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1.
J Oncol Pharm Pract ; 26(1): 124-132, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31106664

RESUMO

INTRODUCTION: Biosimilar drugs have significantly shaken the global pharmaceutical market through a better access to the health care services. The aim of this study is to establish a state of play in Tunisia based on the knowledge and perceptions of doctors on biosimilars in order to identify the problems related to these drugs and to propose solutions for improvement. MATERIALS AND METHODS: In our study, we conducted a prospective, descriptive survey using a questionnaire, destinated to oncologists and hematologists with different grades, from both public and private sectors and from several regions. The questions focused on physicians' general knowledge of biosimilars and their comparison with reference on safety, quality, efficacy, and indication. Finally, we explored the proportion of physicians who are favorable to the policy encouraging biosimilar use. RESULTS: One hundred and seven doctors among 150 answered the questionnaire; 57% were oncologists and 43% were hematologists. About one over five physicians defines biosimilar as a chemical drug. About 29% do not differentiate between a biosimilar and a generic one. A percentage of 68 believe that a biosimilar can have all the indications of its reference following complementary clinical studies. On the other side, 68.2% support the policy encouraging these drugs. Last, only 3.7% of the practitioners believe that they are well informed about biosimilars. DISCUSSION: Our results are comparable to other surveys described in the literature. However, this is the first study that targets oncologists and hematologists specifically. CONCLUSION: Our study showed a lack of information from oncologists and hematologists about biosimilars in Tunisia. Thus, health authorities should carry out training programs on biosimilars and introduce clear and effective legislation in order to allow better access to health care services.


Assuntos
Atitude do Pessoal de Saúde , Medicamentos Biossimilares/uso terapêutico , Hematologia/normas , Oncologistas/normas , Inquéritos e Questionários , Medicamentos Genéricos/uso terapêutico , Humanos , Oncologistas/psicologia , Estudos Prospectivos , Tunísia/epidemiologia
2.
Gynecol Oncol ; 155(1): 161-169, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31422857

RESUMO

Effective communication between gynecologic oncology providers and patients is vital to patient-centered care. Skilled communication improves the patient's knowledge retention, builds trust in providers, enhances shared decision-making, and alleviates anxiety of both patients and caregivers. Effective communication is also associated with reduced provider burnout due to improved comfort from possessing the skills to handle emotionally charged situations. Therefore, training in serious illness communication skills is critically important to gynecologic oncology practice and benefits patients, providers, and the healthcare system. Like surgical skills, communication skills can be learned and improved upon, particularly by making use of communication skills courses and other resources. While the purpose of each conversation will vary based on the medical setting, most communication roadmaps incorporate four basic components: 1) Assess patient knowledge and understanding, 2) inform patient in accordance with her communication preferences, 3) recognize and respond to emotion 4) elicit patient values, and create a plan that aligns with those values. Improved patient outcomes associated with addressing patient emotions underscore a critical need to recognize and address emotional cues during difficult conversations. We present strategies for delivering serious news, and for discussing prognosis and goals of care. In each strategy, we highlight skills for recognizing and responding to patient and family emotional cues.


Assuntos
Neoplasias dos Genitais Femininos/psicologia , Relações Médico-Paciente , Comunicação , Barreiras de Comunicação , Tomada de Decisões , Feminino , Humanos , Oncologistas/psicologia
3.
Oncol Res Treat ; 42(9): 458-465, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31291638

RESUMO

BACKGROUND: Cancer patients often face decisions whether to proceed with cancer-specific treatment or to switch to best supportive care. In these decisions, patients' preferences should be determining cornerstones. The aim of this survey was to elicit patients' preferences regarding discussions about forgoing treatment and factors influencing their preferences. METHODS: We surveyed 194 patients at the National Center for Tumor Diseases, Germany. Quality of life (FACT-G), cancer-specific distress (QSC-R10), anxiety/depression (PHQ-4/GAD-2), preferences regarding quality/length of life (QQ), patient-physician communication (CARES-SF), and family role (CCAT-P) were assessed. RESULTS: Patients weighting quality of life over lifetime wanted their oncologists to address treatment limitations as early as possible (p = 0.00). Patients striving for a longer lifetime did not want such discussions (p = 0.05). Having discussed treatment limitations was not associated with increased anxiety, depression, or distress. Limiting treatment was discussed only with one-third of the patients with a prognosis of less than 6 months and rather with elderly patients or patients in a worse medical condition. Attributing an important role to family decisions was associated with striving for lifetime (p = 0.01). CONCLUSION: Preferences for either quality or length of life were associated with patients' willingness to discuss forgoing cancer-specific treatment. Timely discussion of realistic treatment goals is one way to avoid overtreatment. Patients striving for lifetime require increased attention and opportunities to address prognosis and risks of treatment.


