EMBRACE (Empowering Medical students' skills in BReaking bAd news with Compassion and Empathy) module improves the skills of undergraduate medical students in effectively breaking the bad news: a case-control study.

Effective communication skills are pivotal in health care, particularly when conveying distressing information to patients and their families. However, medical education still lacks the adoption of a universal model that can be incorporated into the curricula to train and assess students in effectively communicating with patients. This study aims to assess the impact of training undergraduate medical students to deliver bad news effectively using the Empowering Medical students' skills in BReaking bAd news with Compassion and Empathy (EMBRACE) module. This randomized case-control study involved medical students from the first, second, and third professional years (study group, n = 75; control group, n = 75). For the study group, the EMBRACE modules were distributed. Then, a 1-hour training session on effectively delivering bad news was followed by a multiple-choice question test and objective structured clinical examination with response, interpretation, and communication skills stations. Participants' feedback was obtained on a five-point Likert scale. There was a highly significant improvement in knowledge and skills among the study group compared to controls with a P value less than 0.0001. Of the participants, 98.76% perceived that the training equipped them with practical skills, and 98.77% felt that the facilitator had demonstrated the steps of delivering bad news clearly and effectively. Only 4.44% of participants were confident in effectively interacting with patients before the session, and an overwhelming 81.11% gained confidence in their communication skills after the training. With demonstrated significant improvement in knowledge and skills, this study supports the adoption of EMBRACE modules in undergraduate medical education, ultimately improving patient experiences, doctor-patient relationships, and health outcomes.NEW & NOTEWORTHY The Empowering Medical students' skills in BReaking bAd news with Compassion and Empathy (EMBRACE) module is noteworthy for its holistic approach to training medical students in the delicate art of delivering distressing news to patients. It not only incorporates the evidence-based setting, perception, invitation, knowledge, emotions, and strategy (SPIKES) method but also distinguishes itself by providing real-life conversation examples and self-assessment cases, which make the training highly relatable and practical for students to actively engage in their learning and personal development.

A coisa em psicanálise e o objeto no lísis de Platão / The thing in psychoanalysis and object in Plato's lysis / La cosa en psicoanálisis y el objeto en lisis de Platón

Este artigo propõe o estudo sobre o conceito de outro como semelhante e como objeto. Partindo de textos que interpelam a alteridade na psicanálise e remetendo aos temas do complexo semelhante, da satisfação, da perda, do luto, da negativa, da repetição; avalia o conceito de outro articulando textos de diversos autores. A partir da psicanálise freudiana, estuda o das Ding e a negação, discriminando com estes termos um objeto estruturante na origem do psiquismo. Aborda textos técnicos da psicanálise para delimitar o tema da repetição. Também a recordação e a repetição são vinculadas ao objeto e estudadas na perspectiva da filosofia moderna. São retomados temas do diálogo platônicos para definir o lugar do erótico e da amizade. No fim do presente artigo, propomos o termo clássico grego Oikos com valor equivalente ao da Coisa freudiana e como esta aparece em escritos psicanalíticos.(AU)

This article studies the concept of other as similar and object. It is based on texts that question the alterity in psychoanalysis and refers to the themes of otherness complex, loss, grief, negative, repetition, and evaluates the concept of other, using articles of diverse authors. Based on Freudian psychoanalysis, it studies the Thing and the denial and discriminates a structuring object in the origin of psychism. It approaches technical texts of psychoanalysis to delimitate the theme of repetition. The recordation and repetition are also linked to the object and studied from the perspective of modern philosophy. Themes of the platonic dialogues are resumed to define the place of the erotic and the friendship. In the end of the article, we propose the greek classic term Oikos, with equal value to the Freudian Thing, as this one appears in psychoanalytic writings.(AU)

