Karen S. Ogle

Cancer and comorbidity

A narrow subspecialty model of cancer care has led to cancer treatment often being given outside the full medical context of the patient. The full range of comorbid illness must be considered in all aspects of diagnosis and treatment. This study was conducted to describe the prevalence of comorbidity in cancer patients and examine its relation with multiple demographic and clinical variables.

Physicians and Hospice Care: Attitudes, Knowledge, and Referrals

Underutilization of hospice care continues to be a public health issue in the United States. Physician barriers related to incorrect knowledge and unfavorable attitudes have been hypothesized as part of the explanation. We conducted a mail survey of 264 area physicians, obtaining a response rate of 72% (n = 190). The survey examined attitudes toward, knowledge about, and perceptions of benefits and barriers to hospice care. Physicians demonstrated very positive attitudes toward hospice. They had correct knowledge about some aspects of hospice, but were uncertain about correct answers on the majority of items. They had erroneous knowledge on few items. Physicians perceived many benefits to hospice care, and identified patient and family readiness as the major barriers to earlier hospice referrals. Demographic and practice variables were related to responses on few of the survey items. These findings have many implications for outreach strategies for physicians as well as future research.

Hospice and primary care physicians: Attitudes, knowledge, and barriers

Underuse of hospice services is a significant problem in the United States. Primary care physicians constitute an increasing referral base and have been hypothesized to be important barriers to increased use. We conducted a mail survey of 131 primary care physicians (overall response rate of 72 percent), examining their attitudes toward, knowledge about, and perceived benefits and barriers to hospice care. Physicians demonstrated very favorable attitudes towards hospice. They had correct knowledge about most aspects of hospice, and, where they did not, they were far more likely to be uncertain than erroneous. Primary care physicians perceived many benefits to hospice care and identified patient and family readiness as the major barrier to earlier hospice referrals. A significant subgroup had concerns about problems in interacting with hospices. There were very few differences between family practitioners and general internists. These findings have many implications for directing collaborative efforts between primary care physicians and hospices to improve end-of-life care.

Graduating medical students' competencies and educational experiences in palliative care

Palliative care involves an interdisciplinary approach to patient care and specific clinical skills. Little prior research on palliative care education has involved medical students, and the few reported studies focus mainly on student attitudes. This study describes a needs assessment of senior medical students based on a newly developed competency-based palliative care curriculum. Prior to graduation, 102 senior students were mailed an anonymous survey with four parts: a self-assessment of attitudes, knowledge, and skills; adequacy of instruction; exposure to specific clinical experiences; and demographic information. The response rate was 47%. While attitudinal goals were strongly endorsed by students, they were less confident with regards to knowledge and skills. Ratings varied across the five content areas of the curriculum. The results suggest a need for educational efforts more focused on specific clinical competencies as well as systematic evaluation of student competencies.

Medical students as standardized patients to assess interviewing skills for pain evaluation

The use of medical students as standardized patients in a performance assessment of pain evaluation was studied.

Patterns of Predeath Service Use by Dementia Patients with a Family Caregiver

OBJECTIVE: To describe site of death and patterns of predeath service use (hospital, nursing home, and in‐home services) among persons with dementia who have a family caregiver.

No Relief in Sight: Postgraduate Training in Pain Management

This study investigated training in pain management in postgraduate medical education programs. A mail survey of program directors was conducted, evaluating the format of training in pain management and the self-assessed adequacy of the training. The response rate was 70%, with 188 total respondents. It included all programs in a large Midwestern state, representing most specialties. Just over half of all programs offered any formal training in pain management, and even fewer required it. Less than one quarter required a clinical component to such training. Nonetheless, an overwhelming majority of program directors (85%) rated their training as adequate or excellent. Improvements are clearly needed in postgraduate training in pain management, and external incentives, such as requirements in the accreditation process, will be needed.

The Web-Based Worksheet: An Opportunity for Prompt, Consistent, and Expert Feedback in a Community-Based Hospice Experience

We faced a challenge in providing a consistent high-quality learning experience in hospice care, especially because our community-based medical school has students rotating in hospices in six separated communities and the number of faculty with expertise in palliative care is limited. To address these concerns, a Web-based worksheet with interaction with a central campus faculty member was designed for use in a hospice module in a family practice clerkship.

Physician home visits for persons with dementia: Is there a need?:

This study explores the potential role ofphysician home visits in the care of persons with dementia. Family caregivers (n = 182) of relatives with irreversible dementia were surveyed about their use of physician home visits, perceptions of the availability of home visits and anticipatedfuture need for this service. Persons with dementia who had used home visits had higher functional and mobility deficits, were more likely to have used other types of in-home assistance and were more likely to require catheter or decubitus care. Over half of the sample intends to use physician home visits in the future, but mostfamilies have not investigated the availability of the service. Barriers to the use of physician home visits are presented and policy implications are discussed.

Internet resources for end-of-life care

Numerous publications highlight the need for critically evaluating medical information on the Internet. This review identifies Internet resources specifically dedicated to end-of-life care. An annotated review of key webbased resources is presented. The Internet has the potential to catalyze the doctor-patient relationship toward true “partnership.” Physicians and patients will benefit from using a focused research strategy.