scholarly journals Patient–physician relationship and use of gut feeling in cancer diagnosis in primary care: a cross-sectional survey of patients and their general practitioners

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e027288 ◽  
Author(s):  
Anette Fischer Pedersen ◽  
Christina Maar Andersen ◽  
Mads Lind Ingeman ◽  
Peter Vedsted
Keyword(s):  
Primary Care ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Secondary Outcome ◽  
Diagnostic Process ◽  
Patient Encounter ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Physician Relationship ◽  
High Degree

ObjectivesTo examine whether the quality of the patient–physician relationship, assessed by the general practitioner (GP) and the patient, associates with GPs’ use of gut feeling (GF) in cancer diagnosis.DesignCross-sectional questionnaire survey of cancer patients and their GPs.SettingDanish primary care.ParticipantsNewly diagnosed cancer patients and their GPs. Patients completed a questionnaire and provided the name of the GP to whom they have presented their symptoms. The named GP subsequently received a questionnaire.Primary and secondary outcome measuresGPs’ use of GF in the diagnostic process for the particular patient. GPs who answered that they used their GF ‘to a high degree’ or ‘to a very high degree’ were categorised as ‘used their GF to a great extent’. GPs who answered that they used their GF ‘to some degree’, ‘to a limited degree’ or ‘not at all’ were categorised as ‘limited or no use of GF’.ResultsGPs were less likely to use GF when they assessed relational aspects of the patient encounter as difficult compared with less difficult (OR=0.67; 95% CI 0.46 to 0.97). The physician-reported level of empathy was positively associated with use of GF (OR=2.60; 95% CI 1.60 to 4.22). The lower use of GF in difficult encounters was not modified by level of empathy.ConclusionsExperiencing relational aspects of patient encounter as difficult acted as a barrier for the use of GF in cancer diagnosis. Although physician-rated empathy increased use of GF, high empathy did not dissolve the low use of GF in difficult encounters. As diagnosis of cancer is a key challenge in primary care, it is important that GPs are aware that the sensitivity of cancer-related GF is compromised by a difficult patient–physician relationship.

scholarly journals Incidentally diagnosed cancer and commonly preceding clinical scenarios: a cross-sectional descriptive analysis of English audit data

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e028362 ◽  
Author(s):  
Minjoung Monica Koo ◽  
Greg Rubin ◽  
Sean McPhail ◽  
Georgios Lyratzopoulos
Keyword(s):  
Primary Care ◽  
Cancer Patient ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Cancer Site ◽  
Cross Sectional ◽  
Incidental Diagnosis ◽  
Audit Data ◽  
Clinical Scenarios ◽  
Incidental Cancer

ObjectivesCancer can be diagnosed in the absence of tumour-related symptoms, but little is known about the frequency and circumstances preceding such diagnoses which occur outside participation in screening programmes. We aimed to examine incidentally diagnosed cancer among a cohort of cancer patients diagnosed in England.DesignCross-sectional study of national primary care audit data on an incident cancer patient population.SettingWe analysed free-text information on the presenting features of cancer patients aged 15 or older included in the English National Audit of Cancer Diagnosis in Primary Care (2009–2010). Patients with screen-detected cancers or prostate cancer were excluded. We examined the odds of incidental cancer diagnosis by patient characteristics and cancer site using logistic regression, and described clinical scenarios leading to incidental diagnosis.ResultsAmong the studied cancer patient population (n=13 810), 520 (4%) patients were diagnosed incidentally. The odds of incidental cancer diagnosis increased with age (p<0.001), with no difference between men and women after adjustment. Incidental diagnosis was most common among patients with leukaemia (23%), renal (13%) and thyroid cancer (12%), and least common among patients with brain (0.9%), oesophageal (0.5%) and cervical cancer (no cases diagnosed incidentally). Variation in odds of incidental diagnosis by cancer site remained after adjusting for age group and sex.There was a range of clinical scenarios preceding incidental diagnoses in primary or secondary care. These included the monitoring or management of pre-existing conditions, routine testing before or after elective surgery, and the investigation of unrelated acute or new conditions.ConclusionsOne in 25 patients with cancer in our population-based cohort were diagnosed incidentally, through different mechanisms across primary and secondary care settings. The epidemiological, clinical, psychological and economic implications of this phenomenon merit further investigation.

