Background Young adults with cancer are at increased risk for suicidal ideation. The impact of the patient-oncologist alliance on suicidal ideation has not been examined. This study examined the relationship between the patient-oncologist therapeutic alliance and suicidal ideation in young adults with advanced cancer. Methods Young adult patients (age 20-40 years; n=93) with incurable, recurrent, or metastatic cancer were evaluated by trained interviewers. Suicidal ideation was assessed with the Yale Evaluation of Suicidality, dichotomized into a positive and negative score. Predictors included diagnoses of Major Depressive Disorder (MDD) and Post-Traumatic Stress Disorder (PTSD), physical quality of life, social support, and utilization of mental health and supportive care services. The Human Connection Scale, dichotomized into strong (upper third) and weak (lower two-thirds) therapeutic alliance assessed strength of the patients’ perceived oncologist alliance. Results 22.6% screened positive for suicidal ideation. Patients with a strong therapeutic alliance were at reduced risk for suicidal ideation after controlling for confounding influences of cancer diagnosis, performance status, number of physical symptoms, physical quality of life, MDD, PTSD, and social support. A strong therapeutic alliance was also associated with reduced risk for suicidal ideation after controlling for mental health discussions with healthcare providers and use of mental health interventions. Conclusions The patient-oncologist alliance was 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.

Changes in adolescents’ motivations and capabilities pose unique challenges to parents who play a continuing role in ensuring the youth’s safety and well-being. We describe sensitively attuned parenting as an optimal response to this challenge and summarize practices of positive engagement, supervision/guidance and open communication that support sensitive attunement and facilitate the continuing development of the adolescent’s self-confidence, autonomous decision-making, and communication skills. We then consider factors that require parents to adapt their practices to the particular needs and developmental level of the adolescent. Individual differences that may challenge parent’s effectiveness in implementing these practices include: biological vulnerabilities, differential sensitivity to parenting, relationship history and temperament. Clinical interventions that seek to improve parenting offer an opportunity to test sensitive attunement as a mechanism for reducing adolescents’ symptoms and problem behaviors.

Context Recent studies have shown that patients’ quality of life at the end of life (QOL@EOL) affects the psychosocial adjustment of bereaved family caregivers. Objectives To examine the relationship between patients’ QOL@EOL and their surviving bereaved caregivers’ suicidal ideation. Methods Data were derived from the Coping with Cancer (CwC1) Study, a U.S. National Cancer Institute-funded multicenter prospective cohort investigation of patients with advanced cancer and their caregivers, enrolled September 2002 – February 2008. CwC1 data were used to examine changes in suicidal ideation in family caregivers before and after the patient’s death (N=127). Caregiver baseline suicidal ideation was assessed using the Yale Evaluation of Suicidality (YES) Scale a median of 4.1 months pre-loss; caregivers’ perception of patients’ QOL@EOL was assessed a median of 1.9 months post-loss; and caregiver suicidal ideation in bereavement was assessed using the YES a median of 6.5 months post-loss. Suicidal ideation was defined as a positive screen on the YES. Multiple logistic regression analysis examined the effect of caregivers’ perceptions of patients’ QOL@EOL on bereaved caregiver’s suicidal ideation, adjusting for the caregiver’s baseline suicidal ideation and confounding influences. Results Caregivers’ perception of patients’ QOL@EOL was significantly inversely related to caregivers’ suicidal ideation post-loss (AOR=0.79, P=0.023), adjusting for caregivers’ baseline suicidal ideation, relationship to patient, and years of education. Conclusion The more caregivers perceive their loved ones’ QOL@EOL to be poor, the greater their risk for suicidal ideation in bereavement over and above prior levels of suicidal ideation. Caregivers of patients who have poor QOL@EOL appear to be a group of caregivers to target for reduction of suicidal risk.

Eighty-five young adults exposed to a cluster of peer suicides as adolescents completed measures of attitudes toward suicide, grief, and social support. Closeness to the peers lost to suicide was positively correlated with grief and the belief that suicide is not preventable, with grief further elevated in close individuals with high social support from friends. Overall, social support was related to healthy attitudes about suicide including preventability, yet it was also related to some stigmatizing beliefs. Compared with 67 young adults who had not been exposed to a suicide cluster, the exposed sample was more likely to think that suicide is normal but more likely to think of it as incomprehensible.

