James S. Zoller

Importance of Faith on Medical Decisions Regarding Cancer Care

PURPOSE Decisions regarding cancer treatment choices can be difficult. Several factors may influence the decision to undergo treatment. One poorly understood factor is the influence of a patients faith on how they make medical decisions. We compared the importance of faith on treatment decisions among doctors, patients, and patient caregivers. METHODS One hundred patients with advanced lung cancer, their caregivers, and 257 medical oncologists were interviewed. Participants were asked to rank the importance of the following factors that might influence treatment decisions: cancer doctors recommendation, faith in God, ability of treatment to cure disease, side effects, family doctors recommendation, spouses recommendation, and childrens recommendation. RESULTS All three groups ranked the oncologists recommendation as most important. Patients and caregivers ranked faith in God second, whereas physicians placed it last (P <.0001). Patients who placed a high priority on faith in God had less formal education (P <.0001). CONCLUSION Patients and caregivers agree on the factors that are important in deciding treatment for advanced lung cancer but differ substantially from doctors. All agree that the oncologists recommendation is most important. This is the first study to demonstrate that, for some, faith is an important factor in medical decision making, more so than even the efficacy of treatment. If faith plays an important role in how some patients decide treatment, and physicians do not account for it, the decision-making process may be unsatisfactory to all involved. Future studies should clarify how faith influences individual decisions regarding treatment.

Attitudes towards screening for lung cancer among smokers and their non-smoking counterparts

Background: There has been resurgence of interest in lung cancer screening using low-dose computed tomography. The implications of directing a screening programme at smokers has been little explored. Methods: A nationwide telephone survey was conducted. Demographics, certain clinical characteristics and attitudes about screening for lung cancer were ascertained. Responses of current, former and never smokers were compared. Results: 2001 people from the US were interviewed. Smokers were significantly (p<0.05) more likely than never smokers to be male, non-white, less educated, and to report poor health status or having had cancer, and less likely to be able to identify a usual source of healthcare. Compared with never smokers, current smokers were less likely to believe that early detection would result in a good chance of survival (p<0.05). Smokers were less likely to be willing to consider computed tomography screening for lung cancer (71.2% (current smokers) v 87.6% (never smokers) odds ratio (OR) 0.48; 95% confidence interval (CI) 0.32 to 0.71). More never smokers as opposed to current smokers believed that the risk of disease (88% v 56%) and the accuracy of the test (92% v 71%) were important determinants in deciding whether to be screened (p<0.05). Only half of the current smokers would opt for surgery for a screen-diagnosed cancer. Conclusion: The findings suggest that there may be substantial obstacles to the successful implementation of a mass-screening programme for lung cancer that will target cigarette smokers.

Post-traumatic stress disorder screening test performance in civilian primary care

PURPOSE we determined the test performance characteristics of four brief post-traumatic stress disorder (PTSD) screening tests in a civilian primary care setting. METHODS this was a cross-sectional cohort study of adults attending a family medicine residency training clinic in the southeastern USA. Four hundred and eleven participants completed a structured telephone interview that followed an index clinic visit. Screening tests included: PTSD Symptom Checklist-Civilian Version (17 items), SPAN (four items), Breslaus scale (seven items) and Primary Care PTSD screen (PC-PTSD) (four items). A modified Clinician-Administered PTSD Scale was used to determine past month PTSD for comparison. Receiver operating characteristic analysis based on area under the curve (AUC) was used to assess diagnostic efficiency (>0.80 desired). Cut-off scores were selected to yield optimal sensitivity and specificity (>80%). RESULTS past month PTSD was substantial (women = 35.8% and men = 20.0%; P < 0.01). AUC values were PTSD Symptom Checklist (PCL) (0.897), SPAN (0.806), Breslaus scale (0.886) and PC-PTSD (0.885). Optimal cut-scores yielded the following sensitivities and specificities: PCL (80.0% and 80.7%; cut-off = 43), SPAN (75.9% and 71.6%; cut-off = 3), Breslaus scale (84.5% and 76.4%; cut-off = 4) and PC-PTSD (85.1% and 82.0%; cut-off = 3). Overall and gender-specific screening test performances were explored. CONCLUSIONS results confirm: (i) PTSD was common, especially among women; (ii) all four PTSD screening tests were diagnostically adequate; (iii) Two of four PTSD screening tests showed adequate sensitivity and specificity (>80%) and (iv) The PC-PTSD screening test (four items) appeared to be the best single screening test. There are few studies to establish the utility of PTSD screening tests within civilian primary care.

Interprofessional education in US medical schools

IntroductionInterprofessional education (IPE) is called for in United States health professionseducation (Institute of Medicine, 2003). The Association of American Medical Colleges(AAMC) includes interprofessional health education and practice as a strategic area inwhich the organization and members should engage (AAMC, 2007). The current statusof IPE within United States medical schools has remained largely unexamined.Therefore, we sought to learn the current practice of IPE in US medical schools,including program features, institutional governance and resource contexts, and barriersto implementation.MethodsWe surveyed college of medicine education deans or dean designees of 126 US medicalschools as identified by the AAMC in late summer, 2008, using an instrument we developedfollowing a literature review. The instrument was composed of three sections: (1) adescription of specific IPE offerings at the school, (2) information regarding institutionalsupports and IPE resources, and (3) perceptions of potential barriers to IPE. With respect tothe description of specific IPE offerings, respondents were asked the following: (a) if offeringwas required or elective, (b) learner disciplines involved, (c) faculty disciplines involved, (d)type of learning experience, (e) type of learning setting, (f) general content area of offering,and (g) student assessment methods. With respect to institutional supports and resourcesfor IPE, respondents were asked the following: (a) administrative unit with responsibility forcoordinating IPE, (b) budget for IPE, (c) governance of IPE, (d) resources (monetary and

Costs, charges, and reimbursements for persons with sickle cell disease

PURPOSE The aims of this study were to describe health care costs and charges for patients with sickle cell disease (SCD) and identify predictors of high use. PATIENTS AND METHODS Patients with SCD were identified by International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes from a university hospitals administrative databases from January 1, 1996, to September 30, 1997. Clinical and administrative data were gathered on each patient for all hospital admissions and ambulatory clinic visits. Logistic regression models were used to determine predictors of high health care use. RESULTS A total of 947 patients with SCD were identified, 73% of whom resided within three South Carolina counties. On average, there were 0.9 admissions per patient per year and 8.0 outpatient visits per patient per year. Mean inpatient hospital charges, physician charges, and direct hospital costs per admission were

Predicting patient intent to return from satisfaction scores.

7290,

Non-pregnant patients’ preference for delivery route

1589, and

Direct and indirect effects of neighborhood factors and self-care on glycemic control in adults with type 2 diabetes

5405, respectively, and the average length of stay was 4.5 days. Mean hospital charges, physician charges, and direct hospital costs per outpatient visit were

Early Treatment Withdrawal from Evidence-Based Psychotherapy for PTSD: Telemedicine and in-Person Parameters

305,

The Presidential Scholars Program at the Medical University of South Carolina: An extracurricular approach to interprofessional education

169, and