Burden of Burn: A Norm-Based Inquiry into the Influence of Burn Size and Distress on Recovery of Physical and Psychosocial Function
James A. FauerbachDennis C. LezotteRebecca HillsG. F. CromesKaren KowalskeBarbara J. de LateurCleon W. GoodwinPatricia BlakeneyDavid N. HerndonShelley A. WiechmanLoren H. EngravDavid R. Patterson
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Abstract:
This prospective, longitudinal study examined the influence of baseline physical and psychological burden on serial assessments of health-related quality of life among adults with major burns from three regional burn centers (n = 162). Physical burden groups were defined by % TBSA burned: <10%, 10% to 30%, or >30%. Psychological burden groups were defined by in-hospital distress using the Brief Symptom Inventory Global Severity Index T-score with scores of < 63 or > or = 63. Analyses compared groups across level of burden and with published normative data. Assessments reflected health and function (Short Form 36) during the month before burn, at discharge, and at 6 and 12 months after burn. Physical functioning was significantly more impaired and the rate of physical recovery slower among those with either large physical burden or large psychological burden. Notably, psychosocial functioning also was more impaired and the rate of psychosocial recovery slower among those with greater psychological burden. These results suggest that, in addition to aggressive wound closure, interventions that reduce in-hospital distress may accelerate both physical and psychosocial recovery.A review of literature investigates the psychosocial impact of alopecia and therapeutic interventions, in order to enhance theoretical and applied knowledge. The review reports on findings summarised under the following headings: (1) psychosocial impact: (1.1) hair and identity, (1.2) less hair loss, less distress, (1.3) impact on quality of life, (1.4) social impact; (2) therapeutic interventions: (2.1) psychotherapy, and (2.2) cognitive behaviour therapy (CBT). Results identified an adverse psychosocial impact of alopecia whereby people affected were likely to be anxious/depressed with reduced self–confidence, body image, and quality of life. Therapeutic interventions showed to guide people in understanding the condition and accept that the alopecia could be permanent or ongoing. Furthermore, to regain control over their situation by grieving for a previous identity, adjusting to a new identity, and moving forward again. Therapeutic interventions for people living with alopecia appear to be limited and group psychotherapy or body image CBT are suggested ways forward to explore outcomes.
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Abstract Purpose: During active cancer treatment, there is a high prevalence of unmet supportive care needs and many patients suffer from increased psychological distress, which impairs health related quality of life (HRQoL) and lead to poorer treatment outcomes. Recent literature has emphasised the benefits of electronic health (eHealth) or the use of new technologies to improve health management and access to psychosocial support for patients with cancer. Since initially the main research area was cancer survivors, there are few reviews in the field of active cancer treatment, and they mainly focus on symptom tracking and symptom management. Methods: this review examines the impact of eHealth interventions on psychological distress, coping strategies, HRQoL and unmet psychosocial care needs among patients with cancer during treatment. A systematic literature search according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. Results: Eighteen RCTs met the inclusion criteria and were included. The results indicated that the evidence of eHealth interventions for patients during anti-cancer treatment is currently limited, but there is a trend towards positive effects and encouraging results, especially for HRQoL and depressive symptoms. Conclusion: Overall, there was a high degree of heterogeneity in both interventions and outcomes, making it difficult to compare the results of individual studies. Therefore, to improve the quality of research, there is an urgent need to develop guidelines for the design and structure of interventions and for the evaluation and reporting of interventions.
eHealth
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Recent research has further documented the need for and the efficacy of psychosocial interventions for patients with cancer and their families.Interventions have been shown to reduce emotional distress, improve quality of life, decrease cancer-related pain, lessen anticipatory nausea and vomiting associated with chemotherapy, improve immune parameters, and facilitate familial adjustment to the diagnosis and treatment of cancer. In light of such findings, it is reasonable to assert that psychosocial interventions should be used as an integral part of competent, comprehensive medical care, and not just an independent treatment modality for cancer. Curr Opin Psychiatry 11:601-605.
