Daily Archives: February 18, 2021

The snow. It just wont stop. Leave me alone. Nobody wants you here anymore.

David Ross confirmed that Rowan Wicks intercostal injury (ribs) is related to the oblique strain that ended his 2020 season, which is mildly concerning, even as hes right that its early (Cubs.com): It was feeling better and then he started throwing. Its just still a little bit uncomfortable. Theres just literally zero reason to rush anything right now, and we want that guy to be healthy. As important as Wick can be for the Cubs this year, its important to remember that guys might not be able to pitch a full six months (plus postseason) anyway this year. So with an overload of possible bullpen options for the Cubs this year (some without minor league options remaining), it really wouldnt be the worst thing in the world for Wick to begin the season on the IL anyway. In fact, if there arent long-term concerns, bringing him along slowly and pushing back his season debut may actually wind up the best thing for the team and his own performance.

Speaking of the bullpen overload and roster decisions, the Brandon Workman signing is official as of this morning, and the Cubs DFAd infielder Sergio Alcantara to make room on the 40-man roster. The Cubs will have a week to trade, release, or waive Alcantara. Given the need to keep some middle infield depth around especially a guy who can play top-tier defense at shortstop if needed I expect the Cubs to waive Alcantara, hope he clears, and then outright him to Iowa. The Cubs will need to soon clear out one more 40-man spot for Jake Marisnick.

On Workmans terrible 2020 after a dominant 2019:

Adding to that, Workman got wrecked on his curveball in 2020, which is probably why he started throwing it less often as the year went on but you also always wonder about how the whole pitch mix is working together. Its not always just that a guy doesnt have a single pitch for a season.

Kyle Hendricks on the return of Jake Arrieta: We both kinda said it was weird, like no time ever passed. I dont know where those three years went, but its almost like he never left. Me and him have had an awesome relationship since day one. One thing thats great about the two getting back together is that theyre both such cerebral, hard-working, dig-in-behind-the-scenes types and now both such long-standing successful veterans that their comfort in helping each other, maybe even with things the other isnt seeing, is probably going to be huge.

Folks:

Fernando Tatis, Jr.s massive extension is, as you might have guessed, tremendously backloaded:

Given how much its backloaded, the lack of opt-outs may not really matter, as he wouldve been a lot less likely to exercise one. That said, the fact that its hugely backloaded AND hes getting full no-trade rights means that he is now entirely in control of his career going forward. If there ever comes a time when the Padres decide they need to get his contract off the books, then Tatis is going to get to dictate that process. So, even without the opt-outs, Tatis still has a lot of control here.

Random, indeed:

The podcast I do over at The Athletic is back on our regular schedule for Spring Training, so go ahead and find Onto Waveland wherever you get your podcasts, and smack that subscribe button:

This *might* be my favorite locker room picture in the history of baseball. Emphasis on history:

This ends tonight at midnight:

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Alcantara DFA'd, Wick's Injury, Hendricks and Arrieta, Tatis Particulars, Wilkins, and Other Cubs Bullets - bleachernation.com

BEAUFORT, S.C. (WSAV) A dangerous side effect of COVID-19 is the greater chance for child abuse and domestic violence.

South Carolina has been in the top 10 states for domestic violence rates for nearly two decades.

The Palmetto States domestic homicide rates are nearly 1.5 times the national average.

Its a problem Hopeful Horizons has been battling for years, and one experts say isnt going away anytime soon.

We have seen a significant increase in people who are dealing with domestic violence, explained Hopeful Horizons CEO Kristen Dubrowski. We served approximately 50% more people in our shelter program this year than in prior years. Thats more folks than we have served in a single year.

We have seen a lot more situations that have seemed more lethal. More physical abuse and more threats of violence, she added.

In South Carolina, more than 41% of women and 17% of men will experience domestic violence, abuse as a child or adult, or stalking.

We are already working with victims who have already experienced trauma, and then theres the trauma of the pandemic on top of that, said Dubrowski.

Hopeful Horizons works to address victims basic needs of housing or transitional housing. The organization is also focused on victims who are having trouble reaching out for assistance because of the pandemic and close quarters it has created their abusers.

Its more difficult for people to reach out for help, Dubrowski said. Victims being trapped at home with abusers, there is no respite for them.

Dubrowski says Hopeful Horizons has already seen more than 1,300 victims or people in need of help this year.

There has been a decline in the number of kids they have seen for child abuse. But that could be a sign of more kids out of school and learning at home. Already as students return to class, those numbers are going back up to close to pre-pandemic levels.

Hopeful Horizons is helping victims in five different Lowcountry counties and looking for different ways to do it.

One way is by turning their crisis line into a 24-hour protection line, so people know to call 843-770-1070 before its too late.

Another is offering more intimate and anonymous group sessions and online services.

