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Aim: This study aimed to examine the reasons why some people chose to abate (i.e., stop or not start) renal dialysis, together with the personal and social impact of this decision on the person concerned, and/or their families. Method: A qualitative design based on the principles of Grounded Theory was employed. Semi-structured interviews were conducted with sixteen patients and/or carers (depending on whether the patient was able to be interviewed) where the issue of dialysis abatement was being considered, or had recently been decided. Results: Of 52 participants considered for entry into the study 41 were ineligible, with impaired cognition, rapid medical deterioration, and inability to speak sufficient English being the main reasons for exclusion. The desire not to burden others and the personal experience of a deteriorating quality of life were crucial elements in the decision to stop or decline dialysis. The problem of prognostic uncertainty and a sense of abandonment were also prominently expressed. Conclusions: From this small Australian sample, it appears that there would be considerable potential benefit from a more proactive and open approach to end-of-life issues, with incorporation of the clinical and health promoting principles of palliative care into renal dialysis practice. The high number of exclusions shows how sick and unstable this population of patients is, but the issue of data gathering from people whose main language is not English requires attention. [ABSTRACT FROM AUTHOR]

Abstract: Background: No studies to date exist regarding the attire of physicians on a surgical service. The objective of this study was to determine patient, surgeon, and nonhospitalized public (NHP) attitudes and preferences regarding surgeons’ attire and mannerisms. Methods: A questionnaire was developed to survey each group. The Internet was used as a novel avenue to survey the NHP. Eight questions were presented to each group, and each question had three possible responses: agree, disagree, or no opinion. Total responses and percentages were determined for each group’s answers, and statistical analysis was performed using chi-square test. Results: Thirty-eight surgical inpatients, 38 surgeons, and 334 NHP participated in the study. All groups agreed that surgeons should wear nametags while they are seeing patients. Inpatients agreed with surgeons that surgeons should wear white coats while seeing patients (P > .05). Surgeons considered scrubs and clogs to be acceptable attire, which differed from all other groups (P < .05). Although 31% of the NHP considered blue jeans acceptable, only 10% of surgeons (P < .05) and 22% of patients (P > .05) considered them acceptable. All groups believed that a surgeon’s appearance influences their perceptions and impressions regarding the quality of medical care they received (P < .05). Conclusions: Based on the agreement of all groups that a surgeon’s appearance and mannerisms affects perceptions of the quality of medical care received, surgeons should respond to these perceptions and dress accordingly while seeing surgical patients. [Copyright &y& Elsevier]

GARCEA G., LLOYD T., STEWARD W.P., DENNISON A.R.& BERRY D.P. (2005) European Journal of Cancer Care 14, 166–170 Differences in attitudes between patients with primary colorectal cancer and patients with secondary colorectal cancer: is it reflected in their willingness to participate in drug trials? Recruitment of patients into drug trials is essential in order to evaluate new treatments. Knowing why patients enter drug trials and their fears regarding them can be used in future research to ensure good recruitment and provide a supportive atmosphere for patients. Forty patients with colorectal cancer and 30 patients with colorectal liver metastases were asked to participate in a drug trial involving the oral consumption of a diet-derived agent of unknown therapeutic action. All patients agreeing or refusing to participate were asked to complete a short questionnaire with a series of options detailing the reasons behind their decision. Patients with colorectal hepatic metastases were motivated by altruism in entering the trial (e.g. helping others, helping the investigator) and displayed a realistic expectation that the drug would give little direct benefit to them. Patients with primary colorectal tumours were motivated by more‘selfish’ reasons such as helping themselves and displayed an unrealistic expectation concerning any therapeutic benefit from the trial drug. Over 90% of all patients polled stated that their decision was made after reading the patient information leaflet. Patients with different stages of the same disease have very different fears and anticipations of drug trials, which need to be addressed specifically. The importance of the initial contact is demonstrated. Unrealistic expectations regarding the trial drug are common despite clear information to the contrary. [ABSTRACT FROM AUTHOR]

