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JAMA Network Open Oct 2023Prior authorization (PA) requires clinicians and patients to navigate a complex approval pathway. Resultant delays and denials can be particularly problematic for...
IMPORTANCE
Prior authorization (PA) requires clinicians and patients to navigate a complex approval pathway. Resultant delays and denials can be particularly problematic for patients with cancer, who often need urgent treatment or symptom management.
OBJECTIVE
To investigate the patient perspective of PA for cancer-related care, including perceptions about the process, outcomes (including delays and denials), and patient administrative burden.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional, anonymous survey used a convenience sample of patients with PA experience. Participants were recruited using social media and email lists of US-based cancer advocacy organizations from July 1 to October 6, 2022.
EXPOSURE
Prior authorization for any cancer-related service.
MAIN OUTCOMES AND MEASURES
Delays to care, outcome of PA, communication, and changes in anxiety (measured on a scale of 0-100, with 0 indicating no anxiety and higher scores indicating higher levels of anxiety) and trust.
RESULTS
Of 178 respondents (158 women [88%], 151 non-Hispanic White respondents [84%], 164 respondents [92%] <65 years), 112 (63%) reported that their cancer care was approved and given as recommended, and 39 (22%) did not receive recommended care due to delays or denials. Most respondents (123 [69%]) reported a PA-related delay in care; of those with delayed care, 90 (73%) reported a delay of 2 or more weeks. Most respondents (119 [67%]) had to personally become involved in the PA process; 35 (20%) spent 11 or more hours dealing with PA issues. Overall, the PA experience was rated as bad (70 [40%]) or horrible (55 of 174 [32%]); ratings were associated with the length of delay (ρ = 0.36; P < .001) and the time spent on PA (ρ = 0.42; P < .001). Self-reported PA-related anxiety was higher than usual anxiety (mean [SD] score, 74.7 [20.2] vs 37.5 [22.6]; P < .001) and was correlated with delay length (ρ = 0.16; P = .04), time spent on PA (ρ = 0.27; P < .001), and overall PA experience (ρ = 0.34; P < .001). After PA, 159 respondents (89%) trusted their insurance company less, and 148 respondents (83%) trusted the health care system less. Patient involvement in the PA process was associated with increased odds of distrusting their insurance company (β = 6.0; 95% CI, 1.9-19.2) and the health care system (β = 3.3; 95% CI, 1.4-8.1) and of having a negative experience (β = 6.6; 95% CI, 3.1-14.3).
CONCLUSIONS AND RELEVANCE
This survey-based cross-sectional study of the patient experience with PA highlights an adverse outcome of PA: 22% of patients did not receive the care recommended by their treatment team because of PA. Most respondents experienced a delay in recommended oncology care, and delays were associated with increased anxiety, a negative perception of the PA process, and patient administrative burden.
Topics: Humans; Female; Prior Authorization; Cross-Sectional Studies; Surveys and Questionnaires; Neoplasms; Patient Outcome Assessment
PubMed: 37851442
DOI: 10.1001/jamanetworkopen.2023.38182 -
BMC Psychiatry Apr 2022Major depressive disorder (MDD) is a global public health concern that is notably underdiagnosed and undertreated due to its complexity and subjective diagnostic...
BACKGROUND
Major depressive disorder (MDD) is a global public health concern that is notably underdiagnosed and undertreated due to its complexity and subjective diagnostic methods. A holistic diagnostic procedure, which sufficiently considers all possible contributors to MDD symptoms, would improve MDD diagnosis and treatment. This study aims to explore whether personality and coping styles can predict MDD status and differentiate between depressed patients and healthy individuals.
METHODS
Seventy healthy controls (N = 54 females) were matched to 70 MDD patients for age, sex, ethnicity, and years of education. MDD severity was measured using the Hamilton Depression Rating Scale, while personality traits and coping styles were measured by the Ten-Item Personality (TIPI) and Brief COPE questionnaires, respectively. Logistic regression analyses were conducted to investigate the diagnostic and predictive potential of personality and coping styles. Receiver operating characteristic (ROC) analyses were also conducted to examine their discriminative ability to distinguish between depressed and healthy individuals.
RESULTS
Introversion, lack of organisation skills, and neuroticism were statistically significant in predicting MDD status. Dysfunctional coping strategies, such as denial and self-blame, were also shown to significantly predict MDD status. ROC analyses found both the TIPI questionnaire (AUC = 0.90), and dysfunctional coping (as measured by Brief COPE) (AUC = 0.90) to be excellent predictors of MDD.
