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Vanoli S, Grobet-Jeandin E, Windisch O, Valerio M, Benamran D. Evolution of anxiety management in prostate biopsy under local anesthesia: a narrative review. World J Urol 2024; 42:43. [PMID: 38244150 PMCID: PMC10799769 DOI: 10.1007/s00345-023-04723-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/24/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION AND METHODS Prostate biopsy (PB) is an essential step in the diagnosis and active surveillance of prostate cancer (PCa). Transperineal PB (TP-PB) is now the recommended approach and is mostly conducted under local anesthesia. However, this procedure can potentially cause anxiety for patients, given the oncological context and the fear of peri-procedural pain and complications. The objective of this narrative review is to summarize the currently available tools for the management of peri-interventional anxiety during TP-PB, with a particular emphasis on the potential role of virtual reality (VR) in this setting. RESULTS In TP-PB, preoperative anxiety can lead to increased pain perception, longer procedure time, and decreased patient satisfaction. Pharmacological and non-pharmacological approaches have been explored to reduce anxiety, such as premedication, deep sedation, education, relaxation techniques, hypnosis, and music therapy, albeit with mixed results. VR has recently emerged in the technological armamentarium for managing pain and anxiety, and the efficiency of this technology has been evaluated in various medical fields, including pediatrics, gastroenterology, urology, gynecology, and psychiatry. CONCLUSION Despite the paucity of available data, VR appears to be a safe and effective technique in reducing anxiety in many procedures, even in frail patients. No studies have evaluated the role of VR in TP-PB. Future research should thus explore the optimal way to implement VR technology and any potential benefits for TP-PB patients.
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Affiliation(s)
- Sylvain Vanoli
- Urology Department, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Elisabeth Grobet-Jeandin
- Urology Department, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Olivier Windisch
- Urology Department, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Massimo Valerio
- Urology Department, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Daniel Benamran
- Urology Department, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
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Shen Q, Ma Y, Jöud A, Schelin MEC, Fall K, Andrén O, Fang F. Psychiatric Disorders and Cardiovascular Diseases During the Diagnostic Workup of Suspected Prostate Cancer. JNCI Cancer Spectr 2020; 5:pkaa108. [PMID: 33554033 PMCID: PMC7853179 DOI: 10.1093/jncics/pkaa108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/16/2020] [Accepted: 10/22/2020] [Indexed: 12/02/2022] Open
Abstract
Background It is unknown whether the rate of psychiatric disorders and cardiovascular disease increases during the diagnostic workup of suspected prostate cancer. Methods We designed a population-based cohort study including 579 992 men living during 2005-2014 in Skåne, Sweden, according to the Swedish Total Population Register and the Skåne Healthcare Register (SHR). We used the Swedish Cancer Register and the SHR to identify all men with a new diagnosis of prostate cancer (N = 10 996), and all men underwent a prostate biopsy without receiving a cancer diagnosis (biopsy group, N = 20 482) as exposed to a diagnostic workup. Using Poisson regression, we compared the rates of psychiatric disorders and cardiovascular disease during the period before diagnosis or biopsy of exposed men with the corresponding rates of unexposed men. Results We found an increased rate of psychiatric disorders during the period before diagnosis or biopsy among men with prostate cancer (incidence rate ratio [IRR] = 1.87, 95% confidence interval [CI] = 1.67 to 2.10) and men in the biopsy group (IRR = 2.22, 95% CI = 2.08 to 2.37). The rate of cardiovascular disease increased during the period before diagnosis or biopsy among men with prostate cancer (IRR = 2.22, 95% CI = 2.12 to 2.32) and men in the biopsy group (IRR = 2.56, 95% CI = 2.49 to 2.63). Greater rate increases were noted for a diagnostic workup due to symptoms than due to other reasons. Conclusions There was an increased risk of psychiatric disorders and cardiovascular disease during the diagnostic workup of suspected prostate cancer regardless of the final cancer diagnosis.
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Affiliation(s)
- Qing Shen
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Correspondence to: Qing Shen, PhD, Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Box 210, Nobels väg 13, 171 77 Stockholm, Sweden (e-mail: ) and Fang Fang, Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Box 210, 171 77 Stockholm, Sweden (e-mail: )
| | - Yuanjun Ma
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Anna Jöud
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine Lund, Lund University, Lund, Sweden
| | - Maria E C Schelin
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine Lund, Lund University, Lund, Sweden
| | - Katja Fall
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Ove Andrén
- Department of Urology, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Fang Fang
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Correspondence to: Qing Shen, PhD, Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Box 210, Nobels väg 13, 171 77 Stockholm, Sweden (e-mail: ) and Fang Fang, Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Box 210, 171 77 Stockholm, Sweden (e-mail: )
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Amini M, Ganji MR, Najafi I, Hakemi MS, Soleymanian T, Yaghoubi F, Tavakoli F, Sheikh V, Yousefi A, Afrasiab AA, Movassaghi A, Amini H. Percutaneous biopsy of kidney; comparison between prone position and sitting position. Iran J Kidney Dis 2019; 13:300-303. [PMID: 31705745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/12/2019] [Accepted: 03/12/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Percutaneous kidney biopsy has been established as a safe, reliable and minimally invasive method. This study aims to describe the author's experience with biopsy of the kidney and to compare the results in sitting position versus prone in terms of the complication rate. MATERIALS AND METHODS Patients were divided into two groups: prone and sitting position according to the clinician's and patient's preference. Followed by kidney biopsy, a questionnaire was completed. Then, data and the mean number of glomeruli in each group were compared. RESULTS Apart from sweat, presumably due to the prone position, no significant differences were found regarding the side effects including dizziness, seizure, nausea, and vomiting between the two groups. The number of glomeruli was not significantly different between two groups. CONCLUSION In comparison with the prone position, kidney biopsy at sitting position is more comfortable at least for patients who seems couldn't tolerate prone position. We recommend sitting position for kidney biopsy owing to the low side effects rate of this diagnostic technique.
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Kamangar F, Petukhova TA, Monico G, Mathis S, Joo J, Zhuang A, Li CS, Liu Y, Lee E, Eisen D. Anxiety levels of patients undergoing common dermatologic procedures versus those seeking general dermatologic care. Dermatol Online J 2017; 23:13030/qt64d8r1gq. [PMID: 28537871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 05/22/2017] [Indexed: 06/07/2023] Open
Abstract
Patients undergoing Mohs micrographic surgery frequently experience anxiety as a result of multiple potential factors. There is currently no data regarding how this anxiety compares to other common procedures performed in dermatology offices, such as shave biopsy and excision, relative to a general dermatology visit. Herein, we conducted a survey of 471 dermatology patients at an academic medical center, using a validated tool (Visual Analogue Scale from 1 "no anxiety at all" to 10 "extremely anxious").
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Affiliation(s)
- Faranak Kamangar
- Department of Dermatology, University of California, Davis, California.
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Anandani C, Metgud R, Ramesh G, Singh K. Awareness of General Dental Practitioners about Oral Screening and Biopsy Procedures in Udaipur, India. Oral Health Prev Dent 2016; 13:523-30. [PMID: 25386629 DOI: 10.3290/j.ohpd.a32993] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE Oral cancer presents with high mortality rates, and the likelihood of survival is remarkably better when detected early. The present study aimed to assess the awareness of general dental practitioners (GDPs) about oral screening and biopsy procedures in Udaipur, India. MATERIALS AND METHODS In this cross-sectional study, 83 GDPs were surveyed using a self-administered structured questionnaire consisting of several mandatory and optional questions. The data were analysed and frequency distribution was performed. RESULTS Most of the GDPs adequately performed complete oral cavity examinations and were aware of suspicious oral lesions, most common sites and risk factors for oral pre-cancer/cancer, but did not inquire about patients' tobacco/ alcohol consumption habits. Half of them referred lesions requiring biopsy to a specialist/higher centre rather than performing biopsies themselves, even after recognising the importance of biopsy as a diagnostic tool due to concerns of inadequate experience and instruments required. Varied results regarding selection of the appropriate site for biopsy and preservation of biopsied specimens were noted. CONCLUSION Most of the GDPs were adequately aware of oral screening and biopsy procedures but felt reluctant to perform them, which suggests that dental education programmes are needed for GDPs in oral pre-cancer/cancer detection as well as screening and diagnostic procedures.