Family orientation is one of basic features of family practice. The purpose of the study was to explore the patients’ opinions about family physician involvement in family related issues, and to identify the factors that may influence the patients’ opinions. Altogether 514 patients complited a questionnaire. Logistic regression analysis was used to predict the factors which determine patient orientation to talk about family related issues. The results indicate that the patients’ health and the family background influence their willingness to talk to family physicians about their family related problems. The findings of the study confirm that special attention should be paid to patients who definitely have family problems because of chronic illness, or an alcohol or drug using family member, or those who are widowed or divorced. Also, the ethnic origin was found to have an impact on patient opinions of family physicians’ family involvement. [Copyright &y& Elsevier]

Despite significant debate about appropriate disposition of cryopreserved embryos, information about the attitudes of individuals who will ultimately decide about disposition, namely individuals who underwent IVF to create them, is limited. Our aim was to qualitatively describe the range of attitudes of individuals regarding their cryopreserved embryos. We conducted in-depth, semi-structured interviews with 31 women and 7 couples from two reproductive endocrinology clinics who have, have had, or anticipate having cryopreserved embryos as a result of IVF. Thirty-one individuals/couples had from 1 to more than 20 embryos in storage. Many expressed uncertainty about plans for embryo disposition, citing a lack of resources for informed decision-making and concerns about available options. When questioned about potentially acceptable options, 28 specified future attempts at pregnancy, 14 specified donation for research purposes, 9 specified donation to another couple, and 4 specified thawing and discarding spare embryos. These data suggest a wide range of attitudes among individuals regarding disposition of their cryopreserved embryos. Further study is needed to quantify the prevalence of these attitudes and concerns. [Copyright &y& Elsevier]

This paper draws upon published literature, focus groups, workshops, and individual patient views to identify general use of Internet for health information and, specifically, use of cross-border Internet pharmacy Web sites to locate and purchase prescription drugs. The paper applies the theoretical frameworks of risk perception theory and social cognition theory to attempt to explain why American patients continue to shop for prescription medications through cross-border Internet pharmacies (CBIP) despite its questionable legal status and potential for serious harm. [ABSTRACT FROM PUBLISHER]

Many randomized trials in specialist palliative care (SPC) have failed to recruit sufficient numbers of patients. A questionnaire was designed to assess the attitudes of inpatients of a SPC unit to taking part in research. Only 50% of patients were considered physically and mentally fit for interview. Forty patients and 13 nurses were asked to indicate their willingness to take part, or for their patients to take part, in research in general and then in three hypothetical trials. Reasons for their responses were analysed. The patients were generally agreeable to trial participation (66% 'quite happy' or 'very happy'). The nurses were strongly in favour of research participation for the same group of patients (92% 'quite happy' or 'very happy'). The most invasive study involving venepuncture and random drug allocation had the least favourable response (46% of patients and 54% of nurses 'quite happy' or 'very happy'). A trial of reflexology attracted 77% of patients, while 62% were happy to take part in a study involving mood assessment and interview. Factors deterring willingness to participate included the need for record keeping by the patient and concern about potential emotional strain. The nurses correctly identified some of the factors deterring patients, but often their willingness for trial participation did not match that of the patient. Although there is support for research among the small number of potential trial entrants in specialist palliative care units, their limited physical and emotional reserves make careful attention to appropriate trial design essential to the success of future studies. [ABSTRACT FROM AUTHOR]

