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L A Siminoff

Publications and source records attributed to L A Siminoff.

At least 19 recordsLinked to original sources
PubMed2000

Factors that predict the referral of breast cancer patients onto clinical trials by their surgeons and medical oncologists.

PURPOSE: To improve understanding of physicians' reluctance to refer patients to clinical trials. METHODS: This study was conducted in a large metropolitan region from 1993 to 1995 using a two-staged population-based sampling strategy. A total of 147 physicians discussed 245 patient cases and their own knowledge, attitudes, and practices toward clinical trials. RESULTS: Ninety-three patients (38. 0%) were offered a trial, and 49 (52.7%) of them agreed to participate. Forty-five patients (18.4%) actually received their adjuvant therapy on trial. Older patients and those with a poorer prognosis were less likely to be referred. Patients who delayed their decision were more than three times as likely to participate in a trial and more than eight times as likely to participate when they were reported to be actively involved in making the decision. Generally, physicians in university settings and who had formal support from a cooperative group were more likely to refer patients to trials. More specifically, surgeons referred more patients to trials when they felt comfortable explaining trials or believed that treatment should not stray from protocol. Oncologists were less likely to make referrals if they perceived the paperwork to be onerous or entry requirements to be too stringent. Surgeons' participation in recommending adjuvant therapy to patients resulted in more trial referrals unless they treated their patients with tamoxifen. CONCLUSION: (1) Physicians still need to overcome attitudinal and practical barriers to trial participation, (2) more support for physicians is needed, (3) surgeons may play a pivotal role in the recruitment of patients to adjuvant therapy trials, and (4) garnering patient enthusiasm for trial participation and involving them in the choice of adjuvant therapy may be key components to increasing trial enrollment.

Adult↗
PubMed1999

The accuracy of hospital reports of organ donation eligibility, requests, and consent: a cross-validation study.

BACKGROUND: Many states require hospitals to complete a form for each patient who dies, reporting the patient's organ and tissue donation eligibility status, whether a request was made, and the outcome of the request. A study was conducted to determine the accuracy of state-required forms in documenting organ eligibility and procurement activities. METHODS: Four Level 1 trauma hospitals in northeast Ohio were sampled by using a weekly review of all deaths. Detailed chart reviews were conducted on a total of 2,270 deaths occurring during a six-month period in 1997, interviews with health care providers and staff members at organ procurement organizations were held, and records of the local Ohio Department of Health (ODH) were reviewed. Agreement between these data sources and the ODH form were compared to evaluate whether the ODH form correctly documented patients' eligibility status, occurrence of a donation request, and donation request outcome. Descriptive statistics and sensitivity and specificity analyses were completed. RESULTS: The quality of the information provided through these forms was variable. Problems included missing, inaccurate, and contradictory data. State reporting forms overrepresented the size of the organ donor pool by about four times, and requests for donation and consent to donation were inaccurately reported. Hospital form completion rates ranged from 12% to 82.6%. CONCLUSIONS: Basing the evaluation of hospital or statewide organ procurement performance on summary information provided by these forms would lead to an inaccurate picture of organ procurement activities in the state.

Brain Death↗
PubMed1998

Patient knowledge and physician predictions of treatment preferences after discussion of advance directives.

OBJECTIVE: To determine patient knowledge about life-sustaining treatments and physician understanding of patient preferences for proxies and treatments after outpatient discussions about advance directives. DESIGN: Cross-sectional interview-based and questionnaire-based survey. SETTING: Two university general internal medicine practices, two Department of Veterans Affairs general internal medicine practices, and one university-based geriatrics practice, in two different cities. PATIENTS: Fifty-six patients of primary care internists. INTERVENTION: Physicians discussed "advance directives" (ADs) with one randomly selected patient during an outpatient visit. MEASUREMENTS AND MAIN RESULTS: After the discussions, physicians identified the patient's proxy and predicted the patient's preferences for treatment in 20 scenarios. Patients provided treatment preferences in the 20 scenarios, the name of their preferred surrogate decision maker, and their understanding of cardiopulmonary resuscitation and mechanical ventilation. Of the 39 patients who discussed resuscitation, 43% were able to identify two important characteristics; 26% identified none; 66% did not know that most patients need mechanical ventilation after undergoing resuscitation. None of the 43 patients who had a discussion about mechanical ventilation had a good understanding of it; 67% did not know that patients generally cannot talk while on ventilators; 46% expressed serious misconceptions about ventilators. There was poor agreement between physicians and their patients regarding treatment preferences in 18 of 20 scenarios (kappa -0.04 to 0.31). Physicians correctly identified the proxy 89% of the time (kappa 0.78). CONCLUSIONS: Patients leave routine AD discussions with serious misconceptions about life-sustaining treatments. Physicians are unable to predict treatment preferences but do learn about patients' preferences for surrogate decision makers.

