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J B Yu - One of the best experts on this subject based on the ideXlab platform.
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The impact of county-level radiation Oncologist density on prostate cancer mortality in the United States
Prostate Cancer and Prostatic Diseases, 2012Co-Authors: Sanjay Aneja, J B YuAbstract:Background: The distribution of radiation Oncologists across the United States varies significantly among geographic regions. Accompanying these variations exist geographic variations in prostate cancer mortality. Prostate cancer outcomes have been linked to variations in urologist density, however, the impact of geographic variation in the radiation Oncologist workforce and prostate cancer mortality has yet to be investigated. The goal of this study was to determine the effect of increasing radiation Oncologist density on regional prostate cancer mortality. Methods: Using county-level prostate cancer mortality data from the National Cancer Institute and Centers for Disease Control as well as physician workforce and health system data from the Area Resource File a regression model was built for prostate cancer mortality controlling for categorized radiation Oncologist density, urologist density, county socioeconomic factors and pre-existing health system infrastructure. Results: There was statistically significant reduction in prostate cancer mortality (3.91–5.45% reduction in mortality) in counties with at least 1 radiation Oncologist compared with counties lacking radiation Oncologists. However, increasing the density of radiation Oncologists beyond 1 per 100 000 residents did not yield statistically significant incremental reductions in prostate cancer mortality. Conclusion: The presence of at least one radiation Oncologist is associated with significant reductions in prostate cancer mortality within that county. However, the incremental benefit of increasing radiation Oncologist density exhibits a plateau effect providing marginal benefit. In order to optimize outcomes a geographically aware policy, which addresses the size and distribution of the workforce, must be in place in order prevent geographic disparities in prostate cancer mortality.
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radiation Oncologist density and colorectal cancer mortality
Journal of Clinical Oncology, 2011Co-Authors: Sanjay Aneja, J B YuAbstract:605 Background: Although the use of radiation therapy is increasing, there exists geographic variation among the distribution of radiation Oncologists. The impact of this variation on colorectal cancer (CRC) outcomes remains unexplored. The goal of this study was to determine the effect of radiation Oncologist density on CRC mortality. Methods: Using county-level data from the 2008 Area Resource File, National Program for Cancer Registries, and US Centers for Disease Control, a regression model was constructed for CRC mortality, controlling for county-level categorized radiation Oncologists density, demographics, socioeconomic status and existing healthcare facilities. Results: There was a statistically significant reduction in CRC mortality (reduction in mortality ranging from 12% to 47%, p<0.001) associated with counties that possessed at least one radiation Oncologist. However, increasing the county density to greater than two radiation Oncologists per 100,000 people had no statistically significant re...
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radiation Oncologist density and esophageal cancer mortality
Journal of Clinical Oncology, 2011Co-Authors: Sanjay Aneja, J B YuAbstract:116 Background: Although the use of radiation therapy to treat esophageal cancer is increasing, there exists a geographic variation among the distribution of radiation Oncologists. The impact of this variation on esophageal cancer (EC) outcomes remains unexplored. The goal of this study was to determine the effect of radiation Oncologist density on EC mortality. Methods: Using county- level data from the 2008 Area Resource File, National Program for Cancer Registries, and U.S. Centers for Disease Control, a multivariate regression model was constructed for EC mortality, controlling for county-level categorized radiation Oncologists density, demographics, socioeconomic status, and existing hospital facilities. Results: There was a statistically significant reduction in esophageal cancer mortality (reduction ranging from 22% to 79% p < 0.001) associated with counties that possessed at least one radiation Oncologist. However, increasing the county density to greater than two radiation Oncologists per 100,000...
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Radiation Oncologist density and colorectal cancer mortality.
