Journal of general internal medicine
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Comparative Study Clinical Trial
Behind closed doors: physician-patient discussions about colorectal cancer screening.
Despite the availability of multiple effective screening tests for colorectal cancer, screening rates remain suboptimal. The literature documents patient preferences for different test types and recommends a shared decision-making approach for physician-patient colorectal cancer screening (CRCS) discussions, but it is unknown whether such communication about CRCS preferences and options actually occurs in busy primary-care settings. ⋯ If a preference for colonoscopy is widespread among primary-care physicians, the implications for intervention are either to prepare patients for this preference or to train physicians to offer options when recommending screening to patients.
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Limited research exists regarding views of patients, oncology specialists, and primary care providers (PCPs) concerning breast cancer survivorship care. ⋯ Breast cancer patients may experience difficulties transitioning to survivorship, including ongoing psychosocial issues. African-American patients may face additional and unique barriers to successful survivorship. Oncology specialists may have concerns about discharging cherished patients. These findings suggest a psychological component that may influence the use of written survivorship care plans. PCPs may need additional training and greater access to specialists in order to care for survivors.
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Meta Analysis Comparative Study
Methodological challenges and limitations of research on alcohol consumption and effect on common clinical conditions: evidence from six systematic reviews.
Despite the high prevalence of alcohol consumption in the US, 'mainstream' physicians generally consider it to be peripheral to most patient care. This may be due in part to a dearth of rigorous research on alcohol's effect on common diseases. ⋯ We recommend more high-quality observational and experimental studies in primary care settings as well as a more standard approach to quantifying alcohol use and to defining alcohol use disorders.
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Multicenter Study Comparative Study
The association of stigma with self-reported access to medical care and antiretroviral therapy adherence in persons living with HIV/AIDS.
The stigma of HIV-infection may profoundly affect the lives of persons living with HIV/AIDS (PLHA). However few studies have examined the association of HIV stigma with multiple components of HIV treatment and care. ⋯ The association of stigma with self-reported access to care and adherence suggests that efforts to improve these components of HIV care will require a better understanding of the possible effects of stigma and its mediators.
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Multicenter Study Comparative Study
Barriers and facilitators to routine HIV testing in VA primary care.
Approximately 21% of the 1.1 million HIV-infected persons in the United States are unaware of their HIV status. The Centers for Disease Control (CDC) recommend routine opt-out HIV testing for all patients aged 13-64. Yet little is known about patient and provider perspectives on routine HIV testing. ⋯ Patients and providers appear ready for implementation of routine HIV testing. However, providers should use patient-centered communication strategies to ease patients' concerns about confidentiality and stigma associated with HIV disease.