Advance Directives↗
PubMed1998

Do nurses avoid AIDS patients? Avoidance behaviours and the quality of care of hospitalized AIDS patients.

To examine whether AIDS patients are stigmatized by nurses providing their care a study was conducted with 100 matched AIDS and general medical (GM) patients in two university and two community hospitals. Quality of care and avoidance behaviours were measured by direct, systematic observation during a concurrent 12-hour period. Stigmatizing attitudes of nurses were measured using standardized instruments of homophobia, fear of AIDS and attitudes toward illicit drug use. Nurses made more eye contact and touched AIDS patients more frequently then GM patients, however these differences did not reach the level of statistical significance They spent significantly more time with AIDS patients (W = 3134.0, p = 0.012). Whether or not nurses were fearful of HIV infection, were homophobic or held negative feelings about drug use made no difference in the level of care provided to AIDS patients, but did for GM patients. However, avoidance behaviours were associated with lower quality of care across all patients regardless of diagnosis. Hierarchical regression models demonstrated that increased time spent with patients and higher percentage positive of verbal mannerisms were associated with an increase in the quality of patient care. Provision of physical care showed the least amount of variation between patients in general. It was concluded that nurses' attitudes had no impact on whether or not AIDS patients were shunned by nurses. The provision of psychosocial care showed the greatest variation and seemed more sensitive to individual nurses' attitudes. The quality of care received by the overwhelming majority of patients could only be termed adequate. Nurses exhibited the greatest caution when performing procedures with patients whose HIV status was unknown. The AIDS population studied were mostly well-educated, homosexual men. Whether these results would be replicated with a different population of patients is as yet unknown.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Ethical issues in organ procurement: a review for intensivists.

The current state of organ procurement and the ethical issues raised by the procurement process are reviewed in this article. After an examination of the legislative framework governing organ procurement, the intensivist's role in donation is discussed, including (1) donor identification, (2) asking the family to donate, and (3) obtaining consent. Recent proposals for changing the organ procurement system are analyzed, including increasing family donation or increasing the donor pool.

Death↗
PubMed1995

Public policy governing organ and tissue procurement in the United States. Results from the National Organ and Tissue Procurement Study.

OBJECTIVE: To determine why Required Request policies, which mandate that hospitals request donation from donor-eligible families, have not resulted in increased organ procurement. SETTING: Stratified sample of 23 acute-care general hospitals in two metropolitan areas. DESIGN: Chart review identified all eligible donors in study hospitals during a 20-month period. Health care professionals who spoke with the families of eligible donors after death were interviewed to determine families' and health care providers' behaviors after patients' deaths with reference to the donation process. PARTICIPANTS: All patient deaths (n = 10,681) were reviewed, and 841 donor-eligible cases were chosen for in-depth study; 1809 health care professionals who provided care to these patients were interviewed. MEASUREMENTS: The ability of health care providers to identify donor-eligible patients, approach families about donation, and obtain families' consent to donation. RESULTS: 83% of health care professionals correctly identified donor-eligible patients. The families of donor-eligible patients were approached about donation in 73.0% of the cases. Families were more likely to be approached about organ (86.6%) donation than either tissue (69.5%) or cornea (67.3%) donation (P < 0.001). The families of organ-eligible patients were less likely to be approached if the patient was female, was on a general medical or surgical floor, or was being cared for by internists. Only 46.5% of families of eligible donors agreed to donate organs, 34.5% agreed to donate tissues, and 23.5% agreed to donate corneas. CONCLUSIONS: Although health care professionals do request that families donate, families consent to donation less frequently than was previously assumed. Empirically based education campaigns are needed so that health care professionals can improve their communication skills and so that discussion about this important issue can be stimulated among family members.

Adolescent↗
PubMed1995

Health care professional attitudes toward donation: effect on practice and procurement.