Integration between primary care providers and the cancer system: Gaps and opportunities

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6584-6584
Author(s):  
J. Sussman ◽  
W. Evans ◽  
T. Whelan ◽  
D. Bainbridge ◽  
S. Schiff ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Patients ◽  
Primary Care Providers ◽  
Cancer Case ◽  
Care Providers ◽  
Care Needs ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Compensation Model ◽  
Cancer Program

6584 Background: A number of reports suggest that family physicians (FPs) are poorly integrated with the cancer care system. The specific gaps in care integration are poorly understood. In this study we examine specific processes of care associated with integration between FPs and regional cancer programs. Methods: Cross sectional survey of all identified primary care providers within a representative health region in Ontario, Canada. The survey instrument was created specifically for this study with items generated from published literature and expert input and pilot tested in a representative sample. A modified dilman method was used. Results: 500 physicians responded (response rate 60%). Overall 90% of respondants reported confidence in the workup of a new cancer case for the major disease sites but only half (54%) knew the process of referring to the regional cancer program. Only 57% felt investigations necessary could be done in a timely manner and 44% indicated that coordination of care needs to be improved. Most indicated preferance for an active navigation structure for newly diagnosed patients. Despite over 80% of respondents indicating use of the internet only 10% reported accessing cancer program web portals for information on the regional cancer program (such as waiting times). The majority of respondants (75%) indicated ongoing involvement in care during the active treatment phase, mostly for non cancer related medical issues but 20% indicated that they were not properly infomed of patients’ health status by the oncology program and only 57% indicated that they felt their role was valued by the cancer program during this phase in the care trajectory. In the follow up phase, 35% were unclear of their role specific to monitoring and surveillance. 60% felt their current compensation model was inadequate to support care of cancer patients. This did not vary by compensation model reported. Factors associated with better integration included attendance at educational sessions and years in practice. Conclusions: Cancer systems need to be more responsive to the needs of FPs to better integrate them and support optimal quality of care for cancer patients. Policies to clarify and support roles and responsibilites are necessary to ensure that FPs are integrated team members. No significant financial relationships to disclose.

scholarly journals Discharge of breast cancer patients to primary care at the end of hospital follow-up: A cross-sectional survey

2013 ◽  
Vol 49 (8) ◽  
pp. 1836-1844 ◽  
Author(s):  
Carriene Roorda ◽  
Annette J. Berendsen ◽  
Manon Haverkamp ◽  
Klaas van der Meer ◽  
Geertruida H. de Bock
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Cancer Patients ◽  
Breast Cancer Patients ◽  
Cross Sectional Survey ◽  
Cross Sectional

scholarly journals Primary care doctor and nurse consultations among people who live in slums: a retrospective, cross-sectional survey in four countries

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e054142
Author(s):  
Keyword(s):  
Primary Care ◽  
Traditional Healers ◽  
Primary Care Doctor ◽  
Secondary Outcome ◽  
Health Seeking ◽  
Provider Type ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Care Services ◽  
Primary Care Services

