No abstract

Interpersonal isolation has been implicated as a correlate of various negative psychological and psychosocial outcomes. However, less is known about how existential isolation (EI), or the feeling that no one can truly understand your subjective experience, relates to psychological maladjustment and beliefs about, and experiences with, psychosocial treatments. Representing the integration of basic social psychological science on the EI construct and applied psychotherapy-relevant research, the aim of this preliminary, cross-sectional study was to examine the association between EI and (a) specific domains of clinical distress (i.e., depression, anxiety, stress), (b) prospective beliefs about future psychotherapy (i.e., intention to seek therapy, stigma tolerance, therapist expertness), and (c) satisfaction with current mental health treatment (for the subsample of those actively engaged in it). Participants were 500 adults who completed relevant measures via the Amazon Mechanical Turk (MTurk) platform. As expected, EI was positively correlated with depression (p Ͻ .001), anxiety (p Ͻ .001), and stress (p Ͻ .001). Also as expected, and when controlling for general distress and relevant clinical experiences, EI was negatively associated with intention to seek therapy (p Ͻ .001), beliefs about therapist expertness (p Ͻ .001), and satisfaction with current mental health treatment (p Ͻ .001). Results indicated that the negative consequences of high EI extend to clinical symptomatology, more pessimistic beliefs about psychotherapy, and worse experiences when receiving treatment. We discuss tentative implications and recommend future research directions.

versus-host disease (GVHD) is one of most common complications following allogeneic hematopoietic cell transplantation (HCT) and the most significant contributor to morbidity and nonrelapse mortality. The physical burdens and psychosocial difficulties of these patients have not been described systematically. An exploration into the rates and correlates of mood and quality of life (QOL) in patients with chronic GVHD is necessary to develop a clinically relevant, evidence-based intervention to promote well-being. From July 2015 to July 2017, adult allogeneic HCT survivors with established moderate to severe chronic GVHD (N = 52) enrolled in a prospective, longitudinal study at a tertiary academic center. We examined the rates and correlates of depression and anxiety symptoms (Hospital Anxiety and Depression Scale) and explored whether constructs including coping strategies (Coping Inventory for Stressful Situations), symptom burden (Lee Symptom Assessment Scale), physical functioning (Human Activity Profile), and perceived social support (Medical Outcomes Study Social Support Survey) predicted QOL trajectory over time (Functional Assessment of Cancer TherapyÀBone Marrow Transplant) at the baseline, 3-month, and 6-month follow-up. Analyses adjusted for age, sex, chronic GVHD severity, and time since chronic GVHD diagnosis. At the baseline, 3-month, and 6-month follow-up, 32.7%, 31.1%, and 37.8% of patients reported clinically significant depression symptoms, and 30.8%, 20.0%, and 36.4% reported clinically elevated anxiety symptoms, respectively. Adjusting for covariates, greater use of negative emotion-oriented coping (b = 0.20, P = .002), less use of task-oriented coping (b = À0.10, P = .021), worse physical functioning (b = À0.07, P = .004), and higher symptom burden (b = 0.07, P = .002) were independently associated with depression symptoms at baseline. Greater use of negative emotion-oriented coping (b = 0.28, P < .001) and worse physical functioning (b = À0.05, P = .034) were independently associated with anxiety at baseline. Patients who used more negative emotion-oriented coping (b = À0.58, P = .035), had less task-oriented (b = 0.40, P = .028) and social diversion-oriented coping (b = 0.35, P = .039), and had higher symptom burden (b = À0.30, P = .001), worse physical functioning (b = 0.32, P < .001), and lower perceived social support (b = 6.47, P = .003) at baseline reported poorer QOL over time. The unmet physical and psychosocial needs of patients with chronic GVHD are substantial and warrant investigation into evidence-based interventions that may improve QOL and mood by targeting modifiable psychosocial constructs identified in this study.

Fowers et al. (2017) recently made a general argument for virtues as the characteristics necessary for individuals to flourish, given inherent human limitations. For example, people can flourish by developing the virtue of friendship as they navigate the inherent (healthy) human dependency on others. This general argument also illuminates a pathway to flourishing during the COVID-19 pandemic, the risks of which have induced powerful fears, exacerbated injustices, and rendered life and death decisions far more common. Contexts of risk and fear call for the virtue of courage. Courage has emerged more powerfully as a central virtue among medical personnel, first responders, and essential workers. Longstanding inequalities have been highlighted during the pandemic, calling for the virtue of justice. When important personal and public health decisions must be made, the central virtue of practical wisdom comes to the fore. Wise decisions and actions incorporate the recognition of relevant moral concerns and aims, as well as responding in fitting and practical ways to the specifics of the situation. Practicing courage, justice, and practical wisdom illuminates a path to flourishing, even in a pandemic.

BACKGROUND:Although most patients with cancer prefer to know their prognosis, prognostic communication between oncologists and patients is often insufficient. Targeted therapies for lung cancer improve survival yet are not curative and produce variable responses. This study sought to describe how oncologists communicate about prognosis with patients receiving targeted therapies for lung cancer. METHODS: This qualitative study included 39 patients with advanced lung cancer with targetable mutations, 14 caregivers, and 10 oncologists. Semistructured interviews with patients and caregivers and focus groups or interviews with oncologists were conducted to explore their experiences with prognostic communication. One oncology follow-up visit was audio-recorded per patient. A framework approach was used to analyze interview transcripts, and a content analysis of patient-oncologist dialogue was conducted. Themes were identified within each source and then integrated across sources to create a multidimensional description of prognostic communication. RESULTS: Six themes in prognostic communication were identified: Patients with targetable mutations develop a distinct identity in the lung cancer community that affects their information-seeking and self-advocacy; oncologists set high expectations for targeted therapy; the uncertain availability of new therapies complicates prognostic discussions; patients and caregivers have variable information preferences; patients raise questions about progression by asking about physical symptoms or scan results; and patients' expectations of targeted therapy influence their medical decision-making. CONCLUSIONS: Optimistic patient-oncologist communication shapes the expectations of patients receiving targeted therapy for lung cancer and affects their decision-making. Further research and clinical guidance are needed to help oncologists to communicate uncertain outcomes effectively.