Highlights • Most patients wanted to be asked about religion/spirituality by their doctor. • A significant minority of patients did not desire or objected to doctor enquiry. • It is not clear how to ...identify which patients desire discussion of spirituality. • Patients and doctors do not always agree on what spiritual discussion entails.
Improvements in early detection and treatment have led to a growing prevalence of survivors of cancer worldwide. Models of care fail to address adequately the breadth of physical, psychosocial, and ...supportive care needs of those who survive cancer. In this Series paper, we summarise the evidence around the management of common clinical problems experienced by survivors of adult cancers and how to cover these issues in a consultation. Reviewing the patient's history of cancer and treatments highlights potential long-term or late effects to consider, and recommended surveillance for recurrence. Physical consequences of specific treatments to identify include cardiac dysfunction, metabolic syndrome, lymphoedema, peripheral neuropathy, and osteoporosis. Immunotherapies can cause specific immune-related effects most commonly in the gastrointestinal tract, endocrine system, skin, and liver. Pain should be screened for and requires assessment of potential causes and non-pharmacological and pharmacological approaches to management. Common psychosocial issues, for which there are effective psychological therapies, include fear of recurrence, fatigue, altered sleep and cognition, and effects on sex and intimacy, finances, and employment. Review of lifestyle factors including smoking, obesity, and alcohol is necessary to reduce the risk of recurrence and second cancers. Exercise can improve quality of life and might improve cancer survival; it can also contribute to the management of fatigue, pain, metabolic syndrome, osteoporosis, and cognitive impairment. Using a supportive care screening tool, such as the Distress Thermometer, can identify specific areas of concern and help prioritise areas to cover in a consultation.
Introduction
Patient‐reported outcomes (PROs) are direct reports from patients about the status of their health condition without amendment or interpretation by others. Patient‐reported outcome ...measures (PROMs) are the tools used to measure PROs; they are usually validated questionnaires patients complete by self‐assessing their health status. Whilst the benefits of using PROs and PROMs to guide real‐time patient care are well established, they have not been adopted by many oncology institutions worldwide. This literature review aimed to examine the barriers associated with using PROs and PROMs in routine oncology care.
Methods
A literature search was conducted across EMBASE, Medline and CINAHL databases. Studies detailing barriers to routine PRO use for real‐time patient care were included; those focusing on PRO collection in the research setting were excluded.
Results
Of 1165 records captured, 14 studies informed this review. At the patient level, patient time, incapacity and difficulty using electronic devices to complete PROMs were prominent barriers. At the health professional level, major barriers included health professionals’ lack of time and knowledge to meaningfully interpret and integrate PRO data into their clinical practice and the inability for PRO data to be acted upon. Prominent barriers at the service level included difficulties integrating PROs and PROMs into clinical workflows and inadequate information technology (IT) infrastructures for easy PRO collection.
Conclusion
This review has outlined potential barriers to routine PRO use in the oncology setting. Such barriers should be considered when implementing PROs into routine clinical practice.
Patient‐reported outcomes (PROs) are direct reports from patients about the status of their health condition without amendment or interpretation by others. This review article outlines potential barriers to routine PRO use in the oncology setting. Such barriers should be considered when implementing PROs into routine clinical practice.
Communication is a core component of effective healthcare that impacts many patient and doctor outcomes, yet is complex and challenging to both analyse and teach. Human-based coding and audit systems ...are time-intensive and costly; thus, there is considerable interest in the application of artificial intelligence to this topic, through machine learning using both supervised and unsupervised learning algorithms. In this article we introduce health communication, its importance for patient and health professional outcomes, and the need for rigorous empirical data to support this field. We then discuss historical interaction coding systems and recent developments in applying artificial intelligence (AI) to automate such coding in the health setting. Finally, we discuss available evidence for the reliability and validity of AI coding, application of AI in training and audit of communication, as well as limitations and future directions in this field. In summary, recent advances in machine learning have allowed accurate textual transcription, and analysis of prosody, pauses, energy, intonation, emotion and communication style. Studies have established moderate to good reliability of machine learning algorithms, comparable with human coding (or better), and have identified some expected and unexpected associations between communication variables and patient satisfaction. Finally, application of artificial intelligence to communication skills training has been attempted, to provide audit and feedback, and through the use of avatars. This looks promising to provide confidential and easily accessible training, but may be best used as an adjunct to human-based training.
•Artificial intelligence (AI) applied to health professional-patient communication enables efficient audit and feedback.•Very recent advances have increased the ability of AI to encode the complexity in human interaction.•AI can now encode words as well as a person does, as well as emotion and non-verbal aspects of communication.•AI coding has been shown to be moderately to substantially reliable.•Translation into the real world has yet to be demonstrated.
Anxiety is common in the context of cancer, but there are few theoretical models that apply to people with cancer across the trajectory of their illness. The aims of this review are to identify ...existing theories and to propose an integrated model of cancer-related anxiety. Using a systematic literature search of Medline, Premedline and PsycINFO databases, we identified nine theoretical models of anxiety in the context of cancer. We reviewed these for psychological concepts that fell under five themes: pre-existing schema, the inherent nature of cancer, cognitive factors, coping responses and contextual factors. From these themes, we integrated concepts from different models to develop a theoretical framework to explain the development and maintenance of anxiety in the context of cancer. The resulting model suggests that pre-existing schema, past experiences of cancer, an intolerance of uncertainty and meta-cognitive beliefs about worry interact with the inherent nature of cancer to produce overwhelming distress. The distress activates cognitive processes characterized by vigilance, worry and rumination. Attempts to cope by re-establishing control, and a pattern of vigilance to cancer-related cues and/or avoidance reinforce anxiety, in the context of a range of systemic factors that can either buffer against or worsen the anxiety.
