Communication about standard treatment options and clinical trials: can we teach doctors new skills to improve patient outcomes?

BACKGROUND: The International Breast Cancer Study Group conducted a phase III trial in Australian/New Zealand (ANZ) and Swiss/German/Austrian (SGA) centres on training doctors in clear and ethical information delivery about treatment options and strategies to encourage shared decision making. METHODS: Medical, surgical, gynaecological and radiation oncologists, and their patients for whom adjuvant breast cancer therapy was indicated, were eligible. Doctors were randomised to participate in a workshop with standardised teaching material and role playing. Patients were recruited in the experimental and control groups before and after the workshop. RESULTS: In ANZ centres, 21 eligible doctors recruited a total of 304 assessable patients. In SGA centres, 41 doctors recruited 390 patients. The training was well accepted. There was no overall effect on patient decisional conflict (primary endpoint) 2 weeks after the consultation. Overall, patients were satisfied with their treatment decision, their consultation and their doctors' consultation skills. Considerable variation was observed in patient outcomes between SGA and ANZ centres; the effect sizes of the intervention were marginal (<0.2). CONCLUSIONS: Shared decision making remains a challenge. A sustained training effect may require more intensive training tailored to the local setting. Cross-cultural differences need attention in conducting trials on communication interventions.

Eros and Transgression in an Age of Immanence: Georges Bataille’s (Religious) Critique of Kinsey

This paper explores the religious implications of eroticism in Western culture since the Sexual Revolution, a period at once applauded for its open and immanent view of sexuality and denounced for its shamelessness and promiscuity. After discussing the work and effects of Alfred C. Kinsey, the father of the Sexual Revolution, I focus on a critical appraisal of Kinsey written by French theorist Georges Bataille (“Kinsey, the Underworld and Work,” in L’Erotisme, 1957). Bataille situates contemporary Western sexuality within a larger historical movement towards the “desacralization” of all aspects of human life: sex, under the scientific gaze of the Kinsey team, became simply another “object” to be analyzed and classified, and “good” sex defined solely in terms of frequency and explosiveness of orgasm. For many, including Hugh Hefner, this approach to sex occasioned a refreshing awakening from the long dark night of Victorian sexual repression. However, as Bataille’s protégé Foucault has shown, the scientific approach to sexuality often masks a desire to control and delimit sexual behaviour, not “liberate” it. Moreover, Bataille makes the point that the desacralization of sexuality denudes sex of a vital component—eroticism—which is necessary for real pleasure and ecstasy. Beyond the “moral” critiques one often hears leveled against Kinsey and his work, Bataille provides a “religious” critique, one that stands, perhaps surprisingly, on the “near side” of sexuality.