Patient‐oncologist alliance as protection against suicidal ideation in young adults with advanced cancer. Issue 15 (28th May 2014)

• Record Type: Journal Article
• Authors: Trevino, Kelly M.; Abbott, Caroline H.; Fisch, Michael J.; Friedlander, Robert J.; Duberstein, Paul R.; Prigerson, Holly G.
• Is Part Of: Cancer. Volume 120:Issue 15(2014)
• Page Start: 2272
• Page End: 2281
• Publication Date: 2014-05-28
• Subjects: Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.28740
• Languages: English
• ISSNs: 0008-543X

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="cncr28740-sec-0001" sec-type="section"> <title>BACKGROUND</title> <p>Young adults with cancer are at an increased risk of suicidal ideation. To the authors' knowledge, the impact of the patient‐oncologist alliance on suicidal ideation has not been examined to date. The current study examined the relationship between the patient‐oncologist therapeutic alliance and suicidal ideation in young adults with advanced cancer.</p> </sec> <sec id="cncr28740-sec-0002" sec-type="section"> <title>METHODS</title> <p>A total of 93 young adult patients (aged 20 years‐40 years) with incurable, recurrent, or metastatic cancer were evaluated by trained interviewers. Suicidal ideation was assessed with the Yale Evaluation of Suicidality scale, dichotomized into a positive and negative score. Predictors included diagnoses of major depressive disorder and posttraumatic stress disorder, physical quality of life, social support, and use of mental health and supportive care services. The Human Connection Scale, dichotomized into a strong (upper third) and weak (lower two‐thirds) therapeutic alliance, assessed the strength of the patients' perceived oncologist alliance.</p> </sec> <sec id="cncr28740-sec-0003" sec-type="section"> <title>RESULTS</title> <p>Approximately 22.6% of patients screened positive for suicidal ideation. Patients with a strong therapeutic alliance were found to be at reduced risk of suicidal ideation after controlling for confounding influences of cancer diagnosis, Karnofsky performance status, number of physical symptoms, physical quality of life, major depressive disorder, posttraumatic stress disorder, and social support. A strong therapeutic alliance was also associated with a reduced risk of suicidal ideation after controlling for mental health discussions with health care providers and use of mental health interventions.</p> </sec> <sec id="cncr28740-sec-0004" sec-type="section"> <title>CONCLUSIONS</title> <p>The patient‐oncologist alliance was found to be a robust predictor of suicidal ideation and provided better protection against suicidal ideation than mental health interventions, including psychotropic medications. Oncologists may significantly influence patients' mental health and may benefit from training and guidance in building strong alliances with their young adult patients. <bold><italic>Cancer</italic> 2014;120:2272–2281.</bold> © <italic>2014 American Cancer Society</italic>.</p> </sec> </abstract>