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Mazzi MA, Perlini C, Deledda G, Ghilardi A, Buizza C, Bottacini A, Goss C, Del Piccolo L. Employment status and information needs of patients with breast cancer: a multicentre cross-sectional study of first oncology consultations. BMJ Open 2020; 10:e038543. [PMID: 32994250 PMCID: PMC7526300 DOI: 10.1136/bmjopen-2020-038543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To investigate the early information needs of women with a recent diagnosis of breast cancer (BC) according to their employment status. DESIGN Cross-sectional. SETTING Secondary-care patients attending three outpatient oncology clinics in northern Italy. PARTICIPANTS 377 women with a recent diagnosis of early-stage, non-metastatic BC aged 18-75 were recruited. Of them, 164 were employed, 103 non-employed and 110 retired. OUTCOME MEASURES The first consultation visit with an oncologist was audio-recorded and analysed for the number and type of questions asked. Linear regression models considering consultations' and patients' characteristics as confounding variables were applied. RESULTS Employed patients asked significantly more questions than non-employed and retired patients (17 vs 13 and 14; F=6.04; p<0.01). When age and education were included in the statistical model, the significance of employment status was rearranged among all the variables and was no more significant (b=1.2, p=0.44). Employed women asked more questions concerning disease prognosis (0.7 vs 0.4 and 0.6; F=3.5; p=0.03), prevention (1.4 vs 0.6 and 0.7; F=10.7; p<0.01), illness management (7.2 vs 6 and 5.4; F=3.8; p=0.02) and social functioning (37% vs 18% and 20%; χ2=14.3; p<0.01) compared with the other two groups. Finally, they attended more frequently the consultation alone (37% vs 18% and 25%; χ2=10.90, p<0.01), were younger (50 vs 58 and 67 years; F=63.8; p<0.01) and with a higher level of education (77% vs 27% and 45%; χ2=68.2; p<0.01). CONCLUSIONS Employment status is related to the type of questions asked during the first consultation. Also, it interrelates with other patients' characteristics like age and education in determining the number of questions asked. Patients' characteristics including employment status could be considered in tailoring work and social-related information provided during the first oncological consultation. Future studies could explore potential differences in information needs according to the different kinds of work.
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Affiliation(s)
- Maria Angela Mazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Psychology, University of Verona, Verona, Italy
| | - Cinzia Perlini
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Psychology, University of Verona, Verona, Italy
| | - Giuseppe Deledda
- Clinical Psychological Service, UO of Clinical Psychology, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS) "Sacro Cuore - Don Calabria", Negrar di Valpolicella, Verona, Italy
| | - Alberto Ghilardi
- Department of Clinical and Experimental Sciences, Unit of Clinical Psychology, University of Brescia, Brescia, Italy
| | - Chiara Buizza
- Department of Clinical and Experimental Sciences, Unit of Clinical Psychology, University of Brescia, Brescia, Italy
| | - Alessandro Bottacini
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Psychology, University of Verona, Verona, Italy
| | - Claudia Goss
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Psychology, University of Verona, Verona, Italy
| | - Lidia Del Piccolo
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Psychology, University of Verona, Verona, Italy
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Del Piccolo L, Mazzi MA, Mascanzoni A, Lonardi M, De Felice M, Danzi OP, Buizza C, Ghilardi A, Bottacini A, Goss C. Factors related to the expression of emotions by early-stage breast cancer patients. PATIENT EDUCATION AND COUNSELING 2019; 102:1767-1773. [PMID: 30967297 DOI: 10.1016/j.pec.2019.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE (1) To report the number and type of emotional expressions (cues/concerns) raised by breast cancer patients; (2) to identify the influence of setting, patient characteristics, and doctor-patient interaction on emotional expression. METHODS 308 Italian-speaking female patients were recruited at their first breast cancer consultation. The visits were audio-recorded and analysed for number and type of emotional expressions (VR-CoDES). Oncologists' interaction skills were rated by the VR-COPE. Socio-demographic, clinical and personality variables were gathered before the consultation. Clinical variables and oncologists' evaluations of the patient were collected after. RESULTS Breast cancer patients raised emotional issues mainly as cues. The setting (centre where the consultations took place), the oncologist's attribution of anxiety, regardless of anxiety test screening (STAI-X1) score before the consultation, and the oncologist's ability to pick up on patient's worries, handle emotional needs or understand psychosocial condition were all positively related with the number of emotional expressions. More tightly structured consultations had fewer emotional expressions. CONCLUSION Both contextual and interactional aspects have an impact on patient emotional expressions. PRACTICE IMPLICATIONS Oncologists need to be trained to manage both the content and the process of medical consultation. Work organization of the consultation setting needs to be taken into account.
