BACKGROUND High-quality lung cancer care includes physician-patient communication about the disease and treatment, patient needs/preferences, and care goals. In this study, the authors evaluated communication with patients at all stages across multiple topics. METHODS A standardized questionnaire asked patients with lung cancer to rate (on 5-point, verbal descriptor scale) the extent of communication with physicians on symptoms, spiritual concerns, practical needs, proxy appointment, living will preparation, prognosis, care goals, potential complications of therapy, life support preferences, and hospice. Communication was defined as inadequate if the patient reported discussing ?5 of 11 questionnaire topics “not at all” or “a little bit.” Multivariate logistic regression was used to evaluate the factors associated with inadequate communication. RESULTS In total, 276 of 348 (79%) eligible patients were enrolled (mean age [±standard deviation], 65 ± 10 years; 55% white, 21% black, and 19% Hispanic; all disease stages). For most topics, the majority of respondents reported that physicians communicated “not at all” or “a little bit.” Low ratings were frequent for discussion of emotional symptoms (56%; 95% confidence interval [CI], 49%–62%), practical needs (71%; 95% CI, 65%–76%), spiritual concerns (80%; 95% CI, 75%–85%), proxy appointment (63%; 95% CI, 57%–69%), living will preparation (90%; 95% CI, 85%–93%), life support preferences (80%; 95% CI, 75%–84%), and hospice (88%; 95% CI, 86%–94%). Communication was inadequate for patients of different ages, stages, and races, although Hispanics were less likely than non-Hispanic whites and blacks to report inadequate communication (odds ratio, 0.31; 95% CI, 0.15–0.65). CONCLUSIONS Across all stages, patients with lung cancer reported low rates of physician-patient communication on key topics, which may increase patient distress, impair decision-making, and compromise clinical outcomes and use patterns.
Nelson, Judith E.; Gay, Elizabeth B.; Berman, Andrew R.; Powell, Charles A.; Salazar-Schicchi, John; Wisnivesky, Juan P.
The central aim of this thesis was to unravel the relationship between patient characteristics, communication between patient and clinician, and subsequent patient information recall in the context of medical consultations with older cancer patients. Chapter 2 reviewed the literature to explore age differences in cancer patients’ need for information and support surrounding cancer treatment. The results indicated that older patients
Objective To examine physician communication associated with prognosis discussion with cancer patients. Methods We conducted a study of physician-patient communication using trained actors. Thirty-nine physicians, including 19 oncologists and 20 family physicians participated in the study. Actors carried two hidden digital recorders to unannounced visits. We coded recordings for eliciting and validating patient concerns, attentive voice tone, and prognosis talk. Results Actor adherence to role averaged 92% and the suspected detection rate was 14%. In a multiple regression, eliciting and validating patient concerns (?=.40, C.I. = 0.11-0.68) attentiveness (?=.32, C.I. = 0.06-0.58) and being an oncologist vs. a family physician (?=.33, C.I. = 0.33 - 1.36) accounted for 46% of the variance in prognosis communication. Conclusion Eliciting and validating patient concerns and attentiveness voice tone is associated with increased discussion of cancer patient prognosis as is physician specialty. Practice Implications Eliciting and validating patient concerns and attentive voice tone may be markers of physician willingness to discuss emotionally difficult topics. Educating physicians about mindful practice may increase their ability to collect important information and to attend to patient concerns.
Shields, Cleveland G.; Coker, Casey J.; Poulsen, Shruti S.; Doyle, Jennifer M.; Fiscella, Kevin; Epstein, Ronald M; Griggs, Jennifer J.
Objective Relational communication refers to those messages communicators naturally express that carry meaning about the type and quality of relationship they share. It is expected that patients of oncologists who express positive relational communication will be more communicatively involved in their office visits, and regret their decision for adjuvant therapy following surgery less. Methods One hundred eighty (180) audio-recorded discussions between oncologists (n = 40) and early stage (I–III) breast cancer patients were coded with the Siminoff Communication Content and Affect Program (SCCAP). The data were used to test the relationships between patient demographics, oncologist relational communication, patient communication involvement and self-reported patient decision regret. Results After controlling for clinician clusters, oncologists’ verbal (i.e., confirming messages) and nonverbal (i.e., direct and inclusive speech) relational communication is indirectly associated with lower patient decision regret via the mediating effect of greater patient communication involvement. Conclusion Clinician relational communication provides an influential affective climate for decision-making that appears to have important effects on patients’ decision confidence. Practice Implications Clinicians should recognize the potential of their own relational messages to facilitate patients’ communication involvement in decision-making during cancer care.
Step, Mary M.; Rose, Julia Hannum; Albert, Jeffrey M.; Cheruvu, Vinay K.; Siminoff, Laura A
Objectives: Unmarried women are less likely than married women to receive recommended cancer screenings. Patient-provider communication is a consistent predictor of cancer screening among women. The purpose of this study was to investigate the relationship between patient-provider communication, barriers to cancer screening, and on-schedule breast and cervical cancer screening (BCCS) among unmarried women. Methods: Data were from the Cancer Screening Project for Women, a 2003-2005 survey examining cancer screening practices. We computed polytomous logistic regression models to examine the relationship between communication (communication about tests, communication about sexual and intimate relationships), barriers to screening, and on-schedule BCCS among unmarried women. Results: A total of 630 women were enrolled, and 605 women completed the baseline questionnaire. Overall, more than 60% reported on-schedule BCCS. More than half reported that their providers communicated about BCCS most or all of the time. Fewer than half communicated about sexual history and intimate relationships. Women who reported that their providers communicated about screening tests and their sexual and intimate relationships were more likely to be on-schedule for BCCS. Conclusion: Patient-provider communication in multiple areas may encourage women to remain on-schedule for their recommended cancer screenings. Longitudinal research should be conducted to examine whether communication predicts BCCS, and to examine how patient and provider characteristics may influence communication in order to promote adherence to screening guidelines for unmarried women. Practice Implications: Comprehensive communication that goes beyond information about screening tests may impact adherence to cancer screening guidelines.
Politi, Mary C.; Clark, Melissa A.; Rogers, Michelle L.; McGarry, Kelly; Sciamanna, Chris N.
On May 15-16, 2006, the Outcomes Research Branch (ORB) and the Health Communication and Informatics Research Branch (HCIRB) organized a symposium on Patient-centered Communication (PCC) in Bethesda, MD. Participants included more than 25 researchers and practitioners from federal agencies, private sector healthcare systems, cancer centers, and other academic departments. The expert panel of researchers and practitioners represented various areas of expertise, including oncology, nursing, primary care, health services research, large delivery systems, communication and behavioral sciences, and patient advocacy.
National Cancer Institute PATIENT-CENTERED COMMUNICATION IN CANCER CARE Promoting Healing and Reducing Suffering U.S. DEPARTMENT OF HEAL TH AND HUMAN SERVICES National Institutes of Health PATIENT-CENTERED COMMUNICATION IN CANCER CARE Promoting
This paper presents a comprehensive conceptual model of health care communication involving three key health care partners: patients, physicians, and significant family members (health significant other, HSOs). A unique feature of this model is its focus on proactive roles played by elderly patients in information gathering and communication with health care partners regarding both cancer prevention and cancer care. We
Eva Kahana; Boaz Kahana
This paper presents a comprehensive conceptual model of health care communication involving three key health care partners: patients, physicians, and significant family members (health significant other, HSOs). A unique feature of this model is its focus on proactive roles played by elderly patients in information gathering and communication with health care partners regarding both cancer prevention and cancer care. We outline how proactive initiatives by health care consumers and involvement of their HSOs can enhance patient outcomes (satisfaction with physician, adherence to preventive and corrective practice recommendations, and quality of life). Finally, we also note primary antecedents of health care partner communication in terms of both medical care context and patient characteristics. We hope that this testable causal model will inform future research in the field of health communication. PMID:12767588
Kahana, Eva; Kahana, Boaz
Background: Two-thirds of adults aged 50 years and older are adherent to recommendations for colorectal cancer screening. Provider-patient communication and characteristics of the patient-provider relationship may relate to screening behavior. Methods: The association of provider communication quality, relationship, and colorectal cancer screening…
Underhill, Meghan L.; Kiviniemi, Marc T.
Effective patient-clinician communication is central to the delivery of high-quality care. It becomes even more crucial in the cancer setting where patients have to deal with stress, uncertainty, complex information, and life-altering medical decisions.
Terrance Albrecht, MD, of the Barbara Ann Karmanos Cancer Institute in Detroit, Michigan, discusses how communication occurring among physicians, patients, and family companions influences whether or not patients decide to participate in a clinical trial. Dr. Albrecht presents the results of her communications research and translates the findings into practical application in the clinic setting.
A December 2009 special issue of Patient Education and Counseling highlighted empirical studies from across the world that inform researchers, clinicians, and policy makers about the salience of patient-clinician communication at different phases of the cancer control continuum, from prevention to end-of-life care. The papers highlight the multidisciplinary nature of cancer communication research. A variety of study designs and analytical strategies are employed. Neeraj K.
Objectives To investigate provider and patient views about communication regarding cervical cancer screening follow-up. Methods Using qualitative analysis, we interviewed 20 providers and 10 patients from two urban clinics that serve low-income African American and Hispanic women. Semi-structured interviews and focus groups assessed familiarity with National Cancer Institute's Cancer Information Service (CIS) and reactions to a letter asking women with abnormal Pap test to telephone CIS. The letter suggested questions to ask prior to receiving follow-up. Results No patient or provider was familiar with CIS. Providers but not patients expressed discomfort with use of the word `cancer' in the letter and in CIS's name. Providers feared that reference to cancer would provoke fatalism and impede timely follow-up, whereas patients felt information about cancer risk was needed to prompt timely follow-up. Information providers found necessary to convey in order to accurately explain abnormal Pap tests surpassed patients' literacy levels. Conclusion Qualitative data suggest important gaps in perspective between providers and patients. There is a need to bridge the gap and overcome communication challenges to promote timely medical follow-up and have better health outcomes. Practice Implications Implications and strategies for improving patient-provider education and communication about abnormal pap test are discussed.
Simon, Melissa A.; Cofta-Woerpel, Ludmila; Randhawa, Veenu; John, Priya; Makoul, Gregory; Spring, Bonnie
Background Cancer patients and their oncologists often report differing perceptions of consultation discussions and discordant expectations regarding treatment outcomes. CONNECT™, a computer-based communication aid, was developed to improve communication between patients and oncologists. Methods CONNECT includes assessment of patient values, goals, and communication preferences; patient communication skills training; and a pre-consult physician summary report. CONNECT was tested in a three-arm, prospective, randomized clinical trial. Prior to the initial medical oncology consultation, adult patients with advanced cancer were randomized to (a) control; (b) CONNECT with physician summary, or (c) CONNECT without physician summary. Outcomes were assessed with post-consultation surveys. Results Of 743 patients randomized, 629 completed post-consultation surveys. Patients in the intervention arms (versus control) felt that the CONNECT program made treatment decisions easier to reach (p=0.003) and helped them to be more satisfied with these decisions (p<0.001). In addition, patients in the intervention arms reported higher levels of satisfaction with physician communication format (p=0.026) and discussion regarding support services (p=0.029) and quality of life concerns (p=0.042). The physician summary did not impact outcomes. Patients with higher levels of education and poorer physical functioning experienced greater benefit from CONNECT. Conclusion This prospective randomized clinical trial demonstrates that computer-based communication skills training can positively affect patient satisfaction with communication and decision making. Measureable patient characteristics may be used to identify subgroups most likely to benefit from an intervention such as CONNECT.
Meropol, Neal J.; Egleston, Brian L.; Buzaglo, Joanne S.; Balshem, Andrew; Benson, Al B.; Cegala, Donald J.; Cohen, Roger B.; Collins, Michael; Diefenbach, Michael A.; Miller, Suzanne M.; Fleisher, Linda; Millard, Jennifer L.; Ross, Eric A.; Schulman, Kevin A.; Silver, Allison; Slater, Elyse; Solarino, Nicholas; Sulmasy, Daniel P.; Trinastic, Jonathan; Weinfurt, Kevin P.
This study examined the use of complementary and alternative medicine (CAM) therapies by breast cancer patients and the communication of their CAM use to their physicians relative to lymphedema symptoms and other factors. Breast cancer patients (N=148) in the State of Vermont were interviewed 2-3 years after their primary surgery using computer-aided telephone interviewing methods. Questionnaire items included demographic information,
Taka Ashikaga; Kwadwo Bosompra; Patricia O'Brien; Lee Nelson
Abstract Background Effective communication by hospice nurses enhances symptom management for the patient, reduces family caregiver burden and distress, and potentially improves bereavement adjustment. However, research has not kept pace with the rising use of hospice by patients with cancer and thus we know little about how hospice nurses communicate. Methods The overriding objective of this pilot study was to provide insight into these in-home visits. Hospice nurses audiorecorded their interactions over time with family caregivers and patients with cancer. The communication within these tapes was coded using Roter Interaction Analysis System (RIAS) and analyzed. Results We found that tape recording home hospice nurse visits was feasible. RIAS was suited to capture the general content and process of the home hospice encounter and the coded interactions show the range of topics and emotions that are evident in the dialogue. Implications and future directions for research are discussed.
Reblin, Maija; Clayton, Margaret F.; Berry, Patricia; Mooney, Kathleen
A case-control study of quality of life in patients with lung cancer was carried out. The investigation was conducted by means of a series of interviewer-administered instruments. As part of the study, patients' attitudes towards the interviewer-administered questionnaires were studied. Previously we reported that a high proportion of the patients found being interviewed acceptable. The present study firstly examines why patients found being interviewed acceptable and secondly investigates whether there is an association between gender, age, diagnosis, place of interview, patients' overall health status, global quality of life and patients' feelings. Two hundred and thirty-two patients attending an outpatient clinic with either lung cancer or chronic respiratory disease were interviewed by means of a short questionnaire. They were asked to indicate their feelings about interviews, and to explain the reasons why they had their particular feelings. We documented issues on communication between interviewers and patients. These include observations on interviewing cancer patients, interviewing at home, and interviewing in the clinic. Nearly all the patients (96%) indicated that they found being interviewed acceptable. A content analysis of data showed that patients' feelings can be attributed to four major themes: the interview was not disturbing, they felt relaxed and at ease, they liked to talk, and the interview was conversational. There were no significant association between gender, age, diagnosis (cases and controls), place of interview, patients' overall health status and global quality of life and the reasons expressed. Practical experience from interviewing patients at home or in the clinic reveals several issues on communication between interviewer and patients. The study results suggest that apart from communication factors, other parameters such as age, gender, diagnosis, overall health status and quality of life and interview setting do not have significant role in patients' feelings about interviews. If data on quality of life studies are to be collected by interviewers, then proper communication is essential. How to achieve this remains a major question. PMID:8961476
Montazeri, A; Milroy, R; Gillis, C R; McEwen, J
A critical step in facilitating the delivery of patient-centered communication (PCC) as part of routine cancer care delivery is creating a measurement and monitoring system that will allow for the ongoing assessment, tracking, and improvement of these six functions of patient-centered communication. To build the foundation of such a system and to advance research methodology in this area, the ORB has collaborated with the Agency for Healthcare Research and Quality (AHRQ) on a research project conducted within AHRQ's DEcIDE network.
This study evaluated a 2-day communication skills training program in nursing care through surveys with nurses and patients before and after the training. The training had no effect on patient perception of nurse empathy and attentiveness, patients’ moods, or cancer-related self-efficacy. The training also did not significantly affect nurses on measures related to communication and work-related stress.
Background: Effective communication is increasingly recog- nised as a core clinical skill. Many health and social care professionals, however, do not feel adequately trained in communicating and in handling interpersonal issues that arise in the care of patients with cancer. Aim: The aim of this paper was to assess the effectiveness of different training methods used in communication training courses
Marjolein Gysels; Alison Richardson; Irene J. Higginson
Research shows that African Americans tend to have poorer and less informative patient–physician communication than Whites. We analyzed survey data from 248 African American and 244 White cancer patients to examine whether this disadvantage could be explained by race variability on several other variables commonly reported to affect communication. These variables were organized into background, enabling, and predisposing factors, based
Clara Manfredi; Karen Kaiser; Alicia K. Matthews; Timothy P. Johnson
As computers and smartphones continue to transform the doctor-patient relationship, it is essential that healthcare professionals understand how their patients wish to interact with these devices. The results from a satisfaction questionnaire of 225 Oncology patients treated in 2011 in Quebec, Canada provide insight into the manner in which patients have been and wish to communicate with their healthcare teams. The survey also addressed whether or not patients searched the Internet for supplementary information regarding their condition. Generally, patients were neutral regarding adopting greater usage of modern means of communication. The majority of patients did not want to be contacted via e-mail or SMS, nor did the patients want to make appointments or fill out surveys online. Forty four percent of patients used the Internet to learn more about their condition. Concerning the patients who were not provided with links to medically relevant websites, 44% wished their doctors had supplied them with such links. Though there was much overlap between the 44% of patients who went on the Internet to learn more about their condition and the 44% of the patients who wished their physicians provided them with such links, 14% of all the patients wished their medical teams had provided them with links, but did not independently search for medically relevant information about their condition. Using chi-square testing education level was found to be the best predictor of which patients searched the web for supplementary information about their conditions (p = 0.003). Contrary to findings in other studies, a comparable proportion of patients in each age-group used the Internet to research their condition. Given the wealth of web-resources available to cancer patients, it would be beneficial for both healthcare teams and their patients if physicians consistently offered a list of trustworthy websites to their patients. PMID:24000994
Katz, J E; Roberge, D; Coulombe, G
Several recent reports, including NCI's Strategic Plan for Leading the Nation and the NCI-designated cancer center directors' report Accelerating Successes Against Cancer, have recognized the salience of patient-clinician communication in optimizing cancer patients' and survivors' health outcomes.
Background Aboriginal Australians experience poorer outcomes from cancer compared to the non-Aboriginal population. Some progress has been made in understanding Aboriginal Australians’ perspectives about cancer and their experiences with cancer services. However, little is known of cancer service providers’ (CSPs) thoughts and perceptions regarding Aboriginal patients and their experiences providing optimal cancer care to Aboriginal people. Communication between Aboriginal patients and non-Aboriginal health service providers has been identified as an impediment to good Aboriginal health outcomes. This paper reports on CSPs’ views about the factors impairing communication and offers practical strategies for promoting effective communication with Aboriginal patients in Western Australia (WA). Methods A qualitative study involving in-depth interviews with 62 Aboriginal and non-Aboriginal CSPs from across WA was conducted between March 2006 - September 2007 and April-October 2011. CSPs were asked to share their experiences with Aboriginal patients and families experiencing cancer. Thematic analysis was carried out. Our analysis was primarily underpinned by the socio-ecological model, but concepts of Whiteness and privilege, and cultural security also guided our analysis. Results CSPs’ lack of knowledge about the needs of Aboriginal people with cancer and Aboriginal patients’ limited understanding of the Western medical system were identified as the two major impediments to communication. For effective patient–provider communication, attention is needed to language, communication style, knowledge and use of medical terminology and cross-cultural differences in the concept of time. Aboriginal marginalization within mainstream society and Aboriginal people’s distrust of the health system were also key issues impacting on communication. Potential solutions to effective Aboriginal patient-provider communication included recruiting more Aboriginal staff, providing appropriate cultural training for CSPs, cancer education for Aboriginal stakeholders, continuity of care, avoiding use of medical jargon, accommodating patients’ psychosocial and logistical needs, and in-service coordination. Conclusion Individual CSPs identified challenges in cross-cultural communication and their willingness to accommodate culture-specific needs within the wider health care system including better communication with Aboriginal patients. However, participants’ comments indicated a lack of concerted effort at the system level to address Aboriginal disadvantage in cancer outcomes.
Low participation among underserved populations in health research constrains progress in public health practices. From 2003 to 2005, Women's Health Clinic patients at the VCU Health System were recruited to a trial investigating breast cancer risk communication. In secondary analyses, we examined dimensions of the recruitment of these diverse women. The sample characteristics (age, insurance, race and previous mammograms) were compared to the overall clinic. Of recruitment attempts for eligible women, 45% consented; of those who declined, the top cited reasons were lack of time (40%) and lack of interest (18%). Of 899 participants, 35% qualified for the indigent care program, compared to 31% of the overall clinic (P<0.001). Forty-five percent of participants were African American, compared to 54% of overall clinic patients (P<0.001). Participants were younger (50 vs. 53 years, P<0.001) than the overall clinic population. Nonrepresentative enrollment of patients in clinical trials is common and could lead to suboptimal applicability of findings. Although there were statistically significant race and age differences between the study sample and the overall population, we demonstrate that waiting room recruitment can engage diverse women in a clinical trial and cancer risk communication.
Bodurtha, Joann N.; Quillin, John M.; Tracy, Kelly A.; Borzelleca, Joseph; McClish, Donna; Wilson, Diane Baer; Jones, Resa M.; Quillin, Julie; Bowen, Deborah
Interactive Health Communication Applications (IHCAs) are increasingly used in health care. Studies document that IHCAs provide patients with knowledge and social support, enhance self- efficacy and can improve behavioural and clinical outcomes. However, research exploring patients' experiences of using IHCAs has been scarce. The aim of this study was to explore cancer patients' perspectives and experiences related to the use of an IHCA called WebChoice in their homes. Qualitative interviews were conducted with infrequent, medium and frequent IHCA users-six women and four men with breast and prostate cancer. The interviews were transcribed and analyzed inspired by interactionistic perspectives. We found that some patients' perceived WebChoice as a "friend," others as a "stranger." Access to WebChoice stimulated particularly high frequency users to position themselves as "information seeking agents," assuming an active patient role. However, to position oneself as an "active patient" was ambiguous and emotional. Feelings of "calmness", "normalization of symptoms", feelings of "being part of a community", feeling "upset" and "vulnerable", as well as "feeling supported" were identified. Interaction with WebChoice implied for some users an increased focus on illness. Our findings indicate that the interaction between patients and an IHCA such as WebChoice occurs in a variety of ways, some of which are ambivalent or conflicting. Particularly for frequent and medium frequency users, it offers support, but may at the same time reinforce an element of uncertainty in their life. Such insights should be taken into consideration in the future development of IHCAs in healthcare in general and in particular for implementation into patients' private sphere. PMID:22582085
Grimsbø, Gro H; Engelsrud, Gunn H; Ruland, Cornelia M; Finset, Arnstein
Interactive Health Communication Applications (IHCAs) are increasingly used in health care. Studies document that IHCAs provide patients with knowledge and social support, enhance self- efficacy and can improve behavioural and clinical outcomes. However, research exploring patients’ experiences of using IHCAs has been scarce. The aim of this study was to explore cancer patients’ perspectives and experiences related to the use of an IHCA called WebChoice in their homes. Qualitative interviews were conducted with infrequent, medium and frequent IHCA users—six women and four men with breast and prostate cancer. The interviews were transcribed and analyzed inspired by interactionistic perspectives. We found that some patients’ perceived WebChoice as a “friend,” others as a “stranger.” Access to WebChoice stimulated particularly high frequency users to position themselves as “information seeking agents,” assuming an active patient role. However, to position oneself as an “active patient” was ambiguous and emotional. Feelings of “calmness”, “normalization of symptoms”, feelings of “being part of a community”, feeling “upset” and “vulnerable”, as well as “feeling supported” were identified. Interaction with WebChoice implied for some users an increased focus on illness. Our findings indicate that the interaction between patients and an IHCA such as WebChoice occurs in a variety of ways, some of which are ambivalent or conflicting. Particularly for frequent and medium frequency users, it offers support, but may at the same time reinforce an element of uncertainty in their life. Such insights should be taken into consideration in the future development of IHCAs in healthcare in general and in particular for implementation into patients’ private sphere.
Grimsb?, Gro H.; Engelsrud, Gunn H.; Ruland, Cornelia M.
BackgroundEffective communication is increasingly recognised as a core clinical skill. However, there is evidence that health and social care professionals still lack basic communication skills.PurposeTo assess the effectiveness of different communication skills training courses for health professionals in cancer care.MethodsWe searched six computerised databases and augmented this with a follow-up of references and grey (unpublished) literature. We included all studies
Marjolein Gysels; Alison Richardson; Irene J. Higginson
This qualitative research explored how cancer patients' writing and reading on the Internet play a role in their illness experience. Focus-group interviews were conducted, with 34 cancer patients participating. A grounded qualitative analysis method was applied to analyze the interview transcripts. The results show that by writing personal blogs, cancer patients reconstructed their life story, expressed their closure of life, and expected to be remembered after death. Reading fellow cancer patients' stories online significantly influenced cancer patients' perceptions and expectations of their own illness prognosis, and that influence was sometimes greater than that of the doctors' influence. PMID:23221492
Chiu, Yu-Chan; Hsieh, Yu-Ling
This article addresses the question of how to improve the informed consent process. The investigators tested a one-day communications course for physicians and research nurses that included lecture and role-play approaches for its ability to improve the quality of informed consent and the satisfaction of patients who enrolled in a randomized clinical trial of adjuvant treatment for breast cancer.
Background: Communication is a key component of palliative care. The area of pediatric palliative care is emotionally distressing for families and healthcare providers. Inadequate communication can increase the stress and lead to mistrust or miscommunication. Materials and Methods: Reviewing the literature on communication between physicians and patients, we identified several barriers to communication such as paternalism in medicine, inadequate training in communication skills, knowledge of the grieving process, special issues related to care of children and cultural barriers. In order to fill the void in area of cultural communication, a study questionnaire was administered to consecutive families of children receiving chemotherapy at a large, north Indian referral hospital to elicit parental views on communication. Results: Most parents had a protective attitude and favored collusion, however, appreciated truthfulness in prognostication and counseling by physicians; though parents expressed dissatisfaction on timing and lack of prior information by counseling team. Conclusion: Training programs in communication skills should teach doctors how to elicit patients’ preferences for information. Systematic training programs with feedback can decrease physicians stress and burnout. More research for understanding a culturally appropriate communication framework is needed.
Abstract Background Shared decision-making has become the standard of care for most medical treatments. However, little is known about physician communication practices in the decision making for unstable critically ill patients with known end-stage disease. Objective To describe communication practices of physicians making treatment decisions for unstable critically ill patients with end-stage cancer, using the framework of shared decision-making. Design Analysis of audiotaped encounters between physicians and a standardized patient, in a high-fidelity simulation scenario, to identify best practice communication behaviors. The simulation depicted a 78-year-old man with metastatic gastric cancer, life-threatening hypoxia, and stable preferences to avoid intensive care unit (ICU) admission and intubation. Blinded coders assessed the encounters for verbal communication behaviors associated with handling emotions and discussion of end-of-life goals. We calculated a score for skill at handling emotions (0–6) and at discussing end of life goals (0–16). Subjects Twenty-seven hospital-based physicians. Results Independent variables included physician demographics and communication behaviors. We used treatment decisions (ICU admission and initiation of palliation) as a proxy for accurate identification of patient preferences. Eight physicians admitted the patient to the ICU, and 16 initiated palliation. Physicians varied, but on average demonstrated low skill at handling emotions (mean, 0.7) and moderate skill at discussing end-of-life goals (mean, 7.4). We found that skill at discussing end-of-life goals was associated with initiation of palliation (p?=?0.04). Conclusions It is possible to analyze the decision making of physicians managing unstable critically ill patients with end-stage cancer using the framework of shared decision-making.
Mohan, Deepika; Alexander, Stewart C.; Garrigues, Sarah K.; Arnold, Robert M.
Physicians seem to underestimate patients’ desire for information and their ability to understand it. Patients perceived obtaining as much information as possible about the trial as an asset rather than a burden. Providing detailed and comprehensive treatment information helps patients make decisions about participating in clinical trials.
Prostate cancer is the most commonly diagnosed cancer among American men. The multiple treatment options for localized prostate cancer and potential side effects can complicate the decision-making process. We describe the level of engagement and communication among the patient, family member, and physician (the decision-making “triad”) in the decision process prior to treatment. Using the Family and Cancer Therapy Selection (FACTS) study baseline survey data, we note racial/ethnic variations in communication among the triad. Sensitivity to and awareness of decision-making styles of both the patient and their family member (or caregiver) may enable clinicians to positively influence communication exchanges about important clinical decisions.
Rim, Sun Hee; Hall, Ingrid J; Fairweather, Megan E; Fedorenko, Catherine R; Ekwueme, Donatus U; Smith, Judith Lee; Thompson, Ian M; Keane, Thomas E; Penson, David F; Moinpour, Carol M; Zeliadt, Steven B; Ramsey, Scott D
Purpose To assess the impact of patient-provider communication on adherence to tamoxifen (TAM) and aromatase inhibitors (AI) 36 months after breast cancer (BC) diagnosis in a low-income population of women. Methods California statewide surveys were conducted among 921 low-income women with BC at 6-, 18-, and 36-months after BC diagnosis. A subset of 303 women with stage I–III BC who initiated hormone treatment after diagnosis was identified. Bivariate and multivariate logistic regression analyses were performed, and adjusted adherence rates were calculated. The main outcome measure was self-reported hormone use at 36 months after BC diagnosis and the chief independent variables were patient-centered communication after diagnosis by patient report as measured by the Consumer Assessment of Healthcare Providers and Systems (CAHPS) and patients’ self-efficacy in patient-physician interactions (PEPPI). Results Overall adherence to TAM/AI was relatively high (88%). Adjusted rates of adherence were 59% and 94% for patients with the lowest vs. highest scores on the CAHPS communication scale (AOR=1.22, P=0.006) and 72% vs. 91% for patients with the lowest and highest rating of PEPPI (AOR=1.04, P=0.04). Having at least one comorbid condition also increased the odds of adherence to hormonal therapy (AOR=3.14, P=0.03). Having no health insurance and experiencing side-effects from hormone treatment were barriers for adherence (AOR=0.12, P=0.001; AOR=0.26, P=0.003, respectively). Conclusions Patient-centered communication and perceived self-efficacy in patient-physician interaction were significantly associated with patient adherence to ongoing TAM/AI therapy among low-income women with BC. Interventions on patient-provider communication may provide opportunities to improve patient outcomes in this vulnerable population.
Liu, Yihang; Malin, Jennifer L.; Diamant, Allison L; Thind, Amardeep; Maly, Rose C
The purpose of this article is to analyze the nonverbal communication of the participants in a group of bowel cancer ostomy bearers. The type of the investigation was exploratory and observational. The investigation was carried out in a Teaching Hospital. The population was composed by 5 persons, bearing ostomy due to bowel cancer. There were 5 meetings in October and November of 2001. Data was gathered through video recording and field notes. Among the findings we remark the room small size forced the participants to maintain a very close distance that led in difficulties for their spontaneous expression. This article clarifies that the reading of the nonverbal communication enabled the understanding the universe of the investigated persons. PMID:14692274
Paegle, Silene Oliveira; da Silva, Maria Júlia Paes
ObjectiveCoaching patients to be more active in health encounters may improve communication with physicians but does not necessarily improve health outcomes. We explored this discrepancy by examining relationships between self-efficacy for communicating with physicians and pain control self-efficacy and subsequent pain severity among cancer patients participating in a coaching trial.
Anthony Jerant; Peter Franks; Richard L. Kravitz
The purpose of this study was to evaluate ambulatory cancer patients' knowledge of their diagnosis and stage, their expectations of medical and nursing staff, and issues related to communication with the professional staff. A structured interview was conducted with each of 103 consecutive cancer patients attending the Oncology Day Hospital of the Shaare Zedek Medical Center. There were 77 women
Rama Sapir; Raphael Catane; Bella Kaufman; Ruti Isacson; Amiel Segal; Simon Wein; Nathan I. Cherny
A case-control study of quality of life in patients with lung cancer was carried out. The investigation was conducted by means of a series of interviewer-administered instruments. As part of the study, patients' attitudes towards the interviewer-administered questionnaires were studied. Previously we reported that a high proportion of the patients found being interviewed acceptable. The present study firstly examines why
Ali Montazeri; Robert Milroy; Charles R. Gillis; James McEwen
Communication is an important component of patient care. Traditionally, communication in medical school curricula was incorporated informally as part of rounds and faculty feedback, but without a specific or intense focus on skills of communicating per se. The reliability and consistency of this teaching method left gaps, which are currently getting increased attention from medical schools and accreditation organizations. There is also increased interest in researching patient-doctor communication and recognizing the need to teach and measure this specific clinical skill. In 1999, the Accreditation of Council for Graduate Medical Education implemented a requirement for accreditation for residency programs that focuses on "interpersonal and communications skills that result in effective information exchange and teaming with patients, their families, and other health professionals." The National Board of Medical Examiners, Federation of State Medical Boards. and the Educational Commission for Foreign Medical Graduates have proposed an examination between the. third and fourth year of medical school that "requires students to demonstrate they can gather information from patients, perform a physical examination, and communicate their findings to patients and colleagues" using standardized patients. One's efficiency and effectiveness in communication can be improved through training, but it is unlikely that any future advances will negate the need and value of compassionate and empathetic two-way communication between clinician and patient. The published literature also expresses belief in the essential role of communication. "It has long been recognized that difficulties in the effective delivery of health care can arise from problems in communication between patient and provider rather than from any failing in the technical aspects of medical care. Improvements in provider-patient communication can have beneficial effects on health outcomes". A systematic review of randomized clinical trials and analytic studies of physician-patient communication confirmed a positive influence of quality communication on health outcomes. Continuing research in this arena is important. For a successful and humanistic encounter at an office visit, one needs to be sure that the patient's key concerns have been directly and specifically solicited and addressed. To be effective, the clinician must gain an understanding of the patient's perspective on his or her illness. Patient concerns can be wide ranging, including fear of death, mutilation, disability; ominous attribution to pain symptoms; distrust of the medical profession; concern about loss of wholeness, role, status, or independence; denial of reality of medical problems; grief; fear of leaving home; and other uniquely personal issues. Patient values, cultures, and preferences need to be explored. Gender is another element that needs to be taken into consideration. Ensuring key issues are verbalized openly is fundamental to effective patient-doctor communication. The clinician should be careful not to be judgmental or scolding because this may rapidly close down communication. Sometimes the patient gains therapeutic benefit just from venting concerns in a safe environment with a caring clinician. Appropriate reassurance or pragmatic suggestions to help with problem solving and setting up a structured plan of action may be an important part of the patient care that is required. Counseling around unhealthy or risky behaviors is an important communication skill that should be part of health care visits. Understanding the psychology of behavioral change and establishing a systematic framework for such interventions, which includes the five As of patient counseling (assess, advise, agree, assist, and arrange) are steps toward ensuring effective patient-doctor communication. Historically in medicine, there was a paternalistic approach to deciding what should be done for a patient: the physician knew best and the patient accepted the recommendation without question.
Background The use of tobacco is known to increase the incidence of developing oral cancer by 6 times, while the additive effect of drinking alcohol further increases the risk leading to higher rate of morbidity and mortality. In this short communication, we prospectively assessed the effect of tobacco smoking and alcohol drinking in oral cancer patients on the overall mortality from the disease, as well as the effect of smoking and drinking reduction/cessation at time of diagnosis on mortality in the same group. Materials and methods A cohort, involved 67 male patients who were diagnosed with oral squamous cell carcinoma, was included in this study. The smoking and drinking habits of this group were recorded, in addition to reduction/cessation after diagnosis with the disease. Comparisons were made to disease mortality at 3 and 5 years. Results Follow-up resulted in a 3-year survival of 46.8% and a 5-year survival of 40.4%. Reduction of tobacco smoking and smoking cessation led to a significant reduction in mortality at 3 (P < 0.001) and 5 (P < 0.001) years. Reduction in drinking alcohol and drinking cessation led to a significant reduction in mortality at 3 (P < 0.001) and 5 (P < 0.001) years. Conclusion Chronic smoking and drinking does have an adverse effect on patients with oral cancer leading to increased mortality from cancer-related causes. Reduction/cessation of these habits tends to significantly reduce mortality in this group of patients. Smoking and drinking cessation counseling should be provided to all newly diagnosed oral cancer patients.
Many women who have, or are at risk for, BRCA 1/2 mutations or breast cancer decline prophylactic surgery, but questions remain as to how they make and experience these decisions. Our methods consisted of interviewing 32 women for 2 hr each; 19 were tested, 20 were symptomatic. Our results showed that these surgical options forced women to confront questions, involving stresses and uncertainties, regarding: implications of test results, prognoses with and without surgery, and effects of surgery (e.g., on self-image). Given these dilemmas, many women turned to doctors who then ranged in what and how they communicated about these issues, and how strongly they offered input. Some patients felt disappointed at provider non-directiveness, while others found providers too directive. Patients turned to family members and friends, who also ranged in how and what they communicated, and whether they agreed with the patient and/or each other. Many women turned to patient communities, but then had to decide how involved to be, and what information to provide or accept. These data suggest that providers and others may need to be more aware of the series of questions, involving stresses and uncertainties, that these women face, and the complex roles providers themselves may play. These data highlight needs for physicians to be able to address these issues flexibly, gauging patient preferences for information and paternalism (vs. autonomy). These data suggest areas for future research: for example, on how providers decide whether, what and how to communicate about these issues, and how these choices shape treatment decisions.
Klitzman, Robert; Chung, Wendy
The authors developed a communication skills training module for health professionals who work with professional translators in interviewing patients. The module combines didactic presentation of information and group role-play exercises in which trained medical interpreters help trainees communicate with bilingual patients. The module stresses communication strategies, including optimal seating arrangements that strengthen the clinician-patient relationship and de-emphasize interpreter-patient and interpreter-clinician interactions.
Patients' satisfaction is a paramount in the delivery of health care provisions, particularly in patients with poor prognosis. Effective communication with such patients helps in achieving a better satisfaction score. A survey was conducted on upper gastrointestinal cancer patients to assess their perceived satisfaction regarding the healthcare received. A frank but supportive communication helps in meeting the expectations of these patients in their cancer journey. PMID:23374529
Jafferbhoy, Sadaf; Tappenden, Janine; Allen, Tracey; Shiwani, Muhammad Hanif
In this chapter the "communication compass" is introduced. It defines the key elements of communication and provides a language with which to communicate about communication in cancer care. The communication compass consists of two axes. One axis defines the associated perspectives of the clinician and the patient, the other axis the content of information and emotional experience. "Two lovers sat on a park bench with their bodies touching each other, holding hands in the moonlight. There was silence between them. So profound was their love for each other, they needed no words to express it." (Samuel Johnson). Sometimes communication just flows. There are these special moments, as fleeting as they are intense. Often communication is stuck. It is as if we speak another language and never manage to understand one another. The lovers on the park bench need no words to express what they feel, neither do they need words to speak about communication. Where communication gets stuck, we need a suitable language to speak about communication. Professional communication cannot be learned from a cookbook. Most of all it implies a readiness to communicate, which means openness to the other. The old adage that it is impossible not to communicate is only true if no criterion of quality is applied. As soon as some mutual understanding is implied in the definition of communication, the fact that it is at all possible to communicate becomes a miracle. Since there is an important gap between theory and practice, we created a tool that aims to bridge that gap. We call it the communication compass. It does not propose a model of "ideal communication," but provides a language with which to examine and analyze specific situations and to determine what the pitfalls and possibilities are. It is useful as a tool for identifying communicational difficulties in daily clinical practice and it can serve as a model for training basic communication skills. PMID:17073187
Maex, E; De Valck, C
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Previous research suggests that caregivers and terminally ill patients face substantial difficulties discussing illness and death. Existing research, however, has focused primarily on the experience of patients. The current study compared responses as well as the relative strength of association between mortality communication, fear of death, and…
Bachner, Yaacov G.; O'Rourke, Norm; Carmel, Sara
Community awareness of the goals and benefits of the NCCCP pilot is critical to its success. The Communications Subcommittee works with public affairs and communications representatives from the 16 participating hospitals to educate pilot communities about the local availability of the latest evidence-based cancer care and the importance of patient participation in cancer research.
