Expert-reviewed information summary about communicating with the cancer patient and his or her family, including unique aspects of communication with cancer patients, factors affecting communication, and training in communication skills.
Newton, J Tim
Effective communication has benefits for both patients and members of the health care team. Five main communication tasks in head and neck cancer are identified: Screening for head and neck cancer and communicating risk; Communicating the diagnosis of head and neck cancer; Providing information about treatment and pre-treatment; Communicating following treatment and dealing with fear of recurrence; Discussing the end of life. For each specific aspects of the communication situation are discussed. Underpinning each is the use of core communication skills.
Muszbek, Katalin; Gaal, Ilona
There is a "confusion of tongues" in the communication between patient and physician that hinders mutual understanding. Cancer - because of its malignant and often chronic nature - accentuates the communication problems and emphasizes the importance of human relationship. The confusion of tongues can only be resolved through understanding of the situation and motivations of the other person. Thus our aim is to help medical doctors to recognize and understand the most important communication characteristics of the doctor-patient interactions that are strained by the burden of cancer. Interviews with directly concerned professionals and non-professionals were recorded in order to reveal the most common communication disturbances. The majority of the "communication vacuum" arose when bad news should be disclosed for the patient, as bad news is bad for the physician as well. It is emotionally burdening to perceive bad news, and a big challenge for the physician to break it gently, to be tactful, while he/she has no possibility to pay attention with regard to his/her own emotional stability. Medical doctors can cope with this challenge if they are acquainted with the psychological difficulties of the patients that block the effective medical communication.
Khoshnazar, Tahereh Alsadat Khoubbin; Rassouli, Mrayam; Akbari, Mohammad Esmaeil; Lotfi-Kashani, Farah; Momenzadeh, Syrus; Rejeh, Nahid; Mohseny, Maryam
Introduction: Since communication is considered to be one of the central concepts in caregiving practices, this study aims to examine the perception of women with breast cancer in terms of their communication needs. Methods: In this qualitative study, 20 participants (9 women with breast cancer, 10 of health-care professionals, and one family caregiver) were selected through purposive sampling, and a face-to-face semi-structured interview was conducted with each of them. After data collection, all interviews were transcribed and reviewed, and categories were extracted. The data were analyzed with Conventional Content Analysis of Landman and Graneheim using MAXQDA10 software. Results: The analysis resulted in two extracted categories: “therapeutic communication” and “facilitating empathy”, and five subcategories: “trust-building therapist”, “crying out to be heard,” “seeking a soothing presence,” “sharing knowledge,” and “supportive peers”. Conclusion: Identifying and promoting the communicative needs of patients could lead to a considerably better care of patients under treatment. Therefore, therapeutic communication, as an integral part, should be incorporated into the care plan for patients with breast cancer and their families in the Oncology and Palliative Care wards. PMID:27803561
Gao, Ge; Burke, Nancy; Somkin, Carol P.; Pasick, Rena
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. PMID:19363141
Underhill, Meghan L.; Kiviniemi, Marc T.
Background: Two-thirds of adults aged 50 years and older are adherent to recommendations for colorectal cancer screening. Provider-patient communication and characteristics of the patient-provider relationship may relate to screening behavior. Methods: The association of provider communication quality, relationship, and colorectal cancer screening…
Ishikawa, Hirono; Takayama, Tomoko; Yamazaki, Yoshihiko; Seki, Yukiko; Katsumata, Noriyuki
Over the past few decades, physician-patient communication has been intensively studied in western countries, because of its importance for the physician-patient relationship and patient health outcomes. Although various concepts and models of this relationship have recently been introduced in Japan, there are few studies on Japanese physician-patient interaction. The purpose of this study is to describe characteristics of physician-patient communication in a Japanese cancer consultation, and to examine the relation of this interaction with patient satisfaction. One hundred and forty cancer outpatients and twelve physicians were included. The Roter Interaction Analysis System (RIAS), one of the most frequently used systems for analyzing physician-patient interaction, was applied, physicians made more utterances directing the interaction than patients did, and their discussion was largely focused on biomedical topics. It can be concluded that the structure of the physician-patient interaction in our study was basically similar to those in previous western studies, although some differences were also found. The relation between physician-patient communication and patient satisfaction was generally consistent with previous studies. Patients were more satisfied with consultations in which the physician used more open-ended questions. On the other hand, physician direction and encouragement was negatively associated with patient satisfaction. Also, patients who asked more questions were less satisfied with the consultation.
Wilbur, Kerry; Al-Okka, Maha; Jumaat, Ebaa; Eissa, Nesma; Elbashir, Merwa; Al-Yafei, Sumaya M Al Saadi
Purpose Cancer treatments are frequently associated with adverse effects, but there may be a cultural reluctance by care providers to be forthcoming with patients regarding these risks for fear of promoting nonadherence. Conversely, research in a number of countries indicates high levels of patient desire for this information. We sought to explore cancer patient experiences, satisfaction, and preferences for medication risk communication in a Middle East care setting. Methods We developed and administered a ten-item questionnaire (Arabic and English) to a convenience sample of consenting adult patients receiving treatment at the National Center for Cancer Care and Research in Qatar. Results One hundred and forty-three patients were interviewed. Most (88%) stated that the level of side effect information they received was sufficient, with physicians (86%) followed by pharmacists (39%) as the preferred sources. The majority (97%) agreed that knowing about possible side effects would help them recognize and manage the reaction, and 92% agreed that it would help them understand how to minimize or prevent the risks. Eighteen percent indicated that this information would make them not want to take treatment. Two-thirds (65%) had previously experienced intolerance to their cancer treatment regimen. Conclusion Most patients surveyed expressed preference for the details of possible side effects they may encounter in their treatment. However, one in five considered such information a factor for nonadherence, indicating the need for patient-specific approaches when communicating medication risks. PMID:27175061
Finkelstein, A; Carmel, S; Bachner, Y G
Physician-patient communication style is of utmost importance to patients with life-threatening diseases. This study identifies the most desired physician communication style by older cancer patients; and examines which of the studied communication styles significantly explains cancer patients' satisfaction with family physicians. A total of 200 older cancer patients, with average age of 75 years, participated in the study, yielding a response rate of 42%. Prospective respondents were randomly selected from the list of cancer patients in the central geographical district of Israel's second largest Health Maintenance Organization fund. Respondents rated their satisfaction with physicians as relatively high. All three communication styles studied were found to be associated with patient's satisfaction. Associations were found between self-rated health, time since the diagnosis of cancer and satisfaction. Women were less satisfied than men with their physicians. Two variables emerged as significant predictors of satisfaction: the physician's caring communication style and patient's gender. Intervention programmes should focus on elevating physicians' awareness of the importance of their communication with cancer patients in general, and of the caring communication style in particular.
Wibe, Torunn; Ekstedt, Mirjam; Hellesø, Ragnhild; Varsi, Cecilie; Ruland, Cornelia
To some extent, electronic communication has supplemented nurses' face-to-face contact with patients over the last few years. In this paper, we report findings from a study in which we examined cancer nurses' answers to messages from testicular cancer patients in a nurse-managed online patient-provider communication service. The aim of the study was to investigate how nurses manage to meet patients' different questions and concerns, and what aspects of expert nursing care are demonstrated when they communicate with patients online. The content of the messages formed a continuum from practical to existential issues. In their answers, the nurses demonstrated an ability to make reflected choices between both support modalities and means of communication. The professional knowledge and care of expert cancer nurses were clearly exposed in the nurses' answers, although they were good at adapting their professional language so that it would be understandable to the patients.
Hillen, Marij A; de Haes, Hanneke C J M; van Tienhoven, Geertjan; Bijker, Nina; van Laarhoven, Hanneke W M; Vermeulen, Daniëlle M; Smets, Ellen M A
Trust in the oncologist is crucial for breast cancer patients. It reduces worry, enhances decision making, and stimulates adherence. Optimal nonverbal communication by the oncologist, particularly eye contact, body posture, and smiling, presumably benefits patients' trust. We were the first to experimentally examine (1) how the oncologist's nonverbal behavior influences trust, and (2) individual differences in breast cancer patients' trust. Analogue patients (APs) viewed one out of eight versions of a video vignette displaying a consultation about chemotherapy treatment. All eight versions varied only in the oncologist's amount of eye contact (consistent vs. inconsistent), body posture (forward leaning vs. varying), and smiling (occasional smiling vs. no smiling). Primary outcome was trust in the observed oncologist (Trust in Oncologist Scale). 214 APs participated. Consistent eye contact led to stronger trust (β = -.13, p = .04). This effect was largely explained by lower educated patients, for whom the effect of consistent eye contact was stronger than for higher educated patients (β = .18, p = .01). A forward leaning body posture did not influence trust, nor did smiling. However, if the oncologist smiled more, he was perceived as more friendly (rs = .31, p < .001) and caring (rs = .18, p = .01). Older (β = .17, p = .01) and lower educated APs (β = -.25, p < .001) were more trusting. Trust was weaker for more avoidantly attached APs (β = -.16, p = .03). We experimentally demonstrated the importance of maintaining consistent eye contact for breast cancer patients' trust, especially among lower educated patients. These findings need to be translated into training for oncologists in how to optimize their nonverbal communication with breast cancer patients while simultaneously managing increased time pressure and computer use during the consultation.
Lin, Jenny J.; Lake, Jessica; Wall, Melanie M.; Berman, Andrew R.; Salazar-Schicchi, John; Powell, Charles; Keller, Steven M.; Halm, Ethan A.; Leventhal, Howard; Wisnivesky, Juan P.
Background Patient-physician communication is critical for helping patients understand and complete the complex steps needed to diagnose stage and treat lung cancer. We assessed which domains of patient-physician communication about lung cancer and its treatment are associated with receipt of disease-directed, stage-appropriate treatment. Methods Patients with recently-diagnosed lung cancer were recruited from four medical centers in New York City from 2008 to 2011. Participants were surveyed about discussions with physicians regarding treatment, symptoms and needs. Multiple regression analysis and structural equation modeling were used to assess which communication factors were associated with disease treatment. Results Of the 352 participants, 191 (54%) received disease-directed, stage-appropriate treatment. Unadjusted associations between communication items and treatment found that participants who felt that their physicians explained the risks and disadvantages of lung cancer treatment (P<0.01), discussed their chances of cure (P=0.02), discussed goals of treatment (P<0.01) or who were warm and friendly (P=0.04) were more likely to undergo treatment. Three communication domains were identified: treatment information, physician support, and patient symptoms/needs. After adjusting for known determinants of lung cancer treatment, increased treatment information was associated with higher probability of cancer-directed treatment (P=0.003). Other communication domains (physician support or patient symptoms/needs) were not independent predictors of treatment (P>0.05 for both comparisons). Conclusions These data suggest that treatment information is particularly important for increasing the probability of cancer-directed therapy among lung cancer patients. Clinicians should ensure that they clearly discuss treatment goals and options with patients while maintaining empathy, supporting patient needs, and addressing symptoms. PMID:25122421
African American women and Latinas often experience suboptimal breast cancer care. This article describes providers' self-rated skills in communication practices when working with African American women and Latinas diagnosed with breast cancer. Current literature reveals how providers are lacking in the ability to communicate with these patients and often fail to incorporate cultural beliefs into breast cancer care and treatment. This poor communication and failure to acknowledge cultural beliefs can be correlated with poor patient outcomes. In a study of providers' perceptions of how they address the cultural beliefs of African American women and Latinas diagnosed with breast cancer, interviews with physicians, inpatient nurses, cancer clinic nurses, mammography technicians, and ultrasound technicians showed that they used the same approach for all patients, regardless of race, ethnicity, or culture but felt they practiced culturally sensitive care. Increased and improved cultural competence education is recommended for providers at all levels as a first step toward increasing culturally competent communications.
Cancer patients' use of complementary and alternative medicine (CAM) is widespread, despite the fact that clinical studies validating the efficacy of CAM remain sparse in the Nordic countries. The purpose of this study was to explore possible connections between cancer patients' communication experiences with doctors and the decision to use CAM as either supplement or alternative to conventional treatment (CT). The Regional Committee for Medical and Health Research Ethics and the Norwegian Data Inspectorate approved the study. From a group of 52 cancer patients with self-reported positive experiences from use of CAM, 13 were selected for qualitative interviews. Six used CAM as supplement, and seven as alternative to CT, periodically or permanently. Communication experiences with 46 doctors were described. The analysis revealed three connections between doctor-patient communication and patients' treatment decisions: (i) negative communication experiences because of the use of CAM; (ii) negative communication experiences resulted in the decision to use CAM, and in some cases to decline CT; and (iii) positive communication experiences led to the decision to use CAM as supplement, not alternative to CT. The patients, including the decliners of CT, wanted to discuss treatment decisions in well-functioning interpersonal processes with supportive doctors. In doctors' practices and education of doctors, a greater awareness of potential positive and negative outcomes of doctor-patient communication that concern CAM issues could be of importance. More research is needed to safeguard CAM users' treatment decisions and their relationship to conventional health care.
Cohen, Mallory; Anderson, Rebecca C; Jensik, Kathleen; Xiang, Qun; Pruszynski, Jessica; Walker, Alonzo P
Breast cancer patients encounter body image changes throughout their diagnosis, treatment, and recovery from breast cancer. No prospective studies were identified investigating communication between physicians and breast cancer patients related to body image. This qualitative pilot study determines (1) how breast cancer patients prefer their physicians communicate regarding body image changes and (2) how comfortable physicians are in discussing body image issues with their patients. Data were collected from patients over 12 weeks through the breast evaluation questionnaire (BEQ), a valid and reliable instrument, and a qualitative questionnaire. Ten physicians completed a qualitative questionnaire. The data were analyzed using frequency analysis. Nearly 70% of the patients reported there was more the physician could do to improve patient comfort in discussing breast-related body image concerns. Honesty, openness, and directness were important to the patients. Thirty-three percent of the patients answered that their physicians should be honest, open, and direct while discussing these issues. On a five-point Likert scale (1 = very uncomfortable and 5 = very comfortable), the physicians most frequently answered a 4 when asked how comfortable they are speaking about breast-related body image issues; however, only four out of 10 always address the topic themselves during the patient's visit. These data suggest that patients want honesty, openness, and directness from their physicians during the discussion of breast-related body image issues. The physicians report they are comfortable speaking about breast-related body image issues; yet, they do not directly initiate the topic.
Singh, Hardeep; Arora, Neeraj K.; Mazor, Kathleen M.; Street, Richard L.
The Veterans Health Administration (VHA) is charged with providing high-quality health care, not only in terms of technical competence but also with regard to patient-centered care experiences. Patient-centered coordination of care and communication are especially important in cancer care, as deficiencies in these areas have been implicated in many cases of delayed cancer diagnosis and treatment. Additionally, because cancer care facilities are concentrated within the VHA system, geographical and system-level barriers may present prominent obstacles to quality care. Systematic assessment of patient-centered communication (PCC) may help identify both individual veterans who are at risk of suboptimal care and opportunities for quality improvement initiatives at the service, facility, or system-wide level. In this manuscript, we describe our vision to implement an assessment of PCC through patient self-report to improve the quality of cancer care and other health services in the VHA. We outline a possible strategy to assess PCC that leverages the VHA’s existing initiative to promote use of an online personal health record for veterans (MyHealtheVet). Questionnaires administered periodically or following specific episodes of care can be targeted to assess PCC in cancer care. Assessment of PCC can also be tied to clinical and administrative data for more robust analysis of patient outcomes. Ultimately, the goal of any assessment of PCC is to gather valid, actionable data that can assist VHA clinicians and staff with providing the best possible care for veterans with cancer.
Peterson, Emily B; Ostroff, Jamie S; DuHamel, Katherine N; D'Agostino, Thomas A; Hernandez, Marisol; Canzona, Mollie R; Bylund, Carma L
Cancer screening is critical for early detection and a lack of screening is associated with late-stage diagnosis and lower survival rates. The goal of this review was to analyze studies that focused on the role of provider-patient communication in screening behavior for cervical, breast, and colorectal cancer. A comprehensive search was conducted in four online databases between 1992 and 2016. Studies were included when the provider being studied was a primary care provider and the communication was face-to-face. The search resulted in 3252 records for review and 35 articles were included in the review. Studies were divided into three categories: studies comparing recommendation status to screening compliance; studies examining the relationship between communication quality and screening behavior; and intervention studies that used provider communication to improve screening behavior. There is overwhelming evidence that provider recommendation significantly improves screening rates. Studies examining quality of communication are heterogeneous in method, operationalization and results, but suggest giving information and shared decision making had a significant relationship with screening behavior. Intervention studies were similarly heterogeneous and showed positive results of communication interventions on screening behavior. Overall, results suggest that provider recommendation is necessary but not sufficient for optimal adherence to cancer screening guidelines. Quality studies suggest that provider-patient communication is more nuanced than just a simple recommendation. Discussions surrounding the recommendation may have an important bearing on a person's decision to get screened. Research needs to move beyond studies examining recommendations and adherence and focus more on the relationship between communication quality and screening adherence.
Rose, Julia Hannum; Radziewicz, Rosanne; Bowmans, Karen F; O'Toole, Elizabeth E
As our society ages, increasing numbers of older Americans will be diagnosed and eventually will die of cancer. To date, psycho-oncology interventions for advanced cancer patients have been more successful in reaching younger adult age groups and generally have not been designed to respond to the unique needs and preferences of older patients. Theories and research on successful aging (Baltes and Baltes 1990; Baltes 1997), health information processing style (Miller 1995; Miller et al 2001) and non-directive client-centered therapy (Rogers 1951, 1967), have guided the development of a coping and communication support (CCS) intervention. Key components of this age-sensitive and tailored intervention are described, including problem domains addressed, intervention strategies used and the role of the CCS practitioner. Age group comparisons in frequency of contact, problems raised and intervention strategies used during the first six weeks of follow up indicate that older patients were similar to middle-aged patients in their level of engagement, problems faced and intervention strategies used. Middle-aged patients were more likely to have problems communicating with family members at intervention start up and practical problems as well in follow up contacts. This is the first intervention study specifically designed to be age sensitive and to examine age differences in engagement from the early treatment phase for late-stage cancer through end of life. This tailored intervention is expected to positively affect patients' quality of care and quality of life over time.
Kai, J; Beavan, J; Faull, C
Background: Evidence concerning the influence of ethnic diversity on clinical encounters in cancer care is sparse. We explored health providers' experiences in this context. Methods: Focus groups were conducted with a purposeful sample of 106 health professionals of differing disciplines, in 18 UK primary and secondary care settings. Qualitative data were analysed using constant comparison and processes for validation. Results: Communication and the quality of information exchanged with patients about cancer and their treatment was commonly frustrated within interpreter-mediated consultations, particularly those involving a family member. Relatives' approach to ownership of information and decision making could hinder assessment, informed consent and discussion of care with patients. This magnified the complexity of disclosing information sensitively and appropriately at the end of life. Professionals' concern to be patient-centred, and regard for patient choice and autonomy, were tested in these circumstances. Conclusion: Health professionals require better preparation to work effectively not only with trained interpreters, but also with the common reality of patients' families interpreting for patients, to improve quality of cancer care. Greater understanding of cultural and individual variations in concepts of disclosure, patient autonomy and patient-centredness is needed. The extent to which these concepts may be ethnocentric and lack universality deserves wider consideration. PMID:21863029
Expert-reviewed information summary about communicating with the cancer patient and his or her family, including unique aspects of communication with cancer patients, factors affecting communication, and training in communication skills.
Katz, J E; Roberge, D; Coulombe, G
As computers and smartphones continue to transform the doctor-patient relationship, it is essential that healthcare professionals understand how their patients wish to interact with these devices. The results from a satisfaction questionnaire of 225 Oncology patients treated in 2011 in Quebec, Canada provide insight into the manner in which patients have been and wish to communicate with their healthcare teams. The survey also addressed whether or not patients searched the Internet for supplementary information regarding their condition. Generally, patients were neutral regarding adopting greater usage of modern means of communication. The majority of patients did not want to be contacted via e-mail or SMS, nor did the patients want to make appointments or fill out surveys online. Forty four percent of patients used the Internet to learn more about their condition. Concerning the patients who were not provided with links to medically relevant websites, 44% wished their doctors had supplied them with such links. Though there was much overlap between the 44% of patients who went on the Internet to learn more about their condition and the 44% of the patients who wished their physicians provided them with such links, 14% of all the patients wished their medical teams had provided them with links, but did not independently search for medically relevant information about their condition. Using chi-square testing education level was found to be the best predictor of which patients searched the web for supplementary information about their conditions (p = 0.003). Contrary to findings in other studies, a comparable proportion of patients in each age-group used the Internet to research their condition. Given the wealth of web-resources available to cancer patients, it would be beneficial for both healthcare teams and their patients if physicians consistently offered a list of trustworthy websites to their patients.
Lin, Jenny J; Chao, Jennifer; Bickell, Nina A; Wisnivesky, Juan P
Side effects from hormonal therapy (HT) for breast cancer treatment occur frequently and are associated with worse quality of life and HT non-adherence. Whether improved patient-physician communication is associated with patients' reporting of side effects is unknown. We undertook this study to assess factors associated with women's reports of HT side effects. Between December 2012 and April 2013, we conducted a cross-sectional survey of breast cancer patients undergoing HT in an urban medical center. Descriptive statistics, univariate analyses, and multivariate analyses were used to evaluate associations. Of the 100 participants, 67% reported having HT side effects. However, when prompted, an additional 9% reported experiencing specific HT-related symptoms. Despite very high communication scores, one-third of participants reported they had not discussed side effects with providers. Multivariate analysis showed that after controlling for age, education, race, and medication beliefs, women who had difficulty asking providers for more information were more likely to report side effects (odds ratio 8.27, 95% confidence interval 1.01-69.88). Although HT side effects often occur and are bothersome, patient-provider discussions about side effects remain suboptimal. Providers should actively ask patients about medication side effects so that they can be addressed to improve quality of life and potentially, medication adherence.
Bishop, Thomas W; Gorniewicz, James; Floyd, Michael; Tudiver, Fred; Odom, Amy; Zoppi, Kathy
This workshop demonstrated the utility of a patient-centered web-based/digital Breaking Bad News communication training module designed to educate learners of various levels and disciplines. This training module is designed for independent, self-directed learning as well as group instruction. These interactive educational interventions are based upon video-recorded patient stories. Curriculum development was the result of an interdisciplinary, collaborative effort involving faculty from the East Tennessee State University (ETSU) Graduate Storytelling Program and the departments of Family and Internal Medicine at the James H. Quillen College of Medicine. The specific goals of the BBN training module are to assist learners in: (1) understanding a five-step patient-centered model that is based upon needs, preferences, and expectations of patients with cancer and (2) individualizing communication that is consistent with patient preferences in discussing emotions, informational detail, prognosis and timeline, and whether or not to discuss end-of-life issues. The pedagogical approach to the training module is to cycle through Emotional Engagement, Data, Modeled Practices, Adaptation Opportunities, and Feedback. The communication skills addressed are rooted in concepts found within the Reaching Common Ground communication training. A randomized control study investigating the effectiveness of the Breaking Bad News module found that medical students as well as resident physicians improved their communication skills as measured by an Objective Structured Clinical Examination. Four other similarly designed modules were also created: Living Through Treatment, Transitions: From Curable to Treatable/From Treatable to End-of-Life, Spirituality, and Family.
Lewis, Nehama; Martinez, Lourdes S
This study addresses whether having a broad social network of close friends equips cancer patients with increased efficacy to engage in communication about their cancer, which then leads to an increased likelihood of patients actively seeking cancer-related information. Guided by the theory of motivated information management, the study also tests whether the effect of the number of close social ties on information seeking is mediated, in part, by communication efficacy. Results are based on data collected from a randomly drawn sample from the Pennsylvania Cancer Registry of 2,013 cancer patients who completed mail surveys in the Fall of 2006. Results are consistent with a cross-sectional mediation effect in which the number of close social ties in one's social network is positively associated with communication efficacy (b = .17, p = .001), which, in turn, is positively associated with cancer-related information seeking (b = .13, p < .001).
Background Aboriginal Australians experience poorer outcomes from cancer compared to the non-Aboriginal population. Some progress has been made in understanding Aboriginal Australians’ perspectives about cancer and their experiences with cancer services. However, little is known of cancer service providers’ (CSPs) thoughts and perceptions regarding Aboriginal patients and their experiences providing optimal cancer care to Aboriginal people. Communication between Aboriginal patients and non-Aboriginal health service providers has been identified as an impediment to good Aboriginal health outcomes. This paper reports on CSPs’ views about the factors impairing communication and offers practical strategies for promoting effective communication with Aboriginal patients in Western Australia (WA). Methods A qualitative study involving in-depth interviews with 62 Aboriginal and non-Aboriginal CSPs from across WA was conducted between March 2006 - September 2007 and April-October 2011. CSPs were asked to share their experiences with Aboriginal patients and families experiencing cancer. Thematic analysis was carried out. Our analysis was primarily underpinned by the socio-ecological model, but concepts of Whiteness and privilege, and cultural security also guided our analysis. Results CSPs’ lack of knowledge about the needs of Aboriginal people with cancer and Aboriginal patients’ limited understanding of the Western medical system were identified as the two major impediments to communication. For effective patient–provider communication, attention is needed to language, communication style, knowledge and use of medical terminology and cross-cultural differences in the concept of time. Aboriginal marginalization within mainstream society and Aboriginal people’s distrust of the health system were also key issues impacting on communication. Potential solutions to effective Aboriginal patient-provider communication included recruiting more Aboriginal staff
Farquhar, M C; Barclay, S I G; Earl, H; Grande, G E; Emery, J; Crawford, R A F
Effective communication across the primary/secondary interface is vital for the planning and delivery of appropriate patient care throughout the cancer patient journey. This study describes GPs' views of the communication issues across the primary/secondary interface in relation to ovarian cancer patients using qualitative interviews with purposively sampled general practitioners (GPs) and an audit of hospital medical records of 30 deceased ovarian cancer patients. 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.
Farias, Albert J.; Ornelas, India J.; Hohl, Sarah D.; Zeliadt, Steven B.; Hansen, Ryan N.; Li, Christopher I.; Thompson, Beti
Purpose To better understand how physicians communicate with breast cancer patients about adjuvant endocrine therapy (AET), we explored, from the breast cancer patient’s perspective, dimensions of the patient-provider communication among women who were on active AET treatment. Methods Qualitative methods using semi-structured in-depth interviews were conducted with breast cancer patients (n = 22) who filled a prescription for AET in the previous 12 months. Interview questions aimed to elicit experiences with AET. We reviewed and coded interview transcripts using qualitative principles of inductive reasoning to identify concepts and themes from interview data. Results We grouped emergent themes into four major functions of physician-patient communication: (1) information exchange, (2) decision-making to take and continue AET, (3) enabling patient self-management and monitoring potential side effects, and (4) emotional support. Physicians exchanged information with patients in a way that they understood and enhanced patient’s health literacy regarding the benefits and knowledge of AET. Physicians empowered patients to make decisions about their care. Patients expressed trust and confidence in their physician which helped them seek care when needed. Patients reported a high degree of self-efficacy to self-manage AET and were continuing treatment despite potential side effects. Conclusions The results from our study suggest that women’s interactions and communication with their physician may be an important factor that contributes to the continued use of AET. Physicians who can communicate information about AET treatment benefits, purpose, and expectations in a way that patients can understand is a critical aspect of care that needs to be further studied. PMID:27557832
Wibe, Torunn; Hellesø, Ragnhild; Varsi, Cecilie; Ruland, Cornelia; Ekstedt, Mirjam
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.
BADR, HODA; CARMACK, CINDY L.; DIEFENBACH, MICHAEL A.
Interactive health communication technologies (IHCTs) present a new opportunity and challenge for cancer control researchers who focus on couple and family-based psychosocial interventions. In this article we first present findings from a systematic review of eight studies that utilized IHCTs in psychosocial interventions with cancer patients and their caregivers. Although this research area is still in its infancy, studies suggest that it is feasible to incorporate IHCTs in such interventions, that IHCTs are generally well-accepted by patients and caregivers, and that the choice of technology is largely dependent on intervention target (i.e., patient, caregiver, or both) and outcomes (e.g., decision-making, symptom management, lifestyle behaviors). A major research gap has been the lack of integration of Web 2.0 technologies (e.g., social media), despite the fact that social support and communication are frequently targeted components of interventions that involve cancer patients and their caregivers. Given this, we next present findings from a qualitative study that we conducted to describe the different needs and preferences of 13 cancer survivors and 12 caregivers with regard to social media use. Finally, we discuss some of the opportunities and challenges of using IHCTs in psychosocial interventions for cancer patients and their caregivers and propose directions for future research. PMID:25629218
Manfredi, Clara; Kaiser, Karen; Matthews, Alicia K.; Johnson, Timothy P.
Research shows that African Americans tend to have poorer and less informative patient-physician communication than Whites. We analyzed survey data from 248 African American and 244 White cancer patients to examine whether this disadvantage could be explained by race variability on several other variables commonly reported to affect communication. These variables were organized into background, enabling, and predisposing factors, based on the Precede-Proceed Model. Multivariate regressions were used to test whether race differences on communication and information variables persisted after successively controlling for background, enabling and predisposing factors. African American patients had higher interpersonal communication barriers than Whites, but this difference did not persist after controlling for background factors. African Americans also had higher unmet information needs and were less likely to receive the name of a cancer expert. These differences persisted controlling for all other factors. Future research should focus on the informational disadvantages of African American patients and how such disadvantages may affect cancer treatment decisions. PMID:20432108
DuBenske, Lori L; Gustafson, David H; Shaw, Bret R; Cleary, James F
Over the cancer disease trajectory, from diagnosis and treatment to remission or end of life, patients and their families face difficult decisions. The provision of information and support when most relevant can optimize cancer decision making and coping. An interactive health communication system (IHCS) offers the potential to bridge the communication gaps that occur among patients, family, and clinicians and to empower each to actively engage in cancer care and shared decision making. This is a report of the authors' experience (with a discussion of relevant literature) in developing and testing a Web-based IHCS-the Comprehensive Health Enhancement Support System (CHESS)-for patients with advanced lung cancer and their family caregivers. CHESS provides information, communication, and coaching resources as well as a symptom tracking system that reports health status to the clinical team. Development of an IHCS includes a needs assessment of the target audience and applied theory informed by continued stakeholder involvement in early testing. Critical issues of IHCS implementation include 1) need for interventions that accommodate a variety of format preferences and technology comfort ranges; 2) IHCS user training, 3) clinician investment in IHCS promotion, and 4) IHCS integration with existing medical systems. In creating such comprehensive systems, development strategies need to be grounded in population needs with appropriate use of technology that serves the target users, including the patient/family, clinical team, and health care organization. Implementation strategies should address timing, personnel, and environmental factors to facilitate continued use and benefit from IHCS.
McCormack, Lauren A; Treiman, Katherine; Rupert, Douglas; Williams-Piehota, Pamela; Nadler, Eric; Arora, Neeraj K; Lawrence, William; Street, Richard L
Patient-centered communication (PCC) is a critical element of patient-centered care, which the Institute of Medicine (Committee on Quality of Health Care in America, 2001) promulgates as essential to improving healthcare delivery. Consequently, the US National Cancer Institute's Strategic Plan for Leading the Nation (2006) calls for assessing the delivery of PCC in cancer care. However, no comprehensive measure of PCC exists, and stakeholders continue to embrace different conceptualizations and assumptions about how to measure it. Our approach was grounded in the PCC conceptual framework presented in a recent US National Cancer Institute monograph (Epstein & Street, 2007). In this study, we developed a comprehensive inventory of domains and subdomains for PCC by reviewing relevant literature and theories, interviewing a limited number of cancer patients, and consulting experts. The resulting measurement domains are organized under the six core functions specified in the PCC conceptual framework: exchanging information, fostering healing relationships, recognizing and responding to emotions, managing uncertainty, making decisions, and enabling patient self-management. These domains represent a promising platform for operationalizing the complicated PCC construct. Although this study focused specifically on cancer care, the PCC measurements are relevant to other clinical contexts and illnesses, given that patient-centered care is a goal across all healthcare. Finally, we discuss considerations for developing PCC measures for research, quality assessment, and surveillance purposes. United States Department of Health and Human Services, National Institutes of Health, National Cancer Institute (2006). The NCI Strategic Plan for Leading the Nation: To Eliminate the Suffering and Death Due to Cancer. NIH Publication No. 06-5773.
Yi, Haeseung; Xiao, Tong; Thomas, Parijatham S.; Aguirre, Alejandra N.; Smalletz, Cindy; Dimond, Jill; Finkelstein, Joseph; Infante, Katherine; Trivedi, Meghna; David, Raven; Vargas, Jennifer; Crew, Katherine D.; Kukafka, Rita
The purpose of this study was to identify barriers and facilitators to patient-provider communication when discussing breast cancer risk to aid in the development of decision support tools. Four patient focus groups (N=34) and eight provider focus groups (N=10) took place in Northern Manhattan. A qualitative analysis was conducted using Atlas.ti software. The coding yielded 62.3%–94.5% agreement. The results showed that 1) barriers are time constraints, lack of knowledge, low health literacy, and language barriers, and 2) facilitators are information needs, desire for personalization, and autonomy when communicating risk in patient-provider encounters. These results will inform the development of a patient-centered decision aid (RealRisks) and a provider-facing breast cancer risk navigation (BNAV) tool, which are designed to facilitate patient-provider risk communication and shared decision-making about breast cancer prevention strategies, such as chemoprevention. PMID:26958276
Yi, Haeseung; Xiao, Tong; Thomas, Parijatham S; Aguirre, Alejandra N; Smalletz, Cindy; Dimond, Jill; Finkelstein, Joseph; Infante, Katherine; Trivedi, Meghna; David, Raven; Vargas, Jennifer; Crew, Katherine D; Kukafka, Rita
The purpose of this study was to identify barriers and facilitators to patient-provider communication when discussing breast cancer risk to aid in the development of decision support tools. Four patient focus groups (N=34) and eight provider focus groups (N=10) took place in Northern Manhattan. A qualitative analysis was conducted using Atlas.ti software. The coding yielded 62.3%-94.5% agreement. The results showed that 1) barriers are time constraints, lack of knowledge, low health literacy, and language barriers, and 2) facilitators are information needs, desire for personalization, and autonomy when communicating risk in patient-provider encounters. These results will inform the development of a patient-centered decision aid (RealRisks) and a provider-facing breast cancer risk navigation (BNAV) tool, which are designed to facilitate patient-provider risk communication and shared decision-making about breast cancer prevention strategies, such as chemoprevention.
Anxiety Disorder; Depression; Ductal Breast Carcinoma in Situ; Lobular Breast Carcinoma in Situ; Psychosocial Effects of Cancer and Its Treatment; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage II Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer
Ruland, Cornelia M; Borosund, Elin; Varsi, Cecilie
This paper describes the use of participatory design methods in the development of a nurse-administered online patient-provider communication (OPPC) service that is designed to be integrated into routine clinical practice. The OPPC service let patients stay connected with expert nurses and other health care providers to ask questions and receive advice from home. Through focus groups, workshops, heuristic evaluations and usability testing, we identified patients' and clinicians' (nurses' and physicians') user requirements, factors important for successful adoption, implementation and maintenance of the OPPC service, and usability. This paper shares important insights from these participatory design processes that may be helpful for other researchers who wish to implement clinical applications into routine practice.
Jones, M M
Use of clinical hypnosis in the postsurgical psychotherapy of an esophageal cancer patient who could not swallow involved reenactment of the successful surgery and producing hallucinations of taste and smell, as well as working through emotions relations to the surgery and her disease. An apnea that occurred in a late phase of the treatment was addressed with the familiar arm pumping technique that had been used as a deepening technique, resulting in the patient's resuming normal breathing. The experience reminds the practitioner of the possible unexpected professional demands when working in a medical environment. It also provides clues as to the underlying psychological mechanisms and their role in successful symptom removal. A 6-year follow-up confirmed the lasting effect of this brief psychotherapy.
Swenson, Sara L; Buell, Stephanie; Zettler, Patti; White, Martha; Ruston, Delaney C; Lo, Bernard
OBJECTIVE To investigate patient preferences for a patient-centered or a biomedical communication style. DESIGN Randomized study. SETTING Urgent care and ambulatory medicine clinics in an academic medical center. PARTICIPANTS We recruited 250 English-speaking adult patients, excluding patients whose medical illnesses prevented evaluation of the study intervention. INTERVENTION Participants watched one of three videotaped scenarios of simulated patient-physician discussions of complementary and alternative medicine (CAM). Each participant watched two versions of the scenario (biomedical vs. patient-centered communication style) and completed written and oral questionnaires to assess outcome measurements. MEASUREMENTS AND MAIN RESULTS Main outcome measures were 1) preferences for a patient-centered versus a biomedical communication style; and 2) predictors of communication style preference. Participants who preferred the patient-centered style (69%; 95% confidence interval [CI], 63 to 75) tended to be younger (82%[51/62] for age < 30; 68%[100/148] for ages 30–59; 55%[21/38] for age > 59; P < .03), more educated (76%[54/71] for postcollege education; 73%[94/128] for some college; 49%[23/47] for high school only; P = .003), use CAM (75%[140/188] vs. 55%[33/60] for nonusers; P = .006), and have a patient-centered physician (88%[74/84] vs. 30%[16/54] for those with a biomedical physician; P < .0001). On multivariate analysis, factors independently associated with preferring the patient-centered style included younger age, use of herbal CAM, having a patient-centered physician, and rating a “doctor's interest in you as a person” as “very important.” CONCLUSIONS Given that a significant proportion of patients prefer a biomedical communication style, practicing physicians and medical educators should strive for flexible approaches to physician-patient communication. PMID:15566435
Agénor, Madina; Bailey, Zinzi; Krieger, Nancy; Austin, S Bryn; Gottlieb, Barbara R
Few studies have focused on the health and health care of U.S. black lesbian, bisexual, and queer (LBQ) women. To understand the facilitators of and barriers to cervical cancer screening in this population, focus group discussions were conducted in Boston and Cambridge, Massachusetts between November and December 2012. Using purposive sampling methods, the authors enrolled 18 black LBQ women who participated in one of four focus groups. Using thematic analysis, patient-provider communication was identified, which consisted of four sub-themes--health care provider communication style and demeanor; heteronormative provider assumptions; heterosexism, racism, and classism; and provider professional and sociodemographic background--as the most salient theme. Participants reported fears and experiences of multiple forms of discrimination and preferred receiving care from providers who were knowledgeable about same-sex sexual health and shared their life experiences at the intersection of gender, race/ethnicity, and sexual orientation. The cervical cancer screening experiences of black LBQ women would be improved by training all health care providers in same-sex sexual health, offering opportunities for clinicians to learn about the effects of various forms of discrimination on women's health care, and increasing the presence of LBQ women of color in health care settings.
Longacre, Margaret L; Galloway, Thomas J; Parvanta, Claudia F; Fang, Carolyn Y
Despite advances in treatment, head and neck cancer (HNC) patients often experience considerable functional impairment during and following treatment. As a result, family caregivers are essential in a patient's recovery; however, few caregivers are well-prepared to handle the extensive caregiving needs of this patient population. To date, little is known about HNC caregivers' informational needs in this role. Thus, we surveyed a sample of HNC caregivers about their informational needs including those related to interacting in the medical context as a caregiver and meeting patient needs. We also asked these caregivers their preferences for obtaining caregiving information. We conducted a cross-sectional study of 59 family caregivers for HNC patients who had completed radiation therapy at a comprehensive cancer center. The majority of caregivers (74.6%) reported having high informational need at diagnosis related to interacting as a caregiver. Although the need for such information decreased over time, over half still had a high need for information at treatment end. Importantly, caregivers who desired information about reducing patient pain and distress also reported having greater informational needs on issues related to interacting in the medical context. Further, the caregivers most often preferred to receive information from health-care professionals as a first source. However, preferring an informal (e.g., Internet) resource at first was significantly associated with needing information on how to talk to a doctor or nurse. The development of evidence-based resources and tools for HNC caregivers as well as clinicians may help caregivers more effectively manage patient symptoms and warrants further attention. Further, Internet resources may represent an effective resource for providing caregivers with strategies toward enhancing communication with healthcare professionals.
Morita, T; Tsunoda, J; Inoue, S; Chihara, S; Oka, K
Although valid measurement of the severity of terminal delirium is of great importance in palliative care settings, existing instruments have considerable limitations. In order to quantify patients' communication capacity and agitated behaviour, two new operational observer-rating scales, the Communication Capacity Scale (Communication Scale) and Agitation Distress Scale (Agitation Scale), were validated. Thirty terminally ill cancer patients diagnosed with delirium were evaluated simultaneously by two palliative care physicians blinded to each other's coding using the Communication Scale and Agitation Scale. In addition, the Memorial Delirium Assessment Scale (MDAS), Delirium Rating Scale (DRS) and Sedation Scale were rated by one researcher. Both scales achieved high internal consistency and inter-rater reliability with Cronbach's alpha coefficients of 0.91 and 0.96, and Cohen's kappa values on each item of 0.72-1.00. The principal components analysis resulted in the emergence of only one component for each scale. The total score on the Communication Scale was highly associated with that of the MDAS (rho = 0.78), Sedation Scale (rho = 0.86), and cognitive items from the MDAS and DRS (rho = 0.83). The whole score on the Agitation Scale was significantly correlated with that of the DRS (rho = 0.61) and agitation items from the MDAS and DRS (rho = 0.61). In conclusion, the Communication Scale and Agitation Scale have acceptable reliability and validity to quantify patients' communication capacity and agitation symptoms of terminally ill cancer patients with delirium.
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.
Staniszewska, Agnieszka; Kłoszewska, Iwona
Delirium is a frequent complication of cancer. It is the cause of patients' suffering and due to worsening of communication, the impediment to clinical assessment. It lowers the quality of life of family caregivers as well. Instant diagnosis and therapy of delirium are essential in clinical practice. In this review etiology, prevalence, clinical features and management of delirium in cancer patients are described.
Boyle, Frances M; Robinson, Emma; Heinrich, Paul; Dunn, Stewart M
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.
Alby, Francesca; Zucchermaglio, Cristina; Fatigante, Marilena
In cancer communication, most of the literature is in the realm of delivering bad news while much less attention has been given to the communication of uncertain news around the diagnosis and the possible outcomes of the illness. Drawing on video-recorded cancer consultations collected in two Italian hospitals, this article analyzes three communication practices used by oncologists to interactionally manage the uncertainty during the visit: alternating between uncertain bad news and certain good news, anticipating scenarios, and guessing test results. Both diagnostic and personal uncertainties are not hidden to the patient, yet they are reduced through these practices. Such communication practices are present in 32 % of the visits in the data set, indicating that the interactional management of uncertainty is a relevant phenomenon in oncological encounters. Further studies are needed to improve both its understanding and its teaching.
Communication and care in an acute cancer center: the effects of patients' willingness to communicate about health, health-care environment perceptions, and health status on information seeking, participation in care practices, and satisfaction.
Wright, Kevin B; Frey, Lawrence R
This study investigated the role of willingness to communicate about health (WTCH) among older patients in a state-of-the-art cancer center. Specifically, relationships were examined between patients' WTCH and their information seeking, perceptions of coping activities the center offered, and satisfaction with the center. The study also explored how those relationships may be mediated by patients' perceptions of the health-care environment and their health status. The results indicated that WTCH may play an important role in predicting information-seeking behaviors, perceived helpfulness of center-sponsored activities, and overall satisfaction with care received at the center. Evidence also was found that perceptions of the health-care environment mediated cancer patients' WTCH. The implications of these findings for communication theory and application, as well as limitations and future directions for research, are discussed.
Moore, Angelo D; Hamilton, Jill B; Knafl, George J; Godley, P A; Carpenter, William R; Bensen, Jeannette T; Mohler, James L; Mishel, Merle
The purpose of this study was to determine if a particular set of health behaviors of health care providers and African American men (AAM) influence patient satisfaction from the AAM's perspective. This descriptive, correlational study consisted of 505 AAM in North Carolina diagnosed with prostate cancer and enrolled in the North Carolina-Louisiana Prostate Cancer Project (PCaP). Analyses consisted of bivariate analyses and multiple regression. Patient-to-provider communication, interpersonal treatment, and provider-to-patient communication accounted for 45% (p ≤ .0001) of the variability in patient satisfaction. Interpersonal treatment (provider focusing on the patient) explained the greatest amount (F = 313.53, R² = .39) of patient satisfaction. Since interpersonal treatment focuses on the patient and demonstrated to be the strongest predictor in patient satisfaction, it is noteworthy to consider the emphasis that should be placed on patient-centered care. In addition, knowing important variables positively affecting patient satisfaction provides useful information for developing appropriate interventions to improve AAM health care experiences.
Bachner, Yaacov G.; O'Rourke, Norm; Carmel, Sara
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…
de Pheils, Pilar Bernal; Saul, Naledi Marie
This article describes the efforts of the University of California, San Francisco, School of Nursing to develop the Spanish language and cultural competency skills of advanced practice nursing students by establishing an elective course, Communicating with the Latino Patient. The need for this training is reflected in the literature, which has shown that language barriers decrease patient satisfaction and quality of care and increase the likelihood of medical error. Fifty-seven first-year master's students participated in this course. The effectiveness of the training was monitored during and after each course by self-assessment surveys of the participants' language acquisition. The data suggest that the most successful outcomes result from limiting class size, emphasizing high interactivity, and incorporating clinical experiences in the instruction, as well as focusing exclusively on intermediate-level speakers when resources are limited. Training can be time consuming and costly, yet graduates agreed that the training was imperative and valuable.
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: 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…
Gnagnarella, Patrizia; Misotti, Alessandro Maria; Santoro, Luigi; Akoumianakis, Demosthenes; Del Campo, Laura; De Lorenzo, Francesco; Lombardo, Claudio; Milolidakis, Giannis; Sullivan, Richard; McVie, John Gordon
We hypothesized that cancer patients using an Internet website would show an improvement in the knowledge about healthy eating habits, and this might be enhanced by social media interaction. A 6-month randomized intervention was set up. Eligible subjects were allocated in intervention (IG) and control groups (CG). IG had access to the website, and CG was provided with printed versions. All enrolled participants filled in Nutrition Questionnaire (NQ), Quality of Life Questionnaire (QoL) and Psychological Distress Inventory (PDI), at baseline and after 6 months. The difference between post- vs pre-questionnaires was calculated. Seventy-four subjects (CG 39; IG 35) completed the study. There was an increase in the score after the intervention in both groups for the NQ, even if not statistically significant. Dividing the IG into three categories, no (NI), low (LI) and high interactions (HI), we found a decreased score (improvement) in the CG (-0.2) and in the HI (-1.7), and an increased score (worsening) in the NI (+3.3) (p = NS) analysing the PDI. We found an increased score in the QoL both in CG and IG (adjusted LSMeans +3.5 and +2.8 points, respectively; p = NS). This study represents an example for support cancer patients. Despite the lack of significant effects, critical points and problems encountered may be of interest to researchers and organization working in the cancer setting. Intervention strategies to support patients during the care process are needed in order to attain the full potential of patient-centred care on cancer outcomes.
Cultural competence in oncology requires the acquisition of specific knowledge, clinical skills, and attitudes that facilitate effective cross-cultural negotiation in the clinical setting, thus, leading to improved therapeutic outcomes and decreased disparities in cancer care. Cultural competence in oncology entails a basic knowledge of different cultural attitudes and practices of communication of the truth and of decision-making styles throughout the world. Cultural competence always presupposes oncology professionals' awareness of their own cultural beliefs and values. To be able to communicate with cancer patients in culturally sensitive ways, oncologists should have knowledge of the concept of culture in its complexity and of the risks of racism, classism, sexism, ageism, and stereotyping that must be avoided in clinical practice. Oncologists should develop a sense of appreciation for differences in health care values, based on the recognition that no culture can claim hegemony over others and that cultures are evolving under their reciprocal influence on each other. Medical schools and oncology training can teach communication skills and cultural competence, while fostering in all students and young doctors those attitudes of humility, empathy, curiosity, respect, sensitivity, and awareness that are needed to deliver effective and culturally sensitive cancer care.
Matuszak, Katarzyna; Bonikowska, Agata; Kuczma, Monika; Hagner, Wojciech
Aphasia is a speech disorder caused by disorders of speech centre in brain cortex. Patient with aphasia compensates communication disorders by communication strategy, witch are spontaneous mechanisms, and uses individual rehabilitation methods. Compensation mechanisms are divided in to: phonetic, inflective, formative, semantic, discursive and structural. Patients with aphasia early therapy have to be individual and consists in not only articulation correction, but in establish over verbal contact or verbal, and improvement this contacts, to create patients ability of communication with society. Later therapy is oriented on improvement of cognitive functions for possibility of participation in social live and if it is possible for return to work.
Back, Anthony L; Anderson, Wendy G; Bunch, Lynn; Marr, Lisa A; Wallace, James A; Yang, Holly B; Arnold, Robert M
Cancer communication near the end of life has a growing evidence base, and requires clinicians to draw on a distinct set of communication skills. Patients with advanced and incurable cancers are dealing with the emotional impact of a life-limiting illness, treatment decisions that are complex and frequently involve consideration of clinical trials, and the challenges of sustaining hope while also having realistic goals. In this review, the authors sought to provide a guide to important evidence about communication for patients with advanced cancer regarding communication at diagnosis, discussing prognosis, decision making about palliative anticancer therapy and phase 1 trials, advance care planning, transitions in focus from anticancer to palliative care, and preparing patients and families for dying and death.
Shi, Songsong; Xia, Wenkai
This study sought to identify factors associated with objectively assessed exercise behavior in Chinese patients with early-stage cancer. Three hundred and fifty one cancer patients were recruited from the Affiliated Jiangyin Hospital of Southeast University Medical College and the Nantong Tumor Hospital. One-way ANOVA, Pearson Chi-square tests and regression analysis were employed to identify the correlations between physical exercise and the measured factors. The results showed that occupation type (χ2 = 14.065; p = 0.029), monthly individual monthly income level (χ2 = 24.795; p = 0.003), BMI (χ2 = 15.709; p = 0.015) and diagnosis (χ2 = 42.442; p < 0.000) were significantly correlated with the subjects self-reported exercise with different frequency per week. Differences in the frequency of exercise were associated with different degrees of reported Benefit Finding (BF) (F = 24.651; p < 0.000), communication with doctors (F = 15.285; p < 0.000), medical coping modes (F = 45.912; p < 0.000), social support (F = 2.938; p = 0.030), depression (F = 6.017; p < 0.000), and quality of life (F = 12.288; p < 0.000). Multiple regression analysis showed that 1.6%-6.4% of the variance in five variables, excluding social support and optimism could be explained by exercise. Our results indicated that benefit finding, medical coping modes, communication with doctors, social support, depression and quality of life were significantly correlated with exercise. The variance in several psychosocial factors (benefit finding, medical coping modes, the communication with doctors, depression and quality of life) could be explained by exercise. Psychosocial factors should be addressed and examined over time when evaluating the effect of physical exercise that is prescribed as a clinically relevant treatment. PMID:28072832
Wiggers, J H; Donovan, K O; Redman, S; Sanson-Fisher, R W
A diagnosis of cancer places considerable stress on patients and requires them to make major adjustments in many areas of their lives. As a consequence, considerable demands are placed on health care providers to satisfy the complex care needs of cancer patients. Currently, there is little available information to indicate the extent to which cancer patients are satisfied with the quality of care they receive. The present study assessed the perceptions of 232 ambulatory cancer patients about the importance of and satisfaction with the following aspects of care: doctors technical competence and interpersonal and communication skills, accessibility and continuity of care, hospital and clinic care, nonmedical care, family care, and finances. The results indicate that all 60 questionnaire items used were considered to reflect important aspects of care, but that greater importance was given to the technical quality of medical care, the interpersonal and communication skills of doctors, and the accessibility of care. Most patients were satisfied with the opportunities provided to discuss their needs with doctors, the interpersonal support of doctors, and the technical competence of doctors. However, few patients were satisfied with the provision of information concerning their disease, treatment, and symptom control and the provision of care in the home and to family and friends.
