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Guillem P Bolla M Courby S Descotes JL Laramas M Moro-Sibilot D 《Bulletin du cancer》2011,98(9):989-998
Resulting medical decision from a multidisciplinary team (MDT) meeting has to be accurate regarding to various patient criteria and relevant specialists participation. The target is to optimize treatment or management options for patients taking into account patients' benefit. The aim of our study was to examine quality criteria of MDT meeting processes, implementation of the MDT decision, and the follow-up of national or regional clinical guidelines. The results lead us to discuss about care management in cancer. Ten various medical specialities of MDT meetings were studied. Relevant multidisciplinarity varied between MDT meetings specialities and was effective between 55 and 100%. Implementation of the decisions that arise from MDT meetings was 86.3%. The most frequent grounds of non-application were patient refusal and new or previous unknown clinical data. The percentage of MDT meetings decisions following national or regional recommendations was 74%. The main reason of not following was the complexity of clinical patient circumstances. Participation in MDT meetings is more and more time-consuming related to enforce the completeness referred to the Plan Cancer (National recommendations). Leading to completeness raises questions about medical time employment and meaning of the MDT meeting for standard clinical cases. The priority seems to enforce multidisciplinarity rather than reach completeness. 相似文献
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Garwin MJ 《Hematology / Oncology Clinics of North America》2002,16(6):1351-1363
One can now only speculate as to the future of the law regarding risk creation and loss of chance. Freed from the moorings of the traditional rules in medical malpractice cases, courts are adopting a variety of approaches to this problem in a manner that approaches the idiosyncratic--the law is whatever it happens to be on any given day, in any given jurisdiction. Regrettably, until such time as uniform guiding principles are established, it appears that the laws governing the interaction between risk, causation, and liability will remain in a state of flux. 相似文献
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Meeting patient expectations in the cancer consultation 总被引:1,自引:0,他引:1
Background: Low scores on satisfaction measures may be anticipated when patients' expectations of the doctor are unmet during the cancer consultation. We correlated discrepancies between patient expectations of their ideal doctor and their perceptions of their actual doctor with scores on a validated satisfaction scale to determine whether patients whose expectations were unmet were less satisfied.Patients and methods: The expectations questionnaire used a forced choice method designed to elicit patient preferences for either emotional or informational support from the physician. One hundred and five new patients with heterogeneous cancers, of five medical oncologists at a major teaching hospital were sampled. The patients were mostly female (55%) middle aged (mean age 54.3) and newly diagnosed with cancer (56% within two months prior to consultation).Results: Patients did not demonstrate a clear preference for an emotionally or informationally supportive approach. Seventy percent of patients did not want emotionally negative physicians but most (88.4%) would tolerate negative information. The mean number of exact matches between patients expectations of the ideal and their perceptions of their actual doctor was 3.7 (from a total of six). 5.9% of patients received exactly the doctor they wanted. No significant differences in satisfaction were found between patients whose expectations were met and those whose expectations were not met.Conclusions: Patient satisfaction with the consultation was independent of patient expectation for informational or emotional support. 相似文献
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There is growing consensus that multidisciplinary meetings (MDMs) are the optimal means of arriving at a comprehensive treatment plan for cancer patients. However, if a patient was grieved by a decision made by an MDM and wished to recover damages, the courts would find all involved consultants responsible for decisions related to their area of expertise. The aim of this study was to assess (i) whether doctors participating in oncology MDMs are aware that they are individually accountable for the MDM decisions and (ii) whether MDMs are conducted in a way that reflects this individual responsibility. A 35-question survey was developed and peer reviewed. Doctors attending MDMs in four Australian tertiary-care hospitals