Pathfinders Research & Publications

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  • JOURNAL ARTICLES

    Phase 2 pilot study of Pathfinders, a psychosocial intervention for cancer patients
    Abernethy AP, Herndon JE, Coan A, Staley T, Wheeler JL, Rowe K, Smith SK, Lyerly HK
    Supportive Care in Cancer 2010; In Press.  DOI: 10.1007/s00520-010-0823-z

    • Abstract
      PURPOSE:
      Pathfinders is a multi-faceted psychosocial care program for cancer patients; it was developed in community oncology and adapted to the academic oncology setting. This prospective, single-arm, phase 2 pilot study examined the acceptability and feasibility of Pathfinders for women with metastatic breast cancer. METHODS: Over 3 months, participants completed patient-reported surveys including the Patient Care Monitor (PCM, review of systems), Functional Assessment of Chronic Illness Therapy-Breast Cancer (FACT-B), Self Efficacy, and a single-item survey asking patients whether the program was helpful to them. A technology-based data collection system was used to capture electronic patient-reported outcomes at point of care, report symptoms in real time to clinicians, and collect warehouse data to provide a detailed longitudinal picture of the patient experience when receiving Pathfinders. RESULTS: Participants (n = 50) were: mean age 51 (SD 11); 76% white, 20% black; 74% married; 50% college degree. Forty-two (n = 42) patients completed baseline and 3-month assessments. Statistically significant improvements (all P < 0.05) occurred in PCM subscales for Distress (mean [SE] = -3.42 [1.21]), Despair (-4.53 [1.56]), and Quality of Life (2.88 [0.97]), and the FACT-B Emotional Wellbeing subscale (2.07 [0.46]). Of the 29 participants asked if Pathfinders was helpful, 27 (93%) responded positively and two did not respond. Other instruments measuring symptoms, quality of life, and self-efficacy showed improvement. CONCLUSIONS: In a phase 2 pilot study, Pathfinders was helpful to patients and is feasible in an academic medical center. Follow-up data collected at the 3-month assessment suggest that the program impacts various psychological outcomes, notably distress and despair.

    Correlates of Quality of Life-related Outcomes in Breast Cancer Patients Participating in the Pathfinders Pilot Study

    Smith SK, Herndon JE, Lyerly HK, Coan A, Wheeler JL, Staley T, Abernethy AP
    Psychooncology 2010; In press. 

    • Abstract:
      Objective:
      In a pilot study, participation in the Pathfinders program was associated with reductions in distress and despair and improvements in quality of life (QOL) among advanced breast cancer patients. This paper explores the relationship between psychosocial resources invoked through the Pathfinders intervention and outcomes.
      Methods:
      Advanced breast cancer patients were enrolled in a prospective, single-arm, pilot study of the Pathfinders psychosocial program. Participants met at least monthly with a licensed clinical social worker who administered the Pathfinders intervention, which focused on strengthening adaptive coping skills, identifying inner strengths, and developing a self-care plan. Longitudinal assessments over 6 months used validated instruments to assess changes in Pathfinders targets (coping, social support, self-efficacy, spirituality, optimism) and outcomes (distress, despair, QOL, fatigue). Multiple linear regression models examined the joint effect of average changes in target subscales on average outcome changes, adjusted for baseline outcome scores and patient characteristics.
      Results:
      Participants (n=44) were: mean age 51 (SD, 12), 20% non-Caucasian, 50% college degree, 75% married. Improvements in active coping skills, self-efficacy and spiritual meaning/peace significantly correlated with an improvement in despair after adjustment for demographic characteristics (all P<0.05). Improvements in social support significantly correlated with positive changes in distress (P<0.05). Gains in learned optimism independently correlated with an increase in overall QOL (P<0.01).
      Conclusions:
      In this pilot assessment, changes in pre-defined Pathfinders targets such as coping skills, social support, self-efficacy, spirituality and optimism correlated with improvements in patient-reported outcomes.

  • ABSTRACTS & PRESENTATIONS:

    Targeting psychosocial resources in a pilot study of Pathfinders.

