The experience of social determinants of health within a Southern European Maltese culture

A qualitative exploration of Maltese couples' care experiences of prostate cancer diagnosis and radiotherapy treatment

INTRODUCTION

Although prostate cancer is male-specific, the diagnosis and treatment also affect close family members, particularly spouses. Following diagnosis, treatment choices have to be made and this may lead to a period of stress and confusion for both patient and their family. This study investigated couples' care experiences with prostate cancer from diagnosis to radiotherapy treatment in Malta.

METHODS

A qualitative descriptive methodology was adopted using semi-structured interviews with twelve couples and two men. Data were collected between January and December 2019. The participants were recruited from a local oncology hospital in Malta. Data were analysed Thematically and included the identification of potential contrasts and overlaps between men and their spouses.

RESULTS

A prostate cancer diagnosis and treatment was a significant source of distress for men and their spouses. Healthcare professionals did not consistently attend to the couple's concerns, such as perceived delays in the management of prostate cancer and the treatment decision-making process. Most couples did not disclose the diagnosis to wider family and friends and several men valued the experience of men who previously underwent prostate cancer treatment.

CONCLUSION

Ensuring that these couples receive the right information, support, and resources is crucial to assisting couples in navigating the challenges of the cancer journey effectively. When experiences were less positive, the communication process with healthcare professionals was not perceived as adequate, which negatively impacted their emotional well-being.

IMPLICATIONS FOR PRACTICE

Additional communication training for healthcare professionals may improve their recognition and response to the needs of service users. Information tailored to the needs of men and spouses may also be considered such as the use of digital tools or involving men who previously underwent treatment.

Attitudes towards disclosure of familial genetic risk in a Mediterranean island population - A survey of the Maltese population

Germline genetic testing has implications that extend beyond the individual patient to relatives, particularly for high-penetrance variants implicated in hereditary cancer or neurodegenerative syndromes. Many countries encourage patient-led communication to inform at-risk relatives, although the efficacy and uptake of this approach varies. Alternative scenarios envisage direct contact mediated by clinicians. The familial disclosure of sensitive genetic information is also determined by complex socio-ethnic factors. To date, no study has explored whether relatives would want to be informed of familial genetic risk and their preferences on different methods of communication in Malta. We thus used a published instrument that utilizes hypothetical scenario methodology to survey the attitudes of the Maltese population (n = 334) to receiving genetic information from family members. Two vignettes on Huntington's disease and colorectal cancer were presented. We also explored preferences towards the communication of genetic risk, confidentiality, and disclosure policies. Our preliminary results show that most respondents want to be informed of their increased risk by a family member or a clinician and would opt to receive confirmatory genetic testing. Most respondents preferred being informed of genetic risk by a close relative, but in the case of non-disclosure would want to be informed by a clinician. Most respondents expressed preference in favour of the introduction of registries, legislative change and sharing of contact details to address cases of nondisclosure. Our findings contribute further to evidence that supports, in selected hypothetical scenarios, an envisioned change in disclosure of genetic data policy by the public that is different from current practice to date.

Exploring Patient Beliefs and Medication Adherence in the Mediterranean Context: A Cross-Sectional Study in Patients with Cardiovascular Diseases and Cardiometabolic Disorders in Greece-The IACT-Study

BACKGROUND

Evidence has shown that poor adherence to vascular medications contributes to a considerable proportion of all cardiovascular disease (CVD) events and mortality. The aim of the present work was to examine patients' beliefs/views that affect their level of adherence to the assigned medical treatment in the context of a multi-center study in Greece.

METHODS

Between July 2022 and April 2023, 1988 patients (1180 females) with established cardiovascular disease or relevant cardiometabolic disorders were chosen from seven medical centers in Greece. The 4-item Morisky Medication Adherence Questionnaire gauged medication adherence and investigated patients' beliefs/views regarding treatment.

RESULTS

Among participants, 51.2% showed perfect medication adherence, contrasting with 48.8% displaying poor adherence. Patients with negative medication beliefs were around three times more likely to be non-adherent (OR = 2.73; 95% CI = 2.28-3.28). Non-adherers held concerns about drug efficacy (OR = 2.34; 95% CI = 1.10-4.97) and favored alternative therapies (OR = 2.25; 95% CI = 1.75-2.91).

CONCLUSION

The findings highlight the significance of addressing patient beliefs/views to improve medication adherence. The distinct Mediterranean context, influenced by cultural, socioeconomic, and clinical factors, emphasizes the need for tailored interventions. This underscores the call for contextually sensitive strategies to boost medication adherence and improve health outcomes in this unique region.

Adverse Health and Psychosocial Repercussions in Retirees from Sports Involving Head Trauma: Looking at the Sport of Boxing

Academic scholarship has steadily reported unfavourable clinical findings on the sport of boxing, and national medical bodies have issued calls for restrictions on the sport. Yet, the positions taken on boxing by medical bodies have been subject to serious discussions. Beyond the medical and legal writings, there is also literature referring to the social and cultural features of boxing as ethically significant. However, what is missing in the bioethical literature is an understanding of the boxers themselves. This is apart from their brain injuries, the debates about the degenerative brain disease known as chronic traumatic encephalopathy (CTE), and related issues about the disease. This article argues that the lives of boxers, their relationships, their careers, and their futures, also requires its own research, particularly in telling stories about their lives, and those lives and futures which boxing affects. The article uses two approaches. First, to imagine a more enduring “whole of life viewpoint” by using an extended future timeframe. Second, to consider perspectives of a person’s significant others. After reviewing the boxing literature, the article discusses social settings and then explores the hidden social relationships in life after boxing. With these longer time and close relationship viewpoints, three important themes emerge: family and kinship; age, stage and career; and the effects of boxing fatalities. These analyses are used in conjunction with relevant clinical findings which complement the telling of stories to improve medical information, and engages professional and public empathy for people’s experience of illness and difficulties in coping.

Religion, Health, Social Capital and Place: The Role of the Religious, Social Processes and the Beneficial and Detrimental Effects on the Health and Wellbeing of Inhabitants in Deprived Neighbourhoods in Malta

This paper emphasises the important role that place has in determining how religious social processes operate and impact on health and wellbeing. It draws upon evidence through qualitative in-depth interviews with families (both parents and children) living in two deprived neighbourhoods in Malta, a 'traditional' and a 'modern' one. It emerged that religious faith and practices can generate normative and resource-based social capital which can positively impact on health and wellbeing. However, some individuals found this social capital constraining and this had detrimental effects on their wellbeing. The context, composition, history and norms of the place emerge as highly important. This study emphasises that religious social processes operate in a highly complex manner, and 'adherents' and 'disaffiliates' are likely to enjoy positive or negative health and wellbeing according to where they live and according to important persons living in the neighbourhood such as the parish priest. This study contributes to the research gap between religion, social capital and health and the complex, social processes that operate at the local level of place.