Methodological Approaches to Transform, Develop, and Evaluate Cancer Care Interventions

Cancer diagnoses in older adults are often abrupt and unexpected, requiring patients to make quick therapy choices. Further, reflecting on traumatic therapy is often difficult. In our symposium, we bring together researchers from varied disciplines to report on patients’ cancer therapy choices. Carrion will discuss her mixed-methods approach to older Latino adults’ cancer therapy preferences. Next, Blackberry will present how patient-derived photographs (photovoice) can improve supportive care for older Australians in facilitating empowerment, patient-centered care, and shared decision making. Halpin, who will apply conversation analysis to examine how multiple myeloma patients interacted with supplemental material during in-person nurse-led education. Last, Seaman will use his work with head and neck cancer survivors to illustrate the conceptual and methodological challenges of investigating those who discontinue care. Understanding how patients from diverse populaces with various cancer diagnoses navigate their therapy may help inform future cancer-related health services’ approaches.

Renal Replacement Therapy Preferences Survey: Is Allo-Hemodialysis an Acceptable Option for Patient Caregivers and Health Care Professionals?

End-stage kidney disease (ESKD) is a worldwide unsolved problem. Access to renal replacement therapies (RRT) is still a challenge in some developed countries and even more so in developing countries. Allo-hemodialysis (alloHD) is a recently proposed, still hypothetical, alternative RRT where the blood of a healthy subject (“buddy”) flows countercurrent to the patient’s blood through the dialyzer. Solutes and fluid are transferred to the buddy and then cleared by his/her healthy kidneys, making alloHD essentially a procedure where the buddy “donates” kidney function intermittently to the patient. Its drastically reduced complexity makes ­alloHD particularly attractive for low-resource settings. The acceptance of alloHD by patients, caregivers, and health care professionals (HCP) is unknown. In this cross-sectional study, we surveyed the preferences and acceptance of alloHD in 3 groups: caregivers related to ESKD patients, nonrelated caregivers (nrCG), and HCP. Four areas were explored: RRT preferences, kidney organ donation for transplant acceptance, ­alloHD acceptance as a potential RRT, and alloHD technique acceptance. Hemodialysis was the preferred form of RRT. Kidney donation acceptance was similar in all groups. Intermittent kidney function donation (i.e., alloHD) was mainly accepted by related and nrCG but less accepted by HCP (87, 90, and 60% respectively, p < 0.01). New RRT alternatives such as alloHD are expected to be better received and accepted once animal, and clinical studies have demonstrated their feasibility, safety, and benefits. New RRT strategies are required primarily in most vulnerable populations and should be explored.

Evidence-Based Psychotherapy Responsiveness: The Third Task Force

This chapter introduces the second volume of Psychotherapy Relationships That Work and frames its work within the Interdivisional APA Task Force on Evidence-Based Relationships and Responsiveness. The book presents clinical examples, original meta-analyses, diversity considerations, training implications, and research-infused practice recommendations for nine methods of adapting or tailoring psychotherapy to clients’ transdiagnostic characteristics (attachment style, coping style, racial/ethnic culture, gender identity, therapy preferences, reactance level, religion/spiritual identity, sexual orientation, and stages of change). The chapter outlines the purpose and history of the interdivisional task force and its relation to previous efforts to identify evidence-based practices in psychotherapy. The chapter also presents the key limitations of the work.

Introduction

This introduction to Working with goals in counselling and psychotherapy outlines the key concepts, debates, and scope for the book. Goals can be defined as ‘subjectively desirable states of affairs that the individual intends to attain through action’. They are closely associated to such phenomena as strivings, desires, purposes, and personal strivings. Goal-oriented therapy can be understood as including goal-setting, goal-monitoring, goal-discussion, and goal-based formulations; as well as attempts to achieve goal-agreement. Recent developments in policy, research, and practice have supported the use of goals in therapy. Goals can help focus therapeutic work, empower clients, and are consistent with many clients’ therapy preferences. However, when applied in rigid ways, there is also the risk that they may increase clients’ feelings of self-judgement, and reduce the depth of the work. The aim of this book is to explore these issues and to detail an effective goal-oriented practice.

Patient values and preferences for antithrombotic therapy in atrial fibrillation

SummaryGuidelines recommend that patients’ values and preferences should be considered when selecting stroke prevention therapy for atrial fibrillation (SPAF). However, doing so is difficult, and tools to assist clinicians are sparse. We performed a narrative systematic review to provide clinicians with insights into the values and preferences of AF patients for SPAF antithrombotic therapy. Narrative systematic review of published literature from database inception. Research questions: 1) What are patients’ AF and SPAF therapy values and preferences? 2) How are SPAF therapy values and preferences affected by patient factors? 3) How does conveying risk information affect SPAF therapy preferences? and 4) What is known about patient values and preferences regarding novel oral anticoagulants (NOACs) for SPAF? Twenty-five studies were included. Overall study quality was moderate. Severe stroke was associated with the greatest disutility among AF outcomes and most patients value the stroke prevention efficacy of therapy more than other attributes. Utilities, values, and preferences about other outcomes and attributes of therapy are heterogeneous and unpredictable. Patients’ therapy preferences usually align with their values when individualised risk information is presented, although divergence from this is common. Patients value the attributes of NOACs but frequently do not prefer NOACs over warfarin when all therapy-related attributes are considered. In conclusion, patients’ values and preferences for SPAF antithrombotic therapy are heterogeneous and there is no substitute for directly clarifying patients’ individual values and preferences. Research using choice modelling and tools to help clinicians and patients clarify their SPAF therapy values and preferences are needed.Supplementary Material to this article is available online at www.thrombosis-online.com.