Physician-assisted suicide.
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Attitude of Health Personnel↗
Biomedical subjects
M J Verhoef
Publications and source records attributed to M J Verhoef.
Determinants of Canadian physicians' opinions about legalized physician-assisted suicide: a national survey.
OBJECTIVES: To ascertain the opinions of practising Canadian physicians about their willingness to participate in legalized physician-assisted suicide; and to seek possible associations between willingness to practise legalized assisted suicide, and personal and medical professional determinants. DESIGN: Cross-sectional, mailed survey of a random sample of Canadian physicians, stratified non-proportionally with respect to five geographic regions, and proportionally for type of practice (general practitioner or specialist). RESULTS: Useable responses came from 2,010 (59 per cent) physicians (regional range 53 to 64 per cent), of whom 1,855 were in clinical practice. Respondents' gender and type of practice did not deviate from national reference data; 57 per cent were unwilling to practice legalized assisted suicide, but 40 per cent would wish it for themselves. Significantly different associations were found between opinions about willingness to practise legalized assisted suicide and the personal determinants of age, geographic regions, country of graduation, and religious activity, but not for gender, and type or experience in practice and terminal care. CONCLUSIONS: The opinions of Canadian physicians about the practice of legalized physician-assisted suicide are more strongly influenced by personal determinants than by medical professional determinants. This reveals potential conflicts between physicians' professional and personal preferences. In this context, a plurality of Canadian physicians supports legislated change, but most would not practise legalized physician-assisted suicide at this time in Canada.
Attitude of Health Personnel↗
Complementary and alternative medicine: evaluating its effectiveness in inflammatory bowel disease.
The use of complementary and alternative medicine (CAM) by patients with inflammatory bowel disease (IBD) is common. Physicians and scientists believe that the randomized controlled trial (RCT) provides the best evidence of an intervention's efficacy. However, there are only a few controlled trials that have assessed these therapies in IBD and all contain methodological problems. The RCT does not always fit well with the underlying principles of disease causation and treatment of CAM. Many forms of CAM take a holistic approach to the diagnosis and treatment of disease, where the patient plays an active and key role in healing and treatments are often highly individualized. Therefore, the use of placebos, blinding, and random allocation to structured treatment protocols in an RCT setting is often contradictory to the principles of CAM. We still know relatively little about the use of CAM in IBD. Prior to embarking upon a program of clinical trials to evaluate these therapies, a better understanding of the specific therapies being used, reasons for their use, and their potential side effects is required. We also need to understand how the CAM practitioners use their therapies, what they view as the appropriate indications, and how treatments are best administered.
Clinical Protocols↗
The utility of endoscopy in the management of patients with gastroesophageal reflux symptoms.
OBJECTIVE: The utility of endoscopy in the management of patients with symptoms of gastroesophageal reflux disease (GERD) is unclear. The purpose of this prospective study was to assess the impact of endoscopy on the subsequent management of patients with uncomplicated reflux symptoms. METHODS: A total of 742 patients underwent endoscopy for symptoms of GERD. Endoscopists recorded the therapy before endoscopy, the findings of endoscopy, and the treatment recommendations after endoscopy. RESULTS: There was no difference in pre-endoscopy therapy or grade of esophagitis in subjects undergoing endoscopy for failed therapy versus GERD symptoms alone. After endoscopy, the most common strategy for patients taking omeprazole was to maintain or increase the dose. For those taking an H2 blocker before endoscopy, the most common outcome was to switch the patient to omeprazole, independent of the grade of esophagitis. CONCLUSIONS: Most patients undergoing endoscopy for symptoms of GERD were switched to omeprazole regardless of the endoscopic findings. No esophageal cancer was identified and the incidence of Barrett's esophagus was low. It appears that endoscopy itself did not change the management of patients receiving H2-blocker therapy. A trial of a proton pump inhibitor before endoscopy should be considered.
Adolescent↗
Complementary medicine use by patients with inflammatory bowel disease.
