scholarly journals Paradoxes in Advance Care Planning: The Complex Relationship of Oncology Patients, Their Physicians, and Advance Medical Directives

2010 ◽  
Vol 28 (2) ◽  
pp. 299-304 ◽  
Author(s):  
Lindsay A. Dow ◽  
Robin K. Matsuyama ◽  
V. Ramakrishnan ◽  
Laura Kuhn ◽  
Elizabeth B. Lamont ◽  
...  
Keyword(s):  
Primary Care ◽  
Advance Directives ◽  
Primary Care Physicians ◽  
Care Physician ◽  
Point Of View ◽  
Inpatient Service ◽  
Structured Interviews ◽  
Patients With Cancer ◽  
Seriously Ill Patients ◽  
Seriously Ill

Purpose Many seriously ill patients with cancer do not discuss prognosis or advance directives (ADs), which may lead to inappropriate and/or unwanted aggressive care at the end of life. Ten years ago, patients with cancer said they would not like to discuss ADs with their oncologist but would be willing to discuss them with an admitting physician. We assessed whether this point of view still held. Patients and Methods Semi-structured interviews were conducted with 75 consecutively admitted patients with cancer in the cancer inpatient service. Results Of those enrolled, 41% (31 of 75) had an AD. Nearly all (87%, 65 of 75) thought it acceptable to discuss ADs with the admitting physician with whom they had no prior relationship, and 95% (62 of 65) thought that discussing AD issues was very or somewhat important. Only 7% (5 of 75) had discussed ADs with their oncologist, and only 23% (16 of 70) would like to discuss ADs with their oncologist. When specifically asked which physician they would choose, 48% (36 of 75) of patients would prefer their oncologist, and 35% (26 of 75) would prefer their primary care physician. Conclusion Fewer than half of seriously ill patients with cancer admitted to an oncology service have an AD. Only 23% (16 of 70) would like to discuss their ADs with their oncologist but nearly all supported a policy of discussing ADs with their admitting physician. However, fully 48% (36 of 75) actually preferred to discuss advance directives with their oncologist if AD discussion was necessary. We must educate patients on why communicating their ADs is beneficial and train primary care physicians, house staff, hospitalists, and oncologists to initiate these difficult discussions.

scholarly journals Investigating information-seeking behaviors of primary care physicians who care for older depressed patients and their family caregivers: a pilot study

2005 ◽  
Vol 26 (4) ◽  
pp. 111 ◽  
Author(s):  
Mary Jo Dorsey ◽  
Ellen Detlefsen
Keyword(s):  
Primary Care ◽  
Pilot Study ◽  
Information Seeking ◽  
Primary Care Physicians ◽  
Care Physician ◽  
Structured Interviews ◽  
Depressed Patients ◽  
Types Of Information ◽  
Primary Care Practices ◽  
Information Seeking Behaviors

Objective – To describe preliminary findings from a study of information-seeking behaviors of primary care physicians who care for elderly and depressed patients, and the correlation between what is sought versus what is provided to the patient and (or) caregiver. Setting – Physicians in two large ambulatory primary care practices throughout urban Pittsburgh, Pennsylvania, who take care of geriatric patients. Methods – Structured interviews, with common questions, will be conducted with 12 primary care physicians to determine patterns of information-seeking behaviors. Environmental scans of physicians' offices for evidence of their existing information behaviors will complement the information obtained from the interviews. Results – This pilot study provides an analysis of the resources primary care physicians use to seek information to provide to patients and caregivers. Analyses show types of information sought, time spent seeking information, and methods used to find information given to patients. Conclusions – With mounting evidence of the Internet being used for patient self care, it is essential to understand if primary care physicians understand the scope and breadth of information readily available to their patients. The primary care physician needs to be aware of the types of information made available to their patients and the caregivers who are inclined to obtain information for the patient.

