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Objectives: Over half of new cancer diagnoses occur in patients aged 65 or older, with up to 40% experiencing anxiety. The American Society of Clinical Oncology recommends using the Generalized Anxiety Disorder Scale (GAD‐7) for anxiety screening, but the GAD‐7 psychometric properties in this population are unknown. This study examined the GAD‐7's reliability, validity, and item parameters, comparing its utility with the GAD‐2 in older adults with cancer. Methods: This cross‐sectional secondary analysis of a nationwide multi‐site two‐arm cluster randomized trial in older adults (≥ 70) with advanced cancer. The GAD‐7 was administered at baseline. Properties were evaluated with Cronbach's α, Pearson correlation coefficients, and a 2‐parameter logistic model. Logistic regression models compared the GAD‐2 and GAD‐7. Results: The sample included 718 participants (Mean age = 77, SD = 5) with mild anxiety (M = 3.74, SD = 4.74). Internal consistency was strong (Cronbach's alpha = 0.89) and item‐total correlations ranged 0.53 to 0.78. Item 2 (Not being able to stop or control worrying) was the most discriminating and item 5 (Being so restless that it is hard to sit still) was least discriminating. Area Under the Curve (AUC) analyses demonstrated the GAD‐2 had a 0.93–0.96 AUC. Conclusions: Establishing the psychometric properties of anxiety screening measures is crucial in the older adults with cancer to maximize referral efficiency and accuracy. This study indicates that the GAD‐7 is reliable and valid for older adults with cancer. Analyses suggest the GAD‐2 may be as sufficient as the GAD‐7 in identifying anxiety in older adults with cancer, thereby reducing assessment burden. [ABSTRACT FROM AUTHOR]

Key Points: Prognostic understanding among advanced cancer patients is associated with higher levels of engagement in advance care planning (ACP), preference for comfort over aggressive care, and receipt of goal‐concordant care, but few patients have accurate prognostic understanding.Talking about Cancer (TAC) is a communication‐based intervention for advanced cancer patients and their caregivers designed to improve shared accurate prognostic understanding.This case study describes the use of TAC with an interracial friend dyad for whom medical mistrust and experienced bias on the part of the patient significantly impacted interactions with the medical team.Using TAC strategies, this dyad was able to improve communication with the oncology team and each other and engage in ACP. [ABSTRACT FROM AUTHOR]

The present study investigated the relationship between spiritual struggles and various types of psychopathology symptoms in individuals who had and had not suffered from a recent illness. Participants completed self-report measures of religious variables and symptoms of psychopathology. Spiritual struggles were assessed by a measure of negative religious coping. As predicted, negative religious coping was significantly linked to various forms of psychopathology, including anxiety, phobic anxiety, depression, paranoid ideation, obsessive-compulsiveness, and somatization, after controlling for demographic and religious variables. In addition, the relationship between negative religious coping and anxiety and phobic anxiety was stronger for individuals who had experienced a recent illness. These results have implications for assessments and interventions targeting spiritual struggles, especially in medical settings. Keywords: spiritual struggles; negative religious coping; religion; spirituality; psychopathology

This paper explores the outcomes associated with spirituality following a personal transgression. Personal transgressions differ from externally caused stressful events in various ways. However, the appraisals of and outcomes associated with personal transgressions indicate that such events are often stressful experiences. Many world religions provide their adherents with spiritual methods for addressing their transgressions. Therefore, transgressors may place their transgressions in a spiritual context. This paper describes four spiritual resources available to individuals struggling with personal transgressions: confession, forgiveness, meaning-making, and conversion. The purposes of these resources are to reduce or eliminate distress and stimulate change or transformation. The paper concludes with clinical implications of these spiritual resources illustrated with case vignettes. [ABSTRACT FROM AUTHOR]