CONCLUSIONS
Our findings demonstrate the diagnostic and predictive potential of personality and coping styles for MDD in the clinical setting. They also demonstrate the remarkable ability of personality and coping styles to differentiate between depressed patients and healthy controls.
Topics: Adaptation, Psychological; Depressive Disorder, Major; Female; Humans; Male; Personality; Personality Disorders; Personality Inventory
PubMed: 35484526
DOI: 10.1186/s12888-022-03942-y -
BMC Psychiatry Jan 2022The prevalence of non-suicidal self-injury (NSSI) is high among adolescents. Parents have significant impact on the development of NSSI. Many quantitative studies have...
BACKGROUND AND OBJECTIVES
The prevalence of non-suicidal self-injury (NSSI) is high among adolescents. Parents have significant impact on the development of NSSI. Many quantitative studies have demonstrated the relationship between parental factors such as parenting behaviors and adolescents' NSSI. However, few studies have explored parents' responses and adolescent-parent reciprocal interaction during repeated NSSI. This study aimed to explore parents' cognition, behaviors and adolescent-parent reciprocal interaction during repeated NSSI.
METHODS
This is a phenomenological study. By purposive sampling, 24 parents of adolescents with repeated NSSI were recruited from a child and adolescent psychiatric ward in a mental health center in Chengdu, China. Semi-structured interviews were conducted and audio-recorded. Audio-recordings were transcribed verbatim and analyzed using thematic analysis.
FINDINGS
Three themes were identified: parents' attribution, perceptions and coping behaviors of NSSI. Chronic stress of adolescents and triggers of NSSI were associated with parental expectations. Parents initially perceived NSSI as a manifestation of puberty, a way of making needs met or a coping strategy of negative emotions, and gradually realized that it was a condition requiring psychological assistance. Parents' coping behaviors of NSSI were divided into 4 stages, namely denial, dissuasion, reflection and adaptation, and working as a team. To be more specific, parents' coping strategies at dissuasion stage included criticizing and conciliating, while those at reflection and adaptation stage included neglecting, avoiding conflicts and increasing control.
CONCLUSIONS
These findings suggest that adjusting parents' expectation and negative perceptions of NSSI is beneficial to reduce adolescent-parent conflict and adolescents' inner conflict and prevent NSSI. Furthermore, it's necessary to publicize NSSI related knowledge to promote the early detection and treatment of NSSI.
Topics: Adaptation, Psychological; Adolescent; Child; China; Humans; Parent-Child Relations; Parenting; Parents; Self-Injurious Behavior
PubMed: 35090423
DOI: 10.1186/s12888-022-03715-7 -
Journal of Affective Disorders Jul 2023Emotional reactivity predicts poor health and psychopathology. Despite its theoretical importance, little research has tested whether coping predicts emotional...
BACKGROUND
Emotional reactivity predicts poor health and psychopathology. Despite its theoretical importance, little research has tested whether coping predicts emotional reactivity to stressors. We analyse three studies to test this hypothesis for negative (NA) and positive affect (PA) reactivity to daily stressors.
METHODS
422 Participants (72.5 % females, M = 22.79 ± 5.36) came from three longitudinal, ecological momentary assessment (EMA) studies across 7-15 days (ACES N = 190; DESTRESS N = 134; SHS N = 98). Coping was measured at baseline. NA, PA, and daily stressors were assessed via EMA. Mixed effects linear models tested whether coping predicted NA and PA reactivity, defined as their slope on within- and between-person daily stressors.
RESULTS
Behavioural disengagement and mental disengagement coping predicted greater within-person NA reactivity across all studies (all p < .01, all f = 0.01). Denial coping predicted greater within-person NA reactivity in ACES and DESTRESS (both p < .01, f from 0.02-0.03) and between-person in ACES and SHS (both p < .01, f from 0.02 to 0.03). For approach-oriented coping, only active planning coping predicted lower within-person NA reactivity and only in DESTRESS (p < .01, f = 0.02). Coping did not predict PA reactivity (all p > .05).
LIMITATIONS
Our findings cannot be generalised to children or older adults. Emotional reactivity to daily stressors may differ from severe or traumatic stressors. Although data were longitudinal, the observational design precludes establishing causality.
CONCLUSIONS
Avoidance-oriented coping strategies predicted greater NA reactivity to daily stressors with small effect sizes. Few and inconsistent results emerged for approach-oriented coping and PA reactivity. Clinically, our results suggest that reducing reliance on avoidance-oriented coping may reduce NA reactivity to daily stressors.
