Aims:To assess clinicians' self-reported knowledge of current policies in African oncology settings, of their personal communication practices around sharing bad news with patients, and to identify barriers to the sharing of serious news in these settings. Methods:A cross-sectional study of cancer care providers in African oncology settings (N = 125) was conducted. Factor analysis was used to assess cross-cultural adaptation and uptake of an evidence-based protocol for disclosing bad news to patients with cancer and of providers' perceived barriers to disclosing bad news to patients with cancer. Analysis of Various (ANOVA) was used to assess strength of association with each dimension of these two measurement models by various categorical variables.Results: Providers from Nigeria, Kenya, Ghana, and Rwanda represented 85% of survey respondents. Two independent, psychometrically reliable, multi-dimensional measurement models were derived to assess providers' personal communication practices and providers' perceived barriers to disclosing a cancer diagnosis. Forty percent (40%) of respondent nurses but only 20% of respondent physicians had had formal communications skills training. Approximately 20%-25% of respondent physicians and nurses reported having a consistent plan or strategy for communicating bad news to their cancer patients. Conclusions: Results show that effective communication about cancer diagnosis and prognosis requires an appreciation and clinical skill set that blends an understanding of cancer-related internalized stigmas harbored by patient and family, dilemmas posed by treatment affordability, and the need to navigate family wishes about cancer-related diagnoses in the context of African oncology settings. Findings underscore the need for culturally grounded communications research and program design.
Objective. The aim of this study was to understand the needs and experiences of oncology professionals involved in communicating a diagnosis to adult and pediatric cancer patients in the low-middle income (LMI) context of Kenya, with a focus on identifying barriers and facilitators. Methods. A World Café focus group methodology was conducted and comprised 19 discussion groups of approximately 6 participants (n = 114 professionals). Thematic analysis was used to clarify barriers and facilitators of professional–patient communication. Results. Participants reported several obstacles that hinder communication between cancer patients and healthcare professionals in Kenya, including: patient-related barriers (ie, lack of terminology, health literacy), culture-related barriers (ie, cultural and religious beliefs about cancer, beliefs about children), and physician- and system-related barriers (ie, limited communication skills, organizational barriers). Communication facilitators included: the central role of family and cultural traditions, and the caring attitude of physicians when disclosing diagnosis and treatment procedures. Conclusions. The data indicate the potential need to adapt communication guidelines to the Kenyan context to disseminate skills training in a culturally relevant way. Also of importance may be to embed parallel public health strategies and health care structural changes to facilitate disclosure and mitigate any unintended negative effects such as stigma and social isolation.
SUMMARY We investigated the capacity for phenotypic plasticity of skeletal muscle from Varanus exanthematicus, the savannah monitor lizard. Iliofibularis muscle from one leg of each lizard was electrically stimulated for 8 weeks. Both stimulated and contralateral control muscles were collected and processed for electron microscopy. We used stereological analysis of muscle cross-sections to quantify the volume densities of contractile elements, sarcoplasmic reticulum, mitochondria and intracellular lipids. We found that mitochondrial volume density was approximately fourfold higher in the stimulated muscle compared to controls, which were similar to previously reported values. Sarcoplasmic reticulum volume density was reduced by an amount similar to the increase in mitochondrial volume density while the volume density of contractile elements remained unchanged. Intracellular lipid accumulation was visibly apparent in many stimulated muscle sections but the volume density of lipids did not reach a significant difference. Although monitor lizards lack the highly developed aerobic metabolism of mammals, they appear to possess the capacity for muscle plasticity.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.