Potentially inappropriate prescribing in elderly: assessing doctor knowledge,confidence and barriers

Introduction Inappropriate medication prescribing by doctors is an important preventable cause of morbidity and mortality in the elderly. This study investigates doctor knowledge about potentially inappropriate prescribing (PIP) in elderly, their confidence in prescribing for the elderly and explores perceived barriers. Methods Family and Internal Medicine resident and attending doctors at three teaching hospitals were asked to complete a survey. Six clinical vignettes based on the 2003 Beers criteria were used to evaluate doctor knowledge about medications to avoid in the elderly. Confidence in prescribing for the elderly and perceived barriers to appropriate prescribing in elderly was assessed using a 5‐point Likert scale. Results Eighty‐nine doctors completed the survey, for a response rate of 45%. Forty‐four per cent of surveyed doctors estimated that over 25% of their practice consisted of patients 65 years or older. When knowledge of PIP was assessed via vignettes, the mean correct response was 3.9 (SD: 1.1, min = 1, max = 6). Only 14% of those doctors scoring ≤4 vignettes correctly had used the Beers criteria for prescribing; 31% of the doctors answering ≥5 vignettes correctly had used the Beers criteria (P = 0.08). Overall, 75% of doctors felt confident about their prescribing irrespective of their knowledge scores. Seventy per cent of surveyed doctors cited at least seven different barriers to appropriate prescribing in elderly. Conclusions Many primary care doctors possess a poor knowledge of PIP and are unaware of prescribing guidelines such as the Beers criteria. Our survey indicates that doctor usage of the Beers criteria might correlate with improved judgement in prescribing for the elderly. Most doctors report multiple barriers to appropriate prescribing in the elderly. Lack of formal education about prescribing guidelines was the only barrier that correlated with the doctors' level of training.     

Debriefing critical incidents in the paediatric emergency department: Current practice and perceived needs in Australia and New Zealand

Anecdotally critical incident debriefing (CID) is an important topic for staff in paediatric ED. The present study aimed to determine current baseline CID practices and perceived needs of ED staff. A questionnaire regarding CID practice was circulated to all 13 Paediatric Research in Emergency Departments International Collaborative (PREDICT) sites in Australia and New Zealand (including all tertiary paediatric ED), and completed by 1 senior doctor and 1 senior nurse. All PREDICT sites participated (13 nurses, 13 doctors). Seventy per cent did not currently have a hospital protocol on debriefing and 90% did not have ED‐specific guidelines. The most commonly debriefed topics were death of a patient, multi‐trauma and sudden infant death syndrome, also ranked highest in importance for debriefing. The median reported debriefs per department were 4 per year (range 0–12), all conducted within a week of the CI with half within 24 h. ED workers most likely to be invited to the CID session were doctors, nurses and social workers (96%). Debriefing was mostly conducted internally (62%) and most likely facilitated by a doctor (81%) or nurse (54%). Debriefing addressed both clinical and emotional issues (89%) within the same session (69%). Debriefing was rated as very important, median of 8/10 by doctors and 10/10 by nurses. Almost 90% of those surveyed indicated that they would like a CID programme and guidelines for their department. Debriefing is perceived as important by senior ED clinicians, yet few ED have formalized guidelines or programmes. Best‐practice guidelines should be developed.     

Complementary and alternative medicine: Canadian physiatrists' attitudes and behavior

