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Mohamed Hussin NA, Syed Jamaludin SS. Strategizing early interventions to improve hemodialysis acceptance among chronic kidney disease patients. Chronic Illn 2024; 20:246-257. [PMID: 37170585 DOI: 10.1177/17423953231174466] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Chronic kidney disease (CKD) is described as a global health crisis. Hemodialysis (HD) is a treatment that helps CKD patients prolong their lives. However, not all patients accept HD. To date, there is limited understanding of the factors for this resistance, especially in developing countries. This Phenomenological study employed individual telephone interviews with 35 CKD patients. The interview questions were related to the refusal factors of HD. Thematic analysis revealed six themes-concerns about becoming a burden to others, cost, age considerations, advice from others, fear regarding HD treatment, and self-healing plans. This study is vital to support medical social workers in strategizing early interventions to improve hemodialysis acceptance among CKD patients. The ability of medical social workers to understand these factors and tailor appropriate interventions will help improve the treatment acceptance and outcomes.
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Affiliation(s)
- Nur Atikah Mohamed Hussin
- Universiti Sains Malaysia, Minden, Malaysia
- Faculty of Social Sciences (Health), Tampere University, Tampere, Finland
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Emamikia S, Gomez A, Ådahl T, von Perner G, Enman Y, Chatzidionysiou K, Arkema EV, Parodis I. Factors associated with non-adherence to medications in systemic lupus erythematosus: Results from a Swedish survey. Lupus 2024; 33:615-628. [PMID: 38545763 PMCID: PMC11015713 DOI: 10.1177/09612033241242692] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/05/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE To identify determinants of medication non-adherence in a Swedish population of systemic lupus erythematosus (SLE). METHODS Patients with SLE from Karolinska and Örebro University Hospitals participated in a survey-based cross-sectional study. Demographics, disease activity, organ damage, HRQoL (LupusQol, EQ-5D-5 L), medication non-adherence (<80% on CQR-19 or MASRI) and beliefs about medicines (BMQ) were registered. MASRI was used to report adherence to different drugs/drug classes, categorised into (i) antimalarial agents (AMA), (ii) glucocorticoids and (iii) other SLE medications. Multivariable logistic regression adjusted for age, sex, disease activity and organ damage. RESULTS Among 205 respondents, the median age was 52.0 years (IQR: 34.0-70.0), 86.3% were women, 66.8% were non-adherent to their medications according to CQR-19, and 6.6% and 6.3% were non-adherent to AMA and glucocorticoids, respectively, according to MASRI. Positive beliefs about glucocorticoids (OR; 95% CI: 0.77; 0.59-0.99; p = .039) and medications overall (0.71; 0.52-0.97; p = .029) were protective against non-adherence to glucocorticoids. Anxiety/depression (3.09; 1.12-8.54; p = .029), medication concerns (1.12; 1.05-1.20; p < .001) and belief that medications are overused (1.30; 1.15-1.46; p < .001) or harmful (1.36; 1.19-1.56; p < .001) were associated with medication non-adherence (CQR-19); beliefs in the necessity of medications (0.73; 0.65-0.82; p < .001) and positive beliefs in medications were protective (0.72; 0.60-0.86; p < .001). No associations were found between other investigated factors and medication non-adherence. CONCLUSIONS Beliefs about medications were a major determinant of medication non-adherence. Patient education may help alleviate the negative impact of misinformation/unawareness on adherence.
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Affiliation(s)
- Sharzad Emamikia
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Alvaro Gomez
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Theodor Ådahl
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Gunilla von Perner
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Yvonne Enman
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Katerina Chatzidionysiou
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Elizabeth V. Arkema
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Borger T, Feather AR, Wakeman KE, Bowling W, Burris JL. Understanding cancer patients' desire to quit tobacco without assistance: A mixed-methods study. J Health Psychol 2024:13591053231223345. [PMID: 38282364 DOI: 10.1177/13591053231223345] [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] [Indexed: 01/30/2024] Open
Abstract
While many cancer patients who use tobacco try to quit post-diagnosis, some prefer to quit without using tobacco treatment, despite evidence against unassisted quit attempts. This study aimed to understand the rationale for some cancer patients' desire to quit tobacco without assistance. Thirty-five adult cancer patients who currently used tobacco and declined tobacco treatment because of the desire to quit unassisted provided data via a standardized questionnaire and a semi-structured interview. The sample was predominately White, non-Hispanic (85.71%) and female (68.57%). The most common cancer site was gynecological. Key themes that emerged from the interviews were: self-reliance, willpower, social norms, and negative attitudes toward tobacco treatment. The most frequently endorsed barrier to tobacco treatment was "I know others who have quit without tobacco treatment" (82.86%). This study with cancer patients identified affective, cognitive, and personality factors related to quitting unassisted, and social and systemic reasons to not use tobacco treatment.
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Affiliation(s)
- Tia Borger
- University of Kentucky, Lexington, KY, USA
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Wang X, Lian Z, Wu Q, Wu F, Zhang G, Liu J, Chen C, Sun J. Refusal of treatment among HER2-positive breast cancer patients in China: a retrospective analysis. Front Public Health 2024; 11:1305544. [PMID: 38303960 PMCID: PMC10832033 DOI: 10.3389/fpubh.2023.1305544] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/19/2023] [Indexed: 02/03/2024] Open
Abstract
Background There is a need to update the understanding of treatment refusal among cancer patients in China, taking into account recent developments. This study investigated how public insurance coverage of the first breast cancer targeted therapy contributed to the changes in treatment refusal among HER2-positive breast cancer patients in China. And it intensively examined and discussed additional barriers affecting patient utilization of innovative anticancer medicines based on the types and reasons for treatment refusal. Methods This retrospective study included female breast cancer patients diagnosed as HER2-positive who received treatment at a provincial oncology center in southern China between 2014 and 2020. Multivariable analysis was conducted using a binary logistic regression model. Subgroup analysis was performed with the same regression model. Results Among the 1,322 HER2-positive breast cancer patients who received treatment at the study hospital between 2014 and 2020, 327 (24.55%) had ever refused treatment. Economic reasons were reported as the primary cause by 142 patients (43.43%). Patients diagnosed after September 2017, when the first breast cancer targeted therapy was included in the public health insurance, were less likely to refuse treatment (OR = 0.64, 95% CI:0.45 ~ 0.91, p = 0.01) compared to those diagnosed before September 2017. Patients enrolled in the resident health insurance were more likely to refuse treatment (OR = 2.43, 95% CI:1.77 ~ 3.35, p < 0.001) than those enrolled in the employee health insurance. Conclusion This study reveals a high rate of treatment refusal among HER2-positive breast cancer patients, primarily attributed to financial factors. The disparity in public health insurance benefits resulted in a heavier economic burden for patients with less comprehensive benefits. Furthermore, the study identified challenges faced by patients seeking quality-assured cancer care in underdeveloped regions in China. By addressing economic barriers, promoting accurate health information, and improving cancer care capacity across the country can reduce the rate of treatment refusal.
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Affiliation(s)
- Xin Wang
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiwei Lian
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Qiyou Wu
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fan Wu
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Gong Zhang
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Jian Liu
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Chuanben Chen
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Jing Sun
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Mentrup F, Klein A, Lindner LH, Nachbichler S, Holzapfel BM, Albertsmeier M, Knösel T, Dürr HR. Refusal of Adjuvant Therapies and Its Impact on Local Control and Survival in Patients with Bone and Soft Tissue Sarcomas of the Extremities and Trunk. Cancers (Basel) 2024; 16:239. [PMID: 38254731 PMCID: PMC10814158 DOI: 10.3390/cancers16020239] [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: 12/11/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND In soft tissue or bone sarcomas, multimodal therapeutic concepts represent the standard of care. Some patients reject the therapeutic recommendations due to several reasons. The aim of this study was to assess the impact of that rejection on both prognosis and local recurrence. METHODS Between 2012 and 2019, a total of 828 sarcoma patients were surgically treated. Chemotherapy was scheduled as a neoadjuvant, and adjuvant multi-agent therapy was performed following recommendations from an interdisciplinary tumor board. Radiotherapy, if deemed appropriate, was administered either in a neoadjuvant or an adjuvant manner. The recommended type of therapy, patient compliance, and the reasons for refusal were documented. Follow-ups included local recurrences, diagnosis of metastatic disease, and patient mortality. RESULTS Radiotherapy was recommended in 407 (49%) patients. A total of 40 (10%) individuals did not receive radiation. A reduction in overall survival and local recurrence-free survival was evident in those patients who declined radiotherapy. Chemotherapy was advised for 334 (40%) patients, 250 (75%) of whom did receive all recommended cycles. A total of 25 (7%) individuals did receive a partial course while 59 (18%) did not receive any recommended chemotherapy. Overall survival and local recurrence-free survival were reduced in patients refusing chemotherapy. Overall survival was worst for the group of patients who received no chemotherapy due to medical reasons. Refusing chemotherapy for non-medical reasons was seen in 8.8% of patients, and refusal of radiotherapy for non-medical reasons was seen in 4.7% of patients. CONCLUSIONS Divergence from the advised treatment modalities significantly impacted overall survival and local recurrence-free survival across both treatment modalities. There is an imperative need for enhanced physician-patient communication. Reducing treatment times, as achieved with hypofractionated radiotherapy and with therapy in a high-volume sarcoma center, might also have a positive effect on complying with the treatment recommendations.
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Affiliation(s)
- Franziska Mentrup
- Department of Orthopaedics and Trauma Surgery, Orthopaedic Oncology, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, 81377 München, Germany; (F.M.); (A.K.); (B.M.H.)
- SarKUM, Center of Bone and Soft Tissue Tumors, LMU University Hospital, LMU Munich, 81377 München, Germany; (L.H.L.); (S.N.); (M.A.); (T.K.)
| | - Alexander Klein
- Department of Orthopaedics and Trauma Surgery, Orthopaedic Oncology, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, 81377 München, Germany; (F.M.); (A.K.); (B.M.H.)
- SarKUM, Center of Bone and Soft Tissue Tumors, LMU University Hospital, LMU Munich, 81377 München, Germany; (L.H.L.); (S.N.); (M.A.); (T.K.)
| | - Lars Hartwin Lindner
- SarKUM, Center of Bone and Soft Tissue Tumors, LMU University Hospital, LMU Munich, 81377 München, Germany; (L.H.L.); (S.N.); (M.A.); (T.K.)
- Department of Medicine III, LMU University Hospital, LMU Munich, 81377 München, Germany
| | - Silke Nachbichler
- SarKUM, Center of Bone and Soft Tissue Tumors, LMU University Hospital, LMU Munich, 81377 München, Germany; (L.H.L.); (S.N.); (M.A.); (T.K.)
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, 81377 München, Germany
| | - Boris Michael Holzapfel
- Department of Orthopaedics and Trauma Surgery, Orthopaedic Oncology, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, 81377 München, Germany; (F.M.); (A.K.); (B.M.H.)
- SarKUM, Center of Bone and Soft Tissue Tumors, LMU University Hospital, LMU Munich, 81377 München, Germany; (L.H.L.); (S.N.); (M.A.); (T.K.)
| | - Markus Albertsmeier
- SarKUM, Center of Bone and Soft Tissue Tumors, LMU University Hospital, LMU Munich, 81377 München, Germany; (L.H.L.); (S.N.); (M.A.); (T.K.)
- Department of General, Visceral and Transplantation Surgery, LMU University Hospital, LMU Munich, 81377 München, Germany
| | - Thomas Knösel
- SarKUM, Center of Bone and Soft Tissue Tumors, LMU University Hospital, LMU Munich, 81377 München, Germany; (L.H.L.); (S.N.); (M.A.); (T.K.)
- Institute of Pathology, LMU Munich, 81377 München, Germany
| | - Hans Roland Dürr
- Department of Orthopaedics and Trauma Surgery, Orthopaedic Oncology, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, 81377 München, Germany; (F.M.); (A.K.); (B.M.H.)
- SarKUM, Center of Bone and Soft Tissue Tumors, LMU University Hospital, LMU Munich, 81377 München, Germany; (L.H.L.); (S.N.); (M.A.); (T.K.)
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Benedetti DJ, Beskow LM, Brown AEC. Overcoming refusal of treatment in pediatric cancer without legal involvement: A descriptive case series from interviews with pediatric oncologists. Pediatr Blood Cancer 2023; 70:e30656. [PMID: 37638811 DOI: 10.1002/pbc.30656] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 08/29/2023]
Abstract
To describe strategies that pediatric oncologists utilize to persuade families to initiate or continue chemotherapy after refusing treatment, we examined transcripts from interviews of oncologists with relevant experience. We identified three cases in which the pediatric oncologists' approaches led to voluntary acceptance of recommended treatment without legal intervention. Strategies used include direct communication with alternative medicine providers, time-limited trial of alternative therapy, and praying with the family. While we cannot conclude whether these approaches could be generalized to other cases, they offer ideas for pediatric oncologists to consider when facing the decision to seek judicial involvement or discontinue persuasive efforts.