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Schonberg MA, Silliman RA, Ngo LH, Birdwell RL, Fein-Zachary V, Donato J, Marcantonio ER. Older women's experience with a benign breast biopsy—a mixed methods study. J Gen Intern Med 2014; 29:1631-40. [PMID: 25138983 PMCID: PMC4242866 DOI: 10.1007/s11606-014-2981-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/30/2014] [Accepted: 07/15/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little is known about older women's experience with a benign breast biopsy. OBJECTIVES To examine the psychological impact and experience of women ≥ 65 years of age with a benign breast biopsy. DESIGN Prospective cohort study using quantitative and qualitative methods. SETTING Three Boston-based breast imaging centers. PARTICIPANTS Ninety-four English-speaking women ≥ 65 years without dementia referred for breast biopsy as a result of an abnormal mammogram, not aware of their biopsy results at baseline, and with a subsequent negative biopsy. MEASUREMENTS We interviewed women at the time of breast biopsy (before women knew their results) and 6 months post-biopsy. At both interviews, participants completed the validated negative psychological consequences of screening mammography questionnaire (PCQ, scores range from 0 to 36 [high distress], PCQ ≥ 1 suggests a psychological consequence, PCQs <1 are reported at time of screening) and women responded to open-ended questions about their experience. At follow-up, participants described the quality of information received after their benign breast biopsy. We used a linear mixed effects model to examine if PCQs declined over time. We also reviewed participants' open-ended comments for themes. RESULTS Overall, 88% (83/94) of participants were non-Hispanic white and 33% (31/94) had a high-school degree or less. At biopsy, 76% (71/94) reported negative psychological consequences from their biopsy compared to 39% (37/94) at follow-up (p < 0.01). In open-ended comments, participants noted the anxiety (29%, 27/94) and discomfort (28%, 26/94) experienced at biopsy (especially from positioning on the biopsy table). Participants requested more information to prepare for a biopsy and to interpret their negative results. Forty-four percent (39/89) reported at least a little anxiety about future mammograms. CONCLUSIONS The high psychological burden of a benign breast biopsy among older women significantly diminishes with time but does not completely resolve. To reduce this burden, older women need more information about undergoing a breast biopsy.
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Affiliation(s)
- Mara A. Schonberg
- />Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA USA
| | - Rebecca A. Silliman
- />Geriatrics Section, Boston University Schools of Medicine and Public Health, Boston University Medical Center, Boston, MA USA
| | - Long H. Ngo
- />Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA USA
| | - Robyn L. Birdwell
- />Breast Imaging, Department of Radiology, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA USA
| | - Valerie Fein-Zachary
- />Department of Radiology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215 USA
| | - Jessica Donato
- />Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA USA
| | - Edward R. Marcantonio
- />Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA USA
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Robiner WN, Strand TD, Mauer M. Adherence and renal biopsy feasibility in the Renin Angiotensin-System Study (RASS) primary prevention diabetes trial. Diabetes Res Clin Pract 2013; 102:25-34. [PMID: 24050942 PMCID: PMC4452734 DOI: 10.1016/j.diabres.2013.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 05/22/2013] [Accepted: 06/06/2013] [Indexed: 11/28/2022]
Abstract
AIMS Enhancing adherence in research trials is fundamental to the proper testing of treatment hypotheses. METHODS Regimen and follow-up adherence as well as factors associated with adherence in the Renin Angiotensin-System Study (RASS) diabetic nephropathy primary prevention trial were evaluated. Adherence to medication (i.e., pill count), follow-up visits, and follow-up renal biopsies was evaluated. RESULTS 89.8% of subjects completed the second renal biopsy. 96% of follow-up visits were attended within prescribed time windows. Mean medication adherence was 85.6%. Subgroup analyses revealed greater declines in the least adherent participants over time. Factors associated with greater adherence levels included older age, type 1 diabetes (TIDM) duration, lower HbA1c and blood pressure, GFR, ethnicity, and participants', principal investigators' (PI), and trial coordinators' (TC) baseline predictions of adherence. CONCLUSIONS T1DM patients without nephropathy were willing to take experimental medications and undergo repeat renal biopsies. Although overall adherence was excellent, patterns of adherence varied among participants, suggesting the need to better track adherence and to develop customized and targeted approaches for promoting adherence to clinical research regimens. Staff subjective predictions of adherence were imprecise, supporting need for further development of adherence predictors.
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Affiliation(s)
- William N. Robiner
- Health Psychology, Department of Medicine, University of Minnesota Medical School, USA
- Corresponding author at: Health Psychology, Department of Medicine, University of Minnesota Medical School, MMC 741, 420 Delaware Street S.E., Minneapolis, MN 55455, USA. Tel.: +1 612 624 1479; fax: +1 612 624 3189. (W.N. Robiner)
| | - Trudy D. Strand
- Health Psychology, Department of Medicine, University of Minnesota Medical School, USA
- Division of Pediatric Nephrology, Department of Pediatrics, University of Minnesota Medical School, 2450 Riverside Avenue, 6th Floor East Building, MB681, Minneapolis, MN 55454, USA
| | - Michael Mauer
- Health Psychology, Department of Medicine, University of Minnesota Medical School, USA
- Division of Pediatric Nephrology, Department of Pediatrics, University of Minnesota Medical School, 2450 Riverside Avenue, 6th Floor East Building, MB681, Minneapolis, MN 55454, USA
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Okonkwo CA, Ezeanochie MC, Olagbuji BN. Physical after effects and clients satisfaction following colposcopy and cervical biopsy in a Nigerian population. Afr Health Sci 2013; 13:402-6. [PMID: 24235942 DOI: 10.4314/ahs.v13i2.29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although Nigeria has a high prevalence of cervical cancer, screening services including colposcopy and directed cervical biopsy are not widely available. OBJECTIVES A prospective study among 111 women who had colposcopy and cervical biopsy following an abnormal Pap smear result at the University of Benin Teaching Hospital in Nigeria. It explored physical after effects experienced and satisfaction of clients after the procedure. RESULTS The mean age of the population was 49.5±8.7 years (range, 30 - 64 years) and majority (64.9%) had tertiary education. Overall, 69 women (62.2%) reported physical effects following the procedure. Common physical effects experienced included spotting blood per vaginam (65.2%), pain (34.8%) and vaginal discharge (17.4%). Spontaneous resolution of symptoms occurred within 48 hours in 90.9% of those who reported physical effects. Clients who experienced physical after effects were significantly older (p=0.002) and had tertiary education (p=0.019). Majority of the women (94.6%) were satisfied with the screening services and more than 97% were willing to accept a repeat procedure. CONCLUSIONS Although majority of the clients who had colposcopy and cervical biopsy reported they experienced physical side effects, more than 97% were willing to have a repeat procedure. This information can assist colposcopic service providers in counseling clients.
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Affiliation(s)
- C A Okonkwo
- Department of Obstetrics and Gynecology, University of Benin Teaching Hospital, Benin City, Edo state, Nigeria
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Gomez-Roca CA, Lacroix L, Massard C, De Baere T, Deschamps F, Pramod R, Bahleda R, Deutsch E, Bourgier C, Angevin E, Lazar V, Ribrag V, Koscielny S, Chami L, Lassau N, Dromain C, Robert C, Routier E, Armand JP, Soria JC. Sequential research-related biopsies in phase I trials: acceptance, feasibility and safety. Ann Oncol 2012; 23:1301-1306. [PMID: 21917737 DOI: 10.1093/annonc/mdr383] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Sequential tumour biopsies are of potential interest for the rational development of molecular targeted therapies. PATIENTS AND METHODS From June 2004 to July 2009, 186 patients participated in 14 phase I clinical trials in which sequential tumour biopsies (13 trials) and/or sequential normal skin biopsies (6 trials) were optional. All patients had to sign an independent informed consent for the biopsies. RESULTS Tumour biopsies were proposed to 155 patients and 130 (84%) signed the consent while normal skin biopsies were proposed to 70 patients and 57 (81%) signed the consent. Tumour biopsies could not be carried out in 41 (31%) of the 130 consenting patients. Tumour biopsies were collected at baseline in 33 patients, at baseline and under treatment in 56 patients. Tumour biopsies were obtained using an 18-gauge needle, under ultrasound or computed tomography guidance. Only nine minor complications were recorded. Most tumour biopsy samples collected were intended for ancillary molecular studies including protein or gene expression analysis, comparative genomic hybridization array or DNA sequencing. According to the results available, 70% of the biopsy samples met the quality criteria of each study and were suitable for ancillary studies. CONCLUSIONS In our experience, the majority of the patients accepted skin biopsies as well as tumour biopsies. Sequential tumour and skin biopsies are feasible and safe during early-phase clinical trials, even when patients are exposed to anti-angiogenic agents. The real scientific value of such biopsies for dose selection in phase I trials has yet to be established.