ObjectivesTo survey on the availability and use of primary care services in slum populations.DesignRetrospective, cross-sectional, household, individual and healthcare provider surveys.SettingSeven slum sites in four countries (Nigeria, Kenya, Pakistan and Bangladesh).ParticipantsResidents of slums and informal settlements.Primary and secondary outcome measuresPrimary care consultation rates by type of provider and facility.ResultsWe completed 7692 household, 7451 individual adult and 2633 individual child surveys across seven sites. The majority of consultations were to doctors/nurses (in clinics or hospitals) and pharmacies rather than single-handed providers or traditional healers. Consultation rates with a doctor or nurse varied from 0.2 to 1.5 visits per person-year, which was higher than visit rates to any other type of provider in all sites except Bangladesh, where pharmacies predominated. Approximately half the doctor/nurse visits were in hospital outpatient departments and most of the remainder were to clinics. Over 90% of visits across all sites were for acute symptoms rather than chronic disease. Median travel times were between 15 and 45 min and the median cost per visit was between 2% and 10% of a household’s monthly total expenditure. Medicines comprised most of the cost. More respondents reported proximity (54%–78%) and service quality (31%–95%) being a reason for choosing a provider than fees (23%–43%). Demand was relatively inelastic with respect to both price of consultation and travel time.ConclusionsPeople in slums tend to live sufficiently close to formal doctor/nurse facilities for their health-seeking behaviour to be influenced by preference for provider type over distance and cost. However, costs, especially for medicines are high in relation to income and use rates remain significantly below those of high-income countries.

Biographic Characteristics and Factors Perceived as Affecting Female and Male Careers in Academic Surgery: The Tenured Gender Battle to Make It to the Top

2016 ◽  
Vol 57 (3-4) ◽  
pp. 139-154 ◽  
Author(s):  
Laura Schwarz ◽  
Sonia Sippel ◽  
Andrew Entwistle ◽  
Anna Kathrin Hell ◽  
Sarah Koenig
Keyword(s):  
Career Guidance ◽  
Work Satisfaction ◽  
Attrition Rate ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Professional Career ◽  
Academic Surgery ◽  
Female Surgeons ◽  
High Degree

Purpose: Given the high attrition rate in the field of academic surgery, we aimed to characterise the professional and personal situations of female and male academic surgeons as well as to gather data on their respective perceptions of career advancement and work satisfaction. Methods: We conducted a cross-sectional survey in Germany, inviting all identifiable academically highly qualified female surgeons and their male counterparts in a 1:2 ratio to participate. An anonymous 103-item online questionnaire was designed and the data collected between July and September 2014. Results: The questionnaire was sent to 93 female and 200 male surgeons, of whom 63 women (67.7%) and 70 men (35.0%) replied. The average age was 47.5 and 47.1 years, respectively. Respondents identified ‘high degree of expertise', ‘ambition', and ‘clarity of one's professional aims' as important factors affecting professional career development. Both groups felt ‘workload', ‘working hours/shifts', and ‘gender' to be a hindrance, the latter of significantly greater importance to female surgeons. The mean work satisfaction scores were high in both female (69.5%) and male (75.7%) surgeons. The predictors ‘support from superiors' (standardised β coefficient = 0.41) and ‘manual aptitude' (β = 0.41) contributed incrementally to the variance in ‘high degree of work satisfaction' (90-100%) observed for female surgeons. However, childcare provided by ‘kindergarten/crèche/after-school care' had the greatest negative predictive value (β = -1.33). Conclusions: Although there are many parallels, female faculty members experience the culture of academic surgery to some extent differently from their male counterparts, especially when impacted by parenthood and childcare. Faculty development programmes need to develop strategies to improve perceived equality in career opportunities by respecting individuals' requirements as well as offering gender-appropriate career guidance.

scholarly journals Prepared and highly committed despite the risk of COVID-19 infection: a cross-sectional survey of primary care physicians’ concerns and coping strategies in Singapore

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jerrald Lau ◽  
David Hsien-Yung Tan ◽  
Gretel Jianlin Wong ◽  
Yii-Jen Lew ◽  
Ying-Xian Chua ◽  
...  
Keyword(s):  
Primary Care ◽  
Coping Strategies ◽  
Stress Management ◽  
Primary Care Physicians ◽  
Well Being ◽  
Pandemic Preparedness ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Accessible Information ◽  
And Coping

