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BACKGROUND High-quality lung cancer care includes physician-patientcommunication 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-patientcommunication 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.
This study examined facilitators and barriers to effective patient and caregiver communication with providers with emphasis on communication related to cancer pain management. Focus groups and personal interviews were conducted with cancerpatients and family caregivers of patients. Communication experiences of subjects as well as suggestions for ways to improve the communication process were elicited. Twenty-two cancerpatients and 16
Carole Kimberlin; David Brushwood; William Allen; Ellyn Radson; Debbie Wilson
In this paper the balance of affective and intrumental communication employed by nurses during the admission interview with recently diagnosed cancerpatients was investigated. Rationale: The balance of affective and instrumental communication employed by nurses appears to be important, especially during the admission interview with cancerpatients. Methods: For this purpose, admission interviews between 53 ward nurses and simulated cancer
Irma P. M. Kruijver; Ada Kerkstra; Jozien M. Bensing
The purpose of this study was to describe and interpret the phenomenon of communication as lived by Lebanese cancerpatients. Phenomenology based on the Utrecht School was chosen as an interpretive descriptive methodology to guide the processes of data collection, analysis and synthesis. In-depth semi structured interviews were carried out with a purposeful sample of ten cancerpatients. Results of this qualitative study emphasise the needs of Lebanese cancerpatients for a clear and truthful communication with healthcare professionals, and family members. Informants highlighted the influence of words used during communication on their outlook and morale. They also stressed the need to move from the paternalistic approach in care provision to patient-centered care that promotes patient autonomy. Informants clearly accentuated their rights to be told the truth about their condition. PMID:18844560
In this paper the effect of a communication training programme on the instrumental and affective communication skills employed by ward nurses during the admittance interview with recently diagnosed cancerpatients was investigated. The training focused on teaching nurses skills to discuss and handle patient emotions. For this purpose, 46 nurses participated in 92 videotaped admittance interviews with simulated patients. The
Irma P. M. Kruijver; Ada Kerkstra; Jan J. Kerssens; Chantal. C. M. HoItkamp; Jozien M. Bensing
Background/Aims For over four years, CRN CancerCommunication Research Center (CCRC)-affiliated investigators have conducted research into patient-centered cancercommunication and care coordination. One of 5 National Cancer Institute-funded Centers of Excellence in CancerCommunication Research, the CRN CCRC is the only center whose primary focus is studying and improving clinical care. This abstract describes CCRC research, lessons learned, and future directions. Methods CCRC research studies include two RO1-type projects; one focuses on enhancing communication and coordination through innovative use of nurse navigators in oncology care; the other focuses on understanding and improving clinician-patientcommunication related to breakdowns in cancer care. CCRC pilot studies have explored diverse topics including improving communication to reduce home medication errors in pediatric oncology, clinician-patientcommunication around prostate cancer screening decisions, the relationship between "oral" health literacy and colorectal cancer screening, and direct-to-consumer communication about genetic testing. An NCI-funded supplement explored stakeholders' views on collecting patient reports of cancer-related communication, while another examined the feasibility of cancer prognostic tools in clinical practice. Results Setting CCRC studies in CRN clinical systems has provided the distinct advantage of allowing researchers to examine feasibility as well as effectiveness of interventions. Patients, clinicians and clinical leaders have all expressed support for CCRC efforts to improve communication and care coordination, acknowledging the importance of communication in cancer care. At the same time, leaders and clinicians are conscious of increasing time constraints, competing priorities, and limited resources. Patients are willing to share their experiences and insights, as long as doing so does not jeopardize their care, or distract them from their battle with cancer. Conclusions Patient-centered communication and care coordination are central to quality cancer care. CCRC research projects have engendered support and enthusiasm among the clinical systems, but have also faced significant challenges. Ultimately, the CCRC has provided CRN researchers with opportunities to develop and test multi-level interventions focusing on cancercommunication and care coordination in clinical systems. Going forward, CCRC-affiliated researchers look forward to implementing systems for collecting patient reports of communication experiences across the cancer care continuum, and to expanding communication research capabilities within the CRN. PMID:24085869
Background/Aims For over four years, CRN CancerCommunication Research Center (CCRC)-affiliated investigators have conducted research into patient-centered cancercommunication and care coordination. One of 5 National Cancer Institute-funded Centers of Excellence in CancerCommunication Research, the CRN CCRC is the only center whose primary focus is studying and improving clinical care. This abstract describes CCRC research, lessons learned, and future directions. Methods CCRC research studies include two RO1-type projects; one focuses on enhancing communication and coordination through innovative use of nurse navigators in oncology care; the other focuses on understanding and improving clinician-patientcommunication related to breakdowns in cancer care. CCRC pilot studies have explored diverse topics including improving communication to reduce home medication errors in pediatric oncology, clinician-patientcommunication around prostate cancer screening decisions, the relationship between “oral” health literacy and colorectal cancer screening, and direct-to-consumer communication about genetic testing. An NCI-funded supplement explored stakeholders’ views on collecting patient reports of cancer-related communication, while another examined the feasibility of cancer prognostic tools in clinical practice. Results Setting CCRC studies in CRN clinical systems has provided the distinct advantage of allowing researchers to examine feasibility as well as effectiveness of interventions. Patients, clinicians and clinical leaders have all expressed support for CCRC efforts to improve communication and care coordination, acknowledging the importance of communication in cancer care. At the same time, leaders and clinicians are conscious of increasing time constraints, competing priorities, and limited resources. Patients are willing to share their experiences and insights, as long as doing so does not jeopardize their care, or distract them from their battle with cancer. Conclusions Patient-centered communication and care coordination are central to quality cancer care. CCRC research projects have engendered support and enthusiasm among the clinical systems, but have also faced significant challenges. Ultimately, the CCRC has provided CRN researchers with opportunities to develop and test multi-level interventions focusing on cancercommunication and care coordination in clinical systems. Going forward, CCRC-affiliated researchers look forward to implementing systems for collecting patient reports of communication experiences across the cancer care continuum, and to expanding communication research capabilities within the CRN.
Objective: African Americans are often viewed as ineffective communicators during medical encounters. However, most previous studies have been conducted among noncancer populations and based on the perceptions of health care providers (HCP) and researchers. This study aimed to explore African American cancerpatients' perspectives of HCPs' communication behaviors and how these communication patterns facilitate or hinder their cancer management and
In 2010, an estimated 24,600 Canadian men were diagnosed with prostate cancer (Canadian Cancer Society, 2011). Upon diagnosis, men and their family members begin an arduous journey of information gathering surrounding prostate cancer and its various forms of treatment. Men have to consider the impact a treatment may potentially have on their quality of life and, frequently, they experience decisional conflict and require support. In May 2008, the Prostate Cancer Assessment Clinic opened to receive men for an evaluation of a possible prostate cancer. Our inter-professional model of care provides support, guidance and education to our patients from assessment to diagnosis and treatment planning. A major goal of our diagnostic assessment unit has been to improve the patient experience. Communication is defined as "to make known, to exchange information or opinions" (Cayne, Lechner, et al., 1988). Nursing is the critical link for information exchange that is patient-centred and collaborative. The focus of this paper will highlight the development and implementation of nurse-led initiatives within our program to improve the prostate cancerpatient experience. These initiatives include: a patient information guide, prostate biopsy care, patient resources, community links, surgery education classes and implementation of a decision aid. Communication is the key. PMID:22764588
Racial and ethnic disparities exist in both incidence and stage detection of colorectal cancer (CRC). We hypothesized that cultural practices (i.e., communication norms and expectations) influence patients’ and their physicians’ understanding and talk about CRC screening. We examined 44 videotaped observations of clinic visits that included a CRC screening recommendation and transcripts from semistructured interviews that doctors and patients separately completed following the visit. We found that interpersonal relationship themes such as power distance, trust, directness/indirectness, and an ability to listen, as well as personal health beliefs, emerged as affecting patients’ definitions of provider–patient effective communication. In addition, we found that in discordant physician–patient interactions (when each is from a different ethnic group), physicians did not solicit or address cultural barriers to CRC screening and patients did not volunteer culture-related concerns regarding CRC screening.
Gao, Ge; Burke, Nancy; Somkin, Carol P.; Pasick, Rena
Background Despite the documented benefits of colorectal cancer screening, patient participation rates remain low. Physician recommendation\\u000a has been identified as a significant predictor of screening completion.\\u000a \\u000a \\u000a \\u000a Objective The aim of this study is to investigate how primary care physicians perceive colorectal cancer screening communication tasks,\\u000a as well as to explore the form and content of actual screening discussions.\\u000a \\u000a \\u000a \\u000a Design The research design includes
Communication is crucial to establishing trust with patients, gathering information, addressing patient emotions, and assisting\\u000a patients in decisions about care. The quality of communication in cancer care has been shown to affect patient satisfaction,\\u000a decision making, patient distress, and even malpractice litigation. Communication is now recognized as a core clinical skill\\u000a in medicine and in cancer care. In using a
|Background: Two-thirds of adults aged 50 years and older are adherent to recommendations for colorectal cancer screening. Provider-patientcommunication and characteristics of the patient-provider relationship may relate to screening behavior. Methods: The association of provider communication quality, relationship, and colorectal cancer…
Patients with cancer seem to experience distress particularly in the first period after diagnosis, and are likely to develop an affective disorder in the first 2 to 3 months. Communicative behaviors of nurses seem to play an important role in meeting the cognitive and affective needs of patients with cancer. This review of the literature examines the communicative behaviors of
Irma P. M. Kruijver; Ada Kerkstra; Jozien M. Bensing; Harry B. M. van de Wiel
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.
Objective Test whether three mediating processes of Self-Determination Theory are involved in intervention effects on quality of life for breast cancerpatients. Methods A randomized clinical trial recruited newly diagnosed breast cancerpatients for 6 months of (1) Internet training and access, (2) access to an integrated eHealth system for breast cancer (CHESS), (3) a series of phone conversations with a Human Cancer Information Mentor, or (4) both (2) and (3). Results This paper reports results after the initial 6 weeks of intervention, at which point patients in the combined condition had higher quality of life scores than those in the other three conditions. All three Self-Determination Theory constructs (autonomy, competence, and relatedness) mediated that effect as hypothesized. In addition, the single-intervention groups were superior to the Internet-only group on relatedness, though perhaps this was too soon for that to carry through to quality of life as well. Conclusions The SDT constructs do mediate these interventions’ effects. Practice implications Intervention design can profitably focus on enhancing autonomy, competence and relatedness.
Hawkins, Robert P.; Pingree, Suzanne; Shaw, Bret; Serlin, Ronald C.; Swoboda, Chris; Han, Jeong-Yeob; Carmack, Cindy L.; Salner, Andrew
BACKGROUND: Oncology nurses have opportunities to engage in prognosis-related communication with patients who have advanced cancer but encounter barriers that impede the patient's understanding of prognosis, delay transitions to end-of-life care, and contribute to nonbeneficial treatments. PURPOSE: To describe nurses' experiences with prognosis-related communication with patients who have advanced cancer. METHOD: Thematic analysis of audio-recorded interviews with oncology nurses (n = 27). After data coding, themes were identified, and a thematic map was developed. Methods to ensure trustworthiness of the findings were used. RESULTS: Six themes were identified: being in the middle, assessing the situation, barriers to prognosis communication, nurse actions, benefits of prognosis understanding, and negative outcomes. Nurses managed barriers through facilitation, collaboration, or independent actions to help patients with prognosis understanding. CONCLUSIONS: Shortcomings in prognosis-related communication with patients who have advanced cancer may contribute to negative outcomes for patients and nurses. Interventions that empower nurses to engage in prognosis communications are needed. Interprofessional communication skills education also may be beneficial. PMID:23402782
McLennon, Susan M; Lasiter, Sue; Miller, Wendy R; Amlin, Kathryn; Chamness, Amy R; Helft, Paul R
This study examined the use of complementary and alternative medicine (CAM) therapies by breast cancerpatients and the communication of their CAM use to their physicians relative to lymphedema symptoms and other factors. Breast cancerpatients (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
Objective This study examined the effect of a theoretically grounded, tailored education-coaching intervention to help patients more effectively discuss their pain-related questions, concerns, and preferences with physicians. Methods Grounded in social-cognitive and communication theory, a tailored education coaching (TEC) intervention was developed to help patients learn pain management and communication skills. In a RCT, 148 cancerpatients agreed to have their consultations audio-recorded and were assigned to the intervention or a control group. The recordings were used to code for patients’ questions, acts of assertiveness, and expressed concerns and to rate the quality of physicians’ communication. Results Patients in the TEC group discussed their pain concerns more than did patients in the control group. More active patients also had more baseline pain and interacted with physicians using participatory decision-making. Ratings of physicians’ information about pain were higher when patients talked more about their pain concerns. Conclusions The study demonstrates the efficacy of a theoretically grounded, coaching intervention to help cancerpatients talk about pain control. Practice implications Coaching interventions can be effective resources for helping cancerpatientscommunicate about their pain concerns if they are theoretically grounded, can be integrated within clinical routines, and lead to improve health outcomes.
Street, Richard L.; Slee, Christina; Kalauokalani, Donna K; Dean, Dionne Evans; Tancredi, Daniel J; Kravitz, Richard L.
Physician assistants (PAs) and other midlevel practitioners have been taking on increasing clinical roles in oncology settings. Little is known about the communication needs and skills of oncology PAs. PAs working in oncology (n = 301) completed an online survey that included questions about their perceived skill and difficulty on several key communication tasks. Overall, PAs rated these communication tasks as "somewhat" to "moderately" difficult and their skill level in these areas as "average" to "good." Areas of most perceived difficulty were intervening with angry patients or those in denial and breaking bad news. Highest perceived skills were in communicating with patients from cultures and religions different than your own and telling patient he/she has cancer or disease has progressed, and the lowest perceived skills were in discussing do not resuscitate orders. There are areas in which enhancement of communication skills may be needed, and educational opportunities should be developed for PAs working in oncology. PMID:20383673
Parker, Patricia A; Ross, Alicia C; Polansky, Maura N; Palmer, J Lynn; Rodriguez, M Alma; Baile, Walter F
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
BACKGROUND:: Adequate provider-patientcommunication is viewed as an important aspect of good quality (cancer) care, supports patients' stress control, and can positively influence health outcomes. OBJECTIVE:: The objective of this study was to describe nurse-patientcommunication in 2 consecutive follow-up consultations after head and neck cancer, with or without a partner present. METHODS:: This was a descriptive observational study of 17 video-recorded, coded, and analyzed consultations of 10 head and neck cancerpatients and 6 partners. RESULTS:: Nurses responded adequately to about 25% of patients' and partners' emotional cues. In almost 75%, nurses responded to cues using distancing behaviors. The majority of informational questions of both patients and partners were adequately answered. Comparison of consecutive visits showed small differences for patients' and partners' cue-emission and for nurses' responsive behaviors between visits 1 and 2. CONCLUSION:: Nurses adequately responded to informational questions from patients and partners. However, they seemed to be less observant of and able to address emotional cues. Communication on nurse-patient-partner interaction deserves further research in a much larger sample and over a longer time period. IMPLICATION FOR PRACTICE:: Nurses' awareness of the importance of adequate cue responding is vital, as is the choice to "unlearn" the predominant distancing behaviors. The needs and the role of the patients' partner in consultations and managing consultations require further attention in training and professional practice. PMID:23519036
de Leeuw, Jacqueline; Prins, Judith B; Uitterhoeve, Ruud; Merkx, Matthias A W; Marres, Henri A M; van Achterberg, Theo
Many have studied the interrelations between online spaces and offline contexts, highlighting that internet spaces are fundamentally embedded within specific social, cultural and material contexts. Drawing upon a study of breast cancerpatients' computer-mediated communication (CMC), this article aims to contribute to our understanding of the role of cultural elements in shaping the participation in and design of, CMC environments.
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
This study assesses caregivers' perceived level of open communication about illness and death with their terminally ill relatives and examines the contribution of caregivers' characteristics and situational variables to the explanation of open communication. A total of 236 primary caregivers of terminal cancerpatients participated in the study. Level of open communication was measured by 6 items clustered into 1
Background/Aims Information about cancer prognosis is a main topic of interest for cancerpatients and clinicians alike. Prognostic information can help with decisions about treatment, lessen patients' uncertainty and empower them to participate in the decision making process. Calculating and communicatingcancer prognostic information can be challenging due to the high complexity and probabilistic nature of the information. Furthermore, prognostic information is further complicated by the potential interplay between cancer and other comorbid medical conditions. The purpose of this presentation is to present findings from a systematic review of web-based interactive prognostic calculators and assess how they might support patient-centered communication of prognostic information with cancerpatients. Methods A systematic review of web-based cancer prognostic calculators was conducted using web search engines, peer-reviewed manuscripts, and expert input. Calculators had to be interactive, focus on cancer, available in English, and provide information about probabilities of survival/mortality, recurrence, spread, or clinical response to treatment. Eligible calculators were reviewed and abstracted for content, format, and functions of patient-centered communication and findings were summarized in a tabular format for comparison. The abstraction guide was pilot tested by all abstractors and was refined using a consensus approach. Results A total of 22 eligible web-based cancer prognostic tools including 95 individual calculators for 88 distinct cancer sites were identified and abstracted. Thirteen of the tools recommended patients as potential direct users; all other tools were designed for clinicians. Outcomes presented will include: 1) general description of calculators, including cancer type, designated users, types of data elements used in prognosis prediction, and validation, 2) calculator interface data entry features, and graphic output, 3) interpretation of prognosis and additional resources, 4) strengths and limitations in supporting patient-centered cancercommunication about cancer prognosis. Examples from selected calculators will be demonstrated throughout the presentation. Conclusions A large number of web-based cancer prognostic calculators have been developed and are available for use by cancer specialists and patients. The ability of most of these calculators to support patient-centered calculators around cancer prognosis is limited by their design and content and the degree to which they include and present information in an actionable way. PMID:24085873
Background/Aims Information about cancer prognosis is a main topic of interest for cancerpatients and clinicians alike. Prognostic information can help with decisions about treatment, lessen patients’ uncertainty and empower them to participate in the decision making process. Calculating and communicatingcancer prognostic information can be challenging due to the high complexity and probabilistic nature of the information. Furthermore, prognostic information is further complicated by the potential interplay between cancer and other comorbid medical conditions. The purpose of this presentation is to present findings from a systematic review of web-based interactive prognostic calculators and assess how they might support patient-centered communication of prognostic information with cancerpatients. Methods A systematic review of web-based cancer prognostic calculators was conducted using web search engines, peer-reviewed manuscripts, and expert input. Calculators had to be interactive, focus on cancer, available in English, and provide information about probabilities of survival/mortality, recurrence, spread, or clinical response to treatment. Eligible calculators were reviewed and abstracted for content, format, and functions of patient-centered communication and findings were summarized in a tabular format for comparison. The abstraction guide was pilot tested by all abstractors and was refined using a consensus approach. Results A total of 22 eligible web-based cancer prognostic tools including 95 individual calculators for 88 distinct cancer sites were identified and abstracted. Thirteen of the tools recommended patients as potential direct users; all other tools were designed for clinicians. Outcomes presented will include: 1) general description of calculators, including cancer type, designated users, types of data elements used in prognosis prediction, and validation, 2) calculator interface data entry features, and graphic output, 3) interpretation of prognosis and additional resources, 4) strengths and limitations in supporting patient-centered cancercommunication about cancer prognosis. Examples from selected calculators will be demonstrated throughout the presentation. Conclusions A large number of web-based cancer prognostic calculators have been developed and are available for use by cancer specialists and patients. The ability of most of these calculators to support patient-centered calculators around cancer prognosis is limited by their design and content and the degree to which they include and present information in an actionable way.
Background/Aims The Cancer Research Network CancerCommunication Research Center (CCRC), one of five National Cancer Institute-funded Centers of Excellence in CancerCommunication Research, had the unique opportunity to collaborate with colleagues from the National Cancer Institute (NCI) to conduct real world testing of an NCI-developed decision aid. This abstract describes the feasibility and small scale implementation testing of the NCI-developed cancer prognostic tool, the Cancer Survival Query System (CSQS). Methods A web-based prognostic tool, the CSQS was developed by the Statistics Research and Applications Branch of the NCI in 2008. It was designed for physicians to use so they could better understand and communicate with cancerpatients valid estimates of their cancer survival within the context of all causes of death. Our research team at the CCRC has completed stage one feasibility testing of the CSQS tool in four health care delivery systems and will soon begin a small-scale implementation study of this tool in three health care delivery systems in Colorado. We are also proposing a more structured process of product development and developed a comprehensive plan for the dissemination and implementation of CSQS. Results A total of 57 providers from four health care delivery systems participated in formal usability testing and semi-structured interviews. Providers perceived CSQS as a well-designed tool that has the potential of increasing provider efficiency delivering prognostic information, and improving patient experience and understanding of this information. Feedback from these providers informed the revision of the CSQS content and format, and the development of a structured, large-scale dissemination and implementation plan. An ongoing small-scale follow-up study is testing strategies for the dissemination and implementation of this web-based decision aid. Findings available to date from both studies will be discussed in this presentation. Conclusions Development of decision aids that support patient-centered communication requires a multi-step, iterative process and the early engagement of multiple stakeholders including potential users and organizational decision makers. This case study exemplifies different aspects of this process and illustrates lessons learned in this area from the work in the CCRC.
Objective: The aim is to investigate the relationship between nurses' cue-responding behaviour and patient satisfaction. Methods: One hundred patient-nurse conversations about present concerns were videotaped and patients' expression of emotional cues and nurses' cue responses were coded using the Medical Interview Aural Rating Scale. Nurses (N=34) and patients (N=100) were recruited from seven oncology inpatient clinics from a University Medical
Ruud Uitterhoeve; Jozien Bensing; Eefje Dilven; A. R. T. Donders; P. H. M. de Mulder; Theo van Achterberg
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
Background: Previous studies have employed short follow-up periods or examined only certain aspects of quality of life (QoL). This study aimed to examine the effect of communication on breast cancerpatients' QoL and to investigate the role of age in this relationship. Patients and methods: In a prospective, observational study breast cancerpatients were sent question- naires, including the European
J. Kerr; J. Engel; A. Schlesinger-Raab; H. Sauer; D. Hölzel
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
The aim of this study was to investigate the beliefs that patients with advanced cancer held about the curability of their cancer, their use of alternatives to conventional medical treatment, and their need to have control over decisions about treatment. Of 149 patients who fulfilled the criteria for participation and completed a self-administered questionnaire, 45 patients (31%) believed their cancer
G F Beadle; P M Yates; J M Najman; A Clavarino; D Thomson; G Williams; L Kenny; S Roberts; B Mason; D Schlect
Effective communication across the primary/secondary interface is vital for the planning and delivery of appropriate patient care throughout the cancerpatient journey. This study describes GPs' views of the communication issues across the primary/secondary interface in relation to ovarian cancerpatients using qualitative interviews with purposively sampled general practitioners (GPs) and an audit of hospital medical records of 30 deceased ovarian cancerpatients. Issues raised by the GPs related to the content and format of communications, but of most concern was the tardiness. The time lag between dictation and typing letters ranged from 0 to 27 days, with a delay of up to 8 days for signing before transit through various mail systems to the GP. Three stages in the patient journey were characterized by particular issues: (1) in the pre-diagnostic and diagnostic stage was a need for prompt information regarding the results of tests and diagnoses, and clearer guidance on the use of tests and fast-track referrals; (2) in the active treatment phase, when GPs could lose touch with their patients, they needed effective communication in order to provide moral support and crisis management; and (3) when oncology withdrew and the focus of care switched back to the community for the terminal phase, GPs needed information to enable them to pick up the baton of care. There is a need to develop and evaluate interventions aimed at improving the content and speed of communications between secondary and primary care. Such interventions are likely to be complex and might include the greater use of telephone or fax for more selected communications, a review of secretarial support, the use of email, the development of GP designed proformas, the feasibility of patient/carer letter delivery options, nurse-led communication, universal electronic patient records, or a revisiting of the patient-held record. PMID:16098121
Farquhar, M C; Barclay, S I G; Earl, H; Grande, G E; Emery, J; Crawford, R A F
This paper describes a study investigating the provider–patientcommunication perceptions, experiences, needs, and strategies of doctors and nurses working together in a UK cancer setting. This was a qualitative study using individual interviews and focus group discussions. Interpretative phenomenological analysis was used to underpin data collection and analysis. Twenty-six staff participated in the project (18 nurses and 8 doctors). Both professional groups identified an inherent emotional strain in their daily interactions with patients. The strategies they adopted to reduce this strain fell into two main categories: (1) Handling or managing the patient to keep negative emotion at bay; and (2) Managing self to keep negative emotion at bay. These strategies allowed staff to maintain a sense of control in an emotionally stressful environment. Most believed that their communication skills were sufficient. In conclusion, communicating with and caring for cancerpatients causes considerable psychosocial burden for doctors and nurses. Managing this burden influences their communication with patients. Without recognition of the need for staff to protect their own emotional well-being, communication skills training programs, emphasized in current UK cancer care guidelines, may have little impact on practice.
McLean, Margaret; Cleland, Jennifer A.; Worrell, Marcia; Vogele, Claus
This paper describes a study investigating the provider-patientcommunication perceptions, experiences, needs, and strategies of doctors and nurses working together in a UK cancer setting. This was a qualitative study using individual interviews and focus group discussions. Interpretative phenomenological analysis was used to underpin data collection and analysis. Twenty-six staff participated in the project (18 nurses and 8 doctors). Both professional groups identified an inherent emotional strain in their daily interactions with patients. The strategies they adopted to reduce this strain fell into two main categories: (1) Handling or managing the patient to keep negative emotion at bay; and (2) Managing self to keep negative emotion at bay. These strategies allowed staff to maintain a sense of control in an emotionally stressful environment. Most believed that their communication skills were sufficient. In conclusion, communicating with and caring for cancerpatients causes considerable psychosocial burden for doctors and nurses. Managing this burden influences their communication with patients. Without recognition of the need for staff to protect their own emotional well-being, communication skills training programs, emphasized in current UK cancer care guidelines, may have little impact on practice. PMID:22144970
McLean, Margaret; Cleland, Jennifer A; Worrell, Marcia; Vögele, Claus
BACKGROUND: A healthcare provider's recommendation to undergo screening has been shown to be one of the strongest predictors of completing a colorectal cancer (CRC) screening test. We sought to determine the relationship between the general quality of self-rated patient-provider communication and the completion of CRC screening. METHODS: A formative study using qualitative data from focus groups and quantitative data from
Mira L Katz; Aimee S James; Michael P Pignone; Marlyn A Hudson; Ethel Jackson; Veronica Oates; Marci K Campbell
Online communication has become a potential means of communication between patients and health care providers, but so far few studies are published about online communication as part of nursing care. The aim of this study was to explore how an online patient-nurse communication (OPNC) service meets the information needs of men with newly diagnosed testicular cancer. We applied a qualitative approach by examining the content of online messages sent by patients to nurses in a specialist cancer unit. In addition, individual interviews were conducted with patients who had used the OPNC service. Four themes became distinct through a synthesis of the material from the interviews and the messages: “a means for managing illness-related concerns at home,” “a means for ensuring information flow,” “a means for strategic information seeking,” and “not yet available when needed most.” Individualized information provided by nurses with access to their medical record was shown to be important to these patients. The findings of this study indicate that not only may access to an OPNC service help patients fulfill their otherwise unmet information needs, but also it may prevent delays and discontinuity in care due to informational gaps and lead to improved patient safety.
