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4. Pilot study of an online training program to increase genetic literacy and communication skills in oncology healthcare professionals discussing BRCA1/2 genetic testing with breast and ovarian cancer patients.

Author

Meiser B., Woodward P., Gleeson M., Kentwell M., Fan H.M., Antill Y., Butow P.N., Boyle F., Best M., Taylor N., Bell K., Tucker K., Meiser B., Woodward P., Gleeson M., Kentwell M., Fan H.M., Antill Y., Butow P.N., Boyle F., Best M., Taylor N., Bell K., and Tucker K.

Abstract

The increasing use of genetic testing for BRCA1/2 and other pathogenic variants in the management of women with breast and ovarian cancer necessitates increased genetic literacy in oncology healthcare professionals. This pilot study aimed to evaluate an online training program to increase genetic literacy and communication skills in Australian oncology healthcare professionals tasked with discussing and coordinating mainstream genetic testing with breast and ovarian cancer patients. A training website with embedded videos was developed. This study assesses the website's acceptability and user-friendliness; suggestions for improvement were also elicited. Oncology healthcare professionals were recruited through relevant professional organisations, invited to the study by email, asked to work through the website and then complete an online questionnaire. Thirty-two oncology healthcare professionals completed the questionnaire after viewing the website. Nearly all participants were satisfied with the information contained in the program (very satisfied: n = 14/32, 44%, satisfied: n = 17/32, 53%, neither satisfied nor dissatisfied: n = 1/32, 3%) and reported that they had gained new skills (n = 29/32, 91%) and had increased confidence (n = 29/31, 94%) in communicating with breast and ovarian cancer patients about genetic testing. More than 93% (28/30) of participants endorsed the online program as clearly presented, informative, relevant and useful. This pilot study demonstrated high feasibility and acceptability of the training program to increase genetic literacy and communication skills in oncology healthcare professionals discussing genetic testing with breast and ovarian cancer patients. Further evidence from a randomised trial is needed to evaluate effects on changing clinical practice, improving patient outcomes, and cost-effectiveness.Copyright © 2021, The Author(s), under exclusive licence to Springer Nature B.V.

Published
2022

9. Patient-reported outcomes and personalised cancer care.

Author

Koczwara B., Bonnamy J., Briggs P., Brown B., Butow P.N., Chan R.J., Cohn R.J., Girgis A., Jefford M., JL Joske D., Licqurish S., Mackay G., Saunders C.M., Webber K., Koczwara B., Bonnamy J., Briggs P., Brown B., Butow P.N., Chan R.J., Cohn R.J., Girgis A., Jefford M., JL Joske D., Licqurish S., Mackay G., Saunders C.M., and Webber K.

Published
2021

10. Pilot study of an online training program to increase genetic literacy and communication skills in oncology healthcare professionals discussing BRCA1/2 genetic testing with breast and ovarian cancer patients.

Author

Meiser B., Woodward P., Gleeson M., Kentwell M., Fan H.M., Antill Y., Butow P.N., Boyle F., Best M., Taylor N., Bell K., Tucker K., Meiser B., Woodward P., Gleeson M., Kentwell M., Fan H.M., Antill Y., Butow P.N., Boyle F., Best M., Taylor N., Bell K., and Tucker K.

Abstract

The increasing use of genetic testing for BRCA1/2 and other pathogenic variants in the management of women with breast and ovarian cancer necessitates increased genetic literacy in oncology healthcare professionals. This pilot study aimed to evaluate an online training program to increase genetic literacy and communication skills in Australian oncology healthcare professionals tasked with discussing and coordinating mainstream genetic testing with breast and ovarian cancer patients. A training website with embedded videos was developed. This study assesses the website's acceptability and user-friendliness; suggestions for improvement were also elicited. Oncology healthcare professionals were recruited through relevant professional organisations, invited to the study by email, asked to work through the website and then complete an online questionnaire. Thirty-two oncology healthcare professionals completed the questionnaire after viewing the website. Nearly all participants were satisfied with the information contained in the program (very satisfied: n = 14/32, 44%, satisfied: n = 17/32, 53%, neither satisfied nor dissatisfied: n = 1/32, 3%) and reported that they had gained new skills (n = 29/32, 91%) and had increased confidence (n = 29/31, 94%) in communicating with breast and ovarian cancer patients about genetic testing. More than 93% (28/30) of participants endorsed the online program as clearly presented, informative, relevant and useful. This pilot study demonstrated high feasibility and acceptability of the training program to increase genetic literacy and communication skills in oncology healthcare professionals discussing genetic testing with breast and ovarian cancer patients. Further evidence from a randomised trial is needed to evaluate effects on changing clinical practice, improving patient outcomes, and cost-effectiveness.Copyright © 2021, The Author(s), under exclusive licence to Springer Nature B.V.

