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Andersen RS, Frumer M, Merrild CH, Offersen SMH, Aarhus R, Tørring ML. How do we avoid polarization of interdisciplinary research on cancer diagnosis? A critical comment to: "Rethinking the Logic of Early Diagnosis in Cancer" by Damhus, Risør, Brodersen, and Jønsson (2024). Health (London) 2025; 29:23-33. [PMID: 39051480 DOI: 10.1177/13634593241258392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Affiliation(s)
- Rikke Sand Andersen
- Department of Anthropology, AU, Denmark
- Department of Public Health, Research Unit for General Practice, SDU, Denmark
| | - Michal Frumer
- Research Unit, Horsens Regional Hospital, Horsens, Midtjylland, Denmark
- External Lecturer, Department of Public Health, Faculty of Health, AU, Denmark
| | | | | | - Rikke Aarhus
- VIVE, The Danish Center for Social Science Research, Denmark
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Evans R, MacArtney J. "Backlash!"? A qualitative exploration of hospice palliative care staff's ongoing experiences of "living with covid". Palliat Care Soc Pract 2024; 18:26323524241283064. [PMID: 39371349 PMCID: PMC11452853 DOI: 10.1177/26323524241283064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 08/26/2024] [Indexed: 10/08/2024] Open
Abstract
Background "Living with covid" has meant that the SARS-CoV-2 virus has become a background concern for many in the United Kingdom. However, people with terminal conditions remain some of those at higher risk of Covid-19 affecting the quality-of-life left, as well as the amount of life. Little is known about how staff manage the ongoing risks and challenges-to themselves and those they seek to support-when providing palliative care in the context of an airborne transmissible virus. Objective To explore the experiences of UK hospice staff of "living with covid" to identify how Covid-19 continues to affect their work and well-being. Design An interpretivist qualitative interview study. Methods Reflexive thematic analysis of semi-structured online interviews with 12 staff recruited from three hospices in the West Midlands, UK. Results We explored how participants' accounts of "living with covid" included several ambivalences: Participants not only sought to assert the importance of not forgetting that time but also wished to "move-on." This included moving Covid-19 to the "background" through embedding systemic adaptions and lessons learnt, while also recognizing that they had to address issues relating to Covid-19 "case-by-case." Finally, participants' wish to move-on and a mostly reactive approach to mitigations meant that they were unable to meaningfully reconcile how asymptomatic transmission promotes patients' quality-of-life left. Conclusion Recollections of the difficulties of the Covid-19 public health emergency were part of a "backlash" to any future consideration of mitigations for airborne transmissible viruses and helped justify a "living with (getting) covid" approach. However, this also created uncertainty of how best to support patients who are vulnerable to having the quality and amount of life left compromised by viral infection. The pandemic has brought renewed impetus to re-examine hospice palliative care's ideals and practices in the context of airborne transmissible viruses.
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Affiliation(s)
- Rebecca Evans
- Warwick Medical School, University of Warwick, Coventry, UK
| | - John MacArtney
- Warwick Medical School, University of Warwick, Medical School Building, Coventry, West Midlands CV4 7AL, UK
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Hoeks RA, Deml MJ, Dubois J, Senn O, Streit S, Rachamin Y, Jungo KT. Broken bones and apple brandy: resilience and sensemaking of general practitioners and their at-risk patients during the COVID-19 pandemic in Switzerland. Anthropol Med 2023; 30:346-361. [PMID: 38288956 PMCID: PMC10860889 DOI: 10.1080/13648470.2023.2269523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/05/2023] [Indexed: 02/09/2024]
Abstract
In early 2020, when the first COVID-19 cases were confirmed in Switzerland, the federal government started implementing measures such as national stay-at-home recommendations and a strict limitation of health care services use. General practitioners (GPs) and their at-risk patients faced similar uncertainties and grappled with subsequent sensemaking of the unprecedented situation. Qualitative interviews with 24 GPs and 37 at-risk patients were conducted which were analyzed using thematic analysis. Weick's (1993) four sources of -resilience - improvisation, virtual role systems, attitudes of wisdom and respectful interaction - heuristically guide the exploration of on-the-ground experiences and informal ways GPs and their at-risk patients sought to ensure continuity of primary care. GPs used their metaphorical Swiss army knives of learned tools as well as existing knowledge and relationships to adapt to the extenuating circumstances. Through improvisation, GPs and patients found pragmatic solutions, such as using local farmer apple brandy as disinfectant or at-home treatments of clavicle fractures. Through virtual role systems, GPs and patients came to terms with new and shifting roles, such as "good soldier" and "at-risk patient" categorizations. Both parties adopted attitudes of wisdom by accepting that they could not know everything. They also diversified their sources of information through personal relationships, formal networks, and the internet. The GP-patient relationship grew in importance through respectful interaction, and intersubjective reflection helped make sense of shifting roles and ambiguous guidelines. The empirical analysis of this paper contributes to theoretical considerations of sensemaking, resilience, crisis settings and health systems.
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Affiliation(s)
- Rebekah A. Hoeks
- Institute of Social Anthropology, University of Basel, Basel, Switzerland
| | - Michael J. Deml
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
| | - Julie Dubois
- Institute of Family Medicine, University of Fribourg, Fribourg, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Yael Rachamin
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Campus Stiftung Lindenhof Bern (SLB), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
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Barisone M, Busca E, Bassi E, De Luca E, Profenna E, Suardi B, Dal Molin A. The Family and Community Nurses Cultural Model in the Times of the COVID Outbreak: A Focused Ethnographic Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1948. [PMID: 36767312 PMCID: PMC9915317 DOI: 10.3390/ijerph20031948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/14/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
The ageing population, increasingly frail and chronically ill, and COVID-19 pandemic challenges have highlighted national health systems' vulnerability and, more strongly/to a greater extent, the pivotal role of the family and community nurse (FCN). However, the recent introduction of FCNs in primary care settings has yet to be explored in Italy. This study aimed to identify the FCNs' cultural model and its implementation during the COVID-19 outbreak. A focused ethnographic study was performed in a primary care community service in northern Italy. Participants were FCNs (N = 5), patients and caregivers (N = 12). Qualitative data were collected through semi-structured interviews, field notes, observation of FCNs' activities and access to documents. Qualitative analysis identified themes concerned with crucial aspects of FCNs' activities, role implementation, and their relationship with patients and families. This study illuminated how the FCN strategically takes care of and identifies patients' and community needs. Although the COVID-19 outbreak hindered effective FCN project implementation, this study highlighted that the pandemic provided a chance to better identify cultural, organisational and educational weaknesses that need to be addressed to support the full accomplishment of FCNs' scope of practice.
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Affiliation(s)
- Michela Barisone
- S.C. Centro Controllo Direzionale, Azienda Socio Sanitaria Ligure (ASL2), Piazza Pertini, 10, 17100 Savona, Italy
- Department of Translational Medicine, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy
| | - Erica Busca
- Department of Translational Medicine, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy
- Azienda Ospedaliero Universitaria Maggiore della Carità Novara, Corso Mazzini 18, 28100 Novara, Italy
| | - Erika Bassi
- Department of Translational Medicine, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy
- Azienda Ospedaliero Universitaria Maggiore della Carità Novara, Corso Mazzini 18, 28100 Novara, Italy
| | - Enrico De Luca
- Department of Nursing, Faculty of Health and Life Sciences, University of Exeter, St. Luke’s Campus, Exeter EX1 2LT, UK
| | - Emanuele Profenna
- Azienda Sanitaria Locale di Parma, Strada del Quartiere n. 2/A, 43125 Parma, Italy
| | - Barbara Suardi
- S.C. Direction of Health Professions, Azienda Sanitaria di Vercelli, Ospedale Sant’Andrea, Corso Mario Abbiate 21, 13100 Vercelli, Italy
| | - Alberto Dal Molin
- Department of Translational Medicine, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy
- Azienda Ospedaliero Universitaria Maggiore della Carità Novara, Corso Mazzini 18, 28100 Novara, Italy
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Tachom Waffo B, Ngah Essomba H, Tagne Nossi A, Gouertoumbo Mete R, Mvessomba A. Échelle du fatalisme en santé version française (EFS-VF) : une validation de l’échelle du fatalisme en santé. EUROPEAN REVIEW OF APPLIED PSYCHOLOGY 2023. [DOI: 10.1016/j.erap.2022.100800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Seeking Rhetorical Validity in Fear Appeal Research: An Application of Rhetorical Theory. Comput Secur 2022. [DOI: 10.1016/j.cose.2022.103020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Wanko Keutchafo EL, Kerr J, Baloyi OB. A Model for Effective Nonverbal Communication between Nurses and Older Patients: A Grounded Theory Inquiry. Healthcare (Basel) 2022; 10:2119. [PMID: 36360461 PMCID: PMC9690069 DOI: 10.3390/healthcare10112119] [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] [Received: 09/22/2022] [Revised: 10/11/2022] [Accepted: 10/18/2022] [Indexed: 08/24/2023] Open
Abstract
Nonverbal communication is an inevitable art to be effectively mastered by nurses. Nurse nonverbal communication has many benefits when it is effective. For instance, nonverbal communication is important to convey affective and emotional information, and demonstrate respect for and build therapeutic relationships with older patients. As the older population is growing fast worldwide, effective nonverbal communication with older patients is an essential skill for nurses and will improve patients' satisfaction and the quality of care. Therefore, this article presents a model to guide effective nonverbal communication between nurses and older patients. A Grounded Theory approach guided the study. Data were collected between July 2018 and January 2020 through overt participant observations and individual interviews. Purposive and theoretical sampling were used to select 13 clinically experienced nurses, 4 nursing students, and 8 older adults. Data analysis encompassed open coding, axial coding, and selective coding. The results showed that effective nonverbal communication emerged as the co-phenomenon hinged within context and/or environment and is influenced by certain factors. This model, which is in support of person-centered communication and care, advocates for effective nonverbal communication between nurses and older patients.
