Better Palliative Care for Older People

Most deaths in European and other developed countries occur in people aged over 65, but relatively little health policy concerns their needs in the last years of life. As life expectancy increases, the number of people living to older ages is also increasing in many countries. At the same time, the relaive number of people of working age is declining and he age of potential caregivers is increasing. Palliatve care is therefore of growing public health importance. Older people have traditionally received less palliative care than younger people and services have focused on cancer. This booklet is part of the WHO regional Office for Europe's work to present evidence for health policy - and decision-makers in a clear and understandable form. It presents the needs of older people, the different trajectories of illnesses they suffer, evidence of underassessment of pain and other symptoms, their need to be involved in decision-making, evidence for effecive palliative care solutions, and issues for the future

Living with multiple myeloma: A focus group study of unmet needs and preferences for survivorship care

Purpose: To describe the unmet informational, psychological, emotional, social, practical, and physical needs and preferences for posttreatment survivorship care of individuals living with multiple myeloma to inform the development of relevant, personcentered, survivorship services. Methods: An exploratory, descriptive study using 2 focus groups with 14 participants, 6 to 49 months postdiagnosis. Results: Thematic analysis revealed 7 key themes: information needs, experience with health-care professionals, coping with side effects, communicating with family and friends, dealing with emotions, support needs, and living with the chronicity of myeloma. Participants described key characteristics of survivorship care relevant to their needs and indicated they would like a more whole of person approach to follow-up when the main treatment phases had completed. Conclusion: Participants in this study described unmet needs across a breadth of domains that varied over time. The development of flexible, person-centered approaches to comprehensive survivorship care is needed to address the considerable quality-of-life issues experienced by people living with multiple myeloma. Nurse-led care may offer 1 viable model to deliver enhanced patient experience—providing the vital “link” that people described as missing from their survivorship care

Munchausen by internet: current research and future directions.

The Internet has revolutionized the health world, enabling self-diagnosis and online support to take place irrespective of time or location. Alongside the positive aspects for an individual's health from making use of the Internet, debate has intensified on how the increasing use of Web technology might have a negative impact on patients, caregivers, and practitioners. One such negative health-related behavior is Munchausen by Internet

Spiritual Wellbeing in Breast and Cervical Cancer Survivors: Differences in Each Stage of Survivorship

Spiritual needs in cancer survivors are underappreciated compared to physical and psychological needs. This study aimed to: 1) compare and analyze the differences in spiritual wellbeing (SWB) between breast and cervical cancer survivors (BCS and CCS) generally, and between stages of survivorship specifically, and 2) determine the best predictor of SWB in both cases. This cross-sectional study involved 58 BCS and 47 CCS (n=105). Questionnaire of QOL-CS part IV was used in data collection. Various statistical tests were used in data analysis (α<0.05). SWB was significantly different between BCS and CCS (p=0.002), which influenced by significant differences in religious activity, spiritual activity, uncertainty, positive life changes, life goals, and hope (all p<α). In BCS, overall SWB was not significantly different between survivorship stages (p=0.179); but religious activity, life goals, and hope were significantly different (p=0.043, p=0.022, and p=0.036 respectively) which indicate that these three aspects change overtime along with the survivorship stages. While in CCS, SWB and all of its aspects were not significantly different between survivorship stages (all p>α) which indicate that SWB is stable/stagnant across the survival life span in CCS. Spiritual life changes and religious activity are the best predictors of SWB in both cases and were accounted for 70.3% (R2=0.703) and 69.7% (R2=0.697) variance of SWB in BCS and CCS respectively

Mobilizing Public Will For Social Change

Examines the theory and strategies of "public will" campaigns and offers tangible criteria for their evaluation. It provides a rich inventory of strategies for use in mobilizing the public will through an integration of models of agenda building, social problem construction, issues management, social movements, media advocacy, and social capital. In addition, the paper provides cases and examples of public will campaigns directed at various social problems, along with criteria for evaluating these campaigns at various stages of a social problem's life cycle

