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V Jenkins

Publications and source records attributed to V Jenkins.

At least 19 recordsLinked to original sources
PubMed2006

A 3-year prospective study of the effects of adjuvant treatments on cognition in women with early stage breast cancer.

The neuropsychological performance of 85 women with early stage breast cancer scheduled for chemotherapy, 43 women scheduled for endocrine therapy and/or radiotherapy and 49 healthy control subjects was assessed at baseline (T1), postchemotherapy (or 6 months) (T2) and at 18 months (T3). Repeated measures analysis found no significant interactions or main effect of group after controlling for age and intelligence. Using a calculation to examine performance at an individual level, reliable decline on multiple tasks was seen in 20% of chemotherapy patients, 26% of nonchemotherapy patients and 18% of controls at T2 (18%, 14 and 11%, respectively, at T3). Patients who had experienced a treatment-induced menopause were more likely to show reliable decline on multiple measures at T2 (OR=2.6, 95% confidence interval (CI) 0.823-8.266 P=0.086). Psychological distress, quality of life measures and self-reported cognitive failures did not impact on objective tests of cognitive function, but were significantly associated with each other. The results show that a few women experienced objective measurable change in their concentration and memory following standard adjuvant therapy, but the majority were either unaffected or even improve over time.

Adult↗
PubMed2006

Current concepts of communication skills training in oncology.

Too many patients leave their consultations with insufficient understanding about their diagnosis, prognosis, the need for further diagnostic tests, the management plans, or the therapeutic intent of treatment. This situation is not entirely due to paternalism or a lack of awareness that patients worldwide desire more information, but rather a reflection of the dismal communication skills training that most healthcare professionals receive. There have been many developments aimed at rectifying this situation, but there are still too few publications available demonstrating efficacy. Nevertheless, evidence shows that communication skills can be taught and that if taught well then the impact endures into the clinic. This chapter looks at some of the history of good evidence-based interventions to improve communication and makes a plea for more research-based evidence for improved patient outcomes following training. Unless attention and resources are given to help healthcare professionals in this core clinical skill then we will never be able to help patients and their families take an informed and educated role in their own cancer care.

Communication↗
PubMed2005

The informational roles and psychological health of members of 10 oncology multidisciplinary teams in the UK.

We report here the different roles undertaken by the members of 10 multidisciplinary cancer teams in conveying information to patients during their care. Team members completed an Informational Roles Questionnaire measuring an individual's perception of their major role and that of their colleagues in giving information to patients. They also completed two standard psychological health measures, the General Health Questionnaire and Maslach Burnout Inventory. The information giving roles of the surgeon, oncologist, radiologist and clinical nurse specialist were well recognised by their colleagues; however, other team members' roles were more ambiguous and less well understood. The clinical nurse specialist provided the broadest information coverage for patients. Few professional groups regularly informed patients about clinical trials and family history and the clinical nurse specialist was often the only person to deal with patients' sexual well being, consequently these areas are likely to receive poor coverage. Probable psychiatric morbidity (GHQ> or =4) in teams ranged from 5 to 27%. High levels of emotional exhaustion were particularly apparent in team leaders and nurses and feelings of low levels of personal accomplishment were prevalent in the histopathologists and radiologists. Putative benefits to patients and healthcare professionals from multidisciplinary team working may not be realised without investment in team training.

Burnout, Professional↗
PubMed2005

Atypical hearing loss in women with breast cancer receiving adjuvant treatment.

There are no reports of adjuvant treatments for early breast cancer causing hearing loss. Yet in this exploratory study 14/16 women who had received Fluorouracil, Epirubicin and Cyclophosphamide (FEC) chemotherapy regimen, 11 of whom also received endocrine treatment, had reduced hearing sensitivity, with 9/16 being atypical. It is not clear whether this finding is related to oestrogen reduction and/or ototoxicity but a more detailed investigation in this area is warranted given the large number of women with breast cancer who receive adjuvant treatments.

Adult↗
PubMed2005

The preferences of 600 patients for different descriptions of randomisation.

A total of 600 patients from cancer centres throughout the UK identified their most preferred and most disliked descriptions of randomisation found in current patient information sheets and websites. The CancerBACUP description, which describes both the process of randomisation and why it is done, was most preferred 151 out of 533 (28%) patients. The NCI description was viewed as overly technical and most disliked 185 out of 483 (38%) patients.