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Affiliation(s)
- Daniel J Benedetti
- Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura M Beskow
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amy E Caruso Brown
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, and Center for Bioethics and Humanities, SUNY Upstate Medical University, Syracuse, New York, USA
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Balakrishnan A, Burdett KB, Kocherginsky M, Jordan N. Racial and ethnic disparities in surgery for kidney cancer: a SEER analysis, 2007-2014. Ethn Health 2023; 28:1103-1114. [PMID: 37165613 DOI: 10.1080/13557858.2023.2212145] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/04/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Compared with White patients, Black and American Indian/Alaskan Native (AI/AN) patients experience higher rates of kidney cancer incidence, and Black, AI/AN, and Hispanic patients face later stages of disease at diagnosis, poorer survival rates, and greater risk of mortality. Despite the importance that appropriate treatment has in ensuring positive outcomes, little is known about the association between race and ethnicity and receipt of treatment for kidney cancer. Accordingly, the aim of this study was to explore differences in receipt of treatment and patterns of refusal of recommended treatment by race and ethnicity. DESIGN 96,745 patients ages 45-84 with kidney cancer were identified in the Surveillance, Epidemiology, and End Results (SEER) program between 2007 and 2014. Logistic regression models were used to examine the association of race and ethnicity with treatment and with patient refusal of recommended treatment. Outcomes of interest were (1) receiving any surgical procedure, and (2) refusing recommended surgery. RESULTS Relative to White patients, Black and AI/AN patients had lower odds of undergoing any surgical procedure (OR = 0.76; 95% CI: 0.72-0.81; p < 0.001, and OR = 0.92; 95% CI: 0.76-1.10; p = 0.36, respectively) after adjusting for gender, age, insurance status, stage at diagnosis, unemployment status, education status, and income as additive effects. Black and AI/AN patients also had higher odds of refusing recommended surgery (OR = 1.93; 95% CI: 1.56-2.39; p < 0.001, and OR = 1.99; 95% CI: 1.05-3.76; p = 0.035, respectively). Hispanic patients had slightly higher odds of undergoing any surgical procedure (OR = 1.10; 95% CI: 1.04-1.17; p = 0.001) and lower odds of refusal (OR = 0.67; 95% CI: 0.50-0.90; p = 0.007, respectively). CONCLUSIONS Compared with White patients, Black patients were less likely to receive potentially life-saving surgery, and both Black and AI/AN patients were more likely to refuse recommended surgery.
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Affiliation(s)
| | | | - Masha Kocherginsky
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Quantitative Data Sciences Core, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Neil Jordan
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Gebreyohannes EA, Salter SM, Chalmers L, Radford J, Lee K, D’Lima D. Patients' Perspectives on Commencing Oral Anticoagulants in Atrial Fibrillation: An Exploratory Qualitative Descriptive Study. Pharmacy (Basel) 2023; 11:153. [PMID: 37888498 PMCID: PMC10609834 DOI: 10.3390/pharmacy11050153] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Oral anticoagulants (OACs) are prescribed to patients with atrial fibrillation (AF) in order to lower stroke risk. However, patient refusal to commence OACs hinders effective anticoagulation. This study aimed to explore barriers and facilitators to patient agreement to commence OACs from the perspectives of patients with AF attending Australian general practices. METHODS A qualitative descriptive study utilising semi-structured individual interviews was conducted from March to July 2022. RESULTS Ten patients (60% male, median age = 78.5 years) completed interviews. Patients' passive roles in decision-making were identified as a facilitator. Other prominent facilitators included doctors explaining adequately and aligning their recommendations with patients' overall health goals, including the prevention of stroke and associated disabilities, and a clear understanding of the pros and cons of taking OACs. Reportedly insufficient explanation from doctors and the inconvenience associated with taking warfarin were identified as potential barriers. CONCLUSION Addressing factors that influence patient agreement to commence OACs should be an essential aspect of quality improvement interventions. Subsequent studies should also delve into the perspectives of eligible patients with AF who choose not to commence OACs as well as the perspectives of both patients and doctors regarding the decision to continue OAC treatment.
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Affiliation(s)
- Eyob Alemayehu Gebreyohannes
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Crawley 6009, WA, Australia (K.L.)
| | - Sandra M. Salter
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Crawley 6009, WA, Australia (K.L.)
| | - Leanne Chalmers
- Curtin Medical School, Curtin University, Bentley 6102, WA, Australia
| | - Jan Radford
- Launceston Clinical School, Tasmanian School of Medicine, University of Tasmania, Launceston 7250, TS, Australia;
| | - Kenneth Lee
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Crawley 6009, WA, Australia (K.L.)
| | - Danielle D’Lima
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London 181445, UK
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Wode K, Sharp L, Fransson P, Nordberg JH. Communication About Complementary and Alternative Medicine When Patients Decline Conventional Cancer Treatment: Patients' and Physicians' Experiences. Oncologist 2023; 28:e774-e783. [PMID: 37071805 PMCID: PMC10485293 DOI: 10.1093/oncolo/oyad084] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 02/17/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Complementary and alternative medicine (CAM) is a broad set of nonconventional practices used alongside or instead of conventional treatment: The latter poses obvious risks related to cancer prognosis. Patient-physician dialogue about CAM is crucial for patient safety and mutual trust. Little is known about communication in the rare situations when patients decline recommended cancer treatment and consider using CAM. The objective of this study was to explore patients' and physicians' experiences from situations when patients decline recommended cancer treatment and consider using CAM. MATERIALS AND METHODS Semi-structured interviews were carried out with 7 CAM-using cancer patients who had declined some or all conventional treatment as well as 10 physicians from oncology and palliative care. Framework analysis was used. RESULTS Regarding treatment choices, there was a dissonance between physicians' focus on medical reasoning and patients' expression of complex values. Physicians' difficulty in understanding patients' treatment decline was exacerbated when patients considered using CAM, impairing communication even further. Inequalities in roles resulting in power struggles risked pushing both parties toward extreme and inflexible standpoints. Despite these challenges regarding treatment choices and hierarchical roles, both parties considered open and respectful communication as crucial. CONCLUSIONS This study highlights the difficulty of shared decision-making in practice when patients' and physicians' views on treatment decisions deviate in clinically challenging situations. Our results point to a need to address the complexity of these situations, pay attention to patients' values, and improve knowledge among physicians about CAM.
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Affiliation(s)
- Kathrin Wode
- Department of Radiation Sciences/Oncology, Umeå University, Umeå, Sweden
- Regional Cancer Centre Stockholm Gotland, Stockholm, Sweden
- Department of Nursing, Umeå University, Sweden
| | - Lena Sharp
- Regional Cancer Centre Stockholm Gotland, Stockholm, Sweden
- Department of Nursing, Umeå University, Sweden
| | | | - Johanna Hök Nordberg
- Regional Cancer Centre Stockholm Gotland, Stockholm, Sweden
- Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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10
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Werner B, Lee SW. Who Left the Hospital Against Medical Advice During the Early COVID-19 Pandemic? HCA Healthc J Med 2023; 4:291-296. [PMID: 37753415 PMCID: PMC10519635 DOI: 10.36518/2689-0216.1530] [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] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Background Patients leaving against medical advice (AMA) presents a challenge to hospitals as they try to manage costs and improve patient outcomes in an ever-increasing competitive market. Investigating AMA discharges that occurred during the early COVID-19 pandemic presents a unique opportunity to better understand this phenomenon and be better prepared for the future. Methods This retrospective analysis of 34 379 patients from a nationwide private healthcare system across 20 states analyzed patients during the early stages of the pandemic who chose to leave against medical advice (AMA) after being admitted with COVID-19 infection and identified several patient characteristics associated with subsequent AMA discharge. Results These patient characteristics included being younger than 50; identifying as male sex; having non-white ethnicity, including both Black and Hispanic; having either Medicaid or no health insurance; and the presence of specific medical comorbidities. The identified medical comorbidities were substance abuse, renal failure, deep vein thrombosis, hypertension with heart failure, hypertension with chronic kidney disease stage 5, rheumatoid arthritis or collagen vascular diseases, alcohol abuse, chronic pulmonary disease, hypertensive encephalopathy, and solid tumor. Conclusion This study confirms some of the findings in previous studies looking at AMA discharges and has some interesting findings as it relates specifically to the COVID-19-infected patient population. An additional understanding of the factors leading to AMA discharges can help providers and administrators prevent suboptimal discharge outcomes in the future.
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Affiliation(s)
- Bryan Werner
- Sunrise Hospital & Medical Center, Las Vegas, NV
| | - Se Won Lee
- Sunrise Hospital & Medical Center, Las Vegas, NV
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11
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Al-Wathinani AM, Barten DG, Alsahli H, Alhamid A, Alghamdi W, Alqahtani W, Alghamdi R, Aljuaid M, Albaqami NA, Goniewicz K. The Right to Refuse: Understanding Healthcare Providers' Perspectives on Patient Autonomy in Emergency Care. Healthcare (Basel) 2023; 11:1756. [PMID: 37372874 DOI: 10.3390/healthcare11121756] [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: 04/29/2023] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Healthcare providers in prehospital care and emergency departments are often at the frontline of medical crises, facing a range of ethical dilemmas, particularly when it comes to patients refusing treatment. This study aimed to delve into the attitudes of these providers toward treatment refusal, unearthing the strategies they employ in navigating such challenging situations while actively working in prehospital emergency health services. Our findings showed that, as the participants' age and experience increased, so did their inclination to respect patient autonomy and avoid persuading them to change their decision about treatment. It was noted that doctors, paramedics, and emergency medical technicians demonstrated a deeper understanding of patients' rights than other medical specialists. However, even with this understanding, the prioritization of patients' rights tended to diminish in life-threatening situations, giving rise to ethical dilemmas. This underlines the complexity of balancing the healthcare professionals' responsibilities and the patients' autonomy, which can generate ethically challenging scenarios for those working in emergency healthcare. By investigating these attitudes and experiences, this study seeks to foster a more profound understanding of the ethical quandaries faced by emergency healthcare providers. Our ultimate aim is to contribute to the development of effective strategies that support both patients and professionals in managing these tough circumstances.
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Affiliation(s)
- Ahmed M Al-Wathinani
- Department of Emergency Medical Services, Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh 11451, Saudi Arabia
| | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, 5912 BL Venlo, The Netherlands
| | - Hind Alsahli
- Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Anfal Alhamid
- Primary Care Clinic and Emergency Department, Dental University Hospital-KSUMC, King Saud University, Riyadh 11451, Saudi Arabia
| | - Waad Alghamdi
- Department of Respiratory Services, King Abdulaziz Medical City, Ministry of National Guard, Riyadh 1154, Saudi Arabia
| | - Wadha Alqahtani
- Department of Respiratory Services, King Abdulaziz Medical City, Ministry of National Guard, Riyadh 1154, Saudi Arabia
| | - Raghad Alghamdi
- Department of Respiratory Services, King Abdulaziz Medical City, Ministry of National Guard, Riyadh 1154, Saudi Arabia
| | - Mohammad Aljuaid
- Department of Health Administration, College of Business Administration, King Saud University, Riyadh 11541, Saudi Arabia
| | - Nawaf A Albaqami
- Department of Emergency Medical Services, Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh 11451, Saudi Arabia
| | - Krzysztof Goniewicz
- Department of Security Studies, Polish Air Force University, 08-521 Dęblin, Poland
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Jauho KR, Skovmand K, Cedergreen P, Johansson PI, Wildgaard K. Perioperative management of patients declining transfusions of blood components-National survey of anaesthesiologists, abdominal surgeons and obstetricians in Denmark. Acta Anaesthesiol Scand 2023. [PMID: 37070551 DOI: 10.1111/aas.14245] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/14/2023] [Accepted: 03/17/2023] [Indexed: 04/19/2023]
Abstract
Perioperative management of patients declining transfusions of blood products can be challenging both ethically and clinically. Jehovah's Witnesses (JW) decline treatment with blood products and have published a list of interventions they might accept as substitutes. No detailed documentation of available substitute interventions at Danish hospitals exists. Likewise, no national guidelines exist on how to optimise patients who refuse to receive treatment with blood products. The primary aim was to investigate which treatments are currently available to healthcare professionals in Denmark when treating patients who refuse transfusion of blood components. Additionally, we wanted to investigate how many departments have local guidelines for treatment for this group of patients. Based on our findings we would suggest potential improvements in the treatment of patients declining transfusion of blood components. Consultants from Danish departments of anaesthesiology, abdominal surgery and obstetrics were invited to participate in a nationwide cross-sectional online survey. The questionnaire explored available interventions offered perioperatively. Respondents were all on-call consultants. The questionnaire underwent content, face and technical validation during pilot testing. Ninety-six of 108 (89%) respondents from 55 departments completed the questionnaire. Thirty-five (36%) respondents reported having a departmental guideline mostly dealing with judicial aspects regarding patients declining transfusions with blood, and 34 (35%) would in collaboration with other professionals make an interdisciplinary strategy for patients declining transfusions with blood. For patients declining treatment with blood products in anticoagulant treatment, and hence with a greater risk of bleeding, reverting treatment is essential. Depending on the type of anticoagulant, between 31 (32%) and 59 (60%) of respondents reported locally available guidelines for reverting anticoagulant treatments. We found a considerable variation and limited availability of interventions to minimise blood loss in patients declining transfusion of blood components. This scarcity of local guidelines together with the considerable variation of available treatment documented in our survey could possibly be enhanced by a lack of national guidelines.