OBJECTIVE: The purpose of this study was to establish the degree and determinants of the use of complementary therapies by patients with inflammatory bowel disease (IBD) and their reasons for seeking them. METHODS: The first phase was a cross-sectional survey of 134 patients with IBD (98 with Crohn's disease, 34 with ulcerative colitis, and two indeterminate) using a mailed, structured questionnaire (response rate 70%). Determinants of complementary medicine use were examined using logistic regression. The second phase was an in-depth exploration using personal interviews of the beliefs and perceptions of 14 complementary medicine users about the management of their disease. Analysis was performed using standard qualitative techniques and the identification of important, patient-identified themes about the management of IBD. RESULTS: Complementary therapies had been used by 51% of patients in the previous 2 yr. Current use was reported by 33%, of whom one-half were using it for their IBD. Vitamins and herbal products were the most commonly reported therapies. In multivariate analysis, duration of disease > 10 yr and a history of hospitalization were independent predictors of complementary medicine use. The side effects and lack of effectiveness of standard therapies were the most commonly cited reasons for seeking complementary medicine. Sixty-two percent had told their doctor about their use of complementary medicine. CONCLUSION: Complementary medicine use is common in patients with IBD, especially among those with a longer duration of disease or a history of hospitalization.
Adolescent↗
Research and the Internet.
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Colitis, Ulcerative↗
Anxious attachment and self-reported depressive symptomatology in women.
OBJECTIVE: Lack of intimacy has been identified as an important provoking agent that increases the risk of depressive symptoms in women. This study precisely characterized lack of intimacy by assessing a woman's attachment style and investigated the specificity of association between depressive symptoms and an anxious attachment pattern. METHOD: Four hundred and twenty women participated in this cross-sectional study of depressive symptomatology and anxious attachment. All participants completed the following measures: a sociodemographic questionnaire, the Centre for Epidemiological Studies Depression Scale (CES-D), the Reciprocal Attachment Questionnaire, the Social Support Questionnaire, the Rosenberg Self-Esteem Scale, and the Global Assessment of Recent Stress Scale. RESULTS: A score of 16 or above on the CES-D, which indicates the presence of depressive symptoms, was used to divide the sample into 2 groups: a depressed group (N = 129) and a nondepressed group (N = 291). We found that women in the depressive symptomatology group were more likely than women in the nondepressive symptomatology group to exhibit anxious attachment and adverse social and cognitive characteristics. Lower levels of self-esteem and higher levels of recent stress were also predictive of depressive symptomatology. Feared loss of the attachment figure and a lack of use of the attachment figure were independent predictors of depressive symptomatology in the same model. CONCLUSION: The feared loss of security associated with an attachment figure seems to be related to an increased likelihood of depressive symptoms.
Adult↗
Physicians' perspectives on massage therapy.
OBJECTIVE: To examine the knowledge, opinions, and referral behaviour of family physicians with respect to massage therapy and to explore factors associated with referral. DESIGN: A random, cross-sectional mailed survey. SETTING: Alberta family practices. PARTICIPANTS: Family physicians (n = 300). MAIN OUTCOME MEASURES: A self-report survey was developed for the study. This survey contained questions about sociodemographic and practice characteristics, perceived knowledge of massage therapy, opinions about the usefulness and legislation (government regulations) of massage therapy, and referral behaviour. RESULTS: Fifty-four percent of physicians (n = 161) completed the questionnaire. Sixty-eight percent of respondents indicated they had minimal or no knowledge of massage therapy. Despite this low level of knowledge, most (83%) believed massage therapy was a useful adjunct to their own practice. Moreover, 71% had referred patients to massage therapists and most (72%) perceived increasing demand from their patients for massage therapy. Approximately half of physicians surveyed supported government regulation of massage therapy. CONCLUSIONS: Physicians demonstrated a discrepancy between their knowledge of massage therapy and their opinions of, and referrals to, the profession. Physicians who referred patients to massage therapists generally held more positive opinions and had more knowledge of the discipline.
Adult↗
A multimethod research study on the use of complementary therapies among patients with inflammatory bowel disease.
