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Biomedical subjects

Bernard Lo

Publications and source records attributed to Bernard Lo.

54 records · Page 3Linked to original sources
PubMed2002

Discussing religious and spiritual issues at the end of life: a practical guide for physicians.

As patients near the end of life, their spiritual and religious concerns may be awakened or intensified. Many physicians, however, feel unskilled and uncomfortable discussing these concerns. This article suggests how physicians might respond when patients or families raise such concerns. First, some patients may explicitly base decisions about life-sustaining interventions on their spiritual or religious beliefs. Physicians need to explore those beliefs to help patients think through their preferences regarding specific interventions. Second, other patients may not bring up spiritual or religious concerns but are troubled by them. Physicians should identify such concerns and listen to them empathetically, without trying to alleviate the patient's spiritual suffering or offering premature reassurance. Third, some patients or families may have religious reasons for insisting on life-sustaining interventions that physicians advise against. The physician should listen and try to understand the patient's viewpoint. Listening respectfully does not require the physician to agree with the patient or misrepresent his or her own views. Patients and families who feel that the physician understands them and cares about them may be more willing to consider the physician's views on prognosis and treatment. By responding to patients' spiritual and religious concerns and needs, physicians may help them find comfort and closure near the end of life.

Decision Making↗
PubMed2002

How do patients view the role of the primary care physician in inpatient care?

As hospitalized patients are increasingly cared for by physicians who are not their primary care physicians, discontinuity of care occurs when patients are sickest. We sought to determine hospitalized patients' knowledge, preferences, and satisfaction regarding the involvement of their primary care physician in their inpatient care. We conducted a cross-sectional questionnaire of 73 patients cared for by inpatient physicians and 12 relatives of such patients on an inpatient general medical service in a teaching hospital. Eligible patients were those admitted to the care of an inpatient physician other than their primary care provider (PCP), who stayed in the hospital for >1 day. If these patients were too sick to be interviewed or did not speak English, a relative knowledgeable about their medical care was interviewed. In all, 87% of patients had a primary care physician. Of these, 33% had some contact with their PCP while in the hospital. A total of 66% of respondents were satisfied with the contact they or their relative had with the PCP. Some 61% of respondents knew that communication had occurred between the inpatient and PCP. Respondents generally had positive opinions of their hospital care. However, most agreed that patients receive better care from and have more trust in physicians they have known for a long time, compared with those they have just met. About 50% of respondents believed that a PCP (rather than a separate hospital physician) should inform a patient of a serious diagnosis or discuss choices between medical and surgical management. Patients under the care of an inpatient physician want contact with their PCP and want good communication between the PCP and hospital doctors. Systems should be established to facilitate communication between in patient and primary care physicians, and between PCPs and patients.

Adult↗
PubMed2002

Ethical and policy implications of hospitalist systems.

Hospitalist systems raise ethical and policy concerns regarding informing patients about the hospitalist system itself, communication between primary care physicians and hospitalists, continuity of care, and conflicts of interest. Patients may worry that hospitalist systems are intended to achieve cost savings and that the role of the primary care physician as coordinator of care may be undermined. These concerns may be particularly salient for certain subgroups of patients. Hospitalists and health-care organizations that set up hospitalist systems should take steps to reduce the foreseeable risks that discontinuity of care might cause. Practice standards should be set for communication between primary care physicians and hospitalists and for involvement of primary physicians in inpatient care under certain circumstances. By setting such standards and monitoring performance, hospitalist systems can improve the quality of care and reassure patients.

Communication↗
PubMed2002

The challenges of IRB review and human subjects protections in practice-based research.

