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At least 19 recordsLinked to original sources
PubMed2006

Fluctuating awareness of treatment goals among patients and their caregivers: a longitudinal study of a dynamic process.

BACKGROUND: Because increasing numbers of people now survive for months or years with advanced cancer, communication between patients, service providers, and family caregivers often continues over long periods. Hence, understanding of the goals of medical treatment may develop and change as time elapses and disease progresses. This understanding is closely related to the "awareness of dying," which has been studied in both qualitative and quantitative research. However, when both a patient and family caregiver are involved, the question of "awareness" becomes more complex. A recent longitudinal study reported on patient and caregiver knowledge of treatment goals, but no comparison of such knowledge using matched interview schedules and paired data analysis has been provided. This report examines patterns of awareness and factors associated with these patterns. MATERIALS AND METHODS: One hundred sixty-three patients with incurable cancer and their nominated principal family caregivers (136) were recruited from The Canberra Hospital Oncology Services. Participants' understanding of the treatment goals were measured by interview questions at weeks 1 and 12. RESULTS: One-third of both patients and caregivers understood that the treatment goal was not curative; however, not all patient and caregiver pairs had the same understanding. In 15% of pairs, both patient and caregiver believed that the goal of treatment was curative, while another 13% said that they did not know the aim of the treatment. Thirty-nine percent of pairs registered incongruent responses in which only one member of the pair understood that the treatment was not intended to cure the disease. Over time, a few respondents changed their perception of the treatment goals toward accurate clarification. Bivariate analysis using an awareness variable, constructed for the purpose, showed that in 6 months before death, at least one person in 89% of pairs understood that the treatment was noncurative. Time-to-death, gender, and place of residence were also important predictors of knowledge. CONCLUSIONS: Discrepancies between patients and their caregivers may complicate the delivery of effective care when patients are seriously ill. Misunderstanding or uncertainty about treatment goals will obstruct proper informed consent. Health professionals providing care for families dealing with advanced cancer must recognize that the discussion of treatment goals is a dynamic process, which may require them to extend their communication skills.

Adult↗
PubMed1998

Quality and care: patients' perceptions.

Patients and health care professionals view quality nursing care from different perspectives. Health care professionals view competent nursing care as quality nursing care. Patients perceive quality nursing care as caring, interpersonal interactions. Institutions measure quality care through satisfaction surveys that exclude components of nurse caring behaviors. In three studies utilizing the Holistic Caring Inventory (HCI), patients perceived nurse caring behaviors and attitudes that indicated quality nursing care. The way to bridge the gap between institutions' and patients' perceptions of quality care lies in valuing the interactions that patients consider quality care and including these interactions in measures of quality care.

Adult↗
PubMed1996

Care mapping: measuring clinical and financial outcomes.

A medical center's nursing units were asked to develop care maps for s elected DRGs, with the goal of improving the level of patient care, reducing cost, and curtailing length of stay. However, none of the efforts provided a tangible way to measure the results. After a comprehensive study effort, the medical team decided that the missing element was better management of the emotional aspects of care.

Breast Neoplasms↗
PubMed2005

A year in Bristol. Back from the red.

United Bristol Healthcare trust has pulled back from a predicted 3.5m pounds sterling deficit to achieve zero balance. It faces a raft of new challenges, ranging from tough cancer targets to censure over waiting-list breaches. The trust has cut the use of nursing agencies drastically, with 95 per cent of nurses now bank staff. Non-clinical issues such as litter, food and the appearance of buildings are also being tackled.

Decision Making, Organizational↗
PubMed2003

Oncology service correspondence: do we communicate?

The aim of this study is to assess the content of letters sent from a hospital oncology service regarding the initial assessment of new referrals and the requirements of hospital specialists and General Practitioners (GPs) regarding oncology service correspondence. The content of letters regarding the initial consultation of 204 consecutive new oncology patients was analysed. General Practitioners and referring specialists were sent a 13-point survey to gauge their preferences for the information contained in oncology correspondence pertaining to the initial assessment of an oncology patient. Seventy-two percent of the patients had a letter written following their initial oncology assessment. The GP received a copy of 81% of the letters (58% of the study sample). The diagnosis was recorded in all our letters, and the proposed treatment plan was addressed in 84% of our letters. Both GPs and specialists required information on examination and investigation findings, diagnosis, treatment options, proposed management plan, and what the patient was told. The GPs required further information on current medication, likely side-effects of the proposed management, and clarification of when to contact the oncologist. The majority of the respondents were in favour of a structured letter.

Correspondence as Topic↗
PubMed1998

A new ambulatory classification and funding model for radiation oncology: non-admitted patients in Victorian hospitals.

