Communication skills training in oncology: it works!

While the previous chapter by L. Fallowfield and V. Jenkins focuses on different communication skills training (CST) concepts currently being utilized, this chapter reviews and comments the scientific evidence of the impact of CST on improving communication skills. The aim of this chapter is not to provide a complete review of the evidence-this has already been done in systematic reviews-but to discuss the scientific evidence and reflect on the available results and relevant topics for further investigations.

Financial Power of Attorney

A financial power of attorney (FPOA) is a document authorizing someone else (an agent) to manage your finances on your behalf if you (the principal) become incapacitated and are unable to make financial management decisions for yourself. If you become unable to decide for yourself and you have not prepared a financial power of attorney, a court proceeding will likely be required before a loved one will be able to assume authority over at least some of your financial affairs. Your FPOA can be drafted to go into effect as soon as you sign it or it can become effective at a later date or only in the case that a physician certifies that you have become incapacitated.

Healthcare Power of Attorney

A health care power of attorney (HC-POA) is a document authorizing an attorney-in-fact (your designated agent) to make health care decisions on your behalf if you (the principal) are unable, in the judgment of your attending physician, to make health care decisions. Health care is defined as any care, treatment, service or procedure required to maintain, diagnose or treat a physical or mental condition. Through your HC-POA, you may authorize someone else to consent, refuse or withdraw consent to health care on your behalf. The attorney-in-fact is permitted to make only health care-related decisions on your behalf. In exercising this authority, the attorney-in-fact must act consistently with your desires (as stated in the HC-POA document).

Les divers sens de la notion d'autonomie en médecine et leur pertinence en clinique [The various senses of autonomy and their relevance to clinical practice]

Since the introduction of the principle of respect of autonomy in medical ethics, the respect of the will of the patient occupied a central place in the decision-making process. To face up to the difficulties that appeared during the application of this principle in clinical medicine, Bruce Miller proposed in the early eighties one way to clarify the significance of this notion in the field of medical practice. He showed that the concept of autonomy can be understood under four senses which deserve to be explored in case of ethical conflict. This article shows, through the analysis of a clinical situation, the relevance of the approach suggested by this author and proposes to refer to this approach in case of ethical dilemmas in clinical practice.

Les errances de la posologie

La posologie de nombreux médicaments doit souvent être réduite de manière importante après leur mise sur le marcbé. Ce fait en dit long sur l'échec des procédures de développement et d'évaluation des médicaments. Pour qu'un patient bénéficie de l'activité pharmacologique d'un médicament sans courir de risques injustifiés, l'efficacité de cette procédure doit être améliorée et des informations précises fournies au praticien pour lui permettre d'individualiser la posologie

Information and risk management during the first trimester care for pregnant women: Some reflections about the ethical challenges and the legal framework in Switzerland. [L'information et la gestion des risques dans le suivi de la grossesse lors du 1er trimestre : quelques réflexions sur le défi éthique et le cadre légal en Suisse.]

The progress in prenatal medicine raises complex questions with respect to the physician-patient relationship. The physician needs to reconcile medical aspects, ethical principles as well as judicial norms. Already, during the first trimester, the physician has to put into practice the schedule combining for each individual pregnancy physical, laboratory and other appropriate exams. Physicians are under the obligation to inform in a clear and comprehensive way without creating unnecessary anxiety for their patients. Legal requirements include informed consent, the respect for the patient's right to self-determination, and compliance with the Swiss federal law on genetic testing, especially with its articles on prenatal screening and diagnosis. This article discusses the complexity of obstetrical practice when it comes to delivering adequate information within the scope of ethical and legal requirements in Switzerland. L'évolution de la médecine prénatale soulève des enjeux complexes dans la relation médecin-patient. Il s'agit de concilier à la fois les aspects médicaux, les principes éthiques et les normes juridiques. Dès le premier trimestre de la grossesse le médecin doit poser le cadre du suivi et des examens appropriés pour chaque grossesse. Son devoir est d'informer de manière claire et précise sans inquiéter inutilement, en respectant l'exigence légale d'un consentement éclairé et plus largement le droit de la patiente à l'autodétermination ainsi que le cadre de la loi fédérale suisse sur l'analyse génétique humaine dans le domaine du dépistage et du diagnostic prénatal. Cet article discute de la complexité de l'information et de l'application des principes éthiques et légaux dans la pratique obstétricale en Suisse.

Health Care Power of Attorney FAQs

A health care power of attorney (HC-POA) is a document authorizing an attorney-in-fact (your designated agent) to make health care decisions on your behalf if you (the principal) are unable, in the judgment of your attending physician, to make health care decisions. Health care is defined as any care, treatment, service or procedure required to maintain, diagnose or treat a physical or mental condition. Through your HC-POA, you may authorize someone else to consent, refuse or withdraw consent to health care on your behalf.