The aim of this study was to undertake a systematic analysis, using qualitative software, of the free text comments from a postal survey exploring women's experiences of breast symptoms, their expectations of treatment, knowledge of breast cancer risk factors and perceptions of risk, in 34 group general practices in South Wales. The 959 women who returned the questionnaire, out of 1126 (response rate 85%), comprised 497 women who consulted their general practitioner (GP) with a new breast symptom during the baseline data collection period and 462 controls who had not. When the survey was conducted the researchers did not know whether these women had cancer or had previously been treated for it. One-third (33.1%) of those returning the survey (n = 318) wrote comments. Compared to the rest, they were significantly more likely to have consulted their GP for a new breast symptom and to have stayed on at school and/or gone on to more education or training. The majority wrote about their own experience of breast symptoms and/or the care received in primary and secondary settings. The general tone was factual and when evaluation took place positive comments were more frequent than negative ones. Nothing suggested that the respondents had been upset or made more anxious by the preceding questions on such a potentially sensitive topic. Free text comments gathered in surveys can provide valuable data if systematically analysed. Doctors, particularly GPs, can be reassured that more women in this community sample who expressed an opinion on care were positive. The negative comments, however, highlight issues that still need to be addressed in therapeutic relationships. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To lay the groundwork for a better understanding of patient views on medical confidentiality. DESIGN: Studies were found by searching medline, bioethicsline, and selected bibliographies. Articles concerning physician perspectives or implications of legal and administrative regulations were excluded. Only peer-reviewed journal articles reporting original research on patients' confidentiality views and conduct were included. MAIN RESULTS: Many patients are unaware of or misunderstand their legal or ethical right to medical confidentiality protections, which leads them to both over- and underestimate confidentiality protections. The possibility that medical information might be revealed, intentionally or not, to acquaintances in a clinic or other social community troubles patients as much as information release to insurers or employers. A significant minority of patients distrust confidentiality protections, leading some to report that they delay or forgo medical care. If doubtful that confidentiality will be upheld, patients will act independently to protect information. CONCLUSIONS: Our review found a wider variety of understandings and beliefs about medical confidentiality among patients than are often indicated in the writings of practitioners or legal experts. As medical confidentiality regulations evolve, these differences need to be recognized and accounted for in interactions between practitioners and patients. [ABSTRACT FROM AUTHOR]

: ObjectiveTo further explore the patient experience of seeking help for a sexual function complaint.: DesignSurvey administered on a Web-based instrument.: SettingHealthy volunteers visiting an online Website.: Patient(s)The majority of participants were married (73%), Caucasian (88%), and premenopausal (67%). Most commonly reported sexual complaints included low desire (77%), low arousal (62%), and difficulty achieving orgasm (56%).: Intervention(s)None.: Main outcome measure(s)Patient experience survey on a women’s sexual health website.: Result(s)Although 40% of the women reported that they did not seek help from a physician for sexual function complaints, 54% reported that they would like to. Although only a minority of the women internalized their experience with extremely negative emotions like shame, devaluation, or disgust, the experience was not a particularly emotionally positive one along the lines of relief, optimism, or confidence, and a great deal of frustration and anxiety about treatment was reported.: Conclusion(s)The extent to which health professionals currently receive exposure to training in human sexuality as well as the way in which female sexual complaints are handled in the medical setting remain ambiguous. The inflow of patients with sexual function complaints only will increase, and it is time for physicians to start to acknowledge women’s sexuality with the same importance their patients do. [Copyright &y& Elsevier]

This qualitative study explores the feelings and beliefs of patients hospitalized in an orthopedic rehabilitation ward for receiving psychological help in that setting. Semi-structured interviews with 10 hospitalized patients were audiotaped, transcribed verbatim, and analyzed using interpretative phenomenological analysis (IPA). Themes of an approach–avoidance conflict towards receiving psychological help were identified, some of them unique to the hospital setting. Approach tendencies were associated with high psychological distress, awareness of free accessibility, and beliefs in body-mind relationship. Avoidance tendencies were associated with fears of psychotherapy, misconceptions, and perceived threats to one’s independence and self-esteem. The implications of these findings for the provision of psychological counseling in hospital settings are discussed. [Copyright &y& Elsevier]

