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A Randomized Pilot Study of Brief Intervention versus Simple Advice for Women Tobacco Users in an Urban Community in India.

Fri, 05/19/2017 - 6:09am
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A Randomized Pilot Study of Brief Intervention versus Simple Advice for Women Tobacco Users in an Urban Community in India.

Indian J Psychol Med. 2017 Mar-Apr;39(2):131-136

Authors: Jhanjee S, Lal R, Mishra A, Yadav D

Abstract
AIM: The study aimed to assess the efficacy of providing brief intervention (BI) for women tobacco users in a community-based setting.
METHODS: In this open-labeled randomized study, a representative sample of women (n = 100) from a community in East Delhi were screened using Alcohol, Smoking and Substance Involvement Screening Test. Eligible women were randomized to BI or simple advice (SA) arms. At baseline, they were assessed for tobacco use characteristics and severity of nicotine dependence using Fagerstrom's test for nicotine dependence. Intervention in the form of a single session of BI or SA to quit tobacco was provided at baseline. All participants were assessed at 1 week and 3 months following intervention. The principal outcome was self-reported abstinence from tobacco use at 3 months follow-up.
RESULTS: The mean age of the sample was 43 years (standard deviation = 13). Most women were married (80%), housewives (69%), illiterate (61%), socioeconomically disadvantaged and were smokeless tobacco users (94%). The subjects in the BI group were twice more likely to stop tobacco use as compared to individuals in the SA group (odds ratio = 2.2, 95% confidence interval: 0.962-5.197, P = 0.06).
CONCLUSION: The study results are suggestive of beneficial effect of BI. A larger study might provide more significant results.

PMID: 28515547 [PubMed - in process]

A Sequential Implementation Model for Workforce Development: A Case Study of Medical Residency Training for Substance Use Concerns.

Wed, 05/17/2017 - 5:15pm
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A Sequential Implementation Model for Workforce Development: A Case Study of Medical Residency Training for Substance Use Concerns.

Teach Learn Med. 2017 May 12;:1-11

Authors: O'Sullivan PS, Yuan P, Satre DD, Wamsley M, Satterfield J

Abstract
PROBLEM: In graduate medical education, residency programs are often educationally isolated from each other, with varying needs and patient populations, so strategies are needed when attempting to implement training in evidence-based practices across multiple residencies.
INTERVENTION: Using implementation science as a guide, we adapted a community development model to sequentially implement an evidence-based intervention, Screening, Brief Intervention, and Referral to Treatment (SBIRT) for alcohol and drug use problems, across internal medicine, pediatrics, emergency medicine, psychiatry, and obstetrics and gynecology residency programs.
CONTEXT: A grant-funded "executive" team coordinated the implementation, enrolled a new residency program annually, and served as the consultative team to span the programs. The team was attentive to aligning implementation with the needs of each program. To assist in planning, the team included a program champion 1 year prior to SBIRT implementation to provide the opportunity to develop resources and work with peers. We evaluated this model through an implementation science lens using a case study approach that included interviews and quantitative tabulation of products and resident perceptions.
OUTCOME: We successfully instituted SBIRT training in all 5 residency programs through the use of a supported local champion model. Teams developed 90 curricular products and had 57 presentations and publications. Residents reported satisfaction with the SBIRT activities. Champions reported that SBIRT was a useful approach and that they gained valuable knowledge and relationships from working with the executive team when designing learning materials appropriate for their residency. Champions successfully incorporated SBIRT into routine clinical practice.
LESSONS LEARNED: Having a strong team to support subsequent SBIRT champions was essential for implementation. The champions needed financial support to have the necessary time to implement training. The strategy of building a peer network across programs was critical for sustaining the implementation. Collecting and sharing resources aided the champions in developing their materials.

PMID: 28498004 [PubMed - as supplied by publisher]

Psychometric validation of the POSIT for screening alcohol and other drugs risk consumption among adolescents.

Fri, 05/12/2017 - 2:41pm
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Psychometric validation of the POSIT for screening alcohol and other drugs risk consumption among adolescents.

