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Clark SB, Lippe MP. Vicarious learning and communication self-efficacy: A pediatric end-of-life simulation for pre-licensure nursing students. J Prof Nurs 2022; 43:107-116. [PMID: 36496231 DOI: 10.1016/j.profnurs.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND End-of-life clinical experiences, particularly in pediatrics, are quite limited for pre-licensure nursing students. Though effective, end-of-life simulations can be costly, require facilitators trained in palliative and end-of-life care, and are restricted by limited space and time availability. Such barriers prompt the question as to whether there is an effective alternative to simulation by which students can gain improved self-efficacy in therapeutic communication during pediatric end-of-life situations. PURPOSE Bandura's Social Cognitive Theory and work exploring self-efficacy posits that vicarious learning provides learners opportunities to gain experience and knowledge through observation of peers in simulated settings. This study evaluated the effectiveness of vicarious versus active learning on pre-licensure nursing students' perceived self-efficacy in providing therapeutic communication during a pediatric end-of-life situation. METHOD Data were collected over three time points - pre-simulation, post-simulation, and post-debriefing - using a modified Self-Efficacy in Communication Scale. RESULTS Learners in both groups had significant improvement in self-efficacy across all time points. Only two items had significant differences between vicarious and active learner groups, but the effect was minor. CONCLUSION Vicarious learning presents as a viable pedagogical approach for providing pre-licensure nursing students important learning opportunities related to pediatric end-of-life simulations during both the scenario and debriefing.
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Affiliation(s)
- Stephanie B Clark
- One Harrison Plaza, Anderson College of Nursing and Health Professions, Harrison Hall Box 5054, University of North Alabama, Florence, AL 35632, United States.
| | - Megan P Lippe
- University of Alabama Capstone College of Nursing, Box 870358, Tuscaloosa, AL 35487, United States.
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Becevic M, Nair P, Wallach E, Hoffman K, Sohl K. ECHO Autism: Evaluation of Participants’ Perceptions of Collaborative Telementoring Network. J Patient Exp 2021; 8:23743735211065292. [PMID: 34988286 PMCID: PMC8721706 DOI: 10.1177/23743735211065292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Primary care clinicians report inadequate training and lack of support regarding identification of early signs of Autism Spectrum Disorder (ASD), resulting in later diagnosis and poor outcomes. The objective of this study was to evaluate the perception of participants in ECHO Autism project regarding the value of the virtual collaborative as a mentoring tool. Methods: We completed a retrospective cross-sectional study of post-virtual clinic surveys of all participants who attended Autism ECHO from September 2, 2015 to June 5, 2019. Results: There were 87 Autism ECHO sessions held, with 83 didactic presentations. A total of 92 de-identified patient cases were discussed with 490 unique learners in attendance. Participants reported increase in self-efficacy in identifying ASD symptoms in children, assessing medical comorbidities, and learning new information. Discussion: Continuing education platforms in healthcare professions are increasingly embracing virtual live-interactive conferences. They provide opportunities to connect with experts, but also hear from peers regarding real-life case examples. During COVID-19 pandemic ECHO Autism was a lifeline for rural providers and will likely continue to increase in participation.