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Affiliation(s)
| | | | | | - T De Baere
- Department of Medical Imaging-Interventional Radiology
| | - F Deschamps
- Department of Medical Imaging-Interventional Radiology
| | - R Pramod
- Department of Medical Imaging-Interventional Radiology
| | | | | | | | | | - V Lazar
- Department of Translational Research Laboratory
| | | | | | - L Chami
- Department of Medical Imaging-Echography; Department of Medicine, Dermatology Unit
| | - N Lassau
- Department of Medical Imaging-Echography; Department of Medicine, Dermatology Unit
| | - C Dromain
- Department of Medical Imaging-Echography; Department of Medicine, Dermatology Unit
| | - C Robert
- Department of Medical Imaging-CT-scan/MRI, Institut Gustave Roussy, Villejuif
| | - E Routier
- Department of Medical Imaging-CT-scan/MRI, Institut Gustave Roussy, Villejuif
| | - J P Armand
- Department of Medicine, Centre Claudius Regaud, Toulouse, France
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Conley S, Lenton C. Waiting for test results is like storm watching. Sometimes the worst part of a medical procedure is anticipating the outcome. Med Econ 2012; 89:69-76. [PMID: 24422312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Uldry EF. [A subtle manual approach]. Krankenpfl Soins Infirm 2012; 105:61. [PMID: 23120977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Abstract
A skin biopsy is one of the most frequently performed procedures in the dermatology outpatient clinic, but doctors often do not consider the cognitive impact of the biopsy procedure. Based on "terror management theory," we reasoned that a skin biopsy increases patient compliance by unconsciously stimulating mortality salience. To study this hypothesis, trust toward doctors, authoritarian personality, mood, attitude toward recommendations, and intention to accept recommendations were compared be-tween skin biopsy and non-skin biopsy groups of patients. Eighty-three patients participated in the study, and 78 responses were used for the analysis. The results showed that patients who had a skin biopsy had a more positive attitude toward doctors' recommendations and a higher intention to follow the recommendations. These effects were not moderated by the patient's own personality (patient trust and authoritarian personality). The outcome of this study implies that performing a procedure itself can subliminally influence a patient's attitude toward a doctor's recommendations.
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Affiliation(s)
- Jae Hwan Kim
- Department of Dermatology, Korea University Medical College of Medicine, Sungbuk-gu, 136-705 Seoul, Korea
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Zografos GC, Zagouri F, Sergentanis TN, Giannakopoulou G, Provatopoulou X, Kalogera E, Papadimitriou C, Filippakis G, Sagkriotis A, Bramis J, Gounaris A. Excisional breast biopsy under local anesthesia: stress-related neuroendocrine, metabolic and immune reactions during the procedure. In Vivo 2009; 23:649-652. [PMID: 19567403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIM The aim of this study was to evaluate three axes: the sympathetic system (adrenaline and noradrenaline), surgical stress-related endocrine factors (prolactin, cortisol, insulin, glucose and growth hormone) and inflammatory cytokines (IL-1alpha, IL-1beta and IL-6) during excisional breast biopsy under local anesthesia (EBBLA). PATIENTS AND METHODS On 14 women undergoing EBBLA, all the aforementioned molecules were measured in peripheral venous blood samples prior (baseline), during (at 10 and 30 minutes), at the end of EBBLA (46+/-9 minutes) and one hour after its end. RESULTS Serum growth hormone glucose and cortisol were found elevated at the 10th and 30th minute and at the end of EBBLA. Serum prolactin increased only at the 30th minute. Of notice, none of the measured parameters was found elevated one hour after the end of biopsy. Concerning adrenaline, noradrenaline and interleukins, no significant changes were documented. CONCLUSION During EBBLA, significant stress-related endocrine events arise. However, no significant sympathetic / cytokine triggering was noted.
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Affiliation(s)
- George C Zografos
- Breast Unit, First Department of Propaedeutic Surgery, Hippokratio Hospital, School of Medicine, Associate Professor of Surgery, University of Athens, 101, Vas Sofias Ave, Ampelokipi, Athens 11521, Greece.
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Schnur JB, Montgomery GH, Hallquist MN, Goldfarb AB, Silverstein JH, Weltz CR, Kowalski AV, Bovbjerg DH. Anticipatory psychological distress in women scheduled for diagnostic and curative breast cancer surgery. Int J Behav Med 2008; 15:21-8. [PMID: 18444017 DOI: 10.1007/bf03003070] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Psychological distress is a central experience for women facing diagnostic and curative breast cancer surgery. PURPOSE The present study was designed to predict anticipatory distress in 187 women scheduled to undergo excisional breast biopsy or lumpectomy. METHOD Participants completed questionnaires assessing emotional distress and predictors of this distress (surgery type, worry about the surgical procedure, and worry about what the surgeon will find). RESULTS The study found that lumpectomy patients experienced greater anticipatory distress than excisional breast biopsy patients on three of the four distress measures (all ps < 0.05) and that worry about what the surgeon might find partially mediated these effects. CONCLUSION The results suggest that although women awaiting lumpectomy are more distressed than women awaiting biopsy, both groups report substantial distress, and, consequently, psychosocial interventions are recommended for both groups.
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Affiliation(s)
- Julie B Schnur
- Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
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Hegel MT, Collins ED, Kearing S, Gillock KL, Moore CP, Ahles TA. Sensitivity and specificity of the Distress Thermometer for depression in newly diagnosed breast cancer patients. Psychooncology 2008; 17:556-60. [PMID: 17957755 PMCID: PMC3806281 DOI: 10.1002/pon.1289] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Receiving a new diagnosis of breast cancer is a distressing experience that may precipitate an episode of major depressive disorder. Efficient screening methods for detecting depression in the oncology setting are needed. This study evaluated the receiver operating characteristics (ROC) of the single-item Distress Thermometer (DT) for detecting depression in women newly diagnosed with Stage I-III breast cancer. METHODS We assessed 321 patients (of 345 consecutive patients) at the time of their pre-surgical consultation at a Comprehensive Breast Cancer Program. Patients were administered the DT along with the Patient Health Questionnaire 9-Item Depression Module (PHQ-9) as a gold standard diagnostic assessment of depression status. RESULTS Mean DT scores (11-point scale, 0-10) were significantly higher for depressed versus non-depressed patients (8.1 versus 4.4). In ROC analyses the DT showed strong discriminatory power relative to the PHQ-9-derived diagnosis of depression, with an area under the curve of 0.87. Patient age, education, marital status and stage of disease resulted in similar operating characteristics. A score of 7 represented the optimal trade-off between sensitivity (0.81) and specificity (0.85) characteristics for detecting depression. CONCLUSIONS The single-item DT performs satisfactorily relative to the PHQ-9 for detecting depression in newly diagnosed breast cancer patients. A cutoff score of 7 on the DT possesses the optimal sensitivity and specificity characteristics. The strength of these findings suggests that a careful psychosocial evaluation should follow a positive screen.
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Affiliation(s)
- Mark T Hegel
- Department of Psychiatry, Dartmouth-Hitchcock MedicalCenter, Lebanon, NH 03756, USA.
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Hovan AJ, Laronde DM, Zhang L, Currie BL. What do I say to my patient who needs a biopsy? J Can Dent Assoc 2008; 74:257-258. [PMID: 18389926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Allan J Hovan
- University of British Columbia, and Department of Oral Oncology, BC Cancer Agency, Vancouver, British Columbia.
