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Næss SCK. 'Don't freak out if you get a letter saying cancer patient pathways!': Communication work between different demands in cancer care. Health (London) 2024; 28:313-330. [PMID: 36238971 PMCID: PMC10900861 DOI: 10.1177/13634593221127819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article explores healthcare professionals' experiences of their work with patient communication in standardised cancer patient pathways (CPPs). The theoretical and methodological framework for this study is institutional ethnography. Data were collected through semi-structured interviews with 72 healthcare professionals, including general practitioners, specialist physicians and other hospital staff, in five Norwegian hospitals. The study reveals four aspects of communication work that illuminate how the CPP policy mediates the way healthcare professionals interact with patients through communicating continuity, communicating (by dodging) the dreaded C-word, communicating patient participation, and communicating the relevance of time. Healthcare professionals' balancing of their different experiential realities run as a common thread through the four aspects of communication work identified in this study. The CPP policy, with its explicit focus on transparency, speed, and time frames creates challenges in an already delicate situation.
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2
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Klostermann J. Bev Said "No": Learning From Nursing Home Residents About Care Politics in Our Aging Society. THE GERONTOLOGIST 2023; 63:1663-1671. [PMID: 37330624 DOI: 10.1093/geront/gnad069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Indexed: 06/19/2023] Open
Abstract
How do nursing home residents decide when, whether, or how to respond to their own and others' care needs when the need to do is constant? What can we learn from them about care politics in our aging society? Drawing on ethnographic research conducted in three long-term residential care homes in Ontario Canada, this article weaves approaches from the arts, humanities, and interpretive sociology to respond to these questions. Contextualizing nursing home residents' stories of care within broader sociocultural and political contexts, I consider how they develop critical and creative insights, not only about direct care or nursing home life but about moral, philosophical, and culturally significant questions relevant to care provision. As political actors engaged in a "politics of responsibility," they put work into navigating, negotiating, and making sense of their own and others' care needs in under-resourced contexts and in relation to circulating narratives about care, aging, and disability. Exposed to constant demands to care for others, residents' stories highlight the importance of expanding cultural narratives to embrace embodied differences or care needs, to help people to talk about their own needs or limits, and to organize care as a shared, collective responsibility.
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Affiliation(s)
- Janna Klostermann
- Department of Sociology, University of Calgary, Calgary, Alberta, Canada
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3
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Grauman Å, Ancillotti M, Veldwijk J, Mascalzoni D. Precision cancer medicine and the doctor-patient relationship: a systematic review and narrative synthesis. BMC Med Inform Decis Mak 2023; 23:286. [PMID: 38098034 PMCID: PMC10722840 DOI: 10.1186/s12911-023-02395-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The implementation of precision medicine is likely to have a huge impact on clinical cancer care, while the doctor-patient relationship is a crucial aspect of cancer care that needs to be preserved. This systematic review aimed to map out perceptions and concerns regarding how the implementation of precision medicine will impact the doctor-patient relationship in cancer care so that threats against the doctor-patient relationship can be addressed. METHODS Electronic databases (Pubmed, Scopus, Web of Science, Social Science Premium Collection) were searched for articles published from January 2010 to December 2021, including qualitative, quantitative, and theoretical methods. Two reviewers completed title and abstract screening, full-text screening, and data extraction. Findings were summarized and explained using narrative synthesis. RESULTS Four themes were generated from the included articles (n = 35). Providing information addresses issues of information transmission and needs, and of complex concepts such as genetics and uncertainty. Making decisions in a trustful relationship addresses opacity issues, the role of trust, and and physicians' attitude towards the role of precision medicine tools in decision-making. Managing negative reactions of non-eligible patients addresses patients' unmet expectations of precision medicine. Conflicting roles in the blurry line between clinic and research addresses issues stemming from physicians' double role as doctors and researchers. CONCLUSIONS Many findings have previously been addressed in doctor-patient communication and clinical genetics. However, precision medicine adds complexity to these fields and further emphasizes the importance of clear communication on specific themes like the distinction between genomic and gene expression and patients' expectations about access, eligibility, effectiveness, and side effects of targeted therapies.
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Affiliation(s)
- Å Grauman
- Centre for Research Ethics and Bioethics, Uppsala University, Box 564, Uppsala, SE-751 22, Sweden.
| | - M Ancillotti
- Centre for Research Ethics and Bioethics, Uppsala University, Box 564, Uppsala, SE-751 22, Sweden
| | - J Veldwijk
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - D Mascalzoni
- Centre for Research Ethics and Bioethics, Uppsala University, Box 564, Uppsala, SE-751 22, Sweden
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
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4
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Ross E, Kerr A, Swallow J, Chekar CK, Cunningham‐Burley S. Unsettling the treatment imperative? Chemotherapy decision-making in the wake of genomic techniques. SOCIOLOGY OF HEALTH & ILLNESS 2023; 45:1063-1081. [PMID: 36965058 PMCID: PMC10946787 DOI: 10.1111/1467-9566.13637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
Social scientists have argued that a treatment imperative shapes experiences of biomedicine. This is evident within oncology, where discourses of hope are tempered by persistent fears surrounding cancer. It is within this context that genomic decision-making tools are entering routine care. These may indicate that a treatment is not appropriate for a particular disease profile. We draw on qualitative interviews and observations centred on gene expression profiling to consider the implications of this technique for the treatment imperative in early breast cancer. Influenced by sociological perspectives on medical technologies, we discuss how fallibilities of established tools have forged a space for the introduction of genomic testing into chemotherapy decision-making. We demonstrate how high expectations shaped patients' interpretations of this tool as facilitating the 'right' treatment choice. We then unpick these accounts, highlighting the complex relationship between gene expression profiling and treatment decision-making. We argue that anticipations for genomic testing to provide certainty in treatment choice must account for the sociocultural and organisational contexts in which it is used, including the powerful entwinement of chemotherapy and cancer. Our research has implications for sociological perspectives on treatment decision-making and clinical expectations for genomic medicine to resolve the 'problem' of overtreatment.
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Affiliation(s)
- Emily Ross
- Department of Sociological StudiesUniversity of SheffieldSheffieldUK
| | - Anne Kerr
- School of Social and Political SciencesUniversity of GlasgowGlasgowUK
| | - Julia Swallow
- Centre for Biomedicine, Self, and SocietyUsher InstituteUniversity of EdinburghEdinburghUK
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5
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De Silva L, Baysari M, Keep M, Kench P, Clarke J. Patient requests for radiological services: An Australian study of patient agency and the impact of online health information. Health Promot J Austr 2022; 34:437-442. [PMID: 36054419 DOI: 10.1002/hpja.647] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 07/13/2022] [Accepted: 07/27/2022] [Indexed: 11/11/2022] Open
Abstract
ISSUE ADDRESSED The Internet has been instrumental in patients' knowledge about health and medicine through increasing consultation of online sources that advocate self-management. For example, those patients who request referrals from their doctors for tests and procedures in radiology. Such patient-initiated referral requests can devolutionise the traditional model of health care. This study aimed to understand individuals who sought online health information (OHI) and whether requests for radiological referrals were the result of OHI seeking. METHODS The individuals targeted were those who have had a radiological procedure in the past 5 years. Using an online survey tool, individuals completed a 20-min anonymous survey. Included in the survey was a validated digital health literacy measurement scale, eHEALS. RESULTS Those who scored higher on the eHEALS measure were likely to be under 55 years of age and were more inclined to request radiological referrals. Though they were not concerned with the credibility of sourced websites, most secured the desired outcome from their requests. CONCLUSION Overall, this study indicates that patients are consulting online sites for health information, and individuals with higher digital literacy scores are asking doctors for referrals for radiological tests and procedures. These findings confirm our anecdotal experience in radiology departments. So what?: In conducting this study, we hope to better inform radiology and other health practitioners of the way OHI is impacting clinical practice.
