scholarly journals Oncologists' Communication About Uncertain Information in Second Opinion Consultations: A Focused Qualitative Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Jamie L. van Someren ◽  
Vicky Lehmann ◽  
Jacqueline M. Stouthard ◽  
Anne M. Stiggelbout ◽  
Ellen M. A. Smets ◽  
...  
Keyword(s):  
Qualitative Analysis ◽  
Medical Oncology ◽  
Second Opinion ◽  
Future Research ◽  
Uncertain Information ◽  
Medical Decisions ◽  
Long Term Prognosis ◽  
Guidance Needs ◽  
A Prospective Study

Introduction: Uncertainty is omnipresent in cancer care, including the ambiguity of diagnostic tests, efficacy and side effects of treatments, and/or patients' long-term prognosis. During second opinion consultations, uncertainty may be particularly tangible: doubts and uncertainty may drive patients to seek more information and request a second opinion, whereas the second opinion in turn may also affect patients' level of uncertainty. Providers are tasked to clearly discuss all of these uncertainties with patients who may feel overwhelmed by it. The aim of this study was to explore how oncologists communicate about uncertainty during second opinion consultations in medical oncology.Methods: We performed a secondary qualitative analysis of audio-recorded consultations collected in a prospective study among cancer patients (N = 69) who sought a second opinion in medical oncology. We purposively selected 12 audio-recorded second opinion consultations. Any communication about uncertainty by the oncologist was double coded by two researchers and an inductive analytic approach was chosen to allow for novel insights to arise.Results: Seven approaches in which oncologists conveyed or addressed uncertainty were identified: (1) specifying the degree of uncertainty, (2) explaining reasons of uncertainty, (3) providing personalized estimates of uncertainty to patients, (4) downplaying or magnifying uncertainty, (5) reducing or counterbalancing uncertainty, and (6) providing support to facilitate patients in coping with uncertainty. Moreover, oncologists varied in their (7) choice of words/language to convey uncertainty (i.e., “I” vs. “we”; level of explicitness).Discussion: This study identified various approaches of how oncologists communicated uncertain issues during second opinion consultations. These different approaches could affect patients' perception of uncertainty, emotions provoked by it, and possibly even patients' behavior. For example, by minimizing uncertainty, oncologists may (un)consciously steer patients toward specific medical decisions). Future research is needed to examine how these different ways of communicating about uncertainty affect patients. This could also facilitate a discussion about the desirability of certain communication strategies. Eventually, practical and evidence-based guidance needs to be developed for clinicians to optimally inform patients about uncertain issues and support patients in dealing with these.

Physicians’ predictions of long-term survival and functional outcomes do not influence the decision to admit patients with advanced disease to intensive care: A prospective study

2020 ◽  
pp. 026921632096393
Author(s):  
Monica Escher ◽  
Mathieu Nendaz ◽  
Fabienne Scherer ◽  
Stéphane Cullati ◽  
Thomas Perneger
Keyword(s):  
Intensive Care ◽  
Functional Outcomes ◽  
Advanced Disease ◽  
Short Term ◽  
Term Survival ◽  
Admission Decisions ◽  
Long Term Prognosis ◽  
A Prospective Study ◽  
Short Term Survival

Background: Long-term survival and functional outcomes should influence admission decisions to intensive care, especially for patients with advanced disease. Aim: To determine whether physicians’ predictions of long-term prognosis influenced admission decisions for patients with and without advanced disease. Design: A prospective study was conducted. Physicians estimated patient survival with intensive care and with care on the ward, and the probability of 4 long-term outcomes: leaving hospital alive, survival at 6 months, recovery of functional status, and recovery of cognitive status. Patient mortality at 28 days was recorded. We built multivariate logistic regression models using admission to the intensive care unit (ICU) as the dependent variable. Setting/participants: ICU consultations for medical inpatients at a Swiss tertiary care hospital were included. Results: Of 201 evaluated patients, 105 (52.2%) had an advanced disease and 140 (69.7%) were admitted to the ICU. The probability of admission was strongly associated with the expected short-term survival benefit for patients with or without advanced disease. In contrast, the predicted likelihood that the patient would leave the hospital alive, would be alive 6 months later, would recover functional status, and would recover initial cognitive capacity was not associated with the decision to admit a patient to the ICU. Even for patients with advanced disease, none of these estimated outcomes influenced the admission decision. Conclusions: ICU admissions of patients with advanced disease were determined by short-term survival benefit, and not by long-term prognosis. Advance care planning and developing decision-aid tools for triage could help limit potentially inappropriate admissions to intensive care.

