Problematic integration theory: implications of supportive communication for breast cancer patients

Problematic Integration: Racial Discordance in End-of-Life Decision Making

We describe racially discordant oncology encounters involving EOL decision-making. Fifty-eight provider interviews were content analyzed using the tenets of problematic integration theory. We found EOL discussions between non-Black providers and their Black patients were often complex and anxiety-inducing. That anxiety consisted of (1) ontological uncertainty in which providers characterized the nature of Black patients as distrustful, especially in the context of clinical trials; (2) ontological and epistemological uncertainty in which provider intercultural incompetency and perceived lack of patient health literacy were normalized and intertwined with provider assumptions about patients' religion and support systems; (3) epistemological uncertainty as ambivalence in which providers' feelings conflicted when deciding whether to speak with family members they perceived as lacking health literacy; (4) divergence in which the provider advised palliative care while the family desired surgery or cancer-directed medical treatment; and (5) impossibility when an ontological uncertainty stance of Black distrust was seen as natural by providers and therefore impossible to change. Some communication strategies used were indirect stereotyping, negotiating, asking a series of value questions, blame-guilt framing, and avoidance. We concluded that provider perceptions of Black distrust, religion, and social support influenced their ability to communicate effectively with patients.

Application of Problematic Integration Theory in Health Communication: A Scoping Review

Problematic integration theory is a theory in communication that deals with the processing of messages by humans. It is helpful to study challenges and their solutions in the health communication context to develop effective relationships, treat patients, and, ultimately, ensure the well-being of society. A scoping review was conducted. Three databases were searched following the PRISMA-ScR statement without a time frame. Independent screening of titles, abstracts, and full texts was performed, and the studies selected based on the inclusion and exclusion criteria were assessed. The required information was then extracted from the studies and entered into Excel software. A total of 43 studies related to PI theory were identified in the databases. The results indicated that PI theory is used to interpret feelings, beliefs, challenges, concerns, and problematic dilemmas in five thematic categories: elderly care, cancer care, infertility, pregnancy, and childbirth care, illness care, and sexual care. Each of the papers also offers distinctive and valuable considerations for interventions such as communication strategies, coping mechanisms, uncertainty and certainty management, information management, education, training, support groups, and campaigns to improve decision-making and meet the challenges of health communication.

Survived but feeling vulnerable and insecure: a qualitative study of the mental preparation for RTW after breast cancer treatment

Background

Improvements in treatment have resulted in an increasing number of cancer survivors potentially being able to return to work after medical treatment. In this paper we focus on the considerations regarding return to work (RTW) of breast cancer absentees in the Belgian context and how these considerations are related to reactions from their social environment.

Methods

A qualitative study was performed to understand the RTW considerations of Belgian breast cancer absentees who had undergone breast cancer surgery in 2006. Twenty-two participants (mean age 46) were included and interviewed between May 2008 and August 2009 in their personal environment. An in-depth analysis (Grounded Theory) took place using the Qualitative Analysis Guide of Leuven (Quagol).

Results

Before the actual RTW, breast cancer employees try to build an image of the future resumption of work based on medical grounds and their knowledge of the workplace. Four matters are considered prior to RTW: (i) women want to leave the sick role and wish to keep their job; (ii) they consider whether working is worth the effort; (iii) they reflect on their capability; and (iv) they have doubts about being accepted in the workplace after returning. These inner thoughts are both product and input for the interaction with the social environment. The whole process is coloured by uncertainty and vulnerability.

Conclusion

Our study demonstrated that mental preparation for RTW is not a linear process of improvement. It shows a detailed picture of four types of considerations made by breast cancer survivors before they actually resume work. Vulnerability appears to be an overarching theme during mental preparation. As the social environment plays an important role, people from that environment must become more aware of their influence on decreasing or increasing a woman’s vulnerability while preparing for RTW.