Perceived barriers and facilitators to physical activity in men with prostate cancer: possible influence of androgen deprivation therapy.

While physical activity is beneficial for men with prostate cancer, too few perform sufficient activity for such benefit. This study examined perceptions of men with prostate cancer of their barriers and facilitators to physical activity, and how androgen deprivation therapy (ADT) may influence these perceptions. Two focus groups were conducted, involving six ADT and eight non-ADT patients respectively. Data were transcribed verbatim and themes developed using a general inductive thematic approach. Facilitators to physical activity common to both groups of cancer survivors included clinician and spousal involvement, with pre-existing co-morbidities and increased age cited as barriers by both groups. The ADT subgroup cited personal involvement as a facilitator to physical activity, with fatigue, reduced motivation and a relative lack of specific advice from their clinician as additional barriers. The non-ADT subgroup had no additional facilitators to physical activity but cited time constraints as a barrier. These results highlight the important role that cancer clinicians and spouses play in promoting physical activity for men with prostate cancer and how ADT may influence their other facilitators and barriers. As physical activity is beneficial for prostate cancer survivors, especially those on ADT, cancer clinicians should regularly discuss physical activity with their patients.

Early clinical exposure to people who are dying: learning to care at the end of life.

BACKGROUND: The nature of medical care at the end of life and, in particular, the way in which caring is learned remain problematic for medical educators and the profession. Recent work has indicated that doctors learn to care, in an emotional and intimate way, from people who are dying. METHODS: This paper reports on the development of a programme designed for medical students in their first clinical year who spend time with a person who is dying and their family. The students are required to produce a portfolio assignment that includes a personal reflection of the experience. The findings from a phenomenological study undertaken using these personal reflections are reported. These reflections and comments are interpreted as being embedded in five key themes. RESULTS: The actual encounters differed from the medical students' anticipation of them. Students identified an emotional component to the experience; they explored their own and the patient's understandings of spirituality; they reflected on personal meanings of the encounter and they suggested ways in which they might learn to care more effectively for people who are dying. DISCUSSION: The way in which many of these students approach end-of-life care has been altered through a transformative educational experience that encouraged them to draw on their own experiences and skills. Their learning was facilitated by the writing of accounts and the discussion that each group held with teaching staff at the conclusion of the programme.

On reflection: doctors learning to care for people who are dying.

Humane care is an essential component of the doctor's role at the end of life. Over the last 20 years, there has been a steady global increase in the extent and variety of medical teaching about the care of people who are dying. In some countries, palliative medicine is now recognised as a discrete medical specialty. Rightly, much emphasis has been placed on symptom management, communication skills and ethical issues. But rarely does the concept of care, or how doctors learn to care, emerge in the medical literature. The concept of "care" is usually defined as a professional behaviour: attending to a patient's needs. Yet, the concept of care also requires a professional commitment on a more holistic level. To care is to be receptive to and responsible for others. This is care motivated by true empathy: a concern for the patient's well-being that comes from a sensitive identification with the patient's situation. This paper reports some of the findings from an interpretive phenomenological study involving 10 doctors and their experiences of learning to care for people who were dying. The doctors came from differing medical disciplines and had varying levels of experience. During the interviews the doctors retrospectively identified "turning points" at which they first perceived some notion of what it means to care for someone who is dying. The doctors often used poignant language when recollecting the strong feelings associated with these critical incidents. They felt that their training had been inadequate in preparing them for such care. The article asks whether their medical education had adequately prepared these doctors for this key element of their work. It recommends ways in which practitioners may be better prepared to care for people who are dying.

Improving the effectiveness of palliative care education.

Over the last three decades palliative care has emerged as a discrete specialty that has brought with it a developing field of education. Problematic areas have been identified within palliative care education that may limit its effectiveness. Areas of particular concern are identified that may prove obstructive in the pursuit of effectiveness in palliative care education. The possibility of developing performance indicators is explored with reference to the development of such indicators in other areas of education. Proposals are made as a starting point for the evolution of such indicators.

Evaluating palliative care education.

This paper illustrates the evaluation of some of the effects of a 3-day workshop for principals and trainees in general practice on a number of aspects of palliative care, using pre-, immediate and late post-tests. Further qualitative evaluation is attempted by including a questionnaire with the late post-test. The evaluation is to demonstrate significant shifts, or differences, in confidence in dealing with physical and psychosocial symptoms, and in participants' perceived ability to cope, and to support these findings with qualitative data where appropriate.

The problematic nature of education in palliative care.

As the need for palliative care increases, palliative care is emerging as a field of medical care in its own right. At the same time there are many aspects of palliative care that are problematic, particularly in palliative care education. The aspects reviewed here include: (a) the lack of a long tradition and adequate conceptualization of palliative care; (b) the significance of psychological, emotional, and spiritual aspects; (c) the importance of but inadequate understanding of symptom control; (d) the fact that palliative care is not curative in the accepted sense; (e) its multiprofessional nature; (f) the range of different settings of palliative care; and (g) the fact that palliative caregivers have to perform their duties in situations where the emotional and psychological demands on them may be immense. A number of general issues relevant to palliative care education are also reviewed.

Education in palliative medicine: a review.

The development of the specialty of palliative medicine has produced variable activity in the field of medical education. This article reviews published papers (primarily from Europe but with reference to other countries) identifies the extent of activity, and notes the absence of evaluative work. Undergraduate and postgraduate activity is identified.

Teaching hospice medicine to medical students, house staff, and other caregivers in the United Kingdom.

This paper outlines the development of a medical education programme within the existing programme of the Macmillan Education Centre of the Dorothy House Foundation, Bath, England, between 1989 and 1992. A review of some of the significant contributions to the literature in this area is followed by a description of the initial research that was instrumental in designing these courses. A review of activities of the Centre is reported. A more detailed description of a course specifically designed for family doctors is made. A natural development from that course was one for all disciplines involved in caring for the terminally ill--this is described--along with some of the difficulties of such a method of education. Reference is made to evaluative work undertaken with reporting of initial data and work still in progress. Conclusions are drawn about the nature of such workshops and comment made on the role of facilitation.

Teaching palliative care in general practice: a survey of educational needs and preferences.

We surveyed general practitioners in the Bath District Health Authority to determine their educational needs in palliative care and their preferred methods of learning, in order to develop an appropriate education program. The survey confirmed our ideas as to the content of the program. There was support for our hypothesis that the majority would favor didactic approaches and would feel generally uncomfortable with experiential methods. The issue of professionals' needs in stressful situations proved to be a surprisingly strong one.

CELL DOUBLING TIME IN THE APICAL MM OF ELONGATING LATERAL ROOTS OF VICIA FABA L.

Cell doubling time was determined in several ways in the apical mm of newly emerged, 0·2, 1 and 4 cm long lateral roots of Vicia faba L. and in every case it tended to decrease with increase in root length. Similar values were obtained in the roots of each length investigated when cell doubling time was calculated from the rate of passage of cells into the period of DNA synthesis (S) in both control and colchicine treated roots and from the rate of accumulation of cells in metaphase in the presence of colchicine, assuming cell number increased exponentially, i.e. colchicine had not affected the rate of entry of cells into mitosis or S during the 3 to 6 h period over which measurements were taken. A discrepancy was found, however, between the values determined for cell doubling time obtained from these rates and those calculated on the basis of the method devised by Evans and his co-workers (Evans, Neary and Tonkinson, 1957). Possible reasons for such a discrepancy are discussed.