Topics: Female; Child; Humans; Aged; Adolescent; Young Adult; Adult; Male; Ecological Momentary Assessment; Adaptation, Psychological; Affect; Stress, Psychological
PubMed: 37019388
DOI: 10.1016/j.jad.2023.03.090 -
BMC Women's Health May 2023Breast cancer impacts millions of people worldwide, and in Peru, breast cancer is the most common cause of cancer related death among women. Breast cancer treatment is...
BACKGROUND
Breast cancer impacts millions of people worldwide, and in Peru, breast cancer is the most common cause of cancer related death among women. Breast cancer treatment is physically and emotionally burdensome and challenging for patients.
METHODS
In-depth interviews were conducted with 14 female breast cancer patients and survivors in Lima, Peru. The interviews explored four main themes: the women's emotional experiences, coping mechanisms, resources available or needed, and advice for newly diagnosed breast cancer patients.
RESULTS
Respondents described a tremendous lack of informational support during and after diagnosis and treatment and requested more of this support from health professionals. Social support groups were helpful to participants; however, these forms of support were not available to all participants. Emotional and esteem support seemed amply received from family and friends, faith organizations, and fellow cancer patients. Participants experienced a range of emotions upon diagnosis and during treatment including fear, anxiety, difficulty accepting bodily changes, loneliness, and denial.
CONCLUSION
Breast cancer and its treatment can be a long, emotional journey; more extensive forms of informational support could help patients cope with this process.
Topics: Female; Humans; Breast Neoplasms; Peru; Social Support; Adaptation, Psychological; Emotions
PubMed: 37143060
DOI: 10.1186/s12905-023-02321-3 -
HealthcarePapers Jul 2023Despite notions of colour-blindness and denials of widespread systemic racism, anti-Black racism remains inherent in the political, economic, educational and healthcare...
Despite notions of colour-blindness and denials of widespread systemic racism, anti-Black racism remains inherent in the political, economic, educational and healthcare systems in Europe. We use the Netherlands as a case study to explore some of these mechanisms. Here, we discuss how a focus on cultural deficiency and the denial of racism allows the bearers of inequality and inequity to be blamed for their own disenfranchisement. Nonetheless, scholars in the Netherlands continue to show how everyday racism is negatively impacting marginalized people's lives and their access to the social determinants of health and well-being in society.
Topics: Humans; Racism; Antiracism; Delivery of Health Care
PubMed: 37887166
DOI: 10.12927/hcpap.2023.27195 -
American Journal of Men's Health 2019This study aimed at examining social appearance anxiety levels of male nursing students and their coping attitudes and identifying the relationship between them. A...
This study aimed at examining social appearance anxiety levels of male nursing students and their coping attitudes and identifying the relationship between them. A cross-sectional research approach was adopted in a study population of 180; the sample comprised 129 students. Data were collected using a socio-demographic information form, the Social Appearance Anxiety Scale (SAAS), and the Assessment of Coping Attitudes Inventory (COPE). The average age of students was 20.54 ± 1.49 years. The male students' average score obtained from the SAAS measure was 32.64 ± 13.07, while that of the COPE Inventory was 138.11 ± 14.47. Significant correlations were detected between students' SAAS scores and COPE scale scores. There were negative relationships between social anxiety scores and COPE subscales of positive reinterpretation and growth ( p < .05), use of instrumental social support ( p < .05), active coping ( p ≤ .01), and planning ( p ≤ .01). In contrast, there were positive relationships between social anxiety scores and COPE subscales of mental disengagement ( p ≤ .01), denial ( p ≤ .01), behavioral disengagement ( p ≤ .01), restraint ( p ≤ .01), use of emotional social support ( p < .05), substance use ( p ≤ .01), and acceptance ( p < .05). The conclusion was that male students who do not perceive themselves as having an ideal body image face high social appearance anxiety. There is a prejudice that social appearance anxiety has negative effects on these students' self-confidence. In this context, this research revealed concrete results about how male nursing students have battled the prejudices that they have faced throughout their student life.
Topics: Adaptation, Psychological; Adult; Cross-Sectional Studies; Humans; Male; Nurses, Male; Personal Satisfaction; Self Concept; Social Perception; Social Support; Students, Nursing; Workplace; Young Adult
PubMed: 30739556
DOI: 10.1177/1557988319825922 -
Psychology in Russia : State of the Art 2023The COVID-19 pandemic is a multifaceted stressor. Its impact suggests long-term psychological effects. Self-determination promotes flexibility of goals and actions and... (Review)
Review
BACKGROUND
The COVID-19 pandemic is a multifaceted stressor. Its impact suggests long-term psychological effects. Self-determination promotes flexibility of goals and actions and helps to overcome the difficulties caused by stress.