Willingness of cancer patients to discuss advance directives with admitting doctor or oncologists

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9539-9539
Author(s):  
L. A. Dow ◽  
T. J. Smith ◽  
R. Matsuyama ◽  
E. B. Lamont ◽  
V. Ramakrishnan ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Patients ◽  
Advance Directives ◽  
Primary Care Doctor ◽  
Structured Interviews ◽  
Common Misconception ◽  
Primary Care Doctors ◽  
Aggressive Care ◽  
Hospice Palliative Care ◽  
Seriously Ill

9539 Background: Many seriously ill cancer patients do not discuss prognosis or advance directives (ADs), which may lead to aggressive care at end of life (Harrison & Smith, JAMA 2008). Ten years ago, cancer patients did not want to discuss ADs with their oncologist (ONC), but would discuss them with an admitting doctor (Lamont JPM 2000).We assessed if this still held. Methods: We administered semi-structured interviews to cancer inpatients on the VCUHS Hematology-Oncology service. 55/63 consecutive patients accrued. Information was collected regarding ADs and knowledge of hospice/palliative care. Results: Of those enrolled, 22/55 (40%) reported having ADs. Only 2/55 had discussed ADs with their oncologist. Only 12/55 (22%) would want to discuss ADs with their ONC. But when specifically asked, 22/55 (40%) of patients would prefer to discuss ADs with their oncologist, and 40% with their primary care doctor. 86% would discuss ADs with the admitting doctor. There was no difference in doctor preference based upon prior AD completion. The preference not to discuss ADs with the oncologist was often because they felt their family could make the decisions, or that it was only necessary “If it got serious.” There was a common misconception that ADs mean death is imminent and lead to termination of care. Conclusions: Most patients (86%) are willing to discuss ADs with an admitting doctor, but only a small number (22%) want to discuss with their ONC. However, most patients will discuss ADs and 40% actually prefer their ONC if ADs are discussed. We therefore need to train primary care doctors, house staff, hospitalists, and oncologists to have these difficult discussions. [Table: see text] No significant financial relationships to disclose.

Oncology beyond the hospital: 7 years taking care of cancer patients from the very begining until the last consequences.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 75-75
Author(s):  
Alberto Jacobo Cunquero Tomas ◽  
Claudio Dario Avila Andrade ◽  
Ferri Pep ◽  
Lauren Condori Farfan ◽  
Amaya Belen Fernandez Diaz ◽  
...  
Keyword(s):  
Primary Care ◽  
High Resolution ◽  
Cancer Patients ◽  
Primary Care Physicians ◽  
Treatment Plan ◽  
Breast Disease ◽  
Care Physician ◽  
Patients With Cancer ◽  
Continuous Care

75 Background: Comprehensive and continuous care is esential for the correct management of cancer patients. To achieve this, specific programs for early diagnosis and long survivor care are needed. Since 2007, within the project “Oncology beyond the Hospital: Oncologic assistance at the Universitary General Hospital of Valencia”, the Oncologist Liaison was created. Methods: Two tracks were designed: High-resolution track for patients with suspicion of non-diagnosed cáncer; and Oncologist Liaison track, to organize the follow-up of cáncer long survivors. We present a descriptive and retrospective study by reviewing medical records of patients referred to the high-resolution diagnostic consultation; and long survivors followed up by the Oncologist Liaison from May 2007 to September 2015 (2016 data under review). Results: High-resolution track: 1,596 patients with suspected cancer were visited. The mean time between the primary care physician consultation and the oncologist visit was 4.32 days. Main reasons for consultation were: breast disease (25.4%), blood test disorders (16.4%), enlarged lymph nodes (11.1%) and radiological suspicion of tumor (12%). 424 cancers were diagnosed (26.5%) all having been studied in Oncologic Committee: 22.6% lung; 17% lung; 16.2% breast; 11.8% lymphomas; 12.5% superior dighestive tract; and19.8% miscelanea. Long-survivors track: 1406 patienst free from disease were referred for surveillance of recurrence and treatment sequelae: 44% breast; 20% gastrointestinal; 17% gynecological; 7% double neoplasia; 4% of lung cancer and other tumors, 8%. Conclusions: With the integration of the Oncologist Liaison in the continuum of care, we have achieved: Normalization of oncologic approach among patients and primary care physicians; implementation of a fast-track for patients with cancer suspicion: access to the oncologist in less tan a week; case study in the Oncologic Comittee in the following week; and consensus in diagnosis and treatment plan in each case. Ensure control over long-survivors.