Its easier for them to access online counseling through telehealth services, said Dubrowski, and not have to travel to get counseling services. For a lot of people, its been very beneficial.

Still, Dubrowski says there are the victims who have limited to no access to technology or internet.

Hopeful Horizons has begun sending fliers out to the community with the phone number for help on them to make it easier.

The agency also plans to continue its prevention work in middle and high schools. Hopeful Horizons says its been very difficult to reach as many students as normal because of the pandemic, but the hope is as things loosen up, catching these kids early will identify victims or teach them early about the dangers of becoming an abuser themselves.

That abusive behavior is passed on from one generation to the next, explained Dubrowski. The good news is we have a lot stronger dialogue in schools than 11 years ago when we started prevention efforts in those classes.

That has helped take some of the stigma away, and giving victims hope for their future.

Victims feel ashamed about feels like it is their fault and a lot what we do at Hopeful Horizons it to let them know its not their fault, let them come together voice to it, Dubrowski said. It is in that darkness and silence that this abuse is allowed to exist.

The agency is doing all of this while dealing with funding issues.

For two straight years, their biggest fundraiser has been canceled. In addition, the funding from the victims of crime act was cut by 10% last year and 18% in 2020.

That is a more than $300,000 shortfall that funds the bulk of their services.

Grants have helped pick up some of the slack, but fundraisers they can do, like this weekends race, are key to allowing everyone to do their jobs and offer as much aid as possible.

The 2021 Hopeful Horizons Walk4Love Candlelight Walk will start at First Presbyterian Church, 1201 North Street, in downtown Beaufort. Starting time is 5:15 p.m. on Friday.

Meanwhile, the Race4Love will start at 9 a.m. on Saturday. Organizers say the course is flat and quick and offers a pleasant trip through the scenic neighborhoods and Sanctuary Golf Course on Cat Island located at 8 Waveland Ave. in Beaufort.

The Race4Love fee is $30 with a $2.50 sign up fee.

Masks and physical distancing will be required at the events. Participants are also asked to pre-register.

To sign up for either of these races, visit here before the registration period ends on Wednesday, Feb. 17 at 7:59 p.m.

If you are signing up with a group of five or more, click the multi-person tab on the page to get the discounted price.

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Domestic violence and abuse agency changing approach during the pandemic - WSAV-TV

Theres a squirrel in my shed.

Well, Im not 100% sure on that. He might still be in there, or he might not, since I got up on a ladder and stapled a bunch of old screen up in the eaves.

For the last few months, Ive had an ongoing saga with this squirrel. Actually theres a history that goes back years, but the most recent episodes are worth noting, specifically because theres not much else going on at the moment.

Were mid-February in the pandemic winter, and even for those most willing to get outside, life has come to a bit of a standstill. Now, Im not comparing this to the standstill of last April, which was for all intents and purposes about 63 nerve-wracking days long. That was far more stressful, with a far greater fear of the unknown. But were certainly dealing with some tedium.

While were not out of the woods yet, Id say there are faint signs of hope. First, the most vulnerable are getting stabbed in the arm, albeit slowly. Second, we saw how infection rates dropped last summer. And third, frankly, everyone under 60 has had the damn virus at this point. So I guess you could say, as awkward as it sounds, these are all lights at the end of the tunnel.

Unfortunately, that light is so far off and uncertain that it almost seems best to keep your head down, support a local business, focus on what you can and not count too much on when we might emerge from the darkness. Plus, its winter on LBI. Were all broke. That doesnt help.

Consequently, I am focused on this squirrel. I actually considered opening Liquid Lines this week with 10 paragraphs about how dangerous Saturday night felt when everything iced over. Six-foot noreaster swell in 39-degree water is routine for some of us. But that ice glaze was terrifying.

But the squirrel has made an awful mess, knocking things off the shelves, spilling things onto the second-hand rug and tearing up paper bags, cardboard and even bits of wood for nesting. Truth is I would have a soft spot for him (or her) if there werent so much crap everywhere.

Years ago, I had a squirrel problem. I put up chicken wire inside the eaves of the shed, which worked for a while. They still got into the plant food and made a whole disarray of some rags I had stored under an overhang behind the shed, but at least they werent in the shed.

However, as the weather turned on us this year, every time I go into my shed to grab one of my surfboards, covered with that gross, dark-colored winter wax, I would awaken the squirrel somewhere on a high shelf between old fishing gear I will never use and windshield wiper fluid. (Sidenote: I am using a lot of wiper fluid this year and wary of Cool Blue Gatorade.) Mr. Squirrel bangs around, makes his escape and, as I poke my head back out the door to get a look at him, I just see the tree branches move on his getaway route.

