Would Palliative Care Patients Benefit from Social Workers' Retaining the Traditional 'Casework' Role rather than Working as Care Managers? A Prospective Serial Qualitative Interview Study

Social workers have made a significant contribution to the developmentand delivery of palliative care. Both palliative care and socialwork are rapidly evolving but, given their changing contextsand increasing workloads, can they sustain compatibility? Advancesin treatment of life-threatening illness mean that people livelonger in a period of palliative care. Social work has undergoneradical change in the wake of the 1990 NHS and Community CareAct and subsequent local-authority modernizations, with socialworkers now given the role of care managers, rather than themore traditional ‘casework’ or therapeutic role.This paper aims to explore the current and potential role ofthe social worker in palliative care for people with cancerand other prolonged life-threatening illness. It draws uponevidence from a prospective qualitative, patient-centred researchstudy, which detailed the experiences of forty people with lungcancer and advanced cardiac failure, and their personal andprofessional carers (Murray et al., 2002). A total of two hundredand nineteen qualitative interviews were carried out. We found that social workers were conspicuous by their absencefrom the lives of these forty vulnerable adults, who were livingand dying in the community with many unmet needs which, potentially,could be met by social-work input. The study highlights sixareas of concern in which social-work assessment and interventioncould have impacted on dying patients’ quality of lifeand that of their carers: loss and dependency, family-centredissues, carers’ needs, practical tasks, emotional andspiritual struggles, and finally, support needs of staff. Theseareas are outlined to explore the territory which a social workermight inhabit if resources and policies permitted.     

Parenting: Can Skills be Learned?

The effectiveness of parent education courses conducted in the northern suburbs of Sydney was assessed in terms of Hereford's Parent Attitude Scale after norms for this area had been established. The results indicated that on completion of these courses participants had greater confidence in their abilities as parents, were more aware of the influence of environment on their children and had a more trusting relationship with their children. Kavanagh doubted the relevance of a course such as PET to parents of lower socioeconomic status—these parents have also been shown to score lower on the PAS. However in this study participants who scored lowest initially improved most, showing that the course is reaching those who are not very well informed about childrearing.     

Cooperating,reflecting, making open and meta-dialogue — Outline of a systemic approach on constructivist grounds

In this paper the authors first describe the theoretical background of their constructivist approach to therapy: the Kiel-Meyn-Consultation-Model. They then outline their guidelines “cooperating, reflecting, making open” for interviewing, briefly describe the “meta-dialogue” and point out some basic helpful attitudes consultants can hold. Annotated excerpts from a consultation are then presented to give an idea of how the model works. The paper closes with summaries of follow-up sessions and their evaluation by the therapist.     

Times Are Tough—Brother,Can You Paradigm?

Ten years ago, the National Academy of Science released its risk assessment/risk management (RA/RM) “paradigm” that served to crystallize much of the early thinking about these concepts. By defining RA as a four-step process, operationally independent from RM, the paradigm has presented society with a scheme, or a conceptually common framework, for addressing many risky situations (e.g., carcinogens, noncarcinogens, and chemical mixtures). The procedure has facilitated decision-making in a wide variety of situations and has identified the most important research needs. The past decade, however, has revealed that additional progress is needed. These areas include addressing the appropriate interaction (not isolation) between RA and RM, improving the methods for assessing risks from mixtures, dealing with “adversity of effect,” deciding whether “hazard” should imply an exposure to environmental conditions or to laboratory conditions, and evolving the concept to include both health and ecological risk. Interest in and expectations of risk assessment are increasing rapidly. The emerging concept of “comparative risk” (i.e., distinguishing between large risks and smaller risks that may be qualitatively different) is at a level comparable to that held by the concept of “risk” just 10 years ago. Comparative risk stands in need of a paradigm of its own, especially given the current economic limitations. “Times are tough; Brother, can you paradigm?”     

Agreement Between Scales in the Measurement of Breast Cancer Risk Perceptions

The objective of this article is to compare the accuracy and numeric responses of breast cancer risk perception as measured by a frequency scale and percentage scale. A cross-sectional survey was conducted. Perceptions of five-year and lifetime breast cancer risk were measured using a frequency and a percentage scale. Estimation error was calculated as the absolute difference between actual breast cancer risk as determined by the Gail model and perceived risk. Agreement between scales was determined by calculating the mean and standard deviation of the difference between numeric responses. The study was conducted among women enrolled in two primary care clinics associated with an academic medical center. Two-hundred-fifty-four participants were recruited from one of the two participating internal medicine clinics. Inclusion criteria included female gender and age 40-84 years. Exclusion criteria included a history of breast cancer, dementia, or a life expectancy of less than two years. The frequency scale was more accurate than the percentage scale in estimating lifetime risk (p= 0.05), but less accurate in estimating five-year risk (p < 0.02). Only 79 participants (31%) were considered consistent scale users, providing identical responses when using the frequency and percentage scale for a given risk estimate. Although the mean difference (percentage-frequency scale) for estimates of breast cancer lifetime risk was only 2.4, the empirically determined 90% limits of agreement between the frequency and percentage scale for lifetime risk were wide, from -30 to 40. Higher numeracy was associated with consistent use of scales (OR 1.61, 95% CI; 1.09-2.37). We report disagreement in breast cancer risk perceptions when measured by a frequency and a percentage scale. The accuracy and direction of bias associated with each scale varies according to the time frame of risk being assessed.     

What recruiters can't/won't tell you. 6 questions that good headhunters won't answer.

If you're frustrated because a headhunter won't give you certain information about a hiring organization, get over it. There are some very good reasons why a respectable recruiter won't answer particular questions from job candidates. Find out the questions and why they won't answer them.     

Physician fee-setting requires scrutiny.

To avoid antitrust liability from physician fee-setting in HMOs and PPOs, participating physicians should share the risk of profit and loss. "Health Law" is a regular feature of Physician Executive contributed by the law firm of Epstein Becker and Green, P.C. Douglas A. Hastings, Esq., a partner in the firm's Washington, D.C., offices serves as column editor.     

Osteoporosis: an invisible, undertreated, and neglected disease of elderly men

This article highlights a silent disease that threatens the health and vitality of older men. Among elderly men and women, osteoporosis is among one of the leading causes of morbidity and mortality in the United States. Once perceived as only a female dominated disease, osteoporosis is now known to be gender blind. The following discussion will review the epidemiology and pathology of osteoporosis, and identify the concerns raised for men, including neglect. Special management considerations for older men and recommendations for future research into this overlooked major health problem will be explored. Better understanding of how osteoporosis affects older men may help to encourage prevention strategies earlier in life, appropriate screening and monitoring, as well as more effective treatment later in life.