scholarly journals Prognostic Value of the Acute-to-Chronic Glycemic Ratio at Admission in Heart Failure: A Prospective Study

2021 ◽  
Vol 11 (1) ◽  
pp. 6
Author(s):  
Mª José Carrera ◽  
Pedro Moliner ◽  
Gemma Llauradó ◽  
Cristina Enjuanes ◽  
Laura Conangla ◽  
...  
Keyword(s):  
Heart Failure ◽  
Multivariable Analysis ◽  
Acute Hyperglycemia ◽  
Glucose Levels ◽  
Long Term Prognosis ◽  
Shape Curve ◽  
A Prospective Study ◽  
The Impact ◽  
The Relationship

Acute hyperglycemia has been associated with worse prognosis in patients hospitalized for heart failure (HF). Nevertheless, studies evaluating the impact of glycemic control on long-term prognosis have shown conflicting results. Our aim was to assess the relationship between acute-to-chronic (A/C) glycemic ratio and 4-year mortality in a cohort of subjects hospitalized for acute HF. A total of 1062 subjects were consecutively included. We measured glycaemia at admission and estimated average chronic glucose levels and the A/C glycemic ratio were calculated. Subjects were stratified into groups according to the A/C glycemic ratio tertiles. The primary endpoint was 4-year mortality. Subjects with diabetes had higher risk for mortality compared to those without (HR 1.35 [95% CI: 1.10–1.65]; p = 0.004). A U-shape curve association was found between glucose at admission and mortality, with a HR of 1.60 [95% CI: 1.22–2.11]; p = 0.001, and a HR of 1.29 [95% CI: 0.97–1.70]; p = 0.078 for the first and the third tertile, respectively, in subjects with diabetes. Additionally, the A/C glycemic ratio was negatively associated with mortality (HR 0.76 [95% CI: 0.58–0.99]; p = 0.046 and HR 0.68 [95% CI: 0.52–0.89]; p = 0.005 for the second and third tertile, respectively). In multivariable analysis, the A/C glycemic ratio remained an independent predictor. In conclusion, in subjects hospitalized for acute HF, the A/C glycemic ratio is significantly associated with mortality, improving the ability to predict mortality compared with glucose levels at admission or average chronic glucose concentrations, especially in subjects with diabetes.

scholarly journals Long-Term Prognostic Role of Computed Tomography Coronary Angiography for Stable Angina

2020 ◽  
Vol 22 (9) ◽  
Author(s):  
Mohammed N. Meah ◽  
Michelle C. Williams
Keyword(s):  
Computed Tomography ◽  
Chest Pain ◽  
Coronary Angiography ◽  
Stable Angina ◽  
Computed Tomography Coronary Angiography ◽  
Plaque Burden ◽  
Future Research ◽  
Long Term Prognosis ◽  
Randomised Controlled

Abstract Purpose of review Chest pain is a common presentation, and there are a wide variety of ways in which it can be investigated and treated. There is growing interest in whether the way we reach a diagnosis of angina can affect the long-term prognosis. In addition to its unparalleled negative predictive value, computed tomography coronary angiography (CCTA) gives anatomical information on the extent and severity of coronary artery disease. This article discusses recent research into the ability of CCTA to predict and improve long-term prognosis for patients with stable angina. Recent findings Results from retrospective studies, randomised controlled trials and meta-analyses all suggest that initial investigation with computed tomography coronary angiography confers a prognostic benefit. In addition, the most recent studies have shown that the assessment of plaque burden and plaque constituents is predictive of long-term outcomes. Summary Management of stable chest pain should be guided by a CCTA-based approach. Future research should focus on whether incorporating plaque analysis strategies into clinical practice confers additional benefit.