Abstract Background Primary care physicians (PCPs) are first points-of-contact between suspected cases and the healthcare system in the current COVID-19 pandemic. This study examines PCPs’ concerns, impact on personal lives and work, and level of pandemic preparedness in the context of COVID-19 in Singapore. We also examine factors and coping strategies that PCPs have used to manage stress during the outbreak. Methods Two hundred and sixteen PCPs actively practicing in either a public or private clinic were cluster sampled via email invitation from three primary care organizations in Singapore from 6th to 29th March 2020. Participants completed a cross-sectional online questionnaire consisting of items on work- and non-work-related concerns, impact on personal and work life, perceived pandemic preparedness, stress-reduction factors, and personal coping strategies related to COVID-19. Results A total of 158 questionnaires were usable for analyses. PCPs perceived themselves to be at high risk of COVID-19 infection (89.9%), and a source of risk (74.7%) and concern (71.5%) to loved ones. PCPs reported acceptance of these risks (91.1%) and the need to care for COVID-19 patients (85.4%). Overall perceived pandemic preparedness was extremely high (75.9 to 89.9%). PCPs prioritized availability of personal protective equipment, strict infection prevention guidelines, accessible information about COVID-19, and well-being of their colleagues and family as the most effective stress management factors. Conclusions PCPs continue to serve willingly on the frontlines of this pandemic despite the high perception of risk to themselves and loved ones. Healthcare organizations should continue to support PCPs by managing both their psychosocial (e.g. stress management) and professional (e.g. pandemic preparedness) needs.

scholarly journals Population-based cross-sectional prevalence survey of diabetes and diabetic retinopathy in Sohag—Egypt, 2019

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e047757
Author(s):  
Heba AlSawahli ◽  
Caleb D Mpyet ◽  
Gamal Ezzelarab ◽  
Ibrahim Hassanin ◽  
Mohammad Shalaby ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Rapid Assessment ◽  
Good Control ◽  
Population Based ◽  
Secondary Outcome ◽  
Public Health Approach ◽  
Eye Care ◽  
Cross Sectional Survey ◽  
Prevalence Survey ◽  
Cross Sectional

ObjectivesTo determine the prevalence of diabetes mellitus (DM), prevalence of diabetic retinopathy (DR) and sight-threatening conditions among persons with DM aged 50 years and older in Sohag governorate in Upper Egypt.DesignPopulation-based, cross-sectional survey using the standardised Rapid Assessment of Avoidable Blindness with the addition of the Diabetic Retinopathy module methodology.SettingsSohag governorate in Egypt where 68 clusters were selected using probability proportional to population size. Households were selected using the compact segment technique.Participants4078 people aged 50 years and older in 68 clusters were enrolled, of which 4033 participants had their random blood sugar checked and 843 examined for features of DR.Primary and secondary outcomesThe prevalence of DM and DR; secondary outcome was the coverage with diabetic eye care.ResultsThe prevalence of DM was 20.9% (95% CI 19.3% to 22.5%). The prevalence in females (23.8%; 95% CI 21.4% to 26.3%) was significantly higher than in males (18.9%; 95% CI 17.1% to 20.7%) (p=0.0001). Only 38.8% of persons diagnosed with diabetes had good control of DM. The prevalence of DR in the sample was 17.9% (95% CI 14.7% to 21.1%). The prevalence in females was higher (18.9%; 95% CI 14.0% to 23.8%) than in males (17.1%; 95% CI 13.0% to 21.2%). Up to 85.3% of study participants have never had eye examination. Sight-threatening DR (R4 and/or M2) was detected in 5.2% (95% CI 3.4% to 7.0%) with only 2.3% having had laser treatment.ConclusionThe prevalence of uncontrolled DM in Sohag governorate in Egypt is higher than the national prevalence. There is a high prevalence of sight-threatening retinopathy and/or maculopathy with few people having access to diabetic eye care. A public health approach is needed for health promotion, early detection and management of DR.

scholarly journals Parental evaluation of a revised autism spectrum disorder diagnostic process for children under 36 months of age