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Affiliation(s)
- Lidia Del Piccolo
- Department of Neurological, Biomedical and Movement Sciences, Section of Clinical Psychology, University of Verona, Italy.
| | - Maria Angela Mazzi
- Department of Neurological, Biomedical and Movement Sciences, Section of Clinical Psychology, University of Verona, Italy
| | - Andrea Mascanzoni
- Department of Neurological, Biomedical and Movement Sciences, Section of Clinical Psychology, University of Verona, Italy
| | - Miriam Lonardi
- Department of Neurological, Biomedical and Movement Sciences, Section of Clinical Psychology, University of Verona, Italy
| | - Mariangela De Felice
- Department of Neurological, Biomedical and Movement Sciences, Section of Clinical Psychology, University of Verona, Italy
| | - Olivia Purnima Danzi
- Department of Neurological, Biomedical and Movement Sciences, Section of Clinical Psychology, University of Verona, Italy
| | - Chiara Buizza
- Department of Clinical and Experimental Sciences, Section of Clinical and Dynamic Psychology, University of Brescia, Italy
| | - Alberto Ghilardi
- Department of Clinical and Experimental Sciences, Section of Clinical and Dynamic Psychology, University of Brescia, Italy
| | - Alessandro Bottacini
- Department of Neurological, Biomedical and Movement Sciences, Section of Clinical Psychology, University of Verona, Italy
| | - Claudia Goss
- Department of Neurological, Biomedical and Movement Sciences, Section of Clinical Psychology, University of Verona, Italy
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Pratt-Chapman M, Bhadelia A. Patient-Reported Outcomes in Health Economic Decision-Making: A Changing Landscape in Oncology. Recent Results Cancer Res 2019; 213:67-83. [PMID: 30543008 DOI: 10.1007/978-3-030-01207-6_6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Cancer causes significant death and disability globally. However, costs of more personalized cancer care continue to climb, while access to basic cancer screening and treatment is not available to much of the world. This chapter provides an overview of the status of patient-reported outcomes (PROs) in cancer clinical care and research. PROs are valuable for health care and health economic decision-making at institutional, regional, national, and international levels. PRO data should be considered along with cost and survival data when approving new therapies. PRO data can also be helpful when assessing existing treatment options for patients, particularly for drugs with minor outcome and toxicity differences. Finally, PROs can be useful in reimbursement algorithms to ensure delivery of quality cancer care in value-based financing environments. The authors advocate for reframing the concept of health value, aligning PRO measures with societal values, and broadening the definition of society to extend beyond national boundaries.
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Affiliation(s)
| | - Afsan Bhadelia
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Johns Hopkins School of Public Health, Baltimore, MD, USA
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Robinson JD, Tate A, Heritage J. Agenda-setting revisited: When and how do primary-care physicians solicit patients' additional concerns? PATIENT EDUCATION AND COUNSELING 2016; 99:718-23. [PMID: 26733124 DOI: 10.1016/j.pec.2015.12.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/10/2015] [Accepted: 12/12/2015] [Indexed: 05/16/2023]
Abstract
OBJECTIVE Soliciting patients' complete agendas of concerns (aka. 'agenda setting') can improve patients' health outcomes and satisfaction, and physicians' time management. We assess the distribution, content, and effectiveness of physicians' post-chief-complaint, agenda-setting questions. METHODS We coded videotapes/transcripts of 407 primary-, acute-care visits between adults and 85 general-practice physicians operating in 46 community-based clinics in two states representing urban and rural care. Measures are the incidence of physicians' questions, their linguistic format, position within visits, likelihood of being responded to, and the nature of such responses. RESULTS Physicians' questions designed to solicit concerns additional to chief concerns occurred in only 32% of visits (p<.001). Compared to questions whose communication format explicitly solicited 'questions' (e.g., "Do you have any questions?"), those that were formatted so as to allow for 'concerns' (e.g., "Any other concerns?") were significantly more likely to generate some type of agenda item (Chi(2) (1, N=131)=11.96, p=.001), and to do so more frequently when positioned 'early' vs. 'late' during visits (Chi(2) (1, N=73)=4.99, p=.025). CONCLUSIONS Agenda setting is comparatively infrequent. The communication format and position of physicians' questions affects patients' provision of additional concerns/questions. PRACTICE IMPLICATIONS Physicians should increase use of optimized forms of agenda setting.