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Affiliation(s)
- Kristian R Jauho
- Department of Anaesthesia, Surgery and Intensive Care, Herlev Hospital, Copenhagen, Denmark
| | - Kamilla Skovmand
- Department of Anaesthesia, Pain Management and Respiratory Support, Rigshospitalet Glostrup, Copenhagen, Denmark
| | - Pernille Cedergreen
- Department of Anaesthesia, Surgery and Intensive Care, Herlev Hospital, Copenhagen, Denmark
| | - Pär I Johansson
- Department of Clinical Immunology and Blood Bank, Rigshospitalet, Copenhagen, Denmark
| | - Kim Wildgaard
- Department of Anaesthesia, Surgery and Intensive Care, Herlev Hospital, Copenhagen, Denmark
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13
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Alahmad G. Attitudes toward the Care of Children with Cancer in Saudi: An Exploratory Survey. Children (Basel) 2023; 10:children10040693. [PMID: 37189942 DOI: 10.3390/children10040693] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/28/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023]
Abstract
The ethical challenges of pediatric cancer care across Arab countries are not well addressed, despite medical advancements and increased awareness of children's rights. The ethical challenges related to pediatric cancer in Saudi Arabia were investigated by surveying 400 respondents at King Abdulaziz Medical City in Riyadh, Jeddah, and Dammam, Saudi Arabia, from four groups: pediatricians, medical students, nurses, and parents of children with cancer. Respondents' characteristics were surveyed across three outcomes: awareness of care, knowledge, and parent consent/child assent, developed from a systematic review and a qualitative analysis. A majority of respondents (89.0%) considered pediatric cancer different from adult cancer. Families considered alternative treatment, according to 64.3% of respondents, while 88.0% emphasized understanding the family's needs and values. Furthermore, 95.8% of respondents believed physicians should offer time for pedagogy, 92.3% viewed parental consent as essential, and 94.5% thought that sufficient discussion about the plan and type of treatment should precede consent. However, child assent showed lower levels of agreement, with only 41.3% and 52.5% agreeing with getting child assent and having a discussion. Finally, 56% agreed that parents might refuse suggested treatment, while only 24.3% agreed that the child could refuse it. In all these ethical considerations, nurses and physicians showed significantly more positive results compared with other groups.
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Affiliation(s)
- Ghiath Alahmad
- King Abdullah International Medical Research Center (KAIMRC), King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
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14
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Ponomareva IV, Tsiring DA, Pakhomova YN. [The psychological factors of renunciation of antitumoral therapy by women with breast cancer (international publications review)]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2023; 31:222-226. [PMID: 37129395 DOI: 10.32687/0869-866x-2023-31-2-223-226] [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] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/29/2022] [Indexed: 05/03/2023]
Abstract
The article presents analytical review of studies considering problem of patient refusal from antitumoral treatment, in particular of women with breast cancer. The analysis of main results of empirical studies describes factors associated with patient refusal from treatment. Among factors affecting decision making related to patient voluntarily refuse of treatment are toxicity of treatment (nausea and vomiting), senile age, disease stage, availability and type of medical insurance, characteristics of family status. Besides objective factors, such subjective factors as beliefs, values of patients are described. The deficiency of research studies concerning psychological factors of patient refusal of antitumoral treatment is established. However, patient loyalty to antitumoral treatment plays decisive role in prognosis of survival and favorable course of disease. In connection with that, studies covering such areas as psychological characteristics of personality of patients refusing of antitumoral treatment, verification of psychological factors of this voluntary refusal are required in order to organize continuum of oncological care of patients, their psychological maintenance and increasing of commitment to treatment.
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Affiliation(s)
- I V Ponomareva
- The Federal State Autonomous Educational Institution of Higher Education "The Tomsk National Research State University", 634050, Tomsk, Russia,
- The Ural Branch of the Federal State Budget Educational Institution of Higher Education "The Financial University under the Government of the Russian Federation", 454084, Chelyabinsk, Russia
- The Federal State Budget Educational Institution of Higher Education "The Chelyabinsk State University", 454084, Chelyabinsk, Russia
| | - D A Tsiring
- The Federal State Autonomous Educational Institution of Higher Education "The Tomsk National Research State University", 634050, Tomsk, Russia
- The Ural Branch of the Federal State Budget Educational Institution of Higher Education "The Financial University under the Government of the Russian Federation", 454084, Chelyabinsk, Russia
| | - Ya N Pakhomova
- The Ural Branch of the Federal State Budget Educational Institution of Higher Education "The Financial University under the Government of the Russian Federation", 454084, Chelyabinsk, Russia
- The Federal State Budget Educational Institution of Higher Education "The Chelyabinsk State University", 454084, Chelyabinsk, Russia
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15
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Leung E, Kerr D, Askelson N, Chi DL. Understanding topical fluoride hesitancy and refusal behaviors through the extended parallel process model and health belief model. J Public Health Dent 2023; 83:3-8. [PMID: 35288941 PMCID: PMC9470784 DOI: 10.1111/jphd.12512] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/19/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Topical fluoride helps prevent dental caries. However, many caregivers are hesitant about topical fluoride for their children and may refuse it during clinic visits. In this qualitative study, we assessed the relevance of the extended parallel process model (EPPM) and health belief model (HBM) in caregivers' decision-making about topical fluoride. METHODS We interviewed 56 fluoride-hesitant or fluoride-refusing caregivers using a semi-structured interview script that included questions based on select constructs from the EPPM (perceived severity, susceptibility, response efficacy) and HBM (perceived benefits and consequences). Two team members conducted a thematic analysis of the interview data. RESULTS Most caregivers acknowledged the severity of cavities but did not believe their child was susceptible. Caregivers also understood the general benefits of fluoride in preventing tooth decay, but reported low response efficacy of fluoride for their children especially compared to the other ways of reducing caries risk like reducing sugar intake and toothbrushing. Many caregivers had concerns about topical fluoride, especially regarding safety, with the potential consequences of fluoride outweighing its benefits. CONCLUSION Our findings were generally consistent with the EPPM and HBM, which appear to be relevant in understanding fluoride hesitancy behaviors. Additional research is needed on ways to improve provider communications about topical fluoride with caregivers.
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Affiliation(s)
- Esther Leung
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
| | - Darragh Kerr
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
| | - Natoshia Askelson
- Department of Community and Behavioral Health, University of Iowa, Iowa City, Iowa, USA
| | - Donald L. Chi
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
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16
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Isennock SM. The Legal Limits of Parental Autonomy: Do Parents Have the Right to Refuse Intramuscular Vitamin K for Their Newborn? HCA Healthc J Med 2023; 4:5-11. [PMID: 37426560 PMCID: PMC10327957 DOI: 10.36518/2689-0216.1289] [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] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Description The American Academy of Pediatrics recommends that all newborns receive an intra-muscular (IM) dose of vitamin K within 6 hours of delivery for the prevention of vitamin K deficiency bleeding (VKDB). There has been an increase in the number of parents who have refused the IM vitamin K dose for their infant based on its possible link to leukemia, preservatives that may lead to adverse reactions, and wanting to avoid pain for the infant. When newborns do not receive IM vitamin K, the most serious feared potential complication is intracranial hemorrhage with potential neurologic sequela including seizures, developmental delay, and death. Recent studies support the contention that parents are making the choice to refuse IM vitamin K without sufficient knowledge of the potential consequences. Parental decisions typically align with the best interest of the child; however, when parental decisions veer from the child's best interest, the limit of parental autonomy is tested. The precedent set by previous cases in which parental autonomy was challenged suggests parents should not be able to refuse IM vitamin K because the therapy has nearly no burden and forgoing this therapy has the potential for substantial harm. It has been argued that as long as the degree of intrusion is modest (a single IM injection) and the benefit substantial (prevention of possible death), states are granted the power to mandate the use of such an intervention. Mandated IM vitamin K for all newborns, regardless of parental approval, would rescind some parental autonomy but improve overall beneficence, nonmaleficence, and justice in the care of newborns.
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Affiliation(s)
- Shannon M. Isennock
- Mercer University School of Medicine, Savannah, GA
- University of Tennessee Health Science Center Graduate Medical Education, Memphis, TN
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17
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dos Santos AP, Cordeiro JFC, Fracarolli IFL, Gomide EBG, de Andrade D. Instruments to assess adherence to medication in people living with HIV: a scoping review. Rev Saude Publica 2022; 56:112. [PMID: 36629703 PMCID: PMC9749734 DOI: 10.11606/s1518-8787.2022056004475] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/18/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To compile the instruments validated in Brazil for assessing adherence of people living with HIV to antiretroviral therapy. METHODS Scoping review using the Web of Science, Scopus, Medline (via PubMed), Embase, BDENF, CINAHL and Lilacs databases. In addition, the Preprints bioRxiv, Google Scholar and OpenGrey servers were checked. There was no language restriction for the search, and it considered articles published from the year 1996 onwards. RESULTS Three publications were included in the qualitative synthesis. Following were the instruments identified "Questionário para Avaliação da Adesão ao Tratamento Antirretroviral" (Questionnaire for Assessment of Adherence to Antiretroviral Treatment) developed in Porto Alegre (RS) and published in 2007; the "Escala de autoeficácia para adesão ao tratamento antirretroviral em crianças e adolescentes com HIV/Aids" (Self-efficacy Scale for Adherence to Antiretroviral Treatment in Children and Adolescents with HIV/Aids) developed in São Paulo (SP) and published in 2008; and the "WebAd-Q, um instrumento de autorrelato para monitorar a adesão à terapia antirretroviral em serviços de HIV/Aids no Brasil" (WebAd-Q, a self-report instrument to monitor adherence to antiretroviral therapy in HIV/Aids services in Brazil) developed in São Bernardo do Campo (SP) and published in 2018. The instruments were validated in Brazil, and presented statistically acceptable values for psychometric qualities. CONCLUSION The instruments to assess adherence of people living with HIV to antiretroviral therapy are validated strategies for the Brazilian context. However, their (re)use in different settings and contexts of the nation should be expanded. The use of these instruments by health professionals can improve the understanding of factors that act negatively and positively on antiretroviral therapy adherence, and the proposition of strategies intended to consolidate good adherence and intervene in the treatment of people with low therapeutic engagement.
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Affiliation(s)
- André Pereira dos Santos
- Universidade de São PauloEscola de Enfermagem de Ribeirão PretoRibeirão PretoSPBrasilUniversidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil,Universidade de São PauloEscola de Educação Física e Esporte de Ribeirão PretoRibeirão PretoSPBrasilUniversidade de São Paulo. Escola de Educação Física e Esporte de Ribeirão Preto. Grupo de Estudos e Pesquisa em Antropometria, Treinamento e Esporte. Ribeirão Preto, SP, Brasil,Universidade de São PauloEscola de Educação Física e Esporte de Ribeirão PretoRibeirão PretoSPBrasilUniversidade de São Paulo. Escola de Educação Física e Esporte de Ribeirão Preto. Ribeirão Preto, SP, Brasil,Human Exposome and Infectious Diseases NetworkRibeirão PretoSPBrasilHuman Exposome and Infectious Diseases Network. Ribeirão Preto, SP, Brasil
| | - Jéssica Fernanda Corrêa Cordeiro
- Universidade de São PauloEscola de Enfermagem de Ribeirão PretoRibeirão PretoSPBrasilUniversidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | - Isabela Fernanda Larios Fracarolli
- Universidade de São PauloEscola de Enfermagem de Ribeirão PretoRibeirão PretoSPBrasilUniversidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | - Euripedes Barsanulfo Gonçalves Gomide
- Universidade de São PauloEscola de Enfermagem de Ribeirão PretoRibeirão PretoSPBrasilUniversidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil,Universidade de São PauloEscola de Educação Física e Esporte de Ribeirão PretoRibeirão PretoSPBrasilUniversidade de São Paulo. Escola de Educação Física e Esporte de Ribeirão Preto. Grupo de Estudos e Pesquisa em Antropometria, Treinamento e Esporte. Ribeirão Preto, SP, Brasil,Claretiano – Centro UniversitárioBatataisSPBrasilClaretiano – Centro Universitário. Batatais, SP, Brasil
| | - Denise de Andrade
- Universidade de São PauloEscola de Enfermagem de Ribeirão PretoRibeirão PretoSPBrasilUniversidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil,Human Exposome and Infectious Diseases NetworkRibeirão PretoSPBrasilHuman Exposome and Infectious Diseases Network. Ribeirão Preto, SP, Brasil
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18
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Fletcher JJ, Aughenbaugh A, Svabek C, Hahn PY, Grifka RG. Ventilator avoidance among critically ill COVID-19 patients with acute respiratory distress syndrome. J Int Med Res 2022; 50:3000605221135446. [PMID: 36324277 PMCID: PMC9634208 DOI: 10.1177/03000605221135446] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective To determine the incidence and significance of ventilator avoidance in
patients with critical coronavirus disease 2019 (COVID-19). Methods This prospective observational cohort study evaluated hospital mortality and
1-year functional outcome among critically ill patients with severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated acute respiratory
distress syndrome (ARDS). The explanatory variable was ventilator avoidance,
modeled as ‘initial refusal’ of intubation (yes/no). Modified Rankin Scale
(mRS) scores were obtained from surviving patients (or their surrogates) via
phone or email questionnaire. Results Among patients for whom intubation was recommended
(n = 102), 40 (39%) initially refused (95% confidence
interval [CI] 30%, 49%). The risk of death was 79.3% (49/62) in those who
did not initially refuse intubation compared with 77.5% (31/40) in those who
initially refused, with an adjusted odds ratio for death of 1.27 (95% CI
0.47, 3.48). The distribution of 1-year mRS scores was not significantly
different between groups. Conclusion Among critically ill patients with COVID-19-associated ARDS, ventilator
avoidance was common, but was not associated with increased in-hospital
mortality or 1-year functional outcome.