CONTEXT: The purpose of this study was to gain a better understanding of the use of complementary therapies among patients with inflammatory bowel disease. OBJECTIVE: To examine factors influencing the use of complementary therapies, to explore patient-physician communication concerning those therapies, and to assess the effect of combining qualitative with quantitative research. DESIGN: In-depth qualitative interviews. PARTICIPANTS: Fourteen patients were selected from a quantitative study in which the use of complementary therapies among patients with inflammatory bowel disease was assessed. RESULTS: Patients reported using complementary therapies because of the serious side effects of medical treatment, because they felt conventional treatments did not help, and because complementary therapies were thought to be safe. Psychological and social factors for using complementary therapies must be considered and understood. Patients cited many reasons for not discussing the use of complementary therapies with their doctors. Adding qualitative data to quantitative research greatly increased the authors' understanding of factors that contribute to complementary therapy use. CONCLUSIONS: Multiple factors contribute to the decision to use complementary therapies among those with inflammatory bowel disease. Identifying these factors is important for educating physicians regarding their patients' use of complementary therapies and may contribute to improved patient-physician communication.
Adult↗
Decision-making and outcomes for percutaneous endoscopic gastrostomy: a pilot study.
We undertook a retrospective review of 25 patients who had undergone percutaneous endoscopic gastrostomy (PEG). Data regarding the clinical courses were collected, and a questionnaire was administered to patients when possible; in most cases the individual responsible for care answered questions. We pinpointed concerns relevant to the decision-making process. In a substantial proportion of cases, the clinical courses subsequent to PEG were poor. Of 21 surrogates interviewed, 33% were uncertain that proceeding to nutritional support via PEG had been the right decision. Findings indicate a need to improve the process by which decisions to treat by PEG are made, ideally including better prognostic information.
Aged↗
Endoscopists' opinions of indications for upper gastrointestinal endoscopy.
OBJECTIVE: To determine whether endoscopists and general internists agreed with the characterization of appropriateness for endoscopy of various clinical scenarios, as previously reported by the RAND Corporation. DESIGN: Mail survey. STUDY SAMPLE: All endoscopists in western Canada and a random sample of general internists who did not perform endoscopy. METHODS: Questionnaires were sent to 179 endoscopists in western Canada who were asked to rate the 53 scenarios for endoscopy on a nine-point scale ranging from most appropriate to most inappropriate. A similar questionnaire was sent to 39 general internists practising in the province of Alberta. RESULTS: Response rate was 72% of endoscopists (n = 128) and 64% of general internists (n = 25). Among the endoscopists, there was agreement with the RAND classification for 32 scenarios. All 18 indications previously thought to be appropriate were considered to be appropriate. However, endoscopists agreed with only six of 16 equivocal and eight of 19 indications considered inappropriate. Discrepancies were reviewed by five experienced endoscopists and most appeared to be related to a concern regarding possible malignancy linked in part with the definition of failure to respond to medical therapy; and to a refusal to request a barium meal before endoscopy. Among general internists, there was agreement with RAND in 26 scenarios. When the appropriateness rankings of endoscopists and general internists were compared, there was agreement in 40 of 53 scenarios. Significant discrepancies in ratings were identified in scenarios in which barium studies were described as being normal, known or not done. CONCLUSIONS: The equivocal and inappropriate ratings developed by the RAND Corporation are not uniformly accepted by the endoscopy community or general internists. Use of the RAND indications for assessing quality assurance can be challenged.
Adult↗
Euthanasia in family practice in The Netherlands. Toward a better understanding.