Practice-based research raises unique challenges with respect to human subjects protections and institutional review board (IRB) review. In this paper, three challenges posed by practice-based research are analyzed: (1) IRB review for clinician investigators who are not affiliated with an institution that has an IRB; (2) multiple IRB review; and (3) required human subjects protection training of key personnel. Investigators should be proactive in addressing required IRB review in practice-based research. In particular, they need to ensure that appropriate IRB review is obtained for all performance sites and plan for review for unaffiliated investigators. Practice-based research investigators and professional societies should educate IRB members and policy makers and publish articles regarding how IRBs might best address human subjects concerns in practice-based research. Furthermore, practice-based research investigators and professional societies should work with IRBs and the Office for Human Research Protections to facilitate centralized or cooperative review of practice-based research. Finally, practice-based research investigators need to ensure that their clinician investigators receive appropriate training in human subjects protection. Practice-based research investigators and professional societies can facilitate this process by helping to define and implement the appropriate training for busy practice-based research clinicians and office staff.

Ethics↗
PubMed1992

Futility: not just a medical issue.

We do not like the idea of doctors and nurses being forced to provide care that offends their sense of themselves and their art. But we like even less the idea of physicians allocating resources without the force of society's judgment. Physicians must help craft the policies on futility or those policies will not reflect sound medical judgment. But how our country creates policies is as important as what the policies mandate. If our society requires physicians to create health care policies on their own, we will shirk our responsibility to ourselves.

Decision Making↗
PubMed1986

Legal perceptions and medical decision making.

Medicine and law are more closely intertwined than ever before, particularly regarding issues of life-sustaining treatment for the elderly. The legal system's potential as a positive force in medical decision making has been limited by pervasive misperceptions by physicians of its processes and role. Identifying these myths and misperceptions is a first step toward a more effective partnership of medicine and law on behalf of the dying or demented patient.

Aged↗
PubMedDate not supplied

Advance care planning.

Advance directives allow patients to have some control over decisions even when they are no longer able to make decisions themselves. All states authorize written advance directives, such as the appointment of a health care proxy, but commonly impose procedural requirements. Some states have restricted the use of oral advance directives, although they are frequently used in everyday practice. Advance directives are limited because they are infrequently used, may not be informed, and may conflict with the patient's current best interests. Moreover, surrogates often cannot state patients' preferences accurately. Furthermore, discussions among physicians and patients about advance directives are flawed. Physicians can improve discussions about advance directives by asking the patient who should serve as proxy and by ascertaining the patient's values and general preferences before discussing specific clinical situations.

Advance Care Planning↗
PubMedDate not supplied

Human subjects issues and IRB review in practice-based research.

PURPOSE: This article explores the challenges that practice-based research networks (PBRNs) face with respect to the regulatory requirements for institutional review board (IRB) review and the protection of human subjects in research. METHODS: We used a regulatory and literature review, our previous research involving PBRN researchers, and our experience to identify issues in regulatory compliance and human subjects protections that present challenges to PBRNs and to suggest possible responses. RESULTS: We identified 3 challenges that PBRNs face with respect to regulatory compliance and human subjects protections. First, ensuring compliance with federal regulations governing human subjects research across all participating practices may be difficult. Clinicians may be unfamiliar with the regulatory requirements and may not have access to an IRB that can provide the required protocol review; moreover, different IRBs may impose inconsistent requirements. Second, conducting research in the practice setting presents unique issues regarding identification of human subjects, consent, and confidentiality. Finally, the use of electronic databases across practices for research raises concerns about how to respect the wishes of participants when combining data and how to maintain confidentiality of data. CONCLUSIONS: PBRN research makes unique contributions to the clinical evidence base by collecting data in community settings where most clinical care is provided. Such research, however, also presents unique challenges to human subject protections and regulatory compliance. Addressing these challenges is necessary to maintain public trust in and support for PBRN research. With careful planning, these ethical and regulatory challenges can be overcome.

Biomedical Research↗
PubMedDate not supplied

A new era in the ethics of human embryonic stem cell research.

