Treatment of older adult or frail patients with multiple myeloma

Older adults with multiple myeloma (MM) are a growing population, and personalizing treatment based on disease and health status is imperative. Similar to MM staging systems that provide disease-related prognostic information, myeloma-specific frailty tools can better identify subgroups at greatest risk for treatment-related toxicity and early treatment discontinuation, as well as predict overall survival. Several myeloma-specific validated tools are well studied. Although these fitness/frailty scores have shaped our understanding of the heterogeneity among older adults with myeloma, the application of such scores in treatment decision making (ie, transplant considerations, relapse) is an unmet need. Here we outline how to incorporate frailty assessments in the evaluation of older adults with MM in the clinical setting with consideration of other factors such as patient preferences, treatment risks/benefits, life expectancy, and disease biology.

Women’s attitudes, beliefs and values about tests, and management for hypertensive disorders of pregnancy

Background Advances in research suggest the possibility of improving routine clinical care for preeclampsia using screening (predictive) and diagnostic tests. The views of women should be incorporated into the way in which such tests are used. Therefore, we explored the views of women with experience of preeclampsia and other hypertensive disorders in pregnancy (HDPs) about predictive and diagnostic tests, treatment risks, and expectant management. Method Eight hundred and seven women with experience of preeclampsia or other HDPs completed an online questionnaire. These women were participants in the Preeclampsia Registry (USA). The questionnaire contained 22 items to elicit women’s views about predictive tests (n = 8); diagnostic tests (n = 5); treatment risks (n = 7), and expectant management (n = 2). An optional text box allowed participants to add qualitative open-ended comments. Levels of agreement with the statements were reported descriptively for the sample as a whole, and a preliminary investigation of the role of lived experience in shaping women’s views was conducted by comparing subgroups within the sample based on time of HDP delivery (preterm/term). The qualitative data provided in the optional text box was analysed using inductive thematic analysis to examine participants’ responses. Results Women generally favored predictive and diagnostic testing, although not because they would opt for termination of pregnancy. Participants generally disagreed that taking daily low-dose aspirin (LDA) would make them nervous, with disagreement significantly higher in the preterm delivery subgroup. A high proportion of participants, especially in the preterm delivery subgroup, would take LDA throughout pregnancy. The majority of participants would be more worried about the possibility of preeclampsia than about the risks of treatments to their health (60%), and that proportion was significantly higher in the preterm delivery subgroup. There were no differences between subgroups in the views expressed about expectant management, although opinion was divided in both groups. Overall, most participants opted to put the baby’s interests first. Conclusion Women with experience of hypertensive disorders were enthusiastic about improved predictive and diagnostic tests. However, varied views about treatment options and expectant management suggest the need for a shared decision-making tool to enable healthcare professionals to support pregnant women’s decision-making to maximize the utility of these tests and interventions.

A cross sectional study into the use of YouTube™ as a source of patient education in orthodontic treatment risks

Introduction: To investigate the quality of information offered by videos on YouTube™ for those individuals seeking information regarding risks associated with orthodontic treatment. The quality of information was compared the British Orthodontic Society (BOS) patient information leaflet ‘Orthodontic treatment- what are the risks’. Materials and Method: YouTube™ was searched systematically for videos on orthodontic treatment risks using the terms ‘orthodontic risks’ and ‘braces risks’. Videos were selected based on a strict inclusion and exclusion criteria and demographics recorded. Completeness was assessed using a 8-point score based on the BOS patient information leaflet ‘Orthodontic treatment- what are the risks’. Descriptive statistics and statistical analysis using correlation tests were generated. Result: 19.2% videos met the specified criteria with 80.8% videos excluded. Videos varied in regards to completeness with the mean completeness score of 3 and only 13% meeting all criteria. The risk of pain and discomfort was most commonly included orthodontic risk 61%. No statistical significance was found for completeness of the video with viewers interaction (R = 0.2665, P=0.219897) viewing rate (R=0.1138, P=0.617326) or length of video (R=0.0062, P= 0.977601). Conclusion: YouTube™ generally hosts videos with low completeness with regards to orthodontic treatment risks. Therefore, orthodontists should be aware of this resource and caution patients regarding the comprehensiveness of information. In addition to the potentially misleading content which is avail-able within YouTube™ videos

Informed consent, Montgomery and the duty to discuss alternative treatments in England and Australia

The UK Supreme Court in Montgomery v Lanarkshire Health Board imposes a duty on healthcare professionals in relation to information disclosure. The obligation is to take reasonable care to ensure that patients are aware, not just of material risks inherent in any recommended treatment, but of any reasonable alternative treatments. While liability for information non-provision was previously decided according to whether the profession would deem disclosure appropriate, the law now judges the sufficiency of information from a patient’s perspective. In doing so, it adopts the approach advocated for Australia in Rogers v Whitaker. However, commentators, in this journal and elsewhere, have expressed concern that the disclosure obligation is unclear. Although Montgomery defines what is ‘material’ for the purpose of identifying notifiable treatment risks, it offers less guidance as to when alternative treatments will be sufficiently ‘reasonable’ to warrant disclosure. Through an analysis of Australian and UK case law and examples, this article considers the ambit of a practitioner’s duty to discuss alternatives. It concludes that although likely subject to further litigation, the identification of reasonable treatment options requiring disclosure will be influenced by the patient’s clinical condition, their prognosis and viable options from a medical perspective, and various non-clinical matters influenced by the test of materiality.