Communication within oncology is a core clinical skill but one in which few oncologists or specialist cancer nurses have received much formal training. Inadequate communication may cause much distress for patients and their families, who often want considerably more information than is usually provided. Many patients leave consultations unsure about the diagnosis and prognosis, confused about the meaning of—and need
L Fallowfield; V Jenkins
Background: Low rates of colorectal cancer (CRC) screening persist due to individual, provider, and system level barriers. Purpose: To develop and obtain initial feedback about a CRC screening educational video from community members and medical professionals. Methods: Focus groups of patients were conducted prior to the development of the CRC…
Katz, Mira L.; Heaner, Sarah; Reiter, Paul; van Putten, Julie; Murray, Lee; McDougle, Leon; Cegala, Donald J.; Post, Douglas; David, Prabu; Slater, Michael; Paskett, Electra D.
Three levels of deafness exist: persons who are born deaf, persons who lost hearing after speech was acquired, and persons with sudden deafness. Nurses need to find methods to communicate with the patient, and not the family in lieu of the patient. Props, audio-visual aids, gestures, and written information should be used. PMID:7800759
A cancer diagnosis does not prevent smoking among pediatric oncology patients, and anti-smoking communications among parents and health care providers have been proposed as influencing smoking outcomes in this group. Anti-smoking communications were compared among 93 preadolescents with cancer and 402 controls. After adjusting for demographics and covariates, preadolescents with cancer were less likely than control participants to report receipt
Leslee Throckmorton-Belzer; Vida L. Tyc; Leslie A. Robinson; James L. Klosky; Shelly Lensing; Andrea K. Booth
Regular screening for colorectal cancer (CRC) facilitates earlier detection, lowers mortality, and may reduce incidence through detection and removal of pre-cancerous polyps. Optimizing health professional delivery of CRC screening information and recommendations can assist in reducing CRC disparity in the African-American community. This article presents qualitative data on African Americans' attitudes about health professional CRC communications based on the analysis of focus groups (N = 79). Using a social-ecological framework, colorectal cancer and professional communication themes are examined to offer four general and nine cancer-specific theoretically based and culturally appropriate strategies for improving health professional cancer communication with African Americans. PMID:25050658
Caito, Nikki; Hood, Sula; Thompson, Vetta L Sanders
The quality of physician-patient communication affects important health care outcomes. Managed care presents a number of challenges to physician-patient communication, including shorter visits, decreased continuity, and lower levels of trust. Good communication skills can help physicians create and maintain healthy relationships with patients in the face of these challenges. We describe 5 communication dilemmas that are common in managed care and review possible solutions suggested by recent literature on physician-patient communication. We also describe ways that managed care plans can promote more effective communication between physicians and patients.
Gordon, G H; Baker, L; Levinson, W
The objective of this paper is first to describe the different strategies used to communicate risks to patients in the field of cancer or genetics, to review their effectiveness, and to summarise the state of the art of this practice in particular, in cancer genetics. The target audience is health care professionals involved in the communication of cancer risks, and
Claire Julian-Reynier; Myriam Welkenhuysen; Lea Hagoel; Marleen Decruyenaere; Penelope Hopwood
Cancer patients report significant levels of unmet needs in the realm of communication. Communication skills training programs\\u000a have been shown to improve clinical communication. However, advanced communication skills training programs in oncology have\\u000a lacked institutional integration, and thus have not attended to institutional norms and cultures that may counteract explicit\\u000a communication skills training. We developed and implemented an advanced communication
Carma L. Bylund; Richard F. Brown; Philip A. Bialer; Tomer T. Levin; Barbara Lubrano di Ciccone; David W. Kissane
A microscopic analysis of doctor-patient communication in the general practitioner's surgery is presented. Verbatim transcripts of 85 medical interviews, audiotaped in a natural situation were analysed. The effects of type of complaint, patient gender and physician gender on the process of verbal communication were assessed. This study focused upon the relational aspects of communication, using Stiles' Verbal Response Mode coding
Ludwien Meeuwesen; Cas Schaap; Cees van der Staak
Skip to content The National Cancer Institute www.cancer.gov The National Institutes of Health AccrualNetTM STRATEGIES, TOOLS AND RESOURCES TO SUPPORT ACCRUAL TO CLINICAL TRIALS User menu Register Sign In Search form Search Main menu Protocol Accrual
Skip to content The National Cancer Institute www.cancer.gov The National Institutes of Health AccrualNetTM STRATEGIES, TOOLS AND RESOURCES TO SUPPORT ACCRUAL TO CLINICAL TRIALS User menu Register Sign In Search form Search Main menu Protocol Accrual
In Japan, the number of patients with cancer is increasing drastically with the increase in number of elderly people. Therefore, recently, the necessity of rehabilitation for cancer patients has been realized. Cancer rehabilitation can be classified as preventive, restorative, supportive, or palliative and is administered according to the degree of cancer progression. Rehabilitation is of great significance even for patients with progressive cancer as it helps maintain their quality of life. Various forms of impairment, disability, and handicap are associated with cancer rehabilitation. Examples of impairments that cancer patients experience are hemiplegia and higher brain dysfunction in brain tumor cases, paraplegia and quadriplegia in spinal or spinal cord tumor cases, neuropathy and radiculopathy in cases of tumor invasion, complications after surgery, peripheral neuropathy after chemotherapy, and dysphagia after radiotherapy. It is important to evaluate these impairments and the risks associated with rehabilitation. PMID:24047769
The transformation of healthcare from a seller’s market to a consumer’s market has pushed the element of patient satisfaction into the forefront of various medical facility evaluation tools, including those used by Medicare when weighing reimbursement to hospitals for patient care. Research has identified good communication skills to be a key factor in ensuring better patient outcomes, and nurturing patient satisfaction. Because of the growing amount of money at stake for patients’ satisfaction with a facility, the communication skills of individual healthcare providers are bound to impact their employees' reimbursement, bonuses, and promotion options. Although the dangers of “poor communication,” are evident: “poor communication” is a primary reason for filing a law suit in >80% of cases (Avery, 1985). Identifying the characteristics of “good communication” has been difficult. One factor that adds to the confusion is that research has found some long accepted codes of professional communication protocol to actually be counterproductive. Another factor that adds to the uncertainty is that accurate interpretations of some communication events are counterintuitive. Fortunately it has been possible to extract observable, proven, and teachable “good communication” behaviors from large-scale trials in the radiology department. The resultant Comfort Talk™ approach to communication includes rapid rapport techniques, patient-centered talking styles, and use of hypnotic language. This article overviews some of the Comfort Talk™ approaches to patients interaction and provides operational summaries of a sampling of specific Comfort Talk™ communication techniques, which nurses, technologists, and other healthcare workers can implement in their own practices.
Lang, Elvira V.
Communication disorders following stroke are common, but have varied presentations. This article explains the range of communication disorders that can occur after stroke. The effect of communication impairment is not always related to its severity and should be considered in terms of its effects on patient relationships and wellbeing, and healthcare delivery. Speech and language therapists have a key role in assessing, planning and delivering interventions for patients with communication impairment following stroke. However, it is vital that all members of the multidisciplinary team have sufficient awareness to recognise potential communication difficulties. It is hoped that with increased knowledge and awareness of communication impairment, healthcare staff can make full use of their skills as effective communicators to overcome any potential barriers to communication. PMID:22356064
While the importance of intrafamilial communication of hereditary cancer risk has been acknowledged, the factors that promote and act as barriers to patients disclosing their information to their families are complex and emerging. This raises the question: How are patients guided in practice to contemplate intrafamilial communication? Focusing on breast cancer, we conducted an exploratory study examining current resources supporting patients and health-care professionals, and isolated the messages surrounding intrafamilial communication of cancer risk. We find the duty for health-care professionals to counsel patients regarding intrafamilial communication is acknowledged to varying degrees by multiple actors in the cancer care delivery landscape, including health-care professional associations, health service organizations, and patient groups. A range of medical, psychosocial, and other factors underlying intrafamilial communication are acknowledged in messages to patients. Patients, however, are often referred to a single group of health-care professionals to discuss their diverse and complex needs. At the same time, messages aimed at patients appear to place the emphasis on barriers that could exist for patients contemplating intrafamilial communication, while highlighting the benefits families derive from such communication. Taken together, this points to a lack of coherence within materials directed to patients and suggests the need to do coordinated research among stakeholders to address two related issues: (1) determining who are the actors best positioned to send messages surrounding intrafamilial communication to patients and (2) addressing the content of messages conveyed in patient materials. PMID:23340514
McClellan, Kelly A; Kleiderman, Erika; Black, Lee; Bouchard, Karine; Dorval, Michel; Simard, Jacques; Knoppers, Bartha M; Avard, Denise
This article presents a conceptual model of factors affecting patient decisions about participating in clinical trials and describes videotaping methods for observing interactions between patients, physicians, and family members. Preliminary findings suggest that awareness of the camera during videotaped conversations does not significantly alter the behavior of participants. Further study of this model and methodology may produce results that can be incorporated into provider training.
Purpose/Objectives: To identify and describe communication behaviors used by hospice nurses when eliciting and addressing concerns of patients with cancer and their caregivers.Design: Secondary analysis.Setting: Home hospice in Salt Lake City, UT.Sample: Audio recordings from seven patient and caregiver dyads and five hospice nurses.Methods: Audio recordings were coded using the Roter Interaction Analysis System for patient and caregiver concern statements indicating negative affect and distress and the surrounding nurse communication behaviors. Concern content was categorized using domains developed by the National Consensus Project for Quality Palliative Care.Main Research Variables: Patient and caregiver concern statements and nurse communication behaviors.Findings: 180 patient and caregiver speaking turns containing concerns were identified across 31 hospice visits. Patients and caregivers expressed at least one concern in the vast majority of visits. The most prevalent distress areas reflected psychological and physical issues. Nurses used proportionally more positive emotion statements before patient and caregiver concerns, compared to the visit overall. Nurses asked proportionally more physical questions after concern statements. Nurses also used more emotional responses before and after patient and caregiver concerns, relative to the entire visit.Conclusions: Patients with cancer and caregivers frequently talk about distressing issues. Hospice nurses use specific communication behaviors to elicit and address those issues.Implications for Nursing: Home hospice provides a venue to examine nurse communication behaviors used to elicit and respond to patient and caregiver distress. These strategies could be taught to nurses who encounter patient distress less frequently or are less comfortable with emotional conversations. PMID:24769595
Clayton, Margaret F; Reblin, Maija; Carlisle, McKenzie; Ellington, Lee
Rehabilitation for cancer patients aims at reducing the impact of disabling and limiting conditions resulting from cancer and its treatment in order to enable patients to regain social integration and participation. Given current trends in cancer incidence and survival along with progress in medical treatment, cancer rehabilitation is becoming increasingly important in contemporary healthcare. Although not without limitations, the International Classification of Functioning, Disability, and Health (ICF) provides a valuable perspective for cancer rehabilitation in understanding impairments in functioning and activity as the result of an interaction between a health condition and contextual factors. The structure of cancer rehabilitation varies across countries as a function of their health care systems and social security legislations, although there is a broad consensus with respect to its principal goals. Cancer rehabilitation requires a careful assessment of the individual patient's rehabilitation needs and a multidisciplinary team of health professionals. A variety of rehabilitation interventions exist, including psycho-oncological and psycho-educational approaches. Research on the effectiveness of cancer rehabilitation provides evidence of improvements in relevant outcome parameters, but faces some methodological challenges as well. PMID:24305771
Weis, Joachim; Giesler, Jürgen M
Four audiovisual programs about cancer and cancer treatment were evaluated. Cancer patients, their families, and friends were asked to complete questionnaires before and after watching a program to determine the effects of the program on their knowledge of cancer, anxiety levels, and perceived ability to communicate with the staff. (Author/MLW)
Cassileth, Barrie R.; And Others
Quantifying cancer patient survival from the perspective of cure is clinically relevant. However, most cure models estimate cure assuming no competing causes of death. We use a relative survival framework to demonstrate how flexible parametric cure models can be used in combination with competing-risks theory to incorporate noncancer deaths. Under a model that incorporates statistical cure, we present the probabilities that cancer patients (1) have died from their cancer, (2) have died from other causes, (3) will eventually die from their cancer, or (4) will eventually die from other causes, all as a function of time since diagnosis. We further demonstrate how conditional probabilities can be used to update the prognosis among survivors (eg, at 1 or 5 years after diagnosis) by summarizing the proportion of patients who will not die from their cancer. The proposed method is applied to Swedish population-based data for persons diagnosed with melanoma, colon cancer, or acute myeloid leukemia between 1973 and 2007. PMID:25036430
Eloranta, Sandra; Lambert, Paul C; Andersson, Therese M-L; Björkholm, Magnus; Dickman, Paul W
This is a pathfinding study to identify problems which interfere in communication between doctor and patient. This was accomplished by interview techniques including: tape recording of actual clinical interviews, questionnaires, and post consultation disc...
Purpose Migrants with cancer struggle to communicate with their health care team. This study aimed to identify health-care related\\u000a unmet needs and communication issues for migrants who develop cancer and factors associated with these challenges. In this\\u000a paper, the findings related to communication issues are presented.\\u000a \\u000a \\u000a \\u000a \\u000a Patients and methods Seventy-three cancer patients diagnosed within the previous 3 years and 18 carers, who had
Phyllis N. Butow; Ming Sze; Priya Dugal-Beri; Michelle Mikhail; Maurice Eisenbruch; Michael Jefford; Penelope Schofield; Afaf Girgis; Madeleine King; David Goldstein
Adjuvant endocrine therapy improves overall survival for women with breast cancer. However, side effects may compromise patients' quality of life (QOL). This study examined how two communication variables (self-efficacy for symptom communication [SE] and holding back from discussing cancer-related concerns [HB]) relate to QOL, pain and menopausal symptoms. Participants with breast cancer (N = 61) completed questionnaires regarding symptoms, communication, and QOL. SE was positively related to QOL and negatively related to pain interference. HB from discussing cancer-related concerns was related negatively to QOL and positively to pain interference. HB mediated the relationship between SE and QOL as well as between SE and pain interference. Increased SE is beneficial among women on endocrine therapy for breast cancer. Future research should determine if interventions to improve SE are feasible and can improve QOL and symptom tolerability. PMID:24175903
Edmond, Sara N; Shelby, Rebecca A; Kimmick, Gretchen G; Marcom, Paul K; Peppercorn, Jeffrey M; Keefe, Francis J
Patient-centeredness is increasingly being recognized as a critical indicator of high-quality health care delivery. Although several definitions of patient-centeredness have been proposed in the literature, two attributes are considered central to the delivery of patient-centered care. These attributes are being responsive to patient needs and incorporating the patient's perspective and experiences in care planning and decision-making.
Cancer patients are at increased risk for stroke from direct and indirect effects of their malignancy. Some tumors are at\\u000a high risk for cerebrovascular complications. Certain stroke mechanisms are specific to cancer, such as compression and occlusion\\u000a of cerebral vessels by tumor, coagulopathy predisposing to hemorrhage and thrombosis, and treatment-related atherosclerosis.\\u000a Special consideration for these mechanisms needs to be made
Teri Nguyen; Lisa M. DeAngelis
Communication can be seen as the main ingredient in medical care. In reviewing doctor-patient communication, the following topics are addressed: (1) different purposes of medical communication; (2) analysis of doctor-patient communication; (3) specific communicative behaviors; (4) the influence of communicative behaviors on patient outcomes; and (5) concluding remarks.Three different purposes of communication are identified, namely: (a) creating a good inter-personal
L. M. L. Ong; A. M. Hoos; F. B. Lammes
An increasing number of older people are treated for cancer. Several factors, such as comorbidity and sensory deficits, occur more frequently in older patients than in younger patients. In addition, their life circumstances, values, and preferences may differ. These factors ask for tailored nurse-older patient communication. This article reviews recent literature on the specific needs of older patients with cancer
Jesse Jansen; Weert van J. C. M; Dulmen van A. M; Thea Heeren; Jozien Bensing
Background Optimal patient decision making requires integration of patient values, goals, and preferences with information received from the physician. In the case of life-threatening illness such as cancer, the weights placed on quality of life (QOL) and length of life (LOL) represent critical values. The objective of this study is to describe cancer patient values regarding QOL and LOL, and explore associations with communication preferences. Methods Patients with advanced cancer completed a computer-based survey prior to the initial consultation with a medical oncologist. Assessments included sociodemographics, physical and mental health state, values regarding quality and length of life, communication preferences and cancer-related distress. Results Seven hundred forty three advanced cancer patients were enrolled. Among 459 advanced cancer patients, fifty-five percent of patients equally valued QOL and LOL, 27% preferred QOL, and 18% preferred LOL. Patients with a QOL preference had lower levels of cancer-related distress (p < 0.001). QOL preference was associated with older age (p = 0.001), male gender (p = 0.003), and higher education (p = 0.062). Patients who preferred LOL over QOL desired a more supportive and less pessimistic communication style from their oncologists. Conclusions These data indicate that a values preference for length vs. quality of life may be simply measured, and is associated with wishes regarding the nature of oncologist communication. Awareness of these values during the clinical encounter could improve decision making by influencing the style and content of the communication between oncologists and their patients.
Meropol, Neal J.; Egleston, Brian L.; Buzaglo, Joanne S.; Benson, Al B.; Cegala, Donald J.; Diefenbach, Michael A.; Fleisher, Linda; Miller, Suzanne M.; Sulmasy, Daniel P.; Weinfurt, Kevin P.
Purpose Most cataract surgery is now performed under local anaesthesia on a day-case basis. As patients are fully conscious during the procedure, it is important that they remain still. There are a variety of reasons why patients may need to move, and it is important that the surgeon is made aware that this may happen. Some centres offer a nurse's
A Mokashi; B Leatherbarrow; J Kincey; R Slater; V Hillier; S Mayer
A critical mass of Internet users is leading to a wide diffusion of electronic communications within medical practice. Unless implemented with substantial forethought, these new technological linkages could disturb delicate balances in the doctor-patient relationship, threaten the privacy of medical information, widen social disparity in health outcomes, and even function as barriers to access. The American Medical Informatics Association (AMIA) recently published recommendations to guide computer-based communications between clinicians and patients. This paper describes the motivations for and the design of HealthConnect, a web-based patient-doctor communications tool currently in use at Children's Hospital, Boston. Structural and process-oriented features of HealthConnect, as they relate to promotion of adherence with the Guidelines, are discussed. Images Figure 1 Figure 2 Figure 3
Mandl, K. D.; Kohane, I. S.
Thrombocytopenia is a frequent complication of cancer and its treatment. The causes of thrombocytopenia in cancer patients can be diverse and multifactorial. Systemic chemotherapy is the most frequent cause of thrombocytopenia. The degree and duration thrombocytopenia depends upon whether the chemotherapeutic treatment is myeloablative, as used in stem cell transplants, or non-myeloablative, as typically used in solid non-hematologic malignancies. Additional causes of significant thrombocytopenia include tumor involvement of bone marrow and spleen; microangiopathic disorders such as disseminated intravascular coagulation, thrombotic thrombocytopenic purpura or hemolytic uremia syndrome. Lymphoproliferative malignancies can also be associated with secondary immune thrombocytopenia. Due to the broad differential diagnosis associated with cancer related thrombocytopenia, a careful diagnostic evaluation is indicated. The goal of treatment should be to maintain a safe platelet count to allow effective treatment of the underlying malignancy, prevent bleeding complications and to minimize the use of platelet product transfusion. PMID:24862148
Liebman, Howard A
By progression of the disease, motor neurons degenerate in patients with amyotrophic lateral sclerosis (ALS) eventually lose nearly all voluntary muscles in the body. They are awake and aware but cannot move or communicate (locked-in state). Since the function of the brain is preserved, one possible measure to support their communication is to interpret their motor intention by decoding (deciphering) brain signals and present it with external devices. This technology called "brain-machine interface (BMI)" is now close to clinical use in Japan and USA.In our system, we record electrocorticogram (ECoG) obtained with subudural electrodes during their motor imagery, decode it and determine the movement they intended. So far, one patient of ALS with severe paralysis, implanted with this electrodes, successfully operated the PC communication tool only by thinking. PMID:24292005
Yoshimine, Toshiki; Yanagisawa, Takufumi; Sawada, Jin-Ichi; Hazama, Takanori; Mochizuki, Hideki; Hirata, Masayuki
The report presents data on communicative disorders among patients in Veterans Administration health care facilities. The data for the report were collected in the 1981 Annual Patient Census and focus on the impact of patients' communicative disorders upo...
The guide is designed for physicians and other medical practitioners who need to work with medical interpreters to improve communication with patients. Special attention is given to the Australian context. An introductory section discusses the need for medical interpreters and explains the guide's organization. Subsequent sections address these…
Accurate and sensitive communication of cancer-risk information is important. Based on a literature review of 75 research reports, expert opinion papers, and clinical protocols, a synthesis of what is known about the communication of cancer-risk information is presented. Relevance of information to those not tested is discussed. (Author/EMK)
Bottorff, Joan L.; Ratner, Pamela A.; Johnson, Joy L.; Lovato, Chris Y.; Joab, S. Amanda
Objective. To explore patient perceptions of patient-provider communication after an actual adverse medical event because prior patient error studies are rarely based on real situations. Design. We conducted four patient focus groups using a semi-structured guide. We analyzed transcripts using an editing approach to identify themes. Setting. Three sites in Colorado. Study participants. Participants were recruited from statewide post-injury program.
CHRISTINE W. DUCLOS; MARY EICHLER; LESLIE TAYLOR; JAVAN QUINTELA; DEBORAH S. MAIN; WILSON PACE; ELIZABETH W. STATON
Complete and continuous documentation in patient records is an important condition for adequate communication with patients, between the professions concerned and to ensure the quality of the following working steps in care provision. Part of a German research project concerning the interprofessional communication in hospital was therefore to analyse the use of the documentation system. 54 users were asked about practical aspects of their documentation system and 450 patient records were evaluated. The analysis focused on the medical and nursing documentation of admission, process and discharge. Deficits that need to be improved appeared first of all in the practical aspects of the documentation system, the flow of information between the professions, in specific gaps of medical and nursing admission, documentation of process and discharge. Quality management is asked to improve and develop the documentation in collaboration with the users and to consider specific problems when introducing computer based records. PMID:15283085
Klapper, B; Lecher, S; Schaeffer, D; Koch, U
Political, legal, ethical, social, economic, and technological changes in the twentieth century have produced a profound effect on the health care and health status of Americans and the way in which physicians and patients communicate. In the latter half of this century, the responsibility for individual health care has shifted from a physician-oriented, paternalistic approach to a patient-centered one. Patients now assume two identities: health consumers and active participants in the medical decision-making process. This phenomenon has created an environment where consumer demand for information has shifted from a single focus on symptoms, diagnosis, and treatment of diseases to an increasing preoccupation with cost, quality, and access to health care. This shift emphasizes the critical role played by medical librarians in the dissemination of needed information, and it challenges librarians to take a leadership role in opening newer channels of communication between physicians and patients. The 1992 Janet Doe Lecture analyzes the evolutionary change in the physician-patient relationship and its modes of communication, projects future roles for medical librarians, and provides an extensive list of references for further reading.
Rees, A M
Cancer patients receive rehabilitation services in acute hospitalizations, rehabilitation wards, outpatient rehabilitation facilities, and home settings. Given the complexity and acuity of their medical care coupled with the long-term effects of the cancer and its treatments, patient safety is a significant concern in the delivery of rehabilitation services for this population. Cancer survivorship is growing in importance as a significant number of adults and children diagnosed with cancer are surviving beyond the 5-year mark. The goal of this article is to provide an overview to rehabilitation clinicians on the topic of patient safety in the rehabilitation of cancer patients. PMID:22537705
Cristian, Adrian; Tran, Andy; Patel, Karishma
Physicians' ability to effectively and compassionately communicate information is key to a successful patient-physician relationship. The current health care environment demands increasing clinical productivity and affords less time with each patient, which can impede effective patient-physician communication. The use of patient-centered interviewing, caring communication skills, and shared decision making improves patient-physician communication. Involving advanced practice nurses or physician assistants may improve the patient's experience and understanding of her visit. Electronic communication with established patients also can enhance the patient experience in select situations. PMID:24451677
BACKGROUND: Cancer health disparities affecting low-income and minority patients are well documented. Root-causes are multifactorial, including diagnostic and treatment delays, social and financial barriers, and poor communication. Patient navigation and communication coaching (activation) are potential interventions to address disparities in cancer treatment. The purpose of this clinical trial is to test the effectiveness of an intervention combining patient navigation and
Samantha Hendren; Jennifer J Griggs; Ronald M Epstein; Sharon Humiston; Sally Rousseau; Pascal Jean-Pierre; Jennifer Carroll; Amanat M Yosha; Starlene Loader; Kevin Fiscella
In an ever more burdened healthcare system, there is an urgent need to investigate whether patients benefit from the resources allocated to nurses' communication skills training in terms of improved patient outcomes. This study aimed to evaluate a standardized two 2-day (33 hours) communication skills training program in nursing cancer care. Twenty-four nurses in an oncology outpatient clinic participated and were randomly assigned to the intervention program or a control group. A total of 413 patients treated in the clinic during 2 recruitment periods (before and after the communication skills training) completed a questionnaire package assessing the nurse-patient relationship, psychological well-being, and cancer-related self-efficacy. Nurse group differences in change scores between time points (baseline, 1 week, and 3 months after the communication skills training) on measures related to communication and work-related stress were all nonsignificant. Time-by-group analyses of patient data showed no training effect on patient perception of nurse empathy and attentiveness, and we found no training effect on patients' anxious/depressed, angry, or positive mood, as well as no effect on cancer-related self-efficacy. The results were unable to support the hypotheses that nurse communication skills training would be associated with improved nurse and patient outcomes. PMID:19104193
Rask, Mette Trøllund; Jensen, Mette Lund; Andersen, Jørn; Zachariae, Robert
A major focus in the literature about doctor-patient communication is information-giving. In the case of cancer patients, one significant issue is which factors determine whether and how, general practitioners and oncologists give information to their patients. Whatever may be the content of information, the most important choice for the doctor is to give information or not. Our research group at
Jesús Rodríguez-Marín; Sofía López-Roig; María A. Pastor
The goal of this project was to develop educational materials to communicate gene- tic health information in a culturally sensi- tive manner. These materials were designed to communicate information about cancer risk, genetic testing options, and health management options in an African American kindred with a known BRCA1 mutation. Educational materials were pilot-tested in four African American focus groups varying
Bonnie Jeanne Baty; Anita Yeomans Kinney; Sara Marie Ellis
From 1981 through 1990, 21 urologic cancer cases were discovered in 21 uremic patients at our hospital. This constituted 55% (11 of 20) of the total malignancies in nondialyzed uremic patients, 41% (nine of 22) of the total in chronic hemodialysis patients, and 50% (one of two) of those in patients on continuous ambulatory peritoneal dialysis. No cases of urologic
Kuo-Su Chen; Ming-Kuen Lai; Chiu-Ching Huang; Sheng-Hsien Chu; Mei-Ling Leu
Pancreatic cancer marked significant increase of incidence during the last decades in the elderly population. Despite the certain increase of incidence there are no international guidelines for elderly patients who are suffering from pancreatic cancer. During the ASCO Annual Meeting 2014, two abstracts focusing on elderly patients suffering from different histological types of pancreatic cancer were presented. The first retrospective study (Abstract #4119) showed the benefit of the systemic treatment on overall survival for elderly patients with stage IV pancreatic adenocarcinoma. The second retrospective study (Abstract #4112) demonstrates the positive effect of somatostatin analogue (octreotide-LAR) treatment on overall survival for elderly patients with neuroendocrine pancreatic carcinoma. PMID:25076333
Kougioumtzopoulou, Andromachi S; Syrigos, Kostas N; Saif, Muhammad Wasif
In September 2010, the American Cancer Society and National Cancer Institute convened a conference to review current issues in DCIS risk communication and decision-making and to identify directions for future research. Specific topics included patient and healthcare provider knowledge and attitudes about DCIS and its treatment, how to explain DCIS to patients given the heterogeneity of the disease, consideration of nomenclature changes, and the utility of decision tools/aids. This report describes the proceedings of the workshop in the context of the current literature and discusses future directions. Evidence suggests that there is lack of clarity about the implications and risks of a diagnosis of DCIS, among patients, providers and researchers. Research is needed to understand better the biology and mechanisms of the progression of DCIS to invasive breast cancer and the factors which predict those subtypes of DCIS which do not progress, as well as efforts to improve communication and informed decision-making surrounding DCIS.
Partridge, Ann H.; Elmore, Joann G.; Saslow, Debbie; McCaskill-Stevens, Worta; Schnitt, Stuart J.
There has been extensive research on the factors associated with patient satisfaction with communication during medical encounters, however, little attention has been paid to satisfaction among subgroups of patients, including the elderly. It is inappropriate to assume that all patients have the same physician-patient relationship needs, and thus, they will all be satisfied with the same communication approaches during medical
Michele G. Greene; Ronald D. Adelman; Erika Friedmann; Rita Charon
Objective: Effective communication between physicians and their patients is important in optimizing patient care. This project tested a brief, intensive, interactive medical education intervention using coaching and standardized psychiatric patients to teach physician-patient communication to family medicine trainees. Methods: Twenty-six family…
Ravitz, Paula; Lancee, William J.; Lawson, Andrea; Maunder, Robert; Hunter, Jonathan J.; Leszcz, Molyn; McNaughton, Nancy; Pain, Clare
Goals of work: To assess complementary and alternative medi- cine (CAM) therapies being utilized by cancer patients during treatment and communication about CAM usage between the patient and physi- cian. Patients and methods: Newly diagnosed cancer patients receiving chemotherapy or radiation therapy were recruited to complete a CAM survey within 2 weeks after the termination of treatment. Patients were queried
Jennifer S. Yates; Karen M. Mustian; Gary R. Morrow; Leslie J. Gillies; Devi Padmanaban; James N. Atkins; Brian Issell; Jeffrey J. Kirshner; Lauren K. Colman
Cancer risks were studied in 834 thyroid cancer patients given 131I (4,551 MBq, average) and in 1,121 patients treated by other means in Sweden between 1950 and 1975. Record-linkage with the Swedish Cancer Register identified 99 new cancers more than 2 years after 131I therapy [standardised incidence ratio (SIR) = 1.43; 95% confidence interval (CI) 1.17-1.75] vs 122 (SIR = 1.19; 95% CI 0.88-1.42) in patients not receiving 131I. In females treated with 131I overall SIR was 1.45 (95% CI 1.14-1.83) and significantly elevated were noted for tumours of the salivary glands, genital organs, kidney and adrenal gland. No elevated risk of a subsequent breast cancer or leukaemia was noted. SIR did not change over time, arguing against a strong radiation effect of 131I. Organs that were estimated to have received more than 1.0 Gy had together a significantly increased risk of a subsequent cancer following 131I treatment (SIR = 2.59; n = 18). A significant trend was seen for increasing activities of 131I with highest risk for patients exposed to greater than or equal to 3,664 MBq (SIR = 1.80; 95% CI 1.20-2.58). No specific cancer or group of cancers could be convincingly linked to high-dose 131I exposures since SIR did not increase after 10 years of observation. However, upper confidence intervals could not exclude levels of risk that would be predicted based on data from the study of atomic bomb survivors. We conclude that the current practice of extrapolating the effects of high-dose exposures to lower-dose situations is unlikely to seriously underestimate radiation hazards for low LET radiation.
Hall, P.; Holm, L. E.; Lundell, G.; Bjelkengren, G.; Larsson, L. G.; Lindberg, S.; Tennvall, J.; Wicklund, H.; Boice, J. D.
In response to the evolution of the information-seeking behaviour of patients and concerns from health professionals regarding cancer patient information, the French National Federation of Comprehensive Cancer Centres (FNCLCC) introduced, in 1998, an information and education program dedicated to patients and relatives, the SOR SAVOIR PATIENT program (SSP). The methodology of this program adheres to established quality criteria regarding the elaboration of patient information. Cancer patient information, developed in this program, is based on clinical practice guidelines produced by the FNCLCC and the twenty French cancer centres, the National League against Cancer, The National Cancer Institute, the French Hospital Federation, the National Oncology Federation of Regional and University Hospitals, the French Oncology Federation of General Hospitals, many learned societies, as well as an active participation of patients, former patients and caregivers. The information and dialogue handbook SOR SAVOIR PATIENT Vivre pendant et après un cancer reporting on the psychological aspects of cancer was worked out and published on the Web in 2005. The guide aims to provide cancer patients with support and advice about the psychological impact of the disease. It provides information on the possible personal consequences of the disease and treatments, in every domain: psychological, emotional, interpersonal, familial or professional. Patients are also advised of the emotional challenges associated with cancer, of the support they may expect at every stage of the disease, from diagnosis to treatment, and of psychological outcome after the disease is over. The document also provides healthcare professionals with a valuable, concise source of validated information on the psychological aspects of cancer, thus facilitating communication between carers and patients. Information provided in the present article has been selected from the information and dialogue handbook SOR SAVOIR PATIENT Vivre pendant et après un cancer. The document addresses the issue of the psychological support made available to the patients during and after the disease. The SOR SAVOIR PATIENT guide can be downloaded from the FNCLCC website at: http://www.fnclcc.fr PMID:17338095
Machavoine, Jean-Luc; Bonnet, Valérie; Leichtnam-Dugarin, Line; Dolbeault, Sylvie; Marx, Eliane; Dauchy, Sarah; Flahault, Cécile; Bendrihen, Nicolas; Pelicier, Nicole; Syp, Laurence; Pérennec, Marie-Estelle; Dilhuydy, Jean-Marie; Marx, Gilles; Chaussumier, Caroline; Brusco, Sylvie; Carretier, Julien; Delavigne, Valérie; Fervers, Béatrice; Philip, Thierry
Although considerable attention has been given to doctor?patient communication over the last 20 years, relatively little research has emphasized the role of patients’ communication skills. This research extended the modest work in patient communication skills training by (a) employing a more sophisticated definition of question?asking than has been used in previous studies, and (b) expanding training to include information?verifying skills.
Deborah Socha McGee; Donald J. Cegala
Summary Nearly all patients with cancer manifest laboratory evidence of hypercoagulability and some develop clinical thromboembolic disease (TED). Routine laboratory studies of blood coagulation have been performed in several large, prospective trials of the use of anticoagulant drugs in cancer treatment. The results of these studies, as well as data from several smaller studies of more sensitive tests of hypercoagulability
Frederick R. Rickles; Mark Levine; Richard L. Edwards
Patient portals (ie, secure web-based services for patient health record access) and secure messaging to health care professionals are gaining popularity slowly. Advantages of web portals include timely communication and instruction, access to appointments and other services, and high patient satisfaction. Limitations include inappropriate use, security considerations, organizational costs, and exclusion of patients who are uncomfortable with or unable to use computers. Attention to the organization's strategic plan and office policies, patient and staff expectations, workflow and communication integration, training, marketing, and enrollment can facilitate optimal use of this technology. Other communication technologies that can enhance patient care include automated voice or text reminders and brief electronic communications. Social media provide another method of patient outreach, but privacy and access are concerns. Incorporating telehealthcare (health care provided via telephone or Internet), providing health coaching, and using interactive health communication applications can improve patient knowledge and clinical outcomes and provide social support. PMID:24261435
Roett, Michelle A; Coleman, Mary Thoesen
States that the purpose of two studies was to develop an instrument to measure patients' perceived communication apprehension in patient/physician interactions. Describes how, in the first study, the five-item Patients' Report of Communication Apprehension with Physicians (PRCAP) was developed. Examines the validity of the new test instrument.…
Ayres, Joe; And Others
... droppings. This includes places like chicken coops and caves. Wear gloves when handling materials such as soil, ... Fungal infections in cancer patients: an international autopsy survey. European Journal of Clinical Microbiology & Infectious Diseases 1992; ...
A qualitative analysis revealed that Internet-based cancer groups engage in discussion regarding clinical trials. The communication related to diverse aspects of participation and reflected the complex nature of decision making about trial participation. This abstract may be of interest for those designing interventions and recruitment procedures to promote trial participation.
Since its invention, the telephone has been an important tool in medical practice, particularly for primary care physicians. Approximately half the calls made to a physician's office during regular consulting hours are for clinical problems and most are handled effectively over the phone without an immediate office visit. Telephone encounters are generally very brief, and managing such calls requires a pragmatic approach that is often quite different from the approach taken in the office visit. The telephone encounter should be recognized and recorded as a specific medical interaction in the medical chart for both clinical and legal reasons. Effective telephone encounters depend on good communication skills; decision making regarding disposition is a major goal. The physician's perception of a medical problem may be different from the patient's; patients are frequently seeking advice and reassurance rather than diagnosis and treatment, and may call because of anxiety and psychological stress. For physicians and their families who are not prepared for after-hours telephone encounters, calls that interrupt more “legitimate” activities may result in anger or frustration for the physician and dissatisfaction for the patient.
Curtis, Peter; Evens, Susan
This study reinforces the need for better communication between oncologists and cancer patients regarding clinical trials. In general, oncologists believe that patients are more fearful of trial participation than patients really are. In addition, although 84 percent of oncologists believe they discuss clinical trials with eligible patients, 81 percent of patients indicated that they were unaware of available and appropriate trials when they were exploring treatment options.
Background\\/Aims: Tumor lysis syndrome is a challenging complication of cancer therapy. This review focuses on the risk factors and pathologies of patients at risk for hyperuricemic complications. Methods: A review of the literature was performed that included original articles and related reviews from MEDLINE (PubMed) and published abstracts of meeting presentations. Results: Both host-related and tumor-related factors predispose cancer patients
A. Tsimberidou; M. J Keating
Background The goal of this research is to determine if different gender-preferred social styles can be observed within the user interactions at an online cancer community. To achieve this goal, we identify and measure variables that pertain to each gender-specific social style. Methods and Findings We perform social network and statistical analysis on the communication flow of 8,388 members at six different cancer forums over eight years. Kruskal-Wallis tests were conducted to measure the difference between the number of intimate (and highly intimate) dyads, relationship length, and number of communications. We determine that two patients are more likely to form an intimate bond on a gender-specific cancer forum (ovarian P?=?<0.0001, breast P?=?0.0089, prostate P?=?0.0021). Two female patients are more likely to form a highly intimate bond on a female-specific cancer forum (Ovarian P<0.0001, Breast P<0.01). Typically a male patient communicates with more members than a female patient (Ovarian forum P?=?0.0406, Breast forum P?=?0.0013). A relationship between two patients is longer on the gender-specific cancer forums than a connection between two members not identified as patients (ovarian forum P?=?0.00406, breast forum P?=?0.00013, prostate forum P?=?.0.0003). Conclusion The high level of interconnectedness among the prostate patients supports the hypothesis that men prefer to socialize in large, interconnected, less-intimate groups. A female patient is more likely to form a highly intimate connection with another female patient; this finding is consistent with the hypothesis that woman prefer fewer, more intimate connections. The relationships of same-gender cancer patients last longer than other relationships; this finding demonstrates homophily within these online communities. Our findings regarding online communication preferences are in agreement with research findings from person-to-person communication preference studies. These findings should be considered when designing online communities as well as designing and evaluating psychosocial and educational interventions for cancer patients.
