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Biomedical subjects

L Fallowfield

Publications and source records attributed to L Fallowfield.

At least 19 recordsLinked to original sources
PubMed1996

Anxiety in women "at risk' of developing breast cancer.

Do family history clinics offering counselling, surveillance and preventative programmes alleviate or exacerbate anxiety in women at a high risk of developing breast cancer? In this study risk perceptions and anxiety of 99 'at risk' women participating in the Tamoxifen Prevention Trial were compared with those of 87 'at risk' women not attending any specialist clinic who were recruited from the National Breast Screening Programme (NBSP). Most anxiety was found in NBSP women with a family history. Women attending the family history clinic and participating in the trial had anxiety scores comparable with 86 women recruited from the NBSP who did not have a family history. We conclude that such specialist clinics do not see a selected group of the most anxious 'at risk' women nor does participation in tamoxifen prevention programmes appear to increase anxiety.

Analysis of Variance↗
PubMed1995

Psychological morbidity in newly referred patients with cancer.

Over the last 10 yr, research has shown that although the majority of patients are able to cope with the stresses of cancer, a substantial number have difficulties which require some form of psychological help. This study reports on the levels of psychological distress in a heterogeneous group of 117 newly referred out-patients with cancer over a 6-month period. Each patient reported their levels of distress by completing two self-administered questionnaires (the GHQ-30 and HADS) on three separate occasions. A descriptive examination of the socio-demographic characteristics of the sample was also carried out. At the first assessment 30% of the sample scored above the threshold for probable psychiatric disorder on the GHQ-30 and 26% on the HADS anxiety scale. At 6 months follow-up levels had fallen to 21% for the GHQ-30 and 10% for HADS anxiety. The numbers of probable cases of HADS depression was 7% at the first assessment and 5% at follow-up. Differences in levels of psychological morbidity according to age, sex, partner status and socioeconomic group were demonstrated. However, we were unable to make any firm conclusions as to whether these effects were independent of each other as a controlled multivariate analysis of the data set was not possible.

Adaptation, Psychological↗
PubMed1995

The efficacy of audiotapes in promoting psychological well-being in cancer patients: a randomised, controlled trial.

Open or uncontrolled studies have suggested that providing cancer patients with audiotapes of their clinical interviews can improve information recall and reduce psychological distress. We tested these hypotheses in a 'clinician-blind', prospective, randomised controlled trial. A total of 117 patients newly referred to a medical oncology clinic who were to be given 'bad news' had their consultations audiotaped. Blind to the clinician, patients were randomly allocated to receive a copy of the tape to play at home or not (control group). At 6 months follow-up, tape group patients reported positive attitudes to the audiotape and were shown to recall significantly more information about their illness than did controls. Overall improvement in psychological distress at 1 and 6 months follow-up, as measured with the 30-item General Health Questionnaire and the Hospital Anxiety and Depression Scale was no different in the two groups. However, a second-order interaction suggested that poor-prognosis patients were disadvantaged specifically by access to the audiotape, with less improvement in psychological distress at 6 months follow-up than non-tape controls. Patient access to audiotapes of clinical interviews promotes factual retention but does not reliably reduce psychological distress and may be actively unhelpful in some subgroups of patients.

Adult↗
PubMed1995

Questionnaire design.

Explore the source record for details and available documents.

Surveys and Questionnaires↗
PubMed1994

Can oncologists detect distress in their out-patients and how satisfied are they with their performance during bad news consultations?

Recognition of psychological distress in patients with cancer, some of which can be ameliorated with appropriate intervention, is a crucial aspect of patient care. Previous studies, with the exception of one, indicate that oncologists often fail to detect general distress and do not identify those patients with significant psychological disorder. As approximately 25-30% of patients experience anxiety and/or depression severe enough to merit psychological intervention, this is a serious problem. This study assessed the ability of five oncologists to recognise distress in newly referred out-patients who were receiving bad news. Self-report measures of the oncologists' satisfaction with their performance during the bad news interviews were also collected. Each patient had two clinical interviews in which information concerning diagnosis and treatment were given. Prior to each interview patients reported their own levels of distress by completing two self-report questionnaires. These were correlated with the ratings of distress and satisfaction made by each clinician on a visual analogue scale after each interview. Only one oncologist's ratings consistently correlated with patients' self-reported scores. The clinicians tended to under-rate the distress in their patients and were mostly satisfied with their performances during each interview. The ability to detect distress varied between each clinician and confirmed the conclusions of past studies that oncologists would benefit from up-grading their psychological assessment skills.

Adult↗
PubMed1993

Giving sad and bad news.

When bad news is broken insensitively the impact can be distressing for both giver and recipient. For the recipient especially, the effect can be longlasting. Poor training in communication skills leaves most doctors unable to give bad news appropriately. Doctors must realise what impact the news can have on the patient; must overcome fear of being blamed for the message and of a sense of failure for not being able to improve the situation; and must learn how to cope with the recipient's reaction. Doctors should prepare adequately for the meeting, ensure that the patient has understood the message, and see to the patient's immediate needs after the interview. If diagnostic investigations or therapeutic options are being discussed at the same time, giving the patient an audiotape recording of the interview is helpful.

Communication↗
PubMed1993

The psychological consequences of being at risk of developing breast cancer.

Recently the hereditary nature of some breast cancers has received a considerable amount of publicity. Consequently many more women today recognize that their family history places them at an increased risk of developing breast cancer. One justification for informing women that they may have a predisposition to breast cancer is to ensure that individuals at increased risk undergo regular screening. However, evidence suggests that women with a family history of breast cancer are no more likely to use available screening than those without such a family history. There is some evidence that a significant minority of these women at risk may be psychologically distressed to a degree that would warrant professional counselling. Research is needed to assess the psychological impact of being identified as at risk of developing breast cancer due to family history and to establish what can be done to reduce psychological morbidity in these women. In view of the advances being made generally in molecular biology, with the identification of genetic markers for different diseases being announced regularly, such psychosocial research is overdue and imperative.

Attitude to Health↗
PubMed1991

Breast cancer in elderly women: a Cancer Research Campaign trial comparing treatment with tamoxifen and optimal surgery with tamoxifen alone. The Elderly Breast Cancer Working Party.

Three hundred and eighty-one women with operable breast cancer aged over 70 years were randomly allocated to 40 mg tamoxifen daily and optimal surgery or to tamoxifen alone. At a median follow-up of 34 months there was no demonstrable difference in survival rate or in quality of life between the two treatment groups. More patients treated with tamoxifen alone had a subsequent change of management and this was usually an operation for local treatment failure. This progression to surgery has not been shown to be disadvantageous and the study will continue. Informed consent for randomization was difficult to obtain, leading to the exclusion of eligible patients, and it is therefore proposed to include non-randomized patients in a total cohort study.

Aged↗
PubMed1989

Getting it taped: the 'bad news' consultation with cancer patients.

'Not being told what is wrong' is the most frequent complaint patients make (Fletcher, 1980). In cancer a lack of information greatly increases the stress and anxiety experienced. In this report, 46 patients with cancer were given audiotape recordings of their 'bad news' consultations to take home. Analysis of subsequent questionnaire data revealed that both patients and their families benefited enormously from the opportunity to hear the details of their diagnosis and treatment again.

Humans↗