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Affiliation(s)
- Mirna Becevic
- Department of Dermatology, University of Missouri, Columbia, MO, USA
- Missouri Telehealth Network, University of Missouri, Columbia, MO, USA
- Institute for Data Science and Informatics, University of Missouri, Columbia, MO, USA
| | - Pooja Nair
- School of Medicine, University of Missouri, Columbia, MO, USA
| | | | - Kimberly Hoffman
- Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA
| | - Kristin Sohl
- Missouri Telehealth Network, University of Missouri, Columbia, MO, USA
- Department of Child Health, University of Missouri, Columbia, MO, USA
- Continuing Education for Health ProfessionsUniversity of Missouri, Columbia, MO, USA
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Abstract
In Study 1, 20 incurious worry reduction motive (IWRM) items were administered to 280 participants along with curiosity and worry scales. With factor analysis, two six–item scales were developed: focus on distress (IWRM–FD) and focus on relief (IWRM–FR). IWRM–FD was associated with wanting positive news about threats, whereas IWRM–FR was related to wanting negative news to be free from further worry. Neither the curiosity nor worry scales predicted wanting information. In Study 2, the IWRM scales were administered to 170 participants along with a coping inventory. IWRM–FD correlated with avoidant–coping, whereas IWRM–FR was associated positively with active–coping and advice–seeking. The results suggest that IWRM–FD reflects a desire to minimize distress, whereas IWRM–FR motivates identifying and dealing directly with problems. Copyright © 2010 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jordan A. Litman
- Department of Psychology, University of South Florida, St. Petersburg, FL, USA
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Huang Y, Wang S, Chen S, Hsu W, Chang M. The experience of spousal caregivers of patients recently diagnosed with cancer in Taiwan. Collegian 2019; 26:477-84. [DOI: 10.1016/j.colegn.2018.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Stuckey A, Febbraro T, Laprise J, Wilbur JS, Lopes V, Robison K. Adherence Patterns to National Comprehensive Cancer Network Guidelines for Referral of Women With Breast Cancer to Genetics Professionals. Am J Clin Oncol 2016; 39:363-7. [PMID: 24710121 DOI: 10.1097/COC.0000000000000073] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Genetic predisposition is responsible for 5% to 10% of breast cancer. The National Comprehensive Cancer Network (NCCN) established guidelines delineating appropriate candidates for genetic counseling. This study aims to determine referral patterns for genetic counseling in women who met such guidelines. MATERIALS AND METHODS Utilizing an institutional tumor registry, patients from an academic oncology program who met a subset of NCCN guidelines for genetic referrals between 2004 and 2010 were identified (breast cancer diagnosis ≤50 y without a known BRCA mutation). A retrospective chart review was conducted. Statistics were analyzed using SAS version 9.2. RESULTS A total of 314 patients were identified and 107 (34.1%) were referred for genetic counseling. Median age at diagnosis was younger for those referred versus not referred (43 and 46 y; P<0.0001). Women were more likely referred with a family history suspicious for an inherited cancer syndrome (67.3% vs. 36.2%; P<0.0001). There was no difference in stage at diagnosis, insurance, or race among women referred. Those patients who choose prophylactic contralateral mastectomy were likely to have been referred for genetic counseling (63.6% vs. 36.4%, P<0.0001). Among patients referred, 77.6% consulted with a genetics counselor, 95.2% underwent genetic testing, and 16.5% had a BRCA mutation. CONCLUSIONS Genetic counseling and testing is being underutilized in women who meet NCCN referral guidelines. Age and family history were noted to be predictive of referral for genetic evaluation. Further research is needed to determine additional factors that may impact not only referral rates but subsequent care for women with possible genetic predispositions to cancer.
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Lelorain S, Brédart A, Dolbeault S, Cano A, Bonnaud-Antignac A, Cousson-Gélie F, Sultan S. How does a physician's accurate understanding of a cancer patient's unmet needs contribute to patient perception of physician empathy? Patient Educ Couns 2015; 98:734-741. [PMID: 25817423 DOI: 10.1016/j.pec.2015.03.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 02/19/2015] [Accepted: 03/07/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Unmet supportive care needs of patients decrease patient perception of physician empathy (PE). We explored whether the accurate physician understanding of a given patient's unmet needs (AU), could buffer the adverse effect of these unmet needs on PE. METHODS In a cross-sectional design, 28 physicians and 201 metastatic cancer patients independently assessed the unmet supportive care needs of patients. AU was calculated as the sum of items for which physicians correctly rated the level of patient needs. PE and covariates were assessed using self-reported questionnaires. Multilevel analyses were carried out. RESULTS AU did not directly affect PE but acted as a moderator. When patients were highly expressive and when physicians perceived poor rapport with the patient, a high AU moderated the adverse effect of patient unmet needs on PE. CONCLUSION Physician AU has the power to protect the doctor-patient relationship in spite of high patient unmet needs, but only in certain conditions. PRACTICE IMPLICATIONS Physicians should be encouraged toward AU but warned that high rapport and patient low emotional expression may impede an accurate reading of patients. In this latter case, they should request a formal assessment of their patients' needs.
