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Biomedical subjects

L Fallowfield

Publications and source records attributed to L Fallowfield.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1984

Selective loss of chromatic sensitivity in demyelinating disease.

Thresholds for detecting changes in color for isoluminant stimuli and for detecting changes in luminance were measured in patients with histories of demyelinating disease and in normal controls. Thresholds for detecting changes in color were higher for patients' affected eyes, that is, ones in which symptoms had been found previously, than in their unaffected eyes, or for eyes of control subjects. Thresholds for detecting changes in luminance were raised less than those for changes in color. The pattern of loss is different than that found in subjects with congenital color blindness. The results suggest that the impairment occurs at a level in the nervous system beyond which signals from more than one class of cone receptor are combined.

Color Perception↗
PubMedDate not supplied

Missing quality of life data in cancer clinical trials: serious problems and challenges.

Measurement of quality of life (QOL) in cancer clinical trials has increased in recent years as more groups realize the importance of such endpoints. A key problem has been missing data. Some QOL data may unavoidably be missing, as for example when patients are too ill to complete forms. Other important sources are potentially avoidable and can broadly be divided into three categories: (i) methodological factors; (ii) logistic and administrative factors; (iii) patient-related factors. Logistic and administrative factors, for example, staff oversights, have proven to be most important. Since most QOL measurements require patient self-report, it is usually not possible to rectify the failure to collect baseline data or any follow-up assessments. There is strong evidence that such data are not 'missing at random', and cannot be ignored without introducing bias. Although several approaches to the analysis of partly missing data have been described, none is entirely satisfactory. Prevention of avoidable missing data is better than attempted cure. In July 1996, an international conference on missing QOL data in cancer clinical trials reported the experience of most major groups involved. This paper will serve as an introduction to the problem and provide an estimation of its magnitude, and approaches to its prevention and solution.

Bias↗
PubMedDate not supplied

The ideal consultation.

Poor communication skills have adverse consequences on physical, psychosocial and economic aspects of health care. The essential elements of an ideal consultation as described lead to more accurate diagnosis, greater patient satisfaction, and more rewarding consultations both professionally and personally.

Clinical Protocols↗