Changes in residents' self-assessed competences during a two-year family practice program.

PURPOSE: To compare changes in self-assessed clinical confidence over a two-year residency between two groups of family practice residents, one starting in a family practice center and the other starting in a hospital. METHOD: All 44 entering residents at the University of Western Ontario in either 1984 or 1985 were eligible. Forty-two participated at baseline, and 24 (57%) provided completed responses after two years. Confidence regarding 177 topics in 19 general topic areas was assessed using self-completed questionnaires administered at baseline and after six, 12, and 24 months. The residents rotated every six months between sites, with approximately half starting in each site. Nonrandom assignment to starting site included consideration of the residents' stated preferences; hence self-selection bias was possible. Mean differences were evaluated using t-tests, and trends over time were assessed using repeated-measures analysis of variance. RESULTS: There was no difference between the groups' grand means at any time. In the 19 areas, five statistically significant differences were seen, four at six months and one at 12 months; four involved greater confidence by the center-start group. No difference was seen after two years, and both groups displayed substantial increases in confidence over two years. CONCLUSIONS: The few significant differences in confidence between the two groups suggest that their training might have been deficient if it had omitted one of the settings. However, because these differences had disappeared after the groups had each experienced 12 months in each setting, the initial site of training appears not to affect learning.

Self-help groups: oncology nurses' perspectives.

During the past decade in North America, the number of self-help groups for cancer patients has grown dramatically. Nurses' knowledge and attitudes about self-help groups could influence their practice behaviours and the information they provide to cancer patients. However, little is known about oncology nurses' views regarding self-help groups. This study used a cross-sectional survey to gather information about knowledge, attitudes, and practice behaviours of Canadian oncology nurses regarding self-help groups. A total of 676 nurses completed the survey (response rate of 61.3%). The respondents had spent, on average, 21.6 years in nursing and 11.6 years in oncology nursing. Results indicated that a large majority of nurses knew about available self-help groups. Approximately one-fifth of the nurses are speaking frequently about self-help groups with patients (20.7%) and are initiating the conversation on a frequent basis (22.0%). Overall, oncology nurses rated self-help groups as helpful with regards to sharing common experiences (79.5%), sharing information (75.6%), bonding (74.0%), and feeling understood (72.0%). The most frequently identified concern regarding the groups was about misinformation being shared (37.9%), negative effects of associating with the very ill (22.1%), and promoting unconventional therapies (21.2%). Implications from the study suggest that oncology nurses would benefit from learning more about the nature of self-help groups and being able to talk with patients about the self-help experience.

Factors associated with location of death (home or hospital) of patients referred to a palliative care team.

OBJECTIVE: To identify factors associated with the location of death (home or hospital) of patients referred to a palliative care home support team. DESIGN: Retrospective case-control chart review. SETTING: Palliative care inpatient unit with a home support team in a large chronic care hospital. SUBJECTS: All 75 patients receiving services from the home support team who died at home between June 1988 and January 1990 and 75 randomly selected patients receiving the same services who died in hospital. OUTCOME MEASURES: Place of death (home or hospital). RESULTS: Of the 267 patients referred to the palliative care home support team during the study period 75 (28.1%) died at home. Factors significantly associated with dying at home were the patient's preference for dying at home recorded at the time of the initial assessment (p < 0.001), a family member other than the spouse involved in the patient's care (p = 0.021) and the use of private shift nursing (p < 0.001). The patients who died in hospital were more likely than the other patients to have had no home visits from the palliative care team after the initial assessment (p = 0.04). The patient's preference for dying at home was not met if the caregiver could not cope or if symptoms were uncontrolled. The patient's preference for dying in hospital was not met if his or her condition deteriorated rapidly or if the patient died suddenly. CONCLUSIONS: Patients' preference as to place of death, level of caregiver support and entitlement to private shift nursing were significantly associated with patients' dying at home. The determination of these factors should be part of every palliative care assessment. Patients and their families should be informed about available home support services.

Self-help groups.

OBJECTIVE: To assess Ontario family physicians' attitudes toward, awareness of, and practices related to self-help groups in general and cancer self-help groups specifically. DESIGN: Mailed survey using a modified Dillman method. SETTING: Ontario family practices. PARTICIPANTS: A random sample of 1500 Ontario members of the College of Family Physicians of Canada, of whom 949 responded. A total of 911 completed questionnaires were received, for an eligible response rate of 64%. MAIN OUTCOME MEASURES: Physician demographics, practice characteristics; extent of awareness of self-help groups and their perceived value; attitudes toward self-help groups; practices related to interactions with patients about self-help groups. RESULTS: Only 40.2% of respondents were aware of six or more self-help groups in their region; 56.8% were aware of at least one cancer self-help group. Discussions with patients about groups were reported as occurring "frequently" by 12% of respondents, who indicated they made referrals to an array of groups. Ratings of group helpfulness were relatively high (83.8% scoring 3, 4, or 5 on a 5-point scale, where 5 is "very helpful"). There were low ratings of potential harm (1% scoring 4 or 5 on a 5-point scale, where 5 is "very harmful"). Confidence intervals for proportions reported on in this paper were all within 4%. CONCLUSIONS: Family physicians have predominantly positive attitudes about the potential benefits of self-help groups, and many are recommending groups to their patients.

