Prostate Cancer Decision-Making, Health Services, and the Family Physician Workforce

摘要

id="p1">Does untreated cancer equal death? Does having a registered nurse versus a licensed practical nurse versus a medical assistant affect diabetes quality outcomes? Do physicians caring for stressed patients experience vicarious traumatic stress? Oregon presents an operationalized definition of a patient-centered medical home for their state. Lots of important clinical topics in family medicine—adult attention deficit disorder office questionnaire; Bell palsy; cancer screening and treatment decisions; lubrication during Papanicolaou testing; changes in maternity care training by residencies; changing prescribing patterns for thiazide diuretics; and night sweats remain a mystery. id="p-2">Untreated cancer equals death? This is the underlying fear and myth that drives many patients. However, there is the corresponding assumption than an unfound cancer is not a deadly cancer and a found cancer is a deadly cancer. With prostate cancer screening, we would argue, the main issue is not the prostate-specific antigen test itself, certainly an imperfect test, but what happens afterward. Having a lower level of prostate-specific antigen does not require immediate treatment. This is not a myth, but it is very difficult concept for patients and physicians. Once men know the cancer is actually present (as compared with the large number of men whom have prostate cancer but do not know it), they struggle to decide to watch and wait. For those who consider watchful waiting, significant others and physicians often pushed toward active treatment. Read some of the telling comments in Xu et al.id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1 id="p-3">Three articles in this issue are on colon cancer screening. Baldwin et al,id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2 in a study with an excellent methodology, observed physicians with high or low patient screening rates with simulated patients and compared the 2 groups of physicians. Their results provide dramatic help in how to get patients to carry through with screening, including consequence messaging and problem solving (see the article for more). Fagan et alid="xref-ref-3-1" class="xref-bibr" href="#ref-3">3 note that patients who are obese do not understand they have an increased risk of colon cancer, yet those who perceived higher risk were more likely to follow through with screening, so we should provide this helpful information to the appropriate patients. Furthermore, Hudson et alid="xref-ref-4-1" class="xref-bibr" href="#ref-4">4 found that women and smokers were less likely to report receiving recommendation for colorectal cancer screening (CRC) and also identified factors related to nonscreening for patients who did report having a recommendation. Interestingly, the patients in the Hudson et alid="xref-ref-4-2" class="xref-bibr" href="#ref-4">4 study were far more likely to report having received recommendations for CRC (go New Jersey!) than those in the Fagan et al studyid="xref-ref-3-2" class="xref-bibr" href="#ref-3">3 that reported data from the National Health Interview Survey.