Grieving "The Death of Possibility": Memorable Messages of (Dis)Enfranchised Loss in Invisible, Physical Illness

Making end-of-life health disparities in the U.S. visible through family bereavement narratives

Objective

End-of-life experiences can have important implications for the meaning-making and communication of bereaved family members, particularly due to (in)access to formal healthcare services (i.e., palliative care and hospice). Grounded in Communicated Narrative Sense-Making theory, this study extends knowledge about how the stories told about end-of-life by bereaved family members affect and reflect their sense-making, well-being and importantly, potential disparities in end-of-life care.

Methods

Semi-structured interviews with 25 bereaved individuals were conducted regarding their experiences with the terminal illness and death of an immediate family member. Using a framework of family bereavement narratives, a cross-case data analysis demonstrated qualitative patterns between (in)access to end-of-life care and how participants framed bereavement stories.

Results

Four themes illustrated the continuum of communication that families engaged in when making sense of end-of-life experiences, including reflections on silence, tempered frustrations, comfort with care, and support from beyond.

Innovation

This innovative qualitative connection between family members' bereavement stories and end-of-life care emphasizes the importance of employing a health equity lens within hospice and palliative care, especially in addressing the important aim of comprehensively supporting families even when illness ends. This study demonstrates that access to, quality of, and imagining beyond current structures for EOL may be vital factors for facilitating effective sense-making for the dying and their family systems.

Conclusion

These findings illustrate the potential interconnections between (in)access to end-of-life care, sense-making, and communication for individuals and families experiencing terminal illness and bereavement.

"Saving us to Death": Ideology and Communicative (Dis)enfranchisement in Misapplications of the 2016 CDC Opioid Prescribing Guidelines

Guided by the theory of communicative (dis)enfranchisement (TCD), this study interrogates how interactions in which chronic pain patients are force tapered from their prescribed opioids are constrained and afforded by the hegemonic ideologies. To interrogate the harms caused for chronic pain patients by ideological policies enacted by the Centers for Disease Control and Prevention and assess what communicative mechanisms reify and resist such ideologies, this research analyzes 238 posts authored by chronic pain patient Reddit users. Reflexive thematic analysis illuminated a hegemonic ideology of opiophobia, (im)material ramifications of (a) discrimination by doctors, and (b) political and legal interference; mechanisms of reification: (a) positioning suicide as a rational option, (b) advocating for the use of illicit substances, and (c) stopping opioids voluntarily; and mechanisms of resistance: (a) counter-organizing and (b) counter-generating knowledge. We offer theoretical implications for the TCD and practical implications for patients, providers, patient advocacy organizations, and policymakers.

"I have to fight for them to investigate things": a qualitative exploration of physical and mental healthcare for women diagnosed with mental illness

Introduction

Women play a significant role in the management of their own healthcare and that of others, however women diagnosed with mental illness and physical health concerns experience significant health inequalities as compared to people living without mental health concerns.

Methods

In this paper, we reflect on the experiences of 20 cis women diagnosed with mental and physical health concerns who agreed to be a part of this research. This qualitative study is part of the larger Healthtalk Australia research project which was not gender specific. Female participants shared many experiences of mental and physical healthcare in interviews with researchers that pointed to the need for a gendered approach to addressing health inequalities. Consequently, we iteratively consolidated transcripts of interviews with participants into thematic categories facilitated by NVIVO 12.

Results

We identified two broad themes and a set of subthemes: in the doctor's office - experience of labelling; negotiating medications; and interactions with physical and mental health, and outside the doctor's office - responses to trauma, financial concerns, and reliance on participant's internal resources to get healthcare needs met.

Discussion

We conclude that participants in this study undertook significant work to manage their own healthcare needs, despite being challenged by clinicians and systems that failed to see them as whole people with expertise regarding their own health.

Framing Chronic Pain in U.S. News Coverage of the Opioid Epidemic (2012-2022)

Chronic pain, pain persisting longer than six months, afflicts 20% of the U.S. population and is the leading cause of disability. To manage pain, many chronic pain patients (CPPs) and healthcare providers turn to opioids, prescription medications that block pain signals and offer relief. However, in light of the U.S.' ongoing opioid epidemic, CPPs without a history of opioid use disorder (OUD) are facing increased stigma when seeking opioid medication. Further, many have been forced to taper their therapeutic dose due to updated Centers for Disease Control and Prevention prescribing guidelines in 2016 and 2022, with a range of (adverse) outcomes. Though research has explored experiences of chronic pain and OUD independently, few studies have explored how media coverage of the opioid epidemic has shaped representations, and resulting stereotypes, of CPPs. Guided by framing theory, this content analysis examines sources' characterization of CPPs amidst a decade of U.S. news coverage of the opioid epidemic (N = 492). Findings identify four dominant news frames, including two novel frames termed culpability and strategy, and elements (i.e., characters, significant events) that comprise these frames. When discussed, CPPs were ascribed the identity of a drug-seeking addict 82% of the time. Collectively, this study provides insight as to how news media coverage of the opioid epidemic influence(d) public perceptions of chronic pain (patients). Findings offer theoretical and practical implications for media outlets, policymakers, CPPs and healthcare providers, as well as highlighting how use of opioids for pain management does not equate to abuse of opioids.