Informed Consent Revisited: A Doctrine in the Service of Cancer Care

Schachter, Madeleine; Fins, Joseph J.

doi:10.1634/theoncologist.2008-0101

Cited by 12 publications

(5 citation statements)

References 7 publications

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“…The age of the patient might be the missing link between the context of patient compliance, consequences, and the quality of the doctor's informed consent discussion with the patient and the clinical outcome and quality of care. There is certainly a need for a specific focus on elderly female patients with early breast cancer in order to determine their interaction with caregivers and compliance with recommended treatment models .…”

Section: Discussionmentioning

confidence: 99%

The impact of patient compliance with adjuvant radiotherapy: a comprehensive cohort study

et al. 2013

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Postoperative radiotherapy (RT) is the standard of care for early stage breast cancer. It reduces the risk for local recurrence and prolongs survival. We assessed whether, the omission of RT because of patient's preference may influence the prognosis and, thus, the quality of cancer care. Detailed information from a prospectively collected database of a breast cancer center was analyzed. Multiple regression analysis and univariate and multivariate analysis for risk factors for recurrence were performed. The entire cohort of primary breast cancer patients in a given time period was analyzed. Data from 1903 patients undergoing treatment at breast cancer center between 2003 and 2008 were used. All patient underwent breast conserving surgery and RT was performed for all patients of the cohort. Local tumor control and disease-free survival were calculated. After a median follow-up of 2.18 years (maximum 6.39 years), 5.5% of patients did not follow guideline-based recommendations for RT. There was a significant correlation between noncompliance and patient's age, adjuvant hormonal therapy (97.0%), and adjuvant chemotherapy (96.8%). Seventy local recurrences occurred that corresponds to a local recurrence rate of 3.9%. The difference in regard to local recurrence-free 5-year survival between the compliant patients and the noncompliant patients is absolute 17.9 (93.3% and 75.4%). Noncompliant patients had suffered a 5.02-fold increased risk of local recurrence than compliant patients. The omission of RT after breast-conserving surgery results in a higher local failure rate and significantly worsens clinical outcome. Age may play an important role because of the comorbidities of aged patients or the assumed low RT tolerance in this group. On a clinical level, this data suggests that improvement is needed to correct this situation, and the question remains as to how best to improve RT compliance.

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Section: Discussionmentioning

confidence: 99%

The impact of patient compliance with adjuvant radiotherapy: a comprehensive cohort study

et al. 2013

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“…Although the factors, described by Thornson et al [32] as empathy, spatial orientation, cognitive involvement (both passive and active), ability to construct mental models, and introversion, were identified using questionnaires with college graduates, they demonstrate some resonance with the observations made of the participants in this study. However achieved, the subjective experience of being there prompted participants in this study to remember previous experiences of medical treatments and visits to a hospital, which has the potential to provide the foundation for new learning, to open up an opportunity for clinical dialogue in order to elicit additional clinical information, and to assess psychosocial concerns [36]. …”

Section: Discussionmentioning

confidence: 99%

Using Virtual Reality to Provide Health Care Information to People With Intellectual Disabilities: Acceptability, Usability, and Potential Utility

Hall¹,

Conboy-Hill²,

Taylor³

2011

J Med Internet Res

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BackgroundPeople with intellectual disabilities have poor access to health care, which may be further compromised by a lack of accessible health information. To be effective, health information must be easily understood and remembered. People with intellectual disabilities learn better from multimodal information sources, and virtual reality offers a 3-dimensional (3D) computer-generated environment that can be used for providing information and learning. To date, research into virtual reality experiences for people with intellectual disabilities has been limited to skill-based training and leisure opportunities within the young to mid age ranges.ObjectiveThis study assessed the acceptability, usability, and potential utility of a virtual reality experience as a means of providing health care-related information to people with intellectual disabilities. We designed a prototype multimodal experience based on a hospital scenario and situated on an island in the Second Life 3D virtual world. We wanted to know how people of different ages and with varying levels of cognitive function would participate in the customized virtual environment, what they understood from being there, and what they remembered a week later.MethodsThe study drew on qualitative data. We used a participatory research approach that involved working alongside people with intellectual disabilities and their supporters in a community setting. Cognitive function was assessed, using the Matrix Analogies Test and the British Picture Vocabulary Scale, to describe the sample. Participants, supported by facilitators, were video recorded accessing and engaging with the virtual environment. We assessed recall 1 week later, using a specialized interview technique. Data were downloaded into NVivo 8 and analyzed using the framework analysis technique.ResultsStudy participants were 20 people aged between 20 and 80 years with mild to severe intellectual disabilities. All participants were able to access the environment and voluntarily stayed there for between 23 and 57 minutes. With facilitator support, all participants moved the avatar themselves. Participants engaged with the scenario as if they were actually there, indicating cognitive presence. Some referred back to previous medical experiences, indicating the potential for experiential knowledge to become the foundation of new learning and retention of knowledge. When interviewed, all participants remembered some aspects of the environment.ConclusionsA sample of adults with intellectual disabilities of all ages, and with varying levels of cognitive function, accessed and enjoyed a virtual-world environment that drew on a health care-related scenario, and remembered aspects of it a week later. The small sample size limits generalizability of findings, but the potential shown for experiential learning to aid retention of knowledge on which consent is based appears promising. Successfully delivering health care-related information in a non-National Health Service setting indicates potential for delivery in in...

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“…19,20 The doctrine is conspicuously aligned with values in patient autonomy; it also alleviates some of the physician's burden of decisionmaking by enlisting the patient's determination, and it induces the patient's complicity in the agreed treatment plan. 21 The global biomedical ethical approach would not endeavor to impose the doctrine when it would contravene normative values; the goal is not homogeny with Western values. Accordingly, the global approach might well seek consent from a tribal chief, at least absent effectively solicited evidence of coercion, an inability to appreciate the risks and benefits, the individual's dissent, or a decision for the community that is not in the best interests of the individual.…”

Section: Pedagogical Approachesmentioning

confidence: 99%

The role of global bioethics in medical pedagogy

Schachter

2016

IGHPE

Self Cite

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The study of global biomedical ethics warrants the attention, scholarship, and commitment afforded to the study of general medical ethics. While it is difficult to precisely define the field, it basically comprises the ethical provision of healthcare and investigation across borders, which takes into account disparate societal and individual normative values. Medical ethics is primarily patient-centric; global biomedical ethics is focused on patients insofar as they comprise communities. Global biomedical ethics eschews imperialist approaches. Instead, the field seeks to promote approaches that comport with relevant principled approaches.Ultimately, the field of global biomedical ethics orients the integrity of the medical profession within society. Global biomedical ethics is important for all clinicians and investigators, and should not be relegated to those who address disease that affects people in a region where the physician does not reside. The field contextualizes the practice of medicine and research within the world community. Global biomedical ethics inexorably enhances the doctor’s own propioperception of his profession and his place within the world.

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Informed Consent Revisited: A Doctrine in the Service of Cancer Care

Cited by 12 publications

References 7 publications

The impact of patient compliance with adjuvant radiotherapy: a comprehensive cohort study

The impact of patient compliance with adjuvant radiotherapy: a comprehensive cohort study

Using Virtual Reality to Provide Health Care Information to People With Intellectual Disabilities: Acceptability, Usability, and Potential Utility

The role of global bioethics in medical pedagogy

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