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Affiliation(s)
- Esther L. Wanko Keutchafo
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa
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Møller A, Merrild CH. Exploring targeted preventive health checks in a socially disadvantaged neighborhood in Denmark. Health Promot Int 2020; 35:1150-1158. [PMID: 31697350 DOI: 10.1093/heapro/daz110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Recently studies have focused on how health promotion interventions sometimes sideline issues of social context, framing health as a matter of individual choice and, by implication, a personal responsibility. Part of this criticism is that health promotion interventions often do not draw on situated understandings of the contextual aspects of health and illness practices. Theoretically, this study departs in practice theory and contemporary public heath discussions on targeted health promotion. Based on semi-structured interviews with 18 people living in a social housing association we explored the significance of participating in a preventive health check and how participation configured into everyday life. All participants in our study had been identified with a 'risk' health profile. Overall, we found that they were well aware of their health risks and challenges, and that they reflected a great deal on how their health status was intrinsically linked with their lifestyle and health practices, such as lack of exercise or smoking. The health checks were, however, not able to support or improve their general health, and did not seem to address the challenges the participants seemed to struggle with in life. By way of conclusion, we suggest that we implement a more practice-oriented form of public health that focus on the 'lives' that people live, and the problems that they face. Moreover, attention should be paid to how and to whom health promotion initiatives are offered, in order to ensure the relevance of targeted interventions.
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Affiliation(s)
- Anne Møller
- Department of Public Health, Health, Aarhus University, Aarhus, Denmark
| | - Camilla Hoffmann Merrild
- Department of Public Health, Health, Aarhus University, Aarhus, Denmark.,Center for General Practice, Aalborg University, Aalborg, Denmark
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Broholm-Jørgensen M, Langkilde SM, Tjørnhøj-Thomsen T, Pedersen PV. 'Motivational work': a qualitative study of preventive health dialogues in general practice. BMC FAMILY PRACTICE 2020; 21:185. [PMID: 32900366 PMCID: PMC7487907 DOI: 10.1186/s12875-020-01249-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 08/17/2020] [Indexed: 11/10/2022]
Abstract
Background The aim of this article is to explore preventive health dialogues in general practice in the context of a pilot study of a Danish primary preventive intervention ‘TOF’ (a Danish acronym for ‘Early Detection and Prevention’) carried out in 2016. The intervention consisted of 1) a stratification of patients into one of four groups, 2) a digital support system for both general practitioners and patients, 3) an individual digital health profile for each patient, and 4) targeted preventive services in either general practice or a municipal health center. Methods The empirical material in this study was obtained through 10 observations of preventive health dialogues conducted in general practices and 18 semi-structured interviews with patients and general practitioners. We used the concept of ‘motivational work’ as an analytical lens for understanding preventive health dialogues in general practice from the perspectives of both general practitioners and patients. Results While the health dialogues in TOF sought to reveal patients’ motivations, understandings, and priorities related to health behavior, we find that the dialogues were treatment-oriented and structured around biomedical facts, numeric standards, and risk factor guidance. Overall, we find that numeric standards and quantification of motivation lessens the dialogue and interaction between General Practitioner and patient and that contextual factors relating to the intervention framework, such as a digital support system, the general practitioners’ perceptions of their professional position as well as the patients’ understanding of prevention —in an interplay—diminished the motivational work carried out in the health dialogues. Conclusion The findings show that the influence of different kinds of context adds to the complexity of prevention in the clinical encounter which help to explain why motivational work is difficult in general practice.
