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Biomedical subjects

L Fallowfield

Publications and source records attributed to L Fallowfield.

At least 19 recordsLinked to original sources
PubMed1997

Offering choice of surgical treatment to women with breast cancer.

Much has been written about the psychosocial and sexual dysfunction associated with the diagnosis and treatment of breast cancer. Hopes that breast conserving techniques would lead to a reduction in some of the psychosocial morbidity experienced, have not materialised. Most of the methodologically sound studies reported to date demonstrate few differences in quality of life domains between women whatever their primary surgical treatment. Some researchers suggested that if women were offered an opportunity to select the surgical option they preferred, then two things would occur: (1) women would choose breast-conserving techniques, and (2) choice in itself would prevent psychosocial morbidity. Despite strong support for both of these assumptions, neither have been borne out. Significant numbers of women, when offered choice, opt for mastectomy and choice in itself does not convey protection from psychological morbidity. The majority of women seem to welcome being given clear information about the options available, together with the reasons as to why a clinician would advise one policy rather than another. However, fewer women than expected wish to take a major role in decision-making about their breast cancer treatment.

Breast Neoplasms↗
PubMed1996

Information needs of cancer patients in west Scotland: cross sectional survey of patients' views.

OBJECTIVE: To assess the needs of patients with cancer for information about their condition. DESIGN: Cross sectional survey of patients' views by means of semistructured interview with questionnaire. SETTING: A regional cancer centre and two university hospitals in west Scotland. SUBJECTS: 250 (93%) of 269 cancer patients invited to participate in study who were selected by age, sex, socioeconomic status, and tumour site to be representative of cancer patients in west Scotland. MAIN OUTCOME MEASURES: Patients' need to know whether they had cancer, the medical name of their illness, progress through treatment, how treatment works, side effects, chances of cure, and treatment options. RESULTS: 79% (95% confidence interval 73% to 84%) of patients wanted as much information as possible, and 96% (93% to 98%) had a need or an absolute need to know if they had cancer. Most patients also wanted to know the chance of cure (91% (87% to 94%)) and about side effects of treatment (94% (90% to 97%)). When the replies were cross tabulated with patients' age, sex, deprivation score, and type of treatment there was a linear trend for patients from more affluent areas to want more information and those from deprived areas to want less. There was a strong preference for diagnosis of cancer to be given by a hospital doctor (60% (53% to 66%). CONCLUSION: Almost all patients wanted to know their diagnosis, and most wanted to know about prognosis, treatment options, and side effects.

Adolescent↗
PubMed1996

The Sexual Activity Questionnaire: a measure of women's sexual functioning.

Sexual activity is an important dimension of quality of life. Therefore it is important to assess the impact that any treatment may have on sexual functioning so that patients can be warned of possible side effects and interventions offered to help ameliorate these. The Sexual Activity Questionnaire (SAQ) was developed to investigate the impact of long-term tamoxifen on the sexual functioning of women at high risk of developing breast cancer. It was also tested on a sample of women with no such risk. The majority of variance in sexual functioning can be explained by three factors: pleasure from sexual intercourse, discomfort during sexual intercourse and habit. We found that the frequency of sexual activity decreased steadily with age. Furthermore, pleasure dropped and discomfort increased in women aged over 55. We report psychometric data showing that the SAQ is a valid, reliable and acceptable measure for describing the sexual functioning of women in terms of activity, pleasure and discomfort. It is quick and easy to administer and has good face validity discriminating between the sexual functioning of pre- and post-menopausal women.

Adult↗
PubMed1996

Doctor-patient interactions in oncology.

Studies which apply content analysis techniques to the cancer consultation are few. This descriptive study examines the structure and content of the bad news cancer consultations of 117 outpatients newly referred to the Medical Oncology Department of a large London teaching hospital. From previous communication research three main hypotheses are formed: (i) the cancer consultation is clinician-dominated rather than patient-centred; (ii) the level of psychosocial discussion between clinicians and patients is low and (iii) patient characteristics such as sex, age and prognostic category influence clinician behaviours. Each patient had two consultations with one of 5 oncologists. Both these were audiotaped with the patients' consent. The tapes were content coded using the Roter Interaction Analysis System. Results showed that clinicians tended to use closed rather than open questions. Patients asked few questions and were seldom given space to initiate discussion. Thus, the level of patient-centredness was low. Despite the fact that consultations concerned life threatening disease and often contained information regarding toxic treatment which is known to provoke psychological dysfunction, the number of questions relating to patients' psychological health were few. The amount of discussion concerning medical topics from both parties was 2.5 times greater than the amount of psychosocial discussion. Although there was a suggestion in the data that 3 clinicians showed variations in behaviour according to patient age and prognostic group, the number of patients for each doctor was small. Patients were well informed about their diagnosis, prognosis and treatment options, but their emotional well-being was rarely probed.

Adult↗
PubMed1996

Anxiety in women "at risk' of developing breast cancer.

Do family history clinics offering counselling, surveillance and preventative programmes alleviate or exacerbate anxiety in women at a high risk of developing breast cancer? In this study risk perceptions and anxiety of 99 'at risk' women participating in the Tamoxifen Prevention Trial were compared with those of 87 'at risk' women not attending any specialist clinic who were recruited from the National Breast Screening Programme (NBSP). Most anxiety was found in NBSP women with a family history. Women attending the family history clinic and participating in the trial had anxiety scores comparable with 86 women recruited from the NBSP who did not have a family history. We conclude that such specialist clinics do not see a selected group of the most anxious 'at risk' women nor does participation in tamoxifen prevention programmes appear to increase anxiety.

