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White SJ, Kim JW, Rakhra H, Ranatunga D, Parker RB, Roger P, Cartmill JA. Exploring patient ideas, concerns, and expectations in surgeon-patient consultations. PATIENT EDUCATION AND COUNSELING 2024; 125:108289. [PMID: 38631197 DOI: 10.1016/j.pec.2024.108289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 03/27/2024] [Accepted: 04/10/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES This study explores patient perspectives (ideas, concerns, and expectations) in surgeon-patient consultations. METHODS We examined 54 video-recorded consultations using applied conversation analysis. Consultations took place from 2012 to 2017 in an Australian metropolitan hospital clinic centre and involved seven surgeons across six specialties. RESULTS Patient perspectives emerged in less than one third of consultations. We describe the initiation of and response to potential perspectives sequences, demonstrating how patients and surgeons co-construct these sequences when they do occur. CONCLUSIONS Findings suggest a need for greater attention to supporting patient agency through explicit pursuit of patient perspectives. The implications extend to the Calgary-Cambridge Guide, suggesting that it may benefit from a focus on active pursuit and appropriate responsiveness to patient perspectives. PRACTICE IMPLICATIONS This study highlights the need for surgeons to actively engage with the patient perspective offered in consultations, emphasising the importance of respect for the patient's knowledge and expectations to improve patient satisfaction and healthcare outcomes.
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Affiliation(s)
- Sarah J White
- Centre for Social Impact, UNSW, Sydney, Australia; Macquarie Medical School, Macquarie University, Sydney, Australia.
| | - Ji Woo Kim
- Macquarie Medical School, Macquarie University, Sydney, Australia
| | - Harkirti Rakhra
- Macquarie Medical School, Macquarie University, Sydney, Australia
| | | | | | - Peter Roger
- Department of Linguistics, Macquarie University, Sydney, Australia
| | - John A Cartmill
- Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, Australia
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Newlan TM, Greig J. The marked body: Exploring experiences of post-mastectomy scarring, body image and change through artistic tattooing. J Health Psychol 2024; 29:382-395. [PMID: 38102733 PMCID: PMC11005302 DOI: 10.1177/13591053231215050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
Breast cancer has become the most prevalent cancer globally, predominantly affecting women, with mastectomy surgery a frequent treatment. Women often experience a discrepancy between their post-mastectomy body, and their former sense of self, affecting negatively on wellbeing. The narratives of eight women who chose to artistically tattoo over their mastectomy scars were explored in this study, through semi-structured interviews and Interpretative Phenomenological Analysis (IPA). Seven master themes are presented. These themes follow the women from a state of disruption (of body image and gender identity) and surgical scarring as the first marking of the body, to the second marking of the body through artistic tattooing, bringing with it transformation, acceptance, feeling heard and connection with the artist, closure and control and the creation of significance and meaning. Viewed through Self-Discrepancy Theory, the findings of this study has implications for psycho-oncology and wellbeing support for women following mastectomy surgery.
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Affiliation(s)
| | - Jenni Greig
- Charles Sturt University—Bathurst Campus, Australia
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Paynter J, Qin KR, Brennan J, Hunter-Smith DJ, Rozen WM. The provision of general surgery in rural Australia: a narrative review. Med J Aust 2024; 220:258-263. [PMID: 38357826 DOI: 10.5694/mja2.52232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024]
Abstract
Rural surgery is most commonly provided by general surgeons to the 29% of people (7 million) living in rural Australia. The provision of rural general surgery to enable equitable and safe surgical care for rural Australians is a multifaceted issue concerning recruitment, training, retention, surgical procedures and surgical outcomes. Sustaining the rural general surgical workforce will be dependent upon growing an increased number of resident rural general surgeons, as well as changed models of care, with a need for ongoing review to track the outcomes of these changes. To increase recruitment, rural general surgical training must improve to be less stressful for trainees and to be incorporated alongside a rural-facing generalist curriculum. Rural general surgical outcomes (excluding some oncology conditions) achieve comparable results to metropolitan centres. Access to, and outcomes of, surgical oncology services continues to be inequitable for rural Australians and should be a major focus for improved service delivery.