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Affiliation(s)
- Marie Broholm-Jørgensen
- National Institute of Public Health, Research Program on Health and Social Conditions, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark.
| | - Siff Monrad Langkilde
- The Danish Centre for Urban Regeneration and Community Development, Hvidovre, Denmark
| | - Tine Tjørnhøj-Thomsen
- National Institute of Public Health, Research Program on Health and Social Conditions, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark
| | - Pia Vivian Pedersen
- National Institute of Public Health, Research Program on Health and Social Conditions, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark
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10
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MacArtney JI, Andersen RS, Malmström M, Rasmussen B, Ziebland S. The convivial and the pastoral in patient-doctor relationships: a multi-country study of patient stories of care, choice and medical authority in cancer diagnostic processes. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:844-861. [PMID: 32103515 PMCID: PMC7318254 DOI: 10.1111/1467-9566.13067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Experiences of cancer diagnosis are changing in light of both the increasingly technological-clinical diagnostic processes and the socio-political context in which interpersonal relations take place. This has raised questions about how we might understand patient-doctor relationship marked by asymmetries of knowledge and social capital, but that emphasise patients' empowered choices and individualised care. As part of an interview study of 155 participants with bowel or lung cancer across Denmark, England and Sweden, we explored participants' stories of the decisions made during their cancer diagnostic process. By focusing on the intersections of care, choice and medical authority - a convivial pastoral dynamic - we provide a conceptual analysis of the normative ambivalences in people's stories of their cancer diagnosis. We found that participants drew from care, choice and medical authority to emphasise their relationality and interdependence with their doctors in their stories of their diagnosis. Importantly negotiations of an asymmetrical patient-doctor relationship were part of an on-going realisation of the healthcare processes as a human endeavour. We were therefore able to draw attention to the limitations of dichotomising emancipatory-empowerment discourses and argue for a theorisation of the patient-doctor relationship as a contextually bounded and relationally ambivalent humanity.
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Affiliation(s)
- John I. MacArtney
- Unit of Academic Primary CareWarwick Medical SchoolUniversity of WarwickWarwickUK
| | - Rikke S. Andersen
- Research Centre for Cancer Diagnosis in Primary CareResearch Unit of General Practice & Department of AnthropologyAarhus UniversityAarhusDenmark
| | - Marlene Malmström
- The Institute for Palliative CareLund University and Region SkåneLundSweden
- Lund UniversityDepartment of Health SciencesLundSweden
| | - Birgit Rasmussen
- The Institute for Palliative CareLund University and Region SkåneLundSweden
- Lund UniversityDepartment of Health SciencesLundSweden
| | - Sue Ziebland
- Health Experiences Research GroupNuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
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Broholm-Jørgensen M, Kamstrup-Larsen N, Guassora AD, Reventlow S, Dalton SO, Tjørnhøj-Thomsen T. ‘It can’t do any harm’: A qualitative exploration of accounts of participation in preventive health checks. HEALTH RISK & SOCIETY 2019. [DOI: 10.1080/13698575.2019.1602251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Nina Kamstrup-Larsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Ann Dorrit Guassora
- The research Unit and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Reventlow
- The research Unit and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Danish Cancer Society Research Center, Survivorship, Copenhagen, Denmark
- Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Tine Tjørnhøj-Thomsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Ziebland S, Rasmussen B, MacArtney J, Hajdarevic S, Sand Andersen R. How wide is the Goldilocks Zone in your health system? J Health Serv Res Policy 2019; 24:52-56. [PMID: 30060724 DOI: 10.1177/1355819618790985] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In astrophysics, the 'Goldilocks Zone' describes the circumstellar habitable zone, in which planets, sufficiently similar to Earth, could support human life. The children's story of Goldilocks and the Three Bears, one of the most popular fairy tales in the English language, uses this metaphor to describe conditions for life that are neither too hot nor too cold and neither too close to the sun nor too far from its warmth. We propose that the 'Goldilocks Zone' also offers an apt metaphor for the struggle that people face when deciding if and when to consult a health care provider with a possible health problem. Drawing on decades of research in Denmark, England and Sweden on people's accounts of their experiences of accessing health care, this essay considers the ambivalence of health care seeking that individuals face in identifying when it is 'just right' to consult a general practitioner and the steps that health systems and individual clinicians might take to widen the zone.
