Assessing competency for concealed-weapons permits - The physician's role

Shortly after the shootings in Newtown, Connecticut, two of us received letters from our county sheriff in North Carolina asking whether one of our patients had medical or physical conditions that would preclude issuance of a permit to carry a concealed weapon. Uncomfortable with our limited knowledge about such permits and our expected role, and fearing that our participation could affect our relationships with patients, we began exploring the ethical, legal, and policy considerations regarding physician involvement in this process

Physician attitudes and experience with permit applications for concealed weapons

To the Editor: Every U.S. state allows people to carry concealed weapons within certain limits and after varied approval processes. Although many states require physician participation to help determine competency, it is not known whether physicians are capable of assessing a patient’s competence to carry a concealed weapon

Toward a basic science of communication in serious illness

Health and self-regulatio

Accuracy and congruence of patient and physician weight-related discussions: From project CHAT (Communicating health: Analyzing talk)

10.3122/jabfm.2014.01.130110Journal of the American Board of Family Medicine27170-7

Physician empathy and listening: Associations with patient satisfaction and autonomy

10.3122/jabfm.2011.06.110025Journal of the American Board of Family Medicine246665-67

Taking a "Snapshot": Evaluation of a Conversation Aid for Identifying Psychosocial Needs in Young Adults with Cancer

Item does not contain fulltextPURPOSE: Young adults (YAs) aged 18-35 years with cancer often experience unmet psychosocial needs. We aimed to evaluate a conversation aid ("Snapshot") that offered a framework for discussing YA-specific psychosocial concerns between patients and clinicians. METHODS: We developed and implemented Snapshot between 2014 and 2016 as part of a quality improvement initiative at Dana-Farber Cancer Institute. We extracted pre- and postimplementation data from chart documentation of psychosocial concerns. YAs and social workers provided qualitative feedback on the use of Snapshot in clinical care. RESULTS: Postintervention chart reviews revealed a significant increase in the median number of topics documented in charts after implementation of Snapshot (preintervention median = 9 [range: 1-15] vs. postintervention median = 11 [range 6-15]; p = 0.003). Overall, YAs and social workers reported that using Snapshot improved communication and consistency of psychosocial care, with documented improvement in the following domains: understanding illness (p < 0.001), sexuality and intimacy (p = 0.03), symptom burden (p = 0.003), care planning (p < 0.001), support for caregivers and children (p = 0.02), and social, work, and home changes (p = 0.05). CONCLUSION: Snapshot improved the quality of psychosocial needs assessment among YAs with cancer. Implementation was successful in reducing variability identified in the preintervention cohort and increasing the number of YA-specific psychosocial topics discussed. A standardized conversation aid has the potential to improve quality of care for YAs by enabling early identification and intervention of psychosocial issues for all patients

Pain coping, multidisciplinary care, and mHealth: Patients' views on managing advanced cancer pain

Objective Pain is common among people with advanced cancer. While opioids provide significant relief, incorporating psycho-behavioral treatments may improve pain outcomes. We examined patients' experiences with pain self-management and how their self-management of chronic, cancer-related pain may be complemented by behavioral mobile health (mHealth) interventions. Methods We conducted semi-structured qualitative interviews with patients with advanced cancer and pain. Each participant reviewed content from our behavioral mHealth application for cancer pain management and early images of its interface. Participants reflected on their experiences self-managing cancer pain and on app content. Interviews were transcribed verbatim and analyzed using a combination of inductive and deductive thematic analysis. Results Patients (n = 28; 54% female; mean age = 53) across two geographic regions reported using psychological strategies (e.g., reframing negative thoughts, distraction, pain acceptance, social support) to manage chronic cancer-related pain. Patients shared their perspectives on the integration of psycho-behavioral pain treatments into their existing medical care and their experiences with opioid hesitancy. Patient recommendations for how mHealth interventions could best support them coalesced around two topics: 1.) convenience in accessing integrated pharmacological and psycho-behavioral pain education and communication tools and 2.) relevance of the specific content to their clinical situation. Conclusions Integrated pharmacological and psycho-behavioral pain treatments were important to participants. This underscores a need to coordinate complimentary approaches when developing cancer pain management interventions. Participant feedback suggests that an mHealth intervention that integrates pain treatments may have the capacity to increase advanced cancer patients' access to destigmatizing, accessible care while improving pain self-management