The goals of medical interaction and communication are to provide information to promote biophysical and psychological health, prevent illness and cope with illness. According to the literature and the results of our own studies on quality of life, the first step medical staff should take in understanding the principles and processes of effective patientcommunication before and after treatment is
Sabine Hawighorst-Knapstein; Dirk O. Brueckner; Götz Schoenefuss; Paul Georg Knapstein; Heinz Koelbl
Communication between physicians and patients is considered to be a core component in the provision and receipt of appropriate medical care. However, previous research indicates that doctor-patient relationships can be problematic, with negative consequences for patients including higher levels of anxiety, distrust of medical providers, dissatisfaction with healthcare and lower quality of life. This research utilizes data collected from a
Susan M. Allen; Ann C. Petrisek; Linda L. Laliberte
BACKGROUND: There is a growing awareness among providers of the symptom burden experienced by cancerpatients. Systematic symptom screening is difficult. Our plan was to evaluate a technology-based symptom screening process using touch-tone telephone and Internet in our rural outreach cancer program in Indiana. Would rural patients have adequate access to technologies for home-based symptom reporting? OBJECTIVES: 1) To determine
Ma'n Abdullah; Dale E Theobald; Donna Butler; Kurt Kroenke; Anthony Perkins; Sara Edgerton; William M Dugan
There is consistent evidence that health care professionals (hcps) are not addressing the sexual information and support needs of people with cancer. Thirty-eight Australian hcps across a range of professions working in cancer care were interviewed, to examine constructions of sexuality post-cancer, the subject positions adopted in relation to sexual communication, and the ways in which discourses and subject positions shape information provision and communication about sexuality. Participants constructed sexual changes post-cancer in physical, psychological and relational terms, and positioned such changes as having the potential to significantly impact on patient and partner well-being. This was associated with widespread adoption of a discourse of psychosocial support, which legitimated discussion of sexual changes within a clinical consultation, to alleviate distress, dispel myths and facilitate renegotiation of sexual practices. However, this did not necessarily translate into patient-centred practice outcomes, with the majority of participants positioning personal, patient-centred and situational factors as barriers to the discussion of sex within many clinical consultations. This included: absence of knowledge, confidence and comfort; positioning sex as irrelevant or inappropriate for some people; and limitations of the clinical context. In contrast, those who did routinely discuss sexuality adopted a subject position of agency, responsibility and confidence. PMID:23805956
Ussher, Jane M; Perz, Janette; Gilbert, Emilee; Wong, W K Tim; Mason, Catherine; Hobbs, Kim; Kirsten, Laura
Recent converging evidence suggests that the brain may receive stimuli and possibly modulate tumor progression via the vagus nerve. The present study aimed to compare brain metabolism in patients with and without lung cancer and to assess if signifi- cantdifferencesexist inregionsassociatedwiththevagusnerve. Methods: Eighteen patients with lung malignancy and 19 con- trols underwent 18F-FDG PET of the brain. Brain metabolism was
Haim Golan; John A. Kennedy; Alex Frenkel; Ysrael Parmet; Akiva Feintuch; Ofer Levi; Yori Gidron
Context Physicians psychological characteristics may influence their communication styles and may thus interfere with patient-centred communication.Objective Our aim was to test the hypothesis that, in interviews with a cancerpatient and a relative, physicians with an external locus of control (LOC; who believe that life outcomes are controlled by external forces such as luck, fate or others) have a communication style different
Yves Libert; Isabelle Merckaert; Christine Reynaert; Nicole Delvaux; Serge Marchal; Anne-Marie Etienne; Jacques Boniver; Jean Klastersky; Pierre Scalliet; Jean-Louis Slachmuylder; Darius Razavi
Background Communication about prognosis and treatment choices is essential for informed decision making in advanced cancer. This article describes an investigation designed to facilitate communication and decision making among oncologists, patients with advanced cancer, and their caregivers. Methods/design The Values and Options in Cancer Care (VOICE) Study is a National Cancer Institute sponsored randomized controlled trial conducted in the Rochester/Buffalo, NY and Sacramento, CA regions. A total of 40 oncologists, approximately 400 patients with advanced cancer, and their family/friend caregivers (one per patient, when available) are expected to enroll in the study. Drawing upon ecological theory, the intervention uses a two-pronged approach: oncologists complete a multifaceted tailored educational intervention involving standardized patient instructors (SPIs), and patients and caregivers complete a coaching intervention to facilitate prioritizing and discussing questions and concerns. Follow-up data will be collected approximately quarterly for up to three years. Discussion The intervention is hypothesized to enhance patient-centered communication, quality of care, and patient outcomes. Analyses will examine the effects of the intervention on key elements of physician-patient-caregiver communication (primary outcomes), the physician-patient relationship, shared understanding of prognosis, patient well-being, and health service utilization (secondary outcomes). Trial registration Clinical Trials Identifier: NCT01485627
Several researchers have questioned the merits of early mammography and prostate-specific-antigen (PSA) screening policies, arguing that these programs have not been proven useful in lowering mortality rates. This controversy highlights the necessity and importance of effectively communicating probability information to patients. Probability information, however, has been plaguing the health care profession—as numerous investigators have shown that it is often difficulty
Low-income, minority women are more likely to be undertreated for breast cancer (BC) treatment-related symptoms than whites.\\u000a This study assessed the impact of patient–physician communication on symptom resolution. A cross-sectional, California statewide\\u000a survey was conducted among 921 low-income women with BC. Ethnic\\/racial differences in BC treatment-related symptoms (pain,\\u000a nausea\\/vomiting, depression) reporting and physician’ awareness of these symptoms were assessed by
Rose C. Maly; Yihang Liu; Barbara Leake; Amardeep Thind; Allison L. Diamant
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. PMID:20014126
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
In most psychological and medical research, patients are assumed to have difficulties with health statistics but clinicians not. However, studies indicate that most doctors have problems in understanding health statistics, including those of their own speciality. For example, only two out of 20 urologists knew the information relevant for a patient to make an informed decision about whether to take PSA screening for prostate cancer, just 14 out of 65 physicians in internal medicine understood that 5-year survival rates do not tell anything about screening's benefit, and merely 34 out of 160 gynecologists were able to interpret the meaning of a positive test result. This statistical illiteracy has a direct effect on patients understanding and interpretation of medical issues. Not rarely their own limited health literacy and their doctors' misinformation make them suffer through a time of emotional distress and unnecessary anxiety. The main reasons for doctors' statistical illiteracy are medical schools that ignore the importance of teaching risk communication. With little effort doctors could taught the simple techniques of risk communication, which would make most of their statistical confusion disappear. PMID:23535552
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 an educational video and focus groups of patients provided initial feedback about the developed CRC screening educational video. Medical personnel reviewed the video and made recommendations prior to final editing of the video. Results Patients identified CRC screening barriers and made suggestions about the information to include in the educational video. Their suggestions included using a healthcare provider to state the importance of completing CRC screening, demonstrate how to complete the fecal occult blood test, and that men and women from diverse ethnic groups and races could be included in the same video. Participants reviewed the developed video and mentioned that their suggestions were portrayed correctly, the video was culturally appropriate, and the information presented in the video was easy to understand. Medical personnel made suggestions on ways to improve the content and the delivery of the medical information prior to final editing of the video. Discussion Participants provided valuable information in the development of an educational video to improve patient knowledge and patient-provider communication about CRC screening. The educational video developed was based on the Protection Motivation Theory and addressed the colon cancer screening barriers identified in this mostly minority and low-income patient population. Future research will determine if CRC screening increases among patients who watch the educational video. Translation to Health Education Practice Educational videos can provide important information about CRC and CRC screening to average-risk adults.
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.
BACKGROUND:: Studies document that caregivers face severe difficulties in communicating with their loved ones about both illness and death. To date, a paucity of studies has examined caregiver-patientcommunication at the end of life within the context of ethnic origin. OBJECTIVE:: This study compares the level of open communication between caregivers from 2 ethnic groups and examines the contribution of different caregiver characteristics and situational variables to the explanation of open communication. METHODS:: A total of 77 spouse caregivers of terminally ill cancerpatients (comprising 41 Jews of Sephardi origin and 36 Jews of Ashkenazi origin) participated in the study. The questionnaire included measures of caregiver communication, caregiver characteristics (ie, age, gender, education level, optimism, self-efficacy), and situational variables (ie, duration and intensity of care). RESULTS:: Spouses of Ashkenazi origin communicated more with their loved ones about illness and death compared with their Sephardi counterparts. Ethnic origin accounted for 16.6% of the explained variance, caregiver characteristics added 20.3%, and situation variables lent a modest contribution of 3.5%. Four variables emerged as significant predictors of caregivers' level of open communication: self-efficacy (? = .33, P < .05), gender (? = .32, P < .01), ethnic origin (? = .25, P <.05), and duration of care (? = .20, P < .05). CONCLUSIONS:: These findings demonstrate the importance of ethnic origin to caregivers' open communication with terminal cancerpatients about illness and death. Moreover, communication level with patients is mostly explained by the caregiver characteristics. IMPLICATIONS FOR PRACTICE:: Caregiver characteristics should be considered by nurses when developing intervention programs for increasing caregivers' level of open communication with dying patients. PMID:23348664
There is increasing evidence that effective communication is a critical means by which surgeons can assist their patients to achieve the best outcomes. This paper examines the processes and outcomes of effective communication by surgeons in cancer teams, and includes: (i). strategies that promote collaborative relationships with patients and lead to more effective treatment; (ii). strategies to improve multidisciplinary team performance; and (iii). methods to minimize the risk of error and litigation. The experience of a cancer diagnosis involves radical changes in patients' lives, somewhat akin to suddenly finding yourself in the middle of a rugby scrum for the first time. The analogy of rugby throws fresh light on such critical factors in communication as prematch preparation, orientation to the game and the team, a good kick off, sizing up the opposition, creative plays and optimizing teamwork to promote quality of life and survival. PMID:15191487
Boyle, Frances M; Robinson, Emma; Heinrich, Paul; Dunn, Stewart M
Health professionals such as doctors and nurses are in a key position to help reduce the high prevalence of affective disorders and psychological problems experienced by cancerpatients. This role, however, is inhibited by ineffective communication practices which include the use of distancing strategies and avoidance by the health professional. A number of contributory factors such as skill deficits and
On November 7, 2005, the directors of the National Cancer Institute's (NCI's) Comprehensive Cancer Centers met to identify ways of accelerating success against cancer using current knowledge. Not surprisingly, cancercommunication was identified as a focal point of research that needed to be conducted to extend the benefits of cancer knowledge throughout the population. There were three foci of communication
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.
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 psychological distress (i.e., depressive symptomatology, emotional exhaustion) among secular and religiously observant family
|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…
In this enquiry a cross-sectional study of hospitalized psychiatric patients was undertaken to assess prevalence and nature of suicidal behaviour. We have been able to delineate these subjects into three categories i.e. non-communicators, partial communicators and definite communicators on the basis of their scores upon 31ucid.il intent questionnaire. A follow up study of these patients which is in progress may further provide knowledge about relationship between predictive criterion and their final outcome.
Objective This paper describes the development of a theory-guided and evidence-based multimedia training module to facilitate breast cancer survivors’ preparedness for effective communication with their health care providers after active treatment. Methods The iterative developmental process used included: (1) theory and evidence-based content development and vetting; (2) user testing; (3) usability testing; and (4) participant module utilization. Results Formative evaluation of the training module prototype occurred through user testing (n = 12), resulting in modification of the content and layout. Usability testing (n = 10) was employed to improve module functionality. Preliminary web usage data (n = 256, mean age = 53, 94.5% White, 75% college graduate and above) showed that 59% of the participants accessed the communication module, for an average of 7 min per login. Conclusion The iterative developmental process was informative in enhancing the relevance of the communication module. Preliminary web usage results demonstrate the potential feasibility of such a program. Practice implications Our study demonstrates survivors’ openness to the use of a web-based communication skills training module and outlines a systematic iterative user and interface program development and testing process, which can serve as a prototype for others considering such an approach.
Wen, Kuang-Yi; Miller, Suzanne M.; Stanton, Annette L.; Fleisher, Linda; Morra, Marion E.; Jorge, Alexandra; Diefenbach, Michael A.; Ropka, Mary E.; Marcus, Alfred C.
Health professionals such as doctors and nurses are in a key position to help reduce the high prevalence of affective disorders and psychological problems experienced by cancerpatients. This role, however, is inhibited by ineffective communication practices which include the use of distancing strategies and avoidance by the health professional. A number of contributory factors such as skill deficits and anxiety about negative consequences for the patient and the health professional have been identified in previous research and brief problem-focused training workshops developed to address these factors with only limited success. Researchers in applied psychology have recommended that the development of training programmes and their evaluation are based upon approaches which take into account cognitive and affective factors as well as change in skills. The aim of this paper is to develop a conceptual model of communication behaviour in the cancer setting. The model aims to take account of the role that knowledge and skill deficits, self-efficacy and outcome expectancy beliefs and perceived support plays in the ability and willingness of health professionals to assess their patients' concerns. It has been applied to guide the development of a revised approach to brief, problem-focused workshops for health professionals. It also allows a systematic and multi-dimensional evaluation of training outcomes. Preliminary results indicate this is a promising area of communications research. PMID:9015875
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.
Goal of Work The goal of this work was to identify methods of clinician–patientcancer-related communication that may impact patient outcomes\\u000a associated with distress at critical points in the course of cancer care.\\u000a \\u000a \\u000a \\u000a Materials and methods A systematic review of practice guidelines, systematic reviews, or randomized trials on this topic was conducted. Guidelines\\u000a for quality was evaluated using the Appraisal of Guidelines
Gary Rodin; Jean A. Mackay; Camilla Zimmermann; Carole Mayer; Doris Howell; Mark Katz; Jonathan Sussman; Melissa Brouwers
To provide insights about how women with breast cancer learn from interactive cancercommunication systems (ICCSs), this study examined how use of different types of services that employ conceptually distinct pedagogical methods relates to learning outcomes. The study sample included 231 recently diagnosed, lower income breast cancerpatients. Partici- pants were provided a free computer, Internet access and training in
Bret R. Shaw; Jeong Yeob Han; Timothy Baker; Jeffre Witherly; Robert P. Hawkins; Fiona McTavish; David H. Gustafson
Purpose Doctors commonly use genomic testing for breast cancer recurrence risk. We sought to assess whether the standard genomic report provided to doctors is a good approach for communicating results to patients. Methods During 2009–2010, we interviewed 133 patients with stages I or II, node-negative, hormone-receptor positive breast cancer and eligible for the Oncotype DX genomic test. In a randomized experiment, patients viewed 6 vignettes that presented hypothetical recurrence risk test results. Each vignette described a low, intermediate, or high chance of breast cancer recurrence in 10 years. Vignettes used one of five risk formats of increasing complexity that we derived from the standard report that accompanies the commercial assay or a sixth format that used an icon array. Results Among women who received the genomic recurrence risk test, 63% said their doctors showed them the standard report. The standard report format yielded among the most errors in identification of whether a result was low, intermediate or high risk (i.e., the gist of the results), while a newly developed risk continuum format yielded the fewest errors (17% vs. 5%; OR, 0.23; 95% CI, 0.10 to 0.52). For high-recurrence risk results presented in the standard format, women made errors 35% of the time. Women rated the standard report as one of the least understandable and least liked formats, but they rated the risk continuum format as among the most understandable and most liked. Results differed little by health literacy, numeracy, prior receipt of genomic test results during clinical care and actual genomic test results. Conclusion The standard genomic recurrence risk report was more difficult for women to understand and interpret than other formats. A less complex report, potentially including the risk continuum format, would be more effective in communicating test results to patients.
Brewer, Noel T.; Richman, Alice R.; DeFrank, Jessica T.; Reyna, Valerie F.; Carey, Lisa A.
The workbook contains lessons and exercises in patient relations and workplace communication in a medical services office, particularly for interactions involving one or more non-native speaker of English. Seven units address these topics: (1) greetings and basic assistance, greeting established patients, and measuring height and weight and taking…
Career Resources Development Center, Inc., San Francisco, CA.
Twenty-four patients with differentiated thyroid cancer were studied with diagnostic I-131 neck chest scans after having undergone bilateral subtotal thyroidectomy and initial I-131 therapy with either 30- or 100-mCi doses. With an endogenous stimulation protocol, follow-up studies were performed with neck and chest scans using 2 and 10 mCi I-131. A 400% increase in sensitivity was found with a 10-mCi dose relative to a 2-mCi dose. Comparison with therapeutic doses of 30 and 100 mCi resulted in further increases in the detection of residual iodine-avid tissue. We conclude that a 2-mCi or lower dose of I-131 is inadequate in evaluating residual iodine-avid tissue visually in patients with thyroid cancer. The study does not answer the critical question of whether it is necessary to treat a patient presenting a negative 2-mCi but a positive 10-mCi scan. It may be appropriate to define ablation visually as well as clinically, with further studies directed toward determining a treatment rationale in this patient population.
Waxman, A.; Ramanna, L.; Chapman, N.; Chapman, D.; Brachman, M.; Tanasescu, D.; Berman, D.; Catz, B.; Braunstein, G.
We sought to develop a reliable and valid measure of patient self-efficacy within the context of productive communication and positive attitude for cancerpatients. A set of 19 potential items for the Communication and Attitudinal Self-Efficacy scale for cancer (CASE-cancer) was pilot tested with 50 cancerpatients. Based on the pilot test, item valence was made consistent (i.e., all items
Michael S. Wolf; Chih-Hung Chang; Terry Davis; Gregory Makoul
... Concerns Readiness to learn Preferences Support Barriers and limitations (such as physical and mental capacity, and low ... support available to your patient. Identify barriers and limitations : You may perceive barriers to education, and your ...
Although quality communication has been identified as a necessary component to cancer care, communication skills training programs have yet to focus on the unique role of nurses. This study explored communication barriers as reported by seven nurse managers to better identify communication skills needed for oncology nurses to practice patient-centered care. Thematic analysis of transcripts was used to identify barriers to patient and family communication and desirable patient-centered nursing communication skills. Overall, the nurse managers reported that nurses experience patient and family communication difficulties as a result of inconsistent messages to patients and family from other healthcare staff. Physician assumptions about nursing left nurses feeling uncomfortable asking for clarification, creating a barrier to team communication processes. Patient-centered communication and care cannot be actualized for nurses unless team roles are clarified and nurses receive training in how to communicate with physicians, patients, and family. Therefore, the authors of this article created the COMFORT communication training protocol, and key concepts and resources for nurse communication training through COMFORT are detailed in this article. PMID:23538250
There is a patient demand for online services provided by their doctor, but at the present, in Belgium, there are very few physicians offering such services. This article examines the different types of services and the practical, technical, legal and economic aspects of an interface for electronic doctor-patientcommunication in the ambulatory sector in the Belgian context. The inventory of pilot projects carried out in other countries shows high patient satisfaction rates and a low impact on doctors' workload. However, the lack of funding hinders the implementation. Given the confidential nature of data exchanged, both high level of security and development of guidelines adapted to the local Belgian context are required. Electronic communication should remain one of the modalities in a therapeutic relationship. At a technical level, using the Belgian electronic identity card and the opportunity to create a digital signature with legal value would provide a solution to most of the security requirements. PMID:21942075
ObjectiveProvision of high quality patient-centered care is fundamental to eliminating healthcare disparities in breast cancer. We investigated physicians’ experiences communicating with limited English proficient (LEP) breast cancerpatients.
Leah S. Karliner; E. Shelley Hwang; Dana Nickleach; Celia P. Kaplan
BACKGROUND: Guidelines in paediatric oncology encourage health care providers to share relevant information with young patients and parents to enable their active participation in decision making. It is not clear to what extent this mirrors patients' and parents' preferences. This study investigated communication preferences of childhood cancerpatients, parents, and survivors of childhood cancer. METHODS: Communication preferences were examined by
Marieke Zwaanswijk; Kiek Tates; Sandra van Dulmen; Peter M Hoogerbrugge; Willem A Kamps; Jozien M Bensing
The number of cognitively impaired elderly in Canada has increased greatly during the past two decades; nearly all have Alzheimer's disease (AD). The memory problems and changes in language and communication of these patients place tremendous strain on physicians who are searching for a differential diagnosis and are trying to communicate with them. Reviewing the salient language and communication features of AD patients leads to strategies for improving effective physician-patientcommunication.
Orange, J. B.; Molloy, D. W.; Lever, J. A.; Darzins, P.; Ganesan, C. R.
... of the American Medical Association JAMA PATIENT PAGE Lung Cancer L ung cancer is the leading cause of ... CT) screening for lung cancer. RISK FACTORS FOR LUNG CANCER FOR MORE INFORMATION • American Cancer Society www.cancer. ...
Background: This study was designed to investigate: (i) parent-adolescent communication in families of cancerpatients; (ii) relationships between parent-adolescent communication and posttraumatic stress symptoms (PTSS) in adolescent children; and (iii) associations between parents' illness charac- teristics and parent-adolescent communication. Patients and methods: A total of 212 adolescents completed the Impact of Event Scale and Parent- Adolescent Communication Scale. Results: Adolescents
CONTEXT: Many cancerpatients are using non-herbal nutritional supplements (NHNS), often without informing their oncologists. OBJECTIVES: To review the literature and summarize the beneficial effects and safety of NHNS in the prevention and reduction of treatment-related symptoms. METHODS: Databases were searched for randomized, controlled clinical trials (Jadad score ? 2) using AltHealthWatch, Cochrane Database of Systematic Reviews, Embase, MEDLINE, Memorial Sloan-Kettering Integrative Medicine Service Database, Natural Standard Database, and PubMed. The key words searched were the following: alternative and/or complementary medicine, nutritional and/or dietary supplements, quality of life, symptoms and/or side effects, specific toxicities (e.g., neuropathy, mucositis), and specific supplements (e.g., vitamin E, glutamine, etc.). RESULTS: A number of NHNS products were found to be effective. The incidence and severity of peripheral sensory neuropathy associated with taxane-agents such as paclitaxel can be reduced with vitamin E, glutamine, and acetyl-L-carnitine. Vitamin E and glutamine also have been shown to reduce oral mucositis resulting from radiation and chemotherapy, and glutamine and probiotics can reduce chemotherapy-induced diarrhea. CONCLUSION: There is a need to develop an open and nonjudgmental dialogue between oncologists and cancerpatients, addressing the needs of the patient while dealing with issues related to the efficacy and safety of these products. Referral of patients to an integrative medicine consultant may help achieve these goals, providing both parties with the option of reaching an informed and respectful decision about treatment. PMID:23707384
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 cancerpatients 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 cancerpatients 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
Patients may be rendered speechless because of many conditions, including cancer surgery, stroke, cerebral palsy, cervical cord and head trauma, neuromuscular paralysis, and intubation for respiratory failure. These same conditions may also be associated with decreased use of the hands, so that writing and other nonverbal forms of communication are also impaired. Lack of communication can frustrate the patient, the family, and health care personnel; increase the patient's isolation; and lead to poor patient cooperation, thus impeding progress in therapy and producing secondary psychiatric disturbances. Two communication programs that use a Commodore 64 computer are described in this paper. One communication program uses the alphabet and the other is based on the international Morse code. These programs are easy to use and inexpensive to establish, and they accommodate any switching device. PMID:2528298
Risk communication is an integral part of genetic counseling and testing for cancer susceptibility. This paper reviews the emerging literature on this topic. Three relevant aspects of risk communication are addressed: communication of indi- vidual risk, communication of the risks inherent in genetic testing, and family communications related to risk. These studies suggest that (a) most individuals with some family
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. PMID:23471099
Text Version... Effective PatientCommunication: ... Start Med Guide with description of medication, indication ... judgment about prescription medications ... More results from www.fda.gov/downloads/advisorycommittees/committeesmeetingmaterials
The 2001 Institute of Medicine (IOM) report titled “Crossing the Quality Chasm” cited a need to make care “patient-centered”. To achieve that end physicians and organizations who are delivering care must begin to see medical care from the patient perspective. As outlined in a recent NCI report on Patient-Centered Communication (2007), “patient-centeredness” is a multi-dimensional concept that goes beyond the notion of satisfaction.
Background Empathy is important in patientphysician communication and is associated with improved patient satisfaction and adherence to physicians’ recommendations. Methods To evaluate empathic opportunities and physician responses, we conducted a qualitative thematic analysis of 20 audiorecorded, transcribed consultations between patients with lung cancer and their thoracic surgeons or oncologists, from a larger observational study of 137 patients in a Veterans Affairs hospital in the southern United States. Using qualitative analysis, we collaboratively developed themes and subthemes until saturation. Then, each transcript was coded, using grounded theory methods, until consensus was achieved, counting and sequentially analyzing patient empathic opportunities and physician responses. Results Subthemes regarding patients’ statements about lung cancer included (1) morbidity or mortality concerns, (2) cancer-related symptoms, (3) relationship to smoking, (4) decisions about treatment, (5) beliefs about or mistrust of medical care, (6) factors limiting ability to treat cancer, and (7) confusion regarding cancer status and treatment. We identified 384 empathic opportunities and found that physicians had responded empathically to 39 (10%) of them. Otherwise, physicians provided little emotional support, often shifting to biomedical questions and statements. We defined this phenomenon as missed opportunities for “interval empathy.” When empathy was provided, 50% of these statements occurred in the last one-third of the encounter, whereas patients’ concerns were evenly raised throughout the encounter. Conclusions Physicians rarely responded empathically to the concerns raised by patients with lung cancer, and empathic responses that did occur were more frequently in the last third of the encounter. Our results may provide a typologic approach to help physicians recognize empathic opportunities and with further development may aid in improving physicians’ communication skills.
Morse, Diane S.; Edwardsen, Elizabeth A.; Gordon, Howard S.
Cancer is increasing in incidence and prevalence worldwide, and the WHO has recently included cancer and its treatments as\\u000a a health priority in developed and developing countries. The cultural diversity of oncology patients is bound to increase,\\u000a and cultural sensitivity and competence are now required of all oncology professionals. A culturally competent cancer care\\u000a leads to improved therapeutic outcome and
In a qualitative study using focus group interviews, family physicians in London, Ont, were asked to describe how they perceived their role in follow-up cancerpatient care. Barriers to fulfilling this role existed both in the tertiary cancer care setting and among the family physicians themselves. Suggestions for overcoming these barriers were generated.
Cultural competence in oncology requires the acquisition of specific knowledge, clinical skills, and attitudes that facilitate\\u000a effective cross-cultural negotiation in the clinical setting, thus, leading to improved therapeutic outcomes and decreased\\u000a disparities in cancer care. Cultural competence in oncology entails a basic knowledge of different cultural attitudes and\\u000a practices of communication of the truth and of decision-making styles throughout the
Cancer ruins the patient's daily routine and causes anxiety thus affecting adaptation. An analysis of past conversations gives a glimpse of psychological problems tormenting cancerpatients. The paper gives a glimpse in adaptation at the crux of a crisis and evaluates the role and potential of anxiety which can help go through it. PMID:20361623
In stroke patients, it has been suggested that communication disorders could result from lexical and syntactic disorders in\\u000a left hemisphere lesions and from pragmatics problems in right lesions. However, we have little information on patient behaviour\\u000a in dyadic communication, especially in conversation. Here, we analyzed the various processes participating in communication\\u000a difficulties at the rehabilitation phase (1–6 months) post-stroke, in order
In research on doctor-patientcommunication, the patient role in the communication process has received little attention. The dynamic interactions of shared decision making and partnership styles which involve active patientcommunication are becoming a growing area of focus in doctor-patientcommunication. However, patients rarely know what makes "good communication" with medical providers and even fewer have received coaching in this type of communication. In this study, 180 patients were randomly assigned to either an intervention group using a written communication tool to facilitate doctor-patientcommunication or to standard care. The goal of this intervention was to assist patients in becoming more effective communicators with their physicians. The physicians and patients both rated the quality of the communication after the office visit based on the patients' knowledge of their health concerns, organizational skills and questions, and attitudes of ownership and partnership. The results supported that patients in the intervention group had significantly better communication with their doctors than patients in the standard care condition. Physicians also rated patients who were in the intervention group as having better overall communication and organizational skills, and a more positive attitude during the office visit. This study supports that helping patients structure their communication using a written format can facilitate doctor-patientcommunication. Patients can become more adept at describing their health concerns, organizing their needs and questions, and being proactive, which can have a positive effect on the quality of the doctor-patientcommunication during outpatient office visits. (PsycINFO Database Record (c) 2011 APA, all rights reserved). PMID:21787080
Talen, Mary R; Muller-Held, Christine F; Eshleman, Kate Grampp; Stephens, Lorraine
Effective doctor-patientcommunication is a central clinical function in building a therapeutic doctor-patient relationship, which is the heart and art of medicine. This is important in the delivery of high-quality health care. Much patient dissatisfaction and many complaints are due to breakdown in the doctor-patient relationship. However, many doctors tend to overestimate their ability in communication. Over the years, much has been published in the literature on this important topic. We review the literature on doctor-patientcommunication.
