A Community-Oriented Approach to Questionnaire Development for Assessment of Oral Cancer Awareness Among Hispanic Migrant Farmworkers.

While disparities in the incidence, treatment, and mortality of oral cancer have been investigated in underrepresented groups, the Hispanic migrant farmworker population is understudied. A questionnaire was designed to assess oral cancer knowledge, awareness, and care-seeking behavior in this population. We aim to review this survey and outline its development.

Forcible Amputation in Delusional Patients: A Narrative Analysis of Decisional Capacity.

This case study concerns the predicaments faced by two women who each had been advised by her physicians to have a gangrenous foot amputated to prevent the potentially fatal spread of infection. In both cases, the determination of the patients' decisional capacity was a critical component in judging whether or not to honor their medical treatment decisions. The communicative complexity of navigating a double bind, a situation in which a person confronts a choice between two undesirable courses of action, is also discussed. The patients in these cases had no medically appropriate choice that also respected other valued outcomes, such as independence, a sense of dignity, or control over one's destiny. Taken together, these cases raise issues about the context-specific meaning of decisional capacity and its role in informed consent.

Victim of Abuse, or Bully? The Case of the 800-Pound Man.

Obesity in the United States has been declared both a disease and an epidemic. Physicians have thus been identified as the "experts" in managing weight loss, but they have few effective solutions to recommend except bariatric surgery. Most physicians and medical facilities are unprepared to manage the complex medical needs of obese patients, and most families are unprepared to manage the dietary issues in helping a family member lose weight, much less the physical, psychological, and interpersonal issues that surface. This case explores the medical, ethical, and communication challenges that arose in the case of a patient who weighed 800 pounds.

Assessing Oral Cancer Awareness Among Rural Latino Migrant Workers.

Latino migrant farm workers suffer significant health disparities, including poor oral health. The purpose of this research was to assess Latino migrant farm workers' OC awareness, including knowledge and care-seeking behaviors. A 42-item survey was developed. Trained, bilingual researchers verbally administered the survey to migrant farm workers in Hillsborough County, Florida. Frequencies and descriptive statistics were generated to report baseline data. The sample consisted of 53.7 % female respondents. The mean age for males and females respectively was 38.7 and 39.2. Most respondents had attended grade school; 6.7 % never attended school. Perceptions of cancer susceptibility were present; knowledge of OC risk factors, signs and symptoms was low. Participants were unlikely to seek preventive care. The results contribute to the limited studies regarding Latino migrant farm workers and oral cancer risk factor awareness and knowledge. Findings highlight factors influencing motivation and care-seeking behaviors, as well as provide guidance for development of educational materials.

In search of a good death.

Spirituality and storytelling can be resources in aging successfully and in dying well given the constraints of modern day Western culture. This paper explores the relationship of aging to time and the dynamic process of the life course and discusses issues related to confronting mortality, including suffering, finitude, spirituality, and spiritual closure in regard to death. And, finally, the role of narrative in this process is taken up.

Ethical considerations in the treatment of head and neck cancer.

BACKGROUND: The second half of the 20th century saw not only important developments in medical science and technology, but also a rapid growth in the application of biomedical ethics in medical decision making. Withdrawal of treatment, allowing to die, informed consent, and patient autonomy are concerns that now comprise a part of the overall medical treatment, particularly in patients with head and neck cancers. METHODS: The author discusses ethical issues relating to disfigurement/dysfunction in head and neck cancer patients and examines the aspects of "principlism": autonomy, nonmaleficence, beneficence, and justice. Two case reports are presented to illustrate the ethical challenges that may confront physicians who treat head and neck cancer patients. RESULTS: Head and neck oncology generates unique problems relating to disfigurement and dysfunction. An algorithm that considers the patient's medical good and greater good, as well as the goods of others, can assist in arriving at appropriate ethical decisions. CONCLUSIONS: Bioethical decision making requires the integration of virtues with principles, followed by the application of these standards to each patient.