Patients and physicians: cross representations anthropological study of the construction of individuality in radiation therapy

The methods of anthropology allow us to understand group dynamics by bringing to light a web of linked causalities in order to describe human and social relationships. The density and dimension of the relationship with a patient have direct repercussions on professional motivation. But this proximity has its drawbacks. The process of identification to patients is inevitable and the fear of "contamination" is not medical but symbolic: it is expressed in the difficulty of appreciating the distance, the difference between the "other" (the patient) and the self (the physician). Health professionals have therefore to find a delicate compromise between proximity and strategies of distance. The temptation is therefore great, of considering the patient only through his pathology. This "imagined patient" allows the clinician to define the frames structuring his relation to the patient. But at the same time, this creates a loss of identity for the patient. In this context, the relation between patient and clinician should be based primarily on a necessary individual acknowledgement of the patient who expresses it in a re appropriation of his illness. Thus he sets himself as an actor of the therapeutic relation and no longer as an object of clinical care.     

« Regards croisés 2009 » : perceptions croisées des patients atteints de cancer et des professionnels de santé sur les conséquences de la fatigue et de l’anémie chimio-induite sur la vie quotidienne

“Regards croisés 2009” survey was conducted among 300 cancer patients, 250 physicians (oncologists, hematologists, pneumologists, and gastroenterologists), and 109 nurses, in order to evaluate and compare their perceptions of the management of fatigue and chemotherapy-induced anemia. The included patients had a diagnosis of breast, lung, or colorectal cancer, or nonmyeloid malignant hemopathy, were undergoing ambulatory chemotherapy, and presented or had presented with anemia (Hb < 11 g/dl) during chemotherapy. Fatigue was the most common symptom reported by 77 % of the patients. Regarding consequences of fatigue on daily life activities, health professionals’ perceptions were close to those of patients. Health professionals were convinced that management of fatigue was a priority and they were conscious that it was difficult to do. This means that the perception of professionals has changed compared to previous surveys, where insufficient management of fatigue in cancer patients was demonstrated. Results also show that patients ignored the relation between fatigue, chemotherapy, and anemia. Information upon available treatments against anemia should therefore be increased. This is one of the main priorities identified by the three investigated populations. Others are increasing the consciousness of health professionals upon the necessary management of fatigue, and use of efficacious treatments against fatigue, easily integrated in chemotherapy cycles and daily life of the patients.     

A Legal Approach to Cancer Epidemiology in Public Health

The Public Health Act encompasses scientific research and law enforcement as causes, distributions, and preventive factors for diseases and injuries of a particular population. Today, the Public Health Law is growing into a field that expects to cultivate and utilize lawful practitioners who can apply specialized legal skills in health policy development and public health performance. The multidisciplinary approach of the Public Health Act integrates the legal and scientific elements of the field and the workforce, characterized by a more dynamic understanding of the health impact of legislation and the rapid deployment of effective policies. Thus, legal health interventions that manage and treat diverse populations need to be evaluated more rigorously and quickly. In addition, funding for policy surveillance and other legislation and policy mapping needs to be more sophisticated to maximize utility and avoid duplication. This study investigated legal interventions to manage and treat various groups of populations for health and discussed the necessity of public health laws.     

Differences in perception of quality of life issues between health professionals and patients with pancreatic cancer