Over the last 10 years, the number of cancer survivors in South Korea has reached nearly one million with a survival rate of 49.4%. However, integrated supportive care for cancer survivors is lagging. One area in which the current cancer control policy needs updating is in the utilization of information and communication technology (ICT). The remarkable progress in the field of ICT over the past 10 years presents exciting new opportunities for health promotion. Recent communication innovations are conducive to the exchange of meta-information, giving rise to a new service area and transforming patients into active medical consumers. Consequently, such innovations encourage active participation in the mutual utilization and sharing of high-quality information. However, these benefits from new ICTs will almost certainly not be equally available to all, leading to so-called communication inequalities where cancer survivors from lower socioeconomic classes will likely have more limited access to the best means of making use of the health information. Therefore, most essentially, emphasis must be placed on helping cancer survivors and their caregivers utilize such advances in ICT to create a more efficient flow of health information, thereby reducing communication inequalities and expanding social support. Once we enhance access to health information and better manage the quality of information, as a matter of fact, we can expect an alleviation of the health inequalities faced by cancer survivors. PMID:23886120
This article describes nurse–patientcommunication during counseling sessions. It focuses on the patient as a participant in a discussion and aims at a description of patients’ communicator styles, which were observed on videotape based on 38 counseling sessions transcribed word by word. Interviews of the participating nurses and patients were used for partial support of the interpretations. The analytic method
Tarja Kettunen; Marita Poskiparta; Leena Liimatainen
Developments in predictive testing for inherited cancers have focused attention on the accurate and sensitive communication of risk information. Although sharing risk information is often equated with genetic testing, it is important to acknowledge that the need for risk information related to familial cancer is also relevant to those not eligible for, or interested in, testing. Communicatingcancer risk information
Joan L Bottorff; Pamela A Ratner; Joy L Johnson; Chris Y Lovato; S. Amanda Joab
In both kinds of newspapers, cancer risks were rarely communicated numerically. When numeric presentations of cancer risks were used, only 26.2% of mainstream and 29.5% of ethnic newspaper stories provided estimates of both absolute and relative risk. For both kinds of papers, only 19% of news stories presented risk communication optimally. Cancer risks were more likely to be communi- cated
Jo Ellen Stryker; Jessica Fishman; Karen M. Emmons; Kasisomayajula Viswanath
|Four audiovisual programs about cancer and cancer treatment were evaluated. Cancerpatients, 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)|
Abstract Objective It is not known how often physicians use metaphors and analogies, or whether they improve patients' perceptions of their physicians' ability to communicate effectively. Therefore, the objective of this study was to determine whether the use of metaphors and analogies in difficult conversations is associated with better patient ratings of their physicians' communication skills. Design Cross-sectional observational study of audio-recorded conversations between patients and physicians. Setting Three outpatient oncology practices. Patients Ninety-four patients with advanced cancer and 52 physicians. Intervention None. Main outcome measures Conversations were reviewed and coded for the presence of metaphors and analogies. Patients also completed a 6-item rating of their physician's ability to communicate. Results In a sample of 101 conversations, coders identified 193 metaphors and 75 analogies. Metaphors appeared in approximately twice as many conversations as analogies did (65/101, 64% versus 31/101, 31%; sign test p?0.001). Conversations also contained more metaphors than analogies (mean 1.6, range 0–11 versus mean 0.6, range 0–5; sign rank test p?0.001). Physicians who used more metaphors elicited better patient ratings of communication (??=?0.27; p?=?0.006), as did physicians who used more analogies (Spearman ??=?0.34; p?0.001). Conclusions The use of metaphors and analogies may enhance physicians' ability to communicate.
Pickard, Amy; Fishman, Jessica M.; Alexander, Stewart C.; Arnold, Robert M.; Pollak, Kathryn I.; Tulsky, James A.
Concerns have been raised about the quality of life and health care received by cancerpatients at the end of life (EOL). Many patients die with pain and other distressing symptoms inadequately controlled, receiving burdensome, aggressive care that worsens quality of life and limits patient exposure to palliative care, such as hospice. Patient–physician communication is likely a very important determinate
Nurses are required to keep their knowledge and skills up to date to ensure their practice is evidence-based. Reflection in and on practice can be used to ensure care provision is evidence-based, to increase self-awareness and to promote positive change. Timely communication of high-quality information tailored to patients' needs is required. When a breakdown in communication occurs in practice, it can have a negative effect on patients and the professionals providing their care. Using an example from my practice experience, this article aims to highlight the importance of communication, reflection and knowledge in nursing practice. PMID:24063485
Communication can be seen as the main ingredient in medical care. In reviewing doctor-patientcommunication, the following topics are addressed: (1) different purposes of medical communication; (2) analysis of doctor-patientcommunication; (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
Advances in the production of novel therapies for cancer management are creating new challenges for the support of increasing numbers of persons surviving for extended periods with advanced disease. Despite incurable and life-limiting metastatic conditions, these patients are living longer with serious disease, pushing the boundaries of what science explains and clinicians can confidently interpret using available evidence. Here we report findings from an early subset of such individuals within a longitudinal qualitative cancer cohort study on clinician-patientcommunication across the cancer trajectory. In these findings, we contextualize experiential accounts of communication in a changing environment of the costs and uncertainties of personalized medicine, and examine the complex psychosocial circumstances of this rapidly growing patient population. Interpretation of these findings illustrates how emerging issues in cancer treatment influence the experience of these patients, their social and support networks, their cancer care specialists, and the multidisciplinary teams charged with coordinating their care. PMID:23567298
Thorne, Sally E; Oliffe, John L; Oglov, Valerie; Gelmon, Karen
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 patientcommunication. 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
Communication of familial risk of breast cancer and melanoma has the potential to educate relatives about their risk, and may also motivate them to engage in prevention and early detection practices. With the Health Insurance Portability and Accountability Act (HIPAA) privacy laws, the patient often becomes the sole communicator of such risks to family members. This study surveys mothers diagnosed with either breast cancer or melanoma and their adult children about their family communication style, knowledge of increased risk, and early detection practices. In both cancer groups, most mothers alerted their children of the risk and need for early detection practices. Breast cancer mothers communicated risk and secondary prevention with early detection by breast self-examination and mammograms whereas the melanoma mothers communicated risk and primary prevention strategies like applying sunscreen and avoiding deliberate tanning. Open communication about health matters significantly increased the likelihood that children engaged in early detection and/or primary prevention behaviors. Examining the information conveyed to at-risk family members, and whether such information motivated them to engage in early detection/prevention behaviors, is key to guiding better cancer prevention communication between doctors and patients. PMID:23965923
Gaber, Rikki; Desai, Sapna; Smith, Maureen; Eilers, Steve; Blatt, Hanz; Guevara, Yanina; Robinson, June K
Communication of familial risk of breast cancer and melanoma has the potential to educate relatives about their risk, and may also motivate them to engage in prevention and early detection practices. With the Health Insurance Portability and Accountability Act (HIPAA) privacy laws, the patient often becomes the sole communicator of such risks to family members. This study surveys mothers diagnosed with either breast cancer or melanoma and their adult children about their family communication style, knowledge of increased risk, and early detection practices. In both cancer groups, most mothers alerted their children of the risk and need for early detection practices. Breast cancer mothers communicated risk and secondary prevention with early detection by breast self-examination and mammograms whereas the melanoma mothers communicated risk and primary prevention strategies like applying sunscreen and avoiding deliberate tanning. Open communication about health matters significantly increased the likelihood that children engaged in early detection and/or primary prevention behaviors. Examining the information conveyed to at-risk family members, and whether such information motivated them to engage in early detection/prevention behaviors, is key to guiding better cancer prevention communication between doctors and patients.
Gaber, Rikki; Desai, Sapna; Smith, Maureen; Eilers, Steve; Blatt, Hanz; Guevara, Yanina; Robinson, June K.
Oncologists commonly encounter patients with depressive symptoms. It is important for the clinician to recognize and treat\\u000a these symptoms in cancerpatients, since they can occur for both physical and psychological reasons. This chapter describes\\u000a assessment of depression, differentiating between types and causes of depressive disorders, and treatment interventions. Risk\\u000a factors for suicide, assessment and management of suicide are also
Many factors can modify nutritional status in cancerpatients, including cachexia, nausea and vomiting, decreased caloric intake or oncologic treatments capable of determining malabsorption. Cachexia is a complex disease characterized not only by a poor intake of nutrients or starvation, but also by metabolic derangement. Nausea and vomiting may limit the nutrient intake and are most often the consequences of
Every pediatrician would want to satisfy their patients and their parents to sustain good practice, earn name and fame and simultaneously to avoid litigation in this era of consumer protection act. This can be achieved only by use of good communication skills. Today the patients demand time, information and want their questions to be answered. They expect politeness, empathy and human touch from doctors. Time constraints, arrogance, telephone calls, language barriers and cultural insensitivity are the important barriers to good communication. Research has shown that doctor, who undergoes training to acquire good communication skills, can better satisfy his patients. Good communication skill is an art which can be acquired or improved by putting conscious efforts in day to day practice. Such skills should also be incorporated as part of medical teaching curriculum. Asking open ended questions, effective listening, appropriate praise, providing enough information as part of advice and finally checking their understanding, are the key areas of communication during medical interview. During this process pediatrician should ensure to address the parental concerns, should empathize with parents and involve parents in decision making. This will not only ensure satisfaction of parents but also their adherence to the therapy and to the pediatrician. PMID:23378053
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…
Effective communication is the most important part of any healthcare organization. For many years, hospital nurse call solutions had been stand-alone systems with occasional integration to pocket paging for outputting patient call alerts to mobile staff. In the late 1990's, technology enabled in-building wireless phones to supplement or replace paging systems as a means of not only sending alerts, but also enabling voice communication between mobile staff and patients. Today's nurse call market requires integration of additional information from location and ADT (admit, discharge, transfer) systems into what have traditionally been nurse call applications. This system information is required not only at the nursing station, pagers, and phones, but also at PC's placed on each patient care floor in hallways, nurse stations, and offices, and at areas away from the patients, including administrator and clinical engineering offices. It is crucial that nurses have the latest patient information in their hand wherever they go in the hospital. In this paper, MatchMaker.NET has been developed to integrate all these technologies into the hospital's LAN to improve nurse-patientcommunication. PMID:21541690
This study examined associations between couple communication about cancer and psychological distress and relationship satisfaction of women diagnosed with early stage breast cancer. One hundred forty-eight couples completed a videotaped discussion of a cancer-related issue and a general issue. Patients completed measures of psychological distress…
Manne, Sharon; Sherman, Marne; Ross, Stephanie; Ostroff, Jamie; Heyman, Richard E.; Fox, Kevin
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
OBJECTIVE Little is known about the effects of lung cancer on intimate and sexual relationships. This study explores health care provider, patient, and partner perspectives on: 1) the effects of lung cancer on physical and emotional intimacy, 2) the ways in which intimacy affects the experience of living with lung cancer, and 3) communication about intimacy and sexuality in the context of lung cancer. METHODS Qualitative, in-depth interviews with 8 cancer care providers and 13 married couples (ages 43–79) affected by lung cancer were conducted and audiotaped in the clinical setting. Interviews were transcribed, iteratively analyzed, and coded according to the above domains. Coding was performed independently by members of an interdisciplinary team; inter-rater reliability was assessed using the kappa statistic; and analyses were summarized by domain. RESULTS Most cancer care providers and couples affected by lung cancer believed intimacy and sexuality issues were salient, yet few reported discussing these. Couples described negative and positive effects of cancer on intimacy. Negative effects were driven by cancer or its treatment, including physical and psychological effects. Positive effects included an increase in non-coital physical closeness and appreciation of the spouse. Age was perceived as an important factor influencing the relationship between lung cancer and intimacy. CONCLUSIONS Emotional intimacy and sexuality are important concerns for couples affected by lung cancer. The findings suggest previously unrecognized positive effects of lung cancer on emotional and physical intimacy. Couples affected by lung cancer and providers believe these issues are relevant for lung cancer care.
Lindau, Stacy Tessler; Surawska, Hanna; Paice, Judith; Baron, Shirley R.
\\u000a A complex relationship exists between the coagulation system and tumour cells, with common mechanisms linking haemostasis\\u000a and malignancy. Venous thromboembolism (VTE) is the second most common cause of death in cancerpatients and it is estimated\\u000a that about 1 in 7 patients die of avoidable pulmonary embolism (PE), rather than the cancer itself. Treating a patient with\\u000a cancer requires a
|Many efforts to teach and evaluate physician-patientcommunication are based on two assumptions: first, that communication can be conceptualized as consisting of specific observable behaviors, and second, that physicians who exhibit certain behaviors are more effective in communicating with patients. These assumptions are usually implicit, and…
Mazor, Kathleen M.; Ockene, Judith K.; Rogers, H. Jane; Carlin, Michele M.; Quirk, Mark E.
Situation-Background-Assessment-Recommendation (SBAR) communication has become the standard for communicating across disciplines. It has demonstrated its effectiveness at improving patient outcomes, enhancing patient and clinician satisfaction, and helping to control healthcare costs. It can help home healthcare clinicians with efforts to prevent avoidable hospitalizations. But how often and how well do home health clinicians use this method of shared communications with physicians? This article explores why communication between physicians and home health clinicians can be so problematic. It introduces the SBAR communication method, its origins, its features, and some of the published evidence that it provides effective and efficient communication, thereby promoting better patient outcomes. PMID:24081133
Background Guidelines in paediatric oncology encourage health care providers to share relevant information with young patients and parents to enable their active participation in decision making. It is not clear to what extent this mirrors patients' and parents' preferences. This study investigated communication preferences of childhood cancerpatients, parents, and survivors of childhood cancer. Methods Communication preferences were examined by means of online focus groups. Seven patients (aged 8–17), 11 parents, and 18 survivors (aged 8–17 at diagnosis) participated. Recruitment took place by consecutive inclusion in two Dutch university oncological wards. Questions concerned preferences regarding interpersonal relationships, information exchange and participation in decision making. Results Participants expressed detailed and multi-faceted views regarding their needs and preferences in communication in paediatric oncology. They agreed on the importance of several interpersonal and informational aspects of communication, such as honesty, support, and the need to be fully informed. Participants generally preferred a collaborative role in medical decision making. Differences in views were found regarding the desirability of the patient's presence during consultations. Patients differed in their satisfaction with their parents' role as managers of the communication. Conclusion Young patients' preferences mainly concur with current guidelines of providing them with medical information and enabling their participation in medical decision making. Still, some variation in preferences was found, which faces health care providers with the task of balancing between the sometimes conflicting preferences of young cancerpatients and their parents.
Zwaanswijk, Marieke; Tates, Kiek; van Dulmen, Sandra; Hoogerbrugge, Peter M; Kamps, Willem A; Bensing, Jozien M
Cancerpatients and relatives worldwide are turning more and more to the internet to obtain health information. The goal of this survey was to clarify their experiences and suggestions on the implementation of information and communication technology (ICT) in oncology. A total of 127 patients and 60 relatives visiting the outpatient clinic at the Department of Oncology, University of North
Jan Norum; Anne Grev; Mari-Ann Moen; Lise Balteskard; Kari Holthe
Terminally ill cancerpatients and their caregivers experience significant difficulties discussing illness and impending death (herein defined as mortality communication). The current study compares response levels as well as patterns of association between mortality communication and psychological distress among caregivers of home hospice and hospital inpatients. For this study, 231 family caregivers were recruited within a year of bereavement from
Yaacov G. Bachner; Norm ORourke; Eldad Davidov; Sara Carmel
Older patients may benefit from chemotherapy to an extent comparable with that of younger patients if some proper precautions are taken. These include selection of the patients on the basis of life expectancy and tolerance of treatment, prophylactic use of hemopoietic growth factors for moderately toxic chemotherapy (cytoxan, adriamycin, oncovin [vincristine], prednisone [CHOP] and CHOP-like regimens), adjustment of the first treatment dose to the glomerula filtration rate, maintenance of hemoglobin levels > or = 12 g/dL, and selection of agents with a more favorable toxicology profile. This approach is outlined in the National Cancer Center Network guidelines for the management of cancer in the older person. PMID:16018197
Although weight loss is a frequent, though not invariable, component of the cancer syndrome, the associated malnutrition is a poor prognostic sign among both children and adults. This article describes the possible mechanisms of cancer cachexia; reviews the present state of nutritional support in cancerpatients; identifies nutritional problems and workable approaches during the pre- and post-treatment periods; discusses the unconventional nutritional practices commonly encountered and lists resource materials for patients and families.
Physicians often struggle with how to manage the task of breaking bad news with patients. Moreover, the arduous nature of the task can contribute to physician detachment from the patient or an avoidance of breaking the news in a timely manner. A plan of action can only improve physician confidence in breaking bad news, and also make the task more manageable. Over a decade ago, Rabow and McPhee offered a strategy; the ABCDE plan, which provided a patient centered framework from which to deliver troubling news to patients and families. At the heart of this plan was the creation of a safe environment, the demonstration of timely communication skills, and the display of empathy on the physician's part. Careful consideration of the doctor's own reactions to death and dying also played an important role. A close review of the five tenets of this plan indicates the relevance of Rabow and McPhee's strategy today. The patient base in our nation and state continues to be older, on average, and physicians are faced with numerous patients who have terminal illness. A constructive plan with specific ideas for breaking bad news can help physicians effectively navigate this difficult task. PMID:22655433
An Ontario cancer agency started an initiative to improve and promote effective communications between health care providers and their patients, using a 4.5-hour workshop developed by the Bayer Institute for Health Care Communications. Each of the eight regional cancer centers in Ontario sent two people, one physician and one other health care professional, for training in delivery of the workshop. Subsequently, each center provided workshops for physicians, nurses, pharmacists, physicists, social workers, psychologists, radiotherapists, and secretarial staff. The ongoing workshops are multiprofessional in composition and interactive and participatory in design. Between September 1996 and September 1997, the workshops involved over 400 cancer care professionals. Their success has been attributed to the knowledge, skills, and enthusiasm of the trained pair of facilitators; the interactive and participatory nature of the workshop design; the multiprofessional participation; and the support of the board of directors and senior management and the administration of each cancer center. PMID:9883778
Rath, D; Poldre, P; Fisher, B J; Laidlaw, J C; Cowan, D H; Bakker, D
Goals of work: To assess complementary and alternative medi- cine (CAM) therapies being utilized by cancerpatients during treatment and communication about CAM usage between the patient and physi- cian. Patients and methods: Newly diagnosed cancerpatients 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
|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-patientcommunication 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
This study investigated the communication barriers perceived by older hospitalized patients and nurses in Korea, with the aim of identifying disparities between the two parties. The authors developed a 50-item communication-barrier questionnaire that includes patient, nurse, and environmental factors. One hundred older hospitalized patients and 136 nurses were asked to rate the importance of each communication-barrier item. Nurses and patients
Objectives The incidence of cancer among the indigenous Sami people of Northern Finland is lower than among the Finnish general population. The survival of Sami cancerpatients is not known, and therefore it is the object of this study. Study design The cohort consisted of 2,091 Sami and 4,161 non-Sami who lived on 31 December 1978 in the two Sami municipalities of Inari and Utsjoki, which are located in Northern Finland and are 300–500 km away from the nearest central hospital. The survival experience of Sami and non-Sami cancerpatients diagnosed in this cohort during 1979–2009 was compared with that of the Finnish patients outside the cohort. Methods The Sami and non-Sami cancerpatients were matched to other Finnish cancerpatients for gender, age and year of diagnosis and for the site of cancer. An additional matching was done for the stage at diagnosis. Cancer-specific survival analyses were made using the Kaplan–Meier method and Cox regression modelling. Results There were 204 Sami and 391 non-Sami cancer cases in the cohort, 20,181 matched controls without matching with stage, and 7,874 stage-matched controls. In the cancer-specific analysis without stage variable, the hazard ratio for Sami was 1.05 (95% confidence interval 0.85–1.30) and for non-Sami 1.02 (0.86–1.20), indicating no difference between the survival of those groups and other patients in Finland. Likewise, when the same was done by also matching the stage, there was no difference in cancer survival. Conclusion Long distances to medical care or Sami ethnicity have no influence on the cancerpatient survival in Northern Finland.
Soininen, Leena; Pokhrel, Arun; Dyba, Tadek; Pukkala, Eero; Hakulinen, Timo
Many cancerpatients experience impairments of neurocognitive function, including memory loss, distractibility, difficulty in performing multiple tasks (multitasking), and a myriad of other symptoms. Patients may also concurrently suffer from mood disturbance and symptoms that compromise their ability to function adequately, including fatigue and pain. The etiologies of these problems are diverse and include the direct effects of cancer within the central nervous system (CNS), indirect effects of certain cancers (e.g., paraneoplastic brain disorders), and both diffuse and highly specific effects of cancer treatments on the brain. In addition to these cancer-related causes, patients may have coexisting neurologic or psychiatric disorders that affect their cognition and mood. Careful assessment of patients complaining of neurocognitive or behavioral problems is essential to providing appropriate interventions and maximizing their ability to carry out usual activities. PMID:10680150
Cancer management occurs within a system of relationships. Advancing a context based view of client provider communication, we first posit that family is central to client provider communication in cancer management. This premise is followed by three additional premises that emphasize the importance of culture, disease stage and communication styles, within this family-centered perspective. Supporting research questions are offered for
Sexuality is a basic need for every human being as long as he or she is alive, irrespective of age or health status. Approximately 23,500 individuals are diagnosed with cancer each year in Israel and join the 120,000 cancerpatients currently living in Israel. The results of cancer treatments are traditionally assessed and based on the outcome regarding mortality versus survival. An equally important aspect to be addressed in this assessment must relate to quality of life. One of the more painful insults to the quality of life of cancerpatients relates to the deleterious effects on sexuality. This article aims to present physicians with the spectrum of sexuality-related issues which are encountered by cancerpatients and their partners, starting from the moment of diagnosis, throughout the various stages of treatment and to provide basic knowledge. Many individuals contracting cancer have difficulty dealing with the issue of sexuality. They are typically embarrassed and feel uneasy when asking health care providers about such a non-life threatening issue. Partners similarly feel both shame and guilt. In many cases sexuality, intimacy and emotional attachment are important aspects and may be essential for survival. Addressing these issues during treatment can provide patients with a sense of security, avoiding embarrassment and further exacerbation of such problems. Unfortunately, little has been done to develop an optimal interventional program, although standard sexual treatments have often been applied. Prospective clinical research and outcomes are missing. The physician can use the well-known PLISSIT model (1978): to provide sexuality involvement on different levels. The very new BETTER model (2004) can help emphasize that cancer treatment and the disease have an influence on intimacy and sexuality. PMID:20070056
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...CancerCommunications Messages; Proposed Collection...public comment on proposed data collection projects...CancerCommunications Messages. Type of Information...2) produce or refine messages that have the greatest...obtain a copy of the data collection plans...
...CancerCommunications Messages Summary: In compliance...public comment on proposed data collection projects...CancerCommunications Messages, Type of Information...2) produce or refine messages that have the greatest...obtain a copy of the data collection plans...
Objectives To examine young people's and parents' accounts of communication about cancer in childhood. Design Semistructured interviews analysed using the constant comparative method. Setting Paediatric oncology unit. Participants 13 families, comprising 19 parents (13 mothers, six fathers) and 13 patients aged 8›17 years, recruited from one paediatric oncology unit. The patients had cancer or brain tumour. Results Most parents described
Bridget Young; Mary Dixon; Kate C Windridge; David Heney
Many training curricula, research efforts, and resources have been focused on what makes competent doctor communication. However, few studies have identified what makes good patientcommunication. This project was designed to explore physicians' perspective on patientcommunication. Forty-one primary care physicians participated in focus group discussions on what constitutes competent patientcommunication. The results of these discussions pointed to three
Mary R. Talen; Kate Grampp; Angela Tucker; Janet Schultz
|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
Online communication among patients and consumers through support groups, discussion boards, and knowledge resources is becoming more common. In this paper, we discuss key methods through which such web-based peer-to-peer communication may affect health promotion and disease prevention behavior (exchanges of information, emotional and instrumental support, and establishment of group norms and models). We also discuss several theoretical models for studying online peer communication, including social theory, health communication models, and health behavior models. Although online peer communication about health and disease is very common, research evaluating effects on health behaviors, mediators, and outcomes is still relatively sparse. We suggest that future research in this field should include formative evaluation and studies of effects on mediators of behavior change, behaviors, and outcomes. It will also be important to examine spontaneously emerging peer communication efforts to see how they can be integrated with theory-based efforts initiated by researchers.
Ancker, Jessica S.; Carpenter, Kristen M.; Greene, Paul; Hoffmann, Randi; Kukafka, Rita; Marlow, Laura A.V.; Prigerson, Holly G.; Quillin, John M.
Whether patient suffering is caused by physical symptoms, unwanted medical intervention, or spiritual crisis, the common pathway to relief is through a provider who is able to elicit these concerns and is equipped to help the patient and family address them. This paper reviews the current state of knowledge in communication at the end of life, organized according to a framework of information gathering, information giving, and relationship building; and then focuses on interventions to enhance communication among patients, providers, and families. Several observations emerge from the existing literature. Patients have highly individualized desires for information and we cannot predict patient preferences. Communication coding methodology has advanced significantly yet the current systems remain poorly understood and largely inaccessible. Physicians and other health care providers do not discuss sufficiently treatment options, quality of life or respond to emotional cues from patients, and there is plenty of room for improvement. On the positive side, we have also learned that physicians and other health care providers can be taught to communicate better through intensive communication courses, and that communication interventions can improve some patient outcomes. Finally, huge gaps remain in our current knowledge, particularly with regard to understanding the relationship between communication style and outcomes. These findings suggest several recommendations. We should create larger and more diverse datasets; improve upon the analysis of recorded communication data; increase our knowledge about patient preferences for information; establish a stronger link between specific communication behaviors and outcomes; and identify more efficient ways to teach providers communication skills. PMID:16499474
This study analyzed doctor-patientcommunication from a sociolinguistic perspective, focusing on two issues: (1) why patients are not more effective in asserting themselves in talking with doctors, and (2) why doctors don't talk more like normal people (i.e., patients). Research on communication in health care contexts is reviewed, looking at such…
|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…
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…
|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…
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…
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
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 cancerpatients. The authors of this report provide an overview of issues in the study of informal caregivers for cancerpatients 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. PMID:23695928
Romito, Francesca; Goldzweig, Gil; Cormio, Claudia; Hagedoorn, Mariët; Andersen, Barbara L
Introduction: With the growing number of older cancerpatients, the burden of chronic diseases among older cancerpatients will become increasingly important. Chronic diseases often interfere with treatment decisions and prognosis for cancerpatients. However, little is known about the occurrence of chronic diseases among older cancerpatients. Aim: We aim to examine the frequency of pre-existing and subsequent chronic
L. D. Deckx; M. A. van der Akker; J. M. Metsemakers; A. K. Knottnerus; F. G. Schellevis; F. B. Buntinx
In hypertensive patients, treatment adherence is improved with patient-centered communication (PTC), leading to better outcomes. Many barriers to PTC should be overcome, including patient background characteristics, provider time constraints, and provider discomfort. Using patient-centered education increases patient awareness of choices and builds a partnership between the provider and patient. Nurse practitioners should adhere to PTC by discussing the disease of
The radical and transformative developments in information and communication technologies (ICTs) offer unprecedented opportunities to promote cancer control and enhance population and individual health. However, the current context in which these technologies are being deployed—where cancer incidence and mortality and communication are characterized by inequalities among different racial/ethnic and socioeconomic status groups—raises important questions for cancercommunication research, policy, and practice. Drawing on illustrative data, this essay characterizes the communications revolution and elucidates on its implications for cancer control, with a particular focus on communication inequalities and cancer disparities.
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
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|Studies of doctor-patientcommunication 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
Online communication among patients and consumers through support groups, discussion boards, and knowledge resources is becoming more common. In this article, the summary of a workgroup discussion, we discuss key methods through which such web-based peer-to-peer communication may affect health promotion and disease prevention behavior (exchanges of information, emotional and instrumental support, and establishment of group norms and models). We
Jessica S. Ancker; Kristen M. Carpenter; Paul Greene; Randi Hoffman; Rita Kukafka; Laura A. V. Marlow; Holly G. Prigerson; John M. Quillin
PURPOSE Patient ratings of physician’s patient-centered communication are used by various specialty credentialing organizations and managed care organizations as a measure of physician communication skills. We wanted to compare ratings by real patients with ratings by standardized patients of physician communication. METHODS We assessed physician communication using a modified version of the Health Care Climate Questionnaire (HCCQ) among a sample of 100 community physicians. The HCCQ measures physician autonomy support, a key dimension in patient-centered communication. For each physician, the questionnaire was completed by roughly 49 real patients and 2 unannounced standardized patients. Standardized patients portrayed 2 roles: gastroesophageal disorder reflux symptoms and poorly characterized chest pain with multiple unexplained symptoms. We compared the distribution, reliability, and physician rank derived from using real and standardized patients after adjusting for patient, physician, and standardized patient effects. RESULTS There were real and standardized patient ratings for 96 of the 100 physicians. Compared with standardized patient scores, real-patient–derived HCCQ scores were higher (mean 22.0 vs 17.2), standard deviations were lower (3.1 vs 4.9), and ranges were similar (both 5–25). Calculated real patient reliability, given 49 ratings per physician, was 0.78 (95% confidence interval [CI], 0.71–0.84) compared with the standardized patient reliability of 0.57 (95% CI, 0.39–0.73), given 2 ratings per physician. Spearman rank correlation between mean real patient and standardized patient scores was positive but small to moderate in magnitude, 0.28. CONCLUSION Real patient and standardized patient ratings of physician communication style differ substantially and appear to provide different information about physicians’ communication style.
Fiscella, Kevin; Franks, Peter; Srinivasan, Malathi; Kravitz, Richard L.; Epstein, Ronald
With increasing frequency, patients are being asked to make complex decisions about cancer screening, prevention, and treatment. These decisions are fraught with emotion and cognitive difficulty simultaneously. Many Americans have low numeracy skills making the cognitive demands even greater whenever, as is often the case, patients are presented with risk statistics and asked to make comparisons between the risks and benefits of multiple options and to make informed medical decisions. In this commentary, we highlight 10 methods that have been empirically shown to improve patients’ understanding of risk and benefit information and/or their decision making. The methods range from presenting absolute risks using frequencies (rather than presenting relative risks) to using a risk format that clarifies how treatment changes risks from preexisting baseline levels to using plain language. We then provide recommendations for how health-care providers and health educators can best to communicate this complex medical information to patients, including using plain language, pictographs, and absolute risks instead of relative risks.