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Affiliation(s)
- Sue Ziebland
- 1 Professor of Medical Sociology, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Birgit Rasmussen
- 2 Professor, Department of Health Sciences, Lund University, Sweden
| | - John MacArtney
- 3 Senior Qualitative Researcher, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | | | - Rikke Sand Andersen
- 5 Associate Professor, Research Centre for Cancer Diagnosis in Primary Care, Aarhus Universitet, Denmark
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Scorgie F, Stadler J, Baron D, Ju S, Ikaneng T, Mabude Z, Makgopa S, Malefo MA, Manenzhe KN, Mazibuko T, Ntjana H, Nkala B, Palanee-Phillips T, Gray G, Rees H, Delany-Moretlwe S. "It Was Not My Aim to Sleep There": The Impact of Timing and Location of Sex on Adherence to Coitally-Dependent HIV Pre-exposure Prophylaxis. AIDS Behav 2018; 22:3692-3704. [PMID: 29909589 DOI: 10.1007/s10461-018-2195-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The FACTS 001 trial found that vaginal pre- and post-coital application of 1% tenofovir gel did not prevent HIV-1 infection amongst young South African women. The trial included a multi-faceted approach to adherence support and collected objective and self-reported adherence measures. Using qualitative data collected from a random sub-set of FACTS 001 participants (135 in-depth interviews at product discontinuation and 13 focus group discussions at dissemination of trial results), we explore the importance of 'place' and 'timing' in shaping acts of sexual intimacy and product adherence. Demographically, this qualitative sub-sample is similar to the trial cohort of predominantly young, unemployed women living with parents or other family members. Sexual intimacy was largely unpredictable and happened across multiple locations in which women had limited privacy, autonomy, or control over the timing of sex. This made adherence to the dosing strategy challenging. Findings may inform the development of future event-driven pre-exposure prophylaxis regimens or products.
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Affiliation(s)
- Fiona Scorgie
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Corner Esselen and Klein Street, Hillbrow, Johannesburg, 2001, South Africa.
