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Rahman R, Mariam L, Su R, Malhotra C, Ozdemir S. Quality of life and its predictors among patients with metastatic cancer in Bangladesh: the APPROACH survey. BMC Palliat Care 2024; 23:2. [PMID: 38166890 PMCID: PMC10762837 DOI: 10.1186/s12904-023-01301-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 10/28/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND This study aimed to assess the health-related quality of life (HRQOL) (physical, functional, emotional, social, spiritual) and psychological (anxiety and depression) well-being and their associations with patient characteristics among patients with metastatic cancer in Bangladesh. METHODS A convenience sample of 386 Bangladeshi patients with stage IV solid cancers was recruited from a palliative care outpatient department and an inpatient palliative center. Dependent variables included the physical, functional, emotional, social, and overall scores of the Functional Assessment of Cancer Therapy-General (FACT-G) scale, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being (FACIT-SP) scale, the anxiety, depression, and overall scores of the Hospital Anxiety and Depression (HADS) scale. Linear regressions examined the association between dependent variables and patient characteristics. RESULTS A substantial proportion of Bangladeshi patients reported anxiety (59% of outpatients and 55% of inpatients) and depression (60% of outpatients and 73% of inpatients) symptoms. Generally, greater financial difficulty and symptom burden scores were associated with worse health outcomes. Older patients reported poorer functional and spiritual well-being but better anxiety scores. Females reported worse anxiety and depressive symptoms and physical well-being but better spiritual outcomes. CONCLUSIONS Additional efforts must be directed at improving the HRQOL of patients with metastatic cancer in Bangladesh. Furthermore, assistance should be made more accessible to vulnerable groups, including women, the elderly, and those with financial difficulty.
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Affiliation(s)
- Rubayat Rahman
- Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Lubna Mariam
- Department of Radiation Oncology, National Institute of Cancer Research & Hospital, Dhaka, Bangladesh
| | - Rebecca Su
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Signature Programme in Health Services and System Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Signature Programme in Health Services and System Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Semra Ozdemir
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
- Signature Programme in Health Services and System Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
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Hsiung K, Skaug L, Daunis D. Communicating a Plan for Involuntary Psychiatric Admission: A Standardized Patient Workshop Intervention for General Psychiatry Residents. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11355. [PMID: 37854310 PMCID: PMC10579457 DOI: 10.15766/mep_2374-8265.11355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 07/26/2023] [Indexed: 10/20/2023]
Abstract
Introduction One important and often difficult act of communication common in psychiatry is communication regarding the need for involuntarily commitment for psychiatric treatment. Thus, we designed an educational workshop for psychiatry residents on how to communicate the plan for involuntarily commitment to a psychiatric hospital. Methods Using faculty expertise, we created a protocol to guide trainees on how to structure conversations around involuntary commitment. Residents first attended a didactic on the protocol, followed by a 1-hour workshop with standardized patients (SPs) 1 week later. The workshop consisted of three 14-minute simulated scenarios with the SP with debriefing. Trainees filled out pre- and postworkshop surveys. Results Fifteen and 12 residents completed the pre- and postworkshop surveys, respectively. Residents' perceived comfort level in their ability to deliver involuntary commitment news significantly improved after the workshop when compared to before (3.0 vs. 3.7 for pre- and postworkshop surveys, respectively). Residents trended toward intending to make more changes to their approach after the workshop when compared to before (2.2 vs. 2.6, respectively). Feedback on the didactic and workshop were largely positive. Discussion To our knowledge, our intervention is the first designed specifically to teach psychiatry residents how to communicate to patients that they are being involuntarily committed to emergent psychiatric treatment. This educational model has potential for improving resident skills and confidence in having difficult conversations around involuntary commitment.
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Affiliation(s)
- Kimberly Hsiung
- Third-Year Resident, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center
| | - Laura Skaug
- Senior Standardized Patient Educator, Center for Experiential Learning and Assessment, Vanderbilt University Medical Center
| | - Daniel Daunis
- Assistant Professor, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center
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Aker S, Kahve AC. What do psychiatrists think about renaming schizophrenia in Turkey? Schizophr Res 2022; 248:8-13. [PMID: 35907348 DOI: 10.1016/j.schres.2022.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/30/2022] [Accepted: 07/10/2022] [Indexed: 10/16/2022]
Abstract
In this study, it was aimed to evaluate the opinions of psychiatrists in Turkey on whether to change the name of schizophrenia in order to reduce stigma. This cross-sectional survey was conducted with psychiatrists (resident in psychiatry, specialist, and lecturer) in Turkey. An online survey was created via the Google Forms public web address. Online questionnaires were delivered through Google Forms by emailing and messaging on WhatsApp, Telegram, Google and Yahoo groups and asking them to pass the questionnaire to other possible participants in their network. The study was performed between June 20, 2021 and July 10, 2021. 460 psychiatrists participated in the study. Forty-five-point 2 % of psychiatrists think that the name of schizophrenia should be renamed to reduce stigma. Forty-two-point 8 % of those who support the name change state that this change should be done as soon as possible. While 64.1 % of psychiatrists stated that naming the disease with another (new) name instead of schizophrenia could increase the hopes of patients and their relatives for recovery, 12.6 % stated that renaming would not cause any positive or negative changes. There is no statistical difference between psychiatrists who have a relative diagnosed with schizophrenia and psychiatrists who do not, in terms of thinking that the name of schizophrenia should be renamed to reduce stigma. In order to remove the stigma on schizophrenia, many interventions are required in social, cultural, economic and political fields. Renaming schizophrenia may be a good start for interventions.
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Affiliation(s)
- Servet Aker
- Department of Medical Education, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey.
| | - Aybeniz Civan Kahve
- Department of Psychiatry, Ankara City Hospital, University of Health Sciences, Ankara, Bilkent, Turkey
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Satija A, Bhatnagar S, Ozdemir S, Finkelstein E, Maholtra C, Teo I, Yang GM. Patients' Awareness of Advanced Disease Status, Psychological Distress and Quality of Life Among Patients With Advanced Cancer: Results From the APPROACH Study, India. Am J Hosp Palliat Care 2021; 39:772-778. [PMID: 34477010 DOI: 10.1177/10499091211042837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Prognostic disclosure to patients with advanced cancer facilitates treatment decisions and goals of care discussions. However, the perspectives of patients, families and physicians differ in this regard across different cultures. Non-disclosure of cancer diagnosis or prognosis is commonly observed in family-centric cultures such as India. AIM To assess the prevalence of and factors associated with cancer patients' awareness of advanced disease status; and its with quality of life and psychological distress. METHODS Patients for this cross-sectional questionnaire-based survey were recruited from oncology and palliative medicine clinics at a tertiary cancer hospital in India from January 2017 to June 2018. Patients aged ≥ 21 years, aware of cancer diagnosis and receiving oncology treatment for Stage IV solid cancer were included in the study after obtaining written informed consent. RESULTS Two hundred patients were enrolled, of which 146 (73%) were not aware of the stage of their malignancy and 9 (4.5%) believed that their disease was at stage I, II or III. Those who were aware of their advanced cancer stage had more years of education (9.9 years vs 8.1 years, p = .05) and had poorer spiritual wellbeing in the faith domain (adjusted difference -1.6, 95% confidence interval -3.1 to -0.1, p = .03) compared to those who were unaware. CONCLUSION It is recommended that future studies may explore prognostic understanding in Indian patients according to their socio-cultural, spiritual and educational background.
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Affiliation(s)
- Aanchal Satija
- Dr B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Semra Ozdemir
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Eric Finkelstein
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Chetna Maholtra
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Irene Teo
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore.,Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Grace Meijuan Yang
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore.,Department of General Medicine, Sengkang General Hospital, Singapore, Singapore
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Amsalem D, Martin A, Mosheva M, Soul O, Korotkin L, Ziv A, Gothelf D, Gross R. Delivering Difficult News: Simulation-Enhanced Training Improves Psychiatry Residents' Clinical Communication Skills. Front Psychiatry 2021; 12:649090. [PMID: 33746804 PMCID: PMC7973022 DOI: 10.3389/fpsyt.2021.649090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 02/10/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Delivering difficult news to individuals diagnosed with mental health disorders and their family members can be challenging. The use of simulated patients (SP) is an effective teaching method to enhance clinical skills, particularly those around communication. We developed, implemented, and evaluated the effectiveness of an SP-based training module to improve psychiatric residents' clinical communication skills in delivering difficult news. Methods: We conducted 5-h workshops consisting of 3 components: (1) a high-fidelity simulation session with a professional actor; (2) a 30-min lecture; and (3) role-playing of 3 short scenarios, during which residents rotated taking on different roles (as psychiatrist, patient, or family member). We observed through a 1-way mirror and videotaped each resident's simulation session and followed it with personalized debriefing. Following the workshop, each resident received the full-length video of their simulated interview, together with a list of questions as a take-home assignment. Two months after the workshop, the residents were invited to a second SP-based session, during which 2 independent evaluators, each a board-certified psychiatrist with expertise in medical simulation, evaluated the participants' communication skills using a previously validated instrument. To avoid observation bias, the 2 evaluators rated the videotapes blind to the timing of the simulation (pre- vs. post-training). Participants completed self-report questionnaires on satisfaction and self-confidence, before, after, and 2 months following the workshop. Findings: Of the 28 psychiatric residents who participated in the training day, 24 (86%) completed the post-workshop evaluation. Mean communication score increased from 24.9 to 27.8 (paired t-test: 5.6, p < 0.001). The mean score for the self-confidence questionnaire, calculated on a 1 to 5 Likert scale, increased from 3.4 to 4.0 after the training day, and remained unchanged (4.2) 2 months later (p < 0.001). Conclusions: An SP-based training module proved useful in improving the objectively measured communication skills of psychiatric residents delivering difficult news. The training further enhanced participants' subjective sense of confidence in those clinical skills.
