Tradeoffs of Life: between Quality and Quantity Development of the QQ Questionnaire for Cancer Patient Attitudes

The patient's perspective is of prime concern in weighing the benefits and side effects of oncologic treatment. Little is known about patients' preference and attitudes. The authors developed a short questionnaire to assess patient attitudes concerning trade-offs between quality of life and length, or quantity, of life (the QQ Questionnaire). The questionnaire turned out to be feasible for use in various groups of cancer patients. In a factor analysis, the questionnaire was shown to consist of two factors, a Q(uality) and a L(ength) factor. Values of Cronbach's alpha for the Q and L scales (consisting of four items each) were 0.68 and 0.79, respectively. Younger patients and patients who have children assigned relatively more importance to striving for prolonged survival. Contrary to our expectation, no association was found between scores on the two scales and time tradeoff utility scores. The QQ Questionnaire can be used in research settings to study patient attitudes and the stability and determinants of patients' preference

Cancer patients' trust in their physician-a review

Objective: Patient's trust in their physician is crucial for desirable treatment outcomes such as satisfaction and adherence. In oncology, trust is possibly even more essential, due to the life-threatening nature of cancer. A review was undertaken of the current knowledge of the conceptualization, assessment, correlates, and consequences of cancer patients' trust in their physician. Methods: The empirical literature published in peer-reviewed journals between October 1988 and October 2008 was searched, employing all combinations and variations of the following keywords: trust, physician-patient relations, and cancer. Results: The search identified 45 relevant papers, only 11 of which drew attention to the conceptualization of trust, and 5 of which focused on trust as the primary subject of interest. Trust in physicians was strong overall. Patients' trust appeared to be enhanced by the physician's perceived technical competence, honesty, and patient-centred behaviour. A trusting relationship between patient and physician resulted in facilitated communication and medical decision making, a decrease of patient fear, and better treatment adherence. Conclusions: A lack of focus on trust and the conceptualization thereof, strong methodological variations between studies and a possible publication bias lead us to conclude that cancer patients' trust in their physician deserves more systematic, theoretically based, research attention. Consequently, studies are needed aimed at gaining a thorough understanding of the nature and impact of cancer patients' trust in their physician, and how the interaction between physician and patient may contribute to such trust. Copyright (C) 2010 John Wiley & Sons, Lt

Predictors of health care utilization in the chronically ill: a review of the literature

The objective of this paper is to identify predictors of health care utilization in the chronically ill. This paper reviews 53 studies on hospitalizations and physician visits, published between 1966 and 1997 and identified by MEDLINE and ClinPSYCH databases. Studies with both univariate and multivariate analyses were included. On the basis of the Andersen-Newman model of health care utilization, the effects of predisposing, enabling and need variables are examined. Most studies reviewed indicate that predisposing factors such as age, sex, and marital status are not predictors of hospital utilization in the chronically ill. The enabling factors income, insurance and social support have not been shown to affect health care utilization, but characteristics of the hospitals could have an effect. Need factors such as disease severity, symptom severity and complications adversely affected health care utilization in the chronically ill, while disease duration and comorbidity do not have such an effect. Quality of life and perceived health might affect hospital utilization and physician use. Finally, depression and psychological distress proved to be among the strongest predictors of hospitalizations and physician visits. In conclusion, both disease severity and psychological well-being are most important in health care utilization. Intervention programs to support depressed or psychologically distressed patients should be considered. These could both help the patient and reduce health care utilization cost