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Affiliation(s)
- Jessica Paynter
- Monash Rural Health - Bendigo, Monash University, Bendigo, VIC
- Bendigo Health, Bendigo, VIC
| | - Kirby R Qin
- Monash Rural Health - Bendigo, Monash University, Bendigo, VIC
- Bendigo Health, Bendigo, VIC
| | - Janelle Brennan
- Monash Rural Health - Bendigo, Monash University, Bendigo, VIC
- Bendigo Health, Bendigo, VIC
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Alkhaibari RA, Smith-Merry J, Forsyth R, Raymundo GM. Patient-centered care in the Middle East and North African region: a systematic literature review. BMC Health Serv Res 2023; 23:135. [PMID: 36759898 PMCID: PMC9909864 DOI: 10.1186/s12913-023-09132-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND The need for patient centered care (PCC) and its subsequent implementation has gained policy maker attention worldwide. Despite the evidence showing the benefits and the challenges associated with practicing PCC in western countries there has been no comprehensive review of the literature on PCC practice in the Middle East and North African (MENA) region, yet there is good reason to think that the practices of PCC in these regions would be different. OBJECTIVES This paper summarizes the existing research on the practice of PCC in the MENA region and uses this analysis to consider the key elements of a PCC definition based on MENA cultural contexts. METHODS Five electronic databases were searched (EMBASE, Cochrane, Medline, CINAHL and Scopus) using the search terms: patient OR person OR client OR consumer AND centered OR centred AND care. The MENA countries included were Bahrain, Iran, Iraq, Jordan, Kuwait, Lebanon, Oman, Palestine, Israel, Qatar, Saudi Arabia, Syria, United Arab Emirates, Yemen, Algeria, Egypt, Libya, Morocco, Tunisia, Djibouti, Pakistan, Sudan, and Turkey. Identified papers were imported to Covidence where they were independently reviewed against the inclusion criteria by two authors. The following data were extracted for each paper: author, year, location (i.e., country), objectives, methodology, study population, and results as they related to patient centred care. RESULT The electronic search identified 3582 potentially relevant studies. Fifty articles met the inclusion criteria. Across all papers five themes were identified: 1) patient centered care principles; 2) patient and physician perceptions of PCC; 3) facilitators of PCC; 4) implementation and impact of PCC; and 5) barriers to PCC. CONCLUSION The preliminary findings suggest that the concept of PCC is practiced and supported to a limited extent in the MENA region, and that the implementation of PCC might be impacted by the cultural contexts of the region. Our review therefore highlights the importance of establishing patient-centered care definitions that clearly incorporate cultural practices in the MENA region. The elements and impact of culture in the MENA region should be investigated in future research.
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Affiliation(s)
- Reeham Ahmed Alkhaibari
- grid.1013.30000 0004 1936 834XSydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia ,grid.412895.30000 0004 0419 5255Nursing Department, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.
| | - Rowena Forsyth
- grid.1013.30000 0004 1936 834XCyberpsychology Research Group, Biomedical Informatics and Digital Health Theme, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia
| | - Gianina Marie Raymundo
- grid.1013.30000 0004 1936 834XSydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia
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Pel E, Engelberts I, Schermer M. Diversity of interpretations of the concept "patient-centered care for breast cancer patients"; a scoping review of current literature. J Eval Clin Pract 2022; 28:773-793. [PMID: 34002460 PMCID: PMC9788211 DOI: 10.1111/jep.13584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 12/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Patient-centered care is considered a vital component of good quality care for breast cancer patients. Nevertheless, the implementation of this valuable concept in clinical practice appears to be difficult. The goal of this study is to bridge the gap between theoretical elaboration of "patient-centered care" and clinical practice. To that purpose, a scoping analysis was performed of the application of the term "patient-centered care in breast cancer treatment" in present-day literature. METHOD For data-extraction, a literature search was performed extracting references that were published in 2018 and included the terms "patient-centered care" and "breast cancer". The articles were systematically traced for answers to the following three questions: "What is patient-centered care?", "Why perform patient-centered care?", and "How to realize patient-centered care?". For the content analysis, these answers were coded and assembled into meaningful clusters until separate themes arose which concur with various interpretations of the term "patient-centered care". RESULTS A total of 60 publications were retained for analysis. Traced answers to the three questions "what", "why", and "how" varied considerably in recent literature concerning breast cancer treatment. Despite the inconsistent use of the term "patient-centered care," we did not find any critical consideration about the nature of the concept, regardless of the applied interpretation. Interventions that are supposed to contribute to the heterogeneous concept of patient-centered care as such, seem to be judged desirable, virtually without empirical justification. CONCLUSIONS We propose, contrary to previous efforts to define "patient-centered care" more accurately, to embrace the heterogeneity of the concept and apply "patient-centered care" as an umbrella-term for all healthcare that intends to contribute to the acknowledgement of the person in the patient. For the justification of measures to realize patient-centered care for breast cancer patients, instead of a mere contribution to the abstract concept, we insist on the demonstration of desirable real-world effects.
