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…cell phones and cancer…why now?

June 2, 2011

We have been hearing about the World Health organization’s conclusion that cell phones pose a health risk that is similar to lead exposure [http://www.latimes.com/health/la-he-who-cell-phones-20110601-1,0,3926296.story]. A summary of the report will appear in a medical journal in July. But advance news stories indicate that as with lead exposure, more exposure increases risk. Cell phone use rarely–less risk. Cell phone use for hours at a time and/or every day–greater risk.

Why has this report come out now? Last year, the U.S. National Cancer Institute reviewed research relating to cell phone use and cancer and posted a summary of their conclusions at http://www.cancer.gov/cancertopics/factsheet/Risk/cellphones. It is tricky to read through the findings. They sometimes suggest that the issue has been directly studied. The ‘gold standard’ for clinical trials is based on randomly assigning individuals to a condition in which the thing to be studied is ‘given’ to those participants and another condition for which the randomly assigned individuals do not have exposure to the thing being studied. Thus, when the NCI reports about studies that have compared individuals who subscribe to cell phone service with those who do not, it begins to sound like a randomized trial. I subscribe to a cell phone service and seldom use my cell phone. My daughter has a cell phone service, it is the only phone she has [no land line], and she uses the phone–talks on it–a lot. So if we were both included in the study mentioned by NCI based on being subscribers, the results might not be an accurate reflection of a relationship between cancer and cell phone use. Subscribers who seldom use their cell phones, if included in the denominator of an equation designed to inform about risk, may artificially reduce the overall risk.

For example, if there are 2 cases of cancer in people in the population that is not subscribed to cell phone service–let’s say that is 100 people–and there are 2 cases of cancer in people in the population that is subscribed to cell phone service–let’s say that is 200 people–it suddenly appears that  there are fewer cases in the latter…. But what if only 50 subscribers use the cell phone everyday….not even counting how long everyday–just everyday. 2 cases among 50 people is twice the risk of the poulation of nonsubscribers… Is that accurate?

So that has been the challenge for some years now. No one is going to conduct a randomized trial of cell phone use in which they randomly assign some people to be users and some to be nonusers, and then have some users use briefly everyday, and some users use for two hours, and some more…and track cancer incidence across yearssssss of the lives of the participants. So we have to rely on the research that makes comparisons such as the one described above. The WHO’s group of scientists apparently reached the conclusion that the nearly four dozen published studies reviewed with the thousands of particpants is sufficient evidence to classify cell phones as a possible risk for cancer. In view of how cell phones work, it seems a safe bet. And the ways to reduce risk by using the cell phone with a device that keeps the phone away from my brain is an easy and effective way to reduce that risk…

How should we talk about tanning?

April 12, 2011 GUEST BLOG POST by Danielle Torrisi

Take a look around any college campus, and you’ll notice at least a handful of tanning salons. Pick up their college’s newspaper and you’ll find ads for tanning salons with gorgeous, tanned women pictured with the slogan “Beautiful Tan Today. Young looking skin tomorrow” and promotional discounts that is sure to catch the eye of any student. The tanning industry portrays tanning as harmless and risk-free. However, research has shown that the incidence of melanoma has continued to rapidly increase since the 1970’s.   

A recent study at a southern university surveyed 492 students and results showed that a majority of the participants knew sun exposure increases the risk for skin cancer, but only 29% correctly identified behaviors that reduce this risk.

Less than 46% of the participants were able to identify signs of melanoma, and less than 10% were able to identify the primary area of the body for melanoma. Approximately half of the participants strongly believed that a tan improves one’s appearance, and only half thought that sun safe behaviors are necessary. It is very troubling to learn that they think their appearance outweighs their health.

College students need to be informed about the dangers of using tanning beds in hopes of changing attitudes and behaviors. It all starts with the media and advertisements need to show a more natural appearing skin. “As long as marketers portray being tan as healthy, attractive and sexy, young women will continue to believe that a tan is desirable, regardless of the risks” (Spradlin et al).

It needs to be understood that there is no such thing as a healthy tan. “In fact, UVA rays which are used in tanning beds can go all the way through the skin’s protective epidermis to the dermis, where blood vessels and nerves are found. Because of this, UVA rays may damage a person’s immune system, making it harder to fight off diseases and leading to illnesses like melanoma, the most serious (and deadly) type of skin cancer” (Tanning). This needs to be reinforced in student’s minds in order to see a behavior and attitude change.

