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PubMedDate not supplied

Decreased use of adjuvant breast cancer therapy in a randomized controlled trial of a decision aid with individualized risk information.

OBJECTIVE: Oncology patients often seek involvement in their medical consultations. Such involvement is endorsed by most health care providers and mirrored in practice guidelines. However, oncologists exhibit great variation in how they provide patients with disease-relevant information, and many remain reluctant to do so at all. The authors examined the impact of a patient-specific decision aid on women's decisions about adjuvant therapy for breast cancer. METHOD: 386 women with breast cancer were randomized to receive either an informational pamphlet about adjuvant therapy (usual care) or a patient-specific, evidence-based decision aid about adjuvant therapy. The authors compared rates of adjuvant therapy between the groups controlling for age, education, marital status, race, tumor severity, and practice type of their physician (university-based or community-based). RESULTS: Among women with low tumor severity, only 58% (35/60) of women in the decision aid group chose adjuvant therapy, compared to 87% (33/38) of their counterparts in usual care (P<0.01). CONCLUSIONS: This study illustrates the important impact of medical decision aids on treatment choices, particularly for patients for whom treatment has little benefit. In the case of adjuvant therapy for breast cancer, providing individualized, evidence-based risk information for shared decision making resulted in fewer women with low tumor severity choosing adjuvant treatment.

Aged↗

PubMed1999

The "rights" of husbands and the "duties" of wives: power and desire in the American bedroom, 1850-1910.

Historians of the nineteenth-century family have long argued for the dominance of a patriarchal model of marital relations in which demanding husbands subjected their passionless wives to a continual grind of emotional and sexual brutalization. This perspective has been challenged by revisionist historians who have argued that the compasionate marital ideal, characterized by considerate husbands and sexually satisfied wives, best reflected the experiences of middle-class married men and women. Based on the sexual experiences described in the pamphlets, letters, and newspaper articles written by sexual radicals known as "Free Lovers," this article argues that the late nineteenth-century marriage bed still was a site of conflict. Opening the door into the Victorian bedroom, the Free Lovers provide a unique view of both marital models in operation and transition that sheds light on the dynamic of change in which married couples struggled, failed,and sometimes achieved the erotic relationships promised by the companionate ideal.

History, 19th Century↗

PubMed1995

A score sheet for evaluating breastfeeding educational materials.

Lactation consultants and other professionals are frequently asked to review or recommend a video, pamphlet, or teaching aid for a specific audience. This article lists positive features that support the art and science of breastfeeding, and identifies errors and concepts detrimental to the course of breastfeeding. Six central messages are detailed: milk supply, comfort during breastfeeding, health of baby and mother, social support, presentation of the message, and packaging, including the financial motivation of the author.

Breast Feeding↗

PubMed2003

John Aitken (d. 1790)--grinder or scholar?

John Aitken attended the University of Edinburgh between 1763 and 1769 but did not graduate MD. He gained the membership (i.e. fellowship) of the Royal College of Surgeons of Edinburgh in 1770, and was for two sessions Senior President of the Royal Medical Society. Between 1771 and 1790 he published numerous books and pamphlets on surgery, medicine, midwifery, anatomy and physiology. As a surgeon at the Royal Infirmary, from 1779, he lectured on most subjects in the medical curriculum. John Struthers was particularly scathing of Aitken's scholarship, and this article attempts to restore Aitken's reputation as a scholar and probably one of the first of the extra-academical lecturers, who taught both anatomy and surgery in Edinburgh from 1779 until his death in 1790.

Education, Medical↗

PubMed1995

A randomised controlled trial of strategies to prompt attendance for a Pap smear.

OBJECTIVE: To assess the comparative efficacy, by randomised controlled trial, of three interventions designed to encourage "at risk" women to have a Pap smear: an educational pamphlet; letters inviting attendance at a women's health clinic; and letters from physicians. METHODS: Subjects at risk for cervical cancer who had not been adequately screened were identified by a random community survey and randomly allocated to one of the intervention groups or a control group. Six months after intervention implementation, a follow up survey assessed subsequent screening attendance. Self report was validated by comparison with a national screening data base. RESULTS: A significantly greater proportion of women (36.9%) within the group receiving a physician letter reported screening at follow up than in any other group (P = 0.012). The variables most strongly predicting screening attendance were: age, perceived frequency of screening required, use of oral contraceptives, and allocation to receive the physician letter intervention. CONCLUSIONS: The relative efficacy of the GP letter in prompting screening attendance shows that this strategy is worthy of further investigation. There remains a need to examine the barriers to screening for older women, and to develop tailored strategies for this population.