were invited to respond. One hundred and thirty-six responses (91% response rate) were received from 18 MDMs across 4 hospitals. Only 48% of doctors believe they are individually liable for decisions made by the MDM. This awareness was greater for an MDM where the patient attends, than in those that were 'discussion only' (58 vs 37%; P = 0.036). Seventy-three per cent stated they would like further education about their legal responsibilities in MDMs. Thirty-three per cent of doctors feel that the MDM discussion environment is suboptimal and radiation oncologists are significantly more likely to hold this view. Even though 85% of doctors have disagreed with the final MDM decision in an important way at some time, 71% did not formally dissent on those occasions. Doctors should be made aware of the legal implications of their participation in MDMs. A greater awareness of these responsibilities and improved team dynamics should optimize patient outcomes while limiting exposure of participants to legal liability. 相似文献
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This paper presents a study of hopes and expectations concerning the professional health-care sector, as expressed by a group of Swedish cancer patients. The data are derived from a cross-sectional interview study of patients diagnosed with a malignant disease at one general hospital in Stockholm in 1987. A seeming discrepancy exists between the problematic situations and experiences described in narrative form by the participants, and the high rate of positive responses to direct questions concerned with satisfaction with care in this study. A combination of data types and an analytic process derived from medical anthropology has been utilized in order to understand the culturally related hopes and expectations which are behind statements of satisfaction with care. Hopes and expectations reflect the perceived breadth and limits of the professional health-care sector. Patients appear to organize their experiences in manners which ‘work’. General dissatisfaction with care may not be an effective technique for promoting well-being when diagnosed with a potentially life-threatening disease. The patients in this study actively avoid dissatisfaction in a number of ways, which include assuming responsibility themselves, accepting the unarticulated as a form of discourse and adapting frameworks for that which is ‘normal’ from the professional sector. 相似文献
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结直肠癌患者中肺是继肝脏之后最常见的远处转移器官之一,但由于肺转移发病率较低且生物学侵袭性相对温和,因而与结直肠癌肝转移相比,结直肠癌肺转移无论是关注程度、综合治疗理念还是相关的临床和基础研究都相对匮乏。本文现介绍1例直肠癌伴同时性多发性肺转移患者在浙江大学医学院附属第二医院大肠癌诊治中心的多学科综合治疗(multidisciplinary team,MDT)经过,以探讨该类患者的临床病理特征、预后影响因素、合理的综合治疗决策以及现有的诊治争议与共识,以期促进临床诊疗的规范化和个体化,使患者更多获益。 相似文献
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G. DEMIRIS
phd associate professor D. POROCK
phd professor 《European journal of cancer care》2010,19(6):729-735
PARKER OLIVER P., DEMIRIS G., WITTENBERG‐LYLES E. & POROCK D. (2010) European Journal of Cancer Care 19 , 729–735 The use of videophones for patient and family participation in hospice interdisciplinary team meetings: a promising approach Inclusion of patients and caregivers in decisions related to the delivery of care is inherent in the hospice philosophy. Telemedicine technologies offer a potential solution to the challenges presented by the geographic distance between team meetings and the home environment. While inclusion requires additional coordination by the hospice team, it also offers an important opportunity to improve communication between the team and the patient and family. A modified conceptual model based on two previous frameworks is outlined to support patient and family involvement in hospice team meetings. Further research is suggested to determine the structural feasibility of patient and family involvement via videophone as well as the structural and procedural changes resulting from this inclusion. Finally, clinical outcomes and family evaluation of the inclusion experience need to be thoroughly researched before final conclusions may be reached. 相似文献
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The correlation between patient characteristics and expectations of benefit from Phase I clinical trials 总被引:4,自引:0,他引:4
Weinfurt KP Castel LD Li Y Sulmasy DP Balshem AM Benson AB Burnett CB Gaskin DJ Marshall JL Slater EF Schulman KA Meropol NJ 《Cancer》2003,98(1):166-175