2021 ◽  
Author(s):  
Jean-François Lemay ◽  
Shauna Langenberger ◽  
Scott McLeod
Keyword(s):  
Autism Spectrum Disorder ◽  
Early Intervention ◽  
Parent Education ◽  
Positive Impact ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Diagnostic Process ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
High Level

Abstract Background The Alberta Children’s Hospital-Autism Spectrum Disorder Diagnostic Clinic (ACH-ASDC) was restructured due to long wait times and unsustainable clinic workflow. Major changes included the initiation of pre- and post-ASD parent education sessions and distinct ASD screening appointments before the ASD diagnostic appointment. Methods We conducted a parental program evaluation in summer 2018 of the ACH-ASDC. We used a cross-sectional survey to evaluate key outcomes including parental satisfaction, and the percentage of families obtaining access to government supports and early intervention programs. Results For the 101 eligible patients diagnosed with ASD under 36 months of age 70 (69.3%) parents agreed to participate. The mean diagnostic age of the children diagnosed with ASD was 30.6 months (SD=4.1 months). There were no statistically significant age differences between biological sexes. Ninety-three per cent of parents felt that ASD educational sessions were useful, and 92% of parents were satisfied to very satisfied with the overall ASD diagnostic process. Ninety per cent of parents had access to at least one of the key resources available for ASD early intervention in our province following diagnosis. Parents reported a positive impact on intervention provided to their child in the areas of communication, social interaction, and behaviour. Conclusion Parents of children diagnosed with ASD expressed a high level of satisfaction with the restructured ACH-ASDC process. Implementing parent education sessions was well received and met parents’ needs. Parents were able to access intervention services following diagnosis and reported positive impacts for their child. Re-envisioning program approaches to incorporate novel strategies to support families should be encouraged.

To Determine the Degree of Agreement between Ki67 and Histopathology to Differentiate between Hydatidiform Mole

2021 ◽  
Vol 15 (10) ◽  
pp. 2619-2621
Author(s):  
Mariya Manzoor ◽  
Haseeb Ahmed Khan ◽  
Sabiha Riaz ◽  
Imrana Tanvir ◽  
Atiya Batool Gardezi ◽  
...  
Keyword(s):  
Hydatidiform Mole ◽  
P Value ◽  
Kappa Statistics ◽  
Cross Sectional Survey ◽  
Ki 67 ◽  
Cross Sectional ◽  
Histopathologic Diagnosis ◽  
Hematoxylin And Eosin ◽  
High Degree ◽  
Gross Examination

Aim: To determine the degree of agreement between Ki67 and histopathology to differentiate between hydatidiform mole and hydropic abortus. Methods: Descriptive, Cross Sectional Survey was conducted in the Department of Pathology, Fatima Memorial Hospital, Lahore during 6 months (May 11, 2016 to Nov 11, 2016). Using non-probability consecutive sampling, 105 cases were included in this study as per the inclusion and exclusion criteria. 10% buffered formalin was used to fix the sepecimens. Gross examination and staining with Hematoxylin and Eosin was done. The cases were diagnosed by a histopathologist. IHC staining Ki67 was performed, assessed by histopathologist and the data was recorded on the proforma. Results: The mean age was 27.79±5.81 years with minimum and maximum ages of 18 years and 42 years respectively. The histopathological findings showed hydatidiform mole in 41 (39%) women and hydropic abortus in 64(61%) women. The Ki67 was reported to be >25 in 41(39%) patients and less than or equal to 25 in 64(61%) patients. The agreement of differentiation in the two types for histopathology and Ki67 was found in 101(96.2%) patients. Kappa statistics showed 92% (p-value= 0.000) strength of agreement between histopathology and Ki67. Conclusion: There is high degree of agreement between Ki67 and histopathology for differentiation of hydatidiform mole and hydropic abortus. So Ki67 can be used as an adjacent in histopathologic diagnosis of hydatidiform mole in difficult cases. MeSh words: Hydatidiform Mole, Immunohistochemistry, Ki-67 Antigen

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