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Affiliation(s)
- Doron Amsalem
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
| | - Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT, United States
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mariela Mosheva
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Child & Adolescent Psychiatry, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
| | - Omer Soul
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Child & Adolescent Psychiatry, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
| | - Liran Korotkin
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amitai Ziv
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sheba Medical Center, Integrated Rehabilitation Hospital, Ramat Gan, Israel
| | - Doron Gothelf
- Division of Child & Adolescent Psychiatry, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
- Faculty of Medicine, Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Raz Gross
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel
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Swinson N, Webb R, Shaw J. The prevalence of severe personality disorder in perpetrators of homicide. Personal Ment Health 2021; 15:49-57. [PMID: 33569927 DOI: 10.1002/pmh.1503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Current UK evidence on the prevalence of personality disorder in homicide is lacking. The aims were to estimate the prevalence of personality disorder in homicide perpetrators from court reports and carry out a dimensional assessment in keeping with the new ICD-11 classification of the prevalence of severe personality disorder. Associations between severe personality disorder and sociodemographic, historical and offence-related characteristics were then explored. METHODS Six hundred court reports from a national case series of homicide perpetrators in England and Wales were analysed using a document-derived version of the Personality Assessment Schedule (PAS-DOC), providing categorical and dimensional personality assessments. The prevalence of personality disorder and severe personality disorder was estimated. Factors associated with the diagnosis of severe personality disorder were examined. RESULTS The prevalence of personality disorder using the PAS-DOC was 56.3% (95% confidence interval 52.3%, 60.3%), compared with 16% as diagnosed in reports. Severe personality disorder was present in 62% (n = 338) of all those with a personality disorder and was significantly associated with homicides of strangers and previous violence. CONCLUSIONS Severe personality disorder is highly prevalent among perpetrators of homicide, and the finding that it is more prevalent when strangers are the victims stresses both the need for early identification of those at risk of developing severe personality disorder and the development of appropriate early preventive interventions. There is also a need for the development of effective treatment and interventions for those with established severe personality disorder and better identification of this level of disorder by psychiatrists. The forthcoming ICD-11 classification should help in this endeavour. © 2021 The Authors Personality and Mental Health Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Nicola Swinson
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK.,Hope House, Bellsdyke Hospital, NHS Forth Valley, UK
| | - Roger Webb
- Mental Health Epidemiology, University of Manchester, UK
| | - Jenny Shaw
- Forensic Psychiatry, University of Manchester, UK
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Lasalvia A, Vita A, Bellomo A, Tusconi M, Favaretto G, Bonetto C, Zanalda E, Mencacci C, Carpiniello B. Renaming schizophrenia? A survey among psychiatrists, mental health service users and family members in Italy. Schizophr Res 2021; 228:502-509. [PMID: 32593734 DOI: 10.1016/j.schres.2020.03.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/17/2020] [Accepted: 03/21/2020] [Indexed: 01/10/2023]
Abstract
This survey explores how psychiatrists, service users and family members in Italy perceive the term schizophrenia and if they consider a name change a useful option in order to overcome the stigma attached to it. Opinions on the term schizophrenia were collected by a self-rated questionnaire used in previous international surveys. Questionnaires were delivered members of the Italian Psychiatric Association. Survey of mental health users was conducted among members of the main users' association of the Veneto region; survey of family members was conducted among one of the most representative Italian family association. Overall, 350 psychiatrists, 71 mental health users and 110 family members filled in the questionnaires. Considering the whole sample, 41.5% found the term inappropriate, 67.6% stigmatizing and 72.3% advocated a name change. Among psychiatrists 57% reported that schizophrenia was inappropriate, 70% considered the term stigmatizing and 71% was in favor of a name change. Similarly, 56% of service users and 71% of family members found schizophrenia a stigmatizing term and, respectively, 75% and 77% advocated a name change. Conflicting results were found on possible alterative terms: psychiatrists proposed a wide range of possible options, most of which referred to the term 'psychosis' (53%), whereas users and family members preferred terms referring to the broad category of 'mental health suffering'. Overall, most of respondents in the three stakeholders' groups agree that schizophrenia should be renamed to reduce the stigma attached to it; the main challenge, however, is the lack of consensus on the best alternative term to use.
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Affiliation(s)
- Antonio Lasalvia
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy; UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy.
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Massimo Tusconi
- Section of Psychiatry, Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Gerardo Favaretto
- Department of Mental Health, Local Health Authority ULSS 2 Marca Trevigiana, Treviso, Italy
| | - Chiara Bonetto
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Enrico Zanalda
- Integrated Mental Health Department ASL TO 3 and AOU San Luigi Gonzaga, Torino, Italy
| | - Claudio Mencacci
- Department of Neuroscience, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
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Amidi Naeini A, Ranjbar H, Mohammadsadeghi H, Alavi K, Ahmadkhaniha H, Rasoulian M. Assessment of psychiatrists' approaches regarding disclosure of psychiatric disorders to their patients: a qualitative study. Med J Islam Repub Iran 2020; 34:82. [PMID: 33306057 PMCID: PMC7711037 DOI: 10.34171/mjiri.34.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background: Diagnosis disclosure is the result of a shift in medical approaches from traditional paternalism to participatory and patient-centered decision making. Disclosure of psychiatric diagnosis remained uncommon and controversial. Giving information about psychiatric illnesses is very complicated, and it is affected by several factors. While clinical guidelines provide a clear pathway for treating patients, in practice, the treatment of patients is influenced by cultural and social factors. The aim of the current study was a qualitative assessment of psychiatrists’ approaches regarding the disclosure of psychiatric disorders to their patients.
Methods: The current study was conducted with a qualitative approach. The participants were purposefully selected psychiatrists from three medical universities in Tehran, Iran. The data gathered using the semi-structured interview method. Sixteen interviews with 14 psychiatrists were conducted. Data were analyzed using thematic analysis.
Results: Psychiatrists decide to disclose the diagnosis based on several factors. We summarized these factors in a central theme, passive situational decision making based on paternalism and displacement of responsibility. It has two subthemes, including "passive and situational decision making" and "paternalism and displacement of responsibility." Each theme presented by detailed quotations.
Conclusion: The results of this study showed that psychiatrists did not actively disclose the diagnosis name to patients. Diagnosis disclosure was influenced by several factors, such as the certainty about the diagnosis and the severity of the disease. This passive approach does not respect the patient's rights. The paternalistic nature of this approach mandates psychiatrists to consider themselves as the responsible perosn for their patients’ welfare.
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Affiliation(s)
| | - Hadi Ranjbar
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Science, Tehran, Iran
| | - Homa Mohammadsadeghi
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Science, Tehran, Iran
| | - Kaveh Alavi
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Science, Tehran, Iran
| | - Hamidreza Ahmadkhaniha
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Science, Tehran, Iran
| | - Maryam Rasoulian
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Science, Tehran, Iran
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Yi J, Kim MA, Choi KH, Bradbury L. Oncologists' Experience of Delivering Bad News in Korea. OMEGA-JOURNAL OF DEATH AND DYING 2020; 85:285-302. [PMID: 32698675 DOI: 10.1177/0030222820944087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study explored oncologists' experiences of delivering bad news to patients with cancer and their families. Nine oncologists recruited from three superior hospitals in Korea completed in-depth interviews. The results of thematic analyses identified four themes: precursors to bad news delivery, why it is difficult to deliver bad news, when it is more difficult to deliver bad news, and strategies of delivering bad news. The participants felt unprepared for the task and stressed because breaking bad news goes against their responsibility to do no harm and their professional objective to promote healing. Although they were unclear about best practices regarding communication styles, they individualized their communication style to meet the needs of their patients, who have an array of cultural, social, and spiritual backgrounds. Understanding oncologists' perceptions of bad news delivery can inform culturally appropriate interventions for alleviating their stress and improving patient-physician relationships in communication of bad news.