BACKGROUND: Patients in Phase I clinical trials sometimes report high expectations regarding the benefit of treatment. The authors examined a range of patient characteristics to determine which factors were associated with greater expectations of benefit from Phase I trials. METHODS: Participants were adult patients with cancer who had been offered participation in Phase I studies and had decided to participate. Patients completed interviewer-administered surveys before initiation of treatment. Physicians assessed Eastern Cooperative Oncology Group performance status for each patient. Statistical analyses (Pearson product moment correlation and t tests) used multiple imputation to account for missing data. RESULTS: Overall, 593 patients who were offered participation in Phase I trials were contacted, and 328 patients agreed to participate in a study of decision making by cancer patients. Of these, 260 patients (79%) enrolled in a Phase I trial. Patients' expectations regarding the chance that their disease would be controlled with experimental therapy were unrelated to age, gender, living situation, education level, or functional status. Expectations were correlated positively with beliefs about the benefit of standard therapy and the maximum benefit patients may experience from experimental therapy. Greater expectations of benefit were associated with better health-related quality of life, stronger religious faith, optimism, relative health stock, monetary risk seeking, and poorer numeracy. CONCLUSIONS: Expectations expressed as beliefs in personal outcomes may be related more to quality of life and personality variables than to patients' knowledge or functional status. Whether such expectations are accurate reflections of knowledge has important implications for evaluating the informed consent process. 相似文献
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Leoncio Arribas Alpuente Antonio Menéndez López Ricardo Yayá Tur 《Clinical & translational oncology》2011,13(4):240-248
Glioblastoma (GB) represents the most aggressive glioma in the adult population. Despite recent research efforts, the prognosis
of patients with GB has remained dismal. Lately, the knowledge of genetic information about gliomagenesis has increased; we
even have a classification of the genetic expression of the tumour. The main problem is that at the moment we do not have
any therapeutical resources to help us better treat these tumours, as we can do, with others tumours like breast, lung and
colorectal cancer. We have also improved on diagnostic imaging, especially with the new MRI sequences; we can now better define
the characteristics of the tumour area and the surrounding brain structures, allowing us to adjust resections. Thanks to the
most advanced surgery techniques, such as neuronavigation, intraoperative control of the nervous function and the tumour volume,
the neurosurgeon is able to complete tumour exeresis with less morbidity. These imaging techniques allow the radiation oncologist
to better contour the irradiation target volume, the structures and the organs at risk, to diminish the irradiation of apparently
healthy tissue. Nowadays, knowledge of brain stem cells provides new expectations for future treatments. Novel targeted agents
such as bevacizumab, imatinib, erlotinib, temsirolimus, immunotherapy, cilengitide, talampanel, etc. are helping classical
chemotherapeutic agents, like temozolomide, to achieve an increase in overall survival. The main objective is to improve median
overall survival, which is currently between 9 and 12 months, with a good quality of life, measured by the ability to carry
out daily life activities. 相似文献
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Orbital rhabdomyosarcoma (RMS) accounts for 10% of childhood RMS and has a relatively good prognosis of up to 85% 5‐year survival. Improved survival has led to increased interest in late effects of treatment. The objective of this study was to review the results of treating orbital RMS with multidisciplinary treatment at Women's and Children's Hospital and Royal Adelaide Hospital with emphasis on late effects of treatment. A retrospective review was carried out of all patients with orbital RMS treated with multidisciplinary treatment including radiation therapy and chemotherapy in the two institutions between 1982 and 2002. A total of five patients (age range 5.5‐12 years) satisfied the eligibility requirements. Late effects were significant and included facial bone hypoplasia, cataract formation and growth hormone deficiency. Overall survival was 80% (4/5) with mean follow up of 8 years (range 3‐13 years). Given the high cure rates achieved, future treatments must aim to maintain the good results but to reduce the high incidence of late effects of treatment. Standardised rating of late toxicity, long‐term follow‐up clinics, and implementation of modern radiation techniques (3‐D conformal radiotherapy, intensity modulated radiotherapy, proton therapy) for patients with orbital RMS are important to improving outcome. 相似文献
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