Published
2021

11. Seeking informed consent to cancer clinical trials: describing current practice

Author

Brown, R.F., Butow, P.N., Ellis, P., Boyle, F., and Tattersall, M.H.N.

Subjects
Cancer -- Research, Health, Social sciences
Abstract

Clinical trials have come to be regarded as the gold standard for treatment evaluation. However, many doctors and their patients experience difficulties when discussing trials, leading to poor accrual to trials and questionable quality of informed consent. We have previously developed a typology for ethical communication about Phase II and III clinical trials within four domains: (a) shared decision making, (b) sequencing information, (c) type and clarity of information, and (d) disclosure/coercion. The aim of this study was to compare current clinical practice when seeking informed consent with this typology. Fifty-nine consultations in which l0 participating oncologists sought informed consent were audiotaped. Verbatim transcripts were analysed using a coding system to (a) identify the presence or absence of aspects of the four domains and (b) rate the quality of aspects of two domains: (i) shared decision-making and (ii) type and clarity of information. Oncologists rarely addressed aspects of shared decision-making, other than offering to delay a treatment decision (78%). Moreover, many of these discussions scored poorly with respect to ideal content. The oncologists were rarely consistent with the sequence of information provision. A general rationale for randomising was only described in 46% of consultations. In almost one third of the consultations (28.8%) doctors made implicit statements favouring one option over another, either standard or clinical trial treatment. Doctors complied with some but not other aspects of a standard procedure for discussing clinical trials. This reflects the difficulty inherent in seeking ethical informed consent and the need for communication skills training for oncologists. Keywords: Australia; Clinical trials; Communication; Informed consent

Published
2004

12. Developing ethical strategies to assist oncologists in seeking informed consent to cancer clinical trials

Author

Brown, R.F., Butow, P.N., Butt, D.G., Moore, A.R., and Tattersall, M.H.N.

Subjects
Medical ethics -- Analysis, Medical research -- Ethical aspects, Medicine, Experimental -- Ethical aspects, Oncology, Experimental -- Ethical aspects, Cancer -- Ethical aspects, Cancer -- Research, Health, Social sciences
Abstract

Randomised clinical trials have come to be regarded as the gold standard in treatment evaluation. However, many doctors see the discussion of a clinical trial as an intrusion into the doctor patient relationship and find these discussions difficult to initiate. Detailed informed consent is now a requirement of patient participation in trials; however, it is known that patients commonly fail to understand and recall the information conveyed. These difficulties for doctors and patients raise questions about the ethical integrity of the informed consent process. In this study, we have developed a set of communication strategies underpinned by ethical, linguistic and psychological theory, designed to assist doctors in this difficult task. Initially, audiotape transcripts of 26 consultations in which 10 medical oncologists invited patients to participate in clinical trials were analysed by expert ethicists, linguists, oncologists and psychologists, using rigorous qualitative methodology. A subset of seven of these was subjected to detailed linguistic analysis. A strategies document was developed to address themes which emerged from these analyses. This document was presented to relevant expert stakeholders. Their feedback was incorporated into the final document. Four themes emerged from the analysis; (a) shared decision-making, (b) the sequence of moves in the consultation, (c) the type and clarity of the information provided and (d) disclosure of controversial information and coercion. Detailed strategies were developed to assist doctors to communicate in these areas. We have developed a set of ethical strategies which may assist health professionals in this difficult area. A training package based on these strategies is currently being evaluated in a multicentre randomised controlled trial. Keywords: Clinical trials; Doctor-patient communication; Oncology; Informed consent; Australia

Published
2004

22. Benefits of a brief psychological intervention targeting fear of cancer recurrence in people at high risk of developing another melanoma: 12‐month follow‐up results of a randomized controlled trial.

Author

Dieng, M., Morton, R.L., Costa, D.S.J., Butow, P.N., Menzies, S.W., Lo, S., Mann, G.J., Cust, A.E., and Kasparian, N.A.