Health Knowledge, Attitudes, Practice↗
PubMed2005

Discussing randomised clinical trials of cancer therapy: evaluation of a Cancer Research UK training programme.

OBJECTIVE: To evaluate a training intervention aimed at improving healthcare professionals' communication with cancer patients about randomised clinical trials. DESIGN: Before and after evaluation of training programme. SETTING: Members of the National Cancer Research Network, Scottish Trials Network, and the Welsh Cancer Trials Network. PARTICIPANTS: 101 healthcare professionals (33 clinicians and 68 research nurses). INTERVENTION: Four modules delivered by a trained facilitator using videotapes and interactive exercises to cover general issues about discussing randomised clinical trials with patients, problems specific to adjuvant trials, trials with palliation as the goal, and trials where patients had a strong preference for one treatment arm. MAIN OUTCOME MEASURES: Before and after the intervention, participants were videotaped discussing a trial with an actor portraying a patient. These consultations were assessed for presence of information required by good clinical practice guidelines. The actor patients gave an assessment after each interview. Participants reported their self confidence about key aspects of trial discussion. RESULTS: Analysis of the videotaped consultations showed that, after intervention, significantly more participants displayed key communication behaviours such as explaining randomisation (69 v 81, odds ratio 2.33, P = 0.033), checking patients' understanding (11 v 31, odds ratio 3.22, P = 0.002), and discussing standard treatment (73 v 88, odds ratio 4.75, P = 0.005) and side effects (69 v 85, odds ratio 3.29, P = 0.006). Participants' self confidence increased significantly (P < 0.001) across all areas. Actor patients' ratings of participants' communication showed significant improvements for 12/15 key items. CONCLUSION: This intensive 8 hour intervention significantly improved participants' confidence and competence when communicating about randomised clinical trials.

Clinical Competence↗
PubMed2005

The effects of adjuvant chemotherapy on cognition in women with breast cancer--preliminary results of an observational longitudinal study.

Several studies have reported that chemotherapy-treated patients have impaired cognition function relative to control groups. We are conducting a longitudinal study with cognitive assessments at baseline, 6 and 18 months. A planned preliminary analysis of data from 50 chemotherapy patients and 43 healthy controls at baseline and post-treatment found a significant group by time interaction on three measures of verbal and working memory. Chemotherapy patients were more likely to show cognitive decline than controls (OR 2.25). Patients were significantly more likely to have GHQ(12) scores indicative of possible psychological morbidity and showed significant increases in endocrine symptoms and fatigue post-treatment however neither GHQ(12) nor quality-of-life variables were related to cognitive performance.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2005

Preferences of healthy men for two different endocrine treatment options offered for locally advanced prostate cancer.

OBJECTIVE: The aim of this study was to determine whether healthy men would prefer either luteinizing hormone releasing hormone analogues (LHRHa) or non-steroidal anti-androgen therapy (NSAA) should they hypothetically develop locally advanced prostate cancer. PARTICIPANTS AND METHODS: A representative sample of 180 men without prostate cancer (68% over 65 years of age, range 50-90 years), read two scenarios describing LHRHa or NSAA treatments for locally advanced prostate cancer. Participants chose which drug treatment they hypothetically would prefer, gave a reason for their choice and indicated the degree to which they wanted to avoid side effects specific to each drug. RESULTS: Eighty-six per cent (156/180) of the men chose NSAA therapy, 7% (12/180) chose LHRHa therapy and 7% (12/180) could not decide. The main reason men chose LHRHa therapy was because of the method of administration (9/12) whereas those who chose NSAA therapy cited avoidance of the side effects associated with LHRHa treatment (115/156). The side effects, ranked in order of importance, that men who chose NSAA therapy most wanted to avoid included risk of potential fractures (85%), reduced physical strength (76%), decreased sexual interest (56%), impotence (51%), hot flushes (49%), breast enlargement (17%) and breast tenderness (13%). CONCLUSION: Although this project was a hypothetical study, several important issues emerged from the data that are relevant to patient choice. Men should be fully informed about the side-effect profiles of different endocrine treatments, involved in decision making and allowed to choose therapies less likely to cause side effects they would prefer to avoid.

Aged↗
PubMed2003

Enduring impact of communication skills training: results of a 12-month follow-up.

