Utility of a Referral Letter to Improve Comprehensibility of Cancer Patients in Palliative Care: a Single-Center Study.

In spite of a referral letter as an important document for communicating between physicians, whether it could also be useful as a source of information for patients has not yet established. We included cancer patients in palliative care setting, all of whom completed a standardized questionnaire regarding their opinion concerning the utility of a referral letter as a source of information and its requirements to achieve a better understanding. Completed questionnaires were received from 50 cancer patients. Ninety-four percent of participants agreed that a referral letter could be of great importance for procuring medical information to them. There was only minor divergence among the participants respecting age, gender, or education. Particular requirements were diagnosis, treatment plan, prognosis, list of drugs, and contact data of involved physicians. Additional important topics were laboratory values, alternatives to current therapy, side effects and supportive therapy, and advices regarding lifestyle and naturopathy. The majority of patients also concluded to accept technical terms in doctor's letters if a glossary supported their comprehension. The majority of patients prefer a concise description of medical information in a referral letter. This form of a letter would boost patients' involvement and help them transfer medical information to other therapists or relatives.

Physiologic effects of voice stimuli in conscious and unconscious palliative patients-a pilot study.

BACKGROUND: Sounds and acoustic stimuli can have an effect on human beings. In medical care, sounds are often used as parts of therapies, e. g., in different types of music therapies. Also, human speech greatly affects the mental status. Although calming sounds and music are widely established in the medical field, clear evidence for the effect of sounds in palliative care is scare, and data about effects of the human voice in general are still missing. Thus, the aim of this study was to evaluate the effects of different voice stimuli on palliative patients. METHODS: Two different voice stimuli (one calm, the other turbulent) were presented in a randomized sequence, and physiological parameters (blood pressure, heart frequency, oxygen saturation, respiratory rate) were recorded. RESULTS: Twenty patients (14 conscious and 6 unconscious) participated in this study. There was a decrease of heart frequency as well as an increase of oxygen saturation in the group of conscious patients, whereas no significant change of blood pressure or respiratory rate were detected in either group, conscious and unconscious patients. CONCLUSIONS: Although our dataset is heterogeneous, it can be concluded that voice stimuli can influence conscious patients. However, in this setting, no effect on unconscious patients was demonstrated. More clinical research on this topic with larger groups and a broader spectrum of parameters is needed.

Information Deficits and Second Opinion Seeking - A Survey on Cancer Patients.

OBJECTIVE: To learn more about cancer patients' motivation for seeking a second opinion. METHODS: Participants filled in a standardized questionnaire. RESULTS: Among 106 patients, 34% had looked for a second opinion, 81% wanted to check the accuracy of their treatment, and 49% needed to better understand the diagnosis. Low understanding of information was associated with looking for a second opinion, and 79% felt assured after a second opinion. CONCLUSIONS: Seeking a second opinion may help cancer patients in coping with the disease. As data on benefits are missing, other strategies, such as qualified first opinion and a sound physician-patient communication, may be advisable.

Aroma oil therapy in palliative care: a pilot study with physiological parameters in conscious as well as unconscious patients.

OBJECTIVE: The aim of this pilot study is to analyze the reactions of healthy test persons and conscious as well as unconscious palliative patients to aroma stimuli. PATIENTS AND METHODS: In a randomized controlled study, healthy probands, conscious and unconscious palliative patients were exposed to two essential oils (lemon, lavender). Water was used as the control stimulus. Physiological parameters (breathing rate and heart rate, oxygen saturation, systolic, diastolic and mean arterial pressure) were measured. RESULTS: 10 test persons (control group), 15 conscious patients and 5 unconscious palliative patients were exposed to the stimuli. Healthy test persons reacted to lemon oil with a significant increase in respiration rate, heart rate and diastolic blood pressure, whereas to lavender oil with a significant decrease in respiration rate was measured. There were no significant reactions concerning the other parameters. Conscious and unconscious patients reacted with a significant increase in all measured parameters to lemon oil and with a significant decrease in all parameters except for oxygen saturation to lavender oil. No significant differences in the reactions were measured between the conscious and unconscious patients and no significant reactions to control stimuli were detected. All physiological reactions were very short and only detectable during stimulus presentation. CONCLUSION: Significant physiological reactions were measured after simulation with aroma oils in all three groups in this study. Healthy probands showed different reactions than palliative patients irrespective to their conscious state.

Internet Information for Patients on Cancer Diets - an Analysis of German Websites.