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Affiliation(s)
- Jeffrey J Fletcher
- Department of Critical Care
Medicine, University of Michigan Health West, Wyoming, MI, USA,Department of Neurosurgery,
University of Michigan Medical School, Ann Arbor, MI, USA,Jeffrey J Fletcher, University of Michigan
Health West, Critical Care Medicine, 5900 Byron Center Ave, Wyoming, MI 49519,
USA.
| | - Arielle Aughenbaugh
- Michigan State University College
of Osteopathic Medicine, East Lansing, MI, USA
| | - Catherine Svabek
- Department of Research, University
of Michigan Health West, Wyoming, MI, USA
| | - Peter Y Hahn
- Department of Critical Care
Medicine, University of Michigan Health West, Wyoming, MI, USA
| | - Ronald G Grifka
- Department of Research, University
of Michigan Health West, Wyoming, MI, USA
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19
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Storrier K, Ouliaris C, George D. New injectable antiretroviral therapy for HIV facilitates novel treatment pathways for persons without capacity to consent to medical treatment. Australas Psychiatry 2022; 30:375-378. [PMID: 35285293 DOI: 10.1177/10398562221077892] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The development of new injectable antiretroviral therapy facilitates treatment for Human immunodeficiency virus (HIV) positive individuals who lack capacity to consent, posing a safety risk to both themselves and the wider community. We consider pathways to enforce treatment and propose an algorithm to determine the most appropriate legal instrument for application. CONCLUSION Legislative safeguards in mental health and guardianship legislation provide oversight and protection for those who suffer from illness and require coercive treatment. These frameworks have utility in the treatment of HIV patients who lack capacity to consent to treatment.
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Affiliation(s)
| | - Calina Ouliaris
- 522555Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Duncan George
- School of Psychiatry, Faculty of Medicine, 3960University of New South Wales, Australia; School of Rural Health, Faculty of Medicine and Health, University of Sydney, Australia; Consultation Liaison Psychiatry, The Albion Centre & Prince of Wales Hospital, NSW, Australia; and Dubbo Base Hospital, Dubbo, NSW, Australia
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20
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Hazarika M, Kumar G, Saikia BJ, Sarangi SS, Roy PS, Bhattacharjee K, Barman M. Clinicoepidemiological Profile and Treatment Outcomes in Children with Retinoblastoma: Experience from a Cancer Care Center in Northeast India. South Asian J Cancer 2022; 11:269-273. [PMID: 36588614 PMCID: PMC9803543 DOI: 10.1055/s-0041-1740326] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Gaurav KumarBackground Retinoblastoma (RB) is the most common primary intraocular malignancy in children. We sought to provide a comprehensive assessment of epidemiological profile and treatment outcomes of children with RB. Methods In this retrospective study, we analyzed 189 children diagnosed with RB at our center between 2004 and 2017. Survival was analyzed with the Kaplan-Meier method and log-rank test. Results Median age at presentation was 14 months with male: female ratio 1.2:1. Mean duration between onset of symptoms and presentation was 49 days (standard deviation ± 79). Most common presenting symptom was white pupillary reflex in 60% of children. Family history of RB and other cancers was found in one (0.5%) and seven (4%) children, respectively. Primary mode of diagnosis and staging was ocular ultrasonography (bone scan) in 87% of patients. Computed tomographic scan and magnetic resonance imaging were done in 124 (66%) and 30 (16%) patients, respectively. International staging system grade E disease was found in 144 (76%), extraocular disease in 55 (29%), bilateral disease in 49 (26%), and trilateral disease in 3 (1.5%) children. Out of 189 children with RB, 33 (18%) refused treatment and 156 children received treatment (24 children [15%] abandoned treatment midway and 132 [85%] completed treatment). One hundred children (64%) received systemic therapy as neoadjuvant or adjuvant chemotherapy and 20 (13%) received local therapy. Eyeball and vision salvage rate with chemotherapy were 20 (13%) and 9 (6%), respectively. Cryotherapy was the most common modality of local treatment used in 11 (55%) children. Five-year survival for patients who received treatment was 76% (median survival not reached). In the treatment refusal group, median survival was 9 months. Conclusion In developing countries, RB is mostly detected in advanced stages resulting in poor outcomes. Increased awareness and accessibility to dedicated centers for treating childhood malignancy can lead to early diagnosis, better prognosis, and increased vision salvage.
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Affiliation(s)
- Munlima Hazarika
- Department of Medical oncology, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
| | - Gaurav Kumar
- Department of Medical oncology, Dr. B Borooah Cancer Institute, Guwahati, Assam, India,Address for correspondence Gaurav Kumar, MD, DM Medical Oncology Department of Medical oncology, Dr. B Borooah Cancer Institute, Guwahati781016, AssamIndia
| | - Bhargab Jyoti Saikia
- Department of Medical oncology, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
| | - Satya Sadhan Sarangi
- Department of Medical oncology, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
| | - Partha Sarathi Roy
- Department of Medical oncology, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
| | - Kasturi Bhattacharjee
- Department of Ophthalmology, Srimanta Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Manabjyoti Barman
- Department of Ophthalmology, Srimanta Sankaradeva Nethralaya, Guwahati, Assam, India
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Cardenas V, Rahman A, Zhu Y, Enguidanos S. Reluctance to Accept Palliative Care and Recommendations for Improvement: Findings From Semi-Structured Interviews With Patients and Caregivers. Am J Hosp Palliat Care 2022; 39:189-195. [PMID: 33896233 PMCID: PMC8684814 DOI: 10.1177/10499091211012605] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Despite some insurance plans now paying for home-based palliative care, recent reports have suggested that insurance coverage for palliative care may be insufficient in expanding patient access to home-based palliative care. AIM To identify patients' and caregivers' perceived barriers to home-based palliative care and their recommendations for overcoming these barriers. DESIGN We conducted a qualitative study using semi-structured individual interviews. Our interview protocol elicited participants' perspectives on home-based palliative care services; positive and negative aspects of the palliative program explanation; and suggestions for improving messaging around home-based palliative care. SETTING/PARTICIPANTS Twenty-five participants (patients, proxies, and their caregivers) who were eligible for a randomized controlled trial of home-based palliative care were interviewed by telephone. RESULTS Themes related to home-based palliative care referral barriers included reluctance to have home visits, enrollment timing, lack of palliative care knowledge, misconceptions about palliative care, and patients' self-perceived health condition. Themes related to recommendations for overcoming these obstacles included ensuring that palliative care referrals come from healthcare providers or insurance companies and presenting palliative care services more clearly. CONCLUSION Findings reinforce the need for additional palliative care education among patients with serious illness (and their caregivers) and the importance of delivering palliative care information and referrals from trusted sources.
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Affiliation(s)
- Valeria Cardenas
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Anna Rahman
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Yujun Zhu
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Susan Enguidanos
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
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22
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Byrne J, Willis A, Dunkley A, Fitzpatrick C, Campbell S, Sidhu MS, Choudhary P, Davies MJ, Khunti K. Individual, healthcare professional and system-level barriers and facilitators to initiation and adherence to injectable therapies for type 2 diabetes: A systematic review and meta-ethnography. Diabet Med 2022; 39:e14678. [PMID: 34432914 DOI: 10.1111/dme.14678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/22/2021] [Accepted: 08/24/2021] [Indexed: 11/30/2022]
Abstract
AIMS To review and synthesise the contemporary qualitative evidence, relating to the individual, healthcare professional and system-level barriers and facilitators to injectable therapies in people with type 2 diabetes, and evaluate (using an intersectional approach to explore the diverse perspectives of different identities) whether views have changed with treatment and guideline advancements. METHODS A meta-ethnography approach used. Eight databases searched from the years 2006 (GLP-1 analogues introduced) to February 2021. Study selection (using a pre-defined inclusion criteria), quality appraisal and data extraction, conducted independently by two reviewers. RESULTS Screened 7143 abstracts, assessed 93 full-text papers for eligibility and included 42 studies-using data from 818 individuals with type 2 diabetes and 160 healthcare professionals. Studies covered a diverse range of views from healthcare professionals and individuals, including those relating to older adults and people from ethnic migrant backgrounds, and 10 studies rated moderate to strong research value. Key themes abstracted: barriers (physical/psychological/social) and facilitators (motivation/capability/opportunity). CONCLUSIONS The first synthesis of contemporary qualitative data to adopt an intersectionality approach and explore diverse views relating to barriers and facilitators that influence engagement with injectable treatments for type 2 diabetes. A model is presented to help patients, health practitioners and policy makers identify barriers and facilitators and understand the complex interplay of physical, psychological and social factors involved when prescribing injectable therapies. Despite advances in injectable treatments and guidelines, findings highlight the many barriers that still exist and show how strongly held culturally-specific health beliefs of people from diverse socio-economic and ethnic backgrounds can become substantial obstacles to treatment.
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Affiliation(s)
- Jo Byrne
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Andrew Willis
- Leicester Research Centre, University of Leicester, Leicester, UK
| | - Alison Dunkley
- Leicester Research Centre, University of Leicester, Leicester, UK
| | | | - Sandra Campbell
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Manbinder S Sidhu
- Health Service Management Centre, University of Birmingham, Birmingham, UK
| | - Pratik Choudhary
- Leicester Research Centre, University of Leicester, Leicester, UK
| | - Melanie J Davies
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
- Leicester Research Centre, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Leicester Research Centre, University of Leicester, Leicester, UK
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23
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Dean LT, Chang HY, Goedel WC, Chan PA, Doshi JA, Nunn AS. Novel population-level proxy measures for suboptimal HIV preexposure prophylaxis initiation and persistence in the USA. AIDS 2021; 35:2375-2381. [PMID: 34723852 PMCID: PMC8564020 DOI: 10.1097/qad.0000000000003030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE In the United States (USA), HIV preexposure prophylaxis (PrEP) use is suboptimal. Population-level metrics on PrEP use are limited and focus on prescriptions issued rather than how much prescriptions are picked up. We introduce PrEP reversals, defined as when patients fail to pick up PrEP prescriptions at the pharmacy point-of-sale, as a proxy for PrEP initiation and persistence. DESIGN We analysed PrEP pharmacy claims and HIV diagnoses from a Symphony Health Solutions dataset across all US states from 1 October 2015 to 30 September 2019. METHODS We calculated the percentage of individuals who were newly prescribed PrEP and who reversed (i.e. patient did not pick up an insurance-approved prescription and pharmacy withdrew the claim), delayed (reversed and then picked up within 90 days), very delayed (reversed and then picked up between 90 and 365 days) or abandoned (not picked up within 365 days), and subsequent HIV diagnosis within 365 days. RESULTS Of 59 219 individuals newly prescribed PrEP, 19% reversed their index prescription. Among those, 21% delayed initiation and 8% had very delayed initiation. Seventy-one percent of patients who reversed their initial prescription abandoned it, 6% of whom were diagnosed with HIV---three times higher than those who persisted on PrEP. CONCLUSION Nearly one in five patients newlyprescribed PrEP reversed initial prescriptions, leading to delayed medication access, being lost to PrEP care, and dramatically higher HIV risk. Reversals could be used for real-time nationwide PrEP population-based initiation and persistence tracking, and for identifying patients that might otherwise be lost to care.
