Literature Review Rubric - PSYC 2102 Student ID#: ________________________________ DO NOT PUT YOUR NAME ON YOUR PAPER! _____ Your paper is not being graded because it is not written about human thought or behavior from a psychological perspective. _____ Your paper is not being graded because there are issues with plagiarism. _____ Your paper does not follow the format of the assignment (ex. series of article critiques, study format) Area Criteria Pages 5-6 pages of text (not including cover or reference page) -5 points (5%) for each ½ page less than 5 or more than 7 numbered flush right and in Times New Roman 12 1 inch on each side (including running head) Present, proper use of CAPS, flush left, Phrase “Running head” only appears on first page, shorter than paper title, less than 50 characters, Present & includes the following in the upper ½ of the page: title, student ID #, University Affiliation, Professor, Course, Term Title less than 15 words. 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Minimum number of subheadings are present and are in correct APA format/levels Double spaced, Times New Roman (size 12), no extra spaces between paragraphs References cited in text appropriately, Appropriate use of names (No 1st names, no salutations, no university affiliations) No title (journal, article, book, etc.) used in text Quotes –maximum 1 quote not more than 3 lines -5 points for each additional quote All references on reference page are cited in text and all text citations present on reference page References list present and in correct APA format – Double spaced, hanging indents, doi, heading References is not in bold Minimum of 5 references (beyond class texts); Maximum 7 references 3 research studies minimum from psychology related journals No references older the last 10 year (from the 5 primary sources) There is a clear introduction, including research question/thesis, Research question is capable to being adequately addressed in page limits Literature used is related to Research Question/Thesis and connections are made to human thought/behavior Logical organization to paper - Appropriate use of Subheadings Information under subheading is related to the subheading Main Points in review of literature are clear Information is directly presented (no statements like … the study talks about X) Statements are supported (cite information as needed and provide sufficient detail to understand how conclusions were made) Information from sources is integrated (NOT presented in author/author order), Conclusion is clear, well supported, follows from the information presented Results/Findings discussed without statistics Displays objective, unbiased, impartial attitude and tone. Limits use of first person. No personal stories Ideas are not repeated multiple times within the paper (MLA structure not used, using phrases like “as stated earlier”) Grammar, spelling, and usage (no problems): no contractions, does not start sentences with quote marks, acronyms or number, awkward phrase, word choice Pronouns - no 2nd person, no 1st person to reference society, noun-pronoun agreement Paragraph structure/ length is correct Tense – information from studies already completed are discussed in past tense Margins Running head Title Page Headers Font References & Citations Writing Total Possible Points for Paper: 100 Comments: Point Value 0 Points Assigned 1 2 2 3 2 2 4 1 2 5 2 3 2 5 5 6 8 6 5 6 2 6 4 10 2 2 2 Points Assigned: __________ Received: 10 May 2018 Revised: 1 August 2018 Accepted: 5 August 2018 DOI: 10.1002/pon.4859 PAPER Delivering problem‐solving therapy to family caregivers of people with cancer: A feasibility study in outpatient palliative care | George Demiris2 Karla T. Washington1 Kevin W. Craig1 | Paul Tatum1 | Debra Parker Oliver1 | David L. Albright3 | 1 Department of Family and Community Medicine, University of Missouri, Columbia, Missouri Abstract Objective: In response to the well‐documented need for evidence‐based cancer 2 School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania caregiver support, we examined the feasibility of problem‐solving therapy for family 3 caregivers of cancer patients receiving outpatient palliative care and investigated School of Social Work, University of Alabama, Tuscaloosa, Alabama the impact of problem‐solving therapy on family caregivers' anxiety, depression, and Correspondence Karla T. Washington, PhD, Department of Family and Community Medicine, University of Missouri, MA306 Medical Sciences Building, DC032.00 Columbia, MO 65212. Email: washingtonkar@health.missouri.edu quality of life. Funding information National Cancer Institute, Grant/Award Number: R21CA191165 Participants (N = 83) were randomly assigned to receive usual care or usual care plus Methods: We conducted a feasibility study of a structured problem‐solving therapy intervention delivered to family caregivers of cancer patients receiving outpatient palliative care from an