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Abstract
Literature relevant to medical decision making was reviewed, and a model was outlined for testing. Two studies examined whether older adults make more immediate decisions than younger adults about treatments for prostate or breast cancer in authentic scenarios. Findings clearly showed that older adults were more likely to make immediate decisions than younger adults. The research is important because it not only demonstrates the consistency of this age-related effect across disease domains, gender, ethnic groups, and prevalent education levels but begins to investigate a model to explain the effect. Major reasons for the effect focus on treatment knowledge, interest and engagement, and cognitive resources. Treatment knowledge, general cancer knowledge, interest, and cognitive resources relate to different ways of processing treatment information and preferences for immediate versus delayed decision making. Adults with high knowledge of treatments on a reliable test tended to make immediate treatment decisions, which supports the knowledge explanation. Adults with more cognitive resources and more interest tended to delay their treatment decisions. Little support was found for a cohort explanation for the relationship between age and preference for immediate medical decision making.
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Affiliation(s)
- Bonnie J F Meyer
- Department of Educational and School Psychology and Special Education, University Park Campus, Pennsylvania State University, University Park, PA 16802, USA.
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Carlsson S, Aus G, Wessman C, Hugosson J. Anxiety associated with prostate cancer screening with special reference to men with a positive screening test (elevated PSA) - Results from a prospective, population-based, randomised study. Eur J Cancer 2007; 43:2109-16. [PMID: 17643983 DOI: 10.1016/j.ejca.2007.06.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 06/05/2007] [Accepted: 06/06/2007] [Indexed: 10/23/2022]
Abstract
Levels of anxiety were assessed through questionnaires completed by 1781 screen-positive (PSA > or = 3 ng/mL) men attending the European Randomised Study of Screening for Prostate Cancer in Gothenburg, Sweden. During the first visit (clinical examination, including biopsies), no anxiety whilst awaiting the PSA test results was reported by 66% and 2% reported high levels of anxiety. A multinomial logistics model for repeated measurements, adjusted for age, PSA level, heredity, biopsy finding and urinary symptoms, revealed that anxiety awaiting the PSA was only influenced (increased) by the existence of previously elevated PSA tests (p<.0001). No anxiety associated with biopsy was reported by 45%, while 6% experienced high levels of anxiety. Levels of anxiety decreased significantly with subsequent rounds of examinations (p<0.0001) and with increasing age (p=0.0016). Anxiety associated with prostate cancer screening in general is low to moderate, even in men with elevated PSA, and severe anxiety affects a smaller group of susceptible men.
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Affiliation(s)
- Sigrid Carlsson
- Department of Urology, Sahlgrenska University Hospital, Bruna Stråket 11 B, SE-413 45 Göteborg, Sweden.
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20
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Truss MC. Editorial comment on: Erectile function in prostate cancer-free patients who underwent prostate saturation biopsy. Eur Urol 2007; 53:545. [PMID: 17619079 DOI: 10.1016/j.eururo.2007.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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21
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Chong CF, Khoo KL, Lim TK, Chang AY, Lim HL, Lee CN, Wong PS. Comparison of clinical with pathological nodal staging from systematic mediastinal lymph node dissection in early resectable non-small cell lung cancer. Singapore Med J 2007; 48:620-4. [PMID: 17609822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
INTRODUCTION We compared the accuracy of clinical nodal (cN) status N0-1 with that of pathological nodal (pN) status obtained from systematic mediastinal lymph node dissection (SMLD) in primary non-small cell lung cancer. METHODS Data from 22 consecutive patients, who underwent lung cancer resection and SMLD of at least three mediastinal lymph node stations, from November 2001 to May 2003, were ana1ysed retrospectively. Only patients with cN0-1 status on computed tomography (CT) referred for surgery, were included in this study. RESULTS Mean age of patients was 66.6 +/- 8.1 years with a male to female ratio of 17:5. Mean number of lymph node stations dissected was 5.8 +/- 1.8. 41 percent had squamous cell carcinoma, 45.5 percent had adenocarcinoma, and 4.5 percent each had large cell carcinoma, bronchioalveolar carcinoma or a lymphoepithelial carcinoma. pN2 metastases were found in 27.3 percent of patients. The sensitivity of cN0-1 was only 12.5 percent, with a specificity of 92.9 percent and an area under the receiver operating characteristics curve of 0.53. The positive and negative predictive values of cN0-1 status were 50 percent and 65 percent, respectively, with an accuracy of 59 percent. 41 percent of patients were understaged with 27.3 percent in pathological stage III. Curative resections were achieved in 59 percent of patients. CONCLUSION The sensitivity of cN0-1 status based on CT alone is extremely poor when compared with pN status from SMLD. Based on cN0-1 status alone without SMLD, 27.3 percent of patients in pN2 would have been understaged. We recommend that all patients with cN0-1 status should undergo SMLD of at least three appropriate mediastinal node stations, for more accurate staging.
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Affiliation(s)
- C F Chong
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074.
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López Jornet P, Velandrino Nicolás A, Martínez Beneyto Y, Fernández Soria M. Attitude towards oral biopsy among general dentists in Murcia. Med Oral Patol Oral Cir Bucal 2007; 12:E116-21. [PMID: 17322798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
OBJECTIVE The present study explores the attitude of general dentists towards oral biopsy as a diagnostic method in application to oral lesions. MATERIAL AND METHODS A questionnaire was administered by mail to 520 general dentists in the Autonomous Community of Murcia (Spain), addressing a number of items: sociodemographic parameters, years of professional experience, the diagnosis of mucosal lesions, the performance of oral biopsies, and their histopathological evaluation. RESULTS The global response rate was 32.7% (55.9% for males and 43.5% for females), with a global mean age of 35.9 years. Of note is the fact that the group with least professional experience did not include oral biopsy as diagnostic procedure, with statistically significant differences versus the other groups of experience (p=0.048) CONCLUSION The assimilation of oral biopsy as a diagnostic procedure is seen to increase with the number of years of professional experience.
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Affiliation(s)
- Pía López Jornet
- Faculty of Medicine and Dentistry, University of Murcia, Murcia, Spain.
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Awsare NS, Green JA, Aldwinckle B, Hanbury DC, Boustead GB, McNicholas TA. The use of propofol sedation for transrectal ultrasonography-guided prostate biopsy is associated with high patient satisfaction and acceptability. Eur J Radiol 2007; 63:94-5. [PMID: 17276645 DOI: 10.1016/j.ejrad.2006.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2006] [Revised: 12/21/2006] [Accepted: 12/28/2006] [Indexed: 10/23/2022]
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Witek-Janusek L, Gabram S, Mathews HL. Psychologic stress, reduced NK cell activity, and cytokine dysregulation in women experiencing diagnostic breast biopsy. Psychoneuroendocrinology 2007; 32:22-35. [PMID: 17092654 PMCID: PMC3937868 DOI: 10.1016/j.psyneuen.2006.09.011] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2006] [Revised: 09/24/2006] [Accepted: 09/25/2006] [Indexed: 01/06/2023]
Abstract
The purpose of this study was to evaluate a woman's psychological and immunological response to breast biopsy before and after the procedure. Women were enrolled into the study when notified of the need for breast biopsy. Psychological and immunological assessments were made at enrollment, on the day of breast biopsy, as well as 1 month and 4 months after notification of biopsy results. Psychological assessments demonstrated that perceived stress, anxiety, and mood disturbance were heightened before biopsy and remained elevated after biopsy regardless of the diagnosis. Immunologically, the women exhibited reduced natural killer cell activity and INF gamma production before biopsy with reductions significant 1 month after the procedure. In contrast, IL-4, IL-6, and IL-10 production were increased before and after the procedure with most significant increases prior to the procedure and continuing 1 month after the procedure. These results demonstrate that undergoing biopsy of the breast for cancer diagnosis is an emotional experience, characterized by increased perceived stress, anxiety, and mood disturbance. This emotional distress is accompanied by reduced NK cell activity and cytokine dysregulation. The psychological and immunological impact of breast biopsy is not transient, but persists well beyond the actual experience of the biopsy procedure. Noteworthy is the observation that women with benign or malignant biopsy results experienced similar psycho-immune consequences. Hence, these observations are of relevance not only to women diagnosed with malignancy, who face the challenges of cancer treatment and adaptation to illness, but also to women with benign biopsy findings.
