Wwt Lam

Physician–patient–companion communication and decision-making: A systematic review of triadic medical consultations

OBJECTIVEnTo systematically review quantitative and qualitative studies exploring physician-adult patient-adult companion (triadic) communication and/or decision-making within all medical encounters.nnnMETHODSnStudies were identified via database searches and reference lists. One author assessed eligibility of studies, verified by two co-authors. Data were extracted by one author and cross-checked for accuracy. Two authors assessed the quality of included articles using standardized criteria.nnnRESULTSnOf the 8409 titles identified, 52 studies were included. Summary statements and tables were developed for each of five identified themes. Results indicated companions regularly attended consultations, were frequently perceived as helpful, and assumed a variety of roles. However, their involvement often raised challenges. Patients with increased need were more often accompanied. Some companion behaviours were felt to be more helpful (e.g. informational support) and less helpful (e.g. dominating/demanding behaviours), and preferences for involvement varied widely.nnnCONCLUSIONnTriadic communication in medical encounters can be helpful but challenging. Based on analysis of included studies, preliminary strategies for health professionals are proposed.nnnPRACTICE IMPLICATIONSnPreliminary strategies for health professionals include (i) encourage/involve companions, (ii) highlight helpful companion behaviours, (iii) clarify and agree upon role preferences of patient/companions. Future studies should develop and evaluate specific strategies for optimizing triadic consultations.

Validation of the Chinese version of the Short-form Supportive Care Needs Survey Questionnaire (SCNS-SF34-C)

Background: There is no instrument available in Chinese for assessing psychosocial needs. This study aimed to assess the validity and reliability of the Chinese version of the Supportive Care Needs Survey short form (SCNS‐SF34‐C) in Chinese women with breast cancer (BC).

What causes H5N1 avian influenza? Lay perceptions of H5N1 aetiology in South East and East Asia

BACKGROUNDnHealth education to reduce population poultry exposures has limited effect. Lay beliefs about H5N1 highly pathogenic avian influenza (HPAI) causes could provide insights helpful for improving public health interventions.nnnMETHODSnQualitative interviews of poultry farmers, retailers, market stall holders and consumers in Hong Kong (n = 20), Guangzhou (n = 25), Vietnam (n = 38) and Thailand (n = 40) were conducted using purposive sampling and analysed using ethnographic principles.nnnRESULTSnEach location produced three comparable themes: viruses: HPAI exemplified a periodic, natural, disease process therefore, deserving little concern. For some, science had discovered something long known to farmers and lived with for generations. Others believe the virus to be new. Viral ecology was reasonably well understood among farmers, but less so by retailers and consumers; husbandry practices included poor hygiene, overcrowding and industrial farming, modern commercial feed and veterinary drugs; vulnerability factors included uncontrollable external explanations involving the weather, seasonal changes, bird migrations and pollution.nnnCONCLUSIONSnLay explanations were generally ecologically consistent. Nonetheless, beliefs that HPAI is a normal, recurrent process, external factors and roles of industrialized poultry rearing countered health worker claims of H5N1 seriousness for smallholders. These causal beliefs incorporate contemporary models of H5N1 ecology, but in a manner that contradicts public health efforts at control.

Help-seeking patterns in Chinese women with symptoms of breast disease: a qualitative study

BACKGROUNDnPrompt utilization of health services on detecting breast symptoms can improve breast cancer (BC) survival. Little is known about Chinese womens help-seeking behaviour. Our aim was to determine patterns of self-referral among Hong Kong Chinese women with self-detected breast symptoms.nnnMETHODSnWe recruited 37 women awaiting their first consultation at public hospitals for breast symptoms. Interviews were transcribed and analysed based on the grounded theory approaches.nnnRESULTSnA two-stage help-seeking model provided the best interpretation of the data. Symptom recognition was triggered by symptom interpretation, symptom progression and social messages. Painful lumps were seen as symptomatic, but atypical symptoms were often dismissed as benign as they responded to dietary change. Symptom intensification and discussions with someone who had faced BC prompted consultation. Service utilization involved fear of consequences, confirmation need, symptom distress, lay referral, media prompts and opportunistic presentation. Fearing cancer as incurable delayed consultation. Utilization barriers included cost, uncertainty about referral pathways, competing priorities and embarrassment.nnnCONCLUSIONSnAtypical and painless presentation was more common among women delaying presentation. Barriers included cost, access, time and embarrassment. Education should emphasize atypical symptoms, the high-cure rate and the need for early presentation. Reduced cost and improved access to clinics would enhance early consultation.

Severe Trauma Presenting to the Resuscitation Room of a Hong Kong Emergency Department

Background Little is known about the epidemiology or mortality associated with trauma in Hong Kong or of its demands on the service of emergency departments. This study describes both the quantity and quality of trauma presenting to an emergency department in Hong Kong. Methods In a retrospective study conducted from January to June 1997 there were 100,000 new patient attendances at the emergency department of the Prince of Wales Hospital of which 227 trauma patients (0.002%) were triaged to the Resuscitation Room. Patient records were scrutinised for types and mechanisms of injury, times of injury and arrival at the emergency department, role of alcohol, and scored using an injury severity score. Important outcomes were mortality and duration of hospital stay. Results Data was available on 221 (97%) subjects (male to female ratio 3.7:1) of which there were 203 adults and 18 children. Blunt injury accounted for 199/215 (92.6%) cases and penetrating for 16/215 (7.4%) cases. Motor vehicle crashes accounted for 113/205 (55%) cases, falls for 47/205 (23%) cases and assault for 18/205 (9%) cases. 51/224 (23%) cases presented between the hours of midnight and 8 am. The median injury severity score (ISS) was 9 (mean 11; range 1–59). 32/227 (14%) patients died, the majority resulting from road traffic accidents or falls. Conclusion Patterns of ‘severe’ trauma in Hong Kong primarily affect male adults, include a preponderance of motor vehicle crashes and falls, and significant mortality.

Comparing the meanings of living with advanced breast cancer between women resilient to distress and women with persistent distress: a qualitative study

Most women with advanced breast cancer (ABC) show little distress, but about one in ten show persistent distress over time. It remains unclear if meanings ascribed by patients to ABC differentiate these distress trajectories.

Trajectory patterns of supportive care needs among Chinese women with advanced breast cancer

Nadine Köhle 1, Constance Drossaert2, Cornelia van Uden-Kraan3, Irma Verdonck -de Leeuw4, Ernst Bohlmeijer5 1University of Twente, Enschede, Overijssel, The Netherlands, 2University of Twente, Enschede, Overijssel, The Netherlands, 3VU University, Amsterdam, Noord-Holland, The Netherlands, 4VU University, Amsterdam, Noord-Holland, The Netherlands, 5University of Twente, Enschede, Overijssel, The NetherlandsFrom Vision to Action - Innovation and Implementation of an Integrated Cancer Rehabilitation Within Clinical Practice