academic health center in the Midwestern United States. a problem‐solving therapy intervention, which was delivered over three sessions via web‐based videoconferencing or telephone. Descriptive statistics were used to determine feasibility relative to recruitment, retention, and fidelity to core intervention components. Outcome data were analyzed using ordinary least squares multiple regression. Results: Problem‐solving therapy for family caregivers of patients with cancer was found to be highly feasible in the outpatient palliative care setting. Caregivers who received problem‐solving therapy reported less anxiety than those who received only usual care (P = 0.03). No statistically significant differences were observed for caregiver depression (P = 0.07) or quality of life (P = 0.06). Conclusions: Problem‐solving therapy is a feasible and promising approach to reducing cancer family caregivers' anxiety in the outpatient palliative care setting. Further testing in multiple sites is recommended. KEY W ORDS anxiety, cancer, caregivers, depression, family, oncology, problem solving, quality of life 1 | the home, often with little support or preparation.1,2 The numerous B A CKG R O U N D stressors associated with family caregiving for cancer patients are well In recent decades, the primary setting for cancer care has shifted from documented and include insufficient or problematic communication the hospital inpatient unit to the outpatient clinic, leaving family care- with health care providers, lack of skill needed to complete specific givers (FCGs) responsible for providing the majority of patient care in tasks (eg, administering medications and changing dressings), social 2494 © 2018 John Wiley & Sons, Ltd. wileyonlinelibrary.com/journal/pon Psycho‐Oncology. 2018;27:2494–2499. WASHINGTON 2495 ET AL. isolation, and unavailability of necessary information.3 These stressors Specifically, we set out to achieve the following aims: (1) to examine can lead to anxiety, depression, fatigue, neglect of self‐care, and, for the feasibility of PST for FCGs of cancer patients receiving outpatient particularly strained caregivers, psychological symptoms that mirror palliative care relative to recruitment, retention, and fidelity to core those experienced by trauma survivors.3,4 Early studies involving bio- intervention components; and (2) to investigate the impact of PST markers have also identified a physiological toll associated with cancer on FCGs' anxiety, depression, and quality of life. Our corresponding caregiving stress, suggesting that highly stressed FCGs may be at hypotheses were (1) that PST could be feasibility delivered to FCGs increased risk for morbidity and mortality from certain diseases.5 The of cancer patients receiving outpatient palliative care and (2) that it extant literature is clear: Cancer caregiving often takes place in a would result in decreased caregiver anxiety and depression and highly stressful emotional and social context, leaving FCGs vulnerable improved quality of life. to significant, potentially long‐lasting, adverse effects. 1.1 care | Family caregiver support in palliative oncology 2 METHODS | To achieve the aforementioned aims, we conducted a single‐site ran- Palliative oncology, defined as “the integration into cancer care of domized clinical trial of a structured PST intervention for FCGs of peo- therapies to address the multiple issues that cause suffering for ple with cancer receiving outpatient palliative care. The University of 6 Missouri Health Sciences Institutional Review Board (IRB) reviewed Although commonly and approved all study activities (project no. 2002215). The study patients and their families and impact their quality of life,” explicitly 7-10 espouses a commitment to supporting FCGs. misunderstood to be limited to end‐of‐life care, in the United States was registered at clinicaltrials.gov (identifier: NCT02427490). palliative oncology is an interdisciplinary service available to patients and families across the full cancer trajectory. Research documenting the multiple benefits of early palliative care11 has led the American 2.1 | Participant recruitment Society of Clinical Oncology (ASCO) to recommend that many patients After securing IRB approval, we recruited study participants from the and families be offered palliative services concurrent with standard ambulatory palliative care clinic of an academic health center in the 12 as palliative Midwestern United States from October 2015 to February 2017. Cli- care can be provided either alongside interventions with a curative nicians provided an informational brochure to FCGs accompanying intent or as an alternative to disease‐directed therapies. Although patients with cancer to the palliative care clinic and requested permis- most palliative oncology in the United States is presently provided sion to share their contact information with the research team. In oncologic care as early as the time of