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Affiliation(s)
- Lizzie De Silva
- Discipline of Medical Imaging Science Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Camperdown Campus, Western Ave Camperdown NSW Australia
| | - Melissa Baysari
- Biomedical Informatics and Digital Health, Faculty of Medicine and Health, Charles Perkins Centre D17 The University of Sydney Sydney NSW Australia
| | - Melanie Keep
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building D18 Camperdown NSW Australia
| | - Peter Kench
- Discipline of Medical Imaging Science Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Camperdown Campus, Western Ave Camperdown NSW Australia
| | - Jillian Clarke
- Discipline of Medical Imaging Science Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Camperdown Campus, Western Ave Camperdown NSW Australia
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Cupit C, Paton A, Boyle E, Pillay T, Armstrong N. Managerial thinking in neonatal care: a qualitative study of place of care decision-making for preterm babies born at 27-31 weeks gestation in England. BMJ Open 2022; 12:e059428. [PMID: 35760541 PMCID: PMC9237905 DOI: 10.1136/bmjopen-2021-059428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Preterm babies born between 27 and 31 weeks of gestation in England are usually born and cared for in either a neonatal intensive care unit or a local neonatal unit-with such units forming part of Operational Delivery Networks. As part of a national project seeking to optimise service delivery for this group of babies (OPTI-PREM), we undertook qualitative research to better understand how decisions about place of birth and care are made and operationalised. DESIGN Qualitative analysis of ethnographic observation data in neonatal units and semi-structured interviews with neonatal staff. SETTING Six neonatal units across two neonatal networks in England. Two were neonatal intensive care units and four were local neonatal units. PARTICIPANTS Clinical staff (n=15) working in neonatal units, and people present in neonatal units during periods of observation. RESULTS In the context of real-world neonatal practice, with multiple (and rapidly-evolving) uncertainties relating to mothers, babies and unit/network capacity, 'best place of care' protocols were only one element of much more complex decision-making processes. Staff often made judgements from a less-than-ideal starting point, and were forced to respond to evolving clinical and organisational factors. In particular, we report that managerial considerations relating to demand and capacity organised decision-making; demand and capacity management was time-consuming and generated various pressures on families, and tensions between staff. CONCLUSIONS Researchers and policymakers should take account of the organisational context within which place of care decisions are made. The dominance of demand and capacity management considerations is likely to limit the impact of other improvement interventions, such as initiatives to integrate families into the neonatal care provision. Demand and capacity management is an important element of neonatal care that may be overlooked, but significantly organises how care is delivered.
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Affiliation(s)
- Caroline Cupit
- Department of Health Sciences, University of Leicester, Leicester, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alexis Paton
- Sociology and Policy, Aston Medical School, Aston University, Birmingham, UK
| | - Elaine Boyle
- Department of Health Sciences, University of Leicester, Leicester, UK
- Neonatology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Thillagavathie Pillay
- Neonatology, University Hospitals of Leicester NHS Trust, Leicester, UK
- Research Institute for Health Related Sciences, University of Wolverhampton, Wolverhampton, UK
| | - Natalie Armstrong
- Department of Health Sciences, University of Leicester, Leicester, UK
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Yegnanarayanan V, Krithicaa Narayanaa Y, Anitha M, Ciurea R, Marceanu LG. Graph theoretical way of understanding protein-protein interaction in ovarian cancer. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2022. [DOI: 10.3233/jifs-219289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cancer is a major research area in the medical field. Precise assessment of non-similar cancer types holds great significance in according to better treatment and reducing the risk of destructiveness in patients’ health. Cancer comprises a ambient that differs in response to therapy, signaling mechanisms, cytology and physiology. Netting theory and graph theory jointly gives a viable way to probe the proteomic specific data of cancer types such as ovarian, colon, breast, oral, cervical, prostate, and lung. We observe that the P2P(protein-protein) interaction Nettings of the cancerous tissues blended with the seven cancers and normal have same structural attributes. But some of these point to desultory changes from the disease Nettings to normal implying the variation in the dealings and bring out the redoing in the complicacy of various cancers. The Netting-based approach has a pertinent role in precision oncology. Cancer can be better dealt with through mutated pathways or Nettings in preference to individual mutations and that the utility value of repositioned drugs can be understood from disease modules in molecular Nettings. In this paper, we demonstrate how the graph theory and neural Nettings act as vital tools for understanding cancer and other types such as ovarian cancer at the zeroth level.
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Affiliation(s)
- V. Yegnanarayanan
- Deapartment of Mathematics, Kalasalingam Academy of Research and Education, Krishnankoil, Tamilnadu, India
| | - Y. Krithicaa Narayanaa
- Department of Biomedical Sciences, Sri Ramachandra Institute for Higher Education and Research (DU), Chennai, Tamil Nadu, India
| | - M. Anitha
- Deapartment of Mathematics, Kalasalingam Academy of Research and Education, Krishnankoil, Tamilnadu, India
| | - Rujita Ciurea
- Faculty of Medicine, Vasile Goldis Western University of Arad, Arad, Romania
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Besle S, Sarradon-Eck A. Chronicity and the patient's decision-making work. The case of an advanced cancer patient. Anthropol Med 2022; 29:76-91. [PMID: 35306943 DOI: 10.1080/13648470.2022.2041546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
This paper focuses on the particular situation of an advanced cancer patient whose condition has taken a chronic turn. We argue that chronicity of this kind sometimes falls at the frontier of Evidence Based Medicine because the uncertainty about the patient's condition can lead physicians to resort to clinical trials or non-licensed drugs to prevent the disease from progressing. This situation leaves plenty of scope for individual adjustments between patients and their doctors. Advanced cancer is regarded here not just as a biological event but as a chronic illness and a 'negotiated reality'. We argue that the chronicity of advanced cancer patients' situation broadens the patients' scope for 'work', and we have called this specific type of patient's work 'decision-making work'. This paper is based on a case study focusing on Patrick, a middle-aged Frenchman with metastatic lung cancer who underwent oncological treatment for seven years and was strongly determined to find new therapeutic options even if this meant having to go abroad. He actively orchestrated his therapeutic itinerary by reorganising his relationships with the medical world and coordinating the physicians' work. His particular social position enabled Patrick to bypass some of the current medical rules and to reorganise the usual pattern of distribution of medical responsibilities. The chronicity of his condition placed him at the very frontier of the health care system.
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Affiliation(s)
- Sylvain Besle
- Universite Claude Bernard Lyon, Villeurbanne, France.,Human and Social Sciences Department, Centre Léon Bérard, Lyon, France
| | - Aline Sarradon-Eck
- SESSTIM UMR 1252, CANBIOS, Marseille, France.,Paoli-Calmettes Institute, Marseille, France
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9
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Rogers CC, Pope S, Whitfield F, Cohn WF, Valdez RS. The lived experience during the peri-diagnostic period of breast cancer: A scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:547-585. [PMID: 34210570 DOI: 10.1016/j.pec.2021.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The aim of this scoping review is to provide an overview of the existing research that investigates the lived experience during the peri-diagnostic period of breast cancer. METHODS Nine databases were searched for relevant literature between January 2007 and April 2019. Data were extracted and categorized using deductive and inductive approaches. RESULTS A majority of the 66 studies included used qualitative methods to retrospectively explore the treatment decision making process of female breast cancer patients. Patients experienced uncertainty, emotional distress, and a need for more information from providers and relied on social support and family guidance during this period. CONCLUSIONS The results of this review show that the burdens experienced during the peri-diagnostic period parallel those in later periods of cancer care. However, these burdens are prompted by different circumstances. More research is needed to explore the lived experience during this period through the use of mixed-methods and by recruiting a diverse sample with regards to role in the breast cancer experience, age, gender, race, and ethnicity. PRACTICE IMPLICATIONS Interventions positioned at earlier points in the breast cancer experience should provide informational support, which could be delivered through shared decision making models. Additional support could be facilitated by patient navigation programs and health information technology.
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Affiliation(s)
- Courtney C Rogers
- Department of Engineering Systems and Environment, University of Virginia, Charlottesville, VA, United States; Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Shannon Pope
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Francesca Whitfield
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Wendy F Cohn
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Rupa S Valdez
- Department of Engineering Systems and Environment, University of Virginia, Charlottesville, VA, United States; Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States.
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10
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Doctors as Appointed Fiduciaries: A Supplemental Model for Medical Decision-Making. Camb Q Healthc Ethics 2022; 31:23-33. [PMID: 35049458 PMCID: PMC9019555 DOI: 10.1017/s096318012100044x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
How should we respond to patients who do not wish to take on the responsibility and burdens of making decisions about their own care? In this paper, we argue that existing models of decision-making in modern healthcare are ill-equipped to cope with such patients and should be supplemented by an "appointed fiduciary" model where decision-making authority is formally transferred to a medical professional. Healthcare decisions are often complex and for patients can come at time of vulnerability. While this does not undermine their capacity, it can be excessively burdensome. Most existing models of decision-making mandate that patients with capacity must retain ultimate responsibility for decisions. An appointed fiduciary model provides a formalized mechanism through which those few patients who wish to defer responsibility can hand over decision-making authority. By providing a formal structure for deferring to an appointed fiduciary, the confusions and risks of the informal transfers that can occur in practice are avoided. Finally, we note how appropriate governance and law can provide safeguards against risks to the welfare of patients and medical professionals.