Assuntos
Comunicação , Longevidade , Neoplasias/terapia , Preferência do Paciente/psicologia , Relações Médico-Paciente , Qualidade de Vida , Idoso , Assistência Ambulatorial , Ansiedade/psicologia , Estudos Transversais , Depressão/psicologia , Família/psicologia , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Oncologistas/psicologia , Prognóstico , Inquéritos e Questionários
4.
Eur J Cancer Care (Engl) ; 28(5): e13124, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31222849

RESUMO

OBJECTIVE: The aim of this study is to examine the relationship of empathy and professional quality of life in cancer healthcare professionals. METHODS: A Professional Quality of Life instrument measuring compassion satisfaction and compassion fatigue, and the Interpersonal Reactivity Index measuring empathy were distributed to healthcare professionals working in cancer care in the Republic of Ireland. Final analysis was conducted on 117 participants. RESULTS: A quarter of participants experience high levels of compassion satisfaction, and a quarter are at risk of compassion fatigue. A positive correlation was found between personal distress and compassion fatigue, and a negative correlation was found between personal distress and compassion satisfaction. A positive correlation was found between empathic concern and secondary traumatic stress. CONCLUSION: These findings suggest that healthcare professionals working in cancer care are at risk of compassion fatigue. Also, healthcare professionals working in cancer care experience personal distress that may impact negatively on professional quality of life. Implications for practice include a need to identify those HCPs who are at risk of compassion fatigue. The implication for further research suggests further exploration of the impact of personal distress felt by cancer healthcare professionals during empathic engagement.


Assuntos
Pessoal Técnico de Saúde/psicologia , Esgotamento Profissional/psicologia , Fadiga por Compaixão/psicologia , Empatia , Neoplasias/terapia , Enfermeiras e Enfermeiros/psicologia , Oncologistas/psicologia , Adulto , Pessoal Técnico de Saúde/estatística & dados numéricos , Esgotamento Profissional/epidemiologia , Fadiga por Compaixão/epidemiologia , Estudos Transversais , Feminino , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Humanos , Irlanda/epidemiologia , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Enfermagem Oncológica/estatística & dados numéricos , Adulto Jovem
5.
Ann Otol Rhinol Laryngol ; 128(10): 911-914, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31081345

RESUMO

OBJECTIVE: To demonstrate that neurotologists enjoy performing stapedectomies. SUBJECTS: A group of survey recipients consisting of 174 neurotologists who perform stapedectomy, a nonoverlapping control group of 145 head/neck oncologists who perform parotidectomy, and a second nonoverlapping control group of 365 pediatric otolaryngologists who perform tonsillectomy. OUTCOME MEASURES: Responses to surveys distributed by electronic mail to the 3 nonoverlapping recipient groups during nonoverlapping 4-week periods. RESULTS: During the 4-week survey periods, 84 of 174 neurotologists (48%) responded, while 33 of 145 oncologists (23%) and 87 of 365 pediatric otolaryngologists (24%) responded. Most neurotologists performed stapedectomy (80/84; 95% of survey responders), while 33 of 33 (100% of survey responders) oncologists performed parotidectomy and 87 of 87 (100% of survey responders) pediatric otolaryngologists performed tonsillectomy. Seventy-six of the 80 neurotologists who performed stapedectomies (95%) enjoyed performing it, slightly more than the 30 of the 33 oncologists who performed parotidectomies (91%) and appreciably more than the 67 of 87 pediatric otolaryngologists who performed tonsillectomies (77%). Twenty-three neurotologists (30%) would sacrifice vacation time to perform additional stapedectomies, slightly more than 8 oncologists (27%) for additional parotidectomies and more than the 7 pediatric otolaryngologists (10%) for additional tonsillectomies. Ten (13%) of the neurotologists, 3 (9%) of the oncologists, and 1 (2%) of the pediatric otolaryngologists would sacrifice 5 or more vacation days to perform more of the procedures. CONCLUSIONS: Our data suggest that neurotologists enjoy performing stapedectomy.


