Advance directives among health care professionals at a community-based cancer center.

OBJECTIVE: To determine the proportion of health care professionals at our community-based cancer center who had completed advance directives (ADs) and to identify barriers to their doing so. PARTICIPANTS AND METHODS: On October 11, 2005, we sent a Web-based survey via e-mail to 170 health care professionals who have face-to-face contacts with patients at our institution. These health care professionals included medical (physicians, n=15), associate (physician assistants and nurse practitioners, n=7), and support (nurses, radiation therapists, medical or nurse assistants, social workers, nutritionists, geneticist, chaplain, family counselor, and patient liaisons; n=148) staff members. The survey ended on October 31, 2005. For the purpose of this survey, having a written AD was defined as having both a living will and a power of attorney for health care. Key outcome measures of our study were existence of ADs, placement of ADs in the medical record, communication of ADs with loved ones and primary care physician, and factors that influenced the decision to have an AD. Statistical tests included the chi2 and Fisher exact tests. RESULTS: Of the 170 health care professionals to whom the survey was sent, 134 (79%) responded. Although 83% reported that they had discussed their wishes regarding future life-sustaining medical care with those closest to them, only 35% had a written AD (58% of medical staff, 50% of associate staff, and 32% of support staff). Among those with ADs, 66% had informed their primary care physician, and 71% were certain that their ADs were in their medical records. Older age (P less than .001), role as medical or associate staff (P=.05), and more years of work experience with patients with cancer (P=.05) were associated with having an AD, whereas sex, marital or partnership status, and number of children were not. Perceived lack of time was the most common barrier cited (45%). Among those without an AD, 75% reported having end-of-life discussions with family members or loved ones. CONCLUSION: Despite work experience with patients who have a high mortality rate, health care professionals at our cancer center do not adequately communicate (via a written AD) end-of-life planning decisions to their own primary care physicians.

Diethylstilbestrol (DES) update: recommendations for the identification and management of DES-exposed individuals.

Diethylstilbestrol (DES) was etiologically linked to clear cell adenocarcinoma of the vagina in 1971. This article reviews on-going research and emerging information relevant to DES-related health risks, thereby enabling women's health care providers to maintain an evidence-based practice for their DES-exposed patients. To accomplish these goals, the Center for Disease Control and Prevention (CDC) has initiated a national education campaign. This article describes the reasons for this new initiative, the target audiences, the DES historical framework (including major studies and findings), and populations that are affected. Clinical steps for the identification and management of the DES-exposed individual and resultant implications for midwifery and women's health practices are reviewed.