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11
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Bellardita L, Colciago RR, Frasca S, De Santis MC, Gay S, Palorini F, La Rocca E, Valdagni R, Rancati T, Lozza L. Breast cancer patient perspective on opportunities and challenges of a genetic test aimed to predict radio-induced side effects before treatment: Analysis of the Italian branch of the REQUITE project. Radiol Med 2021; 126:1366-1373. [PMID: 34268681 DOI: 10.1007/s11547-021-01395-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/29/2021] [Indexed: 02/06/2023]
Abstract
AIM To explore breast cancer patient's perspective on future genetic testing for prediction of toxicity after breast radiotherapy (RT). MATERIALS AND METHODS The study involved patient enrolled in the Italian branch of the REQUITE project conducted at the National Cancer Institute in Milan. Semi-structured interviews were conducted within one month from the end of radiotherapy treatment by two radiation oncologists and a radiotherapy technician previously trained by a clinical psychologist with experience in the oncology field. Semi-structured interviews are characterized by a set of pre-defined questions and developed ad hoc by researchers in Leicester within the REQUITE project. The interview questions investigated interest in undergoing the genetic test and expectations on its usefulness and disadvantages. RESULTS Eighteen interviews were conducted and analysed. Forty-five initial codes were combined into nine themes which were then clustered in two main macro-areas (i) Opportunities and (ii) Challenges. Overall, all patients understand the aim of the genetic test and considered its intrinsic opportunity to make the physician more confident with the treatment. Regarding side effects, most of patients felt prepared to RT but not without fear. Many women considered important to have the largest and reliable information, also about negative experiences. Prevailing emotions were anxiety and fear but not connected to genetic test's result. CONCLUSIONS A genetic test could be an opportunity because generate knowledge and give patients a dynamic role in the decision-making approach. Prediction of single patient radiosensitivity before RT could prompt suggestion to entail a more and more tailored radiation treatment in the era of personalized approach.
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Affiliation(s)
- Lara Bellardita
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | | | - Sarah Frasca
- Radiation Oncology 1 Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | | | - Simona Gay
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Federica Palorini
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Eliana La Rocca
- Radiation Oncology 1 Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Milan, Italy
| | - Riccardo Valdagni
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Department of Radiotherapy, Università Degli Studi Di Milano Bicocca, Milan, Italy.,Radiation Oncology 1 Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Milan, Italy
| | - Tiziana Rancati
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Laura Lozza
- Radiation Oncology 1 Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
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12
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The social meanings of choice in living-with advanced breast cancer. Soc Sci Med 2021; 280:114047. [PMID: 34090104 DOI: 10.1016/j.socscimed.2021.114047] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/06/2021] [Accepted: 05/17/2021] [Indexed: 11/22/2022]
Abstract
Individual choice is valorised as a core social value; yet the necessity and desirability of making choices takes on new significance for people living with incurable cancer who are required to make often difficult decisions about treatment, care and family life, amidst considerable vulnerability and precariousness. There has been comparatively little exploration of how choice is negotiated and made meaningful under the spectre of incurability and a contracted future. In this paper, drawing on multiple qualitative interviews with 38 women with metastatic breast cancer, we explore how they experience and give meaning to choice in relation to their health (and beyond) in their daily lives. Our analysis highlights that while exercising choice was sometimes a concealed or silent pursuit, choice was always a socially negotiated and temporally unfolding process, nested within relational and interpersonal dynamics. Choices were also often constrained, even foreclosed, due to situational and relational dynamics. Yet even in the absence of choice, the idea of choice-as-control was discursively embraced by women. We argue that greater attention is needed to the affective, temporal and economic dimensions of choice, and how treatment decisions are asymmetrically structured when considered within the normative context of cancer.
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13
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The Effect of Using the Question Prompt List on Shared Decision Making, Self-Efficacy in Decision Making, and Preferences for Participation Among Women with Breast Cancer: A Study Protocol. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2020. [DOI: 10.5812/ijcm.103873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: There is increasing awareness that patients with cancer desire information as well as strategies to support their capacity to actively participate in informed decision-making. This study will evaluate outcomes of using a question prompt list (QPL) on shared decision making (SDM), decision-making self-efficacy, and preferences for participation among Iranian women with breast cancer, who are referred to a Tehran Comprehensive Cancer Center. Methods: This research will utilize a randomized controlled trial. The research population is patients with breast cancer, who are referred to the Oncology Radiotherapy Unit, Imam Khomeini Hospital, Tehran following tumor resection. After completing baseline surveys (demographics and health survey, decision self-efficacy scale, and control preferences scale), participants will be randomized into either a control or a treatment group based on block design. The treatment group will receive routine care along with the QPL that provides information on decision-making relative to treatment options (chemotherapy, radiotherapy, or both treatments) following meeting their oncologist. They will be trained to use the QPL which they will use to ask questions about their treatment choices when meeting with their physician or through computer-mediated modalities such as WhatsApp or other social messengers. These patients will have the opportunity to think about the treatment options and will be referred for medical treatment following their decision. The control group will receive routine care (physician discussion and receipt of treatment information). Following decision-making regarding treatment, the questionnaires will be administered (9-item SDM questionnaire, decision self-efficacy scale, and control preferences scale). Data will be analyzed using SPSS 16. Discussion: The current study will provide experimental evidence for the preliminary efficacy or lack of an intervention that has the potential to improve shared decision-making outcomes, a better understanding of personal preferences related to decision-making and self-efficacy in medical decision-making for Iranian patients with breast cancer.
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14
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Gruß I, McMullen CK. Barriers to eliciting patient goals and values in shared decision-making breast cancer surgery consultations: An ethnographic and interview study. Psychooncology 2019; 28:2233-2239. [PMID: 31461197 DOI: 10.1002/pon.5212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/16/2019] [Accepted: 08/21/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Previous research has demonstrated the importance of eliciting patients' goals and values during shared decision-making (SDM), but this does not occur in most SDM conversations. Understanding challenges to eliciting patients' goals and values is crucial. This study assessed how clinicians balanced sharing medical information and considering patients' goals and values during breast cancer surgery consultation in an integrated health care system. METHODS We conducted interviews with clinicians (n = 6) and patients (n = 11) and conducted naturalistic, ethnographic observations of eight surgical consultations in a multidisciplinary breast cancer clinic. We analyzed the data following the template method using the qualitative software NVivo 10. RESULTS Clinicians prioritized sharing medical information. We identified four patient factors necessary to integrate patients' values and goals into the conversation in addition to sharing medical information: ability to process large quantities of information quickly, willingness to embrace swift decision-making, ability to quickly formulate one's values, and prioritization of surgical choice as the goal of the conversation. CONCLUSIONS We found that SDM implementation results in practices that emphasize information and choice, with less focus on patient goals and values. More research is needed to explore factors that may encourage the elicitation of patients' goals and values.
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Affiliation(s)
- Inga Gruß
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, U.S
| | - Carmit K McMullen
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, U.S
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Stiefel F, Bourquin C. Moving toward the next generation of communication training in oncology: The relevance of findings from qualitative research. Eur J Cancer Care (Engl) 2019; 28:e13149. [PMID: 31429157 DOI: 10.1111/ecc.13149] [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: 01/28/2019] [Revised: 07/01/2019] [Accepted: 08/01/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The critics and recommendations for communication training in oncology call for new ideas, which may contribute to designing the next generation of training. The aim of this work was to search the literature on communication in oncology for empirically grounded observations that might be useful for the development of training approaches. METHODS The approach consists of identifying findings that might serve as cues for the design of the next generation of training. The literature search strategy allowed the inclusion of 68 articles. RESULTS Findings of the articles showed that multiple factors shape clinical communication: the functions and effects of information provision, the relational and interactional aspects of communication, its patient- and context-related dimensions, and the intrapsychic and context-related barriers hampering the patient encounter that clinicians are facing. CONCLUSION A way to reach all oncologists and to provide training centred on the singular needs of participants is a shift in the focus of training from communication tasks or communication-related situations to the clinician. PRACTICE IMPLICATIONS Training should focus on the competencies and qualities to be developed by clinicians, such as being flexible, able to adapt to the singular patient, sensitive to interactional aspects of communication, which influence the clinical encounter.
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Affiliation(s)
- Friedrich Stiefel
- Psychiatric Liaison Service, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Céline Bourquin
- Psychiatric Liaison Service, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
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16
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Ross E, Swallow J, Kerr A, Cunningham-Burley S. Online accounts of gene expression profiling in early-stage breast cancer: Interpreting genomic testing for chemotherapy decision making. Health Expect 2018; 22:74-82. [PMID: 30387238 PMCID: PMC6351409 DOI: 10.1111/hex.12832] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 08/09/2018] [Accepted: 08/10/2018] [Indexed: 11/29/2022] Open
Abstract
Background Genomic techniques are being developed within oncology and beginning to be experienced within routine cancer care. Little is known about how these tools feature in patients’ experiences of treatment decision making. Objective This research explores the ways in which women interpret and discuss gene expression profiling for breast cancer treatment decision making, as articulated within online accounts. Design This study used a qualitative approach to analyse written exchanges focusing on gene expression profiling in the UK (Oncotype DX test). Accounts are taken from online forums hosted by two UK cancer charity websites, comprising 132 discussion threads from a total of seven forums. Authors qualitatively analysed the data and developed key themes drawing on existing literature from medical sociology. Findings Women used online spaces to share and discuss results of gene expression profiling. Women interpreted results in the context of indirect experience of cancer treatment, and sociocultural depictions of cancer and chemotherapy. Users largely represented the test positively, emphasizing its ability to “personalize” treatment pathways, though many also pointed to inherent uncertainties with regards the possibility of cancer recurrence. Discussion and Conclusions We highlight the complex contexts in which genomic techniques are experienced, with these shaped by personal biographies, online environments and pervasive cultural narratives of cancer and its treatment. We highlight tensions between the claims of genomic testing to aid treatment decision making and patient reflections on the capability of these techniques to resolve uncertainties surrounding treatment decisions.
