Distorting the probability of treatment success to justify treatment decisions

Abstract Individuals struggling to conceive or maintain a pregnancy experience considerable stress; however, little is known about its sources. An analysis of 160 infertility narratives, guided by problematic integration (PI) theory, revealed three forms and eight foci of PI or sources of stress specific to the infertility experience. Participant accounts of diverging expectations and desires regarding pregnancy testing and prenatal loss, ambivalence about finances and treatment decisions, and uncertainty about the causes of their infertility and the likelihood of treatment success fit nicely within the PI framework; however, the narrators’ descriptions of relational uncertainty and the various uncertainties involved in adoption did not fit as well, suggesting the need for further theoretical development and refinement.

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Survivor and Caregiver Expectations and Preferences Regarding Lung Cancer Treatment

International Journal of Particle Therapy ◽

10.14338/ijpt-19-00072.1 ◽

2019 ◽

Vol 6 (2) ◽

pp. 42-49

Author(s):

Jana Wieland ◽

Bradford S. Hoppe ◽

Sarah M. Rausch-Osian ◽

Jennifer C. King ◽

Alexandra Sierra ◽

...

Keyword(s):

Lung Cancer ◽

Cancer Survivors ◽

Cancer Patients ◽

Performance Status ◽

Treatment Success ◽

Eastern Cooperative Oncology Group ◽

Treatment Decisions ◽

Lung Cancer Patients ◽

Unsuccessful Treatment ◽

Treatment Morbidity

Abstract Purpose: Treatment success in lung cancer is no longer restricted to objective measures of disease-specific outcomes and overall survival alone but now incorporates treatment morbidity and subjective quality of life (QoL). This study reports how lung cancer patients, survivors, and caregivers define treatment success and prioritize treatment decisions. Materials and Methods: An online survey with both ranking and free-response questions was administered among lung cancer survivors and caregivers. Responses were used to evaluate treatment priorities, perceptions of treatment success based on Eastern Cooperative Oncology Group (ECOG) Performance Status, and troublesomeness of treatment-related toxicities. Results: Among 61 respondents (29 lung cancer survivors, 28 caregivers of survivors, and 4 who were both survivors and caregivers), cancer cure was the highest priority when making treatment decisions for 74.5% of respondents, with QoL during and after treatment ranking second and third. Seventy percent of respondents felt that treatment morbidity resulting in complete dependence on others and spending the entire day confined to bed or chair would represent unsuccessful treatment. Requiring oxygen use was ranked as a very or extremely troublesome treatment toxicity by 64%, followed by shortness of breath (62%), fatigue (49%), chronic cough (34%), and appetite loss (30%). Even with remission, a 3- to 7-day hospital admission for pneumonia during treatment was deemed an unsuccessful outcome by 30%. Conclusion: This study highlights the importance of physicians discussing in detail with their lung cancer patients their desires and goals. Accounting for factors like expected performance status following treatment, troublesomeness of treatment toxicities, and hospitalization rates may help guide treatment decisions.

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PREDICTING SUCCESSFUL OUTCOMES OF WRIST AND FINGER GANGLIA

Hand Surgery ◽

10.1142/s021881041350007x ◽

2013 ◽

Vol 18 (01) ◽

pp. 41-44 ◽

Cited By ~ 6

Author(s):

K. E. Rollins ◽

B. J. Ollivere ◽

P. Johnston

Keyword(s):

Relative Risk ◽

Successful Treatment ◽

Treatment Modality ◽

Treatment Success ◽

Surgical Excision ◽

Treatment Decisions ◽

Published Data ◽

Duration Of Symptoms ◽

Male Sex ◽

One Year

Introduction: Ganglia are the commonest cause of swellings of the hand and wrist; the documented success of outcomes varies considerably. There is little published data to help predict patients likely to benefit from each treatment modality. We sought to identify factors predicting success of each intervention to provide an evidence basis to inform referral criteria and treatment decisions. Materials and Methods: A retrospective series of 140 serial patients referred with confirmed hand and wrist ganglia between June 2005 and January 2011 was studied to a minimum of 12-month follow-up to determine predictors of successful treatment. Treatment was deemed to be successful if the patient did not develop recurrence. Analysis was completed for predictors of successful treatment at presentation; examining gender, presence of pain, duration of symptoms, anatomic location and treatment modality. Results: Treatment success rate following aspiration was 34% for wrist and 58% for finger ganglia and for surgical excision 7% for wrist and 4% for finger ganglia. Surgical excision was significantly more successful than aspiration (p < 0.01). Duration of symptoms greater than one year was significantly associated with increased recurrence rates (relative risk 2.33, p < 0.05) and male sex was associated with lower recurrence (relative risk: 0.54, p = 0.14). Subgroup analysis of different varieties of soft tissue ganglia did not show any statistically significant factors predictive of recurrence, although both painless presentation and male sex were of borderline significance. Discussion and Conclusions: Duration of symptoms less than one year and male sex can be used to identify patients likely to benefit from interventional treatments and guide treatment decisions. Surgical excision was significantly more successful than aspiration (p < 0.01).