Durant, Kathleen T.; McCray, Alexa T.; Safran, Charles
Communication is a major problem in the management of patients. Miscommunication occurs frequently in populations with low reading skills, illiteracy does not completely account for the observed low rates of recall of communicated information. Transmission of the message also plays an important role. Successful strategies to improve communication…
Leiner, Marie; Handal, Gilbert; Williams, Darryl
Purpose: Communication problems are a major contributing factor to adverse events in hospitals. The contextual environment in small rural hospitals increases the importance of emergency department (ED) patient transfer communication quality. This study addresses the communication problems through the development and testing of ED quality…
Klingner, Jill; Moscovice, Ira
According to the recent worldwide estimation by the GLOBOCAN project, in total, 12.7 million new cancer cases and 7.6 million cancer deaths occurred in 2008. The worldwide number of cancer survivors within 5 years of diagnosis has been estimated at be almost 28.8 million. Informal caregivers, such as family members and close friends, provide essential support to cancer patients. The authors of this report provide an overview of issues in the study of informal caregivers for cancer patients and long-term survivors in the United States and Europe, characterizing the caregivers commonly studied; the resources currently available to them; and their unmet needs, their psychosocial outcomes, and the psychosocial interventions tailored to their special circumstances. A broad overview of the state of research and knowledge, both in Europe and the United States, and observations on the directions for future research are provided.
Romito, Francesca; Goldzweig, Gil; Cormio, Claudia; Hagedoorn, Mariet; Andersen, Barbara L.
The interest in fatigue seems to be growing. A Medline search combining the key words fatigue and cancer yielded 248 entries compared with 72 entries 10 years previously. The studies published are mainly descriptive, augmenting the knowledge about the extent of fatigue associated with cancer, as well as during and after the various treatments used to fight it. New measurement instruments integrating the multidimensional concept of fatigue are being proposed. In 1998, the first study describing fatigue in children and adolescents with cancer was published. The knowledge of the causes of fatigue related to cancer remains extremely limited. In only a few studies are interventions and treatment possibilities for fatigue discussed. Hopefully, the refined knowledge about the characteristics of fatigue and its epidemiology will provide new etiologic understanding, resulting in effective treatment. This article provides a survey on the literature published in 1998. PMID:10416875
Simon, A M; Zittoun, R
Six themes of physicians' relational communication were hypothesized to predict patients' satisfaction and compliance, to relate to strategies used by physicians to gain compliance, and to relate to frequency of physician?patient contact. Telephone interviews with 234 adults who had seen a primary care physician within the previous six months confirmed that perceived relational communication was strongly related to affective, cognitive,
Judee K. Burgoon; Michael Pfau; Roxanne Parrott; Thomas Birk; Ray Coker; Michael Burgoon
Patient-centered interactive communication between physicians and patients is recommended to improve the quality of medical care. Numerical concepts are important components of such exchanges and include arithmetic and use of percentages, as well as higher level tasks like estimation, probability, problem-solving, and risk assessment - the basis of preventive medicine. Difficulty with numerical concepts may impede communication. The current evidence on prevalence, measurement, and outcomes related to numeracy is presented, along with a summary of best practices for communication of numerical information. This information is integrated into a hierarchical model of mathematical concepts and skills, which can guide clinicians toward numerical communication that is easier to use with patients.
Paasche-Orlow, Michael K.; Remillard, Janine T.; Bennett, Ian M.; Ben-Joseph, Elana Pearl; Batista, Rosanna M.; Hyde, James; Rudd, Rima E.
The aim of this study was to evaluate the family history of cancer in Japanese gastric cancer patients and to investigate\\u000a the clinicopathological features of gastric cancer patients with and without a family history of cancer. Four hundred and\\u000a forty gastric cancer patients were enrolled in this study. The family history (first- and second-degree relatives) was investigated.\\u000a The 440 patients
Kentaro Kawasaki; Kiyonori Kanemitsu; Takashi Yasuda; Takashi Kamigaki; Daisuke Kuroda; Yoshikazu Kuroda
Background: The doctor-patient relationship has been eroded by many factors. Would e-mail enhance communication and address some of the barriers inherent to our medical practices? Methods: Of our study population, 4 physicians offered e-mail communication to participating pa- tients and 4 did not. Both patients and physicians completed questionnaires regarding satisfaction, per- ceived quality, convenience, and promptness of the communication.
Shou Ling Leong; Dennis Gingrich; Peter R. Lewis; David T. Mauger; John H. George
Studies of doctor-patient communication generally advocate a partnership communication style. However, in Southeast Asian settings, we often see a more one-way style with little input from the patient. We investigated factors underlying the use of a one-way consultation style by doctors in a Southeast Asian setting. We conducted a qualitative…
Claramita, Mora; Nugraheni, Mubarika D. F.; van Dalen, Jan; van der Vleuten, Cees
Purpose We assessed the accuracy of communication between doctors and patients by evaluating the consistency between patient perception of cancer stage and the medical records, and analyzed the most influential factors of incongruence among cancer patients at 10 cancer centers across Korea. Methods Information was gathered from cancer patients at the National Cancer Center and nine regional cancer centers located in every province of Korea between 1 July 2008 and 31 August 2008. Data were analyzed using Pearson's ?2 test and multivariate logistic regression analysis. Results The stages of cancer reported by the 1,854 patients showed a low degree of congruence with the stages given in medical records (k?=?0.35, P<0.001). Only 57.1% of the patients had accurate knowledge of their cancer stage. In total, 18.5% underestimated their stage of disease, and the more advanced the cancer stage, the more likely they were to underestimate it, in order of local (14.2%), regional (23.7%), and distant (51.6%). Logistic regression analysis showed that congruence was lower in patients with cervical cancer (odds ratio [OR]?=?0.51, 95% confidence interval [CI]?=?0.30–0.87), recurrence (OR?=?0.64, 95% CI?=?0.50–0.83), and treatment at the National Cancer Center (OR?=?0.53, 95% CI?=?0.39–0.72). Conclusion There are knowledge gaps between patients' perceived and actual stage of cancer. Patients with cervical cancer, recurrence, and who received treatment at a regional cancer center showed less understanding of their cancer stage.
Shim, Hye-Young; Park, Jong-Hyock; Kim, So-Young; Shin, Dong Wook; Shin, Ji-Yeon; Park, Bo Young; Huh, Jung-Sik; Shin, Hee-Young; Won, Young Joo; Seo, Hong Gwan
Malnutrition is a condition characterized by a shortage or imbalance of energy and proteins and/or other nutrients. Malnutrition leads to measurable undesirable effects on body size and composition, functioning and clinical results. Criteria for malnutrition are eight loss, low BMI and loss of muscle mass. Patients with cancer should be repeatedly screened for malnutrition and its risk factors during the diagnostic and therapeutic treatment trajectory. Patients with cancer who are malnourished or are at risk of becoming so should be referred to a dietician for individualized dietary advice if they are undergoing curative treatment or before they do so. At the start of radiotherapy and/or chemotherapy treatment, tube feeding or parenteral feeding is given to all cancer patients who are malnourished or are at high risk of becoming malnourished. If the gastrointestinal tract is functioning well then tube feeding is preferable to parenteral feeding. Patients who are at an advanced stage of cancer and cancer patients who are anorexic or lose weight can be treated with megastrol acetate. PMID:22992244
de Graeff, Alexander; Vogel, Jeanne; Jager-Wittenaar, Harriët; Chua-Hendriks, Jolanda J C; Beijer, Sandra
The incidence of cancer and related mortality was studied in 1651 patients from six dialysis centres in England over 10 years. The only type of cancer for which there was a significant excess was non-Hodgkin's lymphoma (four cases observed against an expected incidence of 0.15 (p < 0.001); three deaths against an expected 0.1 (p < 0.001)). This excess could
L J Kinlen; J B Eastwood; D N Kerr; J F Moorhead; D O Oliver; B H Robinson; H E de Wardener; A J Wing
Objective In recent years, the importance of social differences in the physician-patient relationship has frequently been the subject of research. A 2002 review synthesised the evidence on this topic. Considering the increasing importance of social inequalities in health care, an actualization of this review seemed appropriate. Methods A systematic search of literature published between 1965 and 2011 on the social gradient in doctor-patient communication. In this review social class was determined by patient's income, education or occupation. Results Twenty original research papers and meta-analyses were included. Social differences in doctor-patient communication were described according to the following classification: verbal behaviour including instrumental and affective behaviour, non-verbal behaviour and patient-centred behaviour. Conclusion This review indicates that the literature on the social gradient in doctor-patient communication that was published in the last decade, addresses new issues and themes. Firstly, most of the found studies emphasize the importance of the reciprocity of communication. Secondly, there seems to be a growing interest in patient's perception of doctor-patient communication. Practice implications By increasing the doctors' awareness of the communicative differences and by empowering patients to express concerns and preferences, a more effective communication could be established.
Bacterial infection is one of the most frequent complications in cancer patients and hematopoietic stem cell transplant recipients. In recent years, the emergence of antimicrobial resistance has become a significant problem worldwide, and cancer patients are among those affected. Treatment of infections due to multidrug-resistant (MDR) bacteria represents a clinical challenge, especially in the case of Gram-negative bacilli, since the therapeutic options are often very limited. As the antibiotics active against MDR bacteria present several disadvantages (limited clinical experience, higher incidence of adverse effects, and less knowledge of the pharmacokinetics of the drug), a thorough acquaintance with the main characteristics of these drugs is mandatory in order to provide safe treatment to cancer patients with MDR bacterial infections. Nevertheless, the implementation of antibiotic stewardship programs and infection control measures is the cornerstone for controlling the development and spread of these MDR pathogens. PMID:24834465
Gudiol, Carlota; Carratalà, Jordi
States health campaign messages designed to encourage behavior adaptation have greater likelihood of success than campaigns promoting avoidance of at-risk behaviors that cannot be avoided. Tests a model of health risk behavior using four different behaviors in a communication campaign aimed at reducing farmers' risk for skin cancer--questions…
Parrott, Roxanne; Monahan, Jennifer; Ainsworth, Stuart; Steiner, Carol
At the Wellesley Hospital in Toronto, a unit designed to house patients awaiting placement developed a communication system to facilitate integrated patient-centred care. The system included a patient and family orientation brochure, an interdisciplinary kardex and an interdisciplinary patient goal sheet. Patient care improved under the new system, as staff was easily able to access current assessment data and establish and document integrated patient goals. Other outcomes included improved communication among team members, enhanced team member accountability, cohesiveness and satisfaction, and increased patient and family satisfaction. PMID:10144378
Although empathy in the physician–patient relationship is often advocated, a theoretically based and empirically derived measure of a physician’s empathic communication to a patient has been missing. This paper describes the development and initial validation of such a measure, the Empathic Communication Coding System (ECCS), which includes a method for identifying patient-created empathic opportunities. To determine the extent to which
Carma L Bylund; Gregory Makoul
We developed a computer-based tailored risk presentation and risk communication aid for colorectal cancer prevention. To evaluate the effectiveness of the tool, we randomized 353 participants to receive different risk presentation formats (relative plus absolute risk vs. absolute risk only vs. none) and different levels of engagement with the risk communication (active vs. passive). Findings suggest the tool to be
KAREN M. EMMONS; MEI WONG; ELAINE PULEO; NEIL WEINSTEIN; ROBERT FLETCHER; GRAHAM COLDITZ
Aim. The aim of this study was to see the clinical, pathological, and demographic profile of young patients with stomach carcinoma besides association with p53. Patients and Methods. Prospective study of young patients with stomach carcinoma from January 2005 to December 2009. A total of 50 patients with age less than 40 years were studied. Results. Male female ratio was 1?:?1.08 in young patients and 2.5?:?1 in older patients. A positive family history of stomach cancer in the first degree relatives was present in 10% of young patients. Resection was possible only in 50% young patients. 26% young patients underwent only palliative gastrojejunostomy. The most common operation was lower partial gastrectomy in 68%. Amongst the intraoperative findings peritoneal metastasis was seen in 17.4% in young patients. 50% young patients presented in stage IV as per AJCC classification (P value .004; sig.). None of the patients presented as stage 1 disease in young group. Conclusion. Early detection of stomach carcinoma is very important in all patients but in young patients it is of paramount importance.
Dhobi, Manzoor A.; Wani, Khursheed Alam; Parray, Fazl Qadir; Wani, Rouf A.; Peer, G. Q.; Abdullah, Safiya; Wani, Imtiyaz A.; Wani, Muneer A.; Shah, Mubashir A.; Thakur, Natasha
Native Hawaiians and Filipinos are disproportionately impacted by cancer, and are less likely to participate in cancer screening than whites. Limited information exists about health information pathways and health communication challenges as they relate to cancer screening in these groups. Six focus groups (n=77) of Native Hawaiian and Filipino women age 40+ years were conducted to investigate these research gaps. Participants noted many health information challenges. Challenges were both practical and interpersonal and included both written and oral health communication. Practical challenges included “big” words, complexity of terms, and lack of plain English. Interpersonal issues included doctors rushing, doctors not assessing comprehension, and doctors treating respondents as patients not people. Women noted that they would often not ask questions even when they knew they did not understand because they did not want the provider to think negatively of them. Overarching themes to improve cancer communication gaps included: (1) the importance of family and community in health information dissemination; (2) the key role women play in interpreting health information for others; (3) the importance of personal experience and relationships to the salience of health information; and (4) the desire for local cultural relevance in health communication. Findings are discussed in light of the 2010 National Action Plan for Health Literacy.
Sentell, Tetine; Cruz, May Rose Dela; Heo, Hyun Hee; Braun, Kathryn
ObjectivePhysicians’ patient-centred communication is assumed to stimulate patients’ active participation, thus leading to more effective and humane exchange in the medical consultation. We investigated the relationship between physicians’ patient-centred communication and patient participation in a medical specialist setting.
Linda C. Zandbelt; Ellen M. A. Smets; Frans J. Oort; Mieke H. Godfried
Although Wernicke encephalopathy has been reported in the oncological literature, only one terminally ill cancer patient with Wernicke encephalopathy has been reported. Wernicke encephalopathy, a potentially reversible condition, may be unrecognized in terminally ill cancer patients. In this communication, we report three terminally ill cancer patients who developed Wernicke encephalopathy. Early recognition and subsequent treatment resulted in successful palliation of
Hideki Onishi; Chiaki Kawanishi; Masanari Onose; Tomoki Yamada; Hideyuki Saito; Akira Yoshida; Kazumasa Noda
For patients with severe motor disabilities, a robust means of communication is a crucial factor for their well-being . We report here that pupil size measured by a bedside camera can be used to communicate with patients with locked-in syndrome. With the same protocol we demonstrate command-following for a patient in a minimally conscious state, suggesting its potential as a diagnostic tool for patients whose state of consciousness is in question. Importantly, neither training nor individual adjustment of our system's decoding parameters were required for successful decoding of patients' responses. PMID:23928079
Stoll, Josef; Chatelle, Camille; Carter, Olivia; Koch, Christof; Laureys, Steven; Einhäuser, Wolfgang
Purpose of review In this review, we update investigations related to cancer biomarkers in HIV-infected populations Recent findings CD4 lymphocyte is associated with PCNSL, systemic NHL (except perhaps for BL), KS, cervical cancer and anal cancer. HIV load is associated with BL and systemic NHL (but not PCNSL), with KS and with anal cancer. CD40 ligand incorporated into the HIV envelope and expression of activation induced cytidine deaminase may help explain the relationship between HIV load and BL. Genetic polymorphisms have been identified that are linked to lymphoma in HIV patients. B cell activation as manifest in immunoglobulin light chain production may be an important marker for NHL risk. Cytokines and related molecules (IL10, sCD30) may identify patients at high risk for NHL. EBV in CSF is useful as a marker for PCNSL, although with the falling incidence of PCNSL, the specificity of the test has been called into question. EBV and KSHV have not yet emerged as especially promising markers of risk for either lymphoma or KS. Summary CD4 lymphocyte count, HIV load, germ line genetic polymorphisms, cytokine and related molecules and immunoglobulin light chains all show increasing promise as biomarkers of malignancy in HIV patients.
Ambinder, Richard F; Bhatia, Kishor; Martinez-Maza, Otoniel; Mitsuyasu, Ronald
The fourth in a series of articles about the practical aspects of telehealth, this paper provides advice and information for specialists to communicate effectively with patients during a telehealth video consultation. PMID:24450527
Sabesan, S; Allen, D; Caldwell, P; Loh, P K; Mozer, R; Komesaroff, P A; Talman, P; Williams, M; Shaheen, N; Grabinski, O
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Purpose: Despite the extensive use of complementary and alternative medicine (CAM) among cancer patients, patient-physician communication regarding CAM therapies remains limited. This study quantified the extent of patient-physician communication about CAM and identified factors associated with its discussion in radiation therapy (RT) settings. Methods and Materials: We conducted a cross-sectional survey of 305 RT patients at an urban academic cancer center. Patients with different cancer types were recruited in their last week of RT. Participants self-reported their demographic characteristics, health status, CAM use, patient-physician communication regarding CAM, and rationale for/against discussing CAM therapies with physicians. Multivariate logistic regression was used to identify relationships between demographic/clinical variables and patients' discussion of CAM with radiation oncologists. Results: Among the 305 participants, 133 (43.6%) reported using CAM, and only 37 (12.1%) reported discussing CAM therapies with their radiation oncologists. In multivariate analyses, female patients (adjusted odds ratio [AOR] 0.45, 95% confidence interval [CI] 0.21-0.98) and patients with full-time employment (AOR 0.32, 95% CI 0.12-0.81) were less likely to discuss CAM with their radiation oncologists. CAM users (AOR 4.28, 95% CI 1.93-9.53) were more likely to discuss CAM with their radiation oncologists than were non-CAM users. Conclusions: Despite the common use of CAM among oncology patients, discussions regarding these treatments occur rarely in the RT setting, particularly among female and full-time employed patients. Clinicians and patients should incorporate discussions of CAM to guide its appropriate use and to maximize possible benefit while minimizing potential harm.
Ge Jin [Perelman School of Medicine at University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States)] [Perelman School of Medicine at University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States); Fishman, Jessica [Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States) [Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States); Annenberg School for Communication at University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States); Vapiwala, Neha [Abramson Comprehensive Cancer Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States) [Abramson Comprehensive Cancer Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States); Department of Radiation Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States); Li, Susan Q.; Desai, Krupali [Department of Family Medicine and Community Health, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States)] [Department of Family Medicine and Community Health, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States); Xie, Sharon X. [Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States)] [Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States); Mao, Jun J., E-mail: firstname.lastname@example.org [Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States); Abramson Comprehensive Cancer Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States); Department of Family Medicine and Community Health, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States)
In Brazil, recent regulations require changes in private and public health systems to make special services available to deaf patients. In the present article, the researchers analyze the perceptions of 25 sign language-using patients regarding this assistance. The researchers found communication difficulties between these patients and health…
Pereira, Patricia Cristina Andrade; Fortes, Paulo Antonio de Carvalho
Effective communication is integral to good medical care. Medical professional groups, regulatory agencies, educators, researchers,\\u000a and patients recognize its importance. Quality of medical communication is directly related to patient satisfaction, improvement\\u000a in medication adherence, treatment compliance, other outcomes, decreased risk of malpractice, and increase in health care\\u000a providers’ levels of satisfaction. However, skill level and training remain problematic in this
Dawn C. Buse; Richard B. Lipton
This study examined the ways in which health care providers (general practitioners and specialists) and patients communicate with each other about managing musculoskeletal (MSK) disorders, a major cause of long-term pain and physical disability. In managing their illness, patients must interact closely with health care providers, who play a large role in transferring knowledge to them. In-depth interviews with patients, general practitioners, and specialist rheumatologists in Australia and Canada were analyzed using Leximancer (a text-mining tool). Results indicated that, in their communication, doctors subtly emphasized accepting and adjusting to the illness ("new normal"), whereas patients emphasized pain relief and getting "back to normal." These results suggest that doctors and patients should accommodate in their communication across subtle and often unexpressed differences in the priorities of provider and patient, or they are likely to be at cross purposes and thus less effective. PMID:21424965
Baker, Susan C; Gallois, Cindy; Driedger, S Michelle; Santesso, Nancy
Background Twitter is an interactive, real-time media that could prove useful in health care. Tweets from cancer patients could offer insight into the needs of cancer patients. Objective The objective of this study was to understand cancer patients’ social media usage and gain insight into patient needs. Methods A search was conducted of every publicly available user profile on Twitter in Japan for references to the following: breast cancer, leukemia, colon cancer, rectal cancer, colorectal cancer, uterine cancer, cervical cancer, stomach cancer, lung cancer, and ovarian cancer. We then used an application programming interface and a data mining method to conduct a detailed analysis of the tweets from cancer patients. Results Twitter user profiles included references to breast cancer (n=313), leukemia (n=158), uterine or cervical cancer (n=134), lung cancer (n=87), colon cancer (n=64), and stomach cancer (n=44). A co-occurrence network is seen for all of these cancers, and each cancer has a unique network conformation. Keywords included words about diagnosis, symptoms, and treatments for almost all cancers. Words related to social activities were extracted for breast cancer. Words related to vaccination and support from public insurance were extracted for uterine or cervical cancer. Conclusions This study demonstrates that cancer patients share information about their underlying disease, including diagnosis, symptoms, and treatments, via Twitter. This information could prove useful to health care providers.
Tsuya, Atsushi; Sugawara, Yuya; Tanaka, Atsushi
Suicide prevention continues to be a significant clinical challenge in the care of psychiatric patients, particularly among youth. New patterns of interactions and communications using online social networks create opportunities for persons to indicate their mood, their opinions, and also to express ideation and plans about suicide. We report a case of a suicide attempt and how communications through online social networks initiated treatment and affected its outcome. We discuss advantages and challenges to clinicians regarding use social networks and electronic communication in patient care. PMID:21596215
Ogburn, Kelin M; Messias, Erick; Buckley, Peter F
Data from the Cancer Registry of Slovenia were used in a cohort studyto determine whether the incidence of second primary cancers in patients withfirst primary breast cancer differs from the incidence expected in thegeneral population. Special interest was given to long-term survivors. Theexpected numbers of second primary cancers were calculated by multiplying thenumber of appropriate person-years at risk by the
N. Volk; V. Pompe-Kirn
Patient-centered cancer care has become a priority in the oncology field. Increasing efforts to train oncologists in communication skills have led to a growing literature on patient-centered cancer education. In addition, systems approaches have led to an increased emphasis on the concept of teams as an organizing framework for cancer care. In this essay, we examine issues involved in educating teams to provide patient-centered cancer care. In the process, we question the applicability of a tightly coordinated ‘team’ concept, and suggest the concept of a ‘care community’ as a more achievable ideal for the way that cancer care is commonly delivered. We discuss the implications that this has for cancer communication education, and propose three principles to guide the development of educational interventions aimed at increasing patient-centeredness in cancer care delivery systems.
Haidet, Paul; Fecile, Mary Lynn; West, Heather F.; Teal, Cayla R.
\\u000a Lower respiratory tract infections result in unacceptably high mortality among cancer patients. Pneumonias cause death in\\u000a this population both directly through impairment of gas exchange and progression to system infection\\/sepsis, as well as indirectly\\u000a by precluding delivery of necessary, antineoplastic therapies. Malignancy and treatment-related impairments of host immune\\u000a responses and the emergence of multidrug-resistant organisms associated with recurrent exposures to
Scott E. Evans; Amar Safdar
Patients with cancer suffer from a multitude of symptoms. Effective treatment strategies are available for a number of the\\u000a common symptoms. A major reason for inadequate symptom relief is lack of effective symptom assessment. Accurate assessment\\u000a of symptoms is necessary before any treatment can be undertaken. Although there are many complexities involved in the assessment\\u000a of symptoms, simple, effective tools
Michael Naughton; Jade Homsi
Ionizing radiation used in treating the head and neck area produces oral side effects such as mucositis, salivary changes, trismus and radiation caries. Sequelae of cancer chemotherapy often include oral stomatitis, myelosuppression and immunosuppression. Infections of dental origin in compromised patients are potentially lethal. Specific programs to eliminate dental pathology before radiation and chemotherapy, and to maintain oral hygiene during and after therapy, will minimize these complications.
Background The risk of developing a second primary tumour in patients with gastric carcinoma is higher than among the general population. The aim was to investigate the clinicopathological characteristics of the second primary cancers in patients with gastric cancer in this study. Patients and methods In the retrospective study, patients with gastric cancers were evaluated between 1995 and 2005 for primary tumours according to Warren and Gates’ criteria related with the second primary cancers. Results Nine of the 112 patients with gastric cancer had second primary cancers. Seven of the patients were males and two females. Six patients with gastric cancers had synchronous, and three had metachronous tumours. The age of the patients ranged from 53 to 78 years, and the mean age was 61 ± 8.3 years. The most frequent site of occurrence of the second tumours was the colo-rectum (33%) followed by the upper respiratory system (22%), and the urogenital system (22%) in descending order of frequency. Conclusions The incidence of the second primary cancer in gastric cancer patients was 8% in the current report. It is recommended that careful preoperative and postoperative examinations for other primary cancers, as well as for the extent of the primary gastric carcinoma, are carried out. Because colorectal cancer was the most common carcinoma combined with gastric carcinoma, the surveillance for this carcinoma (e.g., colonoscopy, abdominopelvic CT) would be appropriate after the diagnosis of gastric carcinoma.
Buyukasik, Oktay; Hasdemir, Ahmet Oguz; Gulnerman, Yusuf; Col, Cavit; Ikiz, Ozgur
Chemotherapy-induced peripheral neuropathies (CIPNs) are an increasingly common neuropathic and pain syndrome in adult and pediatric cancer patients and survivors [1–69]. However, symptoms associated with CIPNs are often undiagnosed, under-assessed, and communications problems between clinicians, family members, and patients have been observed [70–73]. Less is known about the prevalence and impact of CIPNs on pediatric cancer populations [70–71]. This article aims to provide a brief understanding of CIPNs in pediatric populations, and to review the evidence for both its prevention and treatment.
To improve health and reduce costs, we need to encourage patients to make better health care decisions. Since email is widely available, it may be useful for patient-directed interventions. However, we know little about how the contents of an email message can influence a health-related decision. We propose a model to understand how patients may process persuasive email messages.
Walji, Muhammad; Johnson-Throop, Kathy; Johnson, Todd; Bernstam, Elmer; Zhang, Jiajie
CCR's Office of Communications, located in the Office of the Director, Center for Cancer Research, communicates both inside the Center and outside to diverse audiences. Our goal is to effectively communicate the importance of CCR's ongoing basic, translational, and clinical research to the media, the general public, cancer patients and their physicians, other scientists, advocacy groups, and policy makers.
BACKGROUND: Communication about prognosis is fundamental to discussions and planning for end-of-life (EOL) care for patients with advanced heart failure (HF). Little is known about the preferences of patients that could guide communication about prognosis. OBJECTIVES: To identify the preferences of patients with advanced HF regarding communication about their prognosis and its implications. METHODS: A qualitative study using a grounded theory methodology, based on one-to-one interviews with 20 patients recruited from Heart Function Clinic at the McMaster University Medical Centre in Hamilton, Ontario. RESULTS: The following four main themes about patient preferences were identified: level of wellness – patients wanted to learn about their prognosis and its implications at a time of optimal cognitive function, and not when their capacity for EOL decision making was diminished; opportunity to be informed – patients preferred physicians to initiate discussions about prognosis at the time of diagnosis; tell the truth – there was a strong preference for physicians to disclose prognostic possibilities, treatments and outcomes associated with HF, including the possibilities of deterioration and death; and maintain hope – there was a need for truth to be balanced with hope. Hope for quality of life, symptom control and control over EOL decisions were important to participants. CONCLUSIONS: The findings suggested that communication about prognosis between patients and physicians may be difficult and deferred. Preferences identified by patients offer guidance to physicians in planning and initiating dialogue about prognosis.
Caldwell, Patricia H; Arthur, Heather M; Demers, Catherine
Over the past few decades, the concept of "patient-centeredness" has been intensively studied in health communication research on patient-physician interaction. Despite its popularity, this concept has often been criticized for lacking a unified definition and operationalized measurement. This article reviews how health communication research on patient-physician interaction has conceptualized and operationalized patient-centered communication based on four major theoretical perspectives in sociology (i.e., functionalism, conflict theory, utilitarianism, and social constructionism), and discusses the agenda for future research in this field. Each theory addresses different aspects of the patient-physician relationship and communication from different theoretical viewpoints. Patient-centeredness is a multifaceted construct with no single theory that can sufficiently define the whole concept. Different theoretical perspectives of patient-centered communication can be selectively adopted according to the context and nature of problems in the patient-physician relationship that a particular study aims to explore. The present study may provide a useful framework: it offers an overview of the differing models of patient-centered communication and the expected roles and goals in each model; it does so toward identifying a communication model that fits the patient and the context and toward theoretically reconstructing existing measures of patient-centered communication. Furthermore, although patient-centered communication has been defined mainly from the viewpoint of physician's behaviors aimed at achieving patient-centered care, patient competence is also required for patient-centered communication. This needs to be examined in current medical practice. PMID:24034962
Ishikawa, Hirono; Hashimoto, Hideki; Kiuchi, Takahiro
OBJECTIVE: To assess the relationship between physicians’ beliefs about the psychosocial aspects of patient care and their routine communication\\u000a with patients.\\u000a \\u000a \\u000a PARTICIPANTS AND SETTING: Fifty community primary care physicians participating in a continuing medical education program and 473 of their patients\\u000a in Portland, Oregon.\\u000a \\u000a \\u000a \\u000a \\u000a METHODS: Routine office visits were audiotaped and analyzed for communication behaviors and emotional tone using the
Wendy Levinson; Debra Roter
Aim The purpose of this review is to describe the use and definitions of the concepts of nurse-patient interaction and nurse-patient\\u000a communication in nursing literature. Furthermore, empirical findings of nurse-patient communication research will be presented,\\u000a and applied theories will be shown.\\u000a \\u000a \\u000a \\u000a Method An integrative literature search was executed. The total number of relevant citations found was 97. The search results were\\u000a reviewed,
Steffen Fleischer; Almuth Berg; Markus Zimmermann; Kathleen Wüste; Johann Behrens
Given that lung cancer is one of the common cancers world-wide, the implications of focusing on quality of life as well as survival require to be understood. We have carried out a study of the relationship between survival and quality of life in patients with lung cancer comparing patients those who lived with those who died within 3 months. The
Ali Montazeri; Robert Milroy; David Hole; James McEwen; Charles R. Gillis
There are now excellent data that patients with stage III colon cancer or stage II and III rectal cancer live longer if they receive, respectively, systemic or regional and systemic therapy after surgery. In addition, disease-free survival, particularly freedom from the symptom of regional recurrence, in the high risk rectal cancer patient population has been markedly improved by application of
Following surgical resection of Dukes' B or C colorectal cancers 72 patients have been randomly allocated to receive: 5-fluorouracil; or 5-fluorouracil and levamisole; or no treatment. Adjuvant treatment was continued for one year. 66 patients remain evaluable for up to 24 months. Preliminary results show no significant differences in survival or recurrence rates. Two patients receiving 5-fluorouracil and levamisole developed severe, but reversible, neutropenia. Other side effects were uncommon.
Bancewicz, J; Macpherson, S G; McVie, J G; Calman, K C; McArdle, C S; Soukop, M
Objectives To understand racial disparities in the use of total joint replacement, we examined whether there were racial differences in patient-provider communication about treatment of chronic knee/hip osteoarthritis in a sample of African American and white patients referred to Veterans Affairs (VA) orthopedic clinics. Methods Audio-recorded visits between patients and orthopedic surgeons were coded using the Roter Interaction Analysis System and the Informed Decision Making Model. Racial differences in communication outcomes were assessed using linear regression models adjusted for study design, patient characteristics, and clustering by provider. Results The sample (N=402) included 296 white and 106 African American patients. Most patients were male (95%) and 50-64 years old (68%). Almost half (41%) reported an income <$20,000. African American patients were younger and reported lower incomes than white patients. Visits with African American patients contained less discussion of biomedical topics (Beta=-9.14, 95% CI=-16.73,-1.54) and more rapport-building statements (Beta=7.84, 95% CI=1.85,13.82) than visits with white patients. However, no racial differences were observed with regard to length of visit, overall amount of dialogue, discussion of psychosocial issues, patient activation/engagement statements, physician verbal dominance, display of positive affect by patients or providers, or discussion related to informed decision making. Conclusions In this sample, communication between orthopedic surgeons and patients regarding the management of chronic knee/hip osteoarthritis did not, for the most part, vary by patient race. These findings diminish the potential role of communication in VA orthopedic settings as an explanation for well-documented racial disparities in the use of total joint replacement.
Hausmann, Leslie R.M.; Hanusa, Barbara H.; Kresevic, Denise M.; Zickmund, Susan; Ling, Bruce S.; Gordon, Howard S.; Kwoh, C. Kent; Mor, Maria K.; Hannon, Michael J.; Cohen, Peter Z.; Grant, Richard; Ibrahim, Said A.
The Program in Human Sexuality (PHS), an outpatient mental health clinic in the University of Minnesota Medical School that specializes in sexuality-related dysfunctions, had received a number of patient complaints in late 1992 and early 1993 about therapeutic processes and business services. The proactive approach was to survey patients about all…
Young, Laura Throckmorton; And Others
Low literate patients face difficulties when they read health care information. The complex process of reading can be summarized in five steps: input, decoding, encoding, output, and feedback. Each occurs automatically for the fluent reader; the low literate reader might encounter stumbling blocks in one or more of the steps. Once the patient has…
McKeon, Christine A.
A cohort of 6168 schizophrenic patients was followed from 1957 to 1984 to determine the incidence of cancer in these patients. In the male schizophrenic patients the incidence of cancer was found to be significantly reduced in comparison with the general Danish population. This reduction was especially marked for cancer in the respiratory system, cancer of the prostate and cancer of the bladder. In the female patients the overall incidence of cancer did not differ from that of the general Danish population, but there was an increased risk of cancer of the digestive tract, especially cancer of the pancreas and a slight increase of the risk of breast cancer. In the female patients the risk of respiratory cancers and cancer of the female genital organs, especially cancer of the uterine cervix, was reduced. These alterations of the incidence of cancer in schizophrenic patients cannot be ascribed to differences in diagnostic accuracy. As a possible explanation of these findings a reduced exposure to well known carcinogens such as cigarette smoke may be relevant. We speculate that exposure to neuroleptics such as phenothiazines and reserpine may also be part of the explanation for the findings.
Mortensen, P B
Patient-centred care is argued to be an essential component in the delivery of quality health and cancer care. This manuscript discusses the need to generate credible data which indicates the quality of patient-centred care provided by cancer treatment centres. Patient-centred care covers six domains including physical comfort; emotional support; respect for patients' preferences and values; integration and coordination; involvement of family and friends; and the provision of information, communication and education to enable patients to understand and make informed decisions about their care. First, we identify priority areas within each domain. Next, we propose three questions that should be asked of every patient across the six domains of patient-centred care. The first question explores whether patients were specifically asked by a healthcare provider at the cancer treatment centre about their concerns, values and preferences. Research indicates that it cannot be assumed that clinicians are aware of patient's needs or preferences in these six areas. Second, if the answer from the patient suggests that they would like assistance, then it would be expected that this would be offered. Thirdly, if the patient indicates that they would like such assistance and it is provided, then it might be expected that the patient would report that the provided assistance did relieve their suffering, or the assistance provided was consistent with their preferences, needs and values. Regular measurement and reporting of these aspects of patient-centred cancer care has the potential to identify deficits and inequities in care delivery, allow for comparisons across treatment centres and stimulate an improvement in the patient-centred care provided to cancer patients. PMID:24696084
Zucca, Alison; Sanson-Fisher, Rob; Waller, Amy; Carey, Mariko
Hospital physicians care for most seriously ill patients in the United States. We employed dimensional analysis to describe communication about death and dying in audio-recorded admission encounters between seriously ill patients and hospitalists. Acknowledging or not acknowledging the possibility of dying emerged as a key process. Acknowledgment was rare, and depended on synergistic communication behaviors between patient and physician. Facilitators included patients cuing for information and disclosing emotional distress, and physicians exploring the patient’s understanding of his or her illness and emotional distress. When hospitalists focused on acute issues, stated that they were awaiting test results, and deferred to other physicians, discussion moved away from acknowledgment. Meaningful discussion of end-of-life issues, including goals and values, fears about death and dying, prognosis, and options for palliative care followed open acknowledgment. This acknowledgment process can serve as a guide for providers to sensitively and honestly discuss essential end-of-life issues.
Anderson, Wendy G.; Kools, Susan; Lyndon, Audrey
Optimizing patient experiences with care is especially important in cancer because cancer care is often complex and involves communication with and coordination across providers of multiple specialties and across multiple institutional settings. Unsatisfactory interactions with the health care system pose an additional burden on patients when they are already ill and vulnerable. More importantly, less-than-optimal patient experiences can have a significant negative impact on patients’ health-related quality of life.
Non–AIDS-defining cancers are a rising health concern among HIV-infected patients. Cancer screening is now an important component\\u000a of health maintenance in HIV clinical practice. The decision to screen an HIV-infected patient for cancer should include an\\u000a assessment of individualized risk for the particular cancer, life expectancy, and the harms and benefits associated with the\\u000a screening test and its potential outcome.
Keith Sigel; Robert Dubrow; Michael Silverberg; Kristina Crothers; Scott Braithwaite; Amy Justice
BACKGROUND Chemotherapy for metastatic lung or colorectal cancer can prolong life by weeks or months and may provide palliation, but it is not curative. METHODS We studied 1193 patients participating in the Cancer Care Outcomes Research and Surveillance (CanCORS) study (a national, prospective, observational cohort study) who were alive 4 months after diagnosis and received chemotherapy for newly diagnosed metastatic (stage IV) lung or colorectal cancer. We sought to characterize the prevalence of the expectation that chemotherapy might be curative and to identify the clinical, sociodemographic, and health-system factors associated with this expectation. Data were obtained from a patient survey by professional interviewers in addition to a comprehensive review of medical records. RESULTS Overall, 69% of patients with lung cancer and 81% of those with colorectal cancer did not report understanding that chemotherapy was not at all likely to cure their cancer. In multivariable logistic regression, the risk of reporting inaccurate beliefs about chemotherapy was higher among patients with colorectal cancer, as compared with those with lung cancer (odds ratio, 1.75; 95% confidence interval [CI], 1.29 to 2.37); among nonwhite and Hispanic patients, as compared with non-Hispanic white patients (odds ratio for Hispanic patients, 2.82; 95% CI, 1.51 to 5.27; odds ratio for black patients, 2.93; 95% CI, 1.80 to 4.78); and among patients who rated their communication with their physician very favorably, as compared with less favorably (odds ratio for highest third vs. lowest third, 1.90; 95% CI, 1.33 to 2.72). Educational level, functional status, and the patient’s role in decision making were not associated with such inaccurate beliefs about chemotherapy. CONCLUSIONS Many patients receiving chemotherapy for incurable cancers may not understand that chemotherapy is unlikely to be curative, which could compromise their ability to make informed treatment decisions that are consonant with their preferences. Physicians may be able to improve patients’ understanding, but this may come at the cost of patients’ satisfaction with them. (Funded by the National Cancer Institute and others.)