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Affiliation(s)
- Emily Ross
- The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Julia Swallow
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Anne Kerr
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
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17
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Jones EC, Storksdieck M, Rangel ML. How Social Networks May Influence Cancer Patients' Situated Identity and Illness-Related Behaviors. Front Public Health 2018; 6:240. [PMID: 30234086 PMCID: PMC6131661 DOI: 10.3389/fpubh.2018.00240] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 08/10/2018] [Indexed: 11/13/2022] Open
Abstract
Little research is currently available that captures variation in the degree to which individuals who have, or had cancer in the past (but are in remission) integrate their cancer experience into their sense of self or their cancer-associated identity. Such research should cover how those identities shape personal narratives within existing or new social networks so that, ultimately, we understand the implications for treatment choices and health outcomes. Particularly understudied are the social factors influencing the incorporation of cancer into identity, learning, and behavior. Social network analysis captures specific relationships, what they offer, and the structure or constellation of these relationships around someone who has cancer or has had cancer. Some studies point to potential cultural differences in ethnic or social groups in how social influences on the cancer experience play out in terms of individual coping strategies. In some populations, social cohesion or tight networks are common and of particular importance to individuals and include social institutions like church communities. Social status might also generate social pressures not typically noticed or experienced by other groups. We will discuss how social network analysis can be used to elucidate these factors and, conversely, how the specific context of cancer diagnosis can be used through social network analysis to better understand the role of community in helping individuals address situations of severe adversity.
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Affiliation(s)
- Eric C. Jones
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Martin Storksdieck
- Center for Research on Lifelong STEM Learning, Oregon State University, Corvallis, OR, United States
| | - Maria L. Rangel
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
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18
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Burrows Walters C, Duthie EA. Patients' Perspectives of Engagement as a Safety Strategy. Oncol Nurs Forum 2018; 44:712-718. [PMID: 29052666 DOI: 10.1188/17.onf.712-718] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe patient engagement as a safety strategy from the perspective of hospitalized surgical patients with cancer.
. RESEARCH APPROACH Qualitative, descriptive approach using grounded theory.
. SETTING Memorial Sloan Kettering Cancer Center in New York, New York.
. PARTICIPANTS 13 hospitalized surgical patients with cancer.
. METHODOLOGIC APPROACH Grounded theory with maximum variation sampling.
. FINDINGS Participants' perceptions regarding their engagement as a patient safety strategy were expressed through three overarching themes. CONCLUSIONS Using direct messaging, such as "your safety" as opposed to "patient safety," and teaching patients specific behaviors to maintain their safety appeared to facilitate patient engagement and increase awareness of safety issues. Patients may be willing to accept some responsibility for ensuring their safety by engaging in behaviors that are intuitive or that they are clearly instructed to do; however, they described their involvement in their safety as a right, not an obligation.
. INTERPRETATION Clear, inviting, multimodal communication appears to have the greatest potential to enhance patients' engagement in their safety. Nurses' ongoing assessment of patients' ability to engage is critical insofar as it provides the opportunity to encourage engagement without placing undue burden on them. By employing communication techniques that consider patients' perspectives, nurses can support patient engagement.
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19
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Strekalova YA, Hawkins KE, Drusbosky LM, Cogle CR. Using social media to assess care coordination goals and plans for leukemia patients and survivors. Transl Behav Med 2018; 8:481-491. [PMID: 29800400 DOI: 10.1093/tbm/ibx075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Care coordination has been shown to have a positive effect on the management of chronic disease. Specific to the management of leukemia, coordination may occur between primary care physician, medical and radiation oncologists, surgeons, cardiologists, and genetics specialists. Experiencing gaps in communication and care coordination, many health consumers seek instrumental support in their social circles, including online forums and networks. The goal of this theory-guided study was to provide an in-depth assessment of how individuals use online forums to deliberate about their goals and plans for leukemia care coordination. Guided by the planning theory of communication, the data were collected from the American Cancer Society Cancer Survivors Network and included 125 original posts and 1,248 responses. Thematic analysis and axial coding were applied to analyze the data. Goal-related themes included overcoming the diffusion of care coordination and achieving health management cohesion. Planning themes included social health management, communication self-efficacy, and role deliberation. Online patient forums provide an interactive platform for patients and caregivers to engage in active conversations, which in turn can serve as identifiers of care coordination needs. Communication with those who share similar experiences allows cancer patients and survivors to accumulate functional health literacy, gain communication self-efficacy, and articulate a care coordination role acceptable to them.
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Affiliation(s)
- Yulia A Strekalova
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Kimberly E Hawkins
- Division of Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Leylah M Drusbosky
- Division of Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Cristopher R Cogle
- Division of Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
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20
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Wacker EC. Barriers and facilitators to seeking treatment for subclinical eating disorders: The importance of supportive relationships. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/08975353.2018.1471946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Emily C. Wacker
- Department of Human Development, Marriage and Family Therapy Program, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
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21
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Atherton K, Young B, Kalakonda N, Salmon P. Perspectives of patients with haematological cancer on how clinicians meet their information needs: “Managing” information versus “giving” it. Psychooncology 2018; 27:1719-1726. [DOI: 10.1002/pon.4714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 03/12/2018] [Accepted: 03/14/2018] [Indexed: 01/28/2023]
Affiliation(s)
- Kirsten Atherton
- Division of Clinical Psychology, Department of Psychological Sciences; Liverpool UK
| | - Bridget Young
- Division of Clinical Psychology, Department of Psychological Sciences; Liverpool UK
| | - Nagesh Kalakonda
- Department of Molecular and Clinical Cancer Medicine, First floor, The Sherrington Building, New Medical School; Liverpool UK
| | - Peter Salmon
- Division of Clinical Psychology, Department of Psychological Sciences; Liverpool UK
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22
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Voruganti T, Husain A, Grunfeld E, Webster F. Disruption or innovation? A qualitative descriptive study on the use of electronic patient-physician communication in patients with advanced cancer. Support Care Cancer 2018; 26:2785-2792. [DOI: 10.1007/s00520-018-4103-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 02/11/2018] [Indexed: 12/30/2022]
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23
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Kerr A, Ross E, Jacques G, Cunningham‐Burley S. The sociology of cancer: a decade of research. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:552-576. [PMID: 29446117 PMCID: PMC5901049 DOI: 10.1111/1467-9566.12662] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Biomedicine is often presented as the driving force behind improvements in cancer care, with genomics the latest innovation poised to change the meaning, diagnosis, treatment, prevention and lived experience of cancer. Reviewing sociological analyses of a diversity of patient and practitioner experiences and accounts of cancer during the last decade (2007-17), we explore the experiences of, approaches to and understandings of cancer in this period. We identify three key areas of focus: (i) cancer patient experiences and identities; (ii) cancer risk and responsibilities and (iii) bioclinical collectives. We explore these sociological studies of societal and biomedical developments and how sociologists have sought to influence developments in cancer identities, care and research. We end by suggesting that we extend our understanding of innovations in the fields of cancer research to take better account of these wider social and cultural innovations, together with patients, activists' and sociologists' contributions therein.
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Affiliation(s)
- Anne Kerr
- School of Sociology and Social PolicyUniversity of LeedsUK
| | - Emily Ross
- The Usher InstituteEdinburgh Medical SchoolUniversity of EdinburghUK
| | - Gwen Jacques
- School of Sociology and Social PolicyUniversity of LeedsUK
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24
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Rattay T, Symonds RP, Shokuhi S, Talbot CJ, Schnur JB. The Patient Perspective on Radiogenomics Testing for Breast Radiation Toxicity. Clin Oncol (R Coll Radiol) 2017; 30:151-157. [PMID: 29287972 PMCID: PMC5821695 DOI: 10.1016/j.clon.2017.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/31/2017] [Accepted: 11/01/2017] [Indexed: 02/07/2023]
Abstract
Aims In the field of radiogenomics, several potential predictive genetic markers have been identified that are associated with individual susceptibility to radiation toxicity. Predictive models of radiation toxicity incorporating radiogenomics and other biomarkers are being developed as part of the ongoing multicentre REQUITE trial. The purpose of this study was to explore patient attitudes towards future predictive radiogenomics testing for breast radiation toxicity. Patients and methods Twenty-one semi-structured interviews were conducted with breast cancer patients taking part in the REQUITE study at one centre. We used inductive thematic analysis to generate common themes. Results We identified three emerging themes describing attitudes and feelings towards a predictive radiogenomics test for breast radiation toxicity: theme 1 – willingness to undergo a test (subthemes – information, trusted expert); theme 2 – implications of a test (subthemes – preparation and planning, anxiety without recourse); theme 3 – impact on treatment decision-making (subthemes – prioritising cancer cure, preserving breast integrity, patient preferences). Conclusions Results from the present study indicate that patients support and have confidence in the validity of a radiogenomics test for breast radiation toxicity, but they would prefer the result be provided to healthcare professionals. Except in cases of significant chronic symptoms and pain or significant end-organ damage, participants in this study rarely felt that advance knowledge of their personal risk of breast radiation toxicity would influence their treatment decision-making. These findings provide a number of insights that will allow us to anticipate how patients are likely to engage with predictive radiogenomics testing in the future. Patients’ views and opinions on predictive radiogenomics testing were investigated. Semi-structured interviews with breast cancer patients enrolled in the prospective REQUITE cohort. Participants would prefer the test result to be provided to healthcare professionals rather than directly to patients. Participants rarely felt that advance knowledge of their risk of radiation toxicity would influence their treatment decision. Participants were prepared to consider a treatment change, if predicted to have significant chronic side-effects or end-organ damage.
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Affiliation(s)
- T Rattay
- Department of Cancer Studies, University of Leicester, Leicester, UK.
| | - R P Symonds
- Department of Cancer Studies, University of Leicester, Leicester, UK
| | - S Shokuhi
- Department of Breast Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - C J Talbot
- Department of Genetics, University of Leicester, Leicester, UK
| | - J B Schnur
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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25
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Williams J, Phillips C, Byrd HM. Factors Which Influence Owners When Deciding to Use Chemotherapy in Terminally Ill Pets. Animals (Basel) 2017; 7:E18. [PMID: 28272340 PMCID: PMC5366837 DOI: 10.3390/ani7030018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/04/2017] [Indexed: 11/16/2022] Open
Abstract
Chemotherapy is a commonly integrated treatment option within human and animal oncology regimes. Limited research has investigated pet owners' treatment decision-making in animals diagnosed with malignant neoplasia. Dog and cat owners were asked to complete an online questionnaire to elucidate factors which are key to the decision making process. Seventy-eight respondents completed the questionnaire in full. Fifty-eight percent of pet owners would not elect to treat pets with chemotherapy due to the negative impact of the associated side effects. Seventytwo percent of respondents over estimated pet survival time post chemotherapy, indicating a general perception that it would lead to remission or a cure. Vomiting was considered an acceptable side effect but inappetence, weight loss and depression were considered unacceptable. Owners did expect animals' to be less active, sleep more and play less, but common side effects were not rated as acceptable despite the potential benefits of chemotherapy. Based on the results, veterinary teams involved with oncology consultations should establish if clients have prior experience of cancer treatments and their expectations of survival time. Quality of life assessments should also be implemented during initial oncology consultations and conducted regularly during chemotherapy courses to inform client decision making and to safe guard animal welfare.
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Affiliation(s)
- Jane Williams
- Animal Health Research Group, Hartpury University Centre, Gloucester GL19 3BE, UK.
| | - Catherine Phillips
- Veterinary Nursing Research Group, Hartpury University Centre, Gloucester GL19 3BE, UK.
| | - Hollie Marie Byrd
- Veterinary Nursing Research Group, Hartpury University Centre, Gloucester GL19 3BE, UK.
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26
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Salmon P, Young B. A new paradigm for clinical communication: critical review of literature in cancer care. MEDICAL EDUCATION 2017; 51:258-268. [PMID: 27995660 PMCID: PMC5324633 DOI: 10.1111/medu.13204] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/18/2016] [Accepted: 08/15/2016] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To: (i) identify key assumptions of the scientific 'paradigm' that shapes clinical communication research and education in cancer care; (ii) show that, as general rules, these do not match patients' own priorities for communication; and (iii) suggest how the paradigm might change to reflect evidence better and thereby serve patients better. METHODS A critical review, focusing on cancer care. We identified assumptions about patients' and clinicians' roles in recent position and policy statements. We examined these in light of research evidence, focusing on inductive research that has not itself been constrained by those assumptions, and considering the institutionalised interests that the assumptions might serve. RESULTS The current paradigm constructs patients simultaneously as needy (requiring clinicians' explicit emotional support) and robust (seeking information and autonomy in decision making). Evidence indicates, however, that patients generally value clinicians who emphasise expert clinical care rather than counselling, and who lead decision making. In denoting communication as a technical skill, the paradigm constructs clinicians as technicians; however, communication cannot be reduced to technical skills, and teaching clinicians 'communication skills' has not clearly benefited patients. The current paradigm is therefore defined by assumptions that that have not arisen from evidence. A paradigm for clinical communication that makes its starting point the roles that mortal illness gives patients and clinicians would emphasise patients' vulnerability and clinicians' goal-directed expertise. Attachment theory provides a knowledge base to inform both research and education. CONCLUSIONS Researchers will need to be alert to political interests that seek to mould patients into 'consumers', and to professional interests that seek to add explicit psychological dimensions to clinicians' roles. New approaches to education will be needed to support clinicians' curiosity and goal-directed judgement in applying this knowledge. The test for the new paradigm will be whether the research and education it promotes benefit patients.
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Affiliation(s)
- Peter Salmon
- Department of Psychological SciencesUniversity of LiverpoolLiverpoolUK
| | - Bridget Young
- Department of Psychological SciencesUniversity of LiverpoolLiverpoolUK
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27
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Doherty C, Stavropoulou C, Saunders MNK, Brown T. The consent process: Enabling or disabling patients' active participation? Health (London) 2017; 21:205-222. [PMID: 26487687 PMCID: PMC5349318 DOI: 10.1177/1363459315611870] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Standards expected by doctors' regulatory bodies in respect of the process of consent to treatment have arguably sought to restructure the nature of the doctor-patient relationship from one of the paternalism to that of shared decision-making. Yet, few studies have explored empirically, from patients' perspectives, the extent to which the process of consent to treatment enables or disables patients' participation in medical decision-making. Our article examines patients' attitudes towards the consent process, exploring how and why these attitudes influence patients' active participation in decision-making and considering possible consequent medico-legal issues. Data were collected longitudinally using semi-structured interviews and field observations involving 35 patients and 19 of their caregivers, in an English hospital between February and November 2014. These indicate that generally patients defer to the doctor in respect of treatment decision-making. Although most patients and their caregivers wanted detailed information and discussion, they did not necessarily expect that this would be provided. Furthermore, patients perceived that signing the consent form was an obligatory routine principally to protect doctors from legal action should something go wrong. Our study suggests that patients' predominantly paternalistic perceptions of the consent process can not only undermine attempts by doctors to involve them in decision-making but, as patients are now considered in law as informed actors, their perceptions of the consent form as not being in their interests could be a self-fulfilling prophecy if signing is undertaken without due consideration to the content.
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28
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Atherton K, Young B, Salmon P. Understanding the information needs of people with haematological cancers. A meta-ethnography of quantitative and qualitative research. Eur J Cancer Care (Engl) 2017; 26. [DOI: 10.1111/ecc.12647] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2016] [Indexed: 12/30/2022]
Affiliation(s)
- K. Atherton
- Department of Psychological Sciences; Institute of Psychology, Health and Society; Brownlow Hill Liverpool UK
| | - B. Young
- Department of Psychological Sciences; Institute of Psychology, Health and Society; Brownlow Hill Liverpool UK
| | - P. Salmon
- Department of Psychological Sciences; Institute of Psychology, Health and Society; Brownlow Hill Liverpool UK
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29
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Bolderston A. Patient Experience in Medical Imaging and Radiation Therapy. J Med Imaging Radiat Sci 2016; 47:356-361. [DOI: 10.1016/j.jmir.2016.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/24/2016] [Accepted: 09/14/2016] [Indexed: 11/24/2022]
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30
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Hagan TL, Cohen S, Stone C, Donovan H. Theoretical to Tangible: Creating a Measure of Self-Advocacy for Female Cancer Survivors. J Nurs Meas 2016; 24:428-441. [PMID: 28714448 PMCID: PMC5514617 DOI: 10.1891/1061-3749.24.3.428] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Self-advocacy is well appreciated but poorly defined concept in oncology. METHODS The development of the Female Self-Advocacy in Cancer Survivorship (FSACS) Scale's theoretical underpinnings and item development led to evaluations of the measure's content validity and reliability. RESULTS The construct of self-advocacy contains 3 subdimensions with 57 Likert-type self-report items. Content validity results (S-CVI = 0.81 and S-CVI/UA = 0.83) indicated strong relevancy of items. Reliability results for each of the 3 subdimensions supported the consistency of the FSACS Scale scores, with strong internal consistency (Cronbach's alphas = .88, .81, and .90) and test-retest reliability (PPMC r = .85, .97, and .88). CONCLUSIONS The FSACS Scale captures the construct of self-advocacy, and its scores show strong reliability.