Este artículo estudia el concepto Otro como semejante y como objeto. A partir de textos que interpelan la alteridad en psicoanálisis y que se refieren a temas del complejo semejante, de la satisfacción, de la pérdida, del duelo, de la negación, de la repetición, se evalúa el concepto de Otro articulando textos de diferentes autores. Basado en el psicoanálisis freudiano, se aborda Ding y la negación, discriminando con estos términos un objeto estructurante en el origen de lo psíquico. Se abordan textos técnicos del psicoanálisis para delimitar el tema de la repetición; el recuerdo y la repetición son vinculadas al objeto y estudiadas desde la perspectiva de la filosofía moderna; y se retoman temas de los diálogos platónicos para definir el lugar de lo erótico y la amistad. Al culminar este artículo se propone leer el término griego clásico Oikos con un valor equivalente al de la Cosa freudiana como aparece en los escritos psicoanalíticos.(AU)

Prevalence of complementary and alternative medicine despite limited perceived efficacy in patients with rheumatic diseases in Mexico: Cross-sectional study.

INTRODUCTION: Complementary and alternative medicine (CAM) is frequently used by patients with rheumatic diseases (RD) to improve their symptoms; however, its diversity and availability have increased notably while scientific support for its effectiveness and adverse effects is still scarce. OBJECTIVE: To describe the prevalence and diversity of CAM in patients with RD in Chihuahua, Mexico. METHODS: A cross-sectional study was conducted in 500 patients with RD who were interviewed about the use of CAM to treat their disease. The interview included sociodemographic aspects, characteristics of the disease, as well as a description of CAM use, including type, frequency of use, perception of the benefit, communication with the rheumatologist, among others. RESULTS: The prevalence of CAM use was reported by 59.2% of patients, which informed a total of 155 different therapies. The herbal CAM group was the most used (31.4%) and included more than 50 different therapies. The use of menthol-based and arnica ointments was highly prevalent (35%). Most patients (62.3%) reported very little or no improvement in their symptoms. Only a fourth of the patients informed the rheumatologist of the use of CAM. The use of CAM was influenced by female sex, university degree, diagnosis delay, lack adherence to the rheumatologist's treatment, family history of RD, and orthopedic devices. CONCLUSION: The use of CAM in our population is highly prevalent and similar to reports in different populations suggesting a widespread use in many different societies. We found high use of herbal remedies; however, there were many different types suggesting a lack of significant effect. Patients continue using CAM despite a perception of no-effectiveness. Recurrent use of CAM is explained by factors other than its efficacy.

Genital herpes - diagnosis, treatments, attitudes and response to disclosure amongst members of the UK Herpes Viruses Association.

A diagnosis of genital herpes may result in psychological as well as physical morbidity. Many patients require on-going help and contact the Herpes Viruses Association (HVA), a UK patient support organisation. The HVA conducts occasional questionnaires relating to various issues surrounding herpes and this study reports on a survey conducted amongst members in 2015. The survey was done using SurveyMonkey and covered diagnosis/treatment, both allopathic and self-help, physical and psychological impact and disclosure to partners. Three hundred and fifty-eight women and 103 men completed the questionnaire. Male respondents were older than women (48.6 versus 42.9 years). The majority were first diagnosed in sexual health clinics. A high proportion had informed partners about the diagnosis and in 83% disclosure did not result in rejection. 57% were taking prophylaxis with more taking treatment episodically rather than continually; 11.3% sourced medications on-line. Alternative treatments were used commonly with Lomaherpan cream (Melissa officinalis), lidocaine ointment and a diet with reduced arginine and increased lysine the most frequent choices. Other alternative treatments included olive leaf extract, Eleuthercoccus senticosus and vitamin supplements. Women reported being troubled psychologically more than men. Neuropathic pain was reported by 80.4% of the women and 64.1% of the men. Although antiviral treatment is cheap and well-tolerated it is still being refused by some healthcare providers. There still appears to be a considerable degree of stigma experienced by patients which can be mitigated by support from patients' support groups such as the HVA.

Announcing fetal pathology: Challenges encountered by physicians and potential role of simulation in training for breaking bad news.

