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Biomedical subjects

R E Gray

Publications and source records attributed to R E Gray.

At least 19 recordsLinked to original sources
PubMed2000

Changing physicians' attitudes toward self-help groups: an educational intervention.

BACKGROUND: Members of self-help groups (SHGs) for support of cancer patients are concerned that physicians are skeptical about these groups and see them as potentially harmful. The purpose of this study was to assess family physicians' attitudes towards self-help groups and see whether these could be changed through an educational intervention. METHODS: A questionnaire assessing attitudes toward SHGs was mailed to 1,422 eligible Ontario family physicians, to which 911 responded (64% response rate). Responders were sent an educational package consisting of an article about self-help groups, a list of local cancer self-help groups, and a follow-up questionnaire. RESULTS: The study was completed by 584/911 family physicians (64%). After being exposed to educational material, the physicians were more positive about the helpfulness of SHGs (p = 0.021), and less concerned about SHGs' being harmful (p = 0.003). They were more positive about the potential for SHGs to provide participants with opportunities for: sharing information (p = 0.004), bonding with other patients (p < 0.001), feeling understood (p = 0.004), sharing common experiences (p = 0.004), providing hope (p < 0.001), sharing laughter (p = 0.001), becoming more assertive (p < 0.001), communicating with health professionals (p = 0.04), dealing with issues related to death and dying (p = 0.005), advocacy (p = 0.01), and overcoming isolation (p = 0.002). They were less concerned with the potential for SHGs to provide misinformation (p = 0.003), the negative effects of associating with the very ill (p = 0.002), dwelling on illness (p = 0.002), or cultivating false hope (p = 0.001). CONCLUSION: Having family physicians complete a questionnaire, followed by educational material specific to their concerns, changed their attitudes toward self-help groups. Further study is needed to see whether behavioral changes resulted.

Attitude of Health Personnel↗
PubMed1999

Oncology nurses' perspectives on unconventional therapies.

Unconventional therapies have become increasingly popular with health care consumers in recent years. As patients seek information and attempt to make decisions about unconventional therapies, they often turn to nurses, asking their opinion about certain therapies. The nurse's attitudes and beliefs about unconventional therapies very likely will influence the response to the patient's inquiries. This work represents the findings of interviews with 48 nurses regarding their perspectives on unconventional therapies. Without exception, all nurses interviewed emphasized the need for information regarding unconventional therapies to be readily available for patients and health care professionals. The other themes identified in the interviews included the following: various people use unconventional therapies; people seek unconventional therapies for a variety of reasons; communication about unconventional therapies needs to be open; and conventional and unconventional practitioners ought to work collaboratively. The participants interviewed saw a clearly defined role for nurses regarding unconventional therapies.

Attitude of Health Personnel↗
PubMed1999

Nurses' perspectives on unconventional therapies.

Unconventional therapies have become increasingly popular with health care consumers in recent years. As patients seek information and attempt to make decisions about unconventional therapies, they often turn to nurses, asking the nurse's opinion about certain therapies. The nurse's attitudes and beliefs about unconventional therapies quite likely will influence the response to the patient's inquiries. This article represents the findings of interviews with 20 nurses regarding their perspectives on unconventional therapies. Without exception, all nurses who were interviewed emphasized that information regarding unconventional therapies needs to be available readily for both patients and health care professionals. Other themes identified in the interviews included the following: Various people use unconventional therapies; people seek unconventional therapies for a variety of reasons; communication about unconventional therapies needs to be open, and a place should be found for unconventional therapies. The interviewees saw a clearly defined role for nurses regarding unconventional therapies.

Attitude of Health Personnel↗
PubMed1999

Canadian women's perspectives on ovarian cancer.