Im not so sure why I want to see this menace. Perhaps Im curious if its the same guy I had evicted a few years ago. Not that I would recognize him. And Im not the type to stop anyone and ask for their name or ID. How long do squirrels live, anyway?

And I fully realize why Im a target for this small woodland mammal. I have these odd things in my yard called trees. Makes my property look totally strange on this island that is going full bore in its war on plants.

But yes, this is what I think about, the little problems that I can hopefully solve.

And I have to wonder what stage of the pandemic everyone else is in around here. Chilly winters have a way of pushing us indoors. Even for the hardcore surfers, skiers, sledders, gearheads, bird watchers, hikers, etc., we do our outdoor thing and then head right for the comforts of four walls and a heat vent. And with the virus shutting down or limiting most public indoor options, weve been forced inside our own homes for long stretches. I know weve all jumped straight into home improvement projects. You probably redid your bathroom last April. Have you reached the point of spackling all the popped nail holes in your ceiling? Anyone else sanded down their rusted baseboard heaters and restored them with Rustoleum and a clear coat?

Theres evidence for cautious optimism. New cases in New Jersey are down to half of what they were in January, and even more on the national scale compared to when the Pancake Patriots stormed the Capitol.

But nothing is going to really change this month. And then we have March and well celebrate/mourn the one-year anniversary of the day the world shut down. So maybe we just have to keep controlling what we can control until the third week of March, in which the first crocus will pop up and, within a few days, snow will fall on said crocus. And our friends will complain that it doesnt really feel like spring because they forget every year that its just the start of late winter. Maybe you should just cross the occasion off the calendar for March 20 and move it to May 20. And then continue controlling what you can because it will still feel a lot like February as soon as the wind comes onshore.

But it does make sense to get rid of your squirrels, paint your dinettes and redo your backsplash now. Because if we really are mostly out of the woods by summer, there will be no time for such quaran-tedium. Youll be outside, having fun again.

Winter Waveland: This winter has been cold, but you cant really complain too much about the surf, especially if youre a 9-to-5 worker, as most of the favorable conditions have been falling on Saturdays and Sundays.

Looking back on Super Bowl Sunday weekend, there were two separate swells as we had lows getting spat past us pretty regularly. The first was an offshore low, and the wind died just before dark on Saturday. Then that Sunday, we had a little snowfall and north winds blowing up some swell. When everyone was preparing for the big game, there was a brief period of north/northwest winds that clocked just enough for some clean ones. Both sessions were short-lived, but there were clean waves nonetheless.

The surf was either tiny or junky for the following week, although there were a few tiny onshore waves during last weeks snowstorm. These were not anything worth surfing, save for the fact that surfing in the snow is still really fun. We also havent had a significant accumulation in two years, so it was just kind of fun to see snow on the beach again. I watched kiteboarder Todd Page out kiting on the beach with a snowboard, and it looked pretty epic.

The surf picked up again with Saturday nights sleet storm, and Sundays winds were north, but light enough for the South End to work. The sand isnt as good as it was a few weeks ago and it wasnt fully clean; nevertheless, there were some really long, quality lefts for those who wanted to get after it.

A tiny bit of swell stuck around, and Tuesday threw us a little south combo swell that unfortunately came with southwest winds, making most of LBI undesirable.

State of Our Beaches: Giant winter noreasters get a lot of fanfare in New Jersey. Its likely the intersection of solid waves with snow and cold that gets people outside of the Northeast and outside of the core surf crowd interested. Obviously, photographers and writers have ridden that for a good 30 years or so. Snow and surfing are such a novel juxtaposition to the rest of the world.

But yes, we love them here. Yet on post-jetty LBI, I have to ask how great they are in the long run. Noreasters do a serious number on our beaches and sandbars. Lets take a look at Winter Storm Orlena, for example.

Throughout January, I reported on a few swells that were pretty good and rated even higher on a fun meter because they were rideable at more than just a few select spots. More spots working means the ability to surf with fewer people, hence more waves and better surf experiences.

The reason for this was because the sand was set up well. Good sand in the winter means there are healthy sandbars in tight to the beach, as opposed to that narrow strip of sand way offshore. Scientists call the drop just off the beach the trough, a trademark of a winter beach profile. In less technical circles, you might call it a hole, but be sure to use quotation marks. Either way, it means the waves lurch up and break on the bar and then fizzle out in the hole for shorter or non-existent rides. The hole generally fills in for summer and develops again after an August noreaster or a close tropical storm.

We consider this a post-jetty issue because back when we had big groins, they would hold that sand in place better. Until the late 2000s, we had far more surf spot options. Any surfer over the age of 30 can remember the way certain spots in Harvey Cedars used to break. Now the sand off the beach is much more susceptible to moving around in winter storms.