The Victorian Department of Human Services has developed a classification and funding model for non-admitted radiation oncology patients. Agencies were previously funded on an historical cost input basis. For 1996-97, payments were made according to the new Non-admitted Radiation Oncology Classification System and include four key components. Fixed grants are based on Weighted Radiation Therapy Services targets for megavoltage courses, planning procedures (dosimetry and simulation) and consultations. The additional throughput pool covers additional Weighted Radiation Therapy Services once targets are reached, with access conditional on the utilisation of a minimum number of megavoltage fields by each hospital. Block grants cover specialised treatments, such as brachytherapy, allied health payments and other support services. Compensation grants were available to bring payments up to the level of the previous year. There is potential to provide incentives to promote best practice in Australia through linking appropriate practice to funding models. Key Australian and international developments should be monitored, including economic evaluation studies, classification and funding models, and the deliberations of the American College of Radiology, the American Society for Therapeutic Radiology and Oncology, the Trans-Tasman Radiation Oncology Group and the Council of Oncology Societies of Australia. National impact on clinical practice guidelines in Australia can be achieved through the Quality of Care and Health Outcomes Committee of the National Health and Medical Research Council.

Abstracting and Indexing↗
PubMed1993

The value of early discharge: dispelling some myths.

Our objective in this paper is to assess the value of early discharge schemes following the economic evaluation of three such schemes in New South Wales, Australia. An early discharge programme for obstetric patients, a fractured hip management programme and a continuing community cancer care programme were evaluated. The results of the economic evaluation of these schemes are discussed in the light of four commonly held beliefs about the value of early discharge: that early discharge schemes succeed in reducing length of stay, that early discharge schemes save money, that the welfare of patients is not reduced by early discharge and that early discharge schemes are cost-effective. The caution expressed by previous authors about the perceived advantages of early discharge schemes is still warranted.

Aged↗
PubMed1999

Delivery of non-surgical oncology care.

The changes and options for future change in the provision of non-surgical oncology care within the UK are discussed in the context of the recommendations of the Calman report, the drive towards site specialization and the changing nature of the specialties of clinical and medical oncology. Options for the creation of an improved and more flexible service are discussed.

Humans↗
PubMed1992

Fostering collaboration by understanding physician behavior: the cancer program perspective.

To build collaborative relations with physicians, which are particularly desirable in cancer programs, hospital administrators must first understand the intrinsic differences between the ways physicians and hospital administrators operate. Administrators' failure to understand physicians' behavior can hamper the development of such programs. Relations between physicians and hospitals have traditionally been good, and while hospital administrators and physicians have approached health care from different perspectives, their activities have generally been mutually supportive. Over the last decade, however, health care payment reform has exacerbated differences in hospitals' and physicians' goals and expectations, and these differences have begun to threaten the traditional collaborative relationship between hospitals and physicians. This report is intended for hospital administrators who wish to strengthen their relationships with their physicians and thereby develop a more comprehensive approach to the delivery of cancer care services. It identifies specific physician behavioral tendencies and analyzes their potential impact on the delivery of patient-centered cancer care. It also examines the ways physicians' attitudes and behaviors develop, as well as the reasons physicians may find themselves in conflict with other health care providers. Finally, it reviews current factors affecting physician/hospital relations and suggests ways hospitals and their medical staffs can develop mutually supportive, collaborative activities.

Attitude of Health Personnel↗
PubMed1982

Therapeutic choices made by patients with end-stage cancer.

The Oklahoma Children's Memorial Hospital Oncology Service has developed a new approach for its patients with end-stage cancer. The emphasis is on the patients' acknowledgement of the progression of the disease and the imminence of death, and informed choice between the use of research drugs and no further chemotherapy. Forty-three patients between 6 and 20 years of age participated in a conference of this type. The results demonstrated that they understood that their health was declining. They decided about further therapy autonomously or together with their family. The majority of children who chose supportive care without chemotherapy and lived for a period of time, participated in activities at home as far as their state of health permitted. Severe depression and severe behavioral problems occurred rarely. There was evidence that this open approach enabled patients and family members to communicate openly with each other.

Adolescent↗
PubMed2006

What is valuable for specialist registrars to learn in order to become good consultant clinical oncologists?

AIMS: Given the pressures for change in training, it is important that what is valuable for specialist registrars to learn in order to become good consultant clinical oncologists is identified to aid in curricular design. MATERIALS AND METHODS: A qualitative, one-to-one, semi-structured interview study was undertaken with 12 clinical oncologists who had been appointed as consultants within the last 2 years. RESULTS: They described the 'shock' on realising that they had entered foreign territory. The three main themes that emerged were surviving, navigating and moving forward. CONCLUSIONS: It was not enough to be a competent clinician. The newly appointed consultant could only carry out their clinical work adequately and develop as clinicians, researchers and educators if they could navigate the maze of emotions, relationships and management structures contained in the clinical and organisational contexts of their work.

Consultants↗