Weeks, Jane C.; Catalano, Paul J.; Cronin, Angel; Finkelman, Matthew D.; Mack, Jennifer W.; Keating, Nancy L.; Schrag, Deborah
Advances in cancer research and therapy have improved prognosis and the quality of life of many patients. However, previous epidemiological studies in oncologic patients have shown an increased risk of suicide. Suicidal thoughts, relatively well known in those terminally ill, may be just as important for cancer patients who are survivors or are living with the disease. Nonetheless, there is
Nuno Madeira; Emília Albuquerque; Tiago Santos; Alexandre Mendes; Marta Roque
While attention must be paid to the changes discovered within the genomic profile of a cancerous growth, equal attention must be paid to the intrinsic genetic background of each patient. Cancer does not develop in a vacuum, but within a patient, and each patient's distinctive genetic background results from both intrinsic and extrinsic factors.
Objective Describe the content and frequency of provider-patient dietary supplement discussions during primary care office visits. Methods Inductive content analysis of 1477 transcribed audio-recorded office visits to 102 primary care providers was combined with patient and provider surveys. Encounters were collected in Los Angeles, California (2009–2010), geographically-diverse practice settings across the United States (2004–2005), and Sacramento, CA (1998–1999). Results Providers discussed 738 dietary supplements during encounters with 357 patients (24.2% of all encounters in the data). They mentioned: 1) reason for taking the supplement for 46.5% of dietary supplements; 2) how to take the supplement for 28.2%; 3) potential risks for 17.3%; 4) supplement effectiveness for 16.7%; and 5) supplement cost or affordability for 4.2%. Of these five topics, a mean of 1.13 (SD=1.2) topics were discussed for each supplement. More topics were reviewed for non-vitamin non-mineral supplements (mean 1.47 (SD=1.2)) than for vitamin/mineral supplements (mean 0.99 (SD=1.1); p<0.001). Conclusion While discussions about supplements are occurring, it is clear that more discussion might be needed to inform patient decisions about supplement use. Practice Implication Physicians could more frequently address topics that may influence patient dietary supplement use, such as the risks, effectiveness, and costs of supplements.
Tarn, Derjung M.; Paterniti, Debora A.; Good, Jeffrey S.; Coulter, Ian D.; Galliher, James M.; Kravitz, Richard L.; Karlamangla, Arun; Wenger, Neil S.
Context: Cancer care requires specialty surgical and medical resources that are less likely to be found in rural areas. Purpose: To examine the travel patterns and distances of rural and urban colorectal cancer (CRC) patients to 3 types of specialty cancer care services--surgery, medical oncology consultation, and radiation oncology consultation.…
Baldwin, Laura-Mae; Cai, Yong; Larson, Eric H.; Dobie, Sharon A.; Wright, George E.; Goodman, David C.; Matthews, Barbara; Hart, L. Gary
The composition of the human intestinal microbiota is linked to health status. The aim was to analyze the microbiota of normal and colon cancer patients in order to establish cancer-related dysbiosis.Patients and MethodsStool bacterial DNA was extracted prior to colonoscopy from 179 patients: 60 with colorectal cancer, and 119 with normal colonoscopy. Bacterial genes obtained by pyrosequencing of 12 stool
Iradj Sobhani; Julien Tap; Françoise Roudot-Thoraval; Jean P. Roperch; Sophie Letulle; Philippe Langella; Gérard Corthier; Jeanne Tran van Nhieu; Jean P. Furet; Sylviane Pied
The research study, 'Pharmacists as Health Educators and Risk Communicators in the Prevention of Prostate Cancer' is a prostate cancer education for prevention project. The principle investigator is Cynthia Warrick, formerly at Howard University; she is n...
Background Uterine cancer (UC) represents 5.1% of all female malignancies in Sweden. Accumulation of UC in families occurs in around 5% of cases. We wanted to identify any familial association between UC and other selected cancers and to study the frequency of Lynch,Cowden and cancer syndromes among consecutive UC patients in Sweden. Methods 481 UC patients were included. Information on the cancer diagnoses of their relatives (first- (FDRs) and second-degree (SDRs) relatives and first cousins) was obtained. The relative frequencies of different cancers among relatives were compared to those in the Swedish general cancer population in 1970 and 2010. Families that fulfilled the criteria for hereditary cancer syndromes were tested for mutations in the causative genes. Families with at least one case of UC in addition to the index patient were compared to families with no additional cases to investigate possible characteristics of putative hereditary cancer syndromes. Results There was an increased prevalence of UC in our study population compared to the Swedish general cancer population in 1970 and 2010 (6% vs. 4% and 3%, respectively). Seven families had Lynch Syndrome according to the Amsterdam II criteria. No families fulfilled the criteria for Cowden syndrome. In total 13% of index patients had at least one relative with UC and these families tended to have more cases of early onset cancer among family members. In addition, 16% of index patients were diagnosed with at least one other cancer. No families fulfilled the criteria for Cowden syndrome. Conclusion We showed a familial clustering of UC among relatives of our index patients. Of the seven families with mutation-verified Lynch Syndrome, only one had been previously diagnosed, highlighting the need to increase gynecologists’ awareness of the importance of taking family history. Our data on multiple cancers and young age of onset in families with uterine cancer is compatible with the existence of additional hereditary uterine cancer syndromes.
Background Communication impairment is a frequent consequence of stroke. Patients who cannot articulate their needs respond with frustration and agitation, resulting in poor optimization of post-stroke functions. A key component of patient-centred care is the ability of staff to communicate in a way that allows them to understand the patient’s needs. We developed a patient-centred communication intervention targeting registered and unregulated nursing staff caring for complex continuing care patients with communication impairments post stroke. Research objectives include 1) examining the effects of the intervention on patients’ quality of life, depression, satisfaction with care, and agitation; and (2) examining the extent to which the intervention improves staff’s attitudes and knowledge in caring for patients with communication impairments. The intervention builds on a previous pilot study. Methods/design A quasi-experimental repeated measures non-equivalent control group design in a complex continuing care facility is being used. Patients with a communication impairment post-stroke admitted to the facility are eligible to participate. All staff nurses are eligible. Baseline data are collected from staff and patients. Follow-up will occur at 1 and 3 months post-intervention. Subject recruitment and data collection from 60 patients and 30 staff will take approximately 36 months. The Patient-Centred Communication Intervention consists of three components: (1) development of an individualized patient communication care plan; (2) a one-day workshop focused on communication and behavioural management strategies for nursing staff; and (3) a staff support system. The intervention takes comprehensive patient assessments into account to inform the development of communication and behavioural strategies specifically tailored to each patient. Discussion The Patient-Centred Communication Intervention will provide staff with strategies to facilitate interactions with patients and to minimize agitation associated with considerable stress. The improvement of these interactions will lead to a reduction of agitation, which has the additional significance of increasing patients’ well-being, quality of life, and satisfaction with care. Trial registration ClinicalTrials.gov Identifier NCT01654029
The Cancer Information Service (CIS) was established in 1975 by the National Cancer Institute (NCI) to meet the information needs of cancer patients, their families, health professionals, and the public. As the nation's foremost source for cancer information, the CIS applies a unique health communications model to bring the latest research findings on cancer prevention, detection, treatment, and supportive care to the nation. It does this through two main program components: a toll-free telephone service (1-800-4-CANCER) and an outreach program that focuses on providing technical assistance, specifically to partners reaching minority and underserved audiences. During its 22-year history, more than 7.5 million callers have reached the CIS telephone service. In addition, 100,000 requests are received each year from 4,500 organizations nationwide seeking cancer-related outreach expertise. This overview describes the CIS model for health communications, describes the program's impact in broad terms, and defines the critical role evaluation plays in each program component. The overview describes two customer satisfaction and impact surveys performed by an independent survey research firm in 1996 to evaluate the CIS model: (a) the telephone service user survey, a random sample of 2,489 persons representing major caller groups who were interviewed 3 to 6 weeks after their initial call to the CIS; and (b) the outreach partner survey, a random sample of 867 partner organizations, the majority of which reach minority and underserved audiences with information and programs, surveyed within a few months after a contact with the CIS outreach program. Impact data for both program areas were favorable: Approximately 8 out of 10 CIS callers reported that the information they received had a positive impact (either in eliciting a positive action [56%] or in reassurance of decisions made [22%]) and two-thirds of CIS partners said the CIS has an important impact on their programs. PMID:10977265
Thomsen, C A; Ter Maat, J
The change from the sociology of medicine to the sociology of health comes about in a post-modern social context characterized by a complex and ambiguous situation. This is particularly true in the case of maternity where communication between people of different knowledge is fundamental: the researcher, doctor and female patient tend to lean towards an auto-referential relationship based on an informative communication method (as emerged from a survey on how women patients received information in the cities of Bologna and Urbino). Adopting a relational type communication based on listening, the three subjects can create a common system which, thanks also to the support of modern technology, can help to easily overcome the difficulties encountered. PMID:10645665
CancerChatCanada is a pan-Canadian initiative with a mandate to make professionally led cancer support groups available to more people in Canada. Although online support groups are becoming increasingly popular, little is known about therapist-led, synchronous groups using live chat. The purpose of this study was to generate a rich descriptive account of communication experiences in CancerChatCanada groups and to gain an understanding of processes associated with previously-reported benefits. We used interpretive description to analyze interview segments from 102 patients, survivors and family caregivers who participated in CancerChatCanada groups between 2007 and 2011. The analysis yielded four inter-related process themes (Reaching Out From Home, Feeling Safe, Emotional Release, and Talking With Text) and one outcome theme (Resonance and Kinship). The findings extend previous research about text-only online support groups and provide novel insights into features of facilitated, live chat communication that are valued by group members. PMID:24581076
Stephen, Joanne; Collie, Kate; McLeod, Deborah; Rojubally, Adina; Fergus, Karen; Speca, Michael; Turner, Jill; Taylor-Brown, Jill; Sellick, Scott; Burrus, Kimberly; Elramly, Mai
Counseling is a technique used in psychology that has shown a major impact on health: in deep, it is the methodology recommended by the Worl Health Organization to help HIV-infected patients. Although it has been translated to spanish by assisted counseling or helping relationship, counseling covers a broader concept. It is defined as an interactive process based on communication in which the clinician helps the patients to think about their own health and to take appropiate decisions based on their values and interests. In short, counseling is a tool to enhance communication with the patient, resulting very useful during clinical interview in pharmaceutical care programs in order to improve pharmacotherapy and patient safety. PMID:23789800
Martí-Gil, C; Barreda-Hernández, D; Marcos-Pérez, G; Barreira-Hernández, D
Healthcare providers often look for feedback from patient surveys. Does health-professional awareness of patient survey results improve communication between patients and providers? To test this hypothesis, we analyzed the data of two surveys on organizational-climate and patient experience in Italy. The two surveys were conducted in 26 hospitals in the Tuscany region and involved 8942 employees and 5341 patients, respectively. Statistical analysis showed that the patient experience index significantly improved by 0.35 points (scale: 0-100) when the professionals' knowledge of the patient survey results increased by 1%. These findings suggest that the control systems should focus more on the dissemination phase of patient survey results among health professionals in order to improve the quality of services. PMID:24630781
Murante, Anna Maria; Vainieri, Milena; Rojas, Diana; Nuti, Sabina
Cancer mortality and survival rates are much poorer for Black patients than for White patients. We argue that Black–White treatment disparities are a major reason for these disparities. We examine three specific kinds of Black–White treatment disparities: disparities in information exchange in oncology interactions, disparities in the treatment of breast cancer, and disparities in the treatment of clinically localized prostate cancer. In the final section, we discuss possible causes of these disparities, with a primary focus on communication within medical interactions and the role that race-related attitudes and beliefs may play in the quality of communication in these interactions.
Penner, Louis A.; Eggly, Susan; Griggs, Jennifer J.; Underwood, Willie; Orom, Heather; Albrecht, Terrance L.
Cancer therapy can be lifesaving but significantly diminish female reproductive potential. This review provides an overview of the deleterious effects of cancer treatments on reproductive function, the fertility preservation options currently available for young women and the outcomes of pregnancy after cancer treatment. In addition, special considerations for women who are diagnosed with cancer during pregnancy are discussed. To optimize the continuum of care for the patient, new corridors of communication between obstetricians, gynecologists and oncology specialists must be developed to ensure the best outcomes for the patient, both in terms of cancer treatment and fertility preservation.
Kong, Betty Y.; Skory, Robin M.; Woodruff, Teresa K.
Contents: Psychosocial adjustment to pediatric and adolescent cancer; Social functioning of families and pediatric cancer patients; Psychosocial effects of therapy on pediatric cancer patients; Neuroendocrinological effects of therapy on pediatric cancer ...
Special consideration is required when prescribing antipsychotic drugs for patients with an existing diagnosis of breast cancer. The package inserts of all approved antipsychotics contain precautions regarding their administration in this patient group. These drugs are well known to elevate serum prolactin levels to varying degrees. Overexpression of the prolactin receptor is seen in more than 95% of human breast cancers. Many genes that are activated by the prolactin receptor are associated with tumorigenesis and cancer cell proliferation. The authors discuss the pathophysiology, clinical implications, and pertinent preclinical data and make specific recommendations regarding the use of antipsychotics in patients with breast cancer. PMID:24880509
Rahman, Tahir; Clevenger, Charles V; Kaklamani, Virginia; Lauriello, John; Campbell, Austin; Malwitz, Kari; Kirkland, Robert S
Doctor–patient communication is an interpersonal process and essential to relationship-centered care. However, in many studies, doctors and patients are studied as if living in separate worlds. This study assessed whether: 1) doctors' perception of their communication skills is congruent with their patients' perception; and 2) patients of a specific doctor agree with each other about their doctor's communication skills. A
David A. Kenny; Wemke Veldhuijzen; Trudy van der Weijden; Annie LeBlanc; Jocelyn Lockyer; Craig Campbell
Colorectal adenocarcinoma ranks second as a cause of death due to cancer in the Western world. In Europe, 40% of patients with this disease is over 70 years old and only 52% of them with positive nodes usually receive an adjuvant chemotherapy. Despite early reports to the contrary, these patients tolerate cancer treatment and surgical resections as well as their
Lara Maria Pasetto; Elena Rossi; Antonio Jirillo; Silvio Monfardini
Purpose Shared breast cancer treatment decision-making between patients and physicians increases patient treatment satisfaction and compliance and is influenced by physician-related factors. Attitudes and behaviors about patient involvement in breast cancer treatment decisions and treatment-related communication were assessed by specialty among breast cancer physicians of women enrolled in the Breast Cancer Quality of Care Study (BQUAL). Results Of 275 BQUAL physicians identified, 50.0% responded to the survey. Most physicians spend 46–60 min with the patient during the initial consult visit and 51.5% report that the treatment decision is made in one visit. Oncologists spend more time with new breast cancer patients during the initial consult (p = 0.021), and find it more difficult to handle their own feelings than breast surgeons (p = <0.001). Conclusion Breast surgeons and oncologists share similar attitudes and behaviors related to patient involvement in treatment decision-making, yet oncologists report more difficulty managing their own feelings during the decision-making process.
Hillyer, Grace Clarke; Hershman, Dawn L.; Kushi, Lawrence H.; Lamerato, Lois; Ambrosone, Christine B.; Bovbjerg, Dana H.; Mandelblatt, Jeanne S.; Rana, Sargam; Neugut, Alfred I.
This chapter addresses concepts used as a foundation for bowel management in patients with cancer. Because cancer treatment\\u000a can be very noxious and disrupt bowel function, a preventive approach is an important part of bowel management for patients\\u000a with cancer. The 6 steps to good bowel management are assessment and diagnosis of bowel dysfunction, normalization of the\\u000a bowel, establishment of
Annette K. Bisanz
\\u000a Acute kidney injury (AKI) in cancer patients is a dreadful complication that causes substantial morbidity and mortality. Moreover,\\u000a AKI may preclude optimal cancer treatment by requiring a decrease in chemotherapy dosage or by contraindicating potentially\\u000a curative treatment. The pathways leading to AKI in cancer patients are common to the development of ARF in other conditions.\\u000a However, AKI may also develop
Michael Darmon; Laurent Camous; Camille Devanlay; Emmanuel Canet; Benoit Schlemmer; Fabrice Zeni
This Special Listing of Current Cancer Research Projects is a publication of the International Cancer Research Data Bank (ICRDB) Program of the National Cancer Institute. Each Listing contains descriptions of ongoing projects in one selected cancer research area. The research areas include: Infectious disease in cancer patients; Immunological aspects of supportive care of cancer patients; Nutritional evaluation and support of cancer patients; Pain management of cancer patients.
More theory development about interpersonal communication during cancer is needed so that scholarship can be advanced and practical applications of findings can be best disseminated and applied. We proposed an evidence-based extension to the theory of illness trajectories based on findings from a qualitative study of cancer survivors' (n?=?40) experiences with communication. Grounding our analysis in respondents' descriptions of the
Erin Donovan-Kicken; Andrew C. Tollison; Elizabeth S. Goins
More theory development about interpersonal communication during cancer is needed so that scholarship can be advanced and practical applications of findings can be best disseminated and applied. We proposed an evidence-based extension to the theory of illness trajectories based on findings from a qualitative study of cancer survivors' (n?=?40) experiences with communication. Grounding our analysis in respondents' descriptions of the
Erin Donovan-Kicken; Andrew C. Tollison; Elizabeth S. Goins
Kidney disease is very common in patients with cancer. Nephrologists are vital members of the multidisciplinary care team for these patients. Given the high prevalence of comorbidities in patients treated for active malignancy, it is not surprising that these individuals frequently develop renal diseases that are common among other hospitalized patients, such as those arising from sepsis, hypotension or use
John R Foringer; Kevin W Finkel
Objective Although there is broad consensus that careful content vetting and user testing is important in the development of technology-based educational interventions, often these steps are overlooked. This paper highlights the development of a theory-guided, web-based communication aid (CONNECT™), designed to facilitate treatment decision making among patients with advanced cancer. Methods The communication aid included an online survey, patient skills training module and an automated physician report. Development steps included: 1) evidence-based content development, 2) usability testing, 3) pilot testing, and 4) patient utilization and satisfaction. Results Usability testing identified some confusing directions and navigation for the on-line survey and validated the relevance of the “patient testimonials” in the skills module. Preliminary satisfaction from the implementation of the communication aid showed that 66% found the survey length reasonable and 70% found it helpful in talking with the physician. Seventy percent reported the skills module helpful and about half found it affected the consultation. Conclusion Designing patient education interventions for translation into practice requires the integration of health communication best practice including user feedback along the developmental process. Practice Implications This developmental process can be translated to a broad array of community based patient and provider educational interventions.
Fleisher, Linda; Buzaglo, Joanne; Collins, Michael; Millard, Jennifer; Miller, Suzanne M.; Egleston, Brian L.; Solarino, Nicholas; Trinastic, Jonathan; Cegala, Donald J.; Benson, Al B.; Schulman, Kevin A.; Weinfurt, Kevin P.; Sulmasy, Daniel; Diefenbach, Michael A.; Meropol, Neal J.
In light of recent evidence suggesting the importance of communication in the health care setting, an instrument to measure communication style preferences was developed. This reliable and content-valid paper-and-pencil measure consisted of six scenarios depicting physician-patient interactions, each followed by four potential verbal responses from the physician. The four responses, representing four communications styles--humor, hostility, reassurance, and neutrality--were ranked by respondents according to their preferences. Among both physicians and consumers, reassuring responses were the most preferred, followed by neutral, humorous, and hostile responses. The intercorrelations of the four preferences and their relationships to standardized tests of both facilitating verbal response preferences and nonverbal expressiveness are presented. Potential uses of the instrument are discussed. PMID:6656345
Linn, L S; DiMatteo, M R
Objective To examine whether the effect of health literacy (HL) on patient–physician communication varies with patient–physician language concordance and communication type. Methods 771 outpatients rated three types of patient–physician communication: receptive communication (physician to patient); proactive communication (patient to physician); and interactive, bidirectional communication. We assessed HL and language categories including: English-speakers, Spanish-speakers with Spanish-speaking physicians (Spanish-concordant), and Spanish-speakers without Spanish-speaking physicians (Spanish-discordant). Results Overall, the mean age of participants was 56 years, 58% were women, 53% were English-speakers, 23% Spanish-concordant, 24% Spanish-discordant, and 51% had limited HL. Thirty percent reported poor receptive, 28% poor proactive, and 56% poor interactive communication. In multivariable analyses, limited HL was associated with poor receptive and proactive communication. Spanish-concordance and discordance was associated with poor interactive communication. In stratified analyses, among English-speakers, limited HL was associated with poor receptive and proactive, but not interactive communication. Among Spanish-concordant participants, limited HL was associated with poor proactive and interactive, but not receptive communication. Spanish-discordant participants reported the worst communication for all types, independent of HL. Conclusion Limited health literacy impedes patient–physician communication, but its effects vary with language concordance and communication type. For language discordant dyads, language barriers may supersede limited HL in impeding interactive communication. Practice implications Patient–physician communication interventions for diverse populations need to consider HL, language concordance, and communication type.
Sudore, Rebecca L.; Landefeld, C. Seth; Perez-Stable, Eliseo J.; Bibbins-Domingo, Kirsten; Williams, Brie A.; Schillinger, Dean
Purpose: Cancer treatment can be a complex and confusing process for both the patients and the care providers. With an ever-increasing array of treatment options, a push toward personalized medicine, and a complex payer system, coordination of cancer care is essential in streamlining the process. At Intermountain Healthcare, we have developed a hospital-based multidisciplinary cancer clinic that provides coordinated and comprehensive treatment planning in a single visit. Provider participation is open to employed, affiliated, and community physicians. Methods: The first multidisciplinary clinic, which was for breast cancer, was held in 2005. Similar clinics for other tumor types have subsequently been instituted, including clinics for genitourinary/prostate, GI/liver/pancreas, sarcoma, and thoracic cancer. Each clinic is staffed by a surgeon, medical oncologist, radiation oncologist, and other specialists as needed. Clinic meetings are held immediately following a specialty tumor conference during which each patient is discussed. The patients then meet one-on-one with each specialist and leave the clinic with an individualized treatment plan. Patient and physician satisfaction surveys are regularly conducted. Financial metrics are calculated to track downstream revenue. Results: Satisfaction with the clinic has been high, and 98% of patients rated their overall experience as “excellent.” Physicians also give the clinic high marks, crediting it with improving communication, building patient confidence, and increasing efficiency. Conclusion: The multidisciplinary clinic at Intermountain Healthcare has greatly improved the cancer care process for patients, physicians, and the community. If implemented appropriately, multidisciplinary clinics have the potential to enhance quality of care and increase downstream revenue.
Litton, Gregory; Kane, Dianne; Clay, Gina; Kruger, Patricia; Belnap, Thomas; Parkinson, Brett
Background The objective of this exploratory study was to identify patient-related predictors of communication preferences in patients with chronic low back pain for various dimensions of patient-physician communication (patient participation and orientation, effective and open communication, emotionally supportive communication, communication about personal circumstances). Methods Eleven rehabilitation centers from various parts of Germany participated in collection of data between 2009 and 2011. A total of 701 patients with chronic low back pain were surveyed at the start of rehabilitation. The patient questionnaire captured communication preferences, pain impact, pain intensity, and psychologic variables (fear avoidance beliefs, illness coherence, control beliefs, communication self-efficacy, and personality characteristics). The rehabilitation physicians filled out a documentation sheet containing information on diagnosis, inability to work, duration of the illness, and comorbidity at the beginning and end of rehabilitation. Hierarchical regression analyses were performed. Results On average, effective, open, and patient-centered communication was very important for patients with back pain, emotionally supportive communication was important, and communication about personal circumstances was somewhat important. The variance in communication preferences explained by the predictors studied here was 8%–19%. Older patients showed a lower preference for patient-centered and open communication, but a higher preference for communication about personal circumstances. Patients with psychologic risk factors (eg, fear avoidance beliefs), extroverted patients, and patients with high self-efficacy in patient-physician interaction generally had higher expectations of the physician’s communicative behavior. Conclusion Providers should take into consideration the fact that patients with back pain have a strong need for effective, open, and patient-centered communication. A flexible approach to communication needs appears to be especially important for communication about emotional and personal circumstances, because the patients differ most clearly in this respect. Personal characteristics provided only initial clues to possible preferences; for more precision, an individual assessment (by means of questionnaires or discussion) is needed.
Farin, Erik; Gramm, Lukas; Schmidt, Erika
The digital revolution will have a profound impact on how physicians and health care delivery organizations interact with patients and the community at-large. Over the coming decades, face-to-face patient/doctor contacts will become less common and exchanges between consumers and providers will increasingly be mediated by electronic devices. In highly developed health care systems like those in Israel, the United States, and Europe, most aspects of the health care and consumer health experience are becoming supported by a wide array of technology such as electronic and personal health records (EHRs and PHRs), biometric & telemedicine devices, and consumer-focused wireless and wired Internet applications. In an article in this issue, Peleg and Nazarenko report on a survey they fielded within Israel's largest integrated delivery system regarding patient views on the use of electronic communication with their doctors via direct-access mobile phones and e-mail. A previous complementary paper describes the parallel perspectives of the physician staff at the same organization. These two surveys offer useful insights to clinicians, managers, researchers, and policymakers on how best to integrate e-mail and direct-to-doctor mobile phones into their practice settings. These papers, along with several other recent Israeli studies on e-health, also provide an opportunity to step back and take stock of the dramatic impact that information & communication technology (ICT) and health information technology (HIT) will have on clinician/patient communication moving forward. The main goals of this commentary are to describe the scope of this issue and to offer a framework for understanding the potential impact that e-health tools will have on provider/patient communication. It will be essential that clinicians, managers, policymakers, and researchers gain an increased understanding of this trend so that health care systems around the globe can adapt, adopt, and embrace these rapidly evolving digital technologies.
The digital revolution will have a profound impact on how physicians and health care delivery organizations interact with patients and the community at-large. Over the coming decades, face-to-face patient/doctor contacts will become less common and exchanges between consumers and providers will increasingly be mediated by electronic devices.In highly developed health care systems like those in Israel, the United States, and Europe, most aspects of the health care and consumer health experience are becoming supported by a wide array of technology such as electronic and personal health records (EHRs and PHRs), biometric & telemedicine devices, and consumer-focused wireless and wired Internet applications.In an article in this issue, Peleg and Nazarenko report on a survey they fielded within Israel's largest integrated delivery system regarding patient views on the use of electronic communication with their doctors via direct-access mobile phones and e-mail. A previous complementary paper describes the parallel perspectives of the physician staff at the same organization. These two surveys offer useful insights to clinicians, managers, researchers, and policymakers on how best to integrate e-mail and direct-to-doctor mobile phones into their practice settings. These papers, along with several other recent Israeli studies on e-health, also provide an opportunity to step back and take stock of the dramatic impact that information & communication technology (ICT) and health information technology (HIT) will have on clinician/patient communication moving forward.The main goals of this commentary are to describe the scope of this issue and to offer a framework for understanding the potential impact that e-health tools will have on provider/patient communication. It will be essential that clinicians, managers, policymakers, and researchers gain an increased understanding of this trend so that health care systems around the globe can adapt, adopt, and embrace these rapidly evolving digital technologies. PMID:22929000
Weiner, Jonathan P
Abstract Cancer patients tend to have a higher incidence of herpes zoster (HZ), but little is known about their risk of HZ complications. We conducted a retrospective study of 424 newly diagnosed hematologic (HM, n = 140) and solid tumor malignancy (STM, n = 284) patients who developed HZ between January 2001 and December 2006 to measure the frequency and identify risk factors of HZ complications. Patients were adult members of Kaiser Permanente Northern California. HZ diagnosis and complications were confirmed by medical chart review. HM patients with HZ tended to have more HZ complications than STM patients (34% vs 23%, p = 0.02), largely due to more frequent non-pain complications. On multivariate analysis, older age and being male were associated with a higher risk of HZ complications in HM patients; more advanced cancer stage was associated with HZ complications in STM patients. HZ complications are frequent and can present extra disease burden in cancer patients who develop HZ. PMID:24796470
Tran, Trung N; Ray, G Thomas; Horberg, Michael A; Yawn, Barbara P; Castillo, Adrienne L; Saddier, Patricia; Habel, Laurel A
Purpose In order to improve the likelihood of curative and safe gastric surgery, this study investigated the clinical features and surgical outcomes of gastric cancer with a synchronous cancer. Patients and Methods The clinicopathological data of 10,090 gastric cancer patients at Samsung Medical Center from September 1994 to December 2006 were retrospectively analyzed. Of them, 90 patients with gastric cancer and a synchronous second primary cancer underwent simultaneous surgery for gastric cancer and second primary cancer. The clinicopathological characteristics of the patients, surgical outcome, and prognosis were examined. Results The most common synchronous second primary cancer was colorectal cancer (37 patients), followed by hepatocellular carcinoma (13 patients), renal cell carcinoma (11 patients), and pancreatic carcinoma (5 patients). The incidence of a second primary cancer in the gastric cancer patients was higher than the incidence in the general population. Stage I gastric cancer patients had more synchronous cancers than stage II patients (59 vs. 31). Postoperative complications were encountered in 7 patients. Four patients underwent reoperation. Two patients died from hepatic failure and leakage of esophagojejunal anastomosis. The 5-year survival rate of stage I and II gastric cancer was 61% and 39%, respectively. Conclusion Since gastric cancer patients with a synchronous second primary cancer are not rare, the possibility of synchronous cancers in gastric cancer patients should be considered. The prognosis of early stage gastric cancer patients with a synchronous second primary cancer was influenced more by the presence of the second primary cancer than by the gastric cancer itself.
Ha, Tae Kyung; An, Ji Yeong; Youn, Ho Geun; Noh, Jae Hyung; Sohn, Tae Sung
Objectives Qualitative research aimed at identifying patient acceptance of active surveillance (AS) has been identified as a public health research priority. The primary objective of this study was to determine if analysis of a large-sample of anonymous internet conversations (ICs) could be utilized to identify unmet public needs regarding AS. Methods English-language ICs regarding prostate cancer (PC) treatment with AS from 2002–12 were identified using a novel internet search methodology. Web spiders were developed to mine, aggregate, and analyze content from the world-wide-web for ICs centered on AS. Collection of ICs was not restricted to any specific geographic region of origin. NLP was used to evaluate content and perform a sentiment analysis. Conversations were scored as positive, negative, or neutral. A sentiment index (SI) was subsequently calculated according to the following formula to compare temporal trends in public sentiment towards AS: [(# Positive IC/#Total IC) - (#Negative IC/#Total IC) x 100]. Results A total of 464 ICs were identified. Sentiment increased from -13 to +2 over the study period. The increase sentiment has been driven by increased patient emphasis on quality-of-life factors and endorsement of AS by national medical organizations. Unmet needs identified in these ICs include: a gap between quantitative data regarding long-term outcomes with AS vs. conventional treatments, desire for treatment information from an unbiased specialist, and absence of public role models managed with AS. Conclusions This study demonstrates the potential utility of online patient communications to provide insight into patient preferences and decision-making. Based on our findings, we recommend that multidisciplinary clinics consider including an unbiased specialist to present treatment options and that future decision tools for AS include quantitative data regarding outcomes after AS.
Mishra, Mark V.; Bennett, Michele; Vincent, Armon; Lee, Olivia T.; Lallas, Costas D.; Trabulsi, Edouard J.; Gomella, Leonard G.; Dicker, Adam P.; Showalter, Timothy N.
Narrative forms of communication—including entertainment education, journalism, literature, testimonials, and storytelling—are\\u000a emerging as important tools for cancer prevention and control. To stimulate critical thinking about the role of narrative\\u000a in cancer communication and promote a more focused and systematic program of research to understand its effects, we propose\\u000a a typology of narrative application in cancer control. We assert that narrative
Matthew W. Kreuter; Melanie C. Green; Joseph N. Cappella; Michael D. Slater; Meg E. Wise; Doug Storey; Eddie M. Clark; Daniel J. O’Keefe; Deborah O. Erwin; Kathleen Holmes; Leslie J. Hinyard; Thomas Houston; Sabra Woolley
Each phase of the cancer experience profoundly affects patients’ lives. Much of the literature has focused on negative consequences of cancer; however, the study of resilience may enable providers to promote more positive psychosocial outcomes before, during, and after the cancer experience. The current review describes the ways in which elements of resilience have been defined and studied at each phase of the cancer continuum. Extensive literature searches were conducted to find studies assessing resilience during one or more stages of the adult cancer continuum. For all phases of the cancer continuum, resilience descriptions included preexisting or baseline characteristics, such as demographics and personal attributes (e.g., optimism, social support), mechanisms of adaptation, such as coping and medical experiences (e.g., positive provider communication), as well as psychosocial outcomes, such as growth and quality of life. Promoting resilience is a critical element of patient psychosocial care. Nurses may enable resilience by recognizing and promoting certain baseline characteristics and optimizing mechanisms of adaptation.
Molina, Yamile; Yi, Jean C.; Martinez-Gutierrez, Javiera; Reding, Kerryn W.; Yi-Frazier, Joyce P.; Rosenberg, Abby R.
An amendment to the German medical curriculum in April 2002 will place communication and social skills at the centre of medical training. In addition to providing cognitive knowledge, psychosomatic courses offer the opportunity to integrate affective learning, with a focus on communication and interaction processes. In winter term 2001/2002 a training with standardised patients was implemented and evaluated as part of the psychosomatic internship of the Department of General Internal and Psychosomatic Medicine at the Medical Hospital of the University of Heidelberg. Quantitative and qualitative results showed that training with standardised patients is well accepted and that acceptance is independent of student gender, career choice, or interests. These training units are easy to integrate into psychosomatic practical courses. The results discussed here will focus on the role and importance of various elements of medical training. PMID:14600846
Nikendei, Christoph; Zipfel, Stephan; Roth, Christiane; Löwe, Bernd; Herzog, Wolfgang; Jünger, Jana
BACKGROUND Racial disparities in hypertension control contribute to higher rates of cardiovascular mortality among blacks. Patient-physician\\u000a communication quality is associated with better health outcomes, including blood pressure (BP) control. Both race\\/ethnicity\\u000a and BP control may adversely affect communication.\\u000a \\u000a \\u000a \\u000a OBJECTIVE To determine whether being black and having poor BP control interact to adversely affect patient-physician communication more\\u000a than either condition alone, a situation
Crystal W. Cené; Debra Roter; Kathryn A. Carson; Edgar R. Miller; Lisa A. Cooper
In Brazil, recent regulations require changes in private and public health systems to make special services available to deaf patients. In the present article, the researchers analyze the perceptions of 25 sign language-using patients regarding this assistance. The researchers found communication difficulties between these patients and health services staff, as well as a culture clash and a harmful inability among the service providers to distinguish among the roles of companions, caretakers, and professional translator/interpreters. Thus, it became common for the patients to experience prejudice in the course of treatment and information exchange, damage to their autonomy, limits on their access to services, and reduced efficacy of therapy. The researchers conclude that many issues must be dealt with if such barriers to health access are to be overcome, in particular the worrying degree of exclusion of deaf patients from health care systems. PMID:20503906
Pereira, Patrícia Cristina Andrade; Fortes, Paulo Antonio de Carvalho
Patients with advanced gastric cancer who received standard chemotherapy plus trastuzumab (Herceptin®) survived several months longer than those who received chemotherapy alone, according to findings presented at the 2009 ASCO meeting in Orlando.
Asthma is an increasingly common disorder, affecting 5-10% of the population. It involves a dysregulated immune function, which may predispose to subsequent cancer. We examined cancer risk among Swedish subjects who had hospital admission once or multiple times for asthma. An asthma research database was created by identifying asthma patients from the Swedish Hospital Discharge Register and by linking them with the Cancer Registry. A total of 140 425 patients were hospitalised for asthma during 1965-2004, of whom 7421 patients developed cancer, giving an overall standardised incidence ratio (SIR) of 1.36. A significant increase was noted for most sites, with the exception of breast and ovarian cancers and non-Hodgkin's lymphoma and myeloma. Patients with multiple hospital admissions showed a high risk, particularly for stomach (SIR 1.70) and colon (SIR 1.99) cancers. A significant decrease was noted for endometrial cancer and skin melanoma. Oesophageal and lung cancers showed high risks throughout the study period, whereas stomach cancer increased towards the end of the period. The relatively stable temporal trends suggest that the asthmatic condition rather than its medication is responsible for the observed associations. PMID:19174822
Ji, J; Shu, X; Li, X; Sundquist, K; Sundquist, J; Hemminki, K
Objective The authors report the outcomes of a community-based, barber health adviser pilot intervention that aims to develop customized educational materials to promote knowledge and awareness of prostate cancer (CaP) and informed decision making about prostate cancer screening (PCS) among a predominantly African American clientele. Method First, the authors implemented a series of learner verification processes with barbershop clients (n = 15) to adapt existing CaP health promotion materials. Following intervention implementation in the barbershop, they conducted structured surveys with barbershop clients (n = 40) to evaluate the intervention. Results Findings from the posttest showed both a significant increase in barbershop clients' self-reported knowledge of CaP and in the likelihood of discussing PCS with a health care provider (p < .001). The client's cultural model of CaP risk factors revealed cultural consensus (eigenratio = 3.3) and mirrored the biomedical model. All clients surveyed reported positively on the contents of the educational materials, and more than half (53%) had discussed CaP at least twice with their barber in the last month. Conclusion Based on the pilot results, the barber-administered intervention was an appropriate and viable communication channel for promoting CaP knowledge and awareness in a priority population, African American men.
Luque, John S.; Rivers, Brian M.; Gwede, Clement K.; Kambon, Maisha; Green, B. Lee; Meade, Cathy D.