Scientific progress in human embryonic stem cell (hESC) research and increased funding make it imperative to look ahead to the ethical issues generated by the expected use of hESCs for transplantation. Several issues should be addressed now, even though phase I clinical trials of hESC transplantation are still in the future. To minimize the risk of hESC transplantation, donors of materials used to derive hESC lines will need to be recontacted to update their medical history and screening. Because of privacy concerns, such recontact needs to be discussed and agreed to at the time of donation, before new hESC lines are derived. Informed consent for phase I clinical trials of hESC transplantation also raises ethical concerns. In previous phase I trials of highly innovative interventions, allegations that trial participants had not really understood the risk and benefits caused delays in subsequent trials. Thus, researchers should consider what information needs to be discussed during the consent process for hESC clinical trials and how to verify that participants have a realistic understanding of the study. Lack of attention to the special ethical concerns raised by clinical trials of hESC transplantation and their implications for the derivation of new hESC lines may undermine or delay progress toward stem cell therapies.

Cell Line↗
PubMedDate not supplied

Direct-to-consumer advertising: physicians' views of its effects on quality of care and the doctor-patient relationship.

BACKGROUND: The objective of the study was to determine physicians' views of the effects of Direct-to-Consumer Advertising (DTCA) on health service utilization, quality of care, and the doctor-patient relationship. METHODS: Cross-sectional survey of a nationally representative sample of US physicians to determine their perceptions of the effects of patients discussing information from DTCA on time efficiency; requests for specific interventions; health outcomes; and the doctor-patient relationship. RESULTS: Physicians reported that more than half (56%) of patients who discussed information from DTCA in a visit did so because they wanted a specific intervention, such as a test, change in medication, or specialist referral. The physician deemed 49% of these requests clinically inappropriate. Physicians filled 69% of requests they deemed clinically inappropriate; 39% of physicians perceived DTCA as damaging to the time efficiency of the visit, and 13% saw it as helpful. Thirty-three percent of physicians thought discussing DTCA had improved the doctor-patient relationship; 8% felt it had worsened it. The effect on the relationship was strongly associated with doing what the patient wanted. CONCLUSIONS: DTCA can have good and bad effects on quality of care, the doctor-patient relationship, and health service utilization. The benefits might be maximized, and the harms minimized, by increasing the accuracy of information in advertisements; enhancing physicians' communication and negotiation skills; and encouraging patients to respect physicians' clinical expertise.

Adult↗
PubMedDate not supplied

Direct-to-consumer advertising: public perceptions of its effects on health behaviors, health care, and the doctor-patient relationship.

PURPOSE: To determine public perceptions of the effect of direct-to-consumer advertising (DTCA) of prescription medications on health behaviors, health care utilization, the doctor-patient relationship, and the association between socioeconomic status and these effects. METHODS: Cross-sectional survey of randomly selected, nationally representative sample of the US public using computer-assisted telephone interviewing. MAIN OUTCOME MEASURES: numbers and proportions of respondents in the past 12 months who, as a result of DTCA, requested preventive care or scheduled a physician visit; were diagnosed with condition mentioned in advertisement; disclosed health concerns to a doctor; felt enhanced confidence or sense of control; perceived an effect on the doctor-patient relationship; requested a test, medication change, or specialist referral; or manifested serious dissatisfaction after a visit to a doctor. RESULTS: As a result of DTCA, 14% of respondents disclosed health concerns to a physician, 6% requested preventive care, 5% felt more in control during a physician visit; 5% made requests for a test, medication change, or specialist referral, and 3% received the requested intervention. One percent of patients reported negative outcomes, including worsened treatment, serious dissatisfaction with the visit, or that the physician acted challenged. Effects of DTCA were greater for respondents with low socioeconomic status. CONCLUSIONS: DTCA has positive and negative effects on health behaviors, health service utilization, and the doctor-patient relationship that are greatest on people of low socioeconomic status. The benefits of DTCA in terms of encouraging hard-to-reach sections of the population to seek preventive care must be balanced against increased health care costs caused by clinically inappropriate requests generated by DTCA.

Advertising↗