OBJECTIVE: To examine patient and physician preferences in regard to 5 colorectal cancer screening alternatives endorsed by a 1997 expert panel, determine the impact of patient and physician values regarding certain test features on screening preference, and assess physicians' perceptions of patients' values. DESIGN: Cross-sectional survey. SETTING: A general internal medicine practice at an academic medical center in 1998. PARTICIPANTS: Patients (N = 217; 76% response rate) and physicians (N = 39; 87% response rate) at the study setting. MEASUREMENTS AND MAIN RESULTS: Patients preferred fecal occult blood testing (43%) or colonoscopy (40%). In patients for whom accuracy was the most important test feature, colonoscopy (62%) was the preferred screening method. Patients for whom invasive test features were more important preferred fecal occult blood testing (76%; P < .001). Patients and physicians were similar in their values regarding the various test features. However, there was a significant difference between physicians' perceptions of which test features were important to patients compared with the patients' actual responses (P < .001). The largest discrepancy was for accuracy (patient actual 54% vs physician opinion 15%) and discomfort (patient actual 15% vs physician opinion 64%). CONCLUSIONS: Patients have distinct preferences for colorectal cancer screening tests that are associated with the importance placed on certain test features. Physicians incorrectly perceive those factors that are important to patients. Physicians should incorporate patient values in regard to certain test features when discussing colorectal cancer screening with their patients and when eliciting their screening preferences. [ABSTRACT FROM AUTHOR]

Objective: To investigate how patients included in trials on treatment in the early phase of acute myocardial infarction experience the consent procedure. Design: A combined qualitative and quantitative interview concerning the patients' knowledge of the trial, their feelings about being asked to participate, and their attitudes towards the consent procedure. Setting: Tertiary referral centre. Patients: 31 patients who had given written informed consent for their participation in randomised intervention trials of acute myocardial infarction. Results: The patients interviewed had only fragmentary knowledge about the trial they were involved in. Most considered that reading and signing a consent form was an unwanted or unnecessary procedure. Instead, they would have preferred to have been given concise verbal information about the study. Most were willing to allow a physician to decide for them in the event of their being too ill to be asked about their participation. Conclusions: Patients who are asked to participate in intervention trials in the early phase of acute myocardial infarction often appear to lack sufficient knowledge to reach an autonomous choice. There were problems and disadvantages associated with the process of obtaining written informed consent in this particular situation, especially regarding the need for the patient to sign a consent form during the acute phase of the disease. [ABSTRACT FROM AUTHOR]

We used a cross-sectional survey to compare the views of African-American and white adult primary care patients (N = 76) regarding the importance of various aspects of depression care. Patients were asked to rate the importance of 126 aspects of depression care (derived from attitudinal domains identified in focus groups) on a 5-point Likert scale. The 30 most important items came from 9 domains: 1) health professionals' interpersonal skills, 2) primary care provider recognition of depression, 3) treatment effectiveness, 4) treatment problems, 5) patient understanding about treatment, 6) intrinsic spirituality, 7) financial access, 8) life experiences, and 9) social support. African-American and white patients rated most aspects of depression care as similarly important, except that the odds of rating spirituality as extremely important for depression care were 3 times higher for African Americans than the odds for whites. [ABSTRACT FROM AUTHOR]

Objective: To examine the experience, knowledge and attitudes of recipients of transcranial magnetic stimulation (TMS) regarding the treatment. There have been no studies of patient views about TMS. Method: A 60-item survey was administered by telephone to persons with depressive illness who received TMS at Royal Hobart Hospital, Tasmania. Results: Forty-eight patients were interviewed. About two-thirds also had a history of treatment with electroconvulsive therapy (ECT). Experience and opinions about TMS were generally very positive. Almost three-quarters of interviewees believed TMS had been helpful. The vast majority rated TMS as more acceptable than having, or the prospect of having, ECT. The majority would have TMS again and would recommend it to others. Conclusions: The mostly favourable experiences and attitudes reported by interviewees will be reassuring to patients, their families and treating health professionals when TMS is being considered. [ABSTRACT FROM AUTHOR]