Adolescent↗

PubMedDate not supplied

Understanding of the term "palliative care": a Canadian survey.

This article examines the results of two studies conducted in Atlantic Canada to evaluate people's understanding of palliative care. In Study 1, a sample of adults were asked to respond to a brief survey. Respondents were asked if they had ever heard of palliative care. Those who answered "yes" were asked to respond to a number of additional questions about palliative care. The results of Study 1 revealed that over three-quarters of the respondents (75.3 percent) had heard of palliative care, however, only about half of these (48.4 percent) defined it as care for terminally ill or dying persons. Of those who had heard of palliative care, the vast majority (92.3 percent) said they would use palliative care services if they had a terminally ill family member In Study 2, respondents were presented with a written description of palliative care. After reading the description, respondents were asked to indicate whether or not they knew (prior to reading the description) what palliative care was. Those who answered "yes" were asked to provide a written explanation of how they first learned about palliative care; those who answered "no" were asked to provide written suggestions of how they believed information about palliative care should be disseminated to the public. The results revealed that 60.5 percent of the respondents knew about palliative care before reading the description. Of those who knew about palliative care, 40.8 percent of them first learned about it through personal experience with the death of a family member or close friend. Of those who did not know what palliative care was, the suggestions they gave for creating community awareness of palliative care included: information disseminated by healthcare providers, use of pamphlets, the media, and the church.

Adult↗

PubMed1977

Disclosure and informed-consent: does it matter how we tell it?

Traditionally, informed consent has been handled by the physician in a one-to-one interchange with the patient. As standards for adequate disclosure become more rigid and demands on physician time increase, however, the physician-patient model may cease to be practical. This study evaluated four alterative disclosure models: a formal discussion, a videotape, a pamphlet, and an informal discussion, each designed and executed by a team of health educators. Study results suggest that the informed consent process is little affected by disclosure medium and that it may be possible to strive for cost-efficiency in disclosure without compromising the quality of the consent obtained. Based on these results, a two-part disclosure process is proposed which allocates certain aspects of the disclosure to the treating physician, others to health education.

Adult↗

PubMed1984

Resource guide to occupant protection programs and materials.

This article lists public and private sector associations and organizations concerned with occupant protection. Many of these organizations will provide catalogues and other public information materials on occupant protection. Some have operational programs designed to influence their members in the health professions or the general public. All of the organizations have printed material available. Some provide additional resources on occupant protection such as educational kits, consumer information pamphlets, posters, written testimony, public service announcements, sample legislation, and audio visual aids useful in conjunction with health promotion program development. For information relative to state occupant protection programs, readers should contact their State Office of Highway (Traffic) Safety, Governor's Office, Regional Office of the National Highway Safety Administration, Regional Office of the Department of Health and Human Services, State Health Department or Department of Preventive Health Services, and regional or state affiliate chapters of national organizations, such as the Child Passenger Safety Associations and the National Safety Councils.

Automobiles↗

PubMed1987

Promoting self-management in adults with asthma: an overview of the UAB program.

Most asthma self-management programs have focused on children, but the prevalence and impact, both personal and economic, of adult asthma is substantial. Moreover, failure to adhere to treatment regimens appears to be a significant problem in adult asthma. It appears important, therefore, to develop asthma self-management programs for adults. The UAB program is based on the Health Belief Model for health behavior and on the PRECEDE Model for patient education. A needs assessment and a review of existing educational materials were used to specify the content of a self-care workbook. This workbook seeks to increase cognitive skills, encourage daily self-assessment of asthma, demonstrate success in asthma self-management, and promote effective social support. The overall intervention integrates this workbook with systematic reinforcement of self-monitoring and self-management. A prospective controlled study is comparing patients receiving this "special intervention" with "usual care" patients who receive only routinely available pamphlets providing information about asthma. Patients are randomly assigned to treatments by the closed envelope technique. Sample sizes were determined on the basis of statistical power. Outcomes in five areas are assessed: (1) health care utilization, (2) functional status, (3) knowledge, (4) adherence, and (5) psychological reactions.

