Multidimensional Problems Among Advanced Cancer Patients in Cuba: Awareness of Diagnosis Is Associated with Better Patient Status (original) (raw)
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Physician, patient and family attitudes regarding information on prognosis: a Brazilian survey
Annals of Oncology, 2012
Background: Communication between physicians and patients is a fundamental aspect of cancer care, yet most physicians' perceptions are often inconsistent with the patients' stated preferences while prognostic information is the most misunderstood. Patients and methods: Members of the Brazilian Society of Oncology Physicians (n = 609) were identified and asked to complete a mailed questionnaire. Outpatients (n = 150) and their family members (n = 150), oncologists and fellows (n = 55) from a public healthcare hospital and a tertiary cancer hospital in Sao Paulo were also personally invited to participate. Results: A total of 202 physicians, 150 outpatients and 150 family members were participated. The majority of patients (92%) believe they should know about their terminal stage compared with 79.2% of physicians and 74.7% of families (P = 0.0003). Cancer patients were most likely to support disclosure of diagnosis and terminality (P = 0.001), to consider that this disclosure was not stressful (P < 0.0001) and that this knowledge would improve their quality of life (P < 0.0001). Conclusions: Cancer patients seen in these centers in Southeastern Brazil prefer to know the truth about their poor prognosis more than their physicians and families think. Further studies with larger samples of patients and physicians are necessary to show if our results are representative of all Brazilian situations.
Knowledge of Palliative Care in Ecuador
International Journal of Environmental Research and Public Health, 2021
Palliative care is a holistic approach to care for people with chronic, advanced, and life-threatening illnesses. It improves the quality of life of patients and their caregivers. However, there is still limited access to palliative care in many countries. Knowledge about palliative care is key to increase its availability. Thus, this article aimed to explore the knowledge of the general population about palliative care in Ecuador. The study had a descriptive cross-sectional design. Through snowball sampling, between September 2019 and January 2020, 257 people completed an anonymous online questionnaire about general and specific aspects of palliative care. Descriptive and ANOVA analyses indicate that people have many misconceptions about palliative care and how it should be provided. Gender, education, training, occupation, and experience as caregivers were related to the total level of knowledge about palliative care. Regression analyses show other variables as predictors of knowl...
Information to the patient with cancer: the oncologist's view
Revista da Associação Médica Brasileira (English Edition), 2011
Objective: To identify what information is provided to patients by oncologists, assess what they take into account in the process of informing the patient, and to ascertain whom the information is provided to. Methods: The study subjects were oncologists recruited among those registered at the Brazilian Society of Clinical Oncology-SBOC. All material was mailed to the Society, which was then forwarded to the participant oncologists. The previously stamped envelopes contained: a questionnaire, the questionnaire instructions, and the informed consent form to be signed. The data obtained was statistically treated, following a 95% confidence interval. Results: 876 questionnaires were sent (total number of physicians registered at SBOC) and a 16.55% response rate was achieved. Regarding the information provided, 81% of the physicians responded they informed patients about diagnosis, treatment and prognosis; however, 73% reported that in most cases the patient is already aware of his/her disease. Nevertheless, the information is provided to the patient and his(her) family by 81% of doctors. Among the relevant aspects in the information process, the patient's gender has little influence on the information for 95% of doctors. Conclusion: Considering the results achieved, we conclude that in the study population, physicians are concerned about providing information according to the patient's profile. We could also notice that oncologists try to provide patients with the information they are entitled to-the truth, although they often resort to the family's assistance in providing that information.
International Journal of Environmental Research and Public Health
Background: The worldwide need for palliative care is high, especially in mid- income countries like Ecuador, where the percentage of patients receiving such care is very small due to the scarcity of infrastructure and specialized personnel and to the unequal distribution in the country. The objective of this study is to explore the knowledge, attitudes and expectations related to palliative care of the physicians in Ecuador. Methods: A qualitative study based on 28 semi-structured interviews, from March 2014 to November 2016, with physicians working in four cities in Ecuador recruited through the snowball technique. Thematic analysis was developed supported by the ATLAS.ti software. Results: Five core themes were identified: (1) training, (2) health policy, (3) professionals’ activities, (4) health services and (5) development of palliative care in Ecuador. Conclusions: Strategies are needed which intensify the training of medical professional in palliative care, as well as avail t...
Psycho-Oncology, 2017
Evidence supports the early integration of palliative care in oncology setting. We sought to describe rates of distress in patients diagnosed with incurable cancer and identify factors associated with these symptoms. A cross‐sectional analysis of data from patients diagnosed with cancer stage IV, undergoing chemotherapy treatment at two cancer settings (public and private), was performed. It was enrolled 468 patients (61.8% public hospital). Most of them were female, white, married and diagnosed with GI and breast cancers. A greater proportion of patients from public hospital reported significantly more distress (44.6%vs 23.5%) and anxiety symptoms (22.1%vs 12.8%). However, the proportion of patients reporting depressive symptoms (17.3% vs 16.8%) did not significantly differ. Patients from public hospital tends to report significantly more financial (38.4% vs 16.8%), transportation (15.9% vs 2.2%), breathing (30.8% vs 11.2%), fatigue (60.2% vs 45.8%), and pain (52.9% vs 30.7%). Pain (B = 1.4), fatigue (B = 1.2) and breathing (B = 1.6) were associated with distress (ps < .001). Our findings highlight the substantial emotional morbidity experienced by patients at stage IV and also emphasize the benefit from targeted palliative care and psychosocial interventions. Patients treated at a public setting is at particularly risk for distress. Earlier intervention in patients' disease course may prevent ongoing burden and enhance their ability to cope with their disease.
Supportive Care in Cancer, 2014
Purpose Palliative care-related problems have not been measured in Africa in line with the WHO definition. This study aimed to measure the three-day period intensity of multidimensional problems (physical, psychological, social, and spiritual) among advanced cancer patients in Kenya and Uganda. Methods Adults with advanced malignant disease gave selfreport data to the African Palliative Outcome Scale (POS). Results Among 210 respondents, more than half had an underlying HIV diagnosis (51.9 %). The worst ranked POS items were pain and information. In three multivariable ordinal logistic regression models with the 3 POS factors as dependent variables, for the first model (factor 1 physical and psychological well-being), as age increased, the wellbeing also improved (B=0.022, p=0.037), and as physical function score worsened, factor score also worsened (B= −0.685, p<0.001). In the second model (factor 2 interpersonal well-being), a trend toward significance was found for gender, with being male predicting a higher (better) factor score (B= 0.502, p=0.067). For the third model (factor 3 existential and spiritual), increasing age was predictive of higher (better) factor score (B=0.023, p=0.032), and worsening function was predictive of lower (worse) factor score (B=−0.543, p<0.001). Conclusions This novel data revealed pain and information to plan for the future to affect patients most severely, underlining the importance of analgesia and social support. HIV infection did not affect the level of need. Our data suggest increasing need as function declines; therefore, home-based models with adequate family support are essential.
Disclosing the truth to terminal cancer patients a discussion of ethical and cultural issues
One of the most difficult ethical dilemmas facing health care professionals working in oncology is whether, when, how and how much to tell terminal cancer patients about their diagnosis and prognosis. The aim of this article is to review the trends in this issue worldwide. While a majority of physicians in both developed and developing countries tell the truth more often today than in the past, the assumption that truth-telling is always beneficial to patients can be questioned. The issue of truth-telling is still approached differently in different countries and cultures and there is a need for an increased awareness of cultural differences to truth-telling among patients from ethnic minorities.