The efficacy of a communication skills training programme was shown through a randomised trial. Oncologists (N=160) from 34 cancer centres were allocated to written feedback plus course; course alone; written feedback alone or control. Each clinician had 6 - 10 interviews with patients videotaped at baseline and 3 months postintervention. Analysis of videotapes revealed improvements in the communication skills of clinicians randomised to training (n=80) compared with others (n=80). A 12-month follow-up assessment is reported here. Robust Poisson conditional analyses of counts of changes in communication behaviours revealed no demonstrable attrition in those who had shown improvement previously, including fewer leading questions, appropriate use of focused and open-ended questions and responses to patient cues. Additional skills, not apparent at 3 months, were now evident; the estimated effect sizes corresponded to 81% fewer interruptions (P=0.001) and increased summarising of information to 38% (P=0.038). However, expressions of empathy (54%, P=0.001) declined. The overall results show that 12 - 15 months postintervention, clinicians had integrated key communication skills into clinical practice and were applying others. This is the first RCT to show an enduring effect of communication skills training with transfer into the clinic.

Adult↗
PubMed2002

Describing randomisation: patients' and the public's preferences compared with clinicians' practice.

Explaining the concept of randomisation in simple terms to patients during the discussion of randomised clinical trials can be a difficult task for many health care professionals. We report the results of a questionnaire-based survey, using seven descriptions of randomisation taken from Corbett's study. We examined the preferences of the general public and patients towards the descriptions and compared the results with the clinicians' choice. Participants in the survey were 341 lay people without cancer, 200 patients with cancer and 200 oncologists from cancer centres throughout the UK. It was difficult to identify 'the best' way to describe the process of randomisation. The two most favoured statements for patients and members of the public included a very explicit statement that mentioned 'a computer', 'chance' and 'not the doctor's or patient's decision' and a succinct statement that played down the role of 'chance'. Clinicians chose neither of these statements as closely resembling their own practice. Patients and members of the public most disliked the statement 'a computer will perform the equivalent of tossing a coin to allocate you to one of two methods of treatment'. This analogy used by 26% of oncologists, was viewed as trivialising and upsetting in the context of determining treatment for life threatening disease.

Female↗
PubMed2001

Psychiatric morbidity and its recognition by doctors in patients with cancer.

Psychiatric morbidity in patients with cancer is high and without appropriate treatment unremitting. We assessed the ability of 143 doctors to establish the psychological status of 2297 patients during outpatient consultations in 34 cancer centres and hospitals in the UK. Prior to seeing the doctor, consenting patients completed a short self-report questionnaire (GHQ12), designed for the psychological screening of large populations. At the end of the consultation, doctors completed visual analogue scales rating patients' distress. 837/2297 (36.4%) patients had GHQ scores suggestive of psychiatric morbidity. The doctors' sensitivity (true positive rate) was 28.87% (SD 25.29), specificity (true negative rate) 84.79% (SD 17.44). The misclassification rate was 34.7% (SD 13.79) meaning that for 797 patients the wrong assessment was probably made. These data show that much of the probable psychiatric morbidity experienced by patients with cancer goes unrecognized and therefore untreated. Doctors need communication skills training to elicit problems during consultations. Appropriate referrals to psychological services are necessary when patients requiring help are identified and ought to be an integral part of cancer care.

Adult↗
PubMed2001

Information needs of patients with cancer: results from a large study in UK cancer centres.

As part of a multi-centred study evaluating a communication skills training model for clinicians, we collected information preferences using an adaptation of Cassileth's Information Needs questionnaire from a heterogeneous sample of 2331 patients. Results showed that 87% (2027) wanted all possible information, both good and bad news and 98% (2203) preferred to know whether or not their illness was cancer. Cross tabulation of responses revealed no significant differences in information preferences for tumour site or treatment aims but did show an effect of age and sex. The few 58/440 (13.2%) patients who stated that in general they preferred to leave disclosure of details up to the doctor, tended to be older patients more than 70 years of age (chi square = 26.01, df = 2, P< 0.0001), although paradoxically they still wanted to know certain specific details. In comparison to men women preferred to know the specific name of the illness (chi square = 4.9, df = 1, P< 0.02) and what were all the possible treatments (chi square = 8.26, df = 1, P< 0.004). The results from this very large sample provide conclusive evidence that the vast majority of patients with cancer want a great deal of specific information concerning their illness and treatment. Failure to disclose such information on the grounds that significant numbers of patients prefer not to know is untenable.

Adult↗
PubMed2001

Results of an intervention study to improve communication about randomised clinical trials of cancer therapy.