Cancer in older people is a common problem worldwide. Among various types of cancer, skin cancers represent an important percentage. The principal risk factors are sun exposure, family history of skin cancer, fair skin color, but also the age plays an important role in the genesis of skin cancers. In older people there are a more prolonged exposure to carcinogenesis and a decreased functionality of reparation mechanisms of the cells so they acquire a selective advantage of growing and proliferating. At the same time age causes alteration in immune system by increasing NK-cells absolute number and decreasing both the endogenous and the lymphokine-induced lytic activities. The anti-tumor immune response is also mediated by the cytotoxic T- lymphocytes and in the elderly a strong reduction of T-cell function has been demonstrated. In elderly patients the diagnosis and the treatment of skin cancers can be different from younger counterpart. For example in older patients with melanoma is important to evaluate Breslow depth while higher mitotic rate has major value in younger patients. Moreover, the treatment should consider the performance status of patients and their compliance. PMID:24102278
Objective To evaluate the patient, physician, and visit-related factors associated with patient ratings of positive physician relational communication. Methods Pre- and post-visit surveys were conducted with 485 patients attending a routine periodic health exam with one of 64 participating physicians. The audio-recorded visits were coded for elements of patient-physician communication including assertive responses, partnership building, question asking, supportive talk, and expressions of concern. Results Patient reports of positive physician relational communication were associated with patient perceptions of how well the physician understood the patient’s health care preferences and values, a patient-physician interaction outside of the exam room, and physician-prompted patient expressions of concern. Conclusion In addition to a patient’s perception of their relationship with their physician going into the visit, relatively simple acts like extending the interaction beyond the exam room and ensuring that patients feel invited to express concerns they may have during the visit may influence patient perceptions of physician relational communication. Practice Implications This study offers preliminary support for the idea that relational communication and its associated benefits may be fostered through simple physician-driven acts such as interacting with patients outside of the exam room and encouraging patients to express concerns within the visit.
Shay, L. Aubree; Dumenci, Levent; Siminoff, Laura A.; Flocke, Susan A.; Lafata, Jennifer Elston
Communication between patients and providers forms the backbone of the patient–provider relationship. Often such communication is strained due to time and space limitations on the part of both patients and providers. Many healthcare organizations are developing secure e-mail communication facilities to allow patients to exchange e-mail messages with their providers. Providers are worried that opening such lines of communication will
Cancer pain management is expected to become more important because of the growing number of cancerpatients in the years to come. To improve cancer pain relief requires understanding and adequate application of the WHO three-step analgesic ladder. Selective cox-2 inhibitors have efficacy in decreasing side effects. Tramadol and a new type of transdermal fentanyl patch that provides 24-hour sustained release of fentanyl is commercially available to alleviate pain. New anti-seizure drugs such as Gabapentin and Pregabalin can be used for neuropathic pain and cancer pain as analgesic adjuvant drugs. They allow simple use than with palliative drugs so far. Palliation of cancer pain requires a multi-discipline approach for intensive management of symptoms. PMID:20948246
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-patientcommunication. 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-patientcommunication 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-patientcommunication 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-patientcommunication. 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.
Contemporary cancer research has led to unparalleled advances in therapeutics and improved survival. Even as treatment options\\u000a continue to improve, quality of life should remain a priority. Headache drastically impacts the quality of life of patients\\u000a with cancer and has a wide etiological scope, making diagnosis a challenge. Intracranial mass lesions are only one cause;\\u000a others include extracranial tumors, paraneoplastic
Samuel A. Goldlust; Jerome J. Graber; Dana F. Bossert; Edward K. Avila
Nurses' awareness of their communication strategies is critically important both in identifying effective patterns in their interaction and in teaching themselves to improve their patient education techniques. Ineffective communication between client and nurse practitioner can result in failure to improve health status or deterioration of health status when recommendations are not followed. Studies of nonverbal aspects of clinical communication tend to count or average types of communication behaviors over the entire interaction rather than use sequential analysis of these behaviors. This paper presents initial results of a pilot study that used a sequential analysis of strategic roles played by nonverbal communication in nurse practitioner-patient interactions involving patient education. Because there is little previous work in applying sequential analysis, the grounded theory approach was used to identify nonverbal communication behaviors. Routine visits that focused on osteoporosis prevention were conducted by three nurse practitioners. Two visits per nurse were videotaped and analyzed for sequential events of nonverbal communication by the researchers alone and then in combination with the nurse conducting the visit. Descriptions of each visit were developed based upon both the verbal and nonverbal characteristics of the nurse-patient interactions as observed in the videotaped visits. From these, vignettes were created that summarized each nurse-patient visit according to the nature of the clinical communication that took place. Interviews of both nurses and patients were conducted before and after the visits to explore osteoporosis knowledge, goals, and strategies for the visit.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2631934
Allogeneic blood transfusion (ABT) therapy plays a major role in the case of patients with cancer. Packed red blood cells (PRBC) are given for increased oxygen-carrying capacity, platelets concentrates (PC) and fresh frozen plasma (FFP) for the cessation and prevention of bleeding due to thrombocytopenia and other defects of hemostasis associated with neoplasia. All these blood components can induce complications and/or adverse reactions in cancerpatients including transfusion-associated graft versus host disease (TA-GVHD), transfusion transmitted diseases, alloimmunization to blood cell antigens, pulmonary decompensation, immunomodulation. Therefore, specific modifications such as leukocyte-reduction and irradiation of the blood components to be transfused in cancerpatients should be introduced to reduce the risk of these complications. Patients undergoing hematopoietic progenitor cell (HPC) transplantation are a unique group and present complex concerns related to transfusion, including major and minor ABO incompatibility and chimeric blood cells. Therefore, transfusion for patients undergoing treatment with cellular therapies requires careful blood component selection. The process of HPC infusion itself carries many risks including DMSO toxicity and hemolytic reactions. In all areas of transfusion therapy, new advances such as pathogen inactivation and synthetic alternatives to blood components should help to increase the safety and tolerance of transfusion in cancerpatients. PMID:22682136
Federici, Augusto B; Vanelli, Chiara; Arrigoni, Luisa
Carcinoma of the lung is rare in younger patients, but occasional reports of this condition have appeared in the literature. This article reviews the clinical and pathological patterns of bronchogenic carcinoma in 96 patients, 40 years old or younger seen at UCLA (University of California, Los Angeles) Hospital between 1956 and 1976. This review confirms the finding in other reports of a higher proportion of women among younger patients with lung cancer as well as a relatively low incidence of squamous cell carcinoma. Using comparative data from the UCLA and California tumor registries, we could find no significant difference in survival of the younger patients when compared with the general population of patients with lung cancer.
Ganz, Patricia A.; Vernon, Stephen E.; Preston, Dale; Coulson, Walter F.
Objective: To describe patient-obstetrician communication during the first prenatal visit and its relationship to physician gender and patient satisfaction.Methods: The first prenatal visit of 87 women with 21 obstetricians (11 male and ten female) was audiotaped and analyzed using the Roter Interaction Analysis System. Patient satisfaction was measured by postvisit questionnaire.Results: Communication during first prenatal visits was largely biomedical, with
Debra L Roter; Gail Geller; Barbara A Bernhardt; Susan M Larson; Teresa Doksum
This study explores the occurence of non-verbal communication in nurse-elderly patient interaction in two different care settings: home nursing and a home for the elderly. In a sample of 181 nursing encounters involving 47 nurses a study was made of videotaped nurse-patientcommunication. Six non-verbal behaviours were observed: patient-directed eyegaze, affirmative head nodding smiling, forward leaning, affective touch and instrumental
Wilma M. C. M. Caris-Verhallen; Ada Kerkstra; Jozien M. Bensing
Effective health educator-client communication processes are a prerequisite to the acquisition and appropriate application of new knowledge, to discussions that focus on treatment risks and options, and to the mediation of (a) optimal self-management practices, (b) adherence to health recommendations, (c) client satisfaction, (d) autonomous, responsible decision making, and (e) provision of supportive and helpful advice. But is there room for improvement? To provide more uniform high-quality communications to all citizens and to support the practice principles embedded in the Health Education Code of Ethics, this article outlines results of the related literature, the authors' research, and a specific post hoc analysis of a national sample that strongly suggests that much more needs to be done to ensure health providers effectively communicate health promotion messages without bias in at least five related communication domains. PMID:18166665
|Research has shown that social support is psychologically beneficial to cancerpatients, with support from families being especially important. A survey of the social support needs of 407 cancerpatients and an in-depth interview study of 55 of those patients were conducted to examine issues concerning family support and cancerpatients. Results…
Rebuilding and maintaining immunity is paramount to the success of cancer immunotherapy and hematopoietic stem cell transplantation. If immune surveillance indeed can protect from cancer, the very manifestation of malignancy means that the disease has prevailed over immunity. Yet, often, tumor–specific T cells can be found in cancerpatients irrespective of vaccination. Interestingly, patients suffering from malignancy often harbor unexpectedly high levels of immature CD14+HLA-DR? monocytes, although the abundance of CD4+ cells, CD8+ cells and CD4+CD25high cells may be normal. It is plausible that in cancer such cells suppress T cell function, analogous to CD14+HLA-DR? cells in sepsis and major trauma, in addition to their likely failure to re–present tumor-associated antigens once dendritic cells have initiated the T cell response. Recent evidence indicates that tumor–borne adenosine, lactate and hypoxia in the tumor environment may modulate tumor–specific immunity to a significant extent, but their effects on myeloid cell function is unclear. Thus, understanding and controlling these factors may appreciably impact the success of rebuilding and maintaining immunity in cancerpatients.
Although Wernicke encephalopathy has been reported in the oncological literature, only one terminally ill cancerpatient with Wernicke encephalopathy has been reported. Wernicke encephalopathy, a potentially reversible condition, may be unrecognized in terminally ill cancerpatients. In this communication, we report three terminally ill cancerpatients who developed Wernicke encephalopathy. Early recognition and subsequent treatment resulted in successful palliation of
The communication between medical students and cancer caregivers, and the problems they have experienced as well as the outcomes for their professional development before starting clinical practice was assessed in the context of a student research project. Data were collected by questionnaires or by 20 to 40-min long interviews with cancer caregivers. Their communications with physicians, hearing the bad news, and health service satisfaction were questioned. Therefore, the caregivers trusted the professional approach of their physician. However, they expected more empathic communication in the process of diagnosis and therapy. Development of empathy and trust-based communication between patients and physicians and enhancement of the quality of devoted time to cancerpatients and caregivers may have an effect on the course of disease. Interviewer students mentioned that they developed communication skills about difficult clinical tasks and in delivering bad news face to face to cancer caregivers before starting their clinical education. PMID:22733617
Atasoy, Beste M; Sarikaya, Ozlem; Kuscu, M Kemal; Yondem, Merve; Buyukkara, Elif; Eken, E Gokcen; Kahyaoglu, Figen
Racial disparities have been found in the use of chemotherapy as cancer treatment. These disparities may be, in part, due to well-documented differences in the quality of communication during clinical interactions with oncologists and Black versus White patients. In this study using a community-based participatory research approach, academic researchers, community members, and oncologists formed a partnership to develop a communication intervention to address racial disparities in cancer care. Partners developed a question prompt list (QPL), a simple tool that can be used to improve communication, and thus treatment, during clinical interactions in which oncologists and Black patients discuss chemotherapy. Partners endorsed the use of a QPL, provided specific suggestions for content and format, conducted and analyzed qualitative interviews with Black patients receiving chemotherapy, and approved the final version. The feasibility and effectiveness of the QPL that resulted from this research process are currently under evaluation in a separate study. PMID:23440665
Eggly, Susan; Tkatch, Rifky; Penner, Louis A; Mabunda, Lorna; Hudson, Janella; Chapman, Robert; Griggs, Jennifer J; Brown, Richard; Albrecht, Terrance
Background: Teamwork and good communication are essential to providing high-quality care. Methods: We examined clinician perspectives on clinician-to-clinician communication in the context of pediatric patient safety using 90-minute focus groups comprising representatives from varied clinician groups (physicians, nurses, pharmacists) in the five Chicago area hospitals of the Pediatric Patient Safety Consortium. Using a standardized protocol, we asked participants to address
Donna M. Woods; Jane L. Holl; Denise Angst; Susan C. Echiverri; Daniel Johnson; David F. Soglin; Gopal Srinivasan; Julia Barnathan; Laura Amsden; Lenny Lamkin; Kevin B. Weiss
|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
As cancer is the leading cause of death worldwide, every nurse will be required to care for patients with the condition at some point in his/her career. However, non-specialized oncology nurses are often ill-prepared to nurse patients suffering from cancer. This literature review aims to provide an overview of current trends and developments in cancer care nursing in an attempt to identify the range of previous research pertaining to caring for patients with cancer on non-specialist wards. The review finds that non-specialized cancer nurses report a lack of education and training with regard to cancer care and cancer treatments, which acts as a barrier to providing quality nursing care. Emotional and communication issues with patients and their families can also cause non-specialist nurses significant distress. International research has shown that specialist oncology nurses make a considerable difference to physical and psychosocial patient care. It is therefore paramount that non-speciality nurses' educational needs are met to develop clinical competence and to provide supportive holistic care for both patients and their families. PMID:20622795
This study examined the ways in which health care providers (general practitioners and specialists) and patientscommunicate 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
Purpose: The results of epidemiological studies on diet and cancer are often difficult to interpret on an individual level and may influence patients’ beliefs, attitudes and behaviour. This study investigated the behaviour of breast cancerpatients and their attitudes to dietary changes and the need of dietary advice during their disease.Patients and methods: The study population consisted of breast cancer
EK Salminen; HK Lagström; SP Heikkilä; SJ Salminen
The clinical and para-clinical examination of residual self-consciousness in non-communicative severely brain damaged patients (i.e., coma, vegetative state and minimally conscious state) remains exceptionally challenging. Passive presentation of the patient’s own name and own face are known to be effective attention-grabbing stimuli when clinically assessing consciousness at the patient’s bedside. Event-related potential and functional neuroimaging studies using such self-referential stimuli
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...
The accumulation of national epidemiological data since the late 1990s has led to the adoption of evidence-based guidelines for breast cancer screening in Lebanon (2006). Almost 50% of breast cancerpatients in Lebanon are below the age of 50 years and the age-adjusted incidence rate is estimated at 69 new cases per 100,000 per year (2004). This official notification calls for breast self-examination (BSE) every month starting age 20, and a clinical breast examination (CBE) performed by a physician every three years between the ages of 20 and 40 years. Starting age 40, and for as long as a woman is in good health, an annual CBE and mammography are recommended. Women with known genetic family history of breast cancer should start screening 10 years earlier than the first young patient in the family, or earlier depending on medical advice. The Breast Cancer National Task Force (BCNTF) recommends certification of mammography centers and continued training of personnel to assure high quality mammograms, and to minimize unnecessary investigations and surgeries.It recommends that a national program should record call-backs of women for annual screening and follow-up data on abnormal mammograms. BCNTF encourages the adoption of these guidelines and monitoring of their results, as well as follow-up of breast cancer epidemiology and registry in Lebanon, and scientific progress in early breast cancer detection to determine needs for modifications in the future. PMID:19623881
The "How to Talk to Your Doctor" community education forums operate under the assumption that information exchange and consumer involvement in healthcare can empower communities in need. We report on the development and preliminary evaluation of this community-based intervention designed to activate and enhance patients' communicative abilities in the medical encounter. We review evidence supporting the feasibility of and benefits that can be expected from improving patients' communication competency. Our intervention is simple and flexible so, therefore, can be portable to a large number of communities. Our preliminary evaluation suggests that the intervention is well-received and produces improved self-perceptions of communication competence across diverse settings and participants. We describe our intervention and its development and dissemination as a model for improving patients' communicative abilities through a community-based, active learner approach. By sharing our experiences, the barriers we encountered, and our ongoing efforts to improve patientcommunication in the medical encounter, we hope to empower patients to communicate better with their physicians. PMID:14729298
Tran, Anh N; Haidet, Paul; Street, Richard L; O'Malley, Kimberly J; Martin, Frank; Ashton, Carol M
Thromboembolic events are common among patients with cancer as a consequence of cancer- and treatment-related factors. As these events are the second most frequent cause of death in this population, their prevention and treatment are important. Venous ultrasonography is the technique of choice for diagnosis, with sensitivity and specificity above 95 % in symptomatic thrombosis. Routine prophylaxis is not recommended for ambulatory patients, although it could be useful in selected cases. On the other hand, all inpatients should receive prophylactic therapy unless contraindicated. Therapy of thromboembolic disease is based on anticoagulants. Clinical trials demonstrate that the use of low-weight heparins is associated with a lower incidence of bleeding and recurrent thrombosis as compared with non-fractionated heparin or warfarin. Options for recurrent thrombosis include change to another anticoagulant agent, increasing doses of the same agent and cava filters. PMID:23430009
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
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.
Constipation is a frequent, distressing, and underestimated complication in patients with advanced cancer. It may develop from general disturbances that may or may not be cancer related, but the use of opioids is one of the main causes in this population. Opioids affect the intestine by reducing motility and secretions and by increasing fluid absorption and blood flow. Untreated constipation may lead to several complications. Effective management of constipation starts with a careful assessment of the patient, including the history of the frequency and difficulty of defaecation, symptoms caused by constipation, and physical and rectal examinations. When the diagnosis of constipation is unclear, an abdominal X-ray may be required. The treatment of constipation includes general interventions, such as the availability of comfort and privacy or the elimination of medical factors that may contribute to constipation, and therapeutic interventions including oral or rectal laxatives and the use of prokinetic drugs and naloxone. The purpose of this paper is to review the pathophysiology and causes of constipation and the effects of opioids on the gastrointestinal tract, and to propose an approach for its assessment and management. Randomized clinical trials between different laxatives and/or prokinetic agents in cancerpatients are needed, and future studies should focus on the validation of different clinical assessment tools for constipation. PMID:9695203
The objective of this study was to determine emergency department (ED) patient's understanding of common medical terms used by health care providers (HCP). Consecutive patients over 18 years of age having nonurgent conditions were recruited from the EDs of an urban and a suburban hospital between the hours of 7 a.m. and 11 p.m. Patients were asked whether six pairs
E. Brooke Lerner; Dietrich V. K. Jehle; David M. Janicke; Ronald M. Moscati
Psychiatric inpatients were randomly assigned to a medication-related communication skills program or to a control condition that consisted of a medication education program. The medication communication program emphasized learning to ask physicians questions about medications, to describe current problems, and to make relevant requests. Although patients in both groups improved their knowledge of medications, the medication communication skills program had
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 with patients include the use of videotapes, videotape modeling or cartoon illustrations. Do these products communicate effectively because they overcome illiteracy or because they also transmit a very clear message? Can good transmission of messages overcome illiteracy? In this study, we compared the effectiveness of a printed message about polio vaccinations with the same message converted into a production of animated cartoons using marketing and advertising techniques. The production that resulted from using this strategy showed that in the setting of this study, a well-designed animated cartoon is more effective in delivering a message than the same information provided in written instructional materials. PMID:15150139
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
Purpose – The purpose of this paper is to examine changes in patients' satisfaction after their doctor has participated in a brief educational intervention on medicolegal risk management. Design\\/methodology\\/approach – Questionnaire completed by ambulatory patients, measuring satisfaction with their doctor's communication skills before and three months after the doctor participated in a three hour workshop on medicolegal risk management. 75
Stephen C. Trumble; Mark L. OBrien; Matthew OBrien; Bronwyn Hartwig
Oesophageal cancer (OC) is a debilitating disease with significant social, psychological and physical impacts on health and lifestyle (Mills and Sullivan, 2000). The research presented in this paper uses a survey method, and reveals that patients require honest communication and more help with everyday living from nurses to facilitate recovery. Each patient is unique but commonalities can be established that improve experience and outcome. Three themes emerged from the data: food, activity and positivity. To meet long-term needs, the Oesophageal Patients Association is fundamental for patients and carers in order adapt to this major life-changing event. PMID:17170688
BACKGROUND: Yoga has been practiced for thousands of years to improve physical and emotional well-being. Empirical research on yoga has been ongoing for several decades, including several recent studies conducted with cancerpatients and survivors. METHODS: This review provides a general introduction to yoga and a detailed review of yoga research in cancer. RESULTS: Nine studies conducted with cancerpatients
The Center for Epidemiological Studies Depression Scale (CES-D) is commonly used to measure depressive symptomatology in cancerpatients, yet there is little known about the psychometric properties of the measure when applied to a cancer population. The aim of this study was to examine the psychometric properties of the CES-D with cancerpatients. For purposes of comparison, the psychometric properties
The late health effects associated with radioiodine (131I) given as treatment for thyroid cancer are difficult to assess since the number of thyroid cancerpatients treated at each centre is limited. The risk of second primary malignancies (SPMs) was evaluated in a European cohort of thyroid cancerpatients. A common database was obtained by pooling the 2-year survivors of the
C Rubino; F de Vathaire; M E Dottorini; P Hall; C Schvartz; J E Couette; M G Dondon; M T Abbas; C Langlois; M Schlumberger
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
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
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.
Purpose Cancer treatments are complex, involving multiple clinicians, toxic therapies, and uncertain outcomes. Consequently, patients are vulnerable when breakdowns in care occur. This study explored cancerpatients' perceptions of preventable, harmful events; the impact of these events; and interactions with clinicians after such events. Patients and Methods In-depth telephone interviews were conducted with cancerpatients from three clinical sites. Patients were eligible if they believed: something “went wrong” during their cancer care; the event could have been prevented; and the event caused, or could have caused, significant harm. Interviews focused on patients' perceptions of the event, its impact, and clinicians' responses to the event. Results Ninety-three of 416 patients queried believed something had gone wrong in their care that was preventable and caused or could have caused harm. Seventy-eight patients completed interviews. Of those interviewed, 28% described a problem with medical care, such as a delay in diagnosis or treatment; 47% described a communication problem, including problems with information exchange or manner; and 24% described problems with both medical care and communication. Perceived harms included physical and emotional harm, disruption of life, effect on family members, damaged physician-patient relationship, and financial expense. Few clinicians initiated discussion of the problematic events. Most patients did not formally report their concerns. Conclusion Cancerpatients who believe they experienced a preventable, harmful event during their cancer diagnosis or care often do not formally report their concerns. Systems are needed to encourage patients to report such events and to help physicians and health care systems respond effectively.
Mazor, Kathleen M.; Roblin, Douglas W.; Greene, Sarah M.; Lemay, Celeste A.; Firneno, Cassandra L.; Calvi, Josephine; Prouty, Carolyn D.; Horner, Kathryn; Gallagher, Thomas H.
While patients with poor functional health literacy (FHL) have difficulties reading and comprehending written medical instructions, it is not known whether these patients also experience problems with other modes of communication, such as face-to-face encounters with primary care physicians. We enrolled 408 English- and Spanish-speaking diabetes patients to examine whether patients with inadequate FHL report worse communication than patients with
Dean Schillinger; Andrew Bindmana; Frances Wang; Anita Stewart; John Piette
While patients with poor functional health literacy (FHL) have difficulties reading and comprehending written medical instructions, it is not known whether these patients also experience problems with other modes of communication, such as face-to-face encounters with primary care physicians. We enrolled 408 English- and Spanish-speaking diabetes patients to examine whether patients with inadequate FHL report worse communication than patients with
Dean Schillinger; Andrew Bindman; Frances Wang; Anita Stewart; John Piette
Organ transplant recipients suffer from an increased incidence and recurrence rate of nonmelanoma skin cancers. These cancers are often more aggressive than those in the general population, resulting in significant morbidity and mortality. Often times, routine treatment modalities are not adequate and the use of different management strategies is necessary. Treatment modalities, including surgical excision, Mohs micrographic surgery, physically destructive modalities, topical therapy, and photodynamic therapy may be used. Combinations of these therapies may be used in rotation for treatment of extensive field disease. Chemoprophylaxis with oral retinoids and alteration of the immune suppression regimen may be indicated for specific cases. In addition, newly emerging therapies for squamous cell carcinomas including cetuximab and capecitabine may offer heightened control in organ transplant patients with significant cutaneous disease. PMID:24037934
|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
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
Cancer innovations, such as biobanking technologies, are continuously evolving to improve our understanding and knowledge about cancer prevention and treatment modalities. However, the public receives little communication about biobanking and is often unaware about this innovation until asked to donate biospecimens. It is the researchers’ ethical duty to provide clear communications about biobanking and biospecimen research. Such information allows the public to understand biobanking processes and facilitates informed decision making about biospecimen donation. The aims of this paper are 1) to examine the importance of clear communication as an ethical imperative when conveying information about cancer innovations and 2) to illustrate the use of an organizing framework, the CLEAN (Culture, Literacy, Education, Assessment, and Networking) Look approach for creating educational priming materials about the topic of biobanking.
Koskan, Alexis; Arevalo, Mariana; Gwede, Clement K.; Quinn, Gwendolyn P.; Noel-Thomas, Shalewa A.; Luque, John S.; Wells, Kristen J.; Meade, Cathy D.
AbstractObjective: To examine parents' communication with their children about the diagnosis and initial treatment of breast cancer in the mother.Design: Qualitative interview study within cross sectional cohort.Setting: Two breast cancer treatment centres.Participants: 32 women with stage I or stage II breast cancer with a total of 56 school aged children.Main outcome measures: Semistructured interview regarding timing and extent of communication
Effective physician patientcommunication is essential to best practice in medicine. Good communication with patients is critical in making the right diagnosis, improving compliance and overall outcomes for our patients (as well as improving physician satisfaction.) Communication skills can be learned and need to be taught, practiced and given the same emphasis as other core competencies in medicine. The focus of this article is on the Calgary-Cambridge Model for physician patientcommunication in the context of a medical interview. The beginning of a patient encounter is discussed, with emphasis on appropriate introductions and attentive active listening.
One way in which the psychosocial needs of cancerpatients can be addressed is through support groups, which are often recommended to patients by healthcare professionals. The present study aimed to assess the effectiveness of Gilda's Club in meeting the needs of cancerpatients during their first year of membership and whether their experience with this organization was a positive
|The following essays on communication are presented: communication as a condition of survival, communication for special purposes, the means of transmission of communication, communication within social and economic structures, the teaching of communication through the press, the teaching of modern languages, communication as a point of…
Breast cancerpatient advocacy groups emerged in the 1990s to support and empower women with breast cancer. Women with cancer and oncologists tend to have divergent perspectives on how breast cancer prevention should be defined and what the priorities for research should be. As their American counterparts have done, breast cancerpatient advocates in Canada are seeking greater participation in decision making with respect to research. To date they have had more input into research policy decisions than into the planning of specific projects. In 1993 the National Forum on Breast Cancer recommended that women with breast cancer should have more input into the research process; breast cancerpatient advocates will continue to actively pursue this objective.
The composition of the human intestinal microbiota is linked to health status. The aim was to analyze the microbiota of normal and colon cancerpatients 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
African American women suffer a disproportionately high 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 were conducted in North Carolina with 57 women (ages 18-49). Age, race (especially perceptions of cancer as a "White disease"), and lack of family history of breast cancer were all shown to contribute to women's perceptions of low breast cancer susceptibility. Perceptions of low risk were also attributed to conflicting risk information from family, media, and health providers. Women had little to no knowledge of breast cancer subtypes, and emphasized that health communications should be personally relevant, culturally appropriate, and convenient. These findings will assist in developing health communication tools that encourage prevention. PMID:23728042
Allicock, Marlyn; Graves, Neasha; Gray, Kathleen; Troester, Melissa A
The US health care system and its information access models are organized around institutions and providers. Patient-centered functionality is rarely present in prevailing information systems and, if present, it typically does not ideally support shared decision making about important treatment events. We sought to better understand the functional needs of providers and patients around the process of care plan decision making, and used this information to develop a prototype decision support tool, using women with newly diagnosed breast cancer as our clinical scenario. This paper describes the user-centered design process we undertook and the resulting prototype system, the Communication and Care Plan (CCP). PMID:20937486
On their first visit to the Regional Cancer Program, all patients are provided with the “Information for Patients and Families”\\u000a binder that was designed by an interdisciplinary cancerpatient education team. Patients were asked to complete a survey to\\u000a evaluate the usefulness of this binder. Timely delivery of the “Information for Patients and Families” binder validates a\\u000a higher level of
Denise Gauthier-Frohlick; Susan Boyko; Michael Conlon; Sheila Damore-Petingola; Nancy Lightfoot; Terry Mackenzie; Carole Mayer; Elaine Reed; Shawn Steggles
Over the past several years, the science of cancercommunication has been recognized as integral to the dissemination of cancer prevention and control strategies in both the general population as well as higher-risk groups. In this article we draw upon current literature and small group discussion in the 2008 Society for Behavioral Medicine Cancer Special Interest Group Pre-Conference Workshop on
Jennifer Hay; Julie N. Harris; Erika A. Waters; Margaret F. Clayton; Lee Ellington; Alexis D. Abernethy; Heather Prayor-Patterson
People often seek and receive cancer information from mass media (including television, radio, print media, and the Internet), and marketing strategies often inform cancer information needs assessment, message development, and channel selection. In this article, we present the discussion of a 2-hour working group convened for a cancercommunications workshop held at the 2008 Society of Behavioral Medicine meeting in
Peggy Hannon; Gareth P. Lloyd; K. Viswanath; Tenbroeck Smith; Karen Basen-Engquist; Sally W. Vernon; Gina Turner; Bradford W. Hesse; Corinne Crammer; Christian von Wagner; Cathy L. Backinger
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
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
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
A new approach to the discovery of cancer therapeutics is emerging that begins with the cancerpatient. Genomic analysis of primary tumors is providing an unprecedented molecular characterization of the disease. The next step requires relating the genetic features of cancers to acquired gene and pathway dependencies and identifying small-molecule therapeutics that target them.
