An evaluation of information cards as a means of improving communication between hospital and primary care for women with breast cancer.

This paper describes an intervention study aimed at improving communication between hospital services and the primary health care team. A series of information cards were developed by breast specialist secondary care professionals for members of the primary health care team. Women with breast cancer were involved in the communication pathway and were asked to take the information cards to their own general practitioner (GP) practice. It was envisaged that women would be more likely to utilize the primary health care team for information if they were aware that the primary health care team was in receipt of information specific to the treatment they had received. Women newly diagnosed with breast cancer were allocated to either an intervention (n=38) or non-intervention (n=38) group. Patient interviews were carried out around the time of diagnosis and at 4 months from diagnosis. Interviews were also carried out with 31 GPs to ascertain their views on the provision of information for women with breast cancer, and on the information cards if relevant. The study findings were interesting although not significant in terms of the direction anticipated. The cards did not impact on the utilization of the primary health care team and women in the intervention group were no more likely to utilize primary care sources of information than women in the non-intervention group. Factors such as the long-standing relationship women had with their GP, the perceived lack of specialist knowledge on the part of GPs and district nurses, and the women's perception that information seeking was not a tangible reason for primary care contact had an impact on information-seeking behaviour

Information needs and sources of information for women with breast cancer: a follow-up study.

This paper reports a study which examined the specific information needs and sources of information for 105 women with breast cancer at two time points, the time of diagnosis and a mean of 21 months from diagnosis. At diagnosis the priority information needs concerned survival issues. Further from diagnosis survival issues were still a concern, but information about the risk to family members of getting breast cancer showed a significant increase in importance. Information about sexual attractiveness was ranked last at both the newly diagnosed and follow-up stages. Information sources at the time of diagnosis centred around the specialist breast care service, while further from diagnosis few professional or voluntary sector sources were utilized, with women receiving most of their information from media sources such as women's magazines. The relevance of these findings for nurses and other health care professionals is discussed

Meaning of illness for women with breast cancer.

The meaning that women with breast cancer ascribe to their disease may well have an impact on the effectiveness of coping strategies used to come to terms with breast cancer. Health care professionals need to know what meanings women with breast cancer are ascribing to their disease if they are to identify maladaptive coping strategies and ensure that women receive the support that they need in order to promote physical and psychological recovery. This study involved assessing meaning of illness for a group of women with breast cancer at two points in time, the time of diagnosis and a mean of 21 months from diagnosis. The eight meanings of illness devised by Lipowski were depicted by the following words: challenge, enemy, punishment, loss, strategy, relief, weakness and value. The most popular choice of meaning for the women was challenge, although some women's choices indicated that maladaptive coping strategies were being used. The implications of the study for nurses and other health care professionals are discussed

Treatment decision making in women newly diagnosed with breast cancer

The purpose of this study was to explore the hypothesis that women with breast cancer had specific preferences about the degree of control they wanted over treatment decision making. One hundred fifty women, newly diagnosed with breast cancer, were interviewed and their preferences for participation in treatment decision making were established using a measurement tool designed to elicit decision-making preferences (Degner LF, Sloan JF. Decision making during serious illness: What role do patients really want to play? J Clin Epidemiol 1992;45:944-50). Two hundred women with benign breast disease served as a descriptive comparison group. Unfolding theory (Coombs CH. A theory of data. New York: John Wiley and Sons, 1964) provided a means of analyzing the data so that the degree of control preferred by each woman could be established. The majority of the newly diagnosed women preferred to play a passive role in treatment decision making, leaving the decision-making responsibility to their physician, whereas the benign control group preferred a collaborative role in which joint decisions could be made between the patient and the physician. The implications of the results for patient participation are discussed

The information needs of women newly diagnosed with breast cancer.

Nurses can play a key role in patient education, including providing patients with useful and appropriate information. Rather than focusing on the process of education or information giving by nurses, this study places emphasis on the content of that information by taking the patients' perspective and asking the patients themselves what particular types of information are perceived as important at a specific point in time. The aim of the study was to explore what particular types of information were important to women newly diagnosed with breast cancer; to enable nurses and other health care professionals to utilize their time as effectively as possible and provide a high-quality service to individuals in their care. Women with breast cancer (a mean of 2.5 weeks from diagnosis) were interviewed and asked to compare items of information. The items of information were presented in pairs and the women stated a preference for one item in that pair. Thirty-six pairs were presented in total. The analysis involved the use of a Thurstone scaling model, which allowed rank orderings, or profiles of information needs, to be developed, reflecting the perceived importance of each item. Information about the likelihood of cure, the spread of the disease and treatment options were perceived as the most important items of information at the time of diagnosis. Other information needs, in order of descending priority, included information about the risk to family, side-effects of treatments, impact on family, self-care, effect on social life and sexual attractiveness. Profiles of information needs were produced to take account of differences in age, level of education and social class.(ABSTRACT TRUNCATED AT 250 WORDS

Verbal and nonverbal indices of learning during problem-based learning (PBL) among first year medical students and the threshold for tutor intervention

Background: During problem-based learning (PBL), students brainstorm on a problem, generate hypotheses and formulate learning objectives. Certain verbal and non-verbal expressions are used by students in response to specific learning issues. Aims: This study examines the use of these expressions as indices of the learning taking place and the tutors’ threshold to intervene. Methods: Common verbal expressions used by students during PBL were identified and scored on a Likert scale to indicate the learning taking place. These expressions were categorised into the following groups of learning interactions: exploratory questioning, cumulative reasoning and handling conflicts relating to learning. The tutor's threshold for intervention was also scored on a Likert scale. Means for each learning interaction and observed non-verbal expressions were used to construct bar charts for comparison. Results: When the learning interactions involve exploratory questioning or cumulative reasoning, students tend to score high on learning and tutors have high threshold for intervention. When the learning interactions involve handling conflicts relating to knowledge, students score high on learning, but teachers have a low threshold for intervention. Conclusion: Verbal and non-verbal expressions from students during PBL are useful indices of learning and can be used to help tutors decide when and when not to intervene