During the initial stages of development of a pancreatic cancer quality of life (QoL) module to supplement the EORTC core QoL module, the QLQ‐C30, a qualitative study was undertaken to explore observed differences in the health professionals’ and patients’ perception of the illness, treatment and care of pancreatic cancer. Semi‐structured one‐to‐one interviews were conducted with a range of six health professionals and 21 pancreatic cancer patients from two acute general hospitals and one teaching hospital within the Wessex Region. Grounded theory guided data collection and analysis. There was good agreement between the content of issues generated by professionals and patients with 42 relevant and specific issues identified. However, subtle differences in perception were observed when the context of why such issues were important was examined between the two groups. Health professionals took a mechanistic view and saw the impact of each symptom or problem as directly affecting quality of life perception. Patients’ perception of quality of life was mediated by the process of coping. This was grounded by two linked factors. First, the perceived threat of each symptom or problem to the patient and second, the success or otherwise of coping strategies employed to maintain control. Five main coping strategies were identified. This study highlighted that there are important and specific quality of life issues which warrant a need for a pancreatic cancer QoL module. This study emphasises the fact that patients are the best source to describe their quality of life. Health professionals should acknowledge the effect of coping strategies when assessing the impact of symptoms and their treatment on patients with pancreatic cancer. Copyright © 1999 John Wiley & Sons, Ltd.     

Compliance Assessment of Cigarette and Other Tobacco Products Act in Public Places in Delhi Government Hospitals

Objective: Tobacco-free policies in hospital campus reduce exposure to tobacco smoke; change the demeanour ofthe professionals, patients and people visiting hospitals towards tobacco use. Section-4, 5 and 6 of COTPA (Cigarettesand Other Tobacco Products Act) necessitates the need for implementation of the prohibition on smoking in publicplaces. Against this background, the present work was designed to evaluate the status of compliance Section 4, 5 and6 of COTPA in Delhi Government hospitals Methods: A cross-sectional observational study was conducted withinGovernment hospitals. Multistage random sampling was used to select 18 hospitals out of 39 hospitals from 5 zones.Standard assessment Proforma developed by John Hopkins School of Public Health for assessing compliance toTobacco-Free Law was used and modified to address certain aspects of Section-4, 5 and 6 of COTPA. Hospital campuseswere assessed by dividing them into zones like hospital buildings, office buildings, public places outside the hospitaland residential areas. Result: Signs of active tobacco use observed in 40.6% of hospital buildings, 35.3% in officebuildings, and 75.4% in public places outside the buildings. ‘No smoking signage was not as per the COTPA guidelinesin 21.4% of the hospitals and 72% were not tobacco free outdoors in these positions. Conclusion: The study highlighteda lower compliance rate than expected which raises questions on law enforcement concerning tobacco. Hence necessarymeasures have to be used up for sustained awareness campaigns, backed by enforcement drives. Periodic compliancesurveys will strengthen the implementation of tobacco free legislation in health care institutions.     

Clinical Oncology Society of Australia position statement on the use of complementary and alternative medicine by cancer patients

Health professionals involved in the clinical management of cancer are becoming increasingly aware that their patients use complementary and alternative medicine (CAM). As cancer incidence and survival rates increase, use of CAM is also likely to increase. This paper outlines the position of the Clinical Oncology Society of Australia (COSA) on the use of CAM by cancer patients and provides guidance for health professionals involved with the treatment of cancer patients who are using or wish to use CAM. Key definitions and common communication scenarios are presented along with evidence‐based recommended steps for health professionals when discussing CAM use. COSA encourages health professionals to focus on open discussion with their patients regarding CAM, to become familiar with reputable resources for CAM information, to discuss with patients the concept of evidence‐based medicine, to recognize limitations to their knowledge of CAM and seek further advice when necessary, and to be respectful of the patients' right to autonomy.     

<Emphasis Type="Bold">Exemple du parcours personnalisé des patients atteints de cancer ORL : une vision pluriprofessionnelle de la prise en charge</Emphasis> (in partie II : Un parcours personnalisé et coordonné pour mieux répondre aux besoins des patients)

This text aims to provide some points of reference concerning relations between patients and health-care professionals and offers proposals to improve the relational quality of care. First, it defines the notion of relational quality, as in the objectives of a carer/patient relationship, by indicating the basis of this relational quality. Secondly, it develops how the relational quality can differ according to the stages of the disease and depending on the different care providers. It then presents some proposals aimed at ensuring the existence of the relational quality of care, its development, and its continuation throughout the patient-care progress. This aspect is discussed in relation to three areas: inter-professional communication, the communication between professionals, patients and their relatives, and finally the training of professionals.     