Heart failure (HF) continues to place significant demands on health care resources because of the large number of hospital\\u000a admissions for HF, the growth of the elderly population with HF, and the improved survival of patients with chronic heart\\u000a disease who develop HF that requires continuous care. Because HF is best managed using a disease management approach, frequent\\u000a communication is
Abul Kashem; Robert C. Cross; William P. Santamore; Alfred A. Bove
Background. Breaking bad news is 1 of cancer specialists’ most common and difficult duties, yet hematology-oncology fellowship programs\\u000a typically offer little formal preparation for this daunting task. We designed the Breaking Bad News Standardized Patient Intervention\\u000a (BBNSPI) as a standardized patient educational intervention to improve the communication skills of hematology-oncology fellows\\u000a (HOFs) and advanced practice nurses (APNs) in breaking bad
Ahmed Eid; Michael Petty; Laura Hutchins; Reed Thompson
Malnutrition and weight loss negatively affect outcomes in surgical cancer patients. Decades of research have sought to identify the most appropriate use of nutrition support in these patients. National and international guidelines help to direct clinicians' use of nutrition support in surgical patients, but a number of specific issues concerning the use of nutrition support continue to evolve. This review focuses on 5 key issues related to perioperative nutrition support in cancer patients: (1) Which perioperative cancer patients should receive nutrition support? (2) How can the nutrition status and requirements of these patients be optimally assessed? (3) What is the optimal route of administration (parenteral nutrition vs enteral nutrition) and composition of nutrition support in this setting? (4) When should feedings be initiated? (5) What is the role of glycemic control in these patients? PMID:22875752
Huhmann, Maureen B; August, David A
Social characteristics (e.g. race, gender, age, education) are associated with health care disparities. We introduce social concordance, a composite measure of shared social characteristics between patients and physicians. Objective To determine whether social concordance predicts differences in medical visit communication and patients’ perceptions of care. Methods Regression analyses were used to determine the association of patient-provider social concordance with medical visit communication and patients’ perceptions of care using data from two observational studies involving 64 primary care physicians and 489 of their patients from the Baltimore, MD /Washington, DC/Northern Virginia area. Results Lower patient-physician social concordance was associated with less positive patient perceptions of care and lower positive patient affect. Patient-physician dyads with low vs. high social concordance reported lower ratings of global satisfaction with office visits (OR=0.64 vs. OR=1.37, p=0.036) and were less likely to recommend their physician to a friend (OR=0.61vs. OR=1.37, p=0.035). A graded-response was observed for social concordance with patient positive affect and patient perceptions of care. Conclusion Patient-physician concordance across multiple social characteristics may have cumulative effects on patient-physician communication and perceptions of care. Practice Implications Research should move beyond one-dimensional measures of patient-physician concordance to understand how multiple social characteristics influence health care quality.
Johnson Thornton, Rachel L.; Powe, Neil R.; Roter, Debra; Cooper, Lisa A.
This article describes an assignment designed to incorporate the Quality and Safety Education for Nurses (QSEN) competency of patient-centered care into a simulation activity aimed to improve therapeutic communication skills in psychiatric nursing. During this pilot activity, students engaged in an interaction with an actor trained to portray an individual with mental illness. Students viewed their video-recorded interaction to identify communication techniques used and completed a self-evaluation examining their strengths and areas for improvement. Faculty and actors provided feedback to students during a faculty-led debriefing held to discuss the use of therapeutic communication and care focused on the knowledge, skills, and attitudes necessary to provide quality patient-centered care. Desired learning outcomes included the demonstration of therapeutic communication and assessment skills, empathy and caring, and addressing patient values, preferences, and beliefs. PMID:24127180
Pain, Neuropathic; Epilepsy; Renal Pelvis Cancer; Pancreatic Cancer; Breast Cancer; Nervous System Cancer; Chronic Pancreatitis; Stomach Cancer; Renal Cell Carcinoma; Diabetes; Bladder Cancer; Bone and Joint Cancer; Penis Cancer; Anal Cancer; Cancer; Renal Cancer
Health professionals are reluctant to enquire actively about cancer patients' concerns and feelings. They fear that probing will damage patients psychologically and believe they have had insufficient training in the relevant interviewing skills. In considering how their interviewing skills might be improved, the key question is which interviewing behaviours promote patient disclosure and which inhibit it. To test our predictions
P. Maguire; A. Faulkner; K. Booth; C. Elliott; V. Hillier
This review summarizes and synthesizes research findings on risk perception and risk communication related to cancer screening behaviors. The focus is on cancers for which there is evidence that screening reduces mortality, i.e., cervical, breast, and colorectal cancers. The following questions are addressed: 1) Is perceived risk associated with relevant can- cer screening behaviors? 2) What factors are associated with
Sally W. Vernon
Breast cancer survivors often use clues to convey their concerns to their oncologists. The authors conducted a randomized trial of a communication coaching intervention in which 22 female breast cancer survivors were randomized to the coaching and 22 to treatment as usual. They hypothesized that the intervention would increase breast cancer self-efficacy, improve mood, and reduce fears of recurrence. Through
Cleveland G. Shields; Kim Wagler Ziner; Sara A. Bourff; Katherine Schilling; Qianqian Zhao; Patrick Monahan; George Sledge; Victoria Champion
Increasingly, cancer-related Web sites have been developed to provide information for patients. More needs to be done to understand the experience of men with cancer using the Internet. Heideggerian hermeneutics is the interpretive approach used to guide this study. Fifteen men with cancer who used the Internet were recruited through a prostate cancer support group and snowball sampling. Participants were individually interviewed and asked to tell stories of Internet use and practices. Transcribed interviews provided data for interpretive analysis. The overall constitutive pattern describing the men's experience is "cancer diagnosis as a problem to be solved." Five related themes included (1) seeking disease and treatments information from the Internet for decision making, to become comfortable with treatment plan; (2) organizing information to facilitate provider encounters and to monitor for reoccurrence; (3) evaluating Web information by credibility and usability with trust in the physician influencing the end decision point; (4) symptom management by knowing possibilities by hearing patient stories; and (5) navigating through the healthcare system politics and power. Men with cancer are incorporating Internet use into their cancer journey. They perceive changing provider-patient relationships when they participate in treatment decisions and monitor for reoccurrence. PMID:20975535
Dickerson, Suzanne S; Reinhart, Amber; Boemhke, Marcia; Akhu-Zaheya, Laila
Recent models of physician–patient communication emphasize information exchange in promoting partnership. Although considerable attention has been given to physicians’ information exchange, little research has examined patients’ communication contributions. The purpose of this research was to test the effectiveness of a training booklet designed to enhance patients’ communication skills in information exchange. A nested design was used, such that 25 physicians
Donald J. Cegala; Leola McClure; Terese M. Marinelli; Douglas M. Post
Verbal and nonverbal communication between nursing staff and patients has received scant research attention. This study examined patients' and nursing staff members' global affective and instrumental communication, mutual influence, and relationship to postvisit satisfaction. This study employed ratings of videotaped primary care visits of 81 nursing staff members with 235 patients, and assessed communication in 2 channels: nonverbal visual and
Kelly B. Haskard; M. Robin DiMatteo; John Heritage
There is growing evidence that the outcomes of health care for seniors are dependent not only upon patients’ physical health status and the administration of care for their biomedical needs, but also upon care for patients’ psychosocial needs and attention to their social, economic, cultural, and psychological vulnerabilities. Even when older patients have appropriate access to medical services, they also need effective and empathic communication as an essential part of their treatment. Older patients who are socially isolated, emotionally vulnerable, and economically disadvantaged are particularly in need of the social, emotional, and practical support that sensitive provider-patient communication can provide. In this review paper, we examine the complexities of communication between physicians and their older patients, and consider some of the particular challenges that manifest in providers’ interactions with their older patients, particularly those who are socially isolated, suffering from depression, or of minority status or low income. This review offers guidelines for improved physician-older patient communication in medical practice, and examines interventions to coordinate care for older patients on multiple dimensions of a biopsychosocial model of health care.
Williams, Summer L; Haskard, Kelly B; DiMatteo, M Robin
This article describes the design and evaluation of a patient-instructor (PI) program that was developed to teach and as- sess dental student communication skills with patients, with an emphasis on cross-cultural patient encounters. The PIs were indi- viduals from the community trained to portray specific simulated patients. One hundred eighteen dental students (three graduating classes) completed two half-day rotations that
Julie Wagner; Sarita Arteaga; Joseph D'Ambrosio; Cynthia E. Hodge; Efthimia Ioannidou; Carol A. Pfeiffer; Lynne Yong; Susan Reisine
Background Second cancers have been reported to occur in 10-20% of patients with neuroendocrine tumors (NETs). However, most published studies used data from a single institution or focused only on specific sites of NETs. In addition, most of these studies included second cancers diagnosed concurrently with NETs, making it difficult to assess the temporality and determine the exact incidence of second cancers. In this nationwide population-based study, we used data recorded by the Taiwan Cancer Registry (TCR) to analyze the incidence and distribution of second cancers after the diagnosis of NETs. Methods NET cases diagnosed from January 1, 1996 to December 31, 2006 were identified from the TCR. The data on the occurrence of second cancers were ascertained up to December 31, 2008. Standardized incidence ratios (SIRs) of second cancers were calculated based on the cancer incidence rates of the general population. Cox-proportional hazards regression analysis was performed to estimate the hazard ratio (HR) and 95% confidence interval (CI) for the risk of second cancers associated with sex, age, and primary NET sites. Results A total of 1,350 newly diagnosed NET cases were identified according to the selection criteria. Among the 1,350 NET patients, 49 (3.63%) developed a second cancer >3 months after the diagnosis of NET. The risk of second cancer following NETs was increased compared to the general population (SIR = 1.48, 95% CI: 1.09-1.96), especially among those diagnosed at age 70 or older (HR = 5.08, 95% CI = 1.69-15.22). There appeared to be no preference of second cancer type according to the primary sites of NETs. Conclusions Our study showed that the risk of second cancer following NETs is increased, especially among those diagnosed at age 70 or older. Close monitoring for the occurrence of second cancers after the diagnosis of NETs is warranted.
Tsai, Hui-Jen; Wu, Chun-Chieh; Tsai, Chia-Rung; Lin, Sheng-Fung; Chen, Li-Tzong; Chang, Jeffrey. S.
Communicating dental science, especially on issues of health and safety, is assuming increased importance in dental practice and in the relation of the profession to the public. Effective risk communication requires knowledge, balance and sensitivity to the concerns of our patients and the public. It is a skill that takes preparation, training and practice, and schools and professional organizations should be encouraged to include it in their educational programs. Presenting dental science to the public is a more difficult challenge than for the individual patient since there is no readily available site for exchange, such as the office, and no personally established relationship, credibility or trust. A larger cadre of trained spokespersons from the practice, public health, academic and research communities is needed, and more extensive multi-lingual and multi-cultural educational material should be made available for community outreach. Oral presentations to the public require different skills of both a verbal and nonverbal nature than for office communication or professional group presentation-and guidelines are offered. PMID:7829772
Mandel, I D
The risk of germ cell cancer is elevated in many DSD patients, although not to the same extent. A number of risk factors have been identified recently, but their interplay and relative impact is currently not fully clear. Until the advent of reliable screening tools for the detection of pre-invasive cancer lesions, managing germ cell tumour risk focuses on the question if and when to perform biopsy or gonadectomy in most patients and how to interpret the histological findings. PMID:24786700
Cancer patients are at risk of infectious complications due to neutropenia following chemotherapy or early post-HSCT (Hemato\\u000a Stem Cell Transplantation). The first episode of fever during recent onset neutropenia is caused mostly by bacteria, while\\u000a subsequent episodes are mainly fungal in nature. Proper management of infectious complications in neutropenic cancer patients\\u000a requires classification into the appropriate risk category and knowledge
Objective: The treatment of patients with cancer has advanced into a complex, multimodal approach incorporating surgery, radiation, and chemotherapy. Managing wounds in this population is complicated by tumor biology, the patient's disease state, and additional comorbidities, some of which may be iatrogenic. Radiation therapy, frequently employed for local-regional control of disease following surgical resection, has quantifiable negative healing effects due to local tissue fibrosis and vascular effects. Chemotherapeutic agents, either administered alone or as combination therapy with surgery and radiation, may have detrimental effects on the rapidly dividing tissues of healing wounds. Overall nutritional status, often diminished in patients with cancer, is an important aspect to the ability of patients to heal after surgical procedures and/or treatment regimens. Methods: An extensive literature search was performed to gather pertinent information on the topic of wound healing in patients with cancer. The effects that surgical procedures, radiation therapy, chemotherapy, and nutritional deficits play in wound healing in these patients were reviewed and collated. Results: The current knowledge and treatment of these aspects of wound healing in cancer patients are discussed, and observations and recommendations for optimal wound healing results are considered. Conclusion: Although wound healing may proceed in a relatively unimpeded manner for many patients with cancer, there is a potential for wound failure due to the nature and effects of the oncologic disease process and its treatments.
Payne, Wyatt G.; Naidu, Deepak K.; Wheeler, Chad K.; Barkoe, David; Mentis, Marni; Salas, R. Emerick; Smith, David J.; Robson, Martin C.
Amyotrophic Lateral Sclerosis(ALS) patients are unable to successfully communicate their desires, although their mental capacity is the same as non-affected persons. Therefore, the authors put emphasis on Event-Related Potential(ERP) which elicits the highest outcome for the target visual and hearing stimuli. P300 is one component of ERP. It is positive potential that is elicited when the subject focuses attention on stimuli that appears infrequently. In this paper, the authors focused on P200 and N200 components, in addition to P300, for their great improvement in the rate of correct judgment in the target word-specific experiment. Hence the authors propose the algorithm that specifies target words by detecting these three components. Ten healthy subjects and ALS patient underwent the experiment in which a target word out of five words, was specified by this algorithm. The rates of correct judgment in nine of ten healthy subjects were more than 90.0%. The highest rate was 99.7%. The highest rate of ALS patient was 100.0%. Through these results, the authors found the possibility that ALS patients could communicate with surrounding persons by detecting ERP(P200, N200 and P300) as their desire.
Kanou, Naoyuki; Sakuma, Kenji; Nakashima, Kenji
When a patient is diagnosed with cancer, feelings such as fear, anxiety, and hopelessness can negatively affect a person's frame of mind. Hope can help a patient decrease anxiety and increase quality of life. Nurses should assess hope, provide interventions, be empathetic, listen, and treat patients with dignity to help improve hope and quality of life. This article features how hope can have a positive impact and provides specific information about how nurses can promote and foster hope in patients with cancer. PMID:24867106
Information Delivery is one the most important tasks in healthcare practice. This article discusses patient’s tasks and perspectives, which are then used to design a new Effective Electronic Methodology. The system design methods applicable to electronic communication in the healthcare sector are also described. The architecture and the methodology for the healthcare service portal are set out in the proposed system design.
Silhavy, Petr; Silhavy, Radek; Prokopova, Zdenka
An exit interview was conducted during March, 1994 on 314 patients treated and released from the Emergency Department at Kern Medical Center in Bakersfield, California. The questionnaire was designed to assess understanding of diagnosis, prescribed medications, additional instructions, and plans for follow-up care. The patients' own perceptions of the adequacy of communication and whom they considered the most important source
John A. Crane
African American women suffer a higher burden of basal-like breast cancer, an aggressive subtype that has no targeted therapy. While epidemiologic research has identified key prevention strategies, little is known about how best to communicate risk to this population. This study explored women’s knowledge, beliefs, and attitudes about breast cancer to learn about risk perceptions. Six focus groups with 57 women (ages 18–49) women were conducted in North Carolina. Findings revealed that age, race (especially perceptions of cancer as a “White disease”), and lack of family history of breast cancer contributed to women’s perceptions of low breastcancer susceptibility. Perceptions of low risk were also attributed to conflicting risk information from family, media, and health providers. Women had little knowledge about breast cancer subtypes, but emphasized that health communications should be personally relevant, culturally appropriate, and convenient. These study findings will assist in developing health communication tools that encourage prevention.
Allicock, Marlyn; Graves, Neasha; Gray, Kathleen; Troester, Melissa A.
The objective of this study was to estimate the influence of substance use on the quality of patient-provider communication\\u000a during HIV clinic encounters. Patients were surveyed about unhealthy alcohol and illicit drug use and rated provider communication\\u000a quality. Audio-recorded encounters were coded for specific communication behaviors. Patients with vs. without unhealthy alcohol\\u000a use rated the quality of their provider’s communication
P. Todd Korthuis; Somnath Saha; Geetanjali Chander; Dennis McCarty; Richard D. Moore; Jonathan A. Cohn; Victoria L. Sharp; Mary Catherine Beach
The concept of sentinel node biopsy has been validated for female breast cancer patients whereas, ALND remains the standard of care for male breast cancer patients with similar tumours. We evaluated the results of SLN biopsy in male breast cancer patients with clinically negative axillae.This study included all male breast cancer patients who underwent SLN biopsy between February 1998 and
A. Goyal; K. Horgan; M. Kissin; C. Yiangou; M. Sibbering; M. Lansdown; R. G. Newcombe; R. E. Mansel
INTRODUCTION: Intensive care unit (ICU) patients and family members repeatedly note accurate and timely communication from health care providers to be crucial to high-quality ICU care. Practice guidelines recommend improving communication. However, few data, particularly in surgical ICUs, exist on health care provider opinions regarding whether communication is effective. METHODS: To evaluate ICU clinician perceptions regarding adequacy of communication regarding
Rebecca A Aslakson; Rhonda Wyskiel; Dauryne Shaeffer; Marylou Zyra; Nita Ahuja; Judith E Nelson; Peter J Pronovost
This study aims to identify the patient-physician communication barriers in the primary healthcare setting in Pulau Penang, Malaysia. A cross-sectional study was designed to attain the objectives of the study. A self-developed 17-item study tool was used to explore respondent's perception about the barriers they have faced while communicating with physician. The reliability scale was applied and internal consistency of the study tool was estimated on the basis of Cronbach's alpha (? = 0.58). The data analysis was conducted using statistical package for social sciences students SPSS 13(®). Chi Square test was used to test the difference between proportions. A total of n = 69 patients responded to this survey. A higher participation was seen by the male respondents, 39 (56.5%). About 52 (76.5%) of the respondents were satisfied with the information provided by the physician. In an effort to identify the patient-physician barriers, a poor understanding among the patients and physician was revealed. 16 (23.5%) respondents disclosed lack of satisfaction from the information provided to them. Overall, it is seen that lack of physician-patient understanding was the main reason that result hindrance in the affective communication. Moreover, there is a possibility that a low level of health literacy among the patients and inability of the physician to affectively listen to patients may be the other factors that result in a deficient communication. PMID:21897668
Khan, Tm; Hassali, Ma; Al-Haddad, Msm
Background Location of practice, such as working in a rural or urban clinic, may influence how physicians communicate with their patients. This exploratory pilot study examines the communication styles used during doctor-patient interactions in urban and rural family practice settings in Western Canada. Methods We analyzed observation and interview data from four physicians practicing in these different locations. Using a grounded theory approach, communications were categorized as either instrumental or socioemotional. Instrumental communication refers to “cure-oriented interactions” and tends to be more task-oriented focusing on the patient’s health concerns and reason for the appointment. In contrast, socioemotional communication refers to more “care-oriented interactions” that may make the patient feel comfortable, relieve patient anxiety and build a trusting relationship. Results The physicians in small, rural towns appear to know their patients and their families on a more personal level and outside of their office, and engage in more socioemotional communications compared to those practicing in suburban clinics in a large urban centre. Knowing patients outside the clinic seems to change the nature of the doctor-patient interaction, and, in turn, the doctor-patient relationship itself. Interactions between urban doctors and their patients had a mixture of instrumental and socioemotional communications, while interactions between rural doctors and their patients tended to be highly interpersonal, often involving considerable socioemotional communication and relationship-building. Conclusions Despite the different ways that doctors and patients communicate with each other in the two settings, rural and urban doctors spend approximately the same amount of time with their patients. Thus, greater use of socioemotional communication by rural doctors, which may ease patient anxiety and increase patient trust, did not appear to add extra time to the patient visit. Research suggests that socioemotional communication may ultimately lead to better patient outcomes, which implies that health differences between rural and urban settings could be linked to differences in doctor-patient communication styles.
In response to the evolution of the information-seeking behaviour of patients and concerns from health professionals regarding cancer patient information, the French National Federation of Comprehensive Cancer Centres (FNCLCC) introduced, in 1998, an information and education program dedicated to patients and relatives,the SOR SAVOIR PATIENT program. The methodology of this program adheres to established quality criteria regarding the elaboration of patient information. Cancer patient information, developed in this program, is based on clinical practice guidelines produced by the FNCLCC and the twenty French regional cancer centres, the National League against Cancer, The National Cancer Institute, the French Hospital Federation, the National Oncology Federation of Regional and University Hospitals,the French Oncology Federation of General Hospitals, many learned societies, as well as an active participation of patients, former patients and caregivers. The handbookSOR SAVOIR PATIENT Cancer and Fatigue is an adapted version of different publications regarding fatigue in oncology. It is meant to provide a basis for the explanationof the disease and to facilitate discussions with the healthcare team. It is available from the FNCLCC (101, rue de Tolbiac, 75013 Paris, Tel. (0033) 1, 01 76 64 78 00,www.fnclcc.fr). This document has been validated at the end of 2005 and published in January 2006. SOR SAVOIR PATIENT guides are systematically updated when new research becomes available. This article is extract from the handbook SOR SAVOIR PATIENT Cancer and Fatigue and concerns the causes and effects of fatigue and how to cope with fatigue. This information allow patients to better understand the causes and effects of fatigue, how to cope fatigue...which represent important patient information needs. This article is meant to inform patients and relatives about the disease and its treatments. It also offers health professionals a synthetic evidence-based patient information source which facilitates discussions with the patient. PMID:17191350
Dielenseger, Pascale; Dilhuydy, Jean-Marie; Brusco, Sylvie; Chazot, Lucette; Blay, Jean-Yves; Bové, Bertrand; Colcanap, Benoit; Ferrandez, Jean-Claude; Floquet, Anne; Jane Gledhill; Hubert, Nicole; Meslier, Michèle; Rosman, Sophia; Carretier, Julien; Delavigne, Valérie; Fervers, Béatrice; Leichtnam-Dugarin, Line; Philip, Thierry
Supportive care of cancer patients starts from the first day of diagnosis. It is a comprehensive approach involving psychosocial, physical and spiritual supports. Maximum efforts are put in to keep the patients as comfortable as possible during diagnosis, during treatment and during the terminal stages of their disease. PMID:9176964
Shetty, P; Rizk, K; Sadek, H; Abbas, M; Hamza, A; John, A
Objective:Findings of scarcely available studies indicate that there are substantial gaps in intercultural doctor–patient communication. In order to improve intercultural communication in medical practice in The Netherlands, an educational intervention was developed. The aim of the present study was to examine the effects of this intervention on doctor–patient communication.
Barbara C. Schouten; Ludwien Meeuwesen; Hans A. M. Harmsen
Five cancer patients were observed to have the skin change erythema ab igne (EAI) associated with painful underlying lesions, for which they had been applying local heating with hot-water bottles. In 4 cases the pain was produced by metastases and in one by the primary tumour. The EAI may be seen directly over the lesion or in an area of pain referral. In cancer patients it may be a helpful localizing sign, and in all patients (apart from the anterior lower legs of old people) it is very suggestive of a serious underlying cause. PMID:4067962
Five cancer patients were observed to have the skin change erythema ab igne (EAI) associated with painful underlying lesions, for which they had been applying local heating with hot-water bottles. In 4 cases the pain was produced by metastases and in one by the primary tumour. The EAI may be seen directly over the lesion or in an area of pain referral. In cancer patients it may be a helpful localizing sign, and in all patients (apart from the anterior lower legs of old people) it is very suggestive of a serious underlying cause. Images Figure 1 Figure 2. Figure 3. Figure 4. Figure 5.
The most frequent ultimate cause of death is myocardial arrest. In many cases this is due to myocardial hypoxia, generally arising from failure of the coronary macro- and microcirculation to deliver enough oxygenated red cells to the cardiomyocytes. The principle reason for this is occlusive thrombosis, either by isolated circulating thrombi, or by rupture of upstream plaque. However, an additionally serious pathology causing potentially fatal stress to the heart is extra-cardiac disease, such as pulmonary hypertension. A primary cause of the latter is pulmonary embolus, considered to be a venous thromboembolism. Whilst the thrombotic scenario has for decades been the dominating paradigm in cardiovascular disease, these issues have, until recently, been infrequently considered in cancer. However, there is now a developing view that cancer is also a thrombotic disease, and notably a disease predominantly of the venous circulation, manifesting as deep vein thrombosis and pulmonary embolism. Indeed, for many, a venous thromboembolism is one of the first symptoms of a developing cancer. Furthermore, many of the standard chemotherapies in cancer are prothrombotic. Accordingly, thromboprophylaxis in cancer with heparins or oral anticoagulation (such as Warfarin), especially in high risk groups (such as those who are immobile and on high dose chemotherapy), may be an important therapy. The objective of this communication is to summarise current views on the epidemiology and pathophysiology of arterial and venous thrombosis in cancer.
Blann, Andrew D.; Dunmore, Simon
To report on the incidence and use of kelp among patients with thyroid cancer. Data were collected using a web-based online anonymous survey under Institutional Review Board approval from Boston University. This report is based on 27 responses from subjects with thyroid cancer who use kelp. Demographic factors and complementary and alternative use were included. Respondents were primarily over age 40, white, female and have at least a high school education. The top five modalities were multivitamins, special diets, herbal supplements, prayer for health reasons and herbal tea. Only one patient reported perceiving a particular modality had a negative effect on treatment. Complementary and alternative medicine (CAM) was more often perceived as being used to aid their thyroid cancer treatment than to help with symptoms. On average, respondents who use kelp also use at least 11 additional CAM modalities. Only 1/2 of respondents who use kelp reported telling their physicians about their CAM use, and nearly 1/3 of respondents reported their CAM use was neither known, prescribed nor asked about by their physicians. In comparison to both national surveys of the general US population and patients with thyroid cancer, kelp users with thyroid cancer use at least twice the number of additional CAM therapies and report their use far less often. Physicians who treat patients with thyroid cancer should be aware of these data to further assist in their assessment and care. PMID:24573490
Rosen, Jennifer E; Gardiner, Paula; Saper, Robert B; Pearce, Elizabeth N; Hammer, Kallista; Gupta-Lawrence, Rebecca L; Lee, Stephanie L
The emotional content of health care professionals–cancer patient communication is often considered as poor and has to be improved by an enhancement of health care professionals empathy. One hundred and fifteen oncology nurses participating in a communication skills training workshop were assessed at three different periods. Nurses randomly allocated to a control group arm (waiting list) were assessed a first
D Razavi; N Delvaux; S Marchal; J-F Durieux; C Farvacques; L Dubus; R Hogenraad
Women with a personal or maternal history of breast cancer experience psychological stress in relation to breast cancer risk, and adolescent and young adult daughters are particularly at risk for experiencing stress related to their mothers' history of breast cancer. The current study examined interpersonal and biological stress responses during a laboratory-based communication task about breast cancer risk in 32 mother-daughter dyads and explores whether certain communication styles between mothers and daughters are associated with increased stress reactivity during the task. Five saliva samples were collected from each participant to determine cortisol baseline levels, reactivity to, and recovery from the task. Negative maternal communication was associated with higher cortisol levels in daughters. In addition, maternal sadness was correlated with lower levels of daughters' cortisol at all time points with the exception of baseline measures. Implications for understanding the psychobiology of stress in women at risk for breast cancer are highlighted. PMID:22569774
Berlin, Kate L; Andreotti, Charissa; Yull, Fiona; Grau, Ana M; Compas, Bruce E
Objectives: To compare the scorings of real and standardized patients on physician communication skills. Methods: Patient scoring (n=183) on physicians' communication skills was determined by 93 real and 90 standardized patients. Eighty physicians (42 specialists and 38 general physicians) in private practice were enrolled. Data were analyzed using self administered questionnaires and checklists including 16 close ended questions. Results: Twelve percent of patients were not satisfied with the physician communication skills. Poor communication skills were more reported by male patients and those with a higher educational level. The physician communication skill received a higher score with increase of age of patients. A good physician's communication skill was reported more by married patients. A good physician's communication skill was significantly more in female doctors, in general physicians and in doctors wearing a White Coat. Real patients scored physician's communication skills higher than standardized patients. Conclusion: It is important that physicians try to learn the principles of a good physician-patient communication skill. Therefore, providing medical educational programs on the role of a good doctor and patient relationship at all levels for the doctors and applying them in their clinical practice seem necessary to improve the physician communication skills. PMID:24949000
Rezaei, Rita; Mehrabani, G
Objectives: To compare the scorings of real and standardized patients on physician communication skills. Methods: Patient scoring (n=183) on physicians’ communication skills was determined by 93 real and 90 standardized patients. Eighty physicians (42 specialists and 38 general physicians) in private practice were enrolled. Data were analyzed using self administered questionnaires and checklists including 16 close ended questions. Results: Twelve percent of patients were not satisfied with the physician communication skills. Poor communication skills were more reported by male patients and those with a higher educational level. The physician communication skill received a higher score with increase of age of patients. A good physician’s communication skill was reported more by married patients. A good physician’s communication skill was significantly more in female doctors, in general physicians and in doctors wearing a White Coat. Real patients scored physician’s communication skills higher than standardized patients. Conclusion: It is important that physicians try to learn the principles of a good physician-patient communication skill. Therefore, providing medical educational programs on the role of a good doctor and patient relationship at all levels for the doctors and applying them in their clinical practice seem necessary to improve the physician communication skills.
Rezaei, Rita; Mehrabani, G
CRCHD PNP Project: Moffitt Cancer Center Patient Navigator Program Back to CRCHD Ongoing Research PNP Project Listing Patient Navigation Research Program (PNRP) Participating Research Sites Moffitt Cancer Center Patient Navigator Program
While researchers acknowledge broad therapeutic effects of music for patients at the end of life, limited information is available regarding the specific effects of music therapy compared with conversation-based treatment on communication behaviors and predisposition to communicate in hospice patients. Using a pretest-posttest repeated measures design, this study compared the quantity and quality of narrative and conversational advice-giving behaviors as
Jessica Lee Brown
This case report discusses the impact on the mind and body of a cancer recurrence patient in puberty, as he comes to terms with, and adjusts to, a recrudescence in his illness. In our study of the nursing process, we used Gorden's assessment tools for health patterns and gathered subjective or objective information through interviews and observations to establish case problems (i.e., "changes in body and mind", "personal maladjustments related to changes" "injuries of high risk" and "oral cavity mucosa ulcers", etc.). After gaining an understanding of the previous medical treatments employed in this case, in a way of respecting the medical selection and considering the developmental task at the stage of life, we provided support and encouragement through appropriate communications and expressions of sympathy with the objective of enhancing patient self-caring and capacity for adjustment in order to help the patient achieve the best possible quality of life. PMID:16475077
In a prospective follow-up study, attention was focused on adjustment to disease in breast cancer patients one year after diagnosis. Prebioptic data was collected in the original patient group consisting of 95 women with mammary tissue findings that required clarification. Twenty-nine women with histological confirmation of breast cancer and 37 patients of the control group with benign histological findings were recontacted after an interval of one year. Data was collected by means of psychological test questionnaires (STAI, SVF, FPI, CIP-DS), the patients with breast cancer were given an additional problem-oriented questionnaire about coping with disease, compiled by the author. Most denied having disease-related fears-progression of the disease, premature death; instead, marked sleep disturbances, regularly, recurring nightmares, and depressed states of mind characterized the psychosomatic correlate of the mental burden. The psychological consequences of cancer are related to some extent to the stage of tumour growth at the time of diagnosis; the process of social reintegration appears to be facilitated in women whose biopsy operation did not involve removal of a breast. An clear characterization of breast cancer patients could not be established using psychological testing procedures one year after diagnosis of the disease. PMID:8001753
Neuhaus, W; Lanij, B; Ahr, A; Bolte, A
Purpose: To evaluate the utility of an infrared-guided patient setup (iGPS) system to reduce the uncertainties in the setup of lung cancer patients. Methods and Materials: A total of 15 patients were setup for lung irradiation using skin tattoos and lateral leveling marks. Daily electronic portal device images and iGPS marker locations were acquired and retrospectively reviewed. The iGPS-based shifts
Yulia Lyatskaya; Steven James; Joseph H. Killoran; Ricardo Soto; Harvey J. Mamon; Lee Chin; Aaron M. Allen
Venous thromboembolism is a common complication in patients with cancer. The management of deep vein thrombosis and pulmonary embolism can be a considerable challenge in patients with cancer. The cancer itself and associated treatments contribute to an ongoing thrombogenic stimulus, while cancer patients are thought to be at increased risk for anticoagulant-induced bleeding. Initial treatment of acute thromboembolism is with
Mark N. Levine; Agnes Y. Y. Lee
The place of death of cancer patients has become an important theme in UK cancer and palliative care policy. This paper examines the place of death preferences of 41 terminally ill cancer patients and 18 of their informal carers, living in the Morecambe Bay area of north-west England. We interviewed cancer patients referred to the research team by 13 specialist
C Thomas; S. M Morris; D Clark
Whether a patient is a candidate for cancer therapy goes far beyond the person's age. To evaluate an older adult for cancer treatment, oncologists must understand the benefits and quantify the risks of the proposed treatment, determine the patient's decision-making capacity, and make the decision in collaboration with the patient's preferences and values. In her presentation at the NCCN 18th Annual Conference, Dr. Arti Hurria discussed the major components in the comprehensive geriatric assessment in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Senior Adult Oncology, focusing on functional (rather than chronologic) age, comorbidities, nutritional status, cognitive impairment, and psychosocial support. By uncovering problems possibly left undetected on a routine history and physical examination, this assessment may lead to interventions that improve health and wellbeing in older people with cancer. PMID:23704247
This study compared the efficacy of 2 psychological interventions, a coping and communication-enhancing intervention (CCI) and supportive counseling (SC), in reducing depressive symptoms and cancer-specific distress of women diagnosed with gynecological cancer. Demographic, medical, and psychological moderators of intervention effects were…
Manne, Sharon L.; Rubin, Stephen; Edelson, Mitchell; Rosenblum, Norman; Bergman, Cynthia; Hernandez, Enrique; Carlson, John; Rocereto, Thomas; Winkel, Gary
The National Cancer Institute (NCI) will disseminate communications materials to key partners and regional representatives to help better inform the public about potential thyroid cancer risk from Iodine-131 (I-131) radioactive fallout due to nuclear testing in the 1950s and early 1960s. Questions and Answers
Because of the frequency of multiple sites of involvement, a thorough evaluation of the entire spinal canal is essential for detection and treatment of spinal compression in cancer patients. For the examination of the entire spinal canal in cancer patients, a modified approach is described using water-soluble contrast medium (metrizamide), oil-based material (Pantopaque), and a "squeezing" technique for a complete myelographic block. Of 240 patients who underwent myelography for possible spinal compression, the squeezing technique was applied through a lumbar puncture to demonstrate a complete block in 39 patients; six of these had more than one block. Of the other 201 patients, the quality of the myelograms was satisfactory or excellent in 189 (94%). PMID:3876000
Lee, Y Y; Glass, J P; Wallace, S
Approximately 6% of women with breast cancer are diagnosed before the age of 40. Young age is an independent predictor of adverse outcome and most young breast cancer patients receive systemic treatment with chemotherapy, hormonal therapy or both. The loss or impairment of fertility is a potential side effect of antineoplastic treatments. Due to the rising trend to delaying pregnancy in life, an increasing proportion of young cancer patients who are yet to have a pregnancy will face the problem of iatrogenic menopause in the future. The incidence of anticancer-treatment-related ovarian failure depends on the type of chemotherapy regimen administered, the use of tamoxifen and the age of patients. It rises with increasing age, in the range of 22-61% and 61-97% in women aged <40 years and >40 years respectively. Although there is a clear trend to increasing incidence of ovarian failure with the rise in aging, there may be a small proportion of patients who became amenorrhoeic despite the very young age, thus indicating that also individual factors still unknown may affect the probability of treatment-related ovarian failure. A prompt referral of patients to reproductive counseling and a multidisciplinary team including Oncology and Reproductive Units are essential to face the management of fertility issues in cancer patients. Fertility counseling should include a detailed description of all the available techniques to preserve fertility. The main available fertility preservation techniques, standard and experimental, for young breast cancer patients include: temporary ovarian suppression during chemotherapy with gonadotropin-releasing hormone analogues, embryo cryopreservation, cryopreservation of oocytes and cryopreservation of ovarian tissue. Research efforts are still necessary to improve the efficacy and safety of the available fertility preservation strategies as well as an efficient collaboration between oncologists and gynecologists is necessary to improve patients’ access to the strategies themselves.
Anserini, Paola; Levaggi, Alessia; Poggio, Francesca; Del Mastro, Lucia
Tests the effects of patients' culture and cultural orientations on assertiveness and communication apprehension during medical interviews. Suggests that the greater the patient's construal-of-self as interdependent, the more negative her/his beliefs regarding patient participation, which, in turn, leads to a higher degree of communication…
Kim, Min-Sun; Klingle, Renee Storm; Sharkey, William F.; Park, Hee Sun; Smith, David H.; Cai, Deborah
Abstract Background: Prognosis discussion is an essential component of informed decision-making. However, many terminally ill patients have a limited awareness of their prognosis and the causes are unclear. Objective: To explore the impact of physicians' propensity to discuss prognosis on advanced cancer patients' prognosis awareness. Design: Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) study, a prospective cohort study with patient and physician surveys. Setting/Subjects: We investigated 686 patients with metastatic lung or colorectal cancer at diagnosis who participated in the CanCORS study and reported about their life expectancy. Data were linked to the physician survey from 486 physicians who were identified by these patients as filling important roles in their cancer care. Results: Few patients with metastatic cancers (16.5%) reported an accurate awareness of their prognosis, defined as reporting a life expectancy of less than 2 years for lung cancer or less than 5 years for colorectal cancer. Patients whose most-important-doctor (in helping patient make decisions) reported discussing prognosis with terminally ill patients earlier were more likely than those whose doctors deferred these discussions to have an accurate prognosis awareness (adjusted proportion, 18.5% versus 7.6%; odds ratio, 3.23; 95% confidence interval, 1.39-7.52; p=0.006). Conclusions: Few patients with advanced cancer could articulate an accurate prognosis estimate, despite most having received chemotherapy and many physicians reported they would discuss prognosis early. Physicians' propensity to discuss prognosis earlier was associated with more accurate patient reports of prognosis. Enhancing the communication skills of providers with important roles in cancer care may help to improve cancer patients' understanding of their prognosis. PMID:24742212
Liu, Pang-Hsiang; Landrum, Mary Beth; Weeks, Jane C; Huskamp, Haiden A; Kahn, Katherine L; He, Yulei; Mack, Jennifer W; Keating, Nancy L
Within the last 12 years, 125 patients have been subjected to cystectomy which makes up 18.0% of the total of 691 surgical patients. The majority of patients were at T3 (64) or T2 stage (50) whereas T1 and T4 tumors were observed in 8 and 3 cases, respectively. Four patterns of urine derivation were used after cystectomy: ureterosigmoid anastomosis--in 8 patients, one-stage cystectomy with ileocystoplasty--23, double-stage cystectomy with ileocystoplasty--48 and ureterocutaneostomy--in 46 cases. Ileocystoplasty proved the best procedure for urine derivation. Depending on patient condition, it may follow cystectomy immediately or be carried out in 2 stages: cystectomy with ureterocutaneostomy followed by ileocystoplasty 2-4 months after the first operation. PMID:1300828
Galeev, R Kh
In order to determine whether low plasma levels of retinol and its carrier (retinol binding protein) are related to increased risk of cancer recurrence, these were measured in 103 patients who had had colorectal cancer surgically removed. According to the modification of the Dukes' classification, 66 had B2 tumours (with no nodal involvement' and 37 had C tumours (with lymph-node metastases). These patients were part of the Cross Cancer Institute Adjuvant GI Cohorts who were on the control arms receiving no further treatment. At the time of blood sample collection, they were believed to be free of neoplastic disease. The post-operative patients were found to be associated with subnormal circulatory levels of retinol (43.3 micrograms dl-1 vs 65.3 micrograms dl-1) and its carrier protein (4.6 mg dl-1 vs 5.7 mg dl-1), when compared with apparently healthy subjects. The latter being more markedly depressed in patients with "C" type tumour (3.8 mg dl-1) than that in those with "B2" type tumour (5.0 mg dl-1). These findings appeared to be persistent during the follow-up study when a second blood sample was collected, one to four months later from 40 patients. Furthermore, the initial plasma retinol level in conjunction with RBP was found to be even lower in 12 patients (35.1 micrograms dl-1, 3.7 mg dl-1) who subsequently had cancer recurrence than in those who remained free of apparent cancer (44.5 micrograms dl-1, 4.6 mg dl-1). The lowest initial values of retinol (19.3 micrograms; 18.8 micrograms dl-1) and RBP (2.4; 1.6 mg dl-1) recorded in the study were seen in the only two patients who died of the disease at the time of follow-up.
