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This Week in JAMA
July 28, 2004

This Week in JAMA

JAMA. 2004;292(4):411. doi:10.1001/jama.292.4.411
Enhancing Patient Decision Making

Outcomes of 2 clinical trials assessing the utility of decision aids to improve patients' knowledge about cancer treatment and genetic risk are reported in this issue of JAMA. In the first article by Whelan and colleagues,Article women with early stage breast cancer whose surgeons used a decision board—containing written and visual information about surgical treatments—were more knowledgeable about their treatment options and expressed less conflict about and greater satisfaction with their treatment decision than women whose surgeons did not use the decision board. In the second article, Green and colleaguesArticle report results of a randomized trial comparing one-on-one genetic counseling with a computer-based decision aid plus genetic counseling to educate women about testing for the BRCA1 and BRCA2 genes. They found that the computer program was more effective than standard genetic counseling in increasing knowledge of breast cancer genetic risk, but counseling was more effective than the computer program in reducing anxiety and facilitating accurate risk perceptions. In an editorial, Eng and IglehartArticle discuss the benefits and limits of computer-based decision aids.

Combined Therapy for Non–Small-Cell Lung Cancer

Some clinical trials of chemotherapy for advanced non–small-cell lung cancer (NSCLC) have documented that adding a drug to single-agent or double-agent chemotherapy regimens improves the response rate, but whether there is a survival benefit with multiagent therapy is not clear. Delbaldo and colleaguesArticle performed a meta-analysis of data from NSCLC chemotherapy trials that compared 2 agents to a single agent, and 3 agents to a doublet. The authors found a significant increase in response and survival rates for 2-agent regimens compared with single-agent chemotherapy. When comparing 3-agent with 2-agent regimens, they found an increase in response rate but no increase in survival. In an editorial, Argiris and SchillerArticle discuss the limitations of current therapies for NSCLC and promising agents in development.

Functional Decline in Peripheral Arterial Disease

Patients with intermittent claudication may report improvement or stabilization of symptoms over time. However, whether this reflects a lack of disease progression or a compensatory reduction in physical activity is not clear. McDermott and colleagues conducted a prospective cohort study of persons with and without peripheral arterial disease (PAD) to determine whether PAD, the ankle brachial index, and specific leg symptoms predict functional decline. They found that patients with leg pain and a low ankle brachial index score at baseline had an increased risk of decline in walking endurance at the 2-year follow-up assessment.

Improving Correctional Health Care

In 1994, Texas implemented a correctional health care system based on a managed care model and involving clinical faculty and staff from academic medical centers. Raimer and StoboArticle report significant improvements in access to care and health outcomes since the program was established. In an editorial, KendigArticle discusses the many benefits that could accrue from wider collaboration between academic medicine and correctional facilities.

Medical News & Perspectives

Some promising anticancer drugs hit multiple targets on tumor cells, a property scientists say may help forestall the development of resistance to the treatment.

Diagnosing Intra-amniotic Infection

Novel amniotic fluid proteins identified in a primate model of intra-amniotic infection (IAI) were found in the amniotic fluid and serum of women with subclinical IAI and could foster development of rapid and noninvasive diagnostic assays for occult IAI.

Clinician's corner

Clinical implications for bone and vascular diseases of the osteoprotegerin/RANKL/RANK system.

JAMA Patient Page

For your patients: Information about breast cancer genetics.