We had a sweet mid-period swell the last weekend of January. It wasnt huge, but the sets were pushing head high. The sand was set up amazingly, allowing for good surf at select spots and fantastic surf at one particular spot. The surf was coming from a modest offshore low, not a heavy, local storm with extreme winds. These swells are rare, but they afford us a lot of waves without rearranging the sand.

Then came Winter Storm Orlena, which wrecked those sandbars. Orlena did more than that, actually. The angry seas cut the dunes at some spots on the South End and mid-Island into sheer cliffs. It was so severe that we had NBC New York reporting on the situation.

So the steep cliffs and loss of beach are certainly a problem. Nature should return some of that sand with the spring and summer. The question is will more noreasters further scarp away the beach and dunes? Thats something the towns are contending with.

But there also begs the question about how good a big noreaster really is for surfing in the winter. Of course, we get that day of six- or eight- or maybe 10-foot sets. And yes, thats exciting as hell if you get a bunch of waves. The reality is that after the storm, our sandbars are completely morphed, so the next swell is always weird. If you get more significant northeast blow, then you stick with those deep troughs. Bottom line is you have to wonder how much that day of great waves is worth, compared to lessening of the wave quality for the weeks after.

As for the general state of the beaches, there is still debris at a lot of spots, and beaches are certainly on the skinny side. Even two weeks later, if youre on the beach in certain parts of Holgate, youre not getting back up across the dunes without an extension ladder. I should note that despite that huge storm surge, Ship Bottom is as wide as ever.

THE PART OF LIQUID LINES THAT USED TO HAVE UPCOMING EVENTS: Its been a long time since we had an event to mention here. But dont lose hope. And remember this in summer when you can take advantage of every gathering there is.

Back on Saturday, Feb. 6, a few dozen folks who were closest to recently deceased surfer Jack Ryan had a little paddle-out gathering to honor his life. This was a mostly private affair. There is a bigger memorial being planned at the Alliance for a Living Ocean LBI Longboard Classic in August, but his tightest circle felt they needed closure on his life. Despite swell and whipping south winds, it was a beautiful tribute to a truly unique local.

Once again, Science Saturdays at the Long Beach Island Foundation of the Arts and Sciences are virtual, as they will be all season. The Zoom meetings are $5, and free for Foundation members. This Saturday, Richard J. Buckley, director of the Rutgers Plant Diagnostic Laboratory, will discuss the invasive Spotted Lanternfly from China and the risks it poses to agriculture, logging and tourism in our area of the country.

On Feb. 27, Rutgers Kathleen Kerwin, M.S. and Chris Crosby, Ph.D. student, will discuss Coyotes of New Jersey. If ever there were a timely topic, this is it. Coyotes reportedly have been seen all over the state and, most locally, around the Island. I expect this one to be well virtually attended.

As we get through this week, I should mention the ocean has dropped a few degrees again to the mid-30s. Surf temps havent been this low in a few years, so make sure to gear up with the appropriate thicker wetsuits, boots and gloves.

One might think this would take the water longer to warm up as we get into April and May, but we have learned in the past few mild years that it hasnt warmed up faster. So I would say expect the normally cold spring, but fear not a terribly cold one.

Friday looks to be a fun day of waves with some south and east combo swell on offering. Lets hope the winds maintain more west than southwest and we could see some overhead bombs. And get cracking on all those home projects. No one wants to still be inside painting when the weather finally turns.

joncoen@thesandpaper.net

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Lost in 'Quaran-tedium' Projects - The SandPaper

Plain Language Summary

Understanding cancer patients and their families views and preferences (PVPs) regarding treatment and care helps improve the quality of services provided to them. It is important to collect a wide range of PVPs regularly, consistently and in a timely manner, to develop policies and treatment responses accordingly. This study explored a new approach for collecting PVPs regarding cancer treatment and care, by surveying medical staff about the PVPs they encountered in clinical practice. This is the first step to establish a sustainable nationwide system to collect cancer-related PVPs and to utilize them in clinical practice.

The medical staff provided information not only regarding the PVPs related to five different topics (including types, signs, and symptoms of cancer) they had encountered, but also regarding their actual responses to these PVPs. The PVPs encountered differed according to the topic and staff specialty. Content analysis of one of the five topics as representative, namely tingling/numbness/pain, led to the development of clinical questions asked by many patients/families, and the provision of such answers to the public by abstracting keywords and concrete means of expression from PVPs. Despite being an indirect way of collecting PVPs, this method was useful for identifying the most commonly encountered PVPs for each specified topic, as well as any gaps in the information available to the medical staff for responding effectively to these PVPs.