Long-Term Results of Carpal Tunnel Decompression

1993 ◽  
Vol 18 (4) ◽  
pp. 471-474 ◽  
Author(s):  
W. F. HAUPT ◽  
G. WINTZER ◽  
A. SCHOP ◽  
J. LÖTTGEN ◽  
G. PAWLIK
Keyword(s):  
Carpal Tunnel ◽  
Long Term Results ◽  
Variable Degree ◽  
Patients With Diabetes ◽  
Tunnel Syndrome ◽  
Long Term Prognosis ◽  
A Prospective Study ◽  
Variable Analysis

The long-term prognosis of 60 patients operated on for carpal tunnel syndrome has been assessed in a prospective study with a median follow-up period of 5.5 years (range 2–11 years). Analysis of motor, sensory, trophic, and electrodiagnostic findings and assessment of pain were performed pre- and post-operatively using a standardized grading system. The results were generally favourable with a variable degree of improvement in 86% of cases. Statistical evaluation using multiple Dunn-Rankin tests revealed pain to be the most prominent pre-operative finding. On post-operative reexamination, pain was found to be improved to a significantly greater extent than any other variable. Analysis of several potential prognostic factors showed that pain lasting for more than 5 years prior to surgery indicates a poor prognosis. Only patients with diabetes mellitus exhibited a trend toward less pain relief.

scholarly journals Autonomic dysfunction following traumatic brain injury: translational insights

2019 ◽  
Vol 47 (5) ◽  
pp. E8 ◽  
Author(s):  
Fatima Khalid ◽  
George L. Yang ◽  
Jennifer L. McGuire ◽  
Matthew J. Robson ◽  
Brandon Foreman ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Autonomic Dysfunction ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Future Research ◽  
Cardiac Complications ◽  
Paroxysmal Sympathetic Hyperactivity ◽  
Long Term Prognosis

Although there is a substantial amount of research on the neurological consequences of traumatic brain injury (TBI), there is a knowledge gap regarding the relationship between TBI and the pathophysiology of organ system dysfunction and autonomic dysregulation. In particular, the mechanisms or incidences of renal or cardiac complications after TBI are mostly unknown. Autonomic dysfunction following TBI exacerbates secondary injury and may contribute to nonneurologial complications that prolong hospital length of stay. Gaining insights into the mechanisms of autonomic dysfunction can guide advancements in monitoring and treatment paradigms to improve acute survival and long-term prognosis of TBI patients. In this paper, the authors will review the literature on autonomic dysfunction after TBI and possible mechanisms of paroxysmal sympathetic hyperactivity. Specifically, they will discuss the link among the brain, heart, and kidneys and review data to direct future research on and interventions for TBI-induced autonomic dysfunction.

scholarly journals Adolescents’ Perceptions of Gender Discrimination in India: Do Perceptions Differ for Boys and Girls?

2019 ◽  
Vol 2 (1) ◽  
pp. 1-12 ◽  
Author(s):  
Nitasha Chaudhary Nagaraj ◽  
Nitasha Chaudhary Nagaraj ◽  
Amita Vyas ◽  
Amita Vyas ◽  
Megan Landry ◽  
...  
Keyword(s):  
Gender Roles ◽  
Qualitative Analysis ◽  
Youth Development ◽  
Gender Discrimination ◽  
Future Research ◽  
Gender Inequity ◽  
Northern India ◽  
Depth Interviews ◽  
Made In

Despite the gains India has made in recent decades, it remains a country with vast gender inequities. Gender sensitization and empowerment programs aimed at young people, precisely at the time when they are forming their gender attitudes, has the potential to diminish gender inequity in the long-term. This study represents data from 36 qualitative in-depth interviews conducted amongst adolescent boys and girls enrolled in grade 7 in northern India, in schools that serve under-resourced communities. The interviews asked questions related to positive youth development, gender roles, violence, and locus of control. The results of the qualitative analysis provide insights into how adolescents perceive gender discrimination in their families and communnites. The majority of expectations for boys revolved around physical labor, while, for girls, gender roles were primarily focused on stopping education early to get married and take care of the household and children. Many of the responses from both boys and girls on privileges/restrictions were related to daughters not being fully educated while sons often were. Furthermore, when comparing between boys and girls (attributes) and understanding superiority, many participants noted there is a clear preference of boys compared to girls. Girls also had higher proportion of violence codes compared to boys, perhaps because many girls felt they were hit more frequently than boys. The results of this qualitative analysis provide direction for both future research as well as the development of gender sensitization interventions specifically designed for adolescents.