OBJECTIVE
To analyze coping strategies during the COVID-19 pandemic presented in Russian scientific studies (RQ1), and their relationship with self-determination (RQ2).
DESIGN
Relevant studies (2020-2022) were selected from the Russian citation index (RSCI) database. Strict selection criteria were used. Twenty-four articles were selected for the final review. For dynamic analysis, four stages of the pandemic were identified.
RESULTS
Prevailing coping strategies have changed over time. At the beginning of the pandemic, respondents used familiar coping mechanisms. Six months later, active coping strategies were more often used, but deprivation and avoidance strategies increased. A year later, there was an increase in denial and avoidance strategies. Using non-constructive coping strategies may indicate that, due to the long course of the pandemic, meeting basic psychological needs became increasingly frustrated, leading to helplessness, alienation, and lack of control. Later dynamics reflect the growth of effective coping strategies and confirm that when basic needs are blocked for a long time, people seek alternative ways to satisfy them.
CONCLUSION
The dynamics of coping strategies during the pandemic reflected their close relationship with basic psychological needs, as described in the theory of self-determination. The results confirmed the importance of self-determination as a dispositional variable in predicting coping mechanisms.
PubMed: 37818342
DOI: 10.11621/pir.2023.0201 -
Rhode Island Medical Journal (2013) Jun 2020To determine the health and socioeconomic consequences of comprehensive abortion denial in Rhode Island.
OBJECTIVES
To determine the health and socioeconomic consequences of comprehensive abortion denial in Rhode Island.
METHODS
Using Turnaway Study findings and RI abortion data from 2013-2016, we project the burden of negative outcomes for women and their families under 100% abortion denial conditions.
RESULTS
Findings suggest negative impacts on the health and socioeconomic well-being of RI women and their families. 982 and 910 women, who would have otherwise received an abortion, will report anxiety and depression, respectively, at one-week post abortion denial, and 1,499 will report receiving Temporary Assistance for Needy Families funding at six months post denial.
CONCLUSIONS
If women who would seek a safe and legal abortion in RI are denied one, clear and undue burden will exist for those who carry to term and raise the child, as well as affecting existing children.
Topics: Abortion Applicants; Abortion, Induced; Abortion, Legal; Adaptation, Psychological; Adolescent; Adult; Anxiety; Depression; Female; Health Impact Assessment; Humans; Poverty; Pregnancy; Rhode Island; State Government; Young Adult
PubMed: 32481788
DOI: No ID Found -
Journal of Cancer Research and... 2021Self-esteem refers to a person's positive and negative attitudes towards the self, and metacognition is an upper system providing awareness and direction of events and...
BACKGROUND
Self-esteem refers to a person's positive and negative attitudes towards the self, and metacognition is an upper system providing awareness and direction of events and mental functions. Coping refers to the specific and psychological efforts used to deal with stressful events or the negative effects of the agents of these. The aim of this study was to evaluate self-esteem, metacognition status and coping attitudes in patients with cancer, which is known to have severely destructive psychological effects.
MATERIALS AND METHODS
Fifty adult cancer patients who were followed up in the medical oncology clinic between July 2018 and June 2019 and 50 age- and gender-matched healthy controls as control group were included in this study. All the participants were applied with a sociodemographic data form, the Rosenberg self-esteem scale, the Metacognition Assessment Scale, and the Copying Orientation to Problems Experienced (COPE) inventory, and their results were compared between the groups.
RESULTS
The groups comprised 50% females with a median age of 58 (33-82) years. The values related to the degree of participation in discussions, problem-focused coping, active coping, planning, and state of emotional vulnerability were low in the cancer patient group compared to the control group (P < 0.005 for all). The sustaining of their self-image, feeling threatened in interpersonal relationships, and degree of daydreaming were higher, and in the metacognition tests, the positive beliefs related to anxiety, uncontrolled or dangerous negative thoughts, nonfunctional coping, religious coping, joking, reckless behavior, substance use, denial, and mental disengagement scores were higher (P < 0.05 for all).
CONCLUSION
Self-esteem was lower in cancer patients and upper level cognitive functions and problem-focused coping were determined to be worse compared to healthy controls. In the light of these results, psychosocial support given to cancer patients in this respect could contribute to quality of life and social conformity.
Topics: Adaptation, Psychological; Adult; Aged; Aged, 80 and over; Anxiety; Case-Control Studies; Female; Follow-Up Studies; Humans; Male; Metacognition; Middle Aged; Neoplasms; Prognosis; Quality of Life; Self Concept; Stress, Psychological; Surveys and Questionnaires
PubMed: 34528548
DOI: 10.4103/jcrt.JCRT_618_19