To enhance patients adherence to treatments and their subsequent satisfaction, it is crucial for health professionals to understand the patients and families views and preferences (PVPs).13 Understanding PVPs allows health professionals to provide patients and their families (patients/families) with the necessary information and appropriate treatments and care. However, PVPs vary in terms of treatment-related topics, such as the treatment plan,4 possible side effects,5 psychosocial topics,6,7 daily activities,8 and personal values.9 In the rapidly progressing medical environment, health professionals are likely to be required to respond to novel PVPs without any supporting information.10 Therefore, it is important to understand current PVP trends and to collect comprehensive information on these trends consistently and in timely manner. Furthermore, collecting PVPs in clinical practice is expected to enhance the quality of medical environments because it will lead to developing new approaches to unmet PVPs, resulting in effective and reliable communication between medical staff and patients/families. Utilizing the collected PVPs to raise clinical questions in various medical fields will also lead to new evidence regarding medical conditions.

However, it is difficult to collect PVPs in timely manner or at a national level through nationwide or wide-range questionnaire surveys. It is also necessary to collect PVPs repeatedly to develop and evaluate a national policy for specific diseases such as cancer.11,12 Collecting PVPs through nationwide disease-specific medical staff who take care of patients/families within clinical practice is one possible solution to the aforementioned problems. In actual clinical practice, the symptoms, distress, burdens, or problems are not always explicitly expressed by patients/families,5 but they are more likely to be expressed during casual conversations or interactions with medical staff.13 The expressions of concern are likely accompanied by discussions regarding patients/families experiences in their daily activities, and their views and preferences.14 The interactions between patients/families and medical staff can occur in various settings such as at the reception, in examination areas, or in outpatient or inpatient settings, and may range from short conversations to long discussions. Any medical staff member, including physicians, has the opportunity to meet and interact with patients/families in various clinical settings. Medical staff should be sensitive to, and aware of, patients/families symptoms and burdens and adequately guide them toward further symptom management or care.14

Nevertheless, collecting PVPs promptly and widely from various patients has not yet been researched. In addition, a specific method to utilize PVPs in a nationwide clinical practice has not been examined sufficiently. The most appropriate group from whom cancer-related PVPs can be promptly and widely collected are medical staff working in nationwide cancer-specialized hospitals, which are designated based on the governments national cancer policy and execute advanced cancer treatment and care. These medical staff are required to adequately and precisely respond to such PVPs. The aim of this study is to develop a new system for appropriately collecting PVPs regarding cancer from nationwide medical staff and consider the potential utilization of PVPs in clinical practice. We obtained PVPs expressed to various medical staff in the nationwide hospitals designated by the Japanese government (designated cancer care hospitals: DCCHs). At the initial stage of this study, we chose five cancer-related topics that were anticipated to be associated with a diversity of PVPs. We also selected one of the five topicsthe sensation of tingling, numbness, and pain (henceforth, tingling/numbness/pain)to qualitatively analyze the content of the expressed PVPs in detail and to discuss the potential utilization of PVPs in clinical practice.

We conducted a web-based multicenter cross-sectional questionnaire survey of medical staff in DCCHs in Japan during the period of July to September 2018. Participants were recruited from two groups of staff. The first consisted of medical staff (physician, pharmacist, nurse, physical/occupational/speech therapist, radiation/clinical laboratory technologist, dietitian, clinical psychologist, social worker, cancer counselor, and medical clerk) from 32 hospitals belonging to the Japanese Association of Clinical Cancer Centers (JACCC) among 434 DCCHs in Japan.15 The second consisted of cancer counselors in Cancer Information and Support Centers (CISCs) located in all DCCHs. One of the unique features of the CISCs as compared to other typical hospital functions is that anyone, regardless of holding a hospital identification number or not, can access a CISC and obtain reliable cancer-related information and support for adequate referrals without any charge.16 Cancer counselors with predominately nursing and social-work backgrounds are stationed in the CISCs. In this study, we considered cancer counselors as a separate medical staff category from other medical specialties.

To recruit medical staff, an email was sent to the secretariat division of the JACCC, and each hospital secretariat division forwarded the email to medical staff in each hospital. To recruit the cancer counselors, an email was sent to directly to the cancer counselors of 434 CISCs through a mailing list. Only medical staff and cancer counselors who agreed to participate in the study responded to the web-based questionnaire, whose data were transferred directly and anonymously to the Cancer Information Service Division, Center for Cancer Control and Information Services, the National Cancer Center (NCC-CIS), Japan.

In this study, we operationally defined PVPs as questions, values, desires, and experiences expressed to medical staff by patients/families in various medical situations. To collect PVPs, we developed three questions for medical staff based on their interaction with patients/families17 that were used to investigate each topic, as follows. (1) Within the past year, did you receive any questions from your patients and/or their families about each of the five topics described below? Yes or No? If the answer was Yes, they were further asked to (2) describe the question or share information in an open-ended manner and were asked (3)Did you have any source of information such as clinical practice guidelines, booklets published by a public organizations or companies, etc. on responding to the patient/family regarding the topic? Yes or No? We designed the questions to be as simple as possible and to represent minimal burden on the participants.