OBJECTIVE: To document the prevalence and patterns of knowledge about, referrals to, training in, and practice of complementary and alternative medical therapies and their perceived effectiveness by a sample of Canadian physiatrists. DESIGN: Cross-sectional survey by written questionnaire. SETTING: Physiatrists in the province of Ontario, Canada. SUBJECTS: All 116 physiatrist/rehabilitation specialists listed in the Ontario Medical Association directory. Data were obtained from 98 respondents. MAIN OUTCOME MEASURES: Statistical analysis of responses in these areas: attitudes, knowledge, and recommendations about alternative therapies, and clinical approach including referral pattern, training, and practice of alternative medicine. RESULTS: Of the respondents, 72% reported referring patients for alternative medicine therapies, and 20% had training in and 20% practiced some form of alternative medicine. The therapies rated highest in usefulness were acupuncture (85%), biofeedback (81%), and chiropractic (80%). Sixty-three percent believed that alternative medicine had ideas and methods that would be of benefit to physiatrists. Only 9% believed it to be a threat to public health. A greater proportion of physiatrists who refer were women, were younger, had graduated more recently, and scored higher in their ratings of more useful alternative medicine therapies. Previous training in alternative medicine was correlated with a higher practice rate but not with referral rate. Practice profile and academic affiliation were not associated with greater or less use of alternative medicine. CONCLUSION: In Ontario, physiatrists report greater knowledge of and more use of alternative medicine therapies than do general practitioners. The most commonly used therapies are acupuncture, biofeedback, and manipulation (chiropractic, osteopathy). It is recommended that these approaches be taught in physiatry residency training and be the focus of future research. Incorporating such therapies into practice will help to meet the public demand for such approaches in the decade to come.     

A survey of acupuncture patients: results from a questionnaire among a random sample in the general population in Norway

The objective of this study is to survey attitudes to, and use of acupuncture in the general Norwegian population. An anonymous questionnaire was dispatched to a random sample of 1100 in the general population, and 653 responded (60.7%). Nineteen per cent of the general population, most often suffering from musculo-skeletal pain, had tried acupuncture treatment. Lack of effect of conventional medicine was most often given as the reason to try acupuncture. Acupuncture patients had tried other kinds of alternative medicine twice as often as others, most often homeopathy (P<0.01). Acupuncture patients visit their GP more often (P<0.01), and are more concerned about own health (P<0.01) than patients who have not tried acupuncture. Sixty-six per cent say they benefited from acupuncture, and 7% report that the acupuncture treatment had adverse effects. Fifty-six per cent of those with experience of acupuncture felt that doctors should recommend acupuncture for migraine patients, and 34% of those never having tried acupuncture agreed (P<0.01). Both patients who had tried acupuncture and those who had not, felt that the doctor should not interfere in the cancer patient's wish to try acupuncture.     

Family doctors and psychologists working together: doctors' and patients' perspectives

Background Strategies to improve primary care in the Canadian Primary Care Reform include integrating different professionals to the medical team. Objective This demonstration project explores the perceived impact on doctors and patients, of having family doctors and psychologists work together. Setting Two family practices of Eastern Ontario, Canada Methods Two board certified psychologists (one per practice) were integrated in the practices for 12 months. Psychologists conducted assessments, consultations and short‐term treatments, as well as knowledge‐transfer sessions for doctors. Outcome measures included referral patterns, patient outcomes, patient and provider satisfaction as well as doctors' billing. Results Three hundred and seventy‐six participants received psychological care; most were women (68%) and between the ages of 25–64 (67%). Anxiety and depression were the most prevalent diagnoses. Reasons for referral included: psychological treatment (70%); emotional support and counselling (35%); clarification of diagnosis and case conceptualization (25%). Referrals could be for more than one reason. After intervention, 60% of patients had improvement on the outcome questionnaire‐45 (OQ‐45). Quality of life as measured by the EuroQol‐5D also improved (P < 0.001). Over 77% of patients reported increased confidence in handling their problems after treatment. Compared with their family doctor, patients felt the psychologist had more time and was better trained (75%) Doctors felt mental health problems were diagnosed more rapidly, patient care improved as well as their own knowledge of psychological management and treatment. Doctors felt it freed up their time and improved working conditions. Audit of the doctors' billing showed reduction in doctors' mental health billing. Conclusions Having an on‐site psychologist was highly satisfactory for patients and providers, resulting in improved patient care and outcomes.     