Basu, T. K.; Chan, U. M.; Fields, A. L.; McPherson, T. A.
In recent years there have been major advances in the treatment of breast cancer. However, taking the prescribed medication for a sufficient period of time is crucial to the success of any therapy. Thus far, no database-based studies have been published in German-speaking countries empirically examining the influence of the physician on the compliance of patients. The aim of this study is to investigate, quantify, and critically discuss the effect treating physicians have on the compliance of their breast cancer patients. Patients with a confirmed breast cancer diagnosis who started therapy (tamoxifen or aromatase inhibitors) between January 2001 and December 2011 were selected from the representative IMS Disease Analyzer database and analyzed with regard to their compliance. Practices were grouped into two categories concerning the compliance of all treated patients. A regression model showed that a breast cancer patient who is treated in a practice with a trend toward poor compliance has a nearly 60% higher risk for treatment discontinuation than would be the case in a practice with good compliance. It shows how important it is to motivate physicians to strive toward good compliance rates.
Kostev, Karel; Waehlert, Lilia; Jockwig, Achim; Jockwig, Barbara; Hadji, Peyman
This article clarifies how the social contexts in which breast cancer survivors live can contribute to the stress they experience because of the disease. Guided by Solomon and Knobloch's (2004) relational turbulence model and Petronio's (2002) communication privacy management theory, this study explores personal relationship and communication boundary issues within stressors that are associated with the diagnosis, treatment, and early survivorship of breast cancer. A qualitative analysis of discourse posted on breast cancer discussion boards and weblogs using the constant comparative method and open-coding techniques revealed 12 sources of stress. Using axial coding methods and probing these topics for underlying relationship and communication issues yielded 5 themes. The discussion highlights the implications of the findings for the theories that guided this investigation and for breast cancer survivorship more generally. PMID:19089702
Weber, Kirsten M; Solomon, Denise Haunani
Purpose: To review the impact of anemia/tumor hypoxemia on the quality of life and survival in cancer patients, and to assess the problems associated with the correction of this difficulty. Methods: MEDLINE searches were performed to find relevant literature regarding anemia and/or tumor hypoxia in cancer patients. Articles were evaluated in order to assess the epidemiology, adverse patient effects, anemia correction guidelines, and mechanisms of hypoxia-induced cancer cell growth and/or therapeutic resistance. Past and current clinical studies of radiosensitization via tumor oxygenation/hypoxic cell sensitization were reviewed. All clinical studies using multi-variate analysis were analyzed to show whether or not anemia and/or tumor hypoxemia affected tumor control and patient survival. Articles dealing with the correction of anemia via transfusion and/or erythropoietin were reviewed in order to show the impact of the rectification on the quality of life and survival of cancer patients. Results: Approximately 40-64% of patients presenting for cancer therapy are anemic. The rate of anemia rises with the use of chemotherapy, radiotherapy, and hormonal therapy for prostate cancer. Anemia is associated with reductions both in quality of life and survival. Tumor hypoxemia has been hypothesized to lead to tumor growth and resistance to therapy because it leads to angiogenesis, genetic mutations, resistance to apoptosis, and a resistance to free radicals from chemotherapy and radiotherapy. Nineteen clinical studies of anemia and eight clinical studies of tumor hypoxemia were found that used multi-variate analysis to determine the effect of these conditions on the local control and/or survival of cancer patients. Despite differing definitions of anemia and hypoxemia, all studies have shown a correlation between low hemoglobin levels and/or higher amounts of tumor hypoxia with poorer prognosis. Radiosensitization through improvements in tumor oxygenation/hypoxic cell sensitization has met with limited success via the use of hyperbaric oxygen, electron-affinic radiosensitizers, and mitomycin. Improvements in tumor oxygenation via the use of carbogen and nicotinamide, RSR13, and tirapazamine have shown promising clinical results and are all currently being tested in Phase III trials. The National Comprehensive Cancer Network (NCCN) guidelines recommend transfusion or erythropoietin for symptomatic patients with a hemoglobin of 10-11 g/dl and state that erythropoietin should strongly be considered if hemoglobin falls to less than 10 g/dl. These recommendations were based on studies that revealed an improvement in the quality of life of cancer patients, but not patient survival with anemia correction. Phase III studies evaluating the correction of anemia via erythropoietin have shown mixed results with some studies reporting a decrease in patient survival despite an improvement in hemoglobin levels. Diverse functions of erythropoietin are reviewed, including its potential to inhibit apoptosis via the JAK2/STAT5/BCL-X pathway. Correction of anemia by the use of blood transfusions has also shown a decrement in patient survival, possibly through inflammatory and/or immunosuppressive pathways. Conclusions: Anemia is a prevalent condition associated with cancer and its therapies. Proper Phase III trials are necessary to find the best way to correct anemia for specific patients. Future studies of erythropoietin must evaluate the possible anti-apoptotic effects by directly assessing the tumor for erythropoietin receptors or the presence of the JAK2/STAT5/BCL-X pathway. Due to the ability of transfusions to cause immunosuppression, most probably through inflammatory pathways, it may be best to study the effects of transfusion with the prolonged use of anti-inflammatory medications.
Varlotto, John [Department of Radiation Oncology, Boston VA Medical Center, Boston, MA (United States) and Department of Radiation Oncology, Beth (Israel) and Deaconess Medical Center, Harvard Medical School, Boston, MA (United States)]. E-mail: email@example.com; Stevenson, Mary Ann [Department of Radiation Oncology, Boston VA Medical Center, Boston, MA (United States); Department of Radiation Oncology, Beth Israel/Deaconess Medical Center, Harvard Medical School, Boston, MA (United States)
Background This study examines the psychometric properties of 9 items on the Patient Activation component of the Medicare Current Beneficiary Survey (MCBS) that assess how patients approach and communicate with their physicians. The MCBS is a nationally representative, cross-sectional survey of Medicare beneficiaries. Methods We analyzed MCBS data collected in 2002 and 2005 from 15,165 adults aged 65 and older. Exploratory factor analysis was conducted using maximum likelihood to estimate a polychoric correlation matrix on the 2002 data, and confirmatory factor analysis was performed using the 2005 data. Results Exploratory factor analysis of the 2002 data showed a 2-factor solution: approach to interactions (5 items) and views about physician’s healthcare communication (6 items). Findings were confirmed using the 2005 data. Items were combined to form the Patient Approach and Views toward Healthcare Communication (PAV-COM) scale (range 1 to 100; Cronbach’s alpha of 0.75, and item-rest correlations between 0.33 and 0.54). Higher PAV-COM scores were associated with greater fulfillment of preventive health behaviors such as vaccinations and cancer screenings. Conclusions The PAV-COM measure is a valid tool for assessing patient approaches and views toward communication with physicians. This measure can be used to evaluate interventions to improve patient participation during healthcare encounters.
Communication between patients and health care providers may require sharing of data and knowledge that is complex and of high-volume. To support communication of these types of information, visualization techniques and tools can reduce cognitive burden in informed patient-centered health decisions and empower patients in their own care. Designing and implementing effective visualization depend on iterative consideration of cognitive needs
Yair G. Rajwan; George R. Kim
Doctor-patient communication has been extensively studied in non-Western contexts and in relation to patients' cultural and education backgrounds. This study explores the perceived ideal communication style for doctor-patient consultations and the reality of actual practice in a Southeast Asian context. We conducted the study in a teaching…
Claramita, Mora; Utarini, Adi; Soebono, Hardyanto; Van Dalen, Jan; Van der Vleuten, Cees
Background Outcomes for colorectal cancer patients vary significantly. Compared to other countries, Australia has a good record with patient outcomes, yet there is little information available on the referral pathway. This paper explores the views of Australian patients and their experiences of referral for colorectal cancer treatment following diagnosis; the aim was to improve our understanding of the referral pathway and guide the development of future interventions. Methods A purposive sampling strategy was used, recruiting 29 patients representing urban and rural areas from 3 Australian states who participated in 4 focus groups. Seven patients provided individual interviews to supplement the data. Recordings were transcribed verbatim, data was coded with NVivo software and analysed thematically before deductive analysis. Results Four aspects of the referral process were identified by patients, namely detection/diagnosis, referral for initial treatment/specialist care, the roles of the GP/specialist, and the patient’s perceived involvement in the process. The referral process was characterised by a lack of patient involvement, with few examples of shared decision-making and few examples of limited choice. However, patients did not always feel they had the knowledge to make informed decisions. Information exchange was highly valued by patients when it occurred, and it increased their satisfaction with the process. Other factors mediating care included the use of the public versus private health system, the quality of information exchange (GP to specialist and GP to patient), continuity of care between GP and specialist, and the extent of information provision when patients moved between specialist and GP care. Conclusions Patients described poor GP continuity, ad hoc organisational systems and limited information exchange, at both interpersonal and inter-organisational levels, all leading to sub-optimal care. Implementation of a system of information feedback to GPs and engagement with them might improve information exchange for patients, enabling them to be more involved in improved referral outcomes.
Case reports and animal models suggest that chemotherapy, corticosteroids and radiotherapy (RT) may increase the risk of herpes\\u000a simplex encephalitis (HSE). We retrospectively examined cases of HSE at an academic hospital devoted to cancer care. Patients\\u000a were identified by positive herpes simplex virus (HSV) polymerase chain reaction (PCR) in cerebrospinal fluid (CSF) or by\\u000a brain pathology. There were seven patients
Jerome J. Graber; Marc K. Rosenblum; Lisa M. DeAngelis
Pain is one of the cardinal presenting symptoms in cancer patients and often seems to progress in the natural history of the\\u000a disease. In light of the past neglect of this problem, it is becoming crucial for clinicians and researchers in the fields\\u000a of oncology, pain management, and others dealing with this patient population to have a thorough understanding of
Hazem A. Zekry; Eduardo Bruera
2817 Reduced Cancer Incidence among Patients with Schizophrenia Yoram Barak, M.D., M.H.A.1,2 Anat Achiron, M.D., Ph.D.2,3 Matilda Mandel, M.D., M.H.A.2,3 Ilona Mirecki, M.D.1,2 Dov Aizenberg, M.D.2,4 1 Psychogeriatric Department, Abarbanel Mental
Aim To evaluate male breast cancer (MBC) risk among Klinefelter Syndrome (KS) patients and relate this to possible biologic explanations. Methods A literature review was conducted to identify case series and epidemiologic studies that have evaluated MBC risk among KS patients. Results Case reports without expected values have often led to false impressions of risk. Problems include that a diagnosis of cancer can prompt a karyotypic evaluation and that many cases of KS are unrecognized, resulting in incomplete denominators. Few carefully conducted epidemiologic studies have been undertaken given that both KS and male breast cancer are rare events. The largest study found 19.2- and 57.8-fold increases in incidence and mortality, respectively, with particularly high risks among 47,XXY mosaics. These risks were still approximately 30% lower than among females, contradicting case reports that KS patients have breast cancer rates similar to females. Altered hormone levels (especially the ratio of estrogens to androgens), administration of exogenous androgens, gynecomastia, and genetic factors have been offered as possible explanations for the high risks. Conclusions Additional well-designed epidemiologic studies are needed to clarify which KS patients are at a high risk of developing MBC and to distinguish between possible predisposing factors, including altered endogenous hormones.
Brinton, Louise A.
Disease treatments have been significantly influenced by the communications between patients, their families, and doctors the lack of which may lead to malpractice allegations and complaints. In particular, inadequate communication may delay diagnosis and treatment. Therefore, for doctors communication and interpersonal skills, are as important as clinical skills and medical knowledge. In this study we intended to develop two detailed communication content checklists and a modified interpersonal skills inventory, aiming to evaluate their integrity in the midst of communication skills assessments, to provide feedback for some participants, and to observe their communication competence in both aspects
Wu, Xi; Wang, Zhinong; Hong, Bo; Shen, Shengjuan; Guo, Yan; Huang, Qinghai; Liu, Jianmin
INTRODUCTION: Significant problems in clinician-patient communication have been described in the oncology literatures. Advanced stage non-small lung cancer a devastating disease, can cause the communication between survivors, significant others, and clinicians to falter. To date, however, no studies have used qualitative methods to examine experiential aspects of living with non-small cell lung cancer. Nor have any studies evaluated the tools survivors might use to repair some of the damage caused by living with this disease. METHODS: Exploratory, two-part qualitative design. RESULTS: Survivors of non-small cell lung cancer live with multiple fears and losses. These include a diminished sense of self, the loss of health, fears of pain in a future tainted by the threat of death, and increased feelings of alienation due to the loss of previous sources of meaning in life. These experiences significantly affect cancer survivors abilities to communicate with clinicians and significant others. CONCLUSIONS: Survivors of non-small cell lung cancer often have difficulty sharing their experiences with others not suffering a similar affliction. Through their narratives with other survivors, however, patients are better able to initiate a biopsychosocial mechanism which enables them to create a cognitive map. This cognitive map helps survivors share their experiences with others, thereby repairing some of the damage caused by this disease, including the harm done to their communication with other people.
Moore, R. J.; Chamberlain, R. M.; Khuri, F. R.
NCI investigators have identified an inflammatory gene and microRNA biomarker portfolio that can predict aggressive colon cancer, colon cancer patient survival, and patients that are candidates for adjuvant therapy.
Objective Cancer patients have high levels of distress, yet oncologists often do not recognize patients’ concerns. We sought to describe how patients with advanced cancer verbally express negative emotion to their oncologists. Materials and methods As part of the Studying Communication in Oncologist–Patient Encounters Trial, we audio-recorded 415 visits that 281 patients with advanced cancer made to their oncologists at three US cancer centers. Using qualitative methodology, we coded for verbal expressions of negative emotion, identified words patients used to express emotion, and categorized emotions by type and content. Results Patients verbally expressed negative emotion in 17% of the visits. The most commonly used words were: “concern,” “scared,” “worried,” “depressed,” and “nervous.” Types of emotion expressed were: anxiety (46%), fear (25%), depression (12%), anger (9%), and other (8%). Topics about which emotion was expressed were: symptoms and functional concerns (66%), medical diagnoses and treatments (54%), social issues (14%), and the health care system (9%). Although all patients had terminal cancer, they expressed negative emotion overtly related to death and dying only 2% of the time. Conclusions Patients infrequently expressed negative emotion to their oncologists. When they did, they typically expressed anxiety and fear, indicating concern about the future. When patients use emotionally expressive words such as those we described, oncologists should respond empathically, allowing patients to express their distress and concerns more fully.
Anderson, Wendy G.; Alexander, Stewart C.; Rodriguez, Keri L.; Jeffreys, Amy S.; Olsen, Maren K.; Pollak, Kathryn I.; Tulsky, James A.; Arnold, Robert M.
This research examined specific communication patterns in 20 schizophrenic and other family triads, through analysis of transcripts of 15-minute interactions within a systems epistemology. Families with a son or daughter diagnosed as having schizophrenia were found to emphasize two communication patterns: communication that is nebulous, confusing,…
Bayer, Darryl Lee
Patients frequently do not take medicines as prescribed and often do not communicate with their physicians about their medication-taking behavior. The movement for “patient-centered” care has led to relabeling of this problem from “noncompliance” to “nonadherence” and later to a rhetoric of “concordance” and “shared decision making” in which physicians and patients are viewed as partners who ideally come to agreement about appropriate treatment. We conducted a qualitative content analysis of online comments to a New York Times article on low rates of medication adherence. The online discussion provides data about how a highly selected, educated sample of patients thinks about medication use and the doctor–patient relationship. Our analysis revealed patient empowerment and self-reliance, considerable mistrust of medications and medical practice, and frequent noncommunication about medication adherence issues. We discuss how these observations can potentially be understood with reference to Habermas’s theory of communicative action, and conclude that physicians can benefit from better understanding the negative ways in which some patients perceive physicians’ prescribing practices.
Bezreh, Tanya; Laws, M Barton; Taubin, Tatiana; Rifkin, Dena E; Wilson, Ira B
Patients frequently do not take medicines as prescribed and often do not communicate with their physicians about their medication-taking behavior. The movement for "patient-centered" care has led to relabeling of this problem from "noncompliance" to "nonadherence" and later to a rhetoric of "concordance" and "shared decision making" in which physicians and patients are viewed as partners who ideally come to agreement about appropriate treatment. We conducted a qualitative content analysis of online comments to a New York Times article on low rates of medication adherence. The online discussion provides data about how a highly selected, educated sample of patients thinks about medication use and the doctor-patient relationship. Our analysis revealed patient empowerment and self-reliance, considerable mistrust of medications and medical practice, and frequent noncommunication about medication adherence issues. We discuss how these observations can potentially be understood with reference to Habermas's theory of communicative action, and conclude that physicians can benefit from better understanding the negative ways in which some patients perceive physicians' prescribing practices. PMID:22272065
Bezreh, Tanya; Laws, M Barton; Taubin, Tatiana; Rifkin, Dena E; Wilson, Ira B
Question What is the efficacy of pharmacologic and non-pharmacologic treatments for major depression and other depressive disorders in cancer populations? Perspectives Depression occurs at an increased rate in medically ill populations, including patients with cancer. In the general population, depression has been shown to be responsive to structured forms of psychotherapy and to pharmacologic interventions. The Supportive Care Guidelines Group conducted a systematic review of the evidence for the effectiveness of those therapies in patients with depression and cancer and developed the present clinical practice guideline based on that review and on expert consensus. Outcomes Outcomes of interest included symptomatic response to treatment, discontinuation rate of treatment, adverse effects, and quality of life. Methodology Clinical recommendations were developed by the Supportive Care Guidelines Group based on a systematic review of the published literature through June 2005, feedback obtained from Ontario health care providers on the draft recommendations, the Report Approval Panel (rap) of Cancer Care Ontario’s Program in Evidence-Based Care, and expert consensus. Results The systematic review of the literature included eleven trials (seven of pharmacologic agents and four of non-pharmacologic interventions). Feedback received from 44 responding health care providers and the rap on the draft recommendations was addressed and documented in the guideline. Among providers, 82% agreed with the draft recommendations as stated, 68% agreed that the report should be approved as a practice guideline, and 73% indicated that they would be likely to use the guideline in their own practice. Practice Guideline These recommendations apply to adult cancer patients with a diagnosis of major depression or other non-bipolar depressive disorders. They do not address the treatment of non-syndromal depressive symptoms, for which specific antidepressant treatment is not usually indicated. The guideline is intended both for oncology health professionals and for mental health professionals engaged in the treatment of cancer patients. Expert consensus was central to the development of the guideline recommendations because of limited evidence in cancer patients. Recommendations Treatment of pain and other reversible physical symptoms should be instituted before or with initiation of specific antidepressant treatment. Antidepressant medications should be considered for the treatment of moderate-to-severe major depression in cancer patients. Current evidence does not support the relative superiority of one pharmacologic treatment over another, nor the superiority of pharmacologic treatment over psychosocial interventions. The choice of an antidepressant should be informed by individual medication and patient factors: the side effect profiles of the medication, tolerability of treatment (including the potential for interaction with other current medications), response to prior treatment, and patient preference. Cancer patients diagnosed with major depression may benefit from a combined modality approach that includes both psychosocial and pharmacologic interventions. Psychosocial treatment approaches that may be of value include those that provide information and support and those that address any combination of emotional, cognitive, and behavioural factors. Qualifying Statements Referral to a mental health specialist is appropriate when the diagnosis of depression is unclear, when the syndrome is severe, when patients do not respond to treatment, or when other complicating factors that may affect the choice of treatment are present. Although care has been taken in the preparation of the information contained in this guideline, any person seeking to apply or to consult the guideline is expected to use independent medical judgment in the context of individual clinical circumstances or to seek out the supervision of a qualified clinician.
Rodin, G.; Katz, M.; Lloyd, N.; Green, E.; Mackay, J.A.; Wong, R.K.S.
When studying the patient perspective on communication, some studies rely on analogue patients (patients and healthy subjects) who rate videotaped medical consultations while putting hemselves in the shoes of the video-patient. To describe the rationales, methodology, and outcomes of studies using videovignette designs in which videotaped medical consultations are watched and judged by analogue patients. Pubmed, Embase, Psychinfo and CINAHL
L. M. van Vliet; E. van der Wall; A. Albada; P. M. M. Spreeuwenberg; W. Verheul; J. M. Bensing
Nononcologic medical problems are common in patients with cancer. Failure to evaluate and treat these problems leads to considerable morbidity and mortality in people who often have potential for both comfortable and productive lives. While a physician is sometimes powerless to prevent the progression of underlying cancer, he must not allow a diagnostic category to color his approach. By seeing only an end point which is inevitable for all people, one could be inclined not to treat what is treatable. With clinical judgment, information and the eternal question of diagnosticians, “What else could this be?”, a physician can focus not on the inevitability of death but on the quality of life.
Lowitz, Barry B.; Benjamin, Robert S.
Purpose Previous studies have reported that over a third of cancer patients experience significant psychological distress with diagnosis and treatment of cancer. Mental adjustment to cancer as well as other biologic and demographic factors may be associated with their distress. We investigated the relationship between mental adjustment and distress in patients with thyroid cancer prior to thyroidectomy. Materials and Methods One hundred and fifty-two thyroid cancer patients were included in the final analysis. After global distress levels were screened with a distress thermometer, patients were evaluated concerning mental adjustment to cancer, as well as demographic and cancer-related characteristics. A thyroid function test was also performed. Regression analysis was performed to discern significant factors associated with distress in thyroid cancer patients. Results Our regression model was significant and explained 38.5% of the total variance in distress of this patient group. Anxious-preoccupation and helpless-hopeless factors on the mental adjustment to cancer scale were significantly associated with distress in thyroid cancer patients. Conclusion Negative emotional response to cancer diagnosis may be associated with distress in thyroid cancer patients awaiting thyroidectomy. Screening of mental coping strategies at the beginning of cancer treatment may predict psychological distress in cancer patients. Further studies on the efficacy of psychiatric intervention during cancer treatment may be needed for patients showing maladaptive psychological responses to cancer.
Seok, Jeong-Ho; Choi, Won-Jung; Lee, Yong Sang; Park, Cheong Soo; Oh, Young-Ja; Kim, Jong-Sun
Data defining the isolated effect of insulin on whole body protein and glucose metabolism in cancer patients are limited. Ten normal volun teers (controls), age 55 Â± 3 years (mean Â± SEM); 8 cancer patients, age 61 Â±3years, weight loss 2 Â± 1%(CANWL); and 8 cancer patients, age 55 Â±2 years, weight loss 18 Â± 2% (CAWL), were studied in
Martin J. Heslin; Elliot Newman; Ronald F. Wolf; Peter W. T. Pisters; Murray F. Brennan
The aims of this study were to investigate the preparatory grief and traumatic distress in advanced cancer patients in a palliative care unit. A total of 94 advanced cancer patients completed the Preparatory Grief in Advanced Cancer Patients (PGAC) scale and the Greek version of the Impact of Events Scale- Revised (IES-R-Gr). The Eastern Cooperative Oncology Group was used to
Eleni Tsilika; Kyriaki Mystakidou; Efi Parpa; Antonis Galanos; Pavlos Sakkas; Lambros Vlahos
Communication between patient and providers is extremely important, especially for the treatment of chronically ill patients, characterized by a biopsychosocial disease model. This article presents an overview of the current status of research on patient-provider communication in 3 selected areas: the communication preferences of chronically ill persons, the correlation between communication and relevant endpoints, and interventions to improve patient-provider communication. One major result of the research is that patients display a rather high degree of inter- and intra-individual variability with respect to the preference of certain communication styles (e.g. patient participation); there are differences among them, and they develop varying preferences in the course of their illness. However, communicative behavior of the provider that is generally perceived by many patients to be positive can also be identified: affective behavior (for example, asking the patient about his/her feelings, being sensitive to these feelings and responding to them), providing information in an understandable, proactive manner, and attempting to understand the patient's perceptions, expectations, and cognitive concepts. Successful communication requires a certain congruence between the patient's communication preferences and the provider's behavior. It has been sufficiently documented in literature that successful communication leads to greater adherence. The correlation to patient satisfaction is not documented quite as clearly but has often been shown. The findings vary with respect to the improvement in the patient's health status. The effectiveness of communication training for providers has been documented quite well regarding the immediate endpoints in patient-provider interaction (e.g., patient-oriented behavior); the evidence with respect to medium-term endpoints such as patient satisfaction varies, also due to the number of possible operationalizations of the endpoints. Supplementing provider training with communication-related training for patients appears to be an important and useful method as many studies have shown that the behavior of providers can be influenced using relatively simple measures that start with the patient. There is a need for further development of research on patient-provider communication, in particular with respect to a more solid theoretical basis, integration of methods including qualitative and quantitative methods, self-evaluations, and interaction analyses, and also concerning conducting more longitudinal studies. PMID:20963669
Recent evidence questioning the effectiveness of prostate-specific antigen testing leave community-based prostate cancer (CaP) outreach programs with a dilemma between promoting screening and highlighting screening risks. CaP survivors are uniquely positioned to address this problem by drawing upon real-life experiences to share nuanced information and perspectives. While CaP survivors have historically been incorporated into outreach programs, little is known about their impact on psychosocial outcomes and their effectiveness compared to professional health educators. This study addressed these gaps through a quasi-experimental design where African American men attended a CaP screening session conducted by a health educator (HE) or survivor educator (SV). The presentation included prostate cancer statistics, CaP information, and descriptions of CaP screening tests. SV were encouraged to bolster their presentations with personal stories whereas HE maintained fidelity to the curriculum content. All participants completed pre- and post-test questionnaires. Our sample comprised a total of 63 participants (HE group = 32; SV group = 31) with an age range of 40-70 years. Decision self-efficacy increased significantly in the SV group (p = 0.01) whereas perceived screening risks reduced significantly in the HE group (p < 0.001). No significant changes were found in knowledge, subjective norms, outcome expectancies, and screening benefits. Survivor educators were found to have significantly greater appeal (p = 0.03), identification with audience (p = 0.01), and liking (p = 0.03). Training CaP survivors as health educators might be a viable strategy for community-based cancer communication efforts confronted by the CaP screening controversy. We discuss conceptual and programmatic implications of our findings and present directions for future research. PMID:24096473
Vijaykumar, Santosh; Wray, Ricardo J; Jupka, Keri; Clarke, Ryan; Shahid, Mellve
Providing patients with clear and concise information is central to modern medical practice. Patients diagnosed with skin cancer are traditionally told their result by face-to-face consultation in the outpatient clinic. Previous studies have shown poor patient satisfaction with the traditional outpatient consultation. The skin oncology service at Kingston Hospital uses two different methods to inform selected patients of their skin cancer diagnosis. Those diagnosed with thin melanoma (MM) or squamous cell carcinoma (<2 cm) (SCC) are informed by letter (with an accompanying information leaflet), or seen in outpatient clinic for a face-to-face consultation. However, it is unclear which of these methods patients prefer. We performed a retrospective postal questionnaire survey to elicit the views of patients that had been informed of their skin cancer by these two methods. Patients had been diagnosed with either MM or SCC between February 2005 and March 2006. Demographic details and patient satisfaction using five-point Likert scales were determined. Of the eligible 118 patients, 90 (76%) completed the questionnaire. Questionnaires from five respondents were incorrectly completed and excluded from further analysis. Of the final 85 patients, 41 (48%) were told their diagnosis via face-to-face consultation (clinic) and 44 (52%) by letter. The demographic profile of both groups was similar (P>0.05). Patients of both groups had a similar expectation of being told a skin cancer diagnosis (P>0.05). A high level of satisfaction was expressed for both methods of communication, with no difference between the groups (P>0.05). In the letter group, patients placed more value on convenience than preference to seeing a doctor (P<0.001). The option of contacting a support nurse was also cited as a reassuring feature. The findings of this study suggest disclosure of skin cancer diagnosis by letter has high satisfaction, for selected patients. Using this method of communication may ultimately lessen the burden on outpatient service. PMID:18485851
Karri, V; Bragg, T W H; Jones, A; Soldin, M; Misch, K
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This article describes the ways in which group identifications and stereotypes can in- form our understanding of cancer prevention and treatment as well as more general social processes surrounding the experience of cancer. From a perspective grounded in social identity theory, we describe the ways in which understanding primary iden- tities (i.e., those associated with large social collectives such as
Jake Harwood; Lisa Sparks
Background and Purpose Stroke is common among cancer patients. However, risk factors and biomarkers of stroke in cancer patients are not well established. This study aimed to investigate risk factors and biomarkers as well as etiology of ischemic stroke in cancer patients. Methods A retrospective review was conducted in cancer patients with ischemic stroke who were admitted to a general hospital in Busan, Korea, between January 2003 and December 2012. The risk factors and biomarkers for stroke and stroke subtypes in cancer patients were compared with age- and sex-matched noncancer patients with ischemic stroke who were admitted to the same hospital during the same period. Results One hundred fifty-six cancer patients with ischemic stroke were identified. Cancer patients with ischemic stroke were found to have a significantly lower proportion of hypertension, atrial fibrillation, hyperlipidemia, and ischemic heart disease than noncancer patients with ischemic stroke. However, stroke biomarkers, such as erythrocyte sedimentation rate and high-sensitivity C-reactive protein, fibrinogen, pro-brain natriuretic peptide, and D-dimer levels, were significantly increased in cancer patients with ischemic stroke than in noncancer patients. Large-artery atherosclerosis and stroke of undetermined cause were more common in cancer patients with ischemic stroke than in noncancer patients with ischemic stroke. Conclusions Cancer patients with ischemic stroke showed different risk factors, stroke biomarkers, and stroke etiology compared with noncancer patients with ischemic stroke.
BACKGROUND: Communication between physicians and patients is particularly challenging when patients do not speak the local language (in Switzerland, they are known as allophones). AIM: To assess the effectiveness of an intervention to improve communication skills of physicians who deal with allophone patients. DESIGN OF STUDY: 'Before-and-after' intervention study, in which both patients (allophone and francophone) and physicians completed visit-specific questionnaires assessing the quality of communication. SETTING: Two consecutive samples of patients attending the medical outpatient clinic of a teaching hospital in French-speaking Switzerland. METHOD: The intervention consisted of training physicians in communicating with allophone patients and working with interpreters. French-speaking patients served as the control group. The outcomes measured were: patient satisfaction with care received and with communication during consultation; and provider (primary care physician) satisfaction with care provided and communication during consultation. RESULTS: At baseline, mean scores of patients' assessments of communication were lower for allophone than for francophone patients. At follow-up, five out of six of the scores of allophone patients showed small increases (P < 0.05) when compared with French-speaking patients: explanations given by physician; respectfulness of physician; communication; overall process of the consultation; and information about future care. In contrast, physicians' assessments did not change significantly. Finally, after the intervention, the proportion of consultations with allophone patients in which professional interpreters were present increased significantly from 46% to 67%. CONCLUSIONS: The quality of communication as perceived by allophone patients can be improved with specific training aimed at primary care physicians.
Bischoff, Alexander; Perneger, Thomas V; Bovier, Patrick A; Loutan, Louis; Stalder, Hans
Cancer patients with venous thromboembolism (VTE) have more complications related to the anticoagulation treatment than the general population. Vena cava filters are a useful tool in cancer patients, but their use in advanced disease is controversial. In this paper, we reviewed the indications, complications and frequency of retrieval of vena cava filters in cancer patients with VTE. Twenty seven patients with vena cava filter placements were analyzed. Twenty five had solid tumors and two non Hodgkin lymphomas. Twenty five were under active treatment (surgery and/or chemotherapy). Nineteen were classified as stage IV of disease. Indications for filter placement were perioperative prophylaxis in 14 cases (51.9%), hemorrhage (n = 5), thrombocytopenia (n = 4), central nervous system metastases (n = 2), stroke (n = 1) and previous neurosurgery (n = 1). Eight (29.6%) filters were retrieved. The median time to retrieval was 21 days (range: 6-75). There was no statistically significant difference in the frequency of retrieval between perioperative prophylaxis placement (6/14) and other contraindications for anticoagulation treatment (2/13; p = 0.2087). There were no adverse events related to the placement or retrieval procedures. PMID:22892079
Díaz Couselo, Fernando A; Crerar, Silvina; Cravero, Patricia; Santaera, Omar; Eisele, Guillermo; Zylberman, Marcelo
Communication difficulties between oncologists and their patients impede patient accrual to clinical trials because patients are left uncertain about their diagnosis or prognosis, and confused about disease management options or the therapeutic intent of treatment. Oncologists are lacking adequate communication skills training. A three-day intensive training course involving feedback on videotaped consultations with simulated patients resulted in significant and lasting improvements in clinicians’ communication skills. Implementing communication skills training courses may lead to increased recruitment to clinical trials.
The purpose of this study is to investigate the content-specificity of communication skills. It investigates the reliability and dimensionality of standardized patient (SP) ratings of communication skills in an Objective Structured Clinical Examination(OSCE) for final year medical students. An OSCE consisting of seven standardized patient(SP)…
Guiton, Gretchen; Hodgson, Carol S.; Delandshere, Ginett; Wilkerson, Luann
Background: Previous research has identified that many patients admitted into acute hospital stroke units have communication-related impairments such as hearing, vision, speech, language and/or cognitive communicative impairment. However, no research has identified how many patients in acute hospital stroke units have difficulty actually…
O'Halloran, Robyn; Worrall, Linda; Hickson, Louise
Hospitals involve a complex socio-technical health system, where communication failures influence the quality of patient care. Research indicates the importance of social identity and intergroup relationships articulated through power, control, status and competition. This study focused on interspecialty communication among doctors for patients requiring the involvement of multiple specialist departments. The paper reports on an interview study in Australia, framed
David G. Hewett; Bernadette M. Watson; Cindy Gallois; Michael Ward; Barbara A. Leggett
To assess physicians’ use of and attitudes toward electronic mail (e-mail) for patient communication, we conducted a mailin\\u000a survey of physicians who see patients in outpatient clinics affiliated with a large academic medical center (N=283). Seventy-two percent of physicians reported using e-mail to communicate with patients, averaging 7.7 e-mails from patients\\u000a per month. The lowest level of use was by
Barak Gaster; Christopher L. Knight; Dawn E. DeWitt; John V. L. Sheffield; Nassim P. Assefi; Dedra Buchwald
A prerequisite for patient-friendly personal health records (PHR) is their ability to allow seamless integration of patient terminology with professional terminologies. In this work, we mapped a set of symptoms/problems from the self-assessment component of a cancer patient support system to concepts in the Unified Medical Language System (UMLS) Metathesaurus. Our objective was to learn how the UMLS can be used as a tool to connect patient terminology with professional vocabularies. The mapping to UMLS was done with the help of ten expert cancer nurses who evaluated concepts, their synonyms and placement in the source vocabulary hierarchical structure. The UMLS concepts were also compared with terms and phrases found in patient medical records that addressed the same set of symptoms. In this study we observed several problems related to the use of the UMLS Metathesaurus as a tool to connect from patient-level expressions to professional-level classification systems. More work is needed to increase interoperability between layperson health applications and clinical systems.
Slaughter, Laura; Ruland, Cornelia; Rotegard, Ann Kristin
Gastrointestinal cancers are among the most frequently occurring cancer worldwide. Elderly patients represent a large proportion of patients diagnosed with gastrointestinal cancers. Despite this, elderly patients are generally under-represented in clinical trials, therefore a general consensus on how to treat elderly patients is still far from being achieved. In oesophageal cancer, radiochemotherapy can be administered successfully and effectively but should be administered with close monitoring because of potential toxicities especially hematological. In gastric and rectal cancer, there is no clear trade-off between efficacy and side effects and some patients may not gain a survival benefit from combined treatment. Instead, the treatment of elderly pancreatic cancer patients with a good performance status should be no different than the treatment of younger patients. Radiochemotherapy maintains its activity and feasibility in elderly gastrointestinal cancer patients. Finally, it is very important to assess co-morbidity with its severity in order to aid in the development of plans for treatment. PMID:24589952
Fiorica, F; Stefanelli, A; Pascale, G; Fisichella, R
Background The evaluation of cancer patients needs, especially during that delicate period when they are hospitalized, allows the identification of those areas of care that require to be improved. Aims of the study were to evaluate the needs in cancer inpatients and to improve the understanding of the meanings of the needs expressed. Methods The study was conducted during a "sample day", with all the cancer patients involved having been hospitalized at the Istituto Nazionale Tumori of Milan (INT) for at least 48 hours beforehand. The study was carried out using quantitative and qualitative methodologies. The quantitative part of the study consisted in making use of the Needs Evaluation Questionnaire (NEQ), a standardized questionnaire administered by the INT Psychology Unit members, supported by a group of volunteers from the Milan section of the Italian League Against Cancer. The aim of the qualitative part of the study, by semi-structured interviews conducted with a small sample of 8 hospitalized patients, was to improve our understanding of the meanings, implications of the needs directly described from the point of view of the patients. Such an approach determines the reasons and conditions of the dissatisfaction in the patient, and provides additional information for the planning of improvement interventions. Results Of the 224 eligible patients, 182 (81%) completed the questionnaire. Four of the top five needs expressed by 40% or more of the responders concerned information needs (diagnosis, future conditions, dialogue with doctors, economic-insurance solutions related to the disease). Only one of the 5 was concerned with improved "hotel" services (bathrooms, meals, cleanliness). Qualitative analysis showed that the most expressed need (to receive more information on their future conditions) has the meaning to know how their future life will be affected more than to know his/her actual prognosis. Conclusions Some of the needs which emerged from this investigation could be immediately satisfied (the need for psychological support, the need for economic aid, the need for spiritual support), while others will have to be faced in the longer term; for example, the presence of a high percentage of needs in patient-physician relationships and/or information-communication issues, could be resolved by setting up structured introductory training courses for all clinicians in the institution. On the other hand, the needs related to the living infrastructure (bathrooms, meals, etc...) could encourage the Institution to improve its services.
