Balancing - Cancer from a primary care perspective. Diagnosis, posttraumatic stress, and end-of-life care.
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Notice bibliographique
Résumé
This thesis explores cancer from a primary care perspective covering three areas: diagnosis, posttraumatic stress disorder (PTSD), and end-of-life care. We analyzed patient records of every child diagnosed with a malignancy in a defined area. During 12 years 68 children were diagnosed (incidence 14/100,000). For 68% the diagnosis was initiated in primary care. There were 25 children with leukemia, and 22 with brain tumors. Median parent’s and doctor’s delay were 1 and 0 weeks for the former, and 5 and 3 weeks for the latter group. We found that diagnosis for 135 women with breast cancer, and 99 women with ovarian cancer was initiated in primary care for more than 50%. Median patient’s delay was 1 week for breast cancer, and 3.5 weeks for ovarian cancer patients, and provider delay 3 weeks for both groups. Crude and relative 5-year survival was 73% and 91% in breast cancer, and 40% and 49% in ovarian cancer. We found a possible PTSD prevalence of 6.5% (n=72) in 1113 primary care attenders. DSM-IV trauma criteria, and >35 for the Impact of Event Scale combined with >5 for the Posttraumatic Symptom Scale. Cancer was a triggering trauma for 20% of those with possible PTSD. Low well-being had the strongest association with possible PTSD followed by sexual assault, and female gender. We designed an attitude questionnaire to evaluate a learner-centered education in end-of-life care for home care staff. The Hospital Anxiety and Depression scale was used to measure well-being. Attitudes towards end-of-life care improved, and mental well-being increased in the intervention group, while no positive changes were seen in the control group. We did a grounded theory analysis and found that the basic process balancing explains the problem-solving in end-of-life cancer care. Four main balancing stages emerged. Weighing by sensing needs and wishes, and gauging against resources in diagnosing and care planning. Shifting by breaking bad news, changing careplaces and treatments. Compensating by controlling symptoms, educating, team-working, prioritizing and "stretching" time, innovating, improvising, and upholding the "homeostasis of hope". Compromising, the resulting stage, was a "walk on a fine line", between optimizing the care and deceiving the patient. Balancing was also used to conceptualize cancer care in general using data from all of the studies.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle