Teaching senior nurses how to teach communication skills in oncology.

Many nurses acknowledge that their nursing practice is hampered by inadequate teaching about communication skills during their nursing education. Ineffective communication has negative effects on patient care and causes stress when nurses interact with each other, with medical colleagues, with patients and their relatives. Many senior nurses teach junior staff about communication and feel uncertain about their competence to do so despite recognition of its importance.

Are members of multidisciplinary teams in breast cancer aware of each other's informational roles?

Aim: To conduct a commissioned survey of multidisciplinary breast team members' expectations of their own and each other's roles in providing different kinds of information to women with breast cancer.

Design: Questionnaire based survey.

Setting And Participants: Health professionals from five multidisciplinary breast care centres within a Sussex health authority.

Tolerability of hormone therapies for breast cancer: how informative are documented symptom profiles in medical notes for 'well-tolerated' treatments?

Hormonal therapies for cancer are often viewed as a gentler option than many other cancer treatments, but is low toxicity an accurate perception of patients' experiences? Side effects tend to be described as minimal or well tolerated, yet published symptoms from hormonal therapy vary considerably in their descriptions and frequencies. Previous research has highlighted under-reporting of side effects by clinical staff so as part of a wider study examining tamoxifen and goserelin treatment as adjuvant therapy for breast cancer, treatment-related symptoms documented in medical notes were compared with those that patients reported during a research interview. There was a significant difference in the frequency of many side effects reported by the two methods in this study.

Psychiatric morbidity and its recognition by doctors in patients with cancer.

Psychiatric morbidity in patients with cancer is high and without appropriate treatment unremitting. We assessed the ability of 143 doctors to establish the psychological status of 2297 patients during outpatient consultations in 34 cancer centres and hospitals in the UK. Prior to seeing the doctor, consenting patients completed a short self-report questionnaire (GHQ12), designed for the psychological screening of large populations.

Tamoxifen for the prevention of breast cancer: psychosocial impact on women participating in two randomized controlled trials.

Purpose: The purpose of this study was to evaluate the psychosocial implications of tamoxifen versus placebo in women who are at increased risk of breast cancer.

Patients And Methods: The 488 women in the psychosocial study were recruited from participants in two placebo-controlled, double-blind, randomized, controlled trials that investigated the efficacy of tamoxifen in the prevention of breast cancer in women who are at high familial risk. During a 5-year period, repeated assessments were made of anxiety, psychological distress, and sexual functioning using standardized questionnaires before treatment at baseline and at 6-month intervals during the trial.

Results of an intervention study to improve communication about randomised clinical trials of cancer therapy.

We report results from an intervention study to improve communication during consultations about randomised clinical trials of cancer therapy. Patients, eligible for a trial, completed questionnaires about information preferences and attitudes to trials prior to seeing their doctors, who were either shown these questionnaires (intervention) or not (control). Fifteen doctors participated and invited 265 patients to join one of 40 different randomised clinical trials.

The psychosocial impact of bilateral prophylactic mastectomy: prospective study using questionnaires and semistructured interviews.

Objectives: To investigate the psychosocial impact of bilateral prophylactic mastectomy for women with increased risk of breast cancer and to identify, preoperatively, risk factors for postoperative distress.

Design: Prospective study using interviews and questionnaire assessments.

Setting: Participants' homes throughout the United Kingdom.

Information needs of patients with cancer: results from a large study in UK cancer centres.

As part of a multi-centred study evaluating a communication skills training model for clinicians, we collected information preferences using an adaptation of Cassileth's Information Needs questionnaire from a heterogeneous sample of 2331 patients. Results showed that 87% (2027) wanted all possible information, both good and bad news and 98% (2203) preferred to know whether or not their illness was cancer. Cross tabulation of responses revealed no significant differences in information preferences for tumour site or treatment aims but did show an effect of age and sex.

Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction.

The aim of this study was to assess and compare the psychological outcome and satisfaction of patients whom underwent wide local excision, mastectomy alone and mastectomy with breast reconstruction. A total of 577 patients had different types of operations for primary breast cancer (254 (44%) had wide local excision, 202 (35%) had simple mastectomy and 121 (21%) had breast reconstruction). Psychosocial morbidity and satisfaction were studied retrospectively using self-evaluation questionnaires.

Reasons for accepting or declining to participate in randomized clinical trials for cancer therapy.

