Informed consent for investigational chemotherapy: patients' and physicians' perceptions.

One hundred forty-four patients and 68 physicians at three cancer centers were studied for their perceptions of the consent procedure, in which they participated one to three weeks earlier, for chemotherapy by one of 65 investigational protocols. Patients recalled the procedure positively and relied heavily on physician's advice. They felt most physicians wanted them to accept; 29% felt their participation in the decision was not encouraged. Primary reasons for accepting were trust in the physician, belief the treatment would help, and fear the disease (viewed as highly serious) would get worse without it. Nearly a fourth did not recall the information given that treatment was investigational. The consent form played no role in decision-making for 69%. Physicians believed therapeutic benefits would exceed potential problems for most patients; they viewed 41% of the patients as less than eager for details of treatment, a third as avoiding the seriousness of the discussion, and a third as passive in decision-making. The perceptual set of both parties places inadvertent constraint on patients' autonomy in decision making.

Well-being of cancer survivors.

One hundred and four cancer survivors 3 years past their last cancer treatment reported a significantly lower sense of self-control and more general health worries than a matched sample of healthy controls. The two groups did not differ on variables of anxiety, depression, positive well being, and vitality or on two composite scores of mental and general well-being. The well-being scores of the survivors from three geographically distinct cancer centers revealed no significant differences among centers on the composite or any of the individual subscores. Sociodemographic and treatment variables revealed only marriage and no change in job were significantly related to the amount of general well-being experienced.

Pretreatment behavioral profiles associated with subsequent psychosocial adjustment in radiation therapy patients: a prospective study.

A clinically derived system of judging cancer patients' engagement, reality testing and degree of arousal during a pretreatment consultation was found predictive of psychosocial problems or no problems reported by sixty cancer patients one month after starting radiation therapy. Independent ratings of psychosocial problems by the treating oncologists, nurses and radiation therapists three months after starting treatment were also found significantly associated with the pretreatment composite. Disease, treatment and demographic factors were not predictive of psychosocial problems and were not associated with the pretreatment clinical composite. Follow-up observations at six months and eighteen to twenty-four months of forty-four and twenty-four of the original patients available for study revealed there was no continuing association between their pretreatment clinical composites and psychosocial problem ratings.

Clinical trials in psychosocial medicine: methodologic and statistical considerations. Part I. Introduction.

Psychosocial oncology is defined as a newly developing field which requires its own methodology for measuring the importance of psychologic and social factors for cancer patients, their families, and involved health professionals. As with all new areas of research, there must be a systematic approach once clinical observations and initial hypotheses have been made. The science for such an approach has been slow to develop because of the complexities of finding and testing the appropriate instruments for identifying and quantifying variables before trying to improve the patient's adjustment. In order to facilitate this process, a five-center collaborative group has been formed. Among its first tasks are the selection and testing of screening instruments.

The dying patient.

Dying is again being recognized as a natural phase of life for which we spend a lifetime preparing. There are times during life when it seems least appropriate and most difficult to accept dying, as in childhood. It is important to recognize that we go through life acquiring and losing significant objects in our quest for greater self-esteem and in our preparing for dying. To approach the awareness of dying as a life crisis which allows a new awareness towards self and reality makes the process of dying not only challenging but worth the living. Health care professionals must guard against trying to mold patients into their reality and thus meeting their own needs and not the patients'. Specific guidelines for the support of dying called Comfort Care Only shift the therapeutic focus from a preoccupation with the patient's disease to the broader human concerns and a sharing of the experience which is as important for the surviving as it is for the dying.

Psychological aspects of anorexia: areas for study.

Anorexia and weight loss are frequently the first manifestations of cancer. Although psychological reasons are frequently included as a partial explanation for loss of appetite and weight in the cancer patient, there have been no systematic studies which establish the nature of this relationship. It is proposed that anorexia and cachexia are at times somatic consequences of the cancer patient's beliefs and attitudes about their disease and its treatments. The inability to overcome a sense of hopelessness leads to an adaptive biological reaction called conservation-withdrawal. The effects of the reaction of disengagement and inactivity in relation to the external world which includes external nutriment may be constructive or destructive depending on when it is experienced and the length of time the reaction continues. How this reaction is initiated and mediated biologically and how it may be related to and can be reversed by a shift in motivation are questions of great importance.