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Shared Decision-Making During Radiotherapy Enhances Patient Satisfaction

By MedImaging International staff writers
Posted on 05 May 2014

Being an active participant in radiation treatment decisions allows cancer patients to feel more contented with their care, and may even relieve psychological distress with their experience.

Researchers reported their findings March 19, 2014, in the journal Cancer. In a study of 305 patients undergoing radiation treatment, Neha Vapiwala, MD, an associate professor in the department in radiation oncology at the Perelman School of Medicine at the University of Pennsylvania (Penn Medicine; Philadelphia, USA), and colleagues discovered a link between patient satisfaction and patient-perceived control and shared decision-making (SDM)—a process that allows patients and providers to make healthcare decisions together, taking into account scientific evidence as well as the patient’s values and preferences.

Patients who experienced SDM or perceived some control over their treatments were more satisfied with their care than those who did not experience SDM or perception of control—a difference of almost 17% and 26%, respectively. Furthermore, increased depression, anxiety, and fatigue were reported in patients who desired control over treatments but did not perceive this control.

“Most importantly, our findings emphasize the value of patient-physician relationships and communication specifically in radiation oncology, and their impact on patient experience in a way that hasn’t been shown before,” said Dr. Vapiwala. “No matter where cancer patients are in the treatment process, there is always an opportunity to improve patient satisfaction—something hospitals and providers have consciously and increasingly been making a priority.”

Past studies of SDM in patients undergoing chemotherapy, as well as treatments for other medical conditions such as hypertension and diabetes, have shown an association with improved satisfaction and quality of life. The Institute of Medicine recently recognized its significance, and the US Affordable Care Act even devotes an entire section to establishing a program for SDM. However, no group has assessed its impact on patients going through radiotherapy.

Radiation oncology is frequently seen as a treatment path that is, in the end, left to the physician to decide. But there are customized alternatives, decisions, and discussions that can apply to individual patients, even if they all have similar diagnoses. There are different radiation regimens, dosages, risks and benefits, as well as pain control management issues that should be part of the ongoing conversation.

Among the participants in the study, 31% of patients experienced SDM, 32% perceived control in decisions, and 76% reported feeling very satisfied with their radiation treatment course overall. There was a significant association noted between patient satisfaction with his/her radiation treatments and patient-perceived experience of SDM (84.4% vs. 71.4%) or perceived control over one’s treatment (89.7% vs. 69.2%).

Patients who specifically desired control over their treatment decisions, but did not perceive this control, experienced significantly more anxiety (44% vs. 20%), depression (44% vs. 15%), and fatigue (68% vs. 39.2%) in comparison to patients who did not perceive a sense of control in their treatment decisions.

One of the advantages of the study is its patient diversity. Ages ranged from 18–87 years, with patients of varying ethnic and racial backgrounds, and cancers at all stages, as long as they were well enough to participate in the study.

The next phase in the research is to determine both physician and patient hurdles to SDM and to determine methods to break down these barriers. “As providers, it doesn’t matter what treatment you are offering, or how complicated it is, or how busy you may be,” concluded Dr. Vapiwala. “It’s worth taking even a few minutes to talk to patients about seemingly minor decisions in which they can provide some input. It’s not only critical in today's health care setting where both information and misinformation are rampant, but will very likely lead to the patient feeling positively about the encounter.”

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62 (305.8910369873): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752222 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752222 AND published='1' LIMIT 1

63 (!!!!! 7996.0823059082): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

64 (!!!!! 8140.8023834229): SELECT fid FROM jos_deeppockets WHERE id=294752222 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294752222 AND published='1' LIMIT 1

65 (!!!!! 2045.8698272705): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

66 (!!!!! 1036.8824005127): select jos_twitters.link from jos_twitters where cat=10

67 (516.17622375488): select jos_facebook.link from jos_facebook where cat=10

68 (41.007995605469): select jos_google_plus.link from jos_google_plus where cat=10

69 (283.00285339355): select jos_linkedin.link from jos_linkedin where cat=10

70 (66.041946411133): SELECT fid FROM jos_deeppockets WHERE id=294752222 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294752222 AND published='1' LIMIT 1

71 (!!!!! 2787.1131896973): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

72 (!!!!! 1262.903213501): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294752222 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (362.87307739258): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294752222 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

