Comorbid anxiety and depression among women receiving care for breast cancer: analysis of prevalence and associated factors

Background: Living with breast cancer has been associated with increased risk for common mental health problems including depression and anxiety. However, the prevalence of comorbid anxiety and depression (CAD) and their associated factors have received little attention especially in low- and middle-income countries (LMICs) including Ghana. Objectives: This study examined the prevalence of CAD and its correlates in the context of breast cancer. Methods: Participants were 205 women receiving care for breast cancer at a Tertiary Hospital in Ghana. The Hospital Anxiety and Depression Scale (HADS) and socio-demographic questionnaires were administered to the participants. Results: Findings from the study showed that the prevalence of CAD, anxiety and depression was 29.4%, 48.5% and 37.3% respectively. CAD was significantly predicted by patients' English language reading ability, shared decision making and good doctor-patient relationship. Anxiety was significantly predicted by shared decision making and good doctor-patient relationship whereas depression was significantly predicted educational status, patients' English language reading ability, shared decision making and good doctor-patient relationship. Conclusion: The findings suggest relatively high prevalence of comorbid anxiety and depression which could negatively impact breast cancer treatment outcomes and therefore, improved interpersonal relationships between doctors and their patients as well as literacy skills are warranted

COVID-19 and patient-doctor confidentiality

Given the increasing numbers of ethical and legal issues arising from the COVID-19 epidemic, particularly in respect of patient-doctor confidentiality, doctors must explain to patients how the measures taken to combat the spread of the virus impact on their confidentiality. Patients must be reassured that doctors are ethically bound to continue to respect such confidentiality, but it should be made clear to them that doctors must also comply with the demands of the law. While the Constitution, statutory law and the common law all recognise a person's right to privacy, during extraordinary times such as the COVID-19 pandemic, confidentiality must be breached to a degree to halt the spread of the virus

Writing therapy

In the distant past I started to suggest to patients that they might like to write down their stories as a form of therapy.1 They could write me a letter or write a letter to some significant person in their lives that would help them coordinate their thoughts and emotions

Patient Satisfaction with the Quality of Care in a Primary Health Care Setting in Botswana

Primary health care involves a sustained partnership between patients and providers that addresses the majority of a population's health needs over time. Patients' perception of satisfaction is an aspect of healthcare quality that is being increasingly recognised for its importance. The objective of this study was to investigate the factors contributing to patients' satisfaction with and their rating of the quality of care in Extension II Clinic in Gaborone; Botswana. of them were displeased with this aspect. A total of 36.9 Method: This was a cross-sectional study in which 360 systematically selected participants completed five-point Likert scale self-administered questionnaires. Results: Overall; participants were quite satisfied (mean score = 3.75) with the services provided by the different service providers. The participants indicated that overall; the quality of care of the health care facility was good (mean score = 3.45). The pharmacy received the highest satisfaction level with a mean rating of 4.1. Thirty-eight per cent of the participants rated the services provided by the doctors as best despite giving the highest quality ratings with a mean of 3.9 to the pharmacy compared to mean ratings of 3.4 for the doctors. The participants' greatest displeasure was with the time spent at the facility; as 63.9 was most pleased with information given to them as a factor of importance. Conclusion: The participants were quite satisfied with the services provided as well as the quality of care provided by the different service providers of the health care facility. There is; however; a need for interventions in terms of time spent at the facility; which would promote good customer-focused service delivery

The perception of Patients of Doctor-Patient Relationship in Otorhinolaryngology Clinics of the University of Port Harcourt Teaching Hospital (UPTH) Nigeria

Background: The doctor-patient relationship is central to the practice of medicine and is essential for the delivery of high quality healthcare in the diagnosis and treatment of diseases. Recently; patient participation has gained increasing prominence in healthcare delivery. Aim: To explore the perceptions of Nigerian adult patients who attend the University of Port-Harcourt Teaching Hospital (UPTH) Otorhinolaryngology clinics with regard to relation with their doctors during consultations. Methods: This is a descriptive cross-sectional study; the duration of the field work was two weeks. The study population consisted of adult patients who attended the otorhinolaryngology clinics. Data collection was carried out using interviewer-administered semi-structured questionnaires that explored the perception of patients of doctor-patient relationship. Forty patients were selected for the study and the sampling was purposeful. An average of twenty interviews was conducted per clinic day. Each interview took approximately 15 minutes. Results: The majority (95) of patients' treatment was decided by the doctors. The majority of the patients (87.5) welcomed the opportunity to have more involvement in making treatment decisions. Most of the patients (67.5) were not satisfied with the services received from their doctors. Conclusion: This study established paternalistic model as the dominant pattern of doctor-patient relationship in UPTH otorhinolaryngology clinics. The patients preferred a more cordial relationship

Experiences and Perceptions of Midwives and Doctors when Caring for Mothers with Pregnancy Loss in a Gauteng Hospital

The purpose of this study was to explore and describe the experience of midwives and doctors when caring for mothers with pregnancy loss. To realise this goal; the researcher followed a qualitative; exploratory; descriptive and contextual approach. A purposive sampling method was used to select the doctors and midwives; using set criteria. Data was collected by using focused; semi-structured; individual interviews; taped and transcribed verbatim. Open coding combined with conceptualisation were used to analyse data until saturation occurred. Seven doctors and nine midwives who were interviewed described their experiences and perceptions when working with mothers with pregnancy loss. It became clear that both midwives and doctors lack the know-how to support mothers with pregnancy loss; and that they are overwhelmed by problems like shortage of staff and overcrowding. It is recommended that further research be conducted in other public hospitals; i.e. on a larger scale; to see if the findings are the same. It is also recommended that a counselling programme be developed to help health professionals deal with problems in the ward situation; while they are still able to attend to the mothers. The institution should develop guidelines; policies and procedures to help health professionals to cope when a life can no longer be saved. A multidisciplinary approach and conferences that target causes of perinatal loss are also recommended

Medical Futility and End-of-Life Care

Acceptance of the concept of medical futility facilitates a paradigm shift from curative to palliative medicine; accommodating a more humane approach and avoiding unnecessary suffering in the course of the dying process. This should not be looked upon as abandoning the patient but rather as providing the patient and family with an opportunity to come to terms with the dying process. It also does not entail withdrawal or passivity on the part of the health care professional. In addition to medical skills; the treating physician is responsible for guiding this process by demonstrating sensitivity and compassion; respecting the values of patients; their families and the medical staff. The need for training to equip medical staff to take responsibility as empathetic participants in end-of-life decision-making is underscored

Challenges to creating primary care teams in a public health centre: a co-operative inquiry

"Background: Effective teamwork between doctors and clinical nurse practitioners (CNP) is essential to the provision of quality primary care in the South African context. The Worcester Community Health Centre (CHC) is situated in a large town and offers primary care to the rural Breede Valley Sub-District of the Western Cape. The management of the CHC decided to create dedicated practice teams offering continuity of care; family-orientated care; and the integration of acute and chronic patients. The teams depended on effective collaboration between the doctors and the CNPs.Methods: A co-operative inquiry group; consisting of two facility managers; an administrator; and medical and nursing staff; met over a period of nine months and completed three cycles of planning; action; observation and reflection. The inquiry focused on the question of how more effective teams of doctors and clinical nurse practitioners offering clinical care can be created within a typical CHC.Results: The CHC had established three practice teams; but met with limited success in maintaining the teams over time. The group found that; in order for teams to work; the following are needed: A clear and shared vision and mission amongst the staff. The vision was championed by one or two leaders rather than developed collaboratively by the staff. Continuity of care was supported by the patients and doctors; but the CNPs felt more ambivalent. Family-orientated care within practices met with limited success. Integration of care was hindered by physical infrastructure and the assumptions regarding the care of ""chronics"". Enhanced practitioner-patient relationships were reported by the two teams that had staff consistently available. Significant changes in the behaviour and roles of staff. Some doctors perceived the nurse as an ""assistant"" who could be called on to run errands or perform tasks. Doctors perceived their own role as that of comprehensively managing patients in a consultation; while the CNPs still regarded themselves as nurses who should rotate to other duties and perform a variety of tasks; thus oscillating between the role of practitioner and nurse. The doctors felt responsible for seeing a certain number of patients in the time they were available; while the CNPs felt responsible for getting all the patients through the CHC. The doctors did not create space for mentoring the CNPs; who were often seen as an intrusion and a threat to patient privacy and confidentiality when requesting a consultation. For the CNPs; however; the advantage of practice teams was considered to be greater accessibility to the doctor for joint consultation. The identification of doctors and CNPs with each other as part of a functioning team did not materialise. Effective management of the change process implied the need to ensure sufficient staff were available to allow all teams to function equally throughout the day; to be cognisant of the limitations of the building design; to introduce budgeting that supported semi-autonomous practice teams and to ensure that the staff were provided with ongoing opportunities for dialogue and communication. The implications of change for the whole system should be considered; and not just that for the doctors and nurses.Conclusions: Key lessons learnt included the need to engage with a transformational leadership style; to foster dialogical openness in the planning process and to address differences in understanding of roles and responsibilities between the doctors and the CNPs. The unreliable presence of doctors within the practice team; due to their hospital duties; was a critical factor in the breakdown of the teams.. The CHC plans to further develop practice teams; to learn from the lessons so far and to continue with the co-operative inquiry."

