Understanding the needs of colorectal cancer patients during the pre-diagnosis phase.

Patients with colorectal cancer (CRC) face a number of challenges leading up to diagnosis; however, research is limited regarding their specific needs during the pre-diagnosis period. A multicenter cross-sectional survey was conducted to elicit information about the CRC experience during the pre-diagnosis phase. Across the three sites, 104 eligible patients were approached, and 82 patients completed the survey, for a total response rate of 78.9%. The needs most identified by participants during the pre-diagnosis period were informational (31.6%) and emotional (20.3%) needs; social needs were rated as the least important need for these patients (7%). The majority (84.0%) reported that these needs were met. Participants reported feeling shocked or overwhelmed on learning of their diagnosis (57.1%) and high levels of anxiety during this time (40.0%). The majority (77.9%) of participants reported that they were not directed to any resources to help address their anxiety. Informational and emotional needs are identified as the most important needs during the pre-diagnosis phase, and for most these needs are being met; however, some participants are experiencing high levels of anxiety without access to appropriate resources. Further work is required to understand the optimal mechanisms to address identified needs during this pre-diagnosis period and to assess the potential benefits and costs of addressing these needs.

Understanding the needs of lung cancer patients during the pre-diagnosis phase.

Patients with lung cancer have numerous and varying needs spanning across the cancer trajectory; however, only limited research has focused specifically on the pre-diagnosis phase. A multicentre cross-sectional survey was conducted to explore the experience of lung cancer patients during the pre-diagnosis phase. High levels of anxiety were reported by many participants (45.6 %). Informational (32.1 %), and emotional (24.1 %) needs were reported as most important; the majority (89.0 %) reported these needs were met. Most participants sought information throughout, with many (38.6 %) rating their oncology health care providers to be the best source of information. The majority (70.0 %) reported that they were not directed to any resources to help address their anxiety. During pre-diagnosis, informational and emotional needs appear most important, and for the majority, these were reportedly met. Although many experienced high levels of anxiety, few were directed to resources to address it.

Tobacco cessation Clinical Practice Guideline use by rural and urban hospital nurses: a pre-implementation needs assessment.

BACKGROUND: This study was a pre-program evaluation of hospital-based nurses' tobacco intervention beliefs, confidence, training, practice, and perceived intervention barriers and facilitators. It was designed to identify relevant information prior to implementing tobacco cessation guidelines across a large northern rural region, home to 1 urban and 12 rural hospitals. METHODS: This cross-sectional survey was distributed by nurse managers to nurses in the 13 hospitals and returned by nurses (N = 269) via mail to the researchers. RESULTS: Nurses were somewhat confident providing cessation interventions, agreed they should educate patients about tobacco, and 94% perceived tobacco counselling as part of their role. Although only 11% had received cessation training, the majority reported intervening, even if seldom--91% asked about tobacco-use, 96% advised quitting, 89% assessed readiness to quit, 88% assisted with quitting, and 61% arranged post-discharge follow-up. Few performed any of these steps frequently, and among those who intervened, the majority spent < 10 minutes. The most frequently performed activities tended to take the least amount of time, while the more complex activities (e.g., teaching coping skills and pharmacotherapy education) were seldom performed. Patient-related factors (quitting benefits and motivation) encouraged nurses to intervene and work-related factors discouraged them (time and workloads). There were significant rural-urban differences--more rural nurses perceived intervening as part of their role, reported having more systems in place to support cessation, reported higher confidence for intervening, and more frequently assisted patients with quitting and arranged follow-up. CONCLUSIONS: The findings showed nurses' willingness to engage in tobacco interventions. What the majority were doing maps onto the recommended minimum of 1-3 minutes but intervention frequency and follow-up were suboptimal. The rural-urban differences suggest a need for more research to explore the strengths of rural practice which could potentially inform approaches to smoking cessation in urban hospitals.

Brief smoking cessation interventions by family physicians in northwestern Ontario rural hospitals.

INTRODUCTION: We report on physicians' beliefs, confidence and clinical practice relative to the provision of smoking cessation interventions in northwestern (NW) Ontario, where tobacco use and tobacco-related disease prevalence are high and smoking cessation services are scarce. METHODS: Physicians working at the 12 rural hospitals in NW Ontario were eligible for inclusion in the study. Survey items included clinical practices based on the "5 A's" protocol for tobacco intervention, and beliefs about, confidence in, and barriers and facilitators to intervention. RESULTS: Physicians from 8 of the 12 hospitals responded. Almost all (> 91%) reported positive beliefs about providing smoking cessation interventions and were confident intervening. Relative to the 5 A's protocol for tobacco intervention, 100% of respondents ask, advise, assess and assist patients to quit smoking, and 89% arrange follow-up. The most frequent methods of assistance included pharmacotherapy, suggestions of specific actions to make it easier to quit and recommendations for alternatives to tobacco use. The most frequent barrier to intervenion was lack of time. DISCUSSION: Based on respondents' positive beliefs, confidence and current clinical practice relative to tobacco interventions, physicians in NW Ontario seem well positioned to play a key role in helping to reduce the high rates of tobacco use and tobacco-related diseases by providing smoking cessation interventions to patients who have been admitted to hospital.

Screening new cancer patients for psychological distress using the hospital anxiety and depression scale.

The diagnosis of a life-threatening illness creates immediate psychosocial distress for the patient and his or her family. The threat is real and the rational response is to be afraid. We need to be reaching out to patients and their families and not waiting for crises. The responsibility remains with the healthcare system and psychosocial healthcare professionals to identify those who are in most need. Psychological distress is something that can be relatively easily measured and responded to when psychosocial oncology healthcare professionals are immediately available to address those needs. This paper describes the process used to gather this information, how that information has been used by the psychosocial clinicians in the Supportive Care programme, and what we have learned, in terms of a retrospective data analysis, about our patient population. At the Cancer Centre in Thunder Bay, Ontario, Canada new cancer patients complete the HADS on the day of their first appointment. Since October 2000 we have collected baseline psychological distress data for 3,035 new cancer patients who fully completed all 14 items on the HADS. Of those, 781 patients, or 25.7%, scored above cut-off points and were given a telephone call. We were able to contact 607 (or 77.7%) of these patients. Five hundred and eight (or 83.7%) of those contacted made, and subsequently attended, one or more appointments with a psychosocial counsellor.

Coping with cancer: what do patients do.

Although psychosocial coping techniques and supportive care services have been shown to improve cancer patients' quality of life, there is evidence that many of these strategies have not been widely integrated into the routine care of cancer patients. This study examined: (1) the extent to which cancer patients use certain coping strategies; (2) reasons for non-use; (3) perceived effectiveness of the coping strategies; (4) participants' interest in trying the strategies; and (5) if the strategies were recommended to participants. At the Northwestern Ontario Regional Cancer Centre in Thunder Bay, Ontario, Canada, 292 outpatients (98% response rate) completed an in-person interview with a research assistant concerning seven individual coping strategies (music, breathing exercises, meditation, prayer, muscle relaxation, visualization/imagery, hypnosis/self-hypnosis) and four coping strategies offered through supportive care services (individual counselling, family counselling, support groups, religious support). Of all the coping strategies presented, prayer was used by the highest number (n = 186) of participants (64%). Music was the next most commonly used strategy, used by 43% (n = 124) of participants, and all other strategies were used by less than 30%of participants. The individualized approaches that are used for disseminating disease and treatment information to cancer patients should also be used to provide them with information on effective coping strategies.