Familial breast cancer: is it time to move from a reactive to a proactive role?

In 2004 the NICE guidelines on familial breast cancer advised Health Care Professionals that they should not actively seek to identify women with a family history of breast cancer. We have carried out a review of the evidence base and a large scale questionnaire survey of health professionals in four European countries. There is overwhelming support amongst GPs and surgeons against the premise that that health care professionals should not be proactive in identifying patients at risk of familial breast cancer. This that suggest the time is right to overturn the NICE decision.     

An inadvertent contraindicated combined use of newly prescribed TS-1 and unused doxifluridine

A 77-year-old male patient who had been receiving doxifluridine (5'-DFUR) for about a year after surgery for rectal cancer, was newly prescribed TS-1, because tumor markers were elevated and abdominal ultrasonography documented liver metastasis. However, the patient took TS-1 concomitantly with 5'-DFUR, which is contraindicated to TS-1, and experienced a severe drug interaction. This inadvertent drug interaction was caused by a combination of the newly prescribed drug and the unused drug remaining at the patient's home. This type of medication error has not been reported previously. Health professionals should be aware of such drug interactions which may be caused by newly prescribed drugs plus unused drugs remaining in the patient's home. Furthermore, health professionals should instruct patients on the nature of drug interactions as well as explaining their diagnosis and treatment. Although the severity of such drug interaction may vary, health professionals must be alerted to such incidents, which could happen frequently.     

Challenges of mediated communication, disclosure and patient autonomy in cross-cultural cancer care

Background:

Evidence concerning the influence of ethnic diversity on clinical encounters in cancer care is sparse. We explored health providers'' experiences in this context.

Methods:

Focus groups were conducted with a purposeful sample of 106 health professionals of differing disciplines, in 18 UK primary and secondary care settings. Qualitative data were analysed using constant comparison and processes for validation.

Results:

Communication and the quality of information exchanged with patients about cancer and their treatment was commonly frustrated within interpreter-mediated consultations, particularly those involving a family member. Relatives'' approach to ownership of information and decision making could hinder assessment, informed consent and discussion of care with patients. This magnified the complexity of disclosing information sensitively and appropriately at the end of life. Professionals'' concern to be patient-centred, and regard for patient choice and autonomy, were tested in these circumstances.

Conclusion:

Health professionals require better preparation to work effectively not only with trained interpreters, but also with the common reality of patients'' families interpreting for patients, to improve quality of cancer care. Greater understanding of cultural and individual variations in concepts of disclosure, patient autonomy and patient-centredness is needed. The extent to which these concepts may be ethnocentric and lack universality deserves wider consideration.     

Readability Comparison of Pro- and Anti-Cancer Screening Online Messages in Japan

Background: Cancer screening rates are lower in Japan than those in western countries. Health professionals publish pro-cancer screening messages on the internet to encourage audiences to undergo cancer screening. However, the information provided is often difficult to read for lay persons. Further, anti-cancer screening activists warn against cancer screening with messages on the Internet. We aimed to assess and compare the readability of pro- and anti-cancer screening online messages in Japan using a measure of readability. Methods: We conducted web searches at the beginning of September 2016 using two major Japanese search engines (Google.jp and Yahoo!.jp). The included websites were classified as "anti", "pro", or "neutral" depending on the claims, and "health professional" or "non-health professional" depending on the writers. Readability was determined using a validated measure of Japanese readability. Statistical analysis was conducted using two-way ANOVA. Results: In the total 159 websites analyzed, anti-cancer screening online messages were generally easier to read than pro-cancer screening online messages, Messages written by health professionals were more difficult to read than those written by non-health professionals. Claim × writer interaction was not significant. Conclusion: When health professionals prepare pro-cancer screening materials for publication online, we recommend they check for readability using readability assessment tools and improve text for easy comprehension when necessary.     