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The Link Between Verbal Short-Term Memory and Anomia Treatment Gains

American Journal of Speech-Language Pathology ◽

10.1044/2019_ajslp-18-0176 ◽

2019 ◽

Vol 28 (3) ◽

pp. 1039-1052

Author(s):

Reva M. Zimmerman ◽

JoAnn P. Silkes ◽

Diane L. Kendall ◽

Irene Minkina

Keyword(s):

Short Term Memory ◽

Controlled Trial ◽

Treatment Success ◽

Linear Regression Models ◽

Language Performance ◽

Short Term ◽

Term Memory ◽

Treatment Gains ◽

Post Hoc

Purpose A significant relationship between verbal short-term memory (STM) and language performance in people with aphasia has been found across studies. However, very few studies have examined the predictive value of verbal STM in treatment outcomes. This study aims to determine if verbal STM can be used as a predictor of treatment success. Method Retrospective data from 25 people with aphasia in a larger randomized controlled trial of phonomotor treatment were analyzed. Digit and word spans from immediately pretreatment were run in multiple linear regression models to determine whether they predict magnitude of change from pre- to posttreatment and follow-up naming accuracy. Pretreatment, immediately posttreatment, and 3 months posttreatment digit and word span scores were compared to determine if they changed following a novel treatment approach. Results Verbal STM, as measured by digit and word spans, did not predict magnitude of change in naming accuracy from pre- to posttreatment nor from pretreatment to 3 months posttreatment. Furthermore, digit and word spans did not change from pre- to posttreatment or from pretreatment to 3 months posttreatment in the overall analysis. A post hoc analysis revealed that only the less impaired group showed significant changes in word span scores from pretreatment to 3 months posttreatment. Discussion The results suggest that digit and word spans do not predict treatment gains. In a less severe subsample of participants, digit and word span scores can change following phonomotor treatment; however, the overall results suggest that span scores may not change significantly. The implications of these findings are discussed within the broader purview of theoretical and empirical associations between aphasic language and verbal STM processing.

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Routine use of pleural fluid cultures. Are they indicated? Limited yield, minimal impact on treatment decisions

Yearbook of Pulmonary Disease ◽

10.1016/s8756-3452(08)70591-7 ◽

2008 ◽

Vol 2008 ◽

pp. 97

Author(s):

K.L. Lewis

Keyword(s):

Pleural Fluid ◽

Treatment Decisions ◽

Minimal Impact ◽

Impact On Treatment

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Goal Attainment and Treatment Compliance in a Cognitive-Behavioral Telephone Intervention for Family Caregivers of Persons with Dementia

GeroPsych ◽

10.1024/1662-9647/a000043 ◽

2011 ◽

Vol 24 (3) ◽

pp. 115-125 ◽

Cited By ~ 18

Author(s):

Gabriele Wilz ◽

Denise Schinköthe ◽

Renate Soellner

Keyword(s):

Family Caregivers ◽

Mentally Ill ◽

Goal Attainment ◽

Outcome Measurement ◽

Controlled Trial ◽

Treatment Success ◽

Treatment Compliance ◽

Control Group ◽

Telephone Intervention ◽

Effective Interventions

Introduction: The evaluation of effective interventions is still needed to prevent family caregivers of persons with dementia from becoming physically or mentally ill. However, in most existing intervention studies, primary outcomes are not well matched to the treatment goals. Method: A randomized controlled trial (N = 229) was conducted to compare a treatment group (CBT), a treated control group, and an untreated control group. In theses analyses we focused on the primary outcome measurement (GAS) as a perceived treatment success as well as treatment compliance and participants’ evaluation. Results: Results showed that 30.1% achieved complete goal attainment, 39.8% partial goal attainment, and 24.1% declared no change (overachievement 2.4%; deterioration 3.6%). Discussion: The intervention can be considered to have been successful.

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