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Affiliation(s)
- Linda Witek-Janusek
- Niehoff School of Nursing, Loyola University of Chicago, Maywood, IL 60153 USA
| | - Sheryl Gabram
- Cardinal Bernardin Cancer Center, Loyola University of Chicago Medical Center, Maywood, IL 60153 USA
| | - Herbert L. Mathews
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University of Chicago, Maywood, IL 60153 USA
- Correspondence author. Herbert L. Mathews, Ph.D., Dept. of Microbiology and Immunology, Maguire Center, Room 2890, Loyola University of Chicago Medical Center, 2160 South First Ave., Maywood, IL 60153 USA. Tel. (708) 216-4586, Fax. (708) 216-9574,
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Abstract
PURPOSE To determine whether the waiting trade-off (WTO) is feasible for differentiating short-term biopsy preferences in an acute situation where anxiety is the symptomatic disease state. METHODS 75 women with past experience of either breast core-needle biopsy (CNB), more invasive excisional surgical biopsy (EXB), or both, had telephone WTO assessments. Patients' baseline and test-related anxiety were valued by time trade-off (TTO) used to scale the WTO. Rating scales (RS) were obtained for convergent validity assessment with WTO and TTO. RESULTS Data were obtained in 38 women who had both CNB and EXB ("paired") and 20 who had CNB only and 16 who had EXB only ("unpaired"). Patients rated only the procedure(s) they experienced. Median paired and mean unpaired WTO scores indicated patients were willing to wait significantly longer to avoid EXB (P = 0.0003, P = 0.0002, respectively). The waiting time difference between EXB and CNB was 2.1 weeks greater in unpaired data than paired data. RS scores comparing the procedures were significantly different only for paired data (P < 0.05). Median TTO preferences for baseline (1.00) and test anxiety (0.93) obtained in 74 patients were significantly different (P < 0.0001) and consistent with RS. Correlation was noted between WTO and RS (-0.307 to -0.453, P = 0.0205 to 0.0001). The median EXB quality-adjusted life years toll (1.5 quality-adjusted life days) calculated from pooled WTO data (paired and unpaired) from 54 patients is near a threshold in a published model. CONCLUSION The WTO is feasible for discriminating preferences for short-term health states in an acute medical scenario where it might have been expected to be impracticable.
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Affiliation(s)
- J Shannon Swan
- Indiana University, Department of Radiology Education and Research Institute, Indianapolis, USA.
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Agulnik M, Oza AM, Pond GR, Siu LL. Impact and perceptions of mandatory tumor biopsies for correlative studies in clinical trials of novel anticancer agents. J Clin Oncol 2006; 24:4801-7. [PMID: 17050865 DOI: 10.1200/jco.2005.03.4496] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To assess the impact and perceptions of patients, physicians, and institutional review board members (IRBs) on the issue of mandatory serial tumor biopsies to acquire tissues for correlative studies. PATIENTS AND METHODS Complementary, self-administered questionnaires were circulated to trial patients who had previously undergone serial research-related biopsies (TPs), clinic patients who had prior diagnostic but not research-related biopsies (CPs), academic medical oncologists in Canada (MOs), and IRBs at the affiliated academic centers. RESULTS Ten (72%) of 14 TPs, 265 (82%) of 325 CPs, 137 (66%) of 209 MOs, and 142 (49%) of 291 IRBs responded. A 5% to 10% risk of a major biopsy complication was acceptable to 22% of CPs but only to 1% of MOs or IRBs. Anxiety was reported by 30% of TPs and 45% of CPs before their biopsies. More than 82% of MOs or IRBs believed the average patient would have at least borderline anxiety before their biopsy. Among the patients, 84% would authorize their samples for additional unrelated research and 75% would agree to genetic testing. Nearly all MOs and 86% of IRBs considered it ethical to request for additional unrelated research testing. With respect to genetic testing, 82% of MOs and 72% of IRBs would request it. CONCLUSION Although nearly all MOs and IRBs see the value in the biopsy, their threshold for acceptable risk is lower and they anticipate more associated anxiety than patients. Most patients recalled a tendency to tolerate their biopsies well with an average associated anxiety, and would allow their specimens to be tested for research purposes.
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Affiliation(s)
- Mark Agulnik
- Department of Medical Oncology and Hematology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
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Brindle LA, Oliver SE, Dedman D, Donovan JL, Neal DE, Hamdy FC, Lane JA, Peters TJ. Measuring the psychosocial impact of population-based prostate-specific antigen testing for prostate cancer in the UK. BJU Int 2006; 98:777-82. [PMID: 16978272 DOI: 10.1111/j.1464-410x.2006.06401.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the psychosocial impact of participation in a population-based prostate-specific antigen (PSA) testing programme, akin to screening, and to explore the relationship between urinary symptoms reported before PSA testing and the response to the subsequent PSA result. PATIENTS AND METHODS This prospective questionnaire study was nested within the case-finding component of the ProtecT (prostate testing for cancer and treatment) feasibility study (ISRCTN20141297). Men aged 50-69 years from 18 general practices in three cities in the UK completed the Hospital Anxiety and Depression Scale (HADS), the Short Form-12 (SF-12) Health Survey, and the International Continence Society 'male' (ICSmale) questionnaires before giving consent for a PSA test in a community clinic (baseline). Men with an 'abnormal' PSA result returned for further investigation (including biopsy) and repeated these questionnaires before biopsy. RESULTS At baseline, study participants had similar levels of anxiety and depression to the general male population. There was no increase in the HADS scores, or reduction in the SF-12 mental health component summary score, on attendance at the biopsy clinic after receiving an 'abnormal' PSA result. Urinary symptoms were associated with levels of anxiety and depression before receiving a PSA result (baseline), but were not associated with anxiety and depression at biopsy independently of baseline scores. Therefore changes in anxiety or depression at biopsy did not appear to differ between those with and without urinary symptoms. CONCLUSIONS This study confirms the findings of other studies that the deleterious effects of receiving an abnormal PSA result during population screening are not identified by generic health-status questionnaires. Comparisons with outcomes of studies measuring cancer-specific distress and using qualitative research methods raise the question of whether a prostate cancer screening-specific instrument is required. However, a standardized measure of anxiety identified differences at baseline between those who did and did not report urinary symptoms. These findings suggest that it might be advisable to better inform men undergoing PSA testing about the uncertain relationship between urinary symptoms and prostate cancer, to minimize baseline levels of psychological distress.
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Affiliation(s)
- Lucy A Brindle
- School of Nursing and Midwifery, University of Southampton, Southampton, UK.
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Al-Shakhli H, Harcourt D, Kenealy J. Psychological distress surrounding diagnosis of malignant and nonmalignant skin lesions at a pigmented lesion clinic. J Plast Reconstr Aesthet Surg 2006; 59:479-86. [PMID: 16749193 DOI: 10.1016/j.bjps.2005.01.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This study aimed prospectively to investigate psychological distress throughout the diagnostic process in an outpatient pigmented lesion clinic (PLC). Psychological distress was measured at pre clinical diagnosis, post clinical diagnosis, pre histological diagnosis (including a benign follow-up) and post histological diagnosis stages using standard anxiety measurement scales and a study specific measure of satisfaction with care. In total 324 patients undergoing investigation of a suspicious skin lesion consented to take part out of a cohort of 463 patients who attended the PLC in a 6 month period. Using recognised cut-off scores, 27% of women on clinic arrival reported clinically high levels of anxiety, in comparison with 10% of men (p < 0.0001). Patients given an immediate benign post clinical diagnosis reported a reduction in anxiety (p < 0.0001) but patients requiring a biopsy reported elevated levels of anxiety. Approximately, 30% of these biopsy patients reported clinically high levels of anxiety both before and after diagnosis. Patients who received a post histological diagnosis of malignant melanoma also reported the pre histological stage at the clinic as more distressing than waiting for and receiving results (p < 0.01). Patient's quality of life prior to diagnosis was excellent, but emotional functioning (p < 0.05), insomnia (p<or=0.001), and global health status (p<or=0.001) deteriorated throughout the diagnostic process for those patients who were finally diagnosed as having malignant melanoma. Patients reported high levels of satisfaction with clinic attendance and treatment, regardless of diagnosis but a need for further information was identified. This study has implications for all healthcare professionals involved in the provision of care through Pigmented Lesion Clinics in UK. The diagnostic process of a suspicious lesion is evidently a 'critical' stage requiring appropriate provision of care to meet patients' psychosocial and information needs if distress is to minimised for the large numbers of patients attending a PLC each year.