BACKGROUND: Informing couples about the diagnosis of severe fetal pathologies is part of the daily routine in fetal medicine. This situation is usually complex and can put untrained professionals in an uncomfortable position. The aim of this study was to assess the perception of health care professionals when faced with the need to announce a fetal pathology in order to target their training gaps in this domain. MATERIALS AND METHODS: A questionnaire was created and disseminated on a national level among physicians practicing or collaborating with the multidisciplinary centers of prenatal diagnosis in France. The questionnaire focused on the difficulties encountered by practitioners when announcing fetal pathologies, and their potential interest in simulation sessions regarding the delivery of bad news. RESULTS: 193 participants filled the questionnaire. 65 % report not receiving any theoretical courses in this field during their initial training, 49 % admit feeling uncomfortable when a fetal anomaly needs to be announced, 79.5 % think that role-play could help them, 87.5 % believe that training sessions in communication skills would help improve their methods and 73.1 % support teaching the delivery of bad news by simulation sessions. CONCLUSION: This survey illustrates the significance of announcing a fetal pathology for fetal medicine professionals. Many of them report not being properly trained to cope with this situation and would like to improve with a more practical way of teaching. Simulation would be the ideal educational tool to meet this demand.

Mindfulness Improves Otolaryngology Residents' Performance in a Simulated Bad-News Consultation: A Pilot Study.

INTRODUCTION: Delivering bad news is a stressful moment for both patient and clinician. As poor bad-news consultation quality may lead to misunderstandings, lack of treatment adherence, acute or even post-traumatic stress in patients, training interventions to improve communication skills and stress-management are necessary. Mindfulness is a recognised stress-management strategy that has shown its efficacy in reducing stress in both health professionals and students. We then supposed that a short mindfulness meditation session performed just before a simulated breaking bad-news consultation to patients with laryngeal cancer may help ear, nose and throat (ENT) residents to master their stress and improve their management of this consultation. This study aims at showing how a short mindfulness meditation performed before a simulated bad-news consultation may improve performance in its realisation by ENT residents. MATERIALS AND METHODS: We enrolled 53 ENT residents, randomised in 2 groups. The first group completed a 5-minute mindfulness session while the other group listened to a control track. Thereafter, every resident completed an 8-minute simulated bad-news consultation with a standardised patient. Two blinded expert assessors evaluated their performance on a 25-point grid (BNC-OSAS). Residents self-assessed their stress before and after the intervention and simulated patients rated their perception of physician's empathy. RESULTS: The performance was significantly better in the mindfulness group than in the control group (m = 19.8, sd = 3.2 and m = 17.4, sd = 3.7 respectively, F(1,45)=5.27, p = 0.026, d = 0.67), especially in the communication and knowledge subdomains. There was no significant difference in perceived stress between the 2 groups. Empathy perceived by simulated patients was positively correlated to residents' performance. CONCLUSION: A short mindfulness meditation is effective for improving ENT residents' performance in a simulated bad-news consultation. These results encourage further assessments of this method with objective measures of physiological stress. More research is required concerning the feasibility and efficacy of mindfulness before daily clinical activities such as stressing bad-news consultation.

Genotype-first approach to the detection of hereditary breast and ovarian cancer risk, and effects of risk disclosure to biobank participants.

Genotype-first approach allows to systematically identify carriers of pathogenic variants in BRCA1/2 genes conferring a high risk of familial breast and ovarian cancer. Participants of the Estonian biobank have expressed support for the disclosure of clinically significant findings. With an Estonian biobank cohort, we applied a genotype-first approach, contacted carriers, and offered return of results with genetic counseling. We evaluated participants' responses to and the clinical utility of the reporting of actionable genetic findings. Twenty-two of 40 contacted carriers of 17 pathogenic BRCA1/2 variants responded and chose to receive results. Eight of these 22 participants qualified for high-risk assessment based on National Comprehensive Cancer Network criteria. Twenty of 21 counseled participants appreciated being contacted. Relatives of 10 participants underwent cascade screening. Five of 16 eligible female BRCA1/2 variant carriers chose to undergo risk-reducing surgery, and 10 adhered to surveillance recommendations over the 30-month follow-up period. We recommend the return of results to population-based biobank participants; this approach could be viewed as a model for population-wide genetic testing. The genotype-first approach permits the identification of individuals at high risk who would not be identified by application of an approach based on personal and family histories only.