Subjects
CANCER relapse, RANDOMIZED controlled trials, MELANOMA, CLINICAL trial registries, NEOPHOBIA, BRIEF psychotherapy
Abstract

Summary: Background: People with melanoma want and need effective interventions for living with fear of cancer recurrence (FCR). Objectives: This study reports the 12‐month outcomes of a brief, psychological intervention designed to reduce FCR in people at high risk of developing another primary melanoma compared with usual care. Methods: In this two‐arm randomized controlled trial, adults previously diagnosed with stage 0, I or II melanoma were randomly allocated to the intervention (n = 80) or control (usual care) arm (n = 84). The trial was registered with the Australian and New Zealand Clinical Trials Registry on 19 March 2013 (registration: ACTRN12613000304730). The intervention comprised a 76‐page psychoeducational resource and three individually tailored, telephone‐based sessions with a psychologist, scheduled at specific time points around participants' dermatological appointments. The primary outcome was the level of self‐reported fear of new or recurrent melanoma assessed at 12 months postintervention using the severity subscale of the Fear of Cancer Recurrence Inventory. Results: Compared with the control arm, the intervention group reported significantly lower FCR at 12 months postintervention; the between‐group mean difference was −1·41 for FCR severity [95% confidence interval (CI) −2·6 to −0·2; P = 0·02] and −1·32 for FCR triggers (95% CI −2·6 to −0·02; P = 0·04). The odds ratio for FCR severity scores ≥13 (54% intervention, 63% control) was 0·59 (95% CI 0·30–1·14, P = 0·12). There were no differences between groups in secondary outcomes, such as anxiety, depression or health‐related quality of life. Conclusions: The previously reported 6‐month benefits of this brief, patient‐centred psychological intervention in reducing FCR were found to continue 12 months postintervention, with no known adverse effects, supporting implementation as part of routine melanoma care. What's already known about this topic? People treated for early‐stage melanoma are at 5–10 times greater risk of developing new primary disease relative to people without a history of melanoma.As a consequence, people who have had melanoma often experience fear of cancer recurrence (FCR) or progression. What does this study add? In this randomized controlled trial, participants who received a brief, multifaceted, patient‐centred psychological intervention reported significantly lower FCR at 12‐months postintervention compared with those in the control arm.The intervention had no known adverse effects and its benefits persisted long after the last psychology session, supporting implementation as part of routine melanoma care. Respond to this article Linked Editorial:Thompson and Cockayne. Br J Dermatol 2020; 182:821–822. [ABSTRACT FROM AUTHOR]

Published
2020
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24. Fear of Cancer Recurrence in an Era of Personalized Medicine

Author

Thewes, B., Husson, O., Poort, H., Custers, J.A.E., Butow, P.N., McLachlan, S.A., Prins, J.B., Thewes, B., Husson, O., Poort, H., Custers, J.A.E., Butow, P.N., McLachlan, S.A., and Prins, J.B.

Abstract

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Published
2017

25. Randomized Trial of ConquerFear: A Novel, Theoretically Based Psychosocial Intervention for Fear of Cancer Recurrence

Author

Butow, P.N., Turner, J., Gilchrist, J., Sharpe, L., Smith, A.B., Fardell, J.E., Tesson, S., O'Connell, R., Girgis, A., Gebski, V.J., Asher, R., Mihalopoulos, C., Bell, M.L., Zola, K.G., Beith, J., Thewes, B., Butow, P.N., Turner, J., Gilchrist, J., Sharpe, L., Smith, A.B., Fardell, J.E., Tesson, S., O'Connell, R., Girgis, A., Gebski, V.J., Asher, R., Mihalopoulos, C., Bell, M.L., Zola, K.G., Beith, J., and Thewes, B.

