Cancer diagnosis disclosure from Portuguese physicians

OBJECTIVE: Doctor-patient communication in oncology, particularly concerning diagnostic disclosure, is a crucial factor related to the quality of the doctor-patient relationship and the psychological state of the patient. The aims of our study were to investigate physicians' opinions and practice with respect to disclosure of a cancer diagnosis and to explore potential related factors. METHOD: A self-report questionnaire developed for our study was responded to by 120 physicians from Coimbra University Hospital Centre and its primary healthcare units. RESULTS: Some 91.7% of physician respondents generally disclosed a diagnosis, and 94.2% were of the opinion that the patient knowing the truth about a diagnosis had a positive effect on the doctor-patient relationship. A need for training about communicating with oncology patients was reported by 85.8% of participants. The main factors determining what information to provide to patients were: (1) patient intellectual and cultural level, (2) patient desire to know the truth, and (3) the existence of family. SIGNIFICANCE OF RESULTS: Our results point to a paradigm shift in communication with cancer patients where disclosure of the diagnosis should be made part of general clinical practice. Nevertheless, physicians still experience difficulties in revealing cancer diagnoses to patients and often lack the skills to deal with a patient's emotional responses, which suggests that more attention needs to be focused on communication skills training programs.

Shuttle orbiter passenger compartment habitability requirements study for flight personnel accommodations.

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Effects of two teaching strategies on the relationship between nursing students’ self-efficacy and performance in BLS/AED

Purpose: Nurses and nursing students are often first responders to in-hospital cardiac arrest events; thus they are expected to perform Basic Life Support (BLS) and use an automated external defibrillator (AED) without delay. The aim of this study was to explore the relationship between nursing students’ self-efficacy and performance before and after receiving a particular training intervention in BLS/AED. Materials and methods: Explanatory correlational study. 177 nursing students received a 4-h training session in BLS/AED after being randomized to either a self-directed (SDG) or an instructor-directed teaching group (IDG).1 A validated self-efficacy scale, the Cardiff Test and Laerdal SkillReporter® software were used to assess students’ self-efficacy and performance in BLS/AED at pre-test, post-test and 3-month retention-test. Independent t-test analysis was performed to compare the differences between groups at pre-test. Pearson coefficient (r) was used to calculate the strength of the relationship between self-efficacy and performance in both groups at pre-test, post-test and retention-test. Results: Independent t-tests analysis showed that there were non-significant differences (p-values > 0.05) between groups for any of the variables measured. At pre-test, results showed that correlation between self-efficacy and performance was moderate for the IDG (r = 0.53; p < 0.05) and the SDG (r = 0.49; p < 0.05). At post-test, correlation between self-efficacy and performance was much higher for the SDG (r = 0.81; p < 0.05) than for the IDG (r = 0.32; p < 0.05), which in fact was weaker than at pre-test. Finally, it was found that whereas the correlation between self-efficacy and performance increased from the post-test to the retention-test to almost reach baseline levels for the ILG (r = 0.52; p < 0.05), it slightly decreased in this phase for the SDG (r = 0.77; p < 0.05). Conclusion: Student-directed strategies may be more effective than instructor-directed strategies at promoting self-assessment and, therefore, may help to improve and maintain the relationship between nursing student self-efficacy and actual ability to perform BLS/AED.

Relatório de Estágio - Escola Secundária Mouzinho da Silveira, Escola Secundária de São Lourenço e Escola Superior de Saúde de Portalegre

Com a elaboração deste relatório, pretende-se descrever as ações por nós desenvolvidas no estágio do Curso de Mestrado em Enfermagem - Especialização em Enfermagem Comunitária, as quais se realizaram na Escola Secundária Mouzinho da Silveira, na Escola Secundária de São Lourenço e ainda na Escola Superior de Saúde de Portalegre. Na Escola Secundária Mouzinho da Silveira foi aplicado um questionário a 264 alunos de 8º ano, 9º ano, 10º ano e uma turma de CEF, para fazer o diagnóstico de situação daquela comunidade escolar relativamente à sexualidade, para tal foi estabelecido um projeto de trabalho entre esta escola e a Escola Superior de Saúde de Portalegre, no sentido de privilegiar a Área da Educação para a Saúde – Sexualidade na Adolescência. Foi elaborado um projeto de intervenção comunitária, tendo por base o planeamento em saúde, onde foram definidas prioridades, fixaram-se objetivos, selecionaram-se estratégias, fez-se uma preparação da execução, executou-se e avaliou-se a intervenção. Nesta intervenção foram realizadas várias sessões de Educação para a Saúde, onde falamos sobre vários temas, todos eles ligados à Sexualidade. Esta intervenção estendeu-se também a duas turmas da Escola Secundária de São Lourenço. A outra área de intervenção comunitária teve lugar na Escola Superior de Saúde de Portalegre e contou com 317 alunos do 9º ano e 12º ano da área ciências e tecnologia do Concelho de Portalegre, tendo sido realizadas várias sessões de educação para a saúde, sessões essas interativas, onde se falou de Suporte Básico de Vida, se aprendeu a avaliar a tensão arterial, o índice de massa corporal e falamos ainda sobre hábitos de vida saudáveis É na adolescência, que se adquirem hábitos e comportamentos saudáveis. Assim, os profissionais de saúde, conjuntamente com a escola, a família e a comunidade envolvente, poderão ter um papel preponderante, capacitando os jovens de competências que lhes permitam optar por comportamentos saudáveis, a nível de alimentação, álcool, uso de drogas, prevenção de infeções sexualmente transmissíveis, gravidez e cidadania, sendo a escola um lugar de excelência para tal capacitação.

