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.

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 Impact of the Programa Mais médicos (more doctors Programme) on primary care doctor supply and amenable mortality: quasi-experimental study of 5565 Brazilian municipalities

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Thomas Hone ◽  
Timothy Powell-Jackson ◽  
Leonor Maria Pacheco Santos ◽  
Ricardo de Sousa Soares ◽  
Felipe Proenço de Oliveira ◽  
...  
Keyword(s):  
Primary Care ◽  
Human Resources For Health ◽  
Primary Care Doctor ◽  
Substitution Effects ◽  
Programme Implementation ◽  
Potential Health ◽  
The Sustainable Development ◽  
Amenable Mortality ◽  
Quasi Experimental ◽  
Primary Care Doctors

Abstract Background Investing in human resources for health (HRH) is vital for achieving universal health care and the Sustainable Development Goals. The Programa Mais Médicos (PMM) (More Doctors Programme) provided 17,000 doctors, predominantly from Cuba, to work in Brazilian primary care. This study assesses whether PMM doctor allocation to municipalities was consistent with programme criteria and associated impacts on amenable mortality. Methods Difference-in-differences regression analysis, exploiting variation in PMM introduction across 5565 municipalities over the period 2008–2017, was employed to examine programme impacts on doctor density and mortality amenable to healthcare. Heterogeneity in effects was explored with respect to doctor allocation criteria and municipal doctor density prior to PMM introduction. Results After starting in 2013, PMM was associated with an increase in PMM-contracted primary care doctors of 15.1 per 100,000 population. However, largescale substitution of existing primary care doctors resulting in a net increase of only 5.7 per 100,000. Increases in both PMM and total primary care doctors were lower in priority municipalities due to lower allocation of PMM doctors and greater substitution effects. The PMM led to amenable mortality reductions of − 1.06 per 100,000 (95%CI: − 1.78 to − 0.34) annually – with greater benefits in municipalities prioritised for doctor allocation and where doctor density was low before programme implementation. Conclusions PMM potential health benefits were undermined due to widespread allocation of doctors to non-priority areas and local substitution effects. Policies seeking to strengthen HRH should develop and implement needs-based criteria for resource allocation.

Choice in Public Health Services: A Multilevel Analysis of Perceived Primary Care Doctor Choice in 22 Countries

2015 ◽  
Vol 49 (10) ◽  
pp. 1471-1493 ◽  
Author(s):  
Steven Van de Walle ◽  
Sofie Marien
Keyword(s):  
Primary Care ◽  
Health Services ◽  
European Social Survey ◽  
Primary Care Doctor ◽  
Public Health Services ◽  
Social Survey ◽  
Country Level ◽  
Level Of Satisfaction ◽  
Primary Care Doctors ◽  
Doctor Choice

The introduction of choice in public services, and in health services more specifically, is part of a wider movement to introduce consumerism in health care. We analyze how citizens perceive the availability of choice of primary care doctors in 22 European countries and the factors that influence their opinions using multilevel analyses and data from the European Social Survey (Round 2, 2004; 22 countries, N = 33,375). We distinguish between individual factors and structural or country-level factors. We find that perceptions of having enough choice are not influenced by the opportunity to freely choose primary care doctors, the density of doctors in a country, or the level of health expenditure. Instead, these perceptions are influenced by individual attributes, such as personal health circumstances, age, sex, location of residence (rural or urban), and level of satisfaction with the health system.

scholarly journals Idea on the Clinical Services of Primary Care Physicians

2018 ◽  
Vol 1 (3) ◽  
pp. 99
Author(s):  
Adi Heru Sutomo ◽  
Fitriana Fitriana
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Direct Contact ◽  
Health Problems ◽  
Primary Care Doctor ◽  
Clinical Services ◽  
The Family ◽  
Patient Health ◽  
Primary Care Doctors

The increasing needs and health problems that exist in the community and the more critical the community-related health problems that require the ability of a primary care doctor able to handle existing health problems in the community. Primary care doctor complies with Alma Ata Declaration in 1978 as the backbone of health that makes direct contact with the community, so it is essential for a primary care doctor to involve the patient or the patient as part of the team. Patient experience information or patients given to primary care doctors is expected to further improve the quality of patient health services as individuals and is part of the family and society or community....................

scholarly journals Primary care doctors’ understandings of and strategies to tackle health inequalities: a qualitative study

2019 ◽  
Vol 20 ◽  
Author(s):  
Mark Exworthy ◽  
Victoria Morcillo
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
General Practitioners ◽  
Health Inequalities ◽  
Full Potential ◽  
Comparison Process ◽  
Structured Interviews ◽  
Policy And Practice ◽  
The Social ◽  
Primary Care Doctors

AbstractAimTo examine general practitioners’ knowledge of and their role in tackling health inequalities, in relation to their professional responsibilities.BackgroundPrimary care is often seen as being in the frontline of addressing health inequalities and the social determinants of health (SDH).MethodsA qualitative study with a maximum variety sample of English General Practitioners (GPs). In-depth, semi-structured interviews were held with 13 GPs in various geographical settings; they lasted between 30 and 70 min. Interviews were audio-recorded and transcribed. The analysis involved a constant comparison process undertaken by both authors to reveal key themes.FindingsGPs’ understanding of health inequalities reflected numerous perspectives on the SDH and they employ various different strategies in tackling them. This study revealed that GPs’ strategies were changing the nature of (medical) professionalism in primary care. We locate these findings in relation to Gruen’s model of professional responsibility (comprising a distinction between obligation and aspiration, and between patient advocacy, community participation and political involvement). We conclude that these GPs do not exploit the full potential of their contribution to tackling health inequalities. These findings have implication for policy and practice in other practitioners and in other health systems, as they seek to tackle health inequalities.

Opportunities for improving cancer care management through primary care-oncology relationships.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 80-80 ◽  
Author(s):  
Jennifer Tsui ◽  
Jenna Howard ◽  
William L. Miller ◽  
Denalee M. O'Malley ◽  
Shawna V. Hudson ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Patients ◽  
Care Transitions ◽  
The United States ◽  
Care Quality ◽  
Direct Access ◽  
Structured Interviews ◽  
Optimal Care ◽  
Relationship Type ◽  
Primary Care Practices

80 Background: Improvements in the management of care transitions between primary care and oncology are critical for achieving optimal care quality and outcomes for cancer patients and survivors. We examine relationships between innovative PC practices and oncologists to inform and strengthen PC-oncology interfaces in diverse healthcare settings. Methods: Comparative case studies of 14 innovative PC practices throughout the United States examined strategies for providing cancer survivorship care. Field researchers observed each practice for 10-12 days, recording fieldnotes and conducting key informant and formal, semi-structured interviews with clinicians and staff. We extracted all data related to PC-oncology relationships and then collaboratively identified patterns to characterize these relationships through an inductive “immersion/crystallization” analysis process. Results: Nine of the 14 practices discussed either formal or informal PC-oncology relationships. Nearly all practices with existing formal PC-oncology relationships were embedded within healthcare systems. Private, independent practices had more informal relationships between individual PC physicians and specific oncologists. Practices with formal relationships noted ease of communication and transfer of patient information, timeliness in patient referrals, and direct access to oncologists; while practices with informal relationships noted the benefits of having close engagement with specific oncologists. Regardless of relationship type, remaining challenges include lack of clarity about roles during cancer treatment and beyond. Conclusions: With the rapid transformation of U.S. healthcare towards system ownership of primary care practices, efforts are needed to integrate the strengths of both formal and informal PC-oncology relationships to improve care for cancer patients and survivors.

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