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Affiliation(s)
- Sophie Lelorain
- Univ Lille Nord de France, Department of Psychology, Lille, France; UDL3, SCALab UMR CNRS 9193, Villeneuve d'Ascq, France.
| | - Anne Brédart
- Institut Curie, Psycho-oncology Unit, Paris, France; Paris Descartes University, LPPS EA 4057-IUPDP, Boulogne-Billancourt, France
| | - Sylvie Dolbeault
- Institut Curie, Psycho-oncology Unit, Paris, France; Inserm, U 669, Paris, France; Univ Paris-Sud and Univ Paris Descartes, UMR-S0669, Paris, France
| | | | - Angélique Bonnaud-Antignac
- University of Nantes, EA4275 SPHERE 'bioStatistics, Pharmacoepidemiology and Human sciEnces Research', Nantes, France
| | - Florence Cousson-Gélie
- University of Montpellier 3, Laboratory Epsylon 'Dynamics of Human Abilities & Health Behaviors', Montpellier, France; ICM, Institut Régional du Cancer de Montpellier, Epidaure Prevention and Education Cancer Center, Montpellier, France
| | - Serge Sultan
- University of Montreal, Sainte Justine University Hospital Research Center, Montreal, Canada
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De Vries AMM, de Roten Y, Meystre C, Passchier J, Despland JN, Stiefel F. Clinician characteristics, communication, and patient outcome in oncology: a systematic review. Psychooncology 2013; 23:375-81. [DOI: 10.1002/pon.3445] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 10/09/2013] [Accepted: 10/15/2013] [Indexed: 12/30/2022]
Affiliation(s)
- A. M. M. De Vries
- Department of Psychiatry; University Hospital of Lausanne; Lausanne Switzerland
- Faculty of Psychology and Education; Vrije Universiteit Amsterdam; Amsterdam Netherlands
| | - Y. de Roten
- Department of Psychiatry; University Hospital of Lausanne; Lausanne Switzerland
| | - C. Meystre
- Department of Psychiatry; University Hospital of Lausanne; Lausanne Switzerland
| | - J. Passchier
- Faculty of Psychology and Education; Vrije Universiteit Amsterdam; Amsterdam Netherlands
| | - J.-N. Despland
- Department of Psychiatry; University Hospital of Lausanne; Lausanne Switzerland
| | - F. Stiefel
- Department of Psychiatry; University Hospital of Lausanne; Lausanne Switzerland
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Swenne CL, Skytt B. The ward round - patient experiences and barriers to participation. Scand J Caring Sci 2013; 28:297-304. [DOI: 10.1111/scs.12059] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 05/24/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Christine Leo Swenne
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
| | - Bernice Skytt
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
- Department of Health and Caring Sciences; Faculty of Health and Occupational Studies; University of Gävle; Gävle Sweden
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Rhondali W, Perez-Cruz P, Hui D, Chisholm GB, Dalal S, Baile W, Chittenden E, Bruera E. Patient-physician communication about code status preferences: a randomized controlled trial. Cancer 2013; 119:2067-73. [PMID: 23564395 DOI: 10.1002/cncr.27981] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 10/31/2012] [Accepted: 11/08/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Code status discussions are important in cancer care, but the best modality for such discussions has not been established. The objective of this study was to determine the impact of a physician ending a code status discussion with a question (autonomy approach) versus a recommendation (beneficence approach) on patients' do-not-resuscitate (DNR) preference. METHODS Patients in a supportive care clinic watched 2 videos showing a physician-patient discussion regarding code status. Both videos were identical except for the ending: one ended with the physician asking for the patient's code status preference and the other with the physician recommending DNR. Patients were randomly assigned to watch the videos in different sequences. The main outcome was the proportion of patients choosing DNR for the video patient. RESULTS A total of 78 patients completed the study, and 74% chose DNR after the question video, whereas 73% chose DNR after the recommendation video. Median physician compassion score was very high and not different for both videos. All 30 of 30 patients who had chosen DNR for themselves and 30 of 48 patients who had not chosen DNR for themselves chose DNR for the video patient (100% versus 62%). Age (odds ratio = 1.1/year) and white ethnicity (odds ratio = 9.43) predicted DNR choice for the video patient. CONCLUSIONS Ending DNR discussions with a question or a recommendation did not impact DNR choice or perception of physician compassion. Therefore, both approaches are clinically appropriate. All patients who chose DNR for themselves and most patients who did not choose DNR for themselves chose DNR for the video patient. Age and race predicted DNR choice.