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•Theoretical models of cancer-anxiety have mainly considered Fear of Recurrence.•Minimal attention has been given to mortality awareness in models of cancer-anxiety.•The cancer context often involves ongoing threat, uncertainty and lack of control.•A model of cancer-related anxiety relevant to all cancer stages is proposed.•The integrated model includes pre-existing, cognitive, coping and contextual factors.
Highlights • We synthesise evidence for interventions targeting end-of-life communication. • Studies targeted patients, carers, health professionals or multiple stakeholders. • Interventions had ...variable learning/behavior targets, structure, content and length Study designs, outcomes, settings, measures and quality were diverse. • Most evidence is derived from less robust studies, more robust RCTs are needed.
Translation of evidence-based interventions into hospital systems can provide immediate and substantial benefits to patient care and outcomes, but successful implementation is often not achieved. ...Existing literature describes a range of barriers and facilitators to the implementation process. This systematic review identifies and explores relationships between these barriers and facilitators to highlight key domains that need to be addressed by researchers and clinicians seeking to implement hospital-based, patient-focused interventions.
We searched MEDLINE, PsychInfo, Embase, Web of Science, and CINAHL using search terms focused specifically on barriers and facilitators to the implementation of patient-focused interventions in hospital settings. To be eligible, papers needed to have collected formal data (qualitative or quantitative) that specifically assessed the implementation process, as experienced by the staff involved.
Of 4239 papers initially retrieved, 43 papers met inclusion criteria. Staff-identified barriers and facilitators to implementation were grouped into three main domains: system, staff, and intervention. Bi-directional associations were evident between these domains, with the strongest links evident between staff and intervention.
Researchers and health professionals engaged in designing patient-focused interventions need to consider barriers and facilitators across all three identified domains to increase the likelihood of implementation success. The interrelationships between domains are also crucial, as resources in one area can be leveraged to address barriers in others. These findings emphasize the importance of careful intervention design and pre-implementation planning in response to the specific system and staff context in order to increase likelihood of effective and sustainable implementation.
This review was registered on the PROSPERO database: CRD42017057554 in February 2017.
Learning Objectives
After completing this course, the reader will be able to:
Discuss the danger inherent in nondisclosure of complementary and alternative medicine (CAM) use due to the potential for ...herb‐ or vitamin‐drug interactions with conventional treatment.
Explain the need for greater patient‐doctor communication about CAM use in oncology settings in order to maintain patient safety and wellbeing.
This article is available for continuing medical education credit at CME.TheOncologist.com
Objective.
To explore the nondisclosure of complementary and alternative medicine (CAM) use among cancer patients, including reasons for and outcomes from nondisclosure of CAM use, within the context of patient‐doctor communication.
Method.
A systematic review was conducted exploring investigations surrounding the communication of CAM use for patients with cancer published until August 2011.
Results.
A total of 21 studies were located, which reported a prevalence of CAM use among patients with cancer ranging between 11% and 95%; of these patients, 20% to 77% did not disclose their CAM use. The main reasons for nondisclosure were the doctor's lack of inquiry; patient's anticipation of the doctor's disapproval, disinterest, or inability to help; and patient's perception that disclosure of CAM use is irrelevant to their conventional care. There is some evidence to suggest that patient‐doctor communication about the use of CAM was associated with an enhanced patient‐doctor relationship and higher patient satisfaction.
Conclusions.
Although the use of CAM by patients with cancer is high, patients frequently fail to disclose its use to their health professionals for reasons emanating from both sides of the dyadic patient‐doctor relationship. Because a substantial proportion of patients with cancer may use CAM and there is potential for herb‐ or vitamin‐drug interactions, further research in patient‐doctor communication about CAM is necessary to maintain patient safety and wellbeing. The development of effective interventions to improve the disclosure of CAM use should be an integral part of this future research.
摘要
目的. 在医患沟通的背景下，探究癌症患者使用补充与替代医学（CAM）但未告知医生的情况，包括不告知CAM使用情况的原因与临床结局。
方法. 对围绕癌症患者使用CAM沟通情况的调查研究进行系统回顾，纳入的研究发表时间截止至2011年8月。
结果. 共检索到21项研究。据这些研究报道，在癌症患者中使用CAM的比例约为11%~ 95%，而在这些使用CAM的患者中，20% ~77%的患者未向医生告知他们使用了CAM。不告知的主要原因在于医生未问询；患者预计医生不赞同、不感兴趣、或不能提供帮助；以及患者认为是否告知CAM的使用情况与其接受的传统治疗无关。有证据提示医患之间针对CAM使用问题进行沟通与医患关系改善和患者满意度提高有关。
结论. 尽管癌症患者的CAM使用率较高，但患者经常未将其CAM使用情况告知医生，其原因要归于医患双方。由于相当比例的癌症患者可能使用CAM，且中草药或维生素可能产生药物相互作用，有必要针对CAM相关医患沟通开展进一步研究以保障患者的用药安全和身心健康。开发有效的干预措施以提高CAM使用患者的告知率应成为未来此类研究中不可或缺的一部分。
This article explores the nondisclosure of complementary and alternative medicine use among cancer patients, including reasons for and outcomes from nondisclosure, within the context of patient‐doctor communication.
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