initial diagnosis, on an inpatient basis, it is increasingly being offered in outpatient addition, we placed study brochures in high‐traffic clinical areas clinics,13 creating a potentially ideal opportunity to provide additional (eg, oncology waiting rooms and patient and family resource centers). support to FCGs in an effort to decrease their distress and improve The study research nurse reached out to interested FCGs via tele- their quality of life. However, palliative oncology teams wishing to phone or email to assess their eligibility and schedule a face‐to‐face capitalize on this opportunity are limited by the paucity of evidence‐ informational meeting at the clinic, the FCG's home, or another agreed based interventions to support FCGs in general14 and in the outpa- upon location. During the informational meeting, FCGs read, discussed, and—if willing to participate—signed an informed consent tient palliative care setting in particular. document, retaining a copy for their personal records. Inclusion 1.2 | criteria required that participants were English‐speaking adult FCGs Problem‐solving therapy for FCGs of adult patients diagnosed with cancer who were receiving palliative Problem‐solving therapy (PST) is a psychosocial intervention that aims care. Family caregivers included those individuals who provided signif- to enhance coping effectiveness for individuals facing stressors rang- icant, unpaid care to a person living with cancer; a biological or legal 15 The theoretical relationship was not required. In addition, participants were required framework underpinning PST is the relational/problem‐solving model to have sufficient hearing (either naturally or with assistive devices) of stress,16 which conceptualizes psychological distress such as anxi- to allow their participation in a technologically‐mediated intervention. ety and depression as the consequence of ineffective coping. The Individuals not receiving formal services from the specialty palliative model suggests that, by enhancing problem‐solving ability, PST can care clinic were deemed eligible for participation if the patient for minimize the negative effects of stressful life events, leading to whom they provided care was receiving treatment with a palliative improved well‐being (ie, decreased anxiety and depression and greater intent from the primary oncology team, as understood by the FCG. quality of life). Multiple FCGs per patient were allowed to enroll in the study. After ing from daily hassles to major traumatic events. While prior studies have identified PST as a promising strategy to the FCG signed the informed consent document, the research nurse reduce distress and improve the quality of life of individuals opened a numbered sealed envelope, prepared in advance, revealing experiencing stressors associated with cancer caregiving,17-20 its feasi- whether the FCG had been randomly assigned to receive usual care bility and efficacy as a stand‐alone intervention in outpatient palliative (Group 1) or usual care in addition to PST (Group 2). A CONSORT flow oncology settings remains unknown. Thus, in preparation for a large diagram21 summarizing participant recruitment and randomization is multisite trial, our research team sought to test the feasibility of a provided in Figure 1 (all participants were analyzed in their random- PST intervention for FCGs in the ambulatory palliative care setting. ized groups regardless of their duration in the study). 2496 WASHINGTON FIGURE 1 2.2 2.2.1 CONSORT flow diagram Study arms | | ET AL. applicable problem‐solving techniques and to apply them to an acute caregiving stressor. Group 1: usual care Family caregivers randomized to Group 1 experienced no changes in the care they or their patient received due to their participation in 2.3 Study measures | the research study. For these individuals, usual care continued accord- 2.3.1 ing to each patient and family's individualized treatment plan based on To measure progress toward recruiting and retaining an adequately previously established goals of care. While the specific constellation of large study sample, we established monthly recruitment and reten- services provided as part of usual care varied, services available to all tion goals (established by a priori power analysis, described in FCGs participating in the study included routine education and ongo- Section 2.4.1) and noted our progress toward achieving them in a ing support related to pain and symptom management, professionally‐ shared study database. To measure the degree of fidelity to core facilitated support groups, and oncology social work services that, in intervention components, the study Principal Investigator (PI) or this specific setting, tended to focus primarily on resource allocation designee reviewed a randomly selected sample of 25% of the versus delivery of formalized psychosocial support. audio‐recorded intervention sessions and evaluated them using a | Feasibility measures treatment fidelity assessment form developed specifically for the study. Fidelity scores for each session ranged from 0% to 100%, 2.2.2 | Group 2: usual care plus PST with a score of 100% reflecting complete fidelity to the intervention Family caregivers randomized to Group 2 received usual care in addi- protocol. tion to PST. The PST intervention we tested was adapted with permission from Problem‐Solving Intervention to Support Caregivers in 2.3.2 End‐of‐Life Settings (or “PISCES”) of Demiris et al. 18 | Caregiver outcome measures Modifications In addition to reporting basic demographic information, FCGs partic- included revised intervention materials that featured cancer‐specific ipating in the study completed standardized instruments measuring examples, referenced palliative care providers, and illustrated the their anxiety, depression, and quality of life. The Generalized Anxiety application of problem‐solving techniques across the disease and care- Disorder 7‐item scale (GAD‐7)22 measured the frequency with which giving trajectory. FCGs experienced symptoms of anxiety such as excessive restless- A trained research nurse delivered the PST intervention to FCGs ness, uncontrollable worrying, and irritability. The GAD‐7 total over three separate sessions, spaced approximately 1 week apart. scores range from 0 to 21; higher scores reflect greater anxiety. Family caregivers were given the option of receiving the intervention The GAD‐7's internal consistency (Cronbach α = 0.92) and test‐ by telephone, over web‐based videoconferencing, or any combination retest reliability have been supported by prior research.22 The of the two. All sessions were digitally audio‐recorded to permit moni- Patient Health Questionnaire 9‐item scale (PHQ‐9)23 measured the toring of treatment fidelity. The first session focused on topics such as frequency with which respondents experienced symptoms of depres- visualizing success, positive self‐talk, and using emotions adaptively. sion such as anhedonia, sleep disturbance, and impaired concentra- During the second session, FCGs selected a specific caregiving prob- tion. The PHQ‐9 total scores range from 0 to 27; higher scores lem and brainstormed possible solutions. In the third and final session, reflect greater depression. The PHQ‐9's internal consistency FCGs weighed the pros and cons of various possible solutions to their (Cronbach α = 0.89) and test‐retest reliability have been supported selected problem, identified a solution (or combination of solutions) by prior research.23 The Caregiver Quality of Life Index–Revised they judged to be feasible and likely to result in the most desirable (CQLI‐R)24 measured FCGs' quality of life in four domains: emo- outcome(s), and developed a detailed plan for its implementation. tional, social, financial, and physical. Total CQLI‐R scores range from Through this process, FCGs had the opportunity to learn broadly 0 to 40; higher scores indicate better quality of life. The CQLI‐R's WASHINGTON 2497 ET AL. internal consistency (Cronbach α = 0.769) and test‐retest reliability 3 | RESULTS have been supported by prior research.24 Family caregivers in both study groups completed the GAD‐7, Study and intervention feasibility were both supported. We met our PHQ‐9, and CQLI‐R according to the same administration schedule, recruitment goal 1 month early, enrolling 83 FCGs in 17 months which included the following approximate time points: T0 (baseline/ (participant demographic information is summarized in Table 1). study enrollment), T1 (day 15/intervention midpoint for Group 2), T2 Approximately 75% of our sample was retained through 30‐day (day 30/intervention conclusion for Group 2), and T3 (day 60/study follow‐up. Treatment fidelity, which was calculated as the mean exit). With the exception of baseline measures, which were completed percentage of essential intervention elements observed in the sample on paper during their enrollment visit, FCGs were given the option of of audio‐recorded sessions, was 97%. completing the instruments online via Qualtrics (Provo, UT) or by providing their responses verbally by telephone. Preliminary analyses indicated that randomization produced equivalent groups in terms of key demographic variables and baseline outcome measures, which were also controlled for in subsequent modeling (see Table 2); no statistically significant differences were 2.4 2.4.1 noted at baseline. Results from OLS modeling, which we conducted Data analysis | | Statistical power calculation We based our a priori power calculation on changes in GAD‐722 total TABLE 1 Caregiver and patient characteristics No. (%)a scores, as the instrument measures a key variable of interest (anxiety) Characteristic and has demonstrated responsiveness to caregiver PST intervention in Caregivers Patients Our sample size calculation was based on a Gender one‐tailed test of significance and the following assumptions: (1) the Male 