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FOR THOSE UNFAMILIAR WITH THE TERM 'INTEGRATIVE cancer care,' simply substitute 'integrative oncology,' 'complementary cancer care,' 'integrative whole person cancer care,' or even, over the protests of practitioners of 'integrative [...]

PurposeNew strategies for delivering cancer follow-up care are needed. We surveyed primary care providers (PCPs) and oncologists to assess how physician attitudes toward and self-efficacy with cancer follow-up affect preferences for different cancer survivorship models.MethodsThe survey of physician attitudes regarding the care of cancer survivors was mailed to a randomly selected national sample of PCPs and oncologists to evaluate their perspectives regarding physician roles, knowledge about survivorship care processes, and views on cancer surveillance. Multinomial logistic regression models were constructed to examine how physician attitudes towards, and self-efficacy with, their own skills affected preferences for different cancer survivorship care models.ResultsOf 3,434 physicians identified, a total of 2,026 participants provided eligible responses: 938 PCPs and 1,088 oncologists. Most PCPs (51 %) supported a PCP/shared care model; whereas, the majority of specialists (59 %) strongly endorsed an oncologist-based model (p

Replies to comments from Kraemer, Kuchler, and Spiegel on the authors original article Psychotherapy and survival in cancer: The conflict between hope and evidence. The authors recently reviewed evidence related to the notion that psychotherapy extends survival in cancer patients (J. C. Coyne, M. Stefanek, & S. C. Palmer, 2007). The authors found that no study to date, including several designed and powered to test this hypothesis, can be reasonably interpreted as evidence that cancer patients live longer as a result of receiving psychotherapy. The authors concluded that the evidence against psychotherapy as a life-prolonging intervention in cancer is sufficiently robust to discontinue funding studies in this area. H. C. Kraemer, T. Kuchler, and D. Spiegel (2009) critiqued the authors' review. The authors respond directly to numerous misrepresentations made by Kraemer et al. More importantly, the authors provide readers with an accurate overview of the main issues being debated and the reasons for their conclusions. (Contains 1 footnote.)

Health decision aids are a potentially valuable adjunct to patient-physician communication and decision-making. Although the overarching goal of decision aids--to help patients make informed, preference-sensitive choices--is widely accepted, experts do not agree on the means to achieve this end. In this article, the authors critically examine the theoretical basis and appropriateness of 2 widely accepted criteria used to evaluate decision aids: values clarification and reduction of decisional conflict. First, they argue that although clarifying values is central to decision making under uncertainty, it is not clear that decision aids--as they have been conceived and operationalized so far--can and should be used to achieve this goal. The pursuit of clarifying values, particularly values clarification exercises, raises a number of ethical, methodological, and conceptual issues, and the authors suggest research questions that should be addressed before values clarification is routinely endorsed. Second, the authors argue that the goal of reducing decisional conflict is conceptually untenable and propose that it be eliminated as an objective of decision aids. Key words: decision aids; decision making; decisional conflict; values clarification. (Med Decis Making 2007;27:609-618), Decision aids are designed to prepare patients to make informed health decisions that are congruent with their own values. As defined in the Cochrane Collaboration review, 'Decision Aids for People [...]

Objectives. Bilateral prophylactic mastectomy is a drastic breast cancer preventive option for which indicatios are not standardized and efficacy has not been proven. To estimate the magnitude of this controversial practice, surgeons were surveyed on their recommendations about and performance of prophylactic mastectomy. Methods. A cross-sectional survey was sent to general surgeons (n = 522), plastic surgeons (n = 80), and gynecologists (n = 801) licensed to practice in Maryland in 1992. Proportions responding were 41.9%, 66.3%, and 54.9%, respectively. In addition, there were 30 respondents who identified 'other' as their specialty. The respondents were asked about the role of bilateral prophylactic mastectomy and the number of times they had recommended and performed it in a year. Results. Seven hundred forty-two surgeons responded (51.8%). More plastic surgeons (84.6%) than general surgeons (47.0%) and gynecologists (38.3%) agreed that bilateral prophylactic mastectomy has a role in the care of high-risk women. Eighty-one percent of plastic surgeons had recommended the procedure, compared with 38.8% of general surgeons and 17.7% of gynecologists. Conclusions. Indications and practice patterns reveal heterogeneity of medical opinion and practice of prophylactic mastectomy. This study raises the need for better evaluation of the efficacy and appropriateness of prophylactic mastectomy. (Am J Public Health. 1995; 85:801--805), Surgeons have varying opinions on the use of preventative mastectomies in patients with a high risk of breast cancer. Of 742 surgeons surveyed, 54.9% were gynecological surgeons, 66.3% plastic surgeons, and 41.9% general surgeons. Of all the surgeons, 44% believed that a preventative mastectomy has a place in therapy for high-risk women. Among the different specialists, 38.3% of the gynecological surgeons, 84.6% of the plastic surgeons, and 47.0% of the general surgeons believed in a therapeutic role for preventative mastectomies. Of the surveyed surgeons, 17.7% of the gynecological surgeons, 81% of the plastic surgeons, and 38.8% of the general surgeons had actually recommended a preventative mastectomy. Thus, nearly twice as many plastic surgeons as other surgeons believe in the use of this procedure.

The studies on group interventions for patients with cancer and human immunodeficiency virus (HIV) disease cover many aspects, but attention should also be given to certain issues like the follow-up of assessment which will assist in determining the lasting impact of psychosocial benefits and biological changes that impact health outcome as well as the information related to the doses and training, experience and orientation of therapists. More efforts should be taken for studying certain issues related to the social aspects, biological, disease, treatment and psychological factors.