Abstract

Item does not contain fulltext, Purpose Fear of cancer recurrence (FCR) is prevalent, distressing, and long lasting. This study evaluated the impact of a theoretically/empirically based intervention (ConquerFear) on FCR. Methods Eligible survivors had curable breast or colorectal cancer or melanoma, had completed treatment (not including endocrine therapy) 2 months to 5 years previously, were age > 18 years, and had scores above the clinical cutoff on the FCR Inventory (FCRI) severity subscale at screening. Participants were randomly assigned at a one-to-one ratio to either five face-to-face sessions of ConquerFear (attention training, metacognitions, acceptance/mindfulness, screening behavior, and values-based goal setting) or an attention control (Taking-it-Easy relaxation therapy). Participants completed questionnaires at baseline (T0), immediately post-therapy (T1), and 3 (T2) and 6 months (T3) later. The primary outcome was FCRI total score. Results Of 704 potentially eligible survivors from 17 sites and two online databases, 533 were contactable, of whom 222 (42%) consented; 121 were randomly assigned to intervention and 101 to control. Study arms were equivalent at baseline on all measured characteristics. ConquerFear participants had clinically and statistically greater improvements than control participants from T0 to T1 on FCRI total ( P < .001) and severity subscale scores ( P = .001), which were maintained at T2 ( P = .017 and P = .023, respectively) and, for FCRI total only, at T3 ( P = .018), and from T0 to T1 on three FCRI subscales (coping, psychological distress, and triggers) as well as in general anxiety, cancer-specific distress (total), and mental quality of life and metacognitions (total). Differences in FCRI psychological distress and cancer-specific distress (total) remained significantly different at T3. Conclusion This randomized trial demonstrated efficacy of ConquerFear compared with attention control (Taking-it-Easy) in reduction of FCRI total scores immediately post-t

Published
2017

26. e-TC: Development and pilot testing of a web-based intervention to reduce anxiety and depression in survivors of testicular cancer

Author

Heiniger, L.E., primary, Smith, A.B., additional, Olver, I., additional, Grimison, P., additional, Klein, B., additional, Wootten, A., additional, Abbott, J.-A.M., additional, Price, M.A., additional, McJannett, M., additional, Tran, B., additional, Stockler, M.R., additional, Gurney, H., additional, and Butow, P.N., additional

Published
2017
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28. The characteristics and effectiveness of Question Prompt List interventions in oncology: a systematic review of the literature

Author

Brandes, K., Linn, A.J., Butow, P.N., van Weert, J.C.M., and Persuasive Communication (ASCoR, FMG)

Abstract

Objective Question Prompt Lists (QPLs) have been used extensively in the oncology setting to improve communication, psychological and/or cognitive outcomes. In this systematic review, the objectives were to (a) examine the methodological quality of QPL interventions, (b) review the effectiveness of QPL interventions on communication, psychological and/or cognitive outcomes of cancer patients, (c) gain more insight into the characteristics of QPL interventions (e.g., the number and content of questions, and the mode of delivery) and (d) explore whether the effectiveness of QPL interventions might be explained by their characteristics. Method A systematic literature search was conducted in PsycINFO, Medline, CINAHL and CENTRAL. Empirical studies that investigated the use and effectiveness of QPL interventions in an oncology setting were included. The methodological quality of the included studies was assessed using the Cochrane method. Results Sixteen articles met the inclusion criteria. Results indicated evidence for the effectiveness of QPL interventions in enhancing patient participation (i.e., question asking). Furthermore, there was evidence that QPL interventions can influence psychological outcomes (i.e., anxiety at follow-up) and cognitive outcomes (i.e., recall of information). The majority of QPL interventions were given to patients before their consultation in hardcopy. In most studies, QPLs were combined with other intervention components. It is suggested that characteristics of a QPL intervention (i.e., the number of questions on a QPL and provider training) can influence its effectiveness. Conclusion Question Prompt List interventions are effective in improving communication, psychological and cognitive outcomes of cancer patients.

Published
2015

29. A randomized controlled trial (RCT) of a supportive care package (SurvivorCare, SC) for survivors of colorectal cancer (CRC).

Author

Shapiro J., Johnson C., Ganju V., Chong G., Strickland A., Schofield P., Charlton J., Jefford M., Gough K., Drosdowsky A., Russell L., Aranda S., Butow P.N., Phipps-Nelson J., Young J., Krishnasamy M., Ugalde A., King D., Franco M.E., Blum R.H., Shapiro J., Johnson C., Ganju V., Chong G., Strickland A., Schofield P., Charlton J., Jefford M., Gough K., Drosdowsky A., Russell L., Aranda S., Butow P.N., Phipps-Nelson J., Young J., Krishnasamy M., Ugalde A., King D., Franco M.E., and Blum R.H.