Trends in the perceived complexity of primary health care: a secondary analysis

Rationale If the complexity of the patient's medical problems increases or the complexity of the interactions between the doctor and the patient, the staff or the health care system increase, then complexity of patient care will increase. This study examined trends in patient complexity, and identified doctor, practice and improvement strategy characteristics associated with perceived complexity. Methods This secondary analysis used data from three Community Tracking Surveys with 22 134 primary care doctors completing surveys about themselves, their practice setting, practice improvement strategies and complexity of care in three consecutive 2‐year time periods (1996–1997, 1998–1999, 2000–2001). Data were analysed using hierarchical logistic regression. Results The proportion of primary care doctors who perceived that complexity of care had increased over the past 2 years rose from 31.5% to 35.9%. Perceived complexity of patient care was consistently related to being in solo practice and the belief that they could not frequently obtain high‐quality services and referrals for patients. As availability of services increased, complexity decreased whereas as use of practice improvement strategies increased, complexity also increased. Conclusions Understanding that we cannot determine whether respondents understood care as ‘complicated’ or ‘complex’, potential consequences of this increase in complexity include an increase in medical errors and referral rates along with decreased quality of patient care and career satisfaction.     

Emergency nurses' knowledge of perceived barriers in pain management in Taiwan

Aims and objectives. To explore knowledge of and perceived barriers to pain management among emergency nurses in Taiwan. Background. Pain is the most common patient complaint in emergency departments. Quality care of these patients depends on the pain knowledge and pain management skills of emergency nurses. However, no studies have explored emergency nurses’ knowledge of and perceived barriers to pain management in Taiwan. Design and methods. Nurse subjects (n = 249) were recruited from nine hospitals chosen by stratified sampling across Taiwan. Data were collected using the Nurses’ Knowledge and Attitudes Survey‐Taiwanese version, a scale to assess perceived barriers to pain management and a background information form. Results. The overall average correct response rate for the knowledge scale was 49·2%, with a range of 4·8–89·2% for each survey question. The top barrier to managing pain was identified by these nurses as ‘the responsibility of caring for other acutely ill patients in addition to a patient with pain. Knowledge of pain management had a significant, negative relationship with perceived barriers to pain management and a significant, positive relationship with extent of clinical care experience and total hours of prior pain management education. In addition, scores for knowledge and perceived barriers differed significantly by the nursing clinical ladder. Perceived barriers also differed significantly by hospital accreditation category. Conclusions. Our results indicate an urgent need to strengthen pain education for emergency nurses in Taiwan. Relevance to clinical practice. The pain education should target knowledge deficits and barriers to changing pain management approaches for Taiwanese emergency nurses.     

Variation in the management of hypothetical cases of acute agitation in Australasian emergency departments

Objective: To describe the prescribing practice of emergency medicine clinicians in the management of highly agitated patients and to identify perceived barriers to management and the gaps in training. Method: We undertook an anonymous cross‐sectional mail survey of the Australasian College for Emergency Medicine (ACEM) members (fellows and advanced trainees) between June and September 2009. A questionnaire including a case vignette of a hypothetical patient and three clinical scenarios was employed to ascertain prescribing practice and assess perceived barriers to management, confidence and the perceived usefulness of existing and future Clinical Practice Guidelines (CPGs). Results: All 2052 ACEM members were surveyed. However, seven had incorrect postal addresses and could not be reached. Of the remaining 2045, 786/2052 (38.3%, 95% CI 36.2–40.5) responses were received. Of the 786 respondents, 783 were practicing clinicians. If monotherapy was chosen, 622/783 (79.4%, 95% CI 76.4–82.2) of respondents preferred midazolam to manage the common scenario where no history was available, followed by haloperidol 45/783 (5.8%, 95% CI 4.3–7.7) and olanzapine 38/783 (4.9%, 95% CI 3.5–6.7). Most respondents 500/783 (63.9%, 95% CI 60.4–67.2) would also administer another sedative (combination therapy). Important perceived barriers to agitation management included lack of both training (352/783 [45.0%, 95% CI 41.4–48.5]) and a national CPG (313/783 [40.0%, 95% CI 36.5–43.5]). Respondents were generally confident in all aspects of management, although relatively fewer trainees were confident in determining dosing. Institutional CPGs were considered most useful for 415/783 (53.0%, 95% CI 49.4–56.5) respondents. If an ACEM‐endorsed CPG were to be developed in the future, 634/783 (81.0%, 95% CI 78.0–83.6) respondents would consider this useful. Conclusion: There is considerable variation in the management of hypothetical cases of acute agitation in Australasian EDs. Benzodiazepines and antipsychotics, either alone or in combination, are commonly used. An ACEM‐endorsed, Australasian CPG was perceived as useful.     

