Purpose: To explore the sociodemographic and clinical characteristics of cancer patients seeking a second-opinion consultation and to analyze their second opinion-related motives, needs, and expectations.Patients and Methods: In 212 consecutive patients seeking a second opinion at the Surgical Oncology Outpatient Clinic, satisfaction with the first specialist, motivation for the second opinion, need for information, preference for decision participation, and hope for and expectation of a different second opinion were assessed with a questionnaire.Results: The mean age was 53 years. Most patients were women (82%), of whom 76% were diagnosed with breast cancer. Half of the patients (51%) had a low educational level. The majority of patients (62%) only had internal motives for second-opinion seeking associated with the need for reassurance and more certainty, whereas a substantial minority of patients (38%) also had external motives related to negative experiences or unfulfilled needs. The externally motivated patients had a higher anxiety disposition, were less satisfied with their first specialist, preferred a more active role in medical decision making, and more often hoped for and expected a different second opinion.Conclusion: Motives for second-opinion consultations differ greatly. Understanding the difference between internal and external motivation is necessary to develop strategies to prevent unnecessary second-opinion seeking. Additional studies are warranted to evaluate the objective and subjective outcomes of second-opinion consultations.

Little is known about the effectiveness of cognitive behavioral treatment for patients with irritable bowel syndrome on a group basis. Previous studies have used only small samples, and studies with long term follow-up are lacking. The arm of the present study was to investigate: a) the effectiveness of a cognitive-behavioral group treatment compared with a waiting list control condition in alleviating abdominal complaints and b) the long term effectiveness of cognitive-behavioral group treatment. In study 1, we performed a controlled study with 25 patients in the group treatment condition and 20 patients in the waiting list control condition. Treatment consisted of eight 2-hour group sessions over a period of 3 months. In study 2, all patients were treated and followed up for an average of 2.25 years (range 6 months-4 years) after the completion of the group treatment. The abdominal complaints of the patients who underwent treatment were found to improve significantly more than the complaints of the patients awaiting treatment. Moreover, in agreement with the purpose of the therapy, the number of successful coping strategies was found to increase more and patients' avoidance behavior was found to decrease more in the treatment group than in the waiting list control group. The positive changes appeared to persist during follow-up. Cognitive-behavioral group treatment is effective in alleviating irritable bowel syndrome, in stimulating coping strategies, and in reducing avoidance behavior. At long term follow-up, the abdominal complaints, the number of successful coping strategies, and the avoidance behavior were still improved compared with the pretreatment assessment.

Results-The outpatient group contained significantly more men, reported more severe abdominal pain, more frequent complaints, more interference with daily activities, and a higher degree of avoidance of activities (p<0.01) than the primary care group. When each sex was analysed separately, these diVerences remained for female (p<0.01) but not for male patients. Outpatients were more likely to attribute their complaints to somatic causes (p<0.01), whereas primary care patients were more likely to attribute their complaints to stress (p<0.01) or their agitated way of life (p<0.05). Multivariate analysis showed that a high severity score, a large number of additional complaints, and a low score on the stress attribution were important determinants for being in the outpatient group. Conclusions-Female outpatients consider their complaints to be more serious and interfering than do patients with IBS in primary care. Male outpatients were comparable to primary care patients with IBS. More research needs to be done into sex specific diVerences in IBS and into the factors that influence the decision to refer a patient with IBS.

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