74 (277.99606323242): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

75 (988.00659179688): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (!!!!! 5399.9423980713): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (!!!!! 2984.0469360352): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (!!!!! 1193.0465698242): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (376.22451782227): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (94.890594482422): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (271.08192443848): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (152.1110534668): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (!!!!! 1291.036605835): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294752222 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (499.96376037598): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294752222 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

91 (61.03515625): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

92 (!!!!! 1097.2023010254): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (271.08192443848): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (400.06637573242): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (47.206878662109): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (291.10908508301): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (226.02081298828): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (601.05323791504): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (661.13471984863): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (!!!!! 2435.9226226807): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (!!!!! 2068.042755127): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (!!!!! 8224.0104675293): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 2396.1067199707): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (!!!!! 1459.1217041016): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (!!!!! 4383.0871582031): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752222 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752222 AND published='1' LIMIT 1

107 (!!!!! 2842.903137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752222 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752222 AND published='1' LIMIT 1

108 (257.01522827148): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294752222 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (670.9098815918): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294752222 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

110 (!!!!! 2917.0513153076): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752222 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752222 AND published='1' LIMIT 1

111 (!!!!! 2584.9342346191): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752222 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752222 AND published='1' LIMIT 1

112 (!!!!! 1450.0617980957): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294752222 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (!!!!! 1343.9655303955): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294752222 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

114 (!!!!! 1950.9792327881): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

115 (!!!!! 1086.950302124): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

116 (!!!!! 1286.9834899902): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752222 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752222 AND published='1' LIMIT 1

117 (223.15979003906): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752222 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752222 AND published='1' LIMIT 1

118 (!!!!! 2452.1350860596): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752222 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752222 AND published='1' LIMIT 1

119 (331.87866210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752222 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752222 AND published='1' LIMIT 1

120 (!!!!! 1917.1237945557): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752222 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752222 AND published='1' LIMIT 1

121 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752222 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752222 AND published='1' LIMIT 1

122 (!!!!! 1347.0649719238): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752222 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752222 AND published='1' LIMIT 1

123 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752222 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752222 AND published='1' LIMIT 1

124 (712.87155151367): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

125 (!!!!! 77306.985855103): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

126 (!!!!! 10289.907455444): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294752222 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294752222 AND type='deeppockets_item' AND published='1' LIMIT 1

127 (!!!!! 28158.903121948): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

128 (516.89147949219): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

129 (66.995620727539): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

130 (65.088272094727): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

131 (!!!!! 1958.1317901611): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

132 (470.87669372559): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

133 (496.86431884766): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

134 (313.04359436035): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

135 (!!!!! 1362.0853424072): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

136 (324.01084899902): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

137 (!!!!! 7698.0590820312): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752222 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (!!!!! 7924.7951507568): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752222 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (!!!!! 7843.017578125): SELECT name FROM jos_deeppockets WHERE id=211

140 (!!!!! 7988.9297485352): SELECT name FROM jos_deeppockets WHERE id=211

141 (!!!!! 7894.9928283691): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

142 (!!!!! 8043.0507659912): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

143 (!!!!! 7674.9324798584): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752222 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752222 AND published='1' LIMIT 1

144 (!!!!! 11995.792388916): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752222 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752222 AND published='1' LIMIT 1

145 (!!!!! 20975.828170776): TRUNCATE TABLE jos_trademed_module

146 (!!!!! 4097.9385375977): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294752222 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (!!!!! 2640.0089263916): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294752222 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (952.95906066895): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752222 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (226.97448730469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752222 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (398.87428283691): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752222 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752222 AND published='1' LIMIT 1

151 (54.121017456055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752222 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752222 AND published='1' LIMIT 1

152 (!!!!! 2088.0699157715): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

153 (548.12431335449): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752222 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752222 AND published='1' LIMIT 1

154 (239.13383483887): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752222 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752222 AND published='1' LIMIT 1

155 (!!!!! 1325.8457183838): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294752222 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294752222 AND type='deeppockets_item' AND published='1' LIMIT 1

156 (40.054321289062): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

157 (31.948089599609): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

158 (236.98806762695): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

159 (!!!!! 2202.9876708984): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752222 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752222 AND published='1' LIMIT 1

160 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752222 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752222 AND published='1' LIMIT 1

161 (!!!!! 1133.918762207): select jos_twitters.link from jos_twitters where cat=10

162 (53.167343139648): select jos_facebook.link from jos_facebook where cat=10

163 (34.093856811523): select jos_google_plus.link from jos_google_plus where cat=10

164 (29.802322387695): select jos_linkedin.link from jos_linkedin where cat=10

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