OBJECTIVE: To describe the incidence of euthanasia and assisted suicide in family practice in the Netherlands, the reasons for its practice, and the characteristics of patients and physicians involved. DESIGN: Cross-sectional survey of a random sample of Dutch family physicians. SETTING: General practices in The Netherlands. PARTICIPANTS: An anonymous questionnaire was mailed to 1042 general practitioners. Of the 996 eligible physicians, 667 (67%) completed the questionnaire. MAIN OUTCOME MEASURES: Reported practices and beliefs concerning euthanasia and assisted suicide. RESULTS: In the course of an average year, 24% of Dutch family physicians had practised euthanasia or assisted suicide. Most deaths took place at home in the presence of others. According to the physicians, the most important reasons for the request were futile suffering, fear or avoidance of loss of dignity, and unbearable suffering. Euthanasia or assisted suicide was mostly (85%) administered to patients with malignant neoplasms. Physicians were more opposed to euthanasia and assisted suicide if they had never practised it, if they had a religious affiliation, and if they were older. CONCLUSIONS: This study presents empiric data about euthanasia and assisted suicide in the context of a permissive euthanasia policy. Understanding Dutch practices could be helpful for Canadians. However, each country needs to resolve these issues in its own way.
Adult↗
The Chiropractic Outcome Study: pain, functional ability and satisfaction with care.
OBJECTIVE: To examine changes in pain experienced, changes in functional ability and degree of patient satisfaction with chiropractic care. Patient characteristics influencing these parameters were also explored. DESIGN: A follow-up study consisting of a questionnaire to be completed at the beginning of treatment and a mailed questionnaire 6 wk later. SETTING: Non-random sample of 13 chiropractic practices in Calgary and Red Deer, Alberta, Canada. PATIENTS: Three hundred sixty-nine patients presenting with neck and/or back pain who saw a chiropractor for the first time or who had not seen a chiropractor for a period for 6 months before the first visit. RESULTS: Pain relief and changes in functional ability were greatest among patients whose initial pain or disability level was moderate or severe. No significant improvement was found among those whose initial level of pain or disability was mild. Pain relief and improved functional ability was greatest among those with an acute condition and those who saw no one other than the chiropractor during treatment. In addition, pain relief was highest among men, those who perceived themselves to be in good or excellent health and those who had completed treatment in 6 wk. Patients positively endorsed all items on the satisfaction questionnaire, indicating a high level of satisfaction with the care they received. Patients were most satisfied with access to chiropractic care and least satisfied with financial aspects. Improvement in pain and in back and neck disability were significantly related to general satisfaction. CONCLUSION: Based on these results, it seems that patients suffering from back and/or neck complaints experience chiropractic care as an effective means of resolving or ameliorating pain and functional impairments, thus reinforcing previous results showing the benefits of chiropractic treatment for back and neck pain.
Back Pain↗
Combining qualitative and quantitative research methods: considering the possibilities for enhancing the study of chronic diseases.
This paper discusses some of the underlying reasons why health researchers have historically had difficulty working collaboratively across qualitative and quantitative research paradigms and argues why it is imperative that researchers move beyond traditional adherence to particular methods of inquiry. Chronic illnesses are prime examples of conditions that by their very nature need to be studied from a combination of perspectives, using both qualitative and quantitative methods. We suggest that the success of health research on managing these conditions lies in the shared application of both qualitative and quantitative research perspectives, methods and tools. In addition, we argue that effective research into long-term chronic illnesses requires not only combined research efforts but also longitudinal programs of study, so that the experience of managing chronic conditions can be captured over time.
Chronic Disease↗
Alberta Euthanasia Survey: 3-year follow-up.