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Affiliation(s)
- Jaehee Yi
- College of Social Work, University of Utah, Salt Lake City, USA
| | - Min Ah Kim
- Department of Social Welfare, Sungkyunkwan University, Seoul, Republic of Korea
| | - Kwon Ho Choi
- School of Social Welfare, Kyungpook National University, Daegu, Republic of Korea
| | - Laura Bradbury
- College of Social Work, University of Utah, Salt Lake City, USA
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Byrd CT, Werle D, St Louis KO. Speech-Language Pathologists' Comfort Level With Use of Term "Stuttering" During Evaluations. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:841-850. [PMID: 32233922 DOI: 10.1044/2020_ajslp-19-00081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Speech-language pathologists (SLPs) anecdotally report concern that their interactions with a child who stutters, including even the use of the term "stuttering," might contribute to negative affective, behavioral, and cognitive consequences. This study investigated SLPs' comfort in providing a diagnosis of "stuttering" to children's parents/caregivers, as compared to other commonly diagnosed developmental communication disorders. Method One hundred forty-one school-based SLPs participated in this study. Participants were randomly assigned to one of two vignettes detailing an evaluation feedback session. Then, participants rated their level of comfort disclosing diagnostic terms to parents/caregivers. Participants provided rationale for their ratings and answered various questions regarding academic and clinical experiences to identify factors that may have influenced ratings. Results SLPs were significantly less likely to feel comfortable using the term "stuttering" compared to other communication disorders. Thematic responses revealed increased experience with a specific speech-language population was related to higher comfort levels with using its diagnostic term. Additionally, knowing a person who stutters predicted greater comfort levels as compared to other clinical and academic experiences. Conclusions SLPs were significantly less comfortable relaying the diagnosis "stuttering" to families compared to other speech-language diagnoses. Given the potential deleterious effects of avoidance of this term for both parents and children who stutter, future research should explore whether increased exposure to persons who stutter of all ages systematically improves comfort level with the use of this term.
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Affiliation(s)
- Courtney T Byrd
- Department of Communication Sciences and Disorders, The University of Texas at Austin
| | - Danielle Werle
- Department of Communication Sciences and Disorders, The University of Texas at Austin
| | - Kenneth O St Louis
- Department of Communication Sciences and Disorders, West Virginia University, Morgantown
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11
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Su T, He C, Li X, Xiao L, He J, Bai Y, Tang Y. Association between early informed diagnosis and survival time in patients with lung cancer. Psychooncology 2020; 29:878-885. [PMID: 32266740 DOI: 10.1002/pon.5360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/07/2020] [Accepted: 02/10/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE As a malignant tumor with high mortality, lung cancer (LC) often causes great trauma to patients, and a series of negative emotions and a heavy psychological burden accompanies poor prognosis. Whether or not to inform the patients of their condition has always been a controversial topic in the medical community. This retrospective cohort study investigated the association between early informed diagnosis and survival time in patients with LC. METHODS A total of 29 825 patients with LC were enrolled between October 2002 and December 2016. The potential factors influencing LC survival were registered, including knowing their cancer diagnosis status, age, gender, pathological type, clinical stage, surgical history, hospital grade, and patient occupation. All participants were followed up every 6 months until June 2017. RESULTS In June 2017, 23.1% of the participants still survived. Their median survival time (MST) was 11.20 months (95% confidence interval [CI], 10.98-11.43). Generally, patients that knew their cancer diagnosis had longer MST than those who did not (18.33 months vs 8.77 months, P < .001). By stratified analysis, patients that knew their cancer diagnosis had longer survival time in each subgroup (P < .001, all subgroups). Cox regression analysis showed that knowing their cancer diagnosis was an independent influencing factor for survival in patients with LC (hazard ratio, 0.826; 95% CI, 0.802-0.851; P < .001). CONCLUSIONS Knowing their cancer diagnosis contributed to longer survival time in patients with LC, providing clear evidence that medical staff and patients' families should fully disclose cancer diagnoses to patients.
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Affiliation(s)
- Tong Su
- College of Psychology, The Second Military Medical University, Shanghai, China.,Department of Medical Psychology, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, China
| | - Chen He
- College of Psychology, The Second Military Medical University, Shanghai, China
| | - Xiaopan Li
- Department of Cancer Prevention and Vital Statistics, Center for Disease Control and Prevention, Shanghai, China.,Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China
| | - Lei Xiao
- College of Psychology, The Second Military Medical University, Shanghai, China
| | - Jingwen He
- College of Psychology, The Second Military Medical University, Shanghai, China
| | - Yonghai Bai
- Department of Medical Psychology, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, China
| | - Yunxiang Tang
- College of Psychology, The Second Military Medical University, Shanghai, China.,Department of Medical Psychology, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, China
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Jorge R, Teixeira A, Calanzani N, Nunes R, Sousa L. Older people's preferences for prognostic information in a situation of serious illness with less than a year to live. CIENCIA & SAUDE COLETIVA 2019; 24:4313-4324. [PMID: 31664403 DOI: 10.1590/1413-812320182411.02022018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 04/16/2018] [Indexed: 11/21/2022] Open
Abstract
This study aimed to determine the preferences of community-dwelling older people about information disclosure regarding poor prognosis, the likely symptoms and problems, and the care options available in a situation of serious illness with less than a year to live; and to identify factors associated with a preference for information disclosure regarding poor prognosis. The Brazilian version of the Preferences and Priorities for End of Life Care (PRISMA) questionnaire was administered face-to-face to 400 older people, living in the city of Belo Horizonte, Minas Gerais, Brazil. The main results indicated that 74.0% preferred to be informed that they had limited time left, 89.3% wished to be informed about symptoms and problems, and 96.3% about available care options. The factors associated with preferences for information about poor prognosis were: gender (women: OR = 0.446, 95% CI: 0.269-0.738) and choosing the least preferred place to die (home of a relative or friend: OR = 2.423, 95% CI: 1.130-5.198. These results show that most older people want to be informed in an advanced illness situation with less than a year to live. Health care professionals need to be prepared to anticipate news about poor prognosis and the disease.
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Affiliation(s)
- Rafaela Jorge
- Programa Doutoral em Geriatria e Gerontologia, Departamento de Educação e Psicologia, Universidade de Aveiro. Campus Universitário de Santiago. 3810-193. Aveiro, Portugal.
| | - Andreia Teixeira
- Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS). Porto, Portugal
| | - Natália Calanzani
- Instituto Usher de Ciências da Saúde da População e Informática, Centro de Ciências da Saúde da População, Universidade de Edimburgo. Edimburgo Reino Unido
| | - Rui Nunes
- Faculdade de Medicina da Universidade do Porto. Porto, Portugal
| | - Liliana Sousa
- Departamento de Educação e Psicologia, Centro de Investigação em Tecnologias e Serviços de Saúde (Cintesis.ua), Universidade de Aveiro. Aveiro, Portugal
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Kane A, Murphy C, Kelly M. Assessing implicit and explicit dementia stigma in young adults and care-workers. DEMENTIA 2018; 19:1692-1711. [DOI: 10.1177/1471301218804727] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This aim of this study was to assess implicit and self-reported stigma towards people with dementia in young adults with no contact or experience ( n = 23), and in care-workers ( n = 17 professional dementia care-workers). Data were analysed to determine whether stigma was related to self-reported levels of depression, anxiety, stress and professional burnout. Forty participants completed the Implicit Relational Assessment Procedure and Dementia Attitudes Scale. The Depression Anxiety and Stress Scale and Maslach Burnout Inventory were used to measure depression, anxiety, stress and professional burnout. The young adult group showed statistically significant levels of dementia stigma (on the two “ dementia” trial-types, p = .027 and p = .030). Statistical analyses showed more dementia-positive attitudes in care-workers compared to young adults on the Implicit Relational Assessment Procedure and the Dementia Attitudes Scale (both p’s=.021). Spearman’s Rho correlations tests showed that for the care-givers, higher levels of burn-out were associated with more negative attitudes towards people with dementia on both of the Dementia Attitudes Scale subscales (social comfort p<.001 and dementia knowledge p=.005). The results support prior research showing that experience with a stigmatised group can lower stigma and demonstrate the importance of providing a supportive work environment to mitigate burnout.
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Affiliation(s)
- Alan Kane
- National University of Ireland Galway, Ireland
| | - Carol Murphy
- National University of Ireland Maynooth, Ireland
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Ferrer RA, Orehek E, Padgett LS. Goal conflict when making decisions for others. JOURNAL OF EXPERIMENTAL SOCIAL PSYCHOLOGY 2018. [DOI: 10.1016/j.jesp.2018.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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15
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Mitchell AJ, Selmes T. Why don't patients take their medicine? Reasons and solutions in psychiatry. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.106.003194] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Over the course of a year, about three-quarters of patients prescribed psychotropic medication will discontinue, often coming to the decision themselves and without informing a health professional. Costs associated with unplanned discontinuation may be substantial if left uncorrected. Partial non-adherence (much more common than full discontinuation) can also be detrimental, although some patients rationally adjust their medication regimen without ill-effect. This article reviews the literature on non-adherence, whether intentional or not, and discusses patients' reasons for failure to concord with medical advice, and predictors of and solutions to the problem of non-adherence.