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Affiliation(s)
- H Al-Shakhli
- Bristol Clinical Psychology Doctorate, Bristol University, 29 Park Row, Clifton, Bristol BS1 5NB, UK.
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Abstract
The virtues of screening men for prostate cancer continue to be debated in political and public health, as well as clinical forums. Science has been unable to accurately predict screening benefits, yet many men are required to make informed decisions about prostate cancer screening. Clinicians' screening practices have been reported, but little research attention has been given to patients' experiences. The purpose of this study was to describe patients' perspectives of being screened and subsequently diagnosed with prostate cancer. Thirty-five Anglo-Australian men were interviewed, and the data were analyzed using ethnographic content analysis. The findings indicated that most participants experienced screening as a continuum of 3 tests, rather than the simple prostate-specific antigen blood test they had often anticipated. Commitment to a definitive diagnosis when abnormality was detected through screening and uptake of active treatment(s) when prostate cancer was confirmed were strongly represented in this study. The findings offer insight to the complex and often rapid sequence of events that can accompany prostate cancer screening. This has implications for the information that needs to be discussed with men before, rather than after prostate cancer screening has commenced.
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Affiliation(s)
- John Oliffe
- School of Nursing, University of British Columbia, 302-6190 Agronomy Road, Vancouver, BC V6T 1Z3, Canada.
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Bradley PK, Berry A, Lang C, Myers RE. Getting ready: developing an educational intervention to prepare African American women for breast biopsy. ABNF J 2006; 17:15-9. [PMID: 16596896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Focus groups with African American women who had experienced a breast biopsy were conducted during the process of "getting ready" for a breast biopsy educational study in which the intervention's educational materials and study instruments were developed and pre-tested. Recommendations were made for revising the breast biopsy educational booklet. As a result of the focus group discussions, changes were made in several of the graphics, the design and size of the booklet, and the tone of the piece. In addition, language describing the biopsy procedure was further simplified. The outcomes of this study were culturally tailored study materials to be used in an educational intervention to prepare African American women undergoing a breast biopsy procedure.
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Abstract
Research shows that nurse surgery posts strengthen continuity of care and allow collaboration with other health professionals to ensure patients receive appropriate and timely care. The consistent and integrated approach provided with the nurse biopsy role fills gaps in service provision and avoids duplication of services. Skin cancer is the most common cancer in the UK and at Queen's Medical Centre in Nottingham they see approximately 160 suspected cases each week. Before the introduction of the nurse biopsy role there was an 8-week wait for a biopsy by the doctor and a further 8-week wait for the removal of the tumour. Now, a patient with a suspected skin cancer can have a biopsy on the first visit to the clinic, reducing the wait from 8 weeks to 0 weeks. This reduction in waiting time facilitates improved mortality and morbidity from the skin cancer. It took 3 years to develop the nurse biopsy role in Nottingham and another 2 years to provide the service that is currently available. The nurse-led biopsy service is now being adopted nationwide, as recommended by the All Parliamentary Group on Skin (2003). The dermatology department at Queen's Medical Centre in Nottingham also runs an annual course to teach the surgery skills required to primary- and secondary-care nurses.
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Abstract
AIM This paper reports a study examining the relationships between demographic characteristics, social support, anxiety, coping and defence among women with possible breast cancer. BACKGROUND Awaiting a possible breast cancer diagnosis is an anxiety-provoking situation that demands coping. Social support and demographic characteristics have been reported to influence coping and well-being, but the interconnection is insufficiently understood. DESIGN A survey design was used, and self-administrated questionnaires were returned by a convenience sample of 117 women in Norway who had undergone breast biopsy. The data were collected from September 1998 to February 2000. INSTRUMENTS The instruments consisted of: the Social Provisions Scale, State-Trait Anxiety Scale, Utrecht Coping List and Defence Mechanisms Inventory. In addition, data on age, level of education, employment, marital status, and household status were collected. RESULTS Social support was positively related to instrumental-oriented coping and emotion-focused coping, unrelated to cognitive defence and defensive hostility. Educational level was positively related to instrumental-oriented coping. Educational level, employment and marital status were negatively related to cognitive defence. Educational level was the most important contributor to social support. Attachment and education were the most important contributors to instrumental-oriented coping, with education as the strongest predictor. CONCLUSION Better coping was linked primarily to education, and secondly to attachment. Unemployment, low level of education and single/divorced/widowed status were related to greater use of cognitive defence. Women who used a defensive hostile style tended to receive poor social support. Nurses need to be aware of the influence of demographic characteristics on social support, coping and defence and to identify poor copers, as these patients are most in need of professional support.
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Affiliation(s)
- Sigrunn Drageset
- Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway.
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Abstract
OBJECTIVE This study investigated the potential for predicting which patients would have a negative emotional reaction to bronchoscopy. METHODOLOGY A questionnaire was distributed to 120 patients who had undergone diagnostic fibreoptic bronchoscopy. A visual analog scale to evaluate the patient's discomfort was adopted. Multiple linear regression analysis was used to determine factors significantly influencing discomfort. The regression model included the following variables: age, gender, symptoms, smoking habits, proximal bronchial brushing, distal bronchial brushing, bronchial washing, proximal transbronchial biopsy, transbronchial lung biopsy, examination time, the bronchoscopist's experience, and the patient's anxiety level. RESULTS The bronchoscopist's experience (P = 0.001) and the patient's anxiety level (P < 0.001) were variables that significantly influenced discomfort. These results suggest that discomfort decreased with the bronchoscopist's experience and increased with the patient's anxiety regarding bronchoscopy. CONCLUSIONS The results suggest that subjective discomfort can be predicted both by the bronchoscopist's experience and by a questionnaire about the patient's anxiety level before bronchoscopy. Therefore, it is recommended that the patient's anxiety level be determined through the use of a questionnaire before bronchoscopy, and that more experienced bronchoscopists should take charge if the patient is judged as being excessively anxious. If experienced bronchoscopists are unavailable, the more anxious patient should receive more sedatives.
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Abstract
A high level of anticipatory distress in women scheduled for surgery to detect or treat breast cancer emphasizes the importance of investigation of potential targets for distress-reducing interventions. Exercise and sleep have been examined in relation to distress in this population, focusing on the postsurgery period. In this study the authors examined the contributions of physical activity and sleep to anticipatory distress levels in 124 women prior to breast surgery. Patients completed measures of distress, activity and sleep. The authors hypothesized that higher levels of activity and better sleep would be associated with lower anticipatory distress. Additionally, the authors hypothesized that the effects of physical activity on distress would be accounted for by (mediated) sleep quality. Results indicated that physical activity and sleep quality were negatively related to distress (p < .05); however, activity effects were not mediated by sleep. These findings have implications for designing interventions to reduce anticipatory breast surgery distress.
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Affiliation(s)
- Kristin Tatrow
- Biobehavioral Medicine Program, Department of Oncological Sciences, Mount Sinai School of Medicine, USA.
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Abstract
The purpose of this study was to obtain descriptions of the perioperative experiences of women who underwent breast biopsies with local anesthesia. Twenty-two participants were interviewed, and open-ended questions were used to allow the women to describe their experiences. Data analysis revealed three major themes--certitude, care, and justice. The women's most pervasive need was to have the biopsy results as soon as possible. They viewed the surgical phase of the biopsy as a stepping-stone to achieving certitude associated with having the pathology results. The surgical phase of the biopsy did not hold as much significance for the women as the researcher had anticipated.
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Millogo FT, Akotionga M, Lankoande J. [Cervix cancer screening in a health district (Burkina Faso) by voluntary biopsies after the application of acetic acid and lugol]. Bull Soc Pathol Exot 2004; 97:135-8. [PMID: 15255361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
A voluntary screening of uterus cervix cancer took place in Kossodo health district from February 1st 2001 to April 30th 2002. It involved the age-group women of 25 to 59 years. This study included 239 women given a participation rate of 6.8%. We had sampled young women in three categories with average age of 38 years: a) doing a remunerated job (64.9%); b) mostly educated (85.3%); and c) married (86.2%). The visual inspection was the method used after the application of 4% acetic acid followed by that of lugol. In all 74 biopsies have been undertaken. Furthermore, we have noticed a 4.2% prevalence of pre-cancerous injuries. The cancerous lesions represented 2.5% of the sampling and the inflammatory lesions 13.4%. VPH infection was found on 2.5% samples and condylomatous injuries in 5% cases. This experience would deserve to be carried out always and a cervix cancer screening campaign held at national level.