To view this article go to: Citation: Spradlin, Kimberly, Martha Bass, William Hyman, and Rosanne Keathley. (2010). Skin Cancer: Knowledge, Behaviors, and Attitudes of College Students. Southern Medical Journal. 103, 999-1003.

How do you communicate to children about cancer?

April 5, 2011   GUEST BLOG POST by Joey Debernardis

Since cancer has such a huge impact on many people’s lives, I thought it would be a very important topic to talk about. More specifically, the study below considered how to talk to children about cancer. This specific study was done at ‘Three Principal Cancer Treatment’ in the United Kingdom.

The study was based of 38 participants at different levels of their cancer journey. The groups broke down as follows: young children (4-5 years), older children (6-12years), and young people (13-19 years).

Some of the results that were found were quite interesting.  As a young child, the cancer patients were not able to voice their preferences. They just did not have the ability to do so. Children also worried about the permanence of symptoms. Older children were unhappy about their parents leading communications with the health professionals. 

The children aged 4-12 years reside in the background of information sharing with health professionals until they gain autonomy as the young people (roughly 13 years). They then moved in a foreground, and their parents transition into a supportive background role. In this way, younger children begin to realize their abilities to voice their preferences. Parents and the professionals, in turn, can learn to develop their supportive background roles…

Gibson. F. (2010). Children and young people’s experiences of cancer care: a qualitative research study using participatory methods. Pubmed. http://www.ncbi.nlm.nih.gov/pubmed/20430388

How can we really understand informed consent?

April 3, 2011   GUEST BLOG POST by Aimee Hilton

You are told you have a left clavicle contusion and your face just screams “What?” You go home to research and find you simply have a bruised collarbone, i.e your shoulder is going to hurt for a little while. Doctors may forget that they spent eight plus years in education learning the medical jargon that most of their patients do not understand. So when the patient has an important decision on the line, like whether or not to participate in a clinical trial based on their illness, how do we organize the information to make an informed decision? When we can’t understand words like randomization and placebo, how can we really understand the informed consent?

A study performed by Jefford et al. (2009), looked at how well patients understood the clinical trial they recently enrolled in.  102 patients who signed up for a clinical trial concerning cancer within the last two weeks participated in the research. The most important results showed that doctors needed to ask specific questions pertaining to the patient’s understanding of the trial, instead of simply “Do you understand”.  Using a method known as “the teach back method” allows the patient to understand and develop questions.  As a patient, if making a decision about a clinical trial, be sure to restate the clinical trial process and informed consent to your doctor. It will make sure you understand and they know you understand.

Patients should also receive written information and a recording of the conversation discussing the clinical trial. This allows the patient to go back and look over any information they found confusing or did not comprehend. Doctors also should be sure to discuss the standard treatment and other possible treatments in the trial. Patients should be aware of all options and possibilities throughout the trial.

It may seem that clinical trial information is overwhelming. However, if the doctor presents the information in an organized process, the patient will be more likely to understand and receive enough information to understand the informed consent they need to sign. Clinical trials are very important for the advancement of science and treatments. If doctors can help patients have a better understanding of the trial, hopefully more patients will be willing to participate. 

Jefford, M. Mileshkin, L. Matthews J. et al. Satisfaction with the decision to participate in cancer clinical trials is high, but understanding is a problem. (2009) Support Care Cancer, 19, 371-379.

How do nurses cope with the emotions of caring for terminal patients?

March 26, 2010                                   GUEST POST by Jason Bankert

It is the common belief that nurses are the care givers and thus are more compassionate than physicians who are often perceived as hard and emotionless.  The Intensive Care Unit (ICU) can be emotionally draining as many patients are in critical condition or are terminal. The care of terminally ill patients is called end of life care or EOLC.  How do health care professionals, such as physicians and nurses cope with the emotional burden of terminal illness in the ICU and how do there perception, treatment and communication involving terminal ill patients differ?  These different perspectives impact physician-nurse collaboration as well as their satisfaction with the quality of EOLC (Hamric and Blackhall 2007).  

