Providing Information To Patients Research Articles

Using Patient-Provided Information to Refine Sexually Transmitted Infection Screening Criteria Among Women Presenting in the Emergency Department

Emergency department patients are at increased risk for infection with chlamydia and gonorrhea, but routine screening of asymptomatic patients is problematic. Limiting screening to patients answering the affirmative to 2 questions would reduce the number of tests administered by 51.9%, increase the tested population prevalence to 15.7%, and still identify 82.8% of those infected.

Information provision for stroke patients and their caregivers.

Research shows that stroke patients and their families are dissatisfied with the information provided and have a poor understanding of stroke and associated issues. To assess the effectiveness of information provision strategies in improving the outcome for stroke patients or their identified caregivers, or both. For this update we searched the Cochrane Stroke Group Trials Register (June 2012), the Cochrane Central Register of Controlled trials (CENTRAL), the Cochrane Database of Systematic Reviews (CDSR), the Database of Abstracts of Reviews of Effects (DARE), the NHS Economic Evaluation Database (EED), and the Health Technology Assessment (HTA) Database (The Cochrane Library June, 2012), MEDLINE (1966 to June 2012), EMBASE (1980 to June 2012), CINAHL (1982 to June 2012) and PsycINFO (1974 to June 2012). We also searched ongoing trials registers, scanned bibliographies of relevant articles and books and contacted researchers. Randomised trials involving patients or carers of patients with a clinical diagnosis of stroke or transient ischaemic attack (TIA) where an information intervention was compared with standard care, or where information and another therapy were compared with the other therapy alone. Two review authors independently assessed trial eligibility and methodological quality and extracted data. Primary outcomes were knowledge about stroke and stroke services, and impact on mood. We have added four new trials to this update. This review now includes 21 trials involving 2289 patient and 1290 carer participants. Nine trials evaluated a passive and 12 trials an active information intervention. Meta-analyses showed a significant effect in favour of the intervention on patient knowledge (standardised mean difference (SMD) 0.29, 95% confidence interval (CI) 0.12 to 0.46, P < 0.001), carer knowledge (SMD 0.74, 95% CI 0.06 to 1.43, P = 0.03), one aspect of patient satisfaction (odds ratio (OR) 2.07, 95% CI 1.33 to 3.23, P = 0.001), and patient depression scores (mean difference (MD) -0.52, 95% CI -0.93 to -0.10, P = 0.01). There was no significant effect (P > 0.05) on number of cases of anxiety or depression in patients, carer mood or satisfaction, or death. Qualitative analyses found no strong evidence of an effect on other outcomes. Post-hoc subgroup analyses showed that active information had a significantly greater effect than passive information on patient mood but not on other outcomes. There is evidence that information improves patient and carer knowledge of stroke, aspects of patient satisfaction, and reduces patient depression scores. However, the reduction in depression scores was small and may not be clinically significant. Although the best way to provide information is still unclear there is some evidence that strategies that actively involve patients and carers and include planned follow-up for clarification and reinforcement have a greater effect on patient mood.

Are we PREPared? Quality of information available to patients in the UK about PREP on the internet