Advance Directives from the Point of View of Primary Care Physicians in Spain

2014 ◽  
Vol 17 (3) ◽  
pp. 197-198 ◽  
Author(s):  
Beatriz Navarro ◽  
Jesús López-Torres ◽  
Fernando Andrés-Pretel ◽  
Ignacio Párraga ◽  
Alicia Fernández de Peñaranda ◽  
...  
Keyword(s):  
Primary Care ◽  
Advance Directives ◽  
Primary Care Physicians ◽  
Point Of View

How Primary Care Physicians Elicit Sensitive Health Information From Patients: Describing Access to Psychosocial Information

2020 ◽  
Vol 30 (9) ◽  
pp. 1338-1348
Author(s):  
Charles R. Senteio ◽  
Deborah B. Yoon
Keyword(s):  
Primary Care ◽  
Health Information ◽  
Primary Care Physicians ◽  
Care Physician ◽  
Financial Strain ◽  
Structured Interviews ◽  
Personalized Care ◽  
Related Information ◽  
Health Related ◽  
Patient Disclosure

Multiple communication models describe factors that influence disclosure of sensitive health information. However, these models do not address the receiver’s perspective of health-related information, nor do they address how the receiver promotes disclosure. In the primary care chronic disease visit, the patient (sender) must disclose sensitive health-related psychosocial information to the primary care physician (PCP) (receiver) for the PCP to understand potential barriers to care (e.g., financial strain) and make treatment decisions (e.g., referral to social work). A vital gap exists in understanding how PCPs perceive that patients disclose. We conducted individual, semi-structured interviews ( n = 17) to understand PCPs’ perceptions of patient disclosure of sensitive, psychosocial information in the clinical visit. PCPs facilitate patient disclosure by (a) building and maintaining rapport and (b) nurturing the patient–provider relationship. This article describes PCPs’ perceptions of how they access psychosocial information which is vital to inform clinical decisions that facilitate personalized care.

Determining Primary Care Physician Information Needs to Inform Ambulatory Visit Note Display

2014 ◽  
Vol 05 (01) ◽  
pp. 169-190 ◽  
Author(s):  
M.A. Clarke ◽  
L.M. Steege ◽  
J.L. Moore ◽  
R.J. Koopman ◽  
J.L. Belden ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Information Needs ◽  
Relevant Information ◽  
Care Physician ◽  
Third Party ◽  
Structured Interviews ◽  
Ambulatory Visit ◽  
Care Visit

Summary Background: With the increase in the adoption of electronic health records (EHR) across the US, primary care physicians are experiencing information overload. The purpose of this pilot study was to determine the information needs of primary care physicians (PCPs) as they review clinic visit notes to inform EHR display. Method: Data collection was conducted with 15 primary care physicians during semi-structured interviews, including a third party observer to control bias. Physicians reviewed major sections of an artificial but typical acute and chronic care visit note to identify the note sections that were relevant to their information needs. Statistical methods used were McNemar-Mosteller’s and Cochran Q. Results: Physicians identified History of Present Illness (HPI), Assessment, and Plan (A&P) as the most important sections of a visit note. In contrast, they largely judged the Review of Systems (ROS) to be superfluous. There was also a statistical difference in physicians’ highlighting among all seven major note sections in acute (p = 0.00) and chronic (p = 0.00) care visit notes. Conclusion: A&P and HPI sections were most frequently identified as important which suggests that physicians may have to identify a few key sections out of a long, unnecessarily verbose visit note. ROS is viewed by doctors as mostly “not needed,” but can have relevant information. The ROS can contain information needed for patient care when other sections of the Visit note, such as the HPI, lack the relevant information. Future studies should include producing a display that provides only relevant information to increase physician efficiency at the point of care. Also, research on moving A&P to the top of visit notes instead of having A&P at the bottom of the page is needed, since those are usually the first sections physicians refer to and reviewing from top to bottom may cause cognitive load. Citation: Clarke MA, Steege LM, Moore JL, Koopman RJ, Belden JL, Kim MS. Determining primary care physician information needs to inform ambulatory visit note display. Appl Clin Inf 2014; 5: 169–190http://dx.doi.org/10.4338/ACI-2013-08-RA-0064

scholarly journals Understanding the clinical reasoning processes involved in the management of multimorbidity in an ambulatory setting: study protocol of a stimulated recall research