Tamburini, Marcello; Gangeri, Laura; Brunelli, Cinzia; Boeri, Paolo; Borreani, Claudia; Bosisio, Marco; Karmann, Claude Fusco; Greco, Margherita; Miccinesi, Guido; Murru, Luciana; Trimigno, Patrizia
Use of complementary and alternative medicine (CAM) is very frequent in cancer patients. The aims of this study were to analyze the frequency, the reasons of use of CAM in patients with a cancer treated in a Moroccan oncology department. We included in this study 400 patients. An anonymous questionnaire was proposed to patients during treatment. Over 384 analyzable questionnaires, 71% of patients were using CAM. The most frequent method was religious therapy (60%). The second one was herbal medicine (36%). The main reason for using CAM was reducing psychic pain in 53%, and boosting the immune system in 32%. Adverse effects were reported in 2% of cases. Only 5% of patients discussed CAM with their doctors. The cost of CAM was less than 100 Euros in 88% of cases. To optimize the patient-physician relationship and to avoid a propensity to unproved treatments, accurate and adequate communication is necessary. PMID:24057644
Tazi, I; Nafil, H; Mahmal, L; Harif, M; Khouchani, M; Saadi, Z; Belbaraka, R; Elomrani, A; Tahri, A
We evaluated knowledge of gynecologic cancer screening recommendations, screening behaviors, and communication with providers among women with Lynch syndrome (LS). Women aged ?25?years who were at risk for LS-associated cancers completed a semi-structured interview and a questionnaire. Of 74 participants (mean age 40?years), 61% knew the appropriate age to begin screening, 75-80% correctly identified the recommended screening frequency, and 84% reported no previous screening endometrial biopsy. Women initiated discussions with their providers about their LS cancer risks, but many used nonspecific terms or relied on family history. Most were not offered high-risk screening options. While many women were aware of risk-appropriate LS screening guidelines, adherence was suboptimal. Improving communication between women and their providers regarding LS-related gynecologic cancer risk and screening options may help improve adherence. PMID:23906188
Burton-Chase, A M; Hovick, S R; Sun, C C; Boyd-Rogers, S; Lynch, P M; Lu, K H; Peterson, S K
Obstetrics is a medical specialty with high profesional liability exposure. Every aspect of an adverse OB outcome has become an opportunity for a legal review. Common root causes in adverse outcomes include communication failure, poor teamwork, and system failures. Indeed, poor communication is a significant factor in OB-related malpractice claims. This excerpt from the booklet Risk Management Pearls for Obstetrics highlights those causes (particularly poor communications) and provides strategies to address them. PMID:20200923
Shostek, Kathleen; Clark, Christine
Traditional healing is a common practice in low and middle income countries such as Malaysia. Eighty percent of Malaysians consult traditional healers or “bomoh” at some time in their life for health-related issues. The purpose of our study was to explore why breast cancer patients visit traditional healers. This is a qualitative study utilizing in-depth interviews with 11 cancer survivors who sought both traditional and Western medicine. The findings revealed the following reasons for which patients seek traditional healers: (1) recommendation from family and friends, (2) sanction from family, (3) perceived benefit and compatibility, (4) healer credibility, and (5) reservation with Western medicine and system delay. These factors work together and are strongly influenced by the Malaysian cultural context. The issue with the Western health system is common in a developing country with limited health facilities.
Muhamad, Mazanah; Merriam, Sharan; Suhami, Norhasmilia
Context: Breaking of bad news is an important component in the management of cancer patients. Aims: This study aimed to assess the perceptions of breaking bad news of cancer diagnosis. Settings and Design: It was a cross-sectional study using Breaking Bad News Assessment Schedule (BAS) questionnaire on cancer patients in Serian district. Materials and Methods: Using snowballing sampling method, a total of 134 patients were interviewed face-to-face after the consent was obtained from each of the respondents. Statistical Analysis Used: Data was entered and analyzed using SPSS version 19.0. Results: Majority were comfortable with the current method of breaking bad news. The main aspects found to be the areas of concern were the importance of the usage of body language, management of time and identifying patients’ key area of concerns. There were significant difference between sex and “information giving” (P = 0.028) and “general consideration” (P = 0.016) and also between “the age and setting the scene” (P = 0.042). Significant difference was also found between the types of cancer and “the setting of scene” (P = 0.018), “breaking bad news technique” (P = 0.010), “eliciting concerns” (P = 0.003) and “information giving” (P = 0.004). Conclusion: Good and effective communication skill of breaking bad news is vital in the management of cancer patients. As the incidence of new cases of cancer increase every year, breaking of bad news has become a pertinent to the medical professionals’ role. Specific aspects of communication skills based on local characteristics should be more emphasized in the formulation of training for doctors.
Bain, Mathew Gabriel; Lian, Cheah Whye; Thon, Chang Ching
Our objective was to determine the prevalence and characteristics of lung cancer (LC) in HIV patients and compare them with LC patients from the general population. All HIV patients diagnosed at three hospitals in Malaga (southern Spain) who developed LC during January 1989-June 2012 were reviewed. They were compared with a sample of patients with LC taken from the Pneumology and Oncology Department of the Hospital Virgen de le Victoria (Malaga) during the same period. Of the 4721 HIV patients (83% men) followed-up during the study period, 61 (1.29%) developed LC: 82% were men, mean age 48 years, all except two were smokers, 47.5% had a prior lung infection, and the median CD4 count was 237 cells/mm(3). Forty (65.5%) patients were on antiretroviral therapy at LC diagnosis (70% had an undetectable viral load). The HIV-negative group was older at diagnosis, contained fewer active smokers, had a greater frequency of the squamous cell carcinoma histological subtype and fewer cases of adenocarcinoma. Presentation was advanced in both groups and the median survival of HIV patients was three months. LC is a common tumour in HIV patients. It affects men and women equally, with a history of smoking and often a prior opportunistic lung disease. Affected patients are often immunosuppressed and have had an AIDS-related diagnosis. PMID:23970654
Palacios, Rosario; Pascual, Javier; Cabrera, Eva; Lebrón, Jose M; Guerrero-León, Miguel A; del Arco, Alfonso; Colmenero, Juan D; Santos, Jesús
BACKGROUND: Although contralateral prophylactic mastectomy (CPM) reduced the risk of contralateral breast cancer in unilateral breast cancer patients, it was difficult to predict which patients were most likely to benefit from the procedure. The objective of this study was to identify the clinicopathologic factors that predict contralateral breast cancer and thereby inform decisions regarding performing CPM in unilateral breast cancer
Min Yi; Funda Meric-Bernstam; Lavinia P. Middleton; Banu K. Arun; Isabelle Bedrosian; Gildy V. Babiera; Rosa F. Hwang; Henry M. Kuerer; Wei Yang; Kelly K. Hunt
... Oncology , surveyed 1,130 oncologists and 1,020 primary care doctors about their discussions with survivors about handling ... care. The National Cancer Institute study showed that primary care doctors who received a written plan from the ...
Background Obesity and overweight are risk factors for developing an oesophageal cancer, especially the adenocarcinoma in the distal\\u000a oesophagus or at the gastroesophageal junction, and many patients still are overweight at the clinical presentation even if\\u000a they are losing weight. Main mechanisms involved in weight loss are a decreased nutrients’ intake and an alteration in metabolism\\u000a due to a cytokine-driven inflammatory
Abstract Objective To determine whether therapeutic yoga improves the quality of life of patients with cancer. Data sources Search of MEDLINE database (1950–2010) using key words yoga, cancer, and quality of life. Study selection Priority was given to randomized controlled clinical studies conducted to determine the effect of yoga on typical symptoms of patients with cancer in North America. Synthesis Initially, 4 randomized controlled clinical studies were analyzed, then 2 studies without control groups were analyzed. Three studies conducted in India and the Near East provided interesting information on methodologies. The interventions included yoga sessions of varying length and frequency. The parameters measured also varied among studies. Several symptoms improved substantially with yoga (higher quality of sleep, decrease in symptoms of anxiety and depression, improvement in spiritual well-being, etc). It would appear that quality of life, or some aspects thereof, also improved. Conclusion The variety of benefits derived, the absence of side effects, and the cost-benefit ratio of therapeutic yoga make it an interesting alternative for family physicians to suggest to their patients with cancer. Certain methodologic shortcomings, including the limited size of the samples and varying levels of attendance on the part of the subjects, might have reduced the statistical strength of the studies presented. It is also possible that the measurement scales used did not suit this type of situation and patient population, making it impossible to see a significant effect. However, favourable comments by participants during the studies and their level of appreciation and well-being suggest that further research is called for to fully understand the mechanisms of these effects.
Cote, Andreanne; Daneault, Serge
Plasma and urine concentrations of amygdalin, whole-blood concentrations of cyanide, and thiocyanate concentrations in serum and urine were determined in cancer patients following intravenous (4.5 g\\/m2) and oral (500-mg tablet) administration of amygdalin. To measure low plasma concentrations of amygdalin following oral administration a GC\\/MS assay was developed. Following intravenous administration, concentrations of parent drug as high as 1,401 µg\\/ml
Matthew M. Ames; Thomas P. Moyer; John S. Kovach; Charles G. Moertel; Joseph Rubin
Neuropathic pain is an increasingly common problem facing the cancer patient. Painful neuropathy can come from various sources\\u000a and significantly impact quality of life. The most commonly observed scenario is paraesthesia and dysesthesia as a result\\u000a of toxic effects of chemotherapies on the distal peripheral nerves. Neuropathic pain should be addressed ideally with the\\u000a help of a neuro-oncologist, and it
Deborah T. Blumenthal
. The renal functions in pediatric cancer patients who received ifosfamide (IFO) treatment were evaluated and the risk factors\\u000a related to IFO nephrotoxicity were determined. The medical records of all children treated with IFO were reviewed, and 62\\u000a with normal renal function before IFO treatment were selected. Nephrotoxicity was diagnosed by measuring urine ?2-microglobulin and glucose, and serum phosphate, bicarbonate,
Byong Sop Lee; Joo Hoon Lee; Hee-Gyung Kang; Hyewon Hahn; Jun Ho Lee; Hee Young Shin; Il Soo Ha; H. I. Cheong; Hyo Seop Ahn; Yong Choi
Fifty-three breast cancer patients completed an Internet-based diary measuring daily negative affect and positive affect and\\u000a daily negative and positive events for seven consecutive evenings shortly after surgery. The authors used Hierarchical Linear\\u000a Modeling (Raudenbush and Bryk in Hierarchical linear models: applications and data analysis methods. Sage, Thousand Oaks,\\u000a CA, 2002) to examine moderators of affective differentiation, or the daily
Kimberly B. Dasch; Lawrence H. Cohen; Amber Belcher; Jean-Philippe Laurenceau; Jeff Kendall; Scott Siegel; Brendt Parrish; Elana Graber
Purpose To compare the neuropsychological functioning of breast cancer patients with invasive cancer and noninvasive cancer prior\\u000a to adjuvant treatment. Patients and Methods Breast cancer patients (N = 132) with invasive (Stages 1–3, N = 110, age = 54.1 ± 8.1) or noninvasive (Stage 0, N = 22, age = 55.8 ± 8.0) disease completed a battery of neuropsychological and psychological instruments following surgery\\u000a but prior to initiation of chemotherapy, radiation or hormonal therapy.
Tim A. Ahles; Andrew J. Saykin; Brenna C. McDonald; Charlotte T. Furstenberg; Bernard F. Cole; Brett S. Hanscom; Tamsin J. Mulrooney; Gary N. Schwartz; Peter A. Kaufman
Contents: Cancer pain management--diagnosis and evaluation; Cancer pain management--multidisciplinary pain clinics; Cancer pain management--psychologic technics; Cancer pain management--pharmacologic technics; Cancer pain management--neurosurgical technic...
Background: Recent studies have revealed a possible role for the human papillomavirus (HPV) in the pathogenesis of breast cancer. In this study, patients having both a history of invasive cervical cancer and breast cancer as second primary cancer were selected for enrolment in a study of breast carcinomas for the presence of HPV. Methods: Paraffin-embedded tissue from cervical cancer, pelvic
Andreas Widschwendter; Thomas Brunhuber; Annemarie Wiedemair; Elisabeth Mueller-Holzner; Christian Marth
Fifty-three breast cancer patients completed an Internet-based diary measuring daily negative affect and positive affect and daily negative and positive events for seven consecutive evenings shortly after surgery. The authors used Hierarchical Linear Modeling (Raudenbush and Bryk in Hierarchical linear models: applications and data analysis methods. Sage, Thousand Oaks, CA, 2002) to examine moderators of affective differentiation, or the daily relationship between the patients' negative affect and positive affect. Strong affective differentiation is characterized by the relative independence of negative and positive affect. There were no significant Level 1 (within-subject) moderators of affective differentiation. However, at Level 2 (between-subject), as predicted, increased age was associated with stronger affective differentiation, as was greater use of planning to cope with breast cancer. Also as predicted, increased anxiety and greater use of behavioral disengagement and denial coping were associated with weaker affective differentiation. The results suggest the value of the affective differentiation construct, and a daily diary methodology, for research on the daily lives of breast cancer patients. PMID:20585976
Dasch, Kimberly B; Cohen, Lawrence H; Belcher, Amber; Laurenceau, Jean-Philippe; Kendall, Jeff; Siegel, Scott; Parrish, Brendt; Graber, Elana
Aim: To asses cardiac toxicity post radiotherapy in left cancer breast patients with different fractionations. Methods: This is a prospective randomized study conducted at Kasr El-Ainy Center of Clinical Oncology and Nuclear Medicine (NEMROCK). Cardiological assessment using RTOG toxicity criteria was done for left sided breast cancer patients after at least five years of conformal radiation therapy. There were two arms of radiation, conventional (50Gy/25sttt/5 Ws) and hypofractionation (42.5 Gy /16 fractions /3 1/5 weeks). Results: Thirty patients were included in each arm. After a median follow up of 62 months (range 60 to 72), cardiac dysfunction developed more in the conventional arm but was insignificant (P value =0.36). Grade I & II toxicity was 83.3 vs 70% and grade III was 3.3% in the hypofractionated arm only. The rate of localregional tumor relapse at 5 years was similar (3.3%). Conclusion: Hypofractionated radiotherapy decreased cardiac toxicity though not statistically significant, however it is more cost effective and time consuming. Keywords: breast cancer, cardiac toxicity, hypofractionation, Egypt. PMID:24610288
Ibrahim, N Y; Saad, E S
The present study evaluated the effects of physical exercise on heart rate variability (HRV) in cancer patients. 3 matched groups of each 15 tumour patients (60.4±8.9 years, 27 male, 18 female) were recruited: Physical exercise group 1 (acute treatment), Physical exercise group 2 (post treatment) and non-intervention group (acute treatment, no exercise). Exercise group patients received counselling for exercise and participated in a Nordic-Walking program. Short-term HRV-recordings, assessments of fatigue and quality of life (QoL) were performed prior to and 16 weeks after the exercise program initiation. MANCOVA revealed group × time differences in total power frequency domain of HRV and QoL (p<0.05). TP follow-up scores [logms(2)] differed significantly between non-intervention and intervention post treatment (2.0±0.5 vs. 2.6±0.5), but not between non-intervention and intervention during acute treatment. QoL follow-up scores differed significantly between non-intervention and intervention during acute treatment (47±15 vs. 64±18) and post treatment (47±15 vs. 69±19). Exercise enhances cardiac autonomic regulation of tumour patients during and after acute treatment. Because of the association of higher HRV-parameters and prolonged survival in cancer patients, improvement in autonomic control may be an important goal of exercise. PMID:22895874
Niederer, D; Vogt, L; Thiel, C; Schmidt, K; Bernhörster, M; Lungwitz, A; Jäger, E; Banzer, W
Purpose The purpose of this study is to review the literature examining how the beliefs and behaviours of physicians and patients\\u000a influence clinical communication, doctor–patient interaction and treatment decisions for lung cancer treatment.\\u000a \\u000a \\u000a \\u000a \\u000a Methods Literature was obtained via electronic database searches and hand searching of journals from 1990 to 2011.\\u000a \\u000a \\u000a \\u000a Results Wide variability in perceptions of the value of chemotherapy in lung cancer
Patricia M. Davidson; Moyez Jiwa; Alice J. Goldsmith; Sarah J. McGrath; Michelle DiGiacomo; Jane L. Phillips; Meera Agar; Phillip J. Newton; David C. Currow
The study of cancer in patients treated with dialysis in Korea has not been reported. The aim of this study was to investigate the incidence and mortality of cancer among patients on dialysis in Korea. The study subjects were 106 cancer patients (2.3%) out of 4,562 end-stage renal disease (ESRD) patients maintained on hemodialysis (HD) or peritoneal dialysis (PD) at Yonsei University Health System from 1996 to 2005. We excluded patients in whom the diagnosis of cancer preceded dialysis or those who received renal allograft or started dialysis after renal allograft. Seventy-three (69%) of our subjects were male and 33 (31%) were female. The mean age at the time of cancer diagnosis was 57.9±11.7 yr. The mean time from the start of dialysis to the diagnosis of cancer was 75.2±63.9 months. The most common cancer site was gastrointestinal tract (GIT) (51%) followed by urinary tract (20%), lung (8%), and thyroid (7%). Sixty nine percent of the total mortality was due to cancer. The mean time from diagnosis to death was 2.9±2.5 yr. In ESRD patients with cancer, there were no significant differences in mortality rates by dialysis modality. In ESRD patients, the most common cancer was GIT cancer followed by urinary tract cancer. Therefore, careful surveillance of these cancers in ESRD patients is highly recommended.
Lee, Jung Eun; Han, Seung Hyeok; Cho, Byoung Chul; Park, Jung Tak; Yoo, Tae Hyun; Kim, Beom Seok; Park, Hyeong Cheon; Kang, Shin-Wook; Lee, Ho Yung; Han, Dae-Suk; Ha, Sung Kyu
This theme issue on communication includes annotated listings of Web sites, CD-ROM and computer software, videos, books, and professional resources that deal with various methods of communication. Sidebars discuss mythology, photojournalism, sharing ideas on the Web, and songs of protest. Suggestions for class activities are also included. (LRW)
Purpose Although radiation therapy (RT) can palliate symptoms and may prolong life, it is not curative for patients with metastatic lung cancer. We investigated patient expectations about the goals of RT for incurable lung cancers. Patients and Methods The Cancer Care Outcomes Research and Surveillance Consortium enrolled a population- and health system–based cohort of patients diagnosed with lung cancer from 2003 to 2005. We identified patients with stage wet IIIB or IV lung cancer who received RT and answered questions on their expectations about RT. We assessed patient expectations about the goals of RT and identified factors associated with inaccurate beliefs about cure. Results In all, 384 patients completed surveys on their expectations about RT. Seventy-eight percent of patients believed that RT was very or somewhat likely to help them live longer, and 67% believed that RT was very or somewhat likely to help them with problems related to their cancer. However, 64% did not understand that RT was not at all likely to cure them. Older patients and nonwhites were more likely to have inaccurate beliefs, and patients whose surveys were completed by surrogates were less likely to have inaccurate beliefs. Ninety-two percent of patients with inaccurate beliefs about cure from RT also had inaccurate beliefs about chemotherapy. Conclusion Although patients receiving RT for incurable lung cancer believe it will help them, most do not understand that it is not at all likely to cure their disease. This indicates a need to improve communication regarding the goals and limitations of palliative RT.
Chen, Aileen B.; Cronin, Angel; Weeks, Jane C.; Chrischilles, Elizabeth A.; Malin, Jennifer; Hayman, James A.; Schrag, Deborah
The authors conducted an intervention study to improve communication during consultation about randomized trials. Questionnaires were used to collect information about patients’ information needs and their attitudes toward clinical trials. The Preferences for Information Questionnaire was helpful to doctors in understanding their patients’ interest in receiving specific details about clinical trials. The Patient Attitudes to Trials Questionnaire accurately predicted which patients would consent to enroll in the trials they were offered.
Reproductive health consistently ranks as one of the most important issues cited by adolescent and young adult (AYA) cancer survivors. Most literature on AYA cancer populations neglects broader reproductive health issues such as unintended pregnancies, contraception use and sexually transmitted infections, which, for cancer patients and survivors with compromised immune systems, can facilitate a multitude of future health problems. Lack of attention coupled with traditional risk-taking behaviors of AYAs poses a significant health risk to patients and survivors, particularly if fertility status is unknown or inaccurately assessed. AYA oncology patients and survivors are vulnerable to reproductive health complications that should be addressed prior to, during and after treatment; however, there are currently no tracking systems or evidence-based guidelines to discuss this subject with patients and survivors. Further research is needed to identify physician practices, AYA preferences and strategies for communication that can pave the way to establishing guidelines to discuss in oncology settings. PMID:23040131
Murphy, Devin; Klosky, James L; Termuhlen, Amanda; Sawczyn, Kelly K; Quinn, Gwendolyn P
Psychiatric morbidity in patients with cancer is high and without appropriate treatment unremitting. We assessed the ability of 143 doctors to establish the psychological status of 2297 patients during outpatient consultations in 34 cancer centres and hospitals in the UK. Prior to seeing the doctor, consenting patients completed a short self-report questionnaire (GHQ12), designed for the psychological screening of large populations. At the end of the consultation, doctors completed visual analogue scales rating patients' distress. 837/2297 (36.4%) patients had GHQ scores suggestive of psychiatric morbidity. The doctors' sensitivity (true positive rate) was 28.87% (SD 25.29), specificity (true negative rate) 84.79% (SD 17.44). The misclassification rate was 34.7% (SD 13.79) meaning that for 797 patients the wrong assessment was probably made. These data show that much of the probable psychiatric morbidity experienced by patients with cancer goes unrecognized and therefore untreated. Doctors need communication skills training to elicit problems during consultations. Appropriate referrals to psychological services are necessary when patients requiring help are identified and ought to be an integral part of cancer care. © 2001 Cancer Research Campaign http://www.bjcancer.com
Fallowfield, L; Ratcliffe, D; Jenkins, V; Saul, J
Background The number of multiple sclerosis (MS) information websites, online communities, and Web-based health education programs has been increasing. However, MS patients’ willingness to use new ways of communication, such as websites, mobile phone application, short message service, or email with their physician, remains unknown. Objectives We designed a questionnaire to evaluate the a priori use of electronic communication methods by MS patients and to assess their acceptance of such tools for communication with their health care providers. Methods We received complete data from 586 MS patients aged between 17 and 73 years. Respondents were surveyed in outpatient clinics across Germany using a novel paper-and-pencil questionnaire. In addition to demographics, the survey items queried frequency of use of, familiarity with, and comfort with using computers, websites, email, and mobile phones. Results About 90% of all MS patients used a personal computer (534/586) and the Internet (527/586) at least once a week, 87.0% (510/586) communicated by email, and 85.6% (488/570) communicated by mobile phone. When asked about their comfort with using electronic communication methods for communication with health care providers, 20.5% (120/586) accepted communication by mobile Internet application or short message service via mobile phone, 41.0% (240/586) by websites, 54.3% (318/586) by email service, and 67.8% (397/586) by at least one type of electronic communication. The level of a priori use was the best predictor for the acceptance of electronic communication with health care providers. Patients who reported already searching online for health information (odds ratio 2.4, P < .001) and who had already communicated with a physician through a website (odds ratio 3.3, P = .03) reported higher acceptance for Web-based communication. Patients who already scheduled appointments with their mobile phones (odds ratio 2.1, P = .002) were more likely to accept the use of mobile phone applications or short message service for communicating with their physician. Conclusions The majority of MS patients seen at specialist centers already use modern communication technology regularly. New forms of electronic communication appear to have high levels of acceptance for exchanging information about MS between patients and health care providers. Such methods should be integrated into eHealth services such as electronic health records and patient relationship management systems.
Schultheiss, Thorsten; Kempcke, Raimar; Thomas, Katja; Ziemssen, Tjalf
Several themes emerged when interviews were conducted with clinician-researchers regarding their attitudes and concerns when recruiting terminally ill cancer patients into non-therapeutic research. The prominent themes were ethical considerations, patient-centered issues, and health professional issues. Promoting communication and autonomy and fostering familial support are important elements for overcoming patient-centered issues. Facilitating the doctor-patient relationship, using teamwork, and implementing educational programs were seen as key factors for dealing with health professional issues.
Trust, social support and patient type—Associations between patients perceived trust, supportive communication and patients preferences in regard to paternalism, clarification and participation of severely injured patients
ObjectiveTrust is an important aspect of physician–patient-interaction, both in terms of compliance and patient- and physician-reported outcomes. Trust-building communication is especially important in terms of severely injured patients because of severity of their injuries and frequently associated physical and psychological consequences. Patients preferences concerning medical treatment (patient type) is also regarded to be important in terms of trust. The objective
Oliver Ommen; Christian Janssen; Edmund Neugebauer; Bertil Bouillon; Klaus Rehm; Christoph Rangger; Hans Josef Erli; Holger Pfaff
Objective The best innovations in cancer communication do not necessarily achieve uptake by researchers, public health and clinical practitioners, and policy makers. This paper describes design activities that can be applied and combined for the purpose of spreading effective cancer communication innovations. Methods A previously developed Push-Pull-Infrastructure Model is used to organize and highlight the types of activities that can be deployed during the design phase of innovations. Scientific literature about the diffusion of innovations, knowledge utilization, marketing, public health, and our experiences in working to spread effective practices, programs, and policies are used for this purpose. Results Attempts to broaden the reach, quicken the uptake, and facilitate the use of cancer communication innovations can apply design activities to increase the likelihood of diffusion. Some simple design activities hold considerable promise for improving dissemination and subsequent diffusion. Conclusion Augmenting current dissemination practices with evidence-based concepts from diffusion science, marketing science, and knowledge utilization hold promise for improving results by eliciting greater market pull. Practice Implications Inventors and change agencies seeking to spread cancer communication innovations can experience more success by explicit consideration of design activities that reflect an expanded version of the Push-Pull-Infrastructure Model.
Dearing, James W.; Kreuter, Matthew W.
Background: Colorectal cancer is the second most common cause of cancer death in New Zealand. With new chemotherapy regimens, patients with metastatic colorectal cancer are now living longer with the condition and its treatment. Aim: This study aimed to explore patients' experiences of extended palliative chemotherapy for metastatic colorectal cancer. Methods: A convenience sample of 10 outpatients who had been receiving palliative chemotherapy for more than 12 months from a teaching hospital and regional cancer centre in New Zealand participated in face-to-face semi-structured interviews. The data was analysed using a general inductive approach. Findings: Three key themes were identified: the importance of relationships, presenting a positive face, and life is for living. The importance of interpersonal relationships with health professionals and a sense of comradery with other chemotherapy patients positively affected the patients' experiences of treatment. Positivity was a key coping strategy that also has negative implications as patients may not reveal their concerns and needs. Conclusion: The key to improving the care of people with advanced cancer is understanding their experiences of care. Communication between the patient, family, and health-care team ensures assumptions that misinterpret attributes of positivity are not made. PMID:24852028
Cameron, Jenny; Waterworth, Susan
Videotaped interactions during which physicians present the option of clinical trial participation to patients at a Comprehensive Cancer Center revealed that discussing the benefits of participating and potential side effects of the protocol, addressing patient concerns, and offering tangible resources to manage the concerns raised by patients were associated with patient decisions to accrue to a trial.
The importance of maintaining the cancer patient's nutritional status is now recognized as a major part of the medical care. It is necessary for the oncology team to be aware of the psychological and physiological factors that interfere with food acceptance so that the correct food can be offered at the right time in the most palatable form. The oral route is the preferred method of feeding, and nutritional supplements, chosen according to the individual patient's needs, are of great value in assuring an adequate oral intake. Diagnostic tests and therapy are frequent causes of disruption of the meal schedule and the dietary service must be flexible in providing the patient an opportunity to make up for missed meals. Taste disturbance, nausea, vomiting and mucositis caused by therapy may necessitate periods of intravenous hyperalimentation. Food aversions due to therapy can frequently be prevented by avoiding new or unusual foods in the hours before chemotherapy or irradiation. Regular nutrition counseling during clinic visits and/or hospitalization permits diet modification for specific therapeutic needs. The ultimate goal is the prevention of wasting and debilitation due to malnutrition in the cancer patient. PMID:109186
Aker, S N
If a patient is expected to respond optimally to one or more forms of oncologic therapy, he should simultaneously be in the best possible nutritional and metabolic condition. When the alimentary tract cannot be used effectively for feeding cancer patients, parenteral nutrition can be lifesaving. Moreover, patients who are poor candidates or noncandidates for any antineoplastic therapy because of their debility or cachexia can be converted to reasonable candidates following a course of i.v. hyperalimentation. This i.v. hyperalimentation can significantly reduce the morbidity and mortality of cancer patients without stimulating tumor growth when applied conscientiously according to the established principles and techniques and when integrated with specific tumor therapy. With the use of ambulatory or home hyperalimentation techniques, normal nutritional status can be restored or maintained during prolonged periods of antineoplastic therapy on a practical and relatively economical outpatient basis. It is anticipated that specific nutrient substrate formulas and parenteral therapy techniques will be developed to maintain optimal host nutrition while adversely affecting the neoplasm. PMID:405099
Dudrick, S J; MacFadyen, B V; Souchon, E A; Englert, D M; Copeland, E M
BACKGROUND: Many breast cancer patients use complementary and alternative medicine (CAM). We aimed to determine what advice health food store employees present to individuals seeking treatment options for breast cancer. METHODS: Eight data gatherers asked employees of all retail health food stores in a major Canadian city, what they recommended for a patient with breast cancer. The data gatherers inquired
Edward Mills; Edzard Ernst; Rana Singh; Cory Ross; Kumanan Wilson
Introduction. Cancer is the second most common cause of death in the USA (2). Studies have shown a coexistence of cancer and hypogonadism (9,31,13). The majority of patients with cancer develop cachexia, which cannot be solely explained by anorexia seen in these patients. Testosterone is a male sex hormone which is known to increase muscle mass and strength, maintain cancellous
The free patient education website (Cancer.net) offers information about cancer and clinical trials in patient-friendly videos. The videos are produced by ASCO and posted regularly on their YouTube channel. The series includes a variety of cancer topics that patients will find helpful, including clinical trials. Information is presented by physicians and advocates and helps patients accumulate accurate information and formulate questions for their physician as they consider a clinical trial.
Cancer rehabilitation is accepted as an essential part of patient care, aiming to maximise the patient's quality of life. Patients who have received major surgery for head and neck cancer face many challenges and require a tailored rehabilitation programme. This review collate the evidence specific to head and neck cancer patients and divides the programme into five areas: functional, medical, aesthetic, psychological and social. This provides an overall framework in which to consider these unique rehabilitation requirements. PMID:22875267
Mitchell, Oliver; Durrani, Amer; Price, Richard
Although there is a need for systematic research on the psychosocial issues faced by lung cancer patients, there have been\\u000a few studies in this area. The objective of the present study was to investigate potential predictors of psychological distress\\u000a among ambulatory lung cancer patients. The variables examined included the patients' characteristics, coping responses, and\\u000a social support factors. Lung cancer patients
Tatsuo Akechi; Akira Kugaya; Hitoshi Okamura; Yutaka Nishiwaki; Shigeto Yamawaki; Y. Uchitomi
The current study examines the effects of a psychological intervention that encourages emotional expression in ovarian cancer patients and their partners. Ovarian cancer patients (n=130) and their partners are randomly assigned to an intervention or a con...
S. G. Zakowski
The current study examines the effects of a psychological intervention that encourages emotional expression in ovarian cancer patients and their partners. Ovarian cancer patients (n=130) and their partners are randomly assigned to an intervention or a con...
S. G. Zakowski
Cancer procoagulant (CP) is a cysteine proteinase that may be produced by malignant and foetal tissue. The possible role of CP in the pathogenesis of cancer-related thrombosis has been suggested recently. The purpose of the study was to evaluate coagulation prothrombotic markers and their relation to CP concentration in the blood of patients with gastrointestinal adenocarcinomas (GIAC). The study group consisted of 45 patients with confirmed diagnosis of adenocarcinoma (stomach, 18 patients; colon, 27 patients) and without evident metastatic disease. In 24 patients further observation showed metastases. The control group for CP was composed of 10 healthy subjects. Blood samples were drawn on the admission day, before any treatment. Among 45 patients with GIAC, deep venous thrombosis was observed in two (4.4%). In all patients the CP activity in the serum was found, and the mean CP activity shortened the coagulation time almost three times compared with the healthy control group. Also, the mean thrombin-antithrombin complex concentration was above the normal range. A significant elevation of the mean prothrombin fragment 1+2 plasma content in this group of patients was noticed. Despite these observations, CP remained within the normal range and did not correlate with thrombin-antithrombin complex or prothrombin fragment 1+2 plasma concentrations. A positive correlation was observed between serum CP and fibrinogen concentration, and a negative correlation between CP and free protein S plasma content (P = 0.04 and P = 0.025, respectively). A negative correlation between activated protein C resistance ratio and protein C activity in the plasma was confirmed. Protein C activity in the plasma showed a correlation with free protein S plasma content. Analysis of factors influencing the activated partial thromboplastin time revealed the presence of antiphospholipid antibodies in seven persons from the study group (in three cases of IgG and in four cases of IgM class). Our data suggest that CP is a minor risk factor for deep venous thrombosis in GIAC patients. To confirm this, however, the number of patients and controls should be larger. After 3 years of observation, the follow-up in 10 living GIAC patients showed nobody with thromboembolic disease. PMID:16269926
Ka?mierczak, Maciej; Lewandowski, Krzysztof; Wojtukiewicz, Marek Z; Turowiecka, Zofia; Ko?acz, Edyta; Lojko, Anna; Skrzydlewska, Elzbieta; Zawilska, Krystyna; Komarnicki, Mieczys?aw
BACKGROUND Limited evidence exists on the effectiveness of recruitment methods among diverse populations. OBKECTIVE Describe response rates by recruitment stage, ethnic-language group, and type of initial contact letter (for African-American and Latino patients). DESIGN Tracking of response status by recruitment stage and ethnic-language group and a randomized trial of ethnically tailored initial letters nested within a cross-sectional telephone survey on physician-patient communication. PARTICIPANTS Adult general medicine patients with ?1 visit during the preceding year, stratified by 4 categories: African-American (N= 1,400), English-speaking Latino (N= 894), Spanish-speaking Latino (N= 965), and non-Latino white (N= 1,400). MEASUREMENTS AND RESULTS Ethnically tailored initial letters referred to shortages of African-American (or Latino) physicians and the need to learn about the experiences of African-American (or Latino) patients communicating with physicians. Of 2,482 patients contacted, eligible, and able to participate (identified eligibles), 69.9% completed the survey. Thirty-nine percent of the sampling frame was unable to be contacted, with losses higher among non-Latino whites (46.5%) and African Americans (44.2%) than among English-speaking (32.3%) and Spanish-speaking Latinos (25.1%). For identified eligibles, response rates were highest among Spanish-speaking Latinos (75.2%), lowest for non-Latino whites (66.4%), and intermediate for African Americans (69.7%) and English-speaking Latinos (68.1%). There were no differences in overall response rates between patients receiving ethnically tailored letters (72.2%) and those receiving general letters (70.0%). CONCLUSIONS Household contact and individual response rates differed by ethnic-language group, highlighting the importance of tracking losses by stage and subpopulation. Careful attention to recruitment yielded acceptable response rates among all groups.
Napoles-Springer, Anna M; Santoyo, Jasmine; Stewart, Anita L
Purpose: Prostate and colorectal cancer (CRC) rates are disproportionately high among African-American men. The purpose of this paper is to describe the development of an intervention in which barbers were trained to educate clients about early detection for prostate and CRC. Design/methodology/approach: Working with an advisory panel of local…
Holt, Cheryl L.; Wynn, Theresa A.; Lewis, Ivey; Litaker, Mark S.; Jeames, Sanford; Huckaby, Francine; Stroud, Leonardo; Southward, Penny L.; Simons, Virgil; Lee, Crystal; Ross, Louis; Mitchell, Theodies
Introduction: Physician rapport with patients is described as a vital component of relationship-centered care, but rapport-building communication behaviors may exceed boundaries and instead indicate patronizing behavior toward patients with disabilities. This paper addresses the types of communication behaviors and contexts for interpreting when rapport building extends beyond boundaries toward patients with disabilities. Methods: Videotaped interactions between third- and fourth-year medical students (N = 142) and standardized patient educators with physical disabilities were qualitatively analyzed. Results: Results suggest six primary themes of exceeding expected rapport boundaries, including baby talk (ie, exaggerated nonverbal gestures and “we” language to indicate “you”), kinesic movement (ie, stiff posture and awkward handshakes), vocalics (ie, volume or pitch that interfered with the flow of conversation), relationship assumptions (ie, communicating assumptions that relationships were grounded in care-receiving), emotional divergence from patient disclosure (ie, minimizing or embellishing disability), and inconsistency with patient emotional cues (ie, responding to negative or neutral disclosure by overly accentuating positive interpretation). Discussion: This study suggests that communication behaviors generally described as positive, rapport-building behaviors can pose negative implications when they exceed the expected quantity or duration, when they are inconsistent with patient verbal disclosure, or when verbal and nonverbal messages are inconsistent. Identified themes serve as examples to understand when rapport building exceeds beyond affiliation and instead appears to indicate patronizing behavior toward patients with disabilities. Suggestions for interpreting communication behaviors within the context of patient disclosure and building capacity to distinguish attitudes and biases limiting communication are addressed.
Duggan, Ashley P; Bradshaw, Ylisabyth S; Swergold, Natalie; Altman, Wayne
\\u000a Abstract\\u000a \\u000a \\u000a Purpose:\\u000a To evaluate the acute toxicity of simultaneous integrated boost (SIB) technique for dose escalation with helical tomotherapy\\u000a (HT) in patients with locally advanced cervical cancer.\\u000a \\u000a \\u000a \\u000a \\u000a \\u000a Patients and Methods:\\u000a 20 patients (FIGO IB1 pN1-IIIB) underwent primary chemoradiation. Prior to chemoradiation, a laparoscopic\\u000a pelvic and para-aortic lymphadenectomy was performed. A boost region was defined using titanium clips during staging for
Simone Marnitz; Carmen Stromberger; Michael Kawgan-Kagan; Waldemar Wlodarczyk; Ulrich Jahn; Achim Schneider; Uwe Ulrich; Volker Budach; Christhardt Köhler
Summary Breast cancer in the elderly is a rising health care challenge. Under-treatment is common. While the proportion of older patients receiving adjuvant radiotherapy (RT) is rising, the proportion undergoing breast-conserving surgery without irradiation has also risen. The evidence base for loco-regional treatment is limited, reflecting the historical exclusion of older patients from randomised trials. The 2011 Oxford overview shows that the risk of first recurrence is halved in all age groups by adjuvant RT after breast-conserving surgery, although the absolute benefit in older ‘low-risk’ patients is small. There is level 1 evidence that a breast boost after breast-conserving surgery and whole-breast irradiation reduces local recurrence in older as in younger women, although in the former the absolute reduction is modest. Partial breast irradiation (external beam or intraoperative or postoperative brachytherapy) is potentially an attractive option for older patients, but the evidence base is insufficient to recommend it routinely. Similarly, shortened (hypofractionated) dose fraction schedules may be more convenient for older patients and are supported by level 1 evidence. There remains uncertainty about whether there is a subgroup of older low-risk patients in whom postoperative RT can be omitted after breast-conserving surgery. Biomarkers of ‘low risk’ are needed to refine the selection of patients for the omission of adjuvant RT. The role of postmastectomy irradiation is well established for ‘high-risk’ patients but uncertain in the intermediate-risk category of patients with 1–3 involved axillary nodes or node-negative patients with other risk factors where its role is investigational.
