BMJ Press Releases, Saturday 21 September 1996
Volume 313 No 7059
EMBARGOED 00.01 HRS 20 SEPTEMBER 1996
TELLING PATIENTS THE TRUTH ABOUT CANCER
[Information needs of cancer patients in west Scotland: cross sectional survey of patients' views]
[Respecting the autonomy of cancer patients when talking with their families: qualitative analysis of semistructured interviews with patients]
[Editorial: Talking to patients about cancer] Patients with cancer want to be given as much information as possible about their condition according to papers in this week's BMJ, yet there is evidence that many doctors in Britain fail to tell patients if they have cancer. An accompanying editorial reminds doctors that patients want, expect and need the truth, even if providing it proves uncomfortable.
Two papers remind readers that what is comfortable for clinicians is not necessarily what patients want. Meredith et al studied 250 patients with cancer in Scotland: 79 per cent wanted as much information as possible and 96 per cent specifically wanted to know if their illness was cancer. Almost all patients wanted to know the chance of cure and the side effects of treatment. A smaller study by Benson and Britten looked at how cancer patient viewed doctors telling their families about the illness. Patients favoured openness with their families but felt they should have a say in who else was told. Nearly two thirds felt that if the patient did not wish information to be passed on, then the family should not be told and information should not be given without consent except in certain circumstances.
The Meredith et al paper quotes a recent survey of gastroenterologists in Britain which showed that a third would not tell patients that they had cancer unless they asked. In 1984 a postal questionnaire of doctors showed that only 44 per cent of consultants and 25 per cent of GPs told patients their true diagnosis. Traditional justifications for keeping patients in the dark are that the facts might upset them and a presumption that patients do not really want to know. In his editorial Dr Rob Buckman says the current papers "remove the last vestiges of rationality from both arguments". He says there are simple, practical techniques doctors can learn and use to tell patients the truth and there are no longer any excuses for avoiding doing so.
Contact:
Dr Paul Symonds
Consultant clinical oncologist
Beatson Oncology Centre
Western Infirmary
Glasgow G11 6NT
Tel: 0141 211 1744
Fax: 0141 337 1712
Contact:
Dr John Benson
General Practitioner
125 Newmarket Road
Cambridge CB5 8HA
Tel: 01223 364116
Contact:
Dr Rob Buckman
Medical Oncologist
Sunnybrook Regional Cancer Centre
Toronto
Ontario
Canada M4N 3M5
Tel: 001 416 920 8234
Fax: 001 416 960 3375
DEFINING GP CORE SERVICES - A THREAT TO PRIMARY CARE?
[Editorial. Defining core general practitioner services. A threat to the future of general practice]
A warning against defining the core services provided by GPs too narrowly is sounded in an editorial in this week's BMJ.If core services are defined to narrowly the very existence of general practice as we know it will be threatened, writes Martin Roland of the National Primary Care Research and Development Centre in Manchester, England.
GPs in the UK are currently negotiating with the Department of Health over which services they should provide and how. The background to the debate is the Secretary of State for Health's increasing emphasis on a primary care-led NHS with a growing transfer of work from secondary (hospital) to primary (GP led) care and increasing patient expectations.
The editorial claims if GPs have to contract separately for services outside a defined core they will face competition from acute, community and ambulance trusts - all of whom would employ GPs to do the work. "Competition would come in other areas too, from providers who have had five years to develop their skills in bidding for contracts. Physicians would bid for a greater role in chronic disease management, surgeons would bid to provide postoperative care, community psychiatrists would bid for the care of schizophrenics, and community geriatricians would bid to care for the elderly at home. General practitioners, who, as fundholders, have grown used to using the internal market would find the full force of the market turned on them. They would either have to put time and effort into mounting successful bids for these contracts or see them pass to other providers.
"A key feature of general practice is the provision of first contact, coordinated care. In seeking - for understandable reasons - to limit the comprehensive nature of the commitment, the profession will allow a variety of specialists and quasi specialist services to become the patient's first point of contact. General practitioners, who are already overburdened with management, will become increasingly involved in defending their own territory. Primary are will become fragmented, with some practices able to provide only a rump of core contracted services, and the discipline of general practice will become unrecognisable. That is the doomsday scenario," he says.
Contact:
Martin Roland
Director
National Primary Care Research & Development Centre
University of Manchester
Manchester M13 9PL
Tel: 0161 275 7601
Fax: 0161 275 7636/7600
DOCTOR WARNS AGAINST GOING DOWN "AMERICAN PATH OF GUN CULTURE"
[Letter from Washington DC
Guns don't lie: People do]
A warning against going "down the American path of gun culture" comes in an article published in this week's BMJ by Simon Chapman from Australia. "I have just spent five weeks in the United States working on a book analysing the passage of Australia's new gun laws inspired by the Port Arthur massacre," he says. " The American path motif was hard to ignore. Gun deaths here are an obvious place to start. Apart from Columbia - where soccer players can get killed for an own goal - and (interestingly) Russia, no other country outside a war zone comes near to the USA when it comes to gun deaths."
Quoting various statistics, he says, from 1968 - 1991 deaths in the US from motor vehicles declined by 21 per cent while deaths caused by guns increased by 60 per cent and in eight states gun deaths exceed road deaths - in Washington DC by fivefold. In 1991 guns were used in 60.1 per cent of all suicides and 67.8 per cent of all homicides in the USA. Deaths from guns were the fourth leading cause of years of potential life lost before the age of 65.
Contact:
Simon Chapman
Associate professor
Dept. of Public Health and Community Medicine
University of Sydney
Westmead Hospital
Westmead
New South Wales 2145
Australia
Tel: 00 61-2 633 6675
Fax: 00 61-2 689 1049
E-mail: SIMON@cmed.wh.su.edu.au
GPs NEED INCENTIVES TO IMPROVE RESPONSE RATES TO RESEARCH QUESTIONNAIRES
[General practice postal surveys: a questionnaire too far]
GPs should be given incentives to respond to surveys in order to improve response rates, according to an article in this week's BMJ. Brian McAvoy, professor of primary health care and Dr Eileen Kaner, a research associate from Newcastle University medical school, say many GPs feel too busy to complete research questionnaires or routinely throw them away. They often do not see the relevance of the research and do not get information and feedback about it. In order to stop the trend of ever lower response rates they say practices should not be overused, incentives to participate should be given and the relevance of research and the quality of questionnaires should be improved. An accompanying commentary adds that GPs are often frustrated about the large number of non-scientific surveys masquerading as research. A second commentary from Holland, where the response rate to surveys is much higher, says payment is not the answer instead the "face" of research in British general practice must be improved.
Contact:
Dr Eileen Kaner
Dept. of Primary Health Care
School of Health Sciences
Medical School
University of Newcastle
Newcastle Upon Tyne
NE2 4HH
Tel: 0191 222 5439
Fax: 0191 222 7892
EMBARGO: 00.01 HRS FRIDAY 20 SEPTEMBER 1996
Issued on behalf of the authors by: Public Affairs Division, British Medical Association, BMA House, Tavistock Square, London, WC1H 9JP
Telephone: 0171 383 6254, (between 08.30 - 18.00), (After 6pm & at weekends): 01895 239687, 0171 727 2897, 0181 674 6294, 0171 727 2897, 01491 651405
PLEASE STATE THE BMJ AS THE SOURCE OF ALL ARTICLES USED
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