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Medical Sciences	100%

Selected Abstracts

Validation of the quality of The National Pain Database for pain management services in the United Kingdom

ANAESTHESIA, Issue 11 2008
G. C. Hall
Summary Data on specialist pain management is scarce. We evaluated PainDB, a database which aggregates this information from UK pain clinics. PainDB entries for 1120 patients (2648 consultations) were compared to records at 30 pain clinics. Staff were surveyed about normal practice at 28 sites. First consultations (17 135) on the aggregated PainDB were analysed for 2003 for omissions. Those consultations included on PainDB (54.6%) showed good concurrence with written notes (88.1%), with no pattern for the missing visits. Questionnaire responses were often absent from notes (56%) and diagnosis was most frequently omitted from PainDB (12.4,18.4%). Clinic staff overestimated completeness. Despite commitment, PainDB is currently unsuitable for research or audit. As routine hospital data should provide information on activity, specific questions on severity and outcome could be answered by short-term recording of predefined variables. [source]

Psychosocial factors involved in delayed consultation by patients with head and neck cancer

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 4 2005
Olivier Rozniatowski DESS
Abstract Background. In the north of France, a delay in primary consultation has been noted among patients with head and neck cancer. This group is often correlated with lower socioeconomic status and a lack of medical information. Therefore, the choice to seek consultation is often influenced by symptoms such as pain and change in the size of tumors in the neck. We studied this delay in seeking consultation, focusing on psychosocial variables such as professional and social background, the involvement of a spouse/partner, and the presence of anxiety and depression. Methods. Two rating scales were administered to 50 patients with large tumors (T3/T4) and 50 patients with small tumors (T1/T2), and the results were compared. These rating scales were as follows: (1) a 17-item questionnaire assessing sociodemographic data, presenting symptoms, factors generating the consultation, and reasons for delay; and (2) the Hospital Anxiety and Depression Scale (HADS). Results. Both groups were predominantly male and working-class. Significant differences were observed in time since symptom onset and in conscious delay in seeking medical attention. The group with large tumors was characterized by lower involvement of a spouse/partner, conscious delay before first consultation, greater social isolation, fewer medical visits, and lower HADS anxiety scores. The group with small tumors sought consultation sooner and was characterized by greater involvement of a spouse/partner, correlated with significant anxiety. Depression was not a factor influencing delay within either group. Conclusions. The interpersonal relationship with a spouse/partner seemed to be essential in the dynamics surrounding consultation. Anxiety, rather than socioeconomics status, was a discriminating factor in the delay in seeking consultation. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source]

QUOTE-geneca: development of a counselee-centered instrument to measure needs and preferences in genetic counseling for hereditary cancer

PSYCHO-ONCOLOGY, Issue 5 2005
Arwen Pieterse
Counselees' motives for seeking genetic counseling for hereditary cancer have already been investigated, however not using instruments based on counselees' perspective. In addition, expectations regarding the process of counseling have scarcely been assessed. This article describes the construction and psychometric properties of the QUOTE-geneca, a counselee-centered instrument intended to measure needs and preferences in genetic counseling for hereditary cancer. Formulation of the items involved input from counselees and the instrument was derived from a conceptual framework for measuring patient satisfaction. Two-hundred new counselees completed a questionnaire containing the instrument and measures of coping style (TMSI), generalized anxiety (STAI) and cancer-related stress reactions (IES), prior to their first consultation. Results showed that the instrument captures relevant issues of concern with high internal consistency, and was associated, as expected, with validated measures of coping style and distress. Responses showed that major concerns prior to counseling relate to: receiving information about risk and preventive strategies; the procedure of counseling; and preferences on how the interaction with the counselor proceeds. Receiving emotional support and discussing emotional aspects were considered relatively less important. Increasing insight into individual needs may help counselors in better addressing these concerns, potentially increasing the likelihood of successful counseling. Copyright © 2004 John Wiley & Sons, Ltd. [source]

Lay constructions of decision-making in cancer

PSYCHO-ONCOLOGY, Issue 4 2002
M.J. Henman
In recent years there has been increased emphasis on involving people in decision-making about their medical care. However, few studies have addressed the questions of why women with cancer want information, and what they believe to be the important factors influencing their decision-making. In order to examine these questions 20 women with cancer were interviewed via telephone 2 weeks after their first consultation with one of 6 medical oncologists. Recruitment continued until informational redundancy was achieved. While women cited the risk of recurrence, life expectancy, side-effects, and quality of life as influencing their decisions, they placed at least as much emphasis on their personal relationship with the specialist. These ,personal' factors included: feeling that the doctor cared for, understood and respected them; that they could trust and have confidence in the doctor; that the doctor would give them enough time; that they would be listened to; and that the doctor would be open and honest. If these factors were felt to be present, many women were happy to accept the doctor's recommendation, confident that they would receive the optimum treatment. However, many women felt there was no decision to be made: further treatment must be undertaken to reduce risk, and minor variations in the treatment protocol were of little significance. These results underline the importance of establishing patient priorities and concerns before embarking on discussions about treatment. Copyright © 2002 John Wiley & Sons, Ltd. [source]