| | - Jonathan Stadler
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Corner Esselen and Klein Street, Hillbrow, Johannesburg, 2001, South Africa
| | - Deborah Baron
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Corner Esselen and Klein Street, Hillbrow, Johannesburg, 2001, South Africa
| | - Susan Ju
- CONRAD, 1911 North Fort Myer Drive, Arlington, VA, USA
| | - Tshepiso Ikaneng
- MEDUNSA Clinical Research Unit (MeCRU), Ga-Rankuwa, North West Province, South Africa
| | - Zonke Mabude
- MatCH Research Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | | | - Hilda Ntjana
- The Desmond Tutu HIV Foundation, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Busi Nkala
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Thesla Palanee-Phillips
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Corner Esselen and Klein Street, Hillbrow, Johannesburg, 2001, South Africa
| | - Glenda Gray
- South African Medical Research Council, Cape Town, South Africa
| | - Helen Rees
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Corner Esselen and Klein Street, Hillbrow, Johannesburg, 2001, South Africa
| | - Sinead Delany-Moretlwe
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Corner Esselen and Klein Street, Hillbrow, Johannesburg, 2001, South Africa
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Chan EA, Wong F, Cheung MY, Lam W. Patients' perceptions of their experiences with nurse-patient communication in oncology settings: A focused ethnographic study. PLoS One 2018; 13:e0199183. [PMID: 29912967 PMCID: PMC6005521 DOI: 10.1371/journal.pone.0199183] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/01/2018] [Indexed: 11/19/2022] Open
Abstract
Background The nursing shortage and its impact on patient care are well-documented global issues. Patients living with cancer as a chronic illness have many psychosocial problems and often lack adequate support as a result of ineffective nurse-patient communication. A review of the literature on factors influencing the delivery of psychosocial care to cancer patients indicates that the delivery of psychosocial care in routine cancer nursing within a biomedical healthcare system has not been widely explored. Objective To explore patients’ perceptions of their experiences with nurse-patient communication in an oncological clinical environment. Method A focused ethnographic study was undertaken in two oncology wards of a hospital in Hong Kong. Data were collected through observations of the ward environment, the activities and instances of nurse-patient communication, semi-structured interviews with patients, and a review of nursing documents. Results Two main themes were identified: 1. Nurses’ workload and the environment and 2. Nurse-patient partnership and role expectations. Within these two themes were related subthemes on: Sympathy for the busy nurses; Prioritizing calls to the nurses; Partnership through relationship; Nurses’ role in psychosocial care; and Reduction of psychosocial concerns through physical care. Conclusions Many cancer patients do not expect to receive psychosocial care in the form of emotional talks or counseling from busy nurses, but appreciate the attention paid by nurses to their physiological and physical needs. Nurse-patient partnerships in cancer care may reduce the potential workload of nurses. The psychosocial needs of cancer patients could be optimized by providing good physical care through effective communication within a time-constrained oncology setting.
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Affiliation(s)
- Engle Angela Chan
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
- * E-mail: (EA)
| | - Fiona Wong
- School of Optometry, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Man Yin Cheung
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Winsome Lam
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
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Malmström M, Rasmussen BH, Bernhardson BM, Hajdarevic S, Eriksson LE, Andersen RS, MacArtney JI. It is important that the process goes quickly, isn't it?" A qualitative multi-country study of colorectal or lung cancer patients' narratives of the timeliness of diagnosis and quality of care. Eur J Oncol Nurs 2018; 34:82-88. [PMID: 29784144 DOI: 10.1016/j.ejon.2018.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/21/2018] [Accepted: 04/06/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE The emphasis on early diagnosis to improve cancer survival has been a key factor in the development of cancer pathways across Europe. The aim of this analysis was to explore how the emphasis on early diagnosis and timely treatment is reflected in patient's accounts of care, from the first suspicion of colorectal or lung cancer to their treatment in Denmark, England and Sweden. METHOD We recruited 155 patients in Denmark, England and Sweden who were within six months of being diagnosed with lung or colorectal cancer. Data were collected via semi-structured narrative interviews and analysed using a thematic approach. RESULTS Participants' accounts of quality of care were closely related to how quickly (or not) diagnosis, treatment and/or healthcare processes went. Kinetic metaphors as a description of care (such as treadmill) could be interpreted positively as participants were willing to forgo some degree of control and accept disruption to their lives to ensure more timely care. Drawing on wider cultural expectations of the benefits of diagnosing and treating cancer quickly, some participants were concerned that the waiting times between interventions might allow time for the cancer to grow. CONCLUSIONS Initiatives emphasising the timeliness of diagnosis and treatment are reflected in the ways some patients experience their care. However, these accounts were open to further contextualisation about what speed of healthcare processes meant for evaluating the quality of their care. Healthcare professionals could therefore be an important patient resource in providing reassurance and support about the timeliness of diagnosis or treatment.