Adicciones. 2017 Apr 12;0(0):958

Authors: Araujo M, Golpe S, Braña T, Varela J, Rial A

Abstract
Early detection of alcohol and drug abuse among adolescents is decisive not only for rapid referral and intervention in cases of risk, but also as an indicator for use in the evaluation of prevention programs and public policies to reduce consumption. One of the most widely-used screening instruments in the world is the Problem Oriented Screening Instrument for Teenagers (POSIT) (Rahdert, 1991), whose substance use and abuse subscale (POSITUAS) is a brief tool of enormous applied potential. However, there is still no empirical validation study that would ensure its good psychometric performance in Spain. The aim of this paper is to analyse the psychometric properties of POSITUAS among Spanish adolescents. For this purpose, 569 students aged between 12 and 18 years (M = 14.71; SD = 1.79) were personally interviewed. The study sample was selected through two-stage sampling. The results obtained, using the Adolescent Diagnostic Interview (Winters & Henly, 1993) as the gold criterion, allow us to inform that the Spanish version of the POSITUAS has excellent psychometric behaviour, both at the level of internal consistency (a  = .82) as well as regards sensitivity (94.3%) and specificity (83.9%), with an area under the ROC curve of .953. Also, the realisation of a Confirmatory Factor Analysis allows for verifying the one-dimensional character of the scale. As a result, POSITUAS is made available to researchers and professionals in the field of addictive behaviours for use with a minimum of psychometric guarantees.

PMID: 28492958 [PubMed - as supplied by publisher]

Effectiveness of Alcohol, Smoking, and Substance Involvement Screening Test-Linked Brief Intervention on Harmful and Hazardous Alcohol Use in Nigerian Semirural Communities: A Non-Randomized Intervention Study.

Thu, 04/27/2017 - 10:51am
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Effectiveness of Alcohol, Smoking, and Substance Involvement Screening Test-Linked Brief Intervention on Harmful and Hazardous Alcohol Use in Nigerian Semirural Communities: A Non-Randomized Intervention Study.

Front Psychiatry. 2017;8:50

Authors: Lasebikan V, Ola BA, Ayinde OO

Abstract
OBJECTIVE: To determine the prevalence of alcohol consumption and the effectiveness of the alcohol, smoking, and substance involvement screening test (ASSIST)-linked brief intervention on hazardous and harmful alcohol use in semirural settings in Nigeria.
METHODS: In this single arm non-randomized intervention study delivered by community health extension workers (CHEW), participants (N = 1,203), 15 years and older, recruited between October 2010 and April 2011 were assessed for prevalence of alcohol consumption and the associated level of risk. Scores of 0-10 were classified as lower risk scores, 11-26 as moderate risk, and 27+ as high risk. This was followed by a brief intervention. Prevalence of alcohol consumption and level of risk was assessed at 3 and 6 months postbrief intervention. Main outcome measure was the change in ASSIST scores at 3 and 6 months postintervention.
RESULTS: There was a statistically significant difference in the prevalence of alcohol use at baseline compared with that at 6 months, χ(2)(2) = 4.2, p = 0.01. Among all respondents, a repeated measures ANOVA with a Greenhouse-Geisser correction showed that mean ASSIST score significantly reduced between time points [F(1.541, 34.092) = 53.241, p < 0.001]. Post hoc tests using the Bonferroni correction revealed that this difference was due to a significant reduction in the mean ASSIST scores at 3 months vs. baseline, p = 0.001, but not at 3 vs. 6 months, p = 0.09.
CONCLUSION: There is a potential for CHEW-administered ASSIST-linked screening, brief intervention, and referral to treatment for unhealthy alcohol use in Nigerian semirural communities. This is feasible considering serious dearth of addiction specialists in the country.

PMID: 28443034 [PubMed - in process]

A Digital Tool to Promote Alcohol and Drug Use Screening, Brief Intervention, and Referral to Treatment Skill Translation: A Mobile App Development and Randomized Controlled Trial Protocol.

Thu, 04/20/2017 - 10:51am
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A Digital Tool to Promote Alcohol and Drug Use Screening, Brief Intervention, and Referral to Treatment Skill Translation: A Mobile App Development and Randomized Controlled Trial Protocol.