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Affiliation(s)
- Lorraine T Dean
- Department of Epidemiology
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Hsien-Yen Chang
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Philip A Chan
- Department of Medicine, Brown University
- Rhode Island Department of Health
- Rhode Island Public Health Institute, Providence, Rhode Island
| | - Jalpa A Doshi
- Perelman School of Medicine
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amy S Nunn
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
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24
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Opdam F, Dillen JV, Vries M, Hollander M. How to Make the Hospital an Option Again: Midwives' and Obstetricians' Experiences with a Designated Clinic for Women Who Request Different Care than Recommended in the Guidelines. Int J Environ Res Public Health 2021; 18:11627. [PMID: 34770141 DOI: 10.3390/ijerph182111627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 10/30/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND An increasing number of maternity care providers encounter pregnant women who request less care than recommended. A designated outpatient clinic for women who request less care than recommended was set up in Nijmegen, the Netherlands. The clinic's aim is to ensure that women make well-informed choices and arrive at a care plan that is acceptable to all parties. The aim of this study is to make the clinic's approach explicit by examining care providers' experiences who work with or within the clinic. METHODS qualitative analysis of in-depth interviews with Dutch midwives (n = 6) and obstetricians (n = 4) on their experiences with the outpatient clinic "Maternity Care Outside the Guidelines" in Nijmegen, the Netherlands. RESULTS Four main themes were identified: (1) "Trusting mothers, childbirth and colleagues"; (2) "A supportive communication style"; (3) "Continuity of carer"; (4) "Willingness to reconsider responsibility and risk". One overarching theme emerged from the data, which was "Guaranteeing women's autonomy". Mutual trust is a prerequisite for a constructive dialogue about birth plans and can be built and maintained more easily when there is continuity of carer during pregnancy and birth. Discussing birth plans at the clinic was believed to be successful because the care providers listen to women, take them seriously, show empathy and respect their right to refuse care. A change in vision on responsibility and risk is needed to overcome barriers such as providers' fear of adverse outcomes. Taking a more flexible approach towards care outside the guidelines demands courage but is necessary to guarantee women's autonomy. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE In order to fulfil women's needs and to prevent negative choices, care providers should care for women with trust, respect for autonomy, and provide freedom of choice and continuity. Care providers should reflect on and discuss why they are reluctant to support women's wishes that go against their personal values. The structured approach used at this clinic could be helpful to maternity care providers in other contexts, to make them feel less vulnerable when working outside the guidelines.
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25
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Orzechowski W, Buczek W, Szczerba JE, Gellert R, Rydzewski A, Fiderkiewicz B, Żebrowski P, Daniewska D, Kokoszka A. Underdiagnosis of Major Depressive Episodes in Hemodialysis Patients: The Need for Screening and Patient Education. J Clin Med 2021; 10:4109. [PMID: 34575220 DOI: 10.3390/jcm10184109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 11/17/2022] Open
Abstract
This article aims to identify the reasons why patients with major depressive episode (MDE) do not seek treatment for their mental disorder. 89 out of 208 persons screened were diagnosed with major depressive episode using the Mini-International Neuropsychiatric Interview. 85 individuals with untreated depression filled out the following questionnaires: Beck Depression Inventory, List of Explanations of Well-Being (LEWB), Brief Measure to Assess Perception of Self-Influence on the Course of the Disease, Coping Inventory for Stressful Situations, Brief Method of Evaluating Coping with Disease, and Metacognitions Questionnaire. There were 43 women (50.6%) and 42 men (49.4%), aged 24 to 93 years (Mean (M) = 68.26 years; Standard Deviation (SD) = 14.19 years), with dialysis vintage ranging from 1 month to 33 years (M = 70.63 months; SD = 75.26 months). Among study patients, 70.6% declared that depression was the cause of their poor well-being, 75.3% attributed their depressive symptoms to kidney failure, and 49.4%, more specifically, to hemodialysis. A total of 64.7% of patients had a low perception of self-influence on the course of their kidney disease, and 58.5% presented a coping style focused on emotions. The most frequent dysfunctional metacognitive beliefs were negative beliefs about not controlling one's own thoughts. This attitude was related to the low perception of self-influence on the course of the disease, maladaptive coping styles, and dysfunctional metacognitive beliefs.
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26
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Yeung J, Chisholm K, Spinks C, Srinivasan S. Familial hypercholesterolaemia: Experience of a tertiary paediatric lipid clinic. J Paediatr Child Health 2021; 57:1201-1207. [PMID: 33830584 DOI: 10.1111/jpc.15426] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 01/02/2021] [Accepted: 02/14/2021] [Indexed: 11/28/2022]
Abstract
AIM To review the experience of a dedicated paediatric multidisciplinary lipid clinic in the management of familial hypercholesterolaemia (FH) by studying the demographics, clinical presentations as well as statin therapy and outcomes. METHODS Retrospective database review of all patients under 18 years old seen in the lipid clinic at an Australian tertiary paediatric hospital between April 1999 and August 2017. Outcome measures collected included patient demographics, family history, lipid profile, age at treatment commencement, treatment outcomes and complications. RESULTS One hundred and eight patients (53 males) were seen in the lipid clinic. Eighty-five had low-density lipoprotein cholesterol (LDL-C) levels at or above the 75th percentile for sex prior to treatment. Of these, 75 had a first-degree relative with hypercholesterolaemia and/or early cardiac death. Four patients had clinical manifestations. Thirty-two patients (14 males) were started on statin therapy for likely FH. LDL-C levels reduced by 2.4 mmol/L (1.4 to 2.7) in boys and 1.9 mmol/L (0.8 to 2.8) in girls at 12 month follow-up. Five patients reported side effects requiring adjustment in therapy. Main reasons for not starting statin therapy in eligible patients were parental refusal and/or lost to follow up (77%). CONCLUSION A dedicated multidisciplinary lipid clinic is helpful for streamlining and monitoring management of paediatric FH. Clinical manifestations of FH are rare in children and may represent more severe form of FH or other lipid disorder. Statin therapy is efficacious and well tolerated but current recommended targets of treatment are difficult to attain. Greater awareness and coordinated services are required to overcome poor family engagement.
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Affiliation(s)
- Jeffrey Yeung
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Kerryn Chisholm
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Catherine Spinks
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Clinical Genetics Unit. Department of Medical Genomics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Shubha Srinivasan
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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27
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Huber J, Aguirrebarrena G, Ryan CJ. Algorithm for the use of the Guardianship Act, the Mental Health Act and the Public Health Act in emergency departments in New South Wales. Emerg Med Australas 2021; 34:34-38. [PMID: 34258869 DOI: 10.1111/1742-6723.13819] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/11/2021] [Accepted: 06/11/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To address frequently asked questions regarding the use of the Guardianship Act, the Mental Health Act and the Public Health Act within New South Wales EDs and present an algorithm to guide the use of this legislation. METHODS An ED-specific algorithm was developed for the use of the three pieces of legislation. Then an emergency psychiatrist and an emergency physician reviewed the algorithm with ED staff to understand its usefulness and where further detail was required. Frequently asked questions were collated. RESULTS Frequently asked questions are addressed with reference to the algorithm. CONCLUSION This paper offers an algorithm that can be easily followed for use in EDs across New South Wales.
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Affiliation(s)
- Jacqueline Huber
- Department of Medicine, The University of Notre Dame Australia, Sydney, New South Wales, Australia.,Department of Psychiatry, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Gonzalo Aguirrebarrena
- Emergency Department, St Vincent's Hospital, Sydney, New South Wales, Australia.,Department of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher James Ryan
- Department of Psychiatry, The University of Sydney, Sydney, New South Wales, Australia.,The Centre for Values, Ethics and the Law in Medicine, The University of Sydney, Sydney, New South Wales, Australia
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28
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O'Cionnaith C, Wand APF, Peisah C. Navigating the Minefield: Managing Refusal of Medical Care in Older Adults with Chronic Symptoms of Mental Illness. Clin Interv Aging 2021; 16:1315-1325. [PMID: 34285476 PMCID: PMC8285123 DOI: 10.2147/cia.s311773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/21/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this case series is to illustrate the complexity of considerations across health (physical and mental), ethical, human rights and practical domains when an older adult with chronic symptoms of mental illness refuses treatment for a serious medical comorbidity. A broad understanding of these considerations may assist health care professionals in navigating this challenging but common aspect of clinical practice. Case Presentation Three detailed case reports are described. Participants were older adults with an acute presentation of a chronic mental illness, admitted to a specialized older persons mental health inpatient unit (OPMHU) in an Australian metropolitan hospital. Significant comorbid medical issues were detected or arose during the admission and the patient refused the recommended medical intervention. Data extracted from patients' medical records were analyzed and synthesized into detailed case reports using descriptive techniques. Each patient was assessed as lacking capacity for healthcare and treatment consent and did not have relatives or friends to assist with supported decision-making. Multifaceted aspects of decision-making and management are highlighted. Conclusion There are multiple complex issues to consider when an older adult with chronic symptoms of mental illness refuses treatment for serious comorbid medical conditions. In addition to optimizing management of the underlying mental illness (which may be impairing capacity to make healthcare decisions), clinicians should adopt a role of advocacy for their patients in considering the potential impact of ageism and stigma on management plans and inequities in physical healthcare. Consultation with specialist medical teams should incorporate multifaceted considerations such as potentially inappropriate treatment and optimum setting of care. Equally important is reflective practice; considering whether treatment decisions may infringe upon human rights or cause trauma.
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Affiliation(s)
- Cathal O'Cionnaith
- Older Persons Mental Health Service, Jara Unit, Concord Centre for Mental Health, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Anne P F Wand
- Older Persons Mental Health Service, Jara Unit, Concord Centre for Mental Health, Concord Repatriation General Hospital, Concord, NSW, Australia.,Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Discipline of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Carmelle Peisah
- Discipline of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Capacity Australia, Crows Nest, NSW, Australia
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29
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Moya JJ, Moazzez A, Ozao-Choy JJ, Dauphine C. Patients With Invasive Breast Cancer Who Refuse Treatment: An Analysis of Associated Factors and Impact on Survival. Am Surg 2021; 87:1627-1632. [PMID: 34132121 DOI: 10.1177/00031348211024170] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Completion of surgical resection and adjuvant/neoadjuvant treatments (chemotherapy, radiation, and endocrine therapy) is necessary to achieve optimal outcomes in invasive breast cancer. The objective of this study was to determine the characteristics of patients refusing treatment and to analyze the impact of refusal on survival. STUDY DESIGN A retrospective cohort study of invasive breast cancer cases diagnosed 2004-2016 was performed utilizing the National Cancer Database. RESULTS Of 2 058 568 cases comprising the study cohort, .6% refused recommended surgery, 14.1% refused chemotherapy, 5.5% refused radiation, and 6.3% refused endocrine therapy. Patients refusing therapy were older and more likely uninsured; they did not live farther from the treating hospital. Racial disparities were also associated with refusal. Surgery refusal had the highest hazard ratio for mortality (2.7; 95% CI: 2.5-3.0, P < .001) compared to chemotherapy (1.3; 95% CI: 1.3-1.4, P < .001), radiation (1.8; 95% CI: 1.7-1.9, P < .001), and endocrine therapy (1.5; 95% CI: 1.4-1.6, P < .001) independent of race, insurance, receptor status, and stage. CONCLUSION This study demonstrates significant associations with refusal of breast cancer treatment and quantifies the impact on mortality, which may help to identify at-risk groups for whom interventions could prevent increases in mortality associated with declining treatment.
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Affiliation(s)
- Jackelyn J Moya
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ashkan Moazzez
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA.,The Lundquist Institute at Harbor-UCLA, Torrance, CA, USA
| | - Junko J Ozao-Choy
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA.,The Lundquist Institute at Harbor-UCLA, Torrance, CA, USA
| | - Christine Dauphine
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA.,The Lundquist Institute at Harbor-UCLA, Torrance, CA, USA
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30
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Ling S, Davies J, Sproule B, Puts M, Cleverley K. Predictors of and reasons for early discharge from inpatient withdrawal management settings: A scoping review. Drug Alcohol Rev 2021; 41:62-77. [PMID: 34041795 DOI: 10.1111/dar.13311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/06/2020] [Revised: 03/27/2021] [Accepted: 04/25/2021] [Indexed: 11/27/2022]
Abstract
ISSUES Early discharges, also known as 'against medical advice' discharges, frequently occur in inpatient withdrawal management settings and can result in negative outcomes for patients. The purpose of this scoping review is to identify what is known about predictors of and reasons for the early discharge among adults accessing inpatient withdrawal management settings. APPROACH MEDLINE, CINAHL, PsycINFO, ASSIA and EMBASE were searched, resulting in 2587 articles for screening. Title and abstract screening and full-text review were completed by two independent reviewers. Results were synthesised in quantitative and qualitative formats. KEY FINDINGS Sixty-two studies were included in this scoping review. All studies focused on predictors of early discharge, except one which only described reasons for the early discharge. Forty-eight percent of studies involved retrospective review of health records data. The most frequently examined variables were demographics. Variables related to the treatment setting, such as referral source and treatment received, were examined less frequently but were more consistently associated with early discharge compared to demographics. Only six studies described patient reasons for the early discharge, which were retrieved via clinical documentation. The most common reasons for early discharge were dissatisfaction with treatment and family issues. IMPLICATIONS AND CONCLUSIONS Most demographic variables do not consistently predict early discharge, and reasons for early discharge are not well understood. Future studies should focus on the predictive value of non-patient-level variables, or conduct analyses to account for predictors of early discharge among different subgroups of people (e.g. by gender or ethnicity). Qualitative research exploring patient perspectives is needed.
