Disclosure of cancer diagnosis and prognosis: a survey of the general public's attitudes toward doctors and family holding discretionary powers

BACKGROUND: This study aimed to ask a sample of the general population about their preferences regarding doctors holding discretionary powers in relation to disclosing cancer diagnosis and prognosis. METHODS: The researchers mailed 443 questionnaires to registered voters in a ward of Tokyo which had a socio-demographic profile similar to greater Tokyo's average and received 246 responses (response rate 55.5%). We describe and analysed respondents' attitudes toward doctors and family members holding discretionary powers in relation to cancer diagnoses disclose. RESULTS: Amongst respondents who wanted full disclosure about the diagnosis without delay, 117 (69.6 %) respondents agreed to follow the doctor's discretion, whilst 111 (66.1 %) respondents agreed to follow the family member's decision. For respondents who preferred to have the diagnosis and prognosis withheld, 59 (26.5 %) agreed to follow the doctor's decision, and 79 (35.3 %) of respondents agreed with following family member's wishes. CONCLUSIONS: The greater proportion of respondents wants or permits disclosure of cancer diagnosis and prognosis. In patients who reveal negative attitudes toward being given a cancer disclosure directly, alternative options exist such as telling the family ahead of the patient or having a discussion of the cancer diagnosis with the patient together with the family. It is recommended that health professionals become more aware about the need to provide patients with their cancer diagnosis and prognosis in a variety of ways

The enforcement approach to crime prevention

When local government authorities began to develop criminal policies with the police in the 1980s, crime prevention was advocated as an inclusive, holistic approach to crime control that had the potential to challenge the prevailing justice paradigm. To date this new prevention paradigm has not been realized in England and Wales. The police and courts are being relied upon more than ever, and relatively few crime prevention initiatives are directed towards the underlying social and economic determinants of crime. Moreover, in the past 15 years crime prevention partnerships have increasingly resorted to administrative and civil law powers such as fixed penalty notices and injunctions. Rather than provide an alternative to the enforcement approach of the criminal justice system, in England and Wales crime prevention has so far proven to be an addition to, even an extension of criminal justice