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Treatment Decision Making (treatment + decision_making)
Selected AbstractsA model of treatment decision making when patients have advanced cancer: how do cancer treatment doctors and nurses contribute to the process?EUROPEAN JOURNAL OF CANCER CARE, Issue 4 2010L. MCCULLOUGH msc, nurse leader clinical support services MCCULLOUGH L., MCKINLAY E., BARTHOW C., MOSS C. & WISE D. (2010) European Journal of Cancer Care A model of treatment decision making when patients have advanced cancer: how do cancer treatment doctors and nurses contribute to the process? This qualitative study describes how doctors and nurses report their contribution to treatment decision-making processes when patients have advanced cancer. Thirteen nurses and eight doctors involved in cancer treatment and palliation in one geographical location in New Zealand participated in the study. Data were collected using qualitative in-depth, face-to-face interviews. Content analysis revealed a complex context of decision making influenced by doctors and nurses as well as the patient and other factors. A model of clinician and patient decision making emerged with a distinct and cyclical process as advanced cancer remits and progresses. When patients have advanced cancer, nurses and doctors describe a predictable model of decision making in which they both contribute and that cycles through short- and long-term remissions; often nowadays to the point of the patient dying. In conclusion, the findings suggest doctors and nurses have different but complementary roles in what, when and how treatment choices are negotiated with patients, nevertheless within a distinct model of decision making. [source] The epidemiologic, health-related quality of life, and economic burden of gastrointestinal stromal tumoursJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 6 2007P. Reddy PharmD Summary Background and objectives:, Gastrointestinal stromal tumours (GIST) are uncommon tumours believed to arise from interstitial cells of Cajal or their precursors in the gastrointestinal (GI) tract, accounting for a small percentage of GI neoplasms and sarcomas. Given the recent recognition of GIST as a distinct cancer, as well as new treatment options available today, a review of the epidemiologic, health-related quality of life (HRQL), and economic burden of GIST is timely from a payer, provider and patient perspective and may provide guidance for treatment decision making and reimbursement. Methods:, A systematic literature review of PubMed and five scientific meeting databases, was conducted to identify published studies and abstracts describing the epidemiologic, HRQL and economic impact of GIST. Publications deemed worthy of further review, based on the information available in the abstract, were retrieved in full text. Results and discussion:, Thirty-four publications met the review criteria: 29 provided data on GIST epidemiology, one provided cost data, three reported HRQL outcomes, and one reported cost and HRQL outcomes. The annual incidence of GIST (cases per million) ranged from 6·8 in the USA to 14·5 in Sweden, with an estimated 5-year survival rate of 45,64%. On the Functional Illness of Chronic Therapy-fatigue instrument, GIST patients scored 40·0 compared with 37·6 in anaemic cancer patients (0 = worst; 52 = least fatigue). Total costs over 10 years for managing GIST patients with molecularly targeted treatment was estimated at £47 521,£56 146 per patient compared with £4047,£4230 per patient with best supportive care. Conclusions:, The incidence of GIST appears to be similar by country; the lower estimate in one country could be explained by differences in method of case ascertainment. Data suggest that the HRQL burden of GIST is similar to that with other cancers although this requires further exploration. The value of new therapies in GIST needs to consider not only cost but also anticipated benefits and the unmet medical need in this condition. [source] Review article: benefits and risks of chemotherapy in elderly patients with metastatic colorectal cancerALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2009E. MITRY Summary Background, Although metastatic colorectal cancer (mCRC) is largely a disease of older individuals, our understanding of disease processes and their optimal treatment has been gained through trials with populations largely confined to younger individuals. Aim, To identify through a review issues specific to geriatric patients with mCRC (physiological changes associated with aging, burden of coexisting illnesses, altered drug pharmacokinetics and functional impairment) and assess challenges to elderly patients posed by malignancy and exposure to cytotoxic medication. Methods, Our literature search for indexed articles published between 2000 and May 2008 employed terms including irinotecan, oxaliplatin, elderly, mCRC, targeted agents and biologicals. Results, Underrepresentation of older patients in clinical trials makes it difficult to extrapolate findings to older age groups. However, some trials have demonstrated that elderly patients can achieve survival benefits and toxicity comparable to younger patients, although dosage modifications may be required. Conclusions, Currently, benefits with pharmacological therapy are suggested but not proven in the elderly population. Although concurrent illnesses and disabilities can complicate treatment decision making, chronological age alone should not disqualify these patients with mCRC from receiving optimal treatment similar to that offered to their younger cohorts. [source] Do patients benefit from participating in medical decision making?PSYCHO-ONCOLOGY, Issue 1 2006Longitudinal follow-up of women with breast cancer Abstract This study sought to examine the relationships between decisional role (preferred and assumed) at time of surgical treatment (baseline), congruence between assumed role at baseline and preferred role 3 years later (follow-up), and quality of life at follow-up. Two hundred and five women diagnosed with breast cancer completed the decisional role preference scale at baseline and follow-up, and the EORTC QLQ-C30 at follow-up. A statistically significant number of women had decisional role regret, with most of these women preferring greater involvement in treatment planning than was afforded them. Women who indicated at baseline that they were actively involved in choosing their surgical treatment had significantly higher overall quality of life at follow-up than women who indicated passive involvement. These actively involved women had significantly higher physical and social functioning and significantly less fatigue than women who assumed a passive role. Quality of life was significantly related to reports of experienced involvement in treatment decision making, but not to reports of preferred involvement, or congruence between preferred and experienced involvement. Copyright © 2005 John Wiley & Sons, Ltd. [source] Women's experiences with genomic testing for breast cancer recurrence riskCANCER, Issue 8 2010Janice P. Tzeng MPH Abstract BACKGROUND: Few studies have examined how patients understand and use genomic test results when deciding about treatment. This study examined how women receive and incorporate results of Oncotype DX, a genomic test that offers recurrence risk estimates, into decisions about adjuvant treatment for early stage breast cancer. METHODS: Participants in the cross-sectional study were 77 women with early stage, estrogen receptor-positive breast cancer with 0 to 3 positive lymph nodes who received Oncotype DX between 2004 and 2009. Mailed surveys, supplemented by medical chart review, assessed how women received and understood recurrence risk information based on the test. RESULTS: The most common test results were low (50%, 34 of 68) or intermediate (37%, 25 of 68) breast cancer recurrence risk. Most women accurately recalled their recurrence risk based on the test (71%) and felt they understood much of what they were told about it (67%). Approximately 25% of women recalled experiencing test-related distress. Women's perceived recurrence risk was associated with their actual genomic-based recurrence risks, having had a previous cancer diagnosis, and worry about recurrence. Women with high recurrence risk typically had chemotherapy (78%, 7 of 9), whereas only 2 with a low recurrence risk did (7%, 2 of 30). CONCLUSIONS: This is among the first studies to describe patients' experiences with genomic testing for recurrence risk. Although many women understood discussions about their genomic test results, a third reported not fully understanding these discussions, suggesting a need to aid and improve risk communication and treatment decision making. Cancer 2010. © 2010 American Cancer Society. [source] | ||||||||||