Professional bodies in the UK (BASHH/BHIVA) do not currently recommended pre‐exposure prophylaxis (PREP) to prevent HIV aquisition for men who have sex with men (MSM) [1]. Conversely, although Federal Drug Administration approval is awaited, the Centers for Disease Control (CDC) have issued clinicians in the USA with interim guidance to facilitate PREP prescriptions [2]. Increasingly patients search the internet for information on HIV treatment, but disparate international policy can lead to confusing patient messages. This study was conducted to systematically assess the quality of internet information available to patients in the UK about PREP. More than 90% of internet searches in the UK are performed using ‘Google.co.uk’ and ‘Bing’ [3]. Using pre‐specified criteria, we reviewed the first 100 hits retrieved from each search engine when the following searches were performed: [“HIV pre‐exposure prophylaxis”]; [“HIV PREP”]; [“HIV PREP guidelines”]; [“HIV PREP guidelines UK”]; [“truvada prophylaxis HIV”]. Of 172 unique websites identified, 124 websites were active at the time of the review (July 2012). 33 websites were links to academic journals including commentaries and clinical trials, not intended to specifically provide patient information; 5 were internet portals directing users to alternative sites and 10 websites contained no information about PREP. Of the remaining 76 websites, 28 were written by medical professionals and 48 were written by journalists, where 7/48 (15%) were individual blogs. 64/76 (84%) contained a definition of PREP; 63/76 (83%) discussed the rationale and 58/76 (76%) reported efficacy data. Advantages and disadvantages of PREP were presented in 56/76 (74%) and 41/76 (54%) of websites respectively. Only 21/76 (28%) of sites referenced existing national guidelines (CDC/BASHH). A minority of sites described the current clinical practice in the UK (7/76, 9%) with an even smaller number presenting the contrast in clinical stance between the CDC and BASHH/BHIVA (3/76, 4%). The use of PREP is evolving, and the internet is an important patient resource. However, current clinical practice in the UK is seldom described in accessible websites. Avoiding ad hoc and unsupervised use of PREP is crucial to prevent future drug resistance and risky sexual behaviour. More should be done to engage at‐risk groups and ensure patients in the UK have access to comprehensive information including the current UK PREP professional guidance.

Health professionals' perspectives on information provision for patients with brain tumours and their families

A significant number of patients diagnosed with primary brain tumours report unmet information needs. Using concept mapping methodology, this study aimed to identify strategies for improving information provision, and to describe factors that health professionals understood to influence their provision of information to patients with brain tumours and their families. Concept mapping is a mixed-methods approach that uses statistical methods to represent participants' perceived relationships between elements as conceptual maps. These maps, and results of associated data collection and analyses, are used to extract concepts involved in information provision to these patients. Thirty health professionals working across a range of neuro-oncology roles and settings participated in the concept mapping process. Participants rated a care coordinator as the most important strategy for improving brain tumour care, with psychological support as a whole rated as the most important element of care. Five major themes were identified as facilitating information provision: health professionals' communication skills, style and attitudes; patients' needs and preferences; perceptions of patients' need for protection and initiative; rapport and continuity between patients and health professionals; and the nature of the healthcare system. Overall, health professionals conceptualised information provision as 'individualised', dependent on these interconnected personal and environmental factors.

The effects of a poster in informing and empowering patients in infection prevention and control

Finding effective ways to change healthcare workers’ (HCWs) behaviour while informing and empowering patients is challenging. Providing patient information at critical points of care delivery may empower them to address lapses and change HCWs’ behaviour. In this study, posters detailing standards required for five high impact interventions were displayed in patients’ rooms. Research groups were: ‘pre-poster’ (months 1–2; n=142 patients); ‘poster’ (months 3–4; n=59); ‘no-poster’ (months 3–4; n=52); and ‘no-poster’ (months 5–6; n=104). Poster effectiveness was evaluated by a quantitative questionnaire ( n=357). Patients were asked if they identified lapses in five interventions by HCWs and whether patients had addressed them. Patient interviews ( n=10 per group) explored patients’ knowledge of interventions. Only patients with posters addressed lapses. Poster presence was associated with significant increase in noticing lapses in the first two weeks but decreased incidence in noticing lapses in weeks 3–8. There was significant aversion to reporting doctors’ lapses. Interviews showed that posters significantly increased respondents’ knowledge, suggesting that lapses noticed in weeks 1–2 and not noticed in weeks 3–8 by the ‘poster’ group were genuine lapses followed by a change in HCWs’ behaviour. HCW self-interest in avoiding complaints from patients coincides with the aim of the posters in improving standards.

O-002 A retrospective multicenter study of Solitaire device used for the revascularization in the treatment of acute ischemic stroke

PurposeTo evaluate safety and efficacy of the Solitaire device when used as 1st choice device in the treatment of patients with acute ischemic stroke (AIS) secondary to large artery occlusion.MethodsA...

