1
|
Greco C. Coexisting cancer regimes: Transformations of breast and lung cancer in the United Kingdom. Health (London) 2024; 28:615-632. [PMID: 37218210 PMCID: PMC11149387 DOI: 10.1177/13634593231176979] [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: 05/24/2023]
Abstract
Using in-depth interviews with medical professionals working in the UK, I explore the coexistence of two different cancer regimes in which the different innovations for breast and lung cancer can be located. Breast cancer treatment has seen a protracted series of significant innovations in the context of an emphasis on screening that coexists with a segmentation in subtypes that has allowed targeted therapies for most patients. Lung cancer has also seen the introduction of targeted therapies; however, these can only be used for small groups of patients. Consequently, some interviewees working on lung cancer have expressed a stronger focus on increasing the number of patients undergoing surgery, as well as introducing screening also for lung cancer. As a result, a cancer regime based on the promises of targeted therapies coexists with a more traditional approach that focuses on diagnosing and treating cancers in their early stages.
Collapse
|
2
|
Turnbull M, Yu C, Tay D. "We Need to Go Back Home (to) the Philippines Healthy": An Interpretive Phenomenological Analysis of Migrant Domestic Workers' Experiences of Having Breast Cancer in Hong Kong. QUALITATIVE HEALTH RESEARCH 2024; 34:865-877. [PMID: 38311814 PMCID: PMC11323434 DOI: 10.1177/10497323241228789] [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] [Indexed: 02/06/2024]
Abstract
Diagnoses of breast cancer are continuing to increase in the Philippines, but little is known about incidence rates among the significant number of Filipino women working abroad as migrant domestic workers (MDWs). These women are often the main income providers for their families, and their ability to work depends upon their physical health and strength. In this article, we use interpretive phenomenological analysis to explore the experiences of 10 MDWs from the Philippines who were diagnosed with breast cancer during a period of employment in Hong Kong. Analysis of these narratives revealed numerous points at which their status as temporary, transnational migrant workers intersected with their experiences of breast cancer detection, diagnosis, and treatment. We argue that these women's experiences of breast cancer were shaped by the structures of migration that link the Philippines with host destinations like Hong Kong. These structures create a unique context in which these women had to constantly renegotiate their identities as migrants, financial providers, and breast cancer patients.
Collapse
Affiliation(s)
- Margo Turnbull
- Department of English and Communication, The Hong Kong Polytechnic University, Hong Kong, China
| | - Carol Yu
- Department of English and Communication, The Hong Kong Polytechnic University, Hong Kong, China
| | - Dennis Tay
- Department of English and Communication, The Hong Kong Polytechnic University, Hong Kong, China
| |
Collapse
|
3
|
Thamm C, McCarthy AL, Yates P. A Discourse of Deviance: Blame, Shame, Stigma and the Social Construction of Head and Neck Cancer. QUALITATIVE HEALTH RESEARCH 2024; 34:398-410. [PMID: 38019709 PMCID: PMC10996294 DOI: 10.1177/10497323231213819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Cancer of the head and neck is a confronting condition, as the disease and its treatments alter the appearance and function of body organs associated with physical appearance and identity. Many of the risk factors for head and neck cancers, including tobacco, alcohol, and human papilloma virus, can also have significant negative social and moral permutations. Language and action (discourse) plays an important role in constructing disease and illness and shape the way it is managed, both institutionally and socially. This research used a critical constructionist lens to investigate how the common discourses surrounding head and neck cancer are constructed within the healthcare context and how this influences patients and healthcare professionals' responses to the illness. Data were collected through semi-structured interviews, field noting, journaling and literature reviews. Analysis was guided by a three-dimensional approach to critical discourse analysis that investigated text, discursive practices, and social context. The overarching finding was that deviance dominates the common discourse and shapes head and neck cancer and responses to it. Deviance is channelled through metaphors, adjectives, descriptors, and collective nouns and is made overt through labelling, avoidance, blaming, shame, and categorization. Discourse is contextualized by a sociocultural understanding that when someone deviates from what is perceived as normal, they are devalued. Open dialogue and reflection on head and neck cancer discourse could enable better understanding of how people experience their condition and inform more supportive responses.
