ABSTRACT
INTRODUCTION: Our population has an intuitive approach of the screening and is mostly enthusiastic to participate. The related inquiries on breast cancer screening shows that most women misunderstood this advantages as well as disadvantages. Consequently, the Kenniscentrum (Brussels) started a study in order to present those in neutral messages. METHODOLOGY: This aims allowing women to make an informed decision. These messages are obviously based on the best methodologies applied on Belgian data. The content of these messages is especially based on the IPDAS criteria (international Patient Decision Aid Standards). RESULTS: Three visual graphical presentations including these messages were designed for four age brackets (40-49 y.,50-59 y.,60-69 y., 70-79 y.). The first visual presents the burden of breast cancer among other causes of death. The second is related to the impact of screening or no screening on detection and on mortality, this one computed over the ten years after the screening. The third visual shows consequences (positive or negative result, eventual additional investigations needed) of each mammography at short or mid-term. DISCUSSION: This tool can be used in the context of informed decision or shared decision making. This tool is in the public domain and can be downloaded, in French or Dutch, on KCE (https://kce.fgov.be, tab breast).
INTRODUCTION: Notre population a une approche intuitive du dépistage et se montre la plupart du temps enthousiaste à l'idée de se faire dépister. Les enquêtes effectuées auprès des femmes témoignant d'une méconnaissance tant des avantages que des désavantages du dépistage du cancer du sein, le Centre fédéral d'Expertise des Soins de Santé (KCE, Bruxelles) a entrepris une étude ayant pour objectif de présenter ceux-ci sous forme de messages neutres. Méthodologie : Cette étude a pour objectif de permettre aux femmes de prendre une décision éclairée. Ces messages sont basés sur les meilleures méthodologies appliquées aux données belges. Le développement du contenu des messages est notamment inspiré des critères IPDAS (International Patient Decision Aid Standards). Résultats : Trois présentations visuelles intégrant ces messages ont été élaborées pour quatre tranches d'âge (40-49 ans, 50-59 ans, 60-69 ans, 70- 79 ans). Le premier visuel présente le poids du cancer du sein parmi les autres causes de mortalité. Le deuxième visuel illustre les conséquences du dépistage ou du non-dépistage sur la détection du cancer et sur la mortalité, celle-ci étant calculée pour la période des dix années qui suivent le dépistage. Le troisième visuel illustre les conséquences (examen positif ou négatif, examens complémentaires éventuels) de chaque mammographie à court ou moyen terme. DISCUSSION: Cet outil est utilisable dans le cadre d'une prise de décision éclairée, tout comme dans celui d'une décision médicale partagée. Il est dans le domaine public et téléchargeable en français et en néerlandais sur le site du KCE (https:// kce.fgov.be, onglet sein).
Subject(s)
Breast Neoplasms/diagnosis , Clinical Decision-Making , Decision Support Systems, Clinical , Early Detection of Cancer , Adult , Aged , Female , Humans , Middle AgedABSTRACT
The optimal treatment for localized prostate tumours remains unknown. The standard curative options (radical prostatectomy and radiotherapy) are not free of significant complications and risks. High-intensity focused ultrasound (HIFU) appears to be an alternative. It is currently used as primary treatment for patients with localized prostate cancer T(1-2) N(0-x) M0, mostly low and intermediate risk, not suitable for surgery and as salvage treatment for locally proven recurrence of prostate cancer after curative therapy. In Belgium, it is estimated that about 730 patients (0.8% of all new prostate cancer patients) were treated with this new technology at 4 hospitals in the years 2000 to 2008. Given the increasing use of HIFU, this study was conducted to assess the current evidence supporting the effectiveness and safety of HIFU and to examine its role in the management of prostate cancer. A standard literature review showed that there is currently not sufficient evidence to support routine use of this new treatment modality. In order to obtain FDA approval, two multicentric non-randomized controlled trials comparing HIFU with cryotherapy and brachytherapy have been started in the U.S. and are now recruiting patients. Until more evidence becomes available, KCE recommends to limit the use of HIFU treatment to study setting. Future research is recommended in the form of comparative studies, preferably randomized controlled trials.
Subject(s)
Prostatic Neoplasms/surgery , Ultrasound, High-Intensity Focused, Transrectal , Brachytherapy , Combined Modality Therapy , Disease-Free Survival , Humans , Male , Neoplasm Recurrence, Local/surgery , Prostatectomy , Prostatic Neoplasms/mortality , Treatment Outcome , Ultrasound, High-Intensity Focused, Transrectal/adverse effectsABSTRACT
OBJECTIVE: To determine the effect of a non-committal registration specifying the intention of patients to contact a particular general practitioner, on patient loyalty in Belgium. SETTING: Antwerp and Liège DESIGN: Case control study. METHOD: Medical consumption was registered during one year by two health insurance companies for a group of 4000 participating patients (experimental group) and 4000 non-participants (control group) within two selected areas (Antwerp and Liège). Patient loyalty was measured by means of the normalised usual provider continuity index. RESULTS: No relevant differences were found between the experimental group and the control group. Even when taking into account that a general practitioner is not available 20% of the time, the proportion of loyal patients hardly reached 70%. CONCLUSION: A non-committal registration had no influence on patient loyalty. There is a clear difference between intention and actual behaviour. More coercive measures are needed to reach a more loyal behaviour.