Inherited polyglutamine spinocerebellar ataxias in South Africa

To determine the frequency and distribution of polyglutamine spinocerebellar ataxias (SCAs) from referrals over a 24-year period to the National Health Laboratory Service (NHLS) in South Africa (SA). Paper-based clinical reports in the University of Cape Town laboratory and the NHLS electronic patient record database spanning a 24-year period were mined for information regarding the molecular diagnosis, ethnicity and CAG repeat length for individuals referred for molecular genetic testing for the polyglutamine SCAs. SCA1 and 7 are the most frequent types of polyglutamine SCA in the SA patient population, followed by SCA2, 3 and 6. SCA1 is the most common type in the coloured, white and Indian populations, whereas the majority of indigenous black African patients are affected with SCA7 and 2. Of individuals tested, 22% were found to be positive for one of the polyglutamine SCAs. Although trends in the frequency and distribution of the polyglutamine SCAs in SA have not changed significantly since our previous study in 2003, they differ remarkably from those reported elsewhere, and reflect the unique genetic and demographic background of SA. The provision of accurate and complete patient information and family history is crucial to the diagnostic process, to enable comprehensive epidemiological studies and assist in developing therapeutic and patient management strategies.

Scalp cooling for hair preservation and associated characteristics in 1411 chemotherapy patients - Results of the Dutch Scalp Cooling Registry

Background. Chemotherapy-induced alopecia is a frequently occurring side effect of cancer treatment with a high psychological impact which can be prevented by scalp cooling. With this multi-centre patient series we estimated the results of scalp cooling for currently used chemotherapies to provide patient information and we identified characteristics associated with the results. Material and methods. The Dutch Scalp Cooling Registry collected data on scalp-cooled patients in 28 Dutch hospitals. Nurses and patients completed questionnaires on patients, chemotherapy and scalp cooling characteristics. Logistic regression analysis was used to examine associated characteristics of the scalp cooling result. Results. Overall, 50% of the 1411 scalp-cooled patients did not wear a head cover during their last chemotherapy session. Patients were satisfied with the results in 8% of cases after TAC chemotherapy and up to 95% after paclitaxel treatment. Besides type of chemotherapy, higher dose and shorter infusion time, older age, female gender and non-West-European type of hair significantly increased the proportion head cover use. Hair length, quantity, chemical manipulation (dyeing, waving, colouring), wetting hair before scalp cooling, and treatment with chemotherapy ever before did not influence the degree of head covering among patients. Conclusions. Scalp cooling results as recorded in this open patient registry were positive for most regimens, justifying it's use by all eligible patients, except for those needing TAC. Lengthening infusion time may improve the results.

Abstract 75: A Retrospective Multicenter Study of Solitaire™ FR for Revascularization in the Treatment of Acute Ischemic Stroke

Background &amp; purpose: To evaluate safety and efficacy of the Solitaire FR in the treatment of patients with acute ischemic stroke (AIS) secondary to large artery occlusion. Methods: Retrospective study of consecutive patients presenting with AIS treated with Solitaire FR as the first choice device to restore blood flow in 6 experienced European sites according to the hospitals’ stroke protocols (direct IA, bridging IV t-PA/IA and failed or contraindicated IV t-PA). Sites provided patient information at pre-procedure, procedure, 24hrs, discharge and 90 days. An independent Core Lab evaluated TICI scores on the pre-procedure and post-procedure angiograms. Recanalization was defined as TICI 2 or 3 post Solitaire FR device use and prior to any rescue therapy. Baseline and post-treatment brain CT or MRI were also centrally reviewed for symptomatic ICH classification (PH2 + death or neurologic deterioration). Good early neurological outcome was defined as NIHSS score improvement of ≥10 points or NIHSS 0,1 at discharge, and favourable functional outcome as modified Rankin Scale (mRS) score ≤ 2 at day 90. Patients with missing mRS data were judged to have worst possible outcome for data analysis. Results: Of the 206 patients treated with Solitaire FR, the device was used as first line treatment in 141 patients (mean age, 66; median NIHSS, 18): 74 patients were treated with IV t-PA prior to endovascular treatment, 56 had contra indication to IV t-PA and 11 were directly treated IA. Safety and efficacy results in the overall and IV t-PA treated patients are shown in the table . The mean number of recoveries was 1.8 and median time from groin puncture to successful revascularization was 45 minutes. Conclusions: This retrospective, uncontrolled study shows that Solitaire FR is safe and achieves good revascularization rates and functional outcomes in patients with AIS and large artery occlusion.

