Side effects of adjuvant chemotherapy: perceptions of node-negative breast cancer patients.

Twenty-one node-negative breast cancer patients were interviewed shortly after completing adjuvant chemotherapy and asked about side effects they had experienced, expectation of side effects, and strategies for coping with the side effects. Eighteen of the women were interviewed 6 months later to determine their feelings about the chemotherapy experience and ending treatment and what side effects persisted or developed after chemotherapy. Hair loss, fatigue, treatment-related problems, nausea and infections/low blood counts were the most frequently described problems during the first interviews. Patients used coping strategies suggested by physicians and nurses. Six months later, hair problems, fatigue, weight gain, menopausal problems, emotional problems and nail problems were most often reported. Most patients (16/18) did not expect to be experiencing chemotherapy-related problems 6 months after ending treatment. Fatigue interfered with daily lives and weight gain caused concern. A total of 35% of participants experienced fear or anxiety at the end of chemotherapy, but most (62%) recalled at least some positive feelings 6 months later. Given the same circumstances, all but two would make the same decision to undergo adjuvant chemotherapy. Support groups would be especially useful for patients completing chemotherapy who would lose continued frequent support from clinic personnel.

Providing information about breast cancer via public forums.

This study examines whether persons who attended a breast cancer education summit or received written materials (i) exhibited improved knowledge about breast cancer; and (ii) used the information themselves, share it with others, or implemented community education/screening programs. Participants (92 lay persons, 67 health professionals who attended; 44 who did not attend but received written materials) were primarily female, with a mean age of 47. They completed a 10-item knowledge questionnaire on four occasions (pre-conference, immediately post-conference, 9 weeks, 6 months). On the third and fourth occasion, participants also were asked how they had used the information. Paired samples t tests revealed that lay individuals (p < 0.001) and health professionals (p < 0.001) exhibited improved knowledge of breast cancer after attending the conference, used the information in their personal health care, and shared it with others, and some implemented education and screening programs. Of nonattendees, only the health professional group retained knowledge gain over time. A conference can produce increased knowledge about breast cancer and stimulate attendees to use information for themselves and share it with others. For lay persons, conference attendance is superior (p < 0.01) to written materials alone, in achieving long-term gain in knowledge.

Attitudes of medical students and primary care physicians regarding input of older and younger patients in medical decisions.

This study was designed to determine whether medical students, residents, and fully trained physicians differ in their attitudes toward decision-making input by older and younger patients, whether they believe that physicians should have greater input than patients in medical decisions, whether physicians grant different decision-making authority to younger versus older patients, and whether physician gender affects attitudes toward patient input in medical decisions. Respondents (n = 818) were first- (n = 311) and third-year (n = 227) medical students and family practice and internal medicine residents (n = 120) and faculty (n = 160) from the University of Kansas Medical Center (n = 367) and The Ohio State University Hospital (n = 451) who completed the Beisecker Locus of Authority: Geriatrics Scale to assess attitudes regarding involvement in medical decision making for either a 25- or 75-year-old patient. Respondents were alternately assigned to one of the two patient age vignettes. Analyses included descriptive statistics, t tests, and four-way analysis of variance. Ninety percent of respondents believed that physicians should have greater input in decisions than patients. Female respondents advocated greater patient input than male respondents. As training and experience increased beyond medical school, there was an increased tendency toward belief in physician-only decision making. For the older patient, residents advocated the most patient input and faculty advocated the least. Level of training influenced belief in patient input when its interaction with patient age and institution were examined.

Changes in decisions by elderly persons based on treatment description.