Relatório Final de Estágio em Enfermagem Comunitária

O presente Relatório está contextualizado no plano curricular de estágio do 1º Mestrado em Enfermagem da Escola Superior de Saúde de Portalegre - Instituto Politécnico de Portalegre, na Área de Especialização em Enfermagem Comunitária, que decorreu entre 14 de Fevereiro a 30 de Junho de 2011. O estágio foi dividido em duas áreas de intervenção comunitárias distintas: a primeira na área da educação sexual na adolescência que se realizou na Escola Secundária Mouzinho da Silveira e na Escola Secundária de São Lourenço, surgindo como resposta a um projeto trabalho conjunto entre esta escola e a Escola Superior de Saúde de Portalegre, onde foi realizado por nós um diagnóstico de situação. A segunda intervenção surge na área da promoção da imagem da Escola Superior de Saúde de Portalegre, que visou facilitar as escolhas da vida profissional através da promoção da imagem da escola e do conhecimento da oferta formativa nela existente junto dos alunos do 9º e 12º anos do concelho de Portalegre e na informação para o desenvolvimento e promoção de hábitos de vida saudáveis por parte dos jovens e ainda a demonstração da execução do suporte básico de vida. A população alvo de intervenção foram os alunos do 8º,9º 10º, entre os 13 e os 22 anos, num total de 693 jovens. Os objetivos do estágio foram: adquirir competências tendo por base a metodologia do planeamento em saúde, na avaliação do estado de saúde desta comunidade; bem como: Contribuir para o processo de capacitação desta comunidade. Conhecer os comportamentos e os estilos de vida dos adolescentes, integrados no sistema educativo. Em relação ao relatório de estagio o principal objetivo foi: encontrar respostas honestas e proceder a uma auto-avaliação construtiva e de aprendizagem pessoal (Soares et al 1997: 36)

Intervenções de enfermagem ao doente com traumatismo crânio-encefálico: construção e validação de um protocolo

O traumatismo crânio-encefálico é reconhecido como um sério problema de saúde pública com importante impacto económico e social. A realização de um protocolo de intervenção de enfermagem ao doente com traumatismo crânio-encefálico surgiu da necessidade em uniformizar um conjunto de intervenções de enfermagem para uma actuação rápida e eficaz ao doente com traumatismo crânio-encefálico em sala de emergência, baseado nas recomendações do Advanced Trauma Life Support do American College of Surgeons e do Trauma Nursing Core Course da Emergency Nurses Association. A técnica Delphi foi utilizada na metodologia deste estudo através da aplicação de questionários a um grupo de peritos (painel Delphi) na área do trauma, que avaliaram a pertinência e compreensibilidade das intervenções de enfermagem elaboradas. Os resultados evidenciaram um consenso entre os peritos relativamente às intervenções de enfermagem apresentadas. Este estudo, permitiu que se construísse um protocolo com intervenções de enfermagem válidas e consensuais entre peritos, para uma abordagem adequada ao doente com traumatismo crânio-encefálico em sala de emergência.

Podcast: After the Liverpool Care Pathway clear guidance and support on end-of-life care is needed

In this podcast Roberta Heale talks to Dr Peter O'Halloran about the paper "After the Liverpool Care Pathway clear guidance and support on end-of-life care is needed." They discuss the newly implemented pathways and the effects these have on practice and patients.