Wittenberg-Lyles, Elaine; Goldsmith, Joy; Ferrell, Betty
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.
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Hesse, Bradford W
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, cancer communication 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 research identified by the directors: (a) research designed to extend awareness of prevention and early detection, (b) research designed to improve the accuracy and usability of cancer science as portrayed in national news media, and (c) research designed to support behavior through individual and community-level interventions. Each of these foci takes on new meaning when considered in the context of a rapidly changing communication environment. Behavioral science must evolve to keep up with these changes and to offer new evidence-based approaches for extending the reach, effectiveness, and efficiency of cancer communication in order to do its part in accelerating successes against the disease.
Wittenberg, Elaine; Borneman, Tami; Koczywas, Marianna; Del Ferraro, Catherine; Ferrell, Betty
Family caregivers have enormous communication responsibilities tied to caregiving, such as sharing the patient’s medical history with providers, relaying diagnosis and prognosis to other family members, and making decisions about care with the patient. While caregiver stress and burden has been widely documented in the caregiving literature, little is known about how communication burden, real or perceived communication challenges, impacts caregiver quality of life. In family caregiving, the City of Hope (COH) Quality of Life model proposes that the caregiving experience is reciprocal to the patient experience, impacting physical, social, psychological, and spiritual quality of life. We used data from a pilot study testing a communication coaching call intervention with family caregivers of lung cancer patients to analyze caregiver reported communication burden and quality of life. We found variances in each quality of life domain, suggesting that caregiver interventions should range from self-care skill building for physical care to psycho-educational interventions that support caregiver coping and communication skill building. These findings demonstrate the importance of caregiver assessment and attention to communication burden in quality cancer care. PMID:28257110
Bender, J L; O'Grady, L; Jadad, A R
Almost since its inception, the Internet has been used by ordinary people to connect with peers and to exchange health-related information and support. With the rapid development of software applications deliberately designed to facilitate social interaction, a new era is dawning in which patients and their loved ones can collaboratively build knowledge related to coping with illness, while meeting their mutual supportive care needs in a timely way, regardless of location. In this article, we provide background information on the use of "one-to-one" (for example, e-mail), "one-to-many" (for example, e-mail lists), and "many-to-many" (for example, message boards and chat rooms, and more recently, applications associated with Web 2.0) computer-mediated communication to nurture health-related social networks and online supportive care. We also discuss research that has investigated the use of social networks by patients, highlight opportunities for health professionals in this area, and describe new advances that are fuelling this new era of collaboration in the management of cancer.
Eloranta, Sandra; Lambert, Paul C; Andersson, Therese M-L; Björkholm, Magnus; Dickman, Paul W
Quantifying cancer patient survival from the perspective of cure is clinically relevant. However, most cure models estimate cure assuming no competing causes of death. We use a relative survival framework to demonstrate how flexible parametric cure models can be used in combination with competing-risks theory to incorporate noncancer deaths. Under a model that incorporates statistical cure, we present the probabilities that cancer patients (1) have died from their cancer, (2) have died from other causes, (3) will eventually die from their cancer, or (4) will eventually die from other causes, all as a function of time since diagnosis. We further demonstrate how conditional probabilities can be used to update the prognosis among survivors (eg, at 1 or 5 years after diagnosis) by summarizing the proportion of patients who will not die from their cancer. The proposed method is applied to Swedish population-based data for persons diagnosed with melanoma, colon cancer, or acute myeloid leukemia between 1973 and 2007.
Yoon, Heesoo; Sohn, Minsung; Jung, Minsoo
Communication related to health not only substantially affects perceptions and behaviors related to health but is also positively associated with the extent of health-information seeking and the practice of preventive behavior. Despite the fact that the number of cancer survivors has increased dramatically, there are few studies of the lack of health information, factors which act as barriers, and the difficulties in follow-up care experienced by cancer survivors. Therefore, we reviewed media utilization and the types of media used by cancer survivors with regard to risk communication and suggested appropriate strategies for cancer communication. According to the results, health communication contributed to health promotion by providing health-related information, consolidating social support factors such as social solidarity and trust, and reducing anxiety. In particular, participatory health communication may establish preventive programs which reflect the needs of communities, expand accessibility to better quality healthcare, and intensify healthy living by reducing health inequalities. Therefore, when people do not have an intention to obtain cancer screening, we need to intervene to change their behavior, norms, and degrees of self-efficacy. The findings of this study may help those involved in building partnerships by assisting in their efforts to understand and communicate with the public. PMID:27722138
Cassileth, Barrie R.; And Others
Four audiovisual programs about cancer and cancer treatment were evaluated. Cancer patients, their families, and friends were asked to complete questionnaires before and after watching a program to determine the effects of the program on their knowledge of cancer, anxiety levels, and perceived ability to communicate with the staff. (Author/MLW)
Gomez, Izabella; Szekanecz, Éva; Szekanecz, Zoltán; Bender, Tamás
Physiotherapy of cancer patients is one of the most controversial issues in our country. Malignant diseases are firstly mentioned as a contraindication of physiotherapy. Until now, physiotherapy was not suggested (or only in limited accessibility) for those patients who had malignant disease in medical history. International medical practice was less restrictive in managing this topic. The development of imaging techniques put this question in a new light. On the basis of evidence, the majority of articles have reported beneficial effects of physiotherapy in cancer patients, and only few articles mentioned it as harmful. Of course, each patient requires an individual assessment, however, if we exclude the possibility of tumor recurrence and metastasis, most of physiotherapy procedures can be used safely. One of the aims of this review is to support the physicians' decisions when to prescribe treatments, in such a way, that more patients could receive physiotherapy. Orv. Hetil., 2016, 157(31), 1224-1231.
Hesse, Bradford W; Beckjord, Ellen; Rutten, Lila J Finney; Fagerlin, Angela; Cameron, Linda D
Over the past decade, dramatic changes brought about by a rapid diffusion of Internet technologies, cellular telephones, mobile devices, personal digital assistants, electronic health records, and data visualization have helped to create a revolution in health communication. To understand the implications of this communication revolution for cancer care, the National Cancer Institute launched an ambitious set of research priorities under its "extraordinary opportunities" program. We present an overview of some of the relevant behavioral research being conducted within the perspective of this extraordinary opportunity in cancer communication research. We begin by tracing the implications of this research for behavioral scientists across the continuum of cancer care from primary prevention (e.g., tobacco control, diet, exercise, sun protection, and immunization against human papilloma virus), to secondary prevention (e.g., screening for polyps, lesions, and early stage neoplasms), to diagnosis and treatment, posttreatment survivorship, and end of life. Along each point of the continuum, we describe a natural evolution of knowledge from studies on the traditional role of media to research on the changing role of new media and informatics, and we carefully highlight the role that psychological research has played in improving communication- and health-related outcomes along the way. We conclude with an appeal to psychologists of many different backgrounds to join with biomedical researchers, engineers, clinical practitioners, and others to accelerate progress against cancer.
Ohashi, Kumiko; Caligtan, Christine A; Benoit, Angela N; Breydo, Eugene M; Carroll, Diane L; Keohane, Carol A; Bates, David W; Dykes, John S; Dykes, Patricia C
Communication failures have been identified as the root cause of the majority of medical malpractice claims and patient safety violations. We believe it is essential to share key patient risk information with healthcare team members at the patient's bedside. In this study, we developed an electronic Patient Risk Communication Board (ePRCB) to assist in bridging the communication gap between all health care team members. The goal of the ePRCB is to effectively communicate the patient's key risk factors, such as a fall risk or risk of aspiration, to the healthcare team and to reduce adverse events caused by communication failures. The ePRCB will transmit patient risk information and tailored interventions with easy-to-understand icons on an LCD screen at the point of care. A set of patient risk reminder icons was developed and validated by focus groups. We used the results of the evaluation to refine the icons for the ePRCB.
Lynch, H T; Snyder, C; Stacey, M; Olson, B; Peterson, S K; Buxbaum, S; Shaw, T; Lynch, P M
When a cancer predisposing germline mutation is detected in an index case, the presence of the underlying syndrome is confirmed and the potential for predictive testing of at-risk relatives is established. However, the reporting of a positive family history does not routinely lead to communication of information about risk to close, much less distant relatives. This review summarizes information technology utilized to address penetration or 'reach' of knowledge of risk within extended families, including the use of telephone and video counseling to reach distant patients, and anticipate novel internet-based processes for communication between investigators and relatives.
Ghandourh, Wsam A
Advanced cancer patients commonly have misunderstandings about the intentions of treatment and their overall prognosis. Several studies have shown that large numbers of patients receiving palliative radiation or chemotherapy hold unrealistic hopes of their cancer being cured by such therapies, which can affect their ability to make well-informed decisions about treatment options. This review aimed to explore this discrepancy between patients' and physicians' expectations by investigating three primary issues: (1) the factors associated with patients developing unrealistic expectations; (2) the implications of having unrealistic hopes and the effects of raising patients' awareness about prognosis; and (3) patients' and caregivers' perspective on disclosure and their preferences for communication styles. Relevant studies were identified by searching electronic databases including Pubmed, EMBASE and ScienceDirect using multiple combinations of keywords, which yielded a total of 65 articles meeting the inclusion criteria. The discrepancy between patients' and doctors' expectations was associated with many factors including doctors' reluctance to disclose terminal prognoses and patients' ability to understand or accept such information. The majority of patients and caregivers expressed a desire for detailed prognostic information; however, varied responses have been reported on the preferred style of conveying such information. Communication styles have profound effects on patients' experience and treatment choices. Patients' views on disclosure are influenced by many cultural, psychological and illness-related factors, therefore individuals' needs must be considered when conveying prognostic information. More research is needed to identify communication barriers and the interventions that could be used to increase patients' satisfaction with palliative care.
Rousseaux, Marc; Daveluy, Walter; Kozlowski, Odile
In stroke patients, it has been suggested that communication disorders could result from lexical and syntactic disorders in left hemisphere lesions and from pragmatics problems in right lesions. However, we have little information on patient behaviour in dyadic communication, especially in conversation. Here, we analyzed the various processes participating in communication difficulties at the rehabilitation phase (1-6 months) post-stroke, in order to define the main mechanisms of verbal and non-verbal communication (VC, NVC) disorders and their relationship with aphasic disorders. Sixty-three patients were recruited, who belonged to six groups, with left or right cortico-sub-cortical (L-CSC, R-CSC) or sub-cortical (L-SC, R-SC), frontal (Fro) or posterior fossa (PF) lesions. They were compared with an equivalent control group (gender, age, education level). We used the Lille Communication Test, which comprises three parts: participation to communication (greeting, attention, engagement), verbal communication (verbal comprehension, speech outflow, intelligibility, word production, syntax, verbal pragmatics and verbal feedback) and non-verbal communication (understanding gestures, affective expressivity, producing gestures, pragmatics and feedback). We also used the Functional Communication Profile and the Boston Diagnostic Aphasia Examination (BDAE). Decrease in participation was found in L-CSC, R-CSC and Fro patients. Verbal communication was essentially disrupted in L-SCS and L-SC groups, including by verbal pragmatic disorders, and to a lesser degree in frontal patients. Nonverbal communication was mainly affected in R-CSC patients, especially by pragmatic difficulties. L-CSC patients showed an increase in gesture production, compensating for aphasia. In conclusion, communication disorders were relatively complex and could not be summarised by syntactical and lexical difficulties in left stroke and pragmatic problems in right stroke. The former also showed severe
Hashim, M Jawad
Communication skills needed for patient-centered care include eliciting the patient's agenda with open-ended questions, especially early on; not interrupting the patient; and engaging in focused active listening. Understanding the patient's perspective of the illness and expressing empathy are key features of patient-centered communication. Understanding the patient's perspective entails exploring the patient's feelings, ideas, concerns, and experience regarding the impact of the illness, as well as what the patient expects from the physician. Empathy can be expressed by naming the feeling; communicating understanding, respect, and support; and exploring the patient's illness experience and emotions. Before revealing a new diagnosis, the patient's prior knowledge and preferences for the depth of information desired should be assessed. After disclosing a diagnosis, physicians should explore the patient's emotional response. Shared decision making empowers patients by inviting them to consider the pros and cons of different treatment options, including no treatment. Instead of overwhelming the patient with medical information, small chunks of data should be provided using repeated cycles of the "ask-tell-ask" approach. Training programs on patient-centered communication for health care professionals can improve communication skills.
Bennett, A.E., Ed.
The papers in this book explore the fundamental skills necessary for communication between individuals and the important benefits which improved communication could contribute to both the teaching and the practice of good clinical and administrative medicine. The papers consist of an analysis of face-to-face communicaton in terms of four systems…
Spinetta, John J.; Maloney, Lorrie J.
Examines the role of communication and denial in coping efforts of children with cancer. Results indicate level of family communication about cancer expressed by mother's communication is correlated with hypothesized responses in child. Usefulness of three instruments as effective tools in measuring child's reactions is demonstrated. (Author/BEF)
Rowlands, S; Callen, J
The aim of the study was to explore how patient information is communicated between health professionals within a multidisciplinary hospital-based lung cancer team and to identify mechanisms to improve these communications. A qualitative method was employed using semi-structured in-depth interviews with a representative sample (n = 22) of members of a multidisciplinary hospital-based lung cancer team including medical, nursing and allied health professionals. Analysis was undertaken using a thematic grounded theory approach to derive key themes to describe communication patterns within the team and how communication could be improved. Two themes with sub-themes were identified: (1) characteristics of communication between team members including the impact of role on direction of communications, and doctors' dominance in communications; and (2) channels of communication including, preference for face-to-face and the suboptimal roles of the Multidisciplinary Team Meeting and the hospital medical record as mediums for communication. Traditional influences of role delineation and the dominance of doctors were found to impact on communication within the multidisciplinary hospital-based lung cancer team. Existing guidelines on implementation of multidisciplinary cancer care fail to address barriers to effective team communication. The paper-based medical record does not support team communications and alternative electronic solutions need to be used.
Garrett, J Hudson
Breakdowns in health care communication are a significant cause of sentinel events and associated patient morbidity and mortality. Effective communication is a necessary component of a patient safety program, which enables all members of the interdisciplinary health care team to effectively manage their individual roles and responsibilities in the perioperative setting; set expectations for safe, high-reliability care; and measure and assess outcomes. To sustain a culture of safety, effective communication should be standardized, complete, clear, brief, and timely. Executive leadership and support helps remove institutional barriers and address challenges to support the engagement of patients in health care communication, which has been shown to improve outcomes, reduce costs, and improve the patient experience.
Thorne, Sally E; Oliffe, John L; Oglov, Valerie; Gelmon, Karen
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-patient communication 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.
Yamamoto, Kazuo; Gemma, Akihiko
Dyspnea occurs in most cancer patients and is often associated with severe pain. Pulmonary rehabilitation has become increasingly important to improve ADL and QOL and to relieve pain that results from dyspnea. Although pulmonary rehabilitation is now provided mainly during the perioperative period, it has been recognized as an effective procedure for patients before, during, or after chemotherapy or radiotherapy. It is also useful for patients with advanced or terminal cancer. However, an evidence-based cancer rehabilitation procedure has to be established.
This article emphasizes the importance of a good communication between patients and health professionals. It focuses on how patients feels during the cancer journey and how professionals should behave to them. It also go through the different dilemmas and conflicts health professionals may come across in their interaction with patients and it suggests different ways about how those dilemmas can be resolved. The main idea of this article is the fact that health professionals-whether physicians, nurses or psychologists-need to focus on and improve, if necessary, their communication with patients; basically, learn how to unite the humanistic side of care with the technical side; how to be professionals without losing their humanistic identity.
Sima, Camelia S.; Panageas, Katherine S.; Schrag, Deborah
Context Cancer screening has been integrated into routine primary care but does not benefit patients with limited life expectancy. Objective To evaluate the extent to which patients with advanced cancer continue to be screened for new cancers. Design, Setting, and Participants Utilization of cancer screening procedures (mammography, Papanicolaou test, prostate-specific antigen [PSA], and lower gastrointestinal [GI] endoscopy) was assessed in 87 736 fee-for-service Medicare enrollees aged 65 years or older diagnosed with advanced lung, colorectal, pancreatic, gastroesophageal, or breast cancer between 1998 and 2005, and reported to one of the Surveillance, Epidemiology, and End Results (SEER) tumor registries. Participants were followed up until death or December 31, 2007, whichever came first. A group of 87 307 Medicare enrollees without cancer were individually matched by age, sex, race, and SEER registry to patients with cancer and observed over the same period to evaluate screening rates in context. Demographic and clinical characteristics associated with screening were also investigated. Main Outcome Measure For each cancer screening test, utilization rates were defined as the percentage of patients who were screened following the diagnosis of an incurable cancer. Results Among women following advanced cancer diagnosis compared with controls, at least 1 screening mammogram was received by 8.9% (95% confidence interval [CI], 8.6%-9.1%) vs 22.0% (95% CI, 21.7%-22.5%); Papanicolaou test screening was received by 5.8% (95% CI, 5.6%-6.1%) vs 12.5% (95% CI, 12.2%-12.8%). Among men following advanced cancer diagnosis compared with controls, PSA test was received by 15.0% (95% CI, 14.7%-15.3%) vs 27.2% (95% CI, 26.8%-27.6%). For all patients following advanced diagnosis compared with controls, lower GI endoscopy was received by 1.7% (95% CI, 1.6%-1.8%) vs 4.7% (95% CI, 4.6%-4.9%). Screening was more frequent among patients with a recent history of screening (16.2% [95
Cogo, Carla; Petrella, Marco
Over the last ten years, Italian work groups of communication within The National Centre for Screening Monitoring have been working on various aspects of communication in screening: quality surveys, information materials, guidelines, websites, and training. This has been done taking into account that good quality information must be clear, accessible, up to date, evidence based, clear about its limitations and capable of indicating further sources of information. Whenever possible, information has been developed in collaboration with the target groups: citizens but also health professionals. However, if good quality information must be clear about benefits and harms, the communication of quantitative information is particularly complex in cancer screening. Moreover, receiving more information on risks and benefits does not seem to modify participation. In addition, more balanced information does not entail that a person will include it in the decision process.Throughout several focus groups, citizens have made it clear that the information received from the programmes was only a part of the decisional process in which other elements were just as, if not more, important: trust in doctors, family and friends, perception of health authority efficiency, personal experiences, inconsistencies in information or public disagreements with other credible sources. Such elements can be seen as an opportunity to strengthen partnerships with professional and advocacy groups and to cooperate more efficiently with media and specialists from different fields.
Jain, Anshu K; Fennell, Mary L; Chagpar, Anees B; Connolly, Hannah K; Nembhard, Ingrid M
Effective communication is a requirement in the teamwork necessary for improved coordination to deliver patient-centered, value-based cancer care. Communication is particularly important when care providers are geographically distributed or work across organizations. We review organizational and teams research on communication to highlight psychological safety as a key determinant of high-quality communication within teams. We first present the concept of psychological safety, findings about its communication effects for teamwork, and factors that affect it. We focus on five factors applicable to cancer care delivery: familiarity, clinical hierarchy-related status differences, geographic dispersion, boundary spanning, and leader behavior. To illustrate how these factors facilitate or hinder psychologically safe communication and teamwork in cancer care, we review the case of a patient as she experiences the treatment-planning process for early-stage breast cancer in a community setting. Our analysis is summarized in a key principle: Teamwork in cancer care requires high-quality communication, which depends on psychological safety for all team members, clinicians and patients alike. We conclude with a discussion of the implications of psychological safety in clinical care and suggestions for future research.
Skarstein, Jon; Dahl, Alv A; Laading, Jacob; Fosså, Sophie D
Predictors of 'patient satisfaction' with hospitalization at a specialized cancer hospital in Norway are examined in this study. Two weeks after their last hospitalization, 2021 consecutive cancer patients were invited to rate their satisfaction with hospitalization, quality of life, anxiety and depression. Compliance rate was 72% (n = 1453). Cut-off levels separating dissatisfied from satisfied patients were defined. It was found that 92% of the patients were satisfied with their stay in hospital, independent of cancer type and number of previous admissions. Performance of nurses and physicians, level of information perceived, outcome of health status, reception at the hospital and anxiety independently predicted 'patient satisfaction'. The model explained 35% of the variance with an area under the curve of 0.76 of the Receiver Operator Curve. Cancer patients' satisfaction with their hospital stay was high, and predicted by four independently predictive variables related to the performance of caregivers. These suggest areas for further improvement in the healthcare service.
Cancer is increasing in incidence and prevalence worldwide, and the WHO has recently included cancer and its treatments as a health priority in developed and developing countries. The cultural diversity of oncology patients is bound to increase, and cultural sensitivity and competence are now required of all oncology professionals. A culturally competent cancer care leads to improved therapeutic outcome and it may decrease disparities in medical care. Cultural competence in medicine is a complex multilayered accomplishment, requiring knowledge, skills and attitudes whose acquisition is needed for effective cross-cultural negotiation in the clinical setting. Effective cultural competence is based on knowledge of the notion of culture; on awareness of possible biases and prejudices related to stereotyping, racism, classism, sexism; on nurturing appreciation for differences in health care values; and on fostering the attitudes of humility, empathy, curiosity, respect, sensitivity and awareness. Cultural competence in healthcare relates to individual professionals, but also to organizations and systems. A culturally competent healthcare system must consider in their separateness and yet in there reciprocal influences social, racial and cultural factors. By providing a framework of reference to interpret the external world and relate to it, culture affects patients' perceptions of disease, disability and suffering; degrees and expressions of concern about them; their responses to treatments and their relationship to individual physicians and to the healthcare system. Culture also influences the interpretation of ethical norms and principles, and especially of individual autonomy, which can be perceived either as synonymous with freedom or with isolation depending on the cultural context. This, in turn, determines the variability of truth-telling attitudes and practices worldwide as well as the different roles of family in the information and decision-making process of
Marsden, Harue J.
Reports data from three consecutive classes of first- year optometry students at the Southern California College of Optometry, who were tested preceding and following completion of a patient communication course. Findings indicated that students improved their ability to respond to patients and were better able to discriminate among various levels…
Lang, Elvira V.
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
Ohashi, Kumiko; Caligtan, Christine A.; Benoit, Angela N.; Breydo, Eugene M.; Carroll, Diane L.; Keohane, Carol A.; Bates, David W.; Dykes, John S.; Dykes, Patricia C.
Communication failures have been identified as the root cause of the majority of medical malpractice claims and patient safety violations. We believe it is essential to share key patient risk information with healthcare team members at the patient’s bedside. In this study, we developed an electronic Patient Risk Communication Board (ePRCB) to assist in bridging the communication gap between all health care team members. The goal of the ePRCB is to effectively communicate the patient’s key risk factors, such as a fall risk or risk of aspiration, to the healthcare team and to reduce adverse events caused by communication failures. The ePRCB will transmit patient risk information and tailored interventions with easy-to-understand icons on an LCD screen at the point of care. A set of patient risk reminder icons was developed and validated by focus groups. We used the results of the evaluation to refine the icons for the ePRCB. PMID:24199109
Hopper, S V; Fischbach, R L
The threat of blindness creates a difficult and challenging environment for communication between patients and their ophthalmologists. This study examined concordance between what patients want to know from their physicians about their eye condition and what physicians believe their patients need to know. Eight retinal specialists and 24 of their patients with proliferative diabetic retinopathy and at risk of blindness were interviewed using parallel-constructed instruments. Although all recognized that blindness was the patients' greatest concern, disparities were noted that involved the desire/need to know about the possibility of vision loss, the causes of the eye condition, the results of each eye exam, and the extent of patient confusion. Physicians, while conscientious about informed consent, described various communication behaviors to avoid discussing bad news.
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 cancer patients; 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. PMID:21274086
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.
Frenkel, Moshe; Cohen, Lorenzo
Complementary and integrative medicine (CIM) is becoming an increasingly popular and visible component of oncology care. Many patients affected by cancer and their family members are looking for informed advice and desire communication with their physicians about CIM use. Patients affected by cancer come to discuss CIM use with intense emotions and are experiencing an existential crisis that cannot be ignored. Effective communication is crucial in establishing trust with these patients and their families. Communication is now recognized as a core clinical skill in medicine, including cancer care, and is important to the delivery of high-quality care. The quality of communication affects patient satisfaction, decision-making, patient distress and well-being, compliance, and even malpractice litigation. The communication process about CIM use requires a very sensitive approach that depends on effective communication skills, such as experience in listening, encouraging hope, and ability to convey empathy and compassion. This process can be divided into two parts: the "how" and the "what". The "how" relates to the change in clinician attitude, the process of gathering information, addressing patients' unmet needs and emotions, and dealing with uncertainty. The "what" relates to the process of information exchange while assisting patients in decisions about CIM use by using reliable information sources, leading to informed decision-making.
Norouzinia, Roohangiz; Aghabarari, Maryam; Shiri, Maryam; Karimi, Mehrdad; Samami, Elham
Communication, as a key element in providing high-quality health care services, leads to patient satisfaction and health. The present Cross sectional, descriptive analytic study was conducted on 70 nurses and 50 patients in two hospitals affiliated to Alborz University of Medical Sciences, in 2012. Two separate questionnaires were used for nurses and patients, and the reliability and validity of the questionnaires were assessed. In both groups of nurses and patients, nurse-related factors (mean scores of 2.45 and 2.15, respectively) and common factors between nurses and patients (mean scores of 1.85 and 1.96, respectively) were considered the most and least significant factors, respectively. Also, a significant difference was observed between the mean scores of nurses and patients regarding patient-related (p=0.001), nurse-related (p=0.012), and environmental factors (p=0.019). Despite the attention of nurses and patients to communication, there are some barriers, which can be removed through raising the awareness of nurses and patients along with creating a desirable environment. We recommend that nurses be effectively trained in communication skills and be encouraged by constant monitoring of the obtained skills. PMID:26755475
Mandl, K. D.; Kohane, I. S.
A critical mass of Internet users is leading to a wide diffusion of electronic communications within medical practice. Unless implemented with substantial forethought, these new technological linkages could disturb delicate balances in the doctor-patient relationship, threaten the privacy of medical information, widen social disparity in health outcomes, and even function as barriers to access. The American Medical Informatics Association (AMIA) recently published recommendations to guide computer-based communications between clinicians and patients. This paper describes the motivations for and the design of HealthConnect, a web-based patient-doctor communications tool currently in use at Children's Hospital, Boston. Structural and process-oriented features of HealthConnect, as they relate to promotion of adherence with the Guidelines, are discussed. Images Figure 1 Figure 2 Figure 3 PMID:10566480
Clampitt, Phillip G.; Williams, M. Lee
This paper synthesizes much of the literature concerning physician/patient communication as it relates to patient compliance. Using the theoretical perspective that deals with belief, attitude, intention, and behavior (a perspective generated by Martin Fishbein and Icek Ajzen), a new theoretical orientation for predicting patient compliance is…
Godlewski, D; Adamczak, M; Wojtyś, P
Previous studies have failed to explain why the mortality rate of cancer patients is higher in Poland than other countries in the European Union. We aimed to evaluate the health care system in Poland during the diagnosis and treatment of cancer. In this multicentre study, 125 cancer patients treated at 15 centres across Poland participated in focus group interviews in 2014. We identified and assessed crucial elements that affect a patients' experience from the early onset of symptoms, through to diagnosis and treatment. We found that the majority of patients were dissatisfied with the length of time taken to diagnose cancer. Throughout diagnosis, treatment and follow-up, patients reported a lack of communication from health care professionals. While dealings with oncologists and medical staff were viewed favourably, patients felt the cancer centres were not well organised. Patients recommended that having one doctor in charge of an individual's treatment and follow-up would improve patient care and well-being. A late cancer diagnosis may be contributing to the high mortality rate observed in Poland. In the future, new policies should be developed to reduce the time to cancer diagnosis, increase communication with health care professionals and improve the organisation of cancer care for patients.
DiMatteo, M Robin
The goal of this paper is to examine emerging issues in consumer-provider communication and patient adherence to cancer prevention, screening, diagnosis, treatment, and coping with survivorship. Many factors that have been shown to affect adherence can be supported or hindered by provider-patient communication, including the provider-patient relationship, patients' beliefs, social and cultural norms, family and social support, mood, and behavioral management. Six research questions are posed, and substantive and methodological recommendations are offered for empirical research on the measurement and achievement of patient adherence.
Manne, Sharon; Sherman, Marne; Ross, Stephanie; Ostroff, Jamie; Heyman, Richard E.; Fox, Kevin
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…
Siminoff, Laura A; Step, Mary M
The authors present a communication model of shared decision making (CMSDM) that explicitly identifies the communication process as the vehicle for decision making in cancer treatment. In this view, decision making is necessarily a sociocommunicative process whereby people enter into a relationship, exchange information, establish preferences, and choose a course of action. The model derives from contemporary notions of behavioral decision making and ethical conceptions of the doctor-patient relationship. This article briefly reviews the theoretical approaches to decision making, notes deficiencies, and embeds a more socially based process into the dynamics of the physician-patient relationship, focusing on cancer treatment decisions. In the CMSDM, decisions depend on (a) antecedent factors that have potential to influence communication, (b) jointly constructed communication climate, and (c) treatment preferences established by the physician and the patient.
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…
Klabunde, C N; Haggstrom, D; Kahn, K L; Gray, S W; Kim, B; Liu, B; Eisenstein, J; Keating, N L
Post-treatment cancer care is often fragmented and of suboptimal quality. We explored factors that may affect cancer survivors' post-treatment care coordination, including oncologists' use of electronic technologies such as e-mail and integrated electronic health records (EHRs) to communicate with primary care physicians (PCPs). We used data from a survey (357 respondents; participation rate 52.9%) conducted in 2012-2013 among medical oncologists caring for patients in a large US study of cancer care delivery and outcomes. Oncologists reported their frequency and mode of communication with PCPs, and role in providing post-treatment care. Seventy-five per cent said that they directly communicated with PCPs about post-treatment status and care recommendations for all/most patients. Among those directly communicating with PCPs, 70% always/usually used written correspondence, while 36% always/usually used integrated EHRs; telephone and e-mail were less used. Eighty per cent reported co-managing with PCPs at least one post-treatment general medical care need. In multivariate-adjusted analyses, neither communication mode nor intensity were associated with co-managing survivors' care. Oncologists' reliance on written correspondence to communicate with PCPs may be a barrier to care coordination. We discuss new research directions for enhancing communication and care coordination between oncologists and PCPs, and to better meet the needs of cancer survivors post-treatment.
Hundsberger, Thomas; Roth, Patrick; Roelcke, Ulrich
Neurological symptoms in cancer patients have a great impact on quality of life and need an interdisciplinary approach. They lead to significant impairment in activities of daily living (gait disorders, dizziness), a loss of patients independency (vegetative disturbances, wheel-chair dependency) and interfere with social activities (ban of driving in case of epilepsy). In this article we describe three main and serious neurological problems in the context of oncological patients. These are chemotherapy-induced polyneuropathy, malignant spinal cord compression and epileptic seizures. Our aim is to increase the awareness of neurological complications in cancer patients to improve patients care.
de Souza, Jonas A.; Wong, Yu-Ning
Novel diagnostic and therapeutic options offer hope to cancer patients with both localized and advanced disease. However, many of these treatments are often costly and even well-insured patients can face high out-of-pocket costs. Families may also be at risk of financial distress due to lost wages and other treatment-related expenses. Research is needed to measure and characterize financial distress in cancer patients and understand how it affects their quality of life. In addition, health care providers need to be trained to counsel patients and their families so they can make patient-centered treatment decisions that reflect their preferences and values. PMID:24349677
Brown, Ottilia; Ham-Baloyi, Wilma ten; van Rooyen, Dalena RM; Aldous, Colleen; Marais, Leonard Charles
Background Managing cancer in a multicultural environment poses several challenges, which include the communication between the patient and the healthcare provider. Culture is an important consideration in clinical care as it contributes to shaping patients’ health-related values, beliefs, and behaviours. This integrative literature review gathered evidence on how culturally competent patient–provider communication should be delivered to patients diagnosed with cancer. Design Whittemore and Knafl's approach to conducting an integrative literature review was used. A number of databases were systematically searched and a manual search was also conducted. Specific inclusion and exclusion criteria were set and documents were critically appraised independently by two reviewers. Thirty-five documents were included following these processes. Data extraction and synthesis followed and were also independently verified. Results Various strategies and personal characteristics and attitudes for culturally competent communication were identified. The importance of culturally competent healthcare systems and models for culturally competent communication were also emphasised. The findings related to all themes should be treated with caution as the results are based mostly on low-level evidence (Level VII). Conclusions More rigorous research yielding higher levels of evidence is needed in the field of culturally competent patient–provider communication in the management of cancer. Most of the available literature was classified as non-research evidence. The themes that emerged do, however, provide some insight into how culturally competent patient–provider communication may be delivered in order to improve treatment outcomes in patients diagnosed with cancer. PMID:27914190
Namkoong, Kang; Shah, Dhavan V; Gustafson, David H
This study investigates how social support and family relationship perceptions influence breast cancer patients' online communication networks in a computer-mediated social support (CMSS) group. To examine social interactions in the CMSS group, we identified two types of online social networks: open and targeted communication networks. The open communication network reflects group communication behaviors (i.e., one-to-many or "broadcast" communication) in which the intended audience is not specified; in contrast, the targeted communication network reflects interpersonal discourses (i.e., one-to-one or directed communication) in which the audience for the message is specified. The communication networks were constructed by tracking CMSS group usage data of 237 breast cancer patients who participated in one of two National Cancer Institute-funded randomized clinical trials. Eligible subjects were within 2 months of a diagnosis of primary breast cancer or recurrence at the time of recruitment. Findings reveal that breast cancer patients who perceived less availability of offline social support had a larger social network size in the open communication network. In contrast, those who perceived less family cohesion had a larger targeted communication network in the CMSS group, meaning they were inclined to use the CMSS group for developing interpersonal relationships.
Cancer cells release various antigens, some of which appear in the urine. Oral autourotherapy is suggested as a new treatment modality for cancer patients. It will provide the intestinal lymphatic system with the many tumor antigens against which antibodies may be produced. These antibodies may be pierced through the blood stream and attack the tumor and its cells.
Rees, A M
Political, legal, ethical, social, economic, and technological changes in the twentieth century have produced a profound effect on the health care and health status of Americans and the way in which physicians and patients communicate. In the latter half of this century, the responsibility for individual health care has shifted from a physician-oriented, paternalistic approach to a patient-centered one. Patients now assume two identities: health consumers and active participants in the medical decision-making process. This phenomenon has created an environment where consumer demand for information has shifted from a single focus on symptoms, diagnosis, and treatment of diseases to an increasing preoccupation with cost, quality, and access to health care. This shift emphasizes the critical role played by medical librarians in the dissemination of needed information, and it challenges librarians to take a leadership role in opening newer channels of communication between physicians and patients. The 1992 Janet Doe Lecture analyzes the evolutionary change in the physician-patient relationship and its modes of communication, projects future roles for medical librarians, and provides an extensive list of references for further reading. PMID:8428183
Sanatani, Michael S; Vincent, Mark D
Advances in the treatment of metastatic colorectal cancer have improved overall survival (OS); however, this might come at the cost of increased toxicity. Health-related quality of life, a significant concern closely related to toxicity and important when discussing palliative therapy, is infrequently assessed and reported in older clinical trials. As the number of tested regimens increases, the question arises on how to best present palliative treatment options. We present a simple way to compare treatment options in terms of potential risks and benefits. The literature was surveyed for reports of first-line systemic chemotherapies for metastatic colorectal cancer. The largest recent reports with detailed toxicity data were selected as representative for a regimen. Toxicity sum of a regimen was calculated as percent occurrences in the study cohort of severe adverse effects: diarrhea, mucositis, neurocutaneous conditions (excluding alopecia), vomiting, and febrile neutropenia. Limitations of toxicity reporting precluded inclusion of other or milder adverse events. Benefits (OS and progression-free survival [PFS]) were plotted graphically as benefit versus toxicity sum. Thirty-four regimens were found. Overall survival, PFS, and toxicity sum ranged from 8.9-24.7 months, 4.9-9.2 months, and 12-70 months, respectively. Weaknesses of our study include omission of some specific toxicities and of symptom control benefit, as well as heterogeneity of trial design and study populations. Furthermore, more recent OS data might reflect the availability of more lines of therapy rather than the effect of the first-line regimen, as comparison with PFS outcomes show. Our comparative tool helps physicians discuss the large number of available options with a patient in order to arrive at the treatment plan most appropriate to the individual and improve informed consent and disclosure, while highlighting limitations in available evidence.
Ghio, P; Dell'Orco, L
The aim of this work is to be able to publish the information concerning communication with cancer patients as recommended in England. The observation and the study protocol during the stay abroad have been given the opportunity to stylize specific information on the methodology of communication of important information to terminally ill patients. It seems readily apparent as they characterized by both technical precision and sensivity to emotions and descriptions for the individual patient. How is shared by all chronic pain is predominantly complex emotion, a mix of additions and perceived physical and emotional pain - emotional. Because accurate information is beneficial to the patient and that really is not turned, so to speak, a "bullet" it is necessary that you have created, over time, a concrete "therapeutic alliance" between body physician, patient and possibly family. This arises, for sure, even at first accepted the patient during the clinical visit attentive to detail, is renewed in the definition of the common objective to be achieved, so analgesia and it is expressed in the certainty that the physician provides all the resources realistically available. It is then up to the sensitivity of the operator, doctor and/or nurse, described in the "take charge" find, from time to time, the words and manners, verbal and nonverbal, to respond fully to questions of the patient same.
This past July, I started a journey into the fields of communications and cancer research when I joined the Office of Cancer Genomics (OCG) as a fellow in the National Cancer Institute (NCI) Health Communications Internship Program (HCIP). Cancer genomics and working in an office were new and uncharted territory for me: before I came to OCG, I was finishing a Ph.D. in cell biology at Vanderbilt University in Dr. Matthew Tyska’s laboratory.
Salzman, Brooke; Beldowski, Kathryn; de la Paz, Amanda
Although cancer is the second leading cause of death among persons 65 years and older, there is a paucity of clinical trial data about the effectiveness and harms of cancer screening in this population. Given the heterogeneous nature of the older population, cancer screening in these patients should not be based on age alone. Studies suggest that a life expectancy of at least 10 years is necessary to derive a survival benefit from screening for breast and colorectal cancers; therefore, screening for these cancers is not recommended in those with a life expectancy of less than 10 years. Prostate cancer screening, if performed at all, should not be performed after 69 years of age. Cervical cancer screening may be stopped after 65 years of age if the patient has an adequate history of negative screening results. An individualized approach to cancer screening decisions involves estimating life expectancy, determining the potential benefits and harms of screenings, and weighing those benefits and harms in relation to the patient's values and preferences.
Intille, Stephen S; Zabinski, Marion F
The field of cancer communication has undergone a major revolution as a result of the Internet. As recently as the early 1990s, face-to-face, print, and the telephone were the dominant methods of communication between health professionals and individuals in support of the prevention and treatment of cancer. Computer-supported interactive media existed, but this usually required sophisticated computer and video platforms that limited availability. The introduction of point-and-click interfaces for the Internet dramatically improved the ability of non-expert computer users to obtain and publish information electronically on the Web. Demand for Web access has driven computer sales for the home setting and improved the availability, capability, and affordability of desktop computers. New advances in information and computing technologies will lead to similarly dramatic changes in the affordability and accessibility of computers. Computers will move from the desktop into the environment and onto the body. Computers are becoming smaller, faster, more sophisticated, more responsive, less expensive, and—essentially—ubiquitous. Computers are evolving into much more than desktop communication devices. New computers include sensing, monitoring, geospatial tracking, just-in-time knowledge presentation, and a host of other information processes. The challenge for cancer communication researchers is to acknowledge the expanded capability of the Web and to move beyond the approaches to health promotion, behavior change, and communication that emerged during an era when language- and image-based interpersonal and mass communication strategies predominated. Ecological theory has been advanced since the early 1900s to explain the highly complex relationships among individuals, society, organizations, the built and natural environments, and personal and population health and well-being. This paper provides background on ecological theory, advances an Ecological Model of Internet
Shih, Ya-Chen Tina; Chien, Chun-Ru
The American Society of Clinical Oncology released its first guidance statement on the cost of cancer care in August 2009, affirming that patient-physician cost communication is a critical component of high-quality care. This forward-thinking recommendation has grown increasingly important in oncology practice today as the high costs of cancer care impose tremendous financial burden to patients, their families, and the health care system. For the current review, a literature search was conducted using the PubMed and Web of Science databases to identify articles that covered 3 topics related to patient-physician cost communication: patient attitude, physician acceptance, and the associated outcomes; and 15 articles from 12 distinct studies were identified. Although most articles that addressed patient attitude suggested that cost communication is desired by >50% of patients in the respective study cohorts, only <33% of patients in those studies had actually discussed costs with their physicians. The literature on physician acceptance indicated that, although 75% of physicians considered discussions of out-of-pocket costs with patients their responsibility, <30% felt comfortable with such communication. When asked about whether cost communication actually took place in their practice, percentages reported by physicians varied widely from <10% to >60%. The data suggested that cost communication was associated with improved patient satisfaction, lower out-of-pocket expenses, and a higher likelihood of medication nonadherence; none of the studies established causality. Both patients and physicians expressed a strong need for accurate, accessible, and transparent information about the cost of cancer care. Cancer 2017;123:928-39. © 2016 American Cancer Society.
Espinoza, Kimberly M; Heaton, Lisa J
People with special health care needs (PSHCN) often have difficulty communicating with providers in health care settings, including dental practices. This difficulty can affect access to care as well as the quality of care received. This article provides practical tips and tools dental professionals can use to facilitate communication for a diverse population of PSHCNs. The article discusses communication needs of patients with communication disorders; augmentative and alternative communication; and communication for patients with intellectual disability, psychiatric conditions; and dental fears. Examples are given of communication breakdowns, and descriptions of how communication challenges can be resolved.
Quérin, Serge; Clermont, Marie-José; Dupré-Goudable, Catherine; Dalmon, Pauline
Training the nephrologist-to-be to physician-patient communication (PPC) has several objectives: to guide his/her history taking in order to make a diagnosis, of course, but also to help him/her establish a long-lasting relationship, inform and motivate the patient, and prepare him/her to break bad news and to deal with end-of-life issues. PPC rests on specific strategies and on the ethical grounds of a human encounter, the success of which expresses itself in care. An effective PPC offers many benefits to the patient, but also to the clinician. Talking about renal failure and dialysis, about kidney transplantation, and about withdrawing or not starting therapy: these are a few of the communicational challenges awaiting the nephrologist in training, mostly with patients requiring long-term follow-up. PPC also requires specific skills in the field of pediatric nephrology, where one deals alternately with children, adolescents and parents. Whatever the personal abilities of the nephrologist-to-be, PPC is a competency that can be learned and improved, for the benefit of the patient, and also of the physician.
Gudiol, Carlota; Carratalà, Jordi
Bacterial infection is one of the most frequent complications in cancer patients and hematopoietic stem cell transplant recipients. In recent years, the emergence of antimicrobial resistance has become a significant problem worldwide, and cancer patients are among those affected. Treatment of infections due to multidrug-resistant (MDR) bacteria represents a clinical challenge, especially in the case of Gram-negative bacilli, since the therapeutic options are often very limited. As the antibiotics active against MDR bacteria present several disadvantages (limited clinical experience, higher incidence of adverse effects, and less knowledge of the pharmacokinetics of the drug), a thorough acquaintance with the main characteristics of these drugs is mandatory in order to provide safe treatment to cancer patients with MDR bacterial infections. Nevertheless, the implementation of antibiotic stewardship programs and infection control measures is the cornerstone for controlling the development and spread of these MDR pathogens.
Shin, Takeshi; Miyata, Akane; Arai, Gaku; Okada, Hiroshi
Testicular cancer(TC)is the most common and curable cancer affecting men of reproductive age. Successful treatment approaches have resulted in longer life expectancy in TC survivors. The most frequently used treatment for TC is a combination of inguinal orchiectomy, and either radiotherapy or cisplatin-based chemotherapy. In many TC patients, sperm quality is already abnormal and there may even be a lack of viable spermatozoa at the time of diagnosis. Therefore, the effect of cancer treatment on fertility is a potentially significant issue. Fertility preservation in these men has become essential and needs to be discussed prior to the start of cancer treatment. The only currently established fertility preservation method is the cryopreservation of sperm before therapy. For most patients seeking cryopreservation, the semen sample is collected via masturbation. If the patient is unable to ejaculate for any reason, other techniques such as vibratory stimulation and electroejaculation can be performed. In azoospermic or severely oligozoospermic patients, testicular sperm extraction at the time of the inguinal orchiectomy is a useful technique for obtaining spermatozoa before cytotoxic therapy. We herein present an overview of the current topics on fertility in TC patients, including the effects of surgery, chemotherapy, and radiation therapy. We also describe the strategy for fertility preservation in these patients.
Hanson, Laura C.; Boyd, Carlton; Green, Melissa; Goldmon, Moses; Wright, Gratia; Corbie-Smith, Giselle
Abstract Purpose To explore and identify communication and decision making with health care providers for African Americans living with cancer and for their families. Methods We used focus group interviews to identify and explore cultural perceptions, expectations, and desires as they relate to quality of life domains. Participants Of the 42 African American participants, 33 were women. Half of the participants (n = 21) were caregivers of a family member with cancer; the others were cancer survivors and some of them had also cared for a loved one with cancer. Results Participants focused on effective communication and decision making as fundamental to overall quality of life. Furthermore, physicians were viewed as having the responsibility to establish and monitor effective communication with patients and families. Within the domain of effective communication, participants stressed that health care providers needed to know the person and family and to tailor communication with them based on that knowledge. Within the domain of decision making, participants emphasized having a sense of control over treatment choices. They also expressed concerns for populations made vulnerable by advanced age, poverty, or low levels of formal education. Discussion Our participants indicated that relationship-centered care, in which one's sense of personhood is sought, acknowledged, and worked with, is foundational for effective communication and decision making. PMID:19021485
Trojano, Luigi; Moretta, Pasquale; Cozzolino, Autilia; Saltalamacchia, Annamaria; Estraneo, Anna
Conscious patients with severe motor and speech disorders have great difficulty interacting with the environment and communicating with other people. Several augmentative communication devices are now available to exploit these patients' expressive potential, but their use often demands considerable cognitive effort. Non-communicative patients with severe brain lesions may have, in addition, specific cognitive deficits that hinder the efficient use of augmentative communication methods. Some neuropsychological batteries are now available for testing these patients. On the basis of such cognitive assessments, cognitive rehabilitation training can now be applied, but we underline that this training must be tailored to single patients in order to allow them to communicate autonomously and efficiently.
de Souza, Vinicius Barbosa; Silva, Eduardo Nani; Ribeiro, Mario Luiz; Martins, Wolney de Andrade
There is a known association between chemotherapy and radiotherapy for treatment of cancer patients and development or worsening of hypertension. The aim of this article is to review this association. A literature search was conducted for articles reporting this association on the databases PubMed, SciELO and LILACS between 1993 and 2013. There was a high coprevalence of hypertension and cancer, since both diseases share the same risk factors, such as sedentary lifestyle, obesity, smoking, unhealthy diet and alcohol abuse. The use of chemotherapy and adjuvant drugs effective in the treatment of cancer increased the survival rate of these patients and, consequently, increased the incidence of hypertension. We described the association between the use of angiogenesis inhibitors (bevacizumab, sorafenib and sunitinib), corticosteroids, erythropoietin and non-steroidal anti-inflammatory drugs with the development of hypertension. We also described the relationship between hypertension and carotid baroreceptor injury secondary to cervical radiotherapy. Morbidity and mortality increased in patients with cancer and hypertension without proper antihypertensive treatment. We concluded that there is need for early diagnosis, effective monitoring and treatment strategies for hypertension in cancer patients in order to reduce cardiovascular morbidity and mortality. PMID:25742420
Lorusso, Domenica; Bria, Emilio; Costantini, Anna; Di Maio, Massimo; Rosti, Giovanni; Mancuso, Annamaria
Chemotherapy side effects (CSE) have a strong impact on patients' quality of life (QOL). To assess patient perceptions of CSE, their impact on QOL and doctor-patient communication regarding these aspects, a survey was conducted among Italian cancer patients. Patients at least 18 years of age, who received chemotherapy, were administered a dedicated questionnaire to assess their point of view on five domains: expectations about CSE and impact on QOL; doctor-patient communication about CSE; treatments to reduce the impact of CSE; sexual life; family relationships/activities and employment. A total of 761 patients participated. CSE had a considerable impact on patient QOL. Nausea/vomiting was the most feared adverse effect before initiating chemotherapy and the one most commonly experienced during treatment. Patients generally reported good doctor-patient communication regarding information about CSE. In almost all cases, the oncologists prescribed an antiemetic treatment, but the incidence of nausea/vomiting was high. Cancer and CSE severely affected sexual life, daily activities and employment. CSE had a strong negative impact on QOL. Good doctor-patient communication is essential. Improving antiemetic strategies may improve QOL. Doctors' ability to inform patients about delicate issues, such as the impact of CSE on sexual life, needs to be improved.
Robinson, Lynne; Kocum, Lucie; Loughlin, Catherine; Bryson, Lindsay; Dimoff, Jennifer K
Of working women diagnosed with cancer, approximately one-third will have breast cancer. Communicating about their cancer plays an important role in their workplace experience. It is challenging but helpful in eliciting needed social support and accommodations. Fully understanding such communication experiences is important in order to facilitate the well-being and success of such women in their workplaces. A qualitative study permits a richer account of the details of these workplace communications, and a deeper understanding of how women manage the complex and multifaceted communication process. This study used thematic analysis of semistructured interviews from 19 women working full time at the time of their breast cancer diagnosis. We found 3 themes that encapsulated unfolding individual experiences, representing a complex interplay of challenges to maintaining a sense of personal control in workplace responses: challenges to control posed by the experience of sharing information in the workplace about the woman's cancer, women's very individual attempts to control how information about their cancer was shared, and the mixed responses of those who were told. The result was unique individual trajectories in which empathic responses tailored to the individual's needs and preferences were most helpful. These findings can provide guidance on managing cancer communication for survivors, and on how to best support and accommodate women workers with breast cancer, facilitating their ability to control how their cancer impacts their work experience. Our website (http://www.iwantedyoutoknow.ca/) provides a video, tip sheet, and other resources for facilitating supportive communication in the workplace.