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Affiliation(s)
- Sara Ling
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada
| | - Julia Davies
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada
| | - Beth Sproule
- Centre for Addiction and Mental Health, Toronto, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Kristin Cleverley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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Cerda AA, García LY. Hesitation and Refusal Factors in Individuals' Decision-Making Processes Regarding a Coronavirus Disease 2019 Vaccination. Front Public Health 2021; 9:626852. [PMID: 33968880 PMCID: PMC8096991 DOI: 10.3389/fpubh.2021.626852] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/23/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction: Considering the global prevalence of coronavirus disease 2019 (COVID-19), a vaccine is being developed to control the disease as a complementary solution to hygiene measures-and better, in social terms, than social distancing. Given that a vaccine will eventually be produced, information will be needed to support a potential campaign to promote vaccination. Objective: The aim of this study was to determine the variables affecting the likelihood of refusal and indecision toward a vaccine against COVID-19 and to determine the acceptance of the vaccine for different scenarios of effectiveness and side effects. Materials and Methods: A multinomial logistic regression method based on the Health Belief Model was used to estimate the current methodology, using data obtained by an online anonymous survey of 370 respondents in Chile. Results: The results indicate that 49% of respondents were willing to be vaccinated, with 28% undecided or 77% of individuals who would potentially be willing to be inoculated. The main variables that explained the probability of rejection or indecision were associated with the severity of COVID-19, such as, the side effects and effectiveness of the vaccine; perceived benefits, including immunity, decreased fear of contagion, and the protection of oneself and the environment; action signals, such as, responses from ones' family and the government, available information, and specialists' recommendations; and susceptibility, including the contagion rate per 1,000 inhabitants and relatives with COVID-19, among others. Our analysis of hypothetical vaccine scenarios revealed that individuals preferred less risky vaccines in terms of fewer side effects, rather than effectiveness. Additionally, the variables that explained the indecision toward or rejection of a potential COVID-19 vaccine could be used in designing public health policies. Conclusions: We discovered that it is necessary to formulate specific, differentiated vaccination-promotion strategies for the anti-vaccine and undecided groups based on the factors that explain the probability of individuals refusing or expressing hesitation toward vaccination.
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Affiliation(s)
| | - Leidy Y. García
- Faculty of Economics and Business, University of Talca, Talca, Chile
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32
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Shingde R, Salindera S, Aherne NJ, Millard-Newton L, Houlton A, Sanderson E, Bowers P, Shakespeare TP, Ross W. Survival outcomes for breast cancer patients who decline recommended treatment: a propensity score-matched analysis. ANZ J Surg 2021; 91:1766-1771. [PMID: 33844428 DOI: 10.1111/ans.16859] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 02/07/2021] [Accepted: 03/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND For patients with breast cancer who decline recommended treatments, available data examining survival outcomes are sparse. We compared overall survival and relapse-free survival outcomes between patients with breast cancer who declined recommended primary treatments and those who received recommended primary treatments. METHODS Using data from the BreastSurgANZ Quality Audit database, a retrospective cohort study was performed for patients diagnosed with breast carcinoma (stage 0-IV) between 2001 and 2014 who were treated in our integrated cancer centre. A propensity score-matched analysis was performed to compare overall survival and relapse-free survival between patients who either declined or received the standard recommended treatment. RESULTS A total of 56/912 (6.1%) patients declined one or more recommended therapies. Five-year overall survival for those who declined or received treatment as recommended was 81.8% versus 88.9% (P = 0.17), respectively. Ten-year survival was 61.3% versus 67.8% (P = 0.22), respectively. For patients who declined treatments, 5-year relapse-free survival was 72.4%, compared to 87.4% for those who received them (P = 0.005). Ten-year relapse-free survival was 61.0% versus 80.6% (P = 0.002), respectively. On adjusted Cox regression analysis, treatment refusal was associated with poorer relapse-free survival (adjusted hazard ratio 2.76 (95% confidence interval 1.52-5.00), P < 0.001). CONCLUSION In conclusion, patients who declined recommended treatment for breast cancer had poorer relapse-free survival compared to those who received them. These data may help clinicians assist patients with breast cancer in their decision-making.
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Affiliation(s)
- Rashmi Shingde
- School of Medicine, University of New South Wales, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Shehnarz Salindera
- Department of Surgery, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia.,Department of Continuing Education, University of Oxford, Oxford, UK
| | - Noel J Aherne
- School of Medicine, University of New South Wales, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia.,Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia.,School of Health and Human Sciences, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Lee Millard-Newton
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - Adelene Houlton
- Department of Surgery, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Erica Sanderson
- School of Medicine, University of New South Wales, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Phillipa Bowers
- School of Medicine, University of New South Wales, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Thomas P Shakespeare
- School of Medicine, University of New South Wales, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia.,Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - William Ross
- School of Medicine, University of New South Wales, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia.,Department of Surgery, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
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Dias LM, Bezerra MR, Barra WF, Rego F. Refusal of medical treatment by older adults with cancer: a systematic review. Ann Palliat Med 2021; 10:4868-4877. [PMID: 33832317 DOI: 10.21037/apm-20-2439] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/24/2021] [Indexed: 11/06/2022]
Abstract
The literature about the factors associated with cancer treatment refusal, especially by the older patients is scarce. Therefore, this study aimed to identify predictive factors associated with treatment refusal by older patients with cancer. A systematic review was conducted using three databases, Medline, Web of Science, and Scopus with the key concepts, "refusal treatment" and "cancer" and "decision making" and "elderly" or "aged". The search took place in July 2020 and it included articles published in the last 5 years. Of the 211 articles found, 22 were included in the review. Most studies have focused on head and neck and breast cancer treatment decisions and used a quantitative design. The majority of studies evaluated refusal of surgery interventions. Important factors associated with refusal cancer treatment include gender, marital status, race, having government insurance, advanced cancer, poor performance status (cancer stage III or IV) and Charlson Comorbidity Index ≥2. Thus, there are socio-demographic and clinical variables associated with treatment refusal. More studies with the elderly are needed. Understanding these factors may be useful to recognize situations where active education and support can help elderly patients accept optimal care.
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Affiliation(s)
- Laiane Moraes Dias
- Faculty of Medicine of the University of Porto, Porto, Portugal; João de Barros Barreto University Hospital, Federal University of Pará, Belém-Pará, Brazil
| | - Mirella Rebello Bezerra
- Faculty of Medicine of the University of Porto, Porto, Portugal; IMIP, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
| | | | - Francisca Rego
- Faculty of Medicine of the University of Porto, Porto, Portugal
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Deviany PE, Ganti AK, Islam KMM. Factors Associated With Treatment Refusal and Impact of Treatment Refusal on Survival of Patients With Small Cell Lung Cancer. Oncology (Williston Park) 2021; 35:111-118. [PMID: 33818051 DOI: 10.46883/onc.2021.3503.0111] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background With fewer than 7% of patients with small cell lung cancer (SCLC) surviving 5 years after diagnosis, the receipt of recommended treatment is of utmost importance for patient survival. Nevertheless, treatment refusal by patients with SCLC has not been studied well. Our study examined factors associated with treatment refusal and the effect of refusal on patient survival. Methods From the National Cancer Database, we analyzed data of 107,988 patients with SCLC diagnosed between 2003 and 2012. Treatment refusals were analyzed separately for chemoradiotherapy among patients with limited stage disease (LS-SCLC) and chemotherapy among those with extensive stage disease (ES-SCLC). We used logistic regression to investigate factors associated with treatment refusal. We estimated survival probability using the Kaplan-Meier method and compared survival of those who received and refused treatment using Cox proportional hazards regression analysis. Results The refusal rates of chemoradiotherapy among patients with LS-SCLC and chemotherapy among those with ES-SCLC were 1.34% and 4.70%, respectively. From 2003 to 2012, trends show an increase of refusals, especially among the patients with ES-SCLC who were recommended chemotherapy. Multivariable analyses showed that in both SCLC groups, older age at diagnosis (>70 years), female gender, uninsured status, and presence of comorbidities were associated with treatment refusals. Patients with LS-SCLC who refused chemoradiotherapy had a higher risk of mortality than those who received treatment (HR, 4.96; 95% CI, 4.45-5.53); the median survival of those who refused treatment was 3 months vs 18 months for those who received it (P < .001). Similarly, patients with ES-SCLC who refused chemotherapy had a higher risk of mortality than those who received treatment (HR, 3.69; 95% CI, 3.48-3.92); the median survival was 1 month vs 7 months, respectively (P < .001). Conclusions Treatment refusal among patients with SCLC was associated with worse survival. Strategies to increase patient acceptance of the recommended treatment need to be studied further.
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Affiliation(s)
| | - Apar Kishor Ganti
- Division of Oncology-Hematology, Department of Internal Medicine, VA Nebraska- Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, Nebraska
| | - K M Monirul Islam
- Institute of Public and Preventive Health and Department of Population Health Science, Medical College of Georgia, Augusta University, Augusta, Georgia
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Zozula A, Neth MR, Hogan AN, Stolz U, McMullan J. Non-transport after Prehospital Naloxone Administration Is Associated with Higher Risk of Subsequent Non-fatal Overdose. PREHOSP EMERG CARE 2021; 26:272-279. [PMID: 33535012 DOI: 10.1080/10903127.2021.1884324] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective: U.S. opioid overdoses increased nearly sixfold from 1999 to 2018, and greater than 1% of all emergency medical services (EMS) encounters now involve naloxone administration. While "treat and release" protocols may have low short-term mortality, the risk of subsequent non-fatal overdoses is not known. This study compares the risk of repeat overdose encounters between patients transported to an emergency department (ED) and those who refused transport after prehospital naloxone administration. Methods: All EMS charts within a large single-tier fire-based urban EMS system between January 1 and August 31, 2018 were reviewed if either naloxone administration or a clinical impression related to opioid overdose was documented. Charts were excluded if there was no documented evidence of an opioid toxidrome (respiratory depression or altered mental status), if there was another clear explanation for the symptoms (e.g., hypoglycemia), or if naloxone was not administered. Ten percent of charts were reviewed by a second author to assess reliability. Cox regression (survival analysis) was used to estimate the risk of a subsequent EMS encounter with naloxone administration following an index encounter with naloxone administration. Results: Of the 2143 charts reviewed, 1311 unique patients with 1600 overdose encounters involving naloxone administration were identified. Inter-rater reliability for chart inclusion was strong [κ = 0.83 (95% CI: 0.72-0.90)]. Police/bystanders administered naloxone in 208/1600 (13.0%) encounters. A substantial proportion of encounters resulted in transport refusal (674/1600, 42.1%). The final Cox model included only refusal vs. acceptance of transport to an ED during the index EMS encounter. Patient age, gender, and naloxone administration prior to EMS arrival were not statistically significant in univariate or multivariable analyses, nor were they significant confounders. Refusal of transport was associated with a hazard ratio of 1.66 (95% CI: 1.23-2.23) for subsequent EMS encounters with naloxone administration. Conclusions: Non-transport after prehospital naloxone administration is associated with an increased risk of subsequent non-fatal overdose requiring EMS intervention. Limitations include the use of a single EMS agency as patients may have had uncaptured overdose encounters in neighboring municipalities.