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Affiliation(s)
- Marlene Malmström
- The Institute for Palliative Care, Lund University and Region Skåne, Sweden; Lund University, Department of Health Sciences, Lund, Sweden.
| | - Birgit H Rasmussen
- The Institute for Palliative Care, Lund University and Region Skåne, Sweden; Lund University, Department of Health Sciences, Lund, Sweden
| | - Britt-Marie Bernhardson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | | | - Lars E Eriksson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, SE-171 77 Stockholm, Sweden; School of Health Sciences, City, University of London, London EC1V 0HB, United Kingdom; Department of Infectious Diseases, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Rikke Sand Andersen
- Research Centre for Cancer Diagnosis in Primary Care, Research Unit of General Practice & Department of Anthropology, Aarhus University, Denmark
| | - John I MacArtney
- Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
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Brandner S, Stritter W, Müller-Nordhorn J, Sehouli J, Fotopoulou C, Holmberg C. Taking Responsibility. ANTHROPOLOGY IN ACTION 2017. [DOI: 10.3167/aia.2017.240107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractPatient-related diagnostic delay has been established as an analytical category in cancer research. This category has come under critique because it postulates linear cause-and-effect explanations of delayed care-seeking. These explanations are based on a one-dimensional idea of causality that neglects the processual character and the contextual situatedness of bodily experiences and care-seeking decisions. Using a notion of causality that is both process-oriented and context-sensitive, this article aims to understand ovarian cancer patients’ stories on delayed healthcare seeking. It uses data from a qualitative interview study that investigated ovarian cancer patients’ illness and healthcare-seeking experiences. We suggest that the interviewees’ retrospective perspective generated a multilayered notion of diagnostic delay that differs from the definition of patient-related delay commonly used in the literature. Our analysis shows how interviewees negotiate current social discourses on health and (social) responsibility, and thereby situate themselves and their healthcare seeking within a broader socio-economic and political context.
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17
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Merrild CH, Andersen RS, Risør MB, Vedsted P. Resisting "Reason": A Comparative Anthropological Study of Social Differences and Resistance toward Health Promotion and Illness Prevention in Denmark. Med Anthropol Q 2016; 31:218-236. [PMID: 27130785 DOI: 10.1111/maq.12295] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 12/14/2015] [Accepted: 04/11/2016] [Indexed: 11/28/2022]
Abstract
Social differences in health and illness are well documented in Denmark. However, little is known about how health practices are manifested in the everyday lives of different social classes. We propose acts of resistance and formation of health subjectivities as helpful concepts to develop our understanding of how dominant health discourses are appropriated by different social classes and transformed into different practices promoting health and preventing illness. Based on fieldwork in two different social classes, we discuss how these practices both overtly and subtly challenge the normative power of the health promotion discourse. These diverse and ambiguous forms of everyday resistance illustrate how and when situated concerns move social actors to subjectively appropriate health promotion messages. Overall, the different forms of resistance elucidate how the standardized awareness and education campaigns may perpetuate the very inequalities they try to diminish.
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Affiliation(s)
| | - Rikke Sand Andersen
- Research Unit for General Practice, Aarhus University, Denmark.,Department of Culture and Society, Aarhus University, Denmark
| | - Mette Bech Risør
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø
| | - Peter Vedsted
- Research Unit for General Practice, Aarhus University, Denmark.,Diagnostic Center, Silkeborg Hospital, Denmark
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Hills J, Lees J, Freshwater D, Cahill J. Psychosoma in crisis: an autoethnographic study of medically unexplained symptoms and their diverse contexts. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2016. [DOI: 10.1080/03069885.2016.1172201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- John Hills
- School of Healthcare, Baines Wing, The University of Leeds, Leeds, UK
| | - John Lees
- School of Healthcare, Baines Wing, The University of Leeds, Leeds, UK
| | - Dawn Freshwater
- School of Healthcare, Baines Wing, The University of Leeds, Leeds, UK
| | - Jane Cahill
- School of Healthcare, Baines Wing, The University of Leeds, Leeds, UK
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19
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Pelaez I, Infante C, Quintana R. Help-seeking trajectory in patients with rheumatoid arthritis. Clin Rheumatol 2015; 34 Suppl 1:S17-28. [PMID: 26198587 PMCID: PMC4617855 DOI: 10.1007/s10067-015-3013-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 04/10/2015] [Accepted: 05/17/2015] [Indexed: 10/25/2022]
Abstract
Early diagnosis and treatment of rheumatoid arthritis (RA) depends on the degree of fit between the characteristics of the patients and those of the health services. Ensuring timely assessment and treatment is the ideal medical care of RA. The reasons that underlay delays and the help-seeking trajectories are contextually determined. This study aims to identify the empirical evidence related to the help-seeking process and delay in RA in Latin America and to create a comprehensive model integrating the RA medical care processes of help-seeking and delay in a mixed health care system with variable accessibility. Non-systematic literature review of studies with both quantitative and qualitative methodology was conducted. Most of the research about delay and its associated variables have been undertaken in European countries and with White population and cannot be translated to the Latin America context where this research is almost inexistent. These countries have a completely different social context, and for most of the population, the health services are insufficient, inaccessible, fragmented, limited, and inequitable. Our results also show that in RA medical care utilization research, the theories and measurements of the constructs of illness trajectories, help-seeking, and accessibility are not integrated. We offer a conceptual framework that integrates help-seeking trajectories, delay, and accessibility of RA medical health services. If research on RA service utilization is to be undertaken in these countries, there is a need for a comprehensive framework than can enable researchers to integrate and contextualize the study of the problems within broad theoretical and methodological perspectives.