Eastern Canadian Colorectal Cancer Consensus Conference: standards of care for the treatment of patients with rectal,pancreatic, and gastrointestinal stromal tumours and pancreatic neuroendocrine tumours

The annual Eastern Canadian Colorectal Cancer Consensus Conference was held in Halifax, Nova Scotia, October 20–22, 2011. Health care professionals involved in the care of patients with colorectal cancer participated in presentation and discussion sessions for the purposes of developing the recommendations presented here. This consensus statement addresses current issues in the management of rectal cancer, including pathology reporting, neoadjuvant systemic and radiation therapy, surgical techniques, and palliative care of rectal cancer patients. Other topics discussed include multidisciplinary cancer conferences, treatment of gastrointestinal stromal tumours and pancreatic neuroendocrine tumours, the use of folfirinox in pancreatic cancer, and treatment of stage ii colon cancer.     

Benefits and Barriers of Cancer Practitioners Discussing Physical Activity with their Cancer Patients

Our aim was to synthesise the existing empirical literature and theoretical perspectives on the physical activity (PA) promotion practices and determinants of cancer clinicians and health professionals. We conducted a narrative review of theory and evidence to develop practice recommendations for improving the promotion of PA to cancer patients. Surveyed health professionals were aware of many benefits of PA for their cancer patients, although only ~40 % promoted PA to selected cancer patients. Walking was the most commonly promoted form of PA, with this promoted to assist patients control their weight and cardiovascular health risk. Barriers to promotion of PA included lack of time and knowledge of PA and behaviour change skills. Health professionals appear interested in promoting PA to their cancer patients, yet encounter several barriers. Further research is warranted to assist health professionals improve their PA promotion. An adapted reflective-impulsive model of social behaviour shows promise for assisting health professionals overcome barriers and provides an evidence-based theoretical framework for improving communication with patients. Universities, hospitals and/or health-care accreditation organisations also have important roles to play in assisting health professionals improve their promotion of PA to patients.     

Therapeutic patient education in oncology: pedagogical notions for women's health and prevention

Therapeutic patient education has been defined by the World Health Organization as a comprehensive approach to support patients and their families to better understanding of their diseases. In oncology, the contribution of therapeutic education may enable the patients to have adequate information of the illness, to actively participate in the management of the disease, to understand how to live with the illness, to learn how to face the critical moments of the clinical course, and to live in harmony with all health professionals. In addition, there may be several advantages for health professionals: a reduction in emotional labour, increased professional satisfaction, and a reduction in the potential tensions and conflicts with patients and their relatives. We suggest that therapeutic patient education in oncology may be useful for both patients and health professionals and probably lead to a reduction in the costs of healthcare delivery.     

Talking about fertility in the context of cancer: health care professional perspectives

Health care professionals (HCPs) play a key role in providing information and counselling about the implications of cancer for fertility, however, many patients do not receive such information. The aim of this study was to examine the perspectives and practices of Australian HCPs in relation to discussing fertility with cancer patients. A mixed‐methods design, comprising of an online survey of 263 HCPs [41.4% nurses; 25.5% doctors; 31% allied health care professionals (AHP)] and qualitative interviews with 49 HCPs, was utilised. HCPs reported that fertility is an important concern for patients and their partners; however, only 50% of doctors and nurses, and 24% of AHPs reported that they always addressed this issue. The primary barriers to discussing fertility were poor patient prognosis; patient gender or age; time constraints; and absence of appropriate resources and materials. Only a minority of HCPs (29%) had undergone training in discussing fertility with cancer patients. The majority wanted further training or education: including nurses (81.8%), AHPs (80.6%) and doctors (55.4%). HCPs agreed that a number of resources would assist them to raise fertility with their patients, including a list of appropriate referral sources, fact sheets, information booklets, a fertility consultation checklist and on‐line resources.     

