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Studied 51 ambulatory patients with commonly occurring cancers and 25 of their spouses to evaluate a group stress and activity management treatment program. Found support for unique effects of the treatment intervention, but also support for improvement in psychosocial adjustment for patients and spouses with the passage of time. (Author/MCF)

Described the development of the Cancer Inventory of Problem Situations (CIPS), and presented a study of cancer patients (N=84) using the CIPS. Results showed that cancer patients have moderate to severe problems in personal care, activity management, involvement with the health care system, work, and interpersonal interactions. (LLL)

Anxiety associated with medical situations was studied in a heterogeneous sample of 320 adult cancer patients. Patients completed the Cancer Inventory of Problem Situations, which identifies anxiety in a variety of medical situations. On the average, 44% of patients reported some anxiety in medical situations; 23% reported significant anxiety. Anxiety was somewhat situation dependent. Females were more likely to report anxiety and with greater intensity than males in situations such as watching other patients receive treatments, waiting to see the doctor, waiting to find out the results of tests, going to the hospital, and receiving chemotherapy. Multiple regression techniques were used to identify the correlates of anxiety. Age, sex, problems communicating with the health team, and global adjustment to the illness all accounted for a significant amount of the variance. The results suggest important areas for mental health professionals to be involved in the care of individuals with cancer if comprehensive care is to be provided.

The article presents information on the effectiveness of group outpatient physical and behavioral therapy for treating chronic low back pain (CLBP). Both the treatments are included in most comprehensive pain programs and are thought to produce differential outcomes. The major hypothesis about the two treatment interventions is that both interventions would be helpful in treating CLBP patients. However, the physical therapy intervention should affect differentially the variables associated with physical functioning and the behavioral intervention should affect variables primarily associated with interpersonal interactions and improved psychological functioning. The majority of patients selected for the study were referred from clinics of the Sepulveda Veterans Medical Center, the Southern California Permanente Medical Group and physicians in private practice in the San Fernando Valley of Los Angeles. The study found that both treatments achieved successful outcomes in two domains of the pain experience, improving psychological and psychosocial functioning, and altering pain intensity and perception of pain.

Objectives: To examine attitudes, experiences, and preferences regarding advance directives (ADs) among adults of all ages., Study Design: Subjects were surveyed regarding end-of-life (EOL) care wishes. The survey included items measuring knowledge, experiences, and attitudes regarding ADs, as well as preferences toward initiation of discussions., Methods: Subjects included a random sample of patients (age range, 20 to >80 years) from a large midwestern managed care organization stratified by age decade. Descriptive statistics were used to summarize variables, and chi2 tests were performed to examine differences by age category., Results: One hundred eighty-seven surveys were completed. The likelihood of having completed an AD increased with age (P <.001). Of those without an AD, 44% reported having talked with someone about their wishes. Many (62%) subjects thought that it was up to them to raise the topic of EOL care. However, 70% of subjects reported that they would be comfortable if their provider initiated discussion. Participants 60 years or older were more likely to report being very comfortable with their provider bringing up the subject compared with those younger than 60 years (60% vs 39%, P = .02). Few differences were found by age., Conclusions: Room for improvement exists for increasing the number of patients who complete an AD or engage in discussion of their wishes. Ways to involve healthcare providers in the process should be explored, as it seems that patients are receptive to physician-initiated discussions of ADs.