OBJECTIVE: To describe the perspectives of Canadian women living with ovarian cancer regarding their experiences with the disease. DESIGN: A cross-sectional survey of a convenience sample of Canadian women with ovarian cancer. SETTING: Survey questionnaires were sent to physicians in 26 cancer programs that treat women with ovarian cancer and to ovarian cancer self-help groups for subsequent distribution to women. PARTICIPANTS: Women diagnosed with ovarian cancer and able to read English or French. MAIN OUTCOME MEASURES: A variety of individual items in the survey related to information received, communication, physical and psychosocial symptoms, impact of illness and quality of life. RESULTS: A total of 315 women returned the survey. The average age of the respondents is 59 years. Each province and territory is represented in the sample. Over one-half of the women received a diagnosis of ovarian cancer within a month of seeking help for a concern and 85% had multiple treatment modalities. The majority of the women felt adequately informed (80%) and were satisfied with communication with their physicians (mean of 4.1 to 4.5 on a 5-point scale). A majority (62%) said that their lifestyle had changed as a result of their disease. Problems were experienced most frequently regarding side effects (58%), fear of recurrence (54%), sleeping difficulties (46%), bowel difficulties (44%), fear of dying (36%) and difficulty concentrating (32%). Many who experienced problems reported receiving inadequate help for them (16% to 49%). Quality of life was reported as significantly lower following the diagnosis and treatment of ovarian cancer (p = 0.0001). CONCLUSION: This study provides an important foundation for further investigation. There is a pressing need for research regarding the early identification of ovarian cancer and issues of support and coping. Care for women with ovarian cancer requires the expertise of a range of disciplines and community-based agencies working collaboratively as a team.

Adaptation, Psychological↗
PubMed1999

Family physicians' perspectives on ovarian cancer.

OBJECTIVE: To describe the knowledge, practices and perspectives of Canadian family physicians regarding ovarian cancer. DESIGN: A mailed survey questionnaire was followed by a reminder card, a second mailing of the questionnaire and a final reminder card. SETTING: A national sample of family physicians was drawn randomly from the membership database of the College of Family Physicians of Canada. MAIN OUTCOME MEASURES: Knowledge related to ovarian cancer. Practices related to the screening and detection of ovarian cancer. Attitudes towards screening for ovarian cancer. Perceived role in the care of women at risk of, or diagnosed with, ovarian cancer. Perceived educational needs of physicians. RESULTS: A total of 1079 completed questionnaires were returned, providing a response rate of 56.6%. Although most family physicians were aware of the basic facts about ovarian cancer, there were knowledge limitations related to risk factors, familial ovarian cancer syndromes and symptoms. Practices related to asymptomatic women were found to be mostly in accord with current guidelines and recognized the prevailing lack of evidence for the effectiveness of tests. Areas that were troublesome included the role of screening in high-risk women and knowledge about available tests. Most family physicians indicated that they have an important role to play in the care of women after they have been diagnosed with ovarian cancer. They also expressed a high level of interest in obtaining additional information related to ovarian cancer. CONCLUSIONS: This study clearly shows that there is a need for additional research to assist with the development of evidence-based guidelines for women at increased risk of ovarian cancer and for women at no known risk. Pending more definitive evidence, interim guidelines could provide assistance to physicians currently having to make decisions in a context of massive uncertainty. Canadian family physicians would be interested in and would benefit from continuing medical education (CME) initiatives concerning ovarian cancer.

Adult↗
PubMed1999

Gynecologists' perspectives regarding ovarian cancer.

OBJECTIVE: To document the perspectives, practices and knowledge of Canadian gynecologists regarding ovarian cancer. DESIGN: A mailed survey questionnaire was followed by a reminder card and a second mailing of the questionnaire. SETTING: A sample of all gynecologists practising in Canada. MAIN OUTCOME MEASURES: Knowledge related to ovarian cancer. Practices related to the screening and detection of ovarian cancer. Attitudes towards ovarian cancer. Perceived role in the care of women at risk of, or diagnosed with, ovarian cancer. Perceived educational needs of gynecologists regarding ovarian cancer. RESULTS: A total of 504 completed questionnaires were returned, providing a response rate of 46%. Most gynecologists indicated that they knew the basic facts about ovarian cancer and risk factors. Practices related to asymptomatic, low-risk women were found to be mostly in accord with current guidelines and the lack of evidence for the effectiveness of tests. Practices regarding women with suspected early or late-stage ovarian cancer varied, particularly with regard to referral to gynecologic oncologists. Many respondents indicated that they have an important role to play in the care of women after they have been diagnosed with ovarian cancer or referred to another specialist. Respondents also expressed interest in obtaining additional information about ovarian cancer. CONCLUSIONS: This study shows that there is a need for the development and dissemination of evidence-based guidelines regarding ovarian cancer. It also pinpoints areas where educational efforts could be directed.

Adult↗
PubMed1999

Complementary health practitioners' attitudes, practices and knowledge related to women's cancers.