Dispensing practice in the community pharmacies in the Turkish Republic of Northern Cyprus

Good pharmacy practice is the process of supplying the accurate drug to the right patient for an adequate period of time with the lowest cost to the patient and the community. Pharmacist have a crucial role in promoting good pharmacy practice. To assess the dispensing practice of the community pharmacists in the Turkish Republic of Northern Cyprus (TRNC) regarding RDU and to evaluate the quality of dispensing. Setting Community pharmacies in TRNC. Method The study consists of two parts: a face to face interview and a simulated patient visit to these pharmacies. Rationality indicators (average dispensing time, stock availability and adequate labelling), presence of the pharmacist on the premises, dispenser characteristics, prescription checking, and the provided patient information. The majority of the prescriptions (73.3%) were dispensed by the pharmacists. None of the pharmacy employees had pharmacy based training. Eighty nine percent of the pharmacists believed that their employees could very well dispense drugs on their own. The declared average dispensing time for a prescription of a single drug was 233 s while the measured one was 149 s. Few dispensers in reality warned the patient about potential interactions. The difference between the average dispensing scores of the pharmacists and the non-pharmacist dispensers was not significant. The dispensing practice in the community pharmacies in the Turkish part of Cyprus seems inadequate in terms of GPP.

Evaluation of the Quality and Contents of Obesity Patient Education on Internet

Objective : To evaluate web-based patient education material for HSWG criteria and core education concepts. Design : Evaluation of the web sites which contain information relating to Setting : Listing of web-sites was obtained from 14 search engines with the help of Copernic agent professional version 6.21. The search for websites was undertaken using the keyword obesity. Participants: Out of 162 web-sites retrieved from meta search engine, 54 sites themselves provide patient information and so considered for evaluation. Intervention(s) : Data obtained was analyzed by cluster analysis and classified into four categories with respect to quality. Main Outcome Measure(s) : Twelve core educational specific for patient education were developed and the websites were evaluated for compliance. The quality of all the websites providing patient information for were evaluated based on the extent of their adherence to Health Summit Working Group (HSWG) criteria. On the basis of the sum of scores obtained from obesity core educational concepts and HSWG criteria, websites were graded as excellent, medium, good and average. Results : Considerable variability in quality of patient education web-sites was found with respect to core educational and HSWG criteria. Spearman correlation analysis showed significant correlation (P=0.016) at 0.05 level, between total scores of core educational concept and HSWG criteria. Conclusions : Inclusion of stress management, role of family support, enhancement in customized content like chat rooms, discussion forums, customized alerts and easier feedback mechanisms will be a significant development in the direction of patient centred care.

Assessment of the Quality of Patient-Orientated Internet Information on Surgery for Diverticular Disease

The Internet is a vast resource available for patients to obtain health information. This study examines the quality of Web sites that provide information on diverticular disease, treatment options, and surgery. Two search engines (Google and Yahoo) and the search terms "surgery and diverticular disease" and "surgery and diverticulitis" were used. The first 50 sites of each search were assessed. Sites that fulfilled the inclusion criteria were evaluated for content and scored by using the DISCERN instrument, which evaluates the quality of health information on treatment choices. Two hundred sites were examined, of which 60 (30%) provided patient-orientated information. 50 sites (25%) were duplicated, 7 (3.5%) were links, 10 (5%) were advertisements, 14 (7%) were resources for clinicians, 9 (4.5%) were message forums, 27 (13.5%) were articles, and 15 (7.5%) were dead links. Of the 60 Web sites that provided patient information, only 10 (16.7%) had been updated within the past 2 years. Seventeen (28.3%) sites were affiliated with hospitals and clinics, but another 17 (28.3%) sites were associated with private companies with commercial interests. Although most Web sites contained information on symptoms, complications, investigations, and treatment options of diverticular disease, 20 (33.3%) did not describe any of the risks of surgery, and 45 (75%) did not provide information on the timescale of recovery postoperatively. Eighteen sites did not provide balanced information on treatment options; of these, 7 were biased toward medical treatment and 6 focused on laparoscopic surgery. Overall, only 22 (36.7%) were identified as being "good" or "excellent" with the use of the DISCERN criteria. The quality of patient information on surgery for diverticular disease is highly variable, and Web sites that are sponsored by private companies may be biased in discussing treatment options. There is potential for the Internet to provide valuable information, and clinicians should guide patients to access high-quality Web sites.

