Pudor, honor, and autoridad: the evolving patient-physician relationship in Spain

Coping with modesty during radiotherapy for breast cancer: a multicentric study

PURPOSE

Breast cancer is the most frequently diagnosed tumour, representing nearly 30% of all new cases in women. Radiotherapy (RT) plays a crucial role in the management of breast cancer. The objective of this study is to assess modesty in patients undergoing RT for breast cancer and take their suggestions and ideas into consideration to enhance the quality of treatment in this regard.

METHODS

The study enrolled 555 breast cancer patients undergoing adjuvant RT in three Italian centres. Patients completed a self-test questionnaire assessing their comfort level concerning modesty during therapy and their relationship with strangers and healthcare professionals. The impact of religious views and potential changes in sexuality were also examined.

RESULTS

Results showed that modesty was a common concern across the overall cohort of patients, with discomfort in being undressed during RT correlating with discomfort experienced in other daily life situations. Most patients felt more at ease with same sex healthcare workers. Age was also a major factor with younger patients generally feeling more comfortable with healthcare workers of the same age group. Interestingly, the surgical technique used (mastectomy vs. quadrantectomy) did not significantly influence modesty perceptions. Patients provided valuable suggestions to improve privacy and modesty during RT.

CONCLUSION

This study demonstrates that modesty is an important issue for women undergoing RT, which can be influenced by personal characteristics and hospital-related factors. A reflection about the need to address modesty concerns and to incorporate dedicated interventions for protecting patients' physical and emotional well-being is warranted. Initiatives to improve communication, involvement, and body image support should also be integrated into the care path of patients to better their overall therapeutic experience. This study paves the way for broader research and interventions in daily cancer care.

Sexual Modesty in Sexual Expression and Experience: A Scoping Review, 2000 - 2021

Sexual modesty is the social, cultural, interpersonal, and psychological systems - defined by the tenets of Script Theory - that regulate individuals' sexual expression and experience at the social, legal, and interpersonal boundaries of acceptable/not-acceptable, private/public, and personal/social. Almost all aspects of sexual expression and experience are touched by the pervasive modesty standards for sexual communication, sexual display, sexual relations, and sexual behaviors. Sexual modesty influences an array of sexual and reproductive health outcomes. Many aspects of sexual modesty are enforced by legal as well as social, cultural, and religious proscriptions, including social shaming and ostracism as well as corporal and capital punishments. The purpose of this paper is to summarize a diverse literature related to sexual modesty from the years 2000 to 2021 in order to clarify its role in sexual health and sexual wellbeing and to identify directions for new research.

Predictors of Physician Compassion, Empathy, and Related Constructs: a Systematic Review

BACKGROUND

Compassion in healthcare provides measurable benefits to patients, physicians, and healthcare systems. However, data regarding the factors that predict care (and a lack of care) are scattered. This study systematically reviews biomedical literature within the Transactional Model of Physician Compassion and synthesizes evidence regarding the predictors of physician empathy, compassion, and related constructs (ECRC).

METHODS

A systematic literature search was conducted in CENTRAL, MEDLINE, PsycINFO, EMBASE, CINAHL, AMED, OvidJournals, ProQuest, Web of Science, and Scopus using search terms relating to ECRC and its predictors. Eligible studies included physicians as participants. Methodological quality was assessed based on the Cochrane Handbook, using ROBINS-I risk of bias tool for quantitative and CASP for qualitative studies. Confidence in findings was evaluated according to GRADE-CERQual approach.

RESULTS

One hundred fifty-two included studies (74,866 physicians) highlighted the diversity of influences on compassion in healthcare (54 unique predictors). Physician-related predictors (88%) were gender, experience, values, emotions and coping strategies, quality of life, and burnout. Environmental predictors (38%) were organizational structure, resources, culture, and clinical environment and processes. Patient-related predictors (24%) were communication ease, and physicians' perceptions of patients' motives; compassion was also less forthcoming with lower SES and minority patients. Evidence related to clinical predictors (15%) was scarce; high acuity presentations predicted greater ECRC.

DISCUSSION

The growth of evidence in the recent years reflects ECRC's ongoing importance. However, evidence remains scattered, concentrates on physicians' factors that may not be amenable to interventions, lacks designs permitting causal commentary, and is limited by self-reported outcomes. Inconsistent findings in the direction of the predictors' effects indicate the need to study the relationships among predictors to better understand the mechanisms of ECRCs. The current review can guide future research and interventions.

The Development and Validation of a Modesty Measure for Diverse Muslim Populations

This paper reports on the multi-phase development of an English-language modesty measure for use among Muslim populations. The process yielded a 10-item measure that has high levels of internal consistency reliability (Cronbach's α of 0.83), and has acceptable discriminant and predictive validity. Specifically although our modesty measure for Muslim women was found to be significantly correlated with measures of positive and negative religious (Islamic) coping, it was not significantly correlated with religious practice-based religiosity (discriminant validity). Further logistic modeling revealed higher modesty levels positively associated with forgoing mammography because of concerns about lack of same-sex providers (predictive validity).

Defining and exploring modesty in Jewish American women

Whether culture-based modesty may be a barrier to women's health care has been a longstanding question. Numerous studies have noted that, in certain cultures, modesty is considered a barrier to mammography screening and breast feeding. Though modesty has been noted as an inherent aspect of the lived experience of many cultures, no extant measures or clear definitions were found. Jewish women, some having strict rules regarding modesty, were sampled to understand their definition of modesty. These perspectives were objectively analyzed using Q methodology. We found that although some perspectives on modesty may be accounted for by culture, there are others that are not.

[Analysis of patients violence in primary care]

OBJECTIVE

Main aim: to determine the frequency of violence in primary care. Secondary aims: to analyse its causes, consequences and connection with professional burnout and reduced motivation.

DESIGN

Transversal, descriptive study.

SETTING

Primary care.

PARTICIPANTS

68 primary care doctors from 4 districts in the province of Jaén (350, 19%).

MAIN MEASUREMENTS

Self-administered questionnaire with an ad hoc design, sent out by mail and including personal and job details and doctors' views on the causes and consequences of burnout and violence, and the attitudes of the Andalusian Health Service (SAS) and professional bodies (overall reliability, Cronbach's alpha =.7898).

RESULTS

58% had suffered aggression (85% verbal abuse, 67.5% threats, 12.5% physical aggression). Being attacked was linked with attributing the responsibility to the patients (odds ratio [OR]=7.6, 95% confidence interval [CI], 2.5-23), with doing extra shifts (OR=6.3; 95% CI, 1.2-33), rigidity (OR=3.5; 95% CI, 1.2-10.7), inadequate handling of emotive situations (OR=3.2; 95% CI, 1.1-9.2,) and incompetence (OR=5.2; 95% CI, 1.6-17). Violence scored the lowest as cause of burnout and was linked to the job being less rewarding (OR=2.9; 95% CI, 1.0-7.8). It was linked to irritation with the SAS (OR=2.8; 95% CI, 1.0-7.5) and fear of reduced motivation (OR=2.8; 95% CI, 1.0-7.5), with this latter being linked to loss of social prestige (P<.01), feeling low self-esteem (P<.01), and depression (P<.01).

CONCLUSIONS

Violence is more common than in the figures given by the International Labour Organisation. It is associated with distrust, lack of communication in health care delivery and incompetence. It is the cause of burnout that is least appreciated and it is linked to the job being less rewarding and to greater fear of reduced motivation.