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Affiliation(s)
- Elise Pel
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Center of Rotterdam, Rotterdam, The Netherlands
| | - Ingeborg Engelberts
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Center of Rotterdam, Rotterdam, The Netherlands.,The Franciscus Breast Clinic, Department of Surgery, Franciscus Gasthuis & Vlietland, Schiedam, The Netherlands
| | - Maartje Schermer
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Center of Rotterdam, Rotterdam, The Netherlands
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Zhang M, Yang BY, Sun Y, Qian Z, Xaverius PK, Aaron HE, Zhao X, Zhang Z, Liu R, Dong GH, Yin C, Yue W. Non-linear Relationship of Maternal Age With Risk of Spontaneous Abortion: A Case-Control Study in the China Birth Cohort. Front Public Health 2022; 10:933654. [PMID: 35910867 PMCID: PMC9330030 DOI: 10.3389/fpubh.2022.933654] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/20/2022] [Indexed: 02/06/2023] Open
Abstract
Background Spontaneous abortion is one of the prevalent adverse reproductive outcomes, which seriously threatens maternal health around the world. Objective The current study is aimed to evaluate the association between maternal age and risk for spontaneous abortion among pregnant women in China. Methods This was a case-control study based on the China Birth Cohort, we compared 338 cases ending in spontaneous abortion with 1,352 controls resulting in normal live births. The main exposure indicator and outcome indicator were maternal age and spontaneous abortion, respectively. We used both a generalized additive model and a two-piece-wise linear model to determine the association. We further performed stratified analyses to test the robustness of the association between maternal age and spontaneous abortion in different subgroups. Results We observed a J-shaped relationship between maternal age and spontaneous abortion risk, after adjusting for multiple covariates. Further, we found that the optimal threshold age was 29.68 years old. The adjusted odds ratio (95% confidence interval) of spontaneous abortion per 1 year increase in maternal age were 0.97 (0.90–1.06) on the left side of the turning point and 1.25 (1.28–1.31) on the right side. Additionally, none of the covariates studied modified the association between maternal age and spontaneous abortion (P > 0.05). Conclusions Advanced maternal age (>30 years old) was significantly associated with increased prevalence of spontaneous abortion, supporting a J-shaped association between maternal age and spontaneous abortion.
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Affiliation(s)
- Man Zhang
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Bo-Yi Yang
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yongqing Sun
- Beijing Maternal and Child Health Care Hospital, Beijing, China
- Prenatal Diagnosis Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Zhengmin Qian
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States
| | - Pamela K. Xaverius
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States
| | - Hannah E. Aaron
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States
| | - Xiaoting Zhao
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Zheng Zhang
- Beijing Maternal and Child Health Care Hospital, Beijing, China
- Prenatal Diagnosis Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Ruixia Liu
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
- *Correspondence: Ruixia Liu
| | - Guang-Hui Dong
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Guang-Hui Dong
| | - Chenghong Yin
- Beijing Maternal and Child Health Care Hospital, Beijing, China
- Prenatal Diagnosis Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Chenghong Yin
| | - Wentao Yue
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
- Wentao Yue
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Dempsey K, Brennan ME, Spillane A. Inaugural roundtable on breast reconstruction practice in Australia: background, process and recommendations. AUSTRALASIAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.34239/ajops.v5n1.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Recommendations from the inaugural roundtable on breast reconstruction held on 9 October 2019 in Queensland, Australia, for improved decision-making and increased funding to support wider, timely access to breast reconstruction.