Objectives: To identify how perceptions, attitudes, and beliefs towards pseudotherapies, health, medicine, and the public health system influence the pseudotherapy use in Spain. Methods: We carried out a cross-sectional study using the Survey of Social Perception of Science and Technology-2018 (5,200 interviews). Dependent variable: ever use of pseudotherapies. Covariables: attitude towards medicine, health and public health system; perceived health; assessment of the scientific character of homeopathy/acupuncture. The association was estimated using prevalence ratios obtained by Poisson regression models. The model was adjusted for age and socioeconomic variables. Results: Pseudotherapy use was higher in women (24.9%) than in men (14.2%) ( p < 0.001). The probability of use in men ( p < 0.001) and women ( p < 0.001) increases with the belief in pseudotherapies' usefulness. Among men, a proactive attitude (reference: passive) towards medicine and health (RP:1.3), and a negative (reference: positive) assessment of the quality of the public health system increased use-probability (RP:1.2). For women, poor health perceived (referencie: good) increased likelihood of use (RP:1.2). Conclusion: Pseudotherapy use in Spain was associated with confidence in its usefulness irrespective of users' assessment of its scientific validity., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Segovia and Sanz-Barbero.)

Aim: The aims of this study were to explore factors that influence initiation and continuation of statin therapy. Patients & methods: Mixed-method design employed with 73 patients completing surveys and 14 patients participating in semi-structured interviews. Results: When lower total cholesterol is achieved, patients' views are favorable while views of statin therapy diminish among those with higher total cholesterol values. All patients are concerned with adverse events including the potential for developing diabetes. However, overall patients believe the benefits of statins outweigh the risk of diabetes. Conclusion: Barriers remain that prevent patients from achieving cholesterol goals and maintaining or initiating statin therapy. Effective strategies to provide accurate information about the risks and benefits of statin therapy, and implementation of shared decision-making to improve medication adherence and persistence are needed.

Introduction: Understanding clinical trial experiences can illuminate opportunities to optimize trial design and management, with potential benefits for recruitment and retention. This study sought to better understand clinical trial participant experiences and attitudes within spinal muscular atrophy (SMA), and how the evolving treatment landscape and participant characteristics may predict attitudes., Methods: A survey was developed following a review of published literature and discussions with caregivers of SMA trial participants. This was distributed via email to known trial participants in Cure SMA's database, announcements in Cure SMA's newsletter, and emails to SMA clinical trial principal investigators., Results: Seventy complete surveys reflecting unique clinical trial experiences were included in analysis. Responses revealed positive attitudes about clinical trial management overall. Top motivators for trial participation included clinical benefit, investigational drug access, and the opportunity to help others. Top concerns were safety, whether benefits would justify risks, and concerns about pain accompanying tests. The greatest stressors were fear of pain, adverse event concerns, and challenges managing medical complications of SMA. Top benefits of trial participation were hope for a better future, helping others, and relationships with the study team. In regression analysis, participant gender, age, and race all emerged as significant predictors (p < 0.05) of motivators, concerns, stressors, and benefits, as did respondent type, knowledge about SMA, distance to the trial site, and treatment era. Top recommendations for improving study management all related to receiving more information., Conclusion: This research provides new perspective on patient experiences in SMA clinical trials. It underscores the importance of information and efforts to anticipate and accommodate participant needs. These findings may inform study design and interactions with research participants. They may become especially important in supporting recruitment and retention as more treatment options become available., (© 2022. The Author(s).)

