behavioral science Flashcards
phase I of clinical trial
small number of health volunteers
assesses safety, toxicity, pharmacokinetics, pharmakodynamics
phase II of clinical trial
small number of patients with disease of interest
assesses treatment efficacy, optimal dosing, and adverse effects
phase III of clinical trial
large number of patients randomly assigned either to the treatment under investigation or to the best available treatment (or placebo)
compares the new treatment to the current standard of care
phase IV of clinical trial
postmarketing surveillance of patients after treatment is approved
detects rare or long-term adverse effects
can result in treatment being withdrawn from market
patient not adherent
attempt to identify the reason for nonadherence and determine his/her willingness to change
do not coerce the patient into adhering or refer him/her to another physician
patient desires an unnecessary procedure
attempt to understand why the patient wants the procedure and address underlying concerns
do not refuse to see the patient or refer him/her to another physician
avoid performing unnecessary procedures
patient has difficulty talking medications
provide written instructions
attempt to simplify treatment regimens
use teach-back method to ensure patient comprehension
family members ask for information about patient’s prognosis
avoid discussing issues with relatives without the patient’s permission
a patient’s family member asks you not to disclose the results of a test if the prognosis is poor because the patient “will not be able to handle it”
attempt to identify why the family member believes the information would be detrimental to the patient’s condition
explain that as long as the patient has decision-making capacity and does not indicate otherwise, communication of information concerning his/her care will not be withheld
a child wishes to know more about his/her illness
ask what the parents have told the child
parents decide what information can be relayed
a 17 year old girl is pregnant and requests an abortion
may require parental notificiation or consent depending on state
don’t try to say patient’s decision
15 year old is pregnant and wants to keep the child but parents want her to give it up for adoption
patient retains right to make decisions regarding her child
provide information about practical issues of caring for a baby
discuss the options if requested
encourage discussion between the teenager and her parents to reach the best decision
terminally ill patient requests physician assisted suicide
in the overwhelming majority of states, refuse involvement in any form of physician-assisted suicide
physicians may, however, perscribe medically appropriate analgesics that coincidentally shorten the patient’s life
patient is suicidal
assess teh seriousness of the threat
if serious, suggest that the patient remain in the hospital voluntarily
patient can be hospitalized involuntarily if he/she refuses
patient states that he/she finds you attractive
ask direct, close-ended questions and use a chaperone if necessary
romantic relationships with patients are never appropriate
never say “there can be no relationship while you are a patient” because this implies that a relationship may be possible if the individual is no longer a patient
a woman who had a mastectomy says she now feels ugly
find out why the patient feels this way
don’t offer falsely reassuring statements
patient is angry about the amount of time he/she spend in the waiting room
acknowledge the patient’s anger but don’t take it personally
apologize for any inconvenience
stay away from efforts to explain the delay
patient is upset by the way he/she was treated by another doctor
suggest the the patient speak directly to that physician
if the problem is with a member of the office staff, tell the patient you will speak to that person
an invasive test is performed on the wrong patient
regardless of the outcome, a physician is ethically obligated to inform a patient that a mistake has been made
a patient requires a treatment not covered by his/her insurance
never limit of deny care because of the expense in time or money
discuss all treatment options with patients, even if some are not covered by their insurance company
effect modification
effect of an exposure on an outcome is modified by another variable
smoking modifies effect of ER agonist on DVT
vs confounding: the different starts will have different measures of association
with confounding stratification usually reveals no sig. dif.