Analysis of Variance↗
PubMed1995

Psychological morbidity in newly referred patients with cancer.

Over the last 10 yr, research has shown that although the majority of patients are able to cope with the stresses of cancer, a substantial number have difficulties which require some form of psychological help. This study reports on the levels of psychological distress in a heterogeneous group of 117 newly referred out-patients with cancer over a 6-month period. Each patient reported their levels of distress by completing two self-administered questionnaires (the GHQ-30 and HADS) on three separate occasions. A descriptive examination of the socio-demographic characteristics of the sample was also carried out. At the first assessment 30% of the sample scored above the threshold for probable psychiatric disorder on the GHQ-30 and 26% on the HADS anxiety scale. At 6 months follow-up levels had fallen to 21% for the GHQ-30 and 10% for HADS anxiety. The numbers of probable cases of HADS depression was 7% at the first assessment and 5% at follow-up. Differences in levels of psychological morbidity according to age, sex, partner status and socioeconomic group were demonstrated. However, we were unable to make any firm conclusions as to whether these effects were independent of each other as a controlled multivariate analysis of the data set was not possible.

Adaptation, Psychological↗
PubMed1995

The influence of audiotapes on patient participation in the cancer consultation.

This study examined the effect of providing patients with an audiotape of a previous consultation on their level of participation during a subsequent consultation. 117 newly referred medical oncology patients randomised to receive a tape (n = 63) or not (n = 54) had two linked consultations which were both audiotaped. A content analysis revealed no significant differences between tape and control group in the mean number of questions asked during the second consultation. However, significantly more tape group patients (77%) asked for clarification of at least one piece of information compared to the control group (57%) (P = 0.04). A larger number of control group patients (61%) made at least one request for facts already provided in their first consultation compared to tape group patients (39%) (P = 0.05). Audiotapes appear to facilitate patients' requests for the clarification of previously given information and permit the re-absorption of complex information given when patients may have been too distressed for it to be assimilated.

Adult↗
PubMed1995

The efficacy of audiotapes in promoting psychological well-being in cancer patients: a randomised, controlled trial.

Open or uncontrolled studies have suggested that providing cancer patients with audiotapes of their clinical interviews can improve information recall and reduce psychological distress. We tested these hypotheses in a 'clinician-blind', prospective, randomised controlled trial. A total of 117 patients newly referred to a medical oncology clinic who were to be given 'bad news' had their consultations audiotaped. Blind to the clinician, patients were randomly allocated to receive a copy of the tape to play at home or not (control group). At 6 months follow-up, tape group patients reported positive attitudes to the audiotape and were shown to recall significantly more information about their illness than did controls. Overall improvement in psychological distress at 1 and 6 months follow-up, as measured with the 30-item General Health Questionnaire and the Hospital Anxiety and Depression Scale was no different in the two groups. However, a second-order interaction suggested that poor-prognosis patients were disadvantaged specifically by access to the audiotape, with less improvement in psychological distress at 6 months follow-up than non-tape controls. Patient access to audiotapes of clinical interviews promotes factual retention but does not reliably reduce psychological distress and may be actively unhelpful in some subgroups of patients.

Adult↗
PubMed1995

Questionnaire design.

Explore the source record for details and available documents.

Surveys and Questionnaires↗
PubMed1994

Can oncologists detect distress in their out-patients and how satisfied are they with their performance during bad news consultations?

Recognition of psychological distress in patients with cancer, some of which can be ameliorated with appropriate intervention, is a crucial aspect of patient care. Previous studies, with the exception of one, indicate that oncologists often fail to detect general distress and do not identify those patients with significant psychological disorder. As approximately 25-30% of patients experience anxiety and/or depression severe enough to merit psychological intervention, this is a serious problem. This study assessed the ability of five oncologists to recognise distress in newly referred out-patients who were receiving bad news. Self-report measures of the oncologists' satisfaction with their performance during the bad news interviews were also collected. Each patient had two clinical interviews in which information concerning diagnosis and treatment were given. Prior to each interview patients reported their own levels of distress by completing two self-report questionnaires. These were correlated with the ratings of distress and satisfaction made by each clinician on a visual analogue scale after each interview. Only one oncologist's ratings consistently correlated with patients' self-reported scores. The clinicians tended to under-rate the distress in their patients and were mostly satisfied with their performances during each interview. The ability to detect distress varied between each clinician and confirmed the conclusions of past studies that oncologists would benefit from up-grading their psychological assessment skills.

Adult↗
PubMed1993

Giving sad and bad news.

When bad news is broken insensitively the impact can be distressing for both giver and recipient. For the recipient especially, the effect can be longlasting. Poor training in communication skills leaves most doctors unable to give bad news appropriately. Doctors must realise what impact the news can have on the patient; must overcome fear of being blamed for the message and of a sense of failure for not being able to improve the situation; and must learn how to cope with the recipient's reaction. Doctors should prepare adequately for the meeting, ensure that the patient has understood the message, and see to the patient's immediate needs after the interview. If diagnostic investigations or therapeutic options are being discussed at the same time, giving the patient an audiotape recording of the interview is helpful.

Communication↗