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Media Advisory: May 21, 1999
The Agency for Health Care Policy and Research (AHCPR) works to improve the quality of health care, reduce costs, and broaden access to essential services. Here are some of the findings described in the most recent issue of AHCPR's Research Activities.
Less than a Minute of Physician Compassion Can Reduce Anxiety in Women Diagnosed with Breast Cancer
A new AHCPR study found that if a doctor takes as little as 40 seconds to acknowledge a breast cancer patient's emotional state, it lessens her anxiety, and she perceives the doctor as more compassionate. Researchers recruited 123 healthy breast cancer survivors and 87 women who had not had cancer. Half of each group was shown a standard videotape of two treatment options for metastatic breast cancer—high-dose and low-dose chemotherapy—that discussed risks and benefits, side effects, and probability of survival for each treatment. The other group was shown an "enhanced compassion" videotape, that was similar to the first tape, except for two short segments in which the doctor acknowledged the patient's concerns, expressed support and partnership, and validated the difficulty of her decision. The women who watched the enhanced videotape gave the doctor a higher score (mean of 220 vs. 137) and rated the physician as warmer, more pleasant, and more sensitive. While both tapes aroused anxiety, the anxiety scores were significantly lower for the women in the enhanced compassion group than for the women in the standard videotape group (40 vs. 45), after controlling for pre-video anxiety scores.
["Can 40 seconds of compassion reduce patient anxiety?" by Linda A. Fogarty, Ph.D., Barbara A. Curbow, Ph.D., John R. Wingard, M.D., and others, in the January 1999 Journal of Clinical Oncology 17(1), pp. 371-379.]
Use of Age as a Threshold for Recommending Prenatal Diagnosis Is Questioned
Physicians typically recommend amniocentesis or chorionic villus sampling for pregnant women 35 years of age and older for prenatal diagnosis of genetic disorders, such as Down syndrome. Age increases a woman's risk of having a baby with a genetic disorder. However, an AHCPR-supported review of current studies calls for the elimination of strict age- or risk-based cutpoints for prenatal diagnosis in favor of the preferences of well-informed women. According to the review, new data show that the risk of having a baby with Down syndrome increases substantially in the early and mid-30s but does not spike at age 35. In addition, the 35-year age cutoff was made by an expert panel in 1979 in part because of limited prenatal screening resources. However, currently there are 268 cytogenetic labs and 500 board-certified cytogeneticists in the United States to detect chromosomal abnormalities.
["Who should be offered prenatal diagnosis? The 35-year-old question," by Miriam Kupperman, Ph.D., M.P.H., James D. Goldberg, M.D., Robert F., Nease Jr., Ph.D., and A. Eugene Washington, M.D. M.Sc., in the February 1999 American Journal of Public Health 89(2), pp. 160-163.]
Cocaine and Tobacco Use During Early Pregnancy Substantially Increases the Risk of Miscarriage
Women who smoke early in pregnancy have nearly twice the risk of having a miscarriage as women who don't smoke and pregnant women who use cocaine also substantially increase their risk of miscarriage, concludes an AHCPR-supported study. It found that cocaine use and smoking together accounted for one out of four miscarriages suffered by a group of predominantly poor and black adolescents and women. Roberta B. Ness, M.D., M.P.H., of the University of Pittsburgh, and colleagues examined the association between cocaine and tobacco use and miscarriage among 970 pregnant adolescents and women who sought care at an urban emergency department. They used the women's self-reports and urinalysis to detect tobacco and cocaine use and additional hair analysis to detect longer term cocaine use. Among those who had miscarriages either at the beginning of the study or up to 22 weeks gestation, 29 percent had used cocaine (hair analysis) and 35 percent smoked (urinalysis), compared with 21 percent (cocaine use) and 22 percent (tobacco use) of adolescents and women who did not have miscarriages. Both nicotine and cocaine are vasoconstrictors that reduce uterine and placental blood flow, which may help to explain their association with miscarriage.
["Cocaine and tobacco use and the risk of spontaneous abortion," by Dr. Ness, Jeane Ann Grisso, M.D., Nancy
Hirschinger, M.A., and others, in the February 2, 1999, New England Journal of Medicine 340(5), pp. 333-339.
Adults Are as Likely as Adolescents To Have Cavities
Based on clinical examination and full-mouth x-rays, 8 percent of adolescents and adults have medium and large dentinal caries (cavities). Those between the ages of 13 and 25 are most likely to have clinically evident caries and to have the greatest percentage of teeth involved. Also, nearly 6 percent of seemingly sound teeth show radiographic evidence of dentinal caries, and the prevalence of these undetected caries increases with patient age. The rate of gingival caries (cavities along the gums) increased dramatically from 4.8 percent to 22.2 for older patients. Researchers from the University of California at Los Angeles and the University of Sao Paolo, Brazil, analyzed clinical mouth exams and interpretations of full-mouth radiographs of 460 patients enrolled in a larger study of guidelines for prescribing dental radiographs. They conclude that the potential for caries is as high for adults as it is for adolescents, and that dentists need to consider carefully x-ray information in all adolescent and adult patients.
["Findings of clinical and radiographic caries among several adult age groups," by Isildinha M. Reis, Dr.P.H., Virginia F. Flack, J.D., Ph.D., Kathryn A. Atchison, D.D.S., M.P.H., and Stuart C. White, D.D.S., Ph.D., in the December 1998 issue of Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, Endodontics 86(6), pp. 760-764.]
Other articles in Research Activities include findings on:
- Care needs of elderly women with chronic diseases.
- Link between hospital stay for childbirth and patient satisfaction.
- Potential of an antibiotic to reduce perinatal HIV transmission.
- Effects of benzodiazepine use on elderly patient's memory.
- Impact of Medicare fee cuts on procedure volume.
- Medication use patterns among cognitively impaired elderly.
- Effectiveness of treating depression by primary care doctors.
- Diagnosis and management of osteoarthritis of the knee.
- Impact of case management on chronic renal insufficiency.
- Success of self-management programs on chronic disease.
- Temporal patterns of cardiac arrests.
- People with AIDS and end-of-life care.
- Impact of tax-preferred medical savings accounts.
- Quality of hospital care for common illnesses.
- Differences in practice style among primary care doctors.
- Frequency of cervical cancer screening for HIV-infected women.
- Women physicians rank health care quality.
For additional information, contact the AHCPR Press Office: Salina Prasad, (301) 427-1864 (SPrasad@ahrq.gov).