We examined effects of sensory self-monitoring and reporting Coaching on pain-related variables in patients with lung cancer. Randomly assigned to Coached or Not-Coached groups, 215 patients had their interactions with their providers audiotaped and completed study measures pre and post intervention. Of the 151 patients who completed the 4-week study, those Coached were more likely than those Not-Coached to give their providers unsolicited sensory pain information and to mention it before their providers asked for it. The mean number of pain parameters discussed during the audiotaped clinic visit was statistically larger at study-end for the Coached group. Scores for analgesic adequacy, all pain indices except one, anxiety, depression, and catastrophizing coping were not significantly different. Although Coaching increased the amount of pain data communicated to providers by patients with lung cancer, the magnitude was small and did not lead to improved adequacy of analgesics prescribed for each patient's pain level.
Motor-independent communication is a novel diagnostic and therapeutic method that is currently in development in order to enable communication with severely physically challenged patients. Some patients with locked-in syndromes or with chronic disorders of consciousness are capable of modulating their brain activities to such a degree that the latter can be analyzed regarding communicative intentions with neuroscientific technologies, such as functional magnetic resonance imaging. Further scientific development and an increasing clinical use of motor-independent communication will aid in meeting essential quality standards for this method. In particular, the requirements need to be clarified under which the method may be utilized to support the patients' autonomy by enabling them to make their own decisions about therapeutic interventions. Communication mediated by technology promises to significantly improve the quality of life for severely physically challenged patients. PMID:24081276
Synchronous or metachronous occurrences of both prostate cancer and male breast cancer are rarely reported, but provide insight into their hormonal and genetic biology. We sought to determine the incidence of prostate cancer in male breast cancerpatients at our institution, and to examine estrogen receptor (ER), progesterone receptor (PR) and HER-2\\/neu receptor (HR) status in these patients. A retrospective
Patients with degenerative dementia often show language disorders, but little is known about their verbal (VC) and non-verbal communication (NVC). Our aim was to analyse VC and NVC in patients with standard criteria of mild-moderately severe dementia (MMSE ?14/30) resulting from Alzheimer's disease (AD; 29 cases), behavioural variant of frontotemporal dementia (FTD; 16), or dementia with Lewy bodies (DLB; 13). We used the Lille Communication Test, which addresses three domains: participation in communication (PC: greeting, attention, participation), VC (verbal comprehension, speech outflow, intelligibility, word production, syntax, verbal pragmatics and verbal feedback), and NVC (understanding gestures, affective expressivity, producing gestures, pragmatics and feedback). Patients were compared with 47 matching control subjects. AD patients were partially impaired (p?0.01) in PC (greeting), and more definitely in VC, especially by verbal comprehension and word finding difficulties and to a much lesser degree in verbal pragmatics (responding to open questions, presenting new information), while NVC was mostly preserved. FTD patients were severely impaired in PC. VC difficulties were related to lexical-semantic, syntactic and more specifically pragmatic problems. NVC was impaired by difficulties in affective expressivity, pragmatics and feedback management. DLB patients showed modest difficulties with VC. PC, VC and NVC strongly correlated with performance in the dementia rating scale. In conclusion, the profile of communication difficulties was quite different between groups. FTD patients showed most severe difficulties in PC and verbal and non-verbal pragmatics, in relation to their frontal lesions. AD patients had prominent impairment of lexical-semantic operations. PMID:20888846
Rousseaux, Marc; Sève, Amandine; Vallet, Marion; Pasquier, Florence; Mackowiak-Cordoliani, Marie Anne
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
Contents: Psychosocial adjustment to pediatric and adolescent cancer; Social functioning of families and pediatric cancerpatients; Psychosocial effects of therapy on pediatric cancerpatients; Neuroendocrinological effects of therapy on pediatric cancer ...
Poor patient–provider interactions may play a role in explaining racial disparities in the quality and outcomes of HIV care in the United States. We analyzed 354 patient–provider encounters coded with the Roter Interaction Analysis System across four HIV care sites in the United States to explore possible racial differences in patient–provider communication. Providers were more verbally dominant in conversations with black as compared to white patients. This was largely due to black patients’ talking less than white patients. There was no association between race and other measures of communication. Black and white patients rated their providers’ communication similarly. Efforts to more effectively engage patients in the medical dialogue may lead to improved patient–provider relationships, self-management, and outcomes among black people living with HIV/AIDS.
Saha, Somnath; Korthuis, P. Todd; Sharp, Victoria; Cohn, Jonathon; Wilson, Ira B.; Eggly, Susan; Cooper, Lisa A.; Roter, Debra; Sankar, Andrea; Moore, Richard
Efforts to improve the quality of end-of-life decision-making have emphasized the principle of individual autonomy to better ensure that patients receive care consistent with their preferences. Advance directives (ADs) can be vehicles for in-depth and ongoing discussions among health care professionals, patients, and families. The aim of our study was to identify preferences and values expressed in ADs of 50 elderly patients with cancer. Main concerns of the patients were resuscitation and introduction of artificial nutrition. Very few patients had unrealistic expectation. Preferences about patient's symptom management were quite different from one to another. Content of ADs not only involved life-sustaining technology, but also psychosocial items and religious beliefs and values. All patients designated at least one surrogate. In conclusion, ADs should not be considered simply as another questionnaire, but more as a process to improve communication. PMID:19446467
Pautex, Sophie; Notaridis, Grigorios; Déramé, Laurence; Zulian, Gilbert B
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 cancerpatients; Immunological aspects of supportive care of cancerpatients; Nutritional evaluation and support of cancerpatients; Pain management of cancerpatients.
Non-AIDS-defining cancers are a rising health concern among HIV-infected patients. Cancer screening is now an important component of health maintenance in HIV clinical practice. The decision to screen an HIV-infected patient for cancer should include an assessment of individualized risk for the particular cancer, life expectancy, and the harms and benefits associated with the screening test and its potential outcome. HIV-infected patients are at enhanced risk of several cancers compared to the general population; anal cancer, hepatocellular carcinoma, Hodgkin's lymphoma, and lung cancer all have good evidence demonstrating an enhanced risk in HIV-infected persons. A number of cancer screening interventions have shown benefit for specific cancers in the general population, but data on the application of these tests to HIV-infected persons are limited. Here we review the epidemiology and background literature relating to cancer screening interventions in HIV-infected persons. We then use these data to inform a conceptual model for evaluating HIV-infected patients for cancer screening. PMID:21695529
In 2008, the International Agency for Research on Cancer (IARC) released its World Cancer Report, which indicated that cancer accounts for approximately 12% of all-cause mortality worldwide. IARC estimated that globally 7.6 million people died from cancer and that 12.4 million new cases were diagnosed in 2008. The report went on to project that, due to increases in life expectancy, improvements in clinical diagnostics, and shifting trends in health behaviors (e.g. increases in smoking and sedentary lifestyles), in the absence of significant efforts to improve global cancer control, cancer mortality could increase to 12.9 million and cancer incidence to 20 million by the year 2030. Looking deeper into the data, it becomes clear that cancer-related stigma and myths about cancer are important problems that must be addressed, although different from a country to another. Stigmas about cancer present significant challenges to cancer control: stigma can have a silencing effect, whereby efforts to increase cancer awareness are negatively affected. The social, emotional, and financial devastation that all too often accompanies a diagnosis of cancer is, in large part, due to the cultural myths and taboos surrounding the disease. Combating stigma, myths, taboos, and overcoming silence will play important roles in changing this provisional trajectory. There are several reasons that cancer is stigmatized. Many people in our area perceived cancer to be a fatal disease. Cancer symptoms or body parts affected by the disease can cultivate stigma. Fears about treatment can also fuel stigma. There was evidence of myths associated with cancer, such as the belief that cancer is contagious, or cancer may be seen as a punishment. After reviewing these different examples of cultural myths and taboos met in cancer care, we can report these lessons learned: 1. Around the world, cancer continues to carry a significant amount of stigma, myths, and taboos; however, there are opportunities to capitalize upon shifting perceptions and positive change. 2. Awareness of cancer prevention, early detection, treatment, and survival are on the rise; however, too many people still report that they feel uninformed when it comes to cancer. 3. Communication is critical to decreasing cancer-related stigma, raising cancer awareness, and disseminating cancer education. People with a personal history of cancer-especially well-known or celebrity survivors-and multiple mass media channels are key resources for dissemination. 4. The school system represents a potential venue for cancer education, and increasing cancer awareness among children may be an investment with high returns. 5. When facing cancer, people around the world want information and emotional support for themselves and their families. 6. Tobacco use and poor nutrition are widely acknowledged as cancer risks. Programs and policies that help people translate this awareness into action are needed. The global cancer community should capitalize upon positive shifts in attitudes about awareness of cancer and leverage these shifts to develop, and disseminate effective media campaigns and behavioral interventions to decrease the incidence of and morbidity and mortality associated with cancer. PMID:22628419
Individual differences in cognitive style, specifically need for cognition (NFC), may play an important role in facilitating communication and psychosocial adjustment to cancer during the presurgical period, a time marked by distress and the need to process disease-related information. This study examines the relations between NFC, adjustment, and communication in 106 prostate cancerpatients and their partners within 2 weeks prior to radical prostatectomy. High NFC was significantly associated with better psychological adjustment for partners only, whereas for patients, communication with the medical team played a more important role. High NFC patients who were partnered with high NFC partners reported better dyadic communication compared with those who were partnered with low NFC partners. This study indicates that predictors of adjustment may differ for patients and partners, who are likely differentially affected by the disease process. PMID:17360313
Oh, Sindy; Meyerowitz, Beth E; Perez, Martin A; Thornton, Andrea A
Ninety-nine cancerpatients underwent PEG placement attempt at Rosewell Park Cancer Institute between January 1, 1985, and December 1, 1987. Ninety-eight of these were successful and were retrospectively reviewed to determine if cancerpatients constitute a high-risk group for PEG placement. Procedure-related mortality was 2% and morbidity was 19%. Morbidity of 17% was noted at less than 30 days and
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
Thyroid function has been assessed in 40 patients with breast cancer and compared with an age-matched control female population. The free thyroxine index was lower and the level of thyroid-stimulating hormone in the serum higher in the cancer group and these changes became more marked at 6 months. It is concluded that patients with breast cancer show more evidence of hypothyroidism as time progresses.
A prospective study was designed to investigate the factors predicting fatigue in breast cancerpatients using the Cancer Fatigue Scale (CFS) in addition to the Hospital Anxiety and Depression Scale (HADS) and a questionnaire containing items on demographic and clinical data, and measures of patients' physical symptoms. The CFS measures total fatigue score ranging from 0 (lowest level) to 60
Shahpar Haghighat; Mohammad Esmail Akbari; Kourosh Holakouei; Abbas Rahimi; Ali Montazeri
The studies were conducted to (a) explain the doctor-patient relationship and communication in Chinese cultural context, and (b) investigate the differences and similarities in doctors' communication styles, patient autonomy, patient satisfaction and their relations across two cultures. ^ Study One is a qualitative exploration on doctor-patientcommunication in China using cultural centered approach. Twenty six participants from different cities and
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 activation to improve cancer treatment. Methods/Design The Rochester Patient Navigation Research Program (PNRP) is a National Cancer Institute-sponsored, patient-level randomized trial (RCT) of patient navigation and activation, targeting newly-diagnosed breast and colorectal cancerpatients in Rochester, NY. The goal of the program is to decrease cancer health disparities by addressing barriers to receipt of cancer care and promoting patient self-efficacy. The intervention uses trained, paraprofessional patient navigators recruited from the target community, and a detailed training and supervisory program. Recruited patients are randomly assigned to receive either usual care (except for baseline and follow-up questionnaires and interviews) or intervention. The intervention patients receive tailored assistance from their patient navigators, including phone calls, in-person meetings, and behind-the-scenes coordination of care. A total of 344 patients have been recruited. Outcomes measured at three month intervals include timeliness of care, patient adherence, patient satisfaction, quality of life, self-efficacy, health literacy, and cancer knowledge. Discussion This unique intervention combining patient navigation and patient activation is designed to address the multifactorial problem of cancer health disparities. If successful, this study will affect the design and implementation of patient navigation programs. Trials Registration clinicaltrials.gov identifier NCT00496678
PURPOSE We wanted to determine patients’ willingness to take preventive cardiovascular disease (CVD) medication in relation to their 5-year CVD risk score and modes of communicating benefits of therapy. METHODS Study participants were 934 consecutive patients drawn from family practitioners’ waiting rooms in Auckland, New Zealand, who knew their 5-year CVD risk (ranging from 5% to 30%) and who completed a questionnaire asking them to rate how much various modes of communicating the benefits of therapy would encourage them to take medication daily, where the benefits from medication were proportional to their estimated CVD risk score. RESULTS Patients’ rankings for modes of communicating the benefits of therapy were little influenced by sex, age, ethnicity, numeracy score, 5-year CVD risk, or concern about a heart attack. Patients clearly found relative risk reduction most encouraging, with absolute risk reduction rated second overall and numbers needed to treat the least likely to be persuasive, although preferences covered the full range and were not predictable from demographic or 5-year CVD risk data. Pictures were preferred to numbers by 55.1%, with a people-chart or a bar chart being equally favored. Even so, 61.8% preferred a doctor’s opinion to any presentation by numbers or pictures. CONCLUSIONS Patients’ willingness to take preventive cardiovascular medication depends more on mode of communicating treatment benefit than on their short-term CVD risk score or their level of concern about a future cardiovascular event. Because individual preferences were not predictable, more than 1 modality is likely to be clinically useful for each patient.
Goodyear-Smith, Felicity; Kenealy, Timothy; Wells, Susan; Arroll, Bruce; Horsburgh, Margaret
This paper draws upon data from my doctoral studies and uses poststructuralism as a methodology to provide a way of seeing and understanding cancerpatients' complex experience of their bodies. Cancerpatients were massaged for the purpose of this study and the themes addressed in this article are linked to the sexuality of the person being massaged and the masseuse (PVDR). In order to capture the richness of the cancerpatients' experience, the data are presented in an unconventional way--in the form of poetry. The poems show that the damaged bodies of cancerpatients are still sexual in nature. In this research, the body of the cancerpatient is a discursive one inscribed with power, culture, society and history. There are also themes of managing the body, altered embodiments of femininity, altered embodiments of masculinity, intimacy, and speaking the unspeakable. PMID:10188486
Although the triadic encounter of physician, patient, and an accompanying family member is a common phenomenon in geriatrics, previous research on the communication in medical encounters has primarily focused on dyadic interactions between physician and patient. This study aimed to explore the triadic communication and communication roles of patient companions in Japanese geriatric encounters.Among elderly patients aged 65 or over
Hirono Ishikawa; Debra L. Roter; Yoshihiko Yamazaki; Tomoko Takayama
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.
The current concepts, recommendations, and principles of sperm banking as it pertains to the comprehensive care of young men of reproductive age with cancer are reviewed. Obstacles to sperm banking are addressed as well as future directions for fertility-preserving technologies. All cancer therapies—chemotherapy, radiation, and surgery—are potential threats to a man’s reproductive potential. In addition, cancer itself can impair spermatogenesis. Thus, sperm cryopreservation prior to initiating life-saving cancer treatment offers men and their families the best chance to father biologically related children and should be offered to all men with cancer before treatment. Better patient and provider education, as well as deliberate, coordinated strategies at comprehensive cancer care centers are necessary to make fertility preservation for male cancerpatients a priority during pretreatment planning.
Utilization of colorectal cancer screening tests is suboptimal. Knowledge of colorectal cancer screening has been associated with completion of screening. Thus, increasing awareness of colorectal cancer screening may lead to significant improvements in screening rates. We assessed for the association among provider–patient interaction, information-seeking patterns, sources of information, trust in cancer information, and Internet usage on colorectal cancer screening behavior
Background Elderly population is on rise. It is an ethical dilemma how aggressive one should be when it comes to treat cancer in elderly. Presumed fear of increased postoperative morbidity and mortality has resulted in delivery of sub-optimal cancer surgery. Methods In this review article we visit physiology of the aged, tools available to assess surgical risks in oncogeriatric patients, and current practice in the management of common cancers encountered in surgical oncology, with the view of increasing awareness on optimising surgical management of senior patients with cancer. A pubmed search for cancer, surgery, elderly, was carried out. Results Cancer is on rise with increasing age predominantly affecting breast, gastrointestinal tract and lung. Increasingly more surgeons are offering surgery to elderly cancerpatient but selection bias is prevalent. Available data reflect short and long-term outcome of cancer surgery in elderly is not greatly different to that of younger patient. Declining physiological reserve along with inability to respond adequately to physiological stress are salient age related changes. Comprehensive Geriatric Assessment (CGA) is not tested in surgical patient. There is need for a tool to define individualised operative risk. Preoperative assessment of cancer in elderly is designed to offer this information based on functional status of an individual utilising currently available tools of risk assessment. Conclusion All elderly cancerpatients should be offered optimal treatment depending on their functional status not on chronological age. Oncogeriatric patient would benefit from dedicated multidisciplinary approach. Recruitment of elderly cancerpatients to more clinical trials is needed to enhance our knowledge and to offer optimum treatment to this unique subgroup.
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/patientcommunication 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/patientcommunication. 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
Impaired and dysfunctional communication, which has been recognized as a major contributor to medical error, has received little attention as healthcare professionals focus on improving patient safety. In this landmark conference, the National Patient Saf...
... M. Bach, MD/Robert J. Motzer, MD/Memorial Sloan-Kettering Cancer Center Testicles Primary Cancer Site CROSS ... M. Torpy, MD, Writer Cassio Lynm, MA, Illustrator Richard M. Glass, MD, Editor 718 JAMA, February 13, ...
The paper presents current news on the possibilities of conducting rehabilitation of patients suffering from lung cancer. It presents the principles of conducting and contraindications for pulmonary rehabilitation for these patients according to current guidelines of American College of Sport Medicine. The methods of measuring exercise capacity for patients with lung cancer have been discussed. The value of ergospirometrial test with maximum oxygen consumption (VO(2peak)) in predicting not only the survival of patients with lung cancer, but also assessing the possibility of pulmonary rehabilitation programs has been highlighted. In the part devoted to physical training for patients before a surgery for lung cancer, current research results have been presented- these show that even a short, high intensity program of pulmonary rehabilitation for patients with lung cancer before surgery is effective and increases the safety of both- the safety of the surgery and extends survival time after operation for lung cancer. The paper describes difficulties in the implementation of rehabilitation programs after surgery conducted on patients with lung cancer resulting from dysfunction of cardiovascular and muscle atrophy - both skeletal and respiratory. The issue of patients with inoperable lung cancer treated with chemotherapy has been discussed so far in only one paper published in 2007. The results shown in it have been discussed as well. The authors demonstrated a significant improvement in the efficiency of respiratory-circulatory system assessed by six-minute walk test, although the rehabilitation program was graduated by small number of patients (44%). It was noted that patients with inoperable lung cancer now account for a large group of patients who use this type of medical intervention and can significantly improve the quality of life and the method shows positive impact on the survival rate. PMID:23109207
Introduction: The study of survival of cancerpatients is essential for monitoring the effectiveness of cancer control. The previous monograph describing cancerpatient survival in Finland was published by the Finnish Cancer Registry in 1981 and covered patients diagnosed in 1953-1974. This new supplement assesses cancerpatient survival up to the year 1995. Material and methods: The study includes over
Paul W. Dickman; Timo Hakulinen; Tapio Luostarinen; Eero Pukkala; Risto Sankila; Bengt Soderman; Lyly Teppo
Daytime plasma melatonin values were measured by radioimmune assay in 86 patients with breast cancer; 280 assays were done and compared with the clinical status of the patients. Patients in the advanced disease group had significantly higher levels than those in the adjuvant treatment group, and patients with progressive disease had significantly higher values than those in remission or with
Geoffrey Falkson; Hentirè C. Falkson; Maria E. Steyn; Bernardo L. Rapoport; Bern J. Meyer
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
Purpose: There is no consensus on how best to communicate risk in breast cancer genetic counseling. We studied risk communication in completed series of counseling visits and assessed associations with counselees' postcounseling risk perception and satisfaction. Methods: Pre- and postcounseling questionnaires and videorecordings of all visits were available for 51 affected and unaffected women from families with no known BRCA1\\/2
Arwen H. Pieterse; Sandra van Dulmen; Sandra van Dijk; Jozien M. Bensing; Margreet G. E. M. Ausems
Fall prevention for hospitalized patients is an important nursing quality indicator. Current studies do not describe characteristics of hospitalized patients with cancer who fall, although these patients have been noted to have higher fall and injury rates. This descriptive study represents an initial attempt to identify characteristics of patients hospitalized with cancer who fall compared with adult medical-surgical hospitalized patients who fall. We found that many characteristics of our sample were similar to those of other patients who had experienced a fall during their hospitalization. PMID:20177392
Capone, Luann J; Albert, Nancy M; Bena, James F; Morrison, Shannon M
Fall prevention for hospitalized patients is an important nursing quality indicator. Current studies do not describe characteristics of hospitalized patients with cancer who fall, although these patients have been noted to have higher fall and injury rates. This descriptive study represents an initial attempt to identify characteristics of patients hospitalized with cancer who fall compared with adult medical-surgical hospitalized patients who fall. We found that many characteristics of our sample were similar to those of other patients who had experienced a fall during their hospitalization. PMID:20516815
Capone, Luann J; Albert, Nancy M; Bena, James F; Morrison, Shannon M
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
During the last years several interfaces have been developed to allow communication to those patients suffering serious physical disabilities. In this work, a computer based communication interface is presented. It was designed to allow communication to those patients that cannot use neither their hands nor their voice but they can do it through their eyes. The system monitors the eyes movements by means of a webcam. Then, by means of an Artificial Neural Network, the system allows the identification of specified position on the screen through the identification of the eyes positions. This way the user can control a virtual keyboard on a screen that allows him to write and browse the system and enables him to send e-mails, SMS, activate video/music programs and control environmental devices. A patient was simulated to evaluate the versatility of the system. Its operation was satisfactory and it allowed the evaluation of the system potential. The development of this system requires low cost elements that are easily found in the market.
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
Cancerpatient navigation (PN) programs have been shown to increase access to and utilization of cancer care for poor and underserved individuals. Despite mounting evidence of its value, cancerpatient navigation is not universally understood or provided. We describe five PN programs and the range of tasks their navigators provide across the cancer care continuum (education and outreach, screening, diagnosis and staging, treatment, survivorship, and end-of-life). Tasks are organized by their potential to make cancer services understandable, available, accessible, affordable, appropriate, and accountable. Although navigators perform similar tasks across the five programs, their specific approaches reflect differences in community culture, context, program setting, and funding. Task lists can inform the development of programs, job descriptions, training, and evaluation. They also may be useful in the move to certify navigators and establish mechanisms for reimbursement for navigation services.
Braun, Kathryn L.; Kagawa-Singer, Marjorie; Holden, Alan E. C.; Burhansstipanov, Linda; Tran, Jacqueline H.; Seals, Brenda F.; Corbie-Smith, Giselle; Tsark, JoAnn U.; Harjo, Lisa; Foo, Mary Anne; Ramirez, Amelie G.
The objective of this study was to discover whether suicide mortality among patients diagnosed with cancer during the period 1985-1999 had decreased with calendar time in comparison to the rate in the general population. 90?197 cancerpatients resident in Tuscany, Central Italy and incident during the period 1985-1999 were followed up for life status to 31 December 2000. The mortality codes for suicide were considered (E950-E959). Time trends for suicide rates were assessed by using Kernel smoothing estimators, standardised mortality ratios and Poisson analysis of the observed/expected ratios. The standardised mortality ratios were 324, 224, and 185 for cancerpatients diagnosed during the periods 1985-1989, 1990-1994, and 1995-1999, respectively. Tests for linear trends were borderline significant (P=0.053). Suicide mortality among cancerpatients in central Italy had decreased with calendar time relative to the suicide trend in the general population. Improved treatment options and better communication of diagnosis are possible explanations of this finding. PMID:15093582
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
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. [J Nurs Educ. 2013;52(11):645-648.]. PMID:24127180
The purpose of this study was to describe characteristics of cancerpatients who were attending Internet Cancer Support Groups (ICSGs) and to provide direction for future research. A total of 204 cancerpatients were recruited through ICSGs by posting the study announcement on the websites of the ICSGs. The participants were asked to fill out Internet survey questionnaires on sociodemographic characteristics and health/disease status. The data were analyzed using descriptive and inferential statistics including t-tests, ANOVA, and chi-square tests. Findings indicate that cancerpatients recruited through the ICSGs tended to be middle-aged, well-educated, female and middle class. The findings also indicate that there were significant differences in some characteristics according to gender and ethnicity. Based on the findings, some implications are suggested for future research using and developing the ICSGs.
Im, Eun-Ok; Chee, Wonshik; Liu, Yi; Lim, Hyun Ju; Guevara, Enrique; Tsai, Hsiu-Min; Clark, Maresha; Bender, Melinda; Shin, Hyunjeong; Kim, Kyung Suk; Kim, Young Hee
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
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…
|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…
Breast cancer in elderly patients (70+) is a major health problem that will only increase in the future. Besides adequate local treatment and hormone therapy, there can be an indication for chemotherapy in this patient group. Due to concerns of excessive toxicity, there is often a defeatist attitude towards chemotherapy in elderly patients. As taxanes are considered to be the
More than half of all cancerpatients now use some form of complementary\\/alternative medicine, yet the majority of these patients do not disclose this use to their physicians. Health care practitioners need to educate themselves about the complementary\\/alternative medicine products their patients are using. Eight herbal products (astragalus, essiac, Asian ginseng, Siberian ginseng, green tea, garlic, Hoxsey formula and iscador)
The purpose of this study was to investigate the feasibility of an exercise program patterned after a phase II cardiac rehabilitation program to positively influence selected physiological and psychological parameters of health in patients with cancer.
... endometrial cancer was published in the October 2, 2002, issue; one on cancer chemotherapy was published in the June 11, 2008, issue; and one on carcinoma of the cervix was published in the November 21, 2007, issue. Janet M. Torpy, MD, Writer ...
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.
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 demands, obligations, and preparatory activities involved in discussing their cancer, we theorized the construct of communication work, which focuses on the labor and resources devoted to managing talk during cancer and living with illness. Findings are discussed in terms of how this conceptualization presents new opportunities for research and practice. PMID:22168391
Donovan-Kicken, Erin; Tollison, Andrew C; Goins, Elizabeth S
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-patientcommunication 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 patientcommunication 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
Background Currently the majority of cancerpatients are considered ineligible for intensive care treatment and oncologists are struggling to get their patients admitted to intensive care units. Critical care and oncology are frequently two separate worlds that communicate rarely and thus do not share novel developments in their fields. However, cancer medicine is rapidly improving and cancer is eventually becoming a chronic disease. Oncology is therefore characterized by a growing number of older and medically unfit patients that receive numerous novel drug classes with unexpected side effects. Discussion All of these changes will generate more medically challenging patients in acute distress that need to be considered for intensive care. An intense exchange between intensivists, oncologists, psychologists and palliative care specialists is warranted to communicate the developments in each field in order to improve triage and patient treatment. Here, we argue that "critical care of cancerpatients" needs to be recognized as a medical subspecialty and that there is an urgent need to develop it systematically. Conclusion As prognosis of cancer improves, novel therapeutic concepts are being introduced and more and more older cancerpatients receive full treatment the number of acutely ill patients is growing significantly. This development a major challenge to current concepts of intensive care and it needs to be redefined who of these patients should be treated, for how long and how intensively.
Clinical practice guidelines for psychological care and examples of announcing results are proposed for different categories of Breast Imaging Reporting and Data system (BI-RADS) of the American College of Radiology (ACR). Interpretation and recontextualization are explained for lesions category 2, management of paradox and doubt (probably benign and surveillance) for category 3, acceptance and emotions of patients for the category 4 or 5, psychological distress for the category 6. These models of exchange in doctor-patient relationship have to be modulated and adjusted to the women's profile and attitudes. A meaningful communication is necessary for the comprehension of information, for mammography adherence, for patient satisfactions and in the short and long term, it allows an adapted psychological adjustment for breast cancer. PMID:17372550
Anemia is a frequent complication of cancer and its treatment. A defect in erythropoietin production has been advocated as\\u000a being the main cause of anemia in cancerpatients. We studied serum erythropoietin levels in 74 patients with solid tumors\\u000a and in a control group consisting of 20 otherwise healthy individuals without any malignancy, who have only iron deficiency\\u000a anemia. Serum
M Ozguroglu; B Arun; G Demir; F Demirelli; NM Mandel; E Buyukunal; S Serdengecti; B Berkarda
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 cancerpatients 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.
