Canadian cancer clinics are straining to keep up with growing numbers of patients and, as a result, the capacity to provide follow-up care to cancer patients is being stretched. The Saskatchewan Cancer Agency has structured its community follow-up program to ensure the routine follow-up of patients who have finished active cancer treatments. Follow-up letters are routinely sent to family physicians and some specialists requesting information on the disease status of their cancer patients. For this thesis, I conducted a mail survey of 925 Saskatchewan physicians serving 21,000 patients to learn about general practitioners' and specialists' views of the follow-up program. A 52.5% response rate was achieved. <p>The program was considered useful for 91.5% of physicians, with the follow-up letter serving an important role in reminding physicians to see their cancer patients for follow-up. High percentages of physicians indicated a need for additional patient-specific information (59.3%), clinical information (73.0%) and training (34.9%) to do follow-up. Logistic regression analyses found female gender, a specialty in general practice and lower physician confidence in following cancer to be associated with the need for additional patient information. Lower physician confidence was associated with the need for additional clinical information and a specialty in general practice and lower physician confidence were associated with the need for more training.<p>Percentages of physicians saying they were very confident in following various cancers ranged widely from 19.1% for lymphomas to 54.2% for breast cancer. All regression models regarding physician confidence in following six different cancers had a common correlate: the need for additional training. A physician�s number of follow-up patients was a significant correlate in four of the six regression models and physician specialty was included in half of the models.<p> The results suggest areas of the program and physician need that should be addressed to ensure the delivery of quality follow-up care and the survey findings will be helpful in devising strategies to this end. At the same time, responses indicate the program to be an essential component in the delivery of community-based follow-up care in Saskatchewan.

Background: To assess physicians' attitudes regarding the legitimacy of complementary and alternative medicine (CAM) in medical practice, as well as factors that affect referral or prescription of a complementary therapy.Methods: Questionnaires were mailed to 380 physicians on staff at a local hospital in a mid-sized southeastern city in the United States; 138 were completed, for a 38% response rate.Results: Physicians in practice for less than 10 years were significantly more likely to accept most CAM therapies as legitimate than those in practice greater than 10 years. Nearly two-thirds of the physicians surveyed (65%, n = 88) had prescribed or referred for at least one complementary therapy. More than one-third of the physicians (34.8%, n = 48) had personally utilized at least one of these therapies, and personal experience resulted in a higher level of acceptance of CAM as legitimate medical therapy.Conclusions: It is likely that more positive attitudes regarding complementary therapies among more recently trained physicians is related to increased exposure during training and an increased awareness within the medical community of patient utilization of CAM. Despite a relatively positive attitude toward some CAM therapies, patients continue to use alternative medicine without notifying their primary care physicians. Unsupervised use of these therapies is potentially harmful and reflects a deficiency in the doctor-patient relationship. Open communication between physicians and their patients will continue to be hindered until physicians become knowledgeable in this area.

Budgetary restraints have forced a re-evaluation of expenditures for health care. regardless of the methods of delivery and financing. Efficiency in resource allocation implies production of an optimal output mix at minimum opportunity cost. Inefficiencies in resource allocation will result in higher costs. It is often argued that the fee-for-service reimbursement method, in particular, provides incentives for over-servicing, with elective surgery receiving most attention since international and intranational variations were out of line with variations in morbidity. Although the initial concern of physicians was with the clinical risks of unnecessary surgery. concern with the rising costs of providing health care has turned attention to financial factors as possible explanations of the variations in elective surgical procedures. The physician plays a key role in the allocation of resources in the health care sector. It is, therefore, likely that the aggregate output mix of different services will be responsive to the differential relative benefit rates received by physicians, with a bias in favour of the more expensive procedures and the consequent higher costs for the system as a whole. The physician's key role is emphasized in this study with the emphasis on supplier incentives and the inherent multiproduct nature of health care output. Economic theory predicts a movement along the production possibility frontier in output space in response to relative price changes. Econometric estimation of multiproduct production relations has been facilitated by the application of duality theory and the development of flexible functional forms. Duality theory establishes that the parameters of the production function can be represented equally well by the corresponding dual profit or cost function. Flexible functional forms for the profit function permit derivation of supply equations with relative prices as independent variables. Four elective surgical procedures were selected in order to estimate the aggregate substitution in production by physicians. With pooled cross-section and time series data for Canada for the period 1973 to 1981, the supply equations were estimated as a system, using the SURE estimation technique. Supply elasticities for price changes and changes in the key fixed factors were calculated. While emphasis was on the price response, the functional form incorporated the constraints imposed by the availability of hospital beds and surgical specialists. Evidence was found in support of the view that physicians allocate their time partly in response to changes in the prices of elective procedures relative to other procedures. With global budget constraints imposed on hospital expenditures, the four procedures, being elective, might possibly be given lower priority. Also, the estimated coefficients for the lagged dependent variables suggest that an inertia model of adjustment applies. Although incentives may exist in the fee structure to substitute toward the more expensive procedures, the results suggest that, at least for the period of the study. substitution was not on the basis of price alone. and that resource constraints. as proxied jointly by the number of hospital beds and surgical specialists, play a greater role in determining aggregate output. / Thesis / Doctor of Philosophy (PhD)