Normal medical practice of referring patients for complementary therapies among Australian general practitioners

OBJECTIVES: Assessing the extent to which general practitioners (GPs) accept complementary therapies as normal medical practice. DESIGN: An examination of two Australian surveys of GPs undertaken in Tasmania and Victoria in 1997. OUTCOME MEASURES: Type of referral (to doctors or non-medical therapists) and therapy. Levels of acceptance. Basis for judgement of acceptability. RESULTS: In Tasmania 66% of GPs referred patients to doctors - primarily for acupuncture and hypnotherapy. Fifty-five per cent referred patients to non-medical practitioners - primarily for chiropractic, massage and osteopathy. In Victoria the rate of referral was 93%. Most GPs accepted acupuncture as a normal, but not orthodox, therapy. There are varying levels of acceptance of other complementary therapies and GPs judge by assessing safety and therapeutic value. CONCLUSION: Some complementary therapies are clearly part of normal, if not orthodox, practice in Australia. Discussion of complementary therapies in medicine must consider the differential levels of acceptance of different therapies.     

Changes in perceived effect of practice guidelines among primary care doctors

RATIONALE, AIMS AND OBJECTIVES: Evidence suggests that when doctors use systematically developed clinical practice guidelines they have the potential to improve the safety, quality and value of health care. The purpose of this study was to evaluate recent changes in the perceptions of practice guidelines among US primary care doctors. METHODS: Data were collected from the Community Tracking Survey 1996-97 and 2000-01. All results were weighted and adjusted to reflect the complex survey design. RESULTS: Over the 5 years, the proportion of primary care doctors who said that practice guidelines had at least a moderate effect on their practice of medicine increased from 45.8% to 60.7%. This increase was nearly equal among primary care doctors of family medicine, internal medicine and paediatrics. In the 2001 survey, a higher perceived effect of practice guidelines was described by female doctors (OR = 1.39, 95% CI 1.19-1.63) and doctors who were practising in a large model group (OR = 1.73; 95% CI 1.04-2.89). Doctors who graduated from medical school within 10 years of the survey were more likely to report that practice guidelines had a positive effect on their practice of medicine than doctors who graduated 10 or more years before the survey. CONCLUSION: The perceived effect of practice guidelines on primary care doctors increased over time. Improved dissemination of guidelines and curriculum changes may have led recent primary care graduates to view practice guidelines as more important.     

Nurses' and doctors' knowledge of pain after surgery

AIM: To analyse the links between levels of acute pain management knowledge, perceptions of clinical skills and the acute pain management education history of doctors and nurses working in orthopaedics and general surgery in an acute hospital. METHOD: Questionnaires were sent to 101 doctors and nurses. Eighty two were returned. Questions were derived from an abridged version of McCaffery and Ferrell's (2002) Nurses' Knowledge and Attitudes Survey Regarding Pain, acute pain literature and the trust's clinical standards and protocols. RESULTS: The results identified the most useful sources of acute pain management education and who accessed these; barriers to good acute pain management, other than a lack of education; differences between doctors and nurses in standards of education, levels of perceived competence and knowledge in assessment, pharmacology and analgesic delivery systems. CONCLUSION: Staff and patient misconceptions, inadequate sources of learning and professional traditions continue to affect the quality of acute pain management. However, progress has been made in the trust to overcome these factors through collaborative practice, review of education programmes and specific practice development initiatives.     