As this study focused on the indirect experiences of medical staff rather than direct collections of PVPs, we needed to understand if this process was sufficiently sensitive to collect PVPs depending on the topic. Therefore, at the initial stage of the study, we chose five topics that were anticipated to have diverse PVPs and collected the PVPs for each topic indirectly. Regarding cancer sites, we chose colorectal cancer and esophageal cancer. Colorectal cancer is the most prevalent cancer type in Japan; there is an associated national screening program and this type of cancer has a relatively favorable prognosis. Esophageal cancer is a type of cancer with the worst prognosis, and there is no cancer screening program for this cancer site in Japan.18 These differences create differences in public knowledge and resultant PVPs. We chose three symptomslymphedema, urinary symptoms, and tingling/numbness/painto assess the effectiveness of collecting the PVPs through medical staff because the symptoms involved different degrees of difficulty in their assessment by a third person.

This study used a quantitative and qualitative mixed-methods design. The number of medical staff who encountered PVPs and those who had related information on the topics were compared among the five topics. Then, we statistically compared the medical staffs experience of PVPs and possession of available information on each topic by their medical specialties using the Chi-square method.

In this report, we analyzed the statements regarding tingling/numbness/pain qualitatively, as representative of the potential utilization of PVPs. Free-text statements were analyzed by two authors (TT and RY) with expertise in cancer care and heath communication perspectives. The statements of the patients/families reported by the participants were analyzed using an inductive approach via conventional content analysis,19 as follows. (1) The statements were repeatedly read by two researchers to obtain a sense of the whole and the statements were divided into several sentences as necessary, if the free-text answers had more than one meaning. (2) Each statement was qualitatively coded by capturing its core meaning, and those with similar meanings were organized into subcategories based on how they were related. Seven categories were abstracted from the subcategories inter-relationships with reference to several preceding studies of unmet needs or patients preferences with respect to cancers.5,20,21 (3) Each statement was categorized one of seven categories: 1) cause and prevention, 2) symptoms, 3) prognosis, 4) treatment, 5) self-management, 6) daily life, and 7) unclassified statements, such as those referring to thoughts, hopes, emotions, and so forth. The frequencies of responses in each category were calculated. All responses were then independently double-coded. In case of discordance in double codes, discussion and negotiation between the two authors continued until a consensus was reached. A total of 940 statements were coded into 44 initial categories, subcategorized into 23 categories, and classified into the seven final categories.

Sociodemographic information was also collected, including sex, age, length of clinical experience, and medical profession. We also investigated the time required to complete the questionnaires from login to logout times on the medical staffs personal computers to judge the future sustainability of this survey.

We developed clinical questions to produce questions and answers (Q & A) regarding tingling/numbness/pain primarily for patients newly diagnosed with cancer or who had recently received treatments. Based on the PVPs related to tingling/numbness/pain identified by the qualitative content analysis, clinical questions for which patients/families strongly desired answers but which were difficult for medical staff to answer were developed by members of the NCC-CIS including two authors (TT and MH). The NCC-CIS provided the public with these questions and corresponding answers through the largest cancer information site in Japan (https://ganjoho.jp/public/index.html). We considered that the questions with higher priority should cover a wide range of categories, high frequency of PVPs, and PVP content that patients/families find difficult to discuss with medical staff, even if infrequently expressed. Concrete words or expressions from PVPs were included in the questions to the extent possible.

This study was conducted in accordance with the Ethical Guidelines for Medical and Health Research Involving Human Subjects of Japan. Medical staff belonging to the JACCCs and cancer counselors of the CISCs were informed of this study in writing. Their voluntary responses to the questionnaire were regarded as consent to participate in the study. The Medical Ethical Committee of the National Cancer Center, Tokyo, Japan, ruled that no formal ethical approval was required for this study (reference number 6000017).

We collected a total of 904 responses; Table 1 illustrates the demographic and clinical characteristics of respondents. Approximately 70% of the respondents were female, and 40% had more than 20 years of clinical experience. The largest proportion of the respondents were nurses (one-fourth), followed by physical/occupational/speech therapists and radiation/clinical laboratory technologists, physicians, and cancer counselors. The average duration required to complete the questionnaires was 15.8 minutes (standard deviation = 23.8), and the median time was 9 minutes, suggesting the survey was sustainable.

Table 1 Demographic and Clinical Characteristics of Respondents

Table 2 illustrates the medical staffs experiences of receiving PVPs and the presence/absence of available information related to the PVPs. Among the five topics, the most number of PVPs were about tingling/numbness/pain, and the least were related to urinary symptoms (63.3% and 35.1%, respectively). More than 70% of the medical staff had some available information regarding colorectal cancer and lymphedema when they needed to respond to patients/families, whereas only half or less of them had information regarding urinary symptoms and tingling/numbness/pain.