JMIR Res Protoc. 2017 Apr 18;6(4):e55

Authors: Satre DD, Ly K, Wamsley M, Curtis A, Satterfield J

Abstract
BACKGROUND: Translation of knowledge and skills from classroom settings to clinical practice is a major challenge in healthcare training, especially for behavioral interventions. For example, screening, brief intervention, and referral to treatment (SBIRT) is a highly-promoted approach to identifying and treating individuals at risk for alcohol or drug problems, yet effective, routine use of SBIRT has lagged.
OBJECTIVE: The objective of this paper is to describe the development, pilot testing, and trial protocol of a mobile app based on the theory of planned behavior (TPB) to promote SBIRT skill translation and application.
METHODS: Intended for use after classroom training occurs, the mobile app has three primary functions designed to increase behavioral intent to deliver SBIRT: (1) review skills (ie, address knowledge and beliefs about SBIRT), (2) apply skills with patients (ie, build confidence and perceived behavioral control), and (3) report performance data (ie, increase accountability and social norms and/or influence). The app includes depression and anxiety screening tools due to high comorbidity with substance use. A randomized controlled trial (RCT) is in progress among health and social service learners (N=200) recruited from 3 universities and 6 different training programs in nursing, social work, internal medicine, psychiatry, and psychology. Participants are randomized to SBIRT classroom instruction alone or classroom instruction plus app access prior to beginning their field placement rotations. TPB-based data are collected via Qualtrics or via the mobile app pre-post and SBIRT utilization, weekly for 10 weeks. Key outcomes include the frequency of and self-reported confidence in delivery of SBIRT.
RESULTS: Beta testing with advanced practice nursing students (N=22) indicated that the app and its associated assessment tools were acceptable and useful. The system usability scale (SUS) mean was 65.8 (n=19), which indicated that the SBIRT app was acceptable but could benefit from improvement. Indeed, modifications were implemented prior to starting the trial. Enrollment of trial participants began in September 2016. Results are expected by December 2017.
CONCLUSIONS: This report describes the process of TPB-based app development and testing, and the protocol for a RCT to determine the effectiveness of the app in enhancing skill translation. If effective, this approach could improve SBIRT implementation, fidelity, and clinical outcomes.

PMID: 28420604 [PubMed - in process]

Problematic alcohol and other substance use among patients presenting to emergency services in South Africa: Who is ready for change?

Thu, 04/13/2017 - 10:51am
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Problematic alcohol and other substance use among patients presenting to emergency services in South Africa: Who is ready for change?

S Afr Med J. 2017 Mar 29;107(4):352-353

Authors: Sorsdahl K, Stein DJ, Naledi T, Breuer E, Myers B

Abstract
BACKGROUND: Studies that identify factors associated with intervention uptake are urgently needed in poorly resourced healthcare systems. This is important, as knowing who is likely to engage may lead to intervention targeting, which is an efficient use of scarce health resources.
OBJECTIVE: To identify patient characteristics that predict the acceptance of a brief intervention for substance use delivered in emergency departments (EDs).
METHODS: Patients presenting to three EDs were screened for substance use using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). All patients identified as at risk for substance use problems were offered a brief psychotherapy intervention focused on substance user education. Data were collected on patients' age, sex, presenting condition (injury/no injury), type of substance used, and severity of substance use. Logistic regression analysis was used to identify variables that predicted acceptance of the offer of a brief intervention.
RESULTS: Being between the ages of 25 and 39 years increased the likelihood of accepting an offer of help compared with 18 - 24-year-olds. Polysubstance users were less likely to accept an offer of help than patients with problematic alcohol use only, while patients with higher ASSIST scores were more likely to accept an offer of help than those with lower scores.
CONCLUSIONS: Findings suggest that more work is needed to understand the mechanisms underlying treatment acceptance. Brief interventions delivered in ED services in countries such as South Africa should target alcohol users with higher ASSIST scores in order to ensure the efficient use of scarce health resources.

PMID: 28395690 [PubMed - in process]

A statewide screening, brief intervention, and referral to treatment (SBIRT) curriculum for medical residents: Differential implementation strategies in heterogeneous medical residency programs.

Mon, 03/27/2017 - 11:44am
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A statewide screening, brief intervention, and referral to treatment (SBIRT) curriculum for medical residents: Differential implementation strategies in heterogeneous medical residency programs.

