Study protocol: addressing evidence and context to facilitate transfer and uptake of consultation recording use in oncology: a knowledge translation implementation study

Background: The time period from diagnosis to the end of treatment is challenging for newly diagnosed cancer patients. Patients have a substantial need for information, decision aids, and psychosocial support. Recordings of initial oncology consultations improve information recall, reduce anxiety, enhance patient satisfaction with communication, and increase patients' perceptions that the essential aspects of their disease and treatment have been addressed during the consultation. Despite the research evidence supporting the provision of consultation recordings, uptake of this intervention into oncology practice has been slow. The primary aim of this project is to conduct an implementation study to explicate the contextual factors, including use of evidence, that facilitate and impede the transfer and uptake of consultation-recording use in a sample of patients newly diagnosed with breast or prostate cancer. Methods: Sixteen oncologists from cancer centres in three Canadian cities will participate in this three-phase study. The preimplementation phase will be used to identify and address those factors that are fundamental to facilitating the smooth adoption and delivery of the intervention during the implementation phase. During the implementation phase, breast and prostate cancer patients will receive a recording of their initial oncology consultation to take home. Patient interviews will be conducted in the days following the consultation to gather feedback on the benefits of the intervention. Patients will complete the Digital Recording Use Semi-Structured Interview (DRUSSI) and be invited to participate in focus groups in which their experiences with the consultation recording will be explored. Oncologists will receive a summary letter detailing the benefits voiced by their patients. The postimplementation phase includes a conceptual framework development meeting and a seven-point dissemination strategy. Discussion: Consultation recording has been used in oncology, family medicine, and other medicine specialties, and despite affirming evidence and probable applications to a large number of diseases and a variety of clinical contexts, clinical adoption of this intervention has been slow. The proposed study findings will advance our conceptual knowledge of the ways to enhance uptake of consultation recordings in oncology

Furthering the prostate cancer screening debate (prostate cancer specific mortality and associated risks)

Screening for prostate cancer remains a contentious issue. As with other cancer screening programs, a key feature of the debate is verification of cancer-specific mortality reductions. Unfortunately the present evidence, two systematic reviews and six randomized controlled trials, have reported conflicting results. Furthermore, half of the studies are poor quality and the evidence is clouded by key weaknesses, including poor adherence to screening in the intervention arm or high rates of screening in the control arm. In high quality studies of prostate cancer screening (particularly prostate-specific antigen), in which actual compliance was anticipated in the study design, there is good evidence that prostate cancer mortality is reduced. The numbers needed to screen are at least as good as those of mammography for breast cancer and fecal occult blood testing for colorectal cancer. However, the risks associated with prostate cancer screening are considerable and must be weighed against the advantage of reduced cancer-specific mortality. Adverse events include 70% rate of false positives, important risks associated with prostate biopsy, and the serious consequences of prostate cancer treatment. The best evidence demonstrates prostate cancer screening will reduce prostate cancer mortality. It is time for the debate to move beyond this issue, and begin a well-informed discussion on the remaining complex issues associated with prostate cancer screening and appropriate management

Coexistence of multiple regimes for near-field thermal radiation between two layers supporting surface phonon polaritons in the infrared

We demonstrate the coexistence of different near-field thermal radiation regimes between two layers supporting surface phonon polaritons (SPhPs) in the infrared. These regimes existwhen the distance of separation between the media d is much smaller than the dominant emission wavelength. This coexistence is noticed after computations of the near-field radiative heat transfer coefficient hr for silicon carbide films using fluctuational electrodynamics and following an asymptotic analysis of hr . We show that the emergence of these regimes is a function of a dimensionless variable D defined as the ratio of the layer thickness t to d. When D _ 1 for both films, SPhPs dominating near-field radiant energy exchange do not couple within the layers, such that hr follows a d−2 power law as for the case of two planar half-spaces.When D_1 for both layers, the dominant SPhPs couple within the films, thus resulting in a splitting of the spectral distribution of flux into two distinct modes. Despite this splitting, the asymptotic expansion reveals that hr varies as d−2 due to the fact that the spectral bands of high emission and absorption are essentially the same for both films. However, when both layers have a thickness of the order of a nanometer or less, a purely theoretical regime emerges where hr follows a d−4 asymptote. Also, when one layer has D _ 1 while the other one is characterized by D _ 1, there is an important mismatch between the spectral bands of high emission and absorption of the films, thus resulting in a hr varying as d−3. These various near-field thermal radiation regimes are finally summarized in a comprehensive regime map. This map provides a clear understanding of near-field thermal radiation regimes between two layers, which are particularly important for designing highly efficient nanoscale-gap thermophotovoltaic power generation devices.European Commissio