The attitudes of heterogeneous groups of cancer patients towards research have been studied extensively. Less is known about these attitudes in the advanced cancer population. Such patients may have differing attitudes for a variety of reasons, including burden of disease and social factors. This systematic review examines the literature on attitudes of patients with advanced cancer toward research and aims to define common themes. The following databases were searched electronically: CINAHL (1982-2007), the Cochrane Database of Systematic Reviews (2007), Embase (1996-2007), and Medline (1996-2007). Additionally, the following journals were hand searched: Palliative Medicine, Journal of Pain and Symptom Management, and the European Journal of Palliative Care. The search terminologies used were: "Cancer" AND "Attitudes" AND "Research" AND "Palliative Care." All subheadings were included. Results were limited to English-language journals and studies involving humans. Of the 637 articles retrieved, 11 were included after an appraisal process. Both positive and negative attitudes toward research in advanced cancer were identified. Common themes of altruism, hope, and self-benefit were identified in 10 studies as a motivation for trial participation. Negative attitudes toward symptom control and risk of increased hospital admissions were identified in four studies. Most of the studies involved patients' views about participating in hypothetical trials, limiting the generalizability of results. An important step for future work would be to examine the experiences and opinions of patients with advanced cancer who have actually participated in a clinical trial.

Background Inflammatory bowel disease (IBD) may impact the extent to which food, eating, and drinking bring satisfaction and enjoyment to peoples’ lives, and this may impact dietary intake. The prevalence of an impaired food-related quality of life (FR-QoL), its associated factors, and its impact on diet have not been explored. Objectives To measure the prevalence and nature of the burden of impaired FR-QoL in people with IBD, the factors associated with these, and their associations with nutrient intake. Methods We recruited 1576 outpatients with IBD (≥16 years old) in person from 7 IBD centers across the United Kingdom. Patients completed validated questionnaires to measure their FR-QoL, quality of life (QoL), distress, fatigue, anxiety, and depression. Dietary intake was recorded using the European Prospective Investigation into Cancer FFQ. A health professional recorded disease activity, Montreal classification, blood results, BMI, and malnutrition risk. FR-QoL was regressed onto explanatory variables using univariable and multivariable analyses. Results Data from 1221 patients were available (77.4% response; Crohn's disease, 65%; ulcerative colitis, 35%). The FR-QoL mean (± SD) score was 80.8 ± 26.9, with wide ranges (minimum, 29; maximum, 145). Following multivariable regression, the strongest associations with FR-QoL were the number of recent disease flares (5 flares β = −12.7; P < 0.001), the IBD-specific QoL (β = 0.33; P < 0.001), and IBD-related distress (β = −0.26; P < 0.001). Patients with poorer FR-QoL had lower intakes of fiber (nonstarch polysaccharide; Q1 to Q5 difference = 2.1 g/d; 95% CI: 0.4–3.8; P = 0.048), calcium (192.6 mg/d; 95% CI: 112.5–272.6; P < 0.001), phosphorus (167 mg/d; 95% CI: 58–276; P = 0.041), and magnesium (34.4 mg/d; 95% CI: 9.3–59.4; P = 0.041). Conclusions Impaired FR-QoL is prevalent in IBD and is associated with recurrent disease flares, a reduced IBD-specific QoL, and greater IBD-related distress. A poorer FR-QoL was associated with lower intakes of key nutrients of importance to IBD, including those relating to gut health and bone mineralization.

Safety concerns combined with the greatly increased costs and difficulties of maintaining the blood supply are major considerations for transfusion services. Previous local surveys demonstrated that hospital blood use at our hospital could be improved. Excessive cross-matching, unnecessary transfusion and high return rates of unused blood were commonplace. Transfusion practice was audited over a 3-month period. An education package with guidelines for transfusion was delivered to all clinician groups within the hospital, over the following 9 months. The audit was repeated exactly 1 year later at the same time period. During the second audit, inpatient hospital numbers increased by 1.02% (from n = 7262 to n = 7336) but no differences in length of stay, cardiovascular morbidity or mortality were demonstrated. Twenty percent (n = 254, 2002; n = 316, 2001) fewer patients received blood, and the number of red cell packs used reduced by 19% (from n = 1093 to n = 880). Total number of patients transfused reduced from 4.4% to 3.5% which, as an absolute difference, is a reduction of 0.9% (CI 0.3-1.5, P = 0.006). The audit, guideline and education package had a major impact on red cell use within the hospital with no adverse effects. Blood use can be improved by the implementation of a suitable education package and guideline. If it is possible to replicate the results of this education programme nationwide, the effect on blood use, with subsequent savings and enhanced patient safety could be significant.