This study examines specific speech forms that comprise physicians' language use, and motives for use. A coding system combining work on verbal immediacy and conversational involvement was used to assess the language of 19 physicians during 58 videotaped interactions with patients. Physicians were found to use more nonimmediate than immediate speech. Information-giving was positively related to use of nonimmediate speech. Use of implicit nonimmediacy was positively related to physicians' perceptions of the medical community's consensus regarding a patient's condition and recommendations for treatment. Experience was positively related to use of spatial nonimmediacy and automatic phrases. Gender and experience interact to predict use of temporal, implicit, and qualified nonimmediacy. Inexperienced males used the least of these forms of speech, while experienced males used the most. No relationship was found between use of nonimmediate speech and patients' understanding, satisfaction, or met expectations. Implicit nonimmediacy was directly related to patients' behavioral intent to comply. Findings are reviewed for implications to both Communication and Medicine.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2009. / Härtill 4 uppsatser.

Thesis (M.A.)--Ball State University, 2009. / Title from PDF t.p. (viewed on Nov. 30, 2009). Includes bibliographical references (p. 100-104).

Nurses and doctors have worked together to manage patients for a long time. Within the past decade, collaboration between doctors and nurses to provide improved health care has become commonplace especially, in hospitals. As and nurses differ in their professional goals – clinical care delivery and patient and advocacy – they face challenges in their work-related collaboration. Most instruments to measure doctor-nurse collaboration were developed for western healthcare institutions. As a result they were unlikely to be psychometrically or culturally oriented to a Chinese healthcare environment. The aim of this study was to develop a valid and reliable tool to test doctor-nurse collaboration in a Chinese healthcare setting and to assess collaboration in public hospitals in China. Two hospitals participated in the study, including 398 doctors and nurses. development included content validity through feedback from experts with international medical or nursing backgrounds to inform questionnaire refinement and reliability testing. Factor analysis was used for data reduction and factor structure and to confirm the factor structure of a previously validated instrument. Internal consistency and test-retest reliability were established. Summary descriptive statistics were calculated to compare the prevalence of levels of collaboration. Logistic and linear regression were used to identify factors contributing to work-place collaboration. 398 doctors and nurses participated. A 28-item questionnaire was developed and validated. Three factors (work related autonomy, work related skills and work related relationships) were identified. The high construct validity was determined for each factor and for the overall questionnaire. Overall Cronbach alpha was 0.83, by hospital 0.85 and 0.88 respectively; and by profession (doctors and nurses) 0.81 and 0.84 respectively. a profession nurses vs doctors and by location the general hospital vs the hospital were associated with more positive work-place collaboration scores. variables were included in the regression model explaining 56% of total variance collaboration scores. Doctor-nurse collaboration was negatively associated with working hours and number of patients under care. Finally, a negative relationship between doctor-nurse collaboration and depression was confirmed. In conclusion, the questionnaire “Work-related Collaboration among Doctors and Nurses Scale” had satisfactory validity and reliability. It has the potential to be a useful tool in evaluating doctor-nurse collaboration in public hospitals in China. The evaluation of both the clinical and cost effectiveness of strategies to improve effective inter-professional education and inter-professional work environments for doctors and nurses is needed to confirm these findings and to add to the evidence of the impact of collaboration on work efficiency, conflict management and avoidance, and unnecessary waste. Fostering collaborative relationships has the potential to decrease workplace stress and depression symptoms and perhaps thereby improve productivity and efficiency. / published_or_final_version / Public Health / Master / Master of Philosophy

No description available.

The main purpose of this research study was to identify variables within the physician-patient relationship that may have a relationship to patients' intentions to adhere to medical recommendations. A literature review regarding the physician-patient relationship identifies two important variables: trust and empathy. This study investigated the impact of trust and empathy on patients' intentions to adhere to medical recommendations. Ajzen's Theory of Planned Behavior (Ajzen, 1988) (Figure 1) was used as a theoretical cognitive framework to help conceptualize the proposed study. Trust and perceived empathy were proposed as variables in the physician-patient relationship that influence a patient's subjective norm, attitude toward the behavior, and perceived behavioral control sufficiently to affect the patient's intentions to adhere to medical recommendations (Figure 2).The participants in this investigation included 128 adult Family Practice Clinic patients, who completed a set of questionnaires following an appointment with their physician. Participants completed the measures of the Perceived Empathy Scale (Plank, Minton, & Reid, 1996), the Trust in Physicians Scale (Anderson & Dedrick, 1990), and a short author generated measure of intentions to follow medical recommendations. The survey included four demographic variables: sex, age, marital status, and number ofphysicians' appointments.A hierarchical regression was performed which indicated that trust in the physician was not a statistically significant predictor of intentions to adhere to medical recommendations. However, patient perceived empathy from the physician was a statistically significant predictor of patients' intentions to adhere to medical recommendations. The only statistically significant demographic predictor of intentions to adhere to medical recommendations was marital status, indicating that participants who were married were more likely to express intentions to follow medical recommendations that those who were not. / Department of Counseling Psychology and Guidance Services

Access to abstract permanently restricted to Ball State community only / Access to thesis permanently restricted to Ball State community only / Department of Communication Studies