1: CMAJ. 2007 Mar 13;176(6):762-3. Related Articles, LinkOut 
Interventional radiology in palliative care.
Baerlocher MO, Asch MR.
Radiology Residency Training Program, University of Toronto, Toronto, Ont.
PMID: 17353527 [PubMed - in process]
2: Arch Intern Med. 2007 Mar 12;167(5):461-7. Related Articles, LinkOut 
Toward shared decision making at the end of life in intensive care units: opportunities for improvement.
White DB, Braddock CH 3rd, Bereknyei S, Curtis JR.
Division of Pulmonary and Critical Care Medicine and Program in Medical Ethics, Department of Medicine, School of Medicine, University of California, San Francisco.
BACKGROUND: In North America, families generally wish to be involved in end-of-life decisions when the patient cannot participate, yet little is known about the extent to which shared decision making occurs in intensive care units. METHODS: We audiotaped 51 physician-family conferences about major end-of-life treatment decisions at 4 hospitals from August 1, 2000, to July 31, 2002. We measured shared decision making using a previously validated instrument to assess the following 10 elements: discussing the nature of the decision, describing treatment alternatives, discussing the pros and cons of the choices, discussing uncertainty, assessing family understanding, eliciting patient values and preferences, discussing the family's role in decision making, assessing the need for input from others, exploring the context of the decision, and eliciting the family's opinion about the treatment decision. We used a mixed-effects regression model to determine predictors of shared decision making and to evaluate whether higher levels of shared decision making were associated with greater family satisfaction. RESULTS: Only 2% (1/51) of decisions met all 10 criteria for shared decision making. The most frequently addressed elements were the nature of the decision (100%) and the context of the decision to be made (92%). The least frequently addressed elements were the family's role in decision making (31%) and an assessment of the family's understanding of the decision (25%). In multivariate analysis, lower family educational level was associated with less shared decision making (partial correlation coefficient, 0.34; standardized beta, .3; P = .02). Higher levels of shared decision making were associated with greater family satisfaction with communication (partial correlation coefficient, 0.15; standardized beta, .09; P = .03). CONCLUSIONS: Shared decision making about end-of-life treatment choices was often incomplete, especially among less educated families. Higher levels of shared decision making were associated with greater family satisfaction. Shared decision making may be an important area for quality improvement in intensive care units.
PMID: 17353493 [PubMed - in process]
3: Arch Intern Med. 2007 Mar 12;167(5):453-60. Related Articles, LinkOut -
Efficacy of communication skills training for giving bad news and discussing transitions to palliative care.
Back AL, Arnold RM, Baile WF, Fryer-Edwards KA, Alexander SC, Barley GE, Gooley TA, Tulsky JA.
Departments of Medicine.
BAC KGROUND: Few studies have assessed the efficacy of communication skills training for postgraduate physician trainees at the level of behaviors. We designed a residential communication skills workshop (Oncotalk) for medical oncology fellows. The intervention design built on existing successful models by teaching specific communication tasks linked to the patient's trajectory of illness. This study evaluated the efficacy of Oncotalk in changing observable communication behaviors. METHODS: Oncotalk was a 4-day residential workshop emphasizing skills practice in small groups. This preintervention and postintervention cohort study involved 115 medical oncology fellows from 62 different institutions during a 3-year study. The primary outcomes were observable participant communication skills measured during standardized patient encounters before and after the workshop in giving bad news and discussing transitions to palliative care. The standardized patient encounters were audiorecorded and assessed by blinded coders using a validated coding system. Before-after comparisons were made using each participant as his or her own control. RESULTS: Compared with preworkshop standardized patient encounters, postworkshop encounters showed that participants acquired a mean of 5.4 bad news skills (P<.001) and a mean of 4.4 transitions skills (P<.001). Most changes in individual skills were substantial; for example, in the bad news encounter, 16% of participants used the word "cancer" when giving bad news before the workshop, and 54% used it after the workshop (P<.001). Also in the bad news encounter, blinded coders were able to identify whether a standardized patient encounter occurred before or after the workshop in 91% of the audiorecordings. CONCLUSION: Oncotalk represents a successful teaching model for improving communication skills for postgraduate medical trainees.
PMID: 17353492 [PubMed - in process]
4: BMJ. 2007 Mar 3;334(7591):440. Related Articles, Compound via MeSH, Substance via MeSH, LinkOut 
Comment on:
Double effect is a myth leading a double life.
Regnard C.
Publication Types:- Comment
- Letter
PMID: 17332545 [PubMed - indexed for MEDLINE]