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
M.-C. Audétat ◽  
S. Cairo Notari ◽  
J. Sader ◽  
C. Ritz ◽  
T. Fassier ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Reasoning ◽  
Primary Care Physicians ◽  
Video Sequence ◽  
Structured Interview ◽  
Ambulatory Setting ◽  
Structured Interviews ◽  
Stimulated Recall ◽  
Study Results

Abstract Background Primary care physicians are at the very heart of managing patients suffering from multimorbidity. However, several studies have highlighted that some physicians feel ill-equipped to manage these kinds of complex clinical situations. Few studies are available on the clinical reasoning processes at play during the long-term management and follow-up of patients suffering from multimorbidity. This study aims to contribute to a better understanding on how the clinical reasoning of primary care physicians is affected during follow-up consultations with these patients. Methods A qualitative research project based on semi-structured interviews with primary care physicians in an ambulatory setting will be carried out, using the video stimulated recall interview method. Participants will be filmed in their work environment during a standard consultation with a patient suffering from multimorbidity using a “button camera” (small camera) which will be pinned to their white coat. The recording will be used in a following semi-structured interview with physicians and the research team to instigate a stimulated recall. Stimulated recall is a research method that allows the investigation of cognitive processes by inviting participants to recall their concurrent thinking during an event when prompted by a video sequence recall. During this interview, participants will be prompted by different video sequence and asked to discuss them; the aim will be to encourage them to make their clinical reasoning processes explicit. Fifteen to twenty interviews are planned to reach data saturation. The interviews will be transcribed verbatim and data will be analysed according to a standard content analysis, using deductive and inductive approaches. Conclusion Study results will contribute to the scientific community’s overall understanding of clinical reasoning. This will subsequently allow future generation of primary care physicians to have access to more adequate trainings to manage patients suffering from multimorbidity in their practice. As a result, this will improve the quality of the patient’s care and treatments.

Community Physician's Role in Case Management of Children With Chronic Illnesses

PEDIATRICS ◽  
1989 ◽  
Vol 84 (3) ◽  
pp. 465-471
Author(s):  
Gregory S. Liptak ◽  
Gail M. Revell
Keyword(s):  
Primary Care ◽  
Case Management ◽  
Primary Care Physicians ◽  
Current System ◽  
Care Physician ◽  
Case Managers ◽  
Chronic Illnesses ◽  
Rural Physicians ◽  
Children With Chronic Illnesses ◽  
Time Required

There is general agreement that case management should be provided to children with chronic illnesses, yet it is not clear who should provide this service. A survey of physicians and parents of children with chronic illnesses was conducted to evaluate the practice and views of pediatricians and compare their assessments with those of parents. Surveys were mailed to 360 physicians and 519 families with response rates of 39% and 63%, respectively. The majority of physicians (74%) thought that the primary care physician should provide case management. When compared with parents, physicians underestimated the parental need for information about the child's diagnosis (8% vs 52%, P < .001), treatments (3% vs 54%, P < .01), and prognosis (30% vs 78%, P < .01). They also overestimated parental needs for information regarding financial aid (70% vs 58%, P < .01), vocations (78% vs 54%, P < .01), and insurance (62% vs 51%, P < .05). Four services ranked by need by parents in the top 10 were not ranked in the top 10 by physicians. Rural physicians noted that services were more difficult to obtain than did those in nonrural areas. The physicians surveyed made several recommendations for steps that could be implemented to facilitate their role as case manageers. If primary care physicians are to be effective case managers, alterations in the current system of care will be required including continuing education related to chronic illness, information about community resources, reimbursement for the time required to perform case management, and better communication between physician and parents.

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