Failure to procure organs, tissues, and corneas for transplantation can be attributed to a number of factors. The existing literature is largely speculative concerning why health care professionals (HCPs) fail to approach the families of medically suitable donors and why requests for donation are not successful. This study is based on the direct examination of 1,797 HCP attitudes and knowledge about donation in conjunction with how HCPs performed when faced with a donor-eligible patient. HCP attitudes, rather than knowledge, are more important to the successful procurement of organs. The HCPs with more positive attitudes about donation and their role in the procurement process were more likely to request donation. HCPs were more successful in obtaining consent to donation when they believed that the donation process would benefit the donor family and that their efforts to procure organs would be successful. These results indicate that educating HCPs about the donation process to make them more comfortable with it is crucial.

Attitude of Health Personnel↗
PubMed1994

Differences in the procurement of organs and tissues by health care professionals.

BACKGROUND: The act of donating organs is familiar to most health care professionals (HCPs). However, the process of tissue and cornea donation is not nearly as well known. Most studies of the donation process have neglected the issue of tissue and cornea donation. This study offers some preliminary data concerning the differences between organ and tissue and cornea donation processes. As well, this is one of the first studies to report an eligibility rate for tissues among hospital deaths. METHODS: During a 5-month period in 1989, the charts of all patients (n = 233) who died in the study hospital were reviewed on a weekly basis to establish eligibility to donate organs, tissues and corneas. A case series of 50 eligible patients cases was selected for in-depth interviews. Cases were defined as those patients who were eligible to donate tissues or organs. The patient's attending physician, house officer, and primary nurse were interviewed using an open-ended interview format. These audiotaped interviews focused on the events surrounding the patient's death, focusing on the issue of donation. We also collected information concerning HCP knowledge of the medical criteria for donation and their attitudes toward donation. Consent was obtained from all HCPs before beginning the interview process. RESULTS: Of the 233 deaths, 4.3% were eligible to donate organs, 11.2% were eligible to donate tissues, and 18.9% were eligible to donate corneas. On the basis of our interview data we found that all eligible organ donors were identified and their families asked by at least one member of the patient's health care team to consider donation. HCPs were less successful identifying tissue patients: 30 of the 41 tissue donors (73.2%) were identified and only 65.9% of donor families were asked to donate. Rates of consent to donation were lower than might be expected based on public opinion polls. 33.3% of families consented to organ donation while only 29.6% consented to donate tissue and cornea. CONCLUSION: HCPs performed less efficiently in terms of the procurement process for tissues and corneas as compared to organs. They were also less knowledgeable about the donation criteria for tissues and corneas than organs. They generally exhibited more positive attitudes about corneal donation. More education of HCPs is necessary before we can optimally procure tissues for transplantation.

Aged↗
PubMed1993

Discussions about limiting treatment in a geriatric clinic.

OBJECTIVE: Obtain detailed information about the frequency and content of discussions about withholding treatment between doctors and elderly outpatients. DESIGN: Survey. SETTING: Primary care geriatric clinic at an urban university. PARTICIPANTS: Twelve physicians and one nurse practitioner completed questionnaires for 185/198 (93.4%) patient visits. MEASUREMENTS: Questionnaires were completed by physicians after each patient visit during August 1989. Interviews were conducted with physicians who had discussed limiting life-sustaining treatment with patients. RESULTS: Ten percent (n = 19) of patients seen had had discussions with their physicians about life-sustaining treatment. These patients were older and had worse prognoses as estimated by their physicians. Physicians usually raised the issue with the families of demented patients and mentioned dementia, quality of life, prognosis, and the need to make other clinical decisions as motivation for initiating discussions. The majority of patients with poor prognoses, however, had not had discussions about life support. CONCLUSIONS: Despite increasing attention given to end-of-life decisions in the medical and lay press, discussions with elderly outpatients about limiting treatment occur rarely. They are more likely when patients are older or have worse prognoses, but age, prognosis, and poor quality of life do not consistently lead physicians to raise the issue.

Advance Directives↗
PubMed1993

Offering the option of randomized clinical trials to cancer patients who overestimate their prognoses with standard therapies.

We have shown that cancer patients' routine (and understandable) overestimations of their prognoses with standard therapy may inhibit their accrual to randomized clinical trials for which standard therapies are the alternative. Patients' appreciation of the rationale for a trial, and the potential benefit of trial participation, can only be enhanced if they understand their prognoses with standard therapy. However, clinical investigators may be reluctant to provide specific information that deflates patients' estimates of their prognoses. The routine withholding of information regarding the modest benefits of standard therapies may avoid patient distress, but such physician behavior is paternalistic and may deleteriously affect trial accrual. On the other hand, the routine communication of prognostic information will cause significant distress among patients and will perhaps be destabilizing to that minority of patients who would otherwise shun this information or truly cannot psychologically tolerate it. A middle ground between these extremes is the stepwise disclosure of potentially distressing information, wherein specific prognostical information is offered by physicians to patients and actually provided or communicated only after patients first understand the nature of it and then indicate their interest in receiving it. A practical disadvantage of this approach is its additional demand on physicians' time. Therefore, if impracticality is to be avoided and yet the approach fostered, clinical investigators might consider developing trial-specific, written or audiovisual materials for patient education about general background information. These could be employed prior to patient-physician dialogue and so enable physicians to focus on more sensitive subjects, such as prognosis with standard therapy.