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Amsalem D, Hasson-Ohayon I, Gothelf D, Roe D. How Do Patients With Schizophrenia and Their Families Learn About the Diagnosis? Psychiatry 2018; 81:283-287. [PMID: 30020033 DOI: 10.1080/00332747.2018.1443676] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The purpose of the present study was to investigate how patients with schizophrenia and their relatives learn about the diagnosis and to study their feelings and degree of satisfaction with the process of delivering that information. METHOD A total of 16 individuals who had been recently diagnosed with schizophrenia spectrum disorders and 15 of their relatives were interviewed. The interviews were recorded, transcribed verbatim, and analyzed using grounded theory. RESULTS Twenty-six (86%) patients and relatives reported having first learned about the diagnosis by reading the patient's release form or during an incidental encounter with personnel. Most patients and their relatives disagreed with the diagnosis and reported negative feelings about the way in which they learned about it. Only four (14%) patients and relatives fully understood why medications were prescribed. Relatives who received the diagnosis incidentally were more dissatisfied with the disclosure process and had poorer adherence to treatment. CONCLUSIONS Development of empirical-based guidelines for delivering difficult news in psychiatry is needed to improve the way of communicating the diagnosis to patients and their relatives.
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Abstract
OBJECTIVE To estimate the prevalence of adult ADHD diagnosis and treatment in U.S. Medicaid beneficiaries. METHOD Using outpatient, inpatient, and pharmacy billing records for patients eligible for Medicaid fee-for-service benefits within 29 states from 1999 to 2010, we estimated the annual prevalence of ADHD diagnosis and treatment. RESULTS The prevalence of ADHD diagnosis increased from 2.20 per 1,000 patients in 1999 to 10.57 in 2010. Likewise, prevalence of ADHD treatment increased from 1.95 per 1,000 patients in 1999 to 13.16 in 2010. Between 40% and 65%, patients had ADHD drug prescription fills 6 months after ADHD diagnosis, whereas 45% to 55% of the beneficiaries with an ADHD drug prescription fill had ADHD diagnoses within 6 months before the prescription. CONCLUSION In publicly insured adults, the prevalence of ADHD diagnosis and treatment increased dramatically over the years. Approximately half of the diagnosed patients are not treated, whereas half of the treated adults are not diagnosed.
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Affiliation(s)
- Yanmin Zhu
- 1 University of Florida, Gainesville, USA
| | - Wei Liu
- 2 Food and Drug Administration, Silver Spring, MD, USA
| | - Yan Li
- 1 University of Florida, Gainesville, USA
| | - Xi Wang
- 1 University of Florida, Gainesville, USA
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Farooq S, Johal RK, Ziff C, Naeem F. Different communication strategies for disclosing a diagnosis of schizophrenia and related disorders. Cochrane Database Syst Rev 2017; 10:CD011707. [PMID: 29064090 PMCID: PMC6485682 DOI: 10.1002/14651858.cd011707.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Delivering the diagnosis of a serious illness is an important skill in most fields of medicine, including mental health. Research has found that communication skills can impact on a person's recall and understanding of the diagnosis, treatment options and prognosis. People may feel confused and perplexed when information about their illness is not communicated properly. Sharing information about diagnosis of a serious mental illness is particularly challenging. The nature of mental illness is often difficult to explain since there may be no clear aetiology, and the treatment options and prognosis may vary enormously. In addition, newly diagnosed psychiatric patients, who are actively ill, often may not accept their diagnosis due to lack of insight or stigma attached to the condition. There are several interventions that aim to help clinicians to communicate life changing medical diagnoses to people; however, little is known specifically for delivering a diagnosis of schizophrenia. OBJECTIVES To evaluate evidence from randomised controlled trials (RCTs) for the efficacy of different communication strategies used by clinicians to inform people about the diagnosis and outcome of schizophrenia compared with treatment as usual and to compare efficacy between different communication strategies. SEARCH METHODS On 22 June 2015 and 29 June 2016, we searched the Cochrane Schizophrenia Group's Study-Based Register of Trials. We also searched sources of grey literature (e.g., dissertations, theses, clinical reports, evaluations published on websites, clinical guidelines and reports from regulatory agencies). SELECTION CRITERIA We planned to include all relevant RCTs that included adults with schizophrenia or related disorders, including schizophreniform disorder, schizoaffective disorder and delusional disorder. The trials would have investigated the effects of communication strategy or strategies that helped clinicians deliver information specifically about a diagnosis of schizophrenia (which can also include communication regarding the treatment options available and prognosis). DATA COLLECTION AND ANALYSIS Review authors independently examined all reports from the searches for any relevant studies. We planned to extract data independently. For binary outcomes, we would have calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we would have estimated the mean difference (MD) between groups and its 95% CI. We would have employed a random-effects model for analyses. We planned to assess risk of bias for included studies. We created a 'Summary of findings' table using GRADE. MAIN RESULTS The searches identified 44 records which appeared to be relevant to the aims of the review. We obtained full reports for seven potential studies; however, after close inspection none of these studies met the inclusion criteria. AUTHORS' CONCLUSIONS Good communication of diagnosis can affect treatment planning, compliance and patient outcomes, especially in the case of conditions such as schizophrenia, which has the potential to cause serious life disruption for both people with schizophrenia and their carers. Currently, there is no evidence based on findings from RCTs assessing the effects of communication strategies for disclosing the diagnosis of schizophrenia and related disorders. Research is required.
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Affiliation(s)
- Saeed Farooq
- Keele UniversityResearch Institute for Primary Care and Health SciencesStaffordshireUKST5 5BG
| | | | - Charlotte Ziff
- New Cross HospitalDepartment of OncologyWednesfield RoadWolverhamptonUKWV10 0QP
| | - Farooq Naeem
- Queen's UniversityDepartment of PsychiatryKingstonONCanada
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Ditton-Phare P, Loughland C, Duvivier R, Kelly B. Communication skills in the training of psychiatrists: A systematic review of current approaches. Aust N Z J Psychiatry 2017; 51:675-692. [PMID: 28462636 DOI: 10.1177/0004867417707820] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES A range of communication skills training programmes have been developed targeting trainees in various medical specialties, predominantly in oncology but to a lesser extent in psychiatry. Effective communication is fundamental to the assessment and treatment of psychiatric conditions, but there has been less attention to this in clinical practice for psychiatrists in training. This review examines the outcomes of communication skills training interventions in psychiatric specialty training. METHODS The published English-language literature was examined using multiple online databases, grey literature and hand searches. The review was conducted and reported using Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Studies examining the efficacy of communication skills training were included. Randomised controlled trials, pseudo-randomised studies and quasi-experimental studies, as well as observational analytical studies and qualitative studies that met criteria, were selected and critically appraised. No limits were applied for date of publication up until 16 July 2016. RESULTS Total search results yielded 2574 records. Of these, 12 studies were identified and reviewed. Two were randomised controlled trials and the remaining 10 were one-group pretest/posttest designs or posttest-only designs, including self-report evaluations of communication skills training and objective evaluations of trainee skills. There were no studies with outcomes related to behaviour change or patient outcomes. Two randomised controlled trials reported an improvement in clinician empathy and psychotherapeutic interviewing skills due to specific training protocols focused on those areas. Non-randomised studies showed varying levels of skills gains and self-reported trainee satisfaction ratings with programmes, with the intervention being some form of communication skills training. CONCLUSION The heterogeneity of communication skills training is a barrier to evaluating the efficacy of different communication skills training programmes. Further validation studies examining specific models and frameworks would support a stronger evidence base for communication skills training in psychiatry. It remains a challenge to develop research to investigate behaviour change over time in clinical practice or to measure patient outcomes due to the effects of communication skills training.
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Affiliation(s)
- Philippa Ditton-Phare
- 1 Hunter New England Mental Health, Newcastle, NSW, Australia.,2 School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,3 Centre for Brain and Mental Health Research, University of Newcastle, Newcastle, NSW, Australia
| | - Carmel Loughland
- 1 Hunter New England Mental Health, Newcastle, NSW, Australia.,2 School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,3 Centre for Brain and Mental Health Research, University of Newcastle, Newcastle, NSW, Australia
| | - Robbert Duvivier
- 2 School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Brian Kelly
- 1 Hunter New England Mental Health, Newcastle, NSW, Australia.,2 School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,3 Centre for Brain and Mental Health Research, University of Newcastle, Newcastle, NSW, Australia
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Martin ASH, Costello J, Griffiths J. Communication in palliative care: the applicability of the SAGE and THYME model in Singapore. Int J Palliat Nurs 2017. [PMID: 28648130 DOI: 10.12968/ijpn.2017.23.6.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Majority of the progress and development in palliative care in the last decade has been improvements in physical aspects of treatment, namely pain and symptom management. Psychosocial aspects of care have improved, although not enough to meet the needs of many patients and family members. This is evident in many parts of the world and notably in Singapore, where palliative care is seen as an emerging medical and nursing specialty. AIM To discuss the implementation of the SAGE and THYME communication model in a palliative care context. The article examines the use of the model and how its implementation can improve communication between patients and nurses. The model works by reviewing contemporary developments made in relation to improving communication in palliative care. These include, highlighting the importance of meeting individual needs, therapeutic relationship building, and advanced communication training within a Singaporean context. RESULTS The implementation of the SAGE and THYME model can be a useful way of enabling nurses to improve and maintain effective communication in a medically dominated health care system. The challenges and constraints in educating and training nurses with limited skills in palliative care, forms part of the review, including the cultural and attitude constraints specific to Singaporean palliative care.