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Affiliation(s)
- Wadih Rhondali
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Katz JD, Haile-Mariam TW, Roth K, Moskovitz P, Niemtzoff M, Fried A. Teaching suffering: The testimonial-commentary method. PSYCHOL HEALTH MED 2012; 17:629-35. [DOI: 10.1080/13548506.2011.652639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
We sought to identify factors associated with greater cancer-related fertility knowledge in a national survey of oncologists. We surveyed 344 oncologists from a sampling pool drawn randomly from the AMA Masterfile. We conducted multiple linear regression to determine the relationship between confidence in knowledge and oncologists' characteristics. Respondents' average age was 48.5, and 75.3% were male. The average confidence in knowledge summary score was 23.8 (SD 6.4, range 8-40). In multivariable regression, confidence was higher among oncologists with more information resources, a sense of responsibility to discuss fertility issues and among gynecologic oncologists vs. other oncology specialties. Physician age, gender, and practice setting were not associated with fertility-related knowledge. Oncologists lack confidence in their knowledge of fertility issues in young women with breast cancer. Increasing professional responsibility to discuss fertility and greater information access could improve the depth and breadth of education regarding fertility issues among oncologists and their young patients.
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Affiliation(s)
- Christine Duffy
- Department of Biology and Medicine, Warren Alpert School of Medicine, Brown University, Rhode Island Hospital/DGIM, Providence, RI 02903, USA.
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Lelorain S, Brédart A, Dolbeault S, Sultan S. A systematic review of the associations between empathy measures and patient outcomes in cancer care. Psychooncology 2012; 21:1255-64. [PMID: 22238060 DOI: 10.1002/pon.2115] [Citation(s) in RCA: 138] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 11/21/2011] [Accepted: 11/23/2011] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Despite a call for empathy in medical settings, little is known about the effects of the empathy of health care professionals on patient outcomes. This review investigates the links between physicians' or nurses' empathy and patient outcomes in oncology. METHOD With the use of multiple databases, a systematic search was performed using a combination of terms and subject headings of empathy or perspective taking or clinician-patient communication, oncology or end-of-life setting and physicians or nurses. Among the 394 hits returned, 39 studies met the inclusion criteria of a quantitative measure of empathy or empathy-related constructs linked to patient outcomes. RESULTS Empathy was mainly evaluated using patient self-reports and verbal interaction coding. Investigated outcomes were mainly proximal patient satisfaction and psychological adjustment. Clinicians' empathy was related to higher patient satisfaction and lower distress in retrospective studies and when the measure was patient-reported. Coding systems yielded divergent conclusions. Empathy was not related to patient empowerment (e.g. medical knowledge, coping). CONCLUSION Overall, clinicians' empathy has beneficial effects according to patient perceptions. However, in order to disentangle components of the benefits of empathy and provide professionals with concrete advice, future research should apply different empathy assessment approaches simultaneously, including a perspective-taking task on patients' expectations and needs at precise moments. Indeed, clinicians' understanding of patients' perspectives is the core component of medical empathy, but it is often assessed only from the patient's point of view. Clinicians' evaluations of patients' perspectives should be studied and compared with patients' reports so that problematic gaps between the two perspectives can be addressed.