Lordick, Florian; Hacker, Ulrich
Cancer patients are regularly affected by malnutrition which often leads to a worsened quality of life and activity in daily living, more side effects and complications during anticancer treatment and shorter survival times. The early diagnosis and treatment of malnutrition are therefore relevant components of oncological treatment. The assessment of the nutritional status and determination of the body-mass-index should be done in every patient with cancer. The clinical examination delivers important findings and indications for malnutrition. Bioimpedance analysis can deliver additional objective information. The treatment of malnutrition should start early and follows a step-wise escalation reaching from nutritional counseling to enteral nutritional support to parenteral nutrition.
Kaplan, Celia P.; Nápoles, Anna; Davis, Sharon; Lopez, Monica; Pasick, Rena J.; Livaudais-Toman, Jennifer; Pérez-Stable, Eliseo J.
Semi-structured interviews were conducted with 16 Latino cancer patients diagnosed in California; 10 health professionals from the San Francisco Bay Area and Fresno, California; and 10 Cancer Information Services (CIS) information specialists from the regional offices handling calls from Spanish-speakers. Interview guides were designed by the investigators to answer three main research questions: 1) How do Latinos obtain information about cancer and what types of information do they access?; 2) What sources of cancer information do they seek out and find credible?; and 3) What are the barriers and facilitators to Latinos obtaining cancer information? Stakeholders generally viewed health professionals as the most credible source of cancer information. All groups regarded family and friends as important sources of information. Patients and health professionals tended to differ on the value of print materials. Although patients found them generally useful, health professionals tended to view them as inadequate for meeting the informational needs of their Latino patients due to the challenge of low health literacy. Health professionals also tended to undervalue Internet resources compared to patients and CIS specialists. All stakeholders viewed language, ethnic discordance and the impact on patients of the initial diagnosis as barriers to effective communication of cancer information. Health professionals and CIS specialists, but not patients, mentioned low literacy as a barrier. Our findings underscore the importance of the physician-patient relationship as a point of intervention to address the unmet informational and psychosocial needs of Latino cancer patients. PMID:27642542
Mazor, Kathleen M.; Ockene, Judith K.; Rogers, H. Jane; Carlin, Michele M.; Quirk, Mark E.
Many efforts to teach and evaluate physician-patient communication 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 are…
Wuyts, Wim A; Peccatori, Fedro A; Russell, Anne-Marie
The progressive and highly variable course of idiopathic pulmonary fibrosis (IPF) can present patients and their families with various challenges at different points of the disease. Structured communication between the healthcare professional and the patient is vital to ensure the best possible support and treatment for the patient. While research in this area has been limited, an increasing number of studies are emerging that support the role of communication in patients with debilitating and fatal lung diseases. Communication models used in other conditions that share many challenges with IPF, such as cancer, provide important insights for developing specifically designed patient support and communications models in IPF. Three communication models will be described: 1) the patient-centred care model (for oncology); 2) the three pillars of care model (for IPF); and 3) the Brompton model of care (for interstitial lung disease). Themes common to all three models include comprehensive patient education, encouraged patient participation and an accessible healthcare system, all supported by a collaborative provider-patient relationship. The development of effective communication skills is an on-going process and it is recommended to examine communication models used in other chronic diseases.
Civilotti, Cristina; Castelli, Lorys; Binaschi, Luca; Cussino, Martina; Tesio, Valentina; Di Fini, Giulia; Veglia, Fabio; Torta, Riccardo
Introduction: The utilization of the post-traumatic stress disorder (PTSD) diagnostic spectrum is currently being debated to categorize psychological adjustment in cancer patients. The aims of this study were to: (1) evaluate the presence of cancer-related traumatic dissociative symptomatology in a sample of cancer patients; (2) examine the correlation of cancer-related dissociation and sociodemographic and medical variables, anxiety, depression, and post-traumatic stress symptomatology; (3) investigate the predictors of cancer-related dissociation. Methods: Ninety-two mixed cancer patients (mean age: 58.94, ds = 10.13) recruited from two hospitals in northern Italy were administered a questionnaire on sociodemographic and medical characteristics, the Karnofsky Scale to measure the level of patient activity and medical care requirements, the Hospital Anxiety and Depression Scale (HADS) to evaluate the presence of anxiety and depression, the Impact of Event Scale Revised (IES-R) to assess the severity of intrusion, avoidance, and hypervigilance, and the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) to quantify the traumatic dissociative symptomatology. Results: 31.5% of participants report a PDEQ score above the cutoff. The results indicated that dissociative symptomatology was positively correlated with HADS scores (HADS-Anxiety: r = 0.476, p < 0.001; HADS-Depression: r = 0.364, p < 0.001) and with IES-R scores (IES-R-Intrusion: r = 0.698, p < 0.001; IES-R-Avoidance: r = 0.619, p < 0.001; IES-R- Hypervigilance: r = 0.681, p < 0.001). A stepwise regression analysis was performed in order to find the predictors of cancer-related traumatic dissociative symptomatology. The results converged on a three predictor model revealing that IES-R-Intrusion, IES-R-Avoidance, and IES-R-Hyperarousal accounted for 53.9% of the explained variance. Conclusion: These findings allow us to hypothesize a specific psychological reaction which may be ascribed to the traumatic
Ravitz, Paula; Lancee, William J.; Lawson, Andrea; Maunder, Robert; Hunter, Jonathan J.; Leszcz, Molyn; McNaughton, Nancy; Pain, Clare
Objective: Effective communication between physicians and their patients is important in optimizing patient care. This project tested a brief, intensive, interactive medical education intervention using coaching and standardized psychiatric patients to teach physician-patient communication to family medicine trainees. Methods: Twenty-six family…
Beckman, Emily S; Helft, Paul R; Torke, Alexia M
Although hope is a pervasive concept in cancer treatment, we know little about how ambulatory patients with cancer define or experience hope. We explored hope through semistructured interviews with ten patients with advanced (some curable, some incurable) colon cancer at one Midwestern, university-based cancer center. We conducted a thematic analysis to identify key concepts related to patient perceptions of hope. Although we did ask specifically about hope, patients also often revealed their hopes in response to indirect questions or by telling stories about their cancer experience. We identified four major themes related to hope: 1) hope is essential, 2) a change in perspective, 3) the content of hope, and 4) communicating about hope. The third theme, the content of hope, included three subthemes: a) the desire for normalcy, b) future plans, and c) hope for a cure. We conclude that hope is an essential concept for patients undergoing treatment for cancer as it pertains to their psychological well-being and quality of life, and hope for a cure is not and should not be the only consideration. In a clinical context, the exploration of patients' hopes and aspirations in light of their cancer diagnosis is important because it provides a frame for understanding their goals for treatment. Exploration of the content of patients' hope can not only help to illuminate misunderstandings but also clarify how potential treatments may or may not contribute to achieving patients' goals.
Dhobi, Manzoor A.; Wani, Khursheed Alam; Parray, Fazl Qadir; Wani, Rouf A.; Peer, G. Q.; Abdullah, Safiya; Wani, Imtiyaz A.; Wani, Muneer A.; Shah, Mubashir A.; Thakur, Natasha
Aim. The aim of this study was to see the clinical, pathological, and demographic profile of young patients with stomach carcinoma besides association with p53. Patients and Methods. Prospective study of young patients with stomach carcinoma from January 2005 to December 2009. A total of 50 patients with age less than 40 years were studied. Results. Male female ratio was 1 : 1.08 in young patients and 2.5 : 1 in older patients. A positive family history of stomach cancer in the first degree relatives was present in 10% of young patients. Resection was possible only in 50% young patients. 26% young patients underwent only palliative gastrojejunostomy. The most common operation was lower partial gastrectomy in 68%. Amongst the intraoperative findings peritoneal metastasis was seen in 17.4% in young patients. 50% young patients presented in stage IV as per AJCC classification (P value .004; sig.). None of the patients presented as stage 1 disease in young group. Conclusion. Early detection of stomach carcinoma is very important in all patients but in young patients it is of paramount importance. PMID:24381753
Brody, J E
The current barrage of information about real and potential cancer risks has created undue fears and misplaced concerns about cancer hazards faced by Americans. Most members of the general public are far more worried about minuscule, hypothetical risks presented by environmental contaminants than about the far greater well-established hazards that they inflict on themselves, for example, through smoking, dietary imbalance, and inactivity. It is the job of the print media to help set the record straight and to help place in perspective the myriad cancer risks that are aired almost weekly in 30-second radio and television broadcasts.
Treatments for head and neck cancers are generally complex and debilitating. Surgery, often mutilating, profoundly affects the relationship between oneself and others and causes verbal communication, breathing and swallowing difficulties. The functional and aesthetic sequelae are a constant reminder to the patient of the disease and make them conscious of their appearance.
Truccolo, Ivana; Cipolat Mis, Chiara; Cervo, Silvia; Dal Maso, Luigino; Bongiovanni, Marilena; Bearz, Alessandra; Sartor, Ivana; Baldo, Paolo; Ferrarin, Emanuela; Fratino, Lucia; Mascarin, Maurizio; Roncadin, Mario; Annunziata, Maria Antonietta; Muzzatti, Barbara; De Paoli, Paolo
In Italy, educational programs for cancer patients are currently provided by the national government, scientific societies, and patient advocate organizations. Several gaps limit their effectiveness, including the lack of coordinated efforts, poor involvement of patient feedback in the planning of programs, as well as a lack of resources on innovative cancer-related topics. This process is parallel to a strong shift in the attitude of patients towards health in general and taking charge of their own health conditions in particular. The National Cancer Institute in the USA and the Organization of European Cancer Institutes encourage comprehensive cancer centers in providing educational programs conceived to overcome these gaps. The goal of this paper is to identify and describe the key elements necessary to develop a global patient education program and provide recommendations for strategies with practical examples for implementation in the daily activities of cancer institutes. A multidisciplinary committee was established for patient education, including patient representatives as equal partners, to define, implement, verify, and evaluate the fundamental steps for establishing a comprehensive education program. Six essential topics were identified for the program: appropriate communication of cancer epidemiology, clinical trial information, new therapeutic technologies, support in the use of medicines, psycho-oncological interventions, age-personalized approaches, and training programs for healthcare providers. Integration of these topics along with patient feedback is the key to a successful model for educational programs. An integrated educational program can transform a comprehensive cancer center to an institution that provides research and care for and with patients.
Diso, Daniele; Onorati, Ilaria; Anile, Marco; Mantovani, Sara; Rendina, Erino A.
There is a worldwide-accepted evidence of a population shift toward older ages. This shift favors an increased risk of developing lung cancer that is primarily a disease of older populations. Decision making is extremely difficult in elderly patients, since this group is under-represented in clinical trials with only 25% of them historically opening to patients older than 65 years. For all these reasons, a “customized” preoperative assessment to identify physiological or pathological frailty should be encouraged since standard tools may be less reliable. The work already done to improve patient selection for lung surgery in the elderly population clearly shows that surgical resection seems the treatment of choice for early stage lung cancer. Further studies are required to improve outcome by reducing postoperative morbidity and mortality. PMID:27942414
Cannon, Geoffrey; Gupta, Prakash; Gomes, Fabio; Kerner, Jon; Parra, William; Weiderpass, Elisabete; Kim, Jeongseon; Moore, Malcolm; Sutcliffe, Catherine; Sutcliffe, Simon
Cancer is a leading cause of death worldwide, accounting for approximately 7.6 million deaths (13% of all deaths) in 2008. Cancer mortality is projected to increase to 11 million deaths in 2030, with the majority occurring in regions of the world with the least capacity to respond. However, cancer is not only a personal, societal and economic burden but also a potential societal opportunity in the context of functional life - the years gained through effective prevention and treatment, and strategies to enhance survivorship. The United Nations General Assembly Special Session in 2011 has served to focus attention on key aspects of cancer prevention and control. Firstly, cancer is largely preventable, by feasible means. Secondly, cancer is one of a number of chronic, non- communicable diseases that share common risk factors whose prevention and control would benefit a majority of the world's population. Thirdly, a proportion of cancers can be attributed to infectious, communicable causal factors (e.g., HPV, HBV, H.pylori, parasites, flukes) and that strategies to control the burden of infectious diseases have relevance to the control of cancer. Fourthly, that the natural history of non-communicable diseases, including cancer, from primary prevention through diagnosis, treatment and care, is underwritten by the impact of social, economic and environmental determinants of health (e.g., poverty, illiteracy, gender inequality, social isolation, stigma, socio-economic status). Session 1 of the 4th International Cancer Control Congress (ICCC-4) focused on the social, economic and environmental, as well as biological and behavioural, modifiers of the risk of cancer through one plenary presentation and four interactive workshop discussions. The workshop sessions concerned 1) the Global Adult Tobacco Survey and social determinants of tobacco use in high burden low- and middle-income countries; 2) the role of diet, including alcohol, and physical activity in modifying the
Roett, Michelle A; Coleman, Mary Thoesen
Patient portals (ie, secure web-based services for patient health record access) and secure messaging to health care professionals are gaining popularity slowly. Advantages of web portals include timely communication and instruction, access to appointments and other services, and high patient satisfaction. Limitations include inappropriate use, security considerations, organizational costs, and exclusion of patients who are uncomfortable with or unable to use computers. Attention to the organization's strategic plan and office policies, patient and staff expectations, workflow and communication integration, training, marketing, and enrollment can facilitate optimal use of this technology. Other communication technologies that can enhance patient care include automated voice or text reminders and brief electronic communications. Social media provide another method of patient outreach, but privacy and access are concerns. Incorporating telehealthcare (health care provided via telephone or Internet), providing health coaching, and using interactive health communication applications can improve patient knowledge and clinical outcomes and provide social support.
This study analyzed doctor-patient communication 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…
Tulsky, James A
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.
MOSAVEL, MAGHBOEBA; PORTS, KATIE A.
Substantial breast and cervical cancer disparities exist in the United States, particularly among African American women with low social economic status. There is considerable potential for discussions about cancer prevention between mothers and daughters. However, upward communication, from child to parent, remains a relatively novel research area, and it remains unclear how receptive mothers would be to messages from their daughter about cancer, a topic that may be considered culturally inappropriate for daughters to initiate. In this study, we simulated cancer message delivery to daughters and then conducted direct observation of daughters as they recalled and shared the message with their mother or female elder. We found that daughters were able to successfully recall and deliver a cancer appeal to their mother and mothers were generally receptive to this message. Not only did mothers listen to their daughters’ appeals, but also daughters’ knowledge of cancer was considerably improved by the opportunity to educate her female elder. Moreover, daughters’ nonverbal communication suggested a surprisingly relaxed demeanor. The potential of young people to impact the screening behavior of their female elders is very promising in terms of reducing cancer disparities. PMID:25848895
Parrott, Roxanne; Monahan, Jennifer; Ainsworth, Stuart; Steiner, Carol
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…
Campbell, G Adam; Hu, Daniel; Okusa, Mark D
Acute kidney injury (AKI) is a frequent and significant complication of cancer and cancer therapy. Cancer patients frequently encounter risk factors for AKI including older age, CKD, prerenal conditions, sepsis, exposure to nephrotoxins, and obstructive physiology. AKI can also be secondary to paraneoplastic conditions, including glomerulonephritis and microangiopathic processes. This complication can have significant consequences, including effects on patients' ability to continue to receive therapy for their malignancy. This review will serve to summarize potential etiologies of AKI that present in patients with cancer as well as to highlight specific patient populations, such as the critically ill cancer patient.
van Bruinessen, Inge R; van der Hout, Lotte E; van Weel-Baumgarten, Evelyn M; Gouw, Hans; Zijlstra, Josée M; van Dulmen, Sandra
Many patients with haematological malignancies experience barriers in clinical communication. Reaching effective communication is of great importance as it has been linked to a range of improved patient outcomes such as satisfaction, compliance to treatment, perceived quality of life and physical and mental health. To get a better understanding how communication in haematological consultations can be improved, the current study focussed on patients' preferences and perceived performances regarding the communicative behaviour of their health care professional. Secondly, the mediation of an online communication tool for patients was analysed. Within a controlled pre- post-test design, 78 datasets of clinical consultations could be analysed. Patients considered both affective and instrumental communication aspects important. The affective communication behaviour of the health care professional met the patients' pre-visit preferences well. In the information exchange, more variability and discrepancies were found. Overall, the online intervention did not seem to influence the patients' perceived communication performance of their health care professional much. To further improve the communication during clinical consultations, health care professionals should inquire about patients' expectations, especially during the exchange of information and advices. At the same time, patients should be supported to express their preferences at the start of the consultation. The study was registered in the Netherlands Trial Register, number 3779.
Siegler, E L; Levin, B W
Communication with dying patients and their families requires special skills to assist them in this extremely stressful period. This article begins with a case that illustrates many of the challenges of communicating with the dying. It then reviews the literature about communication with older patients at the end of life, focusing on physician-patient discussions, decision-making, advance directives, and cultural factors. The article concludes with a practical discussion of problems that physicians may encounter when working with older patients at the end of life and their families and recommendations to improve communication.
Hindi, Nadia; Cordero, Nazaret; Espinosa, Enrique
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.
Martin, Donald R; Tipton, Bryan K
Researchers have long documented the importance of patient advocacy programs as a means of providing customer service in health-care organizations. Yet, while effective communication is often acknowledged as key to effective patient advocacy, knowledge of the specific communication role functions enacted by patient advocates remains limited, as does our understanding of the function of patient advocacy at the organizational level. This qualitative investigation not only provides a typology of communication roles enacted by patient advocates while solving problems on behalf of patients and their family members, but also integrates scholarly research on "boundary-spanning" as a means of theoretically contextualizing the advocacy role at the organizational level.
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.
Väisänen, Paula; Holopainen, Jaana
The aim of this study was to improve the internal communication within the intensive care unit of the Kuopio University Hospital. We developed an intranet based internal communication channel within the patient data management system and studied the effectiveness of this system in improving communication in the ICU. The hypothesis was that the communication difficulties caused by the structure of the unit, large personnel and work schedule (three separate shifts) could be reduced by supplementing oral communication by this intranet based system. The results clearly indicate that this type of system can significantly improve communication within our unit.
Ancker, Jessica S; Carpenter, Kristen M; Greene, Paul; Hoffman, Randi; Kukafka, Rita; Marlow, Laura A V; Prigerson, Holly G; Quillin, John M
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 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 also will be important to examine spontaneously emerging peer communication efforts to see how they can be integrated with theory-based efforts initiated by researchers.
Klingner, Jill; Moscovice, Ira
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…
Hesse, Bradford W; Cole, Galen E; Powe, Barbara D
One of the hallmarks of the communication revolution over the past decade has been its support for participation, whether that be in the active engagement of patients searching the Web for answers to vital health questions, or in the collective energies of self-organizing communities through social media. At the same time, some of the major obstacles to achieving a full and equitable reach of evidence-based cancer control knowledge have been traced back to discontinuities in communication either within clinical care or the broader public awareness system. Communication scientists from the National Cancer Institute, the Centers for Disease Control and Prevention, and the American Cancer Society joined forces in 2010 to investigate ways in which communication science can be used to improve coordination and enhance participation in cancer control for the nation. From 2010 to 2013, the three organizations worked together in 1) convening two meetings designed to assess the status of funded research in communication science, 2) completing a systematic review of literature published over the previous 10 years, and 3) authoring a blueprint for coordinated efforts using the implications of communication science. The blueprint consists of three major goals: first, to identify high-yield targets of opportunity using the health impact pyramid articulated by Centers for Disease Control and Prevention Director, Thomas Frieden; second, to leverage opportunities within the new communication environment, including the opportunities catalyzed by national efforts to create an infrastructure for evidence implementation through health information technology; and third, to assist in coordinating efforts across collaborative entities through participative media.
Birner, Peter; Prager, Gerald; Streubel, Berthold
Recent technical advances have brought insights into the biology of cancer in human, establishing it as a disease driven by genetic mutations. Beside inherited family tumour syndromes caused by germline mutations, somatic genetic alterations occur early in tumourigenesis, which accumulate during the progression of the disease and its treatment. Based on these observations, medical oncology has started to enter an era of stratified medicine, where treatment selection is becoming tailored to drugable molecular pathways. As a pre-requisite of an individualised treatment concept, molecular and genetic characterisation of the individual tumour has to be performed to align the most appropriate therapies according to the patient's disease. Reading the individual molecular tumour profile and responding by a tailored treatment concept is the ‘communication’ required to fight this deadly disease. This way to communicate is currently changing the field of oncology dramatically, and fundamentally involves the discipline of molecular pathology. This review highlights the role of genetic characterisation of human malignancies by giving an overview on the basic methods of molecular pathology, the challenge of the instable tumour genome and its clinical consequences. Trial registration number EK1541/2012. PMID:27933213
Attention to providers' communication skills is likely to increase, given the confluence of forces that have highlighted the importance of communication in healthcare. In the United States, interpersonal and communication skills have been explicitly identified as a priority throughout the continuum of medical education and practice. Ideally, theory and research inform teaching and assessment efforts by suggesting how communication behavior affects outcomes and by providing a conceptual framework for learning skills. This article illustrates the interplay between education and research by discussing examples of useful concepts (models of communication, issues of perceived control, and patterns of non-verbal communication) and understudied topics (physician verbalizations during patients' initial narratives, the mundane aspects of communication in healthcare, conceptual and operational definitions of empathy, and the effect of patient narratives on both patients and providers). Given the breadth and depth of experience, from screening and prevention to treatment and support, the context of cancer offers a promising laboratory for enhancing both education and research about provider-patient communication.
Costello, John M; Patak, Lance; Pritchard, Jennifer
Children in pediatric intensive care units (PICUs) may experience a broad range of motor, sensory, cognitive, and linguistic difficulties that make it difficult for them to communicate effectively. Being unable to communicate is emotionally frightening for children and can lead to an increase in sentinel events, medical errors and extended lengths of stay. Implementation of augmentative and alternative communication (AAC) tools and strategies can address the communication needs of children in the PICU by enabling them to communicate their wants, needs and feelings to healthcare providers and family members and participate in their own care more productively. Hospitals around the world are increasingly recognizing and addressing patients' needs for communication access and have begun to implement communication screenings and assessments and interventions at admission and throughout the hospital stay. New standards for all American hospitals, in fact, mandate efforts to improve patient communication. When patient-provider communication improves, treatment success goes up, hospital-caused errors decrease and patient and family satisfaction improve. This article describes three phases of intervention for communication vulnerable children in the PICU and provides examples of treatment approaches that ensure communication access as their medical condition changes.
Teamwork requires co-operation, co-ordination and communication between members of a team to achieve desired outcomes. In industries with a high degree of risk, such as health care, effective teamwork has been shown to achieve team goals successfully and efficiently, with fewer errors. This article introduces behaviours that support communication, co-operation and co-ordination in teams. The central role of communication in enabling co-operation and co-ordination is explored. A human factors perspective is used to examine tools to improve communication and identify barriers to effective team communication in health care.
Aelbrecht, Karolien; Rimondini, Michela; Bensing, Jozien; Moretti, Francesca; Willems, Sara; Mazzi, Mariangela; Fletcher, Ian; Deveugele, Myriam
Good doctor-patient communication may lead to better compliance, higher patient satisfaction, and finally, better health. Although the social variance in how physicians and patients communicate is clearly demonstrated, little is known about what patients with different educational attainments actually prefer in doctor-patient communication. In…
Gordon, Howard S; Street, Richard L
The purpose of this study was to compare several different measures of physician-patient communication. We compared data derived from different measures of three communication behaviors, patient participation, physician information giving, and physician participatory decision-making (PDM) style, from 83 outpatient visits to oncology or thoracic surgery clinics for pulmonary nodules or lung cancer. Communication was measured with rating scales completed by patients and physicians after the consultation and by two different groups of external observers who used rating scales or coded the frequency of communication behaviors, respectively, after listening to an audio recording of the consultation. Measures were compared using Pearson's correlations. Correlations of patients' and physicians' ratings of patient participation (r = .04) and physician PDM style (r = .03) were low and not significant (p > .0083, Bonferroni-adjusted). Correlations of observers' ratings with patients' or physicians' ratings for patient participation and physician PDM style were moderate or low (r = .15, .27, .07, and .01, respectively) but were not statistically significant (p > .0083, Bonferroni-adjusted). Correlations between observers' ratings and frequency measures were .31, .52, and .63 and were statistically significant with p values .005, <.0001, and <.0001, respectively, for PDM style, information giving, and patient participation. Our findings highlight the potential for using observers' ratings as an alternate measure of communication to more labor intensive frequency measures.
Cohen, Elisia L.; Gordon, Allison Scott; Record, Rachael; Shaunfield, Sara; Jones, Grace M.; Collins, Tom
Changes to the United States Preventive Services Task Force (USPSTF) recommendations for cervical cancer preventive services have led to patient confusion, especially in medically underserved populations. We investigated how patient uncertainty concerning cervical cancer screening guidelines is appraised and managed through communication with healthcare providers by conducting in-depth, face-to-face interviews with 24 adult women between the ages of 24 and 65 (m = 41, SD = 14) living in Appalachia Kentucky. In general, participants expressed a high degree of uncertainty about the updated cervical cancer screening guidelines and appraised this uncertainty as both a danger and an opportunity. Communication with healthcare providers served both to exacerbate and to mitigate patient uncertainty. The study identifies how health care providers may use the change in USPSTF guidelines as a ‘teachable moment’ to productively counsel patients on the importance of timely screening, the typical progression of certain types of high-risk HPV infection to cervical cancer, and the importance of follow-up care. PMID:26949274
Mulder, Bob C; Lokhorst, Anne Marike; Rutten, Guy E H M; van Woerkum, Cees M J
Many type 2 diabetes mellitus patients have difficulties reaching optimal blood glucose control. With patients treated in primary care by nurses, nurse communication plays a pivotal role in supporting patient health. The twofold aim of the present review is to categorize common barriers to nurse-patient communication and to review potentially effective communication methods. Important communication barriers are lack of skills and self-efficacy, possibly because nurses work in a context where they have to perform biomedical examinations and then perform patient-centered counseling from a biopsychosocial approach. Training in patient-centered counseling does not seem helpful in overcoming this paradox. Rather, patient-centeredness should be regarded as a basic condition for counseling, whereby nurses and patients seek to cooperate and share responsibility based on trust. Nurses may be more successful when incorporating behavior change counseling based on psychological principles of self-regulation, for example, goal setting, incremental performance accomplishments, and action planning.
Egleston, Brian L; Fetzer, Dominique; Forman, Andrea; Bealin, Lisa; Rybak, Christina; Peterson, Candace; Corbman, Melanie; Albarracin, Julio; Stevens, Evelyn; Daly, Mary B; Bradbury, Angela R
Background Dissemination of genetic testing for disease susceptibility, one application of “personalized medicine”, holds the potential to empower patients and providers through informed risk reduction and prevention recommendations. Genetic testing has become a standard practice in cancer prevention for high-risk populations. Heightened consumer awareness of “cancer genes” and genes for other diseases (eg, cardiovascular and Alzheimer’s disease), as well as the burgeoning availability of increasingly complex genomic tests (ie, multi-gene, whole-exome and -genome sequencing), has escalated interest in and demand for genetic risk assessment and the specialists who provide it. Increasing demand is expected to surpass access to genetic specialists. Thus, there is urgent need to develop effective and efficient models of delivery of genetic information that comparably balance the risks and benefits to the current standard of in-person communication. Objective The aim of this pilot study was to develop and evaluate a theoretically grounded and rigorously developed protocol for telephone communication of BRCA1/2 (breast cancer) test results that might be generalizable to genetic testing for other hereditary cancer and noncancer syndromes. Methods Stakeholder data, health communication literature, and our theoretical model grounded in Self-Regulation Theory of Health Behavior were used to develop a telephone communication protocol for the communication of BRCA1/2 genetic test results. Framework analysis of selected audiotapes of disclosure sessions and stakeholders’ feedback were utilized to evaluate the efficacy and inform refinements to this protocol. Results Stakeholder feedback (n=86) and audiotapes (38%, 33/86) of telephone disclosures revealed perceived disadvantages and challenges including environmental factors (eg, non-private environment), patient-related factors (eg, low health literacy), testing-related factors (eg, additional testing needed), and
Part of nurses' unique and challenging role in healthcare settings is engaging in difficult conversations with patients. Effective communication is essential to establish a successful nurse-patient relationship, put the patient at ease and promote better interactions. A reflective approach to care can help nurses to learn from experience and use this knowledge to communicate bad news to patients in a sensitive and timely manner.
Claramita, Mora; Nugraheni, Mubarika D. F.; van Dalen, Jan; van der Vleuten, Cees
Studies of doctor-patient communication generally advocate a partnership communication style. However, in Southeast Asian settings, we often see a more one-way style with little input from the patient. We investigated factors underlying the use of a one-way consultation style by doctors in a Southeast Asian setting. We conducted a qualitative…
Adib Hajbaghery, Mohsen; Rezaei Shahsavarloo, Zahra
Background: Clients with communication impairment are at risk for health disparity. Hence, health care workers should be knowledgeable and skillful in communication. However, no studies are available on Iranian nursing and midwifery students’ communication skills with patients with severe communication problems. Objectives: The present study was conducted to investigate Iranian nursing and midwifery students' competencies in communication with patients with severe communication problems. Materials and Methods: This study was performed on all senior nursing and midwifery students of Kashan University of Medical Sciences in spring 2013. Data were collected through a knowledge questionnaire and two checklists for evaluation of skills needed for communication with patients with severe communication problems. Data analysis was performed through independent samples t test, and Fisher’s exact test. Results: In total, 68.8% of the participants were female, 37.6% had a history of part-time job as a nurse or midwife. The mean score of knowledge were 4.41 ± 1.42 and 4.77 ± 1.77 for nursing and midwifery students, respectively and the difference was not significant (P = 0.312). In addition, the mean score of communication skills with deaf patients was 13.23 ± 4.68 and 11.86 ± 5.55 for nursing and midwifery students, respectively and the difference was not significant (P = 0.258). Also, the mean score of communication skills with stutter patients was 23.91 ± 4.17 and 21.25 ± 3.91 for nursing and midwifery students, respectively but the difference was not significant (P = 0.269). Conclusions: Nursing and midwifery students did not significantly differ in terms of communication with patients with severe communication problems. Most of the students had low or very low knowledge and skills in communication with patients with hearing impairment. However, they had better skills in communication with patient with speech problem. Special workshops or training programs are
Baldwin, Laura-Mae; Cai, Yong; Larson, Eric H.; Dobie, Sharon A.; Wright, George E.; Goodman, David C.; Matthews, Barbara; Hart, L. Gary
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.…
Im, Eun-Ok; Lim, Hyun-Ju; Clark, Maresha; Chee, Wonshik
Although very little is known about African American cancer patients' pain experience, a few studies have indicated that their cancer pain experience is unique and somewhat different from that of other ethnic groups. The purpose of the study reported in this article was to explore African American cancer patients' pain experience using an online forum. This study was a qualitative online forum designed from a feminist perspective and conducted among 11 African American cancer patients who were recruited through both Internet and real settings. Nine online forum topics were used to administer the 6-month online forum, and the data were analyzed using thematic analysis. Four themes emerged through the data analysis process. First, participants viewed cancer as a challenge in life that they should fight against. Second, cancer pain was differentiated from ordinary pain because cancer was stigmatized in their culture. Third, participants viewed that African Americans, especially women, were culturally raised to be strong, and this African American cultural heritage inhibited cancer patients from expressing pain and seeking help for pain management. Finally, the findings indicated certain changes in perspectives among African American cancer patients during the disease process, which might make them tolerate pain through praying to God and reading the Bible. Based on the findings, we suggest further studies among diverse groups of African American cancer patients, with a focus on cultural attitudes toward cancer pain and influences of family on cancer pain experience.
Hemsley, Bronwyn; Balandin, Susan
Poor patient-provider communication in hospital continues to be cited as a possible causal factor in preventable adverse events for patients with severe communication disabilities. Yet to date there are no reports of empirical interventions that investigate or demonstrate an improvement in communication in hospital for these patients. The aim of this review was to synthesize the findings of research into communication in hospital for people with severe communication disabilities arising from lifelong and acquired stable conditions including cerebral palsy, autism, intellectual disability, aphasia following stroke, but excluding progressive conditions and those solely related to sensory impairments of hearing or vision. Results revealed six core strategies suggested to improve communication in hospital: (a) develop services, systems, and policies that support improved communication, (b) devote enough time to communication, (c) ensure adequate access to communication tools (nurse call systems and communication aids), (d) access personally held written health information, (e) collaborate effectively with carers, spouses, and parents, and (f) increase the communicative competence of hospital staff. Currently there are no reports that trial or validate any of these strategies specifically in hospital settings. Observational and evaluative research is needed to investigate the ecological validity of strategies proposed to improve communication.
Nguyen, Tien V; Hong, Judith; Prose, Neil S
The motivation for developing patient-centered communication stems from a desire to enhance the quality of patient care, fulfill professional competency requirements, reduce medical errors, and improve health outcomes and patient satisfaction. Patient-centered communication skills can optimize the physician-patient relationship without significantly prolonging office visits. We propose a series of practical and generally effective techniques for verbal and nonverbal communication. We also suggest a targeted approach for specific difficult conversations that may occur frequently in the practice of dermatology.
Ishikawa, Hirono; Hashimoto, Hideki; Kiuchi, Takahiro
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.
Cornwall, Amanda; Moore, Sally; Plant, Hilary
This paper reports on a study exploring the usefulness of e-mail as a means of communication between nurse specialists and patients with lung cancer and their families. The study involved two lung cancer nurse specialists and 16 patients and family members who used e-mail with them during the 6-month study period. Data were collected from three sources: (1) e-mail contact between the nurse specialists and patients/family members, (2) patient/family member questionnaire and (3) a focus group/reflective session with the nurse specialists. Quantitative data collected from the e-mails and the questionnaires were analysed descriptively and are presented as summary statistics. Text data from the questionnaires and e-mails were analysed using content analysis. Findings suggest that e-mail can be an effective and convenient means of communication between nurse specialists, and patients and family members. Patients and family members reported high levels of satisfaction with this method of communication. It was found to be quick and easy, and patients and family members were satisfied with both the response and the speed of response from the nurse specialists. Nurse specialists were also positive about e-mail use and found that the benefits of using e-mail with patients/family members outweighed any disadvantages. Further investigation is recommended involving other health care professionals and different patient groups to ensure the safe and appropriate use of e-mail within health care.
Ruiz de Angulo, David; Munitiz, Vicente; Ortiz, M Ángeles; Martínez de Haro, Luisa F; Frutos, M Dolores; Hernández, Antonio; Parrilla, Pascual
Communication between the bariatric surgeon and the obese patient is very important as it influences the expectations of patients with regard to surgery, aim of the surgery and the understanding of the mechanisms of failure of surgery. Furthermore, the incidence of certain psychopathology in these patients makes it necessary for the surgeon to have the ability to communicate to the patient the need for motivation and the maintenance of healthy life habits. Although the topic is subjective, in this article we review several useful recommendations to optimize communication before and after surgery. Finally, we emphasize the need to create workshops to train the bariatric surgeon in these issues that we consider so important.
Namendys-Silva, Silvio A; Hernández-Garay, Marisol; García-Guillén, Francisco J; Correa-García, Paulina; Herrera Gómez, Angel; Meneses-García, Abelardo
Severe metabolic alterations frequently occur in critically ill cancer patients; hypercalcemia, hypocalcemia, hyponatremia, tumor lysis syndrome, metabolic complications of renal failure and lactic acidosis. Cancer patients with metabolic emergencies should be treated in a medical oncology department or an intensive care unit. Most metabolic emergencies can be treated properly when they are identified early. The clinician should consider that the prognosis of critically ill cancer patients depends on their primary disease, comorbidities and organ failure.
Flannagan, Patricia Ewert
Achieving expertise in communication requires a long-term commitment. There are many strategies available for nurses seeking to accomplish this task. Many online resources (for example, http://www.conversationsincare.com/web-bookchapter05.html and http://www.breakingbadnews.co.uk/) and helpful pocket cards intended to assist in improving communication skills are available.
O'Hair, H. Dan; And Others
Investigated the relationship between patient age and preference for physician communication style in 303 adults. Results showed that, while most patients prefer a high degree of both information and affect, older patients prefer a low-information/high affect strategy. Results may indicate the presence of receiver apprehension in elderly patients.…
Trojano, Luigi; Moretta, Pasquale; Cozzolino, Autilia; Saltalamacchia, Annamaria; Estraneo, Anna
Summary Conscious patients with severe motor and speech disorders have great difficulty interacting with the environment and communicating with other people. Several augmentative communication devices are now available to exploit these patients’ expressive potential, but their use often demands considerable cognitive effort. Non-communicative patients with severe brain lesions may have, in addition, specific cognitive deficits that hinder the efficient use of augmentative communication methods. Some neuropsychological batteries are now available for testing these patients. On the basis of such cognitive assessments, cognitive rehabilitation training can now be applied, but we underline that this training must be tailored to single patients in order to allow them to communicate autonomously and efficiently. PMID:21693090
Poor patient–provider communication in hospital continues to be cited as a possible causal factor in preventable adverse events for patients with severe communication disabilities. Yet to date there are no reports of empirical interventions that investigate or demonstrate an improvement in communication in hospital for these patients. The aim of this review was to synthesize the findings of research into communication in hospital for people with severe communication disabilities arising from lifelong and acquired stable conditions including cerebral palsy, autism, intellectual disability, aphasia following stroke, but excluding progressive conditions and those solely related to sensory impairments of hearing or vision. Results revealed six core strategies suggested to improve communication in hospital: (a) develop services, systems, and policies that support improved communication, (b) devote enough time to communication, (c) ensure adequate access to communication tools (nurse call systems and communication aids), (d) access personally held written health information, (e) collaborate effectively with carers, spouses, and parents, and (f) increase the communicative competence of hospital staff. Currently there are no reports that trial or validate any of these strategies specifically in hospital settings. Observational and evaluative research is needed to investigate the ecological validity of strategies proposed to improve communication. PMID:25229213
Lanceley, Anne; Clark, Jill Macleod
Despite evidence that nurses may play a crucial part in the wellbeing and recovery of cancer patients by facilitating their expression of feelings, research is lacking into the emotional content of nurse-patient talk and patients' use of language in emotion disclosure. In this study, 23 participating nurses in a variety of cancer care settings were asked to tape-record their conversations with patients during daily care. A data set of 60 nurse-patient conversations was collected. Individual expression of emotion by patients was identified through interpretive literary analysis within a framework of psychodynamic theory. Overall the picture of emotion disclosure was intense. In particular, patients' use of metaphor and figurative language to express their distress was powerful and pervasive. Participating nurses demonstrated responsive skills but their responses to figurative expression were often problematic. The study provides evidence of unconscious processes in nurses' work and advocates career-long psychoanalytically informed supervision for nurses to better support them in challenging dialogue with cancer patients. Research is needed to evaluate the impact of supervision on communications with cancer patients to ensure patients have access to appropriate emotional supportive and care.
Lanceley, Anne; Clark, Jill Macleod
Despite evidence that nurses may play a crucial part in the wellbeing and recovery of cancer patients by facilitating their expression of feelings, research is lacking into the emotional content of nurse–patient talk and patients' use of language in emotion disclosure. In this study, 23 participating nurses in a variety of cancer care settings were asked to tape-record their conversations with patients during daily care. A data set of 60 nurse–patient conversations was collected. Individual expression of emotion by patients was identified through interpretive literary analysis within a framework of psychodynamic theory. Overall the picture of emotion disclosure was intense. In particular, patients' use of metaphor and figurative language to express their distress was powerful and pervasive. Participating nurses demonstrated responsive skills but their responses to figurative expression were often problematic. The study provides evidence of unconscious processes in nurses' work and advocates career-long psychoanalytically informed supervision for nurses to better support them in challenging dialogue with cancer patients. Research is needed to evaluate the impact of supervision on communications with cancer patients to ensure patients have access to appropriate emotional supportive and care. PMID:24748706
Brangan, Sanja; Sonicki, Zdenko
A growing interest of general population to seek health information on the Internet and a growing body of health websites have been well documented in the recent health literature. Moreover, the Internet has become a popular mode of communication between healthcare providers and patients. This has resulted in many efforts to set specific quality guidelines for development of information for patients on the Internet, including different aspects of access to health information. This paper presents results of a study that explored the structure of information sources of surgical patients. Analysis of patient profiles shows that older patients rarely sought surgical information on the Internet, and mostly relied on communication with their doctors. This paper discusses various options of how to make this medium more attractive to patients and how to use the rich experience of the older patient generations to improve the quality of doctor-patient communication.
Ge Jin; Fishman, Jessica; Vapiwala, Neha; Li, Susan Q.; Desai, Krupali; Xie, Sharon X.; Mao, Jun J.
Purpose: Despite the extensive use of complementary and alternative medicine (CAM) among cancer patients, patient-physician communication regarding CAM therapies remains limited. This study quantified the extent of patient-physician communication about CAM and identified factors associated with its discussion in radiation therapy (RT) settings. Methods and Materials: We conducted a cross-sectional survey of 305 RT patients at an urban academic cancer center. Patients with different cancer types were recruited in their last week of RT. Participants self-reported their demographic characteristics, health status, CAM use, patient-physician communication regarding CAM, and rationale for/against discussing CAM therapies with physicians. Multivariate logistic regression was used to identify relationships between demographic/clinical variables and patients' discussion of CAM with radiation oncologists. Results: Among the 305 participants, 133 (43.6%) reported using CAM, and only 37 (12.1%) reported discussing CAM therapies with their radiation oncologists. In multivariate analyses, female patients (adjusted odds ratio [AOR] 0.45, 95% confidence interval [CI] 0.21-0.98) and patients with full-time employment (AOR 0.32, 95% CI 0.12-0.81) were less likely to discuss CAM with their radiation oncologists. CAM users (AOR 4.28, 95% CI 1.93-9.53) were more likely to discuss CAM with their radiation oncologists than were non-CAM users. Conclusions: Despite the common use of CAM among oncology patients, discussions regarding these treatments occur rarely in the RT setting, particularly among female and full-time employed patients. Clinicians and patients should incorporate discussions of CAM to guide its appropriate use and to maximize possible benefit while minimizing potential harm.
Tan, Andy S L
Cancer-related direct-to-consumer advertising (DTCA) is controversial because cancer treatment is complex and entails more risks and costs than typical treatments that are advertised for other conditions. Drawing from the Structural Influence Model of Communication, this study explores communication inequalities in DTCA exposure across social determinants among a population-based sample of 2013 patients diagnosed with breast, prostate, or colorectal cancers. Three survey items assessed patients' frequency of encountering ads concerning treatment alternatives for cancer, dealing with side effects of treatment, and doctors or hospitals offering services for cancer following their diagnosis. The analysis showed that overall exposure to DTCA in this study population was modest (median was once per week). Breast cancer patients reported significantly higher exposure to all three ad categories and overall DTCA exposure than prostate and colorectal cancer patients. Older patients consistently reported lower overall exposure to DTCA across the three cancer types. Other significant correlates included ethnicity (higher exposures among African American prostate cancer patients vs. White; lower exposures in Hispanic colorectal cancer patients vs. White) and cancer stage (higher exposures in Stage IV prostate cancer patients vs. Stages 0-II). Education level did not predict patients' DTCA exposure. The implications of these observed inequalities in DTCA exposure on cancer outcomes are discussed.
Tan, Andy SL
Cancer-related direct-to-consumer advertising (DTCA) is controversial because cancer treatment is complex and entails more risks and costs than typical treatments that are advertised for other conditions. Drawing from the Structural Influence Model of Communication, this study explores communication inequalities in DTCA exposure across social determinants among a population-based sample of 2013 patients diagnosed with breast, prostate, or colorectal cancers. Three survey items assessed patients' frequency of encountering ads concerning treatment alternatives for cancer, dealing with side effects of treatment, and doctors or hospitals offering services for cancer following their diagnosis. The analysis showed that overall exposure to DTCA in this study population was modest (median was once per week). Breast cancer patients reported significantly higher exposure to all three ad categories and overall DTCA exposure than prostate and colorectal cancer patients. Older patients consistently reported lower overall exposure to DTCA across the three cancer types. Other significant correlates included ethnicity (higher exposures among African-American prostate cancer patients vs. white; lower exposures in Hispanic colorectal cancer patients vs. white), and cancer stage (higher exposures in stage IV prostate cancer patients vs. stages 0-II). Education level did not predict patients' DTCA exposure. The implications of these observed inequalities in DTCA exposure on cancer outcomes are discussed. PMID:25357119
Marks, Ray; Shive, Steven E
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.
Munro, Michelle L.; Darling-Fisher, Cynthia S.; Ronis, David L.; Villarruel, Antonia M.; Pardee, Michelle; Faleer, Hannah; Fava, Nicole M.
Background Patient-centered communication is the hallmark of care that incorporates the perspective of patients to provide tailored care that meets their needs and desires. However, at this time there has been limited evaluation of patient-provider communication involving youth. Objectives This manuscript will report on results from secondary analysis of data obtained during a participatory research-based randomized control trial designed to test a sexual risk event history calendar intervention with youth to address the following research questions: (a) Based on the event history calendar’s (EHC) inclusion of contextual factors, does the EHC demonstrate improved communication outcomes (i.e., amount, satisfaction, mutuality, client involvement, client satisfaction, patient-provider interaction, and patient-centeredness) when compared to the Guidelines for Adolescent Preventive Services (GAPS) tool? and (b) How do patients and providers describe the characteristics of each tool in regards to patient-centered communication? Method This report will utilize a sequential explanatory mixed methods approach to evaluate communication. A split plot design with one between factor (i.e., communication structure between EHC and GAPS) and one within factor (i.e., time between pretest and posttest) was used for analyses of data collection from male and female youth (n=186) and providers (n=9). Quantitative analysis of survey data evaluated changes in communication from pre-test to post-test. Qualitative data collected from open-ended questions, audio-taped visits, and exit interviews was employed to enhance interpretation of quantitative findings. Results Patient-centered communication using assessment tools (EHC and GAPS) with youth demonstrated improved communication outcomes both quantitatively and qualitatively. Additional analyses with subgroups of males and Arab-Americans demonstrated better post-intervention scores among the EHC group in certain aspects of communication
Munger, Amanda; Rios, Yesenia; Ignowski, Crizelle; Nelson, Megan; Gass, Susie; Festa, Colina
Providing patient care for the unconscious population in the intensive care unit can be very challenging. Over time, some nurses may face barriers that prevent them from providing caring behaviors, such as communication. Review of the literature found the attitude of a nurse, hospital technology, and the working environment are barriers that prevent therapeutic nurse-patient communication with a patient who is unconscious or sedated and ventilated. Becoming more knowledgeable about how communication can help and what can be done if such barriers present themselves in the hospital setting is beneficial to improving nurses' care in the intensive care unit.
Noar, Seth M; Willoughby, Jessica Fitts; Myrick, Jessica Gall; Brown, Jennifer
Announcements by public figures and celebrities about cancer diagnosis or death represent significant events in public life. But what are the substantive effects of such events, if any? The purpose of this article is to systematically review studies that examined the impact of public figure cancer announcements on cancer-oriented outcomes. Using comprehensive search procedures, we identified k = 19 studies that examined 11 distinct public figures. The most commonly studied public figures were Jade Goody, Kylie Minogue, Nancy Reagan, and Steve Jobs, with the most common cancers studied being breast (53%), cervical (21%), and pancreatic (21%) cancer. Most studies assessed multiple outcome variables, including behavioral outcomes (k = 15), media coverage (k = 10), information seeking (k = 8), cancer incidence (k = 3), and interpersonal communication (k = 2). Results fairly consistently indicated that cancer announcements from public figures had meaningful effects on many, if not most, of these outcome variables. While such events essentially act as naturally occurring interventions, the effects tend to be relatively short term. Gaps in this literature include few contemporary studies of high-profile public figures in the United States and a general lack of theory-based research. Directions for future research as well as implications for cancer communication and prevention are discussed.
Stoll, Josef; Chatelle, Camille; Carter, Olivia; Koch, Christof; Laureys, Steven; Einhäuser, Wolfgang
For patients with severe motor disabilities, a robust means of communication is a crucial factor for their well-being . We report here that pupil size measured by a bedside camera can be used to communicate with patients with locked-in syndrome. With the same protocol we demonstrate command-following for a patient in a minimally conscious state, suggesting its potential as a diagnostic tool for patients whose state of consciousness is in question. Importantly, neither training nor individual adjustment of our system's decoding parameters were required for successful decoding of patients' responses.
When a patient is diagnosed with cancer, feelings such as fear, anxiety, and hopelessness can negatively affect a person's frame of mind. Hope can help a patient decrease anxiety and increase quality of life. Nurses should assess hope, provide interventions, be empathetic, listen, and treat patients with dignity to help improve hope and quality of life. This article features how hope can have a positive impact and provides specific information about how nurses can promote and foster hope in patients with cancer.
Leiner, Marie; Handal, Gilbert; Williams, Darryl
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…
The U.S. spends far more per person than any other country in the world in treating cancer, without demonstrably superior results. Though the pursuit and pace of innovation in oncology are perhaps unmatched and promise great benefit for cancer patients, this explosion of innovation has been accompanied by dramatic increases in cost, often without significant increases in patient survival. These trends have led to a growing interest in addressing value--understood as treatment benefits or quality weighed against economic cost--in cancer care. In February 2009, the Institute of Medicine convened a group of experts with diverse perspectives, including those of clinical oncology, patient advocacy, the insurance industry, pharmaceutical manufacturing, health economics, and bioethics, to identify challenges to value in cancer care, suggest potential solutions, and discuss what value entails in oncology. This article presents many of the ideas that emerged from this symposium, including ways to correct misaligned economic incentives, improve clinical communication, and generate evidence to promote value in cancer care.
Eggly, Susan; Tkatch, Rifky; Penner, Louis A.; Mabunda, Lorna; Hudson, Janella; Chapman, Robert; Griggs, Jennifer J.; Brown, Richard; Albrecht, Terrance
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 (CBPR) 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
MEMARPOUR, MAHTAB; BAZRAFKAN, LEILA; ZAREI, ZAHRA
Introduction Establishment of effective communication between the clinician and patient is essential in order to increase the effectiveness of treatment. These skills have been less investigated among dental students. This study aimed to evaluate communication skills of dental students in Shiraz with patients through direct observation, patients' perspectives and students' self-assessments. Methods This cross-sectional study enrolled the fifth and sixth year dental students and one of each student’s patients who was chosen using simple random sampling method. We used a checklist for data collection. Students’ communication skills were assessed at three steps of the student-patient interview – at the beginning of the interview, during the interview, and at the end of the interview. The checklist was completed by three groups: 1) an observer, 2) the patient and 3) the student, as self-assessment. The validity of the checklist was confirmed by clinical professors and the reliability was determined by Cronbach's alpha test. Data were analyzed using descriptive statistics and Student’s t test. A repeated measure MANOVA was used to compare the mean communication skills in the researcher, patients, and students at each step of the patient interviews. Results There were 110 students (mean age: 22.3±8.4 years) and 110 patients (mean age: 32±8.8 years) who completed the checklists. Overall, the communication skills of dental students were rated as good according to the patients. However, the observer and student participants rated the skills at the moderate level. We observed significant differences between communication skills in all three groups and in the three steps of the patient interviews (p<0.001). According to patients' beliefs and students' self assessments, there were no differences between male and female students in communication skills in the three steps of the patient interviews (all p>0.05). However from the observer’s viewpoint, female students
Rouen university hospital cares for increasing numbers of non-French-speaking patients: tourists, patients from the Mediterranean basin, Eastern Europe, etc. To optimise this care, a communication tool was developed in 2012 to be used with English-speaking patients.
