"It's like a mirror image of my illness": Exploring Patient Perceptions About Illness Using Health Mind Mapping-a Qualitative Study

The effects of different surgical approaches on the psychological status, medical coping mode and quality of life of patients with lung cancer

Objective

This study aimed to compare the effects of robot-assisted thoracic surgery (RATS), video-assisted thoracic surgery (VATS), and thoracotomy on the psychological status, medical coping mode, and quality of life of patients with lung cancer.

Methods

A total of 158 patients with lung cancer were selected from the thoracic surgery center of a third-grade hospital in Hunan Province, China, from September to November 2020. The Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Medical Coping Modes Questionnaire (MCMQ), and Medical Outcomes Study (MOS) 36-item Short Form Health Survey (SF-36) were used to assess the effects of the surgical approaches on the study parameters before and 48–96 h after surgery. The t-test and analysis of variance were used to analyze the data.

Results

The results revealed that the patients’ depression increased, their short-term quality of life decreased, and they tended to adopt a positive coping mode after surgery (p < 0.05). The RATS and VATS groups differed in avoidance dimension of medical coping modes (p < 0.05). The VATS and thoracotomy groups differed in the body pain dimension of quality of life (p < 0.05). Different surgical approaches had no effect on the psychological status, medical coping modes except the avoidance dimension, and quality of life except the body pain dimension.

Conclusion

Surgical approaches have little effect on the psychological status, medical coping modes, and quality of life of patients with lung cancer; however, their depression increased and quality of life decreased after the surgery.

Beliefs About Illness and Treatment Decision Modelling During Ill-Health in Arabic Families

Background

The use of self-prescribed antibiotics and other unproven herbal remedies is common in the Arab world. Understanding how family members decide to manage illness is an important priority for health care providers.

Purpose

This paper presents a new model that can be viewed as an extension to the Health Belief Model and help clarifies the cognitive processes families use to manage illness in an Arab family in Jordan. It aims to generate an understanding of family beliefs about the causes of illness and appraisal of how best to manage illness in an Arab family.

Methods

A qualitative approach using a family interview method was used to collect data. Twenty-five families participated in semi-structured interviews designed to elicit representational models of illness and treatment-decisions.

Results

Thematic analysis revealed two forms of intertwined beliefs: core beliefs (fatalistic) and secondary beliefs (biomedical, supernatural and situational beliefs). Four key elements were identified as underpinning the involvement of family in treatment decision: perceived threat of illness, efficacy of treatment option, cost or availability and family prior experience.

Conclusion

An understanding of the health belief model and related cognitive appraisal processes used by families may assist health care providers to engage with and overcome some of the social, cultural, and structural variables that could influence how family members decide to manage illness in Jordan.

Using Mind Mapping in Family Meetings to Support Shared Decision Making with Pediatric and Geriatric Patients

INTRODUCTION

Divergent objectives and narratives among members of a healthcare team may lead to suffering, underscoring the need to align patient care with the patient's self-identified priorities and goals. Shared decision making (SDM) with patients who may not be able to make healthcare decisions for themselves presents a unique challenge to healthcare providers, caregivers, and patients. Children and the elderly are two such groups where substituted decision making is often required. Family meetings, wherein stakeholders in a patient's care are gathered, present opportunities to align expectations and clinical goals. There is a clear need for a technique exploring all facets of the patient's story within the context of the biopsychosocial-spiritual model. We sought to promote narrative equity among stakeholders and maintain patient focus during family meetings. We describe the use of Mind Mapping in the family meeting to meet these objectives.

METHODS

Using two clinical scenarios, one involving a geriatric patient and another involving a pediatric patient, we describe the stepwise development of Mind Maps and how their use informed discussions among stakeholders in the family meeting.

RESULTS

Stakeholders found the Mind Maps easy to draw and helpful in eliciting their own priorities and preferences. Group exploration and refinement of the Mind Maps helped stakeholders to appreciate others' sometimes divergent perspectives, to ensure that the patient's voice was heard, and to ensure that care decisions were patient focused.

DISCUSSION

Mind Mapping was easily performed in two clinical scenarios, allowing the patient, family, and medical team to explore the biopsychosocial-spiritual model extensively, to appreciate each stakeholder's priorities, and to identify areas for further development. We have found that Mind Mapping helps define the 'topography' of relationships, prioritizes team discussions, finds shared interests in seemingly divergent objectives, and identifies which team member may best lead a discussion on a particular topic.

CONCLUSION

Mind Mapping may be a useful tool for family meetings, particularly for geriatric and pediatric patients with multiple stakeholders involved.