Communication of bad news in pediatrics: integrative review.

OBJECTIVES: to identify the scientific evidence of the elements of communication in the process of communicating bad news in pediatrics. METHODS: integrative review searched in the LILACS, PubMed and WoS databases. Primary studies in Portuguese, Spanish or English were included. RESULTS: the evidence from the 40 studies were organized according to the elements of communication: sender (family and/or professional), receiver (family and/or child), message (bad or difficult news about diagnosis/prognosis; empathetically, honestly, objective, hopeful and available), channel (materials, quality, quantity and pace), context and effects (social and emotional changes), noise (feelings and language) and failures (silencing and misleading information). CONCLUSIONS: there is a need to prepare the institution and team, as well as the family and the child, in order to promote co-responsibility in this process, to minimize suffering and communication noise and to avoid failures, recognizing the child's right to know their condition.

Alibi believability: Corroborative evidence and contextual factors.

A disbelief in alibis is one contributor to wrongful convictions. One reason that triers-of-fact may disbelieve alibis is that they lack evidence to corroborate the whereabouts of the suspect at the time of the crime. Contextual factors, such as when the alibi was disclosed and what was the nature of the crime, can also affect alibi believability. This paper outlines two studies where mock jurors evaluated an investigation and trial description online and rated alibi believability, defendant character trait ratings, and verdicts. Both studies examined the impact of corroborative alibi evidence and the timing of the alibi disclosure. In addition, Study 1 included the type of crime and Study 2 included the number of alibi corroborators as additional independent variables. We hypothesized that alibis would be viewed more positively when they were disclosed earlier rather than later, were corroborated by strong physical evidence and multiple corroborators, and involved less violent offenses. As hypothesized, in both studies, alibis with strong physical evidence were thought to be more believable than those with no physical evidence but the number of corroborators and type of crime did not affect any dependent measures. Delayed timing had some negative effects on views of the defendant's character. Corroborative physical evidence affected alibi believability consistently, and contextual factors mattered less. Both implications and suggestions for future research are further discussed.

Effects on Medical Students of Longitudinal Small-Group Learning about Breaking Bad News.

INTRODUCTION: Delivering bad news is a difficult task for physicians, and medical schools do not always prepare future physicians for this inevitable task. OBJECTIVE: To examine training in breaking bad news, to improve medical students' competence and confidence in dealing with this important aspect of clinical practice. METHODS: An exploratory study using a qualitative approach was done at a Brazilian public university's medical school, which receives 30 medical students per semester. Two focus groups were conducted in 2018, with 15 students per group, before and after the training. The intervention consisted of a 6-month (4 h/wk) course about breaking bad news offered to 30 third-year medical students. The communication course included the perspectives of health care professionals, patients, and their families; the SPIKES protocol and the "ABCDE" mnemonic for delivering bad news; general guidelines; and role-playing/simulation strategies to improve students' skills and reduce their personal limitations. RESULTS: Results of the preintervention focus group demonstrated that only 30% of the students were aware of the importance of breaking bad news and of the existence of specific protocols to guide physicians in these situations. Findings from the postintervention focus group indicated that 90% of students understood the importance and began to apply protocols in their practice. DISCUSSION: Breaking bad news is a challenge for undergraduate medical students. The results of our qualitative study showed that students' perceptions about their capability in delivering bad news increased significantly after regular and focused training. The knowledge, skills, and attitudes acquired strengthened the students' self-reported ability to deal with situations requiring breaking bad news. CONCLUSION: The activities offered helped students develop communication skills. They made connections between their formal training (communication and cognitive skills) and actual clinical practice in a community-based rotation. The knowledge and skills acquired gave them tools needed to deliver bad news in their future clinical practice.