Pereira, Patricia Cristina Andrade; Fortes, Paulo Antonio de Carvalho
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…
Kedzierska, Magdalena; Olas, Beata; Wachowicz, Barbara; Jeziorski, Arkadiusz; Piekarski, Janusz
The aim of our study was to estimate oxidative stress (by using different biomarkers of lipid peroxidation--isoprostanes and thiobarbituric acid reactive substances (TBARS)) in patients with invasive breast cancer, patients with benign breast diseases and in a control group. We observed a statistically increased level of TBARS in plasma and isoprostanes in urine of patients with invasive breast cancer in comparison with a control group. The concentration of tested biomarkers in plasma or urine from patients with invasive breast cancer was also higher than in patients with benign breast diseases. Moreover, the levels of tested markers in patients with benign breast diseases and in a control group did not differ. Considering the data presented in this study, we suggest that free radicals induce peroxidation of unsaturated fatty acid in patients with breast cancer.
Adib, Salim M; El Saghir, Nagi S; Ammar, Walid
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 cancer patients 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.
Baker, Susan C; Gallois, Cindy; Driedger, S Michelle; Santesso, Nancy
This study examined the ways in which health care providers (general practitioners and specialists) and patients communicate with each other about managing musculoskeletal (MSK) disorders, a major cause of long-term pain and physical disability. In managing their illness, patients must interact closely with health care providers, who play a large role in transferring knowledge to them. In-depth interviews with patients, general practitioners, and specialist rheumatologists in Australia and Canada were analyzed using Leximancer (a text-mining tool). Results indicated that, in their communication, doctors subtly emphasized accepting and adjusting to the illness ("new normal"), whereas patients emphasized pain relief and getting "back to normal." These results suggest that doctors and patients should accommodate in their communication across subtle and often unexpressed differences in the priorities of provider and patient, or they are likely to be at cross purposes and thus less effective.
Seddighzadeh, Ali; Shetty, Ranjith; Goldhaber, Samuel Z
Patients with cancer have an increased risk of venous thromboembolism (VTE). To further define the demographics, comorbidities, and risk factors of VTE in these patients, we analyzed a prospective registry of 5,451 patients with ultrasound confirmed deep vein thrombosis (DVT) from 183 hospitals in the United States. Cancer was reported in 1,768 (39%), of whom 1,096 (62.0%) had active cancer. Of these, 599 (54.7%) were receiving chemotherapy, and 226 (20.6%) had metastases. Lung (18.5%), colorectal (11.8%), and breast cancer (9.0%) were among the most common cancer types. Cancer patients were younger (median age 66 years vs. 70 years; p < 0.0001), were more likely to be male (50.4% vs. 44.5%; p = 0.0005), and had a lower average body mass index (26.6 kg/m(2) vs. 28.9 kg/m(2); p < 0.0001). Cancer patients less often received VTE prophylaxis prior to development of DVT compared to those with no cancer (308 of 1,096, 28.2% vs. 1,196 of 3,444, 34.6%; p < 0.0001). For DVT therapy, low-molecular-weight heparin (LMWH) as monotherapy without warfarin (142 of 1,086, 13.1% vs. 300 of 3,429, 8.7%; p < 0.0001) and inferior vena caval filters (234 of 1,086, 21.5% vs. 473 of 3,429, 13.8%; p < 0.0001) were utilized more often in cancer patients than in DVT patients without cancer. Cancer patients with DVT and neurological disease were twice as likely to receive inferior vena caval filters than those with no cancer (odds ratio 2.17, p = 0.005). In conclusion, cancer patients who develop DVT receive prophylaxis less often and more often receive filters than patients with no cancer who develop DVT. Future studies should focus on ways to improve implementation of prophylaxis in cancer patients and to further define the indications, efficacy, and safety of inferior vena caval filters in this population.
Eyigor, Sibel; Akdeniz, Sedef
Exercise and rehabilitation approaches in palliative care programs for cancer patients affect patients’ symptoms, physical functioning, muscle strength, emotional wellbeing, psychological symptoms, functional capacities, quality of life, mortality and morbidity positively. Based on scientific data, palliative cancer patients should be recommended to participate in exercise programs. There is no standard approach to recipe an exercise regimen for a palliative cancer survivor. Studies for demonstrating the positive effects of exercising in palliative care patients are increasing in number day by day. At this point, increasing awareness about exercising in the entire team monitoring the patient and our efforts in this matter seems to be very important. PMID:25114869
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.
Cancer is known to be one of the worst diseases on the planet; it highly affects Palestinians; it is the third leading cause of death in Palestine. The main purpose of the research is to highlight the concept of Quality of Life (QOL) for Palestinian cancer patients through providing an understanding about influences of cancer and chemotherapy on QOL of cancer patient. QOL was measured using European Organization for Research and Treatment of Cancer questionnaire EORTC QLQ-C30 (version 3.0) which founded to be valid and reliable in diverse cultures, including, the United Arab Emirates, Iran, Turkey, Japan, India, China, Korea, and Nigeria. Results about QOL were low in all aspects; most of them were less than the half of full function, and, more intense symptoms and negative effects were found to be in Palestinian cancer patients.
Blackstone, Sarah W; Pressman, Harvey
Delivering quality health care requires effective communication between health care providers and their patients. In this article, we call on augmentative and alternative communication (AAC) practitioners to offer their knowledge and skills in support of a broader range of patients who confront communication challenges in health care settings. We also provide ideas and examples about ways to prepare people with complex communication needs for the inevitable medical encounters that they will face. We argue that AAC practitioners, educators, and researchers have a unique role to play, important expertise to share, and an extraordinary opportunity to advance the profession, while positively affecting patient outcomes across the health care continuum for a large number of people.
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 cancer patients 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 PMID:20939928
Aubin-Auger, I; Laouénan, C; Le Bel, J; Mercier, A; Baruch, D; Lebeau, J P; Youssefian, A; Le Trung, T; Peremans, L; Van Royen, P
Colorectal cancer (CRC) mass screening has been implemented in France since 2008. Participation rates remain too low. The objective of this study was to test if the implementation of a training course focused on communication skills among general practitioners (GP) would increase the delivery of gaiac faecal occult blood test and CRC screening participation among the target population of each participating GP. A cluster randomised controlled trial was conducted with GP's practice as a cluster unit. GPs from practices in the control group were asked to continue their usual care. GPs of the intervention group received a 4-h educational training, built with previous qualitative data on CRC screening focusing on doctor-patient communication with a follow-up of 7 months for both groups. The primary outcome measure was the patients' participation rate in the target population for each GP. Seventeen GPs (16 practices) in intervention group and 28 GPs (19 practices) in control group participated. The patients' participation rate in the intervention group were 36.7% vs. 24.5% in the control group (P = 0.03). Doctor-patient communication should be developed and appear to be one of the possible targets of improvement patients adherence and participation rate in the target population for CRC mass screening.
Suhami, Norhasmilia; Muhamad, Mazanah Bt; Krauss, Steven Eric
Islamic healing is frequently referred to as the treatment of choice by many Muslim cancer patients in Malaysia. Despite its widespread use, there is limited information relating to patients' healing preferences. With rising cancer rates in the country, this issue has become a concern to public health policy makers. The purpose of this study was to understand why cancer patients seek Islamic healing. This qualitative study utilized in-depth interviews with 18 cancer patients. The findings indicate three main reasons: (1) recommendations from family, friends and doctors; (2) belief in Islamic healing and (3) the perceived ineffectiveness and dissatisfaction with conventional treatments. Islamic healing will likely continue to be popular complementary cancer treatment in Malaysia as it is grounded in strong cultural and religious beliefs.
Peter Garrett, acting director of NCI's communications office, discusses the Annual Report to the Nation on the Status of Cancer and activities surrounding the broadcast of the documentary film, Cancer: The Emperor of All Maladies.
Walji, Muhammad; Johnson-Throop, Kathy; Johnson, Todd; Bernstam, Elmer; Zhang, Jiajie
To improve health and reduce costs, we need to encourage patients to make better health care decisions. Since email is widely available, it may be useful for patient-directed interventions. However, we know little about how the contents of an email message can influence a health-related decision. We propose a model to understand how patients may process persuasive email messages.
Mujumdar, Sandhya; Santos, Diana
Teamwork and communication failures are leading causes of patient safety incidents in health care. Though health care providers must work in teams, they are not well-trained in teamwork and communication skills. Health care faces the problems of differences in communication styles, communication failures and poor teamwork. There is enough evidence in the literature to show that communication failure is detrimental to patient safety. It is estimated that 80% of serious medical errors worldwide take place because of miscommunication between medical providers. NUH recognizes that effective communication and teamwork are essential in the delivery of high quality safe patient care, especially in a complex organization. NUH is a good example, where there is a rich mix of nationalities and races, in staff and in patients, and there is a rapidly expanding care environment. NUH had to overcome these challenges by adopting a multi-pronged approach. The trials and tribulations of NUH in this journey were worthwhile as the patient safety climate survey scores improved over the years.
Claramita, Mora; Nugraheni, Mubarika D F; van Dalen, Jan; van der Vleuten, Cees
Studies of doctor-patient communication generally advocate a partnership communication style. However, in Southeast Asian settings, we often see a more one-way style with little input from the patient. We investigated factors underlying the use of a one-way consultation style by doctors in a Southeast Asian setting. We conducted a qualitative study based on principles of grounded theory. Twenty residents and specialists and 20 patients of a low or high educational level were interviewed in internal medicine outpatient clinics of an Indonesian teaching hospital and two affiliated hospitals. During 26 weeks we engaged in an iterative interview and coding process to identify emergent factors. Patients were generally dissatisfied with doctors' communication style. The doctors indicated that they did not deliberately use a one-way style. Communication style appeared to be associated with characteristics of Southeast Asian culture, the health care setting and medical education. Doctor-patient communication appeared to be affected by cultural characteristics which fell into two broad categories representing key features of Southeast Asian culture, "social distance" and "closeness of relationships", and to characteristics categorized as "specific clinical context". Consideration of these characteristics could be helpful in promoting the use of a partnership communication style.
Stephen, Joanne; Collie, Kate; McLeod, Deborah; Rojubally, Adina; Fergus, Karen; Speca, Michael; Turner, Jill; Taylor-Brown, Jill; Sellick, Scott; Burrus, Kimberly; Elramly, Mai
CancerChatCanada is a pan-Canadian initiative with a mandate to make professionally led cancer support groups available to more people in Canada. Although online support groups are becoming increasingly popular, little is known about therapist-led, synchronous groups using live chat. The purpose of this study was to generate a rich descriptive account of communication experiences in CancerChatCanada groups and to gain an understanding of processes associated with previously-reported benefits. We used interpretive description to analyze interview segments from 102 patients, survivors and family caregivers who participated in CancerChatCanada groups between 2007 and 2011. The analysis yielded four inter-related process themes (Reaching Out From Home, Feeling Safe, Emotional Release, and Talking With Text) and one outcome theme (Resonance and Kinship). The findings extend previous research about text-only online support groups and provide novel insights into features of facilitated, live chat communication that are valued by group members.
Pain, Neuropathic; Epilepsy; Renal Pelvis Cancer; Pancreatic Cancer; Breast Cancer; Nervous System Cancer; Chronic Pancreatitis; Stomach Cancer; Renal Cell Carcinoma; Diabetes; Bladder Cancer; Bone and Joint Cancer; Penis Cancer; Anal Cancer; Cancer; Renal Cancer
Miller, Victoria A.; Baker, Justin N.; Leek, Angela C.; Drotar, Dennis; Kodish, Eric
Objective To examine children’s and adolescents’ involvement in the informed consent conference for phase I cancer trials and test associations with patient age, ease of understanding, and pressure to participate. Procedure Participants included 61 patients ages 7 through 21 years who were offered participation in a phase I trial. Consent conferences were audiotaped, transcribed, and coded for communication between patients and physicians and between patients and parents. Results Based on word counts, the mean proportion of the consent conference in which the physician was talking to the patient was 36%; the vast majority (73%) of this communication consisted of giving information. Physician-patient communication increased with age, but overall levels of patient-to-physician communication were low (3%). After controlling for patient age, greater physician-to-patient communication was associated with greater ease of understanding. Conclusions The focus on providing information in the context of informed consent may come at the expense of other communication exchanges that are important to patients, especially in the context of end of life decisions. Children and adolescents may benefit from the assent process when physicians direct more of their communication to them. Future research should identify the reasons for low patient communication during the consent conference and strategies to enhance their participation in decision making about phase I trial enrollment. PMID:24487916
The author's personal experience as a kidney cancer patient, researcher and founder of a kidney cancer support group forms the basis for consideration of the challenges involved in researching patients' experiences. The researcher needs to understand the variability of those experiences in both clinical and psychological-emotional terms, and in relation to the personal, familial and social contexts of the patient. It is also essential to define the purpose of the research and to show how an understanding of personal experiences of cancer can be used to enhance the quality of care for cancer patients. The research encounter with a patient is also in some respects a therapeutic encounter requiring a considerable degree of sensitivity on the part of the researcher. The person-centred approach of Carl Rogers is of value in supporting such an encounter.
Cheng, Ju-Fen; Lin, Ya-Ching; Huang, Pai-Ho; Wei, Chih-Hsin; Sun, Jia-Ling
Providing spiritual care to patients with advanced cancer may improve the quality of life of these patients and help them experience a good death. Cancer patients are eager for additional spiritual care and for a sense of peace at the end of their life. However, spirituality is an abstract concept. The literature on spiritual care focuses primarily on elaborations of spirituality theory. Thus, first-line medical care professionals lack clear guidelines for managing the spiritual needs of terminal cancer patients. The purposes of this article were to: 1) introduce a spiritual care model based on the concept of repair and recovery of relationships that addresses the relationship between the self and God, others, id, and objects and 2) set out a four-step strategy for this model that consists of understanding, empathizing, guiding, and growing. This article provides operational guidelines for the spiritual care of terminal cancer patients.
Kang, Seo Young; Yang, Myung Hwa; Lee, Jung Ah; Jang, Wooyoung; Lee, Chong Sik
Background Patients with parkinsonism exhibit motor symptoms, cognitive impairment, and neuropsychiatric changes, and these symptoms increase caregiver burden. Family dynamics can be influenced by the presence of comorbidities, which is especially important in diseases causing caregiver burden. We investigated the effects of spousal parkinsonism on family functioning and communication. Methods Couples without parkinsonism, who visited hospital-based family practices, were recruited by 28 family physicians from 22 hospitals between April 2009 and June 2011; patients with parkinsonism and their spouses were recruited from a single institution. The participants completed questionnaires on demographic characteristics, lifestyle factors, family functioning (the Korean version of the Family Adaptation and Cohesion Evaluation Scale [FACES] III), and family communication (the Family Communication Scale of the FACES-IV). We compared family functioning and communication between spouses of the patients with and without parkinsonism. Results The mean family adaptability and cohesion scores of the spouses of the patients with parkinsonism were 23.09±6.48 and 32.40±8.43, respectively, whereas those of the control group were 23.84±5.88 and 34.89±7.59, respectively. Family functioning and family communication were significantly different between the spouses of individuals with and without parkinsonism. After adjusting for age, sex, income, and cardiovascular disease in the logistic regression analysis, family functioning was found to significantly deteriorate in the spouses of patients with parkinsonism but not the control group. Family communication decreased significantly in spouses of patients with parkinsonism. Conclusion Family functioning and family communication significantly deteriorated in spouses of patients with parkinsonism. PMID:28197328
TARN, DERJUNG M.; HERITAGE, JOHN; PATERNITI, DEBORA A.; HAYS, RON D.; KRAVITZ, RICHARD L.; WENGER, NEIL S.
Physician-patient communication about new medications can influence patient medication adherence. Little is known about the detailed content of conversations about new medications, or about how physicians and patients word information when discussing new medications. Yet nuances in communication may influence patient comprehension and affect behaviour. A comprehensive coding framework delineating the intricacies of physician-patient discussions is needed to better understand the range of communication about new prescriptions. This study used analytic induction to analyse 185 audiotaped outpatient encounters, during which 243 new medications were prescribed by family physicians, internists and cardiologists in two healthcare settings. Seventy-six codes were developed to demonstrate the range of physician counselling about information concerning new prescriptions, such as medication name, purpose, directions for use, side effects, acquisition and monitoring. The conversational content represented by the codes can be used to understand the breadth of conversations regarding new medications, identify sources of potential patient misunderstandings when medication instructions are conveyed, and inform recommendations for desired communication content. The coding system also can be used to measure the quality of new medication discussions for linkage to outcomes and can inform interventions to improve communication when prescribing new drugs. PMID:19644569
Argash, Oz; Caspi, Opher
In recent years there has been an increase in the interest of cancer patients in receiving complementary medicine therapies as supportive measures to cure the disease. In response, medical units that combine conventional and complementary medicine (integrative medicine) have been established in leading cancer centers worldwide. In Israel, a special integrative medicine unit that combines mind-body, Chinese medicine, nutrition, herbs, supplements, and manual therapies (such as shiatsu) before, during and after conventional anti-cancer therapies has been established as an integral part of the Davidoff Comprehensive Cancer Center in 2006. Shiatsu represents a group of manual therapeutic techniques, including acupressure. Shiatsu offers cancer patients a non-pharmacologic method to relieve symptoms and improve quality of life throughout the course of illness. Research indicates that acupressure is relatively effective and safe for common cancer-related symptoms such as nausea, vomiting and insomnia. In our experience, shiatsu is also relatively effective and safe for other common symptoms such as fatigue, muscular pain and body image dissatisfaction. Yet, insufficient evidence exists to delineate the best means by which shiatsu and other manual therapies could or should be integrated into routine cancer care. The purpose of the present paper is to describe what is currently known about this topic in order to support decision-making that is based on facts, rather than on myths and misconceptions. We call for more research that examines the effectiveness and safety of shiatsu and other manual therapies in the care of cancer patients.
Molina, Yamile; Yi, Jean C; Martinez-Gutierrez, Javiera; Reding, Kerryn W; Yi-Frazier, Joyce P; Rosenberg, Abby R
Each phase of the cancer experience profoundly affects patients' lives. Much of the literature has focused on negative consequences of cancer; however, the study of resilience may enable providers to promote more positive psychosocial outcomes before, during, and after the cancer experience. The current review describes the ways in which elements of resilience have been defined and studied at each phase of the cancer continuum. Extensive literature searches were conducted to find studies assessing resilience during one or more stages of the adult cancer continuum. For all phases of the cancer continuum, resilience descriptions included preexisting or baseline characteristics, such as demographics and personal attributes (e.g., optimism, social support), mechanisms of adaptation, such as coping and medical experiences (e.g., positive provider communication), as well as psychosocial outcomes, such as growth and quality of life. Promoting resilience is a critical element of patient psychosocial care. Nurses may enable resilience by recognizing and promoting certain baseline characteristics and optimizing mechanisms of adaptation.
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.
Cancer patient 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, cancer patient 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. PMID:22423178
Tippett, Donna C; Webster, Kimberly T
Swallowing and swallowing-related impairments present important posttreatment challenges in individuals undergoing organ preservation therapy for head and neck cancer. Literature pertinent to this topic is reviewed. A protocol for treatment of speech and swallowing deficits related to oropharyngeal cancer and treatment performed at Johns Hopkins Hospital is described. Data collected from a sample of oropharyngeal patients with cancer, with and without human papillomavirus-related disease, are summarized. Future directions for further study of this population are discussed.
Stephensen, H; Andersson, N; Eklund, A; Malm, J; Tisell, M; Wikkelso, C
Background: B waves, slow and rhythmic oscillations in intracranial pressure (ICP), are claimed to be one of the best predictors of outcome after surgery for normal pressure hydrocephalus (NPH). Object: To determine the relation between the percentage of B waves and outcome in patients with hydrocephalus, and also the diurnal variation of B waves. Methods: ICP and patient behaviour were recorded overnight (17 to 26 hours) in 29 patients with non-communicating hydrocephalus and 26 with NPH. The B wave activity, measured with an amplitude threshold of 0.5, 0.75, 1.0, 1.5, 2.0, 3.0, and 5.0 mm Hg, was estimated as the percentage of total monitoring time (% B waves) using a computer algorithm, and correlated with postoperative outcome, defined as changes in 12 standardised symptoms and signs. Results: There was no linear correlation between improvement after surgery in the 55 patients and total % B waves, but a correlation was found between improvement and % B waves during sleep (r = 0.39, p = 0.04). The percentage of B waves was the same during sleep and wakefulness, and patients with NPH had the same proportion of B waves as the non-communicating patients. Conclusions: B waves are commonly observed in patients with both communicating and non-communicating hydrocephalus, but are only weakly related to the degree of postsurgical improvement. PMID:15965203
Shahrokni, Armin; Wu, Abraham; Carter, Jeanne; Lichtman, Stuart M.
Synopsis With earlier cancer diagnosis among older cancer patients, the possibility of curing cancer increases. However, cancer treatment may have long lasting impact on older cancer survivors. It is vital to screen, diagnose and properly manage the long term toxicities of cancer treatment, in order to maintain quality of life of older cancer survivors PMID:26614861
Shahrokni, Armin; Wu, Abraham J; Carter, Jeanne; Lichtman, Stuart M
With earlier cancer diagnosis among older patients with cancer, the possibility of curing cancer increases. However, cancer treatment may have a long-lasting impact on older cancer survivors. It is vital to screen, diagnose, and properly manage the long-term toxicities of cancer treatment in order to maintain the quality of life of older cancer survivors.
Teng, Chung-Jen; Hu, Yu-Wen; Yeh, Chiu-Mei; Chen, Tzeng-Ji; Liu, Chia-Jen
Abstract This study aimed to evaluate cancer risk and possible risk factors in patients diagnosed with empyema. A total of 31,636 patients with newly diagnosed empyema between January 1, 1999 and December 31, 2010 were included in this study. Standardized incidence ratios (SIRs) were calculated to compare the cancer incidence in these empyema patients to that in the general population. Adjusted hazard ratios were also calculated to investigate whether characteristics increased cancer risk. During the 12-year study period, 2,654 cancers occurred in 31,636 patients with empyema, yielding an SIR of 2.67 (95% confidence interval [CI] 2.57–2.78). We excluded cancer that occurred within 1 year to avoid surveillance bias. The cancer risk remained significantly increased (SIR 1.50, 95% CI 1.41–1.58). Specifically, patients with empyema had higher SIR of cancers of the head and neck (1.50, 95% CI 1.41–1.58), esophagus (2.56, 95% CI 1.92–3.33), stomach (1.49, 95% CI 1.16–1.89), liver and biliary tract (2.18, 95% CI 1.93–2.45), and lung and mediastinum (1.62, 95% CI 1.39–1.86). Age ≥ 60, male sex, diabetes mellitus, and liver cirrhosis were independent risk factors for cancer development. Our study demonstrates an increased incidence of cancer development in patients with empyema, and patients’ age ≥ 60, men, and those with diabetes mellitus and liver cirrhosis showed a higher incidence of developing cancer compared to the general population. The association between such kind of infection and secondary malignancy may be elucidated by further study. PMID:26945399
Leiner, Marie; Handal, Gilbert; Williams, Darryl
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.
Noda, Yasuha; Sakata, Yoshifumi; Kubota, Masakazu; Uemura, Kengo; Kihara, Takeshi; Kimura, Toru; Ino, Masashi; Tsuji, Teruyuki; Hayashi, Michiyuki; Kinoshita, Ayae
Drug adherence is central to the treatment of dementia, which might reduce compliance due to memory loss, particularly among home-based patients with dementia. In order to improve drug adherence, we suggest the efficient and effective supervised administration by use of information communication technology(ICT). ICT makes face-to-face real-time communication possible, and it also enables picture sharing. Therefore, it might be useful to apply ICT to controlling and supervising medication for patients with dementia to improve drug adherence. Accordingly, we enrolled patients who were supposed to take a newly prescribed anti-dementia patch containing the choline esterase inhibitor rivastigmine(Rivastach®)and investigated the effect of ICT-based intervention for drug adherence, emotional change, and cognitive change, utilizing Skype, a free communication software program. Scheduled Skype interventions increased drug adherence ratio, levels of subjective satisfaction, and instrumental activities of daily living(IADL). Furthermore, we can provide patients and their caregivers with a feeling of safety through regular bidirectional communication, as patients can easily consult medical staff regarding the adverse effects of newly prescribed drugs. Instead of frequent visits to their primary physicians, ICT-based communications can be used as a substitute for supervision of medication, given the availability of the telecommunication system. By directly connecting the medical institution to the home, we expect that this ICT-based system will expand into the geriatric care field, including the care of elderly individuals living alone.
Mack, Jennifer W; Feudtner, Chris; Hinds, Pamela S
Clinician communication related to treatment decision making is a fundamentally important health care intervention and is often reported by parents of seriously ill children to be the most valued of clinician skills. Since different children and families have different communication styles and expectations, and since these may change over the course of the illness experience, one of the early and recurring tasks is to clarify and work with these diverse styles and expectations. Adopting a stance of compassionate desire to know more about patients and families, in addition to imparting information, is vital, and can be facilitated by following a general strategy of "ask, tell, ask." In addition to the exchange of information, communication between clinician and patient and family also involves the signaling and exchange of emotions, in which the pace, verbal inflection, and body language of the conversation are fundamental. Discussions about prognosis and goals of care, while needing to be handled in a gentle manner, should start early in the illness experience and be revised whenever there is a relapse or major complication. Children often want to participate in these conversations to a degree of their own choosing, which they themselves can clarify. Effective and empathetic clinician communication can greatly facilitate decision making and care for children with advanced cancer and their families, and provide a substantial source of comfort.
Utilizing Data from Cancer Patient & Survivor Studies and Understanding the Current State of Knowledge and Developing Future Research Priorities, a 2011 workshop sponsored by the Epidemiology and Genomics Research Program.
Schmidt, Laura M; Kinsella, Audrey
Learning more about clients of ours who are from different cultures is a challenging but necessary task. The very characteristics that make up an individual's beliefs, behaviors, and intellectual and spiritual foundations are intrinsic to a person's overall health and well-being, and we must learn to prepare appropriate patient care services. The authors review the different sources that are available to assist home care workers and their multicultural patients.
Aubin, Michèle; Vézina, Lucie; Verreault, René; Fillion, Lise; Hudon, Éveline; Lehmann, François; Leduc, Yvan; Bergeron, Rénald; Reinharz, Daniel; Morin, Diane
PURPOSE There has been little research describing the involvement of family physicians in the follow-up of patients with cancer, especially during the primary treatment phase. We undertook a prospective longitudinal study of patients with lung cancer to assess their family physician’s involvement in their follow-up at the different phases of cancer. METHODS In 5 hospitals in the province of Quebec, Canada, patients with a recent diagnosis of lung cancer were surveyed every 3 to 6 months, whether they had metastasis or not, for a maximum of 18 months, to assess aspects of their family physician’s involvement in cancer care. RESULTS Of the 395 participating patients, 92% had a regular family physician but only 60% had been referred to a specialist by him/her or a colleague for the diagnosis of their lung cancer. A majority of patients identified the oncology team or oncologists as mainly responsible for their cancer care throughout their cancer journey, except at the advanced phase, where a majority attributed this role to their family physician. At baseline, only 16% of patients perceived a shared care pattern between their family physician and oncologists, but this proportion increased with cancer progression. Most patients would have liked their family physician to be more involved in all aspects of cancer care. CONCLUSIONS Although patients perceive that the oncology team is the main party responsible for the follow-up of their lung cancer, they also wish their family physicians to be involved. Better communication and collaboration between family physicians and the oncology team are needed to facilitate shared care in cancer follow-up. PMID:21060123
Matsumata, T; Shikada, Y; Hasuda, S; Kishihara, F; Suehiro, T; Funahashi, S; Nagamatsu, Y; Iso, Y; Shima, I; Koga, C; Osamura, S; Ueda, M; Furuya, K; Sakino, I
Married couples share home environments and life style for years. In the case of colorectal cancer, an association with insulin resistance was reported. We determined the presence of the insulin-resistance syndrome (IRS, 1 or more of the following: body mass index of > 25 kg/m2, diabetes, or hyperlipidemia) in 84 colorectal cancer patients, of whom 61 patients (73%) had IRS. The incidence of the distal colorectal cancer, which has been declining in the United States, was significantly higher in the IRS group than in the non-IRS group (75.4 vs 52.2%, p = 0.0400). Some mechanisms may promote the progression of mucosal lesions to invasive cancers in the distal colorectum. There were no significant differences with respect to the age (64.6 +/- 9.4 vs 64.3 +/- 11.3 yr, p = 0.8298), height (159 +/- 9 vs 157 +/- 8 cm, p = 0.1375), and body mass index (22.2 +/- 3.6 vs 22.4 +/- 2.7 kg/m2, p = 0.6364) between the patients and their spouses. In 84 couples in whom colorectal cancer develops at least in one may then not illustrate the nursery rhyme: "Jack Sprat could eat no fat, His wife could eat no lean...". The spouses had been married for an average of 38 years, and in 30 spouses who had been followed in a colorectal cancer screening, 5 developed colorectal cancer. To diminish the incidence of colorectal cancer in Japan, we might advise screening colonoscopy to the spouses of colorectal cancer patients, or déjà vu all over again?
The present study aimed to examine the relationships among barriers to cancer care, perceived social support, and patient navigation services (PNS) for Korean breast cancer patients. For Korean breast cancer patients, PNS are comprised of five services, including emotional, financial, information, transportation, and disease management. The study findings demonstrated that transportation and disease management barriers were directly associated with PNS, whereas emotional and financial barriers were indirectly associated with PNS through perceived social support. The current study provides a preliminary Korean patient navigation model to identify how barriers to cancer care can be reduced through social support and PNS.
Fingeret, Michelle Cororve; Teo, Irene; Epner, Daniel E.
Background Body image is a critical psychosocial issue for cancer patients as they often undergo significant changes to appearance and functioning. In this review article, our primary purpose was to identify empirically-supported approaches to treat body image difficulties of adult cancer patients that can be incorporated into high-quality comprehensive cancer care. Methods We provided an overview of theoretical models of body image relevant to cancer patients, and presented findings from published literature on body image and cancer from 2003–2013. We integrated these data with information from the patient-doctor communication literature to delineate a practical approach for assessing and treating body image concerns of adult cancer patients. Results Body image difficulties were found across patients with diverse cancer sites, and were most prevalent in the immediate postoperative and treatment period. Age, body mass index, and specific cancer treatments have been identified as potential risk factors for body image disturbance in cancer patients. Current evidence supports the use of time-limited cognitive-behavioral therapy interventions for addressing these difficulties. Other intervention strategies also show promise but require further study. We identified potential indicators of body image difficulties to alert healthcare professionals when to refer patients for psychosocial care, and proposed a framework for approaching conversations about body image that can be used by the oncologic treatment team. Conclusions Body image issues affect a wide array of cancer patients. Providers can use available evidence combined with information from the healthcare communication literature to develop practical strategies for treating body image concerns of cancer patients. PMID:24895287
Tarn, Derjung M.; Paterniti, Debora A.; Good, Jeffrey S.; Coulter, Ian D.; Galliher, James M.; Kravitz, Richard L.; Karlamangla, Arun; Wenger, Neil S.
Objective Describe the content and frequency of provider-patient dietary supplement discussions during primary care office visits. Methods Inductive content analysis of 1477 transcribed audio-recorded office visits to 102 primary care providers was combined with patient and provider surveys. Encounters were collected in Los Angeles, California (2009–2010), geographically-diverse practice settings across the United States (2004–2005), and Sacramento, CA (1998–1999). Results Providers discussed 738 dietary supplements during encounters with 357 patients (24.2% of all encounters in the data). They mentioned: 1) reason for taking the supplement for 46.5% of dietary supplements; 2) how to take the supplement for 28.2%; 3) potential risks for 17.3%; 4) supplement effectiveness for 16.7%; and 5) supplement cost or affordability for 4.2%. Of these five topics, a mean of 1.13 (SD=1.2) topics were discussed for each supplement. More topics were reviewed for non-vitamin non-mineral supplements (mean 1.47 (SD=1.2)) than for vitamin/mineral supplements (mean 0.99 (SD=1.1); p<0.001). Conclusion While discussions about supplements are occurring, it is clear that more discussion might be needed to inform patient decisions about supplement use. Practice Implication Physicians could more frequently address topics that may influence patient dietary supplement use, such as the risks, effectiveness, and costs of supplements. PMID:23466249
Cakar, B; Karaca, B; Uslu, R
Cancer is a life-threatening disease despite the advanced therapeutic strategies now available. A common problem is that physicians and patients tend to concentrate on intensive medical treatment options and underestimate the treatment-related adverse effects. In this review, we summarize one of these adverse effects in cancer patients; sexual dysfunction (SD). In addition, current therapeutic choices with optimal doses and patient selection strategies are defined. All patients should be informed about problems associated with therapy-related SD and must be guided toward the most appropriate therapeutic options before starting treatment.
Oladeru, Oladoyin A; Hamadu, Musleehat; Cleary, Paul D; Hittelman, Adam B; Bulsara, Ketan R; Laurans, Maxwell SH; DiCapua, Daniel B; Marcolini, Evie G; Moeller, Jeremy J; Khokhar, Babar; Hodge, Jeannette W; Fortin, Auguste H; Hafler, Janet P; Bennick, Michael C; Hwang, David Y
Objective To assess whether communication training for housestaff via role-playing exercises (1) is well-received and (2) improves patient experience scores in housestaff clinics. Methods We conducted a pre-post study in which the housestaff for 3 adult hospital departments participated in communication trainingled by trained faculty in small groups . Sessions centered on a published 5-step strategy for opening patient-centered interviews using department-specific role-playing exercises. Housestaff completed post-training questionnaires. For one month prior to and one month following the training, patients in the housestaff clinics completed surveys with CG-CAHPS questions regarding physician communication, immediately following clinic visits. Pre-and post -intervention results for top-box scores were compared. Results Forty -four of a possible 45 housestaff (97.8%) participated, with 31 (70.5%) indicating that the role-playing exercise increased their perception of the 5-step strategy. No differences on patient responses to CG-CAHPS questions were seen when comparing 63 pre-intervention patients surveys to 77 post-intervention surveys. Conclusion Demonstrating an improvement in standard patient experience surveys in resident clinics may require ongoing communication coaching and investigation of the “hidden curriculum” of training.
Wood, Carol A.; Dodge, Richard K.
To define the educational goals and problems of nurses caring for cancer patients in Vermont, a survey was conducted. The most heavily favored topics were those related to helping the patient adapt to illness. Commonly cited difficulties were poor communication with doctors and negative attitudes of coworkers. (Author/SK)
Dickerson, Suzanne S; Reinhart, Amber; Boemhke, Marcia; Akhu-Zaheya, Laila
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.
Naci, Lorina; Monti, Martin M; Cruse, Damian; Kübler, Andrea; Sorger, Bettina; Goebel, Rainer; Kotchoubey, Boris; Owen, Adrian M
A substantial number of patients who survive severe brain injury progress to a nonresponsive state of wakeful unawareness, referred to as a vegetative state (VS). They appear to be awake, but show no signs of awareness of themselves, or of their environment in repeated clinical examinations. However, recent neuroimaging research demonstrates that some VS patients can respond to commands by willfully modulating their brain activity according to instruction. Brain-computer interfaces (BCIs) may allow such patients to circumvent the barriers imposed by their behavioral limitations and communicate with the outside world. However, although such devices would undoubtedly improve the quality of life for some patients and their families, developing BCI systems for behaviorally nonresponsive patients presents substantial technical and clinical challenges. Here we review the state of the art of BCI research across noninvasive neuroimaging technologies, and propose how such systems should be developed further to provide fully fledged communication systems for behaviorally nonresponsive populations.
Riesco, Andres; Leyton, Cecilia
The presence of mucopolysaccharides (MPS) in leucocytes of peripheral blood of 19 cancer patients, 13 patients with pulmonary tuberculosis and 14 normal controls, was studied histochemically. MPS was revealed in different proportions in polynuclears and mononuclears. According to the staining technics, the MPS appear to be mainly carboxylated and contain hyaluronic acid and chondroitinsulphate groups. The quantitative analysis revealed that MPS appeared only in around 3% of leucocytes of normal controls, while in the cancer patients 56% of polynuclear and 90% of mononuclears contained it. In the tuberculous patients, 90% of polynuclears and 86% of the mononuclears revealed MPS. The differences between the prevalence of leucocytes containing MPS in controls and in cancer or tuberculous patients are highly significant. The possibility that the difference in MPS content of leucocytes is related with low inmunological activity is postulated. PMID:4256006
Aelbrecht, Karolien; Rimondini, Michela; Bensing, Jozien; Moretti, Francesca; Willems, Sara; Mazzi, Mariangela; Fletcher, Ian; Deveugele, Myriam
Good doctor-patient communication may lead to better compliance, higher patient satisfaction, and finally, better health. Although the social variance in how physicians and patients communicate is clearly demonstrated, little is known about what patients with different educational attainments actually prefer in doctor-patient communication. In this study we describe patients' perspective in doctor-patient communication according to their educational level, and to what extent these perspectives lean towards the expert opinion on doctor-patient communication. In a multi-center study (Belgium, The Netherlands, UK and Italy), focus group discussions were organised using videotaped medical consultations. A mixed methods approach was used to analyse the data. Firstly, a difference in perspective in communication style was found between the lower educated participants versus the middle and higher educated participants. Secondly, lower educated participants referred positively most to aspects related to the affective/emotional area of the medical consultation, followed by the task-oriented/problem-focused area. Middle and higher educated participants positively referred most to the task-oriented/problem-focused area. The competency of the physician was an important category of communication for all participants, independent of social background. The results indicate that the preferences of lower educated participants lean more towards the expert opinion in doctor-patient communication than the middle and higher educated participants. Patients' educational level seems to influence their perspective on communication style and should be taken into account by physicians. Further quantitative research is needed to confirm these results.
Sarfaty, Mona; Wender, Richard; Smith, Robert
While consensus has grown that primary care is the essential access point in a high-performing health care system, the current model of primary care underperforms in both chronic disease management and prevention. The Patient Centered Medical Home model (PCMH) is at the center of efforts to reinvent primary care practice, and is regarded as the most promising approach to addressing the burden of chronic disease, improving health outcomes, and reducing health spending. However, the potential for the medical home to improve the delivery of cancer screening (and preventive services in general) has received limited attention in both conceptualization and practice. Medical home demonstrations to date have included few evidence-based preventive services in their outcome measures, and few have evaluated the effect of different payment models. Decreasing use of hospitals and emergency rooms and an emphasis on improving chronic care represent improvements in effective delivery of healthcare, but leave opportunities for reducing the burden of cancer untouched. Data confirm that what does or does not happen in the primary care setting has a substantial impact on cancer outcomes. Insofar as cancer is the leading cause of death before age 80, the PCMH model must prioritize adherence to cancer screening according to recommended guidelines, and systems, financial incentives, and reimbursements must be aligned to achieve that goal. This article explores capacities that are needed in the medical home model to facilitate the integration of cancer screening and other preventive services. These capacities include improved patient access and communication, health risk assessments, periodic preventive health exams, use of registries that store cancer risk information and screening history, ability to track and follow up on tests and referrals, feedback on performance, and payment models that reward cancer screening.
Wiesner, D A; Sweeley, C C
Gangliosides were isolated from the sera of recently diagnosed breast-cancer patients and from individuals who were apparently free of disease. Quantificative and qualitative analyses were carried out by 2-dimensional high-performance thin-layer chromatography and gas chromatography. The locations of isolated gangliosides on thin-layer chromatograms were determined by visualization with resorcinol, and each spot was quantified by digital image densitometry. The ganglioside profiles of cancer patients were compared to those of the control group, revealing a significant increase in total lipid-bound sialic acid and a specific increase in polysialogangliosides in the patients with breast cancer. Furthermore, an increase was noted in the ratio of gangliosides of the b-series biosynthetic pathway over those of the a-series in the cancer sera, as compared to the controls. Gas chromatographic analysis of the peracetylated methanolysis mixtures derived from the total ganglioside fraction of cancer patients supported the HPTLC data, with an increase in total sialic acid, galactose, and sphingosine residues. No unusual gangliosides were found in the mixture from breast-cancer patients.
Molina, Yamile; Yi, Jean C.; Martinez-Gutierrez, Javiera; Reding, Kerryn W.; Yi-Frazier, Joyce P.; Rosenberg, Abby R.
Each phase of the cancer experience profoundly affects patients’ lives. Much of the literature has focused on negative consequences of cancer; however, the study of resilience may enable providers to promote more positive psychosocial outcomes before, during, and after the cancer experience. The current review describes the ways in which elements of resilience have been defined and studied at each phase of the cancer continuum. Extensive literature searches were conducted to find studies assessing resilience during one or more stages of the adult cancer continuum. For all phases of the cancer continuum, resilience descriptions included preexisting or baseline characteristics, such as demographics and personal attributes (e.g., optimism, social support), mechanisms of adaptation, such as coping and medical experiences (e.g., positive provider communication), as well as psychosocial outcomes, such as growth and quality of life. Promoting resilience is a critical element of patient psychosocial care. Nurses may enable resilience by recognizing and promoting certain baseline characteristics and optimizing mechanisms of adaptation. PMID:24476731
Biernacka-Wawrzonek, Dorota; Stępka, Michał; Tomaszewska, Alicja; Ehrmann-Jóśko, Agnieszka; Chojnowska, Natalia; Muszyński, Jacek
Introduction Melanosis coli is a benign lesion affecting the mucosa of the large intestine. There is a relationship between the presence of melanosis and anthraquinone laxative use. Melanosis coli is also observed in patients with colon cancer, but there is doubt whether these two conditions are related. Aim To analyze the correlation between melanosis and colon cancer. Material and methods We analyzed retrospectively 436 patients undergoing colon cancer surgery. There were 246 women and 190 men. Patients were divided into three age groups: under 50 years, between 51 and 65 years, and over 66 years. We analyzed sections of the cancer and intestinal mucosa from the tumor’s proximal (2–5 cm) and distal (8–10 cm) zone. Results Melanosis coli was present in 52 patients, which represents 11.9% of patients with colon cancer. More often it was present in women. The most common location of melanosis and colon cancer was the terminal part of the large intestine. In patients below 50 years of age in both sexes melanosis coli did not occur. In men, melanosis was more common in the age group over 66 years. Intensity of pigmentation was higher in the tumor’s distal zone. Conclusions The incidence of melanosis coli increases with age, similar to that of colon cancer. Melanosis was not present inside tumors, in almost half of the cases it was not present in the proximal zone, and the degree of pigmentation increased in distal zone. The cause-effect relationship between melanosis coli and colon cancer remains uncertain. PMID:28337232
Kuehl, Sapna Patel
Effective physician patient communication 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 patient communication in the context of a medical interview. The beginning of a patient encounter is discussed, with emphasis on appropriate introductions and attentive active listening. PMID:23882333
Murante, Anna Maria; Vainieri, Milena; Rojas, Diana; Nuti, Sabina
Healthcare providers often look for feedback from patient surveys. Does health-professional awareness of patient survey results improve communication between patients and providers? To test this hypothesis, we analyzed the data of two surveys on organizational-climate and patient experience in Italy. The two surveys were conducted in 26 hospitals in the Tuscany region and involved 8942 employees and 5341 patients, respectively. Statistical analysis showed that the patient experience index significantly improved by 0.35 points (scale: 0-100) when the professionals' knowledge of the patient survey results increased by 1%. These findings suggest that the control systems should focus more on the dissemination phase of patient survey results among health professionals in order to improve the quality of services.
Luque, John S.; Rivers, Brian M.; Gwede, Clement K.; Kambon, Maisha; Green, B. Lee; Meade, Cathy D.
Objective The authors report the outcomes of a community-based, barber health adviser pilot intervention that aims to develop customized educational materials to promote knowledge and awareness of prostate cancer (CaP) and informed decision making about prostate cancer screening (PCS) among a predominantly African American clientele. Method First, the authors implemented a series of learner verification processes with barbershop clients (n = 15) to adapt existing CaP health promotion materials. Following intervention implementation in the barbershop, they conducted structured surveys with barbershop clients (n = 40) to evaluate the intervention. Results Findings from the posttest showed both a significant increase in barbershop clients' self-reported knowledge of CaP and in the likelihood of discussing PCS with a health care provider (p < .001). The client's cultural model of CaP risk factors revealed cultural consensus (eigenratio = 3.3) and mirrored the biomedical model. All clients surveyed reported positively on the contents of the educational materials, and more than half (53%) had discussed CaP at least twice with their barber in the last month. Conclusion Based on the pilot results, the barber-administered intervention was an appropriate and viable communication channel for promoting CaP knowledge and awareness in a priority population, African American men. PMID:20413392
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.
Held-Warmkessel, Jeanne; Dell, Deena Damsky
Lactic acidosis is the most common metabolic acidosis in hospitalized patients-the result from an underlying pathogenic process. To successfully manage lactic acid production, its cause needs to be eliminated. Patients with cancer have many risk factors for developing lactic acidosis, including the cancer diagnosis itself. Patients with lactic acidosis are critically ill, requiring an intense level of nursing care with accompanying frequent cardiopulmonary and renal assessments. The mortality rate from lactic acidosis is high. Therefore, appropriate nursing interventions may include end-of-life and palliative care.
Martí-Gil, C; Barreda-Hernández, D; Marcos-Pérez, G; Barreira-Hernández, D
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.
McLaughlin, Laura; Mahon, Suzanne M
Taste dysfunction is a significant but underestimated issue for patients with cancer. Impaired taste results in changes in diet and appetite, early satiety, and impaired social interactions. Nurses can play a key role in educating patients and families on the pathophysiology of taste dysfunction by suggesting interventions to treat the consequences of taste dysfunction, when available, and offering psychosocial support as patients cope with this often devastating consequence of treatment. Taste recognition helps humans identify the nutritional quality of food and signals the digestive tract to begin secreting enzymes. Spoiled or tainted foods typically are recognized by their bad taste. Along with the other sensory systems, taste is crucial for helping patients treated for cancer feel normal. This article will review the anatomy and physiology of taste; define the different types of taste dysfunction, including the underlying pathophysiologic basis related to cancer treatment; and discuss potential nursing interventions to manage the consequences of taste dysfunction.
Lopes, Joana Pedro; de Castro Cardoso Pereira, Paula Manuela; dos Reis Baltazar Vicente, Ana Filipa; Bernardo, Alexandra; de Mesquita, María Fernanda
The present study intended to evaluate the nutritional status of Portuguese colorectal patients and associated it with surgery type as well as quality of life outcomes. Malnutrition can affect up to 85% of cancer patients and specifically 30-60% in colorectal cancer and can significantly influence health outcomes. A sample of 50 colorectal cancer patients was evaluated in what refers to several anthropometric measures, food intake, clinical history, complications rate before and after surgery procedure. The sample was divided between convention and fast-track procedures. Most of the individuals were overweight or obese but had lost weight on the past six months. Despite mild, there were signs of malnutrition in this sample with high losses of fat free mass, weight and also fat mass during the hospitalization period. These results reinforce the importance of malnutrition assessment in colorectal patients as well as consider weight loss on the past months and body composition in order to complement nutritional status evaluation.
Hasuo, Hideaki; Ishihara, Tatsuhiko; Kanbara, Kenji; Fukunaga, Mikihiko
Myofascial pain syndrome is started to be recognized as one of important factors of pain in cancer patients. However, no reports on features of myofascial trigger points were found in terminally-ill cancer populations. This time, we encountered 5 patients with myofascial pain syndrome and terminal cancer in whom delirium developed due to increased doses of opioid without a diagnosis of myofascial pain syndrome on initial presentation. The delirium subsided with dose reductions of opioid and treatment of myofascial pain syndrome. The common reason for a delayed diagnosis among the patients included an incomplete palpation of the painful sites, which led to unsuccessful myofascial trigger points identification. The features of myofascial trigger points included single onset in the cancer pain management site with opioid and the contralateral abdominal side muscles of the non-common sites. Withdrawal reflexes associated with cancer pain in the supine position, which are increasingly seen in the terminal cancer patients, were considered to have contributed to this siuation. We consider that careful palpation of the painful site is important, in order to obtain greater knowledge and understanding of the features of myofascial trigger points. PMID:26962285
Koskan, Alexis; Arevalo, Mariana; Gwede, Clement K; Quinn, Gwendolyn P; Noel-Thomas, Shalewa A; Luque, John S; Wells, Kristen J; Meade, Cathy D
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 ( C ulture, L iteracy, E ducation, A ssessment, and N etworking) Look approach for creating educational priming materials about the topic of biobanking.
Słopień, R; Warenik-Szymankiewicz, A; Maciejewska, M
We report a case of primary amenorrhea caused by persistent communicating hydrocephalus. Patient referred to our outpatient clinic because of primary amenorrhea. With the use of computer tomography diagnosis of hydrocephalus was established. After treatment: implantation of ventriculo-peritoneal valvue spontaneous regular menses occurred.
End of Life; Advanced Cancer; Lung Neoplasm; Gastric Cancer; Colon Cancer; Glioblastoma Multiforme; Head and Neck Neoplasms; Rectum Cancer; Melanoma; Kidney Cancer; Prostate Cancer; Testicular Neoplasms; Liver Cancer; Cancer of Unknown Origin
Thirty years ago, the first article on exercise for patients with cancer appeared in the cancer research literature. The time from that first article to the present has included oncology nurses taking the lead in investigations related to exercise and cancer-related symptoms, most notably cancer-related fatigue (CRF). The Oncology Nursing Society (ONS) has been instrumental in publishing much of the research on exercise and cancer and continues in that tradition by issuing this supplement to the Clinical Journal of Oncology Nursing. In addition, ONS has facilitated the translation of research findings to practicing oncology nurses by convening meetings, participating in expert opinion consensus groups, and disseminating evidence through Putting Evidence Into Practice resources.