BACKGROUND: Cancerpatients are presented with advice and instructions during treatment and at discharge. Most recommendations aim at relief of physical problems, psychosocial well-being, and patients' health care behaviors. Patients often struggle to incorporate advice into daily life, and this influences symptom relief, quality of life, and even longevity. OBJECTIVE: The aim of this study was to gain insight into
J. De Leeuw; J. B. Prins; M. A. W. Merkx; H. A. M. Marres; T. van Achterberg
In 1998, the American Medical Informatics Association (AMIA) published a white paper entitled “Guidelines for the Clinical Use of Electronic Mail with Patients,” which outlined a practical framework for this interaction. Interest in the use of other Internet-based tools, such as the World Wide Web, to enhance clinical communication is increasing. In such systems, static information can be made centrally available to patients and interactive tools such as messaging systems, schedules, and individualized care regimens can be integrated within the site. Sitespecific guidelines are needed to address potential problems inherent in the particular services being offered. This article presents advice on developing site-specific guidelines, with examples, based on experience gained in developing and refining guidelines for the use of PatientWeb at the Massachusetts General Hospital Department of Neurology.
Prady, Stephanie L.; Norris, Deirdre; Lester, John E.; Hoch, Daniel B.
The aim of this study was to gain deeper insight into relational aspects of the medical communication pattern in intercultural consultations at GP practices in the Netherlands. We ask whether there are differences in the verbal interaction of Dutch GPs with immigrant and Dutch patients. Data were drawn from 144 adult patient interviews and video observations of consultations between the
Ludwien Meeuwesen; Johannes A. M. Harmsen; Roos M. D. Bernsen; Marc A. Bruijnzeels
Cancerpatients are clearly at increased risk for venous thromboembolism (VTE). However, the risk is not equal for all cancerpatients or even in the same patient over the course of the natural history of cancer. VTE prophylaxis has been shown to be beneficial in certain high-risk populations such as post-surgical or hospitalized cancerpatients but data in the ambulatory
Aggressive chemotherapy has improved the life expectancy for reproductive-age women with breast cancer, but it often causes\\u000a infertility or premature ovarian failure due to destruction of the ovarian reserve. Many questions concerning fertility preservation\\u000a in breast cancerpatients remain unanswered – for example, whether fertility preservation methods interfere with chemotherapy,\\u000a and whether subsequent pregnancy has negative effects on the prognosis.
Theodoros Maltaris; Michael Weigel; Andreas Mueller; Marcus Schmidt; Rudolf Seufert; Franz Fischl; Heinz Koelbl; Ralf Dittrich
The role of nutritional support in the management of the critically ill patient has been a topic of much concern and research. Malnutrition experienced by patients with cancer can be related to the nutritional status of the patient before the development of cancer, to the tumor itself, and to cancer therapy. Aggressive treatment may increase the degree of malnutrition, and the combination of the effects of therapy and progressive malnutrition may be a frequent cause of death. The use of intensive nutritional support for some patients may promote weight gain and positive nitrogen balance, increase tolerance of cancer therapy, and improve immune response. The benefits of nutritional support in the patient with cancer may outweigh concerns of nutrition effects on tumor growth. The choice of nutritional support is dependent on the availability of and access to a functioning gastrointestinal tract, comfort and compliance of the patient, the toxicity of drugs, and site of radiation therapy. Extended length of treatment, availability of care givers, and costs are also factors considered in delivering nutrients. Nutrition requirements, nutritional tolerance, and immune status should be monitored by the nurse. The nurse can function as coordinator for treatments and care as well as act as interpreter, teacher, and counselor to coordinate medical and nutritional management of the patient's illness into overall high-quality nursing care. PMID:1577177
Background Clear communication about the possible outcomes of proposed medical interventions is an integral part of medical care. Despite its importance, there have been few studies comparing different formats for presenting probabilistic information to patients, especially when small probabilities are involved. The purpose of this study was to explore the potential usefulness of several new small-risk graphic communication formats. Methods Information about the likelihoods of cancer and cancer prevention associated with two hypothetical cancer screening programs were used to create an augmented bar chart, an augmented grouped icon display, a flow chart, and three paired combinations of these formats. In the study scenario, the baseline risk of cancer was 53 per 1,000 (5.3%). The risk associated with cancer screening option A was 38 per 1,000 (3.8%) and the risk associated with screening option B was 29 per 1,000 (2.9%). Both the augmented bar chart and the augmented grouped icon display contained magnified views of the differences in cancer risk and cancer prevention associated with the screening programs. A convenience sample of 29 subjects (mean age 56.4 years; 76% men) used the Analytic Hierarchy Process (AHP) to indicate their relative preferences for the six formats using 15 sequential paired comparisons. Results The most preferred format was the combined augmented bar chart + flow diagram (mean preference score 0.43) followed by the combined augmented icon + augmented bar chart format (mean preference score 0.22). The overall differences among the six formats were statistically significant: Kruskal-Wallis Chi Square = 141.4, p < 0.0001. The three combined formats all had statistically significant higher preferences scores than the single format displays (p < 0.05). Conclusion These findings suggest that patients may prefer combined, rather than single, graphic risk presentation formats and that augmented bar charts and icon displays may be useful for conveying comparative information about small risks to clinical decision makers. Further research to confirm and extend these findings is warranted.
Objective To examine the effects of communicating uncertainty regarding individualized colorectal cancer risk estimates, and to identify factors that influence these effects. Methods Two web-based experiments were conducted, in which adults aged 40 years and older were provided with hypothetical individualized colorectal cancer risk estimates differing in the extent and representation of expressed uncertainty. The uncertainty consisted of imprecision (otherwise known as “ambiguity”) of the risk estimates, and was communicated using different representations of confidence intervals. Experiment 1 (n=240) tested the effects of ambiguity (confidence interval vs. point estimate) and representational format (textual vs. visual) on cancer risk perceptions and worry. Potential effect modifiers including personality type (optimism), numeracy, and the information’s perceived credibility were examined, along with the influence of communicating uncertainty on responses to comparative risk information. Experiment 2 (n=135) tested enhanced representations of ambiguity that incorporated supplemental textual and visual depictions. Results Communicating uncertainty led to heightened cancer-related worry in participants, exemplifying the phenomenon of “ambiguity aversion.” This effect was moderated by representational format and dispositional optimism; textual (vs. visual) format and low (vs. high) optimism were associated with greater ambiguity aversion. However, when enhanced representations were used to communicate uncertainty, textual and visual formats showed similar effects. Both the communication of uncertainty and use of the visual format diminished the influence of comparative risk information on risk perceptions. Conclusions The communication of uncertainty regarding cancer risk estimates has complex effects, which include heightening cancer-related worry—consistent with ambiguity aversion—and diminishing the influence of comparative risk information on risk perceptions. These responses are influenced by representational format and personality type, and the influence of format appears to be modifiable and content-dependent.
Han, Paul K. J.; Klein, William M. P.; Lehman, Tom; Killam, Bill; Massett, Holly; Freedman, Andrew N.
Communication in its many forms is a critical component for an effective Space Grant Program. Good communication is needed within individual Space Grant College/Consortia, for example between consortium affiliates and the consortium program office. Effect...
The aim of this study was to gain deeper insight into relational aspects of the medical communication pattern in intercultural consultations at GP practices in the Netherlands. We ask whether there are differences in the verbal interaction of Dutch GPs with immigrant and Dutch patients. Data were drawn from 144 adult patient interviews and video observations of consultations between the patients and 31 Dutch GPs. The patient group consisted of 61 non-Western immigrants (Turkish, Moroccan, Surinamese, Antillean, Cape Verdian) and 83 Dutch participants. Affective and instrumental aspects of verbal communication were assessed using Roter's Interaction Analysis System (RIAS). Patients' cultural background was assessed by ethnicity, language proficiency, level of education, religiosity and cultural views (in terms of being more traditional or more modern). Consultations with the non-Western immigrant patients (especially those from Turkey and Morocco) were well over 2 min shorter, and the power distance between GPs and these patients was greater when compared to the Dutch patients. Major differences in verbal interaction were observed on the affective behavior dimensions, but not on the instrumental dimensions. Doctors invested more in trying to understand the immigrant patients, while in the case of Dutch patients they showed more involvement and empathy. Dutch patients seemed to be more assertive in the medical conversation. The differences are discussed in terms of patients' ethnic background, cultural views (e.g. practicing a religion) and linguistic barriers. It is concluded that attention to cultural diversity does matter, as this leads to different medical communication patterns. A two-way strategy is recommended for improving medical communication, with implications for both doctor and patient behavior. PMID:16928417
Meeuwesen, Ludwien; Harmsen, Johannes A M; Bernsen, Roos M D; Bruijnzeels, Marc A
Management of thromboembolic disease in patients with cancer can be challenging. Patients with cancer who have established thrombosis are at increased risk of recurrent VTE and of anticoagulant-associated bleeding compared to patients with no cancer. The optimal treatment of VTE in patients with cancer should lower the risk of recurrent VTE without increasing the risk of bleeding and ideally improve
In theory, two?way communication between patient and physician is desirable. However, there is a dearth of research that has explored the effects of patients’ culture and cultural orientations on patients’ ability to actively participate in the medical encounter. The purpose of this paper was to test the effects of patients’ culture and cultural orientations on assertiveness and communication apprehension during
Renee Storm Klingle; William F. Sharkey; Hee Sun Park; David H. Smith; Deborah Cai
Communication plays a vital role in breaking down barriers between the patient and dental health professional, and in strengthening the treatment alliance. This paper discusses the ways that communication can be enhanced.
Condylomata acuminata have been shown to increase the risk of anogenital cancers. However, previous studies have been of limited sample size and/or short follow-up duration, which prevent precise estimates of long-term excess risk, especially for specific cancer sites. We estimated the risk of specific cancers in a large cohort of hospitalized patients with condylomata acuminata, as recorded in the Swedish Inpatient Register between 1965 and 1999. Altogether, 10,971 patients (1,685 men and 9,286 women) were followed through 1999 for a median of 13 years. The standardized incidence ratio (SIR)--the ratio of the observed number of cancers to the number expected on the basis of the incidence in the Swedish population at large--was used as a measure of relative risk. After excluding the first-year of follow-up, we observed 43 cases of anogenital cancer in women, and 7 cases in men. Risks were elevated for cancers of the vulva (N = 13, SIR = 10.2, 95% confidence interval (CI) = 5.4-17.4), vagina (N = 4, SIR = 12.0, 95% CI = 3.3-30.7) and penis (N = 5, SIR = 21.9, 95% CI = 7.1-51.2). There was a moderate excess risk of cervical cancer in situ (N = 259, SIR = 1.9, 95% CI = 1.7-2.1), but not invasive cervical cancer. Excess risks of esophageal, buccal cavity, nonmelanoma skin, lung and bladder cancers, and Hodgkin and non-Hodgkin lymphoma, were also observed in both men and women. In conclusion, condylomata acuminata are strongly associated with increased risk of cancers of the vulva, vagina, penis and anus, as well as some nonanogenital malignancies, but not invasive cervical cancer. PMID:16557590
Nordenvall, Caroline; Chang, Ellen T; Adami, Hans-Olov; Ye, Weimin
Cancer genetic counselling represents a very special situation of interaction between the geneticist and the counselee, marked\\u000a by a number of specificities that account for its complexity. Cancer genetic counselling has multiple repercussions, such\\u000a as identification of a deleterious genetic mutation associated with a high probability of developing breast and\\/or ovarian\\u000a cancer, the implementation of preventive measures ranging from close
S. Dolbeault; C. Flahault; D. Stoppa-Lyonnet; A. Brédart
This systematic review, in which 12 original research papers and meta-analyses were included, explored whether patients’ socio-economic status influences doctor–patientcommunication.Results show that patients from lower social classes receive less positive socio-emotional utterances and a more directive and less participatory consulting style, characterised by significantly less information giving, less directions and less socio-emotional and partnership building utterances from their doctor.
S. Willems; S. De Maesschalck; M. Deveugele; A. Derese; J. De Maeseneer
Social support is a critical, yet underutilized resource when undergoing cancer care. Underutilization occurs in two conditions: (a) when patients fail to seek out information, material assistance, and emotional support from family and friends or (b) when family and friends fail to meet the individualized needs and preferences of patients. Social networks are most effective when kept up to date
Meredith M. Skeels; Kenton T. Unruh; Christopher Powell; Wanda Pratt
Pain in patients with cancer can be refractory to pharmacological treatment or intolerable side effects of pharmacological treatment may seriously disturb patients' quality of life. Specific interventional pain management techniques can be an effective alternative for those patients. The appropriate application of these interventional techniques provides better pain control, allows the reduction of analgesics and hence improves quality of life. Until recently, the majority of these techniques are considered to be a fourth consecutive step following the World Health Organization's pain treatment ladder. However, in cancerpatients, earlier application of interventional pain management techniques can be recommended even before considering the use of strong opioids. Epidural and intrathecal medication administration allow the reduction of the daily oral or transdermal opioid dose, while maintaining or even improving the pain relief and reducing the side effects. Cervical cordotomy may be considered for patients suffering with unilateral pain at the level below the dermatome C5. This technique should only be applied in patients with a life expectancy of less than 1 year. Plexus coeliacus block or nervus splanchnicus block are recommended for the management of upper abdominal pain due to cancer. Pelvic pain due to cancer can be managed with plexus hypogastricus block and the saddle or lower end block may be a last resort for patients suffering with perineal pain. Back pain due to vertebral compression fractures with or without pathological tumor invasion may be managed with percutaneous vertebroplasty or kyphoplasty. All these interventional techniques should be a part of multidisciplinary patient program. PMID:21679293
Vissers, Kris C P; Besse, Kees; Wagemans, Michel; Zuurmond, Wouter; Giezeman, Maurice J M M; Lataster, Arno; Mekhail, Nagy; Burton, Allen W; van Kleef, Maarten; Huygen, Frank
Patients with esophageal cancer have a poor prognosis because they often have no symptoms until their disease is advanced. There are no screening recommendations for patients unless they have Barrett’s esophagitis or a significant family history of this disease. Often, esophageal cancer is not diagnosed until patients present with dysphagia, odynophagia, anemia or weight loss. When symptoms occur, the stage is often stage III or greater. Treatment of patients with very early stage disease is fairly straight forward using only local treatment with surgical resection or endoscopic mucosal resection. The treatment of patients who have locally advanced esophageal cancer is more complex and controversial. Despite multiple trials, treatment recommendations are still unclear due to conflicting data. Sadly, much of our data is difficult to interpret due to many of the trials done have included very heterogeneous groups of patients both histologically as well as anatomically. Additionally, studies have been underpowered or stopped early due to poor accrual. In the United States, concurrent chemoradiotherapy prior to surgical resection has been accepted by many as standard of care in the locally advanced patient. Patients who have metastatic disease are treated palliatively. The aim of this article is to describe the multidisciplinary approach used by an established team at a single high volume center for esophageal cancer, and to review the literature which guides our treatment recommendations.
Villaflor, Victoria M; Allaix, Marco E; Minsky, Bruce; Herbella, Fernando A; Patti, Marco G
INTRODUCTION: Significant problems in clinician-patientcommunication 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.
BACKGROUND: Patients with hereditary non-poliposys colorectal cancer (HNPCC) have better prognosis than sporadic colorectal cancer (CRC). Aim of our retrospective study was to compare the overall survival between sporadic CRC and HNPCC patients. METHODS: We analyzed a cohort of 40 (25 males and 15 females) HNPCC cases with a hospital consecutive series of 573 (312 males and 261 females) sporadic
BACKGROUND: Doctor-patientcommunication is an essential component of general practice. Improvement of GPs' communication patterns is an important target of training programmes. Available studies have so far failed to provide conclusive evidence of the effectiveness of educational interventions to improve doctor-patientcommunication. AIM: To examine the effectiveness of a learner-centred approach that focuses on actual needs, to improve GPs' communication
S. O. Hobma; P. Ram; A. M. M. Muijtjens; C. van der Vleuten; R. P. T. M. Grol
Cancer registration has developed in Europe over the last 50 years, and in the last decade intensive joint activities between the European Cancer Registries, in response to the need of pan-European harmonization of registration practices, have taken place. The Hungarian Paediatric Cancer Registry has been functioning as the database of the Hungarian Paediatric Oncology Network since 1971, aiming to follow the incidence and the treatment efficacy of malignant diseases. The goals of this globally unique open source information system are the following: 1) to raise the quality of the registration system to the European level by developing an Internet-based registration and communication system, modernizing the database, establishing automatic statistical analyses and adding an Internet website, 2) to support clinical epidemiological studies that we conduct with international collaborators on detailed analyses of the characteristics of patients and their diseases, evaluation of new diagnostic and therapeutic methods, prevention programs, and long-term quality of life and side effects. The benefits of the development of the Internet-based registration and communication system are as follows: a) introduction of an Internet-based case reporting system, b) modernization of the registry database according to international recommendations, c) automatic statistical summaries, encrypted mail systems, document repository, d) application of data security and privacy standards, e) establishment of a website and compilation of educational materials. The overall objective of this scientific project is to contribute towards the improvement of cancer prevention and cancer care for the benefit of the public in general and of cancerpatients in particular. PMID:15718593
Borgulya, Gábor; Jakab, Zsuzsanna; Schuler, Dezso; Garami, Miklós
New communication technologies represent a potentially valuable resource for cancer care and education. With the Internet and multimedia programs (e.g. CD-ROMs), health care consumers have access to a wealth of information about cancer and its treatment, can participate in online support groups, and can interact with medical experts across the globe. To be most effective, these interventions must be designed, developed, implemented, and evaluated using a sound conceptual framework that connects factors affecting utilization, the user's experience within the media environment, and post interaction outcomes. This essay presents two health communication frameworks, an expanded model of health care consumer-provider communication and a three-stage model of health promotion using interactive media, to help guide future research and development of innovative technologies for cancer care and education. PMID:12767594
The care of patients with cancer who have cardiac disease is dispersed both sequentially and concurrently across multiple providers, and an important goal of education is communication among the providers regarding change of therapy, toxicity of therapy, and symptom assessments. Changes must be made to improve the delivery of cardiac care in patients with cancer and cancer survivors. Therefore, the authors propose a multilevel approach that includes short, targeted curriculum for housestaff training programs in internal medicine, family medicine, pediatrics, cardiology and oncology; increasing presence at national meetings of internists, oncologists and cardiologists; and an Internet-based repository of core information. PMID:21749887
Although it is generally accepted that altered nutrient intake and metabolism are responsible for the progressive loss of body weight observed in most advanced cancerpatients, there is still considerable controversy regarding the contributory role of changes in both resting energy expenditure (REE) and glucose metabolism. Several studies suggest increases in both REE and glucose appearance in advanced cancerpatients compared with healthy control subjects, whereas others revealed no changes in either metabolic parameter. We measured REE with indirect calorimetry and glucose kinetics with a primed constant infusion of D-[U-14C]glucose and D-[6-3H]glucose over the last 4 h of a 24-h fast in 32 advanced lung cancerpatients immediately after diagnosis and before any chemotherapy or radiotherapy and in 19 healthy volunteer subjects. REE for the lung cancer group was not significantly different from that in the control group (1535.8 +/- 78.0 vs. 1670.2 +/- 53.9 kcal/day, respectively, p = 0.151). When REE was expressed as a function of body weight, or lean body mass, no differences between the two groups were observed. The rate of glucose appearance was 9.88 +/- 0.36 mumol.kg-1.min-1 in the cancerpatients and 10.15 +/- 0.53 mumol.kg-1.min-1 in control subjects (p = 0.667), of which 50.4 versus 58.2%, respectively, was oxidized. The amount of glucose recycled was 13.54 +/- 1.22% in cancerpatients and 15.08 +/- 0.99% in control subjects (p = 0.394). The amount of VCO2 from direct oxidation of glucose was 23.39 +/- 0.74% in cancerpatients and 27.45 +/- 1.36% in control subjects (p = 0.006).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1498456
Richards, E W; Long, C L; Nelson, K M; Pinkston, J A; Navari, R M; Geiger, J W; Gandy, R E; Blakemore, W S
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 cancercommunication efforts confronted by the CaP screening controversy. We discuss conceptual and programmatic implications of our findings and present directions for future research. PMID:24096473
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 barbers, cancer survivors and clients, educational materials are developed
Cheryl L. Holt; Theresa A. Wynn; Ivey Lewis; Mark S. Litaker; Sanford Jeames; Francine Huckaby; Leonardo Stroud; Penny L. Southward; Virgil Simons; Crystal Lee; Louis Ross; Theodies Mitchell
The feasibility of using visible fluorimetry as a simple spectroscopic method for cancer diagnosis and\\/or management was investigated by recording the visible fluorescence emission spectra of sera from cancerpatients and healthy individuals. Characteristic visible fluorescence emission spectra were found to occur in sera of some cancerpatients, e.g., patients with breast or lung cancer, with spectral features similar to
ABSTRACT: INTRODUCTION: Increasing numbers of cancerpatients are being admitted to the intensive care unit (ICU), either for cancer-related complications or treatment-associated side effects, yet there are relatively few data concerning the epidemiology and prognosis of cancerpatients admitted to general ICUs. The aim of this study was to assess the characteristics of critically ill cancerpatients, and to evaluate
Fabio Silvio Taccone; Antonio A Artigas; Charles L Sprung; Rui Moreno; Yasser Sakr; Jean-Louis Vincent
Introduction: Both chronic diseases and cancer are associated with ageing. As the population ages, also the number of older cancerpatients with comorbidity will increase dramatically. In the future, general practitioners will be confronted with older patients with cancer and two, three or more concomitant diseases. Aim: We aim to assess the occurrence of comorbidity among older cancerpatients as
L. D. Deckx; M. A. van der Akker; S. B. Bartholomeeusen; J. M. Metsemakers; A. K. Knottnerus; F. G. Schellevis; F. B. Buntinx
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 cancerpatients are thought to be at increased risk for anticoagulant-induced bleeding. Initial treatment of acute thromboembolism is with
The place of death of cancerpatients has become an important theme in UK cancer and palliative care policy. This paper examines the place of death preferences of 41 terminally ill cancerpatients and 18 of their informal carers, living in the Morecambe Bay area of north-west England. We interviewed cancerpatients referred to the research team by 13 specialist
More than half of all cancerpatients now use some form of complementary/alternative medicine, yet the majority of these patients do not disclose this use to their physicians. Health care practitioners need to educate themselves about the complementary/alternative medicine products their patients are using. Eight herbal products (astragalus, essiac, Asian ginseng, Siberian ginseng, green tea, garlic, Hoxsey formula and iscador) commonly used by cancerpatients are reviewed here and a list of recommended reference texts is provided. In addition, health care providers are encouraged to initiate discussions about complementary/alternative products and therapies with their patients so that they may help them make safe and informed decisions about these products. Not knowing what patients are taking is definitely a less desirable option. PMID:14528703
Cancer mainly affects individuals aged 65 and over, so that supportive care for cancer treatment concerns mostly elderly patients.\\u000a Age is a risk factor for increased incidence and severity of chemotherapy-related toxicity and also for the emergence of different\\u000a forms of toxicity including delirium and malnutrition; in addition age may modulate the perception of pain and the response\\u000a to analgesics,
: Although anemia is one of the signs of colorectal cancer, the relationships between histological findings and hematological\\u000a findings other than hemoglobin level have not been adequately investigated. We investigated the relationship between hematological\\u000a findings, serum iron, and histological findings in 358 patients (207 men and 157 women) with colorectal cancer. Their mean\\u000a (±SD) ages were 64.3 ± 12.4 and
Age is now widely accepted as the greatest single risk factor for developing cancer, and cancer is considered primarily as a disease of the elderly. Furthermore, a characteristic of aging is the progressive deterioration of immune function known as immunosenescence. In addition to the increased risk of occurrence of cancer among older patients, they are more predisposed to poor outcomes after definitive treatment. Therapies, outcomes and mortality are often influenced by age and elderly must have a specific and a multidisciplinary approach. It is obvious to consider that one should not consider "age" as the only risk factor, but the condition that this determines to the organism, like the presence of co-morbidities and the consequent poor response to treatment. Cancer occurs frequently in association of one or more other chronic diseases, that affect the efficacy of various treatment interventions. Because of the potential morbidity associated with surgery, the use of mini-invasive techniques have expanded considerably. Aging should not be viewed as a difficulty to definitive therapeutic option. For these reason, it should be correct to value the physiologic capabilities of each organ system and all co-morbidities in the elderly, in order to face possible risks of treatment or improbable benefits. This review takes a look to the tumor biology and to the morbidity of cancer treatment in elderly patients affected by genito-urological cancer like prostate, bladder and renal cancer. PMID:24102276
Anorexia and cachexia frequently complicate the late stages of malignancy and can be a prominent feature of early disease. The resulting weight loss significantly affects the morbidity and mortality of the cancerpatient. A fundamental understanding of nutrition and the pathophysiology of cancer cachexia will aid in diligent treatment decisions to achieve optimal results. The pathophysiology of cancer cachexia is discussed, together with methods of nutritional assessment, nutritional requirements, and postoperative nutritional support. The advantages and disadvantages of the various modes of parenteral and enteral feeding are presented, together with information about enteral feeding in the home.
Substantial progress has been made in the management of breast cancer by targeting HER2 and VEGF pathways. Although the efficacy and safety of target therapy in breast cancer have been established, no specific phase III trial has addressed these issues in the elderly population and the only data available derive from subanalyses or retrospective series. The aim of this review is to summarize the available evidence in this special population and to encourage further well designed studies in elderly breast cancerpatients. PMID:22257652
Although the rate for childhood cancer has remained relatively stable for the past 2 decades, there have been drastic declines in mortality due to early diagnosis and improvements in therapy. Now over 75% of children diagnosed with cancer survive more than 5 years. The pediatric dental professional plays an important role in the prevention, stabilization, and treatment of oral and dental problems that can compromise the child's health and quality of life before, during, and after the cancer treatment. This manuscript discusses recommendations for the dental care of the pediatric oncology patient. PMID:15080359
Utilizing Web 2.0 technologies such as blogs, wikis, and social networking sites can provide innovative and creative means to communicate with library patrons. They can also serve as a purposeful information repository for individuals looking for information on a particular topic. A pain management resource for cancerpatients and their caregivers was created to provide a concise “one-stop” location for
OBJECTIVE: To assess family physicians' and specialists' involvement in cancer follow-up care and how this involvement is perceived by cancerpatients. DESIGN: Self-administered survey. SETTING: A health region in New Brunswick. PARTICIPANTS: A nonprobability cluster sample of 183 participants. MAIN OUTCOME MEASURES: Patients' perceptions of cancer follow-up care. RESULTS: More than a third of participants (36%) were not sure which physician was in charge of their cancer follow-up care. As part of follow-up care, 80% of participants wanted counseling from their family physicians, but only 20% received it. About a third of participants (32%) were not satisfied with the follow-up care provided by their family physicians. In contrast, only 18% of participants were dissatisfied with the follow-up care provided by specialists. Older participants were more satisfied with cancer follow-up care than younger participants. CONCLUSION: Cancer follow-up care is increasingly becoming part of family physicians' practices. Family physicians need to develop an approach that addresses patients' needs, particularly in the area of emotional support.
People often seek and receive cancer information from mass media (including television, radio, print media, and the Internet), and marketing strategies often inform cancer information needs assessment, message development, and channel selection. In this article, we present the discussion of a 2-hour working group convened for a cancercommunications workshop held at the 2008 Society of Behavioral Medicine meeting in San Diego, CA. During the session, an interdisciplinary group of investigators discussed the current state of the science for mass media and marketing communication promoting primary and secondary cancer prevention. We discussed current research, new research areas, methodologies and theories needed to move the field forward, and critical areas and disciplines for future research. PMID:19449266
Using the Perceived Stress Scale (PSS), perceptions of global stress were assessed in 111 women following breast cancer surgery and at 12 and 24 months later. This is the first study to factor analyze the PSS. The PSS data were factor analyzed each time using exploratory factor analysis with oblique direct quartimin rotation. Goodness-of-fit indices (root mean square error of approximation [RMSEA]), magnitude and pattern of factor loadings, and confidence interval data revealed a two-factor solution of positive versus negative stress items. The findings, replicated across time, also indicate factor stability. Hierarchical factor analyses supported a second-order factor of “perceived stress.” This alternative factor model of the PSS is presented along with observations regarding the measure's use in cancer research.
Golden-Kreutz, Deanna M.; Browne, Michael W.; Frierson, Georita M.; Andersen, Barbara L.
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.