Assuntos
Satisfação no Emprego , Otorrinolaringologistas/psicologia , Padrões de Prática Médica , Cirurgia do Estribo , Humanos , Oncologistas/psicologia , Glândula Parótida/cirurgia , Pediatras/psicologia , Inquéritos e Questionários , Tonsilectomia
6.
Eur J Cancer Care (Engl) ; 28(3): e13094, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31090179

RESUMO

BACKGROUND: Oncologists may be particularly at risk of burnout. This systematic literature review and meta-analysis explores the prevalence of burnout and associated factors in oncologists. METHODS: The authors assessed 26 studies that utilised the Maslach Burnout Inventory (MBI) tool to measure burnout. Pooled prevalence rates were calculated via meta-analysis (MetaXL) using random effects models. RESULTS: Approximately 5,768 oncologists provided burnout data. A significant number experience burnout as highlighted by the pooled prevalence rates for MBI subscales of: emotional exhaustion at 32%; depersonalisation at 24%; and low personal accomplishment at 37%. Eighteen of the studies reported factors found to be significantly associated with high levels of burnout in oncology physicians. These were grouped into demographic differences, individual factors and work factors. CONCLUSION: Burnout was found to affect a significant proportion of oncologists. Burnout was associated with being single, being younger in age, reduced psychological well-being, difficulties outside of work, workplace demands and workplace stress. Burnout has considerable implications for oncology physicians and patient safety. Further insight into individual factors, and factors associated with lower burnout would be beneficial.


Assuntos
Esgotamento Profissional/epidemiologia , Oncologistas/estatística & dados numéricos , Fatores Etários , Esgotamento Profissional/psicologia , Humanos , Estado Civil/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Estresse Ocupacional/epidemiologia , Estresse Ocupacional/psicologia , Oncologistas/psicologia , Prevalência , Fatores de Risco , Pessoa Solteira/estatística & dados numéricos
7.
Am Soc Clin Oncol Educ Book ; 39: 590-598, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31099650

RESUMO

The best practice of oncology relies heavily on a mentally and physically healthy oncology clinician workforce. Historically, the mental health of physicians and clinicians has largely been ignored, perhaps in the spirit of a collective collusion to maintain the illusion of Oslerian equanimity. With exceedingly high and unacceptable rates of burnout and suicide in the practice of medicine and oncology in particular, a tacit disavowal of the problem is no longer acceptable. The practice of oncology presents several unique work-related issues that challenge the mental health of its clinicians and contribute to burnout, depression, and suicide. Oncologists work with patients at or nearing the end of life and face administrative and insurance hurdles to obtain needed anticancer medications, heavy workloads, paperwork and electronic medical record demands, and keeping up with expanding pertinent oncologic knowledge for practice and public relations issues. Although oncologists exhibit higher rates of depression with longer work hours than many other internal medicine colleagues, they have higher job satisfaction ratings. This article will (1) review the mental health of professionals in oncology, (2) explore similarities and differences between depression and burnout, (3) describe the unique nature of the oncology work environment, (4) examine suicide and its implications for oncology, and (5) review the evidence for interventions to prevent burnout and suicide. Although individual and system-level strategic approaches to the problem of burnout and its consequences are effective, combinatorial approaches offer the most hope for affecting the most long-lasting change and lessening burnout, depression, and suicide in oncology.