    Smith, SK, Herndon, JE, Coan, A, Wheeler, JL, Staley, T, Abernethy AP. 
    Accepted for Poster Presentation at the Biennial Cancer Survivorship meeting in Washington, DC, June 17, 2010.

    Impact of an intervention targeting psychosocial resources for cancer patients.
    Smith, SK, Herndon, JE, Coan, A, Wheeler, JL, Staley, T, Abernethy AP.
    Poster Presentation at the Annual Association of Oncology Social Work Meeting in Phoenix, AZ, May 12, 2010.

    Pathfinders, an integrative psychosocial care program, improves quality of life, psychological measures, and fatigue in advanced metastatic breast cancer patients.
    Abernethy AP, Staley T, Herndon JE, Coan A, Wheeler JL, Evans J, Rowe K, Horne B, Skye A, Shaw HS, Lyerly HK.  
    Submitted to the 2009 Annual Assembly of the American Academy of Hospice and Palliative Medicine & Hospice and Palliative Nurses Association. Austin, TX.  March 25-28, 2009.  

    Impact of a Psychosocial Intervention on Quality of Life Outcomes in Cancer Patients.
    Abernethy, AP, Smith, SK, Staley, T, Wheeler, JL, Coan, A, Rowe, K, Herndon, JE.
    Oral Paper Presentation at the Annual Meeting of the Society for Social Work and Research in San Francisco, CA, January, 14, 2010.

    Targeting Psychosocial Resources to Improve Quality of Life in Cancer Patients.
    Smith, SK, Herndon, JE, Coan, A, Wheeler, JL, Staley, T, Abernethy AP. 
    Poster Presentation at the Annual Duke Comprehensive Cancer Center meeting in Durham, NC, October 5, 2009.

    Impact of a Psychosocial Program on Quality of Life in Cancer Patients.
    Smith, SK, Abernethy AP, Herndon, JE, Coan, A, Staley, T, Wheeler, JL, Rowe, K, Lyerly, HK. 
    Poster Presentation at the Annual Duke Comprehensive Cancer Center meeting in Durham, NC, October 5, 2009.

    Impact of a Psychosocial Intervention on Performance Status and Coping
    AP Abernethy, T Staley, JE Herndon II, A Coan, JL Wheeler, K Rowe, B Horne, HK Lyerly.
    Poster Presentation at the American Society of Clinical Oncology (ASCO) Annual Meeting, Orlando, FL, May 29 - June 2, 2009.

    Pathfinders: A psychosocial complement to cancer treatment.

    Abernethy AP, Staley T, Shaw HS, Herndon JE, Coan A, Wheeler JL, Rowe K, Skye A, Horne B, Lyerly HK. 
    Poster presentation at the 2008 American Society of Clinical Oncology Breast Cancer Symposium. Washington, DC.  September 5-7, 2008.  Abstract number 251.

    Pathfinders: An integrative psychosocial approach to supportive care in cancer.
    Abernethy AP, Staley T, Herndon JE, Coan A, Shaw HS, Wheeler JL. 
    Poster presentation at the 2008 Multinational Association for Supportive Care in Cancer International Symposium. Houston, TX.  June 26-28, 2008.  Abstract number 300.

    Pathfinders: A pilot study of an integrative psychosocial care program for cancer patients.
    Abernethy AP, Staley T, Herndon JE, Coan A, Wheeler JL, Lyerly HK. 
    2009 Multinational Association for Supportive Care in Cancer International Symposium.  Rome, Italy.  June 25-27, 2009.

    Impact of Pathfinders, an integrative mind-body spirit psychosocial intervention, on patient-reported symptoms in a breast cancer population.
    Abernethy AP, Staley TS, Wheeler J, Herndon J, Rowe K, Skye A, Coan A, Horne B, Jones LW, Lyerly HK, Shaw H.   
    Oral presentation at the 2007 Fourth International Conference of the Society for Integrative Oncology.  San Francisco, CA.  November 16, 2007. Abstract number 18180. Journal of the Society for Integrative Oncology 2007;5(4);188.