Assessing Children's Credibility in Courtroom Investigations of Alleged Child Sexual Abuse: Suggestibility, Plausibility, and Consistency.

As children's testimonies of child sexual abuse (CSA) often lack concrete evidence to corroborate a child's claims, attorneys devote a substantial amount of time to establishing a child as credible during the course of a trial. Examining 134 CSA victim testimonies for children aged 5-17 (M = 12.48, SD = 3.34; 90% female), we explored how attorneys assess child credibility through specifically targeting children's suggestibility/honesty, plausibility, and consistency. Results revealed that while prosecutors examine plausibility more often to establish credibility, defense attorneys focus their assessments on suggestibility/honesty and potential inconsistency. However, both attorneys asked many more questions about children's consistency than any other area of potential credibility. Furthermore, while prosecutors ask proportionally more credibility-challenging questions of older children, the defense do not. These results suggest that prosecutors may be missing an opportunity to establish children as honest and consistent and elucidate a need to train attorneys on the implications of children's inconsistencies, suggestibility, and plausible abuse dynamics.

A cross-sectional survey of pregnant women's perceptions of routine domestic and family violence screening and responses by midwives: Testing of three new tools.

BACKGROUND: Implementing Domestic and Family Violence (DFV) screening, support, and prevention within maternity services is becoming common practice but women's experiences of screening are not routinely evaluated. AIMS: (1) Explore pregnant women's experiences of routine DFV screening and perceptions of responses by midwives; and (2) undertake preliminary testing of three new tools. METHODS: Using a cross-sectional design, pregnant women (n = 210) attending an antenatal service were surveyed. Three new measures: beliefs about DFV screening; non-disclosure of DFV; and midwifery support were tested. RESULTS: Most women (92.3% n = 194) recalled being screened. Twelve (5.8%) respondents had/were experiencing DFV. A quarter (24.1% n = 49) had experienced or witnessed violence in the home as a child. The scales were reliable and factor analysis established validity. Women reported positive beliefs (mean 35.38, SD 3.63 range 19-40) and views about midwifery support (mean 24.88, SD 3.08 range 18-30). There was less agreement about why some women do not disclose DFV (mean 21.97, SD 4.27, range 8-30). Women who experienced or witnessed violence as a child, or were experiencing violence now were less comfortable with screening. Comments (n = 75) revealed support for routine enquiry that was confidential, explained, and occurred in a trusting relationship. DISCUSSION: Women were supportive of screening, but actual rates of disclosure were low. Women acknowledged the importance of screening but did not want their information shared. CONCLUSIONS: Women value screening, even if DFV is not disclosed. Exploring women's experiences is central to ensuring quality care.

Regarding the Yin and Yang of Precision Cancer- Screening and Treatment: Are We Creating a Neglected Majority?

In this commentary, we submit that the current emphasis of precision cancer screening and treatment (PCST) has been to provide and interpret the implications of "positive" screening results for those deemed to be at greatest risk for cancer or most likely to benefit from targeted treatments. This is an important, but proportionately small target group, regardless of the cancer context. Overlooked by this focus is the larger majority of those screened who receive "negative" results. We contend that for optimal dissemination of PCST, the complement of positive and negative results be viewed as an inseparable yin-yang duality with the needs of those who receive negative screening results viewed as important as those deemed to be at highest risk or derive targeted treatment benefit. We describe three areas where communication of negative PCST results warrant particular attention and research consideration: population-based family history screening, germline testing for hereditary cancer syndromes, and tumor testing for targeted cancer treatment decision-making. Without thoughtful consideration of the potential for negative results to have psychological and behavioral influences, there is a potential to create a "neglected majority". This majority may be inclined to misinterpret results, disseminate inaccurate information to family, dismiss the credibility of results, or become disillusioned with existing medical treatments.