Assuntos
Esgotamento Profissional/epidemiologia , Depressão/epidemiologia , Oncologistas/psicologia , Suicídio/psicologia , Depressão/etiologia , Humanos , Médicos/psicologia , Prevalência , Inquéritos e Questionários , Local de Trabalho
8.
Support Care Cancer ; 27(12): 4723-4732, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30972647

RESUMO

PURPOSE: To explore how oncologists, oncology nurses, and oncology social workers perceive suicidality (suicidal ideation, suicidal acts, and completed suicides) in patients with cancer that they are in contact with. METHODS: The grounded theory method of data collection and analysis was used. Sixty-one oncology healthcare professionals from two university-affiliated cancer centers in Israel were interviewed. RESULTS: The findings resulted in three main categories that included perceptions of suicidality, explanatory models of suicidality, and moral views on suicide. Healthcare professionals considered suicidality in their patients to be a cry for help, a sign of distress, or an attempt at attention seeking. Participants explained suicidality as stemming from a biological disease, from mental illness, as an aberration, or as an impulsive, irrational act. Moral views on suicidality were split among those who were mostly accepting of these patients' actions versus those who rejected it outright. A third group of healthcare professionals expressed ambivalence about suicidality in their patients. CONCLUSIONS: Healthcare professionals vary greatly in their perceptions on suicide. Some view the act as part of a patient's choice and autonomy while others view it negatively. Healthcare providers should receive support in handling patient's suicidality.


Assuntos
Pessoal de Saúde/psicologia , Princípios Morais , Suicídio/psicologia , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Oncologistas/psicologia , Assistentes Sociais/psicologia
9.
Support Care Cancer ; 27(12): 4575-4585, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30927112

RESUMO

PURPOSE: Communication in cancer care is multidimensional and may affect patient treatment decision-making and quality of life. This study examined cancer patients' perceptions of the communication with their cancer specialists and explored its impact on the care they received and the financial burden they experienced. METHODS: Semi-structured telephone interviews were conducted with 20 rural and 20 outer metropolitan Western Australians diagnosed with breast, lung, prostate or colorectal cancer. Thematic analysis using a phenomenological approach was undertaken to derive key themes regarding the communication experiences of the participants. RESULTS: Four main themes emerged: information context, communication about treatment options and treatment providers, communication about costs of treatment and impact of communication on continuity of care. The quality of the communication experienced by participants was variable and in many cases sub-optimal. This affected their ability to undertake well-informed decisions regarding treatment and providers and led to substantial out-of-pocket expenses for several participants. Whilst participants differed in their information needs and expectations, most participants trusted clinicians' treatment recommendations. CONCLUSIONS: Our results raise concerns about the quality of communication cancer patients receive during treatment and the repercussions for their treatment decisions and out-of-pocket expenses. Clear treatment and cost communication could empower patients in choosing treatment and providers. However, these findings suggest patients must remain vigilant during consultations and discuss available treatment pathways and their financial dimension to avoid costly treatments or missing out on available financial aid.


Assuntos
Gastos em Saúde , Neoplasias/economia , Neoplasias/psicologia , Relações Médico-Paciente , Idoso , Comunicação , Tomada de Decisões , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Oncologistas/economia , Oncologistas/psicologia , Pesquisa Qualitativa , Qualidade de Vida , População Rural , Confiança , Austrália Ocidental
10.
Support Care Cancer ; 27(11): 4229-4235, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30847701

RESUMO

PURPOSE: The prevalence of cancer in the Middle East is increasing and predicted to nearly double by 2030. In the United Arab Emirates (UAE), cancer ranks as the third leading cause of death. Yet, there are limited data describing the needs of cancer patients in the region. The purpose of this study is to compare cancer patients' reports of unmet supportive care needs with the perceptions of their oncologists. METHODS: A cross-sectional survey of cancer patients and their oncologists, using an Arabic translation of the short form of the Supportive Care Needs Survey (SCNS-SF34), was conducted at a major oncology center in the UAE between December 2014 and March 2017. Descriptive statistics and McNemar test were calculated to determine differences in unmet need responses between oncologists and patients. RESULTS: Nine physicians (100%) and 210 of 268 (78.3%) patients completed the questionnaire. Oncologists accurately assessed the level of unmet physical needs of their patients, but significantly underestimated unmet psychological supportive care needs of the patients. Male patients expressed significantly lower (p < 0.05) physical and psychological unmet needs, compared to female patients. CONCLUSION: Our findings reveal a general concordance between physician and patient perspectives of unmet supportive care needs. This is reassuring as physician perceptions impact the care patients receive. We present multifaceted supportive care strategies for oncology patients in the region.


