Risultati per: Cardio-oncology: rivista open access

Circulation, Volume 149, Issue 22, Page 1749-1751, May 28, 2024.

Objective
To explore the experience and challenges health professionals face during breaking bad news (BBN) to patients with cancer in the oncology centre of Black Lion Specialized Hospital (BLSH), Addis Ababa, Ethiopia 2019.

Design
An exploratory qualitative phenominological study using in-depth interviews was carried out in the only radiotherapy integrated oncology centre in Ethiopia during March 2019. Purposeful maximum variation sampling was used to select participants. OpenCode (V.4.02) assisted thematic analysis approach was employed to analyse the data.

Participants
Eleven oncology health practitioners (oncologists, residents and nurses) working at the oncology centre were interviewed. Repeated interviews and analysis were done until theoretical saturation.

Results
All participants were cognisant of the positive outcome of proper and effective practice of BBN. However, they were practicing it empirically, no standardised protocols or guidelines were in place. Four dimensions of challenges were mentioned: (1) setup centric: unconducive environment, lack of protocols or guidelines, inaccessible treatment, and psychotherapy or counselling services; (2) health care centric, such as inadequate expertise, inadequate time due to patient load,treatment backlog, and referral system; (3) patients/family centric: poor medical literacy level, poor compliance, and family interference; and (4) sociocultural: wrong perception of families on BBN and treatment modalities, and opposition from religious leaders.

Conclusion
BBN is challenging for professionals caring for patients in the oncology centre of BLSH. Hence, there is a critical need to improve practices. Change efforts may focus on the development of contextualised, content and context specific practice oriented training programmes and curriculum interventions. Raising awareness of the community and religious leaders regarding the nature and treatment of cancer may also be a helpful adjunct.

Background
The Rotterdam Eczema Study was an observational cohort study with an embedded pragmatic randomised controlled open-label trial. It was conducted in children with atopic dermatitis (AD) in the Dutch primary care system. The objective of the trial was to determine whether a potent topical corticosteroid (TCS) is more effective than a low-potency TCS.

Objective
We are aiming to communicate transparently about the poor recruitment for the trial part and to explore the reasons why recruitment was weak.

Design
We used a survey to find out what patients in the cohort did when they experienced a flare-up.

Methods
Descriptive statistics were used to present the baseline characteristics of participants in the trial and the results of the survey.

Results
In total, 367 patients were included in the cohort. Of these, 32 were randomly assigned to a trial treatment; they had a median age of 4.0 years (IQR 2.0–9.8). A total of 69 of the 86 children (80.2%) who could participate in the survey responded. 39 (56.5%) suffered a flare-up during the follow-up (making them potentially eligible for inclusion in the trial). 26 out of 39 (66.7%) increased their use of an emollient and/or TCS themselves. Only 12 of the 39 (30.7%) contacted their general practitioner (GP) as instructed in the study protocol, but 8 out of these 12 did not meet the inclusion criteria for the trial.

Conclusion
The main reason why cohort participants did not take part in the trial was that they did not contact their GPs when they experienced an AD flare-up. Furthermore, the majority of patients who contacted their GPs did not match the inclusion criteria of the trial. We expect that the lessons learnt from this study will be useful when developing future studies of children with AD in primary care.

We sincerely thank the 878 peer reviewers who completed manuscript reviews for JAMA Oncology in 2023.

I keep my mother’s dentures warm; they fog the plastic case on my lap. Lips pursed, arms raised above her head, she lies on a table about to slide through the doughnut of an apparatus that looks like a spaceship. I hear David Bowie’s voice: This is Ground Control to Major Tom as the contraption begins its magnetic music— an opus of hammers, a staccato hum. What a brave astronaut my mother is, fitted into a coil helmet, going in alone. She waves off my hand to hold, refuses earbuds the technician offers. I’d give anything if we were anywhere else. Strange, the way I now drift above her, the technician and the machine, high enough to almost touch the floodlights, which somebody has thought to dim.

Circulation, Ahead of Print.