Many types of cancer are now curable or, if not cured, becoming a chronic illness. In 2012, it was estimated that there were more than 13,500,000 cancer survivors in the United States. Late outcomes of these survivors are increasingly related to cardiovascular disease, either as a consequence of the direct effects of cancer therapy or its adverse effects on traditional cardiac risk factors (eg, obesity, hypertension, dyslipidemia, and diabetes mellitus). This article describes the therapies that have led to advances in cancer survival and the acute and chronic cardiovascular toxicities associated with these therapies. Recommendations are made for the surveillance and management of cancer survivors. Published guidelines on the subject of cardio-oncology are reviewed in light of clinical experience caring for these patients. To supplement this cancer-related knowledge base, appropriateness criteria and guidelines for cardiac care in the general population were extrapolated to cancer survivors. The result is a series of recommendations for surveillance and management of cardiovascular disease in cancer survivors. PMID:24331191
Steingart, Richard M; Yadav, Nandini; Manrique, Carlos; Carver, Joseph R; Liu, Jennifer
\\u000a Communication impairment is a core deficit associated with autism spectrum disorder (ASD). Therefore, it should not be surprising\\u000a that this topic has become a major thrust of assessment and treatment in applied behavior analysis (ABA). The types of communication\\u000a skills to target for intervention and the behavioral assessment methods that can be used to identify these target behaviors\\u000a are reviewed
Jeff Sigafoos; Mark F. O’Reilly; Giulio E. Lancioni
Little is known about student nurses experiences of nursing patients with cancer in the UK. With the increasing survival of people with cancer and with cancer no longer seen as a terminal illness it is useful to understand student nurses clinical experience when nursing those with cancer. This study takes a phenomenological approach involving three focus group interviews with 20 student nurses from the second and third year of their course in one centre in the UK. All the students had experience of caring for patients with cancer. The key themes emerging from the study were: Communication, Impact on Self, Lack of Support and End-of-Life-Care. Students emphasised the need to have more knowledge and support in relation to cancer care. They describe how they lack communication skills and found it difficult to handle their emotions. A number of students found the whole experience of caring for patients with cancer emotionally distressing and draining and they describe avoiding contact with these patients by using distancing and avoidance strategies. Student nurses need additional support through demystifying cancer, using reflective practice and good mentoring in the clinical area to enable students to feel supported, and develop confidence in their capacity for care for people with cancer. PMID:24134475
King-Okoye, M; Arber, A
A field study of 28 residents in family practice was conducted. Physicians’ self-reports of empathy, self-monitoring ability, and affective communication skill as well as their objectively measured nonverbal communication skills were examined as predictors of patient satisfaction, appointment noncompliance, and physician workload (schedule density). Physicians completed the Hogan Empathy Scale, Snyder Self-Monitoring Scale, Affective Communication Test, short form of the
M. Robin DiMatteo; Ron D. Hays; Louise M. Prince
A four-drug chemotherapy regimen has produced the longest improvement in survival ever seen in a phase III clinical trial of patients with metastatic pancreatic cancer, one of the deadliest types of cancer.
In the last decade, there has been a proliferation of new drugs and strategies for intensifying the treatments used to combat cancer. These aggressive treatment strategies also have led to increasing toxicities experienced by patients. Often, cancer thera...
L. H. Yoder
Radium-223 Improves Survival in Patients with Advanced Prostate Cancer Summary Results from a phase III trial ... Xofigo®) improves overall survival in men with advanced prostate cancer that has spread to their bones compared ...
Lung cancer patients visit the emergency room (ER) for cancer-related and -unrelated reasons more often compared to patients with other types of cancer. This results in increased admissions and deaths in the ER. In this study, we retrospectively reviewed the characteristics of lung cancer patients visiting the ER in order to optimize the utilization of emergency medical services and improve the patients’ quality of life. Lung cancer patients visiting the ER of a single institution over a 2-year period (2010–2011) were analyzed. The patients’ chief complaints and diagnoses at presentation in the ER were classified as cancer-related and -unrelated. Hospital admission, discharge from the ER, hospital mortality and survival of advanced lung cancer patients hospitalized through admission to the ER was surveyed. A total of 113 patients visited the ER 143 times. Seventy visits (49.0%) were cancer-related and 73 (51.0%) were cancer-unrelated. Respiratory symptoms, pain, gastrointestinal and neurological events and fever were the most common cancer-related issues recorded. With the progression of cancer stage, the number of ER visits, admissions, ambulance use and hospital mortalities increased. In visits due to cancer-unrelated issues, including infection, cardiovascular and gastrointestinal diseases, fever was the most common complaint. Emergency admissions of advanced-stage patients for cancer-related issues revealed a significantly shorter median survival time compared to that for patients admitted for cancer-unrelated issues (61 vs. 406 days, respectively; P<0.05). It was observed that outpatients with lung cancer visited the ER for cancer-related and -unrelated reasons with a similar frequency. Therefore, accurate differential diagnosis in the ER is crucial for patients with lung cancer.
KOTAJIMA, FUTOSHI; KOBAYASHI, KUNIHIKO; SAKAGUCHI, HIROZO; NEMOTO, MANABU
Healthcare staff face significant challenges while caring for hospitalized patients experiencing sudden inability to verbalize their needs (sudden speechlessness). Familiar methods of communication such as non-verbal strategies are limited and often fail to assist suddenly speechless patients (SS) communicate their needs. Consequently, strategies tailored to the needs of hospitalized speechless patients are necessary, and must consider factors intrinsic to the patients and the complexities of the acute care environment. The feasibility and usability of a multi-functional prototype communication system (speech-generating device) tailored to the needs of hospitalized SS patients was evaluated in this pilot study. Adult SS patients admitted to the intensive ewe setting (n = 11) demonstrated independent use of a multi-functional communication system that integrated messages and strategies tailored to the needs of the hospitalized SS patient. Participants reported high satisfaction levels and considered the use of the technology of high importance during an SS event. Additional research should focus on evaluating the impact of technology specific communication interventions on enhancing the communication process between SS patients and healthcare staff.
Rodriguez, Carmen S.; Rowe, Meredeth; Koeppel, Brent; Thomas, Loris; Troche, Michelle S.; Paguio, Glenna
Purpose The incidence of colorectal cancer is increasing due to a westernized dietary lifestyle, and improvements in treatment and diagnostic tools have resulted in more patients being confirmed of having multiple primary cancers. However, studies regarding multiple primary cancers are insufficient. In this study, the clinical aspects of patients with primary multiple cancers, including colorectal cancers, were investigated, and the results were compared to those of patients with primary colorectal cancer only. Methods Seven hundred eighteen patients who received surgery for colorectal cancer between March 2003 and September 2012 in CHA Medical Center were enrolled. A retrograde cohort was done for comparison of the two groups: those with and those without multiple primary cancer. The analysis was done according to sex, age, tumor location, tumor size, metastatic regional lymph-node number, vascular/lymphatic microinvasion, staging, tumor markers, microsatellite instability, and C/T subgroup of polymorphism in methylenetetrahydrofolate reductase. Results Of the 718 subjects, 33 (4.6%) had multiple primary cancers: 12 (36.4%) synchronous and 21 (63.6%) metachronous. The malignancy most frequently accompanying colorectal cancer was gastric cancer, followed by thyroid, prostate, and esophageal malignancies in that order. In the comparison between groups, mean age, tumor location, and microsatellite instability showed statistically significant differences; others parameters did not. Conclusion The incidence of multiple primary cancers, including colorectal cancer, is increasing. Therefore, defining the characteristics of patients with multiple primary cancers is crucial, and those characteristics need to be acknowledged in the follow-up of colorectal cancer patients.
Lee, Jin Woo; Kim, Nam Keun
The extreme aggressiveness of pancreatic ductal adenocarcinoma (PDA) has been associated with blocked gap junctional intercellular communication (GJIC) and the presence of cancer stem cells (CSCs). We examined whether disturbed GJIC is responsible for a CSC phenotype in established and primary cancer cells and patient tissue of PDA using interdisciplinary methods based in physiology, cell and molecular biology, histology and epigenetics. Flux of fluorescent dyes and gemcitabine through gap junctions (GJs) was intact in less aggressive cells but not in highly malignant cells with morphological dysfunctional GJs. Among several connexins, only Cx43 was expressed on the cell surface of less aggressive and GJIC-competent cells, whereas Cx43 surface expression was absent in highly malignant, E-cadherin-negative and GJIC-incompetent cells. The levels of total Cx43 protein and Cx43 phosphorylated at Ser368 and Ser279/282 were high in normal tissue but low to absent in malignant tissue. si-RNA-mediated inhibition of Cx43 expression in GJIC-competent cells prevented GJIC and induced colony formation and the expression of stem cell-related factors. The bioactive substance sulforaphane enhanced Cx43 and E-cadherin levels, inhibited the CSC markers c-Met and CD133, improved the functional morphology of GJs and enhanced GJIC. Sulforaphane altered the phosphorylation of several kinases and their substrates and inhibition of GSK3, JNK and PKC prevented sulforaphane-induced CX43 expression. The sulforaphane-mediated expression of Cx43 was not correlated with enhanced Cx43 RNA expression, acetylated histone binding and Cx43 promoter de-methylation, suggesting that posttranslational phosphorylation is the dominant regulatory mechanism. Together, the absence of Cx43 prevents GJIC and enhances aggressiveness, whereas sulforaphane counteracts this process, and our findings highlight dietary co-treatment as a viable treatment option for PDA. PMID:24742583
Forster, Tobias; Rausch, Vanessa; Zhang, Yiyao; Isayev, Orkhan; Heilmann, Katharina; Schoensiegel, Frank; Liu, Li; Nessling, Michelle; Richter, Karsten; Labsch, Sabrina; Nwaeburu, Clifford C; Mattern, Juergen; Gladkich, Jury; Giese, Nathalia; Werner, Jens; Schemmer, Peter; Gross, Wolfgang; Gebhard, Martha M; Gerhauser, Clarissa; Schaefer, Michael; Herr, Ingrid
The extreme aggressiveness of pancreatic ductal adenocarcinoma (PDA) has been associated with blocked gap junctional intercellular communication (GJIC) and the presence of cancer stem cells (CSCs). We examined whether disturbed GJIC is responsible for a CSC phenotype in established and primary cancer cells and patient tissue of PDA using interdisciplinary methods based in physiology, cell and molecular biology, histology and epigenetics. Flux of fluorescent dyes and gemcitabine through gap junctions (GJs) was intact in less aggressive cells but not in highly malignant cells with morphological dysfunctional GJs. Among several connexins, only Cx43 was expressed on the cell surface of less aggressive and GJIC-competent cells, whereas Cx43 surface expression was absent in highly malignant, E-cadherin-negative and GJIC-incompetent cells. The levels of total Cx43 protein and Cx43 phosphorylated at Ser368 and Ser279/282 were high in normal tissue but low to absent in malignant tissue. si-RNA-mediated inhibition of Cx43 expression in GJIC-competent cells prevented GJIC and induced colony formation and the expression of stem cell-related factors. The bioactive substance sulforaphane enhanced Cx43 and E-cadherin levels, inhibited the CSC markers c-Met and CD133, improved the functional morphology of GJs and enhanced GJIC. Sulforaphane altered the phosphorylation of several kinases and their substrates and inhibition of GSK3, JNK and PKC prevented sulforaphane-induced CX43 expression. The sulforaphane-mediated expression of Cx43 was not correlated with enhanced Cx43 RNA expression, acetylated histone binding and Cx43 promoter de-methylation, suggesting that posttranslational phosphorylation is the dominant regulatory mechanism. Together, the absence of Cx43 prevents GJIC and enhances aggressiveness, whereas sulforaphane counteracts this process, and our findings highlight dietary co-treatment as a viable treatment option for PDA.
Zhang, Yiyao; Isayev, Orkhan; Heilmann, Katharina; Schoensiegel, Frank; Liu, Li; Nessling, Michelle; Richter, Karsten; Labsch, Sabrina; Nwaeburu, Clifford C.; Mattern, Juergen; Gladkich, Jury; Giese, Nathalia; Werner, Jens; Schemmer, Peter; Gross, Wolfgang; Gebhard, Martha M.; Gerhauser, Clarissa; Schaefer, Michael; Herr, Ingrid
Background. Knowledge-based skin cancer risk and prevention educational interventions by physicians and nurses were directed to subjects who had a nonmelanoma skin cancer. These high-risk patients asked relatives or friends to assist with postoperative care rendered after surgical removal of the skin cancer. The patient?s experience with the nonmelanoma skin cancer was expected to raise the awareness of the helper.
J. K. Robinson; A. W. Rademaker
Review of the case notes of 660 patients with a diagnosis of breast cancer during a five-year period showed that in 119 cases there had been thoracic metastases. These were recorded as pleural or extrapleural metastases (79 patients), mediastinal tumour (46 patients), lymphangitic carcinoma (41 patients), pulmonary nodules (34 patients), and solitary pulmonary nodule (nine patients). Endobronchial metastases were present
H Kreisman; N Wolkove; H S Finkelstein; C Cohen; R Margolese; H Frank
Explains how revising patient-education materials provided for undergraduate technical communication students a review and reinforcement of principles they had studied all semester, such as accessible organization of information, audience analysis, use of formatting and graphics to enhance communication, and clear sentence structure and diction.…
Spears, Lee A.
This study used the medium of videotaping to investigate the verbal and nonverbal communication that takes place between nurses and patients during chemotherapy administration. Eight chemotherapy sessions were video recorded and then analyzed for emerging themes. In addition, the videotapes were used in a reflective process with nurses. The findings showed that nurses were efficient in communicating about the physical
Jenny OBaugh; Lesley M. Wilkes; Kerrie Sneesby; Ajesh George
The latest investigations have been searched in order to present new guidelines for the treatment of elderly patients with primary breast cancer. It is concluded that breast-conserving surgery should be offered as well as the sentinel node technique. Axillary lymph node dissection is not necessary in the case of micrometastases. Adjuvant radiotherapy can be omitted in low risk cases. Endocrine treatment can be used in adjuvant and neo-adjuvant settings, but surgery should be offered as well. In high risk cases with receptor-negative tumour chemotherapy should be considered as an option. Generalized follow-up is recommended. PMID:18405474
Paaschburg, Birgitte; Pedersen, Anne; Tuxen, Malgorzata K; Nielsen, Mette Møller; Kroman, Niels
Background: Information on the costs of medical care for patients enrolled in clinical trials is needed by policymakers evaluating ways to facilitate clinical research in a managed care environment. We examined the direct costs of medical care for patients enrolled in cancer clinical trials at a large health maintenance organization (HMO). Methods: Costs for 135 patients who entered 22 cancer
Bruce H. Fireman; Louis Fehrenbacher; Elisabeth P. Gruskin; G. Thomas Ray
PURPOSE: Remembering medical treatment information may be particularly taxing for older cancer patients, but to our knowledge this ability has never been assessed in this specific age group only. Our purpose in this study was to investigate older cancer patients' recall of information after patient education preceding chemotherapy. DESIGN AND METHODS: We constructed a recall questionnaire consisting of multiple-choice questions,
JESSE JANSEN; JULIA VAN WEERT; NIENKE VAN DER MEULEN; SANDRA VAN DULMEN; THEA HEEREN; JOZIEN BENSING
Patients and their loved ones often experience anticipatory grief when learning of a diagnosis of advanced or terminal cancer. Anticipatory grief can be a response to threats of loss of ability to function independently, loss of identity, and changes in role definition, which underlie fear of death. Dealing with multiple losses is a primary task that the dying patient must face. When an oncologist delivers bad news, the patient and family members often hear the same discussion through different filters, which can lead to conflict and dysfunction. By providing a supportive and safe environment, oncology nurses can help patients and their loved ones understand that their feelings are common and are experienced by others in similar situations and assist them with developing coping strategies and in redefining their roles within the family and in the outside world. In addition, an important goal at this time is to help the patients reframe "hope" realistically so they may have the opportunity for personal growth as well as reconciliation of primary relationships toward the end of life. PMID:20118035
Objective To compare patient-reported and observer-rated shared decision making (SDM) use for colorectal cancer (CRC) screening and evaluate patient, physician and patient-reported relational communication factors associated with patient-reported use of shared CRC screening decisions. Methods Study physicians are salaried primary care providers. Patients are insured, aged 50-80 and due for CRC screening. Audio-recordings from 363 primary care visits were observer-coded for elements of SDM. A post-visit patient survey assessed patient-reported decision-making processes and relational communication during visit. Association of patient-reported SDM with observer-rated elements of SDM, as well as patient, physician and relational communication factors were evaluated using generalized estimating equations. Results 70% of patients preferred SDM for preventive health decisions, 47% of patients reported use of a SDM process, and only one of the screening discussions included all four elements of SDM per observer ratings. Patient report of SDM use was not associated with observer-rated elements of SDM, but was significantly associated with female physician gender and patient-reported relational communication. Conclusion Inconsistencies exist between patient reports and observer ratings of SDM for CRC screening. Practice Implications Future studies are needed to understand whether SDM that is patient-reported, observer-rated or both are associated with informed and value-concordant CRC screening decisions.
Wunderlich, Tracy; Cooper, Gregory; Divine, George; Flocke, Susan; Oja-Tebbe, Nancy; Stange, Kurt; Lafata, Jennifer Elston
OBJECTIVE: To measure patient preferences for four different screening strategies: annual fecal occult blood testing (FOBT) alone; flexible\\u000a sigmoidoscopy (FSIG) every 5 years alone; both annual FOBT and FSIG every 5 years; or no screening.\\u000a \\u000a \\u000a DESIGN: Survey.\\u000a \\u000a \\u000a \\u000a \\u000a SETTING: University internal medicine clinic.\\u000a \\u000a \\u000a \\u000a \\u000a PATIENTS: Convenience sample of 146 adults (aged 50–75 years) with no previous history of colon cancer.\\u000a \\u000a \\u000a \\u000a \\u000a INTERVENTION: Three-part
Michael Pignone; Dawn Bucholtz; Russell Harris
The increasing popularity and availability of electronic cigarettes (i.e., e-cigarettes) in many countries has promoted debate among health professionals as to what to recommend to their patients who might be struggling to stop smoking or asking about e-cigarettes. In the absence of evidence based guidelines for using e-cigarettes for smoking cessation, some health professionals have urged caution about recommending them due to the limited evidence of their safety and efficacy, while others have argued that e-cigarettes are obviously a better alternative to continued cigarette smoking and should be encouraged. The leadership of the IASLC asked the Tobacco Control and Smoking Cessation Committee to formulate a statement on the use of e-cigarettes by cancer patients to help guide clinical practice. Below is this statement, which we will update periodically as new evidence becomes available.
Aim To explore physician-patient communication practices during the process of obtaining informed consent in a hospital setting in Croatia. Methods Two hundred and fifty patients (response rate 78%) from five tertiary level hospitals in Zagreb, Croatia, anonymously filled in the questionnaire on informed consent and communication practices by Nemcekova et al in the period from April to December 2011. Results Eighty five percent of patients received complete, understandable information, presented in a considerate manner. Patients in surgical departments received a higher level of information than those in internal medicine departments. Patients were informed about health risks of the proposed treatments (in 74% of cases) and procedures (76%), health consequences of refusing a medical intervention (69%), and other methods of treatment (46%). However, patients pointed out a number of problems in physician-patient communication. Conclusion Communication practices during informed consent-obtaining process in hospitals in Zagreb are based on a model of shared decision-making, but paternalistic physician-patient relationship is still present. Our results indicate that Croatia is undergoing a transition in the physician-patient relationship and communication.
Vucemilo, Luka; Curkovic, Marko; Milosevic, Milan; Mustajbegovic, Jadranka; Borovecki, Ana
Increased levels of patient satisfaction and compliance are found when they assertively participate in clinical conversations. The Internet may be able to aid communication between the patient and the community pharmacist, particularly if the patient is in control of their record. We propose an Internet Medicine Cabinet that affords this aid by providing \\
Jean-pierre Calabretto; James R. Warren; Kathy Darzanos; Benjamin Fry
Researchers conducted a systematic review of studies of interventions to improve cancer patient participation in randomized controlled trials. Across all studies included in this review, there was no evidence that any of the experimental interventions evaluated led to an increase in cancer patient participation. Further research is required to evaluate the effectiveness of strategies to increase participation in cancer treatment trials.
To examine health promotion in a primary-care context, we studied perceived and actual communication in 271 consultations between general practitioners and patients in Oxford (England). Although health promotion is a term usually reserved for public-health or wellness programs, a health promotion perspective enriches the examination of communication in physician-patient interactions by emphasizing issues of empowerment, competence and control. Accordingly, we
Gregory Makoul; Paul Arntson; Theo Schofield
In this paper, we explore the use of a projection-based handheld device to facilitate in-clinic doctor-patient communication. We present the user-centered design process used to understand the workflow of medical professionals and to identify challenges they currently face in communicating information to patients. Based on the lessons learned, we developed AnatOnMe, a prototype projection-based hand-held system for enhancing information exchange
Tao Ni; Amy K. Karlson; Daniel Wigdor
Adults increasingly are conveying their personal experiences with serious disease online, but do such chronicles help the authors or their audience? In the first known study of its kind, UCLA Jonsson Comprehensive Cancer Center researchers discovered that creating a personal website to chronicle the cancer experience and communicate with one's social network can reduce depressive symptoms, increase positive mood and enhance appreciation for life among women diagnosed with breast cancer.
Cancer may be localized in a variety of areas in the human body. This localization is associated with significant issues concerning not only therapy and prognosis but also psychological and psychiatric problems that the patient may be confronted with. The psychic impact on the patient is determined to a significant degree by the symbolism the affected organ carries. The symbolic significance of a sick body area triggers emotions and sets in motion self-defence mechanisms. In this way, patients deal with the new psychic reality that cancer creates. Therapeutic choices may include interventions, involving mutilation, which cause disfigurement and major consequences in the body image which result in narcissistic injuries. The phenomenology of anxiety and depressive disorders is connected to the affected body area. The appearance of cancer not only in sexual organs but also in other body areas, may disturb sexual function and therefore lead to sexual disorders. Especially, head and neck are connected with vital functions. This area of the body has had a major impact on psychic reality since early life. Complicated psychic functions have developed in relation to organs of the head and neck. Therefore, localization of cancer in this area leads to individual psychological and psychiatric problems, since eating and breathing are harmed, verbal communication becomes difficult and body image alters. Also, increased incidence of alcohol and nicotine abuse in these patients reflects special aspects of psychic structure and personality. Because of severe somatic symptoms and poor prognosis, lung cancer patients feel hopelessness and helplessness. Patients with gynaecological cancer are confronted with a disease that affects organs like breast and internal female sexual organs associated with femininity, attractiveness and fertility. Dietary habits are often a source of guilt for patients who suffer from cancer of the gastrointestinal tract. Additionally, stomas, as colostomy, affect body image and cause feelings of embarrassment with severe consequences on the patient's sense of wellbeing, his or her daily activities, interpersonal relationships or sexuality. Depressive symptoms often occur in prodromal stages of pancreatic cancer. Depression is a common diagnosis in patients with prostate cancer. Prostatectomy negatively affects patient's self-esteem, because it might be experienced as a threat to his sexual life. Disfigurement is related to skin cancer because of both cancer and surgical procedures. Therefore, it is a challenge for modern psycho-oncology to identify those patients who are vulnerable in developing psychiatric symptoms, to early diagnose anxiety and depression and to use psychotherapeutic interventions targeting individual psychological and psychiatric problems in relation to the localization of disease in the human body. PMID:22549040
Moussas, G I; Papadopoulou, A G; Christodoulaki, A G; Karkanias, A P
The volume contains information on screening programs; education; diagnosis; grading and prognostic procedures; therapy, treatment methods; supportive care of patients; rehabilitation and clinical cancer data processing.
Hormone treatment is one of the key strategies in the management of metastatic breast cancer. Hormone treatment is one of the key strategies in the management of metastatic breast cancer. Aromatase inhibitors (AI) have been extensively studied in this setting. This section summarizes the key data regarding the use of AI in advanced breast cancer. In postmenopausal women, AI are the first line of treatment for untreated patients, or those who had prior AI treatment and progress after 12 months of adjuvant therapy. A longer disease-free interval and absence of visceral disease is associated with a better response. If tumors recur in less than 12 months, it is recommended that tamoxifen (TAM) or the estrogen-receptor antagonist fulvestrant (FUL) treatment be initiated. In the second-line setting, the best option after progression is the administration of either FUL or TAM. In the third-line setting, reintroduction of AI is considered an acceptable option. In premenopausal women who have not received prior treatment or who have progressed after 12 months following adjuvant treatment, it is recommended to initiate therapy with a combination of TAM and a luteinizing hormone-releasing hormone (LHRH) analog. If there is treatment failure with the use of this combination, megestrol acetate or an LHRH agonist plus an AI may be reasonable alternatives. Intensive research is ongoing to understand the mechanisms of resistance to hormone therapy. In human epidermal growth factor receptor 2 positive-patients, combinations with HER2 antagonists are associated with significant clinical activity. PMID:21922395
Cruz Jurado, J; Richart Aznar, P; García Mata, J; Fernández Martínez, R; Peláez Fernández, I; Sampedro Gimeno, T; Galve Calvo, E; Murillo Jaso, L; Polo Marqués, E; García Palomo, A
Patient-centered care requires that both healthcare providers and patients have access to comparative effectiveness research (CER), which provides direct comparisons of the risks and benefits of available clinical options. However, insufficient attention has been paid to developing the comprehensive communication systems necessary to ensure that CER reaches patients and healthcare providers. In this review, we propose a model of the multiple stages of CER communication necessary for patient-centered care and review the existing research and gaps in knowledge relevant to each stage. These stages include: promotion of the underlying concepts and value of CER; translation of CER results; dissemination of CER results; and utilization of the results of CER in shared decision-making between patients and providers. A comprehensive approach to CER communication is necessary to ensure that the growing interest in and availability of CER is able to support a more patient-centered model of healthcare. PMID:24236683
Halley, Meghan C; Rendle, Katharine A S; Frosch, Dominick L
Five articles discussing communications in vocational education include "The Golden Rule of Administration" by Ben Mortensen; "Vital Link with Parents" by Richard Sullivan; "An Interpersonal Exercise" by John Villiers; "Face to Face with Employers" by Gregg Bosak; and "Recruitment Strategies" by Susan Miller. (SK)
Mortensen, Ben F.; And Others
Physical environments of clinical settings play an important role in health communication processes. Effective medication management requires seamless communication among health professionals of different disciplines. This paper explores how physical environments affect communication processes for managing medications and patient safety in acute care hospital settings. Findings highlighted the impact of environmental interruptions on communication processes about medications. In response to frequent interruptions and limited space within working environments, nurses, doctors and pharmacists developed adaptive practices in the local clinical context. Communication difficulties were associated with the ward physical layout, the controlled drug key and the medication retrieving device. Health professionals should be provided with opportunities to discuss the effects of ward environments on medication communication processes and how this impacts medication safety. Hospital administrators and architects need to consider health professionals' views and experiences when designing hospital spaces. PMID:24486620
Liu, Wei; Manias, Elizabeth; Gerdtz, Marie
Background Cancer mortality continues to be higher in Native Hawaiians than Whites, and research has identified numerous barriers to good cancer care. Cancer navigator programs provide individualized assistance to patients and family members to overcome barriers, promoting early diagnosis and timely and complete treatment. Objectives Our purpose was to design a training curriculum to provide community-based outreach workers serving Native Hawaiians with cancer patient navigator skills. Methods The Ho`okele i ke Ola (Navigating to Health) curriculum was informed by data gathered from Native Hawaiian cancer patients and their family members, outreach workers in Native Hawaiian communities, and cancer care providers. Based on findings, the 48-hour curriculum focused on cancer knowledge, cancer resources, and cancer communications. Three versions were developed: 1) 6 days of training and on-site tours in urban Honolulu; 2) 4 days of training on a neighbor island, with 2 days of on-site tours in Honolulu; and 3) a 3-credit community college independent study course. Graduates were interviewed after each session and 3 months after graduation about application of navigation skills. Results In 18 months, 62 health workers from community-based, clinical and community college settings were trained—31 in Honolulu-based trainings, 29 in neighbor island trainings where earlier graduates served as co-faculty, and 2 through Maui Community College. Follow-up data suggest increased knowledge, skills, capacity, and feelings of competence among trainees. Conclusions All three versions of the Ho`okele i ke Ola curriculum, developed with community input, have proven successful in increasing cancer patient navigation skills of trainees.
Braun, Kathryn L.; Allison, Amanda; Tsark, JoAnn U.
A population-based cancer registry was successfully used to identify and enroll 60 late-stage ovarian cancer patients to a psychosocial intervention designed to improve quality of life. Cancer registries can be used to screen for some medical eligibility requirements and may be a valuable resource for clinical trials examining interventions to promote quality of life or prevent cancer recurrence.
Purpose: To evaluate the utility of an infrared-guided patient setup (iGPS) system to reduce the uncertainties in the setup of lung cancer patients. Methods and Materials: A total of 15 patients were setup for lung irradiation using skin tattoos and lateral leveling marks. Daily electronic portal device images and iGPS marker locations were acquired and retrospectively reviewed. The iGPS-based shifts were compared with the daily electronic portal device image shifts using both the central axis iGPS marker and all five iGPS markers. For shift calculation using the five markers, rotational misalignment was included. The level of agreement between the iGPS and portal imaging to evaluate the setup was evaluated as the frequency of the shift difference in the range of 0-5 mm, 5-10 mm, and >10 mm. Results: Data were obtained for 450 treatment sessions for 15 patients. The difference in the isocenter shifts between the weekly vs. daily images was 0-5 mm in 42%, 5-10 mm in 30%, and >10 mm in 10% of the images. The shifts seen using the iGPS data were 0-5 mm in 81%, 5-10 mm in 14%, and >10 mm in 5%. Using only the central axis iGPS marker, the difference between the iGPS and portal images was <5 mm in 77%, 5-10 mm in 16%, and >10 mm in 7% in the left-right direction and 73%, 18%, and 9% in the superoinferior direction, respectively. When all five iGPS markers were used, the disagreements between the iGPS and portal image shifts >10 mm were reduced from 7% to 2% in the left-right direction and 9% to 3% in the superoinferior direction. Larger reductions were also seen (e.g., a reduction from 50% to 0% in 1 patient). Conclusion: The daily iGPS-based shifts correlated well with the daily electronic portal device-based shifts. When patient movement has nonlinear rotational components, a combination of surface markers and portal images might be particularly beneficial to improve the setup for lung cancer patients.
Lyatskaya, Yulia; James, Steven; Killoran, Joseph H.; Soto, Ricardo; Mamon, Harvey J.; Chin, Lee [Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA (United States); Allen, Aaron M. [Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA (United States)], E-mail: firstname.lastname@example.org
Palliative care involves an approach in the field of care for terminal patients and their families that seeks to assure them better quality of life by establishing good communication. The scope of this study was to verify how nurses use communication in the field of palliative care when assisting patients in the terminal phase. This is exploratory research of a qualitative nature in which 28 nurses working in wards of a hospital in the city of Joao Pessoa in the State of Paraíba participated in the period from August to October 2012. A form was used for data collection that was then analyzed using the content analysis technique. Three categories emerged from the analysis of the material: "palliative care and communication - interpersonal relationship between the nurse and the terminal patient"; "communication in palliative care as a strategy for strengthening the bond between the nurse and the terminal patient"; and "the importance of communication between the nurse and the family of the terminal patient under palliative care." The conclusion reached was that communication is seen to be an effective element of care for the patient in the terminal phase and it is extremely important for the promotion of palliative care. PMID:23989558
de Andrade, Cristiani Garrido; da Costa, Solange Fátima Geraldo; Lopes, Maria Emília Limeira
Promotion of home medical care is absolutely necessary in Japan where is a rapidly aging society. In home medical care settings, triadic communications among the doctor, patient and the family are common. And "communications just between the doctor and the patient without the family" (doctor-patient communication without family, "DPC without family") is considered important for the patient to frankly communicate with the doctor without consideration for the family. However, the circumstances associated with DPC without family are unclear. Therefore, to identify the factors of the occurrence of DPC without family, we conducted a cross-sectional mail-in survey targeting 271 families of Japanese patients who had previously received home medical care. Among 227 respondents (83.8%), we eventually analyzed data from 143, excluding families of patients with severe hearing or cognitive impairment and severe verbal communication dysfunction. DPC without family occurred in 26.6% (n = 38) of the families analyzed. A multivariable logistic regression analysis was performed using a model including Primary disease, Daily activity, Duration of home medical care, Interval between doctor visits, Duration of doctor's stay, Existence of another room, and Spouse as primary caregiver. As a result, DPC without family was significantly associated with malignant tumor as primary disease (OR, 3.165; 95% CI, 1.180-8.486; P = 0.022). In conclusion, the visiting doctors should bear in mind that the background factor of the occurrence of DPC without family is patient's malignant tumors. PMID:24441967
Kimura, Takuma; Imanaga, Teruhiko; Matsuzaki, Makoto
The Georgia Cancer Awareness and Education Campaign was launched in September 2002 with the goals of supporting cancer prevention and early detection efforts, heightening awareness of and understanding about the five leading cancers among Georgia residents, and enhancing awareness and education about the importance of proper nutrition, exercise, and healthy lifestyles. The inaugural year of the campaign is outlined, beginning with adherence to the public health principles of surveillance, risk factor identification, intervention evaluation, and implementation. A strategic and integrated communications campaign, using tactics such as paid advertising, public service announcements, local community relations, media releases, a documentary film, special events, and other components, is described in detail with links to multimedia samples. With an estimated budget of 3.1 million dollars, the first year of the campaign focuses on breast and cervical cancer screening and early detection. PMID:15670430
Parker, Demetrius M
Oncology Overviews are a service of the International Cancer Research Data Bank (ICRDB) Program of the National Cancer Institute, intended to facilitate and promote the exchange of information between cancer scientists by keeping them aware of literature ...
Background: Understanding the psychosocial challenges of cancer survivorship, and identifying which patients experience ongoing difficulties, is a key priority. The ePOCS (electronic patient-reported outcomes from cancer survivors) project aims to develop and evaluate a cost-efficient, UK-scalable electronic system for collecting patient-reported outcome measures (PROMs), at regular post-diagnostic timepoints, and linking these with clinical data in cancer registries. Methods: A multidisciplinary team developed the system using agile methods. Design entailed process mapping the system's constituent parts, data flows and involved human activities, and undertaking usability testing. Informatics specialists built new technical components, including a web-based questionnaire tool and tracking database, and established component-connecting data flows. Development challenges were overcome, including patient usability and data linkage and security. Results: We have developed a system in which PROMs are completed online, using a secure questionnaire administration tool, accessed via a public-facing website, and the responses are linked and stored with clinical registry data. Patient monitoring and communications are semiautomated via a tracker database, and patient correspondence is primarily Email-based. The system is currently honed for clinician-led hospital-based patient recruitment. Conclusions: A feasibility test study is underway. Although there are possible challenges to sustaining and scaling up ePOCS, the system has potential to support UK epidemiological PROMs collection and clinical data linkage.
Ashley, L; Jones, H; Thomas, J; Forman, D; Newsham, A; Morris, E; Johnson, O; Velikova, G; Wright, P
BACKGROUND: The assessment of needs for cancer care is a critical step in providing high quality care and achieving cancer patients' and families' satisfaction. Instruments can be used to assess needs and guide cancer care planning. This study discusses the importance of the needs assessment, relationships between needs, satisfaction and quality of life; and reviews the assessment instruments of needs
Kuang-Yi Wen; David H Gustafson
Significant barriers exist in the delivery of state-of-the-art cancer care to rural populations. Rural providers' knowledge and practices, their rural health care delivery systems, and linkages to cancer specialists are not optimal; therefore, rural cancer patient outcomes are less than achievable. Purpose: To test the effects of a strategy…
Elliott, Thomas E.; Elliott, Barbara A.; Regal, Ronald R.; Renier, Colleen M.; Haller, Irina V.; Crouse, Byron J.; Witrak, Martha T.; Jensen, Patricia B.
Epidemiological studies have shown an inverse association be- tween dietary intake of lycopene and prostate cancer risk. We conducted a clinical trial to investigate the biological and clini- cal effects of lycopene supplementation in patients with local- ized prostate cancer. Twenty-six men with newly diagnosed prostate cancer were randomly assigned to receive a tomato oleoresin extract containing 30 mg of
OMER KUCUK; FAZLUL H. SARKAR; Z ORA DJURIC; WAEL SAKR; MICHAEL N. POLLAK; FRED KHACHIK; MOUSUMI BANERJEE; JOHN S. BERTRAM; DAVID P. WOOD
The world of communication has changed greatly over the centuries of mankind from sounds, sign languages, speech, development of language and in modern times using machines like the computer, mobile and internet. Over the past five decades, the change in communication is remarkable. Similarly positive patient communication is always necessary to build confidence, increased rapport and cooperation and minimizes misunderstanding. Returning the patient in our fold promotes the patient for further preventive care and review and using them as a positive tool helps us in an ambassador of the growth of our health care unit. Our challenge is to provide the best environment for communication with a diverse population of interest, personalities and culture.
AnbuSelvan, Gobichettipalayam Jagatheeswaran; Raja, Subramani; Vilvanathan, Praburajan; Megabob, Nazargi; Prabhakar, Krishnan
QOL is highly affected in individuals suffering from pancreatic cancer. One parameter that influences negatively QOL in these patients is cancer -cachexia syndrome. During the ASCO Annual Meeting 2014, one abstract focusing on cancer-cachexia syndrome (Abstract #15208) emphasized the fact that cachexia is under diagnosed even in patients with pancreatic cancer who constitute a high-risk group for presenting this syndrome. In addition the abstract raises concerns about the benefit of the use of dronabinol and megestrol acetate in treating the cachexia syndrome in this group of patients. Another important factor that determines QOL in pancreatic cancer patients is surgical procedures-pancreatectomies that these patients may undergo. Avery interesting abstract presented also at the ASCO Annual Meeting 2014 (Abstract #15234) explores the benefit of using pasireotide perioperative in ameliorating QOL of patients who had surgical intervention. PMID:25076331
Kiagia, Maria; Syrigos, Kostas N; Saif, Muhammad Wasif
Hospitals involve a complex socio-technical health system, where communication failures influence the quality of patient care. Research indicates the importance of social identity and intergroup relationships articulated through power, control, status and competition. This study focused on interspecialty communication among doctors for patients requiring the involvement of multiple specialist departments. The paper reports on an interview study in Australia, framed by social identity and communication accommodation theories of doctors' experiences of managing such patients, to explore the impact of communication. Interviews were undertaken with 45 doctors working in a large metropolitan hospital, and were analysed using Leximancer (text mining software) and interpretation of major themes. Findings indicated that intergroup conflict is a central influence on communication. Contested responsibilities emerged from a model of care driven by single-specialty ownership of the patient, with doctors allowed to evade responsibility for patients over whom they had no sense of ownership. Counter-accommodative communication, particularly involving interpersonal control, appeared as important for reinforcing social i