Factors that influence physicians' detection of distress in patients with cancer

Abstract

Objective In vitro observations and studies in murine experimental autoimmune encephalomyelitis (EAE) have shown protective effects of sodium channel blockers on central nervous system axons and improved clinical status when treatment is continued throughout the period of observation. Several clinical studies of sodium channel blockers are under way in patients with multiple sclerosis. Here we asked whether a protective effect would persist after withdrawal of a sodium channel blocker. Methods We studied a mouse model of myelin oligodendrocyte glycoprotein–induced EAE treated with phenytoin or carbamazepine. Results Both phenytoin and carbamazepine significantly improved the clinical course of the disease. Withdrawal of phenytoin resulted in acute exacerbation, accompanied by a significantly increased inflammatory infiltrate within the central nervous system and the death of nearly 60% of EAE mice. There were no clinical worsening or deaths in control mice after withdrawal of phenytoin. Withdrawal of carbamazepine led to acute worsening of EAE symptoms, increased inflammatory infiltrate, and was associated with the death of 8% of mice. Interpretation These results, together with results showing effects of sodium channel blockers in immune cells, raise questions about the long‐term effects of sodium channel blockers in neuroinflammatory disorders, and suggest that clinical studies of sodium channel blockers in these disorders should be planned carefully. Ann Neurol 2007

Clinician characteristics, communication, and patient outcome in oncology: a systematic review

“…Five studies found a correlation between training (or years of training) and communication (or patient outcome) [18,27,30,36,42]. Clinician and patient agreement for patient decision-making preferences increased with years of clinician training [42].…”

“…It had no effect on indication for chemotherapy [35] or on communication concerning health-related quality of life (HRQL) [28]. It had no influence on the concordance between clinician and patient perceptions of patient distress and need for support [36,41] or on patient perception of care, information exchange, affective behavior, coordination, or health promotion [23]. In addition, gender was not associated with responses to empathic opportunities.…”

“…The only study to examine the relationship of clinician age to empathy found an association with younger clinicians responding more often to empathic opportunities [38]. Other studies examined the relationship of clinician age to HRQL communication [28], prescription of chemotherapy, [35] and capacity to detect patient distress [36,41]. None found an effect.…”

Communication about cancer near the end of life

“…10, 11 Certain provider behaviors have been shown to elicit these concerns: open-ended questions, allowing more time for patients to speak, and empathy (Table 1). 12–15 Open questions such as “How are you doing with all of this?” or “Is there something else you’d like to talk about today?” 16 let patients know that their doctor will be willing to listen. Patients also give “cues” to providers about their concerns, for example, “I’m not sure what the treatment options are.” [cue for information] or “That’s one thing I have as a big fear.” [cue for emotional exploration and support].…”

A qualitative exploration of the unmet psychosocial rehabilitation needs of cancer survivors in China

“…Many studies worldwide have explored cancer survivors' psychosocial rehabilitation needs [9][10][11][12][13], but little, if any, has been conducted in China. International studies about cancer survivors' psychosocial needs indicate a desire for ongoing psychological counselling, a lack of availability of complementary and alternative therapies, a need for continuous support, for information about rehabilitation possibilities and for support to the family and need for social support [8][9][10][11][12][13]. However, peoples' social and cultural backgrounds have substantial impact on their attitude towards cancer and its causes and on treatment options [14].…”