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Affiliation(s)
- Sophie Lelorain
- Laboratoire de Psychopathologie et Processus de Santé (LPPS EA 4057), IUPDP, Université Paris Descartes, Boulogne-Billancourt, France.
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Jarrett C, Dadich A, Robards F, Bennett D. 'Adolescence is difficult, some kids are difficult': general practitioner perceptions of working with young people. Aust J Prim Health 2011; 17:54-9. [PMID: 21616025 DOI: 10.1071/py10032] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 11/30/2010] [Indexed: 11/23/2022]
Abstract
General practitioners (GPs) are the health care providers from which young people are most likely to seek help. However, the rate at which young people access GPs is less than ideal. Four focus groups were conducted with groups of GPs in New South Wales to inform the development of a GP training program on youth health. Analysis of the focus group interviews yielded three themes that describe the context in which GPs work with young people, how GPs see young people and their work with them, and GPs' expressed training preferences. GPs described working with young people as difficult, which in turn suggests that the self-efficacy of GPs may need to be addressed in training and resource development. GPs also described systemic barriers to working with young people that can be addressed through training, advocacy and policy development.
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Affiliation(s)
- Carmen Jarrett
- NSW Centre for the Advancement of Adolescent Health, Locked Bag 4001, Westmead, NSW 2145, Australia.
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KING S, LIVINGSTON P, TURNER L, BYRNE K, JOHN M, SIDWELL J, SCOTT C. Mapping the information resources available to patients with colorectal cancer. Eur J Cancer Care (Engl) 2009; 19:492-500. [DOI: 10.1111/j.1365-2354.2009.01080.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Van Riel E, Wárlám-Rodenhuis CC, Verhoef S, Rutgers EJTH, Ausems MGEM. BRCA testing of breast cancer patients: medical specialists' referral patterns, knowledge and attitudes to genetic testing. Eur J Cancer Care (Engl) 2009; 19:369-76. [PMID: 19659662 DOI: 10.1111/j.1365-2354.2008.01065.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This study explores knowledge about hereditary breast cancer, attitudes about BRCA testing and referral pattern to a family cancer clinic among medical specialists. A total of 92 questionnaires were completed by surgeons (38), medical oncologists (29), radiation oncologists (13) and radiologists (12). The response rate was 51%. A substantial (11-56%) proportion of medical specialists do not refer patients who meet current criteria for BRCA testing. Although questions on inheritance were less well answered, overall knowledge was good. They had a positive attitude, but were concerned about the distress DNA testing might cause to family members. The majority (75%) stated that the best time for referral is after adjuvant therapy or during follow-up, but another important determinant was the patient's wish or need (12%). Further studies are needed to gain insight into the actual referral process, while ongoing training of medical specialists about genetic aspects of breast cancer is also necessary.
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Affiliation(s)
- E Van Riel
- Department of Medical Genetics, University Medical Centre Utrecht, Utrecht, the Netherlands.
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Abstract
Given the important role of parents in ensuring the well-being of their children, their perceived support is crucial for their own, as well as their child's well-being. Perceptions of support were investigated among 214 Swedish parents of 115 children on cancer treatment. Parents answered questions about their satisfaction with their child's care (The Comprehensive Satisfaction with Care, Short Form, Version 4.0 (CASC SF 4.0)) and about their need, opportunity and benefit to talk to health professionals, significant others and other people. Data were collected over telephone at 1 week (T1), 2 (T2) and 4 (T3) months after the child's diagnosis. Parents reported at least moderate satisfaction with all aspects of their child's care, and highest satisfaction with the technical care. Less than half of the parents who reported a need to talk with a psychologist at T1-T3 reported having had the opportunity to do so. The care organization, doctors' interpersonal skills, information provision and availability, nurses' information provision and the availability of psychologists are areas within Swedish paediatric oncology care for which improvement most obviously is needed.