Health workers who ask about social determinants of health are more likely to report helping patients: Mixed-methods study

ObjectiveTo assess the feasibility of implementing a clinical decision aid called the CLEAR Toolkit that helps front-line health workers ask their patients about social determinants of health, refer to local support resources, and advocate for wider social change.DesignA mixed-methods study using quantitative (online self-completed questionnaires) and qualitative (in-depth interviews, focus groups, and key informant interviews) methods.SettingA large, university-affiliated family medicine teaching centre in Montreal, Que, serving one of the most ethnically diverse populations in Canada.ParticipantsFifty family doctors and allied health workers responded to the online survey (response rate of 50.0%), 15 completed in-depth interviews, 14 joined 1 of 2 focus groups, and 3 senior administrators participated in key informant interviews.MethodsOur multimethod approach included an online survey of front-line health workers to assess current practices and collect feedback on the tool kit; in-depth interviews to understand why they consider certain patients to be more vulnerable and how to help such patients; focus groups to explore barriers to asking about social determinants of health; and key informant interviews with high-level administrators to identify organizational levers for changing practice.Main findingsSenior administrators consider asking about social determinants to be part of the mandate of health workers. However, barriers perceived by front-line clinicians include insufficient training in social history taking, uncertainty about how to address these issues in clinical practice, and a lack of knowledge of local referral resources. Health workers with specific ways of asking patients about their social challenges were more likely to report having helped their patients as compared with those who did not know how to ask (93.8% vs 52.9%; P = .003).ConclusionWhile health workers recognize the importance of social determinants, many are unsure how to ask about these often sensitive issues or where to refer patients. The CLEAR Toolkit can be easily adapted to local contexts to help front-line health workers initiate dialogue around social challenges and better support patients in clinical practice.     

Assessing education in palliative medicine: development of a tool based on the Association for Palliative Medicine core curriculum

The Association for Palliative Medicine (APM) of Great Britain and Ireland has developed a core curriculum for palliative medicine. To establish the appropriateness of this core curriculum as a standard against which training can be measured, we have examined how doctors from different medical, social and cultural backgrounds view its various elements. In 1998, we succeeded in tracing 304 of 390 doctors, past students of the University of Wales College of Medicine's Diploma in Palliative Medicine. Each was sent a postal questionnaire that asked them to rate the importance to their own clinical practice of each element of the APM core curriculum. Two-hundred sixty-three questionnaires were returned--a response rate of 87%. The ages ranged from 30 to 71 (mean 44) years; 56% (147) were female. Forty per cent (105) were general practitioners, and 37% (97) hospice and 23% (61) hospital-based. Eighty-three per cent (220) were from the UK, 5% (14) from the rest of Europe, 8% (21) from the Far East and 3% (8) from other countries. The majority of respondents agreed that all elements of the APM core curriculum were of 'very great' or 'great' importance to their current clinical practice. Respondents' medical, social or cultural setting had only very minor effects on their attitude to individual elements. The elements of the curriculum perceived as being of greatest importance were: communication with patients and their families, assessment, diagnosis and treatment of pain, multiprofessional team working and psychological responses to illness and bereavement. Clinicians from a wide variety of backgrounds confirm the relevance of the APM core curriculum. This justifies its adoption as the audit standard against which the quality of training and educational programmes in Palliative Medicine should be judged.     

Current knowledge and perception of bariatric surgery among Greek doctors living in Thessaly

Introduction

The purpose of this study was to assess doctors’ knowledge, current conceptions, and clinical practice regarding obesity and bariatric surgery.

Methods

A self‐administered survey was administered to 500 doctors with varying medical specialties in public and private practice.

Results

The response rate was 60%. Most participants (77.3%) were in private practice. Although almost half of the participants could define morbid obesity and obesity‐related comorbidities, only 8.7% felt educated about bariatric surgery. Participants had little knowledge of various types of bariatric procedures. A minority of doctors (24.7%) knew of the existence of a bariatric center in their area. Only 21.3% of doctors had referred a patient to a bariatric center. Reasons for non‐referral included lack of interest in bariatric surgery (37.3%), patient refusal (35.3%), increased operative fees (17.3%), lack of confidence in bariatric surgery (6.3%), and lack of access to a nearby bariatric center (3.7%). The majority of doctors were interested in learning more about bariatric surgery and related guidelines, but they remained reluctant to conduct patients’ postoperative follow‐ups.