Does the provision of full day care improve the quality of life for children and their parents

This study sought to explore and examine if the provision of full day care improves the quality of life for children and their parents. Owing to the effects of the Celtic Tiger, life in Ireland has changed considerably over the past five to ten years. Because of the booming economy there are now 60.8% of women employed in the workforce. This means many changes for children, parents and families. Findings in the literature review are based on international studies. The researcher utilised both qualitative and quantitative research methodologies for the study. She interviewed 31 respondents; 27 childcare managers; 3 politicians and the chairperson of a childcare committee. Furthermore, 325 questionnaires were completed in a survey by working parents in the statutory and voluntary sectors in and around Sligo town and in two childcare facilities in Letterkenny, Co. Donegal. Babies as young as 4 months are being cared for in childcare facilities from 6.45am until 6.pm daily, 5 days per week. Some children are spending up to 11 hours per day in childcare facilities. The study has not categorically concluded that full day care is either positive or negative for children. Childcare facilities are providing good quality childcare encompassing various services; however, 25 out of 27 childcare managers reported to the researcher that they would not leave their child in full day care. Parents are finding it difficult to manage work life balance. Health dominated quality of life issues. Two hundred and thirty five (235) parents reported being stressed. The study also found that 315 working parents feel that the government is not doing enough to support working parents. On a positive note, 241 parents said they are happy in general with the quality of life for them, their family and their children. In addition, the researcher has identified a number of recommendations for future changes in policy and further study.

Medical futility at the end of life: the perspectives of intensive care and palliative care clinicians.

Objectives Medical futility at the end of life is a growing challenge to medicine. The goals of the authors were to elucidate how clinicians define futility, when they perceive life-sustaining treatment (LST) to be futile, how they communicate this situation and why LST is sometimes continued despite being recognised as futile. Methods The authors reviewed ethics case consultation protocols and conducted semi-structured interviews with 18 physicians and 11 nurses from adult intensive and palliative care units at a tertiary hospital in Germany. The transcripts were subjected to qualitative content analysis. Results Futility was identified in the majority of case consultations. Interviewees associated futility with the failure to achieve goals of care that offer a benefit to the patient's quality of life and are proportionate to the risks, harms and costs. Prototypic examples mentioned are situations of irreversible dependence on LST, advanced metastatic malignancies and extensive brain injury. Participants agreed that futility should be assessed by physicians after consultation with the care team. Intensivists favoured an indirect and stepwise disclosure of the prognosis. Palliative care clinicians focused on a candid and empathetic information strategy. The reasons for continuing futile LST are primarily emotional, such as guilt, grief, fear of legal consequences and concerns about the family's reaction. Other obstacles are organisational routines, insufficient legal and palliative knowledge and treatment requests by patients or families. Conclusion Managing futility could be improved by communication training, knowledge transfer, organisational improvements and emotional and ethical support systems. The authors propose an algorithm for end-of-life decision making focusing on goals of treatment.

Assessment of needs, health-related quality of life, and satisfaction with care in breast cancer patients to better target supportive care.

BACKGROUND: This study assessed whether breast cancer (BC) patients express similar levels of needs for equivalent severity of symptoms, functioning difficulties, or degrees of satisfaction with care aspects. BC patients who did (or not) report needs in spite of similar difficulties were identified among their sociodemographic or clinical characteristics. PATIENTS AND METHODS: Three hundred and eighty-four (73% response rate) BC patients recruited in ambulatory or surgery hospital services completed the European Organisation for Research and Treatment of Cancer Quality of Life questionnaire (EORTC QLQ)-C30 quality of life [health-related quality of life (HRQOL)], the EORTC IN-PATSAT32 (in-patient) or OUT-PATSAT35 (out-patient) satisfaction with care, and the supportive care needs survey short form 34-item (SCNS-SF34) measures. RESULTS: HRQOL or satisfaction with care scale scores explained 41%, 45%, 40% and 22% of variance in, respectively, psychological, physical/daily living needs, information/health system, and care/support needs (P < 0.001). BC patients' education level, having children, hospital service attendance, and anxiety/depression levels significantly predicted differences in psychological needs relative to corresponding difficulties (adjusted R(2) = 0.11). Medical history and anxiety/depression levels significantly predicted differences in information/health system needs relative to degrees of satisfaction with doctors, nurses, or radiotherapy technicians and general satisfaction (adjusted R(2) = 0.12). Unmet needs were most prevalent in the psychological domains across hospital services. CONCLUSIONS: Assessment of needs, HRQOL, and satisfaction with care highlights the subgroups of BC patients requiring better supportive care targeting.

Care complexity, mood, and quality of life in liver pre-transplant patients.