Andela, Valentine B
In developing countries, low levels of awareness, cost and organizational constraints on access to specialized care contribute to inadequate patient help-seeking behavior. As much as 95% of cancer patients in developing countries are diagnosed at late to end stage disease. Consequently, treatment outcome is dismally poor and a vicious cycle sets in, with public mystification of cancer and the admonishment of cancer medicine as a futile effort, all, to the further detriment of patient help-seeking behavior and treatment engagement. The situation spirals down, when the practice of cancer medicine is not gratifying to the medical practitioner and does not appeal as a medical specialty to those in training. The future of cancer medicine in developing countries thus hinges on the demystification of cancer through positive information, coupled to an effective organization that allows for the optimal use of available resources, facilitates access to specialized care and promotes the flow of knowledge and technology amongst various stakeholders. This paper strives to make a cogent argument and highlight the capital importance of information and communication technologies in organizing and leveraging scarce resources for cancer education, research and practice in developing countries. PMID:16390555
Yoo, Woohyun; Namkoong, Kang; Choi, Mina; Shah, Dhavan V; Tsang, Stephanie; Hong, Yangsun; Aguilar, Michael; Gustafson, David H
This study examines the moderating role of emotional communication competence in the relationship between computer-mediated social support (CMSS) group participation, specifically giving and receiving emotional support, and psychological health outcomes. Data were collected as part of randomized clinical trials for women diagnosed with breast cancer within the last 2 months. Expression and reception of emotional support was assessed by tracking and coding the 18,064 messages that 236 patients posted and read in CMSS groups. The final data used in the analysis was created by merging (a) computer-aided content analysis of discussion posts, (b) action log data analysis of system usage, and (c) baseline and six-month surveys collected to assess change. Results of this study demonstrate that emotional communication competence moderates the effects of expression and reception of emotional support on psychological quality of life and breast cancer-related concerns in both desired and undesired ways. Giving and receiving emotional support in CMSS groups has positive effects on emotional well-being for breast cancer patients with higher emotional communication, while the same exchanges have detrimental impacts on emotional well-being for those with lower emotional communication competence. The theoretical and practical implications for future research are discussed.
Yoo, Woohyun; Namkoong, Kang; Choi, Mina; Shah, Dhavan V.; Tsang, Stephanie; Hong, Yangsun; Aguilar, Michael; Gustafson, David H.
This study examines the moderating role of emotional communication competence in the relationship between computer-mediated social support (CMSS) group participation, specifically giving and receiving emotional support, and psychological health outcomes. Data were collected as part of randomized clinical trials for women diagnosed with breast cancer within the last 2 months. Expression and reception of emotional support was assessed by tracking and coding the 18,064 messages that 236 patients posted and read in CMSS groups. The final data used in the analysis was created by merging (a) computer-aided content analysis of discussion posts, (b) action log data analysis of system usage, and (c) baseline and six-month surveys collected to assess change. Results of this study demonstrate that emotional communication competence moderates the effects of expression and reception of emotional support on psychological quality of life and breast cancer-related concerns in both desired and undesired ways. Giving and receiving emotional support in CMSS groups has positive effects on emotional well-being for breast cancer patients with higher emotional communication, while the same exchanges have detrimental impacts on emotional well-being for those with lower emotional communication competence. The theoretical and practical implications for future research are discussed. PMID:24058261
Simon, Christian; Schramm, Sarah; Hillis, Stephen
Clinician perceptions of patient internet use related to clinical trials are not well documented. This exploratory study surveyed how cancer care providers at one NCI-designated cancer center viewed patient internet use surrounding cancer trials, including whether it affected patient decision making regarding trial enrollment. The sample included 20 oncologists (59%) and 14 (41%) nurses (n=34). Most clinicians (n=26; 76%) perceived the internet as having an effect on whether or not patients decided to enroll in a cancer trial. Two thirds (n=17; 65%) felt that this effect was positive, including in terms of enhancing patient knowledge of, access to, and enrollment in trials. Clinicians were asked if they ever discussed with their patients the topic of going online to find out more about cancer trials. Over half (n=18; 58%) who responded (n=31) to this item said yes; the rest (n=13; 42%) said no. The majority (n=10; 77%) in the "no" category were among those who reported that the internet had an effect on patient decision making. These data provisionally suggest that clinicians may see the internet as having mostly a positive effect on patient decision making about cancer trials, but that their communication efforts with patients do not always logically follow from this perception. Provider-patient discussion about internet use may be an opportunity for clinicians to contribute to improved patient knowledge of and enrollment in cancer trials. More research is needed to confirm and explain the gap between clinician perception and communication regarding trial-related internet use by cancer patients.
Lecumberri, Ramón; Feliu, Jesús; Rocha, Eduardo
The association between neoplastic diseases and venous thromboembolism (VTE) is known since long time ago. The nature of this association is bidirectional. On one hand, cancer increases the incidence of venous thrombosis and, on the other hand, the hemostatic system does play a key role in the tumorigenesis process. However, despite recent advances in the field, prophylaxis and treatment of VTE in cancer patients is still a challenge, due to the complexity of this type of patients. This review is focused on some important points regarding management of VTE in cancer patients such as physiopathology, epidemiology, search for hidden malignancy, prognostic impact, prophylaxis in the medical and surgical setting, or initial and long-term treatment.
Rodríguez, Vivian M.; Corona, Rosalie; Bodurtha, Joann N.; Quillin, John M.
Family health history about cancer is an important prevention and health promotion tool. Yet, few studies have identified family context factors that promote such discussions. We explored relations among family context (cohesion, flexibility, and openness), self-efficacy, and cancer communication (gathering family history, sharing cancer risk information, and frequency) in a diverse group of women enrolled in a randomized control trial. Baseline survey data for 472 women were analyzed. Average age was 34 years, 59% identified as Black, 31% graduated high school, and 75% reported a family history of any cancer. Results showed that greater family cohesion and flexibility were related to higher communication frequency and sharing cancer information. Women who reported greater self-efficacy were more likely to have gathered family history, shared cancer risk information, and communicated more frequently with relatives. Openness was not associated with communication but was related to greater family cohesion and flexibility. Adjusting for demographic variables, self-efficacy and family cohesion significantly predicted communication frequency. Women with higher self-efficacy were also more likely to have gathered family health history about cancer and shared cancer risk information. Future research may benefit from considering family organization and self-efficacy when developing psychosocial theories that, in turn, inform cancer prevention interventions. PMID:26735646
Truccolo, Ivana; Bufalino, Rosaria; Annunziata, Maria Antonietta; Caruso, Anita; Costantini, Anna; Cognetti, Gaetana; Florita, Antonio; Pero, Dina; Pugliese, Patrizia; Tancredi, Roberta; De Lorenzo, Francesco
The international literature data report that good information and communication are fundamental components of a therapeutic process. They contribute to improve the patient-health care professional relationship, to facilitate doctor-patient relationships, therapeutic compliance and adherence, and to the informed consent in innovative clinical trials. We report the results of a multicentric national initiative that developed a 17-information-structure network: 16 Information Points located in the major state-funded certified cancer centers and general hospitals across Italy and a national Help-line at the nonprofit organization AIMaC (the Italian oncologic patients, families and friends association), and updated the already existing services with the aim to create the National Cancer Information Service (SION). The project is the result of a series of pilot and research projects funded by the Italian Ministry of Health. The Information Service model proposed is based on some fundamental elements: 1) human interaction with experienced operators, adequately trained in communication and information, complemented with 2) virtual interaction (Help line, Internet, blog, forum and social network); 3) informative material adequate for both scientific accuracy and communicative style; 4) adequate locations for appropriate positioning and privacy (adequate visibility); 5) appropriate advertising. First results coming from these initiatives contributed to introduce issues related to "Communication and Information to patients" as a "Public Health Instrument" to the National Cancer Plan approved by the Ministry of Health for the years 2010-2012.
Halverson, Julie; Martinez-Donate, Ana; Trentham-Dietz, Amy; Walsh, Matthew C.; Strickland, Jeanne Schaaf; Palta, Mari; Smith, Paul D.; Cleary, James
Purpose Low health literacy is associated with inadequate health care utilization and poor health outcomes, particularly among elderly persons. There is a dearth of research exploring the relationship between health literacy and place of residence (urbanicity). This study examined the association between urbanicity and health literacy, as well as factors related to low health literacy, among cancer patients. Methods A cross-sectional survey was conducted with a population-based sample of 1,841 cancer patients in Wisconsin. Data on sociodemographics, urbanicity, clinical characteristics, insurance status, and health literacy were obtained from the state’s cancer registry and participants’ answers to a mailed questionnaire. Partially and fully adjusted multivariate logistic regression models were fitted to examine: 1) the association between urbanicity and health literacy, and 2) the role of socioeconomic status as a possible mediator of this relationship. Findings Rural cancer patients had a 33% (95% CI: 1.06–1.67) higher odds of having lower levels of health literacy than their counterparts in more urbanized areas of Wisconsin. The association between urbanicity and health literacy attenuated after controlling for socioeconomic status. Conclusions Level of urbanicity was significantly related to health literacy. Socioeconomic status fully mediated the relationship between urbanicity and health literacy. These results call for policies and interventions to assess and address health literacy barriers among cancer patients in rural areas. PMID:24088213
Zaza, Christine; Sellick, Scott M; Hillier, Loretta M
Although psychosocial coping techniques and supportive care services have been shown to improve cancer patients' quality of life, there is evidence that many of these strategies have not been widely integrated into the routine care of cancer patients. This study examined: (1) the extent to which cancer patients use certain coping strategies; (2) reasons for non-use; (3) perceived effectiveness of the coping strategies; (4) participants' interest in trying the strategies; and (5) if the strategies were recommended to participants. At the Northwestern Ontario Regional Cancer Centre in Thunder Bay, Ontario, Canada, 292 outpatients (98% response rate) completed an in-person interview with a research assistant concerning seven individual coping strategies (music, breathing exercises, meditation, prayer, muscle relaxation, visualization/imagery, hypnosis/self-hypnosis) and four coping strategies offered through supportive care services (individual counselling, family counselling, support groups, religious support). Of all the coping strategies presented, prayer was used by the highest number (n = 186) of participants (64%). Music was the next most commonly used strategy, used by 43% (n = 124) of participants, and all other strategies were used by less than 30%of participants. The individualized approaches that are used for disseminating disease and treatment information to cancer patients should also be used to provide them with information on effective coping strategies.
Evans, Scott E.; Ost, David E.
Purpose of review Pneumonia is the leading cause of death among neutropenic cancer patients, particularly those with acute leukemia. Even with empiric therapy, case fatality rates of neutropenic pneumonias remain unacceptably high. However, recent advances in the management of neutropenic pneumonia offer hope for improved outcomes in the cancer setting. This review summarizes recent literature regarding the clinical presentation, microbiologic trends, diagnostic advances and therapeutic recommendations for cancer-related neutropenic pneumonia. Recent findings While neutropenic patients acquire pathogens both in community or nosocomial settings, patients’ obligate healthcare exposures result in the frequent identification of multidrug resistant bacterial organisms on conventional culture-based assessment of respiratory secretions. Modern molecular techniques, including expanded use of galactomannan testing, have further facilitated identification of fungal pathogens, allowing for aggressive interventions that appear to improve patient outcomes. Multiple interested societies have issued updated guidelines for antibiotic therapy of suspected neutropenic pneumonia. The benefit of antibiotic medications may be further enhanced by agents that promote host responses to infection. Summary Neutropenic cancer patients have numerous potential causes for pulmonary infiltrates and clinical deterioration, with lower respiratory tract infections among the most deadly. Early clinical suspicion, diagnosis and intervention for neutropenic pneumonia provide cancer patients’ best hope for survival. PMID:25784246
Sieverding, M; Kendel, F
Aspects of gender and gender roles are important factors influencing the interactions between physicians and their patients. On the one hand, gender roles have an impact on the behavior of the patients, such as in health care utilization or use of preventive examinations. On the other hand, gender issues influence doctors' actions with respect to communication, diagnosis, and treatment. Here, a gender bias may lead to misdiagnosis and inadequate treatment. In this paper certain pertinent aspects of gender roles in the doctor-patient relationship are discussed and illustrated by empirical findings.
Scutariu, Mihaela Monica; Forna, Norina
Dental services for elderly patients are characterized by a series of particularities related to the vulnerability of this age group, which is affected by various co morbidities, and the diminished physical, cognitive and financial capacities. Finding ways to keep elderly patients coming to a dental office is possible by improving the dentist-patient relationship and implicitly the quality of care by increasing the self-esteem of the elderly and their place in society, by increasing the role of oral health in the quality of life, and here we refer to the pleasure of eating, the pleasant physical aspect and normal diction. The present paper presents the psychological aspects that interfere in the communication process between the dentist and the elderly patient and the changes motivation undergoes when people are in pain. These data can sometimes change the reticent attitude of the dentist towards the elderly patient which is often considered to be a risk patient.
Reynolds, Kasey A; Grindler, Natalia M; Rhee, Julie S; Cooper, Amber R; Ratts, Valerie S; Carson, Kenneth R; Jungheim, Emily S
Fertility is important to women and men with cancer. While options for fertility preservation (FP) are available, knowledge regarding the medical application of FP is lacking. Therefore we examined FP practices for cancer patients among reproductive endocrinologists (REs). A 36 item survey was sent to board-certified REs. 98% of respondents reported counseling women with cancer about FP options. Oocyte and embryo cryopreservation were universally offered by these providers, but variability was noted in reported management of these cases-particularly for women with breast cancer. 86% of the respondents reported using letrozole during controlled ovarian stimulation (COS) in patients with estrogen receptor positive (ER+) breast cancer to minimize patient exposure to estrogen. 49% of respondents who reported using letrozole in COS for patients with ER+ breast cancer reported that they would also use letrozole in COS for women with ER negative breast cancer. Variability was also noted in the management of FP for men with cancer. 83% of participants reported counseling men about sperm banking with 22% recommending against banking for men previously exposed to chemotherapy. Overall, 79% of respondents reported knowledge of American Society for Clinical Oncology FP guidelines-knowledge that was associated with providers offering gonadal tissue cryopreservation (RR 1.82, 95% CI 1.14-2.90). These findings demonstrate that RE management of FP in cancer patients varies. Although some variability may be dictated by local resources, standardization of FP practices and communication with treating oncologists may help ensure consistent recommendations and outcomes for patients seeking FP.
Fredette, S L
Adjustment to cancer requires modification of behavior that may be aided through patient education. Numerous programs have been developed to meet this need; however, studies show that even after being taught, patients are not well informed. It seems that the process of educating cancer patients needs to be improved. Authors suggest a progression of psychosocial stages of adjustment to serious illness during which specific behaviors are exhibited and coping mechanisms utilized. Understanding the nature of this process forms the basis for effective patient education since theories of adaptation describe behaviors that impact on motivation to learn, information required, and teaching methodology. Failure to attend to this variable of emotional response to the disease can prevent learning. This article integrates the theories of Weisman, Crate, Engle, and Kubler-Ross into an educational model for the cancer patient consisting of six periods. The model suggests nursing approaches, educational topics, and teaching strategies based on the patient's behavioral responses. Use of this model can improve teaching effectiveness in clinical practice by ensuring that the patient is ready to learn prior to teaching and by utilizing teaching strategies appropriate to the educational period. It can further be used as a tool to teach students of nursing how to use the stages of adjustment to chronic illness when planning patient teaching.
Wielopolski, L.; Meek, A.G.; Moskowitz, M.; Cohn, S.H.
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 cancer patient 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.
Golden-Kreutz, Deanna M.; Browne, Michael W.; Frierson, Georita M.; Andersen, Barbara L.
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. PMID:15358877
Myrick, Jessica Gall; Noar, Seth M; Willoughby, Jessica Fitts; Brown, Jennifer
The present study aimed to examine the public reaction to the death of Steve Jobs, focusing on general and cancer-specific information seeking and interpersonal communication. Shortly after Jobs's death, employees from a large university in the Southeastern United States (N = 1,398) completed a web-based survey. Every employee had heard about Steve Jobs's death, and 97% correctly identified pancreatic cancer as the cause of his death. General (50%) and pancreatic cancer-specific (7%) information seeking, as well as general (74%) and pancreatic cancer-specific (17%) interpersonal communication, took place in response to Steve Jobs's death. In multivariate logistic regression analyses controlling for demographics and several cancer-oriented variables, both identification with Steve Jobs and cancer worry in response to Steve Jobs's death significantly (p < .05) predicted pancreatic cancer information seeking as well as interpersonal communication about pancreatic cancer. Additional analyses revealed that cancer worry partially mediated the effects of identification on these outcome variables. Implications of these results for future research as well as cancer prevention and communication efforts are discussed.
Aksoy, Yakup; Kaydu, Ayhan; Sahin, Omer Fatih; Kacar, Cem Kivilcim
OBJECTIVE: The present study is an analysis of cancer patients who received follow-up treatment for either cancer-related complications or treatment-associated side effects while hospitalized in the intensive care unit (ICU). METHODS: Records of cancer patients treated at Dr. Lütfi Kırdar Kartal Training and Research Hospital ICU between January 1, 2011 and December 31, 2012 were retrospectively reviewed. Demographic data and type of cancer were recorded in prepared forms and subsequently analyzed. RESULTS: Among 2240 ICU patients treated and hospitalized between January 1, 2011 and December 31, 2012, 482 cancer patients were identified and included in the study. Percentage of cancer patients in ICU was 23.9%. Male to female ratio was determined to be 1.55. First 3 most common cancers found were colorectal (19.7%), lung (15.7%), and stomach cancers (11.6%). Mortality rate of cancer patients hospitalized in ICU was 46.6%. Larynx, lung, urinary bladder, skin, rectosigmoid, hematological, and kidney cancer were more prevalent in male patients, whereas esophageal cancer was seen in more female patients than male patients. Incidence of stomach, brain, and pancreatic cancers, as well as unclassified tumors, was found to be unrelated to gender. CONCLUSION: Rectosigmoid cancer was most common type of cancer observed in our ICU. Esophageal cancer was observed in more females than males, while larynx cancer was more frequently present in males. PMID:28275754
Kashem, Abul; Cross, Robert C; Santamore, William P; Bove, Alfred A
Heart failure (HF) continues to place significant demands on health care resources because of the large number of hospital admissions for HF, the growth of the elderly population with HF, and the improved survival of patients with chronic heart disease who develop HF that requires continuous care. Because HF is best managed using a disease management approach, frequent communication is an important component of care. A variety of studies using the telephone to maintain communication have demonstrated reduced hospital admissions and improved morbidity rate. Hardware monitoring systems that can record vital signs and transmit information from the home to a data center have also demonstrated their value in HF care, but such systems become expensive when considered for large populations of HF patients. Most HF patients can transmit their vital signs, weight, and symptoms to a practice data center using the Internet with no specialized hardware other than a sphygmomanometer and a scale. We have used such a system to monitor HF patients and have provided care instructions using the same system. With use of an Internet communication system, it is possible to reduce hospitalizations and maintain a stable HF status without frequent office visits.
Frascà, Giovanni M; Sandrini, Silvio; Cosmai, Laura; Porta, Camillo; Asch, William; Santoni, Matteo; Salviani, Chiara; D'Errico, Antonia; Malvi, Deborah; Balestra, Emilio; Gallieni, Maurizio
Renal cancer occurs more frequently in renal transplanted patients than in the general population, affecting native kidneys in 90% of cases and the graft in 10 %. In addition to general risk factors, malignancy susceptibility may be influenced by immunosuppressive therapy, the use of calcineurin inhibitors (CNI) as compared with mammalian target of rapamycin inhibitors, and the length of dialysis treatment. Acquired cystic kidney disease may increase the risk for renal cancer after transplantation, while autosomal dominant polycystic kidney disease does not seem to predispose to cancer development. Annual ultrasound evaluation seems appropriate in patients with congenital or acquired cystic disease or even a single cyst in native kidneys, and every 2 years in patients older than 60 years if they were on dialysis for more than 5 years before transplantation. Immunosuppression should be lowered in patients who develop renal cancer, by reduction or withdrawal of CNI. Although more evidence is still needed, it seems reasonable to shift patients from CNI to everolimus or sirolimus if not already treated with one of these drugs, with due caution in subjects with chronic allograft nephropathy.
Schöpf, Andrea C; Martin, Gillian S; Keating, Mary A
Humor is a potential communication strategy to accomplish various and potentially conflicting consultation goals. We investigated humor use and its reception in diabetes consultations by analyzing how and why humor emerges and its impact on the interaction. We did this by using an interactional sociolinguistics approach. We recorded 50 consultations in an Irish diabetes setting. Analysis of the humor events drew on framework analysis and on concepts from Conversation Analysis and pragmatics. The study also comprised interviews using tape-assisted recall. We identified 10 humor functions and two umbrella functions. A key finding is that most humor is relationship-protecting humor initiated by patients, that is, they voice serious messages and deal with emotional issues through humor. Our findings imply that patients' and providers' awareness of indirect communication strategies needs to be increased. We also recommend that researchers employ varied methods to adequately capture the interactive nature of humor.
Varlotto, John . E-mail: email@example.com; Stevenson, Mary Ann
Purpose: To review the impact of anemia/tumor hypoxemia on the quality of life and survival in cancer patients, and to assess the problems associated with the correction of this difficulty. Methods: MEDLINE searches were performed to find relevant literature regarding anemia and/or tumor hypoxia in cancer patients. Articles were evaluated in order to assess the epidemiology, adverse patient effects, anemia correction guidelines, and mechanisms of hypoxia-induced cancer cell growth and/or therapeutic resistance. Past and current clinical studies of radiosensitization via tumor oxygenation/hypoxic cell sensitization were reviewed. All clinical studies using multi-variate analysis were analyzed to show whether or not anemia and/or tumor hypoxemia affected tumor control and patient survival. Articles dealing with the correction of anemia via transfusion and/or erythropoietin were reviewed in order to show the impact of the rectification on the quality of life and survival of cancer patients. Results: Approximately 40-64% of patients presenting for cancer therapy are anemic. The rate of anemia rises with the use of chemotherapy, radiotherapy, and hormonal therapy for prostate cancer. Anemia is associated with reductions both in quality of life and survival. Tumor hypoxemia has been hypothesized to lead to tumor growth and resistance to therapy because it leads to angiogenesis, genetic mutations, resistance to apoptosis, and a resistance to free radicals from chemotherapy and radiotherapy. Nineteen clinical studies of anemia and eight clinical studies of tumor hypoxemia were found that used multi-variate analysis to determine the effect of these conditions on the local control and/or survival of cancer patients. Despite differing definitions of anemia and hypoxemia, all studies have shown a correlation between low hemoglobin levels and/or higher amounts of tumor hypoxia with poorer prognosis. Radiosensitization through improvements in tumor oxygenation/hypoxic cell
Kolva, Elissa; Rosenfeld, Barry; Pessin, Hayley; Breitbart, William; Brescia, Robert
Context Anxiety in terminal cancer is linked to diminished quality of life, yet overall it is poorly understood with regard to prevalence and relationship to other aspects of psychological distress. Objectives This study examines anxiety in terminally ill cancer patients, including the prevalence of anxiety symptoms, the relationship between anxiety and depression, differences in anxiety between participants receiving inpatient palliative care and those receiving outpatient care, and characteristics that distinguish highly anxious from less anxious patients. Methods Participants were 194 patients with terminal cancer. Approximately half (n = 103) were receiving inpatient care in a palliative care facility and half (n = 91) were receiving outpatient care in a tertiary care cancer center. The Hospital Anxiety and Depression Scale was used to assess anxiety and depression, and was administered along with measures of hopelessness, desire for hastened death, and social support. Results Moderately elevated anxiety symptoms were found in 18.6% of participants (n = 36) and 12.4% (n = 24) had clinically significant anxiety symptoms. Level of anxiety did not differ between the two treatment settings. However, participants receiving palliative care reported significantly higher levels of depression and desire for hastened death. A multivariate prediction model indicated that belief in an afterlife, social support, and anxiolytic and antidepressant use were unique, significant predictors of anxiety. Conclusion Severity of anxiety symptoms did not differ between the study sites, suggesting that anxiety may differ from depression and desire for hastened death in the course that it takes over the duration of terminal cancer. PMID:21565460
Pereira, Patrícia Cristina Andrade; Fortes, Paulo Antonio de Carvalho
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.
Antonyak, Marc A; Cerione, Richard A
:66-75, 2013; Al-Nedawi et al., Proc Natl Acad Sci U S A 106:3794-3799, 2009; Ge et al., Cancer Microenviron 5:323-332, 2012). Thus, the production of MVs by cancer cells plays crucial roles in driving the expansion of the primary tumor. However, it is now becoming increasingly clear that MVs are also stable in the circulation of cancer patients, where they can mediate long-range effects and contribute to the formation of the pre-metastatic niche, an essential step in metastasis (Skog et al., Nat Cell Biol 10:1470-1476, 2008; Noerholm et al., BMC Cancer 12:22, 2012; Peinado et al., Nat Med 18:883-891, 2012; Piccin et al., Blood Rev 21:157-171, 2007; van der Vos et al., Cell Mol Neurobiol 31:949-959, 2011). These findings, when taken together with the fact that MVs are being aggressively pursued as diagnostic markers, as well as being considered as potential targets for intervention against cancer (Antonyak et al., Small GTPases 3:219-224, 2012; Hosseini-Beheshti et al., Mol Cell Proteomics 11:863-885, 2012; Martins et al., Curr Opin Oncol 25:66-75, 2013; Ge et al., Cancer Microenviron 5:323-332, 2012; Peinado et al., Nat Med 18:883-891, 2012; Piccin et al., Blood Rev 21:157-171, 2007; Al-Nedawi et al., Cell Cycle 8:2014-2018, 2009; Cocucci and Meldolesi, Curr Biol 21:R940-R941, 2011; D'Souza-Schorey and Clancy, Genes Dev 26:1287-1299, 2012; Shao et al., Nat Med 18:1835-1840, 2012), point to critically important roles for MVs in human cancer progression that can potentially be exploited to develop new targeted approaches for treating this disease.
Sobhani, Iradj; Tap, Julien; Roudot-Thoraval, Françoise; Roperch, Jean P.; Letulle, Sophie; Langella, Philippe; Corthier, Gérard; Van Nhieu, Jeanne Tran; Furet, Jean P.
The composition of the human intestinal microbiota is linked to health status. The aim was to analyze the microbiota of normal and colon cancer patients in order to establish cancer-related dysbiosis. Patients and Methods Stool 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 samples (6 Normal and 6 Cancer) were subjected to a validated Principal Component Analysis (PCA) test. The dominant and subdominant bacterial population (C. leptum, C. coccoides, Bacteroides/Prevotella, Lactobacillus/Leuconostoc/Pediococcus groups, Bifidobacterium genus, and E. coli, and Faecalibacterium prausnitzii species) were quantified in all individuals using qPCR and specific IL17 producer cells in the intestinal mucosa were characterized using immunohistochemistry. Findings Pyrosequencing (Minimal sequence 200 nucleotide reads) revealed 80% of all sequences could be assigned to a total of 819 taxa based on default parameter of Classifier software. The phylogenetic core in Cancer individuals was different from that in Normal individuals according to the PCA analysis, with trends towards differences in the dominant and subdominant families of bacteria. Consequently, All-bacteria [log10 (bacteria/g of stool)] in Normal, and Cancer individuals were similar [11.88±0.35, and 11.80±0.56, respectively, (P = 0.16)], according to qPCR values whereas among all dominant and subdominant species only those of Bacteroides/Prevotella were higher (All bacteria-specific bacterium; P = 0.009) in Cancer (-1.04±0.55) than in Normal (-1.40±0.83) individuals. IL17 immunoreactive cells were significantly expressed more in the normal mucosa of cancer patients than in those with normal colonoscopy. Conclusion This is the first large series to demonstrate a composition change in the microbiota of colon cancer patients with possible impact on mucosal immune response
Nikendei, Christoph; Zipfel, Stephan; Roth, Christiane; Löwe, Bernd; Herzog, Wolfgang; Jünger, Jana
An amendment to the German medical curriculum in April 2002 will place communication and social skills at the centre of medical training. In addition to providing cognitive knowledge, psychosomatic courses offer the opportunity to integrate affective learning, with a focus on communication and interaction processes. In winter term 2001/2002 a training with standardised patients was implemented and evaluated as part of the psychosomatic internship of the Department of General Internal and Psychosomatic Medicine at the Medical Hospital of the University of Heidelberg. Quantitative and qualitative results showed that training with standardised patients is well accepted and that acceptance is independent of student gender, career choice, or interests. These training units are easy to integrate into psychosomatic practical courses. The results discussed here will focus on the role and importance of various elements of medical training.
The law relating to patients' rights, published in 2002 in Belgium, could change communication and even relations between general practitioners and their patients. This law stipulates, among other things, the information to be communicated to the patient, the rules for file sharing and litigation procedure. In the field, this law should be applied more by the spirit rather than the letter so as to preserve trust, the source of a real partnership. Moreover, one could be surprised by the fact that a law on patients' rights is not followed by rules also defining their duties.
Blitzer, A.; Baredes, S.; Kutscher, A.; Seeland, I.B.; Barrett, V.W.; Mossman, K.L.
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 Cancer Patients; Normal Tissue Effects of the Radiotherapy of Head and Neck Cancer; Chemotherapy in the Treatment of Head and Neck Cancer; and Thyroid Cancer.
Slivka, H H; Magill, L
Through the use of verbal and nonverbal techniques, a social worker and music therapist have combined their fields into an integral therapeutic modality to provide patients with cancer and their children opportunities to experience intimacy in a time of crisis. Skilled verbal interventions and the sensitive application of the expressive and less threatening medium of music create a relaxed environment where families and patients may explore deeply and express freely.
Mongiat-Artus, P; Pfister, C; Théodore, C; De Crevoisier, R; Guillotreau, J
Adjuvant therapies in bladder cancer are based on risk of recurrence and associated comorbidities (renal failure). Lymph node involvement is the most important prognostic factor for decision. Two adjuvant chemotherapies exist: MVAC or GC. In unfit patients, association (Gemcitabine and Taxanes) could be proposed. Indication of adjuvant radiotherapy depends on metastatic risk and resection margins. Concomitant chemotherapy and radiotherapy should be proposed to selected patients who refuse or are not candidate for radical cystectomy.
Flickinger, Tabor E.; Saha, Somnath; Roter, Debra; Korthuis, P. Todd; Sharp, Victoria; Cohn, Jonathon; Moore, Richard D.; Ingersoll, Karen S.; Beach, Mary Catherine
Objective Attitudes towards patients may influence how clinicians interact. We investigated whether clinician-reported respect for patients was associated with communication behaviors during HIV care encounters. Methods We analyzed audio-recordings of visits between 413 adult HIV-infected patients and 45 primary HIV care providers. The independent variable was clinician-reported respect for the patient and outcomes were clinician and patient communication behaviors assessed by the Roter Interaction Analysis System (RIAS). We performed negative binomial regressions for counts outcomes and linear regressions for global outcomes. Results Clinicians with higher respect When clinicians had higher respect for a patient, they engaged in more rapport-building, social chitchat, and positive talk. Patients of clinicians with higher respect for them engaged in more rapport-building, social chitchat, positive talk, and gave more psychosocial information. Encounters between patients and clinicians with higher respect for them had more positive clinician emotional tone [regression coefficient 2.97 (1.92-4.59)], more positive patient emotional tone [2.71 (1.75-4.21)], less clinician verbal dominance [0.81 (0.68-0.96)] and more patient-centeredness [1.28 (1.09-1.51)]. Conclusions Respect is associated with positive and patient-centered communication behaviors during medical encounters by clinicians and patients. Practice Implications Clinicians should be mindful of their respectful attitudes of respect and work to foster positive regard for patients to promote more patient-centered communication and higher quality of care. Educators should consider methods to enhance trainees’ respect in communication skills training. PMID:26320821
Brinton, Louise A.
Aim To evaluate male breast cancer (MBC) risk among Klinefelter Syndrome (KS) patients and relate this to possible biologic explanations. Methods A literature review was conducted to identify case series and epidemiologic studies that have evaluated MBC risk among KS patients. Results Case reports without expected values have often led to false impressions of risk. Problems include that a diagnosis of cancer can prompt a karyotypic evaluation and that many cases of KS are unrecognized, resulting in incomplete denominators. Few carefully conducted epidemiologic studies have been undertaken given that both KS and male breast cancer are rare events. The largest study found 19.2- and 57.8-fold increases in incidence and mortality, respectively, with particularly high risks among 47,XXY mosaics. These risks were still approximately 30% lower than among females, contradicting case reports that KS patients have breast cancer rates similar to females. Altered hormone levels (especially the ratio of estrogens to androgens), administration of exogenous androgens, gynecomastia, and genetic factors have been offered as possible explanations for the high risks. Conclusions Additional well-designed epidemiologic studies are needed to clarify which KS patients are at a high risk of developing MBC and to distinguish between possible predisposing factors, including altered endogenous hormones. PMID:21241366
Lung cancer accounts for 12% of all cancers and has the highest annual rate of mortality in men and women. The overall aim is cure or prolongation of life without evidence of disease. Almost 60% of patients at the moment of diagnosis are not eligible for radical treatment. Therefore soothing and supportive treatment is the only treatment of choice. Patients with lung cancer who have symptoms of dyspnea, chronic cough, severe pain, exhaustion and cachexia syndrome, fear and depression and significantly reduced physical and intellectual activities are qualified for inpatient or home palliative care. Knowledge about various methods used in palliative treatment allows one to alleviate symptoms that occur in an advanced stage of disease with an expected short survival period. Methods of oncological treatment that are often used in patients with advanced lung cancer include radiotherapy and chemotherapy. Drawing attention to the earlier implementation of palliative care is an objective of research carried out during recent years. Advances in surgical and conservative treatment of these patients have contributed to better outcomes and longer survival time. PMID:24596508
Savino, M. J.; Fernández, E. A.
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.
Prouty, Anne M; Fischer, Judith; Purdom, Ann; Cobos, Everardo; Helmeke, Karen B
The researchers examined the spiritual coping, family communication, and family functioning of 95 participants in 34 families by an online survey. Multilevel linear regression was used to test whether individuals' and families' higher endorsement of more use of spiritual coping strategies to deal with a member's cancer would be associated with higher scores on family communication and family functioning, and whether better communication would also be associated with higher family functioning scores. Results revealed that spiritual coping was positively associated with family communication, and family communication was positively associated with healthier family functioning. The researchers provide suggestions for further research.
Berlin, Kate L; Andreotti, Charissa; Yull, Fiona; Grau, Ana M; Compas, Bruce E
Women with a personal or maternal history of breast cancer experience psychological stress in relation to breast cancer risk, and adolescent and young adult daughters are particularly at risk for experiencing stress related to their mothers' history of breast cancer. The current study examined interpersonal and biological stress responses during a laboratory-based communication task about breast cancer risk in 32 mother-daughter dyads and explores whether certain communication styles between mothers and daughters are associated with increased stress reactivity during the task. Five saliva samples were collected from each participant to determine cortisol baseline levels, reactivity to, and recovery from the task. Negative maternal communication was associated with higher cortisol levels in daughters. In addition, maternal sadness was correlated with lower levels of daughters' cortisol at all time points with the exception of baseline measures. Implications for understanding the psychobiology of stress in women at risk for breast cancer are highlighted.
Lim, Jung-won; Paek, Min-so
Objective The purpose of this study was (1) to compare family communication, decision support (i.e., supporting the patient in making decisions), self-efficacy in patient-physician communication (i.e., patients’ confidence level in communicating with physicians), and health-related quality of life (HRQOL) between Chinese- and Korean-American breast cancer survivors (BCS), and (2) to investigate how family communication, decision support, and self-efficacy in patient-physician communication influences HRQOL for Chinese- and Korean-American BCS. Methods A cross-sectional design was used. A total of 157 Chinese- (n=86) and Korean-American (n=71) BCS were recruited from the California Cancer Surveillance Program and area hospitals in Los Angeles County. The Chronic Care Model was utilized. Results Chinese- and Korean-Americans showed a significant difference in the decision support only. Self-efficacy in patient-physician communication was directly associated with HRQOL for Chinese-Americans, whereas for Korean-Americans, family communication was related to HRQOL. The mediating effects of decision support and self-efficacy in physician-patient communication in the relationship between family communication and HRQOL were observed for Chinese-Americans only. Multiple group analysis demonstrated that the structural paths varied between Chinese- and Korean-American BCS. Conclusions Our results provide insight into the survivorship care of Chinese- and Korean-American BCS, allowing a better understanding of communication among survivors, family, and healthcare providers. Communication skills to manage conflict and attain consensus among them under the cultural contexts are essential to improve HRQOL for BCS. PMID:23111944
Bowen, Deborah J; Hay, Jennifer L; Harris-Wai, Julie N; Meischke, Hendrika; Burke, Wylie
Families often bear the burden of communication about cancer risk, as well as support during and after treatment for cancer in family members. These activities are left up to survivors and their families, with little support or knowledge of useful methods. We present data on aspects of family that are most relevant to risk of cancer-related communication and health promotion among family members. Families (a survivor, one first-degree relative and one parent; n = 313 families) were enrolled in the survey-based study. We assessed multiple aspects of family communication about risk for melanoma among family participants. Families communicate less frequently than desired about cancer risk. Most families do identify a "family health provider" who keeps family data and serves a resource for family members. The reasons given for lack of family communication are diverse but many can be addressed as part of a family communication intervention. Families are poised to improve their family communication about cancer risk and so can play a role in increasing the health of their members.
Kim, Eunkyung; Han, Jeong Yeob; Shah, Dhavan; Shaw, Bret; McTavish, Fiona; Gustafson, David H; Fan, David
Social support in computer-mediated settings is an important variable in health communication research, yet little is known about the factors that influence the amount of social support one gives and receives in online support groups. To shed some light on this issue, the authors examined demographics, disease-related factors, psychosocial factors, and strategies for coping with breast cancer as potential determinants of which patients provide support to others and which ones consume it. Data collected from 177 participants in the Comprehensive Health Enhancement Support System "Living With Breast Cancer" program revealed that individuals who are younger, have higher levels of positive reframing, and lower levels of self-blame are more likely to provide emotional support in online settings. In contrast, individuals who are more educated, have less perceived availability of social support, and have lower levels of religious coping are more likely to receive emotional support from others. The authors discuss the theoretical and practical implications for providing effective psychosocial support for women with breast cancer.
Klein, William M P; Stefanek, Michael E
Cancer risk perceptions are a key predictor of risk-reduction practices, health behaviors, and processing of cancer information. Nevertheless, patients and the general public (as well as health care providers) exhibit a number of errors and biases in the way they think about risk, such that their risk perceptions and decisions deviate greatly from those prescribed by normative decision models and by experts in risk assessment. For example, people are more likely to engage in screening behaviors such as mammography when faced with loss-based messages than gain-framed messages, and they often ignore the base rate of a given disease when assessing their own risk of obtaining this disease. In this article, we review many of the psychological processes that underlie risk perception and discuss how these processes lead to such deviations. Among these processes are difficulties with use of numerical information (innumeracy), cognitive processes (eg, use of time-saving heuristics), motivational factors (eg, loss and regret aversion), and emotion. We conclude with suggestions for future research in the area, as well as implications for improving the elicitation and communication of personal cancer risk.
Sarrel, P M
Surgically menopausal women are 5 times more likely to begin hormone replacement therapy than are naturally menopausal women, and they continue therapy for longer periods. The primary reasons that women refuse hormone replacement are fear of cancer and perceived side effects. In contrast, withdrawal bleeding is the major reason that women discontinue hormone replacement therapy. Physician-patient communication plays an important role in a woman's decision to use hormone replacement therapy, to fill her prescription, and to adhere to the regimen. The first visit at which hormone replacement therapy is discussed is crucial to establishing an effective patient-physician relationship. At least 15 minutes, and preferably 45 minutes, should be reserved for this visit. Patient follow-up-either by phone or in person-during the first month can help improve adherence because this is when many women may have nuisance side effects and discontinue therapy.
Andersen, Trine; Ruland, Cornelia M
Internet-based online patient-nurse communication (OPNC) services can constitute an important opportunity to support patients to manage their illness between treatment and rehabilitation while being at home. We explored the content of messages sent by prostate and breast cancer patients to an OPNC service to identify symptoms, problems, concerns and information needs expressed in these messages. Using qualitative content analyses we examined 276 messages sent from 38 breast and 22 prostate cancer patients during 15 months. Two main themes emerged: Concerns about physical symptoms and treatment side effects; and worries and questions about treatment and follow up. Analyses showed that cancer patients have many serious unanswered questions and concerns that can create considerable uncertainty and anxiety. An OPNC service can to a great extent meet patients' need for advice and information and thus be an important health care supplement that can improve quality of care.
Suhag, Virender; Sunita, B. S.; Sarin, Arti; Singh, A. K.; Dashottar, S.
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 forefront the potential for fertility preservation in patients being treated for cancer. Many survivors will maintain their reproductive potential after the successful completion of treatment for cancer. However total body irradiation, radiation to the gonads, and certain high dose chemotherapy regimens can place women at risk for acute ovarian failure or premature menopause and men at risk for temporary or permanent azoospermia. Providing information about risk of infertility and possible interventions to maintain reproductive potential are critical for the adolescent and young adult population at the time of diagnosis. There are established means of preserving fertility before cancer treatment; specifically, sperm cryopreservation for men and in vitro fertilization and embryo cryopreservation for women. Several innovative techniques are being actively investigated, including oocyte and ovarian follicle cryopreservation, ovarian tissue transplantation, and in vitro follicle maturation, which may expand the number of fertility preservation choices for young cancer patients. Fertility preservation may also require some modification of cancer therapy; thus, patients’ wishes regarding future fertility and available fertility preservation alternatives should be discussed before initiation of therapy. PMID:26942145
Tavares, Teresa; Gonçalves, Edna
Prognostication is a critical medical task for the adequacy of treatment and management of priorities and expectations of patients and families. In 2005, the European Association of Palliative Care (EAPC) published recommendations on the formulation of vital prognosis in advanced cancer patients. The aim of this study is to analyze the literature subsequent to this review and to update the presented recommendations. Using the same strategy of the EAPC group, we performed a systematic literature search in the electronic databases PubMed and Scopus, which included original studies in adults with advanced cancer, without tumor-directed treatment, with a median survival of less than 90 days. The articles were analyzed and classified according to the level of evidence by two independent reviewers. The 41 articles analyzed allowed to keep grade A recommendations for clinical estimation of survival and Palliative Prognostic score and now also for Palliative Prognostic Index, performance status, dyspnea, lymphopenia and lactate dehydrogenase. Recommendations regarding the use of C-reactive protein, leukocytosis, azotemia, hypoalbuminemia and male gender as predictors reached grade B. To formulate the vital prognosis and to communicate it properly to the patient and family are core competencies of physicians, particularly of those who deal with end of life patients. The clinical impression combined with scientific evidence allows us to estimate more accurately the survival, allowing prioritizing and managing more appropriately the existing resources.
Understanding Your Cancer Prognosis is the main video in the NCI Prognosis Video Series, which offers the perspectives of three cancer patients and their doctor, an oncologist who is also a national expert in doctor-patient communication.
Jacobsen, Paul B
Increased recognition of the problem of fatigue in cancer patients can be attributed, in part, to the development of measures that have provided researchers with the tools necessary for quantifying and characterizing fatigue and exploring its etiology and treatment. Although a consensus regarding the definition of fatigue is lacking, there is general agreement that it is a subjective and multidimensional phenomenon whose assessment requires the use of self-report methods. Consistent with this view, several multidimensional measures of fatigue have been developed and validated for use with cancer patients. These measures differ considerably in their format and content and, as with the definition of fatigue, there is no consensus at the present time regarding the dimensional structure of fatigue. In addition to measuring fatigue on a continuum along one or more dimensions, it may also be possible to assess a clinical syndrome of cancer-related fatigue. Criteria for assessing fatigue in this manner have been proposed and are currently undergoing evaluation. Despite the progress that has been made, there are several important unresolved issues in the assessment of fatigue in cancer patients. These include how to distinguish fatigue from depression, how to use self-reports of fatigue in clinical decision-making, how to capture temporal changes in fatigue, and how best to address the continuing lack of consensus regarding the conceptualization and measurement of fatigue.
Hurria, Arti; Li, Daneng; Hansen, Kurt; Patil, Sujata; Gupta, Ravi; Nelson, Christian; Lichtman, Stuart M.; Tew, William P.; Hamlin, Paul; Zuckerman, Enid; Gardes, Jonathan; Limaye, Sewanti; Lachs, Mark; Kelly, Eva
Purpose To determine the predictors of distress in older patients with cancer. Patients and Methods Patients age ≥ 65 years with a solid tumor or lymphoma completed a questionnaire that addressed these geriatric assessment domains: functional status, comorbidity, psychological state, nutritional status, and social support. Patients self-rated their level of distress on a scale of zero to 10 using a validated screening tool called the Distress Thermometer. The relationship between distress and geriatric assessment scores was examined. Results The geriatric assessment questionnaire was completed by 245 patients (mean age, 76 years; standard deviation [SD], 7 years; range, 65 to 95 years) with cancer (36% stage IV; 71% female). Of these, 87% also completed the Distress Thermometer, with 41% (n = 87) reporting a distress score of ≥ 4 on a scale of zero to 10 (mean score, 3; SD, 3; range, zero to 10). Bivariate analyses demonstrated an association between higher distress (≥ 4) and poorer physical function, increased comorbid medical conditions, poor eyesight, inability to complete the questionnaire alone, and requiring more time to complete the questionnaire. In a multivariate regression model based on the significant bivariate findings, poorer physical function (increased need for assistance with instrumental activities of daily living [P = .015] and lower physical function score on the Medical Outcomes Survey [P = .018]) correlated significantly with a higher distress score. Conclusion Significant distress was identified in 41% of older patients with cancer. Poorer physical function was the best predictor of distress. Further studies are needed to determine whether interventions that improve or assist with physical functioning can help to decrease distress in older adults with cancer. PMID:19652074
Manne, Sharon L.; Rubin, Stephen; Edelson, Mitchell; Rosenblum, Norman; Bergman, Cynthia; Hernandez, Enrique; Carlson, John; Rocereto, Thomas; Winkel, Gary
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…
Borţun, D; Matei, CS
One of the weaknesses of the Romanian medical system is the absence of the communicational culture. This absence is felt at all levels of the healthcare system: doctor-patient relationship, doctor-patient’s relatives relationship, labor relations within the medical teams and units, the management of the large hospitals and of the medical institutions from the public administration system and last, but not least, the relationships of these units and institutions with the public opinion and, particularly, with the stakeholders. This paper tackled with some of the principles and values that underlie an efficient communication, the default of which was felt in various domains of the Romanian medical life. They were analyzed from the perspective of the Romanian and international literature and the conclusions drawn might inspire proposals for the improvement of the medical education as well as for the professional development of the Romanian doctors. PMID:28255380
Fredberg, Ulrich; Vedsted, Peter
Danish cancer patients have more advanced cancer at the time of diagnosis than cancer patients in other Scandinavian countries, probably because of a delay in the diagnosis. Only 50% of the cancer patients have specific cancer symptoms when they initially contact their doctor. In Central Region, Denmark, a specific diagnosing program for patients with suspected serious disease that could be cancer without organ specific symptoms has been established at the Diagnostic Centre in Silkeborg. The diagnosing is planned as a parallel course instead of a serial course. A very close co-operation with all internal medical specialties, radiology, clinical biochemistry and gynecology is necessary.
Ely, John W; Levy, Barcey T; Daly, Jeanette; Xu, Yinghui
Only about half of eligible individuals undergo colon cancer screening. We have limited knowledge about the patient beliefs that adversely affect screening decisions and about which beliefs might be amenable to change through education. As part of a clinical trial, 641 rural Iowans, aged 52 to 79 years, reported their beliefs about colon cancer screening in response to a mailed questionnaire. Consenting subjects were randomized into four groups, which were distinguished by four levels of increasingly intensive efforts to promote screening. Two of the groups received mailed educational materials and completed a follow-up questionnaire, which allowed us to determine whether their beliefs about screening changed following the education. We also completed a factor analysis to identify underlying (latent) factors that might explain the responses to 33 questions about readiness, attitudes, and perceived barriers related to colon cancer screening. The strongest predictors of a patient's stated readiness to be screened were a physician's recommendation to be screened (1 point difference on 10-point Likert scale, 95 % confidence interval [CI], 0.5 to 1.6 point difference), a family history of colon cancer (0.85-point Likert scale difference, 95 % CI, 0.1 to 1.6), and a belief that health-care decisions should be mostly left to physicians rather than patients (Spearman correlation coefficient 0.21, P < .001). Of the 33 questionnaire items about screening beliefs, 11 (33 %) changed favorably following the educational intervention. In the factor analysis, the 33 items were reduced to 8 underlying factors, such as being too busy to undergo screening and worries about screening procedures. We found a limited number of underlying factors that may help explain patient resistance to colon cancer screening.
Arain, Amir; Tammaa, Maamoon; Chaudhary, Faria; Gill, Shazil; Yousuf, Syed; Bangalore-Vittal, Nandakumar; Singh, Pradumna; Jabeen, Shagufta; Ali, Shahid; Song, Yanna; Azar, Nabil J
Psychogenic nonepileptic seizures (PNES) are a common cause of refractory seizures. Video-electroencephalographic (EEG) monitoring has allowed PNES to be effectively distinguished from epileptic seizures. Once the diagnosis of PNES is established, neurologists face the challenge of explaining it to patients. Patients may not always receive the diagnosis well. The aim of this study is to evaluate how effectively patients receive and perceive the diagnosis of PNES. This prospective study was conducted in an eight-bed epilepsy monitoring unit (EMU). Adult patients with newly confirmed PNES were included. After receiving written consent, a self-administered questionnaire was given to patients after the attending physician had communicated the diagnosis of PNES. A total of 75 patients were recruited. All patients had their typical seizures recorded on video-EEG (range 1-12, mean 2.18). Seventy patients were satisfied with the diagnosis of PNES. Nine patients did not agree that PNES has a psychological cause. Nineteen patients thought that the EMU doctors had no clue as to the cause of their seizures and 20 thought that there was no hope for a cure of their seizures. A significant number of patients with PNES feel that there is no hope for cure of their seizures. Thorough education about PNES, properly preparing patients before discussing the diagnosis of PNES, and preferably earlier diagnosis may prevent this miscommunication and result in better outcomes. A comprehensive approach including psychological counseling and psychiatric input, evaluation and treatment, in order to bring the illness from the subconscious to the conscious level, and effective follow-up may be helpful.
Ulrey, K L; Amason, P
Cultural diversity is becoming increasingly more important in the workplace. This is particularly true in health care organizations facing demographic shifts in the patients served and their families. This study serves to aid the development of intercultural communication training programs for health care providers by examining how cultural sensitivity and effective intercultural communication, besides helping patients, personally benefit health care providers by reducing their stress. Effective intercultural communication and cultural sensitivity were found to be related. Health care providers' levels of intercultural anxiety also were found to correlate with effective intercultural communication.