Conclusion

The penetration of bariatric surgery in the medical community remains limited, despite its proven effectiveness in facilitating sustained weight loss and resolving several obesity‐related comorbidities. A great effort should be made to inform health‐care providers about the evolution of bariatric procedures, the potential benefits they offer, and the existence of certified bariatric centers. This will allow doctors to provide optimum health care to patients who could benefit from bariatric surgery.     

The views of primary health care professionals about the management of breast problems in clinical practice

Rationale, aims and objectives To identify primary health care professionals’ views about patients presenting with breast problems, and their approaches to clinical management. Methods Qualitative study using practice‐based semi‐structured group discussions with primary health care professionals. All practices were involved in a study evaluating the effect of the national breast symptom management guidelines on clinical practice. Discussion groups were conducted in the practices; 15 of the 34 study practices were audio‐taped. Groups comprised the partners and practice nurses at each practice. All members of each group were well known to one another. There was good attendance by all doctors, with 75% of male partners and 90% of female partners present at the meetings. Of the practice nurses, 51% attended. In all, 86 professionals attended the meetings. Results A number of themes arose consistently from the discussions. Participants were concerned about the possible consequences of errors in diagnosis and about difficulties concerning the ‘management of uncertainty’. Doctors were influenced especially by adverse past experiences. Other difficult situations included referral decisions and the management of risk factors in isolation from clinical presentation. Outside influences on presentation and management, such as the media, were also noted. Conclusions The management of breast disease is perceived as a complex issue by health professionals. The patient and doctor contextual factors described must be taken into account in discussions about what constitutes appropriate clinical management and in the development and implementation of clinical guidelines to improve management.     

Low back pain--a community-based study of care-seeking and therapeutic effectiveness

Purpose : To describe care seeking characteristics among low back pain subjects (LBP); to describe the perceived effectiveness of interventions by recipients of care for LBP; and, to discuss the gap between LBP management guidelines and actual practice in primary care.

Methods : The population consisted of 555 subjects who were recruited from a cross sectional survey of all inhabitants of a small town in Israel. They reported 1 month LBP and were further probed regarding the characteristics of their pain and pattern of care. Data collection was performed by a self-administered questionnaire.

Results : Some form of care was sought by 78.7% of the participants. More than half (58%) visited a physician, 34.4% were prescribed drug therapy, 37.1% attended physical therapy and 28.6% turned to alternative medicine. Participants with severe pain were more likely to seek care. That was demonstrated by all pain measures (e.g. high Roland and Morris disability scores (8.2 ±5.6 vs 4.4 ±4.1), high symptoms frequency (8.9 ±4.1 vs 7.5 ±3.6) and high pain severity scores (5.6 ±2.2 vs 4.5 ±1.7)). The intervention perceived to be most effective was alternative medicine (graded as 'effective' or 'very effective' by 62.8%), followed by therapeutic exercise programmes (56.9%), bed rest (51.9%) and physical therapy (46.8%).

Conclusions : Individuals reporting severe LBP were more likely to seek care. The treatment utilities perceived to be most effective were alternative medicine and therapeutic exercises, whereas the least effective were physicians' office visits. A gap was found between clinical guidelines and physicians referrals for other therapeutic interventions.     