Journal of Clinical Oncology, 2011Co-Authors: Sanjay Aneja, J B YuAbstract:605 Background: Although the use of radiation therapy is increasing, there exists geographic variation among the distribution of radiation Oncologists. The impact of this variation on colorectal cancer (CRC) outcomes remains unexplored. The goal of this study was to determine the effect of radiation Oncologist density on CRC mortality. Methods: Using county-level data from the 2008 Area Resource File, National Program for Cancer Registries, and US Centers for Disease Control, a regression model was constructed for CRC mortality, controlling for county-level categorized radiation Oncologists density, demographics, socioeconomic status and existing healthcare facilities. Results: There was a statistically significant reduction in CRC mortality (reduction in mortality ranging from 12% to 47%, p
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radiation Oncologist density and esophageal cancer mortality
Journal of Clinical Oncology, 2011Co-Authors: Sanjay Aneja, J B YuAbstract:116 Background: Although the use of radiation therapy to treat esophageal cancer is increasing, there exists a geographic variation among the distribution of radiation Oncologists. The impact of this variation on esophageal cancer (EC) outcomes remains unexplored. The goal of this study was to determine the effect of radiation Oncologist density on EC mortality. Methods: Using county- level data from the 2008 Area Resource File, National Program for Cancer Registries, and U.S. Centers for Disease Control, a multivariate regression model was constructed for EC mortality, controlling for county-level categorized radiation Oncologists density, demographics, socioeconomic status, and existing hospital facilities. Results: There was a statistically significant reduction in esophageal cancer mortality (reduction ranging from 22% to 79% p < 0.001) associated with counties that possessed at least one radiation Oncologist. However, increasing the county density to greater than two radiation Oncologists per 100,000...
Marij A Hillen - One of the best experts on this subject based on the ideXlab platform.
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effects of communication about uncertainty and Oncologist gender on the physician patient relationship
Patient Education and Counseling, 2019Co-Authors: Danielle Blanchhartigan, Ellen M A Smets, Marceline Van Eeden, Mathilde G E Verdam, Paul K J Han, Marij A HillenAbstract:Abstract Objective: Physicians are increasingly expected to share uncertain information, yet there is concern about possible negative effects on patients. How uncertainty is conveyed and by whom may influence patients’ response. We tested the effects of verbally and non-verbally communicating uncertainty by a male vs. female Oncologist on patients’ trust and intention to seek a second opinion. Methods: In an experimental video vignettes study conducted in The Netherlands, Oncologist communication behavior (verbal vs. non-verbal and high vs. low uncertainty) and gender (male vs. female) were systematically manipulated. Former cancer patients viewed one video variant and reported trust, intention to seek a second opinion, and experience of uncertainty. Results: Non-verbal communication of high uncertainty by the Oncologist led to reduced trust (β = -0.72 (SE = 0.15), p Conclusion: Non-verbal communication of uncertainty by Oncologists may affect patient trust and intention to seek a second-opinion more than verbal communication. Practice Implications: Further research to understand and improve Oncologists’ non-verbal uncertainty behavior is warranted.
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How can communication by Oncologists enhance patients' trust? An experimental study
Annals of Oncology, 2014Co-Authors: Marij A Hillen, Lukas J A Stalpers, Hanneke C J M De Haes, Phyllis Butow, Jean H.g. Klinkenbijl, E. H. Eddes, J. Van Der Vloodt, H.w.m. Van Laarhoven, E. M. A. SmetsAbstract:Background: Cancer patients need to trust their Oncologist to embark in the process of oncologic treatment. Yet, it is unclear how Oncologist communication contributes to such trust. The aim of this study was to investigate the effect of three elements of Oncologists’ communication on cancer patients’ trust: conferring competence, honesty, and caring. Methods: Eight videotaped consultations, ‘vignettes’, were created, reflecting an encounter between an Oncologist and a patient with colorectal cancer. All vignettes were identical, except for small variations in the Oncologist’s verbal communication. Cancer patients (n= 345) were randomly assigned to viewing two vignettes, asked to identify with the patient and afterwards to rate their trust in the observed Oncologist. The effects of competence, honesty, and caring on trust were established with multilevel analysis. Results: Oncologist’s enhanced expression of competence ( β = 0.17, 95% CI 0.08, 0.27; P< 0.001), honesty ( β= 0.30, 95% CI 0.20, 0.40; P< 0.001), as well as caring ( β= 0.36, 95% CI 0.26, 0.46; P< 0.001) resulted in significantly increased trust. Communication of honesty and caring also increased patients’ expectation of operation success and reported willingness to recommend the Oncologist. Conclusion(s): As hypothesized, Oncologists can influence their patients’ trust by enhanced conveyance of their level of competence, honesty, and caring. Caring behavior has the strongest impact on trust. These findings can be translated
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How attachment style and locus of control influence patients' trust in their Oncologist
Journal of Psychosomatic Research, 2014Co-Authors: Marij A Hillen, Lukas J A Stalpers, Hanneke C J M De Haes, Mathilde G E Verdam, Jean H.g. Klinkenbijl, Eric-hans Eddes, Ellen M A SmetsAbstract:Abstract Objective Cancer patients need to trust their Oncologist. How the Oncologist communicates probably contributes to patients' trust. Yet, patient characteristics such as their attachment style and health locus of control may influence how such communication is perceived. We examined how these personality characteristics influence trust as well as moderate the relation between Oncologist communication and trust. Methods Eight videotaped scenarios of an oncologic consultation were created. Oncologist communication was systematically varied regarding their expressed competence, honesty and caring. Cancer patients (n = 345) were randomly assigned to view the videos and report their trust in the observed Oncologist. Patients' self-reported attachment style, health locus of control and trust in their own Oncologist were assessed. Results Patients with a stronger external health locus of control trusted the observed Oncologist more (p Discussion Patients' attachment avoidance may hamper their trust in their own, but not necessarily in a newly observed, Oncologist. As expected, patients' attachment style influences how Oncologist communication influences trust, underscoring the importance of Oncologists tailoring their communication to individual patients. We confirmed observational findings that patients convinced that others control their health trust their Oncologist more than others.