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Affiliation(s)
- Teresa L Hagan
- University of Pittsburgh School of Nursing, Pennsylvania, USA
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31
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Pluut B. Differences that matter: developing critical insights into discourses of patient-centeredness. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2016; 19:501-515. [PMID: 27251048 PMCID: PMC5088218 DOI: 10.1007/s11019-016-9712-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Patient-centeredness can be considered a popular, and at the same time "fuzzy", concept. Scientists have proposed different definitions and models. The present article studies scientific publications that discuss the meaning of patient-centeredness to identify different "discourses" of patient-centeredness. Three discourses are presented; the first is labelled as "caring for patients", the second as "empowering patients" and the third as "being responsive". Each of these discourses has different things to say about (a) the why of patient-centeredness; (b) the patient's identity; (c) the role of the healthcare professional; (d) responsibilities for medical decision-making, and (e) the role of health information. This article compares and contrasts the discourses in ways that allow us to see differences that matter for practitioners in healthcare. On the basis of a relational constructionist philosophy, it is argued that discursive diversity is both an inevitable and a potentially valuable aspect of conversations in healthcare. We are therefore invited to center the challenge of dealing with diversity in productive ways. This article ends with a discussion of the practical implications of the discourse analysis for projects that aim to make healthcare more patient-centered. Debates on patient-centered "Health Information Exchange" are used to explain the need for a recognition of different discourses of patient-centeredness and a reflexive stance towards them.
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Affiliation(s)
- Bettine Pluut
- Utrecht University School of Governance, Bijlhouwerstraat 6, 3511 ZC, Utrecht, Netherlands.
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32
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Bélanger E, Rodríguez C, Groleau D, Légaré F, MacDonald ME, Marchand R. Patient participation in palliative care decisions: An ethnographic discourse analysis. Int J Qual Stud Health Well-being 2016; 11:32438. [PMID: 27882864 PMCID: PMC5122231 DOI: 10.3402/qhw.v11.32438] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 12/13/2022] Open
Abstract
The participation of patients in making decisions about their care is especially important towards the end of life because palliative care decisions involve extensive uncertainty and are heavily influenced by personal values. Yet, there is a scarcity of studies directly observing clinical interactions between palliative patients and their health care providers. In this study, we aimed to understand how patient participation in palliative care decisions is constructed through discourse in a community hospital-based palliative care team. This qualitative study combined ethnographic observations of a palliative care team with discourse analysis. Eighteen palliative care patients with cancer diagnoses, six family physicians, and two nurses were involved in the study. Multiple interactions were observed between each patient and health care providers over the course of 1 year, for a total of 101 consultations, 24 of which were audio-recorded. The analysis consisted in looking for the interpretive repertoires (i.e., familiar lines of argument used to justify actions) that were used to justify patient participation in decision-making during clinical interactions, as well as exploring their implications for decision roles and end-of-life care. Patients and their health care providers seldom addressed their decision-making roles explicitly. Rather, they constructed patient participation in palliative care decisions in a covert manner. Four interpretive repertoires were used to justify patient participation: (1) exposing uncertainty, (2) co-constructing patient preferences, (3) affirming patient autonomy, and finally (4) upholding the authority of health care providers. The results demonstrate how patients and health care providers used these arguments to negotiate their respective roles in decision-making. In conclusion, patients and health care providers used a variety of interpretive repertoires to covertly negotiate their roles in decision-making, and to legitimize decisions that shaped patients’ dying trajectories. Discourse analysis encourages awareness of the role of language in either promoting or hindering patient participation in decision-making.
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Affiliation(s)
- Emmanuelle Bélanger
- Department of Social and Preventive Medicine, Public Health Research Institute (IRSPUM), Université de Montréal, Montréal, Canada;
| | - Charo Rodríguez
- Department of Family Medicine, McGill University, Montreal, Canada
| | | | - France Légaré
- Department of Emergency and Family Medicine, Université Laval, Quebec City, Canada
| | | | - Robert Marchand
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, Canada
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Gulbrandsen P, Clayman ML, Beach MC, Han PK, Boss EF, Ofstad EH, Elwyn G. Shared decision-making as an existential journey: Aiming for restored autonomous capacity. PATIENT EDUCATION AND COUNSELING 2016; 99:1505-1510. [PMID: 27460801 DOI: 10.1016/j.pec.2016.07.014] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 07/02/2016] [Accepted: 07/06/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE We describe the different ways in which illness represents an existential problem, and its implications for shared decision-making. METHODS We explore core concepts of shared decision-making in medical encounters (uncertainty, vulnerability, dependency, autonomy, power, trust, responsibility) to interpret and explain existing results and propose a broader understanding of shared-decision making for future studies. RESULTS Existential aspects of being are physical, social, psychological, and spiritual. Uncertainty and vulnerability caused by illness expose these aspects and may lead to dependency on the provider, which underscores that autonomy is not just an individual status, but also a varying capacity, relational of nature. In shared decision-making, power and trust are important factors that may increase as well as decrease the patient's dependency, particularly as information overload may increase uncertainty. CONCLUSION The fundamental uncertainty, state of vulnerability, and lack of power of the ill patient, imbue shared decision-making with a deeper existential significance and call for greater attention to the emotional and relational dimensions of care. Hence, we propose that the aim of shared decision-making should be restoration of the patient's autonomous capacity. PRACTICE IMPLICATIONS In doing shared decision-making, care is needed to encompass existential aspects; informing and exploring preferences is not enough.
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Affiliation(s)
- Pål Gulbrandsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; HØKH Research Centre, Akershus University Hospital, Lørenskog, Norway.
| | - Marla L Clayman
- American Institutes for Research, 10 S Riverside Plaza, Suite 600, Chicago, IL, USA
| | | | - Paul K Han
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, USA
| | - Emily F Boss
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eirik H Ofstad
- Department of Internal Medicine, Nordland Hospital, Bodø, Norway
| | - Glyn Elwyn
- The Preference Laboratory, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
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Degeling C, Carter SM, Rychetnik L. All care, but whose responsibility? Community juries reason about expert and patient responsibilities in prostate-specific antigen screening for prostate cancer. Health (London) 2016; 20:465-84. [PMID: 27491944 DOI: 10.1177/1363459316660862] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
General practitioners have implicitly been given responsibility for guiding men's decisions about prostate-specific antigen-based screening for prostate cancer, but patients' expectations of the bounds of this responsibility remain unclear. We sought to explore how well-informed members of the public allocate responsibilities in prostate-specific antigen screening decision-making. In 2014, we convened two Community juries in Sydney, Australia, to address questions related to the content and timing of information provision and respective roles of patients and general practitioners in screening decisions. Participants in the first jury were of mixed gender and of all ages (n = 15); the participants in the second jury were all male and of screening age (n = 12). Both juries were presented with balanced factual evidence on the harms and benefits of prostate-specific antigen screening and expert perspectives on ethico-legal aspects of consent in medical practice. In their deliberations, jurors agreed that general practitioners should take responsibility for informing men of the options, risks and benefits of prostate-specific antigen testing, but arrived at different positions on whether or not general practitioners should also guide screening decisions. Jurors also disagreed on how much and when general practitioners should provide detailed information about biopsies and treatments. These responses suggest that for prostate-specific antigen testing, there is a public expectation that both the allocation of responsibility between general practitioners and their male patients, and the level of information provided will be tailored to individual men. In the presence of expert uncertainty, a well-informed public may have reason to embrace or resist shared decision-making processes.
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Affiliation(s)
- Chris Degeling
- The University of Sydney, AustraliaThe University of Notre Dame Australia, Australia
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Manca T. Health professionals and the vaccine narrative: ‘the power of the personal story’ and the management of medical uncertainty. HEALTH RISK & SOCIETY 2016. [DOI: 10.1080/13698575.2016.1190319] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hagan TL, Medberry E. Patient Education vs. Patient Experiences of Self-advocacy: Changing the Discourse to Support Cancer Survivors. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:375-81. [PMID: 25846573 PMCID: PMC4598253 DOI: 10.1007/s13187-015-0828-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A growing emphasis on patient self-advocacy has emerged in the public discourse on cancer survivorship. This discourse shapes patients' conceptualizations about self-advocacy and in turn influences their health care attitudes and behaviors. The purpose of this discourse analysis is to explore the language of self-advocacy by comparing a published self-advocacy guide with the lived experiences of women with ovarian cancer. Data sources include (1) a self-advocacy patient education guide published by the National Coalition for Cancer Survivorship and (2) transcripts of focus groups conducted with ovarian cancer survivors. Discourse analysis techniques were used to take a close look at the language used by both to uncover the meaning each group ascribed to self-advocacy. Challenges and inconsistencies were noted between the patient education guide and transcripts including viewing self-advocacy as a skill set to assert one's needs as opposed to a means by which to preserve a positive attitude and maintain a trusting relationship with health care providers, respectively. Some women saw themselves as self-advocates yet struggled to locate relevant health information and hesitated to upset their relationship with their health care providers. This analysis highlights tensions between the discourses and points to ways in which patient education materials can be adjusted to support cancer survivors in advocating for their needs according to their unique situations and preferences.