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Crawford D, Allan B, Cogle A, Brown G. Client-led care in HIV: perspectives from community and practice. HIV Med 2021; 22 Suppl 1:3-14. [PMID: 34296511 DOI: 10.1111/hiv.13133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES While current antiretroviral and care strategies can effectively suppress HIV, achieving optimal quality of life (QoL) requires a wider consideration of clients' well-being, the complexity of individuals' lives and social determinants of health. The objective of this commentary was to develop a definition of client-led care in the Australian context and its key supporting principles for people living with HIV (PLHIV). METHODS The authors used two sources of evidence to support their HIV community experience with client-led care: (1) a scoping review of the literature, and (2) consultations with colleagues who were PLHIV advocates or HIV specialist physicians. The findings from the scoping review and consultations were summarised and the key principles of client-led care compared with those identified by the authors. RESULTS Seven articles met the inclusion criteria for qualitative analysis in the scoping review. Five PLHIV advocates and three HIV specialist physicians were consulted. Key principles supporting client-led care identified by the authors based on their experience centred around the themes of: (1) clients and healthcare providers working in partnership, (2) information and communication, (3) coordinating access to care, (4) building trust, and (5) respect for client's needs and preferences. The principles identified by the authors were supported by those of the scoping review and colleague consultations. CONCLUSIONS A client-led approach can complement conventional HIV care strategies and enable empowerment and greater engagement with care, potentially improving the care continuum and overall QoL for individuals living with HIV who can, and want to, lead their own care.
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Affiliation(s)
- David Crawford
- Positive Life New South Wales, Surry Hills, NSW, Australia
| | - Brent Allan
- International AIDS Society and the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine, Melbourne, VIC, Australia
| | - Aaron Cogle
- National Association of People Living with HIV, Newtown, NSW, Australia
| | - Graham Brown
- Centre for Social Impact, University of New South Wales, Kensington, NSW, Australia.,Australian Research Centre in Sex Health and Society, La Trobe University, Bundoora, VIC, Australia
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Flitcroft K, Brennan M, Salindera S, Spillane A. Increasing access to breast reconstruction for women living in underserved non-metropolitan areas of Australia. Support Care Cancer 2019; 28:2843-2856. [PMID: 31729569 DOI: 10.1007/s00520-019-05130-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/09/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE The potential quality of life benefits of breast reconstruction (BR) for women who have undergone mastectomy for breast cancer have long been recognised. While many women will not want to have BR, international best-practice guidance mandates that all should be given the choice. The aim of this article is to highlight potential policies to support patients' informed discussion of BR options and to improve access to BR for women living in underserved locations. METHODS Ninety semi-structured interviews were conducted from May 2015 to May 2017 with a convenience sample of 31 breast reconstructive surgeons, 37 breast cancer health professionals and a purposive sample of 22 women who underwent mastectomy as part of their breast cancer treatment. Breast, plastic reconstructive surgeons and health professionals based in major cities also provided information about how they cared for patients from more remote areas. RESULTS Analysis of interview data revealed a range of barriers that were grouped into four major categories describing issues for women living outside major cities: population characteristics associated with lower socioeconomic status; locational barriers including limited health services resources and distance; administrative barriers such as hospital policies and inadequate support for women who need to travel; and surgical workforce recruitment barriers. CONCLUSIONS Suggestions for potential solutions included the following: greater geographical centralisation of BR services within major cities; the creation of designated breast centres with minimum caseload requirements similar to the UK's system; and a buddy system, whereby smaller hospitals network with multidisciplinary teams based in larger hospitals.
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Affiliation(s)
- Kathy Flitcroft
- Breast & Surgical Oncology at The Poche Centre, 40 Rocklands Rd, Wollstonecraft, Sydney, NSW, 2065, Australia. .,Northern Clinical School, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Meagan Brennan
- Breast & Surgical Oncology at The Poche Centre, 40 Rocklands Rd, Wollstonecraft, Sydney, NSW, 2065, Australia.,Northern Clinical School, The University of Sydney, Sydney, NSW, 2006, Australia.,Westmead Clinical School, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Shehnarz Salindera
- Breast & Surgical Oncology at The Poche Centre, 40 Rocklands Rd, Wollstonecraft, Sydney, NSW, 2065, Australia.,Westmead Clinical School, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Andrew Spillane
- Breast & Surgical Oncology at The Poche Centre, 40 Rocklands Rd, Wollstonecraft, Sydney, NSW, 2065, Australia.,Northern Clinical School, The University of Sydney, Sydney, NSW, 2006, Australia.,The Mater Hospital, North Sydney, NSW, 2060, Australia.,Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
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