Involvement scale (OPTION), Multidimensional analysis of Patient Outcome Predictions (MD.POP) and Communication Content Analysis Software (LaComm). Psychological predictors were assessed with the: Intolerance of Uncertainty Inventory (IUI), Physicians' Reactions to Uncertainty scale (PRU), Decisional Conflict Scale (DCS), and Jefferson Scale of Physician Empathy (JSPE).Physicians' satisfaction (mean=67mm; standard deviation=17mm) was not predicted by their communication, but by their anxiety due to uncertainty (PRU) (β=-.42; p=.001) and their perceived empathy (JSPE) (β=.26; p=.009). These variables accounted for 25% of variance in physicians' satisfaction.Physicians' satisfaction with their management of uncertainty was not affected by their communication performance, but by their psychological characteristics.Training programs should increase physicians' awareness regarding the communication performance required in decision-making encounters under conditions of uncertainty.

The study is part of a Belgian study assessing qualita- tively and quantitatively the needs of Belgian cancer patients, and their expectations from specialists and nurses. From January to November 2004, all the inpatients of 7 onco- logical units were invited to take part in the study, as well as one out- patient out of 2 from the same units. Patients filled in a sociodemogra