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Biomedical subjects

Diane Williams

Publications and source records attributed to Diane Williams.

7 recordsLinked to original sources
PubMed2006

Computerized tomographic simulation compared with clinical mark-up in palliative radiotherapy: a prospective study.

PURPOSE: To evaluate the impact of computed tomographic (CT) planning in comparison to clinical mark-up (CM) for palliative radiation of chest wall metastases. METHODS AND MATERIALS: In patients treated with CM for chest wall bone metastases (without conventional simulation/fluoroscopy), two consecutive planning CT scans were acquired with and without an external marker to delineate the CM treatment field. The two sets of scans were fused for evaluation of clinical tumor volume (CTV) coverage by the CM technique. Under-coverage was defined as the proportion of CTV not covered by the CM 80% isodose. RESULTS: Twenty-one treatments (ribs 17, sternum 2, and scapula 2) formed the basis of our study. Due to technical reasons, comparable data between CM and CT plans were available for 19 treatments only. CM resulted in a mean CTV under-coverage of 36%. Eleven sites (58%) had an under-coverage of >20%. Mean volume of normal tissues receiving >/=80% of the dose was 5.4% in CM and 9.3% in CT plans (p = 0.017). Based on dose-volume histogram comparisons, CT planning resulted in a change of treatment technique from direct apposition to a tangential pair in 7 of 19 cases. CONCLUSIONS: CT planning demonstrated a 36% under-coverage of CTV with CM of ribs and chest wall metastases.

Bone Neoplasms↗
PubMed2006

Decision making in palliative radiation therapy: reframing hope in caregivers and patients with brain metastases.

GOALS OF WORK: To explore the major factors important in decision making for whole-brain radiotherapy (WBRT) for patients with brain metastases and their caregivers. PATIENTS AND METHODS: Two parallel qualitative studies, one for patients and one for caregivers of patients with newly diagnosed brain metastases, were conducted. Semistructured interviews were conducted and audiotaped with each participant. Content analysis and theme extraction of the transcripts were undertaken to identify recurring themes and relational patterns. RESULTS: Twenty patients and 19 caregivers (including eight patient and caregiver pairs) were recruited into the study. Four major factors were identified to influence decision making of whole-brain radiation: hope, knowledge, expectations of radiation therapy, and current symptoms. Analysis reveals that patients generally focus on current informational needs, while caregivers want more information about the future (e.g., life expectancy and anticipated symptoms). Caregivers expressed frustration when unable to explore future needs because patients were unprepared to discuss prognostic issues. Participants expressed substantial relief when offered WBRT after the diagnosis, but WBRT is often considered the only available plan rather than an informed choice. CONCLUSIONS: Given the importance of caregivers in the care of patients with brain metastases, fulfilling their unique informational needs appears to require more attention. The blurred boundary between hopes and expectations for WBRT creates unique challenges in joint treatment decision making for patients with brain metastases and their caregivers.

Adaptation, Psychological↗
PubMed2004

A brief problem-solving intervention for family caregivers to individuals with advanced cancer.

OBJECTIVE: To evaluate a brief problem-solving intervention for family caregivers to individuals with advanced cancer. METHOD: Family caregivers were recruited through oncology clinics of a large tertiary care hospital in Canada. Those providing informed consent completed a baseline survey, received a brief problem-solving intervention, received a detailed home care guide, and completed a follow-up survey over the telephone 4 weeks after receiving the intervention. RESULTS: Thirty-four family caregivers completed all aspects of the study. Sixty-eight percent of caregivers were women, 73.5% were married to the care recipient, and their average age was 53.6 years. This brief intervention resulted in improvements in emotional tension (P<.03), caregiving confidence (P<.06), and positive problem-solving orientation (P<.06). CONCLUSION: These findings suggest that even a brief problem-solving intervention may be beneficial for family caregivers to individuals with advanced cancer.

Caregivers↗
PubMed2003

The success of data collection in the palliative setting--telephone or clinic follow-up?

Assessment of outcomes is essential in order to improve available palliative treatments. Collecting follow-up information can be a challenging task in the palliative setting. We compared the effectiveness of data collection by telephone contact and clinic visit in 112 patients with brain metastases treated with whole-brain radiotherapy. The first 56 patients (group A) were followed by telephone only. The second 56 patients (group B) were asked to attend an outpatient clinic appointment 4 weeks after radiotherapy. Successful contact was defined as obtaining data at week 4. Patients in the two groups did not differ significantly with regard to age, sex, performance status, primary site, number of brain metastases, or the treatment given. The proportions of patients with successful follow-up contact at week 4 were 45% and 61% in groups A and B, respectively ( P = 0.09). The quality of the collected data did not differ significantly between the two groups. The side effects and responses to therapy were similar. However, there were significantly more patients with a reduced dose of dexamethasone among the successful contacts in group B, which probably reflected the better condition of the patients coming back to clinic at week 4. In conclusion, there was a trend towards more successful data collection in our clinic follow-up. Some of the observed outcome data suggest that the two methods of follow-up might be reaching different populations of patients; considering this and the high attrition rate, a combined follow-up strategy of clinic and telephone contacts might be the best strategy.

Ambulatory Care↗