Abstract

Background: Colorectal cancer (CRC) and its treatments can cause distressing short and long-term side effects as well as significant functional consequences. Current models of follow-up do not adequately address these issues. We conducted a multi-center RCT of an innovative program (SurvivorCare (SC)); designed to have a beneficial effect on psychological distress, supportive care needs (SCN) and quality of life (QOL). Method(s): At the end of active treatment for stage I-III CRC, eligible patients ( =18 years, adequate English) were randomized 1:1 to usual care (UC) or to UC+SC. SC comprised educational materials, needs assessment, an individualized survivorship care plan, nurse-led end-oftreatment session and three follow up (FU) phone calls. Distress (BSI-18), SCN (CaSUN) and QOL (EORTC QLQ-C30, CR29) were assessed at baseline, 2 (FU1) and 6 (FU2) months. Primary hypothesis: SC would have a beneficial effect on distress at FU1. Secondary hypotheses: SC would have a beneficial effect on (1) SCN and QOL at FU1; and (2) distress, SCN and QOL at FU2. 15 items assessed satisfaction with survivorship care. Sample size of 180 (90/arm) was based on 80% power, 2-sided alpha of 0.05, to detect a between groups difference of 3.6 on BSI-18 at FU1. Outcome analysis was ITT. Result(s): Of 221 patients randomized (111 UC, 110 SC), 4 were ineligible and 1 lost to FU, leaving 110 UC, 106 SC. Groups appeared well balanced. Median age was 64, 52% male, 56% colon, 35% rectal cancer, 10% overlap. Stage I 7%, II 22%, III 71%. Intervention fidelity was acceptable. Baseline distress and QOL were similar to population norms. Between groups differences in distress at FU1 (primary outcome), distress at FU2 and SCN and QOL at FU1 and FU2 were small and non-significant. SC patients were more satisfied with survivorship care than UC patients (significant differences on 10 of 15 items). Conclusion(s): The addition of SC to UC did not have a beneficial effect on distress, SCN or QOL outcomes bu

Published
2016

31. A randomized controlled trial (RCT) of a supportive care package (Survivor-Care, SC) for survivors of colorectal cancer (CRC).

Author

PhippsNelson J., Strickland A., Jefford M., Gough K., Drosdowsky A., Russell L., Aranda S., Butow P.N., Young J., Schofield P., Charlton J., Chong G., Shapiro J.D., Ganju V., Johnson C., Blum R.H., Franco M.E., King D., Ugalde A., Krishnasamy M., PhippsNelson J., Strickland A., Jefford M., Gough K., Drosdowsky A., Russell L., Aranda S., Butow P.N., Young J., Schofield P., Charlton J., Chong G., Shapiro J.D., Ganju V., Johnson C., Blum R.H., Franco M.E., King D., Ugalde A., and Krishnasamy M.

Abstract

Background: Colorectal cancer (CRC) and its treatments can cause distressing short and long-term side effects as well as significant functional consequences. Current models of follow-up do not adequately address these issues. We conducted a multi-center RCT of an innovative program (Survivor-Care (SC)); designed to have a beneficial effect on psychological distress, supportive care needs (SCN) and quality of life (QOL). Method(s): At the end of active treatment for stage IIII CRC, eligible patients (>=18 years, adequate English) were randomized 1:1 to usual care (UC) or to UC+SC. SC comprised educational materials, needs assessment, an individualized survivorship care plan, nurseled endoftreatment session and three follow up (FU) phone calls. Distress (BSI-18), SCN (CaSUN) and QOL (EORTC QLQ-C30, CR29) were assessed at baseline, 2 (FU1) and 6 (FU2) months. Primary hypothesis: SC would have a beneficial effect on distress at FU1. Secondary hypotheses: SC would have a beneficial effect on (1) SCN and QOL at FU1; and (2) distress, SCN and QOL at FU2. 15 items assessed satisfaction with survivorship care. Sample size of 180 (90/arm) was based on 80% power, 2sided alpha of 0.05, to detect a between groups difference of 3.6 on BSI-18 at FU1. Outcome analysis was ITT. Result(s): Of 221 patients randomized (111 UC, 110 SC), 4 were ineligible and 1 lost to FU, leaving 110 UC, 106 SC. Groups appeared well balanced. Median age was 64, 52% male, 56% colon, 35% rectal cancer, 10% overlap. Stage I 7%, II 22%, III 71%. Intervention fidelity was acceptable. Baseline distress and QOL were similar to population norms. Between groups differences in distress at FU1 (primary outcome), distress at FU2 and SCN and QOL at FU1 and FU2 were small and non-significant. SC patients were more satisfied with survivorship care than UC patients (significant differences on 10 of 15 items). Conclusion(s): The addition of SC to UC did not have a beneficial effect on distress, SCN or QOL outcomes but S

Published
2015

45. Communication and information-giving in high-risk breast cancer consultations: influence on patient outcomes.

Author

Lobb, E.A., Butow, P.N., Barratt, A., Meiser, B., Gaff, C., Young, M.A., Haan, E., Suthers, G., Gattas, M., and Tucker, K.