scholarly journals Predictors for Prognosis in Patients With Nonfatal Pulmonary Embolism: A Registry-Based Cohort Study

2018 ◽  
Vol 24 (9_suppl) ◽  
pp. 84S-88S ◽  
Author(s):  
Marijan Bosevski ◽  
Gorjan Krstevski ◽  
Atanas Gjorgievski ◽  
Irena Mitevska ◽  
Elizabeta Srbinovska Kostovska
Keyword(s):  
Pulmonary Embolism ◽  
Prospective Study ◽  
Multivariate Regression Analysis ◽  
National Registry ◽  
Systolic Pulmonary Artery Pressure ◽  
Study Population ◽  
Long Term Prognosis ◽  
A Prospective Study ◽  
D Dimer

The article’s aim was to determine predictors for short- and long-term prognosis of patients with pulmonary embolism (PE). Cohort prospective study based on the National registry on venous thromboembolism. Eighty-four patients with PE, on age 60.3 + 12.5 years, were selected and followed up in a prospective study. Pulmonary embolism was confirmed by computed tomography angiography in all the patients, while deep venous thrombosis was confirmed by ultrasound in 21 patients. Study population was followed up for 6.7 months. Multivariate regression analysis was done where right ventricular (RV) diameter (mean 37.5 mm), systolic pulmonary artery pressure (68 ± 23 mm Hg) measured by echocardiography, d-dimer level at baseline 2654.5 ± 420.3 ng/mL, number of comorbidities (2.4 ± 0.7), and present symptoms (3.1 ± 0.9) entered the model. The model was age-adjusted. d-dimer level was revealed as a predictor for the length of hospitalization (β = .25, P = .05) and RV diameter as a factor for duration of anticoagulation (β = .29, P = .05). Our results imply that the baseline measurement of these parameters independently influence both the short-term and long-term prognosis of patients with nonfatal PE.

Very long-term outcome of psychotic disorders

2020 ◽  
Vol 66 (7) ◽  
pp. 633-641
Author(s):  
Vaios Peritogiannis ◽  
Afroditi Gogou ◽  
Maria Samakouri
Keyword(s):  
Psychotic Disorders ◽  
International Study ◽  
World Health ◽  
Future Research ◽  
Schizophrenia Spectrum Disorders ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Schizophrenia Spectrum ◽  
Long Term Prognosis

Background: The outcome of schizophrenia and related psychoses is generally modest, and patients display high rates of disability. Aims: The aim of the review is to present an up-to-date account of the research on the very long-term outcome of psychotic disorders. Method: We conducted a search in the PubMed and Scopus databases for articles published since the publication of the very long-term data of the World Health Organization’s International Study of Schizophrenia (the ISoS study), over the last 18 years (from 2002 to 2019). Studies were included if they reported on at least 15-year outcome and if they had used valid and reliable tools for the estimation of the patients’ outcome in terms of symptomatology and functioning. Results: A total of 16 studies were included in this review, involving 1,391 patients with schizophrenia and related psychoses. Most were single-center studies, with moderate size samples of patients, and 11 were prospective studies. Very long-term outcome of psychotic disorders varies considerably among studies. Good outcome ranges from 8% to 73.8%, and it appears to be better in developing countries, whereas differences are less apparent among Western countries (8%–40.3%). Studies in different settings have used different methods involving a variety of samples of patients to estimate their outcome, whereas definitions of good and poor outcome also varied among studies. Longer duration of untreated psychosis was associated with worse outcome in some studies. Schizophrenia was found to have poorer long-term prognosis compared to other schizophrenia spectrum disorders. A large proportion of patients, ranging from 19% to 48.2%, were not on medication. Conclusion: Recent evidence on the very long-term outcome of psychotic disorders is in line with previous reports and suggests that prognosis remains rather modest. There are several limitations of current research regarding outcome definitions and study design that should be addressed by future research.

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