We report results from an intervention study to improve communication during consultations about randomised clinical trials of cancer therapy. Patients, eligible for a trial, completed questionnaires about information preferences and attitudes to trials prior to seeing their doctors, who were either shown these questionnaires (intervention) or not (control). Fifteen doctors participated and invited 265 patients to join one of 40 different randomised clinical trials. Most patients (77.4%) agreed to trial entry and this was predicted by the Patient's Attitudes to Trials questionnaire with an 80.4% accuracy. Accrual, length of consultation, doctor and patient satisfaction were not associated with the intervention. Further research to explore the potential use of written interventions to facilitate communication and accrual to randomised clinical trials is recommended.

Adult↗
PubMed2001

The effects of oestrogens and anti-oestrogens on cognition.

Recent research suggests that oestrogen may play an important role in cognition. Epidemiological and experimental studies of hormone replacement therapy in post-menopausal women suggest that oestrogen may be important to verbal memory in particular, as well as other cognitive functions such as attention and processing speed. Some studies have also suggested that HRT may have a beneficial effect for Alzheimer's disease, both in the prevention or delay of onset and that it is also of therapeutic benefit to patients in whom the disease is established. The use of selective oestrogen receptor modulators (SERMs) and other hormonal therapies for the treatment of breast cancer is common, yet few studies have examined the possible cognitive effects of this form of treatment. Several studies have shown cognitive decline in women receiving treatment for breast cancer, but the focus has been on the effects of chemotherapy. Further confusion has resulted from the diverse methodologies used in the existing literature. A pilot study to develop a suitable cognitive battery of tests for the evaluation of cognitive function in women receiving hormonal therapy for the treatment or prevention of breast cancer is introduced.

Journal Article↗
PubMed2000

Reasons for accepting or declining to participate in randomized clinical trials for cancer therapy.

This paper reports on the reasons why patients agreed to or declined entry into randomized trials of cancer following discussions conducted by clinicians in both District General and University Hospitals. Two hundred and four patients completed a 16-item questionnaire following the consultation, of these 112 (55%) were women with breast cancer. Overall results showed that 147 (72.1%) patients accepted entry to a randomized clinical trial (RCT). The main reasons nominated for participating in a trial were that 'others will benefit' (23.1%) and 'trust in the doctor' (21.1%). One of the main reasons for declining trial entry was that patients were 'worried about randomization' (19.6%). There was a significantly higher acceptance rate for trials providing active treatment in every arm 98 (80.6%) compared with those trials with a no treatment arm 46 (60.5%), chi2 test P= 0.003. The study outlines a number of factors that appear to influence a patient's decision to accept or decline entry into an RCT of cancer therapy. An important factor is whether or not the trial offers active treatment in all arms of the study. Communication that promotes trust and confidence in the doctor is also a powerful motivating influence.

Adult↗
PubMed1999

Effective communication skills are the key to good cancer care.

Communication within oncology is a core clinical skill but one in which few oncologists or specialist cancer nurses have received much formal training. Inadequate communication may cause much distress for patients and their families, who often want considerably more information than is usually provided. Many patients leave consultations unsure about the diagnosis and prognosis, confused about the meaning of--and need for--further diagnostic tests, unclear about the management plan and uncertain about the true therapeutic intent of treatment. Additionally, communication difficulties may impede the recruitment of patients to clinical trials, delaying the introduction of efficacious new treatments into clinics. Lack of effective communication between specialists and departments can also cause confusion and a loss of confidence amongst the team. Oncologists themselves acknowledge that insufficient training in communication and management skills is a major factor contributing to their own stress, lack of job satisfaction and emotional burnout. Consequently, over the past few years there have been several initiatives aimed at improving basic communication skills training for healthcare professionals in the cancer field. In this paper, some of the issues that influence communication within an oncology setting, and ultimately affect patient care, are discussed.

Clinical Competence↗
PubMed1998

Levels of processing and single word priming in amnesic and control subjects.

This paper describes an experiment which examined how levels of processing (LOP) affected word fragment completion in a group of Wernicke-Korsakoff patients, a group of patients with closed head injury, and matched controls. The data showed that both the memory-impaired groups and the controls showed a LOP effect but that the effect was larger in controls. Data from other studies are reviewed and, in conjunction with the present findings, it is concluded that LOP effects obtained when memory-impaired individuals are tested using implicit memory tasks arise mainly from the contribution of lexical processing of targets and from contamination by explicit recollection.

Adult↗