Adult↗
PubMed1992

Improving communication with cancer patients.

Although much more information is being disclosed to cancer patients than in the past, there is still considerable disagreement about how much information should be conveyed. This paper reviews the basic elements of informed consent, examines some of the major barriers to effective communication, and suggests ways in which physicians can enhance communication with their cancer patients. Physicians are urged to evaluate patients in terms of their coping and information-seeking styles and to keep in mind that most patients want information. In fact, studies show that giving patients adequate information usually impacts positively on their psychological and physical well-being.

Cognition↗
PubMed1991

Factors affecting treatment decisions for a life-threatening illness: the case of medical treatment of breast cancer.

Despite notions that patients are now playing a more proactive role in directing their own health care, our study of breast cancer patients considering adjuvant therapy indicates that, at least for a life-threatening illness, patients still rely heavily on their physicians to make treatment decisions. Out of 100 patients, 80.0% accepted their physician's primary treatment recommendation. Using behavioral decision-making theory we examined why some patients chose to disregard the physician's treatment recommendation despite its importance within the decision-making process. The discriminant function analysis performed to examine the factors influencing acceptance or rejection of a physician's treatment recommendation identified two sets of factors. Factors related to the amount and specificity of information about treatments conveyed to the patients, and the strength of the treatment recommendation itself. Patients who did not accept their physician's treatment recommendation were told in more specific terms what the benefits of treatment would be; they also rated side effects of treatment to be more probable and more severe than patients who did concur with the physician's treatment recommendation. These patients also rated their physicians' treatment recommendations as less strong than other physicians'. Nonacceptor patients were also better educated and were more likely to be risk takers. This study supports the findings of other studies that patients want more specific disease and treatment information, but suggests that the provision of this information might lead to therapy decisions which diverge from physicians' recommendations.

Breast Neoplasms↗
PubMed1991

Stigma, AIDS and quality of nursing care: state of the science.

Reports of fear and psychological distress on the part of nurses when caring for AIDS patients have drawn attention to the real possibility that care for this very sick group of patients may be less than adequate. This paper reviews what is currently known about the attitudes of nurses and the care provided to HIV-infected individuals. The authors reveal the paucity of empirical data concerning quality of care and how the concept of stigma might serve to aid our understanding. The need for more research documenting the quality of care provided to HIV-infected patients is discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Effect of patients' expectations of benefit with standard breast cancer adjuvant chemotherapy on participation in a randomized clinical trial: a clinical vignette study.

Patients frequently overestimate the benefit of standard breast cancer adjuvant therapy. This is due in part to vague doctor-patient communication. To examine how the doctor's description and patient's expectations of the benefit of standard therapy affect clinical trial participation, we randomized 282 female cancer patients to one of two versions of a clinical vignette describing a choice between standard cyclophosphamide, methotrexate, and fluorouracil (5FU) (CMF) and a randomized trial comparing CMF with cyclophosphamide, doxorubicin, and 5FU (CAF). The vignettes differed only on whether results with CMF were described verbally or numerically in terms of disease-free survival (DFS). After selecting CMF or the trial, patients estimated their 10-year DFS with CMF. Patients were randomized 3:1 to the verbal vignette. The trial was selected by 110 of 210 (52.4%) verbal vignette patients versus 25 of 72 (34.7%) numeric vignette patients (P = .01). Estimates of 10-year DFS with CMF varied considerably; many were inaccurate. When patients in the verbal vignette group were divided into thirds according to DFS estimate, 22 of 64 (34.4%) in the top third selected the trial versus 38 of 64 (59.4%) and 38 of 65 (58.5%) in the middle and bottom third, respectively (P = .005). Younger age, college education, and previous participation in a trial also predicted trial selection. Multivariate logistic regression suggested that the benefit expected from CMF was more important than how benefit was described in treatment selection. Assuring realistic patient expectations of standard adjuvant therapy benefit is likely to be important during discussion of clinical trials.

Adult↗