   In a recent study conducted in the ICUs of a rural hospital in Southwestern Virginia and an urban hospital in Eastern Virginia, investigators examined these questions to provide an insight on how these different perspectives on EOLC ultimately impacts patient care and what interventions can be taken to reduce moral distress and improve physician-nurse collaboration (Hamric and Blackhall 2007).  The study, based on survey responses, showed that RNs experience more moral distress during EOLC than do physicians, even though both groups identify the situation as morally distressful (such as aggressive treatment as requested from a family member when both groups feel the treatment is unnecessary (Hamric and Blackhall 2007).  As a result, these nurses are less content with their environment or the perception of the quality of care given to the terminal patient.  This higher emotional burden on nurses may be the result of their job.  It is the nurses who provide the majority of the bedside care during EOLC and are in contact with the patient more often than physicians.  Also, nurses lack finally authority over the treatment options implemented by physicians. Even though nurses may disagree with the way physicians communicate prognosis and diagnosis, they feel that they have no say in the final decisions regarding patient treatment during EOLC. 

The emotional environment is more important for nurses who are in contact with the patient more often than physicians, providing most of the daily beside care tasks (Hamric and Blackhall 2007).  Therefore, it is necessary to improve this environment to ultimately improve the overall quality of patient care.  The best care in the ICU occurs when nurses are active participants in diagnosis and treatment decisions and are active in communicating with patients and families alongside physicians (Hamric and Blackhall 2007).  In order to provide a environment where nurses can be proactive in the patient care, special attention and policy needs to be implemented to increase physician awareness of the extra emotional burden experienced by nurses and respect their input in regards to EOLC.  Equally important is the improvement of physician-nurse collaboration. This may be accomplished by promoting open communication about the different perspectives of EOLC through team meetings, individual meetings with chief staff members and conferences involving staff and specialists from other institutions. 

Hamric, A. B., L.J. Blackhall.  (2007). Nurse-physician perspectives on the care of dying patients in intensive care units: collaboration, moral distress, and ethical climate.  Critical Care Medicine, 35, 422-429.  Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/17205001

What didn’t Oprah know about drug use and sperm quality and women’s health that Pam Grier told her?

February 3, 2011

Wild horses… well, not exactly. More like tame pets… A few images from our fall camping trip to Assateague…where ‘wild’ horses live on the beach, walking among the campers and even sharing our water and facilities…

And then, there was Oprah’s show today… [http://www.oprah.com/oprahshow/The-Original-Foxy-Brown/4]

Pam Grier talked about her life–today and during the period of time when she had starring roles in such shows as Foxy Brown. She also talked about relationships she has had, including with Richard Pryor.

As the Oprah show revealed, “After a gynecologist visit, Pam says she discovered Richard’s vices were affecting her too. She writes candidly about the experience with the hope of informing women who may be at risk. “There was an epidemic of a lot of people doing cocaine,” she says. “And it accumulated in the body and often in the prostate gland. It would come out during your sexual activity and [end up] inside a woman.”

Pam’s doctor cautioned her about the dangers of having unprotected sex with Richard. “[The cocaine] could harm the woman’s internal organs,” she says. “So I had to tell Richard, ‘You’re going to have to wear a raincoat—a condom.’ And he had an issue with that, and I said, ‘Well, it’s my life. You have to understand.’ So I chose me.”

Oprah said, “I did not know that–” in response to the revelation about the drugs ending up inside the woman…  We have discussed such matters before http://whyhealthcommunication.com/whc_blog/wp-admin/post.php?post=295&action=edit 

We can’t talk about ‘women’s reproductive health without talking about men’s reproductive health… and we can’t talk about men’s health without talking about women’s health…

What is the meaning of uncertainty when it comes to illness?

117_1746April 21, 2010

Communication and uncertainty go hand-in-hand. Many of our theories in communication focus on uncertainty as a reason to communicate. In these cases, we usually focus on communicating to reduce uncertainy. We talk about how we use cues from others–such as how they dress, the hair style they wear, the way that they gesture, and even how fast or slow they talk and their accent–to decide how much we are like another person. In these ways, we are using nonverbal information to reduce our uncertainty about talking with someone.

In already established relationships, we also experience uncertainty. Relational uncertainty may happen because we don’t know if our friend or family member is being ‘honest’ about whether they think we should take the job, go back to school, or in a million little day-to-day situations–like what to wear, what to eat, or what to do with our free time. We often try to reduce our uncertainty in these sitautions as well by communicating. ‘What do you want to do?’ ‘What are you doing to wear?’ ‘Do you think I should take this job?’ ‘What about the fact that we can’t sell the house right now?’ ‘They didn’t offer me any moving costs–can we afford it?’ So relational uncertainty emerges in a thousand different ways as part of having relationships. And it is a challenge to imagine how to balance the relationship needs and well, live our lives. So what happens when into the mix we introduce illness?

