Summary One hundred cancer patients undergoing active treatment were interviewed to determine how they perceived their illness and how their perceptions compared with those of their attending physicians.Ninety-eight patients recognized that they had cancer and 87 correctly identified the tumour type. Sixtyfour of 67 patients with local or regional disease were aware of this, but 11 of 33 patients with metastatic disease incorrectly believed that the cancer was localized. Five of 52 patients being treated for cure thought they were being treated palliatively, and 16 of 48 patients receiving palliative treatment believed that the doctor's aim was to cure them. Forty of these 48 patients significantly overestimated the probability that the treatment would prolong their lives. (Parsons, 1951). Others have since stressed that "mutual participation" must replace paternalism as the basis of the modern doctor-patient relationship, if physicians are to succeed in combating the public's growing distrust of the profession (Haug & Sussman, 1969;Brody, 1980;Jensen, 1981). It is now generally agreed by doctors and lay people in North America that patients should participate actively in decisions about their care. This participation can only be meaningful if the patient understands his situation well enough to perform the kind of cost-benefit analysis that has traditionally been left to the doctor. Thus it is now more important than ever for patients to be well-informed about their illness and its treatment.Patients must already give their 'informed consent' for any form of medical intervention, but 'informed consent' has proved difficult to define and even more difficult to realize in practice. Information is not always effectively transmitted to the patient, and it has been suggested that complex medical information may be of little value to those who do not have the educational background necessary to interpret it (Robinson and Merav, 1976;Cassileth et al., 1980a; Mackillop & Johnson, 1986 Over a three-month period we attempted to interview every available patient, but, if a member of the healthcare team preferred that the patient not be interviewed, these wishes were respected. One hundred and sixteen patients were approached. They were told that the aims of the study were to find out how well patients understand their illness and to learn if communication between doctors and patients is effective. Written consent was obtained from each participating patient. The consent form outlined the study's objectives and explained that the interview would be videotaped. Sixteen of the 116 patients who were approached chose not to participate. Eleven felt that the interview process would be too stressful and five felt that it would be too inconvenient. The interviewer (WES) is not medically trained and was unaware of the patient's diagnosis. Interviews were videotaped to avoid notetaking during the course of the conversation, but a checklist was used to ensure that all patients were asked the same questions. The content and format o...

Background Blood phosphatidylethanol (PEth) is a promising biomarker of alcohol consumption. This study was conducted to evaluate its performance in patients with liver disease. Methods This study included 222 patients with liver disease. Patient-reported alcohol use was obtained as a reference standard, and PEth was measured by tandem mass spectrometry. Receiver operating characteristic (ROC) and contingency table analyses were used to assess the performance of PEth in detecting any drinking and averaging 4 or more drinks daily in the past 30 days. Results At the limit of quantitation (20 ng/mL), PEth was 73% sensitive (95% confidence interval (CI) 65–80) and 96% specific (95% CI 92–100) for any drinking in the past month. Subjects who drank but had a negative PEth result were mainly light drinkers. Subjects who reported 30-day abstinence but with quantifiable PEth either reported heavy drinking within the past 6 weeks or had data that suggested under-reported drinking. At the optimal cutoff concentration of 80 ng/mL, PEth was 91% sensitive (95% CI 82–100) and 77% specific (95% CI 70–83) for averaging at least 4 drinks daily. Conclusion PEth is a useful test for detecting alcohol use in liver disease patients, but cutoff concentrations for heavy drinking will result in misclassification of some moderate to heavy drinkers.

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Improved treatment of alcohol dependence is a high priority, including defining subtypes that might respond differently. We evaluated a medication combination of intravenous flumazenil (FMZ) and oral gabapentin (GBP) in alcoholics who did and did not exhibit pretreatment alcohol withdrawal (AW) symptoms. Sixty alcohol-dependent individuals (44 with low AW and 16 with high AW) were randomized to receive FMZ (2 mg of incremental bolus for 20 minutes for 2 consecutive days) and GBP (up to 1200 mg nightly for 39 days) or their inactive placebos. Alcohol withdrawal was measured for the first 2 days, and drinking, sleep parameters, and adverse events were monitored during weekly evaluations, along with behavioral counseling sessions. Percent days abstinent (PDA) during treatment and time to first heavy drinking (TFHD) day were primary outcome variables. There was an interaction between the pretreatment AW status and the medication group on PDA (P = 0.0006) and TFHD (P = 0.06). Those in the high AW group had more PDA and more TFHD if treated with active medications, whereas those in the low AW group had more PDA and more TFHD if treated with placebo. This interaction remained for those totally abstinent (P = 0.03) and was confirmed by percent carbohydrate-deficient transferrin values. In addition, the pattern of response remained up to 8 weeks after treatment. In addition, in those with high AW, greater improvement in AW symptoms was observed in the active medication group compared with the placebo group. These results suggest a differential response to FMZ/GBP treatment, depending on pretreatment AW status that should be taken into account during future treatment trials.

Results support PEth measurement by HPLC-MS/MS as a promising marker of past 1- to 2-week moderate to heavy alcohol consumption in patients with and without liver disease. PEth appears useful for differentiating abstinence or light drinking from moderate to heavy consumption, but may have limited utility for differentiating moderate from heavy alcohol use.