Endometrial cancer is the most common cancer in women with Lynch syndrome. The identification of individuals with Lynch syndrome is desirable because they can benefit from increased cancer surveillance. The purpose of this study was to determine the feasibility and desirability of mole- cular screening for Lynch syndrome in all endometrial cancerpatients. Unselected endometrial cancerpatients (N = 543)
Heather Hampel; Wendy Frankel; Jenny Panescu; Janet Lockman; Kaisa Sotamaa; Daniel Fix; Ilene Comeras; Jennifer La Jeunesse; Hidewaki Nakagawa; Judith A. Westman; Thomas W. Prior; Mark Clendenning; Pamela Penzone; Janet Lombardi; Patti Dunn; David E. Cohn; Larry Copeland; Lynne Eaton; Jeffrey Fowler; George Lewandowski; Luis Vaccarello; Jeffrey Bell; Gary Reid
Objective We sought to identify characteristics associated with favorable treatment in receipt of preventive healthcare services, from the perspective of resettled African refugee women. Methods Individual, in-depth interviews with 34 Somali women in Rochester, NY, USA. Questions explored positive and negative experiences with primary health care services, beliefs about respectful vs. disrespectful treatment, experiences of racism, prejudice or bias, and ideas about removing access barriers and improving health care services. Analysis was guided by grounded theory. Results Qualities associated with a favorable healthcare experience included effective verbal and nonverbal communication, feeling valued and understood, availability of female interpreters and clinicians and sensitivity to privacy for gynecologic concerns. Participants stated that adequate transportation, access to healthcare services and investment in community-based programs to improve health literacy about women’s preventive health services were prerequisite to any respectful health care system. Conclusion Effective communication, access to healthcare services with female interpreters and clinicians, and community programs to promote health literacy are themes associated with respectful and effective healthcare experiences among Somali women. Practice Implications Adequate interpreter services are essential. Patient-provider gender concordance is important to many Somali women, especially for gynecological concerns.
Doxorubicin is cardiotoxic and its use must be monitored carefully. Incidence of refractory cardiac failure is shown to increase once the cumulative dose exceeds 450 mg/m2. However, significant decline of ejection fraction (EF) may occur even at lower dose levels. EF was monitored using Multigated Radionuclide Angiography (MUGA) scan of all consecutive lung cancerpatients, treated with Doxorubicin based regimens. Thirteen of 82 patients showed a significant (more than 15%) decline of left ventricular EF. The dose of doxorubicin producing this decline ranged between 91-180 mg/m2. Actual decline in EF ranged between 16-45%. Only 5 of 13 patients developed symptoms attributable to the cardiac disease. Doxorubicin can alter EF significantly in lung cancerpatients at levels well below which are considered 'safe'. The reason for massive decline in ejection fraction in these patients has been hypothesized. PMID:9813976
Breast cancer represents a serious health concern for women across the disease spectrum. First, despite the advances in technology used for intensive disease surveillance and innovative preventative options, interest in and utilization of these technologi...
High energy gamma radiation (8 to 30 MeV) is gaining acceptance for radiation therapy of patients with deep cancers. This radiation is of sufficient energy to induce photonuclear activation of the elements in the human body. Our results of measurements of nitrogen and phosphorus in an anthropomorphic phantom, a cadaver, and a cancerpatient with bremsstrahlung radiation from 15 MeV electrons demonstrate the feasibility of a method to monitor these two elements in the human body in vivo by measuring the radioactivity induced in these targets by photonuclear reactions. 14 refs., 3 figs., 2 tabs.
Wielopolski, L.; Meek, A.G.; Moskowitz, M.; Cohn, S.H.
The contents of this report were developed with guidance from health communication researchers and public health professionals. The contents purpose is twofold: to offer a snapshot at two different points in time of how the American public (18 years and o...
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
|Doctor-patientcommunication 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
The gap in cancer information seeking between high-socioeconomic-status (high-SES) cancerpatients and low-SES cancerpatients deserves serious attention, considering the importance of information and knowledge in cancer control. We thus explored the association of SES, as measured by education, with cancerpatients' overall cancer information seeking, and with seeking from each source (i.e., the Internet, mass media, medical sources, and
Chul-joo Lee; A. Susana Ramírez; Nehama Lewis; Stacy W. Gray; Robert C. Hornik
The elimination of cancer disparities is critically important for lessening the burden of breast cancer (BC). Patient navigator programs (PNPs) have been shown to improve rates of BC screening in underserved communities, but there is a dearth of evidence regarding their benefits after the actual diagnosis of BC. We retrospectively examined sociodemographic characteristics, disease characteristics, and concordance to quality measures (QMs) of BC care among women participating in a PNP that services disadvantaged minority communities in the greater Boston area. Of the 186 PNP patients diagnosed with BC in 2001–2011 in three neighborhood community health centers, treatment data was available for 158 (85%) and race and disease stage information was available for 149 (80%). Regarding stage, 25% were diagnosed with in situ cancer, 32% had stage 1, 25% had stage 2, 13% had stage 3, and 5% had stage 4 BC. Guideline-indicated care was received by 70 of 74 patients (95%) for the hormonal therapy QM, 15 of 17 (88%) patients for the chemotherapy QM, and 65 of 71 (92%) patients for the radiation QM, all similar to published concordance rates at elite National Comprehensive Cancer Network institutions. These findings suggest that PNPs may facilitate evidence-based quality care for vulnerable populations. Future research should prospectively analyze quality metrics to assess measures to improve the process and outcomes of patient navigation in diverse underserved settings, compared with control non-navigated populations.
Raj, Aparna; Ko, Naomi; Battaglia, Tracy A.; Chabner, Bruce A.
|This ten chapter book is designed to provide high school students with an understanding of basic communication processes. The first five chapters include discussions of language development, function, and acquisition in relation to both human and non-human communication. The sixth chapter contains specimen linguistic analyses of speech and…
Locked-in Syndrome is a severe pontine stroke causing quadriplegia, lower cranial nerve paralysis, and mutism with preservation of only vertical gaze and upper eyelid movement in a conscious patient. We present a case of a Locked-in Syndrome patient who received communication training with augmentative and alternative communication equipment by using eye blinks. After 3 weeks of training, the patient was able to make an attempt to interact with other people, and associate a new word by Korean alphabet selection. Augmentative and alternative communication equipment which uses eye blinks might be considered to be beneficial in improving the communication skills of locked-in syndrome patients. PMID:22639753
Park, Si-Woon; Yim, You-Lim; Yi, Sook-Hee; Kim, Hyun-Young; Jung, Seung-Min
While autonomy has gradually become a key concept in the doctor-patient relationship, truth-telling is far from being the norm in many countries in the world. Despite the general agreement on the benefits of open communication between physicians and cancerpatients, there is still strong resistance against disclosure of cancer diagnosis and prognosis in many cultures. Although fear of causing psychological morbidity to patients and their reluctance to find out the truth are two main justifications of non-disclosure attitudes, there are other important contributing factors that need to be further explored and better understood including those related to the relatives, doctors and healthcare systems. Cultural disparities in attitudes towards truth-telling persist; however, these differences should not be used as excuses not to respect the rights and individual preferences of cancerpatients by making assumptions based on their age, sex, type of cancer, language and/or cultural background. PMID:20030693
We describe herein the clinical characteristics of five male breast carcinoma (MBC) patients with a familial history of breast carcinoma (FHBC). Four of these patients suffered from multiple primary cancers, being gastric and prostate cancer in 1, gastric cancer in 1, and asynchronous bilateral breast cancers in 2. The average age of these patients at diagnosis was not lower than
The risk of venous thromboembolism (VTE) is increased in cancerpatients. To improve prediction of VTE in cancerpatients, we performed a prospective and observational cohort study of patients with newly diagnosed cancer or progression of disease after remission. A previously developed risk scoring model for prediction of VTE that included clinical (tumor entity and body mass index) and laboratory (hemoglobin level and thrombocyte and leukocyte count) parameters was expanded by incorporating 2 biomarkers, soluble P-selectin, and D-Dimer. Of 819 patients 61 (7.4%) experienced VTE during a median follow-up of 656 days. The cumulative VTE probability in the original risk model after 6 months was 17.7% in patients with the highest risk score (? 3, n = 93), 9.6% in those with score 2 (n = 221), 3.8% in those with score 1 (n = 229), and 1.5% in those with score 0 (n = 276). In the expanded risk model, the cumulative VTE probability after 6 months in patients with the highest score (? 5, n = 30) was 35.0% and 10.3% in those with an intermediate score (score 3, n = 130) as opposed to only 1.0% in patients with score 0 (n = 200); the hazard ratio of patients with the highest compared with those with the lowest score was 25.9 (8.0-84.6). Clinical and standard laboratory parameters with addition of biomarkers enable prediction of VTE and allow identification of cancerpatients at high or low risk of VTE. PMID:20829374
Background The objective of this study was to show differences between breast cancerpatients ?35 and >35 years with regard to tumor\\u000a characteristics and to present the patient-relevant outcomes overall survival (OAS) and recurrence-free survival (RFS).\\u000a \\u000a \\u000a \\u000a \\u000a Methods We analyzed data from 119 women aged 35 years or younger with breast cancer and compared multiple parameters against breast\\u000a cancerpatients between 36 and 55 (n = 1,097),
Dominic Varga; Jochem Koenig; Kathrin Kuhr; Kathrin Strunz; Verena Geyer; Christian Kurzeder; Ziad Atassi; Maria Blettner; Rolf Kreienberg; Achim Woeckel
BACKGROUND Despite the availability of multiple effective screening tests for colorectal cancer, screening rates remain suboptimal. The\\u000a literature documents patient preferences for different test types and recommends a shared decision-making approach for physician-patient\\u000a colorectal cancer screening (CRCS) discussions, but it is unknown whether such communication about CRCS preferences and options\\u000a actually occurs in busy primary-care settings.\\u000a \\u000a \\u000a \\u000a OBJECTIVE Describe physician-patient CRCS discussions during
Amy McQueen; L. Kay Bartholomew; Anthony J. Greisinger; Gilda G. Medina; Sarah T. Hawley; Paul Haidet; Judith L. Bettencourt; Navkiran K. Shokar; Bruce S. Ling; Sally W. Vernon
In October 2010 The Max Foundation, in partnership with 30 cancerpatient associations in emerging countries, organized a global cancer awareness campaign. The aims of the campaign were: (i) to increase awareness of the needs of people living with cancer in developing countries; (ii) to increase local visibility of patient associations in their countries; (iii) to collect more than 10,000 signatures to the World Cancer Declaration (WCD); and (iv) to improve the lives of cancer survivors by providing them with an opportunity to express their feelings about the disease. The campaign was developed as a global effort, to be implemented by local patient associations through their volunteer survivors and caregivers. The methodology at the global level included developing the framework, branding, and communication tools, while making available limited funding and heavy logistical support. Local patient associations were encouraged to adapt the initiative to a culturally accepted format. Key elements of the campaign were the mix of low tech and high tech elements to allow low tech populations to participate while promoting the initiative using social media and high tech tools. Additionally, the participation of survivors and caregivers ensured the campaign provided immediate benefit to cancerpatients. Finally, the addition of the World Cancer Declaration provided a strong unifying component. More than 60 events were held in 31 countries around the world, collecting more than 13,000 signatures to the World Cancer Declaration and a similar number of support messages to cancer survivors representing 84 countries. Local events gained local media visibility in many countries, and the campaign was promoted in multiple international forums and Web sites. This initiative involving mobilization of volunteers and the development of a global initiative as a grassroots movement taught important lessons on media outreach and selection of leaders for a cancer awareness campaign. PMID:22910498
Gross lymphoedema is a devastating complication in patients with breast cancer and more so in young women. These patients present with more advanced disease and suffer a higher incidence of loco-regional recurrence. Young women are also subject to more traumas to the lymphatics by virtue of their being more active. Treatment contributes to a higher incidence of lymphoedema in these patients. Thrombosis and infection may complicate intravenous chemotherapy, which damages lymphatic drainage. Modern radiotherapy delivers precise dosage and site targeting of treatment so that lymphoedema is less common. However, there is a tendency to return to aggressive treatment of the nodal areas. Early detection of breast cancer and sentinel lymph node biopsy will further decrease axillary dissection. Lymphoedema treatment consists mainly of compression therapy, manual lymphatic drainage and containment. Surgery is rarely required. Lymphoedema is a chronic condition that requires long-term care with patient compliance and active cooperation. PMID:17382865
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 a series of ANCOVAs they found that the intervention led to increases in self-efficacy. Changes in self-efficacy predicted changes in anxiety, depression, and womanhood fears. This coaching intervention shows promise but requires additional studies to establish is efficacy and effectiveness.
Shields, Cleveland G.; Ziner, Kim Wagler; Bourff, Sara A.; Schilling, Katherine; Zhao, Qianqian; Monahan, Patrick; Sledge, George; Champion, Victoria
This book contains 42 chapters divided among six sections. Some of the chapter titles are: The Challenge of Cancer; Communicaton Needs of Head and Neck CancerPatients; Normal Tissue Effects of the Radiotherapy of Head and Neck Cancer; Chemotherapy in the Treatment of Head and Neck Cancer; and Thyroid Cancer.
Kelch-like ECH-associated protein 1 (Keap1) inhibits nuclear factor erythroid 2-related 2 (NEF2L2; also named NRF2)-induced cytoprotection and has been hypothesized to represent a candidate tumor suppressor. We have previously reported the somatic mutations of the NRF2 gene (NFE2L2), however, the correlation between the Keap1 mutation and the clinicopathological features of lung cancer has not been well investigated. Therefore, in the present study, the Keap1 mutational status in non-small cell lung cancer (NSCLC) patients was investigated by reverse transcription PCR and direct sequencing. The study included 76 surgically-removed lung cancer cases from patients of the Nagoya City University Hospital in which the EGFR and NFE2L2 mutation status was already established. Keap1 mutations were identified in 2 (2.6%) adenocarcinoma patients with a history of heavy smoking. These mutations were identified to exist exclusively. The Keap1 mutation was only detected in patients with advanced adenocarcinoma (4.3%) and the completely exclusive status of this mutation and others, including EGFR, Kas, erbB2 and NRF2L2, is likely to improve the selection of personalized therapy for lung cancer.
Denial is a clinically relevant concept in cancerpatients. It has been investigated and discussed extensively. Its definition, however, has been subject to different theoretical trends over time. From a psychoanalytical viewpoint, denial is a pathological, ineffective defence mechanism. On the other hand, according to the stress and coping model denial can be seen as an adaptive strategy to protect
BACKGROUND: A number of qualitative and quantitative changes in hormonal secretion pattern have been found in subjects suffering from neoplastic disease. The aim of this study was to evaluate the presence of alterations in neuro-endo- crine system function and in the pattern of endocrine secretion in patients with lung cancer. METHODS: Cortisol, melatonin, growth hormone (GH), insulin-like growth factor I
Gianluigi Mazzoccoli; Stefano Carughi; Angelo De Cata; Marco La Viola; Antonio Giuliani; Roberto Tarquini; Federico Perfetto
Summary Anemia in cancerpatients is frequent but often underestimated. Anemia affects the health-related quality of life and impacts prognosis and outcome of therapy. Treatment options include the administration of hematopoietic growth factors and red blood cell transfusions. Blood transfusions result in rapid but often transient improvement of anemia. Administration of epoetin or darbepoetin alfa increases hemoglobin levels, decreases blood transfusions,
The clinical and pathological features of 51 patients who survived for more than 20 years after diagnosis of cancer of the breast were compared with those of 176 contemporaries who died within 20 years after diagnosis. Of those who survived, 18 (35%) had had pathologically affected axillary nodes compared with at least 86 (49%) of those who died. Also, 11
On 25 January 2002, the Harvard Center for Cancer Prevention and the Health Communication Core and Risk Reduction Program of the Dana-Farber\\/Harvard Cancer Center co-sponsored a symposium in Boston, MA, on the use of health communication to more effectively promote healthy lifestyles for the prevention of cancer. The purpose of the symposium was to discuss past research developments in this
Perhaps one of the main ethical dilemmas physicians face in cancer medicine is the question of truthfulness with terminally ill cancerpatients. Reluctance to share the truth with the patient about his or her diagnosis and\\/or prognosis is frequently associated with cultural pressures. Based on two cases, the authors illustrate how ethical analysis can help in solving dilemmas related to
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…
|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…
Prognosis is an issue that most doctors and patients describe as difficult to discuss and the best way of presenting prognostic information to optimise patient understanding, psychological adjustment and decision-making is uncertain. A systematic review of the literature was conducted with the aim of clarifying the current available knowledge of patient preferences, clinician views and current practice regarding the communication
R. G. Hagerty; P. N. Butow; P. M. Ellis; S. Dimitry; M. H. N. Tattersall
Background New methods to enhance CRC screening rates are needed. The Web offers novel possibilities to educate patients and to improve health behaviors like cancer screening. Evidence supports the efficacy of health communications that are targeted and tailored to improve uptake of recommendations. Methods We identified unscreened women at average risk for CRC from the scheduling databases of Obstetrics and Gynecology practices in two large health systems. Participants consented to a randomized, controlled trial that compared CRC screening uptake after receipt of CRC screening information delivered via the web or in print form. Participants could also be assigned to a control (usual care) group. Women in the interventional arms received tailored information in a form matched or mismatched with equal likelihood to their Cognitive Social Information Processing (C-SHIP) model defined attentional style. The primary outcome was CRC screening participation at 4 months. Results 904 women were randomized to the interventional or control groups. At 4 months, CRC screening uptake was not significantly different in web (12.2%), print (12.0%) or control (12.9%) groups. Attentional style had no effect on screening uptake for any group. Some baseline participant factors were associated with greater screening including higher income (p<.03), stage of change (p<.004), and physician recommendation to screen (p<.002). Conclusions A web based educational intervention was no more effective than a print based one or control to increase CRC screening rates in average risk women. Risk messages tailored to attentional style had no effect on screening uptake. In average risk populations, use of the internet for health communication without additional enhancement is unlikely to improve screening participation.
Weinberg, David S.; Keenan, Eileen; Ruth, Karen; Devarajan, Karthik; Rodoletz, Michelle; Bieber, Eric
\\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
Purpose: Bacterial translocation (BT) is common in colon cancerpatients and may be associated with increased occurrence of septic complications as well as with adverse oncologic outcomes. The aim of the present study was to correlate the BT detectable through peritoneal lavage culture or identified by abnormal inflammatory parameters with the clinicopathologic parameters and the short-term prognosis in a prospective series of patients. Methods: Fifty-four consecutive patients with histologically proven colorectal cancer were included in this prospective study. White blood cells (WBC), erythrocyte sedimentation rate (ESR) and serum levels of procalcitonin (PCT) and C-reactive protein (CRP) were determined and cultures from peritoneal lavage were collected immediately after laparotomy. Results: Positive PCT was detected in 31 (55.3%) patients while positive cultures were obtained in 6 (11%) patients. Significant positive correlation of PCT with inflammation markers was noticed. Patients with distant metastases had higher serum PCT levels than patients without distant metastases (p=0.01). Borderline statistical significance was found between PCT and tumor grade (p=0.09). PCT was not correlated with the cultures of the lavage or the outcome. Conclusion: PCT is an adequate inflammatory marker, able to preoperatively discriminate patients with bacterial systemic inflammatory reaction due to BT. However, the clinical consequence of BT may be minimal as is shown by the lack of association of PCT or positive peritoneal lavage cultures with time to discharge, complications and short-term survival. PMID:24065474
Keramidaris, D; Koronakis, N; Lagoudianakis, E E; Pappas, A; Koukoutsis, I; Chrysikos, I; Karavitis, G; Toutouzas, K; Manouras, A
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
The democratization of civil society and the development of modern medicine changed the sacrosanct doctor-patient relationship to a doctor-partner dialogue. Values and respect were lost in the process where common courtesy and empathy in trust were replaced by patient rights. LAUNCH OF EUROPA UOMO: Europa Uomo, the European prostate cancer coalition, represents 22 national, autonomous patient support groups. Its aim includes increasing the awareness of prostate diseases, support individualized treatment as a balance between optimal medical treatment and personalized care delivered by a multiprofessional team. We expect our information/education from dedicated professional societies while in return we share care for properly informed members as well as a fast, unbiased and cheap distribution of information/innovation across the European continent. THE ROLE OF A PATIENT GROUP: Our advocacy role is focused on quality of life, tailored treatment, knowledge of risk factors, support for research and last but not least active partnerships. We believe that we can play a modest but basic role in common actions to overcome inequalities in treatment and care in Europe. Our responsibilities range from defining patient obligations to facilitating translational research and saving scarce health resources. THE HORIZON OF THE PATIENT: Our hope is to plead for a treatment policy on the man first and then on his cancer and to improve treatment outcomes by multiprofessional collaboration and the development of expert Prostate Units. FUTURE EXPECTATIONS: A transparent, open communication line between the multiprofessional team and the patient is mandatory. The existing uncertainties should be discussed with common sense but always leave a factor of hope in survival or quality of life. PMID:21604956
Denis, Louis J; Roobol, Monique; Dourcy-Belle-Rose, Brigitte
Understanding the extent to which changes in whole-body protein kinetics contribute to the commonly observed weight loss and decrease in lean body mass (LBM) in patients with cancer is currently obscured by conflicting reports in the literature. While several studies have reported significant increases in whole-body protein turnover (WBPT), synthesis (WBPS), and catabolism (WBPC) in patients with cancer, others have failed to confirm these observations. We have measured whole-body protein kinetics using a primed constant infusion of 15N-glycine in a homogenous group of 32 newly diagnosed advanced lung cancerpatients with comparable staging and before any antineoplastic treatment, and in 19 normal healthy volunteer controls. Urinary urea and ammonia 15N enrichment was determined in individually collected urine samples obtained during the 24-hour study period and averaged for the determination of protein kinetics. During the last 6 hours of urine collection, samples were obtained hourly for determination of 15N plateau enrichment. Twenty-four-hour urinary nitrogen and creatinine excretion was determined from 24-hour pooled urine samples. Resting metabolic expenditure (RME) was determined by indirect calorimetry and LBM was estimated from deuterium oxide dilution. Age body weight, LBM, RME, and 24-hour urinary nitrogen excretion did not differ between cancer and control subjects. WBPT, WBPC, and WBPS (g/kg/d) were significantly increased in lung cancerpatients. However, when the same results were expressed either per kilogram LBM or per gram 24-hour urinary creatinine excretion, WBPT, WBPC, and WBPS rates were not statistically different from those of the controls.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8487646
Richards, E W; Long, C L; Nelson, K M; Tohver, O K; Pinkston, J A; Navari, R M; Blakemore, W S
Background: Previous epidemiological studies have indicated that the risk of suicide in cancerpatients is higher than that of the general population. In addition, euthanasia and physician- assisted suicide (PAS) have recently become controversial medical, ethical and legal issues all over the world. Although suicide in cancerpatients and appropriate management of cancerpatients with suicidality are critical issues in
This study was carried out to examine the status of cancerpatient education in Iran. Using the Multinational Association of Supportive Care in Cancer's (MASCC) patient education questionnaire, 310 individuals - a sample of heterogeneous cancerpatients (n=167) and their relatives (n=143) - were enrolled in the study. The pooled results indicated that only 15% of respondents believed more than
Ali Montazeri; Mariam Vahdani; Mehregan Haji-Mahmoodi; Soghra Jarvandi; Mandana Ebrahimi
While the association between cancer and symptomatic venous thromboembolism (VTE) is well established, the incidence and risk factors for incidental VIE in cancerpatients remain unclear The medical records of 1,921 consecutive cancerpatients starting chemotherapy from January 2003 up to March 2009 were identified Patients with a positive history of VTE were excluded Pre existing signs of VIE, kind
M. Di Nisio; N. Ferrante; M. De Tursi; S. Iacobelli; F. Cuccurullo; H. R. Büller; B. Feragalli; E. Porreca
Abstract Background: At most institutions, medical students learn communication skills through the use of standardized patients (SPs), but SPs are time and resource expensive. Virtual patients (VPs) may offer several advantages over SPs, but little data exist regarding the use of VPs in teaching communication skills. Therefore, we report our initial efforts to create an interactive virtual clinical scenario of
Amy Stevens; Jonathan Hernandez; Kyle Johnsen; Robert Dickerson; Andrew Raij; Cyrus Harrison; Meredith Dipietro; Bryan Allen; Richard Ferdig; Sebastian Foti; Jonathan Jackson; Min Shin; Juan Cendan; Robert Watson; Margaret Duerson; Benjamin Lok; Marc Cohen; Peggy Wagner; D. Scott Lind
|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
|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
|In recent years, communication education has been used as a means of improving the clinician-patient relationship and promoting health. The focus of these interventions has primarily centered on clinician training. An area that has received less focus, although equally important, is training patients to be good communicators. The purpose of the…
Bylund, Carma L.; D'Agostino, Thomas A.; Ho, Evelyn Y.; Chewning, Betty A.
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
Background: Broader patient access to information, expanding clinical options and greater accommodation of patients' personal values makes clinical decision-processes increasingly complex. Given the challenges and implications of risk communication, it is important to explore what is happening when clinicians adopt different approaches to consultations.Aim: To perform an ethical analysis of personal risk communication based around a scenario of cardiovascular risk
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
This study explored differences in the perceived importance of nursing caring behaviors between patients with cancer pain and oncology nurses and to explore the relationship between level of pain intensity and the importance of various nursing caring behaviors. The study included 50 matched cancerpatient-staff pairs from oncology inpatient units of 3 hospitals in northern Taiwan. The Brief Pain Inventory-Chinese version (BPI-C) and the Caring Assessment Report Evaluation Q-sort (CARE-Q) were used for data collection. Results revealed that cancer pain patients ranked "being accessible," "monitors and follows through," and "anticipates" as being the most important nursing caring behaviors; the nursing staff ranked "being accessible," "explains and facilitates," and "monitors and follows through" as being the most important behaviors. No correlations were found between cancer pain patients and staff rankings of the perceived importance of various caring behaviors. The self-reported level of pain intensity by patients was significantly positively correlated with the patient rating of the "anticipates" behavior. Patient self-reported level of pain interference was significantly positively correlated with the "monitors and follows through" behavior and significantly negatively correlated with the "explains and facilitates" behavior. Staff perception of both a patient's level of pain intensity and pain interference was significantly positively correlated with staff rating of the "being accessible" behavior. Results demonstrated that greater patient-staff communication is needed for staff to more accurately provide caring interventions to make patients with cancer pain feel cared for. PMID:16192823
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
SocieteInternationale de Chirurgie 2010 Colorectal cancer is the third most common cancer worldwide, with approximately 1 million new diagnoses each year. This high incidence is a major health problem in the USA and Europe. Synchronous and metachronous diagnosis of gastric cancer among patients with colorectal cancer is rare in the Western world, and at present no gastric cancer surveillance is
BACKGROUND. The risk of suicide is higher in patients with cancer than in the general population, making end-of-life care of suicidal terminal patients with cancer critical. To identify factors and longitudinal changes associated with sui- cidality among terminally ill Japanese patients with cancer, a prospective cohort study was performed. METHODS. Consecutive outpatients with cancer who registered with a palliative care
BACKGROUND: The burden of cancer care in general practice is increasing. Patient-held records may facilitate effective, coordinated care, but no randomised controlled trials of their use in cancer care have been conducted, and concerns about possible negative effects remain. AIM: To evaluate the use of a supplementary patient-held record in cancer care. METHOD: Six hundred and fifty radiotherapy outpatients with any form of cancer were randomised either to hold a supplementary record or to receive normal care. It was explained to record holders that the supplementary record was intended to improve communication with health professionals and act as an aide memoire. After three months, patients' satisfaction with communication and with participation in their own care were assessed. Global health status, emotional functioning, and cognitive functioning were measured using the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire. RESULTS: There were no significant differences between groups in any of the outcome measures. Patients in both groups expressed a high level of satisfaction with communication and participation in their care. Mean (SD) scores in the intervention and control groups were: global health status, 66.8 (24.2) and 65.3 (23.7); emotional functioning, 75.0 (24.6) and 77.4 (22.8); cognitive functioning, 84.5 (21.0) and 84.0 (21.3). CONCLUSION: A supplementary patient-held record for radiotherapy outpatients appears to have no effect on satisfaction with communication, participation in care, or quality of life.
Drury, M; Yudkin, P; Harcourt, J; Fitzpatrick, R; Jones, L; Alcock, C; Minton, M
Background Despite evidence of a positive effect of collaborative patient-provider communication on patient outcomes, our understanding of this relationship is unclear. Purpose To determine whether racial composition of the relationship modified the association between ratings of provider communication and medication adherence. Methods Effect modification of the communication-adherence association, by racial composition of the relationship, was evaluated using general linear mixed models while adjusting for selected covariates. Results 390 patients were in race-concordant (black patient, black provider) relationships, while 207 were in race-discordant (black patient, white provider) relationships. The communication-adherence association was significantly modified in race-discordant relationships (p=0.04). Communication rated as more collaborative in race-discordant relationships was associated with better adherence, while communication rated as less collaborative was associated with poor adherence. There was no significant association between adherence and communication in race-concordant relationships (p=0.24). Conclusions Collaborative patient-provider communication may play an influential role in black patients’ adherence behaviors when receiving care from white providers.