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Affiliation(s)
| | - John Costello
- Associate Professor, University of Manchester, United Kingdom
| | - Jane Griffiths
- Senior Lecturer, University of Manchester, United Kingdom
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Davies F, Wood F, Brain KE, Edwards M, Jones R, Wallbank R, Robertson NP, Edwards A. The Transition to Secondary Progressive Multiple Sclerosis: An Exploratory Qualitative Study of Health Professionals' Experiences. Int J MS Care 2016; 18:257-264. [PMID: 27803641 DOI: 10.7224/1537-2073.2015-062] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Identifying the transition from relapsing-remitting to secondary progressive multiple sclerosis (SPMS) can be challenging for clinicians. Little previous research has explored how professionals experience working with patients during this specific stage of the disease. We explored the experiences of a group of multidisciplinary professionals who support patients in the transition to SPMS to describe this stage from a professional perspective. Methods: This qualitative semistructured interview study included 11 professionals (medical, nursing, and allied health professionals; specialists and generalists) working with patients with MS in South Wales, United Kingdom. Thematic analysis of the interview data was performed. Results: Two overarching themes were identified: the transition and providing support. The transition theme comprised issues related to recognizing and communicating about SPMS. Uncertainty influenced recognizing the transition and knowing how to discuss it with patients. The providing support theme included descriptions of challenging aspects of patient care, providing support for caregivers, using the multidisciplinary team, and working within service constraints. Providing adequate psychological support and engaging patients with self-management approaches were seen as particularly challenging. Conclusions: Caring for patients in the transition to SPMS generates specific challenges for professionals. Further research on health-care interactions and patients'/professionals' experiences regarding the transition phase may help identify strategies for professional development and learning and how to optimize the patient experience at this difficult stage of disease.
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Tabchi S, El Rassy E, Khazaka A, El Karak F, Kourie HR, Chebib R, Assi T, Ghor M, Naamani L, Richa S, Ghosn M, Kattan J. Validation of the EORTC QLQ-INFO 25 questionnaire in Lebanese cancer patients: Is ignorance a Bliss? Qual Life Res 2015; 25:1597-604. [PMID: 26659898 DOI: 10.1007/s11136-015-1201-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2015] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Despite worldwide trends toward optimizing full disclosure of information (DOI), the prevailing belief that cancer diagnosis should be concealed from patients, for their own good, has endured for a substantial period of time in Middle Eastern communities. OBJECTIVES This study would assess the reliability of the Arabic translated version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-INFO 25). The study was also designed to quantify DOI to Lebanese cancer patients and determine patient satisfaction with this DOI. Moreover, we compared the differences in the level of information among groups based on clinical and biographical variables. METHODS A sample of patients, being treated for a variety of malignancies, was prospectively evaluated. A physician interviewed patients using the Arabic version of the EORTC QLQ-INFO 25, on the day of hospitalization for chemotherapy, before treatment was administered. RESULTS In total 201 patients were interviewed. The translated version of the EORTC QLQ-INFO 25 showed high reliability when assessed using Cronbach's alpha coefficients for internal consistency with values scoring higher than 0.7 for all scales and the full questionnaire. There was a considerable lack of information provided to the participants with 38.8 % being unaware of their diagnosis and more than half being uninformed about the extent of their disease. Paradoxically, 86.5 % of patients expressed their satisfaction about the amount of information they received and 89.5 % believe the information provided was helpful. Further analysis showed no significant association between gender, marital status, cancer site and stage and the amount of information received. However, age and level of education were associated with DOI such as younger and more educated patients received more information. Older patients were also found to be the most satisfied with the information they received, despite having less access to information. CONCLUSIONS Although a high proportion of patients were not properly informed about their diagnosis, the overwhelming majority were satisfied with the amount of information they received and believed it was useful, reflecting the complexity of Middle Eastern cultural influences on cancer patients' perspectives.
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Affiliation(s)
- Samer Tabchi
- Faculty of Medicine, Hematology - Oncology Department, Hotel Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon.
| | - Elie El Rassy
- Faculty of Medicine, Hematology - Oncology Department, Hotel Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Aline Khazaka
- Faculty of Medicine, Hematology - Oncology Department, Hotel Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Fadi El Karak
- Faculty of Medicine, Hematology - Oncology Department, Hotel Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Hampig Raphael Kourie
- Department of Oncology, Jules Bordet Institute, Free University of Brussels (ULB), 1 Héger Bordet Street, Brussels, Belgium
| | - Ralph Chebib
- Faculty of Medicine, Hematology - Oncology Department, Hotel Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Tarek Assi
- Faculty of Medicine, Hematology - Oncology Department, Hotel Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Maya Ghor
- Faculty of Medicine, Hematology - Oncology Department, Hotel Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Lara Naamani
- Faculty of Medicine, Hematology - Oncology Department, Hotel Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Sami Richa
- Faculty of Medicine, Psychiatry Department, Hotel Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Marwan Ghosn
- Faculty of Medicine, Hematology - Oncology Department, Hotel Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Joseph Kattan
- Faculty of Medicine, Hematology - Oncology Department, Hotel Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
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Loughland C, Cheng K, Harris G, Kelly B, Cohen M, Sandhu H, Varmos M, Levin TT, Bylund C, Landa Y, Outram S. Communication of a schizophrenia diagnosis: A qualitative study of patients' perspectives. Int J Soc Psychiatry 2015; 61:729-34. [PMID: 25834281 DOI: 10.1177/0020764015576814] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Transparent diagnostic communication is considered best practice for clinicians. However, while patients expect to receive a schizophrenia diagnosis from their psychiatrist, research suggests mental health clinicians are often reluctant to provide this information to patients. AIM This study examines the perceptions of people with schizophrenia surrounding the communication of this diagnosis. METHODS A generic qualitative methodological approach was used. A total of 14 patients with schizophrenia were recruited through community mental health services (n = 10) and the Australia Schizophrenia Research Bank (ASRB; n = 4) in New South Wales (NSW), Australia. Semi-structured interviews were used to explore the experiences and perceptions of people with schizophrenia about the way a schizophrenia diagnosis was communicated by mental health clinicians. Interviews were recorded, transcribed, codes generated and thematic analysis undertaken aided by NVivo. RESULTS The majority of participants felt it was beneficial to receive a diagnosis despite acknowledging the distress this information sometimes caused, with many reporting this knowledge gave a sense of relief. It helped to understand their experiences and behaviours, improved their trust in the psychiatric system and increased treatment adherence. However, many reported difficulty in obtaining information about their condition, its treatment and prognosis, and expressed dissatisfaction with the way a diagnosis of schizophrenia was communicated. DISCUSSION Insight into the perceptions and experiences of patients with schizophrenia about how a diagnosis of schizophrenia is communicated is a key outcome of this research. This knowledge will inform the development of future training programmes for mental health clinicians, and influence the clinical practice of health professionals treating patients with schizophrenia.
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Affiliation(s)
- Carmel Loughland
- Priority Research Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia and Hunter Medical Research Institute Australian Schizophrenia Research Bank (ASRB), Schizophrenia Research Institute (SRI), Sydney, NSW, Australia Hunter New England Mental Health, Newcastle, NSW, Australia
| | - Kylie Cheng
- Hunter New England Mental Health, Newcastle, NSW, Australia
| | - Gillian Harris
- Priority Research Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia and Hunter Medical Research Institute Hunter New England Mental Health, Newcastle, NSW, Australia
| | - Brian Kelly
- Priority Research Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia and Hunter Medical Research Institute Hunter New England Mental Health, Newcastle, NSW, Australia
| | - Martin Cohen
- Hunter New England Mental Health, Newcastle, NSW, Australia
| | | | - Marina Varmos
- Hunter New England Mental Health, Newcastle, NSW, Australia
| | - Tomer T Levin
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
| | - Carma Bylund
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
| | - Yulia Landa
- Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Sue Outram
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia and Hunter Medical Research Institute
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Davies F, Edwards A, Brain K, Edwards M, Jones R, Wallbank R, Robertson NP, Wood F. 'You are just left to get on with it': qualitative study of patient and carer experiences of the transition to secondary progressive multiple sclerosis. BMJ Open 2015; 5:e007674. [PMID: 26201723 PMCID: PMC4513516 DOI: 10.1136/bmjopen-2015-007674] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Although the transition to secondary progressive multiple sclerosis (SPMS) is known to be a period of uncertainty for clinicians, who may find progressive disease challenging to objectively identify, little research has explored the experiences of patients and carers specifically during this transition period. Our objective was to explore what patients and their carers understand about their disease stage and describe their experiences and perspectives on the transition to SPMS. DESIGN Semistructured qualitative interviews and subsequent validation focus groups were analysed using inductive thematic analysis. SETTING South East Wales, UK. PARTICIPANTS 20 patients with MS and 13 carers were interviewed. Eight patients and two carers participated in focus groups. RESULTS Four main themes around disease progression were identified. 'Realisation' describes how patients came to understand they had SPMS while 'reaction' describes their response to this realisation. The 'realities' of living with SPMS, including dealing with the healthcare system during this period, were described along with 'future challenges' envisaged by patients and carers. CONCLUSIONS Awareness that the transition to SPMS has occurred, and subsequent emotional reactions and coping strategies, varied widely between patients and their carers. The process of diagnosing the transition was often not transparent and some individuals wanted information to help them understand what the transition to SPMS meant for them.