Subst Abus. 2017 Feb 08;:1-7

Authors: Pringle JL, Kearney SM, Rickard-Aasen S, Campopiano MM, Gordon AJ

Abstract
BACKGROUND: Many screening, brief intervention, and referral to treatment (SBIRT) training curricula have been implemented within graduate medical residency training programs, with varying degrees of success. The authors examined the implementation of a uniform, but adaptable, statewide SBIRT curriculum in 7 diverse residency training programs and whether it could improve resident knowledge, skills, and attitudes regarding SBIRT and unhealthy alcohol and other drug (AOD) use.
METHODS: The authors assessed the implementation of the Pennsylvania SBIRT Medical and Residency Training (SMaRT) curriculum at 7 residency sites training a variety of disciplines. Faculty could use a variety of training modalities, including (1) Web-based self-directed modules; (2) didactic lectures; (3) small-group sessions; and/or (4) skill-transfer interactions with standardized or real patients in preceptor-led encounters. Acquisition of knowledge, skills, and attitudes regarding SBIRT and unhealthy AOD use-associated patient care were assessed via a pre- and post-survey instrument with 4 domains: Resident Knowledge, Resident Competence, Resident Skills and Attitudes (Alcohol), and Resident Skills and Attitudes (Drug). Responses to the pre- and post-surveys (N = 365) were compared and analyzed with t tests and Wilcoxon signed-rank tests.
RESULTS: The diverse modalities allowed each of the residency programs to adapt and implement the SMaRT curriculum based on their needs and environments. Residents' knowledge, skills, and attitudes regarding SBIRT and working with unhealthy AOD use, as assessed by survey, generally improved after completing the SMaRT curriculum, despite the variety of models used. Specifically, Resident Knowledge and Resident Competence domains significantly improved (P < .000). Residents improved the least for survey items within the Resident Skills and Attitudes (Alcohol) domain.
CONCLUSIONS: Adaptable curricula, such as SMaRT, may be a viable step towards developing a nationwide curriculum.

PMID: 28332942 [PubMed - as supplied by publisher]

Adolescent substance use: Assessing the knowledge, attitudes, and practices of a school-based health center workforce.

Thu, 03/23/2017 - 5:35pm
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Adolescent substance use: Assessing the knowledge, attitudes, and practices of a school-based health center workforce.

Subst Abus. 2017 Feb 08;:1-7

Authors: Ramos MM, Sebastian RA, Murphy M, Oreskovich K, Condon TP

Abstract
BACKGROUND: Recent attention has focused on the potential for school-based health centers (SBHCs) to provide access points for adolescent substance use care. In 2015, the University of New Mexico began screening, brief intervention, and referral to treatment (SBIRT) training for providers at New Mexico Department of Health (NMDOH)-funded SBHCs across the state. This study assesses baseline knowledge, attitudes, and practices of the New Mexico SBHC provider workforce regarding adolescent substance use and provision of services.
METHODS: In early 2015, the NMDOH administered an SBHC provider workforce survey (N = 118) and achieved a 44.9% response rate. This descriptive analysis includes all survey respondents who self-identified as a primary care or behavioral health provider in an SBHC serving middle or high school students (n = 52).
RESULTS: Among respondents, the majority (57.7%) were primary care providers, including nurse practitioners, physicians, and physician assistants. The remaining 42.3% of respondents were master's-level behavioral health providers. Only 44.2% of providers reported practicing the full SBIRT model at their SBHC, and 21.2% reported having received continuing education on SBIRT within the previous 3 years. Most respondents, 84.6%, agreed that it is the responsibility of SBHC providers to screen students for substance use using a standardized tool, and 96.2% agreed that it is the responsibility of the SBHC provider to assess for students' readiness to change. A majority reported self-efficacy in helping students achieve change in their alcohol use, illicit drug use, and prescription drug misuse: 73.1%, 65.4%, and 63.5%, respectively.
CONCLUSIONS: These results suggest that SBIRT training for New Mexico SBHC providers is timely. The authors identified gaps between recommended SBIRT practices and SBIRT delivery as well as discrepancies between reported provider self-efficacy and actual implementation of the SBIRT model. Further study will determine the effectiveness of efforts to address substance use and implement SBIRT in SBHCs.