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Affiliation(s)
- Alexander Zozula
- Department of Emergency Medicine, Division of Prehospital and Disaster Medicine, UMMS-Baystate, Springfield, MA (AZ);; Department of Emergency Medicine, Oregon Health & Science University, Portland, OR (MRN);; Department of Emergency Medicine, Division of EMS, University of Texas Southwestern Medical Center, Dallas, TX (ANH);; Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH (US);; Department of Emergency Medicine, Division of EMS, University of Cincinnati, Cincinnati, OH (JM)
| | - Matthew R Neth
- Department of Emergency Medicine, Division of Prehospital and Disaster Medicine, UMMS-Baystate, Springfield, MA (AZ);; Department of Emergency Medicine, Oregon Health & Science University, Portland, OR (MRN);; Department of Emergency Medicine, Division of EMS, University of Texas Southwestern Medical Center, Dallas, TX (ANH);; Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH (US);; Department of Emergency Medicine, Division of EMS, University of Cincinnati, Cincinnati, OH (JM)
| | - Andrew N Hogan
- Department of Emergency Medicine, Division of Prehospital and Disaster Medicine, UMMS-Baystate, Springfield, MA (AZ);; Department of Emergency Medicine, Oregon Health & Science University, Portland, OR (MRN);; Department of Emergency Medicine, Division of EMS, University of Texas Southwestern Medical Center, Dallas, TX (ANH);; Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH (US);; Department of Emergency Medicine, Division of EMS, University of Cincinnati, Cincinnati, OH (JM)
| | - Uwe Stolz
- Department of Emergency Medicine, Division of Prehospital and Disaster Medicine, UMMS-Baystate, Springfield, MA (AZ);; Department of Emergency Medicine, Oregon Health & Science University, Portland, OR (MRN);; Department of Emergency Medicine, Division of EMS, University of Texas Southwestern Medical Center, Dallas, TX (ANH);; Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH (US);; Department of Emergency Medicine, Division of EMS, University of Cincinnati, Cincinnati, OH (JM)
| | - Jason McMullan
- Department of Emergency Medicine, Division of Prehospital and Disaster Medicine, UMMS-Baystate, Springfield, MA (AZ);; Department of Emergency Medicine, Oregon Health & Science University, Portland, OR (MRN);; Department of Emergency Medicine, Division of EMS, University of Texas Southwestern Medical Center, Dallas, TX (ANH);; Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH (US);; Department of Emergency Medicine, Division of EMS, University of Cincinnati, Cincinnati, OH (JM)
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Datta D, Mondal T, Sarkar M, Chel S, Das SK, Nandy A, M Ivan D, Mondal R. Leave against Medical Advice in Children: Rural Indian Perspective. J Trop Pediatr 2021; 67:6043117. [PMID: 33347590 DOI: 10.1093/tropej/fmaa110] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To determine the burden and etiological factors of leave against medical advice (LAMA) in Indian children. METHODOLOGY In this prospective study, legal guardians of 528 patients who took the decision of LAMA were interviewed (using structured question answers based multi-option) and data were captured over a period of 16 months. The resultant database was analyzed using standard statistical methods. RESULTS About 6.12% of childhood LAMA cases were dealt out of total pediatric admission including newborns. Neonatal preponderance noted in cases of LAMA from intensive care unit (ICU; 57.14%, p < 0.05). The overall male (n = 293) to female (n = 235) ratio in this study was 1.25:1. Number of LAMA patients was higher from rural area (83.33%), mostly admitted in ICU (93.65%, Pearson's chi-squared test, p < 0.05). Higher proportion (29.47%) of patients with infection availed LAMA from neonatal age group but overall LAMA patients fall under category of respiratory disorders (22.35%). Interest of the domestics issues other than suffering child was considered primary during LAMA for those admitted in ward as compared with ICU patients [odds ratio (OR): 1.73, CI: 1.02-2.94, p < 0.05]. ICU patients were reportedly to be taken to private health care facility (OR: 1.93, CI: 1.06-3.49, p < 0.05). Duration of stay before taking LAMA from ward was <7 days (85.59%, OR: 0.19, CI: 0.11-0.35, p < 0.05). Upper-lower socio-economic class attributed financial constraint as the main reason for LAMA (Pearson's chi-squared test, Chi-square value: 152.23, p < 0.05). CONCLUSIONS This study tried to elucidate the determinants of childhood LAMA in rural Indian setting.
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Affiliation(s)
- Debadyuti Datta
- Department of Pediatrics, North Bengal Medical College, Darjeeling, West Bengal, India
| | - Tanushree Mondal
- Community Medicine, Medical College Kolkata, Kolkata, West Bengal, India
| | - Mihir Sarkar
- Pediatric Medicine, Medical College Kolkata, Kolkata, West Bengal, India
| | - Soumita Chel
- Alumni University of Glasgow, Expert Data Science, Kolkata, West Bengal, India
| | - Sankar Kumar Das
- Department of Pediatric Medicine, North Bengal Medical College, Darjeeling, West Bengal, India
| | - Arnab Nandy
- Department of Pediatrics, North Bengal Medical College, Darjeeling, West Bengal, India
| | - Divyoshanu M Ivan
- Department of Biotechnology, Delhi Technological University, Delhi, India
| | - Rakesh Mondal
- Department of Pediatric Medicine, North Bengal Medical College, Darjeeling, West Bengal, India
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Abstract
Introduction: Considering the global prevalence of coronavirus disease 2019 (COVID-19), a vaccine is being developed to control the disease as a complementary solution to hygiene measures-and better, in social terms, than social distancing. Given that a vaccine will eventually be produced, information will be needed to support a potential campaign to promote vaccination. Objective: The aim of this study was to determine the variables affecting the likelihood of refusal and indecision toward a vaccine against COVID-19 and to determine the acceptance of the vaccine for different scenarios of effectiveness and side effects. Materials and Methods: A multinomial logistic regression method based on the Health Belief Model was used to estimate the current methodology, using data obtained by an online anonymous survey of 370 respondents in Chile. Results: The results indicate that 49% of respondents were willing to be vaccinated, with 28% undecided or 77% of individuals who would potentially be willing to be inoculated. The main variables that explained the probability of rejection or indecision were associated with the severity of COVID-19, such as, the side effects and effectiveness of the vaccine; perceived benefits, including immunity, decreased fear of contagion, and the protection of oneself and the environment; action signals, such as, responses from ones' family and the government, available information, and specialists' recommendations; and susceptibility, including the contagion rate per 1,000 inhabitants and relatives with COVID-19, among others. Our analysis of hypothetical vaccine scenarios revealed that individuals preferred less risky vaccines in terms of fewer side effects, rather than effectiveness. Additionally, the variables that explained the indecision toward or rejection of a potential COVID-19 vaccine could be used in designing public health policies. Conclusions: We discovered that it is necessary to formulate specific, differentiated vaccination-promotion strategies for the anti-vaccine and undecided groups based on the factors that explain the probability of individuals refusing or expressing hesitation toward vaccination.
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Affiliation(s)
- Arcadio A Cerda
- Faculty of Economics and Business, University of Talca, Talca, Chile
| | - Leidy Y García
- Faculty of Economics and Business, University of Talca, Talca, Chile
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Fujimoto K, Ishimaru T, Tateishi S, Nagata T, Tsuji M, Eguchi H, Ogami A, Matsuda S, Fujino Y. A cross-sectional study of socioeconomic status and treatment interruption among Japanese workers during the COVID-19 pandemic. J Occup Health 2021; 63:e12232. [PMID: 33998105 PMCID: PMC8126756 DOI: 10.1002/1348-9585.12232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/06/2021] [Accepted: 04/25/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic has caused interruptions to chronic disease and non-emergency treatment. The purpose of this study is to examine which socioeconomic status groups are most at risk of treatment interruption among Japanese workers. METHODS This cross-sectional internet monitor study was conducted among Japanese workers on December 22-26, 2020. Out of a total of 33 302 participants in the survey, 9510 (5392 males and 4118 females) who responded that they required regular treatment or hospital visits were included in the analysis. A multilevel logistic model nested in the prefecture of residence was used to estimate the odds ratio (OR) for treatment disruption. We examined separate multivariate models for socioeconomic factors, health factors, and lifestyle factors. RESULTS During a period of rapid COVID-19 infection, about 11% of Japanese workers who required regular treatment experienced interruptions to their treatment. The OR of treatment interruption associated with not being married compared with being married was 1.44 (95%CI: 1.17-1.76); manual labor work compared with desk work was 1.30 (95%CI: 1.11-1.52); loss of employment when the COVID-19 pandemic started and continued unemployment compared with being employed over the entire pandemic period was 1.62 (95%CI: 1.13-2.31) and 2.57 (95%CI: 1.63-4.07), respectively; and feeling financially unstable was 2.92 (95%CI: 2.25-3.80). CONCLUSION Treatment interruption is a new health inequality brought about by COVID-19 with possible medium- and long-term effects, including excess mortality, morbidity, and productivity loss due to increased presenteeism. Efforts are needed to reduce treatment interruptions among workers who require regular treatment.
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Affiliation(s)
- Kenji Fujimoto
- Occupational Health Data Science CenterUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Tomohiro Ishimaru
- Department of Environmental EpidemiologyInstitute of Industrial Ecological SciencesUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Seiichiro Tateishi
- Department of Occupational MedicineSchool of MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Tomohisa Nagata
- Department of Occupational Health Practice and ManagementInstitute of Industrial Ecological SciencesUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Mayumi Tsuji
- Department of Environmental HealthSchool of MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Hisashi Eguchi
- Department of Mental HealthInstitute of Industrial Ecological SciencesUniversity of Occupational and Environmental Health, JapanJapan
| | - Akira Ogami
- Department of Work Systems and HealthInstitute of Industrial Ecological SciencesUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community HealthSchool of MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Yoshihisa Fujino
- Department of Environmental EpidemiologyInstitute of Industrial Ecological SciencesUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
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Henry R, Massey R, Morgan K, Deeks J, Macfarlane H, Holmes N, Silva E. Evaluation of the effectiveness and acceptability of intramuscular clozapine injection: illustrative case series. BJPsych Bull 2020; 44:239-243. [PMID: 32081110 PMCID: PMC7684781 DOI: 10.1192/bjb.2020.6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
AIMS AND METHOD A series of eleven patients prescribed intramuscular clozapine at five UK sites is presented. Using routinely collected clinical data, we describe the use, efficacy and safety of this treatment modality. RESULTS We administered 188 doses of intramuscular clozapine to eight patients. The remaining three patients accepted oral medication. With the exception of minor injection site pain and nodules, side-effects were as expected with oral clozapine, and there were no serious untoward events. Nine patients were successfully established on oral clozapine with significant improvement in their clinical presentations. CLINICAL IMPLICATIONS Although a novel formulation in the UK, we have shown that intramuscular clozapine can be used safely and effectively when the oral route is initially refused.
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Affiliation(s)
| | | | | | - Johanne Deeks
- Birmingham and Solihull Mental Health NHS Foundation Trust, UK
| | - Hannah Macfarlane
- Birmingham and Solihull Mental Health NHS Foundation Trust, UK.,Aston University, UK
| | - Nikki Holmes
- Nottinghamshire Healthcare NHS Foundation Trust, UK
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Jin P, Zhang X. Family refusal of emergency medical treatment in China: An investigation from legal, empirical and ethical perspectives. Bioethics 2020; 34:306-317. [PMID: 32100330 DOI: 10.1111/bioe.12728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/23/2018] [Revised: 09/16/2019] [Accepted: 01/24/2020] [Indexed: 06/10/2023]
Abstract
This paper is an analysis of the limits of family authority to refuse life saving treatment for a family member (in the Chinese medical context). Family consent has long been praised and practiced in many non-Western cultural settings such as China and Japan. In contrast, the controversy of family refusal remains less examined despite its prevalence in low-income and middle-income countries. In this paper, we investigate family refusal in medical emergencies through a combination of legal, empirical and ethical approaches, which is highly relevant to the ongoing discussion about the place of informed consent in non-Western cultures. We first provide an overview of the Chinese legislation concerning informed consent to show the significance of family values in the context of medical decision-making and demonstrate the lack of legal support to override family refusal. Next, we present the findings of a vignette question that investigated how 11,771 medical professionals and 2,944 patients in China responded to the family refusal of emergency treatment for an unconscious patient. In our analysis of these results, we employ ethical reasoning to question the legitimacy of family refusal of life-sustaining emergency treatment for temporarily incompetent patients. Last, we examine some practical obstacles encountered by medical professionals wishing to override family refusal to give context to the discussion.
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Affiliation(s)
- Pingyue Jin
- School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinqing Zhang
- School of Humanities and Social Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Song Y, Ku BJ, Cho J, Jun Y, Kim B, Nam S. The prevalence of insulin refusal and psychological insulin resistance among Korean patients with type 2 diabetes mellitus. Ann Transl Med 2020; 7:760. [PMID: 32042776 DOI: 10.21037/atm.2019.11.77] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background This study investigated the prevalence of insulin refusal and compared the level of psychological insulin resistance (PIR) with the intention to accept insulin therapy among Korean patients with type 2 diabetes. Methods Type 2 diabetes patients (n=1,209) were recruited from inner city outpatient diabetes clinics in 2016. Patient demographic, insulin recommendation, diabetes treatment type, intention to receive insulin therapy, and PIR information was collected using self-reports. The patients were divided into three groups: those who refused insulin therapy (n=184), those who accepted insulin therapy (n=331), and those not recommended for insulin therapy (n=694). Descriptive statistics were used to calculate the prevalence of insulin refusal; t-tests and analyses of variance were used to compare demographics with PIR. Results The insulin refusal rate was 35.7%. The duration of diabetes, numbers of diabetes-related complications, and glycated hemoglobin levels were significantly lower in the group not recommended for insulin therapy than refused and accepted insulin groups. The level of PIR in insulin refusal group was significantly lower among patients agreeing to receive insulin therapy within 3 months than among those refusing insulin therapy. Conclusions The prevalence of insulin refusal in Korea is not low, and people who refuse insulin therapy have high levels of PIR. Strategies to reduce PIR levels are needed.