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Affiliation(s)
- F Davies
- Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - A Edwards
- Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - K Brain
- Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - M Edwards
- School of Human Sciences, Swansea University, Swansea, UK
| | - R Jones
- Department of Neurology, University Hospital of Wales, Cardiff, UK
| | - R Wallbank
- Department of Neurology, University Hospital of Wales, Cardiff, UK
| | - N P Robertson
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - F Wood
- Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK
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Loughland C, Kelly B, Ditton-Phare P, Sandhu H, Vamos M, Outram S, Levin T. Improving clinician competency in communication about schizophrenia: a pilot educational program for psychiatry trainees. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2015; 39:160-164. [PMID: 25053274 DOI: 10.1007/s40596-014-0195-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 06/23/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Important gaps are observed in clinicians' communication with patients and families about psychiatric disorders such as schizophrenia. Communication skills can be taught, and models for education in these skills have been developed in other fields of medicine, such as oncology, providing a framework for training communication skills relevant to psychiatric practice. This study evaluated a pilot communication skills education program for psychiatry trainees, focusing on discussing schizophrenia diagnosis and prognosis. METHOD Communication skills training modules were developed based on an existing theoretical framework (ComSkil), adapted for discussing a schizophrenia diagnosis and prognosis. Pre-post training rating of self-reported confidence in a range of communication tasks was obtained, along with trainee views on the training methods. RESULTS Thirty-eight participants completed the training. Significant improvements in confidence were reported post training for discussing schizophrenia prognosis, including an increased capacity to critically evaluate their own communication skills. Participants reported high levels of satisfaction with the program. CONCLUSION This preliminary study provides support for the translation of a well-established educational model to psychiatric training addressing core clinical communication tasks and provides the foundation for the development of a more comprehensive evaluation and an extended curriculum regarding other aspects of care for patients with schizophrenia: ongoing management and recovery, dealing with conflict, and conducting a family interview.
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Diagnosis of pervasive developmental disorders: when and how? An area-based study about health care providers. World J Pediatr 2015; 11:48-53. [PMID: 25447633 DOI: 10.1007/s12519-014-0533-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 11/22/2013] [Indexed: 10/24/2022]
Abstract
BACKGROUND Pervasive developmental disorders (PDDs) can be very difficult to diagnose in children and to communicate such a diagnosis to their parents. Families of children with PDD learn of their child's diagnosis long after the first symptoms are noted in the child's behavior. METHODS An area-based survey was conducted to assess all social and health care providers taking care of patients with PDDs in the Veneto Region (North-East Italy). RESULTS Only 28% of health care providers arrived at a definite diagnosis when the child was in his/her first year of age, 51% when the child was 2-3 years old and 21% from age of 4 years and up. On average, the latency between the time of the diagnosis and its communication to the family was 6.9 months. However, a number of families did not ever have a diagnosis communicated to them. Sometimes, 68% of the providers did not communicate a PDDs diagnosis to patient's families, and 4% of them quite commonly. CONCLUSION The well-known delay in making a diagnosis of PDDs has two distinct components: one relating to the difficulty of confirming a diagnosis of PDDs, the other, hitherto unrecognized, relating to the family being notified.
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Outram S, Harris G, Kelly B, Bylund CL, Cohen M, Landa Y, Levin T, Sandhu H, Vamos M, Loughland C. 'We didn't have a clue': Family caregivers' experiences of the communication of a diagnosis of schizophrenia. Int J Soc Psychiatry 2015; 61:10-6. [PMID: 24869849 DOI: 10.1177/0020764014535751] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite widespread acceptance of the principle that patients should be informed about their diagnosis, many clinicians are reluctant to provide a diagnosis of schizophrenia. This study examines family caregivers' experiences of the communication of a schizophrenia diagnosis and related information. METHODS A generic qualitative methodological approach was used. In all, 13 family caregivers were recruited in regional New South Wales, Australia. Semi-structured interviews were used to explore their experiences and perceptions of discussing the diagnosis, prognosis and treatment of schizophrenia with mental health professionals. Interviews were recorded, transcribed, codes generated and thematic analysis undertaken. RESULTS Family caregivers described long and difficult pathways to being given a diagnosis, haphazard means of finding out the diagnosis, high unmet needs for information, exclusion from the medical care process and problematic communication and general interactions with mental health clinicians. Caregivers were unanimous about the importance of receiving a timely diagnosis, for them and their relative with schizophrenia. CONCLUSION Family caregivers are an integral part of the mental health-care system, and they should be included early in discussions of diagnosis and treatment of a person with schizophrenia. Their perspectives on communicating a diagnosis of schizophrenia provide important information for communication skills training of psychiatrists and other mental health professionals.
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Affiliation(s)
- Sue Outram
- Discipline of Health Behaviour Sciences, Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Gillian Harris
- Priority Research Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Brian Kelly
- Priority Research Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia Hunter New England Mental Health, Waratah, NSW, Australia
| | - Carma L Bylund
- Department of Medical Education, Hamad Medical Corporation, Dohar, Qatar
| | - Martin Cohen
- Hunter New England Mental Health, Waratah, NSW, Australia
| | - Yulia Landa
- Department of Psychiatry and Department of Public Health, Weill Cornell Medical College, New York, NY, USA
| | - Tomer Levin
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Marina Vamos
- Priority Research Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia Hunter New England Mental Health, Waratah, NSW, Australia
| | - Carmel Loughland
- Priority Research Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia Hunter New England Mental Health, Waratah, NSW, Australia Schizophrenia Research Institute (SRI), Darlinghurst, NSW, Australia
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Moran GS, Oz G, Karnieli-Miller O. Psychiatrists' challenges in considering disclosure of schizophrenia diagnosis in Israel. QUALITATIVE HEALTH RESEARCH 2014; 24:1368-1380. [PMID: 25147222 DOI: 10.1177/1049732314547085] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Doctors' clear disclosure of diagnoses to patients is fundamental to patient autonomy and patient-centered approaches in health care. Although diagnosis disclosure is common in general health, it is less so in psychiatry. The aim of this study was to explore psychiatrists' experiences of schizophrenia diagnosis disclosure to patients and/or family members. We conducted in-depth interviews with 14 psychiatrists from hospital and community settings in Israel and used a phenomenological framework to analyze the interviews. Overall, psychiatrists experienced disclosure as problematic, unproductive, and harmful. We identified 10 themes of psychiatrist experiences and concerns conceptualized under three domains: (a) characteristics of schizophrenia, (b) the doctor-patient/family relationship, and (c) psychiatrists' difficulties with the disclosure task. We discuss the results suggesting a multilayered model of medical, relational, social, and personal disclosure challenges. We suggest that a constructive schizophrenia diagnosis disclosure needs to take into account psychiatrist- and patient-related factors and specify possible directions.
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Affiliation(s)
| | - Galit Oz
- Health, University of Haifa, Haifa, Israel
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Milton AC, Mullan BA. Communication of a mental health diagnosis: a systematic synthesis and narrative review. J Ment Health 2014; 23:261-70. [DOI: 10.3109/09638237.2014.951474] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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van Weert JCM, Bolle S, van Dulmen S, Jansen J. Older cancer patients' information and communication needs: what they want is what they get? PATIENT EDUCATION AND COUNSELING 2013; 92:388-97. [PMID: 23602863 DOI: 10.1016/j.pec.2013.03.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 03/10/2013] [Accepted: 03/11/2013] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To evaluate what information and communication aspects older cancer patients (≥65) consider important in preparing for chemotherapy treatment (CT), the extent to which this corresponds with what oncology nurses consider important, and the extent to which nurses attend to these aspects during real-life educational visits in oncology. METHODS The QUOTE(chemo) was used to have patients (n=116) and nurses (n=123) rate the importance of 66 aspects of patient education. Subsequently, the implementation of these 66 aspects during videotaped nursing visits (n=155) with older cancer patients receiving CT for the first time was examined. RESULTS Older cancer patients attached most importance to 'treatment-related information', 'rehabilitation information', 'affective communication' and discussing 'realistic expectations'. Nurses placed great importance to almost all aspects except to discussing 'realistic expectations'. Discrepancies were found between expressed importance and the actual performance during the videotaped consultations, particularly in discussing realistic expectations, coping information, interpersonal communication, and tailored communication. CONCLUSION Results pointed to aspects that need improvement to ensure high quality patient education tailored to the patients' needs. PRACTICE IMPLICATIONS To make sure older cancer patients' needs are met, more attention should be paid to the development of interventions supporting both needs assessment and fulfillment.