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Affiliation(s)
- Ingris Pelaez
- Rheumatology Service, General Hospital of Mexico, Mexico City, Mexico
| | - Claudia Infante
- Institute for Social Research, UNAM, National Autonomous University of Mexico, Circuito Mario de la Cueva S/N, Ciudad Universitaria, C.P. 04510, Mexico City, Mexico.
| | - Rosana Quintana
- Provincial Hospital of Rosario, Rosario, Santa Fe, Argentina
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Andersen RS, Tørring ML, Vedsted P. Global Health Care-seeking Discourses Facing Local Clinical Realities: Exploring the Case of Cancer. Med Anthropol Q 2014; 29:237-55. [DOI: 10.1111/maq.12148] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Rikke Sand Andersen
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Faculty of Health and Department of Culture and Society Aarhus University
| | - Marie Louise Tørring
- Research Unit for General Practice; Research Centre for Cancer Diagnosis in Primary Care (CaP), Faculty of Health and Department of Culture and Society Aarhus University
| | - Peter Vedsted
- Research Unit for General Practice Research Centre for Cancer Diagnosis in Primary Care (CaP) Faculty of Health Aarhus University
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Dobson CM, Russell AJ, Rubin GP. Patient delay in cancer diagnosis: what do we really mean and can we be more specific? BMC Health Serv Res 2014; 14:387. [PMID: 25217105 PMCID: PMC4175269 DOI: 10.1186/1472-6963-14-387] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 09/08/2014] [Indexed: 01/07/2023] Open
Abstract
Background Early diagnosis is a key focus of cancer control because of its association with survival. Delays in diagnosis can occur throughout the diagnostic pathway, within any one of its three component intervals: the patient interval, the primary care interval and the secondary care interval. Discussion A key focus for help-seeking research in patients with symptoms of cancer has been the concept of ‘delay’. The literature is plagued by definitional and semantic problems, which serve to hinder comparison between studies. Use of the word ‘delay’ has been criticised as judgemental and potentially stigmatising, because of its implications of intent. However, the suggested alternatives (time to presentation, appraisal interval, help-seeking interval and postponement of help-seeking) still fail to accurately define the concept in hand, and often conflate three quite separate ideas; that of an interval, that of an unacceptably long interval, and that of a specific event which caused delay in the diagnostic process. We discuss the need to disentangle current terminology and suggest the term ‘prolonged interval’ as a more appropriate alternative. Most studies treat the patient interval as a dichotomous variable, with cases beyond a specified time point classified as ‘delay’. However, there are inconsistencies in both where this line is drawn, ranging from one week to three months, and how, with some studies imposing seemingly arbitrary time points, others utilising the median as a divisive tool or exploring quartiles within their data. This not only makes comparison problematic, but, as many studies do not differentiate between cancer site, also imposes boundaries which are not necessarily site-relevant. We argue that analysis of the patient interval should be based on presenting symptom, as opposed to pathology, to better reflect the context of the help-seeking interval, and suggest how new definitional boundaries could be developed. Summary The word ‘delay’ is currently (conf)used to describe diverse conceptualisations of ‘delay’ and more mindful, and discerning language needs to be developed to enable a more sophisticated discussion. By stratifying help-seeking by presenting symptom(s), more accurate and informative analyses could be produced which, in turn, would result in more accurately targeted early diagnosis interventions.
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