A diagnosis, whether it is terminal or not–as suggested by one of the participants in my last post–may spark the motivation to communicate. The diagnosis might be for a chronic condition such as heart disease, high blood pressure, high cholesterol, diabetes, or even HIV. It might be a broken leg or a sprained neck. Into each and every one of these and possibly thousands of other diagnoses enters uncertainty. “Illness uncertainty” is a big part of the uncertainy. But “relational uncertainty” is introduced into a diagnosis as well. To improve our communication about health, keeping both kinds of uncertainty in mind may help.

A diagnosis often leads us to want to reduce illness uncertainty about such things as ‘what is it,’ ‘what does it mean for my life,’ ‘how long will it last,’ ‘how will we treat it,’ and a host of other questions that may lead us to seek information to reduce our illness uncertainty. Sometimes, there will be no answers as we seek information, and so we have to “manage” our illness uncertainty by knowing that we have done what we could to answer our questions and perhaps by joining support groups online or in other ways putting ourselves in a position to keep up-to-date with any new information. What we don’t often think about is that in some situations, “increasing” our illness uncertainty may offer the most hope. As an emotion, hope let’s us look forward to a future that is a positive one and where we see ourselves able to achieve important goals. When we do not have certain information about our illness, that may provide a path toward hope if we frame it based on such comments as, “the doctor told me, ‘I don’t see any expiration date on you'”,–meaning that there is no answer to a question framed as, ‘how long do I have to live’.

In some of my past research, I have talked about the acute phase following a spinal cord injuury. During this phase, patients and families often are most reassured by communication that  increases their uncertainty about the course of the diagnosis. Doctors not knowing whether a patient will walk again is a hopeful thing. At the same time that the patient and family experience hope related to increasing their illness uncertainty, they may experience sadness and fear and anger about a sense of increasing relational uncertainty. This is a case where friends and family may be very supportive in the beginning but seem to be less so over time. Communication may need to be more direct to reveal what is happening. If a friend asks, ‘what can I do for you?’ and the ansswer is always the same–‘nothing’–the friend may quit asking and quit coming around. There are many reasons that we don’t ask for help–and we can discuss those in the coming days–but if we remember that it may increase a friend’s uncertinaty about the relationship if we say ‘nothing’ and we obviously need help. And their lack of helping when we obviously need help may in turn increase our uncertainty about them. And both may contribute to illness uncertainty in negative ways–relating to a lack of tangible and emotional support–perhaps we can stop the spiral and communicate about our health and our relationship in more fruitful ways… not always to reduce uncertainty… but at least in ways to manage it.

What do you say to a loved one just diagnosed with terminal cancer?

122_0562April 13, 2010

Maureen Keeley and Julie Yingling are authors of the award-winning book, Final conversations: Helping the living and dying talk to each other. Through interview data collected from some of us who have gone through the experience of knowing that a close relative has received a terminal diagnosis, Maureen and Julie provide a table of contents that introduce the important topics they address in the book.  Among these–telling our loved one, “I love you.” While saying the words is important, giving clear messages that leave no doubt about the love that has been shared is emphasized in the authors’ summary of what interviewees told them. Telling a parent that she is loved, that you will do your best to live the kind of life she would be proud of, and that you are grateful for the time you had to to share together…these are messages that we want to say explicitly while we have time to do so.

Keeley and Yingling remind of us that a terminal diagnosis does not mean that your loved one is dead–yet. He or she probably wants to go on taking care of everyday business as long as possible. So when your loved one says that he wants to hear about your life, he really means it. There may not be a lot of opportunities left for you to tell him about the everyday and ordinary parts of living.  What did you do at work? Who did you talke to? What did you eat when you went out to dinner last night? Where are you planning to go on vacation this year?

Simple joys…baking cookies for a loved one and eating them with a cup of herbal tea or coffee. Sitting near a window that looks onto a view that is a favorite one. One of my aunts that I felt very close to died from ovarian cancer. I remember her wanting to continue to do some work from the office…right up until she died. Her employer brought some of the bookkeeping to the house and she worked on it when she felt like it. We didn’t say to her, “Why are you spending your time that way?” She wanted to do it. That was enough. An uncle who died from lung cancer wanted to go on a camping trip. It meant getting a trailer that he could be comfortable in so that my aunt could take him on that final campout.