Subjects
*BREAST cancer, *GENETIC counseling, *TUMORS, *CANCER, *ONCOLOGY
Abstract

This longitudinal study aimed to document (i) the information-giving and patient-communication styles of clinical geneticists and genetic counsellors (consultants) in familial breast cancer clinics and (ii) assess the effect of these styles on women's knowledge, whether their expectations were met, satisfaction, risk perception and psychological status. A total of 158 women from high-risk breast cancer families completed self-report questionnaires at 2 weeks preconsultation and 4 weeks postconsultation. The consultations were audiotaped, transcribed and coded. Multivariate logistic regressions showed that discussing prophylactic mastectomy (P=0.00) and oophorectomy (P=0.01) led to women having significantly more expectations met; discussing genetic testing significantly decreased anxiety (P=0.03) and facilitating understanding significantly decreased depression (P=0.05). Receiving a summary letter of the consultation significantly lowered anxiety (P=0.01) and significantly increased the accuracy of perceived risk (P=0.02). Women whose consultant used more supportive communications experienced significantly more anxiety about breast cancer at the 4 weeks follow-up (P=0.00). These women were not significantly more anxious before genetic counselling. In conclusion, this study found that consultants vary in the amount of information they give and the way they communicate; and this variation can result in better or worse psychosocial outcomes. Greater use of supportive and counselling communications appeared to increase anxiety about breast cancer. Identifying methods to assist consultants to address emotional issues effectively may be helpful.British Journal of Cancer (2004) 90, 321-327. doi:10.1038/sj.bjc.6601502 www.bjcancer.com [ABSTRACT FROM AUTHOR]

Published
2004
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46. Tailoring communication in consultations with women from high risk breast cancer families.

Author

Lobb, E.A., Butow, P.N., Meiser, B., Barratt, A., Gaff, C., Young, M.A., Kirk, J., Suthers, G.K., and Tucker, K.

Subjects
*FAMILIAL diseases, *BREAST cancer
Abstract

This multicentre study examined the influence of patient demographic, disease status and psychological variables on clinical geneticists/genetic counsellors (consultants) behaviours in initial consultations with women from high-risk breast cancer families. One hundred and fifty-eight women completed a pre-clinic self-report questionnaire. The consultations were audiotaped, transcribed verbatim and coded. Consultants did not vary their behaviour according to women's expectations. However, significantly more aspects of genetic testing were discussed with women who were affected with breast cancer (P<0.001), screening and management with unaffected women (P=0.01) and breast cancer prevention with younger women (P=0.01). Prophylactic mastectomy was discussed more frequently with women with medical and allied health training (P=0.02), and prophylactic oophorectomy with women affected with breast cancer (P=0.03), those in non-professional occupations (P=0.04) and with a family history of breast and ovarian cancer (P<0.001). Consultants used significantly more behaviours to facilitate understanding with women who were in non-professional occupations (P=0.04); facilitated active patient involvement more with women affected with breast cancer (P<0.001) and used more supportive and counselling behaviours with affected women (P=0.02). This study showed that patient demographics were more likely to predict consultants' communication behaviours than the woman's psychological status. Methods to facilitate assessment of psychological morbidity are needed to allow more tailored communication. [ABSTRACT FROM AUTHOR]

Published
2002
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47. When the diagnosis is cancer: patient communication experiences and preferences

Author

Butow, P.N., Kazemi, J.N., Beeney, L.J., Griffin, A.M., Dunn, S.M., and Tattersall, M.H.N.

Subjects
Cancer patients -- Psychological aspects, Physician and patient -- Psychological aspects, Health, Psychological aspects
Abstract

According to the authors' abstract of an article published in Cancer, 'BACKGROUND: Discrepancies exist between reported experiences of patients when they have been given a diagnosis of cancer, published guidelines [...]

Published
1996

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