PMID: 28328312 [PubMed - as supplied by publisher]

Referral to treatment for hospitalized medical patients with an alcohol use disorder: A proof-of-concept brief intervention study.

Thu, 03/23/2017 - 5:35pm
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Referral to treatment for hospitalized medical patients with an alcohol use disorder: A proof-of-concept brief intervention study.

Soc Work Health Care. 2017 Mar 21;:1-14

Authors: Berger L, Hernandez-Meier J, Hyatt J, Brondino M

Abstract
Substance misuse intervention in healthcare settings is becoming a US national priority, especially in the dissemination and implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT). Yet, the referral to treatment component of SBIRT is understudied. This proof-of-concept investigation tested an enhanced coordinated hospital-community two session brief intervention designed to facilitate the referral to treatment of hospitalized medical patients with an alcohol use disorder. Participants (N = 9) attended the second session of the brief intervention held in the community in most cases (56%), while one out of three (33%) received some level of post-brief intervention alcohol and/or other drug treatment. Alcohol use and alcohol-related problems also statistically improved. Based, in part, on the results plus the widespread dissemination of SBIRT, next step investigations of brief interventions to help bridge hospitalized medical patients in need to community substance abuse treatment are warranted.

PMID: 28323548 [PubMed - as supplied by publisher]

A randomized controlled trial of a brief intervention for alcohol and drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in primary health care in Chile.

Thu, 03/02/2017 - 4:34pm
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A randomized controlled trial of a brief intervention for alcohol and drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in primary health care in Chile.

Addiction. 2017 Feb 27;:

Authors: Poblete F, Barticevic NA, Zuzulic MS, Portilla R, Castillo-Carniglia A, Sapag JC, Villarroel L, Sena BF, Galarce M

Abstract
AIM: To study the effectiveness of a Brief Intervention (BI) associated with the ASSIST (Alcohol Smoking and Substance Involvement Screening Test) for alcohol and illicit drug use as part of a systematic screening program implemented in primary care.
DESIGN: A multi-center randomized open-label trial stratified using the ASSIST-specific substance involvement score (for alcohol, scores ranged from 11 to 15 and 16 to 20; and for the other substances, from 4 to 12 and 13 to 20).
SETTING: Primary care centers (n = 19), local small emergency rooms (n = 8), and police stations (n = 5) in Chile.
PARTICIPANTS: 12,217 people between 19 and 55 years old were screened for moderate alcohol and drug use risk defined by ASSIST Chilean version, differing from standard version on a lower cut-off point for upper end of moderate-risk drug users (21 instead 27). 806 non-treatment-seekers were randomized. Intervention and comparison ASSIST-linked BI (n = 400) compared with an informational pamphlet on risk associated with substance use (n = 406).
MEASUREMENTS: Total ASSIST alcohol and illicit involvement score (ASSIST - AI), and ASSIST-specific score for alcohol, cannabis, and cocaine, at baseline and at three-month follow-up.
FINDINGS: Sixty-two percent of participants completed follow up. An intention-to-treat analysis showed no difference between the two groups for the ASSIST - AI score [Mean difference -0.17, Confidence Interval (-1.87, 2.20)] (MD, CI), either for specific scores alcohol [MD 0.18, CI (-1.45, 1.10)], cannabis [MD -0.62 CI (-0.89, 2.14)], or cocaine [MD -0.79 CI (-2.89, 4.47)].
CONCLUSION: It is not clear whether a brief intervention associated with the Alcohol Smoking and Substance Involvement Screening Test (ASSIST) is more effective than an informational pamphlet in reducing alcohol and illicit substance consumption in non-treatment-seeking, primary care users with moderate risk.

PMID: 28239995 [PubMed - as supplied by publisher]

Efficacy of a universal smoking cessation intervention initiated in inpatient psychiatry and continued post-discharge: A randomised controlled trial.

Thu, 02/16/2017 - 4:34pm

Efficacy of a universal smoking cessation intervention initiated in inpatient psychiatry and continued post-discharge: A randomised controlled trial.