The Effects of Pre-operative Visual Information and Parental Presence Intervention on Anxiety, Delirium, and Pain of Post-Operative Pediatric Patients in PACU

The purpose of this study was to test whether pre-operative visual information and parental presence had positive effects on anxiety, delirium, and pain in pediatric patients who awoke from general anesthesia in a post-surgical stage. This study used a non equivalent control-group post test design (n=76). Independent variables were provision of pre-operative visual information and parental presence for post-surgical pediatric patients in PACU (post anesthesia care unit). Dependent variables were anxiety, delirium, and pain in the pediatric patients measured three times at 10 minute intervals after extubation in the PACU. Measurements included Numerical Rating Scale for assessing state anxiety, Pediatric Anesthesia Emergence Delirium Scale by Sikich & Lerman (2004) for delirium, and Objective Pain Scale by Broadman, Rice & Hannallah (1988) for pain. Experimental group showed significantly decreased state anxiety at time points-10, 20, and 30 minutes after extubation. Delirium was significantly lower at 10 minutes and 30 minutes after extubation in the experimental group. Pain was significantly lower at 10 minutes after extubation in the experimental group. The results of this study suggest that this intervention can be a safe pre-operative nursing intervention for post-surgical pediatric patients at PACU.

P2-16-06: A Systematic Review of Standardised Clinical Outcomes and Patient Reported Outcome Measures (PROMS) in Breast Reconstruction.

Abstract Introduction: Failure to prospectively define and report surgical complications across a range of study designs is a confounding factor that fundamentally compromises the interpretation of data on health-related quality of life (HRQL) and PROMS. The UK National Mastectomy and Breast Reconstruction audit on 5000 breast reconstruction patients found higher than expected levels of complications (including rates of reoperation and levels of infection). We aimed to analyze the reporting of complications in a systematic review of all studies evaluating PROMS in breast reconstruction since 19781. Methods: Efficace criteria for HRQL methodology were used to assess the inclusion eligibility for each study1. Two out of 34 eligible studies were excluded due to overlapping patient datasets and small numbers (n&amp;lt;5) of breast reconstruction cases. Two reviewers examined the reporting of complications. The study designs comprised: 2 randomised controlled trials (RCT); 10 prospective longitudinal studies (PLS) and 20 retrospective studies (RS). RCTs and PLS were evaluated for predefined complications, their grading according to Clavien-Dindo2 and their integration into the evaluation of PROMS results. RS were evaluated for the reporting of complications and their statistical methodology. Results: A total of 3213 patients were included in the 32 studies. The type of reconstruction was only recorded in 71% of patients. The majority of patients in these studies underwent abdominal flap reconstruction, compared to implant only techniques (32%), and less than 10% comprising Latissimus dorsi flaps. Only 19% of studies recorded complications with the majority (81%) failing to report any complications. Only 3 studies provided details of the numbers and level of complications amongst a total of 44 patients (1.4% of the total number of patients). Reported complications were graded and classified either as major (requiring surgical intervention) or minor comprising 55% and 45%, respectively. None of the RCT or PLS studies defined either the type or level of complications a priori, nor stratified complications based on risk factors such as age, body mass index, smoking and diabetes. Conclusion: There is a significant under estimation of the contribution of complications to HRQL and PROMS reporting. This fact diminishes the current evidence on the effects of breast reconstruction on PROMS. There should be collective efforts to improve the standards of documentation for clinical outcomes in breast reconstruction. This together with standardized reporting of PROMS will consolidate clinical evidence upon which decision-making and provision of patient information can be confidently based. 1. Winters ZE, Benson JR, Pusic AL. Annals of Surgery 2010;252(6):929–42 2. Dindo D et al. Annals of Surgery 2004;240(2):205–213 Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-16-06.