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does being informed and feeling informed affect patients trust in their radiation Oncologist
Patient Education and Counseling, 2013Co-Authors: Ellen M A Smets, Marij A Hillen, Lukas J A Stalpers, Caro C E Koning, Kirsten F L Douma, Hanneke C J M De HaesAbstract:Abstract Objective We investigated whether the content of information provided by radiation Oncologists and their information giving performance increase patients' trust in them. Methods Questionnaires were used to assess radiotherapy patients ( n =111) characteristics before their first consultation, perception of information giving after the first consultation and trust before the follow-up consultation. Videotaped consultations were scored for the content of the information provided and information giving performance. Results Patients mean trust score was 4.5 (sd=0.77). The more anxious patients were, the less they tended to fully trust their radiation Oncologist ( p =0.03). Patients' age, gender, educational attainment and anxious disposition together explained 7%; radiation Oncologists' information giving (content and performance) explained 3%, and patients' perception of radiation Oncologists' information-giving explained an additional 4% of the variance in trust scores. Conclusion It can be questioned whether trust is a sensitive patient reported outcome of quality of communication in highly vulnerable patients. Practice implications It is important to note that trust may not be a good patient reported outcome of quality of care. Concerning radiation Oncologists' information giving performance, our data suggest that they can particularly improve their assessments of patients' understanding.
James A Tulsky - One of the best experts on this subject based on the ideXlab platform.
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Oncologist patient caregiver decision making discussions in the context of advanced cancer in an asian setting
Health Expectations, 2020Co-Authors: Chetna Malhotra, Kathryn I Pollak, James A Tulsky, Ravindran Kanesvaran, Nesaretnam Barr Kumarakulasinghe, Singhuang Tan, Ling XiangAbstract:OBJECTIVE Patient involvement in treatment decisions is recommended in clinician-patient encounters. Little is known about how Oncologists engage patients in shared decision making in non-Western countries. We assessed the prevalence of shared decision making among Singaporean Oncologists and analysed how they discussed prognosis. METHODS We audio-recorded 100 consultations between advanced cancer patients and their Oncologists. We developed a coding system to assess Oncologist encouragement of patient participation in decision making and disclosure of an explicit prognosis. We assessed patient and Oncologist characteristics that predicted these behaviours. RESULTS Forty-one consultations involved treatment discussions. Oncologists almost always listed more than one treatment option (90%). They also checked patient understanding (34%), discussed pros and cons (34%) and addressed uncertainty (29%). Oncologists discussed prognosis mostly qualitatively (34%) rather than explicitly (17%). They were more likely to give an explicit prognosis when patients/caregivers asked questions related to prognosis. CONCLUSION Oncologists in our sample engaged their patients in decision making. They have areas in which they can improve to involve patients at a deeper level to ensure shared decision making. Findings will be used to develop an intervention targeting Oncologists and patients to promote patient involvement in decision making.