OBJECTIVE: To determine whether the opinions of Alberta physicians about active euthanasia had changed and to assess the determinants of potential changes in opinion. DESIGN: Follow-up survey (mailed questionnaire) of physicians included in the 1991 Alberta Euthanasia Survey. SETTING: Alberta. PARTICIPANTS: Of the 1391 physicians who participated in the 1991 survey 1291 (93%) had indicated that they were willing to take part in a follow-up survey. A follow-up questionnaire was mailed in 1994 to 1146 physicians who could be traced through the 1994 Medical Directory of the provincial college of physicians and surgeons; 25 questionnaires were returned because they could not be delivered. OUTCOME MEASURES: Physicians' opinions about (a) the morality of active euthanasia, (b) changes in the law to permit active euthanasia and (c) the practice of legalized euthanasia. RESULTS: Of the 1121 physicians sent a follow-up questionnaire 866 (77%) returned it completed. The responses of these same 866 physicians in 1991 provided a basis for comparison. Of the 866, 360 (42%) stated in the 1994 survey that it is sometimes right to practise active euthanasia; a similar proportion (384 [44%]) gave this response in 1991. However, other opinions changed significantly. In 1991, 250 of the respondents (29%) indicated that they would practise active euthanasia if it were legalized, as compared with 128 (15%) in 1994 (p < 0.01). In 1991, 429 (50%) of the respondents thought that the law should be changed to permit active euthanasia, as compared with 316 (37%) in 1994 (p < 0.01). Religious activity was the most important characteristic associated with changes in opinion. Despite the decrease in support for the practice and legalization of active euthanasia between 1991 and 1994, in both surveys at least 70% of those who responded to this question indicated that active euthanasia, if it were legalized, should be performed only by physicians and should be taught at medical sites. CONCLUSION: Alberta physicians' support for the practice and legalization of active euthanasia decreased considerably between 1991 and 1994. However, most physicians remain in favour of restricting active euthanasia, if it were legalized, to the medical profession. These results suggest a need for caution and deliberation when changes in the law concerning active euthanasia are examined.
Adult↗
Beliefs of Alberta physicians concerning active euthanasia: analysis of qualitative data collected in the Alberta Euthanasia Survey.
Often the type of information collected in surveys of physicians' opinions about active euthanasia has not revealed their experiences and the rationale(s) they use in arriving at their opinions. This paper presents a qualitative analysis of comments made in a large survey of Alberta physicians' opinions about active euthanasia to identify issues physicians commented upon, and to explore the rationale(s) behind their opinions. This information adds an important qualitative perspective to the current debate about euthanasia and assisted suicide.
Alberta↗
Integrating complementary medicine and health care services into practice.
Complementary medicine and health care services constitute a significant proportion of the use of health care services in Canada, despite a history of limited acceptance of these therapies by the medical profession. However, physician attitudes appear to be changing. A survey of a random sample of general practitioners in Quebec (see page 29 of this issue) shows that four out of five general practitioners perceive at least one of three complementary health care services to be useful. Similar surveys of samples in Alberta and Ontario suggest that physicians there, although somewhat less enthusiastic than their counterparts in Quebec, have also begun to be more open-minded about these types of therapies. However, physicians have reported little understanding of complementary health care services, which suggests the need for more research on and education about these services. The Medical Society of Nova Scotia has responded to this need by establishing a Section of Complementary Medicine. The authors believe that fair, accountable, scientific and rigorous research on complementary therapies will benefit physicians and patients. The problems inherent in applying reductionist analysis to a holistic approach to care can be largely circumvented by focusing on outcomes research. In light of the popularity of these therapies, inquiry into patient use of complementary health care services should become a part of a complete patient history. This measure would promote greater patient-physician communication and integration of complementary health care services into patient care.
Canada↗
The relationship between chinook conditions and women's physical and mental well-being.
The objective of this study was (1) to determine the relationship between chinook conditions and physical and psychological symptoms in women aged 20-49 years, and (2) to examine the possibility of subgroups of chinook-sensitive women. The evidence for this relationship is at present merely anecdotal. The study carried out in 1985-1986 in Calgary comprises the secondary analysis of a large survey of various health and health-related factors, including different symptoms, of urban women aged 20-49 years. The interview date was used to link these data to days on which pre-chinook, chinook, post-chinook and non-chinook conditions occurred. Between November 1, 1985 and February 28, 1986, 182 women were interviewed on pre-chinook days, 74 on chinook days, 229 on post-chinook days and 886 on non-chinook days. Autonomic reactions and skin disorders were found to be significantly related to chinook conditions. None of the psychological symptoms was related to chinook conditions. However, a significant relationship was found between symptoms and chinook conditions in women with a history of emotional disorders. This type of information is important to educate chinook-sensitive women and health professionals as well as for hospital emergency departments in order to be able to prepare for potential increases in workload.
Acclimatization↗