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Affiliation(s)
- Teresa L Hagan
- School of Nursing, University of Pittsburgh, 336 Victoria Building, 3500 Victoria Street, Pittsburgh, PA, 15261, USA.
| | - Elizabeth Medberry
- Department of Linguistics, University of Pittsburgh, 2816 Cathedral of Learning, Pittsburgh, PA, 15260, USA
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Hopmans W, Damman OC, Senan S, Hartemink KJ, Smit EF, Timmermans DRM. A patient perspective on shared decision making in stage I non-small cell lung cancer: a mixed methods study. BMC Cancer 2015; 15:959. [PMID: 26673216 PMCID: PMC4682255 DOI: 10.1186/s12885-015-1974-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 12/05/2015] [Indexed: 12/25/2022] Open
Abstract
Background Surgery and stereotactic ablative radiotherapy (SABR) are both curative treatment options for patients with a stage I non-small cell lung cancer (NSCLC). Consequently, there is growing interest in studying the role of patients in treatment decision making. We studied how patients with stage I NSCLC perceived shared decision making (SDM) in general, and how they viewed different aspects of SDM. Methods A sequential mixed methods design was used, consisting of qualitative interviews (N = 11), as well as a survey study (N = 76) focusing on different SDM-related aspects. Participants were interviewed to understand their own experience with treatment decision making. In the survey study, patients rated the importance of 20 aspects of shared decision making that were identified during interviews. Descriptive analysis and explorative factor analysis were performed. Results We assessed six qualitative themes covering SDM aspects that were determined by patients to be important. The survey identified four SDM-related factors with sufficient internal consistency, namely (1) ‘guidance by clinician’ (α = .741), (2) ‘conduct of clinician’ (α = .774); (3) ‘preparation for treatment decision making’ (α = .864); and (4) ‘active role of patient in treatment decision making’ (α = .782). Of these, clinician guidance was rated as most important by patients (M = 3.61; SD = .44). Only 28.9 % of patients in the survey study reported that both treatment options were discussed with them. Conclusions Patients with a stage I NSCLC found clinician guidance to be important when making treatment decisions. Nevertheless, the majority of patients reported not being offered both treatment options, which might have influenced this finding.
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Affiliation(s)
- Wendy Hopmans
- Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. .,Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Olga C Damman
- Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Koen J Hartemink
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| | - Egbert F Smit
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands. .,Department of Thoracic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| | - Danielle R M Timmermans
- Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
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Glasdam S, Oeye C, Thrysoee L. Patients' participation in decision-making in the medical field - ‘projectification’ of patients in a neoliberal framed healthcare system. Nurs Philos 2015; 16:226-38. [DOI: 10.1111/nup.12092] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Stinne Glasdam
- Integrative Health Research; Department of Health Sciences; Faculty of Medicine; Lund University; Lund Sweden
| | - Christine Oeye
- Division of Health; Stord/Haugesund University College; Stord Norway
- Centre for Care Research; Bergen University College; Bergen Norway
| | - Lars Thrysoee
- Department of Cardiology; Odense University Hospital; Odense Denmark
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Brown P, de Graaf S, Hillen M, Smets E, van Laarhoven H. The interweaving of pharmaceutical and medical expectations as dynamics of micro-pharmaceuticalisation: advanced-stage cancer patients' hope in medicines alongside trust in professionals. Soc Sci Med 2014; 131:313-21. [PMID: 25465500 DOI: 10.1016/j.socscimed.2014.10.053] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 10/21/2014] [Accepted: 10/27/2014] [Indexed: 11/25/2022]
Abstract
Existing pharmaceuticalisation research denotes the salience of expectations in novel medicines and in the medical contexts through which these may be accessed. Specific processes of expectation such as hope and trust, alongside their shaping of patients' lifeworlds around pharmaceutical use, remain neglected however. Considering data from in-depth interviews and observations involving thirteen patients with advanced-stage cancer diagnoses who were or had recently been involved in clinical trials, we develop an interpretative phenomenological analysis of the influence of hope and trust upon the accessing of novel medicines through trials, illuminating the depth and texture of pharmaceuticalisation at the micro-level. Trust in clinicians and hope in trial medicines, for self and future patients, were important in the reconfiguring of patients' horizon of possibilities when accessing new medicines. Interwoven processes of trust and hope, embedded within heightened vulnerability, sustained the bracketing out of doubts regarding medicines, trials and professionals. The need to maintain hopes, and trusting relations with professionals who facilitated these hopes, generated meaning and momentum of medicines use which inhibited disengagement from trials. Findings indicate the taken-for-granted, as well as more reflexive, pursuit of solutions through medicines, which in this case-study enabled the generation of evidence through trial involvement. Analyses of micro-level dynamics within both downstream-consumption and upstream-substantiation of pharmaceutical solutions assist more nuanced accounts of interests, agency and expectations within pharmaceuticalisation.
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Affiliation(s)
- Patrick Brown
- Department of Sociology and Anthropology, University of Amsterdam, The Netherlands.
| | - Sabine de Graaf
- Department of Sociology and Anthropology, University of Amsterdam, The Netherlands
| | - Marij Hillen
- Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Ellen Smets
- Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, The Netherlands
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Brown P, de Graaf S, Hillen M. The inherent tensions and ambiguities of hope: towards a post-formal analysis of experiences of advanced-cancer patients. Health (London) 2014; 19:207-25. [PMID: 25377667 DOI: 10.1177/1363459314555241] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sociological and anthropological analyses of hope in health-care contexts have tended to address institutional processes, especially the power dynamics that function through such systems or political economies of hope, which in turn shape interactions through which hopes are managed. This article extends this approach through a more detailed consideration of the experience of hoping itself. Our post-formal analysis denotes the tensions that are intrinsic and defining features of lifeworlds around hope, emphasising the dissonance and fragility of hoping. Drawing upon interview and observational data involving patients with advanced-cancer diagnoses who were taking part in clinical trials, we explore three main tensions which emerged within the analysis: tensions involving time and liminality between future and present; ontological tensions involving the concrete and the possible, the 'realistic' and the positive; and tensions in taken-for-grantedness between the reflective and the mundane, the specific and the ambiguous. Rather than three separate sets of tensions, those involving time, ontology and taken-for-grantedness are very much interwoven. In denoting the influence of social processes in engendering tensions, we bridge sociological and anthropological approaches with a more definition-oriented literature, developing understandings of hoping and its key characteristics in relation to other processes of coping amidst vulnerability and uncertainty.
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Affiliation(s)
- Patrick Brown
- Department of Sociology and Anthropology, University of Amsterdam, The Netherlands
| | - Sabine de Graaf
- Department of Sociology and Anthropology, University of Amsterdam, The Netherlands
| | - Marij Hillen
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, The Netherlands
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Lombardo AP, Angus JE, Lowndes R, Cechetto N, Khattak S, Ahmad F, Bierman AS. Women's strategies to achieve access to healthcare in Ontario, Canada: a meta-synthesis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2014; 22:575-587. [PMID: 24405076 DOI: 10.1111/hsc.12093] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/06/2013] [Indexed: 06/03/2023]
Abstract
As part of a mixed methods study on women's access to the healthcare system in Ontario, Canada, we undertook a qualitative meta-synthesis to better understand the contextual conditions under which women access healthcare. An earlier phase of the synthesis demonstrated a series of factors that complicate women's access to healthcare in Ontario. Here, we consider women's agency in responding to these factors. We used meta-study methods to synthesise findings from qualitative studies published between January 2002 and December 2010. Studies were identified by searches of numerous databases, including CINAHL, MEDLINE, Scopus, Gender Studies Database and LGBT Life. Inclusion criteria included use of a qualitative research design; published in a peer-reviewed journal during the specified time period; included a sample at least partially recruited in Ontario; included distinct findings for women participants; and in English language. Studies were included in the final sample after appraisals using a qualitative research appraisal tool. We found that women utilised a spectrum of responses to forces limiting access to healthcare: mobilising financial, social and interpersonal resources; living out shortfalls by making do, doing without, and emotional self-management; and avoiding illness and maintaining health. Across the studies, women described their efforts to overcome challenges to accessing healthcare. However, there were evident limits to women's agency and many of their strategies represented temporary measures rather than viable long-term solutions. While women can be resourceful and resilient in overcoming access disparities, systemic problems still need to be addressed. Women need to be involved in designing and implementing interventions to improve access to healthcare, and to address the root problems of these issues.
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Burt J, Rick J, Blakeman T, Protheroe J, Roland M, Bower P. Care plans and care planning in long-term conditions: a conceptual model. Prim Health Care Res Dev 2014; 15:342-54. [PMID: 23883621 PMCID: PMC3976966 DOI: 10.1017/s1463423613000327] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The prevalence and impact of long-term conditions continues to rise. Care planning for people with long-term conditions has been a policy priority for chronic disease management in a number of health-care systems. However, patients and providers appear unclear about the formulation and implementation of care planning. Further work in this area is therefore required to inform the development, implementation and evaluation of future care planning initiatives. We distinguish between 'care planning' (the process by which health-care professionals and patients discuss, agree and review an action plan to achieve the goals or behaviour change of most relevance and concern to the patient) and a 'care plan' (a written document recording the outcome of a care planning process). We propose a typology of care planning and care plans with three core dimensions: perspective (patient or professional), scope (a focus on goals or on behaviours) and networks (confined to the professional-patient dyad or extending to the entire care network). In addition, we draw on psychological models of mediation and moderation to outline potential mechanisms through which care planning and care plans may lead to improved outcomes for both patients and the wider health-care system. The proposed typology of care planning and care plans offered here, along with the model of the process by which care planning may influence outcomes, provide a useful framework for future policy developments and evaluations. Empirical work is required to explore the degree to which current care planning approaches and care plans can be described according to these dimensions, and the factors that determine which types of patients and professionals use which type of care plans.