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Affiliation(s)
- Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands.
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Understanding the experience of dementia: Utilising the theoretical insights of ‘status passage’. SOCIAL THEORY & HEALTH 2012. [DOI: 10.1057/sth.2012.22] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Fumis RRL, De Camargo B, Del Giglio A. Physician, patient and family attitudes regarding information on prognosis: a Brazilian survey. Ann Oncol 2012; 23:205-211. [PMID: 21447619 DOI: 10.1093/annonc/mdr049] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Communication between physicians and patients is a fundamental aspect of cancer care, yet most physicians' perceptions are often inconsistent with the patients' stated preferences while prognostic information is the most misunderstood. PATIENTS AND METHODS Members of the Brazilian Society of Oncology Physicians (n=609) were identified and asked to complete a mailed questionnaire. Outpatients (n=150) and their family members (n=150), oncologists and fellows (n=55) from a public healthcare hospital and a tertiary cancer hospital in Sao Paulo were also personally invited to participate. RESULTS A total of 202 physicians, 150 outpatients and 150 family members were participated. The majority of patients (92%) believe they should know about their terminal stage compared with 79.2% of physicians and 74.7% of families (P=0.0003). Cancer patients were most likely to support disclosure of diagnosis and terminality (P=0.001), to consider that this disclosure was not stressful (P<0.0001) and that this knowledge would improve their quality of life (P<0.0001). CONCLUSIONS Cancer patients seen in these centers in Southeastern Brazil prefer to know the truth about their poor prognosis more than their physicians and families think. Further studies with larger samples of patients and physicians are necessary to show if our results are representative of all Brazilian situations.
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Affiliation(s)
- R R L Fumis
- Department of Hematology and Oncology, ABC Foundation School of Medicine, Santo André.
| | - B De Camargo
- Post Graduation Program - Cancer Research Center Hospital A C Camargo, Sao Paulo, Brazil
| | - A Del Giglio
- Department of Hematology and Oncology, ABC Foundation School of Medicine, Santo André
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Marr L, Neale D, Wolfe V, Kitzes J. Confronting Myths: The Native American Experience in an Academic Inpatient Palliative Care Consultation Program. J Palliat Med 2012; 15:71-6. [DOI: 10.1089/jpm.2011.0197] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lisa Marr
- Division of Geriatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Devon Neale
- Division of Geriatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Venita Wolfe
- Division of Geriatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Judith Kitzes
- Division of Geriatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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Abstract
PURPOSE OF REVIEW Screening for clinical depression and bipolar disorder remains controversial. Screening is usually based on finding discriminating symptoms, but not all tools perform equally well. Clinicians should be able to assess the clinical utility of screening tests as well as their accuracy and acceptability. RECENT FINDINGS Screening for depression using the Patient Health Questionnaire (PHQ) has been extensively examined. Four main versions of scoring the PHQ exist. The two-item PHQ2, the nine-item PHQ9, the PHQ DSM-IV algorithm, and the two-step PHQ2 then PHQ9. Recent results suggest that the PHQ9 is more accurate than the PHQ2, and that the algorithm scoring method is preferred to the linear cut-off score. The two-step procedure has promise, but it has not been adequately tested. Two screening questions may be a useful compromise in medical settings, as they take less than 2 min, but about a quarter of patients do not receive screening even when implemented systematically. Alternative customized questionnaires have been developed in medical settings such as the Depression Screening in Parkinson's Disease DESPAR and Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). Screening for bipolar disorders is an even greater challenge than screening for unipolar depression. Screening in primary care and the community has low positive predictive value. Screening in high-risk samples, such as those with known depression is somewhat more successful, but not yet sufficiently accurate to be used alone. SUMMARY Screening for depression can bring added value to routine unassisted recognition, but only if followed by good-quality treatment. Screening for bipolar disorder is not yet sufficiently accurate to be used reliably in clinical practice.
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Mitchell AJ, Meader N, Pentzek M. Clinical recognition of dementia and cognitive impairment in primary care: a meta-analysis of physician accuracy. Acta Psychiatr Scand 2011; 124:165-83. [PMID: 21668424 DOI: 10.1111/j.1600-0447.2011.01730.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to examine the ability of the general practitioners (GPs) to recognize a spectrum of cognitive impairment from mild cognitive impairment (MCI) to severe dementia in routine practice using their own clinical judgment. METHOD Using PRISMA criteria, a meta-analysis of studies testing clinical judgment and clinical documentation was conducted against semi-structured interviews (for dementia) and cognitive tests (for cognitive impairment). We located 15 studies reporting on dementia, seven studies that examined recognition of broadly defined cognitive impairment, and eight regarding MCI. RESULTS By clinical judgment, clinicians were able to identify 73.4% of people with dementia and 75.5% of those without dementia but they made correct annotations in medical records in only 37.9% of cases (and 90.5% of non-cases). For cognitive impairment, detection sensitivity was 62.8% by clinician judgment but 33.1% according to medical records. Specificity was 92.6% for those without cognitive impairment by clinical judgment. Regarding MCI, GPs recognized 44.7% of people with MCI, although this was recorded in medical notes only 10.9% of the time. Their ability to identify healthy individuals without MCI was between 87.3% and 95.5% (detection specificity). CONCLUSION GPs have considerable difficulty identifying those with MCI and those with mild dementia and are generally poor at recording such diagnoses in medical records.
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Affiliation(s)
- Alex J Mitchell
- Leicester General Hospital, Leicestershire Partnership Trust, UK.
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Low JA, Kiow SL, Main N, Luan KK, Sun PW, Lim M. Reducing collusion between family members and clinicians of patients referred to the palliative care team. Perm J 2011; 13:11-5. [PMID: 20740097 DOI: 10.7812/tpp/09-058] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Collusion refers to a secret agreement made between clinicians and family members to hide the diagnosis of a serious or life-threatening illness from the patient. Our goal was to reduce the rate of collusion among the family members of patients referred to our institution's palliative care service such that 80% of patients would be aware of their diagnosis within four weeks of referral to the service. We aimed to achieve this target within six months of starting the project. METHODS We undertook a clinical practice improvement project using the methodology of Brent James et al of Intermountain Health to see how we could reduce collusion among clinicians and family members of patients with advanced-stage cancers. This strategy included creating awareness among patients, family, and clinicians of the problems with collusion from the standpoint of each group; adopting an empathetic and compassionate approach to communication; using pamphlets; seeking patients' views; empowering families to reveal the truth to patients; and supporting patients and families until the last moment of each patient's life. RESULTS Between December 2004 and June 2008, 655 patients with advanced-stage cancers were referred to us. We were able to maintain an average awareness rate of nearly 80% of patients starting in February 2005, when we implemented awareness measures. CONCLUSION The deeply entrenched cultural practice of collusion can be changed with simple strategies based on the universal principles of medical ethics and best practices.
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Affiliation(s)
- James Alvin Low
- James Alvin Low, MBBS, FRCP, is a Senior Consultant in the Palliative Care Service within the Department of Geriatric Medicine, Alexandra Hospital, Singapore. E-mail:
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Mitchell AJ, Rao S, Vaze A. Can general practitioners identify people with distress and mild depression? A meta-analysis of clinical accuracy. J Affect Disord 2011; 130:26-36. [PMID: 20708274 DOI: 10.1016/j.jad.2010.07.028] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 07/15/2010] [Accepted: 07/15/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND There is increasing emphasis on distress and mild depression but uncertainty regarding how well general practitioners (GPs) identify these conditions. Further, the proportion of attendees suffering distress is also unclear. AIM To quantify the rate of distress in primary care and to clarify the ability of GPs to identify distressed and/or mildly depressed individuals using their clinical skills. METHODS Meta-analysis of clinical recognition of distress and mild depression defined on a continuum (severity scale) or categorically (semi-structured interview). RESULTS From 157 studies that examined the ability of GPs to diagnose any emotional or mental disorder, we identified 23 that focused on defined distress and 9 that reported on mild depression. The prevalence of broadly defined distress was 37.4% (n=23, 95% CI=29.5% to 45.5) although it was 47.3% (n=14, 95% CI=38.0% to 56.7%) using self-report methods. GPs correctly identified distressed individuals in 48.4% (n=21, 95% CI=42.6% to 54.2%) of presentations and identified non-distressed people in 79.4% (n=21, 95% CI=74.3% to 84.1%) of presentations without distress. GPs correctly identified 33.8% (95% CI=27.3% to 40.7%) of people with mild depression and had a detection specificity of 80.6% (95% CI=66.4% to 91.6%) for the non-depressed. Clinicians' ability to recognize mild depression was significantly lower than their ability to recognize moderate-severe depression. Out of 100 consecutive presentations, a typical GP making a single assessment would correctly identify 19 out of 39 people with distress, missing 20. He or she would correctly re-assure 48 out of 61 people without distress, falsely label 13 people as distressed. For mild depression, out of 100 consecutive presentations, a typical GP would correctly identify 4 out of 11 people with mild depression, missing 7. GPs would correctly re-assure 72 out of 89 people without distress, falsely diagnosing 19. CONCLUSIONS Clinicians have considerable difficulty accurately identifying distress and mild depression in primary care with only one in three people correctly diagnosed. Clinicians are better able to identify distress than mild depression but success remains limited. However not all such individuals want professional help, and some people who are overlooked get help elsewhere, or improve spontaneously, therefore the implications of these detection problems are not yet clear.