Johnson, Lenora; Ousley, Anita; Swarz, Jeffrey; Bingham, Raymond J; Erickson, J Bianca; Ellis, Steven; Moody, Terra
Cancer education is a constantly evolving field, as science continues to advance both our understanding of cancer and its effects on patients, families, and communities. Moving discoveries to practice expeditiously is paramount to impacting cancer outcomes. The continuing education of cancer care professionals throughout their practice life is vital to facilitating the adoption of therapeutic innovations. Meanwhile, more general educational programs serve to keep cancer patients, their families, and the public informed of the latest findings in cancer research. The National Cancer Institute conducted an assessment of the current knowledge base for cancer education which involved two literature reviews, one of the general literature of the evaluation of medical and health education efforts, and the other of the preceding 5 years of the Journal of Cancer Education (JCE). These reviews explored a wide range of educational models and methodologies. In general, those that were most effective used multiple methodologies, interactive techniques, and multiple exposures over time. Less than one third of the articles in the JCE reported on a cancer education or communication product, and of these, only 70% had been evaluated for effectiveness. Recommendations to improve the evaluation of cancer education and the educational focus of the JCE are provided.
Wells, Anjanette A; Palinkas, Lawrence A; Williams, Sha-Lai L; Ell, Kathleen
Previously published work finds significant benefit from medical and behavioral health team care among safety-net patients with major depression. This qualitative study assessed clinical social worker, psychiatrist and patient navigator strategies to increase depression treatment among low-income minority cancer patients participating in the ADAPt-C clinical depression trial. Patient care retention strategies were elicited through in-depth, semi-structured interviews with nine behavioral health providers. Using grounded theory, concepts from the literature and dropout barriers identified by patients, guided interview prompts. Retention strategies clustered around five dropout barriers: (1) informational, (2) instrumental, (3) provider-patient therapeutic alliance, (4) clinic setting, and (5) depression treatment. All strategies emphasized the importance of communication between providers and patients. Findings suggest that strong therapeutic alliance and telephone facilitates collaborative team provider communication and depression treatment retention among patients in safety-net oncology care systems.
Kanou, Naoyuki; Sakuma, Kenji; Nakashima, Kenji
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.
MEYER, AARON A.; HWANG, M.; FARASATPOUR, M.; JANARDHAN, R.; MARGENTHALER, J.A.; VIRGO, K.S.; JOHNSON, FRANK E.
Breast cancer is a major health problem worldwide. The median survival duration for patients with metastatic breast cancer is two to three years. Approximately 1% of populations worldwide have schizophrenia. The manner in which schizophrenic patients fare when diagnosed with metastatic breast carcinoma (MBC) was evaluated. We queried the National Department of Veterans Affairs (DVA) datasets using computer codes for a pre-existing diagnosis of schizophrenia and a later diagnosis of breast carcinoma. Chart-based data concerning the identified subjects were then requested. Previously determined inclusion and exclusion criteria were applied to select evaluable patients from the medical records, prior to extracting demographic details and data concerning the treatment course in each subject. Ten patients had distant metastases at initial diagnosis, while seven developed MBC following prior curative-intent treatment. Two patients refused therapy. Ten did not comply with recommended management. Five harmed or threatened physicians, other caregivers or themselves. Schizophrenic patients with MBC often fail to understand the nature of their illnesses. Often they do not accept palliative treatment, while a number of them do not comply with therapy, once initiated. They often exhibit behaviors that are detrimental to themselves or others. Formal psychiatric consultation is therefore necessary in patients. Several detrimental behaviors may be predicted reliably by history alone. PMID:24649175
Juwon, Lee; Jang, Gookhwan; Kim, Sunmin; Kim, Dajung; Lee, Jinwook; Park, Hyunjoon; Lee, Junyeob; Kim, Sangbin; Kim, Yunkyung; Kim, Soo Young; Yang, Joung Wook; Gwoo, Sangeon; Kim, Ye Na; Shin, Ho Sik; Jung, Yeonsoon; Rim, Hark
Incidence of AKI in hospitalized patients with cancer is increasing, but there have been few studies on AKI in patients with cancer. We conducted a retrospective cohort study in a South Korean tertiary care hospital. A total of 2211 consecutive patients (without cancer 61.5%; with cancer 38.5%) were included over a 140-month period. Predictors of all-cause death were examined using the Kaplan-Meier method and the Cox proportional hazards model. The main contributing factors of AKI were sepsis (31.1%) and ischemia (52.7%). AKI was multifactorial in 78% of patients with cancer and in 71% of patients without cancer. Hospital mortality rates were higher in patients with cancer (42.8%) than in patients without cancer (22.5%) (p = 0.014). In multivariate analyses, diabetes mellitus (DM) and cancer diagnosis were associated with hospital mortality. Cancer diagnosis was independently associated with mortality [odds ratio = 3.010 (95% confidence interval, 2.340-3.873), p = 0.001]. Kaplan-Meier analysis revealed that subjects with DM and cancer (n = 146) had lower survival rates than subjects with DM and without cancer (n = 687) (log rank test, p = 0.001). The presence of DM and cancer was independently associated with mortality in AKI patients both with and without cancer. Studies are warranted to determine whether proactive measures may limit AKI and improve outcomes.
Ajala, Tosin; Rafi, Junaid; Larsen-Disney, Peter; Howell, Richard
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. PMID:20379357
Kreps, Gary L
There are significant challenges to communicating relevant cancer prevention and control information to health care consumers due both to the complexities of the health information to be communicated and the complexities of health communication, especially with vulnerable populations. The need for effective communication about cancer risks, early detection, prevention, care, and survivorship is particularly acute, yet also tremendously complex, for reaching vulnerable populations, those groups of people who are most likely to suffer significantly higher levels of morbidity and mortality from cancers than other segments of the population. These vulnerable populations, typically the poorest, lowest educated, and most disenfranchised members of modern society, are heir to serious cancer-related health disparities. Vulnerable populations often have health literacy difficulties, cultural barriers, and economic challenges to accessing and making sense of relevant health information. This paper examines these challenges to communicating relevant information to vulnerable populations and suggests strategies for effectively using different communication media for marketing cancer prevention and control to reduce health disparities and promote public health.
Meeuwesen, Ludwien; Harmsen, Johannes A M; Bernsen, Roos M D; Bruijnzeels, Marc A
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.
Influential holistic analyses of patient perspectives assume that the concepts that patients associate with medical terms are formed by their total social and cultural contexts. Holistic analyses presuppose conceptual role semantics in the sense that they imply that a medical term must have the same role for a nurse and a patient in order for them to associate the same concept with the term. In recent philosophy of mind, social externalism has emerged as a non-holistic alternative to conceptual role theories. According to social externalism, a nurse and a patient express the same concept by a term if they both have a minimal or better understanding of the term. Three arguments in favour of social externalism are presented in connection with nurse-patient interaction. The first concerns successful communication, the second focuses on belief reports made by patients and the third centres on the need for including medical terms in medical discourse. Finally, the practical implications of the arguments are clarified. The most important of these is that, in cases of misunderstanding, a nurse should not conform to a patient's idiosyncratic understanding, but instead correct the mistaken applications of the term in question.
Magdelijns, Fabienne J H; van den Beuken-van Everdingen, Marieke H J; Courtens, Annemie M; Janssen, Daisy J A
Pain is common in patients with cancer (33-64%) and can be divided into background and breakthrough pain (BTP). BTP is a passing, acute pain that occurs despite the use of analgesia to control background pain. BTP may arise spontaneously or be provoked by certain movements or activities. It lasts 30-60 minutes and is generally self-limiting and is often undertreated. We describe 2 patients aged 68 and 57 years with metastatic disease who were admitted for pain management. BTP was inadequately managed during their hospital stay. Both patients had to wait too long before they received their BTP medication, causing the BTP to have passed its peak. After consultation with their nurses, both patients were allowed to have one dose of breakthrough medication in advance, which resulted in better treatment of their BTP. Every hospitalized patient with BTP should have one dose of breakthrough medication ready for taking in advance.
Loh, Kah Poh; Janelsins, Michelle C.; Mohile, Supriya G.; Holmes, Holly M.; Hsu, Tina; Inouye, Sharon K.; Karuturi, Meghan S.; Kimmick, Gretchen G.; Lichtman, Stuart M.; Magnuson, Allison; Whitehead, Mary I.; Wong, Melisa L.; Ahles, Tim A.
Chemotherapy-related cognitive impairment (CRCI) can occur during or after chemotherapy and represents a concern for many patients with cancer. Among older patients with cancer, in whom there is little clinical trial evidence examining side effects like CRCI, many unanswered questions remain regarding risk for and resulting adverse outcomes from CRCI. Given the rising incidence of cancer with age, CRCI is of particular concern for older patients with cancer who receive treatment. Therefore, research related to CRCI in older patients with cancers is a high priority. In this manuscript, we discuss current gaps in research highlighting the lack of clinical studies of CRCI in older adults, the complex mechanisms of CRCI, and the challenges in measuring cognitive impairment in older patients with cancer. Although we focus on CRCI, we also discuss cognitive impairment related to cancer itself and other treatment modalities. We highlight several research priorities to improve the study of CRCI in older patients with cancer. PMID:27197918
Laureys, Steven; Perrin, Fabien; Brédart, Serge
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 are currently being used to disentangle the cognitive hierarchy of self-processing. We here review neuropsychological, neuropathological, electrophysiological and neuroimaging studies using the own name and own face paradigm obtained in conscious waking, sleep, pharmacological coma, pathological coma and related disorders of consciousness. Based on these results we discuss what we currently do and do not know about the functional significance of the neural network involved in "automatic" and "conscious" self-referential processing.
Partridge, Ann H; Elmore, Joann G; Saslow, Debbie; McCaskill-Stevens, Worta; Schnitt, Stuart J
In September 2010, the American Cancer Society and National Cancer Institute convened a conference to review current issues in ductal carcinoma in situ (DCIS) risk communication and decision-making and to identify directions for future research. Specific topics included patient and health care provider knowledge and attitudes about DCIS and its treatment, how to explain DCIS to patients given the heterogeneity of the disease, consideration of nomenclature changes, and the usefulness of decision tools/aids. This report describes the proceedings of the workshop in the context of the current literature and discusses future directions. Evidence suggests that there is a lack of clarity about the implications and risks of a diagnosis of DCIS among patients, providers, and researchers. Research is needed to understand better the biology and mechanisms of the progression of DCIS to invasive breast cancer and the factors that predict those subtypes of DCIS that do not progress, as well as efforts to improve the communication and informed decision-making surrounding DCIS.
Gorozhanskaia, É G; Sviridova, S P; Dobrovol'skaia, M M; Zybrikhina, G N; Kashnia, Sh R
In order to identify the features of violations of free-radical processes in blood serum of 94 untreated cancer patients with different localization of the tumor (cancer of the stomach, colon, breast, ovarian, hemoblastoses) were determined selenium levels and indicators of oxidative stress (sum of metabolites of nitrogen--NOx, the level of superoxide dismutase--Cu/ZnSOD and malondiialdehyde-MDA, and the activity of catalase). In addition, 40 patients with malignant liver disease and clinical signs of liver failure in the early postoperative period was carried out a comparative evaluation of the efficacy of selenium-containing drug "Selenaze" (sodium selenite pentahydrate). It was found that selenium levels in cancer patients by 25-30% below the norm of 110-120 mg/l at a rate of 73.0 +/- 2.6 mg/l. Low levels of NOx was detected in patients with all tumor localizations (22.1 +/- 1.1 microM, with normal range 28.4 +/- 0.9 microM). The exceptions were patients with extensive malignant process in the liver, in which the NOx levels were significantly higher than normal (p < 0.001). The high level of NOx has a toxic effect on the hepatocyte, causing metabolic disorders and inflammatory-necrotic changes in the liver. Elevated levels of SOD and MDA in normal values of catalase activity was detected in all patients. The use of "Selenaze" in postoperative patients with tumors of the liver increased selenium levels by 10-12%, which was accompanied by a decrease in the content of SOD and NOx, and contributed to earlier recovery of detoxic and synthetic liver function. These findings point to an intensification of oxidative stress and metabolic disorders in the malignant process, which is the basis for metabolic correction.
Chou, Fang-Yu; Kuang, Lily Y.; Lee, Jeannette; Yoo, Grace J.; Fung, Lei-Chun
Objective: This paper summarizes the barriers and challenges in cancer care reported from a validation project of a self-management intervention handbook from Chinese-American cancer patients with limited English proficiency (LEP). Methods: Seven health-care providers (HCPs) and 16 Chinese-American cancer survivors with LEP were invited to validate a self-management intervention handbook through networking sampling method. Bilingual versions were developed and validated using the repeated translation process. Online and paper-based survey and interview were conducted to collect information on the perception of barriers and experiences on cancer care. Data were analyzed by the content analysis method. Results: The HCPs reported a bilingual self-management handbook which is useful and feasible for patient self-management. The challenges in giving cancer care to LEP patients included: patients do not engage in discussion, different cultural health beliefs, unable to speak to patients in their primary language, and patients are less likely to discuss emotional and social challenges during treatments. The common barriers and experiences during cancer care included: limited understanding about treatment/medication and side effects, language barriers such as unable to communicate to make the decision, unable to understand information related to resources and do not know what questions to ask, and do not know what to expect during their cancer treatment. Conclusions: The current findings highlight the need of cancer self-management support for culturally diverse LEP cancer patients. Further research can include applying the supportive intervention to all LEP cancer patients. PMID:27981169
Weber, Kirsten M; Solomon, Denise Haunani
This article clarifies how the social contexts in which breast cancer survivors live can contribute to the stress they experience because of the disease. Guided by Solomon and Knobloch's (2004) relational turbulence model and Petronio's (2002) communication privacy management theory, this study explores personal relationship and communication boundary issues within stressors that are associated with the diagnosis, treatment, and early survivorship of breast cancer. A qualitative analysis of discourse posted on breast cancer discussion boards and weblogs using the constant comparative method and open-coding techniques revealed 12 sources of stress. Using axial coding methods and probing these topics for underlying relationship and communication issues yielded 5 themes. The discussion highlights the implications of the findings for the theories that guided this investigation and for breast cancer survivorship more generally.
Twycross, R. G.
Lung cancer is the commonest form of malignant disease seen at St Christopher's Hospice. More than 35% of the male and about 8% of the female cancer patients are admitted with this diagnosis. This means that each year approximately 100 patients with lung cancer are amitted and cared for at the hospice. The more common symptoms experienced by 185 consecutive terminal lung cancer patients admitted to St Christopher's Hospice are listed in Table 1. PMID:4132166
Dreizen, S; McCredie, K B; Bodey, G P; Keating, M J
Necrotizing dermatitis in patients being treated with cancer chemotherapeutic agents can be of several types. Microbial causes can include a variety of bacteria and fungi, the most common being Pseudomonas aeruginosa. Gangrene from occlusive causes is not uncommon among cancer patients with coexisting atheromatous, thromboembolic, or obliterative vascular disease. Toxic gangrene is most commonly caused by extravasation of intravenously administered cytotoxic antineoplastic drugs but has also been associated with the use of coumarin congeners and the bite of the brown recluse spider. Pyoderma gangrenosum is an idiopathic condition that has been reported in association with myeloproliferative disorders. Finally, necrosis can be caused by the neoplasm itself, when its growth is so great that blood vessels are compressed and ischemia of the surrounding tissue results.
Black, David S.; Lam, Chun Nok; Nguyen, Nathalie T.; Ihenacho, Ugonna
Abstract Objective: Complementary and integrative health (CIH) use among Hispanic adults with colorectal cancer (CRC) diagnosis is not well documented. Understanding the prevalence and patterns of CIH use among Hispanics offers insights to uncover potential needs for clinical services. Design: Participants were age 21 years or older with a first-time diagnosis of CRC from population-based cancer registries in California. In-person and/or telephone-based interviews were administered to collect data on CIH use. Demographic and clinical diagnosis data were abstracted from medical records. Descriptive statistical and logistic regression was used to analyze the frequencies and associations between selected patient characteristics and CIH use. Results: Among 631 Hispanic patients, 40.1% reported ever using CIH. Herbal products/dietary supplements were used most often (35.3%), followed by bodywork (16.5%), mind–body practices (7.8%), and homeopathy (6.7%). About 60% of participants reported CIH use to address specific health conditions; however, most patients did not discuss CIH use with their physicians (76.3%). Women reported higher CIH use than did men (45.1% versus 35.9%; odds ratio, 1.49 [95% confidence interval, 1.07–2.08]; p = 0.02). CIH use did not differ by clinical stage, time since diagnosis, or preferred language. Conclusions: CIH use is prevalent among Hispanic patients with CRC, especially women. Little communication about CIH use occurs between participants and their healthcare providers. Efforts aimed at improving integrative oncology services provide an opportunity to address such gaps in healthcare service. PMID:27163178
Murthy, Santosh B.; Shastri, Aditi; Merkler, Alexander E.; Hanley, Daniel F.; Ziai, Wendy C.; Fink, Matthew E.; Iadecola, Costantino; Kamel, Hooman; Navi, Babak B.
Background Single-center studies suggest that patients with cancer have similar outcomes after intracerebral hemorrhage (ICH) compared to patients without cancer. However, these studies were limited by small sample sizes and high rates of intratumoral hemorrhage. Our hypothesis was that systemic cancer patients without brain involvement fare worse after ICH than patients without cancer. Methods We identified all patients diagnosed with spontaneous ICH from 2002 through 2011 in the Nationwide Inpatient Sample. Our predictor variable was systemic cancer. Our primary outcome was discharge disposition, dichotomized into favorable discharge (home/self-care or rehabilitation) or unfavorable discharge (nursing facility, hospice, or death). We used logistic regression to compare outcomes and performed secondary analyses by cancer subtype (i.e., non-metastatic solid tumors, non-metastatic hematologic tumors, and metastatic solid or hematologic tumors). Results Among 597,046 identified ICH patients, 22,394 (3.8%) had systemic cancer. Stroke risk factors such as hypertension and diabetes were more common in patients without cancer, while anticoagulant use and higher Charlson comorbidity scores were more common among cancer patients. In multivariate logistic regression analysis adjusted for demographics, comorbidities, and hospital-level characteristics, patients with cancer had higher odds of death (OR 1.62, 95% CI 1.56–1.69) and lower odds of favorable discharge (OR 0.59, 95% CI 0.56–0.63) than patients without cancer. Amongst cancer groups, patients with non-metastatic hematologic tumors and those with metastatic disease fared the worst. Conclusions Patients with systemic cancer have higher mortality and less favorable discharge outcomes after ICH than patients without cancer. Cancer subtype may influence outcomes after ICH. PMID:27569708
Ripamonti, C; Bruera, E
Patient-controlled analgesia (PCA) is a relatively new technique in which patients are able to self-administer small doses of opioid analgesics when needed. Many different devices are available for opioid infusion, including a syringe pump, disposable plastic cylinder, and battery-operated computer-driven pump. These devices allow patients to choose an intermittent (demand) bolus, continuous infusion, or both modes of administration. Parameters, such as route, drug concentration dose, frequency, and maximum daily or hourly dose, are programmed by the physician. The patient decides whether or not to take a dose. Devices can be used to deliver the drug into a running intravenous infusion, the epidural space, or subcutaneously. Controlled trials indicate that PCA is probably superior to regular opioid administration in postoperative pain. Reported advantages include greater patient satisfaction, decreased sedation and anxiety, and reduced nursing time and hospitalization. Preliminary experience suggests that PCA is also useful and safe for cancer pain, but further research is greatly needed.
Onishi, Hideki; Kawanishi, Chiaki; Onose, Masanari; Yamada, Tomoki; Saito, Hideyuki; Yoshida, Akira; Noda, Kazumasa
Although Wernicke encephalopathy has been reported in the oncological literature, only one terminally ill cancer patient with Wernicke encephalopathy has been reported. Wernicke encephalopathy, a potentially reversible condition, may be unrecognized in terminally ill cancer patients. In this communication, we report three terminally ill cancer patients who developed Wernicke encephalopathy. Early recognition and subsequent treatment resulted in successful palliation of delirium. Two of the three patients did not show the classical triad of Wernicke encephalopathy. Common clinical symptoms were delirium and poor nutritional status. Intravenous thiamine administration dramatically improved the symptoms of delirium in all three patients. In terminally ill cancer patients, clinicians must remain aware of the possibility of Wernicke encephalopathy when patients with a poor nutritional status present with unexplained delirium. Early intervention may correct the symptoms and prevent irreversible brain damage and the quality of life for the patient may improve.
Leathart, A J
This exploratory study was designed to determine the state of communication between conscious, intubated and orientated patients, and nurses in an intensive therapy unit (ITU) and the factors that influence this communication. The aim was to determine whether nurses are able to identify the needs and problems of their patients. This was done by examining characteristics of nurse-patient interactions through participant observation, and exploring nurses' attitudes and knowledge of communication and the nursing process. Dissatisfaction with the nursing process and continual difficulty in communicating with conscious intubated patients by ITU colleagues was the stimulus to investigate the state of nurse-patient communication in the unit where the researcher works. In this paper critical evaluation of previous studies of nurse-patient communication in ITUs is followed by presentation of results of the observations and interviews in this study. The discussion that follows focuses on the socialisation of nurses in 'becoming' ITU nurses related to Bradby's (1990) interpretation of status passage, and the effect that this has on the way in which they communicate.
Tamburini, Marcello; Gangeri, Laura; Brunelli, Cinzia; Boeri, Paolo; Borreani, Claudia; Bosisio, Marco; Karmann, Claude Fusco; Greco, Margherita; Miccinesi, Guido; Murru, Luciana; Trimigno, Patrizia
Background The evaluation of cancer patients needs, especially during that delicate period when they are hospitalized, allows the identification of those areas of care that require to be improved. Aims of the study were to evaluate the needs in cancer inpatients and to improve the understanding of the meanings of the needs expressed. Methods The study was conducted during a "sample day", with all the cancer patients involved having been hospitalized at the Istituto Nazionale Tumori of Milan (INT) for at least 48 hours beforehand. The study was carried out using quantitative and qualitative methodologies. The quantitative part of the study consisted in making use of the Needs Evaluation Questionnaire (NEQ), a standardized questionnaire administered by the INT Psychology Unit members, supported by a group of volunteers from the Milan section of the Italian League Against Cancer. The aim of the qualitative part of the study, by semi-structured interviews conducted with a small sample of 8 hospitalized patients, was to improve our understanding of the meanings, implications of the needs directly described from the point of view of the patients. Such an approach determines the reasons and conditions of the dissatisfaction in the patient, and provides additional information for the planning of improvement interventions. Results Of the 224 eligible patients, 182 (81%) completed the questionnaire. Four of the top five needs expressed by 40% or more of the responders concerned information needs (diagnosis, future conditions, dialogue with doctors, economic-insurance solutions related to the disease). Only one of the 5 was concerned with improved "hotel" services (bathrooms, meals, cleanliness). Qualitative analysis showed that the most expressed need (to receive more information on their future conditions) has the meaning to know how their future life will be affected more than to know his/her actual prognosis. Conclusions Some of the needs which emerged from this
Yli-Uotila, T; Rantanen, A; Suominen, T
The purpose of the study was to describe why Finnish cancer patients choose the internet as a source of social support. The data were collected in May 2010, using an online questionnaire with open-ended questions, through four discussion forums on the websites of the non-profit Cancer Society of Finland. Seventy-four adult patients with cancer participated. The data were analysed using inductive content analysis. The mean age of the participants was 53 years and they were predominantly women. The most common cancer was breast cancer and more than three quarters of the participants had suffered from cancer for less than 5 years. The initial stimuli to use the internet as a source of social support were the ease of communication and access to information as well as the need for emotional and informational support. The actual motives that drove the use of the internet as a source of social support were the requirements for information and peer support, internet technology, a lack of support outside the internet and the negative experiences caused by the illness. The fact that there is an enormous need for information as well as for emotional support and that cancer treatment in Finland is concentrated in major hospitals, to which cancer patients may travel a considerable distance, suggests that nurses should learn to make more frequent virtual contact with their patients.
Borgulya, Gábor; Jakab, Zsuzsanna; Schuler, Dezso; Garami, Miklós
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 cancer patients in particular.
Kohlhapp, Frederick J.; Mitra, Anirban K.; Lengyel, Ernst; Peter, Marcus E.
Cancer cells grow in an environment comprised of multiple components that support tumor growth and contribute to therapy resistance. Major cell types in the tumor micro-environment are fibroblasts, endothelial cells and infiltrating immune cells all of which communicate with cancer cells. One way that these cell types promote cancer progression is by altering expression of miRNAs, small noncoding RNAs that negatively regulate protein expression, either in the cancer cells or in associated normal cells. Changes in miRNA expression can be brought about by direct interaction between the stromal cells and cancer cells, by paracrine factors secreted by any of the cell types, or even through direct communication between cells through secreted miRNAs. Understanding the role of miRNAs in the complex interactions between the tumor and cells in its micro-environment is necessary if we are to understand tumor progression and devise new treatments. PMID:25867073
Moore, R. J.; Chamberlain, R. M.; Khuri, F. R.
INTRODUCTION: Significant problems in clinician-patient communication have been described in the oncology literatures. Advanced stage non-small lung cancer a devastating disease, can cause the communication between survivors, significant others, and clinicians to falter. To date, however, no studies have used qualitative methods to examine experiential aspects of living with non-small cell lung cancer. Nor have any studies evaluated the tools survivors might use to repair some of the damage caused by living with this disease. METHODS: Exploratory, two-part qualitative design. RESULTS: Survivors of non-small cell lung cancer live with multiple fears and losses. These include a diminished sense of self, the loss of health, fears of pain in a future tainted by the threat of death, and increased feelings of alienation due to the loss of previous sources of meaning in life. These experiences significantly affect cancer survivors abilities to communicate with clinicians and significant others. CONCLUSIONS: Survivors of non-small cell lung cancer often have difficulty sharing their experiences with others not suffering a similar affliction. Through their narratives with other survivors, however, patients are better able to initiate a biopsychosocial mechanism which enables them to create a cognitive map. This cognitive map helps survivors share their experiences with others, thereby repairing some of the damage caused by this disease, including the harm done to their communication with other people. PMID:11922184
Rice, Timothy R; Dobry, Yuriy; Novakovic, Vladan; Appel, Jacob M
Successful formulation and implementation of end-of-life care requires ongoing communication with the patient. When patients, for reasons of general medical or psychiatric illness, fail to verbally communicate, providers must be receptive to messages conveyed through alternate avenues of communication. We present the narrative of a man with schizophrenia who wished to forgo hemodialysis as a study in the ethical importance of attention to nonverbal communication. A multilayered understanding of the patient, as may be provided by both behavioral and motivational models, can inform the provider's ability to receive, process, and represent communicated content to the patient or his or her surrogate decision-maker.
Stanko, Cynthia A.; Taub, Deborah J.
Cancer affects not just the patient but also the entire family system. The effect of a parent's cancer on young children in the family may lead to emotional distress and school problems. This article describes guidelines for a counseling group for elementary school children of cancer patients to be led by the school counselor and meet in the…
Baquet, Claudia R.; Ellison, Gary L.; Mishra, Shiraz I.
Purpose We examined the relationship of sociodemographic factors, urban/rural residence, and countylevel socioeconomic factors on accrual of Maryland patients with cancer to National Cancer Institute (NCI)-sponsored cancer treatment clinical trials. Patients and Methods Data were analyzed for the period 1999 to 2002 for 2,240 Maryland patients with cancer accrued onto NCI-sponsored treatment trials. The extent to which Maryland patients with cancer and patients residing in lower socioeconomic and/or rural areas were accrued to cancer trials and were representative of all patients with cancer in Maryland was determined. Data were obtained from several sources, including NCI’s Cancer Therapy Evaluation Program for Maryland patients with cancer in Cooperative Group therapeutic trials, Maryland Cancer Registry data on cancer incidence, and United States Census and the Department of Agriculture. Results For Maryland patients with cancer accrued onto NCI-sponsored treatment trials between 1999 and 2002, subgroups accrued at a higher rate included pediatric and adolescent age groups, white patients, female patients (for sex-specific tumors), patients with private health insurance, and patients residing in the Maryland National Capitol region. Moreover, between 1999 and 2002, there was an estimated annual decline (8.9% per year; P < .05) in the percentage of black patients accrued onto cancer treatment trials. Logistic regression models uncovered different patterns of accrual for female patients and male patients on county-level socioeconomic factors. Conclusion Results highlight disparities in the accrual of Maryland patients with cancer onto NCI-sponsored treatment trials based on patient age, race/ethnicity, geography of residence, and county-level socioeconomic factors. Findings provide the basis for development of innovative tailored and targeted educational efforts to improve trial accrual, particularly for the underserved. PMID:18612153
Baquet, Claudia R.; Ellison, Gary L.; Mishra, Shiraz I.
Purpose We examined the relationship of sociodemographic factors, urban/rural residence, and countylevel socioeconomic factors on accrual of Maryland patients with cancer to National Cancer Institute (NCI)-sponsored cancer treatment clinical trials. Patients and Methods Data were analyzed for the period 1999 to 2002 for 2,240 Maryland patients with cancer accrued onto NCI-sponsored treatment trials. The extent to which Maryland patients with cancer and patients residing in lower socioeconomic and/or rural areas were accrued to cancer trials and were representative of all patients with cancer in Maryland was determined. Data were obtained from several sources, including NCI’s Cancer Therapy Evaluation Program for Maryland patients with cancer in Cooperative Group therapeutic trials, Maryland Cancer Registry data on cancer incidence, and United States Census and the Department of Agriculture. Results For Maryland patients with cancer accrued onto NCI-sponsored treatment trials between 1999 and 2002, subgroups accrued at a higher rate included pediatric and adolescent age groups, white patients, female patients (for sex-specific tumors), patients with private health insurance, and patients residing in the Maryland National Capitol region. Moreover, between 1999 and 2002, there was an estimated annual decline (8.9% per year; P < .05) in the percentage of black patients accrued onto cancer treatment trials. Logistic regression models uncovered different patterns of accrual for female patients and male patients on county-level socioeconomic factors. Conclusion Results highlight disparities in the accrual of Maryland patients with cancer onto NCI-sponsored treatment trials based on patient age, race/ethnicity, geography of residence, and county-level socioeconomic factors. Findings provide the basis for development of innovative tailored and targeted educational efforts to improve trial accrual, particularly for the underserved. PMID:19711497
Haskard, Kelly B; DiMatteo, M Robin; Heritage, John
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 speech including vocal tone. Communication channel differences and prediction of patient satisfaction were examined. The visual and vocal communication of nursing staff members and patients robustly predicted each other's satisfaction and reflected their own satisfaction with the dyadic visit. Affect was communicated more clearly through the speech with vocal tone channel, whereas instrumental communication was stronger in visual nonverbal behavior. Patients' and nursing staff members' behaviors of pleasantness and involvement frequently co-occurred.
Castillo-Esparcia, Antonio; López-Villafranca, Paloma
The current study focuses on communication strategies employed by rare disease patient organizations. The aims of these organizations are: educate and inform the public about rare diseases, raise awareness of the problems related to rare diseases, and achieve social legitimacy in order give visibility to their demands. We analyzed the portrayal of rare disease and patient organizations by Spain's major media organizations in terms of circulation and viewership - the press (El País, El Mundo, La Vanguardia,ABC and El Periódico), radio (CadenaSer, Onda Cero, Cope and RNE), and television (Telecinco, Antena 3, La 1, La Sexta, Cuatro) -between 2012 and 2014.We then carried out a descriptive analysis of communication activities performed via the World Wide Web and social networks by 143 national organizations. Finally, we conducted a telephone questionnaire of a representative sample of 90 organizations in order to explore the association between media presence and funding and public image. The triangulation of quantitative and qualitative methods allowed us to meet the study's objectives. Increased visibility of the organizations afforded by an increase in the coverage of the topic by the medialed to an increase in membership - but not in donations - and increased awareness of these diseases.
KIM, EUNKYUNG; HAN, JEONG YEOB; SHAH, DHAVAN; SHAW, BRET; McTAVISH, FIONA; GUSTAFSON, DAVID H.; FAN, DAVID
Social support in computer-mediated settings is an important variable in health communication research, yet little is known about the factors that influence the amount of social support one gives and receives in online support groups. To shed some light on this issue, the authors examined demographics, disease-related factors, psychosocial factors, and strategies for coping with breast cancer as potential determinants of which patients provide support to others and which ones consume it. Data collected from 177 participants in the Comprehensive Health Enhancement Support System “Living With Breast Cancer” program revealed that individuals who are younger, have higher levels of positive reframing, and lower levels of self-blame are more likely to provide emotional support in online settings. In contrast, individuals who are more educated, have less perceived availability of social support, and have lower levels of religious coping are more likely to receive emotional support from others. The authors discuss the theoretical and practical implications for providing effective psychosocial support for women with breast cancer. PMID:22070449
Peasant, Courtney; Foster, Rebecca H; Russell, Kathryn M; Favaro, Brianne E; Klosky, James L
Human papillomavirus (HPV) vaccination is recommended for all female survivors of childhood cancer; yet, it is underused. Parent-child sexual communication and health care provider recommendation for HPV vaccination influence familial vaccination decisions. However, caregivers may be less likely to discuss sexual health issues with survivors as compared to healthy peers. Therefore, this study compared mothers of daughters with/without history of childhood cancer on measures of sexual communication, HPV-specific communication, and health care provider recommendation for HPV vaccination, and examined the effects of sociodemographic and medical factors on these measures. There were no differences between mothers of survivors/noncancer survivors on the outcomes (Ps > .05). Among all mothers, daughter's age was associated with sexual communication (Ps < .05). Household income and daughter's age were associated with health care provider recommendation for vaccination (Ps < .05). Among mothers of survivors, daughter's age at diagnosis was associated with sexual communication, HPV-specific communication, and health care provider recommendation for vaccination (Ps < .05). Findings have implications for the role of health care providers as advocates for mother-daughter sexual communication and HPV vaccination, especially among survivors of childhood cancer.
Grimsbø, Gro H.; Engelsrud, Gunn H.; Ruland, Cornelia M.
Interactive Health Communication Applications (IHCAs) are increasingly used in health care. Studies document that IHCAs provide patients with knowledge and social support, enhance self- efficacy and can improve behavioural and clinical outcomes. However, research exploring patients’ experiences of using IHCAs has been scarce. The aim of this study was to explore cancer patients’ perspectives and experiences related to the use of an IHCA called WebChoice in their homes. Qualitative interviews were conducted with infrequent, medium and frequent IHCA users—six women and four men with breast and prostate cancer. The interviews were transcribed and analyzed inspired by interactionistic perspectives. We found that some patients’ perceived WebChoice as a “friend,” others as a “stranger.” Access to WebChoice stimulated particularly high frequency users to position themselves as “information seeking agents,” assuming an active patient role. However, to position oneself as an “active patient” was ambiguous and emotional. Feelings of “calmness”, “normalization of symptoms”, feelings of “being part of a community”, feeling “upset” and “vulnerable”, as well as “feeling supported” were identified. Interaction with WebChoice implied for some users an increased focus on illness. Our findings indicate that the interaction between patients and an IHCA such as WebChoice occurs in a variety of ways, some of which are ambivalent or conflicting. Particularly for frequent and medium frequency users, it offers support, but may at the same time reinforce an element of uncertainty in their life. Such insights should be taken into consideration in the future development of IHCAs in healthcare in general and in particular for implementation into patients’ private sphere. PMID:22582085
Elrick, Ashley; Ashida, Sato; Ivanovich, Jennifer; Lyons, Sarah; Biesecker, Barbara B; Goodman, Melody S; Kaphingst, Kimberly A
Genetic test results have medical implications beyond the patient that extend to biological family members. We examined psychosocial and clinical factors associated with communication of genetic test results within families. Women (N = 1080) diagnosed with breast cancer at age 40 or younger completed an online survey; 920 women that reported prior cancer genetic testing were included in analysis. We examined the proportion of immediate family members to whom they communicated genetic test results, and built multivariable regression models to examine clinical and psychosocial variables associated with the proportion score. Participants were most likely to communicate test results to their mother (83 %) and least likely to their son (45 %). Participants who carried a BRCA mutation (OR = 1.34; 95 % CI = 1.06, 1.70), had higher interest in genomic information (OR = 1.55; 95 % CI = 1.26, 1.91) and lower genetic worry (OR = 0.91; 95 % CI = 0.86, 0.96) communicated genetic test results to a greater proportion of their immediate family members. Participants with a BRCA1/2 mutation shared their genetic test results with more male family members (OR = 1.72; 95 % CI = 1.02, 2.89). Our findings suggest that patients with high worry about genetic risks, low interest in genomic information, or receive a negative genetic test result will likely need additional support to encourage family communication.
Do, Sung-Im; Lee, Hyoun Wook; Sohn, Jin Hee; Kim, Kyungeun
Gallbladder cancer is the most common biliary tract cancer and the fifth most common cancer of the digestive system. However, the clinicopathologic features of gallbladder cancer in young Korean patients have not been studied. This study included 101 consecutive cases of gallbladder cancer that underwent cholecystectomy at Kangbuk Samsung Hospital from December 1990 to March 2011. The patients were divided into two groups by age at initial diagnosis of gallbladder cancer: a young patient group aged less than 45 years and an old patient group aged 45 or older. The young patient group included 10 patients with mean age of 38 (range, 29-44 years). Compared with the old patient group, the young patient group showed polypoid tumor appearance (p=0.014), lower pT stage (p=0.023), more frequent adenoma background (p=0.009), and less frequent dysplasia in remaining mucosa (p=0.001). The disease-related survival rate after 13.5 months was significantly more favorable for the young patients. Gallbladder cancers in young Korean patients have distinct clinicopathologic features of a high frequency of cancer arising in adenoma, rare association with intestinal metaplasia and dysplasia, and a favorable patient's prognosis. These findings suggest that the adenoma-carcinoma pathway could contribute more to gallbladder cancer carcinogenesis in young Korean patients than the metaplasia-dysplasia-carcinoma pathway.
A study by the National Cancer Institute indicates extensive newspaper coverage of the subject of cancer. Some of the media presentations on cancer are highly emotional in nature, such as the PBS special, "Joan Robinson: One Woman's Story." Other more optimistic stories may have a negative impact on patients facing more advanced stages of the disease. Yet the media appear to be gradually stripping the mystery from cancer and preparing patients to deal with their treatment and physicians more intelligently and more assertively. Breast and lung cancers are the two sites that get the most attention from the press. Unfortunately, colon and rectum cancers rank quite low in press attention. The American Cancer Society (ACS) has studied public attitudes toward these cancers and is preparing programs to reach the public about them. This paper will deal with these topics and make some observations on the impact of media coverage on cancer patients.
Lymphedema; Stage IA Cervical Cancer; Stage IA Uterine Corpus Cancer; Stage IA Vulvar Cancer; Stage IB Cervical Cancer; Stage IB Uterine Corpus Cancer; Stage IB Vulvar Cancer; Stage II Uterine Corpus Cancer; Stage II Vulvar Cancer; Stage IIA Cervical Cancer; Stage IIIA Vulvar Cancer; Stage IIIB Vulvar Cancer; Stage IIIC Vulvar Cancer; Stage IVB Vulvar Cancer
Bain, Mathew Gabriel; Lian, Cheah Whye; Thon, Chang Ching
Context: Breaking of bad news is an important component in the management of cancer patients. Aims: This study aimed to assess the perceptions of breaking bad news of cancer diagnosis. Settings and Design: It was a cross-sectional study using Breaking Bad News Assessment Schedule (BAS) questionnaire on cancer patients in Serian district. Materials and Methods: Using snowballing sampling method, a total of 134 patients were interviewed face-to-face after the consent was obtained from each of the respondents. Statistical Analysis Used: Data was entered and analyzed using SPSS version 19.0. Results: Majority were comfortable with the current method of breaking bad news. The main aspects found to be the areas of concern were the importance of the usage of body language, management of time and identifying patients’ key area of concerns. There were significant difference between sex and “information giving” (P = 0.028) and “general consideration” (P = 0.016) and also between “the age and setting the scene” (P = 0.042). Significant difference was also found between the types of cancer and “the setting of scene” (P = 0.018), “breaking bad news technique” (P = 0.010), “eliciting concerns” (P = 0.003) and “information giving” (P = 0.004). Conclusion: Good and effective communication skill of breaking bad news is vital in the management of cancer patients. As the incidence of new cases of cancer increase every year, breaking of bad news has become a pertinent to the medical professionals’ role. Specific aspects of communication skills based on local characteristics should be more emphasized in the formulation of training for doctors. PMID:24818107
Cruz Jurado, J; Richart Aznar, P; García Mata, J; Fernández Martínez, R; Peláez Fernández, I; Sampedro Gimeno, T; Galve Calvo, E; Murillo Jaso, L; Polo Marqués, E; García Palomo, A
Hormone treatment is one of the key strategies in the management of metastatic breast cancer. Hormone treatment is one of the key strategies in the management of metastatic breast cancer. Aromatase inhibitors (AI) have been extensively studied in this setting. This section summarizes the key data regarding the use of AI in advanced breast cancer. In postmenopausal women, AI are the first line of treatment for untreated patients, or those who had prior AI treatment and progress after 12 months of adjuvant therapy. A longer disease-free interval and absence of visceral disease is associated with a better response. If tumors recur in less than 12 months, it is recommended that tamoxifen (TAM) or the estrogen-receptor antagonist fulvestrant (FUL) treatment be initiated. In the second-line setting, the best option after progression is the administration of either FUL or TAM. In the third-line setting, reintroduction of AI is considered an acceptable option. In premenopausal women who have not received prior treatment or who have progressed after 12 months following adjuvant treatment, it is recommended to initiate therapy with a combination of TAM and a luteinizing hormone-releasing hormone (LHRH) analog. If there is treatment failure with the use of this combination, megestrol acetate or an LHRH agonist plus an AI may be reasonable alternatives. Intensive research is ongoing to understand the mechanisms of resistance to hormone therapy. In human epidermal growth factor receptor 2 positive-patients, combinations with HER2 antagonists are associated with significant clinical activity.
A four-drug chemotherapy regimen has produced the longest improvement in survival ever seen in a phase III clinical trial of patients with metastatic pancreatic cancer, one of the deadliest types of cancer.
Development of bone metastases in patients with advanced cancer is associated with skeletal-related events (SREs) such as pathologic fractures, spinal cord compression, the requirement for surgery or palliative radiotherapy to bone, and hypercalcemia of malignancy. Skeletal morbidity may reduce patient mobility, limit functional independence, and impair quality of life (QOL). Proactive management of new or worsening bone pain or motor impairment is crucial because of the potential for rapid progression of symptoms. Administration of bisphosphonate therapy as a monthly infusion to patients with bone metastases prevents or delays the onset and reduces the frequency of SREs and provides clinically meaningful improvements in bone pain and QOL. In addition to administration of therapy, the monthly infusion visit allows a dedicated team of healthcare professionals to regularly assess SREs, response to therapy, adverse events (AEs), QOL, and adherence to oral medications and supplements. The continuity of care that occurs during the monthly infusion visit provides oncology nurses with an opportunity to educate patients about effective strategies to manage SREs and AEs. In addition, regular interaction provides oncology nurses with an opportunity to recognize and proactively address subtle changes in the patients’ medical condition. Using a multidisciplinary medical team also eliminates barriers between the various healthcare professionals involved in patient management. Consequently, the monthly infusion visit can result in effective patient management and improved clinical outcomes in patients with malignant bone disease. PMID:21206517
Nakayama, Yuki; Shimizu, Toshio; Mochizuki, Yoko; Hayashi, Kentaro; Matsuda, Chiharu; Nagao, Masahiro; Watabe, Kazuhiko; Kawata, Akihiro; Oyanagi, Kiyomitsu; Isozaki, Eiji; Nakano, Imaharu
Predictors of communication impairment in patients with amyotrophic lateral sclerosis (ALS) using tracheostomy-invasive ventilation (TIV) were investigated. Seventy-six ALS patients using TIV were enrolled and classified into three subgroups of communication ability: patients who could communicate with communication devices (Stage I), patients who had difficulty with communication (Stage II, III, or IV), and patients who could not communicate by any means (Stage V). Predictors of communication impairment were analysed by the Cox proportional hazard model. Results demonstrated that there were no significant differences in disease duration between subgroups. Within 24 months after disease onset, patients who needed TIV and tube feeding, developed oculomotor impairment or became totally quadriplegic and progressed from Stage I to II and V significantly earlier. Multivariate analyses revealed that within 24 months from onset, the need for TIV and progression to total quadriplegia were significant events in patients who progressed to Stage II, whereas the development of oculomotor limitation was significant in patients who progressed to Stage V. In conclusion, TIV, impaired oculomotor movement and total quadriplegia are predictors of severe communication impairment. Rapid disease progression might indicate future communication impairment after the use of TIV. We highly recommend early detection of impaired communication and identification of the best methods of communication.
Wright, Kevin B; Bylund, Carma; Ware, Jennifer; Parker, Patricia; Query, Jim L; Baile, Walter
Drawing upon Bloom's taxonomy of educational objectives as a theoretical framework, this study examines attitudes toward communication skills training, knowledge of appropriate provider-patient communication, and confidence communicating with patients between first-year and fourth-year medical students at a large medical school in the southern United States. The study findings indicate that fourth-year medical students do not differ from first-year medical students in terms of attitudes towards communication skills training or knowledge of appropriate provider-patient communication, but they have significantly higher confidence scores about communicating with patients. In addition, positive attitudes towards communication skills training are significantly related to perceived importance of communication skills and confidence when communicating with patients. Finally, female medical students have more positive attitudes towards communication skills training than male medical students. The implications of the study findings and directions for future research are also discussed.
Horber, Dot; Langenau, Erik E.; Kachur, Elizabeth
Teaching and assessing doctor-patient communication has become a priority in medical education. This pilot study evaluated resident physicians' perceptions of teaching and assessing doctor-patient communication skills related to pain management using a web-based format. Fifty-nine resident physicians completed four doctor-patient clinical…
Aim To evaluate the process of placing DNR order in elderly cancer patients in practice and analysis of physician perspectives on the issue. Background Decision not to resuscitate (DNR/DNAR) is part of practice in elderly cancer care. Physicians issue such orders when a patient is suffering from irreversible disease and the patient's life is coming to an end. Modern practice emphasises the need of communication with the patients and their relatives while issuing a DNR. The decision making process of placing DNR can be quite daunting. The moral and ethical dimensions surrounding such a decision make it a contentious topic. Materials and methods We searched the literature to find relevant works that would help physicians and especially the junior health care staff in dealing with the complexities. In this article, we discuss the issues that physicians encounter whilst dealing with a DNR order in elderly cancer patients. Results There are no objective adjuncts or guidelines directed towards the approach of placing a DNR in elderly cancer patients. Better communication with the patients and relatives when making such decision remains a very important aspect of a DNR decision. Most health care staff find themselves ill equipped to deal with such situation. Active training and briefing of junior staff would help them deal better with the stresses involved in this process. Conclusion There are complex psychosocial, medical, ethical and emotive aspects associated with placing a DNR order. Patients and their loved ones and the junior staff involved in the care of patient need early communication and briefing for better acceptance of DNR. Studies that could devise or identify tools or recommendations would be welcome. PMID:24381748
Breast cancer in the elderly is a rising health care challenge. Under-treatment is common. While the proportion of older patients receiving adjuvant radiotherapy (RT) is rising, the proportion undergoing breast-conserving surgery without irradiation has also risen. The evidence base for loco-regional treatment is limited, reflecting the historical exclusion of older patients from randomised trials. The 2011 Oxford overview shows that the risk of first recurrence is halved in all age groups by adjuvant RT after breast-conserving surgery, although the absolute benefit in older 'low-risk' patients is small. There is level 1 evidence that a breast boost after breast-conserving surgery and whole-breast irradiation reduces local recurrence in older as in younger women, although in the former the absolute reduction is modest. Partial breast irradiation (external beam or intraoperative or postoperative brachytherapy) is potentially an attractive option for older patients, but the evidence base is insufficient to recommend it routinely. Similarly, shortened (hypofractionated) dose fraction schedules may be more convenient for older patients and are supported by level 1 evidence. There remains uncertainty about whether there is a subgroup of older low-risk patients in whom postoperative RT can be omitted after breast-conserving surgery. Biomarkers of 'low risk' are needed to refine the selection of patients for the omission of adjuvant RT. The role of postmastectomy irradiation is well established for 'high-risk' patients but uncertain in the intermediate-risk category of patients with 1-3 involved axillary nodes or node-negative patients with other risk factors where its role is investigational.
In this article, I explore the communication in an online self-help group for Norwegian women with breast cancer, aiming to add further knowledge to the question of whether the online context functions as a "liberating realm" for alternative discourses about illness. My analysis is conducted within an action-oriented framework and is based on participant observation of the online communication and qualitative interviews of women who participated in the group. Based on the analysis, I argue that proposals of a replication of dominating offline discourses in online communication are affirmed. More precisely, I argue that a "socially desirable" story about the cancer "hero" was further circulated in this online context, and that experiences of resignation and meaninglessness were not woven into the communication. Offering some reflections on this process, I suggest that it has active and voluntary aspects that need attention in further research.
Üstündağ, Sema; Demir Zencirci, Ayten
This descriptive and cross-sectional study was conducted to determine the use and effects of complementary and alternative medicine on cancer patients receiving chemotherapy. The research was conducted in Daytime Chemotherapy Unit of the College District Outpatients in the Ankara Numune Education and Research Hospital and comprised 397 patients in the oncology outpatients. Written informed consents were obtained from all participants. Among the participants, 52.6% were women, 85.1% married, 10.6% illiterate, 41.1% housewife, and 8.8% civil servants. Among the patients participated in the study, 27.7% had cancer in the family, 22.6% had gastrointestinal cancer, and 22.1% had breast cancer. Most of the patients (92.2%) resorted to religious and cultural approaches, and some patients (33.8%) used nutritional and herbal products besides medical treatment. The nutritional and herbal products used as remedy included stinging nettle (22.3%), fennel flower (20.1%), and herbal products that were advertised by herbalists in media (9.7%). It was determined that most of the patients resorting to complementary or alternative medicine were women (52.6%), housewife (51.5%), and patients with a history of cancer in the family (37.7%). Complementary and alternative medicine use as a remedy for cure is common among patients in Turkey. But when it is considered that many of these products had the potential to negatively affect cancer therapy, it is crucial that nurses providing care to cancer patients should be well informed about complementary therapies, be aware of the potential risks and benefits, and communicate openly with patients on their health care choices.
Costa, I; Conçalves, F
The treatment of intestinal obstruction (IO) in patients with advanced or terminal cancer represents an open and widely discussed topic in clinical oncology practice. As surgical palliation is a complex issue, the decision to advance with surgery should be made in consultation with the patients and family members. The prognostic factors, mainly the survival time and the surgical risks can be considered guideline indicators. If there is any possibility that surgery will be of benefit, the patient should be treated with intravenous fluids and nasogastric suction while appropriate radiological investigations are performed. When surgical intervention is contraindicated, symptomatic medical treatment should be started through continuous subcutaneous administration of analgesic and antiemetic drugs. Minor episodes of vomiting may occur, which do not trouble patients since the most distressing symptom, nausea, can be controlled. Dehydration may be avoided with a liquid diet in small quantities. In this way, it is possible to manage patients with IO for several weeks without the need of nasogastric suction or intravenous fluids. Percutaneous gastrostomy, nasogastric tube, or hypodermoclysis may be necessary for a small number of patients, principally with high obstruction, who have refractory symptoms.
