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Purpose: Team-based care is the delivery of health services to an individual by at least two health care providers working collaboratively to achieve optimal care. Participants on the National Cancer Institute and the ASCO Teams in the Cancer Care Delivery Project have defined 13 key principles to serve as the foundation for a successful team; however, it is unclear whether there exist measures of these key principles., Methods: A scoping literature search was conducted for each key principle on PubMed and Embase to identify existing measures for key principles. Articles of interest were exported to a citation manager, Sciwheel, cataloged by the key principle. Existing measures were extracted via a two-stage screening process, with an abstract review followed by a full-text review., Results: Fifteen unique measures were identified, with items extrapolated for 12 of the 13 key principles. Measures were not exclusive and could represent more than one key principle. The number of measures varied per principle from zero to five, with Team Composition and Diversity yielding no existing measure., Conclusion: The long-term goal is to compile and edit these measures, to create a comprehensive measure to be used in various team-based oncology care settings, and to address areas for improvement, ultimately optimizing patient care.

Purpose: The understanding of patients with cancer of their condition and their wishes regarding care as they approach end of life (EoL) have been studied more in high-income countries than in low- and middle-income countries (LMICs)., Patients and Methods: Data were analyzed from a cohort study (N = 221) of patients with advanced cancer who were recruited from a palliative care center in Soweto, South Africa (LMIC), between May 2016 and June 2017. Patients were asked about their understanding of their illness, estimated life expectancy, EoL care communication, and EoL care preferences., Results: Only 13 patients (5.9%) acknowledged that they were terminally ill; nine patients (4.1%) estimated accurately that they had months, not years, left to live. A total of 216 patients (97.7%) reported that they had not had an EoL care discussion with their physician, and 170 patients (76.9%) did not want to know their prognosis even if the doctor knew it. Most patients preferred comfort care (72.9%; n = 161) to life-extending care (14.0%; n = 31), and did not want to be kept alive using extreme measures (80.5%; n = 178) or have their doctors do everything possible to extend their lives (78.3%; n = 173). Finally, 127 patients (57.5%) preferred to die at home, and 51 (23.1%) preferred to die in the hospital. Most patients (81.0%; n = 179) had funeral plans., Conclusion: South African patients demonstrated less awareness of the fact that they were terminally ill, were less likely to have discussed their prognosis with their doctor, and more strongly preferred comfort care to life-extending EoL care than US and other LMIC patients in prior research. These differences highlight the need for culturally appropriate, patient-centered EoL care for South African patients with advanced cancer as well as to determine individual preferences and needs in all EoL settings.

Cancer is rapidly becoming a major health care problem, especially in developing countries, where 60% of the world's total new cases are diagnosed. The success of new antineoplastic medicines and modern radiation devices to cure a good proportion of patients with cancer and to alleviate the suffering of many more has been achieved at a dramatic cost. Therefore, it has become mandatory for health care authorities and pharmaceutical companies to cooperate to use and develop resources in an efficient manner to improve health care delivery to patients with cancer worldwide. Regulatory harmonization is an important key to overcome delays in the approval process, whether for antineoplastic and pain control medicines or for essential medical devices. More emphasis on the significant role of opiates in pain control among patients with cancer is needed to overcome the ingrained belief in their potential for addiction. The World Health Organization (WHO) serves an important role in guiding priorities for health care and efficiently allocating resources by providing essential medicine lists (EMLs) and device lists. However, the financial challenge for access to health care is multi-tiered and requires collaboration between key stakeholders including pharmaceutical industry, local national health authorities, WHO, and other nonprofit, patient-oriented organizations.

Cancer causes changes in the family's identity, roles, and daily functioning. Studies document that spouses are as distressed as cancer patients and that spousal and patient distress are correlated. Three major areas of caregiver concern are: fear of cancer and its spread, helping patients deal with the emotional ramifications of the disease, and managing the disruptions caused by cancer. From 20% to 30% of partners suffer from psychological impairment and mood disturbance as a result of the spouse's cancer. Factors that may predict high levels of spousal distress include: disease stage; emotional adjustment of the patient; gender, age, and other characteristics of the spouse; marital adjustment; and family functioning. Studies show that interventions do not reduce spousal distress. Future studies should explore the role of mediating factors, such as coping style, marital adjustment, and family functioning, on the relationship between illness demands or prognosis and distress. Interventions could then be targeted to high-risk individuals.