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Affiliation(s)
- Alex J Mitchell
- Leicester General Hospital, Leicestershire Partnership Trust, Leicester LE5 4PW, United Kingdom.
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Mitchell AJ. Why do physicians have difficulty diagnosing depression in the elderly? ACTA ACUST UNITED AC 2011. [DOI: 10.2217/ahe.10.67] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Alex J Mitchell
- Leicester General Hospital, Leicester Partnership Trust, Leicester, LE5 4PW, UK and Department of Cancer Studies & Molecular Medicine, Leicester Royal Infirmary, University of Leicester, LE1 5WW, UK
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van Weert JCM, Jansen J, Spreeuwenberg PMM, van Dulmen S, Bensing JM. Effects of communication skills training and a Question Prompt Sheet to improve communication with older cancer patients: a randomized controlled trial. Crit Rev Oncol Hematol 2010; 80:145-59. [PMID: 21075644 DOI: 10.1016/j.critrevonc.2010.10.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 10/07/2010] [Accepted: 10/15/2010] [Indexed: 11/30/2022] Open
Abstract
A randomized pre- and post-test control group design was conducted in 12 oncology wards to investigate the effectiveness of an intervention, existing of a communication skills training with web-enabled video feedback and a Question Prompt Sheet (QPS), which aimed to improve patient education to older cancer patients (≥65 years). The effects were studied by analyzing questionnaires and video recordings of patient education sessions preceding chemotherapy with 210 different patients. Patients' recall of information was the primary outcome of the study. Recall was checked against the actual communication in the video-recordings. Moreover, communication skills were assessed by observing the extent to which nurses implemented 67 communication aspects, categorized in seven dimensions, using the QUOTE(chemo). Experimental nurses demonstrated a significant intervention effect on communicating realistic expectations. Within-group improvements were measured in the experimental group for tailored communication, affective communication and interpersonal communication. Although the use of a QPS significantly increased question asking, only limited results were found on older patients' recall scores. The overall proportion recall of recommendations showed a marginally significant pre-/post-change in proportion recall in favour of the experimental group and there was a significant pre-/post-change in two out of six sub-categories. The results indicate that nurses' communication skills can be improved by communication skills training. More research is needed to understand the difficult relationship between patient-provider communication and recall of information.
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Affiliation(s)
- Julia C M van Weert
- Amsterdam School of Communication Research ASCoR, Department of Communication Sciences, University of Amsterdam, The Netherlands.
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Cherny NI. Factors influencing the attitudes and behaviors of oncologists regarding the truthful disclosure of information to patients with advanced and incurable cancer. Psychooncology 2010; 20:1269-84. [PMID: 20878723 DOI: 10.1002/pon.1853] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 05/19/2010] [Accepted: 08/16/2010] [Indexed: 11/12/2022]
Affiliation(s)
- Nathan I Cherny
- Shaare Zedek Medical Center, Department of Oncology, Cancer Pain and Palliative Medicine Service, Jerusalem, Israel.
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Cleary M, Hunt GE, Walter G. Delivering Difficult News: Views of Mental Health Staff in Inpatient Settings. J Psychosoc Nurs Ment Health Serv 2010; 48:32-9. [DOI: 10.3928/02793695-20100504-02] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 02/16/2010] [Indexed: 11/20/2022]
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Cleary M, Hunt GE, Escott P, Walter G. Receiving Difficult News: Views of Patients in an Inpatient Setting. J Psychosoc Nurs Ment Health Serv 2010; 48:40-8. [DOI: 10.3928/02793695-20100504-01] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 02/16/2010] [Indexed: 11/20/2022]
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Smoyak SA. OMG DNR? DDN? TLA? J Psychosoc Nurs Ment Health Serv 2010; 48:2-3. [DOI: 10.3928/02793695-20100512-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Communication research and investigations into the delivery of bad news are uncommon in psychiatry versus other medical specialties. The question of delivering "bad" diagnostic news in psychiatry has been focused on dementia rather than actual psychiatric disorders and their sequelae. Common problems are that psychiatrists avoid dealing with patients' emotional reactions to bad news and that they avoid providing a clear diagnosis for fear that patients or carers will be distressed. This article aims to provide an overview of key elements of the "breaking bad news" literature, teasing out factors that are relevant to psychiatric practice. Topics explored include: definitions; clinical considerations for delivering difficult news within medical and psychiatric settings; protocols and guidelines; evidence about patient information needs and communication preferences; research into actual delivery of such news; and areas for future education and research.
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Affiliation(s)
- Michelle Cleary
- School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia.
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Validity of routine clinical DSM-IV diagnoses (Axis I/II) in inpatients with mental disorders. Psychiatry Res 2009; 170:252-5. [PMID: 19896721 DOI: 10.1016/j.psychres.2008.09.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2008] [Revised: 09/05/2008] [Accepted: 09/30/2008] [Indexed: 11/23/2022]
Abstract
The assessment of diagnoses is a central issue in the treatment of patients with mental disorders. The aim of this study was to validate routine clinical diagnoses by means of a semi-standardized and structured interview. Semi-standardized and structured interview diagnoses were based on videos of 55 inpatients. The routine clinical diagnoses were given by therapists during the course of psychotherapy. Validation was carried out through proportional agreement, Cohen's kappa, Yule's Y, as well as the sensitivity and specificity of the diagnosis. Agreement rates between diagnoses given in semi-standardized structured interviews and those given in routine clinical assessment were low for the majority of specific disorders (e.g., major depressive disorder). Higher agreement rates were found for major diagnostic categories (e.g., eating disorders or adjustment disorders). In comparison to diagnoses according to structured interviews for inpatients with mental disorders, the validity of diagnoses given in routine clinical interviews is limited and should be improved.
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Affiliation(s)
- Richard Kanaan
- Institute of Psychiatry, Psychological Medicine, London, United Kingdom.
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48
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Kanaan R, Armstrong D, Wessely S. Limits to truth-telling: neurologists' communication in conversion disorder. PATIENT EDUCATION AND COUNSELING 2009; 77:296-301. [PMID: 19560894 PMCID: PMC2773836 DOI: 10.1016/j.pec.2009.05.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 05/13/2009] [Accepted: 05/26/2009] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Neurologists face a dilemma when communicating with their conversion disorder patients - whether to be frank, and risk losing the patient's trust, or to disclose less, in the hope of building a therapeutic relationship. This study reports how neurologists in the UK described dealing with this dilemma in their practice. METHODS Practicing consultant neurologists from an NHS region were recruited by snowball sampling. Twenty-two of 35 consultants in the region were interviewed in depth, and the interviews qualitatively analysed. RESULTS The neurologists were reluctant to disclose conversion disorder as a differential diagnosis until they were certain. They were guided by the receptivity of their patients as to how psychological to make their eventual explanations, but they did not discuss their suspicions about feigning. They described their communications as much easier now than they had seen in training. CONCLUSION Neurologists adapt their disclosure to their patients, which facilitates communication, but imposes some limits on truth-telling. In particular, it may sometimes result in a changed diagnosis. PRACTICE IMPLICATIONS An optimum strategy for communicating diagnoses will need to balance ethical considerations with demonstrated therapeutic benefit.
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Affiliation(s)
- Richard Kanaan
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, London, UK.
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QUOTEchemo: A patient-centred instrument to measure quality of communication preceding chemotherapy treatment through the patient’s eyes. Eur J Cancer 2009; 45:2967-76. [DOI: 10.1016/j.ejca.2009.06.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Revised: 05/30/2009] [Accepted: 06/09/2009] [Indexed: 11/23/2022]
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Panagopoulou E, Mintziori G, Montgomery A, Kapoukranidou D, Benos A. Concealment of Information in Clinical Practice: Is Lying Less Stressful Than Telling the Truth? J Clin Oncol 2008; 26:1175-7. [DOI: 10.1200/jco.2007.12.8751] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Efharis Panagopoulou
- From the Lab of Hygiene; Lab of Physiology, Medical School, Aristotle University, Thessaloniki, Greece
| | - Gesthimani Mintziori
- From the Lab of Hygiene; Lab of Physiology, Medical School, Aristotle University, Thessaloniki, Greece
| | - Anthony Montgomery
- From the Lab of Hygiene; Lab of Physiology, Medical School, Aristotle University, Thessaloniki, Greece
| | - Dorothea Kapoukranidou
- From the Lab of Hygiene; Lab of Physiology, Medical School, Aristotle University, Thessaloniki, Greece
| | - Alexis Benos
- From the Lab of Hygiene; Lab of Physiology, Medical School, Aristotle University, Thessaloniki, Greece
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