Evaluation of a website providing information on regional health care services for patients with rheumatoid arthritis: an observational study

Studies on the effectiveness of information provision for patients with arthritis through the Internet are scarce. This study aimed to describe rheumatoid arthritis (RA) patients’ knowledge and information needs before and after launching a website providing information on regional health care services for patients with rheumatic conditions. The intervention consisted of a weekly updated website comprising practical information on regional health care services for patients with arthritis. In addition, patients were offered information leaflets and an information meeting. Before (T1) and 24 months after (T2) the website was launched, a random sample of 400 RA patients filled in a questionnaire regarding knowledge and information need (scores 0–18) about accessibility and contents of 18 regional health care services. Two hundred and fifty-one patients returned the questionnaire (response rate 63%) at T1 and 200 patients (50%) at T2, respectively, with 160 paired observations (112 females (70%), mean age 60.4 years (SD 9.9)). The total score for insufficient knowledge about contents decreased from 9.3 (SD 4.9) to 8.5 (SD 4.8; p = 0.03) and for accessibility from 8.6 (SD 4.7) to 8.4 (SD 4.9; p = 0.59). Total score for information need about contents decreased from 4.2 (SD 4.5) to 1.9 (SD 2.9; p < 0.01) and for accessibility from 3.6 (SD 4.5) to 1.4 (SD 2.4; p < 0.01) (paired t-tests).After the administration of a website comprising practical health care information, RA patients’ information need and to a lesser extent their perception of having insufficient knowledge on relevant regional health care services decreased significantly. The results of this descriptive study suggest that the use of the Internet to inform patients may be effective, although controlled studies are required to evaluate and optimize web-delivered information.

Help-seeking and coping with the psychosocial burden of chronic hepatitis C: A qualitative study of patient, hepatologist, and counsellor perspectives

BackgroundChronic hepatitis C affects millions of people worldwide, may have significant physical consequences, and patients are also at increased risk of psychiatric morbidity. However, it is currently unknown how patients cope with, and seek help for the psychosocial issues which contribute to this psychiatric morbidity. ObjectivesThis study aimed to qualitatively explore the biopsychosocial burden of chronic hepatitis C, patients’ subsequent coping and help-seeking, and the patient–health professional relationship from the different perspectives of patients, hepatologists, and counsellors. MethodsThirteen patients, five hepatologists, and two hepatitis C specific counsellors from South Australia participated in semi-structured interviews, which were audio-recorded, transcribed verbatim, and analysed thematically. ResultsAll groups perceived chronic hepatitis C as a severe disease involving inextricably intertwined biological, psychological, and social impacts. Negative factors included the impact of diagnosis, stigmatisation, and often unwarranted fears regarding transmission and disease progression. The key positive influences reported across the groups involved information provision and access to informal and formal support. However, a number of barriers were noted to accessing this support, particularly stigmatisation. All respondents highlighted the importance of the patient–health professional relationship. This relationship was perceived to be enhanced by empathetic, compassionate professionals who provided comprehensive information in a sensitive and timely manner. Key negative influences on this relationship included discrimination or inappropriate treatment from mainstream health professionals, time constraints of doctors, patient non-attendance, and discordant views regarding treatment decisions. ConclusionsReducing the psychosocial impact of chronic hepatitis C requires targeted information provision for patients, the general public, and mainstream health services. This may increase patient education, reduce the extent and impact of stigmatisation, remove barriers to help-seeking, and improve the patient–health professional relationship.

Patients' knowledge about treatment for opiate dependence

Aims and methodA cross-sectional survey was conducted to assess patient knowledge and information provision about opioid substitution treatment among individuals with opiate dependence receiving treatment at four treatment centres in South London.ResultsIn total 118 people were recruited to the study. Participants answered a mean of 14 out of 34 questions assessing a range of factors such as medication, blood-borne viruses and overdose correctly. Participants overestimated their performance on average by almost 40%. Individuals with a history of previous treatments scored significantly higher than those in their first treatment episode. The majority reported having been given written information on most of the topics assessed.Clinical implicationsThe results of this study highlight the need to improve education about opioid dependence and its treatment. Poorly informed patients are unlikely to make optimal treatment choices. Improving patients' knowledge and understanding about treatment may lead to better engagement, retention, treatment adherence and, ultimately, better health outcomes.