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Affiliation(s)
- F T Millogo
- Unité de formation et de recherche des sciences de la santé (UFR/SDS) de l'Université de Ouagadougou, Burkina Faso.
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Abstract
OBJECTIVE This study was undertaken to compare patient perceptions of 2 common image-guided breast biopsy procedures on 3 main outcomes: decision making about which procedure to undergo, its convenience, and its side effects. METHODS Women who had either an excisional or ultrasound-guided core needle breast biopsy in 1997 for a screen-detected lesion had telephone interviews 1 to 3 months after the biopsy. Bivariate associations were tested by using chi(2) and t test statistics. Mulitvariate analyses were used to control for effects of demographic characteristics. RESULTS Most women (66%) could not remember being offered a choice of procedures, and of those who did have a choice, a higher proportion had an excisional biopsy. Only 2% reported being told the cost of the biopsy procedure. Women who had an excisional biopsy compared with those who had undergone a core needle biopsy reported statistically more hours and days off from work and reported more side effects 1 to 3 days after the biopsy (P<.05). Associations between side effects and type of biopsy procedure were unchanged when adjustment was made for demographic characteristics. CONCLUSION Women who had the ultrasound-guided needle biopsy reported significantly fewer side effects and needed less time off from work. When a suspicious lesion is noticed on a screening mammogram, it is important that women and their physicians discuss the benefits and risks of the various biopsy procedures before deciding how to proceed, allowing for informed choice.
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Affiliation(s)
- Berta M Geller
- Department of Family Practice, Office of Health Promotion Research, University of Vermont, Burlington, 05401-3444, USA.
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Currence BV, Pisano ED, Earp JA, Moore A, Chiu YF, Brown ME, Kurgat KL. Does biopsy, aspiration or six-month follow-up of a false-positive mammogram reduce future screening or have large psychosocial effects? Acad Radiol 2004; 10:1257-66. [PMID: 14626300 DOI: 10.1016/s1076-6332(03)00382-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES To determine the differences in the psychosocial effects and future mammography screening behavior between women who had an abnormal mammogram followed either by percutaneous or open surgical breast biopsy or cyst aspiration, or by short-term follow-up mammography to provide insight to radiologists making decisions regarding work-up. MATERIALS AND METHODS A structured interview was administered to women who recently had abnormal mammograms, leading to biopsy or aspiration (170 cases), or short-term follow-up (176 controls), by telephone within a month of the eligibility event and again approximately 15 months later. Information was collected on perceived pain/discomfort, interactions with medical staff, emotional impact, general breast cancer knowledge, patient attitude towards early diagnosis of breast cancer, perceived risk, previous and intended screening behavior, and subjective health status. Wilcoxon rank sum statistical test was used to compare the two groups at the time of both interviews. RESULTS Cases and controls had similar demographics. There were no significant differences in the examined psychosocial effects and reported intention to undergo future screening mammography between cases and controls. The overwhelming majority of both cases and controls both reported intention to and underwent routine screening 15 months after the eligibility event. CONCLUSION Undergoing a biopsy, cyst aspiration, or 6-month follow-up after a positive mammogram does not have large psychosocial effects, nor does it deter women from undergoing screening mammography in the future.
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Affiliation(s)
- Beverly V Currence
- Department of Radiology, Radiology Research Lab, CB # 7515, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Kitchener HC, Burns S, Nelson L, Myers AJ, Fletcher I, Desai M, Dunn G, Maguire P. A randomised controlled trial of cytological surveillance versus patient choice between surveillance and colposcopy in managing mildly abnormal cervical smears. BJOG 2004; 111:63-70. [PMID: 14687054 DOI: 10.1046/j.1471-0528.2003.00007.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether choice of colposcopy or six month cytological surveillance would be beneficial to women with mildly abnormal smears when compared with the national policy of six months surveillance in terms of psychological morbidity. DESIGN A randomised trial based on the Zelen design. SETTING A hospital-based research clinic. POPULATION Four hundred and seventy-six women who had had a recurrent borderline or mildly dyskaryotic smear on routine cervical screening in primary care. METHODS Women were randomised either to six months cytological surveillance or to make a choice between that or colposcopy and were followed up for 1 year. MAIN OUTCOME MEASURES The primary outcome measure was caseness (score >or=4) on the General Health Questionnaire at 12 months follow up. Other measures were the Spielberger State and Trait scores, default rates and cytology/colposcopy outcomes. RESULTS There was no significant difference between the arms for General Health Questionnaire (GHQ) scores and Spielberger State and Trait at 12 months. There was a significant reduction in psychometric morbidity between baseline and 12 months in both arms. Overall rates of default from the protocol were the same in both arms, but default that led to uncertain ascertainment of cervical pathology was greater in the no-choice arm. CONCLUSIONS This trial indicates that having choice did not impact favourably or harmfully on anxiety or feelings of wellbeing. If a patient is anxious, allowing the patient to choose immediate colposcopy may be preferable because it will improve ascertainment of underlying disease in a group who are more likely to default.
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Affiliation(s)
- H C Kitchener
- Academic Unit of Obstetrics and Gynaecology, St Mary's Hospital, Manchester, UK
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Lebel S, Jakubovits G, Rosberger Z, Loiselle C, Seguin C, Cornaz C, Ingram J, August L, Lisbona A. Waiting for a breast biopsy. Psychosocial consequences and coping strategies. J Psychosom Res 2003; 55:437-43. [PMID: 14581098 DOI: 10.1016/s0022-3999(03)00512-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this pilot/feasibility study was to describe the experience of women presenting with a suspicious mammogram who are waiting for a breast biopsy and to identify those at risk for distress. METHODS Participants (n=25) were interviewed at two time points: immediately after being put on the waiting list (T1) and again immediately before their biopsy approximately 6 weeks later (T2). Self-report measures of distress and coping were used. Perceived personal risk of a positive biopsy finding and information needs were assessed through open-ended questions. RESULTS Distress levels were high in this sample. Using cognitive-avoidant coping strategies, being employed, history of previous biopsies, and having a family history of breast cancer were associated with greater distress. Perceived personal risk of a positive biopsy finding was overestimated in one half of the cases and was correlated with greater distress. CONCLUSION Waiting period between suspicious mammogram and breast biopsy may be a time of high distress for many women.
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Affiliation(s)
- Sophie Lebel
- Sir-Mortimer B. Davis-Jewish General Hospital, 4333 Cote Ste-Catherine, H3T 1E4 Montreal, Quebec, Canada
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Affiliation(s)
- Navkiran K Shokar
- Department of Family Medicine, University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, TX 77555-1123, USA.
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Abstract
Improvement efforts for women's breast health services were initiated to provide a co-ordinated comprehensive breast health system and increase patient satisfaction for women using the service. The Breast Health Center, initially established to better meet the needs of the community with screening services provided an environment that reduced the anxiety associated with screening mammography services. However, women that required diagnostic follow-up expressed dissatisfaction and increased anxiety as they waited for test results. The diagnostic follow-up process in need of improvement required additional scheduling for services and often lead to delays, added anxiety, and decreased patient satisfaction for women maneuvering through a complex system.