OBJECTIVE: To document the attitudes, practices and knowledge of 3 groups of complementary practitioners (naturopathic doctors, chiropractors and massage therapists) regarding women's cancers in general and ovarian cancer specifically. DESIGN: A mailed survey questionnaire was followed by a reminder card and a second mailing of the questionnaire. SETTINGS: National samples were obtained for naturopathic doctors and chiropractors. The massage therapist sample was drawn from Ontario only because of the absence of a national listing of massage therapists. MAIN OUTCOME MEASURES: Practitioners reported response to patients' suspicious symptoms. Practitioners' perceptions of patients' motivations for seeking treatment. Practitioners' satisfaction with interactions with conventional practitioners. Practitioners' perceptions of their role in the care of women at risk of, or diagnosed with, cancer. Practitioners' perceptions of their knowledge regarding women's cancers. Practitioners' knowledge specific to ovarian cancer. RESULTS: A total of 894 completed questionnaires were returned, providing a response rate of 56%. The vast majority of practitioners who saw women with symptoms possibly related to cancer referred them to a family physician or a cancer specialist. Motivations that practitioners most frequently heard expressed by women seeking complementary treatments were "maximizing quality of life," "seeking natural approaches to healing" and "looking to stay well when disease is in remission." Most respondents were dissatisfied with patient-related communication with both family physicians and cancer specialists. The majority of complementary practitioners indicated that they have an important role to play in the postdiagnostic care of women with cancer. Considerable interest was expressed in further education concerning ovarian cancer. CONCLUSIONS: Whereas the professions reached through this survey differ in important ways from each other, they share an interest in being involved in the care of women with cancer, as well as an enthusiasm for the development of continuing professional education programs to help them better serve their clients.

Adult↗
PubMed1999

Stereotactic breast biopsy: experience in a community setting.

This article reviews the first year experience with stereotactically guided percutaneous breast biopsy at Baptist Health Systems Women's Center. One hundred forty eight procedures were performed on one hundred forty one patients from July 1997 through July 1998. Our biopsy program is a cooperative effort involving surgeons, radiologists, pathologists, and ancillary health care personnel. In accordance with published literature, we have found the procedure to be efficacious, safe, cost effective and well accepted by patients and physicians. The advantages and limitations of minimally invasive breast biopsy are discussed as well as our concept of the role of this technique in management of patients with an abnormal mammogram.

Adult↗
PubMed1998

The information needs of well, longer-term survivors of breast cancer.

Nine focus groups for well, longer-term survivors of breast cancer were held in Ontario, Canada. Prevalent themes identified through analysis of focus group transcripts fell into two broad categories, one reflecting the context within which women seek information and the other reflecting the content of information desired and sought. Themes related to context included: the ongoing impact on women of their initial disease experience and continued uncertainty about possible recurrence; womens' lack of information and understanding about processes involved in developing medical knowledge; prevailing mistrust about the impact of cost curtailment policies; and, concerns related to how professional communication can aid or hinder the goal of obtaining information. Themes related to content issues included: follow-up protocols, tamoxifen, detecting signs of possible recurrence, prevention for daughters, neglected side effects of treatment, insurance, lifestyle, and unconventional therapies.

Adult↗
PubMed1998

A strategy for informing patients and health professionals about unconventional cancer therapies.

BACKGROUND: A Guide to Unconventional Cancer Therapies was produced by the Ontario Breast Cancer Information Exchange Project with the intention of meeting needs of patients, family members, and health professionals for information about unconventional therapies. Concerns raised by health professionals during the development of the guide serve as a focus for considering its impact on cancer patients who purchased it. MATERIALS AND METHODS: Purchasers of the guide were sent a survey questionnaire inquiring about their access to, use of, and attitudes toward it. RESULTS: A total of 634 individuals responded to the survey, including cancer patients, health professionals, and family members. The guide was rated moderately helpful overall, and health professionals found it significantly more helpful than did cancer patients. A minority of patients were influenced to try an unconventional therapy as a result of reading the guide. Those who did try a new therapy typically chose ones that are most popular and have few potential negative effects. CONCLUSIONS: As an informational strategy, the Guide to Unconventional Cancer Therapies has been successful. Concerns expressed by some health professionals about potential harm through implementing the strategy have been shown to be largely unwarranted, at least for study respondents.

Breast Neoplasms↗
PubMed1998

Information needs of women with metastatic breast cancer.