Globalisation and migration trends are reflected in emergency departments (EDs), which increasingly care for patients and employ staff from diverse cultural and/or ethnic backgrounds. EDs are busy, pressured and unpredictable environments where effective communication with patients and families is challenging at the best of times. This is compounded by language and cultural barriers experienced by patients and families whose background differs from the prevailing culture. Cultural differences and language comprehension may also be a challenge for overseas nurses recruited to the ED, who may need support from colleagues and organisations. ED nurses therefore need to be competent in intercultural communication. This involves combining optimal interpersonal skills with cultural awareness, knowledge and sensitivity., Competing Interests: None declared, (© 2022 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

The health sector faces a series of problems generated by patients who miss their scheduled appointments. The main challenge to this problem is to understand the patient's profile and predict potential absences. The goal of this work is to explore the main causes that contribute to a patient's no-show and develop a prediction model able to identify whether the patient will attend their scheduled appointment or not. The study was based on data from clinics that serve the Unified Health System (SUS) at the University of Vale do Itajaí in southern Brazil. The model obtained was tested on a real collected dataset with about 5000 samples. The best model result was performed by the Random Forest classifier. It had the best Recall Rate (0.91) and achieved an ROC curve rate of 0.969. This research was approved and authorized by the Ethics Committee of the University of Vale do Itajaí, under opinion 4270,234, contemplating the General Data Protection Law. [ABSTRACT FROM AUTHOR]

Objectives: Unused/expired medicines that are improperly disposed of can enter soil and water supply and have negative implications for public health. This study aimed to assess patients' knowledge and understanding of medication disposal practices and their willingness to participate in a medication takeback programme., Methods: A self-administered questionnaire comprising of 26 questions based on demographics, knowledge, beliefs, practices and concerns was utilized in this study. The study was conducted over 12 weeks at outpatient pharmacy sites located in the four Regional Health Authorities in Trinidad. Statistical Package for the Social Sciences (SPSS) version 24 was used for statistical analysis., Key Findings: A total of 547 persons completed the questionnaire. Knowledge of the dangers of improper medication disposal was highest in those aged 18-25 years (P = 0.007) and having secondary/tertiary level education (P = 0.002). Disposal of unused/expired medication via household thrash (86.1%) was the most commonly encountered practice. Only 14.1% (n = 77) of respondents asked the pharmacist for advice on best disposal practice, although 47.3% (n = 259) thought that the pharmacist should be the main source of advice for information on medication disposal practices. There was a willingness to participate in a medicine takeback programme from 82% (n = 449) of the respondents, and the majority (67.5%) (n = 303) would prefer it if medication takeback programmes were implemented at private community pharmacies., Conclusions: Patients in Trinidad utilized household garbage as their main disposal method. There is a need to implement a medication takeback programme and educate the public on proper medication disposal., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Royal Pharmaceutical Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To evaluate patients' attitudes regarding their dizziness, provider capabilities, and receptiveness toward treatment., Study Design: Cross-sectional study., Setting: Tertiary care vestibular clinic., Patients: Ages 18 years or older, fluent in English, and who presented with a chief complaint of dizziness or vertigo., Intervention(s): N/A., Main Outcomes Measure(s): Non-validated questionnaire surveying patients' beliefs regarding the cause of their dizziness, likelihood of successful treatment, and openness to various treatment modalities., Results: Patients were asked to complete an online non-validated survey regarding their dizziness prior to being evaluated in neurotology clinic. About 67 surveys were completed between January 2017 and September 2018. A majority of patients attributed their dizziness to their ears (n = 47, 70%), followed by the brain (n = 29, 43%). Most subjects chose "neither agree nor disagree" about whether their provider could identify the cause of their dizziness (27%). Most subjects also chose "neither agree nor disagree" that their dizziness would resolve with treatment (31%). These attitudes were not influenced by demographics, dizziness severity, anxiety, depression, or quality of life on multivariate ordinal regression modeling., Conclusions: Patients who experience dizziness have neutral attitudes with regards to believing that their provider will be able to identify the cause of their dizziness and whether their dizziness will resolve with treatment. These neutral attitudes are experienced by a plurality of patients and do not differ by demographic information, dizziness handicap, quality of life, depression, or anxiety.