A comprehensive approach for evaluating telemedicine-delivered multidisciplinary breast cancer meetings in southern Scotland

Multidisciplinary team (MDT) meetings for decisions on cancer management are a cornerstone of UK cancer policy. We have proposed a comprehensive methodology to assess the clinical and economic effectiveness of telemedicine in this setting, which is being tested in a randomized breast cancer trial. Pre- and post-telemedicine assessment includes attitudes to and expectations of telemedicine, based on semistructured interviews. The communication content of videotapes of the MDT meeting is being scored using Borgatta's revised Interaction Process Analysis System. The technical performance of the telemedicine equipment is reported on a standardized pro forma. A short questionnaire captures key elements of professional satisfaction for each patient discussion (consensus on future management, confidence in and sharing of decision), added value of linkage, group atmosphere, overall conduct of the meeting and compliance with SIGN guidelines. A cost-minimization analysis will be used for economic assessment.

Attitudes of breast cancer professionals to conventional and telemedicine-delivered multidisciplinary breast meetings

We surveyed the attitudes of breast cancer professionals to standard face-to-face and future telemedicine-delivered breast multidisciplinary team (MDT) meetings. Interviews, which included the Group Behaviour Inventory, were conducted face-to-face (n = 19) or by telephone (n = 26). The mean total score on the Group Behaviour Inventory was 96 (SD 19) for 33 respondents, which indicated satisfaction with standard MDT meetings, irrespective of role and base hospital. Positive attitudes to videoconferencing were more common among participants with previous experience of telemedicine (Spearman's rank correlation 0.26, P = 0.91). Common themes emerging from the interviews about telemedicine-delivered MDTs included group leadership, meeting efficiency, group interaction, group atmosphere and technical quality of communication. Most participants were satisfied with standard breast MDTs. Nurses and allied health professionals were least supportive of telemedicine.

Communication training in nursing may damage your health and enthusiasm: some warnings

The purpose of this paper is to outline and discuss some of the fundamental theoretical and practical considerations bearing on the teaching of communications skills to nurses. Although evidence exists that communications training is needed, and welcomed by both nurses and nurse managers, implementation of training schemes without consideration of a number of critical issues is likely to result in only partial success, or even complete failure. The issues identified and discussed in this paper are the need for accurate assessment and evaluation, the need to understand and take into account resistance to change at the level of both the individual and the organization, and most pervasively, the need for a clear relationship between theory and practice.

Psychoanalysis as a human science: critique and reformulation

This paper continues the debate opened by Will (1980), concerning the scientific status of psychoanalysis. A critique is made of Will's paper, on the grounds that it misrepresents the scientific method, and fails to consider appropriate criteria for evaluating psychoanalysis. A defence of Popper, and the importance of prediction as a tool in structuring understanding, is sketched out, and an alternative view of the scientific process which can more adequately encompass the enterprise of psychoanalysis is suggested.