Readability of Neurosurgery-Related Patient Education Materials Provided by the American Association of Neurological Surgeons and the National Library of Medicine and National Institutes of Health

Most professional organizations now provide patient information material, and not all of this material is appropriate for the average American adult to comprehend. The National Institutes of Health (NIH) and the United States Department of Health and Human Services recommend that patient education materials be written at the sixth-grade level. Our aim was to assess the readability of neurosurgery-related patient education material and compare it with The American Medical Association, NIH, and United States Department of Health and Human Services recommendations. Materials provided by the American Association of Neurologic Surgeons (AANS) and the U.S. National Library of Medicine (NLM) and National Institutes of Health were assessed with the Flesch-Kincaid grade level and Flesch Reading Ease score with Microsoft Office Word software. None of the articles had Flesch-Kincaid grade levels at or below the sixth-grade level. All articles on the AANS Conditions and Treatments section were written at or above the ninth-grade level; three of the AANS Camera-Ready Fact Sheets and four of the NIH/NLM articles were written between the seventh- and eighth-grade levels. Current patient education material provided by the AANS is written well above the recommended level. Material from the NLM and NIH performed better, but was still above the recommended sixth-grade level. Education materials should contain information relevant to patients' conditions, be accurate in the information they present, and be written with the average patient in mind.

Developing a Referral System for Fertility Preservation Among Patients With Newly Diagnosed Cancer

The goal of this project was to develop a referral system to increase the likelihood that patients of childbearing age with newly diagnosed cancer receive timely information about fertility, and reduce the burden oncologists may feel when discussing and exploring fertility preservation options with their patients. The group developed and examined the effectiveness of a fertility preservation referral system through pilot-testing a developed patient education brochure. During the 12-month pilot-testing period, 776 patients of childbearing age (< 40 years) were seen at H. Lee Moffitt Cancer Center and 349 brochures were taken. The reproductive endocrinologist/infertility clinic experienced a 9-fold increase in the number of calls received during the 12-month study period, with 122 calls received compared with 13 the prior year. The large increase in calls illuminates the gap in patient interest and referral, and shows an effective method to transmit this information. Improving the communication of time-sensitive information about fertility and preservation options to patients with cancer is associated with an increased likelihood of improving quality of life, reducing patient distress, and increasing use of ancillary fertility-related health services. Through referring and providing patient information, this referral system allows oncologists to fulfill their obligation and make informed decisions about fertility preservation, thereby improving the full cancer care continuum.

A Pilot Study of Website Information Regarding Aromatase Inhibitors: Dietary Supplement Interactions

Patients who have hormone receptor-positive breast cancer and who are taking aromatase inhibitors (AIs) should understand the benefits and risks of concomitant dietary supplement (DS) use. The International Society for Integrative Oncology (SIO) encourages patients to discuss DS use with their health care practitioners. The objective was to conduct a pilot study rating Internet websites from the perspective of health care practitioners for information about AI-DS interactions. Five (5) Internet websites suggested by SIO were evaluated using the DISCERN instrument rating tool. The available AI-DS information on these websites was rated by 4 evaluators: 2 naturopathic doctors, 1 oncology pharmacy resident, and a pharmacy student. The overall rankings ranged from 1.6 to 3.9, with considerable variability in the type of information available from the websites. The interevaluator rankings of the websites ranged from 0.44 to 0.89. The evaluators consistently found the most reliable, unbiased, and comprehensive information on AI-DS interactions at the Natural Medicines Comprehensive Database and Memorial Sloan-Kettering Cancer Center websites. However, more than one database was needed for provision of optimal patient information on AI-DS interactions. In order to effectively advise patients regarding AI-DS interactions, more than one website should be evaluated to assess the potential efficacy and safety of DS in women whose breast cancer is being treated with an AI.