Efficacy of a Short Role-Play Training on Breaking Bad News in the Emergency Department.

INTRODUCTION: Breaking bad news (BBN) in the emergency department (ED) represents a challenging and stressful situation for physicians. Many medical students and residents feel stressed and uncomfortable with such situations because of insufficient training. Our randomized controlled study aimed to assess the efficacy of a four-hour BBN simulation-based training on perceived self-efficacy, the BBN process, and communication skills. METHODS: Medical students and residents were randomized into a 160-hour ED clinical rotation without a formal BBN curriculum (control group [CG], n = 31) or a 156-hour ED clinical rotation and a four-hour BBN simulation-based training (training group [TG], n = 37). Both groups were assessed twice: once at the beginning of the rotation (pre-test) and again four weeks later. Assessments included a BBN evaluation via a simulation with two actors playing family members and the completion of a questionnaire on self-efficacy. Two blinded raters assessed the BBN process with the SPIKES (a delivery protocol for delivering bad news) competence form and communication skills with the modified BBN Assessment Schedule. RESULTS: Group-by-time effects adjusted by study year revealed a significant improvement in TG as compared with CG on self-efficacy (P < 0.001), the BBN process (P < 0.001), and communication skills (P < 0.001). TG showed a significant gain regarding the BBN process (+33.3%, P < 0.001). After the training, students with limited clinical experience prior to the rotation showed BBN performance skills equal to that of students in the CG who had greater clinical experience. CONCLUSION: A short BBN simulation-based training can be added to standard clinical rotations. It has the potential to significantly improve self-efficacy, the BBN process, and communication skills.

The experiences of patients and their family members when receiving bad news about cancer: A qualitative meta-synthesis.

OBJECTIVE: This qualitative meta-synthesis explored the subjective experiences of patients and their family members when receiving bad news about cancer, with a focus on what was important to them during this process and making future recommendations. METHODS: A search of five electronic databases yielded 587 different records that resulted in 88 articles assessed against the inclusion/exclusion criteria. With the supplement of four additional records, 29 articles were analysed using thematic synthesis. A quality appraisal checklist was used to provide further information about the included articles. RESULTS: Patients and family members experienced receiving bad news as a process that involved three phases, labelled as follows: "preparation", "delivery", and "adjusting and coping". The "preparation" phase had four themes: the setting, developing a relationship, knowing the patient, and forewarning. Four themes were identified during the "delivery" phase: emotional reactions, empathy not sympathy, active participation, and understanding. "Adjusting and coping" comprised four themes: hope, holistic support, being a protector, and ongoing relationships. CONCLUSIONS: Receiving bad news is a significant experience for patients and family members. They want bad news delivered in an appropriate setting, in a manner consistent with their personal preferences, and have their psychological needs attended to within the context of an established relationship. Healthcare professionals can be assisted to deliver bad news in the best way possible by additional training and their workplace institutions providing quiet, private rooms, and sufficient time. Future research is needed to better understand family members' experiences and needs.

Hospice for the Primary Care Physician.

Hospice is a model of care that offers significant benefits to patients at the end of their lives, their families, and also to the primary care physicians who have diligently cared for their patients. As comprehensive care physicians, primary care physicians can benefit from a strong understanding of hospice and the Medicare Hospice Benefit. This article describes the history of hospice, palliative care versus hospice care, clinical appropriateness of the hospice patient, the regulatory guidelines of the Medicare Hospice Benefit, hospice reimbursement, primary care reimbursement, and employment opportunities in hospice.

Exploring the utility of internal whistleblowing in healthcare via agent-based models.