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Oncologist communication about emotion during visits with patients with advanced cancer
Journal of Clinical Oncology, 2007Co-Authors: Kathryn I Pollak, Robert M Arnold, Amy S Jeffreys, Stewart C Alexander, Maren K Olsen, Amy P Abernethy, Celette Sugg Skinner, Keri L Rodriguez, James A TulskyAbstract:Introduction Cancer care involves addressing patient emotion. When patients express negative emotions, empathic opportunities emerge. When Oncologists respond with a continuer statement, which is one that offers empathy and allows patients to continue expressing emotions, rather than with a terminator statement, which is one that discourages disclosure, patients have less anxiety and depression and report greater satisfaction and adherence to therapy. We studied whether Oncologist traits were associated with empathic opportunities and empathic responses. Patients and Methods We audio-recorded 398 clinic conversations between 51 Oncologists and 270 patients with advanced cancer; Oncologists also completed surveys. Conversations were coded for the presence of empathic opportunities and Oncologist responses. Analyses examined the relationship with Oncologists’ demographics, self-reported confidence, outcome expectancies, and comfort to address social versus technical aspects of care. Results In 398 conversations, 37% contained at least one empathic opportunity; the range was 0 to 10, and the total empathic opportunities was 292. When they occurred, Oncologists responded with continuers 22% of the time. Oncologist sex was related to the number of empathic opportunities; female patients seen by female Oncologists had the most empathic opportunities (P .03). Younger Oncologists (P .02) and those who rated their orientation as more socioemotional than technical (P .03) were more likely to respond with empathic statements. Conclusion Oncologists encountered few empathic opportunities and responded with empathic statements infrequently. Empathic responses were more prevalent among younger Oncologists and among those who were self-rated as socioemotional. To reduce patient anxiety and increase patient satisfaction and adherence, Oncologists may need training to encourage patients to express emotions and to respond empathically to patients’ emotions. J Clin Oncol 25:5748-5752. © 2007 by American Society of Clinical Oncology
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Studying communication in Oncologist-patient encounters: the SCOPE Trial.
Palliative Medicine, 2006Co-Authors: Celine M. Koropchak, Kathryn I Pollak, Robert M Arnold, Amy S Jeffreys, Stewart C Alexander, Maren K Olsen, Amy P Abernethy, Celette Sugg Skinner, Keri L Rodriguez, James A TulskyAbstract:Study objective: Most Oncologists have not received adequate training in physician-patient communication, and existing effective courses tend to be time and resource intensive. We are developing and testing a tailored CD-ROM educational intervention that includes feedback on Oncologists’ own audio-recorded conversations with their advanced cancer patients. In this report, we describe the study methods and identify challenges to implementation and how these were overcome.Study design: A three-phase, randomized, controlled trial. In Phase 1, we audio-recorded Oncologist-patient clinic encounters. In Phase 2, Oncologists were randomly assigned to a communication CD-ROM intervention or control. Phase 3 consisted of audio-recording all participating Oncologists conversing with a new sample of patients, two to 12 months after the intervention, to assess its effectiveness.Setting: Oncology clinics at Duke University Medical Center (DUMC) and the Durham Veterans Affairs Medical Center (DVAMC) in Durham, NC, and t...
Kathryn I Pollak - One of the best experts on this subject based on the ideXlab platform.
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Oncologist patient caregiver decision making discussions in the context of advanced cancer in an asian setting
Health Expectations, 2020Co-Authors: Chetna Malhotra, Kathryn I Pollak, James A Tulsky, Ravindran Kanesvaran, Nesaretnam Barr Kumarakulasinghe, Singhuang Tan, Ling XiangAbstract:OBJECTIVE Patient involvement in treatment decisions is recommended in clinician-patient encounters. Little is known about how Oncologists engage patients in shared decision making in non-Western countries. We assessed the prevalence of shared decision making among Singaporean Oncologists and analysed how they discussed prognosis. METHODS We audio-recorded 100 consultations between advanced cancer patients and their Oncologists. We developed a coding system to assess Oncologist encouragement of patient participation in decision making and disclosure of an explicit prognosis. We assessed patient and Oncologist characteristics that predicted these behaviours. RESULTS Forty-one consultations involved treatment discussions. Oncologists almost always listed more than one treatment option (90%). They also checked patient understanding (34%), discussed pros and cons (34%) and addressed uncertainty (29%). Oncologists discussed prognosis mostly qualitatively (34%) rather than explicitly (17%). They were more likely to give an explicit prognosis when patients/caregivers asked questions related to prognosis. CONCLUSION Oncologists in our sample engaged their patients in decision making. They have areas in which they can improve to involve patients at a deeper level to ensure shared decision making. Findings will be used to develop an intervention targeting Oncologists and patients to promote patient involvement in decision making.