Not just an older woman’s disease: breast cancer in your 20s and 30s

Draws attention to the unique challenges faced by the 800 young women per year diagnosed with breast cancer in Australia. Executive summary Breast cancer in young women – defined in this report as women less than 40 years of age – is not a phenomenon that has received much attention to date in Australia. Yet almost 800 young women per year are diagnosed. While the incidence of breast cancer is not as high as in older generations, young women face an utterly disproportionate burden of impact on every aspect of their lives. This is poorly publicised, and even more poorly understood, thereby adding to that burden. From the moment of concern when typically they may discover a worrying change in their breasts, young women face an uphill battle. Even being taken seriously with their request for diagnostic testing can be a challenge. Young women tend to think they are ‘bullet proof’. They are often fit, active and lean with no discernible risk factors. Because the incidence of breast cancer in the 20s and 30s is low, when it does occur it takes everyone by surprise. Mammographic screening is not offered to women under 40 in Australia, because it is not particularly effective in younger age groups. So, young women must rely on breast self-examination or clinical breast examination to find any changes. For young women, having an accurate understanding of family history can be an important tool to aid early diagnosis. However, it’s important that young women don’t overestimate the role of family history in breast cancer. We know for women of all ages, only a maximum of 15% of breast cancers are related to family history. Although breast cancer is not common in young women, those affected are typically diagnosed with more aggressive sub-types of the disease and larger tumours – which means a poorer prognosis. Because young women often manifest with ‘triple negative’ disease, there are few targeted therapies available for them – unlike older women who most often manifest with hormonally-driven breast cancers responsive to antihormone therapies. So, young women are often aggressively treated with chemotherapy, which can be effective but also a ‘blunt instrument’ in killing healthy cells as well as cancer cells, with effects for years to come. Treatments can have severe impacts on young women’s abilities to remain employed and certainly to remain employed in the same job and with the same working conditions. This in turn can have very significant impacts on their financial situation and future career prospects. More young women die of their disease, compared with older women, and they have a higher rate of recurrence and spread from the breast to other parts of the body, such as the bone, liver, lungs and brain. Once that metastasis has happened, the science today can keep them alive for some years, but ultimately cannot save them – yet. Young women in this situation are particularly challenged. The content in this report focuses on early detection and management of primary breast cancer. However, we are very conscious of the unmet needs of young women whose breast cancer has spread, and recognise the requirement for further support, greater awareness, better therapies and more research for these women

Human experience in the natural and built environment : implications for research policy and practice

22nd IAPS conference. Edited book of abstracts. 427 pp. University of Strathclyde, Sheffield and West of Scotland Publication. ISBN: 978-0-94-764988-3

Evaluating social games for kids and teenagers diagnosed with cancer

Serious games for health are interactive games with a focus on health care, physical and mental fitness. As it is assumed that social support can also indirectly influence patient's health condition, multiplayer online health games present an innovative approach of improving the player's health condition. In this paper we present the health game prototype "Adventures in Sophoria" developed at the University of Duisburg-Essen with the goal of facilitating the intercommunication of teenagers during cancer treatment. Two versions of the game were implemented, one explicitly referring to cancer and an implicit version with no cancer content. In a between-subjects experimental study with a clinical sample, both versions were compared. Additionally, parents and nursing staff were interviewed in order to evaluate the demand regarding health games. Results suggest that the implicit game version yielded higher enjoyment and acceptance compared to the explicit version. © 2011 IEEE

Breaking the Barriers to Specialty Care: Practical Ideas to Improve Health Equity and Reduce Cost - Striving for Equity in Specialty Care Full Report

Tremendous health outcome inequities remain in the U.S. across race and ethnicity, gender and sexual orientation, socio-economic status, and geography—particularly for those with serious conditions such as lung or skin cancer, HIV/AIDS, or cardiovascular disease.These inequities are driven by a complex set of factors—including distance to a specialist, insurance coverage, provider bias, and a patient's housing and healthy food access. These inequities not only harm patients, resulting in avoidable illness and death, they also drive unnecessary health systems costs.This 5-part series highlights the urgent need to address these issues, providing resources such as case studies, data, and recommendations to help the health care sector make meaningful strides toward achieving equity in specialty care.Top TakeawaysThere are vast inequalities in access to and outcomes from specialty health care in the U.S. These inequalities are worst for minority patients, low-income patients, patients with limited English language proficiency, and patients in rural areas.A number of solutions have emerged to improve health outcomes for minority and medically underserved patients. These solutions fall into three main categories: increasing specialty care availability, ensuring high-quality care, and helping patients engage in care.As these inequities are also significant drivers of health costs, payers, health care provider organizations, and policy makers have a strong incentive to invest in solutions that will both improve outcomes and reduce unnecessary costs. These actors play a critical role in ensuring that equity is embedded into core care delivery at scale.