Table 2 Medical Staffs Experience of Patients Views and Preferences and Possession of Available Information on the Topic

The frequency of experiencing PVPs according to medical specialty of the staff is illustrated in Table 3. The frequencies of PVPs varied by topic depending on the medical specialty (p < 0.0001). For example, the PVPs regarding colorectal and esophageal cancers were most frequently expressed to dietitians; PVPs regarding lymphedema and tingling/numbness/pain were most frequently expressed to cancer counselors and pharmacists, respectively; while urinary symptom PVPs, although rarely encountered, were most frequently expressed to nurses and cancer counselors. Cancer counselors received PVPs on all topics with relatively high frequencies. Table 4 illustrates the presence/absence of information resources that the medical staff used practically when they received PVPs according to their specialty. The percentage of the presence of information resources by topic varied depending on the medical specialty (p < 0.0001). Among the eight medical specialties, cancer counselors most frequently had information available on all five topics. However, only 63.8% of cancer counselors had information available on urinary symptoms.

Table 3 Medical Staffs Experience of Patients' Views and Preferences on Each Topic by Their Medical Specialty

Table 4 Medical Staffs Possession of Available Information by Medical Specialty When Patients Views and Preferences Were Expressed

Table 5 illustrates the results of the content analysis of the tingling/numbness/pain PVPs. Among the seven categories of this topic, patients/families expressed their PVPs the most and the second most frequently regarding prognosis and self-management, respectively. Representatives of PVPs in each category are also illustrated in Table 5. Although unclassified and infrequent, there remained important PVPs, such as How much must I endure numbness to continue treatment? and Will this numbness be a trade-off for life?

Table 5 Representative Patients Views and Preferences for Each Category Under Tingling/Numbness/Pain

Table 6 shows nine questions developed from the tingling/numbness/pain PVPs, consisting of 1 to 3 questions in each of six categories, except the unclassified category. The Q & A was uploaded to the NCC-CIS website in Japanese.22

Table 6 Questions Developed from the PVPs Concerning Tingling/Numbness/Pain

It is important to collect PVPs reflecting issues at a specific time regularly, consistently, and continuously, considering the current circumstances of the rapid appearance of a broad range of new medicines and treatment options. Therefore, we obtained cancer-related PVPs, including questions, values, desires, and experiences, via medical staff with different specialties in nationwide cancer-specialized hospitals. In this study, we collected cancer-related PVPs across five topics and observed differences in staff experiences of PVPs, depending on the topics and the medical specialty of the staff member.

A difference in the number of PVPs was observed across the five topics, which may be due to several reasons. First, the topics for which the medical staff encountered PVPs less frequently might be those that patients/families felt reluctant or uncomfortable to express. Previous studies have demonstrated that the general public often hesitates to talk about topics such as sexuality and egestion,23 and medical specialists are also reluctant to talk about these topics.24,25 Patients/families are more reluctant to express their symptoms or burdens concerning these topics, even to their physicians and nurses, especially if either group is less prepared to discuss these topics.

Second, the differences in PVP frequencies might be attributable to the characteristics of the symptoms. For example, urinary symptoms are likely caused by a specific kind of cancer or its treatment,2628 as well as by the aging process and other reasons unrelated to cancer.29,30 Therefore, patients may deem it unnecessary to report urinary symptoms to their physician and other medical staff. However, PVPs regarding urinary symptoms were reported by nearly half of nurses and cancer counselors (Table 3), suggesting that these specialties could be expected to collect such PVPs from patients/families by approaching them with awareness of this problem and thereby enhancing patient satisfaction by addressing their queries.

The accessibility of medical staff may be another reason for the difference in PVP frequencies. Cancer counselors at the CISCs had the most experiences of receiving PVPs and had more information available about all five topics than did other medical staff. As regular check-ups become gradually less frequent after the main treatments are completed, it might be difficult for patients/families to maintain frequent contact with their physicians and nurses. Research has also demonstrated that most of patients unmet needs are expressed after their main treatment is completed.5 However, patients/families can use CISCs freely and contact cancer counselors whenever required.16 Thus, this demonstrates that it is important for patients/families to have resources that they can spontaneously access with ease, such as CISCs.

Although the most frequent PVP was tingling/numbness/pain, only half of the medical staff had the necessary information on this symptom (Table 2). This may indicate that the PVPs regarding these symptoms were expressed to a wide variety of medical staff, thereby suggesting that an insufficient response was conveyed to the patients/families. Moreover, it also indicates that there was a lack of adequate information available to the medical staff. This has been indicated in the literature, which has demonstrated that evidence and treatments on this topic are rarely established.31,32 The gap between the high frequency of PVPs and the lack of practical information concerning symptoms identified in this study demonstrates the need to find evidence by developing specific clinical questions, which can then be used to establish evidence-based clinical practice guidelines.