EHR adoption among doctors who treat the elderly

Objectives The purpose of this study is to examine Electronic Health Record (EHR) adoption among Florida doctors who treat the elderly. This analysis contributes to the EHR adoption literature by determining if doctors who disproportionately treat the elderly differ from their counterparts with respect to the utilization of an important quality‐enhancing health information technology application. Methods This study is based on a primary survey of a large, statewide sample of doctors practising in outpatient settings in Florida. Logistic regression analysis was used to determine whether doctors who treat a high volume of elderly (HVE) patients were different with respect to EHR adoption. Results Our analyses included responses from 1724 doctors. In multivariate analyses controlling for doctor age, training, computer sophistication, practice size and practice setting, HVE doctors were significantly less likely to adopt EHR. Specifically, compared with their counterparts, HVE doctors were observed to be 26.7% less likely to be utilizing an EHR system (OR = 0.733, 95% CI 0.547–0.982). We also found that doctor age is negatively related to EHR adoption, and practice size and doctor computer savvy‐ness is positively associated. Conclusions Despite the fact that EHR adoption has improved in recent years, doctors in Florida who serve the elderly are less likely to adopt EHRs. As long as HVE doctors are adopting EHR systems at slower rates, the elderly patients treated by these doctors will be at a disadvantage with respect to potential benefits offered by this technology.     

Alcohol and drug screening and brief intervention behaviors among advanced practice registered nurse (APRN) students in clinical settings

Previous research on training health professionals to identify and address unhealthy alcohol and drug use in patients through screening, brief intervention, and referral to treatment (SBIRT) has found that training increases knowledge about substance use and increases students' confidence in addressing substance use in patients. To date, however, there is little information on how health professional students integrate SBIRT into individual practice. Within a U.S. SBIRT training consortium, advanced practice registered nurse (APRN) students were required to practice SBIRT in clinical settings and complete assessment logs for each patient screened. Logs documented results from single item alcohol & drug screening questions; AUDIT or DAST responses; brief intervention (BI)/referral to treatment (RT) steps completed and patients' responses. 113 APRN students completed logs on 538 patients (mean age 44; SD 15.0; 53.5% female). Positive single question alcohol screens were more frequent than positive single question drug screens (55.3% vs. 25.5%). More than one third (36%) of the logs included high-risk AUDIT/DAST scores. The most utilized BI components were discussions regarding consequences of use (76%) and safe levels of use (70%), while the most utilized RT steps included referral to a mutual help group (15%) or a specialty treatment program (8%). Positive screening rates found by APRN students were higher than reported rates in most clinical settings. The logs also demonstrated that APRN students employed many of the SBIRT skills they were taught while also helping identify underutilized SBIRT steps, which may be addressed specifically in future SBIRT trainings.     

To tell or not to tell: attitudes of Chinese oncology nurses towards truth telling of cancer diagnosis

Aims and objectives. To investigate the attitude of oncology nurses towards whether and how to disclose diagnoses to patients with early‐stage cancer or terminal illness. Background. The attitudes of patients and doctors towards the disclosure of cancer diagnosis differed from culture to culture. However, little research has focused on the attitudes of Chinese oncology nurses. Design. Survey. Methods. A questionnaire investigating nurses’ attitudes towards truth telling was delivered to 243 Chinese oncology nurses. Results. One hundred and ninety‐nine (81?9%) nurses completed the questionnaire. 81?4% of the nurses reported that patients with early‐stage cancer should be informed of the diagnosis, while only 44?2% believed that patients with terminal illnesses should know the truth (p < 0?001). Nurses who preferred truth telling reported that patients with early or terminal stages of cancer should be informed by the doctor in charge (76?5% vs. 73?9%, respectively; p > 0?05), immediately after the diagnosis (75?9% vs. 79?5%, respectively) and in a quiet and undisturbed room (80?9% vs. 70?5%, respectively; p > 0?05). Nurses’ attitudes towards truth telling of terminal cancer were influenced by their educational level and work experience. Conclusion. Oncology nurses differed in their attitudes towards truth telling of different stages of cancer. Nurses who preferred disclosure reported that cancer patients should be informed by the doctor in charge immediately after the diagnosis and in a quiet and undisturbed room. Relevance to clinical practice. Many Chinese doctors, patients and their relatives believed that patients with terminal illness should not know their diagnosis. Thus, oncology nurses need additional training to deal with these situations.