The Goal-corrected Partnership Adolescent Coding System (GPACS) has shown promise in assessing a secure as well as three atypical patterns of parent-adolescent interaction during a conflict discussion. The current study of 186 economically disadvantaged families examines the degree to which four GPACS patterns: Secure/Collaborative, Punitive, Role Confused and Disoriented—account for residual change in adolescents’ social competence and maladaptive behavior (internalizing, externalizing, and risk behaviors) between ages 13 to 15. Adolescents from Secure/Collaborative dyads at age 13 were more likely to have a secure state of mind in the AAI at age 15 and showed increases in teachers’ ratings of empathy and decreases in teachers’ ratings of externalizing behaviors between ages 13 and 15. Adolescents in Disoriented dyads showed a dramatic increase in teacher-rated internalizing problems, while male adolescents in Role Confused dyads reported increased involvement in risk behaviors including unprotected sexual activity and substance use problems.

Objective Patients often anticipate cure from palliative chemotherapy. Better resources are needed to convey its risks and benefits. We describe the stakeholder-driven development and acceptability testing of a prototype video and companion booklet supporting informed consent (IC) for a common palliative chemotherapy regimen. Methods Our multidisciplinary team (researchers, advocates, clinicians) employed a multistep process of content development, production, critical evaluation, and iterative revisions. Patient/clinician stakeholders were engaged throughout using stakeholder advisory panels, featuring their voices within the intervention, conducting surveys and qualitative interviews. A national panel of 57 patient advocates, and 25 oncologists from nine US practices critiqued the intervention and rated its clarity, accuracy, balance, tone, and utility. Participants also reported satisfaction with existing chemotherapy IC materials. Results Few oncologists (5/25, 20%) or advocates (10/22, 45%) were satisfied with existing IC materials. In contrast, most rated our intervention highly, with 89–96% agreeing it would be useful and promote informed decisions. Patient voices were considered a key strength. Every oncologist indicated they would use the intervention regularly. Conclusion Our intervention was acceptable to advocates and oncologists. A randomized trial is evaluating its impact on the chemotherapy IC process. Practice Implications Stakeholder-driven methods can be valuable for developing patient educational interventions.

Objective: Although there are currently several efficacious treatments for depressed and suicidal adolescents, less is known about predictors and moderators of adolescents' treatment response. A growing literature has identified family functioning as a prognostic indicator of adolescents' likelihood of benefiting from treatment. The current study tested both observational and perceived measures of family functioning as indicators of adolescents' response to 2 treatment conditions. Method: The sample consisted of 129 depressed and suicidal adolescents (M age ϭ 14.96, 82.9% female, 56% Black/African American) who were randomized to attachment-based family therapy or family-enhanced nondirective supportive therapy (Diamond et al., 2019). Baseline assessments of family functioning included ratings of parent-adolescent communication coded with the Goal-Corrected Partnership in Adolescence Coding System (Lyons-Ruth, Hennighausen, & Holmes, 2005) and adolescent and parent reports of Family Conflict and Cohesion from the Self-Report of Family Functioning (Bloom, 1985). Results: Adolescents who engaged in more uncooperative communication with their parents during a 10-min conflict discussion showed greater reductions in depressive symptoms in both treatments. Adolescents from traditionally underserved (non-White or lower income) families showed greater reductions in suicidal ideation in both treatments. Conclusions: Attachment-based family therapy and family-enhanced nondirective supportive therapy were most effective for adolescents from traditionally underserved families and adolescents who engaged in less cooperative communication with their caregivers. Observational ratings of parent-adolescent communication were better prognostic indicators of treatment response than were self-reported indicators of global family functioning. Implications for generalizing these results to other treatments for depressed and suicidal adolescents are discussed. What is the public health significance of this article?Identification of factors that predict treatment response for depressed and suicidal adolescents holds important implications for treatment planning. The current study extends prior literature by testing multiple measures of family functioning as well as demographic factors as predictors and moderators of depressed and suicidal adolescents' response to attachment-based family therapy (ABFT) and This article was published Online First October 24, 2019.

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