It also may be the time to talk through some things that have been avoided in the past. We don’t have just positive feelings, even about the relatives that we feel close to. A conflict long buried might be on our minds. An invitation to a loved one such as, “Do you want to talk about it?” may open the door to clear the air. We shouldn’t force the invitation, but provide a space for a conversation that many times will be a relief to the living and the dying.

The authors also emphasize how important it can be to say that a connection to a loved one lives on…even when they do not.

Do we want doctors to tell us if we have advanced cancer?

117_1755February 18, 2010

In 2002, Hisako Kakai published an article in the journal, Health Communication, about preferences for disclosure of a cancer diagnosis. Dr. Kakai indicates that in Japan, a direct communication style is usually preferred when it comes to disclosing one’s personal diagnosis of cancer. In other words, people want to be told they  have cancer. However, an indirect communication style with no disclosure, or an ambiguous disclosure to the patient was preferred for a family member. The article raises many interesting communication and ethical issues.   

A serious diagnosis raises the question, ‘how do we deal with uncertainty?’ Communication plays a big role. It points to the reality that we often are not good with dealing with uncertainty. We frame uncertainty as ‘bad’ and let uncertainty overtake everything good that might be going on in our lives. This relates to how we communicate about a serious health condition. It also relates to how we communicate about the economy, about security, and about an endless number of issues that equal being — human.

The message communicated often to us is, ‘work hard and it will pay off’ — with payoff crossing a spectrum from health, relationships, and wealth. The message, ‘life is uncertain. Work hard at your relationships and school and work, and take satisfaction in the fact that you worked hard’ — is communicated less often, if at all. And it shows up in our inability to deal with uncertainty, our obsession with …reducing the uncertainty.    

Should the goal in communicating be to reduce uncertainty? When it comes to our health, that may not always be the best aim. If we can learn to manage the uncertainty of a diagnosis, we may be better able to live our lifes as someone living with cancer or heart disease or diabetes. If we make the diagnosis a more integral part of our being and identity, we may communicate in ways that define us to others as being disabled rather than living with a disability, diabetic rather than managing life while living with diabetes, and so on.  

Even more surprising, when we focus on managing our uncertainty as a part of life, we may even discover that there are times when we communicate to increase uncertainty. Instead of being certain that our future, our health, our well-being are uncertain and that is a bad thing, we can use uncertainty as a way to promote hope. In our own research, Ben Cairns and I found that this was particularly important for people who have newly experienced spinal cord injuries and their family members. ‘Will she walk again? Will he be able to do things for himself? Can she sit up on her own? Can he feed himself?’ Not knowing offers people living with the injury and their families and friends the hope that they might do these things again. 

Communicating to increase uncertainty about a diagnosis thus gives some time to adapt to a diagnosis. And that may be the best and more ethical way to communicate about an advanced cancer diagnosis as well. Not telling so that a patient does not know a true diagnosis may seem to offer a way to manage a serious diagnosis and thus to reduce uncertainty. Telling and acknowledging that the diagnosis is serious, even very serious, but that predicting exactly when the end-of-life will happen is uncertain may give some time to adapt to the diagnosis and some hope that important things that have not been said can be…

…a lesson in Dr. Maureen Keeley’s award-winning book, Final Conversations that has been shown to be so important for those who know that they are dying and the loved ones they will leave behind.

What about public health care reform?

117_1784January 10, 2010

I never hear anyone talk about public health when they talk about ‘health care reform.’ This bothers me because we have a univeral system of public health in the U.S. and we spend quite a lot of resources on it. The services linked to our public health care system range from checking the quality of restaurants and ‘grading’ them to providing newborn screenings. We spend quite a lot of time deciding what services to provide in each state. Besides registering births and deaths, and newborn screenings, many states have prenatal care programs, other women’s health programs, and a wide range of programs from smoking cessation to drug prevention to cancer screenings.

We don’t talk much about public health. But what might a connected system of health care built on the system of clinics and services for public health look like? How would doctors and health care staff feel about building on their infrastructure? Some states have regional health care directors? How would they regard an effort to connect the services they oversee to a broader range of services for the public to consider as a choice for care?

Anyone?

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