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Affiliation(s)
- U Pöder
- Department of Public Health and Caring Sciences, Psychosocial oncology, Uppsala University, Uppsala, Sweden.
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Karliner LS, Napoles-Springer A, Kerlikowske K, Haas JS, Gregorich SE, Kaplan CP. Missed opportunities: family history and behavioral risk factors in breast cancer risk assessment among a multiethnic group of women. J Gen Intern Med 2007; 22:308-14. [PMID: 17356960 PMCID: PMC1824768 DOI: 10.1007/s11606-006-0087-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Clinician's knowledge of a woman's cancer family history (CFH) and counseling about health-related behaviors (HRB) is necessary for appropriate breast cancer care. OBJECTIVE To evaluate whether clinicians solicit CFH and counsel women on HRB; to assess relationship of well visits and patient risk perception or worry with clinician's behavior. DESIGN Cross-sectional population-based telephone survey. PARTICIPANTS Multiethnic sample; 1,700 women from San Francisco Mammography Registry with a screening mammogram in 2001-2002. PREDICTORS well visit in prior year, self-perception of 10-year breast cancer risk, worry scale. OUTCOMES Patient report of clinician asking about CFH in prior year, or ever counseling about HRB in relation to breast cancer risk. Multivariate models included age, ethnicity, education, language of interview, insurance/mammography facility, well visit, ever having a breast biopsy/follow-up mammography, Gail-Model risk, Jewish heritage, and body mass index. RESULTS 58% reported clinicians asked about CFH; 33% reported clinicians ever discussed HRB. In multivariate analysis, regardless of actual risk, perceived risk, or level of worry, having had a well visit in prior year was associated with increased odds (OR = 2.3; 95% CI 1.6, 3.3) that a clinician asked about CFH. Regardless of actual risk of breast cancer, a higher level of worry (OR = 1.9; 95% CI 1.4, 2.6) was associated with increased odds that a clinician ever discussed HRB. CONCLUSIONS Clinicians are missing opportunities to elicit family cancer histories and counsel about health-related behaviors and breast cancer risk. Preventive health visits offer opportunities for clinicians to address family history, risk behaviors, and patients' worries about breast cancer.
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Affiliation(s)
- Leah S. Karliner
- Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, California USA
| | - Anna Napoles-Springer
- Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, California USA
- UCSF Comprehensive Cancer Center, University of California, San Francisco, California USA
| | - Karla Kerlikowske
- General Internal Medicine Section, Department of Veterans’ Affairs, University of California, San Francisco, California USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA USA
- Department of Medicine, University of California, San Francisco, California USA
| | - Jennifer S. Haas
- Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts USA
| | - Steven E. Gregorich
- Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, California USA
| | - Celia Patricia Kaplan
- Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, California USA
- UCSF Comprehensive Cancer Center, University of California, San Francisco, California USA
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Abstract
The gastric mucosal surface was observed using the magnifying fibergastroscope (FGS-ML), and the fine gastric mucosal patterns, which were even smaller than one unit of gastric area, were examined at a magnification of about 30. For simplicification, we classified these patterns by magnifying endoscopy in the following ways; FP, FIP, FSP, SP and MP, modifying Yoshii's classification under the dissecting microscope. The FIP, which was found to have round and long elliptical gastric pits, is a new addition to our endoscopic classification. The relationship between the FIP and the intermediate zone was evaluated by superficial and histological studies of surgical and biopsy specimens. The width of the band of FIP seems to be related to the severity of atrophic gastritis. Also, the transformation of FP to FIP was assessed by comparing specimens taken from the resected and residual parts of the stomach, respectively. Moreover, it appears that severe gastritis occurs in the gastric mucosa which shows a FIP. Therefore, we consider that the FIP indicates the position of the atrophic border.
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