Eight focus groups involving women with metastatic breast cancer were held across Ontario over approximately 6 months in 1996-97. Prevalent themes identified during the sessions are reported under 2 broad dimensions: the women's expressed desire for information in specific content areas, and issues related to whether information can be either beneficial or harmful, depending on how it is provided. The women reported high needs for information, especially that which would relate to their situation. Perceived adequacy of information is closely linked to health professional engagement and care. Although the provision of information is important, the needs of these women for maintenance of hope and provision of interpersonal support and comfort are also critical.

Adult↗
PubMed1998

Self-help groups.

OBJECTIVE: To assess Ontario family physicians' attitudes toward, awareness of, and practices related to self-help groups in general and cancer self-help groups specifically. DESIGN: Mailed survey using a modified Dillman method. SETTING: Ontario family practices. PARTICIPANTS: A random sample of 1500 Ontario members of the College of Family Physicians of Canada, of whom 949 responded. A total of 911 completed questionnaires were received, for an eligible response rate of 64%. MAIN OUTCOME MEASURES: Physician demographics, practice characteristics; extent of awareness of self-help groups and their perceived value; attitudes toward self-help groups; practices related to interactions with patients about self-help groups. RESULTS: Only 40.2% of respondents were aware of six or more self-help groups in their region; 56.8% were aware of at least one cancer self-help group. Discussions with patients about groups were reported as occurring "frequently" by 12% of respondents, who indicated they made referrals to an array of groups. Ratings of group helpfulness were relatively high (83.8% scoring 3, 4, or 5 on a 5-point scale, where 5 is "very helpful"). There were low ratings of potential harm (1% scoring 4 or 5 on a 5-point scale, where 5 is "very harmful"). Confidence intervals for proportions reported on in this paper were all within 4%. CONCLUSIONS: Family physicians have predominantly positive attitudes about the potential benefits of self-help groups, and many are recommending groups to their patients.

Female↗
PubMed1997

Interviews with men with prostate cancer about their self-help group experience.

This study reports on the results of semi-structured interviews with 12 men involved in prostate cancer self-help groups in three Canadian cities. Overall, participants reported their group involvement to be helpful, especially in terms of accessing information. Additional benefits included finding commonality with others, being able to talk about difficult issues, being productive and accomplishing tasks, advocating to make a difference, and engaging with family members around health issues. We conclude that the recent growth of self-help groups speaks to the challenge inherent for men in dealing with prostate cancer and counteracts tendencies to minimize the suffering which they experience.

Adaptation, Psychological↗
PubMed1997

Physician perspectives on unconventional cancer therapies.

The popularity of unconventional therapies has grown dramatically in recent years. This paper reports on the results of a pilot study investigating the perspectives of physicians involved with cancer care regarding their reactions to this trend and their ways of trying to meet associated challenges. Nine oncologists, nine general practitioners, and one surgeon were interviewed over the telephone, employing open-ended questions. The physicians were unanimously interested in having information available about unconventional therapies. They also expressed a desire to be supportive of patient choices in this area, provided conventional therapy was not compromised. However, there was little interest in initiating communication about unconventional therapies, with most seeing such discussions as a poor use of their time. Suggestions for future research, as well as educational and policy strategies, are addressed.

Attitude of Health Personnel↗
PubMed1996

Paget's disease of bone and unvaccinated dogs.

The etiology of Paget's disease is unknown, but several observations suggest a viral cause. Since canine distemper virus is among those proposed to be a causal agent, we investigated the hypothesis that dog ownership may increase the risk of Paget's disease of bone by means of a case control study. One hundred and fifty patients with Paget's disease and 185 controls were interviewed using a structured questionnaire administered by the same interviewer. Participants were asked about their socioeconomic background and their exposure to pets. The risk of Paget's disease was not significantly increased in individuals. However, ownership of a mongrel dog was associated with a significant increase in risk (OR = 1.6; 95% CI = 1.0-2.4) and the risk increased still further with the ownership of an unvaccinated dog (OR = 2.8; 95% CI = 1.8-4.5). Additionally, ownership of cats and birds excluding dog owners, increased the risk of Paget's disease (OR = 2.5; 95% CI = 1.0-5.0; OR = 2.3; 95% CI = 1.0-5.3, respectively). These data suggest that previous exposure to cats, birds, and dogs unvaccinated for canine distemper may increase the risk of an individual developing Paget's disease of bone.

Adult↗