Morsani College of Medicine

The Qualitative Report Volume 11 Number 2 June 2006 229-250 http://www.nova.edu/ssss/QR /QR11-2/quinn.pdf ... A Visual Research Method for Educating Obstetricians and ... H. Lee Mofffitt Cancer Center and Research Institute University of South Florida, Tampa, Florida

Most medical interaction studies have been conducted on audiotaped recordings of physician-patient encounters. Empirical studies have not previously demonstrated whether coders' scores differ on audio-only versus videotaped data. Data from a convenience sample of forty-seven physician-patient interactions were analyzed using the same coding systems to judge audio-only versus video-based data formats. All coding conditions demonstrated acceptable reliability, using intraclass correlation coefficients. However, MANOVA analyses show that ratings of audiotaped physician-patient interactions are not equivalent to ratings of videotaped encounters. Exploratory factor analyses show differences in the underlying structures of the data derived from the audio-only versus the video information. The differences in the video-based factor solutions account for more total variance and are more consistent with theoretical expectations. for their coding assistance with this project.

Recording and analyzing real-time interactions in clinical settings (e.g., doctor-patient visits, therapy sessions) is of substantial value to both basic and applied researchers in fields such as clinical psychology, health psychology, communication, and behavioral medicine. Investigators frequently have used simple audiotaping procedures to record these interactions (e.g., . However, videorecording is increasingly seen as a more reliable and valid technique because it captures a fuller representation of the complex 165

Quality of life (QOL) is increasingly recognized as an important clinical outcome of hematopoietic cell transplantation (HCT), but patient education is often overlooked. The goal of the current qualitative study was to examine education regarding post-HCT QOL from the patient's perspective. Allogeneic HCT recipients participated in one of four focus groups. Participants were asked to recall what they had been told about post-HCT QOL as they were preparing for transplant, how their QOL differed from what they expected, and how to educate future patients about post-HCT QOL. Verbatim transcripts were coded for both a priori and emergent themes using content analysis. A total of 24 patients participated (54% female, mean age 51, range 23-73). Participants frequently expressed the desire for additional education regarding post-HCT QOL, particularly late complications. They noted that late complications were often unexpected, had a profound impact on their QOL, and threatened their ongoing sense of recovery. They emphasized that the timing, content, and format of education regarding QOL should be flexible to meet their diverse needs. Findings from the current study draw attention to the importance of patient education regarding post-HCT QOL as well as additional QOL research designed with patient education in mind.

Purpose: To conduct a systematic review and meta-analysis of all phase III randomized controlled trials comparing efficacy of early versus late first-line or initial treatments for cancer. Methods: A comprehensive literature search of MEDLINE and Cochrane library databases was performed . Data was extracted and pooled as per the methods recommended by the Cochrane Collaboration. Results: Of the 570 identified studies, 10 (3811 patients) met inclusion criteria: three each in prostate cancer and multiple myeloma (MM), two in chronic lymphocytic leukemia (CLL), and one each in lung cancer, and follicular lymphoma. The analyses showed no survival benefit with early treatment except in prostate cancer (hazard ratio [HR] = 1.23, 95% CI 1.11-1.37 p < 0.001). There was no survival difference in MM (HR = 0.92, 95% CI 0.56-1.52 p = 0.74), CLL (HR = 0.76, 95% CI 0.56-1.04 p = 0.09), lung cancer (HR = 0.95, 95% CI 0.72-1.24 p = 0.71), or follicular lymphoma (HR = 1, 95% CI 0.55-1.83 p = 0.99). No statistically significant difference in response rate between early and late treatment was detected in any cancer type. Conclusions: Data shows that delaying cancer treatments does not necessarily compromise therapeutic outcomes except possibly in locally advanced prostate cancer. These findings provide a unique window to oncologists and patients to address time-sensitive issues if desired by patients.

Infertility is a common result of cancer treatment; however, opportunities exist for patients to preserve fertility prior to treatment. Recent evidence suggests that healthcare providers, including nurses, do not consistently discuss fertility preservation (FP) with patients. This qualitative, cross-sectional pilot study used a focus group and in-depth interviews to explore knowledge, attitudes, and practice behaviors related to nurses' discussion of FP with patients with cancer. Results indicate that only half of the nurses discuss FP methods with patients, even though most believe that having discussions with patients about fertility is part of their role. Factors associated with the discussion of FP among nurses included (a) knowledge (FP procedures, fertility institutes and clinics, resources for patients, and practice guidelines), (b) attitudes (difficulty finding facilities, time constraints, role, comfort level, ethical issues, financial considerations, and patient characteristics), and (c) behaviors (patient initiation, physician behaviors, patient characteristics, and timing). Discussion should be stimulated among nurses about the role of nurses in the FP discussion, and educational interventions and practice guidelines should be developed that are aimed at oncology nurses to help facilitate discussions with patients.

Members of families affected by hereditary cancer are often concerned about passing on risk to offspring. Preimplantation genetic diagnosis is a procedure performed to identify embryos that inherit mutations placing them at risk for hereditary conditions. Little is known about attitudes toward the use of this technology among individuals at risk for hereditary breast and ovarian cancer. We sought to determine high risk women's attitudes. This study is a qualitative examination of comments from women who participated in an online survey regarding knowledge and attitudes of preimplantation genetic diagnosis among individuals affected by hereditary breast and ovarian cancer. More than half the respondents held less favorable attitudes about the use of preimplantation genetic diagnosis for hereditary breast and ovarian cancer for both themselves and others. However, among the women who felt favorable about its usage, the majority said it became a new option for them to pursue parenthood whereas previously they had opted to not have a biological child. The high percentage of respondents who have never heard of preimplantation genetic diagnosis and who were in favor of this technology for hereditary breast and ovarian cancer indicates the need for educational campaigns to increase awareness and provide information about the procedure, access and affordability. Further research is needed to determine how this population would like this information presented to them and how best to instruct health care professionals to present this topic to women who do not know to ask about it. Keywords Breast cancer 1 and 2 genes Á Hereditary breast and ovarian cancer Á Preimplantation genetic diagnosis Á Qualitative research Abbreviations BRCA1/2 Breast cancer 1 and 2 genes HBOC Hereditary breast and ovarian cancer PGD Preimplantation genetic diagnosis IVF In vitro fertilization CVS Chorionic villous sampling FISH Fluorescence in situ hybridization FAPC Familial adenomatous polyposis coli HFEA

Objective: To examine codified state policies related to infertility and assess their implications for cancer patients. Lack of insurance is often identified as a barrier to use of fertility preservation (FP) services. Design: None. Setting: A keyword search was developed to identify statutes and administrative regulations of insurance coverage for FP in the United States. Patient(s): N/A Intervention(s): N/A Main Outcome Measure(s): Laws addressing the general population but pertaining to FP were compiled using Lexis-Nexis. Data were analyzed by reviewing the ''plain meaning'' of the text, legislative/administrative history, and annotated case law. Legal reasoning and common rules of statutory construction and legislative interpretation were used. Result(s): Fifteen states (29.4%) had laws relating to insurance coverage for infertility or in vitro fertilization (IVF) procedures and two states (CA and IL) specifically excluded IVF from a mandatory offer of coverage. No state laws or regulations addressed insurance coverage for FP methods specific to cancer patients. Conclusion(s): There is an argument for policies that require coverage for FP for cancer survivors before treatment. (Fertil Steril Ò 2011;95:72-8.