Schoenthaler, Antoinette; Allegrante, John P.; Chaplin, William; Ogedegbe, Gbenga
Background: Colorectal cancer (CRC) patients have an increased risk of developing other malignancies. Understanding the characteristics of the second primary cancer is important to establish an effective surveillance program. Methods: This study investigated 301 CRC patients to assess the risk factors for postoperative primary cancers arising from organs distinct from the colorectal area (extracolorectal cancers). The observed\\/expected ratio (O\\/E ratio)
In the transition from curative to palliative cancer care, communication is of special importance. The aim of this study\\u000a was to explore how patients with a disseminated cancer disease experienced the information about their incurable state, focusing\\u000a on the physician. The persons taking part were 30 patients admitted to a hospital-based home care unit in Sweden. Semi-structured\\u000a interviews were conducted
Maria J. Friedrichsen; Peter M. Strang; Maria E. Carlsson
Although the triadic encounter of physician, patient, and an accompanying family member is a common phenomenon in geriatrics, previous research on the communication in medical encounters has primarily focused on dyadic interactions between physician and patient. This study aimed to explore the triadic communication and communication roles of patient companions in Japanese geriatric encounters. Among elderly patients aged 65 or over who were under continuous care of nine attending physicians at a university affiliated geriatric clinic in Tokyo, 63 accompanied patients and 82 unaccompanied patients were included for this study. The consultation was audiotape recorded and analyzed using the Roter Interaction Analysis System (RIAS) with additional categories developed to code aspects of companion communication. In dyadic encounters, the average proportions of physician's talk and patient's talk were 54% and 46%, respectively, while in triadic encounters the average talk proportions of physician, patient, and companion were 49%, 29%, and 22%. Companions made a significant contribution to the communication during the visit by providing information and asking the physician questions, as well as facilitating patient's talk. The companion's communication may influence not only the patient's but also the physician's communication. The patient's expectation of the companion's role during the visit and the companion's intention regarding their role were generally related to one another, and had positive associations with the companion's actual behavior during the visit. Nevertheless, companions often anticipated playing a more direct communication role during the visit, including the provision of information and asking of questions, than patients expected of them. Further investigation is needed to explore the communication dynamics in triads and dyads, and its relation to patient outcomes. PMID:15748678
Numerous previous studies have suggested that cancer care in rural and regional Australia is fragmented and that rural and regional patients have less access to services. However, knowledge concerning inequality of health and cancer care in regional and rural settings is still inconclusive. The social and economic disadvantages in regional locations are often linked to insufficient resources and infrastructures to support cancer care and treatment. The aim of this study was to explore cancerpatients' experiences from the perspective of patients and healthcare providers in a regional area of Western Australia. It was found that patients who had the involvement of a cancer nurse coordinator and cancer support workers had better experiences and more streamlined care than did those who had to navigate the journey alone. This study endorses the function of cancer nurse coordinators and cancer support workers in providing better coordination of care in rural and regional cancerpatients. PMID:19816163
Infertility can arise as a consequence of treatment of oncological conditions. The parallel and continued improvement in both the management of oncology and fertility cases in recent times has brought to the fore-front the potential for fertility preservation in patients being treated for cancer. Oncologists must be aware of situations where their treatment will affect fertility in patients who are being treated for cancer and they must also be aware of the pathways available for procedures such as cryopreservation of gametes and/or embryos. Improved cancer care associated with increased cure rates and long term survival, coupled with advances in fertility treatment means that it is now imperative that fertility preservation is considered as part of the care offered to these patients. This can only be approached within a multidisciplinary setting. There are obvious challenges that still remain to be resolved, especially in the area of fertility preservation in prepubertal patients. These include ethical issues, such as valid consent and research in the area of tissue retrieval, cryopreservation, and transplantation.
Ajala, Tosin; Rafi, Junaid; Larsen-Disney, Peter; Howell, Richard
Background The evaluation of cancerpatients 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 cancerpatients 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.
Twenty closed head injured (CHI) and 15 control subjects (non-CHI) were selected from a hospital population and evaluated after all CHI subjects were alert and conscious. The test battery included an audiometric evaluation and 21 subtests of intelligence, verbal expressive and receptive language, articulation, auditory and visual short-term memory, oral agility, automatic speech, writing, reading, and simple mathematics. The CHI subjects performed significantly less well than the control group on all subtests except articulation and five of the subtests of reading, writing, and mathematics. Additionally, the less severely involved CHI subjects performed significantly better than the more severely involved CHI subjects on the subtest, Automatized Sequences, and, to a lesser degree, Oral Agility. The implications are that CHI has an immediate generalized effect upon the cerebral mechanisms subserving intelligence, speech, language, memory, and specific writing, reading, and arithmetic skills and that the differences seen in automatic speech and oral-motor skills appear to be dependent upon the severity of the traumatic head injury. I recommend that all CHI patients undergo assessment for communication competence regardless of the level of severity of the trauma. PMID:2427551
Venous thromboembolism (VTE) is a common complication of cancer and chemotherapy. We evaluated the baseline clinical characteristics, thromboprophylaxis patterns, frequency and timing of VTE, and clinical outcomes in 1000 adult hospitalized patients with active cancer. Overall, symptomatic VTE occurred in 5.4% of hospitalized patients with cancer. The VTE occurred in 2.3% of patients with cancer during hospitalization and in 3.4% between hospital discharge and day 90. Few (13.9%) hospitalized patients with cancer received extended duration pharmacological prophylaxis after hospital discharge. Cancer was the most frequent known cause of death in both the groups. In conclusion, VTE was common in hospitalized patients with cancer, especially after discharge. Inhospital death and death between discharge and day 90 were frequent in hospitalized patients with cancer who developed VTE. PMID:23482721
Piazza, Gregory; Rao, Amanda F; Nguyen, Thanh Nha; Seger, Andrew C; Hohlfelder, Benjamin; Fanikos, John; Goldhaber, Samuel Z
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 cancerpatients 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.
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
Cancer is a disease wherein abnormal cells divide without control and are able to attack other tissues. Most of the patients and their families face some degree of depression, anxiety, and fear when cancer becomes a part of their lives. They feel helpless and eager to find ways on how to get rid of it. The study focuses on anxiety among breast cancerpatients. It aims at investigating cancer, its symptoms, and effects the disease has on the anxiety level of patients.
Little is known about hair minerals in cancerpatients, and serum iron level has been shown to be elevated in breast cancer\\u000a patients. Therefore, the aim of this study was to evaluate hair iron and hair minerals’ level related to hair iron in breast\\u000a cancerpatients compared to controls. We compared hair mineral analysis data of 40 breast cancer subjects
Nam-Seok Joo; Sang-Man Kim; Yong-Sik Jung; Kwang-Min Kim
\\u000a Central nervous system (CNS) infections represent an important complication in cancerpatients undergoing therapy. These infections\\u000a are often difficult to diagnose, a high level of suspicion, prompt investigation, and institution of appropriate and early\\u000a therapy remains critical for improved outcomes. A wide variety of viruses, bacteria, mycobacteria, fungi and parasitic meningeal,\\u000a and brain disease makes empiric selection of antimicrobial therapy
Goals of work Constipation is a significant problem in patients taking morphine for cancer pain. The aims of this study were (1) to assess\\u000a the magnitude of constipation in this study cohort, (2) to analyse the constipation treatment strategies and (3) to look for\\u000a evidence of inter-individual variation in both susceptibility to constipation and response to treatment with laxatives in\\u000a this
Joanne Droney; Joy Ross; Sophy Gretton; Ken Welsh; Hiroe Sato; Julia Riley
Neuropathic pain is an increasingly common problem facing the cancerpatient. 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
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
The aim of this study was to explore how cancerpatients with progressive disease perceived and experienced supportive care at the different stages of their cancer journey and to compare this to the perceptions of health care professionals. It was a single centre study using qualitative data obtained from two focus group interviews in an independent centre for specialist palliative care. Eight patients attending the centre were interviewed in two focus groups to ascertain their views on the supportive care that they had experienced during the course of their illness, focusing on: time of diagnosis, acute treatment phase and palliative care phase. Themes that emerged from the analysis of the interview transcripts using the QSR NUD*IST (version 4) software package included the following: manner in which diagnosis was revealed, information made available to family and friends, patients' acceptance of cancer; service provision such as a named contact person, choices in treatment and care, problems of limited resources; feelings of being unsupported, and ways in which supportive care could be improved. PMID:16112527
Fincham, Lorraine; Copp, Gina; Caldwell, Kay; Jones, Louise; Tookman, Adrian
Fatigue affects a majority of patients undergoing cancer-related therapies. We conducted a study of 954 adult cancerpatients presenting for treatment at our hospital between April 2001 and November 2004 to quantify the relationship between fatigue and patient satisfaction with quality of life (QoL). Fatigue was measured using the European Organization for Research and Treatment of Cancer Quality of Life
Digant Gupta; Christopher G. Lis; James F. Grutsch
Doctor-patientcommunication is the heart of any medical practice. The technology of medicine today is focused on knowledge, its application and know-how, rather than skills of being, of knowing and of knowing when to do nothing. In 2005, Belgian High Council of Health emphasizes a quantitative and qualitative reduction of communication aspects within the initial medical training. The aim of our study is to investigate Belgian and foreign students perception of how the doctor-patientcommunication was taught during their studies. A questionnaire was sent by email to 300 Belgian and foreign Universities. We obtained 13.6% of answers of 99 students belonging to 41 Faculties from 22 countries. 55.6% of respondents thought to be well trained in the doctor-patientcommunication. 85.9% of students received theoretical courses out of which only 64.6% have the opportunity to enhance their apprenticeship by practical work. Majority of respondents required more practical work in learning to communicate. All of them agree on that they would like more applied practical communication incorporated into their curriculum. Like wise the society that calls for doctors with increased communication skills and communication researchers who emphasize the central role of the doctor-patientcommunication in the clinical and therapeutic approach, students are also seeking longitudinal transdisciplinary learning, including more practical practices. PMID:23373123
Richard, S; Pardoen, D; Piquard, D; Fostier, P; Thomas, J M; Vervier, J F; Verbanck, P
Modern therapeutic modalities and emphasis on early detection have made oral cancer a treatable, and in many cases, a curable disease. The role of the dentist in cancerpatient management is two-fold. Early detection of oral lesions during routine dental examination has been shown to be a significant factor in cancer diagnosis. The dentist's other role comes after cancer treatment,
Introduction: Cancer is the leading cause of death and the second most common cause of hospitalisation in Singapore. Significant functional gains are achievable with cancer rehabilitation yet there are no formal cancer rehabilitation programmes in Singapore. This study aims to describe the demographics, clinical characteristics, complications and functional outcomes of cancerpatients undergoing comprehensive inpatient rehabilitation at our unit and
Both genetic and environmental factors are known to play an important role in the development of cancer. To determine whether, among individuals who develop cancers, some may have been more susceptible to the mutagenic effects of environmental agents, skin biopsies were taken from 79 cancerpatients with different common types of cancers (e.g., lung, breast, bladder, colon, cervix, ovary, brain,
Objective: To assess whether cancerpatients receive timely information on adoption and third-party reproduction and whether discrimination exists in the system. Methods: A con- venience sample of 11 cancer organizations, 6 international adoption agencies, and 7 adoption specialists was informally surveyed by phone, by e-mail, and in person. Results: Cancer organizations did not know whether cancer is a barrier to
Chinese family members play an important role in end-of-life decision making. Culturally, they may believe that a patient's awareness of a poor prognosis could harm his or her well-being, and thus they may avoid telling the truth to the patient. To examine this cultural belief empirically, this study aimed to explore the relationships among the patient's awareness of the prognosis, the family's awareness of the prognosis, the patient's anxiety, and difficulty in communicating with family members. Clinical data mining was the research method. Clinical records of deceased cancerpatients in the palliative care unit of a hospital during 2003-2005 were reviewed, and 935 patients were included in this study. Logistic regression analyses indicated that patients who did not have a clear awareness of their prognosis were more likely to experience anxiety (odds ratio [OR]?=?1.44, 95% CI?=?1.14-1.82, p?=?0.002) and difficulty communicating with family members (OR?=?2.11, 95% CI?=?1.62-2.76, p?0.001). Patients whose family members were less aware of the prognosis were more likely to experience difficulty communicating with family members (OR?=?4.48, 95% CI?=?1.93-10.42, p?0.001). This study further suggests that awareness of prognosis may not harm Chinese patients. Instead, unrealistic incomplete awareness of prognosis by patients and family members may be associated with patient anxiety and difficulty communicating. PMID:21793730
160 patients (53.3%) replied to an anonymous questionnaire distributed to 300 consecutive patients of our Outpatient Oncology Clinic. 83 patients (53%) mentioned some experience of one or more alternative methods of cancer treatment. Most often cited were various herbal teas (35 instances), beetroot juice (16), Vogel plant extracts (15), laying-on of hands (14), homeopathic medicine (13), the mistletoe extract Iscador (13), magnetopathy (12), various diets (10), acupuncture (10) and psychological methods (9). Resort to alternative methods of treatment correlated significantly with lower age (51.5 years vs 59.8 years, p = 0.001). The reasons for using alternative medicine were the desire to do everything possible to regain health (49), to use one's psychological forces as well (35), reports of successful cancer cures (28), desire for a holistic approach (23), hope of "softer" medicine with less severe side effects (18) and, in 7 cases only, disappointment with conventional university medicine. The major source of information was relatives and friends, not the mass media. The physician should be aware of the locally available alternative medicine options and be able to advise his patients accordingly. He should also recognize and give due consideration to the patient's underlying desire for better control of his disease and a more holistic approach to care. PMID:1882214
Hospital-to-hospital transfers in a tertiary cancer center present an unusual set of problems involving a diverse group of acutely ill patients with highly specialized needs. The level and urgency of care required and the costs of providing optimal management often are exceedingly high. We present the administrative issues involved during a major revamping and streamlining of the Transfer Center at The University of Texas MD Anderson Cancer Center. The impetus for change included overuse of the emergency facility as a triage center for transferred patients, lack of adequate preadmission medical and financial screening of patients in anticipation of a transfer, a suboptimal level of physician-to-physician handoff communication, and insufficient protocols for prioritizing potential admissions and thus optimizing the institution's limited resources. During implementation of these revised policies, additional concerns were identified, including reluctance to modify established protocols and an inability to ensure the arrival of non-emergent transfer patients at our institution during daytime hours. Prioritizing admissions based on the degree of urgency and available resources required ongoing flexibility in accepting new concepts and ideas. The success of the project is documented in this report, as are suggestions for how other centers that experience similar challenging reorganizations can apply the lessons learned from our endeavors. PMID:21714374
Tortorella, Frank R; Ewer, Michael S; Douglas-Ntagha, Pamela B; Harper, Gayle; Walters, Ronald; Ecung, Wenonah B
Objective To teach pharmacy students how to apply transactional analysis and personality assessment to patient counseling to improve communication. Design A lecture series for a required pharmacy communications class was developed to teach pharmacy students how to apply transactional analysis and personality assessment to patient counseling. Students were asked to apply these techniques and to report their experiences. A personality self-assessment was also conducted. Assessment After attending the lecture series, students were able to apply the techniques and demonstrated an understanding of the psychological factors that may affect patientcommunication, an appreciation for the diversity created by different personality types, the ability to engage patients based on adult-to-adult interaction cues, and the ability to adapt the interactive patient counseling model to different personality traits. Conclusion Students gained a greater awareness of transactional analysis and personality assessment by applying these concepts. This understanding will help students communicate more effectively with patients.
The present study was designed to assess the clinical characteristics and outcomes of metaplastic breast cancer (MBC) compared\\u000a to general invasive ductal carcinoma (IDC) and the triple-negative subtype (TN-IDC). The study population included 35 MBC\\u000a and 2,839 IDC patients, including 473 TN-IDC diagnoses, from the National Cancer Center, Korea between 2001 and 2008. The\\u000a clinicopathological characteristics and clinical outcomes were
So-Youn Jung; Hyun Yul Kim; Byung-Ho Nam; Sun Young Min; Seung Ju Lee; Youngmee Kwon; Eun-A Kim; Kyoung Lan Ko; Kyung Hwan Shin; Keun Seok Lee; In Hae Park; Seeyoun Lee; Seok Won Kim; Han-Sung Kang; Jungsil Ro
Patients' ability to effectively communicate with their health care providers is an essential aspect of proper self-care, especially for those with chronic conditions. We wanted to develop and validate a brief, reliable measure of patientcommunication self-efficacy within clinical encounters. Consecutively recruited patients (n = 330) with diagnosed hypertension from seven primary care clinics in Chicago, Illinois, Grand Rapids, Michigan, and Shreveport,
Marla L. Clayman; Anjali U. Pandit; Ashley R. Bergeron; Kenzie A. Cameron; Emily Ross; Michael S. Wolf
Our objective was to gain a better understanding of minority patients’ beliefs about hypertension and to use this understanding to develop a model to explain gaps in communication between patients and clinicians. Eighty-eight hypertensive Black and Latino adults from four inner-city primary care clinics participated in focus groups to elucidate views on hypertension. Participants believed that hypertension was a serious illness in need of treatment. Participants’ diverged from the medical model in their beliefs about the time-course of hypertension (believed hypertension was intermittent); causes of hypertension (believed stress, racism, pollution, and poverty were the important causes); symptoms of hypertension (believed hypertension was primarily present when symptomatic); and treatments for hypertension (preferred alternative treatments that reduced stress over prescription medications). Participants distrusted clinicians who prioritized medications that did not directly address their understanding of the causes or symptoms of hypertension. Patients’ models of understanding chronic asymptomatic illnesses such as hypertension challenge the legitimacy of lifelong, pill-centered treatment. Listening to patients’ beliefs about hypertension may increase trust, improve communication, and encourage better self-management of hypertension.
Kronish, Ian M; Leventhal, Howard; Horowitz, Carol R
The authors' objective was to gain a better understanding of minority patients' beliefs about hypertension and to use this understanding to develop a model to explain gaps in communication between patients and clinicians. Eighty-eight hypertensive black and Latino adults from 4 inner-city primary care clinics participated in focus groups to elucidate views on hypertension. Participants believed that hypertension was a serious illness in need of treatment. Participants' diverged from the medical model in their beliefs about the time-course of hypertension (believed hypertension was intermittent); causes of hypertension (believed stress, racism, pollution, and poverty were the important causes); symptoms of hypertension (believed hypertension was primarily present when symptomatic); and treatments for hypertension (preferred alternative treatments that reduced stress over prescription medications). Participants distrusted clinicians who prioritized medications that did not directly address their understanding of the causes or symptoms of hypertension. Patients' models of understanding chronic asymptomatic illnesses such as hypertension challenge the legitimacy of lifelong, pill-centered treatment. Listening to patients' beliefs about hypertension may increase trust, improve communication, and encourage better self-management of hypertension. PMID:22235822
Kronish, Ian M; Leventhal, Howard; Horowitz, Carol R
In an experimental study neuroticism was examined as a moderator of breast cancerpatients' affective reactions to social comparison information about a fellow patient. Fifty-seven women with breast cancer completed Eysenck's Personality Questionnaire and received social comparison information about a fellow patient who was either doing better (upward condi- tion) or worse (downward condition) than themselves. As expected, patients showed
This study sought to describe counsellor-counselee interaction during initial cancer genetic counselling consultations and to examine whether the communication reflects counselees' previsit needs. A total of 130 consecutive counselees, referred mainly for breast or colon cancer, completed a questionnaire before their first appointment at a genetic clinic. Their visit was videotaped. Counselee and counsellor verbal communications were analysed and initiative to discuss 11 genetics-specific conversational topics was assessed. The content of the visit appeared relatively standard. Overall, counselees had a stronger psychosocial focus than counsellors. Counsellors directed the communication more and initiated the discussion of most of the topics assessed. Counselees did not appear to communicate readily in a manner that reflected their previsit needs. Counsellors provided more psychosocial information to counselees in higher need for emotional support, yet did not enquire more about counselees' specific concerns. New counselees may be helped by receiving more information on the counselling procedure prior to their visit, and may be advised to prepare the visit more thoroughly so as to help them verbalise more their queries during the visit. PMID:15841073
Pieterse, A H; van Dulmen, A M; Ausems, M G E M; Beemer, F A; Bensing, J M
Little is known about the relation between communication during cancer genetic counseling and outcome. We assessed associations between counselor-counselee communication and counselee satisfaction, cognitions, anxiety, and fulfillment of major needs, corrected for pre-visit levels as appropriate. In total 171 consecutive new counselees, mainly referred for breast or colon cancer, received pre- and post-visit questionnaires assessing needs/fulfillment, knowledge, perceived control (PPC), anxiety (STAI), and satisfaction. Initial visits were videotaped and counselor eye gaze was recorded. Verbal communication was rated by Roter Interaction Analysis System (RIAS). Asking more medical questions was associated with lower satisfaction levels. Receiving more medical information was related to higher correct knowledge scores, higher reported fulfillment of some needs, and unrelated to perceptions of control. Receiving more psychosocial information and longer counselor eye gaze were related to higher anxiety scores. Longer visits were related to higher correct knowledge scores. Providing medical information appears the most powerful communication aspect to increase counselee satisfaction and address needs. More research is needed on how to address adequately (emotional) needs and increase feelings of control. PMID:17295054
Pieterse, Arwen H; van Dulmen, Alexandra M; Beemer, Frits A; Bensing, Jozien M; Ausems, Margreet G E M
Abstract Abstract Abstract Abstract AIM: To explore the difference between cancer cells and normal cells, we investigated the Raman spectra of single cells from gastrointestinal cancerpatients. METHODS: All samples were obtained from 30 diagnosed as gastrointestinal cancerpatients. The flesh tumor specimen is located in the center of tumor tissue, while the normal ones were 5 cm away from
Xun-Ling Yan; Rui-Xin Dong; Lei Zhang; Xue-Jun Zhang; Zong-Wang Zhang
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
Hyperthermia-the artificial inducement of abnormally high blood temperature-is designed to cause tumor tissue to retain heat and has additive or synergistic effects with radiation and chemotherapy. Because of the clinically administered high temperature, cancerpatients often experience pain and discomfort. In the study described in this article, 30 cancerpatients undergoing hyperthermia treatment as part of their overall cancer care
Ronald H. Rozensky; Laurie Feldman Honor; Steve M. Tovian; Gordon Herz; Margaret Holland
BACKGROUND: Many breast cancerpatients 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
Cancerpatients at the end of life often take many medications and are at risk for drug interactions. The purpose of this study was to describe the epidemiology of potential drug interactions in cancerpatients receiving supportive care exclusively. We retrospectively reviewed the charts of consecutive adult cancer outpatients attending palliative care clinics at the Princess Margaret Hospital, Toronto, Canada.
Rachel P. Riechelmann; Camilla Zimmermann; Sheray N. Chin; Lisa Wang; Aoife O'Carroll; Sanaz Zarinehbaf; Monika K. Krzyzanowska
The Descriptive cross sectional study was conducted over the period of 1 st July 2006 to 30 th June 2007 (one year) to estimate disability burden and economic loss incurred by cancerpatients. The study was carried out among 224 cancerpatients who attended the National Institute Cancer Research & Hospital (NIRCH). Data was collected by face-to-face interview using a
Objective: Patients with COPD consistently express a desire to discuss end-of-life care with clinicians, but these discussions rarely occur. We assessed whether an intervention using patient-specific feedback about preferences for discussing end-of-life care would improve the occurrence and quality of communication between patients with COPD and their clinicians. Methods: We performed a cluster-randomized trial of clinicians and patients from the outpatient clinics at the Veterans Affairs Puget Sound Health Care System. Using self-reported questionnaires, we assessed patients’ preferences for communication, life-sustaining therapy, and experiences at the end of life. The intervention clinicians and patients received a one-page patient-specific feedback form, based on questionnaire responses, to stimulate conversations. The control group completed questionnaires but did not receive feedback. Patient-reported occurrence and quality of end-of-life communication (QOC) were assessed within 2 weeks of a targeted visit. Intention-to-treat regression analyses were performed with generalized estimating equations to account for clustering of patients within clinicians. Results: Ninety-two clinicians contributed 376 patients. Patients in the intervention arm reported nearly a threefold higher rate of discussions about end-of-life care (unadjusted, 30% vs 11%; P < .001). Baseline end-of-life communication was poor (intervention group QOC score, 23.3; 95% CI, 19.9-26.8; control QOC score, 19.2; 95% CI, 15.9-22.4). Patients in the intervention arm reported higher-quality end-of-life communication that was statistically significant, although the overall improvement was small (Cohen effect size, 0.21). Conclusions: A one-page patient-specific feedback form about preferences for end-of-life care and communication improved the occurrence and quality of communication from patients’ perspectives. Trial registry: ClinicalTrials.gov; No.: NCT00106080; URL: www.clinicaltrials.gov
Udris, Edmunds M.; Engelberg, Ruth A.; Diehr, Paula H.; Bryson, Christopher L.; Reinke, Lynn F.; Curtis, J. Randall
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 resear...
Cancer stem cells (CSCs) have been defined as cells within tumor that possess the capacity to self-renew and to cause the heterogeneous lineages of cancer cells that comprise the tumor. They have been identified in blood, breast, brain, colon, melanoma, pancreatic, prostate, ovarian, lung cancers and so on. It is often considered to be associated with chemo-resistance and radio-resistance that lead to the failure of traditional therapies. Most therapies are directed at the fast growing tumor mass but not the slow dividing cancer stem cells. Eradicating cancer stem cells, the root of cancer origin and recurrence, has been thought as a promising approach to improve cancer survival or even to cure cancerpatients. Understanding the characteristics of cancer stem cells will help to develop novel therapies to eliminate the initiating cancer stem cell, and the relevant patents on the cancer stem cell and cancer therapy by cancer stem cells will be discussed.
Background Most of the studies about invasive Candida infections in cancerpatients have focused on haematological patients. The aim of this study was to provide information about risk factors for candidaemia in patients with solid tumours. Methods Retrospective cohort study. During a 9-year period (1995–2003) we reviewed all cases of candidaemia that affected cancerpatients in Santa Casa Complexo Hospitalar, Brazil. Results During the period of study, 210 patients had the diagnosis of candidaemia in our medical centre, and 83 of these patients had cancer (39.5%). The majority of patients with cancer had solid tumours (77.1%), mostly in the alimentary tract. Most of solid cancers were non-metastatic (71.9%). Major diagnoses in patients with haematological neoplasia were acute leukaemia (n = 13), high grade non-Hodgkin lymphoma (n = 5) and Hodgkin's disease (n = 1). Non-Candida albicans species caused 57.8% of the episodes of candidaemia in patients with cancer, mainly in patients with haematological malignancies (p = 0.034). Neutropenia and treatment with corticosteroids were more frequent in the haematological group, in comparison with patients with solid tumours. Only 22.2% of patients with solid tumours were neutropenic before candidaemia. Nonetheless, the presence of ileus and the use of anaerobicides were independent risk factors for candidaemia in patients with solid cancers. The overall mortality in cancerpatients with candidaemia was 49.4%. We then compared 2 groups of adult patients with candidaemia. The first was composed of non-neutropenic patients with solid tumours, and the second group included patients without cancer. We found that central venous catheters and gastrointestinal surgery were independently associated with candidaemia in patients with solid tumour. Conclusion Cancerpatients with candidaemia seem to have very different predisposing factors to acquire the infection when stratified according to baseline diseases. This study provides some useful clinical information regarding risk for candidaemia in patients with solid tumours.
... October 25, 2013 Related MedlinePlus Pages Breast Cancer Health Disparities FRIDAY, Oct. 25 (HealthDay News) -- Patient assistance programs ... rights reserved. More Health News on: Breast Cancer Health Disparities Recent Health News Page last updated on 28 ...
To understand the influence of Latino culture in breast cancer treatment, by developing a conceptual model of the informal support system utilized by 60 triads consisting of Latina cancerpatients, their spouses/significant others and family/friends. Part...
Purpose, To understand the influence of Latino culture in breast cancer treatment, by developing a conceptual model of the informal support system utilized by 60 triads consisting of Latina cancerpatients, their spouses/significant others and family/frie...
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...
The data of an epidemiologic study of multiple primary malignant neoplasms in breast cancerpatients in Israel are presented. During the 18-year period of the study 12,302 cases of breast carcinoma were diagnosed, and, of these, 984 patients (8%) had multiple primary malignant tumors. Forty-seven of these patients developed two multiple primary cancers. A significantly higher than expected incidence of second primary cancers occurred at the following five sites: the opposite breast, salivary glands, uterine corpus, ovary, and thyroid. Cancers of the stomach and gallbladder were fewer than expected. Treatment of the breast cancer by irradiation was associated with an increased risk of subsequent cancers of lung and hematopoietic system. The prognosis was mainly influenced by the site and malignancy of the second primary cancer. The incidence of multiple primary malignancies justifies a high level of alertness to this possibility in the follow-up of breast cancerpatients.