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Affiliation(s)
- J Burt
- Corresponding author: Jenni Burt, Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0SR. Phone 01223 330596. Fax 01223 762515.
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Sinding C, Warren R, Fitzpatrick-Lewis D, Sussman J. Research in cancer care disparities in countries with universal healthcare: mapping the field and its conceptual contours. Support Care Cancer 2014; 22:3101-20. [PMID: 25120008 DOI: 10.1007/s00520-014-2348-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/29/2014] [Indexed: 02/03/2023]
Abstract
The paper reviews published studies focused on disparities in receipt of cancer treatments and supportive care services in countries where cancer care is free at the point of access. We map these studies in terms of the equity stratifiers they examined, the countries in which they took place, and the care settings and cancer populations they investigated. Based on this map, we reflect on patterns of scholarly attention to equity and disparity in cancer care. We then consider conceptual challenges and opportunities in the field, including how treatment disparities are defined, how equity stratifiers are defined and conceptualized and how disparities are explained, with special attention to the challenge of psychosocial explanations.
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Affiliation(s)
- Christina Sinding
- School of Social Work & Department of Health, Aging and Society, McMaster University, Hamilton, Ontario, Canada,
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Durif-Bruckert C, Roux P, Morelle M, Mignotte H, Faure C, Moumjid-Ferdjaoui N. Shared decision-making in medical encounters regarding breast cancer treatment: the contribution of methodological triangulation. Eur J Cancer Care (Engl) 2014; 24:461-72. [PMID: 25040308 DOI: 10.1111/ecc.12214] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2014] [Indexed: 11/30/2022]
Abstract
The aim of this study on shared decision-making in the doctor-patient encounter about surgical treatment for early-stage breast cancer, conducted in a regional cancer centre in France, was to further the understanding of patient perceptions on shared decision-making. The study used methodological triangulation to collect data (both quantitative and qualitative) about patient preferences in the context of a clinical consultation in which surgeons followed a shared decision-making protocol. Data were analysed from a multi-disciplinary research perspective (social psychology and health economics). The triangulated data collection methods were questionnaires (n = 132), longitudinal interviews (n = 47) and observations of consultations (n = 26). Methodological triangulation revealed levels of divergence and complementarity between qualitative and quantitative results that suggest new perspectives on the three inter-related notions of decision-making, participation and information. Patients' responses revealed important differences between shared decision-making and participation per se. The authors note that subjecting patients to a normative behavioural model of shared decision-making in an era when paradigms of medical authority are shifting may undermine the patient's quest for what he or she believes is a more important right: a guarantee of the best care available.
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Affiliation(s)
- C Durif-Bruckert
- Groupe de Recherche en Psychologie Sociale, Institut de psychologie (GRePS), Université de Lyon (Lyon 2), Bron, France.,CIC-EC3, Inserm, Preducan, Institut de Cancérologie de la Loire, St-Priest-en-Jarez, France
| | - P Roux
- Groupe de Recherche en Psychologie Sociale, Institut de psychologie (GRePS), Université de Lyon (Lyon 2), Bron, France
| | - M Morelle
- Centre Léon Bérard, Lyon, France.,GATE Lyon St Etienne CNRS UMR 5824, Ecully, France
| | | | - C Faure
- Centre Léon Bérard, Lyon, France
| | - N Moumjid-Ferdjaoui
- Centre Léon Bérard, Lyon, France.,GATE Lyon St Etienne CNRS UMR 5824, Ecully, France.,Université Lyon 1, Villeurbanne, France
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Kiyang LN, Labrecque M, Doualla-Bell F, Turcotte S, Roch G, Farley C, Bas MC, Légaré F. Nurses' intention to support informed decision-making about breast cancer screening with mammography: a survey. Can J Nurs Res 2014; 45:136-52. [PMID: 24236376 DOI: 10.1177/084456211304500309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
There is growing interest in informed decision-making about breast cancer screening with mammography and growing advocacy for the provision of balanced information about potential benefits and harms. The authors report on a survey evaluating nurses' intention to support women targeted by the Quebec Breast Cancer Screening Program in making informed decisions about breast cancer screening with mammography. Of the 840 questionnaires completed, 618 were included in the data analysis. The mean +/- standard deviation score for intention was 1.7 +/- 1.2 on a 6-point Likert scale ranging from -3 to +3, indicating strong intention to support the targeted women. Perceived behavioural control was the theory-based variable most strongly associated with intention, followed by attitude and social norm. These results can be used to develop interventions to train nurses in integrating informed decision-making about breast cancer screening with mammography into their practice and to design relevant decision support tools.
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Affiliation(s)
- Lawrence Ndoh Kiyang
- Centre Hospitalier Universitaire de Québec Research Centre, Hôpital Saint-François d'Assise, Quebec City, Quebec, Canada
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Seibel K, Valeo SC, Xander C, Adami S, Duerk T, Becker G. Terminally ill patients as customers: the patient's perspective. J Palliat Med 2013; 17:11-7. [PMID: 24341322 DOI: 10.1089/jpm.2013.0141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Consumerism in health care defines patients as self-determined, rational customers. Yet, it is questionable whether vulnerable patients, such as the terminally ill, also fulfill these criteria. Vulnerable contexts and the patient's perspective on being a customer remain relatively unexplored. The present study addresses this research gap by analyzing terminally ill patients' views on being customers. AIM To explore the ways in which patients in palliative care refer to themselves as patients/customers, and how the patients' concepts of self-determination are related to their attitudes toward the patient/customer role. DESIGN Qualitative interviews were conducted. Data were analyzed in three steps: narrative analysis, thematic content analysis, and typology construction. SETTING/PARTICIPANTS Researchers recruited 25 patients via the Department of Palliative Care, University Medical Center Freiburg, Germany. RESULTS In many ways, palliative patients contradict the image of a self-determined customer. The palliative patient role is characterized by the concept of relational self-determination rather than an unrestricted self-determination. Self-attribution as a customer still occurs when positively associated with a person-centered, individualized treatment. Thus, the customer and patient role overlap within the palliative care setting because of the focus on the individual. CONCLUSIONS The idealized customer role cannot be arbitrarily applied to all medical fields. Palliative patients are dependent on the physician, regardless of whether the customer or patient role is preferred. Hence, self-determination must be understood in relational terms, and physicians must recognize their crucial role in promoting patients' self-determination in the context of shared decision-making.
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Affiliation(s)
- Katharina Seibel
- Department of Palliative Care, Medical Center - University of Freiburg , Freiburg, Germany
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National electronic health records and the digital disruption of moral orders. Soc Sci Med 2013; 101:70-7. [PMID: 24560226 DOI: 10.1016/j.socscimed.2013.11.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 11/11/2013] [Accepted: 11/13/2013] [Indexed: 11/23/2022]
Abstract
The digitalisation of patient health data to provide national electronic health record systems (NEHRS) is a major objective of many governments. Proponents claim that NEHRS will streamline care, reduce mistakes and cut costs. However, building these systems has proved highly problematic. Using recent developments in Australia as an example, we argue that a hitherto unexamined source of difficulty concerns the way NEHRS disrupt the moral orders governing the production, ownership, use of and responsibility for health records. Policies that pursue digitalisation as a self-evident 'solution' to problems in healthcare without due regard to these disruptions risk alienating key stakeholders. We propose a more emergent approach to the development and implementation of NEHRS that supports moral re-ordering around rights and responsibilities appropriate to the intentions of those involved in healthcare relationships.
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Chalamon I, Chouk I, Heilbrunn B. Does the patient really act like a supermarket shopper? Proposal of a typology of patients' expectations towards the healthcare system. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2013. [DOI: 10.1179/2047971913y.0000000036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Thórarinsdóttir K, Kristjánsson K. Patients’ perspectives on person-centred participation in healthcare. Nurs Ethics 2013; 21:129-47. [DOI: 10.1177/0969733013490593] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The aim of this article was to critically analyse the concept of person-centred participation in healthcare from patients’ perspectives through a review of qualitative research findings. In accordance with the integrative review method of Broom, data were retrieved from databases, but 60 studies were finally included in the study. The diverse attributes of person-centred participation in healthcare were identified and contrasted with participation that was not person-centred and analysed through framework analysis. Person-centred participation in healthcare was found to be based on patients’ experiences, values, preferences and needs in which respect and equality were central. It manifested itself via three intertwined phases: the human-connection phase, the phase of information processing and the action phase. The results challenge in many aspects earlier concept analyses of patient participation in addition to illuminating patient participation that is not positively valued by patients.
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