Academic Medical Centers↗

PubMed1991

Identification of campaign recruitment strategies for a stepped smoking cessation intervention for a college campus.

A rapproachement of the Stepped Approach Model of health care delivery and Ajzen's Theory of Planned Behavior was used to identify campaign recruitment strategies for a stepped smoking cessation intervention for a college campus. The study examines outcome expectancies, outcome evaluations, and interest in participating in smoking cessation programs presented in graduated steps of intervention intensity. Telephone surveys were conducted with a probability sample of 191 student smokers. A significant negative trend indicates that the steps are ordered cost-effectively. Scheffé a posteriori tests also reveal that interest in Step 1 (pamphlets and brochures) was significantly higher than interest in any other step, including those representing traditional health care services (i.e., groups and individual treatments). The two strongest predictors of interest in each step were attitudes about participation and control beliefs; normative expectations about program participation discriminated between respondents with high or low interest in Steps 2 through 5. It was concluded that attitudes and control beliefs should be the focus of initial program promotion for college smoking cessation campaigns. Emphasis on attitudes, control beliefs, and especially perceived norms could be helpful in advancing unsuccessful participants to the next more intensive program in a stepped intervention.

Attitude to Health↗

PubMedDate not supplied

Characterizing anxiety in melanoma patients.

BACKGROUND: Over half of melanoma patients experience significantly elevated anxiety levels leading to psychological distress and delays in diagnosis and treatment. OBJECTIVE: To identify melanoma patients likely to experience high levels of anxiety, we characterize the contributing factors and coping strategies and investigated potential anxiety-alleviating interventions. METHOD: Surveys were sent to 94 melanoma patients at Women's College Hospital's Pigmented Lesion Clinic assessing self-reported anxiety, contributing factors, coping strategies, and potential assisting services. RESULTS: Risk factors for anxiety include female gender (p=0.002) and increasing age (p=0.004) but not melanoma depth. Major factors contributing to anxiety are prognosis, fear of death, and the attitude of the diagnosing doctor. Major coping strategies include family support, doctor assistance, and self-distraction. Potentially useful services for decreasing anxiety include the provision of detailed information pamphlets. CONCLUSION: Melanoma patients likely to experience high anxiety can be predicted and managed in ways that minimize the distress experienced.

Adaptation, Psychological↗

PubMed1997

Nurses' evaluations of sources of information about HIV and AIDS.

Reviews of the literature indicate that nurses feel ill-informed about HIV/AIDS and that poor knowledge is associated with anxiety and negative attitudes towards infected patients and their care. Although some studies have sought to identify the sources of HIV/AIDS information available to nurses, few have attempted to understand how nurses evaluate such sources. In this study in 1992, 15 sources of HIV/AIDS information were identified during group discussions with nursing staff and nurse tutors. 277 nursing staff evaluated each of the sources in terms of perceived frequency (how often the source is used) and six items chosen to assess the usability and usefulness of each source (e.g. how informative the source is, how easy it is to understand). The results indicate that in-service training, basic training and professional colleagues are the sources evaluated most highly while posters and advertisements, television and radio and popular newspapers are the most frequently used sources of information. Trades unions' journals and pamphlets are the least frequently used sources of information and receive only modest evaluations. 20% of respondents report never having received any training regarding HIV and AIDS. Implications for the future provision of HIV/AIDS information and directions for further research are discussed.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Harnessing the potential of the internet to promote chronic illness self-management: diabetes as an example of how well we are doing.

OBJECTIVES: Given the potential for the Internet to be used as a dynamic, interactive medium for providing information, changing attitudes and behaviour and enhancing social support, it is important to consider whether what is currently available online for chronic illness self-management adequately harnesses this potential. The objective of this paper was to review the content of diabetes self-management websites and to identify strengths and limitations of online diabetes self-management. METHODS: We reviewed and coded features of 87 publicly available diabetes websites hosted by governmental, health plan, commercial, pharmaceutical, and not-for-profit organizations. We assessed whether each website was using online opportunities in the areas of interactivity, theory-based interventions, social support, and evidence-based care. RESULTS: The majority of sites provided information, essentially using an electronic newspaper or pamphlet format. Few sites offered interactive assessments, social support or problem-solving assistance, although there were some significant differences in these characteristics across the types of site. DISCUSSION: Current diabetes websites fall short of their potential to help consumers. Suggestions are made for ways to improve the helpfulness and interactivity of these resources.