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Affiliation(s)
- Jeffrey D Robinson
- Portland State University, Department of Communication, University Center Building, 520 SW Harrison Street, Suite 440, Portland, OR 97201, USA.
| | - Alexandra Tate
- University of California, Los Angeles, Department of Sociology, Los Angeles, CA, USA
| | - John Heritage
- University of California, Los Angeles, Department of Sociology, Los Angeles, CA, USA
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Procter S, Stewart K, Reeves D, Bowen L, Purdy S, Ridd M, Salisbury C. Complex consultations in primary care: a tool for assessing the range of health problems and issues addressed in general practice consultations. BMC FAMILY PRACTICE 2014; 15:105. [PMID: 24885298 PMCID: PMC4046503 DOI: 10.1186/1471-2296-15-105] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Accepted: 05/19/2014] [Indexed: 11/10/2022]
Abstract
Background There is an increasing recognition that many consultations in general practice involve several problems covering multiple disease domains. However there is a paucity of reliable tools and techniques to understand and quantify this phenomenon. The objective was to develop a tool that can be used to measure the number and type of problems discussed in primary care consultations. Methods Thirteen consultations between general practitioners and patients were initially videoed and reviewed to identify the problems and issues discussed. An iterative process involving a panel of clinicians and researchers and repeated cycles of testing and development was used to develop a measurement proforma and coding manual for assessment of video recorded consultations. The inter-rater reliability of this tool was assessed in 60 consultations. Results The problems requiring action were usually readily identified. However the different dimensions of the problem and how they were addressed required the identification and definition of ‘issues’. A coding proforma was developed that allowed quantification of the numbers and types of health problems and issues discussed. Ten categories of issues were identified and defined. At the consultation level, inter-rater agreements for the number of problems discussed (within ±1), types of problems and issues were 98.3%, 96.5% and 90% respectively. The tool has subsequently been used to analyse 229 consultations. Conclusion The iterative approach to development of the tool reflected the complexity of doctor-patient interactions. A reliable tool has been developed that can be used to analyse the number and range of problems managed in primary care consultations.
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Affiliation(s)
- Sunita Procter
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK.
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McCormack LA, Treiman K, Rupert D, Williams-Piehota P, Nadler E, Arora NK, Lawrence W, Street RL. Measuring patient-centered communication in cancer care: a literature review and the development of a systematic approach. Soc Sci Med 2011; 72:1085-95. [PMID: 21376443 DOI: 10.1016/j.socscimed.2011.01.020] [Citation(s) in RCA: 215] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 11/07/2010] [Accepted: 01/15/2011] [Indexed: 11/19/2022]
Abstract
Patient-centered communication (PCC) is a critical element of patient-centered care, which the Institute of Medicine (Committee on Quality of Health Care in America, 2001) promulgates as essential to improving healthcare delivery. Consequently, the US National Cancer Institute's Strategic Plan for Leading the Nation (2006) calls for assessing the delivery of PCC in cancer care. However, no comprehensive measure of PCC exists, and stakeholders continue to embrace different conceptualizations and assumptions about how to measure it. Our approach was grounded in the PCC conceptual framework presented in a recent US National Cancer Institute monograph (Epstein & Street, 2007). In this study, we developed a comprehensive inventory of domains and subdomains for PCC by reviewing relevant literature and theories, interviewing a limited number of cancer patients, and consulting experts. The resulting measurement domains are organized under the six core functions specified in the PCC conceptual framework: exchanging information, fostering healing relationships, recognizing and responding to emotions, managing uncertainty, making decisions, and enabling patient self-management. These domains represent a promising platform for operationalizing the complicated PCC construct. Although this study focused specifically on cancer care, the PCC measurements are relevant to other clinical contexts and illnesses, given that patient-centered care is a goal across all healthcare. Finally, we discuss considerations for developing PCC measures for research, quality assessment, and surveillance purposes. United States Department of Health and Human Services, National Institutes of Health, National Cancer Institute (2006). The NCI Strategic Plan for Leading the Nation: To Eliminate the Suffering and Death Due to Cancer. NIH Publication No. 06-5773.
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Affiliation(s)
- Lauren A McCormack
- Health Communication Program, RTI International, 3040 Cornwallis Road, RTP, NC 27709, USA.
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