Dynamic informed consent processes vital for treatment with antidepressants.

Advances in technology and transparency have greatly accelerated the ability of clinicians to remain current with regards to being informed and informing patients about the risk/benefit ratio when considering antidepressant medication. In spite of this, the current climate of pharmaceutical industry influence on medical practice does much to hinder informed consent processes. Recent findings of previously unknown and potentially dangerous adverse effects of the second- and third-generation classes of antidepressants underscore the importance of enhancing the practice of informed consent. After considering the concept of informed consent as it has evolved over time, the authors summarize some of the newer side effects associated with second- and third-generation antidepressants and then move on to describe impediments in the way of achieving adequate informed consent at the clinical encounter. Among these impediments, the authors discuss the impact of industry influence, cognitive bias in decision-making, and time constraints. These obstacles and the notion that modern antidepressants are not as safe as once thought offer an opportunity to revisit the process of informed consent. A dynamic concept of informed consent is proposed with the acknowledgement that a mere listing of side effects or pro forma approach to informed consent is inadequate, and that a mindful and ongoing dialog with patients in which clinicians are responsive to patients' evolving needs as new information becomes available will more likely result in patient empowerment and a strengthening of the therapeutic alliance, thereby allowing patient and doctor to shoulder the burden of uncertainty together and leading to more optimal treatment outcomes.

Colorectal cancer among Arab-Israeli women--possible reasons for increased incidence and mortality.

BACKGROUND: Colorectal cancer (CRC) screening is effective in reducing its incidence by discovering precancerous polyps and detecting early cancer. Evidence indicates lower participation in screening programs among minority ethnic groups. In addition, the Israel Cancer Registry published an increase in the incidence of CRC among Israeli-Arab women. It is important to attempt to understand attitudes toward screening among Israeli-Arab women, assuming it has to do to lack of knowledge and compliance. METHODS: During the study period, a female team gave lectures in Arabic regarding CRC to women in 16 Arab villages. Prior to the lecture, the participants were asked to complete a questionnaire, obtaining information regarding CRC knowledge and screening. Following the lecture, FOBT kits were distributed. Two weeks later, a telephone survey was performed, regarding whether the FOBT was performed, the result of the test, and, if FOBT was not performed, the reasons for not completing the test. RESULTS: FOBT was performed by 17.8% prior to the lecture; 61% performed the FOBT following our lecture. Reasons cited for avoiding FOBT: 37% was "afraid of a positive result," 32% avoided performing the test as they were concerned they would be further examined by a male physician; 47.8% concluded that Arab women lack knowledge regarding screening interventions; 23.9% neglect themselves from a health point of view; 11.6% advised that Arab women have no free time to perform tests. CONCLUSIONS: Israeli-Arab women may be less knowledgeable concerning CRC. Educational efforts must be made to increase awareness and promote benefits of CRC screening, by targeting ethnic minorities and women in Israel.