Chronic Disease↗

PubMed1998

Effectiveness of postal smoking cessation advice: a randomized controlled trial in young men with reduced FEV1 and asbestos exposure.

There have been few community-based randomized, controlled intervention trials for cessation in high-risk smokers. In such a trial we evaluated the effects of postal smoking cessation advice in smokers with asbestos exposure and/or reduced forced expiratory volume in one second (FEV1). All men aged 30-45 yrs (n=22,392) living in 34 municipalities in western Norway were invited to a cross-sectional community survey. Information on smoking habits and occupational asbestos exposure were obtained from self-administered questionnaires and measurements of FEV1 were performed with dry-wedge bellow spirometers. Among 16,393 participants we identified a group of 2,610 smokers with previous occupational asbestos exposure and/or adjusted FEV1 in the lowest quartile. A random half (n=1,300) received a mailed personal letter from a respiratory physician with a person-specific health advice to quit smoking and a pamphlet on smoking cessation. The remaining smokers (n=1,310) acted as controls and did not receive any information. Twelve months after the intervention, information on smoking habits was re-examined using a postal questionnaire. Among the respondents (n=2,282), smoking cessation was reported altogether by 13.7% in the intervention group versus 9.9% in the control group (p<0.01). The 1 yr sustained quit rate (no smoking at all during the last year) was 5.6 versus 35% (p<0.05), respectively. Measurements of carbon monoxide in expired air (with < or = 10 parts per million) confirmed self-reported nonsmoking in samples of the two groups. In a community this simple postal smoking cessation advice from a respiratory physician based on person-specific risk factors improved the 1 yr sustained success rate by 60% in identified high-risk smokers.

Adult↗

PubMed2004

Protocol for a randomised controlled trial of a decision aid for the management of pain in labour and childbirth [ISRCTN52287533].

BACKGROUND: Women report fear of pain in childbirth and often lack complete information on analgesic options prior to labour. Preferences for pain relief should be discussed before labour begins. A woman's antepartum decision to use pain relief is likely influenced by her cultural background, friends, family, the media, literature and her antenatal caregivers. Pregnant women report that information about analgesia was most commonly derived from hearsay and least commonly from health professionals. Decision aids are emerging as a promising tool to assist practitioners and their patients in evidence-based decision making.Decision aids are designed to assist patients and their doctors in making informed decisions using information that is unbiased and based on high quality research evidence. Decision aids are non-directive in the sense that they do not aim to steer the user towards any one option, but rather to support decision making which is informed and consistent with personal values. METHODS/DESIGN: We aim to evaluate the effectiveness of a Pain Relief for Labour decision aid, with and without an audio-component, compared to a pamphlet in a three-arm randomised controlled trial. Approximately 600 women expecting their first baby and planning a vaginal birth will be recruited for the trial.The primary outcomes of the study are decisional conflict (uncertainty about a course of action), knowledge, anxiety and satisfaction with decision-making and will be assessed using self-administered questionnaires. The decision aid is not intended to influence the type of analgesia used during labour, however we will monitor health service utilisation rates and maternal and perinatal outcomes. This study is funded by a competitive peer-reviewed grant from the Australian National Health and Medical Research Council (No. 253635). DISCUSSION: The Pain Relief for Labour decision aid was developed using the Ottawa Decision Support Framework and systematic reviews of the evidence about the benefits and risks of the non-pharmacological and pharmacological methods of pain relief for labour. It comprises a workbook and worksheet and has been developed in two forms - with and without an audio-component (compact disc). The format allows women to take the decision aid home and discuss it with their partner.

Journal Article↗

PubMed2006

Progressive resistance training and stretching following surgery for breast cancer: study protocol for a randomised controlled trial.