26 (31.3) difference in GAD‐7 total score means between the usual care and Female 57 (68.7) 44 (53.0) 51.5 (12.8) 60.4 (12.8) 18 previous research. intervention groups would be 2 points, the documented clinically Age, mean (SD) significant effect;22,25 (2) the variance of scores would total 4.93;26 Race 39 (47.0) (3) appropriate error protection would be as follows: α = .20, β = .20; African American/black 2 (2.4) and (4) participant attrition would equal 14%, half of patient attrition Asian/Asian‐American 1 (1.2) 1 (1.2) reported in a recent meta‐analysis of palliative oncology trials, Native American/American Indian 2 (2.4) 0 (0.0) reflecting an assumption that FCGs would be able to actively partici- Caucasian/white 77 (92.8) 75 (90.4) 1 (1.2) 2 (2.4) 27 Multiracial pate in research longer than seriously ill patients. Taking these factors into consideration, we concluded that a sample of 41 participants per Ethnicity group (total of 82) would provide 80% power to detect a 2‐point Latinx difference in GAD‐7 total scores. Non‐Latinx 5 (6.0) 1 (1.2) 4 (4.8) 82 (98.8) 79 (95.2) Relationship to patient 2.4.2 | Feasibility and outcomes data analysis Spouse or partner 44 (53.0) … Adult child 22 (26.5) … 7 (8.4) … We calculated basic descriptive statistics to determine progress Sibling toward meeting feasibility goals and conducted ordinary least squares Parent 3 (3.6) … Friend 3 (3.6) … Other (eg, adult grandchild and nephew) 4 (4.8) … 28 (OLSs) multiple regression to determine the influence of PST on FCGs' anxiety, depression, and quality of life, using the last available Primary Cancer site/typeb measure postbaseline to compare group outcomes. Analyses were performed in R 3.5.0.29 Beta coefficients and confidence intervals Blood … 4 were estimated with a bootstrapping procedure, an analytic approach Brain … 3 that has been considered nonparametric,30 where each estimate was 31 generated based on 1000 resamples. The regressor variable Breast … 9 Colorectal … 13 method was used in order to isolate the effect of the intervention Gynecological … 7 (X) on participants' change scores (Y2–Y1), where Y2–Y1 was Head and neck … 4 regressed on Y1 and X.32 Caregiver age, caregiver gender, patient's Liver … 6 clinic attendance (received care from the specialty palliative care Lung … 15 clinic: yes or no), whether the FCG provided care for more than Melanoma … 4 one person with cancer (yes or no) or provided care in cooperation Mesothelioma … 3 with another FCG enrolled in the study (yes or no), and the number Other … 3 of days FCGs who were ultimately lost to attrition remained in Pancreas … 4 the study were included as covariates in each model to further Prostate … 3 elucidate the unique contribution of the intervention to participant Urinary tract … 5 change scores. a Due to rounding, percentages might not sum to 100. bPer FCG report. 2498 WASHINGTON TABLE 2 Effect of the problem‐solving intervention on family caregiver outcomesa in this study,31 underscoring the need for future, large‐scale research on the effect of PST for FCGs in outpatient palliative care. Second, 95% Confidence Intervalsb the relatively homogenous nature of the study sample must be noted, Lower race and ethnicity. Third, all FCG participants were recruited from the as it limits the study's generalizability, particularly with regard to FCG B Std. Error Sig. (2‐tailed) Constant 16.36 8.61 0.115 −2.30 32.28 be obtained in other settings. Fourth, the 60‐day period of time FCGs Group −2.76 1.22 0.03* −5.18 −0.30 were enrolled in the study is quite brief relative to the overall cancer GAD‐7 baseline score −0.86 0.13 0.002 −1.10 −0.60 trajectory for many individuals. The long‐term impact of the PST inter- Constant 12.80 8.49 0.20 −4.44 29.5 Group −2.68 1.34 0.07 −4.96 0.21 encing technology may have introduced unaccounted for variation in PHQ‐9 baseline score −0.50 0.17 0.01 −0.82 −0.144 the intervention and/or its outcomes. Researchers conducting future −5.29 8.56 0.61 −21.75 10.22 advantages of this approach (eg, facilitated recruitment of a difficult‐ 2.77 1.39 0.06 −0.012 5.42 to‐reach study population, enhanced generalizability to include tech- −0.49 0.09 0.002 −0.66 −0.28 nologically‐averse FCGs) against its limitations when making decisions Upper same health care facility; it is unknown whether similar results would Anxiety (GAD‐7) vention is therefore unknown. Fifth, allowing FCGs to choose whether Depression (PHQ‐9) Constant Group CQLI‐R baseline score to receive the intervention by telephone or web‐based videoconfer- studies of PST with FCGs should carefully weigh the potential Quality of life (CQLI‐R) regarding study design. Finally, given that PST has been repeatedly a Bootstrap results are based on 1000 bootstrap samples. b ET AL. shown to be safe16 and that this was a preliminary trial likely to be Confidence intervals based on 626 samples. *Statistically significant
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