Oncologists' responsibility, comfort, and knowledge managing hyperglycemia in patients with cancer undergoing chemotherapy: a cross sectional study

PURPOSE

To assess oncologists' responsibility, comfort, and knowledge managing hyperglycemia in patients undergoing chemotherapy.

METHODS

In this cross-sectional study, a questionnaire collected oncologists' perceptions about professionals responsible for managing hyperglycemia during chemotherapy; comfort (score range 12-120); and knowledge (score range 0-16). Descriptive statistics were calculated including Student t-tests and one-way ANOVA for mean score differences. Multivariable linear regression identified predictors of comfort and knowledge scores.

RESULTS

Respondents (N = 229) were 67.7% men, 91.3% White and mean age 52.1 years. Oncologists perceived endocrinologists/diabetologists and primary care physicians as those responsible for managing hyperglycemia during chemotherapy, and most frequently referred to these clinicians. Reasons for referral included lack of time to manage hyperglycemia (62.4%), belief that patients would benefit from referral to an alternative provider clinician (54.1%), and not perceiving hyperglycemia management in their scope of practice (52.4%). The top-3 barriers to patient referral were long wait times for primary care (69.9%) and endocrinology (68.1%) visits, and patient's provider outside of the oncologist's institution (52.8%). The top-3 barriers to treating hyperglycemia were lack of knowledge about when to start insulin, how to adjust insulin, and what insulin type works best. Women (ß = 1.67, 95% CI: 0.16, 3.18) and oncologists in suburban areas (ß = 6.98, 95% CI: 2.53, 11.44) had higher comfort scores than their respective counterparts; oncologists working in practices with > 10 oncologists had lower comfort scores (ß = -2.75, 95% CI: -4.96, -0.53) than those in practices with ≤ 10. No significant predictors were identified for knowledge.

CONCLUSION

Oncologists expected endocrinology or primary care clinicians to manage hyperglycemia during chemotherapy, but long wait times were among the top barriers cited when referring patients. New models that provide prompt and coordinated care are needed.

Differences in Practice Characteristics Between Male and Female Chiropractors in Switzerland

OBJECTIVES

A total of 75% of the chiropractic medicine students in the new program at the University of Zürich are women, which is in stark contrast to the traditional ratio of chiropractors in Switzerland, where 75% have been men. Therefore, the purpose of this study was to compare work behaviors between female and male chiropractors relating to workload, patient variety, and chiropractic treatment techniques.

METHODS

This is a secondary analysis of data from the Swiss Job Analysis 2009 study. The design was an online survey to all practicing chiropractors in Switzerland that had a 70% response rate of 183 returned surveys. Differences between male and female chiropractors in the various categorical responses involving practice workload, characteristics and patient types were compared using the χ² test.

RESULTS

Male chiropractors had significantly more years in practice (P = .0001), worked more hours per week (P = .0001), and saw more patients (P = .0001) and more new patients (P = .004) per week compared with female chiropractors. Female chiropractors spent significantly more time with patients during follow-up visits (P = .017). There were no significant differences in treatment techniques used or the types of patients seen between the sexes.

CONCLUSION

Because female chiropractors work fewer hours and see fewer patients per week, this may lead to a shortage of chiropractors in the future as the sex ratio within the profession slowly changes in Switzerland.