Assuntos
Neoplasias/psicologia , Oncologistas/psicologia , Relações Médico-Paciente/ética , Sistemas de Apoio Psicossocial , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários , Adulto Jovem
11.
J Surg Oncol ; 119(7): 909-915, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30737785

RESUMO

BACKGROUND: Few guidelines exist for an opioid prescription after breast surgical oncology (BSO) procedures. We sought to characterize opioid prescribing and use patterns by surgery type. METHODS: Patients (n = 332) undergoing BSO procedure were surveyed one week postoperatively for opioid use. The surgeons were surveyed about pain management preferences surgery type. CPT codes were collected for 2017 to calculate the amount of opioids used by surgery type relative to surgeon preference. RESULTS: Mean oral morphine equivalent (OME) preferred prescription for surgeons who did not tailor prescriptions by surgery type (n = 7, group A) was 177, whereas for those who did tailor (n = 10, group B) varied from 137 to 257 OME. There was a significant difference in opioid use by surgery type: 32 OME for segmental mastectomy (SM) ± sentinel lymph node dissection (SLND), 63 for SM + axillary lymph node dissection (ALND), 76 for total mastectomy (TM) ± SLND, 115 for TM + ALND (P < 0.001). Considering the type of surgeries performed group A prescribers would have 229190 unused OME and group B would have 230826 in 1 year. CONCLUSION: Wide variation in opioid use by BSO procedure type was noted with substantial unused OME regardless ofprescribing preference. Evidence-based guidelines are needed to tailor analgesic prescriptions according to the need.


Assuntos
Analgésicos Opioides/administração & dosagem , Neoplasias da Mama/cirurgia , Dor do Câncer/tratamento farmacológico , Oncologistas/estatística & dados numéricos , Dor Pós-Operatória/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Neoplasias da Mama/fisiopatologia , Feminino , Humanos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Mastectomia/efeitos adversos , Mastectomia/métodos , Oncologistas/psicologia , Manejo da Dor/métodos , Percepção , Cirurgiões/psicologia
12.
Gynecol Oncol ; 153(1): 80-86, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30739720

RESUMO

OBJECTIVE: Implicit prejudice and stereotyping may exist in health care providers automatically without their awareness. These biases can correlate with outcomes that are consequential for the patient. This study examined gynecologic oncology care providers' implicit prejudice and stereotyping toward cervical cancer. METHODS: Members of professional gynecologic oncology organizations were asked to complete two Implicit Association Tests to determine if they implicitly associate cervical cancer with feelings of anger (prejudice) and beliefs about culpability for the disease (stereotypes), compared to ovarian cancer. Linear models and Student t-tests examined average levels of implicit bias and moderators of the implicit bias effects. RESULTS: One-hundred seventy-six (132 female, 43 male, 1 nonresponse; X¯age = 39.18 years, SDage = 10.58 years) providers were recruited and the final sample included 151 participants (93 physicians and 58 nurses, X¯age = 38.93, SDage = 10.59). Gynecologic oncology providers showed significant levels of implicit prejudice, X¯â€¯= 0.17, SD = 0.47, 95% CI: (0.10, 0.25), toward cervical cancer patients. They also showed significant levels of implicit stereotyping of cervical cancer patients, X¯â€¯= 0.15, SD = 0.42, 95% CI: (0.08, 0.21). Whereas physicians did not demonstrate significant levels of implicit bias, nurses demonstrated greater levels of implicit prejudice and implicit stereotyping. Providers without cultural competency/implicit bias training demonstrated greater bias than those who had completed such training (p < .05). CONCLUSIONS: This study provides the first evidence that gynecologic oncology providers hold implicit biases related to cervical cancer. Interventions may be designed to target specific groups in gynecologic oncology to improve interactions with patients.