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Affiliation(s)
- Youngshin Song
- Chungnam National University College of Nursing, Daejeon, Republic of Korea
| | - Bon Jeong Ku
- Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jeonghwa Cho
- Daejeon Institute of Science and Technology Department of Nursing, Daejeon, Republic of Korea
| | - Younghee Jun
- Wonkwang Health Science University Department of Nursing, Wonkwang, Republic of Korea
| | - Bohyun Kim
- Chungnam National University College of Nursing, Daejeon, Republic of Korea
| | - Soohyun Nam
- Yale University, School of Nursing, West Haven, CT, USA
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Tannou T, Hof Demont M, Aubry R. [Is opposition to care in elderly people with cognitive impairment may be considered as a refusal of care?]. Geriatr Psychol Neuropsychiatr Vieil 2019; 17:291-298. [PMID: 31328720 DOI: 10.1684/pnv.2019.0812] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Care or treatment refusal in sick people is a right recognized by law. However, this right is questioned in subjects with cognitive disorders because it is not clear if opposition or refusal to treatment is underpinned by a behavioral disorder, a lack of understanding of the care or treatment, or a refusal to continue living a life heavily impacted by the disease and reflecting a demand for autonomy. Analysis of the literature and our personal experience show that oppositional behaviors in these patients, often described as troublemakers, should be closely analyzed to understand their motivations, and to be attentive to the freedom of choice of the patients, even if their motivations are ambivalent, even contradictory. A major risk for the carers of patients with cognitive disorders is to make decisions ignoring the freedom of choice of the patient, which should be included in the guide lines to improve geriatric care with respect for vulnerable people.
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Affiliation(s)
- Thomas Tannou
- Service de gériatrie, CHU J. Minjoz, Besançon, France, Equipe « Ethique et progrès médical » - Inserm CIC 1431, CHU de Besançon, France, EA 481 Neurosciences, UBFC, Besançon, France
| | | | - Régis Aubry
- Service de gériatrie, CHU J. Minjoz, Besançon, France, Equipe « Ethique et progrès médical » - Inserm CIC 1431, CHU de Besançon, France, EA 481 Neurosciences, UBFC, Besançon, France
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Hazarika M, Mishra R, Saikia BJ, Bhuyan C, Nyuthe CW, Sarma A, Kumar G, Sutnaga C, Kalita M, Roy P. Causes of Treatment Abandonment of Pediatric Cancer
Patients – Experience in a Regional Cancer Centre in North
East India. Asian Pac J Cancer Prev 2019; 20:1133-1137. [PMID: 31030486 PMCID: PMC6948912 DOI: 10.31557/apjcp.2019.20.4.1133] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction: Refusal and abandonment of treatment is often considered as an important reason for poor survival of pediatric cancer patients in developing and underdeveloped countries. In this study we analyze the factors responsible for treatment abandonment and refusal in a Regional Cancer Centre (RCC) in North East India. Material and Methods: All histopathologically or cytologically confirmed cases of childhood cancer from below 15 years of age registered from 1st April, 2010 to 31st March, 2017 were included in this study. Parents or caregivers were interviewed thoroughly and a questionnaire was filled up for analysis of demographic and socio-economic factors. Modified Kuppuswamy scale was used to measure socioeconomic status. Results: Of 592 patients 161 (27.1%) abandoned therapy and 23 (3.9%) refused treatment. Factors associated with abandonment of treatment included: lower risk if residing in urban areas (Odds ratio [OR] = 0.8333, 95% CI 0.565-1.228; P=0.36) and higher risk with maternal education less than secondary school (OR = 1.357; 95%CI: 0.553-3.326; P=0.505). Low socioeconomic status and age >5yrs were also associated with abandonment of treatment. In a binary logistic regression analysis, male sex [Odds Ratio (OR) = 0.701; 95% CI 0.48-1.01; P=0.062] have lowest risk of abandoning treatment with trend to statistical significance. Conclusion: There is a need for proper definition of the problem of childhood cancer patients so that appropriate policy can be introduced to improve survival by improving treatment compliance.
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Affiliation(s)
- Munlima Hazarika
- Department of Medical Oncology, Dr.B Borooah Cancer Institute, Gopinath Nagar, Guwahati, Assam, India.
| | - Rakesh Mishra
- Department of Medical Oncology, Dr.B Borooah Cancer Institute, Gopinath Nagar, Guwahati, Assam, India.
| | - Bhargab Jyoti Saikia
- Department of Medical Oncology, Dr.B Borooah Cancer Institute, Gopinath Nagar, Guwahati, Assam, India.
| | - Chidananda Bhuyan
- Department of Medical Oncology, Dr.B Borooah Cancer Institute, Gopinath Nagar, Guwahati, Assam, India.
| | - C W Nyuthe
- Department of Medical Oncology, Dr.B Borooah Cancer Institute, Gopinath Nagar, Guwahati, Assam, India.
| | - Anupam Sarma
- Department of Pathology, Dr. B Borooah Cancer Institute, Gopinath Nagar, Guwahati, Assam, India
| | - Gaurav Kumar
- Department of Medical Oncology, Dr.B Borooah Cancer Institute, Gopinath Nagar, Guwahati, Assam, India.
| | - Cliffton Sutnaga
- Department of Medical Oncology, Dr.B Borooah Cancer Institute, Gopinath Nagar, Guwahati, Assam, India.
| | - Manoj Kalita
- Population Based Cancer Registry, National Cancer Registry Programme (ICMR), Dr. B Borooah Cancer Institute, Gopinath Nagar, Guwahati, Assam, India
| | - Partha Roy
- Department of Medical Oncology, Dr.B Borooah Cancer Institute, Gopinath Nagar, Guwahati, Assam, India.
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Sealy L, Zwi K, McDonald G, Saavedra A, Crawford L, Gunasekera H. Predictors of Discharge Against Medical Advice in a Tertiary Paediatric Hospital. Int J Environ Res Public Health 2019; 16:E1326. [PMID: 31013860 DOI: 10.3390/ijerph16081326] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/01/2019] [Accepted: 04/08/2019] [Indexed: 12/03/2022]
Abstract
Background: Patients who discharge against medical advice (DAMA) from hospital carry a significant risk of readmission and have increased rates of morbidity and mortality. We sought to identify the demographic and clinical characteristics of DAMA patients from a tertiary paediatric hospital. Methods: Data were extracted retrospectively from electronic medical records for all inpatient admissions over a 5-year period. Demographic characteristics (age, sex, Aboriginality, socioeconomic status and remoteness of residence) and clinical characteristics (admitting hospital site, level of urgency on admission, diagnosis and previous DAMA) were extracted and logistic regression models were used to identify predictors of DAMA with 95% confidence intervals. Results: There were 246,359 admissions for 124,757 patients, of which 1871 (0.8%) admissions and 1730 patients (1.4%) DAMA. Predictors of DAMA in a given admission were hospital site (OR 4.8, CI 4.2–5.7, p < 0.01), a mental health/behavioural diagnosis (OR 3.3, CI 2.2–4.8, p < 0.01), Aboriginality (OR 1.6, CI 1.3–2.1, p < 0.01), emergency rather than elective admissions (OR 0.7ha, CI 0.6–0.8, p < 0.01), a gastrointestinal diagnosis (OR 1.5, CI 1.1–2.0, p = 0.04) and a history of previous DAMA (OR 2.0, CI 1.2–3.2, p = 0.05). Conclusions: There are clear predictors of DAMA in this tertiary hospital admission cohort and identification of these provides opportunities for intervention at a practice and policy level in order to prevent adverse outcomes.
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Abstract
OBJECTIVES The assessment and management of a patient who refuses medical treatment requires clinical skill, and consideration of the relevant law and the patient's decision-making capacity. Psychiatrists are often asked to advise in these situations. We aimed to develop an algorithm describing the relevant legal pathways to assist clinicians, especially psychiatrists, working in New South Wales (NSW), Australia. METHODS We reviewed the academic literature on treatment refusal, relevant legislation, judicial rulings and NSW Health policy directives and guidelines. We consulted with clinicians and representatives of relevant tribunals. RESULTS We developed an algorithm for managing patients who refuse medical treatment in NSW. The algorithm emphases the evaluation of decision-making capacity and tracks separate pathways depending upon a person's status under the Mental Health Act 2007 (NSW). CONCLUSIONS The algorithm provides a clear decision tree for clinicians responding to a patient refusing medical treatment in NSW.
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Affiliation(s)
- Kylie Cheng
- Psychiatry Registrar, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Anne Wand
- Staff Specialist Psychiatrist, Conjoint Senior Lecturer, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Christopher Ryan
- Staff Specialist Psychiatrist, Clinical Associate Professor, Discipline of Psychiatry and Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW, Australia
| | - Sascha Callaghan
- Solicitor and Barrister, Doctoral Scholar, Lecturer, Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW, Australia
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Popper-Giveon A, Keshet Y. The Secret Drama at the Patient's Bedside-Refusal of Treatment Because of the Practitioner's Ethnic Identity: The Medical Staff 's Point of View. Qual Health Res 2018; 28:711-720. [PMID: 29441815 DOI: 10.1177/1049732318755676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Patients' refusal of treatment based on the practitioner's ethnic identity reveals a clash of values: neutrality in medicine versus patient-centered care. Taking the Israeli-Palestinian conflict into account, this article aims at examining Israeli health care professionals' points of view concerning patients' refusal of treatment because of a practitioner's ethnic identity. Fifty in-depth interviews were conducted with 10 managers and 40 health care professionals, Jewish and Arab, employed at 11 public hospitals. Most refusal incidents recorded are unidirectional: Jewish patients refusing to be treated by Arab practitioners. Refusals are usually directed toward nurses and junior medical staff members, especially if recognizable as religious Muslims. Refusals are often initiated by the patients' relatives and occur more frequently during periods of escalation in the conflict. The structural competency approach can be applied to increase awareness of the role of social determinants in shaping patients' ethnic-based treatment refusals and to improve the handling of such incidents.
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Affiliation(s)
| | - Yael Keshet
- 2 Western Galilee Academic College, Akko, Israel
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Douglas T. Going above and beneath the call of duty: the luck egalitarian claims of healthcare heroes, and the accomodation of professionally-motivated treatment refusal. J Med Ethics 2017; 43:801-802. [PMID: 29170198 DOI: 10.1136/medethics-2017-104656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Thomas Douglas
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
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Deiner MS, Fathy C, Kim J, Niemeyer K, Ramirez D, Ackley SF, Liu F, Lietman TM, Porco TC. Facebook and Twitter vaccine sentiment in response to measles outbreaks. Health Informatics J 2017; 25:1116-1132. [PMID: 29148313 DOI: 10.1177/1460458217740723] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Social media posts regarding measles vaccination were classified as pro-vaccination, expressing vaccine hesitancy, uncertain, or irrelevant. Spearman correlations with Centers for Disease Control and Prevention-reported measles cases and differenced smoothed cumulative case counts over this period were reported (using time series bootstrap confidence intervals). A total of 58,078 Facebook posts and 82,993 tweets were identified from 4 January 2009 to 27 August 2016. Pro-vaccination posts were correlated with the US weekly reported cases (Facebook: Spearman correlation 0.22 (95% confidence interval: 0.09 to 0.34), Twitter: 0.21 (95% confidence interval: 0.06 to 0.34)). Vaccine-hesitant posts, however, were uncorrelated with measles cases in the United States (Facebook: 0.01 (95% confidence interval: -0.13 to 0.14), Twitter: 0.0011 (95% confidence interval: -0.12 to 0.12)). These findings may result from more consistent social media engagement by individuals expressing vaccine hesitancy, contrasted with media- or event-driven episodic interest on the part of individuals favoring current policy.
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Affiliation(s)
- Michael S Deiner
- University of California, San Francisco, USA.,University of California, San Francisco, USA
| | - Cherie Fathy
- Vanderbilt University, USA.,University of California, San Francisco, USA
| | - Jessica Kim
- University of California, San Francisco, USA.,University of California, San Francisco, USA
| | - Katherine Niemeyer
- Icahn School of Medicine at Mount Sinai, USA.,University of California, San Francisco, USA
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Chesterman J. Prioritising Patients' Preferences: Victoria's New Advance Planning and Medical Consent Legislation. J Law Med 2017; 25:46-51. [PMID: 29978622] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The introduction of the Medical Treatment Planning and Decisions Act 2016 Vic signals a profound alteration in focus from best interests substitute decision making, and will result in increased opportunities for patients to control their treatment choices. This will apply for advance care directives, and will also more effectively guide decisions made by a proxy. There will be an increased ability for patients to refuse treatment, and an expansion of the treatment choices covered by legislation. This column explores the impact of the legislation and reflects on its extension, and clinical challenges which may arise from the legislation.
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Affiliation(s)
- John Chesterman
- Director of Strategy, Office of the Public Advocate, Victoria
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Abstract
The Convention on the Rights of Persons with Disabilities is considered to be a radical international treaty that affords persons with disability recognition and protection of equal rights in socio-cultural, political, medical and legal arenas. Drawing from the Convention's core principles of equality and non-discrimination, the High Commissioner for Human Rights and the Convention's Committee have called for a replacement of the insanity defence with a disability-neutral doctrine. The rationale is that retaining this special defence is, in itself, discriminatory, given its function is necessarily based on the presence of mental disability and the assumption that such disabilities impair capacity and reasoning. This article interrogates the rationale behind 'abolitionist' views, and asks whether equality necessarily means treating all persons identically regardless of capacity to reason about conduct.
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Affiliation(s)
- Meron Wondemaghen
- Lecturer in Criminology, Department of Sociology, Social Policy, Criminology University of Southampton
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