Informed consent: the radiologist administering radiological contrast media

This study represents the understanding and practice of radiologists in Nigeria in obtaining informed consent from patients before administering radiological contrast media. 120 questionnaires were sent to radiologists practicing in Nigeria. 78(65%) responded, 60(76.9%) of the respondents understood informed consent to mean informing a patient about a procedure and obtaining consent to carry out the procedure. Whereas for consent to be informed it must include the nature of the procedure, purpose, risks and benefits. 52(66.7%) obtained either written or verbal consent while 26(33.3%) neither informed patient nor obtained consent. However, all respondents understood that failure to obtain consent may result in possible litigation by patient or relative while 69(88.5%) requested for a specific policy regarding informed consent. It is concluded that the radiologist in Nigeria does not fully understand the concept of informed consent. A specific policy should be made by the appropriate professional body in Nigeria as to what constitutes the requirements of a truly informed consent since there are simply no guidelines for now. Also informed consent forms, simple enough for patients to understand should be designed. These will assist the individual specialist in the conduct of their practice

Sexual Misconduct in the Practice of Medicine

There is a long-standing consensus within the medical profession that sexual contact or sexual relations between doctors and patients are unethical. Current ethical thought uniformly condemns sexual relations between patients and doctors. The ban on doctor-patient sexual contact is based on the recognition that such contact jeopardises patients' medical care. A number of studies in the Western World have tried to establish the incidence of doctor-patient sexual contact. Much of the research done on the prevalence of doctor-patient sexual contact is based on studies that survey doctors about their own behaviour. The general stigma attached to sexual contact with patients and the professional repercurssions that many researchers to beleive that the occurrence of patient-doctor sexual contact is under-reported. One the local scene no study has ever been conducted on the subject; however; an ecdotal tales reveal that the problem exists. Available studies from eleswhere show that between 5and 10of doctors engage in sexual contact with patients

Evaluation de la satisfaction des patients ; quelle place dans la performance d'un hopital ? Exemple des consultations externes de PPH du CHU de Cocody

Durant la periode du 31juillet 2000 au 04 Octobre 2000; nous avons effectue une etude prospective portant sur l'etat de satisfaction de nos patients en consultation externe de PPH de Cocody.Cette etude avait pour objectif principal d'apprehender les differents niveaux d'insatisfaction et de satisfaction depuis le premier contact du patient avec l'hopital jusqu'a sa sortie de la salle du medecin. De facon specifique; nous nous sommes proposes d'apprehender les differents parametres d'insatisfaction et de satisfaction; de situer les differents niveaux de responsabilite et d'attirer l'attention des decideurs politiques et des prestataires de service sur la situation. Cette etude a sur 150 patients ayant comme caracteristiques sociodemographiques :-les hommes : 52;66 pour cent. -les femmes 47;33 pour cent. -une moyenne d'age de 29 ans. -les patients non scolarises 27;33 pour cent. -patients assures 2 1;33 pour cent. -patients payant en espece la consultation : 74 pour cent. Dans ses rapports avec les vigiles; en passant par le bureau des entrees jusqu'a la salle de consultation; le jugement du patient reste tres fortement tributaire de : -son age; -son sexe; -sont temps d'attente; -son mode de paiement; -l'information qu'il recoit sur sa maladie