Assuntos
Atitude do Pessoal de Saúde , Enfermeiras e Enfermeiros/psicologia , Neoplasias Ovarianas/psicologia , Médicos/psicologia , Preconceito/psicologia , Estereotipagem , Neoplasias do Colo do Útero/psicologia , Adulto , Feminino , Ginecologia , Humanos , Masculino , Oncologia , Oncologistas/psicologia , Enfermagem Oncológica , Neoplasias Ovarianas/terapia , Neoplasias do Colo do Útero/terapia
13.
Front Immunol ; 10: 108, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30778352

RESUMO

Background: We performed a systematic review and meta-analysis to evaluate the risk of pneumonitis and pneumonia associated with immune checkpoint inhibitors (ICIs) for solid tumors. Methods: The following keywords were used in searching the Embase and PubMed database: pneumonitis, pneumonia, and immune checkpoint inhibitors. The data was analyzed by using the R software and Metafor package. Results: Among 3,436 studies, 23 randomized clinical trials (RCTs) met our selection criteria which included data from 12,876 patients. Compared with chemotherapy, PD-1 inhibitors showed significant increase in grade 1-5 and grade 3-5 pneumonitis (RR, 5.17, 95% CI: 2.82-9.47, p < 0.001; RR, 4.14, 95% CI: 1.82-9.42, p < 0.001), but not in pneumonia. PD-L1 inhibitors showed significant increase in grade 1-5 pneumonitis and pneumonia (RR, 3.25, 95% CI: 1.61-6.57, p < 0.001; RR, 2.11, 95% CI: 1.20-3.70, p < 0.001). There was no significant difference in any grade pneumonitis and pneumonia in cytotoxic T lymphocyte-associated protein 4 (CTLA4) inhibitors subgroup. Programmed cell death protein 1 (PD-1) inhibitor (nivolumab and pembrolizumab) both showed significant increase in grade 1-5 pneumonitis, and pembrolizumab specially tended to increase grade 3-5 pneumonitis. (RR, 5.64 95% CI: 1.94-16.38, p < 0.001). Compared with PD-1 inhibitor (nivolumab) or CTLA-4 inhibitor (ipilimumab) monotherapy, PD-1 inhibitor, and CTLA-4 inhibitor (nivolumab plus ipilimumab) combination therapies showed significant increase in grade 1-5 and grade 3-5 pneumonitis (RR 3.47, 95%CI:1.76-6.83, p < 0.001; RR 3.48, 95%CI: 1.10-11.02, p < 0.001). Conclusions: PD-1/PD-L1 inhibitors treatment could increase the risk of all-grade pneumonitis. CTLA4 inhibitor ipilimumab treatment alone could not increase the risk of pneumonitis but could augment the risk of pneumonitis in PD-1/PD-L1 inhibitor treated patients. There was no significant increase in the risk of pneumonia after either PD-1/PDL-1inhibitor or CTLA4 inhibitor treatment alone or in combination.


Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Monoclonais Humanizados/farmacologia , Antineoplásicos Imunológicos/efeitos adversos , Antineoplásicos Imunológicos/farmacologia , Antígeno CTLA-4/antagonistas & inibidores , Pneumonia/etiologia , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Conscientização , Quimioterapia Combinada/efeitos adversos , Humanos , Neoplasias/tratamento farmacológico , Oncologistas/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Risco
15.
J Clin Oncol ; 37(7): 547-558, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30650044

RESUMO

PURPOSE: To identify potential gaps in attitudes, knowledge, and institutional practices toward lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) patients, a national survey of oncologists at National Cancer Institute-Designated Comprehensive Cancer Centers was conducted to measure these attributes related to LGBTQ patients and desire for future training and education. METHODS: A random sample of 450 oncologists from 45 cancer centers was selected from the American Medical Association's Physician Masterfile to complete a survey measuring attitudes and knowledge about LGBTQ health and institutional practices. Results were quantified using descriptive and stratified analyses and by a novel attitude summary measure. RESULTS: Of the 149 respondents, there was high agreement (65.8%) regarding the importance of knowing the gender identity of patients, which was contrasted by low agreement (39.6%) regarding the importance of knowing sexual orientation. There was high interest in receiving education regarding the unique health needs of LGBTQ patients (70.4%), and knowledge questions yielded high percentages of "neutral" and "do not know or prefer not to answer" responses. After completing the survey, there was a significant decrease ( P < .001) in confidence in knowledge of health needs for LGB (53.1% agreed they were confident during survey assessment v 38.9% postsurvey) and transgender patients (36.9% v 19.5% postsurvey). Stratified analyses revealed some but limited influence on attitudes and knowledge by having LGBTQ friends and/or family members, political affiliation, oncology specialty, years since graduation, and respondents' region of the country. CONCLUSION: This was the first nationwide study, to our knowledge, of oncologists assessing attitudes, knowledge, and institutional practices of LGBTQ patients with cancer. Overall, there was limited knowledge about LGBTQ health and cancer needs but a high interest in receiving education regarding this community.


