Race,treatment preferences,and hospice enrollment: Eligibility criteria may exclude patients with the greatest needs for care

BACKGROUND:

The requirement that patients give up curative treatment makes hospice enrollment unappealing for some patients and may particularly limit use among African‐American patients. The current study was conducted to determine whether African‐American patients with cancer are more likely than white patients to have preferences for cancer treatment that exclude them from hospice and whether they are less likely to want specific hospice services.

METHODS:

Two hundred eighty‐three patients who were receiving treatment for cancer at 6 oncology clinics within the University of Pennsylvania Cancer Network completed conjoint interviews measuring their perceived need for 5 hospice services and their preferences for continuing cancer treatment. Patients were followed for 6 months or until death.

RESULTS:

African‐American patients had stronger preferences for continuing their cancer treatments on a 7‐point scale even after adjusting for age, sex, finances, education, Eastern Cooperative Oncology Group performance status, quality of life, and physical and psychologic symptom burden (adjusted mean score, 4.75 vs 3.96; β coefficient, 0.82; 95% confidence interval, 0.22‐1.41 [P = .007]). African‐American patients also had greater perceived needs for hospice services after adjusting for these characteristics (adjusted mean score, 2.31 vs 1.83; β coefficient, 0.51; 95% confidence interval, 0.11‐0.92 [P = .01]). However, this effect disappeared after adjusting for household finances.

CONCLUSIONS:

Hospice eligibility criteria may exclude African‐American patients disproportionately despite greater perceived needs for hospice services in this population. The mechanisms driving this health disparity likely include both cultural differences and economic characteristics, and consideration should be given to redesigning hospice eligibility criteria. Cancer 2009. © 2008 American Cancer Society.     

Unmet information needs and preferences in newly diagnosed and surgically treated oral cavity cancer patients

The purposes of this study were to examine and compare the levels of care information needs, information preferences, unmet information needs, and predictive factors between newly diagnosed and surgically treated oral cavity cancer patients.Patients were divided into two groups comprising: (a) diagnosed patients and (b) surgically treated patients. A cross-sectional survey was conducted to assess information needs about care, disease-/treatment-related characteristics, and physical performance function in 109 diagnosed and 113 surgically treated oral cavity cancer patients.The two groups had statistically different levels of care information needs, information preferences about benefits, and side effects of treatment/ surgery. There were clinically meaningful differences in their information concerns. The diagnosed patients’ information needs were predicted by previous serious illness experiences, prior alcohol use, anxiety level, education level, time since diagnosis, psychological impact, and religion. The surgically treated patients’ information needs were predicted by previous serious illness experiences, prior alcohol use, anxiety level, psychological impact, education level, and marital status. Conclusion: This study revealed differences in information needs between diagnosed patients and surgically treated oral cavity cancer patients. Results suggest that healthcare professionals should design a protocol to guide development of a comprehensive pre- and postoperative information package to be given to these patients.     

南京某三甲医院医疗高层人才偏好特征研究

目的 分析医疗高层人才的偏好特征,从而提出有效的激励方案.方法 根据医疗高层人才的特点,设计调查问卷,针对南京某三甲医院医疗高层人才进行调研,运用主成分分析法对医疗高层人才的偏好特征进行归结.结果 物质需求、成就需要和成长需求的平均得分分别为4.7分、3.8分和3.9分,归结为高层人才偏好的3个具有明显意义的主成分.结论 高层人才偏好按强弱排序依次为成就需要、物质需要、发展需要,并提出了相应的激励对策.     

Decisions about Pap tests: What influences women and providers?