Background: Previous studies have demonstrated that less than 20% of fully eligible patients participate in cancer clinical trials. One of the major factors determining whether patients will be successfully accrued to trials is the quality of the communication occurring between the physician and patient (and family members if present). The accrual process is embedded within the longer-term relationship between the physician and the patient. It is argued that the interaction occurring during the consent process is part of an "alliance building" that the physician and patient use to confront the uncertainty inherent in both the disease itself and the outcome of therapy., Methods and Results: The authors describe the framework of a study currently under way in which they are tracking the variation in ways that this interaction is managed by a sample of oncologists and their patients. Physicians and patients are simultaneously filmed and viewed in a split-screen format. A coding system is being developed to analyze the congruence between physicians and patients as they encode and decode sequences of verbal and nonverbal messages. The goal is to understand how physicians and patients manage uncertainty related to the disease and its outcomes., Conclusions: The authors suggest implications of these observed patterns for the broader range of communicative competencies that medical students must learn.

Effects of a psychosocial intervention program on spouses of cancer patients, and on the cancer patients themselves, will be described. A six session intervention program, which included support, problem-solving and coping skills, was designed to help spouses to cope with the stress of caring for their partner. Forty male and forty female spouses of cancer patients of a regional oncology center were randomly assigned to intervention or usual treatment conditions. Spouses and patients were interviewed prior to intervention, and within two weeks after intervention on a battery of assessment instruments including: (1) demographic variables; (2) psychological variables; (3) health status; (4) social supports; (5) assessment of pressing problems; (6) coping skills; (7) burden levels; and (8) marital satisfaction. Participants were found to be more psychologically distressed than the general population but were not as distressed as psychiatric outpatients. Differences were also found in marital satisfaction and coping activities, when compared to the general population. No significant differences between the conditions were found on any of the measures. Caregivers' level of caregiving activities proved to be low. It is suggested that this may account for why the intervention only appeared effective for a distressed subsample of the caregivers in the study. The implications of these findings is discussed. Recommendations are also made for future research on cancer caregivers.

Quality of life, symptom management, and social support are the traditional foci for the practice of psychosocial oncology and clinical research into the behavioral and psychologic aspects of cancer. The current paradigm for research in this area primarily assesses patient responses to cancer related stressors and the means of ameliorating the negative aspects of those responses. However, clinically meaningful interventions have been the exception, rather than the rule. The authors think that the central event initiating a stressful response is the interaction between the patient and physician conveying the diagnosis, prognosis, or treatment plan. The authors think addressing the initial event in a cascade of responses is an important prerequisite for progress in this area.

Physician behaviors were studied in 473 interactions between oncologists and adult cancer outpatients. Ninety-nine of these interactions occurred when family members were present during the visit. Patients with family members present were likely to be sicker as demonstrated by a poorer performance status. Contrary to earlier reports, age of the patient did not predict whether the patient was likely to be accompanied by a family member. The physician behaviors were factor analyzed to produce six factors and a multivariate analysis of variance was conducted using the presence of family and performance status as independent variables. The time the physician spent in the patient's room, patient satisfaction and quality of life were also examined in separate analyses. The time the physician spent with the patient was greater when family were present. The results showed that, in general, physicians provide more information when patients are accompanied by family members, or if no family are present, when the patient has a worse performance status. Patient satisfaction and quality of life were rated lower for patients with a worse performance status and were not impacted by physician behaviors. Physicians' behavior was affected by both the presence of a family member, and the patient's performance status.

This article addresses psychosocial aspects of cancer and the cancer patient that the authors feel are important to teach medical students. A section on understanding the cancer patient deals with patient psychosocial responses to a diagnosis of cancer. Loss of control, anger and guilt, fear of abandonment, fear of pain, psychiatric disorders, and psychosocial factors all need to be explored by the health care team. Interventions, such as education, support groups, environmental manipulation, or psychological counseling including imagery or relaxation have proved to be effective. Relaxation therapy can also help to counteract the side effects of chemotherapy such as anticipatory nausea and vomiting. An increasing openness about discussing dying and the development of hospices have resulted in improvements of the care of the dying patient and family. Family members should be involved in the care of the cancer patient and can support the patient by promoting autonomy and control and by encouraging communication and expression of feelings. The doctor-patient relationship is central, and is changing from a paternalistic model to one encouraging greater patient participation. In studying the behavior of physicians at Albany Medical College, the authors found that oncologists spend more time with patients with the poorest prognoses. Patient satisfaction with the relationship was found to be high. Students can be instructed in these psychosocial aspects of oncology by means of videotapes, role-playing, or patient presentations, and more importantly by using the physicians as a role model. Comprehensive care of the cancer patient necessitates the integration of psychosocial aspects of care into the overall assessment and management plan. This article reviews the psychosocial aspects of care of the adult cancer patient taught to second year medical students as part of a 42 hour course entitled "The Cellular Basis of Cancer Medicine" at Albany Medical College. The didactic material covered in this article is based on local clinical work and research endeavors with adult cancer patients and is included in the course syllabus given to the students. The students are divided into four small groups, each of which has one of four teaching experiences, each lasting for 2 hours. The psychosocial aspects of cancer is one of the small groups. This group, consisting of 32 students each, is taught by a medical oncologist and a behavioral scientist. Videotapes of interviews done with patients and/or live interviews with patients are used to highlight the material covered in the syllabus.(ABSTRACT TRUNCATED AT 400 WORDS)