Assuntos
Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Neoplasias/terapia , Oncologistas/psicologia , Minorias Sexuais e de Gênero , Adulto , Competência Clínica , Assistência à Saúde Culturalmente Competente , Educação Médica , Feminino , Identidade de Gênero , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Oncologistas/educação , Comportamento Sexual , Pessoas Transgênero
16.
PLoS One ; 14(1): e0210325, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30650112

RESUMO

BACKGROUND: As worldwide cancer prevalence continues to increase, the challenges facing cancer care are also increasing. Various topics related to deficiencies in cancer care have been discussed repeatedly in the literature. The most frequently stated topics are the unmet psychosocial support needs of cancer patients, difficulties in multidisciplinary teamwork, difficulties in communication between physicians and patients, and issues in palliative care settings. However, there is little research regarding the views of health care providers on these topics. With the aim of gaining abundant information regarding the care of German cancer patients, this study explores the stances of psycho-oncologists, physicians, and nurses regarding the quality of cancer care. MATERIALS AND METHODS: Semi-structured interviews were conducted at the University Medical Center Hamburg-Eppendorf (UKE) and in different oncological outpatient offices in Hamburg; twenty-five interviews in total were conducted with health care providers. Interviews were semi-structured to gain a broad range of information on cancer care. The data were analyzed using thematic analysis by Braun and Clarke with an inductive, constant comparison approach to identify themes and categorized codes. RESULTS: The following five principle themes were identified in the interviews: "psycho-oncological care", "cooperation of health care providers", "palliative care", "health care provider-patient contact", and "coordination and organization of care". Participants seemed satisfied with the overall quality of cancer care in Germany. Nevertheless, the results showed deficiencies regarding communication among different health care providers and between health care providers and patients. Important findings in conjunction with these communication problems were a lack of psycho-oncological support, shortages in the oncology work force, language and cultural barriers, and deficient education in the communication of providers. CONCLUSIONS: The statements of psycho-oncologists, physicians, and nurses on cancer care provide a suitable basis to conduct further focused research on the studied deficiencies in cancer care. In particular, communication in psycho-oncological care, communication within multidisciplinary teams, and health care provider-patient communication should be further explored with the aim of developing new ideas for improvements and thereby enhancing the quality of cancer care.


Assuntos
Neoplasias/psicologia , Neoplasias/terapia , Atitude do Pessoal de Saúde , Comunicação , Feminino , Alemanha , Humanos , Entrevistas como Assunto , Masculino , Neoplasias/enfermagem , Enfermeiras e Enfermeiros/psicologia , Oncologistas/psicologia , Cuidados Paliativos/psicologia , Médicos/psicologia , Relações Profissional-Paciente , Psicologia , Sistemas de Apoio Psicossocial , Pesquisa Qualitativa
18.
Transl Behav Med ; 9(2): 347-356, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29596633

RESUMO

Patients' ability to access their provider's clinical notes (OpenNotes) has been well received and has led to greater transparency in health systems. However, the majority of this research has occurred in primary care, and little is known about how patients' access to notes is used in oncology. This study aims to understand oncologists' perceptions of OpenNotes, while also establishing a baseline of the linguistic characteristics and patterns used in notes. Data from 13 in-depth, semistructured interviews with oncologists were thematically analyzed. In addition, the Linguistic Inquiry and Word Count (LIWC) program evaluated over 200 clinician notes, measuring variables encompassing emotions, thinking styles, social concerns, and parts of speech. Analysis from LIWC revealed that notes contained negative emotional tone, low authenticity, high clout, and high analytical writing. Oncologists' use of stigmatized and sensitive words, such as "obese" and "distress," was mainly absent. Themes from interviews revealed that oncologists were uncertain about patients' access to their notes and may edit their notes to avoid problematic terminology. Despite their reluctance to embrace OpenNotes, they envisioned opportunities for an improved patient-provider relationship due to patients initiating interactions from viewing notes. Oncologists believe notes are not intended for patients and altering their content may compromise the integrity of the note. This study established a baseline for further study to compare notes pre-implementation to post-implementation. Further analysis will clarify whether oncologists are altering the style and content of their notes and determine the presence of patient-centered language.