This paper reports on the reasons why patients agreed to or declined entry into randomized trials of cancer following discussions conducted by clinicians in both District General and University Hospitals. Two hundred and four patients completed a 16-item questionnaire following the consultation, of these 112 (55%) were women with breast cancer. Overall results showed that 147 (72.

The psychological impact of immediate rather than delayed breast reconstruction.

Aims: A retrospective analysis of the psychological advantages of immediate reconstruction (IR) against delayed reconstruction (DR).

Methods: A total of 121 patients who underwent different types of breast reconstruction were seen in the follow-up clinic and assessed for: anxiety, depression, body image, self-esteem, sexuality and satisfaction.

Results: Ninety-five percent of the patients who had IR preferred this technique and 76% of the DR group would have preferred IR.

Effective communication skills are the key to good cancer care.

Communication within oncology is a core clinical skill but one in which few oncologists or specialist cancer nurses have received much formal training. Inadequate communication may cause much distress for patients and their families, who often want considerably more information than is usually provided. Many patients leave consultations unsure about the diagnosis and prognosis, confused about the meaning of--and need for--further diagnostic tests, unclear about the management plan and uncertain about the true therapeutic intent of treatment.

The Medical Interaction Process System (MIPS): an instrument for analysing interviews of oncologists and patients with cancer.

The increase in communication skills training for doctors has led to the need for more effective means of evaluation. Analysis of video and audiotaped consultations using systems of interaction analysis can provide the trainee with in-depth feedback about their communication skills. Most interaction process systems were designed for use in primary care and recent research has questioned the applicability of these systems in medical specialties such as oncology.

How do doctors explain randomised clinical trials to their patients?

As part of a larger study designed to improve doctor-patient communication in randomised clinical trials (RCT), we audiotaped the discussions between doctor and patient in which consent was being obtained for a RCT. This paper reports on 82 discussions conducted by 5 clinical oncologists in both District General and University Hospital outpatient departments. When introducing the subject of trials, uncertainty about treatment decisions was expressed by the doctors in the majority of cases (79, 96.

Does cosmetic outcome from treatment of primary breast cancer influence psychosocial morbidity?

Aims: To investigate any influence of cosmetic outcome on psychosocial morbidity in patients who have undergone breast-conserving surgery for primary breast cancer.

Methods: Cosmetic outcome was assessed both objectively and subjectively in 254 patients, aged 20-69 years, who underwent breast-conserving surgery for operable primary breast cancer, View Article and Find Full Text PDF

Assessment of quality of life in women undergoing hormonal therapy for breast cancer: validation of an endocrine symptom subscale for the FACT-B.

Existing quality of life instruments do not include adequate items to measure the side effects and putative benefits of hormonal treatments given in breast cancer. We report the development and validation of an 18 item endocrine subscale (ES) to accompany a standardised breast cancer quality of life measure, the Functional Assessment of Cancer Therapy (FACT-B). The FACT-ES (FACT-B plus ES) was tested initially on 268 women with breast cancer receiving endocrine treatments.

Sexual activity questionnaires in clinical trials: acceptability to patients with gynaecological disorders.

Objective: To assess the feasibility and acceptability of including sexual activity questionnaires in gynaecological clinical trials.

Design: A longitudinal quality of life study during the Maintenance Interferon Trial and the EVALUATE Hysterectomy Trial.

Setting: Gynaecology clinics and women's homes.

Patient evaluation of cosmetic outcome after conserving surgery for treatment of primary breast cancer.

Aims: To investigate patient self-assessment of and satisfaction with cosmetic outcome following breast-conserving treatment.

Methods: A total of 254 patients with primary breast cancer who had been treated by wide local excision (WLE) were assessed objectively for cosmesis. Patients then self-rated their own cosmetic outcome and satisfaction via a questionnaire.

Are we using appropriate self-report questionnaires for detecting anxiety and depression in women with early breast cancer?

The aim of this prospective study was to identify the psychiatric morbidity associated with the diagnosis and treatment of early breast cancer. At each of five time points, 269 women were interviewed using a shortened version of the Present State Examination (PSE) and 266 completed self-assessment questionnaires, the Hospital and Anxiety Depression Scale (HADS) and the Rotterdam Symptom Checklist (RSCL). This paper compares the ability of the questionnaires to detect psychiatric morbidity with that of the PSE.

Attitudes of patients to randomised clinical trials of cancer therapy.

The aim of this study was to test an instrument which might be useful for doctors in explaining the randomisation procedure to an individual patient. The sample comprised 323 patients with cancer attending for out-patient appointments and/or chemotherapy treatment in two major cancer centres in the U.K.