Aust N Z J Psychiatry. 2017 Feb 01;:4867417692424

Authors: Metse AP, Wiggers J, Wye P, Wolfenden L, Freund M, Clancy R, Stockings E, Terry M, Allan J, Colyvas K, Prochaska JJ, Bowman JA

Abstract
OBJECTIVE: Interventions are required to redress the disproportionate tobacco-related health burden experienced by persons with a mental illness. This study aimed to assess the efficacy of a universal smoking cessation intervention initiated within an acute psychiatric inpatient setting and continued post-discharge in reducing smoking prevalence and increasing quitting behaviours.
METHOD: A randomised controlled trial was undertaken across four psychiatric inpatient facilities in Australia. Participants ( N = 754) were randomised to receive either usual care ( n = 375) or an intervention comprising a brief motivational interview and self-help material while in hospital, followed by a 4-month pharmacological and psychosocial intervention ( n = 379) upon discharge. Primary outcomes assessed at 6 and 12 months post-discharge were 7-day point prevalence and 1-month prolonged smoking abstinence. A number of secondary smoking-related outcomes were also assessed. Subgroup analyses were conducted based on psychiatric diagnosis, baseline readiness to quit and nicotine dependence.
RESULTS: Seven-day point prevalence abstinence was higher for intervention participants (15.8%) than controls (9.3%) at 6 months post-discharge (odds ratio = 1.07, p = 0.04), but not at 12 months (13.4% and 10.0%, respectively; odds ratio = 1.03, p = 0.25). Significant intervention effects were not found on measures of prolonged abstinence at either 6 or 12 months post-discharge. Differential intervention effects for the primary outcomes were not detected for any subgroups. At both 6 and 12 months post-discharge, intervention group participants were significantly more likely to smoke fewer cigarettes per day, have reduced cigarette consumption by ⩾50% and to have made at least one quit attempt, relative to controls.
CONCLUSIONS: Universal smoking cessation treatment initiated in inpatient psychiatry and continued post-discharge was efficacious in increasing 7-day point prevalence smoking cessation rates and related quitting behaviours at 6 months post-discharge, with sustained effects on quitting behaviour at 12 months. Further research is required to identify strategies for achieving longer term smoking cessation.

PMID: 28195010 [PubMed - as supplied by publisher]

Family Camp: A multi-disciplinary intervention for brain tumor patients and families.

Thu, 02/09/2017 - 4:34pm
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Family Camp: A multi-disciplinary intervention for brain tumor patients and families.

J Clin Oncol. 2016 Oct 09;34(26_suppl):240

Authors: Lovely M, Levinson Marks A, LaMarre AK, Chang SM, Clarke J, Patt J, Barani E

Abstract
240 Background: The diagnosis of a brain tumor is a catastrophic life changing event that impacts the entire family. Patients and caregivers experience dramatic role changes, concern for their children, financial stress, and isolation. For many, the situation is overwhelming. A novel intervention to address these needs is "Family Camp". Our vision for camp was to provide respite to the entire family, decrease caregiver stress, improve family connections and promote a sense of understanding and connection with the community at large.
METHODS: In a unique partnership with the widow of a former patient, the members of the UCSF Neuro-Oncology Division created and offered a weekend camp for brain tumor patients with children. Team members included MDs, RNs, social workers, psychologists, artists, body workers, "camp counselors" and community volunteers. In addition to respite, camp was structured through art, songs, projects and games to deliver opportunities for understanding and community building, including understanding the disease and its impact on the family. Therapeutic interventions included couples activities, counseling, parenting strategies, and providing a sense of connection to others dealing with brain tumors, the health care team, and camp volunteers. Anxiety, stress, depression, coping and values based living were measured pre and post camp using DASS21, CES-D, Brief Cope, Values Based Living instruments, and survey questions.
RESULTS: 11 families attended camp for 3 days in 2014. Improvement was noted in post camp testing of depression, anxiety and stress versus pre-camp. Survey questions showed the most common and important outcome to be connection, specifically that patients, caregivers, and children made connections with similar others. Families reported being able to relax and felt taken care of. They liked the opportunity for undistracted family time, getting to know their health providers outside of the office, and couples benefited from family counseling.
CONCLUSIONS: Capitalizing on the unique skills of a multi-disciplinary team, one that includes the patient's health care team, can lead to the delivery of a novel intervention that improves the illness experience of brain tumor patients and families.

PMID: 28156540 [PubMed - in process]