Comparison of quality of life after stereotactic body radiotherapy and surgery for early-stage prostate cancer

Background: As the long-term efficacy of stereotactic body radiation therapy (SBRT) becomes established and other prostate cancer treatment approaches are refined and improved, examination of quality of life (QOL) following prostate cancer treatment is critical in driving both patient and clinical treatment decisions. We present the first study to compare QOL after SBRT and radical prostatectomy, with QOL assessed at approximately the same times pre- and post-treatment and using the same validated QOL instrument. Methods: Patients with clinically localized prostate cancer were treated with either radical prostatectomy (n = 123 Spanish patients) or SBRT (n = 216 American patients). QOL was assessed using the Expanded Prostate Cancer Index Composite (EPIC) grouped into urinary, sexual, and bowel domains. For comparison purposes, SBRT EPIC data at baseline, 3 weeks, 5, 11, 24, and 36 months were compared to surgery data at baseline, 1, 6, 12, 24,and 36 months. Differences in patient characteristics between the two groups were assessed using Chi-squared tests for categorical variables and t-tests for continuous variables. Generalized estimating equation (GEE) models were constructed for each EPIC scale to account for correlation among repeated measures and used to assess the effect of treatment on QOL. Results: The largest differences in QOL occurred in the first 16 months after treatment, with larger declines following surgery in urinary and sexual QOL as compared to SBRT, and a larger decline in bowel QOL following SBRT as compared to surgery. Long-term urinary and sexual QOL declines remained clinically significantly lower for surgery patients but not for SBRT patients. Conclusions: Overall, these results may have implications for patient and physician clinical decision making which are often influenced by QOL. These differences in sexual, urinary and bowel QOL should be closely considered in selecting the right treatment, especially in evaluating the value of non-invasive treatments, such as SBRT.

Enfrontar-se a la pràctica assistencial. Avaluació d'una activitat pràctica

Els estudis de Grau de Medicina inclouen 11 hores d'antropologia de la salut en l’assignatura d'Introducció a la salut de 1er curs. Per a aconseguir un aprenentatge significatiu els estudiants han de realitzar una entrevista de caràcter qualitatiu a un pacient crònic amb l’objectiu de conèixer la experiència de patir una malaltia, les repercussions físiques, psicològiques i socials derivades de la malaltia així com les representacions i significats sobre la malaltia i les necessitats sentides del pacient i/o de la família.

Social and medical vulnerability factors of frequent users at the emergency department: a case-control study

BACKGROUND: Up to 5% of patients presenting to the emergency department (ED) four or more times within a 12 month period represent 21% of total ED visits. In this study we sought to characterize social and medical vulnerability factors of ED frequent users (FUs) and to explore if these factors hold simultaneously. METHODS: We performed a case-control study at Lausanne University Hospital, Switzerland. Patients over 18 years presenting to the ED at least once within the study period (April 2008 toMarch 2009) were included. FUs were defined as patients with four or more ED visits within the previous 12 months. Outcome data were extracted from medical records of the first ED attendance within the study period. Outcomes included basic demographics and social variables, ED admission diagnosis, somatic and psychiatric days hospitalized over 12 months, and having a primary care physician.We calculated the percentage of FUs and non-FUs having at least one social and one medical vulnerability factor. The four chosen social factors included: unemployed and/or dependence on government welfare, institutionalized and/or without fixed residence, either separated, divorced or widowed, and under guardianship. The fourmedical vulnerability factors were: ≥6 somatic days hospitalized, ≥1 psychiatric days hospitalized, ≥5 clinical departments used (all three factors measured over 12 months), and ED admission diagnosis of alcohol and/or drug abuse. Univariate and multivariate logistical regression analyses allowed comparison of two JGIM ABSTRACTS S391 random samples of 354 FUs and 354 non-FUs (statistical power 0.9, alpha 0.05 for all outcomes except gender, country of birth, and insurance type). RESULTS: FUs accounted for 7.7% of ED patients and 24.9% of ED visits. Univariate logistic regression showed that FUs were older (mean age 49.8 vs. 45.2 yrs, p=0.003),more often separated and/or divorced (17.5%vs. 13.9%, p=0.029) or widowed (13.8% vs. 8.8%, p=0.029), and either unemployed or dependent on government welfare (31.3% vs. 13.3%, p<0.001), compared to non-FUs. FUs cumulated more days hospitalized over 12 months (mean number of somatic days per patient 1.0 vs. 0.3, p<0.001; mean number of psychiatric days per patient 0.12 vs. 0.03, p<0.001). The two groups were similar regarding gender distribution (females 51.7% vs. 48.3%). The multivariate linear regression model was based on the six most significant factors identified by univariate analysis The model showed that FUs had more social problems, as they were more likely to be institutionalized or not have a fixed residence (OR 4.62; 95% CI, 1.65 to 12.93), and to be unemployed or dependent on government welfare (OR 2.03; 95% CI, 1.31 to 3.14) compared to non-FUs. FUs were more likely to need medical care, as indicated by involvement of≥5 clinical departments over 12 months (OR 6.2; 95%CI, 3.74 to 10.15), having an ED admission diagnosis of substance abuse (OR 3.23; 95% CI, 1.23 to 8.46) and having a primary care physician (OR 1.70;95%CI, 1.13 to 2.56); however, they were less likely to present with an admission diagnosis of injury (OR 0.64; 95% CI, 0.40 to 1.00) compared to non-FUs. FUs were more likely to combine at least one social with one medical vulnerability factor (38.4% vs. 12.1%, OR 7.74; 95% CI 5.03 to 11.93). CONCLUSIONS: FUs were more likely than non-FUs to have social and medical vulnerability factors and to have multiple factors in combination.

Enfrontar-se a la pràctica assistencial. Avaluació d'una activitat pràctica

Els estudis de Grau de Medicina inclouen 11 hores d'antropologia de la salut en l’assignatura d'Introducció a la salut de 1er curs. Per a aconseguir un aprenentatge significatiu els estudiants han de realitzar una entrevista de caràcter qualitatiu a un pacient crònic amb l’objectiu de conèixer la experiència de patir una malaltia, les repercussions físiques, psicològiques i socials derivades de la malaltia així com les representacions i significats sobre la malaltia i les necessitats sentides del pacient i/o de la família.