Health professionals may contribute to the reduction of the negative effects of uncertainty through communication of information regarding process of care as well as medical issues. Strategies tailored to individual differences in information requirements and to changing needs may facilitate positive adjustment.

content validity of the instrument were established and an exploratory factor analysis used to guide restructuring of the tool. Internal consistency/reliability was calculated using Cronbach's a . RESULTSUsing the scale showed that men with prostate cancer placed considerable importance on a broad range of information needs, most of which had been inadequately met. Age had a significant influence on the overall importance attributed to information, with younger patients having more need for information. The construct and content validity of the instrument were established. The factor analysis revealed four discrete factors which together explained > 68% of the variance, termed 'basics of prostate cancer care', 'disease management', 'physical well-being' and 'self-help' . Internal consistency/reliability was satisfactory ( a = 0.91). CONCLUSIONSThe basis of a tool capable of ascertaining the information needs of patients with prostate cancer was developed; it may offer clinicians a valid means of ascertaining information preferences and hence potentially enhance the quality of service provided. Further research is now required to refine the tool and test the effect of its longitudinal use in clinical practice on patient satisfaction and outcome. KEYWORDSprostate cancer, information needs, assessment scale OBJECTIVETo design, from first principles, a valid and reliable scale for assessing the importance of specific items of information needed by patients with prostate cancer that would be straightforward to use in clinical settings, as despite its prevalence, there is little research focusing specifically on the information needs associated with prostate cancer. PATIENTS AND METHODSSeveral stages of consultation and modification were used to inform the development of a scale which was then piloted on 96 patients with prostate cancer. Respondents were asked to rate the importance they placed on a range of prostate cancer-related topics of information, and the extent to which they felt these information needs had been met. The construct and

ICGs are more reliable proxies than HCPs. A trend for overestimation of symptoms was found in both groups which may lead to undervaluation of the quality of life by proxy and overtreatment of symptoms. This highlights the need to always use the patient report when possible, and to be aware of the potential flaws in proxy assessment. Reasons for overestimation by proxies deserve further research.

Slevin et al reported that patients with cancer were much more likely to opt for chemotherapy with minimal chance of benefit than were their professional carers and people without cancer.1 They also said that attitudes changed dramatically once cancer had been diagnosed. We investigated the attitudes of terminally ill patients in our hospice towards investigations and invasive procedures and compared these with the attitudes of their nurses. Subjects, methods, and resultsRandomly selected inpatients with advanced cancer at our hospice and their key nurses took part in an interview based survey. Patients were asked about 14 procedures of increasing invasiveness. Travelling was mentioned when necessary. The questions were prefaced by: "If we thought it would help us improve your care would you want...?" Procedures ranged from having temperatures taken to having an operation, and the survey culminated in the question, "If your heart stopped unexpectedly would you want to be resuscitated?" Standard descriptions of all the tests and procedures were available.Responses were rated 0-10 (0 = no, definitely not; 5 = don't mind; 10 = yes, definitely). The European Organisation for Research and Treatment of Cancer's questionnaire was administered to obtain concurrent quality of life data, 2 and patients were asked to assess their status on the World Health Organisation performance scale.3 The nurses were asked how appropriate it would be to carry out these 14 investigations or procedures if they were thought necessary for the medical management of their patient. Responses were graded 0-10 (0 = inappropriate, 5 = no strong feeling either way, and 10 = appropriate). They were also asked to assess the patient's status on the WHO performance scale. Non-parametric statistics were used.Twenty three patients (15 women; median age 67 (range 47-81) years) and 18 nurses completed the questionnaire. No nurse was interviewed more than twice. One patient became distressed during the interview. Patients were consistently more likely to accept investigations and invasive procedures than were nurses (figure). The greatest divergence of opinion was in relation to resuscitation: 12 patients but no nurses were in favour of the procedure. Patients' responses about intervention were unrelated to age, quality of life, disease stage, or self rated status on the WHO performance scale. Patients with a worse status on the performance scale were more reluctant to accept blood transfusions (r s = − 0.44, P < 0.05). The responses about resuscitation were independent of subscale scores for pain and for emotional, cognitive, and physical functioning on the European organisation's questionnaire.2 Patients self assessed status on the performance scale and their score for global quality of life were significantly correlated (r s = − 0.55, P < 0.01), indicating decreasing quality of life with increasing disability. Patients' and nurses' scores on the performance scale agreed strongly ( (unweighted) = 0.81, 95% confidence interval 0.61 to 1.01).

Conclusion Providing hospice employees with a mental health first aider that can support discussion around mental health concerns is one step in opening up the importance of discussing and seeking support with mental health. This now needs to be measured in terms of impact.