Forum sparks creative energy

Human support committee provides a forum where staff, patients, and administration can become involved in the planning, implementation, and evaluation of patient services.

Anticancer centres in France

The system of anticancer centres in France is described, with a more detailed description of the largest of these, the Institute Gustave Roussy at Villejuif. The anticancer centres between them see and treat 20% to 25% of the cancer patients in France, control over 4,000 inpatients beds, and see over 75,000 new outpatients annually. The centres are staffed by a full-time multidisciplinary team, divided into "communittees" which deal with each individual type of malignancy. The committees have full secretarial and research staffs and regularly evaluate their progress at symposia. They provide a standard of excellence for the oncological services in France.

A cancer registry for the community radiation center

A common problem for cancer treatment centers is maintenance and utilization of the cancer registry. Computerization of the large amount of patient information involved is desirable. Organization and implementation of a patient registry using a PC-12 treatment planning computer is described. This application is reasonable and effective for community radiation centers, and retains the interactive features that make these dedicated mini-computers so useful. Details of organizing and running this type of registry are included. Examples of the patient data from a radiation therapy department are given and the possibilities for analysis of the information discussed. An important part of the registry is the one-line summary of individual cases, termed the "patient status graph," that condenses patient follow-up history for quick review. The importance of a pertinent and practical registry for all cancer centers is discussed.

A different kind of day hospital--for patients with preterminal cancer and chronic disease

A new day hospital has been set up in Sheffield for patients with preterminal cancer and chronic disease. During the first 26 months 197 patients with cancer and 66 chronically sick patients attended. Of the 2701 attendances by patients with cancer, breast cancer accounted for 38%. One hundred and forty of the patients with cancer died, 83% in the terminal-care unit and 12% at home. Ninety per cent of respondents to a questionnaire thought that the support provided was of great importance to both patient and family; and over two-thirds of the patients were said to have benefited from improved control of symptoms. A similar facility could be developed within existing day hospitals without major revenue consequences, and should produce a genuine improvement in care. This study suggests, however, that it would not shorten the terminal stay in hospital.

Perceptions of cancer care by professionals and nonprofessionals

Critical incident descriptions were obtained by questionnaire from 472 practicing physicians, 59 medical students, 31 house officers, 50 clinical faculty, and 43 allied health professionals. Descriptions were obtained by interview from 660 cancer patients and their families, and from 250 noncancer patients. The resulting 4,877 vignettes were analyzed and dissected to yield 13,009 separate, identifiable critical behaviors, i.e., behaviors deemed critical to the delivery of optimal care. After elimination of duplication and those items not specifically relevant to cancer, there remained 339 distinct attributes of an effective cancer care system. The results confirmed that the nonprofessionals are most concerned with items in the affective domain while the professionals are most concerned with items of a technological nature. However, there was a good deal of overlap in these areas of concern, and it appears from it that "needs" as expressed by professionals and "wants" as expressed by nonprofessionals often represent the same things couched in different terms. This study also yielded a list of desirable competencies of value as educational objectives for programs of profes sional education in cancer care.