Despite the success internationally of cervical screening programs debate continues about optimal program design. This includes increasing participation rates among under-screened women, reducing unnecessary early re-screening, improving accuracy of and confidence in screening tests, and determining the cost-effectiveness of program parameters, such as type of screening test, screening interval and target group. For all these issues, information about consumer and provider preferences and insight into the potential impact of any change to program design on consumer and provider behaviour are essential inputs into evidence-based health policy decision making. This paper reports the results of discrete choice experiments to investigate women's choices and providers' recommendations in relation to cervical screening in Australia. Separate experiments were conducted with women and general practitioners, with attributes selected to allow for investigation of how women and general practitioners differ in their preferences for attributes of screening programs. Our results indicate a considerable commonality in preferences but the alignment was not complete. Women put relatively more weight on cost, chance of a false positive and if the recommended screening interval were changed to one year.     

Karyotyping or rapid aneuploidy detection in prenatal diagnosis? The different views of users and providers of prenatal care

Developments in prenatal diagnosis raise the question which test strategy should be implemented. However, preferences of women and caregivers are underexposed. This study investigates what kind of prenatal test pregnant women and caregivers prefer and if differences between the groups exist, using self-report questionnaires. Women preferred either karyotyping (50%) or rapid aneuploidy detection (43%). Caregivers opted for the latter (78%). A test targeted on Down syndrome was the least preferred in both groups. We recommend the use of individualised choice for genetic test in prenatal diagnosis, overcoming the existing differences in preferences between women and caregivers.     

The motivational foundations of different therapeutic orientations as indicated by therapists' value preferences

Objective: The present study investigates the relationships between therapists' value preferences and their beliefs in the efficacy of the four main therapeutic orientations (cognitive behavior, psychodynamic, client-centered, and eco-systemic). Method: The study was conducted in Israel. Social workers practicing individual therapy in different psychosocial services participated in the study (n = 528). Results: Personal value preferences explained a significant proportion of the variance in the social workers' beliefs in the efficacy of different therapeutic orientations. Each therapeutic orientation was associated with a specific pattern of value preferences, thus indicating that different therapeutic orientations promote or impede the attainment of the therapists' specific motivational goals. Conclusions: The study results' implications for understanding the motivational foundations of different therapeutic orientations are discussed, as well as their possible application for therapist training and practice.     

Stability of practice beliefs and preferences for patients among private general dentists: a comparison of 1997 and 2007

Background:  Practice beliefs and dentist preferences for patients have been related to service rates and appropriateness of care. If practice beliefs and preferences for patients are stable then they could restrain long-term changes in practice styles and service rates. The aim of this paper was to assess the stability of practice beliefs and preferences for patients between 1997 and 2007.
Methods:  Practice beliefs and dentist preferences for patients were recorded on a five-point Likert scale using mailed questionnaires from a random sample of dentists in 1997 (response rate = 60 per cent) and 2007 (response rate = 77 per cent).
Results:  In both 1997 and 2007, n = 215 dentists provided data. For practice beliefs, 1 out of 8 items were significantly different (p < 0.05; McNemar's test) between the two observations (12.5 per cent of practice belief items) while 5 out of 37 dentist preferences for patient characteristics items were significantly different (13.5 per cent of items).
Conclusions:  The majority of items were not significantly different over time. This demonstrates a generally high degree of stability over time in the level of agreement with dentist practice beliefs and preferences for patients. Given that it may be difficult for clinicians to change practice beliefs and behaviours that have become established, it is important for policy makers to understand the relationship between provider characteristics and service patterns and for educators to positively shape beliefs and behaviours through undergraduate and continuing education.     

Preferences of pre- and post-weanling long-evans rats for nest odors

Three experiments were conducted on the preferences of infant rats for nest odors. Pre-weanling rats preferred their own nest odor to nests of strange litters and showed low preferences for the nest odors of virgin females. Nest odors of unmated males were investigated less than the pup's own nest odor but more than the odors of virgin females. Male and female rats did not differ in odor preferences. Rats reared with both their dam and sire did not differ in their odor preferences from rats reared with their dam alone when tested at 16–20 days of age, but when tested at 33–38 days of age they showed a greater preference for male odors. Post-weanling rats did not show a preference for the nest odors of lactating females and began to show sex differences in their preferences.