title: An interdisciplinary palliative rehabilitation intervention bolstering general self-efficacy to attenuate symptoms of depression in patients living with advanced cancer.
abstract: OBJECTIVE
  Patients with advanced cancer, post-anticancer treatment, are living longer than 10-20 years ago. This emerging population of survivors has unique palliative and rehabilitation needs. A particular concern is depression, which can impair functioning, quality of life, and survival. The interdisciplinary Palliative Rehabilitation Program offers holistic palliative rehabilitation for this population using a self-efficacy framework. The current study examined the unique impact of three program factors that have been shown to improve depression: inflammation, exercise, and self-efficacy.
  
  
  METHODS
  Patients underwent a 2-month interdisciplinary intervention (up to six disciplines) and thorough pre-post assessments. Measures included serum C-reactive protein, 6-min walk test, General Self-efficacy Scale, and Hospital Anxiety and Depression Scale (depression subscale). Paired t tests analyzed pre-post changes in each variable, and a hierarchical linear regression analyzed the predictors' unique contributions of changes in depression in this quasi-experimental design.
  
  
  RESULTS
  The sample included 80 patients (52.5% females), with stages 3/4 heterogeneous cancers. Results revealed that C-reactive protein (CRP) did not significantly change pre-post, from 7.39 (SD = 11.99) to 9.47 mg/L (SD = 16.41), p = 0.110, exercise significantly increased, from 372.55 (SD = 137.71) to 412.64 m (SD = 144.31), p < 0.001, self-efficacy significantly increased from 27.86 (SD = 6.16) to 31.23 units (SD = 5.77), p < 0.001, and depression scores significantly decreased, from 7.14 (SD = 3.91) to 5.95 units (SD = 3.51), p = 0.002. A hierarchical linear regression revealed that this model explained 15% of variance in changes in depression scores, p = 0.006. Change in self-efficacy accounted for 11% of change in depression scores (p < 0.001). Change in CRP and exercise did not make a significant contribution.
  
  
  CONCLUSIONS
  A self-efficacy framework may be a helpful ingredient in interdisciplinary intervention to decrease depressive symptomatology.
authors.affiliation: School of Psychology, University of Ottawa, Ottawa, ON, Canada. afeld048@uottawa.ca.|Bruyère Research Institute, Bruyère Continuing Care, Ottawa, ON, Canada. afeld048@uottawa.ca.
authors.forename: A
authors.initials: A
authors.lastname: Feldstain
authors.affiliation: School of Psychology, University of Ottawa, Ottawa, ON, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Lebel
authors.affiliation: Bruyère Research Institute, Bruyère Continuing Care, Ottawa, ON, Canada.|Department of Palliative Medicine, Bruyère Continuing Care, Ottawa, ON, Canada.|Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
authors.forename: M R
authors.initials: MR
authors.lastname: Chasen
mesh_terms: D003863:Depression / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000534:rehabilitation*; D010166:Palliative Care; D011788:Quality of Life; D020377:Self Efficacy; D017741:Survivors
keywords: Advanced cancer; Depression; Interdisciplinary; Palliative rehabilitation; Self-efficacy