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Research has found that patient-subjects in early phase cancer trials exhibit unrealistic optimism regarding the risks and possible benefits of trial participation. Unrealistic optimism is associated with therapeutic misconception and failures to appreciate research-related information. This is the first study to assess whether those who decline to participate in these trials also exhibit unrealistic optimism. It is also the first study to assess whether there are significant differences in appreciation of research-related risks/benefits and therapeutic misconception between these two groups. We approached 261 patients at two academic medical centers who were offered enrollment in a Phase I, II, or I/II cancer trial (between 2012 and 2016). Two hundred thirty-three patients agreed to enroll in an early phase cancer trial, 171 of whom agreed to be interviewed for the study. Twenty-eight patients declined the offer to enroll, 15 of whom agreed to be interviewed for the study. Subjects participated in a structured face-to-face interview with a research associate trained to administer the study questionnaires. Acceptors demonstrated a significantly higher level of unrealistic optimism than decliners (p < .05). Decliners had significantly less therapeutic misconception than acceptors (3.37 [SD = 0.85] vs. 3.79 [SD = 0.77], p = .042). There was a significant difference on one of the appreciation questions between acceptors and decliners (p = .009). Comparative assessment of acceptors and decliners to early phase cancer trials casts light on whether unrealistic optimism is consequential for the decision to participate in these trials. The different levels of unrealistic optimism exhibited by these groups suggest that it may be a factor that affects the decision to participate. [ABSTRACT FROM AUTHOR]

Introduction: Many patients with advanced heart failure (HF) experience the life-extending benefits of implantable cardioverter-defibrillators (ICD), but at the end stage of HF, patients may experience shocks with increasing frequency and change the plan for end-of-life (EOL) care including the deactivation of the ICD. This report describes family members’ experiences of patients with ICD making decisions at EOL. Understanding the decision-making of patients with ICD at EOL can promote informed decision-making and improve the quality of EOL care. Methods: This pilot study used a mixed methods approach to test the effects of a nurse-guided discussion in decision-making about ICD deactivation (turning off the defibrillation function) at the EOL. Interviews were conducted, audiotaped, and transcribed in 2012 to 2013 with 6 family members of patients with advanced HF and ICDs. Three researchers coded the data and identified themes in 2014. Results: Three main themes described family members’ experiences related to patients having HF with ICDs making health-care decision at EOL: decision-making preferences, patients’ perception on ICD deactivation, and communication methods. Discussion: Health-care providers need to have knowledge of patients’ decision-making preferences. Preferences for decision-making include the allowing of appropriate people to involve and encourages direct conversation with family members even when advance directives is completed. Information of ICD function and the option of deactivation need to be clearly delivered to patients and family members. Education and guidelines will facilitate the communication of the preferences of EOL care. [ABSTRACT FROM AUTHOR]

Needle- and syringe-exchange programs aim to decrease infections among those who are dependent on injection drugs. Some have questioned whether church sponsorship of such programs constitutes illicit cooperation in the evil of drug abuse. This article examines the question under classical formulations of cooperation and in light of current empirical evidence and concludes that this is not the case. Questions are also raised about whether, if substance dependence is a disease and not a moral failing, an analysis based on cooperation is actually the appropriate category of analysis. [ABSTRACT FROM AUTHOR]

The article presents a study that identified factors related to research participants' preferences about learning the results of genomic studies using their donated tissue samples. The study surveyed 279 patients from the U.S. and Spain who donated a sample for genomic research. It revealed 48 percent of research participants having the interest to be informed about all individual results from future genomic studies using their donated tissue.

Background. Participants in early-phase clinical trials have reported high expectations of benefit from their participation. There is concern that participants misunderstand the trials to which they have consented, which is based on assumptions about what patients mean when responding to questions about likelihood of benefit. Methods. Participants were 27 women and 18 men in early-phase oncology trials at 2 academic medical centers in the United States. To determine whether expectations of benefit differ depending on how patients are queried, the authors randomly assigned participants to 1 of 3 interviews corresponding to 3 questions about likelihood of benefit: frequency type, belief type, and vague. In semistructured interviews, participants were queried about how they understood and answered the question. Participants then answered and discussed 1 of the other questions. Results. Expectations of benefit in response to the belief-type question were significantly greater than expectations in response to the frequency-type and vague questions (P=0:02). The most common justifications involved positive attitude (n=27 [60%]) and references to physical health (n=23 [51%]). References to positive attitude were most common among participants with higher (>70%) expectations (n=11 [85%]) and least common among those with lower (<50%) expectations (n=3 [27%]). Conclusions. The wording of questions about likelihood of benefit shapes the expectations that patients express. Patients who express high expectations may not do so to communicate understanding but rather to register optimism. Ongoing research will clarify the meaning of high expectations and examine methods for assessing understanding. [ABSTRACT FROM AUTHOR]

Discusses emerging issues in medical ethics. Transplantation of fetal tissues into the brains of adult patients; Moral responsibilities of physicians for patients with AIDS; Impact of health maintenance organizations on the changing relationship between doctors and patients.