ABSTRACT
Prior to the proposed development of a pretreatment counselling package for patients with cancer of the larynx or pharynx, a study was undertaken to determine current information giving practice prior to laryngectomy. A postal questionnaire was sent to all UK ENT consultants registered in the Medical Directory. The response rate was 88%, with 48% meeting the study's entry criteria. Counselling practice varies widely. Surgeons report an average of 15 min available for discussion with the patient: 84% gave the diagnosis and discussed the treatment options at the same consultation. The size of the department, as measured by cases seen per year, did not correlate with the consultation time although it did with the numerous different issues discussed. Whilst the survey supports the need and desire for an appropriate counselling package, many surgeons feel that they alone know what the patient's information needs are.
Subject(s)
Laryngeal Neoplasms/surgery , Laryngectomy , Patient Education as Topic/methods , Pharyngeal Neoplasms/surgery , Practice Patterns, Physicians'/statistics & numerical data , Attitude of Health Personnel , Counseling , Health Care Surveys , Humans , Laryngeal Neoplasms/rehabilitation , Patient Care Team , Pharyngeal Neoplasms/rehabilitation , Preoperative Care/methods , Quality of Life , Surveys and Questionnaires , United KingdomABSTRACT
It has been proposed that the effectiveness of medical treatment should be measured by mortality from specified diseases for which death is apparently avoidable given appropriate medical intervention. Unfortunately, that proposal was not supported by direct analysis of the relation between health care resources and avoidable mortality--an analysis which is essential for establishing the validity of avoidable mortality as an indicator of the outcome of health care. Thus the proposal does not yet have any basis, theoretical or practical. A more realistic but still oversimple model is now proposed. With presently available data, however, the validity of avoidable mortality is unlikely to be established, even by this model.