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Affiliation(s)
- Susan Rust
- Columbus Regional Hospital, Planning and Marketing Department, 2400 E. 17th Street, Columbus, IN 47201, USA
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Liang W, Lawrence WF, Burnett CB, Hwang YT, Freedman M, Trock BJ, Mandelblatt JS, Lippman ME. Acceptability of diagnostic tests for breast cancer. Breast Cancer Res Treat 2003; 79:199-206. [PMID: 12825854 DOI: 10.1023/a:1023914612152] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE To assess the acceptability of new non-invasive breast cancer diagnostic tests intended to triage women in need of biopsy. METHODS Women who had abnormal screening tests and had been recommended to have a biopsy were invited to receive digital mammography, magnetic resonance imaging (MRI), and nuclear medicine evaluation (Tc-99m-sestamibi scanning) before biopsy. Participants completed a questionnaire about satisfaction and acceptability of the procedures. Satisfaction measured women's overall and test-specific satisfaction. Acceptability was measured by self-reported discomfort, embarrassment and women's preference in terms of willingness to pay to avoid a biopsy. RESULTS Women were satisfied with all of the potential diagnostic triage procedures. Most found the tests more comfortable than a routine mammogram (47, 50, and 66% undergoing MRI, digital mammography, and sestamibi scanning, respectively). Women who provided a response to willingness to pay questions (N = 43) were willing to pay an average of 611 dollars to have a test instead of a biopsy, if the test was as accurate as biopsy. The willingness to pay significantly decreased to 308 dollars if the test only had 95% accuracy. Those who had prior benign breast disease were less willing to pay for a test with 95% accuracy than those without this history. CONCLUSION Instead of immediate biopsy after an abnormal screening, these results suggest that women would find non-invasive triage tests acceptable, or preferable to biopsy if they were equally accurate or nearly equally accurate as a biopsy. New technologies to diagnose breast cancer should focus on decreasing discomfort as well as increasing test accuracy.
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Affiliation(s)
- Wenchi Liang
- Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington, DC 20007, USA.
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Abstract
Surgical consultation concerning the possibility of breast cancer is a distressing experience, and having to take the next step of breast surgery even more so for many women. However, the sources of variability in such presurgical distress are not well understood. Sixty-one women (mean age = 51) were recruited immediately following surgical consultation in which a recommendation of breast surgery (excisional biopsy/lumpectomy) was made. Patients completed measures of distress, worry about cancer and surgery, trait anxiety, optimism and pessimism prior to surgery. Surprisingly, results revealed no effect of surgeon-provided information concerning preliminary diagnosis on patient distress. Rather, worry about what the surgeon might find concerning the breast mass during surgery, worry about having to go through the operative procedures, and patient optimism were the only factors that uniquely contributed to patient distress (p's < 0.05). This study provides a foundation for future clinical interventions to reduce presurgery distress.
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Affiliation(s)
- Guy H Montgomery
- Biobehavioral Medicine Program, Derald H. Ruttenberg Cancer Center, Mount Sinai School of Medicine, Box 1130, One Gustave L. Levy Place, New York, New York 10029-6574, USA.
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Abstract
The authors investigated the effect of music on the state anxiety of a sample of 20 patients awaiting breast biopsy at a suburban medical facility. The patients were assigned alternately to either the control or experimental group. The individuals in the experimental group were given a 20-minute music-based intervention in a preoperative holding area, whereas the patients in the control group received the customary preoperative care. Clinicians measured blood pressure, heart rate, and respiration in both groups of patients, and the participants completed the State portion of the self-administered State-Trait Anxiety Inventory (STAI). After the patients completed the 20 minutes of music or of preoperative care without music, clinicians again measured the participants' vital signs and the patients completed the STAI. The authors' findings indicated that the posttest state anxiety and respiratory rates of the patients in the experimental group were significantly lower than those of the patients in the control group.
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Affiliation(s)
- M Haun
- Luther Correctional Facility, LaGrange, Kentucky, USA
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Abstract
BACKGROUND The psychological adaptation to a cancer diagnosis is characterized by significant distress. Although distress levels in cancer patients have been reported to be the highest shortly after diagnosis and before treatment, few attempts have been made to study emotional adjustment during the diagnostic period of prostate cancer patients. This study's purpose was to determine whether differences in distress levels can be attributed to differences in diagnostic status, optimism, and/or coping strategies. METHODS This study followed patients across 4 weeks, from prebiopsy to 2 weeks postdiagnosis, using these two time points as measurements. Data were collected between 1995 and 1998 at the Miami and Palo Alto VA Medical Center urology clinics. Biopsies were performed on 101 men (ages 46-87) to determine whether prostate cancer was present. These men completed prebiopsy and postdiagnosis questionnaires. RESULTS Of optimism, coping, and cancer status, the only significant predictor of increased distress at postdiagnosis was dispositional avoidance at prebiopsy for both cancer and noncancer groups. CONCLUSIONS Although these findings complement other studies linking avoidance with increased distress, the similarities between the cancer and noncancer groups underscore the need to consider both of these groups during the first few weeks of the prostate cancer diagnostic process.
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Affiliation(s)
- Ruben E Perczek
- University of Miami School of Medicine and Geriatric Research, Education, and Clinical Center, VA Medical Center, Miami, Florida 33125, USA.
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Cormier L, Guillemin F, Valéri A, Fournier G, Cussenot O, Mangin P, Litwin MS. Impact of prostate cancer screening on health-related quality of life in at-risk families. Urology 2002; 59:901-6. [PMID: 12031378 DOI: 10.1016/s0090-4295(02)01552-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To describe the impact of prostate-specific antigen (PSA) screening on the health-related quality of life (HRQOL) and anxiety of men with a family history of prostate cancer. METHODS We asked 334 brothers or sons of men with prostate cancer who agreed to undergo PSA testing to fill out HRQOL questionnaires. The questionnaires were the RAND SF-36 (generic HRQOL) and State-Trait Anxiety Inventory (anxiety-specific). Participants completed the questionnaires at the time of screening, while waiting for the results, and after receiving normal results. Sociodemographic and HRQOL variables were entered into a logistic regression model to identify factors associated with the deterioration of HRQOL, defined as a decrease of at least one standard error of measurement. Only men with normal PSA results were considered. RESULTS Among 334 candidates, 273 underwent PSA measurement and 220 candidates with a PSA of 4 ng/mL or less returned completed questionnaires. Of these, in 20% their anxiety moderately deteriorated and in 20% their HRQOL minimally deteriorated during the screening process. Factors associated with HRQOL deterioration included age between 50 and 60 years, having more than two relatives with prostate cancer, an anxious personality, a high level of education, and having no children presently living at home. CONCLUSIONS Screening with normal PSA results is accompanied by a minimally to moderate deterioration of HRQOL in some subjects. The identification of such individuals before screening provides opportunities to improve their HRQOL during the screening process.
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Affiliation(s)
- Luc Cormier
- Department of Urology, CHU Nancy-Brabois, Vandoeuvre-les-Nancy, France
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Abstract
Each year, hundreds of thousands of women undergo excisional breast biopsies for definitive diagnosis. Not only do these patients experience pain associated with the procedure, but they also endure distress associated with the threat of cancer. Hypnosis has been demonstrated as effective for controlling patients' pain in other surgical settings, but breast surgery patients have received little attention. To determine the impact of brief presurgical hypnosis on these patients' postsurgery pain and distress and to explore possible mediating mechanisms of these effects, 20 excisional breast biopsy patients were randomly assigned to a hypnosis or control group (standard care). Hypnosis reduced postsurgery pain and distress. Initial evidence suggested that the effects of hypnosis were mediated by presurgery expectations.
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Affiliation(s)
- Guy H Montgomery
- Ruttenberg Cancer Center, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
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Easing fears about undergoing prostate biopsy. Johns Hopkins Med Lett Health After 50 2001; 13:3. [PMID: 14723196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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Högberg L, Nordwall M, Stenhammar L. Small bowel capsule biopsy in children: parents' opinions on children's discomfort. Acta Paediatr 2001; 90:876-8. [PMID: 11529534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
UNLABELLED This questionnaire study asked the parents of 62 children undergoing small bowel capsule biopsy for their reactions to the discomfort experienced by their children. The children were randomized to receive sedation with midazolam either intravenously or intranasally. With regard to the biopsy procedure the parents of 94% of the children had no objections. The parents of 3% of the children found the biopsy very unpleasant and another 3% suggested that the biopsy should be performed under general anaesthesia. The proportion of parents with negative reactions to the biopsy procedure did not differ significantly between the intravenously and intranasally sedated children. With regard to the sedation given, the parents of 79% of the children did not think that their children were in any discomfort at all. Ten percent of the children had obvious signs of nasal discomfort using the intranasal administration. In the remaining 11% of the children the parents reported various symptoms. CONCLUSION The vast majority of parents of children undergoing small bowel capsule biopsy found the procedure satisfactory providing that the sedative medication was given intravenously rather than intranasally.
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Affiliation(s)
- L Högberg
- Department of Paediatrics, Linköping University, Norrköping Hospital, Sweden.
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