Bender, Melinda; Clark, Maresha; Guevara, Enrique; Chee, Wonshik; Im, Eun-Ok
Health care inequities continue to plague African Americans. For African American cancer patients these inequities include access to health care, availability of treatment modalities, support groups, and participation in nursing cancer research. A support group setting is better for recruitment than a clinical setting. Referrals to the researcher from individuals who personally know the African American cancer patients generated the best response rates. If the researcher has no previous connection with the potential participant, interest in the study may be generated but recruitment is minimal or absent. Ethnically sensitive recruitment of African American cancer patients is therefore essential to improving participatory responses in cancer nursing research.
Burton-Chase, AM; Hovick, SR; Sun, CC; Boyd-Rogers, S; Lynch, PM; Lu, KH; Peterson, SK
We evaluated knowledge of gynecologic cancer screening recommendations, screening behaviors, and communication with providers among women with Lynch syndrome (LS). Women aged ≥25 years who were at risk for LS-associated cancers completed a semi-structured interview and a questionnaire. Of 74 participants (mean age 40 years), 61% knew the appropriate age to begin screening, 75–80% correctly identified the recommended screening frequency, and 84% reported no previous screening endometrial biopsy. Women initiated discussions with their providers about their LS cancer risks, but many used nonspecific terms or relied on family history. Most were not offered high-risk screening options. While many women were aware of risk-appropriate LS screening guidelines, adherence was suboptimal. Improving communication between women and their providers regarding LS-related gynecologic cancer risk and screening options may help improve adherence. PMID:23906188
Hannon, Peggy; Lloyd, Gareth P; Viswanath, K; Smith, Tenbroeck; Basen-Engquist, Karen; Vernon, Sally W; Turner, Gina; Hesse, Bradford W; Crammer, Corinne; von Wagner, Christian; Backinger, Cathy L
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 cancer communications 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.
Benoot, Charlotte; Bilsen, Johan; Grypdonck, Maria; Deschepper, Reginald
The social environment is an important determinant in the overall experience of having cancer. The purpose of this article is to identify how patients experience living alone during their cancer treatment. Using qualitative methods based on grounded theory techniques, we interviewed a sample of 32 cancer patients. Living alone was an ambiguous experience during cancer treatment: patients experienced both a lack of support as well a gain in privacy, freedom, and know-how. Living alone was also seen as a constitutive element of the patients' identity. Consequently, patients saw living alone as either a threat or as a resource for their adjustment to cancer treatment. These divergent meanings of living alone did share one common attribute, which was that staying independent was their key goal during cancer treatment. Health care providers should be attentive to the heterogeneous aspects of the experience of living alone when critically appraising the independence of patients.
Jansen, Jesse; van Weert, Julia; van der Meulen, Nienke; van Dulmen, Sandra; Heeren, Thea; Bensing, Jozien
Purpose: Remembering medical treatment information may be particularly taxing for older cancer patients, but to our knowledge this ability has never been assessed in this specific age group only. Our purpose in this study was to investigate older cancer patients' recall of information after patient education preceding chemotherapy. Design and…
Andreassen, Hege K; Trondsen, Marianne; Kummervold, Per Egil; Gammon, Deede; Hjortdahl, Per
The introduction of information and communication technology (ICT) into the patient-doctor relationship represents a significant change in modern health care. Communication via computers-e-mediated communication-is affecting the context of patient-doctor interaction, touching core elements of the relationship. Based on data from a qualitative study conducted among Norwegian patients who had used ICT to communicate with their doctors, the authors argue that patients' use of ICT and the element of trust in the patient-doctor relationship influence each other. Furthermore, they contend that patients' constructions of trust in this relationship can be understood in light of basic mechanisms in modern society. The study sheds light on some potential concerns and benefits as communication technology increasingly is integrated into the patient-doctor relationship.
Diette, Gregory B; Rand, Cynthia
Asthma is a common, chronic illness with substantial morbidity, especially for racial and ethnic minorities in the United States. The care of the patient with asthma is complex and depends ideally on excellent communication between patients and health-care providers. Communication is essential for the patient to communicate the severity of his or her illness, as well as for the health-care provider to instruct patients on pharmacologic and nonpharmacologic care. This article describes evidence for poor provider/patient communication as a contributor to health-care disparities for minority patients with asthma. Communication problems stem from issues with patients, health-care providers, and health-care systems. It is likely that asthma disparities can be improved, in part, by improving patient/provider communication. While much is known presently about the problem of patient/provider communication in asthma, there is a need to improve and extend the evidence base on the role of effective communication of asthma care and the links to outcomes for minorities. Additional studies are needed that document the extent to which problems with doctor/patient communication lead to inadequate care and poor outcomes for minorities with asthma, as well as mechanisms by which these disparities occur.
Carroll, Jennifer; Epstein, Ronald; Fiscella, Kevin; Gipson, Teresa; Volpe, Ellen; Jean-Pierre, Pascal
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. PMID:17337152
Miller, David C; McSparron, Jakob I; Clardy, Peter F; Sullivan, Amy M; Hayes, Margaret M
Effective communication between providers and patients and their surrogates in the intensive care unit (ICU) is crucial for delivery of high-quality care. Despite the identification of communication as a key education focus by the American Board of Internal Medicine, little emphasis is placed on teaching trainees how to effectively communicate in the ICU. Data are conflicting on the best way to teach residents, and institutions vary on their emphasis of communication as a key skill. There needs to be a cultural shift surrounding the education of medical residents in the ICU: communication must be treated with the same emphasis, precision, and importance as placing a central venous catheter in the ICU. We propose that high-stakes communications between physicians and patients or their surrogates must be viewed as a medical procedure that can be taught, assessed, and quality controlled. Medical residents require training, observation, and feedback in specific communication skill sets with the goal of achieving mastery. It is only through supervised training, practice in real time, observation, and feedback that medical residents can become skillful practitioners of communication in the ICU.
Claramita, Mora; Utarini, Adi; Soebono, Hardyanto; Van Dalen, Jan; Van der Vleuten, Cees
Doctor-patient communication has been extensively studied in non-Western contexts and in relation to patients' cultural and education backgrounds. This study explores the perceived ideal communication style for doctor-patient consultations and the reality of actual practice in a Southeast Asian context. We conducted the study in a teaching…
Huang, Dong-Sheng; Tao, Hou-Quan; He, Xu-Jun; Long, Ming; Yu, Sheng; Xia, Ying-Jie; Wei, Zhang; Xiong, Zikai; Jones, Sian; He, Yiping; Yan, Hai; Wang, Xiaoyue
Besides CDH1, few hereditary gastric cancer predisposition genes have been previously reported. In this study, we discovered two germline ATM mutations (p.Y1203fs and p.N1223S) in a Chinese family with a history of gastric cancer by screening 83 cancer susceptibility genes. Using a published exome sequencing dataset, we found deleterious germline mutations of ATM in 2.7% of 335 gastric cancer patients of different ethnic origins. The frequency of deleterious ATM mutations in gastric cancer patients is significantly higher than that in general population (p=0.0000435), suggesting an association of ATM mutations with gastric cancer predisposition. We also observed biallelic inactivation of ATM in tumors of two gastric cancer patients. Further evaluation of ATM mutations in hereditary gastric cancer will facilitate genetic testing and risk assessment.
Piderman, Katherine M.; Euerle, Terin T.; Frost, Marlene H.; Novotny, Paul J.; Rausch Osian, Sarah M.; Nes, Lise Solberg; Patten, Christi A.; Sloan, Jeff A.; Rummans, Teresa A.; Bronars, Carrie A.; Yang, Ping; Clark, Matthew M.
Patients with lung cancer report more disease burden and lower spiritual well-being (SWB) compared with other cancer patients. Understanding variables that lessen disease burden and improve SWB is essential. The aim of this study was to explore the relationship between motivational level for physical activity and SWB in patients with lung cancer. Linear regression showed increased SWB as stage of change for physical activity increased (p<0.0001), even after adjusting for multiple demographic variables. PMID:26463853
Mendes, I A; Trevizan, M A; Nogueira, M S; Sawada, N O
Nurse-patient communication has been a pre-established, unvarying, technical professional and impersonal form of manifestation, reflecting mainly the achievement of nurse's instrumental role. This situation is opposed to our nursing concept as well as to the professional values that we incorporated during our professional life, all of which emphasize the importance of the person and the patient and the meaning of the visualisation of care to a total human being. The present study aims at discussing this question, propitiating an opportunity of reflection about the necessity of humanizing this relationship in the Brazilian scenery. Thus, we focused on the importance of nurse-patient relationship not only as an essential component of nursing assistance but also as a treatment in itself. In addition, we stimulate nurses to examine the way they are taking care of human beings: as objects to be manipulated and treated or as persons that need care and comprehension. The article is concluded with the thesis that nursing is not a technical profession that manipulates knowledge and technologies but a work of valuing human beings, their freedom and dignity.
Varner, Ashley; Ellis, Erin; Ebner, Stephen; Moxley, John; Siegrist, Erika; Weng, David
Background and Purpose. The cost of illness in cancer care and the subsequent distress has attracted scrutiny. Guidelines recommend enhanced discussion of costs, assuming this will reduce both stress and costs. Little is known about patient attitudes about cost considerations influencing treatment decisions. Methods. A convenience-sample survey of patients currently receiving radiation and/or intravenous chemotherapy at an outpatient cancer center was performed. Assessments included prevalence and extent of financial burden, level of financial distress, attitudes about using costs to influence treatment decisions, and frequency or desirability of cost discussions with oncologists. Results. A total of 132 participants (94%) responded. Overall, 47% reported high financial stress, 30.8% felt well informed about costs prior to treatment, and 71% rarely spoke to their oncologists about cost. More than 71% of patients did not want either society’s or personal costs to influence treatment, and this result did not change based on degree of financial stress. Even when asked to assume that lower cost regimens were equally effective, only 28% would definitely want the lower cost regimen. Patients did not believe it was the oncologist’s duty to perform cost discussions. Conclusion. Even insured patients have a high degree of financial distress. Most, including those with the highest levels of distress, did not speak often with oncologists about costs and were strongly adverse to having cost considerations influence choice of regimen. The findings suggest that patients are not cost sensitive with regard to treatment decisions. Oncologists will require improved tools to have meaningful cost discussion, as recommended by the American Society of Clinical Oncology. Implications for Practice: This study raises important questions regarding optimal communication with patients about costs. If patients are not cost sensitive regarding treatment decisions, they will not be full
Shigli, Kamal; Awinashe, Vaibhav
Dentists are considered masters in technical skills and should be able to provide quick solutions to problems that can best be solved through communicating patiently with patients. Effective communication coupled with good clinical skills can lead to apt treatment and satisfaction for both the patient and the dentist. This article intends to highlight the communication skills that can improve the prognosis of complete denture treatment.
Smoczyk, C M; Zhu, W; Whatley, M H
The purpose of this study was to develop a valid and reliable instrument to assess cancer patients' preferences for all types of social support and organizational features of cancer support groups. The content of the instrument was the result of a detailed analysis of four resources: (1) literature relating to cancer support group interventions, (2) program materials from existing groups, (3) interviews with individuals who developed or directed groups, and (4) interviews with patients who have participated in cancer support groups. A jury of six experts was used to establish content validity of the instrument. The reliability of the instrument was examined by measuring a sample of 258 cancer patients. The reliability coefficients of the instrument were all above .80, except for two types of social support (instrumental and informational-educational), which were .72 and .78, respectively. It was concluded that the instrument produces valid and reliable measurements of cancer patients' preferences for cancer support groups.
Insights into the experiences of patients with cancer in London: framework analysis of free-text data from the National Cancer Patient Experience Survey 2012/2013 from the two London Integrated Cancer Systems
Wiseman, Theresa; Lucas, Grace; Sangha, Amrit; Randolph, Anuska; Stapleton, Sarah; Pattison, Natalie; O'Gara, Geraldine; Harris, Katherine; Pritchard-Jones, Kathy; Dolan, Shelley
Objective To shed light on experiences of patients with cancer in London National Health Service (NHS) trusts that may not be fully captured in national survey data, to inform improvement action plans by these trusts. Design Framework analysis of free-text data from 2012/2013 National Cancer Patient Experience Survey (NCPES) from the 2 London Integrated Cancer Systems. Setting and participants Patients with a cancer diagnosis treated by the NHS across 27 trusts in London. Main outcome measures Free-text data received from patients categorised into what patients found good about their cancer care and what could be improved. Methods Using Framework analysis, a thematic framework was created for 15 403 comments from over 6500 patients. Themes were identified across the London data set, by tumour group and by trust. Results Two-thirds of free-text comments from patients in London were positive and one-third of those related to the good quality of care those patients received. However, the majority of comments for improvement related to quality of care, with a focus on poor care, poor communication and waiting times in outpatient departments. Additionally, 577 patients (9% of those who returned free-text data in London) commented on issues pertaining to the questionnaire itself. Some patients who experienced care from multiple trusts were unclear on how to complete the questionnaire for the single trust whose care they were asked to comment on, others said the questions did not fit their experiences. Conclusions NCPES free-text analysis can shed light on the experiences of patients that closed questions might not reveal. It further indicates that there are issues with the survey itself, in terms of ambiguities in the questionnaire and difficulties in identifying patients within specific trusts. Both of these issues have the potential to contribute to knowledge and understanding of the uses and limitations of free-text data in improving cancer services. PMID:26482767
Sánchez-Lara, Karla; Ugalde-Morales, Emilio; Motola-Kuba, Daniel; Green, Dan
Cancer patients receiving chemotherapy have a high risk of malnutrition secondary to the disease and treatment, and 40-80 % of cancer patients suffer from different degrees of malnutrition, depending on tumour subtype, location, staging and treatment strategy. Malnutrition in cancer patients affects the patient's overall condition, and it increases the number of complications, the adverse effects of chemotherapy and reduces the quality of life. The aim of the present study was to evaluate weight-loss prevalence depending on the tumour site and the gastrointestinal (GI) symptoms of oncology patients receiving chemotherapy. We included 191 cancer patients receiving chemotherapy. Files of all patients were reviewed to identify symptoms that might potentially influence weight loss. The nutritional status of all patients was also determined. The cancer sites in the patients were as follows: breast (31·9 %); non-colorectal GI (18·3 %); colorectal (10·4 %); lung (5·8 %); haematological (13·1 %); others (20·5 %). Of these patients, 58 % experienced some degree of weight loss, and its prevalence was higher among the non-colorectal GI and lung cancer patients. Common symptoms included nausea (59·6 %), anorexia (46 %) and constipation (31·9 %). A higher proportion of patients with ≥ 5 % weight loss experienced anorexia, nausea and vomiting (OR 9·5, 2·15 and 6·1, respectively). In conclusion, these results indicate that GI symptoms can influence weight loss in cancer patients, and they should be included in early nutritional evaluations.
Park, Si-Woon; Yi, Sook-hee; Kim, Hyun-young; Jung, Seung-min
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
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.
Baird, Richard; Banks, Ian; Cameron, David; Chester, John; Earl, Helena; Flannagan, Mark; Januszewski, Adam; Kennedy, Richard; Payne, Sarah; Samuel, Emlyn; Taylor, Hannah; Agarwal, Roshan; Ahmed, Samreen; Archer, Caroline; Board, Ruth; Carser, Judith; Copson, Ellen; Cunningham, David; Coleman, Rob; Dangoor, Adam; Dark, Graham; Eccles, Diana; Gallagher, Chris; Glaser, Adam; Griffiths, Richard; Hall, Geoff; Hall, Marcia; Harari, Danielle; Hawkins, Michael; Hill, Mark; Johnson, Peter; Jones, Alison; Kalsi, Tania; Karapanagiotou, Eleni; Kemp, Zoe; Mansi, Janine; Marshall, Ernie; Mitchell, Alex; Moe, Maung; Michie, Caroline; Neal, Richard; Newsom-Davis, Tom; Norton, Alison; Osborne, Richard; Patel, Gargi; Radford, John; Ring, Alistair; Shaw, Emily; Skinner, Rod; Stark, Dan; Turnbull, Sam; Velikova, Galina; White, Jeff; Young, Alison; Joffe, Johnathan; Selby, Peter
The Association of Cancer Physicians in the United Kingdom has developed a strategy to improve outcomes for cancer patients and identified the goals and commitments of the Association and its members. PMID:26913066
Baird, Richard; Banks, Ian; Cameron, David; Chester, John; Earl, Helena; Flannagan, Mark; Januszewski, Adam; Kennedy, Richard; Payne, Sarah; Samuel, Emlyn; Taylor, Hannah; Agarwal, Roshan; Ahmed, Samreen; Archer, Caroline; Board, Ruth; Carser, Judith; Copson, Ellen; Cunningham, David; Coleman, Rob; Dangoor, Adam; Dark, Graham; Eccles, Diana; Gallagher, Chris; Glaser, Adam; Griffiths, Richard; Hall, Geoff; Hall, Marcia; Harari, Danielle; Hawkins, Michael; Hill, Mark; Johnson, Peter; Jones, Alison; Kalsi, Tania; Karapanagiotou, Eleni; Kemp, Zoe; Mansi, Janine; Marshall, Ernie; Mitchell, Alex; Moe, Maung; Michie, Caroline; Neal, Richard; Newsom-Davis, Tom; Norton, Alison; Osborne, Richard; Patel, Gargi; Radford, John; Ring, Alistair; Shaw, Emily; Skinner, Rod; Stark, Dan; Turnbull, Sam; Velikova, Galina; White, Jeff; Young, Alison; Joffe, Johnathan; Selby, Peter
The Association of Cancer Physicians in the United Kingdom has developed a strategy to improve outcomes for cancer patients and identified the goals and commitments of the Association and its members.
van Vliet, Liesbeth M; van der Wall, Elsken; Albada, Akke; Spreeuwenberg, Peter M M; Verheul, William; Bensing, Jozien M
When studying the patient perspective on communication, some studies rely on analogue patients (patients and healthy subjects) who rate videotaped medical consultations while putting themselves in the shoes of the video-patient. To describe the rationales, methodology, and outcomes of studies using video-vignette designs in which videotaped medical consultations are watched and judged by analogue patients. Pubmed, Embase, Psychinfo and CINAHL databases were systematically searched up to February 2012. Data was extracted on: study characteristics and quality, design, rationales, internal and external validity, limitations and analogue patients' perceptions of studied communication. A meta-analysis was conducted on the distribution of analogue patients' evaluations of communication. Thirty-four studies were included, comprising both scripted and clinical studies, of average-to-superior quality. Studies provided unspecific, ethical as well as methodological rationales for conducting video-vignette studies with analogue patients. Scripted studies provided the most specific methodological rationales and tried the most to increase and test internal validity (e.g. by performing manipulation checks) and external validity (e.g. by determining identification with video-patient). Analogue patients' perceptions of communication largely overlap with clinical patients' perceptions. The meta-analysis revealed that analogue patients' evaluations of practitioners' communication are not subject to ceiling effects. Analogue patients' evaluations of communication equaled clinical patients' perceptions, while overcoming ceiling effects. This implies that analogue patients can be included as proxies for clinical patients in studies on communication, taken some described precautions into account. Insights from this review may ease decisions about including analogue patients in video-vignette studies, improve the quality of these studies and increase knowledge on communication from the
The U.S. Food and Drug Administration's Expanded Access program allows patients with life-threatening diagnoses, such as advanced cancer, to use experimental medications without participating in clinical research (colloquially, "Compassionate Use"). Sixteen U.S. states recently passed "right-to-try" legislation aimed at promoting Expanded Access. Acknowledging popular support, Expanded Access could undermine clinical trials that benefit public health. Moreover, existing norms in oncologic care, for example, often lead patients to pursue intense treatments near the end of life, at the expense of palliation, and improved communication about the risks and benefits of Expanded Access would more often discourage its use.
Jeong, Hyun Yong
Background/Aims. To evaluate the incidence of gastric adenoma and gastric cancer in colorectal cancer patients, as well as the clinicopathological features that affect their incidence. Methods. Among patients who underwent surgery after being diagnosed with colorectal cancer between January 2004 and December 2013 at Chungnam National University Hospital, 142 patients who underwent follow-up upper gastrointestinal endoscopy were assigned to the patient group. The control group included 426 subjects randomly selected. The patient group was subdivided into two: one that developed gastric adenoma or cancer and one that did not. Clinicopathological characteristics were compared between these groups. Results. In total, 35 (24.6%) colorectal cancer patients developed a gastric adenoma or gastric cancer, which was higher than the number in the control group (20 [4.7%] patients; p < 0.001). Age, alcohol history, and differentiation of colorectal cancer were associated with higher risks of gastric adenoma or gastric cancer, with odds ratios of 1.062, 6.506, and 5.901, respectively. Conclusions. In colorectal cancer patients, screening with upper gastrointestinal endoscopy is important, even if no lesions are noted in the upper gastrointestinal tract at colorectal cancer diagnosis. Endoscopic screening is particularly important with increasing age, history of alcohol consumption, and poor cancer differentiation. PMID:28105047
Farhat, F.; Othman, A.; el Baba, G.; Kattan, J.
Background Disclosure of a cancer diagnosis to patients is a major problem for physicians in Lebanon. Our survey aimed to identify the attitudes of patients, families and friends, nurses, and physicians regarding disclosure of a cancer diagnosis. Methods Study participants included 343 physicians, nurses, cancer patients, families, and friends from clinics in two major hospitals in Lebanon. All completed a 29-item questionnaire that assessed, by demographic group, the information provided about cancer, opinions about the disclosure of the diagnosis to cancer patients, perceived consequences to patients, and the roles of family, friends, and religion. Results Overall, 7.8% of the patients were convinced that cancer is incurable. Nearly 82% preferred to be informed about their diagnosis. Similarly, 83% of physicians were in favour of disclosing a cancer diagnosis to their patients. However, only 14% of the physicians said that they revealed the truth to the patients themselves, with only 9% doing so immediately after confirmation of the diagnosis. Disclosure of a cancer diagnosis was preferred before the start of the treatment by 59% of the patients and immediately after confirmation of the diagnosis by 72% of the physicians. Overall, 86% of physicians, 51% of nurses, and 69% of patients and their families believed that religion helped with the acceptance of a cancer diagnosis. A role for family in accepting the diagnosis was reported by 74% of the patients, 56% of the nurses, and 88% of the physicians. All participants considered that fear was the most difficult feeling (63%) experienced by cancer patients, followed by pain (29%), pity (8%), and death (1%), with no statistically significant difference between the answers given by the participant groups. Conclusions The social background in Lebanese society is the main obstacle to revealing the truth to cancer patients. Lebanese patients seem to prefer direct communication of the truth, but families take the opposite
Moussas, G I; Papadopoulou, A G; Christodoulaki, A G; Karkanias, A P
Cancer may be localized in a variety of areas in the human body. This localization is associated with significant issues concerning not only therapy and prognosis but also psychological and psychiatric problems that the patient may be confronted with. The psychic impact on the patient is determined to a significant degree by the symbolism the affected organ carries. The symbolic significance of a sick body area triggers emotions and sets in motion self-defence mechanisms. In this way, patients deal with the new psychic reality that cancer creates. Therapeutic choices may include interventions, involving mutilation, which cause disfigurement and major consequences in the body image which result in narcissistic injuries. The phenomenology of anxiety and depressive disorders is connected to the affected body area. The appearance of cancer not only in sexual organs but also in other body areas, may disturb sexual function and therefore lead to sexual disorders. Especially, head and neck are connected with vital functions. This area of the body has had a major impact on psychic reality since early life. Complicated psychic functions have developed in relation to organs of the head and neck. Therefore, localization of cancer in this area leads to individual psychological and psychiatric problems, since eating and breathing are harmed, verbal communication becomes difficult and body image alters. Also, increased incidence of alcohol and nicotine abuse in these patients reflects special aspects of psychic structure and personality. Because of severe somatic symptoms and poor prognosis, lung cancer patients feel hopelessness and helplessness. Patients with gynaecological cancer are confronted with a disease that affects organs like breast and internal female sexual organs associated with femininity, attractiveness and fertility. Dietary habits are often a source of guilt for patients who suffer from cancer of the gastrointestinal tract. Additionally, stomas, as colostomy
Gregory, Larissa A.; Ricart, Rachel A.; Patel, Shyam A.; Lim, Philip K.; Rameshwar, Pranela
The failed outcome of autologous bone marrow transplantation for breast cancer opens the field for investigations. This is particularly important because the bone marrow could be a major source of cancer cells during tertiary metastasis. This review discusses subsets of breast cancer cells, including those that enter the bone marrow at an early period of disease development, perhaps prior to clinical detection. This population of cells evades chemotherapeutic damage even at high doses. An understanding of this population might be crucial for the success of bone marrow transplants for metastatic breast cancer and for the eradication of cancer cells in bone marrow. In vivo and in vitro studies have demonstrated gap junctional intercellular communication (GJIC) between bone marrow stroma and breast cancer cells. This review discusses GJIC in cancer metastasis, facilitating roles of mesenchymal stem cells (MSCs). In addition, the review addresses potential roles for miRNAs, including those already linked to cancer biology. The literature on MSCs is growing and their links to metastasis are beginning to be significant leads for the development of new drug targets for breast cancer. In summary, this review discusses interactions among GJIC, miRNAs and MSCs as future consideration for the development of cancer therapies. PMID:21886602
Anal Cancer; Colorectal Cancer; Esophageal Cancer; Extrahepatic Bile Duct Cancer; Gallbladder Cancer; Gastric Cancer; Head and Neck Cancer; Liver Cancer; Lung Cancer; Pancreatic Cancer; Small Intestine Cancer
Bezreh, Tanya; Laws, M Barton; Taubin, Tatiana; Rifkin, Dena E; Wilson, Ira B
Patients frequently do not take medicines as prescribed and often do not communicate with their physicians about their medication-taking behavior. The movement for "patient-centered" care has led to relabeling of this problem from "noncompliance" to "nonadherence" and later to a rhetoric of "concordance" and "shared decision making" in which physicians and patients are viewed as partners who ideally come to agreement about appropriate treatment. We conducted a qualitative content analysis of online comments to a New York Times article on low rates of medication adherence. The online discussion provides data about how a highly selected, educated sample of patients thinks about medication use and the doctor-patient relationship. Our analysis revealed patient empowerment and self-reliance, considerable mistrust of medications and medical practice, and frequent noncommunication about medication adherence issues. We discuss how these observations can potentially be understood with reference to Habermas's theory of communicative action, and conclude that physicians can benefit from better understanding the negative ways in which some patients perceive physicians' prescribing practices.
Li, Shaojun; Tian, Bole
Abstract Acute pancreatitis (AP) is a rare manifestation of pancreatic cancer (PC). The relationship between AP and PC remains less distinct. From January 2009 to November 2015, 47consecutive patients with PC who presented with AP were reviewed for this study. Clinical features, clinicopathologic variables, postoperative complications, and follow-up evaluations of patients were documented in detail from our database. In order to identify cutoff threshold time for surgery, receiver operating curve (ROC) was built according to patients with or without postoperative complications. Cumulative rate of survival was calculated by using the Kaplan–Meier method. The study was conducted in accordance with the principles of the Declaration of Helsinki and the guidelines of West China Hospital. This study included 35 men (74.5%) and 12 women (25.5%) (mean age: 52 years), with a median follow-up of 40 months. AP was clinically mild in 45 (95.7%) and severe in 2 (4.3%). The diagnosis of PC was delayed by 2 to 660 days (median 101 days). Thirty-nine (83.0%) cases underwent surgery. Eight (17.0%) cases performed biopsies only. Of 39 patients, radical surgery was performed in 32 (82.1%) cases and palliative in 7 (19.9%) cases. Two (8.0%) patients were needed for vascular resection and reconstruction. Postoperative complications occurred in 12 (30.8%) patients. About 24.5 days was the best cutoff point, with an area under curve (AUC) of 0.727 (P = 0.025, 95% confidence interval: 0.555–0.8999). The survival rate of patients at 1 year was 23.4%. The median survival in patients with vascular resection and reconstruction was 18 months, compared with 10 months in patients without vascular resection (P = 0.042). For the primary stage (T), Tix was identified in 3 patients, the survival of whom were 5, 28, 50 months, respectively. And 2 of them were still alive at the follow-up period. The severity of AP was mainly mild. Surgical intervention after 24.5 days may benefit for
Claramita, Mora; Utarini, Adi; Soebono, Hardyanto; Van Dalen, Jan; Van der Vleuten, Cees
Doctor-patient communication has been extensively studied in non-Western contexts and in relation to patients' cultural and education backgrounds. This study explores the perceived ideal communication style for doctor-patient consultations and the reality of actual practice in a Southeast Asian context. We conducted the study in a teaching hospital in Indonesia, using a qualitative and a quantitative design. In-depth interviews were conducted with ten internal medicine specialists, ten internal medicine residents, 16 patients in two groups based on education level and ten most senior medical students. The contributions of doctors and patients to the communication during consultations were observed and rated quantitatively by thirty internal medicine residents, 393 patients with different educational backgrounds and ten senior medical students. The 'informed and shared decision making' is the central observation in this quantitative study. The results of the interviews showed that Southeast Asian stakeholders are in favor of a partnership style of communication and revealed barriers to achieving this: doctors and patients are not prepared for a participatory style and high patient load due to an inefficient health care system does not allow sufficient time for this type of communication. The results of the quantitative study showed a sharp contrast between observed and ideal communication styles. A paternalistic style seems to prevail, irrespective of patients' educational background. We found a sharp conflict between ideal and reality concerning doctor-patient communication in a Southeast Asian context. Further studies should examine ways to change the prevailing communication style in the desired direction.
Elliott, Thomas E.; Elliott, Barbara A.; Regal, Ronald R.; Renier, Colleen M.; Haller, Irina V.; Crouse, Byron J.; Witrak, Martha T.; Jensen, Patricia B.
Significant barriers exist in the delivery of state-of-the-art cancer care to rural populations. Rural providers' knowledge and practices, their rural health care delivery systems, and linkages to cancer specialists are not optimal; therefore, rural cancer patient outcomes are less than achievable. Purpose: To test the effects of a strategy…
Dearing, James W.; Kreuter, Matthew W.
Objective The best innovations in cancer communication do not necessarily achieve uptake by researchers, public health and clinical practitioners, and policy makers. This paper describes design activities that can be applied and combined for the purpose of spreading effective cancer communication innovations. Methods A previously developed Push-Pull-Infrastructure Model is used to organize and highlight the types of activities that can be deployed during the design phase of innovations. Scientific literature about the diffusion of innovations, knowledge utilization, marketing, public health, and our experiences in working to spread effective practices, programs, and policies are used for this purpose. Results Attempts to broaden the reach, quicken the uptake, and facilitate the use of cancer communication innovations can apply design activities to increase the likelihood of diffusion. Some simple design activities hold considerable promise for improving dissemination and subsequent diffusion. Conclusion Augmenting current dissemination practices with evidence-based concepts from diffusion science, marketing science, and knowledge utilization hold promise for improving results by eliciting greater market pull. Practice Implications Inventors and change agencies seeking to spread cancer communication innovations can experience more success by explicit consideration of design activities that reflect an expanded version of the Push-Pull-Infrastructure Model. PMID:21067884
Brooks, Michael D.; Wicha, Max S.
Summary Communication between the diverse assortment of cells that constitute the tumor microenvironment plays an important role in tumor development. Using a p53 null mouse model, Zhang and colleagues describe a novel feedback loop involving breast cancer stem cells and their progeny mediated by Wnt2, CXCL12, and IL6. PMID:25941337
The purpose of the study is to modify a type of counseling called "Individual Meaning Centered Psychotherapy" to meet the needs of Chinese cancer patients. Many cancer patients use counseling or other resources to help cope with the emotional burden of their illnesses. Counseling often helps them cope with cancer by giving them a place to express their feelings. "Meaning-Centered" counseling aims to teach cancer patients how to maintain or even increase a sense of meaning and purpose in their lives, despite cancer. |
Wu, Xi; Wang, Zhinong; Hong, Bo; Shen, Shengjuan; Guo, Yan; Huang, Qinghai; Liu, Jianmin
Disease treatments have been significantly influenced by the communications between patients, their families, and doctors the lack of which may lead to malpractice allegations and complaints. In particular, inadequate communication may delay diagnosis and treatment. Therefore, for doctors communication and interpersonal skills, are as important as clinical skills and medical knowledge. In this study we intended to develop two detailed communication content checklists and a modified interpersonal skills inventory, aiming to evaluate their integrity in the midst of communication skills assessments, to provide feedback for some participants, and to observe their communication competence in both aspects PMID:25018623
Ha, Duc; Mazzone, Peter J; Ries, Andrew L; Malhotra, Atul; Fuster, Mark
The harm associated with lung cancer treatment include perioperative morbidity and mortality and therapy-induced toxicities in various organs, including the heart and lungs. Optimal treatment therefore entails a need for risk assessment to weigh the probabilities of benefits versus harm. Exercise testing offers an opportunity to evaluate a patient's physical fitness/exercise capacity objectively. In lung cancer, it is most often used to risk-stratify patients undergoing evaluation for lung cancer resection. In recent years, its use outside this context has been described, including in nonsurgical candidates and lung cancer survivors. In this article we review the physiology of exercise testing and lung cancer. Then, we assess the utility of exercise testing in patients with lung cancer in four contexts (preoperative evaluation for lung cancer resection, after lung cancer resection, lung cancer prognosis, and assessment of efficiency of exercise training programs) after systematically identifying original studies involving the most common forms of exercise tests in this patient population: laboratory cardiopulmonary exercise testing and simple field testing with the 6-minute walk test, shuttle walk test, and/or stair-climbing test. Lastly, we propose a conceptual framework for risk assessment of patients with lung cancer who are being considered for therapy and identify areas for further studies in this patient population.
Holt, Cheryl L.; Wynn, Theresa A.; Lewis, Ivey; Litaker, Mark S.; Jeames, Sanford; Huckaby, Francine; Stroud, Leonardo; Southward, Penny L.; Simons, Virgil; Lee, Crystal; Ross, Louis; Mitchell, Theodies
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…
Bayer, Darryl Lee
This research examined specific communication patterns in 20 schizophrenic and other family triads, through analysis of transcripts of 15-minute interactions within a systems epistemology. Families with a son or daughter diagnosed as having schizophrenia were found to emphasize two communication patterns: communication that is nebulous, confusing,…
Ports, Katie A; Reddy, Diane M; Barnack-Tavlaris, Jessica L
Research in primary care medicine demonstrates that health care providers' communication varies depending on their sex, and that these sex differences in communication can influence patients' health outcomes. The present study aimed to examine the extent to which sex differences in primary care providers' communication extend to the sensitive context of gynecological care for genital herpes and whether these potential sex differences in communication influence patients' herpes transmission prevention behaviors and herpes-related quality of life. Women (N = 123) from the United States recently diagnosed with genital herpes anonymously completed established measures in which they rated (a) their health care providers' communication, (b) their herpes transmission prevention behaviors, and (c) their herpes-related quality of life. The authors found significant sex differences in health care providers' communication; this finding supports that sex differences in primary care providers' communication extend to gynecological care for herpes. Specifically, patients with female health care providers indicated that their providers engaged in more patient-centered communication and were more satisfied with their providers' communication. However, health care providers' sex did not predict women's quality of life, a finding that suggests that health care providers' sex alone is of little importance in patients' health outcomes. Patient-centered communication was significantly associated with greater quality-of-life scores and may provide a promising avenue for intervention.
Minsky, Bruce D
In the past two decades, substantial progress has been made in the adjuvant management of colorectal cancer. Chemotherapy has improved overall survival in patients with node-positive (N+) disease. In contrast with colon cancer, which has a low incidence of local recurrence, patients with rectal cancer have a higher incidence requiring the addition of pelvic radiation therapy (chemoradiation). Patients with rectal cancer have a number of unique management considerations: for example, the role of short-course radiation, whether postoperative adjuvant chemotherapy is necessary for all patients, and if the type of surgery following chemoradiation should be based on the response rate. More accurate imaging techniques and/or molecular markers may help identify patients with positive pelvic nodes to reduce the chance of overtreatment with preoperative therapy. Will more effective systemic agents both improve the results of radiation as well as modify the need for pelvic radiation? This review will address these and other controversies specific to patients with rectal cancer.
Baranski, Jan; Sinno, Sammy
Background: Lung cancer is the most common cancer worldwide and the leading cause of cancer death. With the development of targeted therapy against causative driver mutations, some patients have experienced dramatic responses that have converted their disease into a chronic, stable form. Shifting concerns away from survival and back to quality-of-life issues has led some of these patients to seek aesthetic surgery. Methods: Three patient examples are presented to illustrate current lung cancer treatment modalities, disease responses, and subsequent experiences with aesthetic surgical procedures. Two patients presented for blepharoplasty and the third for revisional breast augmentation surgery. Results: Two patients were treated for lung cancer with targeted therapy and a third with more traditional chemotherapy before undergoing aesthetic surgery. All 3 patients experienced a normal recovery from surgery without any untoward results. Two remain free of disease and one has chronic stable disease. All have returned to normal, active lives. Conclusions: Recent developments in lung cancer treatment are transforming this entity into a less formidable diagnosis for some patients, much like breast cancer and prostate cancer. Plastic surgeons should be aware of this paradigm shift. Successfully treated patients should be considered as reasonable candidates for aesthetic surgery, particularly when they have the full support of their oncologist. Beyond the typical psychological benefits that plastic surgery can produce, it also provides affirmation in this patient population of a return to normalcy, thereby imparting hope and optimism for the future. PMID:27826480
Chou, Frank H-C; Tsai, Kuan-Yi; Wu, Hung-Chi; Shen, Shih-Pei
People with schizophrenia, who constitute approximately 0.3-1% of the general population, have a nearly 20% shorter life expectancy than the general population. The incidence of varied types of cancers in patients with schizophrenia is controversial. The majority of previous research has demonstrated that patients who have schizophrenia and cancer have early mortality compared to the general population with cancer. The causes of early mortality in patients with schizophrenia and cancer might be attributed to a lower cancer screening rate and lack of effective treatment, including: (i) patient factors, such as poor lifestyle, passive attitude toward treatment, or comorbidity; (ii) physician factors, such as physician bias, which may decrease the delivery of care for individuals with mental disorders; and (iii) hospital administration factors, such as stigma and discrimination. Additional studies on patients with schizophrenia and cancer are warranted and should include the following: a comprehensive review of previous studies; a focus on differentiating the specific types of cancer; and methods for improvement. To decrease the early mortality of patients with schizophrenia, the following measures are proposed: (i) enhance early detection and early treatment, such as increasing the cancer screening rate for patients with schizophrenia; (ii) provide effective, timely treatment and rehabilitation; (iii) improve patients' psychiatric symptoms and cognitive impairment; (iv) promote healthy behavior in the general population and emphasize healthy lifestyles in vulnerable populations; and (v) remove the stigma of schizophrenia. To reduce disparities in physical health, public health strategies and welfare policies must continue to focus on this group of patients.
Yamasaki, Yasushi; Matsushima, Masashi; Tanaka, Hisae; Tajiri, Sakurako; Fukuda, Ryuki; Ozawa, Hideki; Takagi, Atsushi; Hirabayashi, Ken-ichi; Sadahiro, Sohtaro
An 81-year-old woman presented with a chief complaint of swelling of both lower legs. She had a history of surgery for cancers of the stomach, rectum and colon. Among her immediate family members, her son had colon and rectal cancers, and her sister had ovarian cancer. After close examination the patient was diagnosed with small intestine cancer and ascending colon cancer. Gene mutation analyses did not reveal any mutations in DNA mismatch repair genes, but MSH-2 protein expression was lost only in the cancer lesions. Here, we report this rare case of eight metachronous gastrointestinal cancers thought to be HNPCC.
Makarem, Nisrine N.; Antoun, Jumana
Background Email communication between physicians and patients could improve access to and delivery of health care. Most of the literature studies about email communication between physicians and patients have been conducted in developing countries. Therefore, this study aims to analyze the practices, attitudes, and barriers of both physicians’ and patients’ use of email within the same health care setting of a developing country. Methods A cross-sectional paper-based survey was conducted among 39 physicians and 500 patients at the Family Medicine clinics of the American University of Beirut, a tertiary academic medical center. Results Most of the surveyed patients and physicians reported that they would like to communicate through email and agreed that it is useful. However, only 19% of the patients have ever communicated with their physicians via email, and only 5.1% of physicians have often communicated with their patients via email. Almost half of the patients surveyed were unaware of the possibility of this form of communication, and only 17% reported that their physician offered them his or her email address. In addition, physicians and patients did not agree on the services to be provided by email communication. For instance, almost half of the patients indicated consultation for an urgent medical matter as suitable for email communication. Conclusion The use of email communication in health care is still scarce. Patients and physicians have different perspectives of its use and importance. Further rigorous research is needed to clarify the advantages and disadvantages of this form of communication, especially in the developing world. Interested physicians are encouraged to establish appropriate personal policies for email communication with adequate announcement and patient education plans. PMID:27855773
Lyatskaya, Yulia; James, Steven; Killoran, Joseph H.; Soto, Ricardo; Mamon, Harvey J.; Chin, Lee
Purpose: To evaluate the utility of an infrared-guided patient setup (iGPS) system to reduce the uncertainties in the setup of lung cancer patients. Methods and Materials: A total of 15 patients were setup for lung irradiation using skin tattoos and lateral leveling marks. Daily electronic portal device images and iGPS marker locations were acquired and retrospectively reviewed. The iGPS-based shifts were compared with the daily electronic portal device image shifts using both the central axis iGPS marker and all five iGPS markers. For shift calculation using the five markers, rotational misalignment was included. The level of agreement between the iGPS and portal imaging to evaluate the setup was evaluated as the frequency of the shift difference in the range of 0-5 mm, 5-10 mm, and >10 mm. Results: Data were obtained for 450 treatment sessions for 15 patients. The difference in the isocenter shifts between the weekly vs. daily images was 0-5 mm in 42%, 5-10 mm in 30%, and >10 mm in 10% of the images. The shifts seen using the iGPS data were 0-5 mm in 81%, 5-10 mm in 14%, and >10 mm in 5%. Using only the central axis iGPS marker, the difference between the iGPS and portal images was <5 mm in 77%, 5-10 mm in 16%, and >10 mm in 7% in the left-right direction and 73%, 18%, and 9% in the superoinferior direction, respectively. When all five iGPS markers were used, the disagreements between the iGPS and portal image shifts >10 mm were reduced from 7% to 2% in the left-right direction and 9% to 3% in the superoinferior direction. Larger reductions were also seen (e.g., a reduction from 50% to 0% in 1 patient). Conclusion: The daily iGPS-based shifts correlated well with the daily electronic portal device-based shifts. When patient movement has nonlinear rotational components, a combination of surface markers and portal images might be particularly beneficial to improve the setup for lung cancer patients.
NCI scientists have studied cells of patients with an extremely rare genetic disease that is characterized by drastic premature aging and discovered a new protective cellular mechanism against cancer. They found that cells from patients with Hutchinson Gi
Patients with advanced, recurrent, or persistent cervical cancer that was not curable with standard treatment who received the drug bevacizumab (Avastin) lived 3.7 months longer than patients who did not receive the drug, according to an interim analysis
Kreuter, Matthew W; Green, Melanie C; Cappella, Joseph N; Slater, Michael D; Wise, Meg E; Storey, Doug; Clark, Eddie M; O'Keefe, Daniel J; Erwin, Deborah O; Holmes, Kathleen; Hinyard, Leslie J; Houston, Thomas; Woolley, Sabra
Narrative forms of communication-including entertainment education, journalism, literature, testimonials, and storytelling-are emerging as important tools for cancer prevention and control. To stimulate critical thinking about the role of narrative in cancer communication and promote a more focused and systematic program of research to understand its effects, we propose a typology of narrative application in cancer control. We assert that narrative has four distinctive capabilities: overcoming resistance, facilitating information processing, providing surrogate social connections, and addressing emotional and existential issues. We further assert that different capabilities are applicable to different outcomes across the cancer control continuum (e.g., prevention, detection, diagnosis, treatment, survivorship). This article describes the empirical evidence and theoretical rationale supporting propositions in the typology, identifies variables likely to moderate narrative effects, raises ethical issues to be addressed when using narrative communication in cancer prevention and control efforts, and discusses potential limitations of using narrative in this way. Future research needs based on these propositions are outlined and encouraged.
Oh, Hyun Jung; Lee, Byoungkwan
In the context of diabetes, this study tested a mechanism through which Korean diabetes patients' exchange of computer-mediated social support (CMSS) in diabetes online communities influences their sense of empowerment and intention to actively communicate with the doctor. Analysis of data from 464 Korean diabetes patients indicates significant relationships among diabetes patients' online community activities, perceived CMSS, sense of empowerment, and their intention to actively communicate with the doctor. Diabetes patients who have engaged more in online community activities perceived greater social support from other members of the community. Perceived CMSS significantly predicted their intention to actively communicate with the doctor through sense of empowerment. Sense of empowerment was a valid underlying mechanism that explains how patients' perceived CMSS influences their intention to actively communicate with the doctor. The implications for health communication research and practice are discussed.
Geifman, Nophar; Butte, Atul J
Open clinical trial data offer many opportunities for the scientific community to independently verify published results, evaluate new hypotheses and conduct meta-analyses. These data provide a springboard for scientific advances in precision medicine but the question arises as to how representative clinical trials data are of cancer patients overall. Here we present the integrative analysis of data from several cancer clinical trials and compare these to patient-level data from The Cancer Genome Atlas (TCGA). Comparison of cancer type-specific survival rates reveals that these are overall lower in trial subjects. This effect, at least to some extent, can be explained by the more advanced stages of cancer of trial subjects. This analysis also reveals that for stage IV cancer, colorectal cancer patients have a better chance of survival than breast cancer patients. On the other hand, for all other stages, breast cancer patients have better survival than colorectal cancer patients. Comparison of survival in different stages of disease between the two datasets reveals that subjects with stage IV cancer from the trials dataset have a lower chance of survival than matching stage IV subjects from TCGA. One likely explanation for this observation is that stage IV trial subjects have lower survival rates since their cancer is less likely to respond to treatment. To conclude, we present here a newly available clinical trials dataset which allowed for the integration of patient-level data from many cancer clinical trials. Our comprehensive analysis reveals that cancer-related clinical trials are not representative of general cancer patient populations, mostly due to their focus on the more advanced stages of the disease. These and other limitations of clinical trials data should, perhaps, be taken into consideration in medical research and in the field of precision medicine.
Li, Yue; Zhang, Zhaolei
Carcinogenesis consists of oncogenesis and metastasis, and intriguingly microRNAs (miRNAs) are involved in both processes. Although aberrant miRNA activities are prevalent in diverse tumor types, the exact mechanisms for how they regulate cancerous processes are not always clear. To this end, we performed a large-scale pan-cancer analysis via a novel probabilistic approach to infer recurrent miRNA-target interactions implicated in 12 cancer types using data from The Cancer Genome Atlas. We discovered ~20,000 recurrent miRNA regulations, which are enriched for cancer-related miRNAs/genes. Notably, miRNA 200 family (miR-200/141/429) is among the most prominent miRNA regulators, which is known to be involved in metastasis. Importantly, the recurrent miRNA regulatory network is not only enriched for cancer pathways but also for extracellular matrix (ECM) organization and ECM-receptor interactions. The results suggest an intriguing cancer mechanism involving miRNA-mediated cell-to-cell communication, which possibly involves delivery of tumorigenic miRNA messengers to adjacent cells via exosomes. Finally, survival analysis revealed 414 recurrent-prognostic associations, where both gene and miRNA involved in each interaction conferred significant prognostic power in one or more cancer types. Together, our comprehensive pan-cancer analysis provided not only biological insights into metastasis but also brought to bear the clinical relevance of the proposed recurrent miRNA-gene associations.
Li, Yue; Zhang, Zhaolei
Carcinogenesis consists of oncogenesis and metastasis, and intriguingly microRNAs (miRNAs) are involved in both processes. Although aberrant miRNA activities are prevalent in diverse tumor types, the exact mechanisms for how they regulate cancerous processes are not always clear. To this end, we performed a large-scale pan-cancer analysis via a novel probabilistic approach to infer recurrent miRNA-target interactions implicated in 12 cancer types using data from The Cancer Genome Atlas. We discovered ~20,000 recurrent miRNA regulations, which are enriched for cancer-related miRNAs/genes. Notably, miRNA 200 family (miR-200/141/429) is among the most prominent miRNA regulators, which is known to be involved in metastasis. Importantly, the recurrent miRNA regulatory network is not only enriched for cancer pathways but also for extracellular matrix (ECM) organization and ECM-receptor interactions. The results suggest an intriguing cancer mechanism involving miRNA-mediated cell-to-cell communication, which possibly involves delivery of tumorigenic miRNA messengers to adjacent cells via exosomes. Finally, survival analysis revealed 414 recurrent-prognostic associations, where both gene and miRNA involved in each interaction conferred significant prognostic power in one or more cancer types. Together, our comprehensive pan-cancer analysis provided not only biological insights into metastasis but also brought to bear the clinical relevance of the proposed recurrent miRNA-gene associations.
Imparting the bad news has become a hard task for the doctor, and is usually perceived as unpleasant by the patient to whom the bad news is revealed. It is vital that the physician's approach be tailored to the cancer patient's personality. Gathering by the informing process protocols already suggested the hardest step for the doctors to take is empathic understanding which, presupposes tailoring to the individual's needs. The aim of this article was to describe the self-sacrificing type of personality thoroughly, so that any physician can make a diagnosis and tailor the information strategy to their needs. As method of research was used the qualitative method through groups with doctors and nurses, while research within groups lasted for 5 years. Assessing the denial mechanism is hard for a person that regards disease as punishment and propitiation. The physician must mobilize his countertransference, the sense he gets from the discussions with the patient and their overall communication. If he finds that the patient has self-control, then the approach of imparting the news resembles that of the controlling-orderly personality. If he ascertains that the patient has a lasting embarrassment, he should be more careful and impart the news gradually, his approach resembling that of the dependent person.
Zhang, Amy Y.; Gary, Faye; Zhu, Hui
Background Accurately assessing depression in African American cancer patients is difficult because of the similarities of physical symptoms observed in cancer and depression. Aim To identify universal and distinctive depressive symptoms in African American cancer patients. Methods Seventy-four cancer patients (34 depressed and 23 nondepressed African Americans, and 17 depressed Whites) were interviewed. Qualitative and quantitative analyses were conducted. Results Compared to nondepressed African Americans, depressed African Americans reported irritability, social isolation, insomnia, fatigue, and crying (p ≤ .05) more frequently over time. Compared to depressed Whites, they reported sadness, frustration, and intrusive thoughts less frequently (p ≤ .05), but insomnia and fatigue more frequently (p ≤ .05) during cancer treatment. There was little racial difference at the time of interview. Conclusion Depressed African American cancer patients may benefit from more culturally sensitive depression measures that consider symptoms of irritability, social isolation, and altered expressions of depressive mood. PMID:25564890
Anal Cancer; Colorectal Cancer; Esophageal Cancer; Extrahepatic Bile Duct Cancer; Gallbladder Cancer; Gastric Cancer; Gastrointestinal Carcinoid Tumor; Liver Cancer; Pancreatic Cancer; Small Intestine Cancer
Matsuyama, Robin K.; Grange, Christina; Lyckholm, Laurie J.; Utsey, Shawn O.; Smith, Thomas J.