OBJECTIVE: The benefits of internal whistleblowing or speaking-up in the healthcare sector are significant. The a priori assumption that employee whistleblowing is always beneficial is, however, rarely examined. While recent research has begun to consider how the complex nature of healthcare institutions impact speaking-up rates, few have investigated the institutional processes and factors that facilitate or retard the benefits of speaking up. Here we consider how the efficacy of formal inquiries within organisations in response to employees' speaking up about their concerns affects the utility of internal whistleblowing. DESIGN: Using computational models, we consider how best to improve patient care through internal whistleblowing when resource and practical limitations constrain healthcare operation. We analyse the ramifications of varying organisational responses to employee concerns, given organisational and practical limitations. SETTING: Drawing on evidence from international research, we test the utility of whistleblowing policies in a variety of organisational settings. This includes institutions where whistleblowing inquiries are handled with varying rates of efficiency and accuracy. RESULTS: We find organisational inefficiencies can negatively impact the benefits of speaking up about bad patient care. We find that, given resource limitations and review inefficiencies, it can actually improve patient care if whistleblowing rates are limited. However, we demonstrate that including softer mechanisms for internal adjustment of healthcare practice (eg, peer to peer conversation) alongside whistleblowing policy can overcome these organisational limitations. CONCLUSION: Healthcare organisations internationally have a variable record of responding to employees who speak up about their workplace concerns. Where organisations get this wrong, the consequences can be serious for patient care and staff well-being. The results of this study, therefore, have implications for researchers, policy makers and healthcare organisations internationally. We conclude with a call for further research on a more holistic understanding of the interplay between organisational structure and the benefits of whistleblowing to patient care.

Impacts of apolipoprotein E disclosure on healthy Asian older adults: a cohort study.

BACKGROUND: The apolipoprotein E (APOE) genotype provides information about Alzheimer's disease risk, yet genotype disclosure is discouraged due to concerns about possible distress. This is the first study investigating the psychological and behavioral impacts that genetic susceptibility testing for Alzheimer's disease has in an Asian population. METHODS: From March 2016 to November 2017, we ran a prospective cohort study at Duke-National University of Singapore Medical School. 280 healthy Chinese elderly filled in questionnaires that measured psychological symptoms and health behaviors, 1 week before and 6 weeks after APOE genotype disclosure. Responses from ε4-positive subjects (associated with greater Alzheimer's disease risk) were compared to responses from ε4-negative subjects. RESULTS: ε4 presence was not significantly associated with anxiety (p = 0.09) or depression (p = 0.25). No associations were found for changes to diet (p = 0.36), dietary supplements consumption (p = 0.90), physical activity (p = 0.15), or cognitive activity (p = 0.18). CONCLUSION: There is no evidence to suggest that disclosure of APOE to Asian populations was associated with any short-term adverse psychological or behavioral impacts.

Disclosure of complementary medicine use to medical providers: a systematic review and meta-analysis.

Concomitant complementary medicine (CM) and conventional medicine use is frequent and carries potential risks. Yet, CM users frequently neglect to disclose CM use to medical providers. Our systematic review examines rates of and reasons for CM use disclosure to medical providers. Observational studies published 2003-2016 were searched (AMED, CINAHL, MEDLINE, PsycINFO). Eighty-six papers reporting disclosure rates and/or reasons for disclosure/non-disclosure of CM use to medical providers were reviewed. Fourteen were selected for meta-analysis of disclosure rates of biologically-based CM. Overall disclosure rates varied (7-80%). Meta-analysis revealed a 33% disclosure rate (95%CI: 24% to 43%) for biologically-based CM. Reasons for non-disclosure included lack of inquiry from medical providers, fear of provider disapproval, perception of disclosure as unimportant, belief providers lacked CM knowledge, lacking time, and belief CM was safe. Reasons for disclosure included inquiry from medical providers, belief providers would support CM use, belief disclosure was important for safety, and belief providers would give advice about CM. Disclosure appears to be influenced by the nature of patient-provider communication. However, inconsistent definitions of CM and lack of a standard measure for disclosure created substantial heterogeneity between studies. Disclosure of CM use to medical providers must be encouraged for safe, effective patient care.