Regarding potential utilization of the PVPs, we developed clinical questions based on the results of qualitative content analysis of the tingling/numbness/pain PVPs. While developing the questions, the frequencies of the PVPs were considered, and it was very useful for both patients/families and medical staff that keywords and expressions from the PVP statements in the Questions and Answers (Q & A) document were included. The resulting Q & A information was made available to the public through a website based on the results of content analysis of the PVPs.22 This is one example of establishing a system to collect and utilize PVPs from nationwide cancer-related professionals who directly interact with patients/families in clinical practice, in a regular, systematic, and timely manner.

Although some electronic collection trials have begun, collecting PVPs directly from patients/families requires considerable effort and is often time consuming.33,34 Furthermore, it is often difficult or sometimes impossible to collect PVPs about common symptoms of various diseases and from patients with rare cancers or in a critical condition. Therefore, although the method is indirect, collecting PVPs via medical professionals, as discussed in this study, is an effective strategy with a high utility value. More importantly, this system enables PVPs to be collected regularly, consistently, continuously, and more importantly, sustainably. As Brouwers et al demonstrated, medical professionals are important stakeholders in healthcare,35 and they are a group of people with significant impact on improving present medical practices and developing new evidence for future medical practices.

Furthermore, a system in which PVPs are collected through a wide variety of medical professionals with different perspectives would enable the collection of a broad range of PVPs simultaneously. This system would be helpful for using PVPs to develop recommendations for clinical practice guidelines and solve the existing nationwide evidence-practice gap.3639 Even more importantly, collecting PVPs through medical staff would enhance their sensitivity in interactions with patients/families about their values, desires, and experiences. This could ultimately lead to better interactions with patients/families and thereby improve their quality of life,40,41 which is not possible through the electronic collection of PVPs from patients/families.

Despite its strengths, this study has some limitations. The first is the indirect way PVPs were collected, as mentioned in the discussion. Medical staff could have emphasized certain PVPs based on their unique concerns and individual medical experiences, while other PVPs that were less related to their medical specialties or interests may have been neglected. Second, collecting PVPs in a simple statement cannot completely capture the backgrounds of patients/families regarding what was happening to them. Although the questionnaires simplicity was intended to reduce the respondents burden, it might have led to a loss of accuracy in the expressed situation. Third, contrary to the second limitation, collecting PVPs in a free text format would involve considerable time with respect to analyses and provision of an overview. Nevertheless, a free text style would enable the collection of the precise voices of patients/families in their clinical settings, even when collected by medical staff.

To enhance patients adherence to treatments and to improve their subsequent satisfaction, it is crucial for health professionals to understand PVPs. It is also important to collect PVPs in timely manner to reflect issues regularly and continuously within a rapidly changing medical environment. This study suggests that collecting PVPs through nationwide cancer-specialized medical staff might be an efficient way to understand the specific requirements of patients/families. It would also be possible to document PVP trends according to changes in the environments of patients/families by collecting PVPs regularly and continuously. PVPs collected could also be utilized for developing cancer information resources for both patients/families and medical staff by suggesting important clinical questions that require answers. This initiative can support more effective patient-clinician communication and improve the healthcare environment for patients/families and medical staff.

PVP, Patients and families views and preferences; CISC, Cancer Information and Support Centers; JACCC, Japanese Association of Clinical Cancer Centers; DCCH, Designated cancer care hospital; NCC-CIS, Center for Cancer Control and Information Services, National Cancer Center, Japan; Q & A, Questions and answers.

All procedures performed in the study were in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approval was judged as not necessary by the Medical Ethical Committee of the National Cancer Center (6000-017).

The authors would like to thank the medical staff in the 32 hospitals belonging to the Japanese Association of Clinical Cancer Centers and the Cancer Information and Support Centers in designated cancer care hospitals who participated in this study. The authors wish to acknowledge Ms. Otome Watanabe and Dr. Yoshiko Ikeguchi of the NCC-CIS for their useful discussions regarding developing clinical questions. The authors are also grateful to Dr. Takeo Nakayama for his valuable insights on the manuscript. We would like to thank Editage for English language editing.

This study was funded by the Health and Labor Sciences Research Grant awarded to Tomoko Takayama toward Establishing a sustainable system of cancer information and support center system for the future (H29-CancerControl-005) and to Fumihiko Wakao toward Establishing a system for prompt and timely provision of the evidence-based cancer information to the public (R2-Cancer Control-20EA1008).

The authors declare no conflicts of interest.

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