Cancer self-help groups and family physicians.

PURPOSE: Despite the phenomenal growth during the past decade of cancer self-help groups for adult patients with cancer, little research has been conducted to document the interface between these groups and healthcare professionals, especially physicians. This study was initiated to provide information about family physician practices, awareness, and attitudes about self-help groups. DESCRIPTION: A survey questionnaire was mailed to a random sample of Ontario family physicians drawn from the College of Family Physicians of Canada's membership database. RESULTS: A total of 911 completed questionnaires were returned, for a response rate of 64%. A majority (56.8%) of respondents were aware of at least one cancer self-help group in their region; 26.8% of these spoke frequently with their cancer patients about such groups. Most family physicians indicated that they were positively inclined toward cancer self-help groups, giving especially high ratings of helpfulness to sharing common experiences, overcoming isolation, feeling understood, and sharing information. Ratings of potential harm were low, with the most concern expressed about the possible provision of misinformation and the promotion of unconventional therapies. Responses to an open-ended question showed that many family physicians qualify their support for cancer self-help groups, depending on patient need, group composition, and leadership. CLINICAL IMPLICATIONS: Family physicians and other members of the cancer care team should give increased attention to informing cancer patients about the potential benefits of self-help groups. Efforts need to be made to assist cancer self-help groups in developing informational brochures and to ensure that groups are listed in cancer resource directories. Educational initiatives about self-help groups would be useful for family physicians and other health professionals engaged in the care of cancer patients.

Why do patients seek family physicians' services for cold symptoms?

OBJECTIVE: To examine the frequency of presentation to family physicians' offices for cold symptoms, the reasons for presentation, and the duration of symptoms before presentation. DESIGN: Prospective cross-sectional survey. PARTICIPANTS: One hundred consecutive patient encounters in each of 15 family practices from January 27 to February 3, 1994, involving both academic and non-academic family physicians in the London region. Data were collected prospectively using a checklist attached to each chart. MAIN OUTCOME MEASURES: Proportion of patients presenting with cold symptoms, reasons for presentation, number of days patients had had symptoms, billing code. RESULTS: A total of 1421 checklists were analyzed, 822 from academic practices and 599 from community practices. Proportion of presentations for cold symptoms was 14.8%, but visits coded as common cold represented 5.7%. Median number of days patients waited before presentation was 7.0; older patients tended to wait longer. Many patients were worried about developing complications (51.0%) or were fed up with their symptoms (31.9%). Most patients were between the ages of 20 and 64 (44.6%), and 57.6% of all patients had developed complications requiring treatment. CONCLUSIONS: The proportion of visits coded as common cold was lower than Ontario averages. Most patients had complications rather than simple colds and had managed their symptoms on their own for a fairly long time.

Self-assessed competence: before and after residency.

This study measures changes in clinical confidence experienced by 42 family practice residents as they progressed through a 2-year residency program. At the beginning, 20% or more of respondents reported they lacked confidence in 47 of the 177 topics. Self-assessed competence increased substantially in many areas. However, during the residency, new areas of concern emerged.

Changing physicians' attitudes toward self-help groups: an educational intervention.

BACKGROUND: Members of self-help groups (SHGs) for support of cancer patients are concerned that physicians are skeptical about these groups and see them as potentially harmful. The purpose of this study was to assess family physicians' attitudes towards self-help groups and see whether these could be changed through an educational intervention. METHODS: A questionnaire assessing attitudes toward SHGs was mailed to 1,422 eligible Ontario family physicians, to which 911 responded (64% response rate). Responders were sent an educational package consisting of an article about self-help groups, a list of local cancer self-help groups, and a follow-up questionnaire. RESULTS: The study was completed by 584/911 family physicians (64%). After being exposed to educational material, the physicians were more positive about the helpfulness of SHGs (p = 0.021), and less concerned about SHGs' being harmful (p = 0.003). They were more positive about the potential for SHGs to provide participants with opportunities for: sharing information (p = 0.004), bonding with other patients (p < 0.001), feeling understood (p = 0.004), sharing common experiences (p = 0.004), providing hope (p < 0.001), sharing laughter (p = 0.001), becoming more assertive (p < 0.001), communicating with health professionals (p = 0.04), dealing with issues related to death and dying (p = 0.005), advocacy (p = 0.01), and overcoming isolation (p = 0.002). They were less concerned with the potential for SHGs to provide misinformation (p = 0.003), the negative effects of associating with the very ill (p = 0.002), dwelling on illness (p = 0.002), or cultivating false hope (p = 0.001). CONCLUSION: Having family physicians complete a questionnaire, followed by educational material specific to their concerns, changed their attitudes toward self-help groups. Further study is needed to see whether behavioral changes resulted.