BACKGROUND: In recent years, the Internet has become an important source of information for cancer patients. Various cancer diets that are publicized on the Web promise significant benefits. The aim of our study was to evaluate the quality of online patient information about cancer diets. MATERIALS AND METHODS: A patient's search for 'cancer diets' on German websites was simulated using the search engine Google. The websites were evaluated utilizing a standardized instrument with formal and content aspects. RESULTS: An analysis of 60 websites revealed that websites from nonprofit associations as well as self-help groups offer the best content and formal ranking. Websites whose owners aim to make a profit, practices that offer cancer diet therapies, and newspapers received the poorest quality score. The majority of content provided on the Web gets published by profit-oriented content groups. CONCLUSION: The divergence between profit-driven websites offering low-quality content and the few trustworthy websites on cancer diets is enormous. The information given online about cancer diets may turn out to be a hazardous pitfall. In order to present evidence-based information about cancer diets, online information should be replenished to create a more accurate picture and give higher visibility to the right information.

Is there evidence for a better health care for cancer patients after a second opinion? A systematic review.

BACKGROUND: With growing complexity of diagnostics and therapy, as well as increasing involvement of patients in the decision-making process, there is more and more demand for second opinions in oncology. This literature review aims at analyzing the benefits and risks involved, as well as the tools needed to establish a structured program for second opinion within a modern healthcare system. METHODS: A systematic literature search was performed using MEDLINE and Embase and the databases SocINDEX, ERIC and CINAHL. Thirteen articles met the inclusion criteria and offered a relevant insight into the topic of second opinions. RESULTS: Depending on the study, between 6.5 and 36 % of patients search for a second opinion, due to a variety of reasons. Changes in diagnosis, treatment recommendations or prognosis as a result of the second opinion occurred in 12-69 % of cases. In 43-82 % of cases, the original diagnosis or treatment was verified. Patient satisfaction was high, and the second opinion was deemed as helpful and reassuring in most cases. Yet, data on patient-relevant outcomes or on the quality of the second opinion are missing. CONCLUSION: In general, outcome data on second opinion are divergent and scarce. Yet, with patients' demand for second opinion and influence of second opinion on treatment decisions, a structured, high quality and transparent second-opinion program seems mandatory. Such a program may support patient-physician communication and improve the flow of information, as well as decision-making. Its evaluation should be independent from the provider of the second opinion.

What cancer patients find in the internet: the visibility of evidence-based patient information - analysis of information on German websites.

BACKGROUND: The internet is an easy and always accessible source of information for cancer patients. The aim of our study was to evaluate the information provided on German websites. MATERIAL AND METHODS: We developed an instrument based on criteria for patient information from the German Network for Evidence-based Medicine, the Agency for Quality in Medicine, HONcode, DISCERN, and the afgis. We simulated a patient's search and derived the websites for evaluation. We analyzed the visibility of each website and evaluated the websites using the developed instrument. RESULTS: We analyzed 77 websites. The highest visibility index was shown by 4 profit websites. Websites from professional societies and self-help groups have low rankings. Concerning quality, websites from non-profit providers and self-help groups are on top. Websites with a profit interest have the lowest average score. CONCLUSIONS: A discrepancy exists between the visibility and the quality of the analyzed websites. With the internet becoming an important source of information on cancer treatments for patients, this may lead to false information and wrong decisions. We provide a list of suggestions as to how this risk may be reduced by complementary information from the physician and from trustworthy websites.

[Survey on information needs of cancer patients and their relatives in Germany]. / Der Informationsbedarf von Patienten mit Krebserkrankungen in Deutschland - eine Befragung von Patienten und Angehörigen.

INTRODUCTION: Cancer patients generally have a great need for disease-related information. They prefer to be informed personally by the attending doctor. Yet, they also use other sources, mostly from medical laypersons or public media. The goal of our survey was to obtain insight into information patients get and their requirements regarding information. METHODS AND PARTICIPANTS: Using a standardized questionnaire, we conducted a survey on 226 patients and 32 relatives, who attended meetings providing information for cancer patients. RESULTS: Patients were generally content or highly content with the information they got. The direct consultation with the doctor is the most important source of information especially for older patients. Information by other patients and self-help groups rank second, followed by internet and online chats, which both are of minor importance for patients older than 60 years. From the patients' point of view, sources of information should be individualized and comprehensive, provided by experts and allowing for questions. Patients prefer one constant person for communication. Remarkably, empathic communication was not rated as important. Age and gender are not associated with these preferences for these characteristics of sources of information. DISCUSSION: Patients' and relatives' desire for an individualized, comprehensive counseling with high expertise provided by one person points to the limits of resources of the health system. The importance of additional information material will rise accordingly. This material should be tailored to the needs of diverse patient groups.