BACKGROUND: We examined hypotheses that elderly persons refusing minimally described treatment might choose nonaggressive treatment if options were described, and that persons refusing treatment would want an active decision-making role. METHODS: One hundred fifty-one of 260 elderly volunteers recruited from 10 urban and suburban nutrition sites completed a self-administered questionnaire asking whether they would accept treatment of pneumonia in their current health status, in physical incapacity by stroke, or in early or late Alzheimer's disease. Subsequently, treatment choices ranging from oral antibiotics to ventilator use for severe pneumonia were described, and subjects again chose treatment for each situation. For each choice, subjects were asked who they wanted to make the decision. RESULTS: One hundred sixteen subjects (75% women, 78% white) passed a comprehension quiz about pneumonia, stroke, and Alzheimer's disease. When asked to decide on treatment of pneumonia before descriptions of treatment, 1.8% refused treatment in their current state of health, 29.8% in stroke, and 41.3% and 65.7% in early and late Alzheimer's disease, respectively. When treatment choices ranging from oral antibiotics to ventilator treatment were offered, treatment refusal was significantly less in the comorbid situations at 21.7% for stroke, and 30.8% and 51.4% for early and late Alzheimer's disease. However, less aggressive treatment was not chosen more often by persons who had initially refused treatment. For each comorbidity more refusers than acceptors chose to be the decision maker. CONCLUSIONS: Elderly persons are more likely to refuse treatment in situations of severe comorbidities, but accept treatment more often when different options are explained. Refusers may want a strong role in the decision.

Attitudes of oncologists, oncology nurses, and patients from a women's clinic regarding medical decision making for older and younger breast cancer patients.

To assess their attitudes toward patient input in medical decisions for breast cancer patients, 67 oncologists, 94 oncology nurses and 288 patients from a women's clinic completed the Beisecker Locus of Authority in Decision Making: Breast Cancer survey. Nurses and physicians responded in terms of a patient aged 40, 60, or 75 years. All groups believed that physicians should have the dominant role in decision making. Nurses felt that patients should have more input than patients or physicians felt they should. Physicians advocated the least patient input. Patient age was not a significant factor in explaining respondents' attitudes.

Patient information-seeking behaviors when communicating with doctors.

In order to better understand patient differences in question asking and other information-seeking behaviors when communicating with doctors, 106 rehabilitation medicine patients were studied. Sociodemographic data, attitude measures, interview data and tape recordings of doctor-patient encounters revealed that patients desired information about a wide range of medical topics but did not engage in many information-seeking behaviors when communicating with doctors. While desiring information, patients regarded doctors as the appropriate persons to make medical decisions. Regression analyses indicated that patient information-seeking behaviors were more directly associated with situational variables (length of interaction, diagnosis, reason for visit) than with patient attitudes or sociodemographic characteristics. Patient attitudes influenced patient information-seeking behaviors only for patients with interactions lasting at least 19 minutes, indicating that a longer interaction may be necessary for patient attitudes regarding desire for information and participation in medical decisions to manifest themselves in information-seeking communication behavior.

The influence of a companion on the doctor-elderly patient interaction.

Based on findings that elderly patients brought companions to their medical appointments more often than middle-aged patients, the influence of the companion was examined. Twelve of 21 patients 60 to 85 years old brought companions. There was no significant difference in length of interaction for patients with and without companions, indicating that companions, by speaking, took time away from patients. Doctors directed fewer comments to companions than companions directed to doctors, indicating that companions responded or initiated comments when doctors were not addressing them. Companions played three roles: watchdog, significant other, and surrogate patient.

Patients' perspectives of the role of care providers in amyotrophic lateral sclerosis.

Interviews with 41 patients with amyotrophic lateral sclerosis regarding their perspectives of the roles of doctor, nurse, and allied health personnel showed that emotional support, information, and access to assistive devices were the primary expectations that they held for each of these professional roles. In addition, physicians were expected to evaluate the progress of the disease, help with immediate problems, and continue research to find a cure. Patients wanted to see a physician at each clinic visit. In being given the diagnosis of amyotrophic lateral sclerosis, patients expected the physician to be straightforward, honest but not premature, sensitive to patients' readiness for information, and to convey some degree of hope. Patients were accurate in their knowledge of the disease, but came to the clinic expecting help in managing the illness.