BACKGROUND: Currently 1 in 11 women over the age of 60 in Australia are diagnosed with breast cancer. Following treatment, most breast cancer patients are left with shoulder and arm impairments which can impact significantly on quality of life and interfere substantially with activities of daily living. The primary aim of the proposed study is to determine whether upper limb impairments can be prevented by undertaking an exercise program of prolonged stretching and resistance training, commencing soon after surgery. METHODS/DESIGN: We will recruit 180 women who have had surgery for early stage breast cancer to a multicenter single-blind randomized controlled trial. At 4 weeks post surgery, women will be randomly assigned to either an exercise group or a usual care (control) group. Women allocated to the exercise group will perform exercises daily, and will be supervised once a week for 8 weeks. At the end of the 8 weeks, women will be given a home-based training program to continue indefinitely. Women in the usual care group will receive the same care as is now typically provided, i.e. a visit by the physiotherapist and occupational therapist while an inpatient, and receipt of pamphlets. All subjects will be assessed at baseline, 8 weeks, and 6 months later. The primary measure is arm symptoms, derived from a breast cancer specific questionnaire (BR23). In addition, range of motion, strength, swelling, pain and quality of life will be assessed. DISCUSSION: This study will determine whether exercise commencing soon after surgery can prevent secondary problems associated with treatment of breast cancer, and will thus provide the basis for successful rehabilitation and reduction in ongoing problems and health care use. Additionally, it will identify whether strengthening exercises reduce the incidence of arm swelling. TRIAL REGISTRATION: The protocol for this study is registered with the Australian Clinical Trials Registry (ACTRN012606000050550).

Arm↗

PubMed2006

Readability of pediatric health materials for preventive dental care.

BACKGROUND: This study examined the content and general readability of pediatric oral health education materials for parents of young children. METHODS: Twenty-seven pediatric oral health pamphlets or brochures from commercial, government, industry, and private nonprofit sources were analyzed for general readability ("usability") according to several parameters: readability, (Flesch-Kincaid grade level, Flesch Reading Ease, and SMOG grade level); thoroughness, (inclusion of topics important to young childrens' oral health); textual framework (frequency of complex phrases, use of pictures, diagrams, and bulleted text within materials); and terminology (frequency of difficult words and dental jargon). RESULTS: Readability of the written texts ranged from 2nd to 9th grade. The average Flesch-Kincaid grade level for government publications was equivalent to a grade 4 reading level (4.73, range, 2.4-6.6); F-K grade levels for commercial publications averaged 8.1 (range, 6.9-8.9); and industry published materials read at an average Flesch-Kincaid grade level of 7.4 (range, 4.7-9.3). SMOG readability analysis, based on a count of polysyllabic words, consistently rated materials 2 to 3 grade levels higher than did the Flesch-Kincaid analysis. Government sources were significantly lower compared to commercial and industry sources for Flesch-Kincaid grade level and SMOG readability analysis. Content analysis found materials from commercial and industry sources more complex than government-sponsored publications, whereas commercial sources were more thorough in coverage of pediatric oral health topics. Different materials frequently contained conflicting information. CONCLUSION: Pediatric oral health care materials are readily available, yet their quality and readability vary widely. In general, government publications are more readable than their commercial and industry counterparts. The criteria for usability and results of the analyses presented in this article can be used by consumers of dental educational materials to ensure that their choices are well-suited to their specific patient population.

Journal Article↗

PubMed2002

The effect of an educational intervention on promoting breast self-examination in older African American and Caucasian women.

PURPOSE/OBJECTIVES: To test the efficacy of innovative, age- and race-sensitive, self-monitored, video breast health kits in increasing knowledge about breast cancer risk and screening and breast self-examination (BSE) proficiency. DESIGN: Quasi-experimental pretest and post-test design. SETTING: Dual-site study in community-based settings in the Northeast and Southeast United States. SAMPLE: 328 women (206 in the intervention group, 122 in the control group) aged 60 or older; predominantly African American (77%); mean education of 10.8 years; annual income below $10,000 (50%). METHODS: Individual pretest and post-test interviews conducted by nurses at two-week intervals assessed knowledge about breast cancer risk and screening and BSE proficiency as demonstrated on vested breast models. Intervention subjects used video breast health kits in ethnic editions designed for the study. Control subjects received educational pamphlets. MAIN RESEARCH VARIABLES: Dependent variables were knowledge about breast health and BSE proficiency measured by demonstration of inspection and palpation skills and detection of lumps in a simulation model. FINDINGS: Three multiple analyses of covariance revealed statistically significant differences in outcome variables between the intervention and control groups. CONCLUSIONS: The intervention was effective in increasing knowledge about breast cancer risk and screening and BSE proficiency in this sample of older women. IMPLICATIONS FOR NURSING: These and other educational interventions designed specifically for age and race sensitivity may enhance cancer screening with vulnerable populations. Future studies with more diverse multicultural groups are needed to improve understanding of how to best influence breast health behaviors of older women.

Black or African American↗