The Health and Medical Services Law for the elderly and early cancer detection

Anti-cancer measures in Japan were started in the 1950s, and programs for the early detection of stomach and cervical cancer supported by the National Government were begun in 1966 and 1967, respectively. In 1983 the Health and Medical Services Law for the Elderly was enacted, and under this law nationwide early detection programs for stomach and cervical cancer have been under taken and the number of people screened has been steadily increasing. Accuracy control programs for these cancer detection systems are now being established by prefectural governments. The examination of programs for the early detection of lung cancer and breast cancer will be necessary when suitable methods have been established.     

The relationship between available support, unmet needs and caregiver burden in patients with advanced cancer and their carers

Caregiver burden is an increasing problem with patients surviving longer and more care tasks falling to informal caregivers. While research has identified patient and caregiver variables associated with caregiver burden, less research has focused on aspects of the care environment. The present study investigated the available support and unmet needs of 57 patients with advanced cancer, 45 of their carers and 40 of their health professionals. Carers and patients consistently identified higher levels of available support for the patient than health care professionals, with carers identifying higher levels of support than patients. Carers also identified more patient unmet needs than health care professionals, who in turn identified more than patients. Surprisingly, available support did not increase over 6 months and there was a tendency for unmet needs to decrease over time. Low available support, high unmet needs and a larger discrepancy between carer and patients' reports of patients' unmet need predicted negative aspects of caregiver burden. These results suggest that health care professionals underestimate available support to patients and both patients and health care professionals underestimate patients' unmet needs in comparison to carers. Carers' reports of patients' unmet needs are important to consider as they were associated with high levels of caregiver burden, including poorer caregiver health. Health care professionals should encourage opportunities for carers to discuss their views of the ongoing needs of patients with advanced cancer.     

Implementation of a comprehensive cancer plan. A health planning experience

Here we describe the working method used to implement an Integrated Cancer Health Plan in Andalusia (Spain) and to set out some of the lines of work for improving quality of care and health network planning. Four main initial considerations were made: (1) work must be centred on patients and respect for their autonomy; (2) cancer requires action at every healthcare level; (3) integration of expert professionals is to be encouraged; and (4) relevant information and data should be systematically used for planning. Two operative approaches were also established: structured participation and evidence-based healthcare. This methodology was used in various planning programmes, largely in relation to healthcare resources. In this article, as examples, we describe the development of two types of programmes: one for radiotherapy equipment and another for the management of lymphoedema in breast cancer patients. Analysis of results obtained against cancer is always controversial. It is necessary to review the healthcare structure used in terms of effectiveness and excellence. Comprehensive or integrated health plans are a useful model for a wide-ranging and multi-level approach to cancer. The structured and real participation of experts and an evidence- based healthcare strategy proved very useful in this public health planning experience.     

An exploration of the experience of cancer cachexia: what patients and their families want from healthcare professionals

REID J., Mc KENNA H.P., FITZSIMONS D. & Mc CANCE T.V. (2010) European Journal of Cancer Care 19 , 682–689 An exploration of the experience of cancer cachexia: what patients and their families want from healthcare professionals The aim of this paper is to investigate the perceptions of patients and family members with regard to care received for cancer cachexia. A qualitative study recruited 27 participants, of which 15 were patients with advanced cancer who had primary cachexia and 12 were family members. Participants were recruited from a regional cancer centre in the UK. All participants took part in a domiciliary interview, which was transcribed verbatim for analysis. A major finding from analysis was ‘lack of response from health care professionals’ in relation to cancer cachexia management. This finding illuminated that patients and their family members wanted three things from healthcare professionals. They wanted their profound weight loss acknowledged, they wanted information about it and why it was happening and they wanted interventions to deal with it. This paper provides powerful messages for healthcare professionals and highlights the needs of patients and their family regarding cancer cachexia management. Patients and their families want this problem addressed by healthcare professionals. This client group requires supportive healthcare interventions, so that they can understand the nature and impact of this syndrome.