PURPOSE: This exploratory study examined perceptions and beliefs of African Americans and Caucasians related to cancer care. Understanding belief systems and cultures optimizes cancer treatment and care delivery to ethnic minority individuals. PATIENTS AND METHODS: Focus groups were conducted with 39 African-American and Caucasian cancer patients. Data analysis included whole group analysis with a team of five researchers. RESULTS: Regardless of ethnicity, cancer patients share many of the same emotions and experiences, and want complete information and quality care. Differences were also apparent. African-American participants were more likely to report increased religious behaviors, believe that healthcare providers demonstrate care with simple actions and provision of practical assistance, and use church and community information sources. Caucasian participants were more likely to report spiritual but not overtly religious changes, and depend on healthcare providers for information. CONCLUSION: Understanding how culture colors perceptions, communication and information requirements is critical to providing effective care to ethnically diverse cancer patients. Findings have implications for professionals understanding ways patients seek information, the role of spirituality and religion in care, and ways healthcare providers demonstrate care. PMID:17987914
Simonetti, Luigi; Di Paola, Francesco; Leonardi, Marco
The authors empirically evaluated the context of intra-procedural physician-patient communication during imaging-guided procedures in a radiology/neuroradiology interventional clinical framework. Different intra-procedural communicative scenarios are reported. They conclude that the quality of intra-procedural physician-patient communication should be considered an important element of individual and team ethical and professional behaviour, able to strongly influence the therapeutic alliance. As for the whole medical communication strategy, an approach which takes into account the psychological and cultural background of the individual patient is preferred. PMID:26261155
A nursing incentive directed toward enhanced communication, performance improvement, patient safety, and patient satisfaction was initiated by the staff nurses in an endoscopy unit of a 714-bed specialized teaching hospital. Data were collected from approximately 1,800 ambulatory patients using a hands-off communication tool. The population was evenly divided between males and females. The goals of the data collection focused on the utilization of a medical questionnaire given to patients prior to elective procedures. The purpose of this initial study was to ascertain whether the questionnaires contributed to patients' communication regarding their health record while facilitating the admission/assessment phase of undergoing an elective endoscopy procedure. The medical questionnaire also served as a patient education tool whereby staff promoted the importance of safe medication administration. The initiative will remain ongoing and future studies will monitor and identify areas needed for performance improvement, patient safety, and enhanced communication. Patient satisfaction is measured using Press Ganey results.
Stouffer, Donald D.
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. Effective communication between the several programs, NASA Headquarters, and NASA field centers also is required. Further, communication among the above program elements, industry, local and state government, and the public also are necessary for meeting program objectives.
Bal, Manjit Singh; Bodal, Vijay Kumar; Kaur, Jaspreet; Kaur, Mohanvir; Sharma, Swati
The State of Punjab has been in focus because of aperceived increasing rate of cancer. Both print and electronic media have created an impression that Punjab, especially the cotton belt of Malwa Region, has become a high incidence cancer region. Actually the increased number of cancer patients might be at least partly because of increasing population and heightened health awareness and reporting. The purpose of this study is to find out the pattern of cancer amongst patients registered in Mukh Mantri Punjab Cancer Rahat Kosh Scheme (MMPCRKS), under cancer registry at Rajindra Hospital Patiala from the various districts of Punjab. The study covers 500 cancer patients registered under MMPCRKS at Rajindra Hospital Patiala, for free cancer treatment. Information regarding age, gender, religion, method of diagnosis and affected sites was obtained. Results were analyzed statistically. Of the 500 patients, 65% were females and 35% were males. The most affected female age groups were 50-54 and 60-64; while males in the age groups of 65-69 and 60-64 had the highest risk. The leading cancers in females were breast followed by cervix and ovary where as in males they were were colon followed by esophagus and tongue. The commonest histological type was adenocarcinoma followed by squamous cell carcinoma. The increasing trend of cancer in Punjab is alarming. Since this study is a preliminary investigation, it could provide a leading role in prevention, treatment and future planning regarding cancer in Punjab.
Quality of Life Among Breast Cancer Patients 5b. GRANT NUMBER DAMD17-03-1-0264 5c. PROGRAM...used approach to manage hot flashes with 44.2% of sample currently exercising . 15. SUBJECT TERMS Breast Cancer , Hot Flashes, Quality of Life ... breast cancer patients who were menopausal prior to treatment, at any of the time-points. b. to examine longitudinally the quality of life
An informal introduction to the study of communication deals with the major topics in the field. It presents basic theories of communication and language, reviews how language takes on meaning, explains the stimulus-response and Piaget theories of learning, and presents major theories dealing with communications and society. These theories include…
Bernard, Mathieu; de Roten, Yves; Despland, Jean-Nicolas; Stiefel, Friedrich
The aim of this exploratory study was to assess the impact of clinicians' defense mechanisms-defined as self-protective psychological mechanisms triggered by the affective load of the encounter with the patient-on adherence to a communication skills training (CST). The population consisted of oncology clinicians (N=31) who participated in a CST. An interview with simulated cancer patients was recorded prior and 6 months after CST. Defenses were measured before and after CST and correlated with a prototype of an ideally conducted interview based on the criteria of CST-teachers. Clinicians who used more adaptive defense mechanisms showed better adherence to communication skills after CST than clinicians with less adaptive defenses (F(1, 29) =5.26, p=0.03, d=0.42). Improvement in communication skills after CST seems to depend on the initial levels of defenses of the clinician prior to CST. Implications for practice and training are discussed. Communication has been recognized as a central element of cancer care . Ineffective communication may contribute to patients' confusion, uncertainty, and increased difficulty in asking questions, expressing feelings, and understanding information [2, 3], and may also contribute to clinicians' lack of job satisfaction and emotional burnout . Therefore, communication skills trainings (CST) for oncology clinicians have been widely developed over the last decade. These trainings should increase the skills of clinicians to respond to the patient's needs, and enhance an adequate encounter with the patient with efficient exchange of information . While CSTs show a great diversity with regard to their pedagogic approaches [6, 7], the main elements of CST consist of (1) role play between participants, (2) analysis of videotaped interviews with simulated patients, and (3) interactive case discussion provided by participants. As recently stated in a consensus paper , CSTs need to be taught in small groups (up to 10
Eliott, Jaklin A; Olver, Ian N
Within developed nations, there is increasing public debate about and apparent endorsement of the appropriateness of euthanasia as an autonomous choice to die in the face of intolerable suffering. Surveys report socio-demographic differences in rates of acceptance of euthanasia, but there is little in-depth analysis of how euthanasia is understood and positioned within the social and moral lives of individuals, particularly those who might be considered suitable candidates-for example, terminally-ill cancer patients. During discussions with 28 such patients in Australia regarding medical decisions at the end of life, euthanasia was raised by 13 patients, with the others specifically asked about it. Twenty-four patients spoke positively of euthanasia, 19 of these voicing some concerns. None identified euthanasia as a currently favoured option. Four were completely against it. Endorsement for euthanasia was in the context of a hypothetical future or for a hypothetical other person, or temporally associated with acute pain. Arguments supporting euthanasia framed the issue as a matter of freedom of choice, as preserving dignity in death, and as curbing intolerable pain and suffering, both of the patient and of those around them. A common analogy featured was that of euthanising a dog. These arguments were typically presented as self-evident justification for euthanasia, construed as an appropriate choice to die, with opposers positioned as morally inferior or ignorant. The difficulties of ensuring 'choice' and the moral connotations of 'choosing to die,' however, worked to problematise the appropriateness of euthanising specific individuals. We recommend further empirical investigation of the moral and social meanings associated with euthanasia.
Award Number: W81XWH-12-C-0126 TITLE: A Cooperative Communication System for the Advancement of Safe, Effective, and Efficient Patient Care...DATES COVERED 15Aug2014 – 14Aug2015 4. TITLE AND SUBTITLE A Cooperative Communication System for the Advancement of Safe, Effective, and Efficient ...J. (2015, January). Developing a Cooperative Communication System for Safe, Effective, and Efficient Patient Care. Society of Critical Care Medicine
Walsh, T D; Bowman, K B; Jackson, G P
A state registered dietitian assessed the voluntary dietary intake of 13 advanced cancer inpatients on one ward of St. Christopher's Hospice for five consecutive days. There were 11 females, two males; median age 74 years (range 56 to 83). Two patients died on the fourth day of the study. A partially individualised weighed technique was used. Standard sized scoops and spoons were used to serve the food in small, medium or large standard portions (depending on appetite) and were weighed as served. Individual plate waste (by weight) was subtracted to give estimated individual intake. Foods provided by visitors was not included. The median and range of individual mean daily intakes (estimated) were: energy 5760 (938-8945) kJ, 1376 (224-2137) kcal; protein 44 (11-86) g; fat 52 (9-93) g; carbohydrate 169 (21-194) g; calcium 748 (268-1457) mg; iron 4.8 (0.5-21.0) mg; dietary fibre 5.0 (0.5-21.0) g. Compared to recommended amounts, energy, iron and dietary fibre intakes were low; calcium intake was high. Nutritional status may affect prognosis and/or subjective well-being in advanced cancer. The value of nutritional supplementation and the role of appetite stimulants in improving nutritional status needs investigation.
Bylund, Carma L.; D'Agostino, Thomas A.; Ho, Evelyn Y.; Chewning, Betty A.
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…
O'Halloran, Robyn; Worrall, Linda; Hickson, Louise
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…
Guiton, Gretchen; Hodgson, Carol S.; Delandshere, Ginett; Wilkerson, Luann
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)…
Lisper, Lotta; Isacson, Dag; Sjoden, Per-Olow; Bingefors, Kerstin
Hypertensive patients (N=21) were interviewed regarding their views and experience of information and communication with respect to antihypertensive medicines. Patients' attitudes toward hypertension and antihypertensive drugs, communication with pharmacist and physician, perceptions of drug information, and the information environment are…
Javed, Saba; Javed, Syed A; Mays, Rana M; Tyring, Stephen K
Skin cancer in darker skin is associated with considerable morbidity and mortality. We sought to assess the clinical characteristics of cutaneous malignancy amongst Hispanic skin cancer patients and compare them to age-matched non-Hispanic Caucasians. In this retrospective study, 150 Hispanic skin cancer patients were identified from electronic medical records and age-matched to 150 non-Hispanic Caucasian controls with skin cancer. The incidence of actinic keratoses (AKs) in Hispanic skin cancer patients (34.0%) was statistically lower than age-matched non-Hispanic Caucasian skin cancer controls (61.3%, P <0.001; odds ratio, 3.08; 95% confidence interval, 1.92 - 4.93). Moreover, non-Hispanic Caucasian SCC (squamous cell cancer) controls were much more likely to report AKs (36.1%, P = 0.003) than Hispanic SCC patients (25.0%, P = 0.19). This study illustrates a lower incidence of AKs in Hispanic skin cancer patients as compared to their age-matched non-Hispanic Caucasians. The Hispanic skin malignancies present at a more advanced state and there is usually a lack of awareness in such cases. Therefore, patient knowledge and education is crucial for early detection and prevention of skin cancer in the Hispanic population.
Zhou, Eric S.; Nekhlyudov, Larissa
There is a large and growing population of long-term cancer survivors. Primary care physicians (PCPs) are playing an increasingly greater role in the care of these patients across the continuum of cancer survivorship. In this role, PCPs are faced with the responsibility of managing a range of medical and psychosocial late effects of cancer treatment. In particular, the sexual side effects of treatment which are common and have significant impact on quality of life for the cancer survivor, often go unaddressed. This is an area of clinical care and research that has received increasing attention, highlighted by the presentation of this special issue on Cancer and Sexual Health. The aims of this review are 3-fold. First, we seek to overview common presentations of sexual dysfunction related to major cancer diagnoses in order to give the PCP a sense of the medical issues that the survivor may present with. Barriers to communication about sexual health issues between patient/PCPs in order are also described in order to emphasize the importance of PCPs initiating this important conversation. Next, we provide strategies and resources to help guide the PCP in the management of sexual dysfunction in cancer survivors. Finally, we discuss case examples of survivorship sexual health issues and highlight the role that a PCP can play in each of these case examples. PMID:26816826
Few studies have investigated what information women from minority immigrant groups need about breast cancer and screening. Nor has much research been conducted about how such women would prefer to receive this information. Mere translation of breast cancer and screening information from generic materials, without considering and respecting women's unique historical, political, and cultural experiences, is insufficient. This study explored breast cancer and screening information needs and preferred methods of communication among Iranian immigrant women. A convenience sample of 50 women was recruited and interviewed over a 4-month period (June-September 2008); all resided in Toronto Canada, and had no history of breast cancer. Tape-recorded interviews were transcribed and analysed using a thematic analysis technique. While generic breast health communication focusing on physiological risk information meets some of the needs of Iranian immigrant women, results showed that the needs of this group go beyond this basic information. This group is influenced by historical, sociopolitical, and cultural experiences pre- and post-immigration. Their experiences with chemical war, unsafe physical environment (air and water pollution), and their sociopolitical situation appear to have limited their access to accurate and reliable breast cancer and screening information in their homeland. Moreover, the behavioural and psychosocial changes they face after immigration appear to have a strong influence on their breast cancer and screening information needs. Considering their limited time due to their multiple demands post-migration, multi-media methods were highly preferred as a communication means by this group. The results of this study can be used to guide the design and implementation of culturally sensitive breast health information. For instance, video presentations conducted by a trusted Iranian healthcare professional focusing on socioculturally relevant breast cancer risk
Marcus, Alfred C; Diefenbach, Michael A; Stanton, Annette L; Miller, Suzanne M; Fleisher, Linda; Raich, Peter C; Morra, Marion E; Perocchia, Rosemarie Slevin; Tran, Zung Vu; Bright, Mary Anne
The authors describe 3 large randomized trials from the Cancer Information Service Research Consortium. Three web-based multimedia programs are being tested to help newly diagnosed prostate (Project 1) and breast cancer patients (Project 2) make informed treatment decisions and breast cancer patients prepare for life after treatment (Project 3). Project 3 also tests a telephone callback intervention delivered by a cancer information specialist. All participants receive standard print material specific to each project. Preliminary results from the 2-month follow-up interviews are reported for the initial wave of enrolled participants, most of whom were recruited from the Cancer Information Service (1-800-4-CANCER) telephone information program (Project 1: n =208; Project 2: n =340; Project 3: n =792). Self-reported use of the multimedia program was 51%, 52%, and 67% for Projects 1, 2, and 3, respectively. Self-reported use of the print materials (read all, most, or some) was 90%, 85%, and 83% for Projects 1, 2, and 3, respectively. The callback intervention was completed by 92% of Project 3 participants. Among those using the Cancer Information Service Research Consortium interventions, perceived usefulness and benefit was high, and more than 90% reported that they would recommend them to other cancer patients. The authors present 5 initial lessons learned that may help inform future cancer communications research.
Tas, Faruk; Kilic, Leyla; Duranyildiz, Derya
Activated coagulation and fibrinolytic system in cancer patients is associated with tumor stroma formation and metastasis in different cancer types. The aim of this study is to explore the correlation of blood coagulation assays for various clinicopathologic factors in breast cancer patients. A total of 123 female breast cancer patients were enrolled into the study. All the patients were treatment naïve. Pretreatment blood coagulation tests including PT, APTT, PTA, INR, D-dimer, fibrinogen levels, and platelet counts were evaluated. Median age of diagnosis was 51 years old (range 26-82). Twenty-two percent of the group consisted of metastatic breast cancer patients. The plasma level of all coagulation tests revealed statistically significant difference between patient and control group except for PT (p<0.001 for all variables except for PT; p=0.08). Elderly age (>50 years) was associated with higher D-dimer levels (p=0.003). Metastatic patients exhibited significantly higher D-dimer values when compared with early breast cancer patients (p=0.049). Advanced tumor stage (T3 and T4) was associated with higher INR (p=0.05) and lower PTA (p=0.025). In conclusion, coagulation tests show significant differences in patients with breast cancer.
Communication with the patient and within the team is a critical factor that can influence the treatment outcome, especially in complex and multidisciplinary dental treatments. Indeed, effective communication, not focused on marketing but on proper information of the patient's intraoral situation, can encourage greater acceptance of treatment and also greater treatment satisfaction. Better communication within the dental team is also a very important factor to improve the final result and reduce the time needed to reach it. Thanks to new technological devices widely available, such as tablets, we can use visual communication and interaction with the clinical images of the patient in order to improve communication with the patient, and especially within the dental team. The use of this method allows us to obtain a facial, dentolabial and dental esthetic analysis of the patient that can be used in various clinical steps, improving the predictability of the esthetic outcome and at the same time reducing the number of clinical sessions usually required.
Lameire, Norbert; Van Biesen, Wim; Vanholder, Raymond
The interrelation between kidney disease and cancer is complex and reciprocal. Among the most frequent cancer-associated kidney diseases are the electrolyte and acid-base disturbances, which occur frequently and often are associated with an ominous prognosis, and acute kidney injury. Tumor lysis syndrome is a potentially life-threatening condition that frequently occurs in patients with a high tumor burden and high cellular turnover after cytotoxic therapy (including steroids in steroid-sensitive hematologic malignancies). Electrolyte and acid-base disturbances are the consequence of neoplastic spread, anticancer treatment, or, more rarely, paraneoplastic phenomena of all types of tumors. This article reviews hyponatremia and hypernatremia, hypokalemia and hyperkalemia, hypomagnesemia, hypercalcemia and hypocalcemia, hypophosphatemia, and the most important disturbances in acid-base balance in cancer patients. Acute kidney injury (AKI) is a frequent occurrence in cancer patients and has the potential to substantially alter the outcome of patients with cancer and jeopardize their chances of receiving optimal cancer treatment and a potential cure. As in many other circumstances, the etiology of AKI in cancer patients is multifactorial. Initiation and/or continuation of dialysis in the AKI cancer patient should be based on the general clinical condition and overall life expectancy and the personal patient expectations on quality of life after eventual recovery.
Martin, P; Brown, M C; Espin-Garcia, O; Cuffe, S; Pringle, D; Mahler, M; Villeneuve, J; Niu, C; Charow, R; Lam, C; Shani, R M; Hon, H; Otsuka, M; Xu, W; Alibhai, S; Jenkinson, J; Liu, G
In this study, we compared cancer patients preference for computerised (tablet/web-based) surveys versus paper. We also assessed whether the understanding of a cancer-related topic, pharmacogenomics is affected by the survey format, and examined differences in demographic and medical characteristics which may affect patient preference and understanding. Three hundred and four cancer patients completed a tablet-administered survey and another 153 patients completed a paper-based survey. Patients who participated in the tablet survey were questioned regarding their preference for survey format administration (paper, tablet and web-based). Understanding was assessed with a 'direct' method, by asking patients to assess their understanding of genetic testing, and with a 'composite' score. Patients preferred administration with tablet (71%) compared with web-based (12%) and paper (17%). Patients <65 years old, non-Caucasians and white-collar professionals significantly preferred the computerised format following multivariate analysis. There was no significant difference in understanding between the paper and tablet survey with direct questioning or composite score. Age (<65 years) and white-collar professionals were associated with increased understanding (both P = 0.03). There was no significant difference in understanding between the tablet and print survey in a multivariate analysis. Patients overwhelmingly preferred computerised surveys and understanding of pharmacogenomics was not affected by survey format.
Bartlett Ellis, Rebecca J; Bakoyannis, Giorgos; Haase, Joan E; Boyer, Kiersten; Carpenter, Janet S
This research examined provider and hospital factors associated with patients' perceptions of how often explanations of new medications were "always" given to them, using Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. HCAHPS results were obtained for October 2012 to September 2013, from 3,420 hospitals and combined with a Magnet-designated hospital listing. Multiple regression examined correlates of new medication communication, including health care provider factors (perceptions of nurse and physician communication) and health care system factors (magnet designation, hospital ownership, hospital type, availability of emergency services, and survey numbers). Nurse and physician communication was strongly associated with new medication communication (r = .819, p < .001; r = .722, p < .001, respectively). Multivariable correlates included nurse communication (p < .001), physician communication (p < .001), hospital ownership, availability of emergency services, and survey numbers. There was a significant relationship between patients' perceptions of nurse and physician communication and the explanations they had received about their new medications during hospitalization.
Campos, Diana; Austerlitz, Carlos; Allison, Ron R; Póvoa, Helion; Sibata, Claudio
This article reviews updates and provides some data related to nutritional and orthomolecular supplementation in oncology patients with an emphasis on lung cancer, a commonly diagnosed tumor with significant nutritional disturbances. Cancer and its treatment play a significant role in nutritional imbalance which likely has negative impact on the patient both in terms of quality and quantity of life. Nutritional supplementation may correct these imbalances with significant clinical benefit both physiologically and psychologically. This review will help assist in providing clinically useful data to assess the cancer patient's nutritional status and to guide nutritional intervention to assist these patients' recovery.
Sposito, Amanda Mota Pacciulio; de Montigny, Francine; Sparapani, Valéria de Cássia; Lima, Regina Aparecida Garcia de; Silva-Rodrigues, Fernanda Machado; Pfeifer, Luzia Iara; Nascimento, Lucila Castanheira
Children are considered competent social actors. Although they are able to express their opinions, they may have some difficulties in answering direct verbal questions, requiring researchers and health professionals to enter their world by using auxiliary resources for communication. This study presents the experience of using finger puppets as a playful strategy for improving interaction and communication with hospitalized children with cancer, aged seven to 12. It describes the strategy of making and using puppets as an auxiliary tool to communicate with children with cancer and presents the results and limitations of using puppets in clinical practice. The use of the puppets, creatively and in accordance with the children's motor, cognitive, and emotional development, showed benefits, such as allowing the children to freely express themselves; respecting their autonomy; and minimizing the hierarchical adult-child relationship. The use of puppets is an appropriate strategy to communicate with hospitalized children. This tool can also enrich clinical practice, as it encourages children with cancer to report their experience of being ill and also helps the health team during evaluation and intervention.
prominent breast-ovarian cancer susceptibility genes , BRCA 1 and BRCA2, it is now possible to screen women from high-risk families for germ-line mutations...susceptibility genes , BRCAJ and BRCA2. KEY RESEARCH ACCOMPLISHMENTS "* Improved the ability to detect BRCA 1 and BR CA2 mutations in genomic DNA. "* Reduced...options for having a blood test for the BRCA 1/2 genes if it seerns ap- propriate. If you decide you would like to participate, you will also be
Shen, Chan; Sambamoorthi, Nethra; Kelly, Kimberly
Background. Effective communication and high trust with doctor are important to reduce the burden of multimorbidity in the rapidly aging population of the US. However, the association of multimorbidity with patient-doctor communication and trust is unknown. Objective. We examined the relationship between multimorbidity and patient-doctor communication and trust among the elderly. Method. We used the Medicare Current Beneficiary Survey (2012) to analyze the association between multimorbidity and patient-doctor communication and trust with multivariable logistic regressions that controlled for patient's sociodemographic characteristics, health status, and satisfaction with care. Results. Most elderly beneficiaries reported effective communication (87.5–97.5%) and high trust (95.4–99.1%) with their doctors. The elderly with chronic physical and mental conditions were less likely than those with only physical conditions to report effective communication with their doctor (Adjusted Odds Ratio [95% Confidence Interval] = 0.80 [0.68, 0.96]). Multimorbidity did not have a significant association with patient-doctor trust. Conclusions. Elderly beneficiaries had high trust in their doctors, which was not affected by the presence of multimorbidity. Elderly individuals who had a mental condition in addition to physical conditions were more likely to report ineffective communication. Programs to improve patient-doctor communication with patients having cooccurring chronic physical and mental health conditions may be needed. PMID:27800181
Chong, Dawn Q; Mehta, Raaj S; Song, Mingyang; Kedrin, Dmitriy; Meyerhardt, Jeffrey A; Ng, Kimmie; Wu, Kana; Fuchs, Charles S; Giovannucci, Edward L; Ogino, Shuji; Chan, Andrew T
Circulating adiponectin is inversely related to the risk of colorectal cancer. However, its influence on colorectal cancer survival is unclear. We conducted a prospective study to evaluate the association between prediagnostic plasma levels of adiponectin and mortality in patients with colorectal cancer. We identified 621 incident colorectal cancer cases who provided blood specimens prior to diagnosis within the Nurses' Health Study (NHS) and Health Professionals Follow-up Study (HPFS). Cox proportional hazards models were used to calculate HRs and 95% confidence intervals (CI). After a median follow-up of 9 years, there were 269 (43%) total deaths, of which 181 (67%) were due to colorectal cancer. Compared with participants in the lowest quartile of adiponectin, those in the highest quartile had multivariate HRs of 1.89 (95% CI, 1.21-2.97; P(trend) = 0.01) for colorectal cancer-specific mortality and 1.66 (95% CI, 1.15-2.39; P(trend) = 0.009) for overall mortality. The apparent increased risk in colorectal cancer-specific mortality was more pronounced in patients with metastatic disease (HR, 3.02: 95% CI, 1.50-6.08). Among patients with colorectal cancer, prediagnostic plasma adiponectin is associated with an increased risk of colorectal cancer-specific and overall mortality and is more apparent in patients with metastatic disease. Adiponectin may be a marker for cancers which develop through specific pathways that may be associated with worsened prognosis. Further studies are needed to validate these findings.
Patel, Jai N
Cancer pharmacogenomics is an evolving landscape and has the potential to significantly impact cancer care and precision medicine. Harnessing and understanding the genetic code of both the patient (germline) and the tumor (somatic) provides the opportunity for personalized dose and therapy selection for cancer patients. While germline DNA is useful in understanding the pharmacokinetic and pharmacodynamic disposition of a drug, somatic DNA is particularly useful in identifying drug targets and predicting drug response. Molecular profiling of somatic DNA has resulted in the current breadth of targeted therapies available, expanding the armamentarium to battle cancer. This review provides an update on cancer pharmacogenomics and genomics-based medicine, challenges in applying pharmacogenomics to the clinical setting, and patient perspectives on the use of pharmacogenomics to personalize cancer therapy. PMID:27471406
Sadeghi, Shiva; Brooks, Dina; Goldstein, Roger S
Chronic obstructive pulmonary disease (COPD) is the most prevalent form of chronic respiratory diseases worldwide. Pulmonary rehabilitation, including self-management education, highlights the importance of good patient-provider communication in establishing optimal care. There is a growing awareness of the potential impact of health literacy (HL) on the patients' access to and understanding of medical information. This study was designed to explore the patients' and health care professionals' (HCPs) perceptions of the role of HL in health communication. Semi-structured interviews and focus groups were conducted with 12 patients and 20 HCPs at a Pulmonary Rehabilitation Center in Metropolitan Toronto. Although the term health literacy was not familiar to many patients, the contribution of knowledge to patient well-being was consistently identified by patients and HCPs. Barriers to communication included provider time constraints and the use of medical jargon. For providers they also included patient characteristics, language, culture and awareness of health resources. Approaches that might improve communication incorporated family support, peer support, better print and visual teaching material and a trusting empathic patient-provider relationship. The findings provide an increased understanding of patients' and providers' perceptions of HL as a barrier to effective communication of medical information to patients with COPD as well as approaches that might improve this communication.
McLoughlin, H A; Oosthuizen, B L
methods of communication indicated were firstly personal contact and then a combination of personal contact and booklets. An important conclusion which can be reached is that co-operation between the medical professionals, the information services and the patient and his family is essential if the information needs of the cancer patient are to be met satisfactorily.
Higashi, Daijiro; Futami, Kitaro; Kojima, Daibo; Futatsuki, Ryo; Ishibashi, Yukiko; Maekawa, Takafumi; Yano, Yutaka; Takatsu, Noritaka; Hirai, Fumihito; Matsui, Toshiyuki; Iwashita, Akinori
Due to an increase in the number of long-term cases of Crohn's disease, the risk of combined cancer in these patients has been assessed in numerous articles. Most of these reports have involved patients with cancer of the large intestine, while cases of cancer of the small intestine combined with Crohn's disease are very rare. We experienced two cases of cancer of the small intestine combined with Crohn's disease. In both cases, the patients had suffered from Crohn's disease for over 10 years and a second operation was performed after a long period without treatment following the first operation, which had achieved a favorable outcome. In both cases of combined cancer, the patients experienced ileus; however, it was difficult to discern this from ileus due to the presence of Crohn's disease. Therefore, making a definitive diagnosis of combined cancer was not possible before surgery, and the definitive diagnosis was obtained based on an intraoperative pathological diagnosis. It is thought that tumor markers transition in a manner parallel to the progression of cancer, providing a clue for cancer diagnosis. In patients with Crohn's disease, there is a pressing need to establish a method for diagnosing cancer of the small intestine at an early stage.
Gurney, Jason; Sarfati, Diana; Stanley, James
Background: It is known that cancer stage is affected by comorbidity, but the evidence regarding the magnitude and even direction of this effect is highly inconsistent and poorly understood. The aims of this study were to establish the impact of comorbidity on cancer stage at diagnosis, using both specific individual comorbid conditions and a global measure of comorbidity; and to assess whether this impact varied by cancer site, level of comorbidity burden and individual comorbidity type. Methods: We examined comorbidity among 14 096 patients with breast, colon, rectal, liver, stomach, ovarian, uterine, bladder or kidney cancer. Patients were identified from cancer registry data, and then linked to hospitalisation data to determine the presence of comorbidity in the 5 years preceding cancer diagnosis. Individual comorbid conditions were identified using ICD-10 codes, and overall burden of comorbidity attributed using a cancer-specific measure of comorbidity (C3 Index). Results: We observed that the presence of patient comorbidity (a) increases the odds of being diagnosed with distant metastases, (b) does not lead to earlier diagnosis and (c) increases the likelihood of a patient receiving no stage of disease at diagnosis. Conclusions: Patient comorbidity has a substantial impact on cancer stage at diagnosis; however, this impact varies considerably by cancer type, individual comorbid condition and overall comorbidity burden. PMID:26461060
Parker, Demetrius M
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.
Karadeniz, G; Yanikkerem, E; Altiparmak, S; Sevil, U; Ertem, G; Esen, A
The aim of the present study was to identify what hospitalized cancer patients expect from nurses in terms of the care they receive. The specific aims of this study were: (i) to identify those individuals to whom the patients felt closest in the hospital setting and (ii) to evaluate nurses' management of cancer patients during their stay in the hospital. The sample included patients hospitalized at Ege University Hospital and Suat Seren District Hospital, Izmir, Turkey. We found significant differences between the scores of satisfaction and dissatisfaction and gender age, education, occupation, type of cancer and the mode of treatment (p < 0.05). The majority of the cancer patients reported that nursing management was unsatisfactory. Some demographic factors such as cultural and social status affected patients' expectations.
Semchuk, William M.; Sperlich, Catherine
Background: Many patients who experience a venous thromboembolic event have cancer, and thrombosis is much more prevalent in patients with cancer than in those without it. Thrombosis is the second most common cause of death in cancer patients and cancer is associated with a high rate of recurrence of venous thromboembolism (VTE), bleeding, requirement for long-term anticoagulation and poorer quality of life. Methods: A literature review was conducted to identify guidelines and evidence pertaining to anticoagulation prophylaxis and treatment for patients with cancer, with the goal of identifying opportunities for pharmacists to advocate for and become more involved in the care of this population. Results: Many clinical trials and several guidelines providing guidance to clinicians in the treatment and prevention of VTE in patients with cancer were identified. Current clinical evidence and guidelines suggest that cancer patients receiving care in hospital with no contraindications should receive VTE prophylaxis with unfractionated heparin (UFH), a low-molecular-weight heparin (LMWH) or fondaparinux. Patients who require surgery for their cancer should receive prophylaxis with UFH, LMWH or fondaparinux. Cancer patients who have experienced a VTE event should receive prolonged anticoagulant therapy with LMWH (at least 3 months to 6 months). No routine prophylaxis is required for the majority of ambulatory patients with cancer who have not experienced a VTE event. Most publicly funded drug plans in Canada have developed criteria for funding of LMWH therapy for patients with cancer. Conclusions: Evidence suggests that LMWH for 3 to 6 months is the preferred strategy for most cancer patients who have experienced a thromboembolic event and for hospital inpatients, but this is often not implemented in practice. Concerns about adherence with injectable therapy should not prevent use of these agents. Pharmacists should assess cancer patients for their risk of VTE and should
Best, Alicia L; Vamos, Cheryl; Choi, Seul Ki; Thompson, Erika L; Daley, Ellen; Friedman, Daniela B
Cancer prevention and control efforts serve as national priorities, as cancer is the second leading cause of death in the USA. In addition, cancer disparities exist, with racial/ethnic minority, low-income, and uninsured populations suffering the greatest burden. The goal of this paper is to describe the role that effective health communication can play in increasing routine cancer screening among medically underserved populations, thus decreasing persistent health disparities. For this paper, we applied Sorenson's integrated model of health literacy as a framework for identifying communication gaps and opportunities that can help improve cancer screening specifically at federally qualified health centers (FQHCs). This integrated model consists of four interrelated dimensions: access, understand, appraise, and apply. Employing communication strategies across this health literacy framework has the potential to facilitate improved decision making and cancer screening outcomes among the most underserved populations.
Lecumberri, Ramón; Pegenaute, Carlota; Páramo, José A
There is a well-known close relationship between cancer and the haemostatic system. Plasma D-dimer (DD) is a marker of fibrin generation and lysis. In the clinical practice, its main use is in the diagnostic algorithms of venous thromboembolism (VTE), and it is one of the diagnostic criteria of disseminated intravacular coagulation. In patients with cancer, the specificity of DD is lower than in the general population, reducing its usefulness. However, there is a growing evidence that points out a possible application of DD in the clinical management of cancer patients as a predictor of VTE, marker of hidden cancer in patients with idiopathic VTE, or even as an independent prognostic factor of response to chemotherapy and survival. In this review, the current evidence supporting the use of DD in cancer patients is critically exposed and discussed.
Owusu, Cynthia; Berger, Nathan A
Cancer care at the extremes of life, in the young and the old, is characterized by unique issues associated with pediatrics and geriatric medicine, accentuated by the special vulnerabilities of these groups. In response to these needs, the field of pediatric oncology has been well honed to deal with the special problems associated with juvenile cancer patients. While most adult oncologists consider themselves well prepared to deal with older cancer patients, the current expansion of the geriatric population – their variable levels of fitness, frailty and vulnerability, the fact that cancer is primarily a disease of older adults, the significant expansion of agents and approaches to treat cancer, as well as their resultant toxicities and complications – has led to the development of specialized geriatric oncologists. Moreover, the special characteristics and needs of these patients have led to the evolution of new guidelines for evaluation, management and the conduct of research in older patients with cancer. PMID:25642321
Rodríguez Duarte, C; Aguillón, J; Rodríguez, H
The results of a prospective study undertaken in 29 patients with symptomatic benign prostatic hyperplasia (BPH) are presented. Transrectal ultrasound, ultrasound-guided biopsy and prostate specific antigen (PSA) were utilized in the search for hidden cancer of the prostate. However, no cancer was detected in any patient. Very high values of PSA were found, particularly in patients with an indwelling catheter. Transrectal ultrasound yielded no false negatives and no complications were observed.
Akira Kurosawa's 1952 film about a man with a terminal gastric cancer introduces a discussion of hope and faith in the oncology patient. A psychodynamic relationship between hope and faith is explored, using Lawrence LeShan's research in cancer psychotherapy and Erik Erikson's lifespan developmental theory. LeShan describes a cancer personality characterized by hopeless despair, while Erikson formulates a psychogenetic framework for the development of hope and despair. Hope and faith are linked through the individual's earliest strivings toward basic trust in the world and his or her own self-efficacy. Accordingly, cancer psychotherapy may aim at restoring adult patients' faith in life and inner creative resources.
Management of patients with low socioeconomic status and/or low literacy who have prostate cancer presents a challenge to healthcare professionals. Improving treatment outcomes for these men requires specific educational programs to provide a better understanding of prostate cancer including careful posttreatment follow-up to ensure they have recovered well, that the cancer is not progressing and that complications are not proving troublesome. Practice nurses and health educators/navigators can play an important role in achieving these objectives. Education and knowledgeable advice can lead to earlier diagnosis of prostate cancer, improved patient participation in the treatment decision-making process and effective management of posttreatment complications. PMID:16623064
Mets, Sarah; Tryon, Rebecca; Veach, Patricia McCarthy; Zierhut, Heather A
The development of hereditary cancer genetic testing panels has altered genetic counseling practice. Mutations within certain genes on cancer panels pose not only a cancer risk, but also a reproductive risk for autosomal recessive conditions such as Fanconi anemia, constitutional mismatch repair deficiency syndrome, and ataxia telangiectasia. This study aimed to determine if genetic counselors discuss reproductive risks for autosomal recessive conditions associated with genes included on cancer panels, and if so, under what circumstances these risks are discussed. An on-line survey was emailed through the NSGC list-serv. The survey assessed 189 cancer genetic counselors' experiences discussing reproductive risks with patients at risk to carry a mutation or variant of uncertain significance (VUS) in a gene associated with both an autosomal dominant cancer risk and an autosomal recessive syndrome. Over half (n = 82, 55 %) reported having discussed reproductive risks; the remainder (n = 66, 45 %) had not. Genetic counselors who reported discussing reproductive risks primarily did so when patients had a positive result and were of reproductive age. Reasons for not discussing these risks included when a patient had completed childbearing or when a VUS was identified. Most counselors discussed reproductive risk after obtaining results and not during the informed consent process. There is inconsistency as to if and when the discussion of reproductive risks is taking place. The wide variation in responses suggests a need to develop professional guidelines for when and how discussions of reproductive risk for autosomal recessive conditions identified through cancer panels should occur with patients.
Kim-Romo, Dawn N; Barner, Jamie C; Brown, Carolyn M; Rivera, José O; Garza, Aida A; Klein-Bradham, Kristina; Jokerst, Jason R; Janiga, Xan; Brown, Bob
OBJECTIVE To assess Spanish-speaking patients' satisfaction with their clinical pharmacists' communication skills and demonstration of cultural sensitivity, while controlling for patients' sociodemographic, clinical, and communication factors, as well as pharmacist factors, and to identify clinical pharmacists' cultural factors that are important to Spanish-speaking patients. DESIGN Cross-sectional study. SETTING Central Texas during August 2011 to May 2012. PARTICIPANTS Spanish-speaking patients of federally qualified health centers (FQHCs). MAIN OUTCOME MEASURE(S) A Spanish-translated survey assessed Spanish-speaking patients' satisfaction with their clinical pharmacists' communication skills and demonstration of cultural sensitivity. RESULTS Spanish-speaking patients (N = 101) reported overall satisfaction with their clinical pharmacists' communication skills and cultural sensitivity. Patients also indicated that pharmacists' cultural rapport (e.g., ability to speak Spanish, respectfulness) was generally important to Spanish speakers. Multiple linear regression analyses showed that cultural rapport was significantly related to satisfaction with pharmacists' communication skills and demonstration of cultural sensitivity. CONCLUSION Overall, patients were satisfied with pharmacists' communication skills and cultural sensitivity. Patient satisfaction initiatives that include cultural rapport should be developed for pharmacists who provide care to Spanish-speaking patients with limited English proficiency.
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 patient communication, 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. PMID:17786269
Merel, Susan E; McKinney, Christy M; Ufkes, Patrick; Kwan, Alan C; White, Andrew A
Sitting at a patient's bedside in the inpatient setting is recommended as a best practice but has not been widely adopted. Previous studies suggest that a physician's seated posture may increase the patient's perception of time spent in the room but have not included hospitalists. We performed a cluster-randomized trial of seated versus standing physician posture during inpatient rounds on a hospitalist service at an academic medical center. Patients whose physician sat were significantly more likely to rate their physician highly on measures of listening carefully and explaining things in a way that was easy to understand. The average time spent in the patient's room was approximately 12 minutes and was not affected by physician posture. Patients' perception of the time their physician spent in their room was not affected by physician posture. Sitting at the bedside during rounds does not increase the amount of time spent with the patient but may improve patient-physician communication. Journal of Hospital Medicine 2015;11:865-868. © 2015 Society of Hospital Medicine.
Effective communication is central to showing empathy at the end of someone's life, yet it is also perhaps the most difficult skill to get right. As a result, communication is one of the aspects of care that patients most often complain about (Healthcare Commission, 2007). It is widely accepted that effective communication is resource and time-intensive, although the benefits tend to outweigh these perceived drawbacks. More importantly, poor communication can have an impact on patients' decision-making in preparation for death.
Cheah, Whye Lian; Dollah, Nurul Bahariah; Chang, Ching Thon
Background: This study aimed to determine the perceptions and expectations of bone cancer patients with respect to their doctors and the breaking of bad news as well as the environment in which the news was delivered. Methods: A cross-sectional study using a pretested 41-item questionnaire was conducted using convenience sampling among bone cancer patients in Sarawak General Hospital. Face-to-face interviews were conducted after consent was obtained. Data were analysed using SPSS version 16 (SPSS Inc., IL, US). Results: A total of 30 patients were interviewed. The majority of the respondents were younger than 40-years-old, Malays, and female. All of the respondents perceived that they received news in a comfortable place, agreed that the doctor used simple language and appropriate words during the interaction, and believed that the way the doctor delivered the news might influence their life. The majority of the respondents reported that their news was received without interruption, that the doctor was sitting close but without making physical contact, and time was given for patient to ask questions and they were informed accordingly. Conclusion: Delivering bad news regarding cancer is an important communication skill and a complex task that can be learned and acquired. Specially tailored training is proposed to improve medical practice in this area. PMID:23610548
Werlang, Sueli da Cruz; Azzolin, Karina; Moraes, Maria Antonieta; de Souza, Emiliane Nogueira
Preoperative orientation is an essential tool for patient's communication after surgery. This study had the objective of evaluating non-verbal communication of patients submitted to cardiac surgery from the time of awaking from anesthesia until extubation, after having received preoperative orientation by nurses. A quantitative cross-sectional study was developed in a reference hospital of the state of Rio Grande do Sul, Brazil, from March to July 2006. Data were collected in the pre and post operative periods. A questionnaire to evaluate non-verbal communication on awaking from sedation was applied to a sample of 100 patients. Statistical analysis included Student, Wilcoxon, and Mann Whittney tests. Most of the patients responded satisfactorily to non-verbal communication strategies as instructed on the preoperative orientation. Thus, non-verbal communication based on preoperative orientation was helpful during the awaking period.
Lee, Tae Hoon; D'Asti, Esterina; Magnus, Nathalie; Al-Nedawi, Khalid; Meehan, Brian; Rak, Janusz
Cancer cells emit a heterogeneous mixture of vesicular, organelle-like structures (microvesicles, MVs) into their surroundings including blood and body fluids. MVs are generated via diverse biological mechanisms triggered by pathways involved in oncogenic transformation, microenvironmental stimulation, cellular activation, stress, or death. Vesiculation events occur either at the plasma membrane (ectosomes, shed vesicles) or within endosomal structures (exosomes). MVs are increasingly recognized as mediators of intercellular communication due to their capacity to merge with and transfer a repertoire of bioactive molecular content (cargo) to recipient cells. Such processes may occur both locally and systemically, contributing to the formation of microenvironmental fields and niches. The bioactive cargo of MVs may include growth factors and their receptors, proteases, adhesion molecules, signalling molecules, as well as DNA, mRNA, and microRNA (miRs) sequences. Tumour cells emit large quantities of MVs containing procoagulant, growth regulatory and oncogenic cargo (oncosomes), which can be transferred throughout the cancer cell population and to non-transformed stromal cells, endothelial cells and possibly to the inflammatory infiltrates (oncogenic field effect). These events likely impact tumour invasion, angiogenesis, metastasis, drug resistance, and cancer stem cell hierarchy. Ongoing studies explore the molecular mechanisms and mediators of MV-based intercellular communication (cancer vesiculome) with the hope of using this information as a possible source of therapeutic targets and disease biomarkers in cancer.
Ozawa, Hiroyuki; Saitou, Hideyuki; Mizutari, Kunio; Takata, Yasunori; Ogawa, Kaoru
We report on 2 cases of hypothyroidism presenting clinical symptoms that occurred after radiotherapy for cancer of the head and neck and on the results of estimating thyroid function in patients with head and neck cancer who received radiotherapy. The first patient underwent total laryngectomy for laryngeal cancer without sacrificing the thyroid gland and partial gastrectomy for gastric cancer. Radiotherapy of the neck was carried out postoperatively. Two years later, the patient developed chest pain; pericardial effusion was detected, leading to a diagnosis of myxedema caused by hypothyroidism. The second patient received radiotherapy alone for laryngeal cancer. Two months later, low serum sodium concentration and anemia were detected in this patient. The cause of these changes was subsequently found to be hypothyroidism. Based on our experience with these 2 cases, we measured thyroid function in 35 patients who had undergone neck radiation for head and neck cancer at our hospital over the past 10 years. Hypothyroidism was observed in 13 of the 35 patients (37%). The prevalence of hypothyroidism was 46% (6/13) for patients treated with both radiation and surgery, as compared with 32% (7/22) for those who received radiation alone. The risk factors responsible for hypothyroidism were not evident from the statistical analysis of these cases. We believe that thyroid function should be evaluated periodically in patients who have undergone neck radiation because it is often difficult to diagnose hypothyroidism only from clinical symptoms.
Farge-Bancel, D; Florea, L; Bosquet, L; Debourdeau, P
Venous thromboembolism (VTE) disease, as defined by the occurrence of deep venous thrombosis or pulmonary embolism, occurs among 4 to 20% of patients with cancer and is a leading cause of death among these patients. Use of classical anticoagulation to treat VTE in a cancer patient is associated with a higher risk of major bleeding and of VTE recurrence as compared to noncancer patients. Updated comprehensive and systematic review of current data from the medical literature allows to reconsider the classical approach used for anticoagulant treatment in cancer patients and to implement adapted recommendations. In 2008, the use of daily subcutaneous low-molecular-weight heparin (LMWH) for at least three to six months is recommended as first line therapy to treat VTE disease in cancer patients. If LMWH are contra-indicated (renal insufficiency), other therapeutic approaches are warranted, such as use of unfractionated heparin (UFH) with early introduction of anti-vitamin K for at least three months or venous cava filter in case of absolute contra-indications to anticoagulation. VTE prophylaxis in cancer patients relies on the same therapeutic approaches as currently used for noncancer patients at high risk of VTE. The definition of more specific prophylactic approaches for patients with cancer considered at higher risks of VTE, will be the subject of many clinical trials in the forthcoming years.
Costas-Muniz, Rosario; Sen, Rohini; Leng, Jennifer; Aragones, Abraham; Ramirez, Julia; Gany, Francesca
Having more health knowledge has a crucial and positive impact on cancer outcomes. Patients' cancer knowledge influences their ability to participate actively in decision-making processes for medical care and in treatment choices. The purpose of this study was to determine the demographic and medical correlates of lack of cancer stage knowledge and desire for information among Latino cancer patients. The sample included 271 underserved Latino cancer patients recruited from four cancer clinics in New York City. Participants completed a needs assessment survey in their preferred language, which included sociodemographic and health-related questions. Close to two-thirds of the sample (65%) had no knowledge of their stage, and 38% were unaware of the metastatic state of their tumor. Only 15% of the patients expressed that they would like additional information about their diagnosis and/or treatment. After controlling for sociodemographic characteristics, being an immigrant with limited English proficiency and monolingual in Spanish were predictors of stage unawareness and less desire/need for cancer information. Patients needing interpretation for health care were less likely to know whether their tumor had metastasized and their cancer stage and to desire information about their cancer diagnosis and/or treatment. This study shows considerably low levels of stage awareness among Latinos diagnosed with cancer. This lack of knowledge might adversely impact their treatment decisions and disease management. Future studies should focus on identifying barriers to acquisition of disease information and other disease-specific informational deficits.
Keefe, Dorothy M K
Mucositis is an important toxicity to be aware of in anticancer therapy. It contributes to a reduction in cure rates from cancer. Until recently, it has been poorly understood and therefore has not been well managed. It causes patient distress, delays in treatment administration, and reductions in dose intensity, and it costs the health-care system a large amount of money. Mucositis has traditionally been associated more with hematologic malignancies than with solid tumors, because the incidence of severe mucositis has been much higher with the high-dose chemotherapy regimens used in hematologic malignancies. However, the chemotherapy used in solid tumors also causes mucositis and deserves further study. The separation between oral and gastrointestinal mucositis is potentially false and is being removed, with much research now investigating the entire alimentary canal. There are similarities and differences between radiation therapy- and chemotherapy-induced mucositis, and these have implications for treatment and prevention scheduling and type. Risk prediction is another area that requires more work, but there is real hope that, in the future, we might be able to predict who will suffer from mucositis and in which parts of the alimentary canal, thus enabling us to appropriately target the newer antimucotoxic therapies. The Mucositis Study Goup of the Multinational Association for Supportive Care in Cancer has recently published management guidelines for oral and gastrointestinal mucositis and is in the process of updating them. The guidelines serve as an excellent starting place for future mucositis research because they not only review the available treatments but also discuss mechanisms and epidemiology.
Napoles, Tessa M.; Banks, Priscilla J.; Orenstein, Fern S.; Luce, Judith A.; Joseph, Galen
Purpose Despite the Institute of Medicine’s (IOM) 2005 recommendation, few care organizations have instituted standard survivorship care plans (SCPs). Low health literacy and low English proficiency are important factors to consider in SCP development. Our study aimed to identify information needs and survivorship care plan preferences of low literacy, multi-lingual patients to support the transition from oncology to primary care and ongoing learning in survivorship. Methods We conducted focus groups in five languages with African American, Latina, Russian, Filipina, White, and Chinese medically underserved breast cancer patients. Topics explored included the transition to primary care, access to information, knowledge of treatment history, and perspectives on SCPs. Results Analysis of focus group data identified three themes: 1) the need for information and education on the transition between “active treatment” and “survivorship”; 2) information needed (and often not obtained) from providers; and 3) perspectives on SCP content and delivery. Conclusions Our data point to the need to develop a process as well as written information for medically underserved breast cancer patients. An SCP document will not replace direct communication with providers about treatment, symptom management and transition, a communication that is missing in participating safety-net patients’ experiences of cancer care. Women turned to peer support and community-based organizations in the absence of information from providers. Implications for Cancer Survivors “Clear and effective” communication of survivorship care for safety-net patients requires dedicated staff trained to address wide-ranging information needs and uncertainties. PMID:27992491
Nápoles-Springer, Anna M; Santoyo, Jasmine; Stewart, Anita L
BACKGROUND Limited evidence exists on the effectiveness of recruitment methods among diverse populations. OBKECTIVE Describe response rates by recruitment stage, ethnic-language group, and type of initial contact letter (for African-American and Latino patients). DESIGN Tracking of response status by recruitment stage and ethnic-language group and a randomized trial of ethnically tailored initial letters nested within a cross-sectional telephone survey on physician-patient communication. PARTICIPANTS Adult general medici