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Oncologist communication about emotion during visits with patients with advanced cancer
Journal of Clinical Oncology, 2007Co-Authors: Kathryn I Pollak, Robert M Arnold, Amy S Jeffreys, Stewart C Alexander, Maren K Olsen, Amy P Abernethy, Celette Sugg Skinner, Keri L Rodriguez, James A TulskyAbstract:Introduction Cancer care involves addressing patient emotion. When patients express negative emotions, empathic opportunities emerge. When Oncologists respond with a continuer statement, which is one that offers empathy and allows patients to continue expressing emotions, rather than with a terminator statement, which is one that discourages disclosure, patients have less anxiety and depression and report greater satisfaction and adherence to therapy. We studied whether Oncologist traits were associated with empathic opportunities and empathic responses. Patients and Methods We audio-recorded 398 clinic conversations between 51 Oncologists and 270 patients with advanced cancer; Oncologists also completed surveys. Conversations were coded for the presence of empathic opportunities and Oncologist responses. Analyses examined the relationship with Oncologists’ demographics, self-reported confidence, outcome expectancies, and comfort to address social versus technical aspects of care. Results In 398 conversations, 37% contained at least one empathic opportunity; the range was 0 to 10, and the total empathic opportunities was 292. When they occurred, Oncologists responded with continuers 22% of the time. Oncologist sex was related to the number of empathic opportunities; female patients seen by female Oncologists had the most empathic opportunities (P .03). Younger Oncologists (P .02) and those who rated their orientation as more socioemotional than technical (P .03) were more likely to respond with empathic statements. Conclusion Oncologists encountered few empathic opportunities and responded with empathic statements infrequently. Empathic responses were more prevalent among younger Oncologists and among those who were self-rated as socioemotional. To reduce patient anxiety and increase patient satisfaction and adherence, Oncologists may need training to encourage patients to express emotions and to respond empathically to patients’ emotions. J Clin Oncol 25:5748-5752. © 2007 by American Society of Clinical Oncology
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Studying communication in Oncologist-patient encounters: the SCOPE Trial.
Palliative Medicine, 2006Co-Authors: Celine M. Koropchak, Kathryn I Pollak, Robert M Arnold, Amy S Jeffreys, Stewart C Alexander, Maren K Olsen, Amy P Abernethy, Celette Sugg Skinner, Keri L Rodriguez, James A TulskyAbstract:Study objective: Most Oncologists have not received adequate training in physician-patient communication, and existing effective courses tend to be time and resource intensive. We are developing and testing a tailored CD-ROM educational intervention that includes feedback on Oncologists’ own audio-recorded conversations with their advanced cancer patients. In this report, we describe the study methods and identify challenges to implementation and how these were overcome.Study design: A three-phase, randomized, controlled trial. In Phase 1, we audio-recorded Oncologist-patient clinic encounters. In Phase 2, Oncologists were randomly assigned to a communication CD-ROM intervention or control. Phase 3 consisted of audio-recording all participating Oncologists conversing with a new sample of patients, two to 12 months after the intervention, to assess its effectiveness.Setting: Oncology clinics at Duke University Medical Center (DUMC) and the Durham Veterans Affairs Medical Center (DVAMC) in Durham, NC, and t...
Chikashi Ishioka - One of the best experts on this subject based on the ideXlab platform.
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role of medical Oncologist in local medical service and medical oncology education
Annals of Oncology, 2012Co-Authors: Chikashi IshiokaAbstract:ABSTRACT Overall cancer treatment should be coordinated among a radiation Oncologist, surgeon, and medical Oncologist, where appropriate. Unfortunately, there were few medical Oncologists in Japan mainly because of lack of the academic society like JSMO and divisions in medical schools and hospitals for medical oncology. Therefore, the multidisciplinary approach in treating cancers was inappropriate. Since 2006, more than 700 cancer drug therapy specialists (diplomates, Subspecialty Board of Medical oncology, JSMO) were fostered in Japan, and the medical Oncologists with the diplomate are gradually distributed in local cancer core hospitals. The current role of the medical Oncologists in the hospitals is diverse and it includes treatment and management of cancer chemotherapy, such as treatment of both common and rare advanced cancers, management of outpatient chemotherapy center, organization of the regimen review committee and tumor board, education of their medical staffs and patients etc. The expanding role of the medical Oncologists in the management of cancer patients may contribute to the spread of standard cancer chemotherapy. However, the number of medical Oncologist is still limited. Many challenges still exist, both within the hospital and in translating oncological, technological and societal change into the context of local medical society. Because the number of cancer patient is increasing in Japan, wide spread advances in oncology by oncology specialists is urgent matter. In this symposium, current and future roles of the medical Oncologists in local cancer core hospitals and their role in medical oncology education should be discussed.