Psycho-oncology
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To determine whether specific psychosocial interventions can ease discomfort in palliative care (PC) patients, particularly in those with high levels of pain or emotional distress.Changes in the psychological parameters of 8333 patients were assessed in a quasi-experimental, prospective, multicenter, single group pretest/post-test study. Psychosocial care was delivered by 29 psychosocial care teams (PSTs; 137 professionals). Pre- and post-intervention changes in these variables were assessed: mood, anxiety, and emotional distress. Patients were classified as complex, when presented with high levels of anxiety, mood, suffering (or perception of time as slow), and distress (or unease, or discomfort), or noncomplex. These groups were compared to assess changes in suffering-related parameters from baseline.Psychosocial interventions reduced patients' suffering. These interventions were more effective in complex patients.After successive psychosocial interventions, the level of suffering in complex patients decreased until close to parity with noncomplex patients, suggesting that patients with major complexity could benefit most from specific psychosocial treatment. These findings support the importance of assessing and treating patients' psychosocial needs.
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This review summarizes articles from 1980 to 1990 on psychosocial interventions and respite care for caregivers. The review was limited to controlled studies that attempted to change emotional distress in caregivers. Cumulatively, they suggest that individual psychosocial interventions and respite programs are moderately effective; psychosocial interventions with groups are less so.
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To review literature regarding children as bone marrow donors and describe the evaluation of an individualized intervention to support children who will be donors for parents or siblings.Research studies, abstracts, and clinical reports describing interventions or psychosocial issues related to child donors, parent interviews, and clinical experiences.Child marrow donors and caregivers benefit from interventions that illuminate the process and provide psychosocial support. Use of a teaching book enhances intervention and provides a tool for parents to use after transplantation.Psychosocial distress in child marrow donors and parents can be minimized through education and therapeutic interventions. Research is needed to validate the efficacy of interventions and determine whether psychosocial complications are decreased.Child donors, especially those for parents, should receive support and attention for their unique psychosocial needs.
Bone marrow transplant
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Introduction
Adverse psychosocial work factors are recognised as a significant source of psychological distress. The Healthy Enterprise Standard (HES) targets four intervention areas: Lifestyle, Work-life balance, Workplace environment and Management practices; this latter area referring to interventions aimed at improving the psychosocial work environment. The aim of this study was to evaluate the impact of implementing the HES on exposure to adverse psychosocial work factors and the prevalence of psychological distress among ten Quebec organisations.Methods
This was an intervention study with a before-after design derived from secondary data. Organisations adopted the standard of their own initiative and were responsible for implementing interventions. All active employees were solicited to participate before (T1=2849) and 24–38 months (T2=2560) following the standard's implementation. At both time points, participants completed a questionnaire. Psychosocial work factors were assessed with the validated demand-control-support and effort-reward imbalance models. Psychological distress was assessed with the validated K6. Intervention exposure was measured by questionnaire and complemented by qualitative analyses.Result
The prevalence of low social support at work and high psychological distress decreased among all participants between T1 and T2. In organisations that were less exposed to interventions in the Management practices area, an increase in the prevalence of several adverse psychosocial work factors was observed while a decrease in the prevalence of these adverse factors was observed in organisations more exposed to Management practices interventions. Moreover, a more important decrease in high psychological distress was observed in organisations more exposed compared to those less exposed to interventions in this area.Discussion
These results suggest that organisational psychosocial interventions implemented in the context of this standard may be effective in reducing both adverse psychosocial work factors as well as high psychological distress and may therefore be an effective means to improve the mental health of workers.Psychological Distress
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The aim of the present paper is to highlight the psychosocial issues related to cancer and the interventions employed to improve the quality of life of cancer patients. There is considerable evidence that the wide range of surgical, chemotherapeutic and radiation therapies can leave permanent damage to organs and physiological functioning and disfigurement, across the different cancer diagnosis (Loesher et al., 1989). Psychological interventions are shown to be beneficial in cancer patients. There is a well-established body of evidence demonstrating that psychosocial interventions, viz., pain management, social support, psychotherapy, body image counseling etc. increase wellbeing, improve adjustment and coping and reduce distress in people affected by cancer (CarlsonaBultz, 2003; Cunningham, 2000; MeyeraMark,1995; RehseaPukrop, 2003). The recent reviews also conclude that psychosocial interventions reduce depression, anxiety and functional impairment (Owen et al., 2001).
Disfigurement
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This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To investigate the effectiveness of psychosocial interventions to improve QoL in recently diagnosed cancer patients. The review will also evaluate the effectiveness of psychosocial interventions with recently diagnosed cancer patients to address: General psychological distress Anxiety Depression
Depression
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