Current opinion in supportive and palliative care
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Curr Opin Support Palliat Care · Sep 2010
ReviewScreening for prostate cancer: have we resolved the controversy?
Prostate cancer (PCa) screening has long been a source of controversy. In this review, we discuss the interim results of the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Implications of these studies will also be underlined. ⋯ Despite the effects demonstrated by the ERSPC, there is currently insufficient evidence to introduce a population-based screening programme. The studies evaluating quality of life and cost-efficiency need to be completed with the highest urgency and their results should be considered together with more mature data from the ERSPC to reach an effective implementation of screening on PCa. Meanwhile, we have to improve the screening test, screening protocol and further develop an accurate individualized risk assessment to decrease the rates of overdiagnosis and overtreatment, while the mortality reduction and the detection of clinically relevant PCa should be maintained.
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As quality in end-of-life care for the seriously ill and dying patient and his relatives is the central aim of palliative care, the development of clinically relevant quality indicators is essential. To get an insight into the most recent advances concerning quality indicators in end-of-life care, a literature review has been performed. ⋯ In most domains of care the existing indicators have to be specified methodologically. Missing domains mainly concerned with spiritual, religious, existential and cultural aspects have to be focused on to develop meaningful indicators. Additionally the initiatives working on national levels have to collaborate to bring together all their valuable information. Above that the patients and families insight, on what they perceive as quality, should be listened to more intensely.