Assuntos
Acesso à Informação/psicologia , Atitude do Pessoal de Saúde , Registros Eletrônicos de Saúde , Comunicação em Saúde , Oncologistas/psicologia , Feminino , Comunicação em Saúde/métodos , Humanos , Internet , Entrevistas como Assunto , Linguística , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Neoplasias/terapia , Percepção , Relações Médico-Paciente , Padrões de Prática Médica
19.
Patient Educ Couns ; 102(2): 223-237, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29685640

RESUMO

OBJECTIVE: To break new ground by directly examining how patients seek life-expectancy estimates, and how doctors support them in doing so. METHODS: Conversation analytic examination of 10 recorded UK hospice consultations involving 3 palliative specialists. RESULTS: Life-expectancy estimate episodes frequently begin after a doctor has given a patient an opportunity to shape the consultation agenda. Rather than posing direct questions, patients cautiously display their interest in receiving an estimate using statements. These often contain preparatory information about: what they already know about their prognosis, their perspective on it, and readiness to hear more. When patients do not provide this information, doctors invite it before giving an estimate. Patients' companions also contribute to this preparatory work. CONCLUSION: Doctors, patients, and companions collaboratively work to prepare a conversational environment wherein emotional states and uncertainties have been addressed prior to delivery of the actual estimate. This helps manage both possible emotional distress, and prognostic uncertainty entailed in seeking and delivering estimates. PRACTICE IMPLICATIONS: Clinicians should be mindful that rather than overtly requesting estimates, patients may seek them more cautiously. Before delivering estimates, doctors can support patients to articulate their existing understanding and perspective regarding prognosis, and their readiness to hear more.


Assuntos
Comunicação , Cuidados Paliativos na Terminalidade da Vida , Expectativa de Vida , Neoplasias/psicologia , Neoplasias/terapia , Oncologistas/psicologia , Cuidados Paliativos/psicologia , Relações Médico-Paciente , Encaminhamento e Consulta/organização & administração , Adulto , Feminino , Hospitais para Doentes Terminais , Humanos , Masculino , Neoplasias/mortalidade , Participação do Paciente
20.
Transl Behav Med ; 9(1): 139-146, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-29955874

RESUMO

Rates of referral of patients to psychosocial services are low in most cancer treatment centers, while rates of distress are high. The purpose of this study is to identify clinicians' barriers to referring cancer patients to psychosocial services and strategies that could increase rates of referral. A purposive sampling method ensured data were gathered in two large public teaching hospitals from seven oncologists and five hematologists with varying levels of experience, of whom five were female. Data were collected using semistructured interviews guided by the Capability, Opportunity, Motivation and Behavior model (Michie S, Atkins L, West R. The Behaviour Change Wheel: A Guide to Designing Interventions. United Kingdom: Silverback Publishing; 2014.). This helped us to identify modifiable variables associated with referral likelihood and associated evidence-based strategies using the Behavior Change Wheel. Data were analyzed using Thematic Analysis. Barriers relating to capability, opportunity, and motivation to refer to psychosocial services were identified, including lack of knowledge of available services, how to refer to them, and the types of patients who would benefit. Other barriers included the following: lack of time to discuss and refer, convoluted referral pathways, long waiting times, and fear of patient reluctance due to stigma. Respondents identified numerous strategies for overcoming barriers, including training on referral best practice, role-plays, the provision of lists of services with referral and contact details, and increasing service capacity via additional funding. Findings inform the development of acceptable, evidence-based strategies, to improve rates of referral to psychosocial services by oncologists and hematologists. Without implementation, a substantial number of people affected by cancer will continue to suffer from potentially treatable distress.


Assuntos
Atitude do Pessoal de Saúde , Neoplasias/terapia , Oncologistas/psicologia , Psicoterapia , Encaminhamento e Consulta , Adulto , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Hematologia , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Modelos Psicológicos , Motivação , Pesquisa Qualitativa , Fatores de Tempo
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