RATIONALE: This study was intended to document the frequency of care complexity in liver transplant candidates, and its association with mood disturbance and poor health-related quality of life (HRQoL). METHODS: Consecutive patients fulfilling inclusion criteria, recruited in three European hospitals, were assessed with INTERMED, a reliable and valid method for the early assessment of bio-psychosocial health risks and needs. Blind to the results, they were also assessed with the Hospital Anxiety and Depression Scale (HADS). HRQoL was documented with the EuroQol and the SF36. Statistical analysis included multivariate and multilevel techniques. RESULTS: Among patients fulfilling inclusion criteria, 60 patients (75.9%) completed the protocol and 38.3% of them were identified as "complex" by INTERMED, but significant between-center differences were found. In support of the working hypothesis, INTERMED scores were significantly associated with all measures of both the SF36 and the EuroQol, and also with the HADS. A one point increase in the INTERMED score results in a reduction in 0.93 points in EuroQol and a 20% increase in HADS score. CONCLUSIONS: INTERMED-measured case complexity is frequent in liver transplant candidates but varies widely between centers. The use of this method captures in one instrument multiple domains of patient status, including mood disturbances and reduced HRQoL.

Needs, expectations, and concerns of medical students regarding end-of-life issues before the introduction of a mandatory undergraduate palliative care curriculum.

BACKGROUND: In the past, implementation of effective palliative care curricula has emerged as a priority in medical education. In order to gain insight into medical students' needs and expectations, we conducted a survey before mandatory palliative care education was introduced in our faculty. METHODS: Seven hundred nine students answered a questionnaire mainly consisting of numeric rating scales (0-10). RESULTS: Participants attributed a high importance to palliative care for their future professional life (mean, 7.51 ± 2.2). For most students, symptom control was crucial (7.72 ± 2.2). However, even higher importance was assigned to ethical and legal issues (8.16 ± 1.9). "Self-reflection regarding their own role as a physician caring for the terminally ill along with psychological support" was also regarded as highly important (7.25 ± 2.4). Most students were moderately concerned at the prospect of being confronted with suffering and death (5.13 ± 2.4). This emotional distress was rated significantly higher by female students (5.4 ± 2.4 versus 4.6 ± 2.4; p < 0.001). Seventeen percent of all students rated their distress as being 7 of 10 or higher, which indicates a considerable psychological strain in terms of dealing with end-of-life issues in the future. Professional or personal experience with terminally ill persons lowered these anxieties significantly (4.99 ± 2.34 versus 5.47 ± 2.5, p < 0.05). CONCLUSIONS: Medical students stated a remarkably high interest in learning palliative care competencies. Responding to their specific concerns and needs-especially with regard to the acquisition of emotional coping skills-may be key for the development of successful palliative care curricula.

Coercion, Perceived Care and Quality of Life Among Patients in Psychiatric Hospitals

The goals of the study were to describe patients’ perceptions of care after experiencing seclusion/restraint and their quality of life. The goal was moreover to identify methodological challenges related to studies from the perspective of coerced patients. The study was conducted in three phases between September 2008 and April 2012. In the first phase, the instrument Secluded/ Restrained Patients’ Perception of their Treatment (SR-PPT) was developed and validated in Japan in cooperation with a Finnish research group (n = 56). Additional data were collected over one year from secluded/restrained patients using the instrument (n = 90). In the second phase, data were collected during the discharge process (n = 264). In the third phase, data were collected from electronic databases. Methodological and ethical issues were reviewed (n = 32) using systematic review method. Patients perceived that co-operation with the staff was poor; patients’ opinions were not taken into account, treatment targets collated and treatment methods were seen in different ways. Patients also felt that their concerns were not well enough understood. However, patients received getting nurses’ time. In particular, seclusion/restraint was considered unnecessary. The patients felt that they benefited from the isolation in treating their problems more than they needed it, even if the benefit was seen to be minor. Patients treated on forensic wards rated their treatment and care significantly lower than in general units. During hospitalization secluded/restrained patients evaluated their quality of life, however, better than did non-secluded/restrained patients. However, no conclusion is drawn to the effect that the better quality of life assessment is attributable to the seclusion/restraint because patients’ treatment period after the isolation was long and because of many other factors, as rehabilitation, medication, diagnostic differences, and adaptation. According to the systematic mixed studies review variation between study designs was found to be a methodological challenge. This makes comparison of the results more difficult. A research ethical weakness is conceded as regards descriptions of the ethical review process (44 %) and informed consent (32 %). It can be concluded that patients in psychiatric hospital care and having a voice as an equal expert require special attention to clinical nursing, decision-making and service planning. Patients and their family members will be consulted in plans of preventive and alternative methods for seclusion and restraint. The study supports the theory that in ethical decision-making situations account should be taken of medical indications, in addition to the patients’ preferences, the effect of treatment on quality of life, and this depends on other factors. The connection between treatment decisions and a patient’s quality of life should be evaluated more structurally in practice. Changing treatment culture towards patients’ involvement will support daily life in nursing and service planning taking into account improvements in patients’ quality of life.