The current investigation was designed to determine how cancer patients, medical students, medical residents, nononcologically oriented physicians, and cancer educators differ with respect to attitudes towards cancer. A total of 372 individuals completed the Cancer Attitude Survey. Cancer educators displayed more confidence in the patient's ability to cope with diagnostic and prognostic information than students, other physicians, and patients themselves. Patients and cancer educators favored aggressive therapy to greater extent than other physicians, students, and alumni. Among nononcologic physicians and students there were significant effects of respondent's sex and prior personal experience with cancer on the attitudes expressed. Cancer educators differed significantly by specialty with surgical oncologists most likely to favor aggressive therapy. When compared to physician groups studied in the 1960s, our overall physician group (residents, cancer educators, and other physicians) was more likely to exhibit: (1) confidence in the patient's coping ability; (2) skepticism about the efficacy of early diagnosis and the value of aggressive treatment; and (3) stronger beliefs in the patient's ability to prepare for and accept death. Comparisons of our medical student group with students studied by Haley and his colleagues revealed a similar picture. Implications of these findings for the education of medical students are discussed.

Morning rounds are the major focus of physician-patient interaction for hospitalized cancer patients. To determine the impact of specific physician behaviors on patient satisfaction with these rounds, the authors examined 401 such individual interactions using a previously developed Physician Behavior Check List (PBCL) and several visual analogue scales that assessed patient satisfaction. Patient satisfaction for the entire group was high (X = 8.56 on a 10 cm scale) and failed to correlate significantly with specific physician behaviors. By splitting at the median, high and low satisfaction groups were obtained. For the high satisfaction group older age, a poorer prognosis, and a positive quality of the day's news were associated with higher satisfaction. Use of the patient's first name and attempts to establish privacy during an exam were positively correlated with satisfaction, whereas discussing the role of the family and examining nontruncal areas had a negative impact. For the lower satisfaction group, a series of routine social skills behaviors (e.g., sitting while talking to patients, not interrupting) and two medically related behaviors correlated best with patient satisfaction. There was little significant impact on satisfaction of behaviors related to the provision of either medical information or emotional support.

Physician behaviors and patient responses were studied in 439 interactions between hospitalized adult cancer patients and oncologists to investigate patient preferences for a participatory role in the interaction. Patients were asked their preference for information to be given (minimal; only if it is good news; or all information, good or bad) and their preference for participation in decision-making (prefer doctor makes therapeutic decisions or prefer to participate in decisions). The majority (92%) preferred all information be given, but only 69% preferred to participate in therapeutic decisions. Of those wanting all the information, 24.9% preferred the physician to make the therapeutic decisions. This group was comprised primarily of older, sicker males. Those who did not want to participate were also slightly more satisfied (P less than 0.05). These data suggest that, although most patients prefer all information to be given to them, almost one-fourth of them preferred a more authoritarian, rather than participatory, relationship with their oncologist.

Physician behavior during inpatient rounds was observed and quantified for 394 interactions between patients with cancer and physicians. Most patients had solid tumors (90%) and a limited prognosis despite treatment (61%). The physicians spent 1.45 +/- 0.58 h on morning rounds seeing an average of 9.3 +/- 3.39 patients. For each patient an average of 3.61 +/- 2.83 min was spent in the room. The rest of the time was involved in reviewing the results of diagnostic tests, discussing treatment plans, and updating patient's charts. Time spent in the room was significantly related to the patient's sex and diagnosis. Physicians spent more time with patients having the poorest prognosis (p = 0.009). Specific behaviors were analyzed using a Physician Behavior Check List that allows accurate recording of behavior during a brief patients-physician encounter. Factor analysis of responses to the check list resulted in four factors that explained 58.7% of the variance. The physician behavior factor scores failed to correlate with factor scores from the responses of the same physicians to the Cancer Attitude Survey. In addition, the physicians were unable to accurately estimate the time they actually spent with patients or the frequency of specific behaviors that occurred during these interactions.

To examine the impact of a subspecialty care unit on house staff behavior toward patients, fourteen internal medicine teams were observed in 1213 interactions with patients on morning rounds using a previously devised instrument, the Physician Behavior Check List. The eight teams assigned to the hematology/oncology unit (HO teams) saw significantly more cancer patients than did the six teams assigned to general medicine floors (GM teams). Patients seen by HO teams were sicker (P less than 0.001). Hematology/oncology teams engaged in fewer support behaviors, particularly with the sickest cancer patients, than did the GM teams. Teams did not differ on time spent with patient or patient involvement but HO teams were rated significantly lower on addressing the patient's needs. The authors propose the concentration of sick cancer patients on a designated cancer unit diminishes house staff ability to engage in supportive behaviors and to address the needs of patients during morning rounds.