Collapse
Affiliation(s)
- Carla Thamm
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | | | - Patsy Yates
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, QLD, Australia
| |
Collapse
|
4
|
Hammond N, Chantry A, Cheeseman M, Peng A. Disrupted biographies and gendered identities: A qualitative study exploring sexuality and blood cancer. Eur J Oncol Nurs 2024; 70:102544. [PMID: 38513454 DOI: 10.1016/j.ejon.2024.102544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/24/2024] [Accepted: 02/25/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE This study examines how blood cancer impacts patients' sexuality and sense of gendered identity. METHODS An interpretive epistemological framework necessitated a qualitative study design. Participants (6 male and 6 female), recruited from a hospital Haematology department in a large Northern English City, took part in semi-structured in-depth interviews to gather rich data about their subjective experiences. RESULTS A key theme from the qualitative data was a sense of disruption in relation to several aspects of their gendered identities and sexual life. Participants explained disruption to their sexual function and sexual sense of self. They narrated concerns about future imagined relationships. The emotional burden of sexuality related concerns was strongly articulated. A gendered perspective enabled the similarities and differences between men and women to be explored. CONCLUSION This study, drawing on rich qualitative data, documents the sexuality concerns of blood cancer patients; for some such concerns arise many years post treatment. The findings highlight the need for gender appropriate care around sexuality which should continue to be accessible well after diagnosis and treatment phases have ceased.
Collapse
|
5
|
Determining the Research Priorities for Adult Primary Brain Tumours in Australia and New Zealand: A Delphi Study with Consumers, Health Professionals, and Researchers. Curr Oncol 2022; 29:9928-9955. [PMID: 36547195 PMCID: PMC9777470 DOI: 10.3390/curroncol29120781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022] Open
Abstract
The aim of this project was to determine research priorities, barriers, and enablers for adult primary brain tumour research in Australia and New Zealand. Consumers, health professionals, and researchers were invited to participate in a two-phase modified Delphi study. Phase 1 comprised an initial online survey (n = 91) and then focus groups (n = 29) which identified 60 key research topics, 26 barriers, and 32 enablers. Phase 2 comprised two online surveys to (1) reduce the list to 37 research priorities which achieved consensus (>75% 2-point agreement) and had high mean importance ratings (n = 116 participants) and (2) determine the most important priorities, barriers, and enablers (n = 90 participants). The top ten ranked research priorities for the overall sample and sub-groups (consumers, health professionals, and researchers) were identified. Priorities focused on: tumour biology, pre-clinical research, clinical and translational research, and supportive care. Variations were seen between sub-groups. The top ten barriers to conducting brain tumour research related to funding and resources, accessibility and awareness of research, collaboration, and process. The top ten research enablers were funding and resources, collaboration, and workforce. The broad list of research priorities identified by this Delphi study, together with how consumers, health professionals, and researchers prioritised items differently, and provides an evidence-based research agenda for brain tumour research that is needed across a wide range of areas.
Collapse
|
6
|
James JE, Joseph G. "It's personalized, but it's still bucket based": The promise of personalized medicine vs. the reality of genomic risk stratification in a breast cancer screening trial. NEW GENETICS AND SOCIETY 2022; 41:228-253. [PMID: 36936188 PMCID: PMC10021681 DOI: 10.1080/14636778.2022.2115348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
Adaptive pragmatic clinical trials offer an innovative approach that integrates clinical care and research. Yet, blurring the boundaries between research and clinical care raises questions about how clinicians and investigators balance their caregiving and research roles and what types of knowledge and risk assessment are most valued. This paper presents findings from an ethnographic ELSI (Ethical, Legal, Social Implications) study of an innovative clinical trial of risk-based breast cancer screening that utilizes genomics to stratify risk and recommend a breast cancer screening commensurate with the assessed risk. We argue that the trial demonstrates a fundamental tension between the promissory ideals of personalized medicine, and the reality of implementing risk stratified care on a population scale. We examine the development of a Screening Assignment Review Board in response to this tension which allows clinician-investigators to negotiate, but never fully resolve, the inherent contradiction of 'precision population screening'.
Collapse
Affiliation(s)
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco
| |
Collapse
|
7
|
Barradas C, Teixeira LA, Araújo Neto LA. Beyond biomedical classifications: breast cancer experience in Brazil, 1990-2015. HISTORIA, CIENCIAS, SAUDE--MANGUINHOS 2022; 29:625-643. [PMID: 36074353 DOI: 10.1590/s0104-59702022000300003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/23/2021] [Indexed: 06/15/2023]
Abstract
The paper analyses illness experiences of breast cancer in women undergoing treatment at the Hospital of Cancer III of the National Institute of Cancer. It argues that part of the interviewed women's experience was constructed from the interaction between family coexistence and the mobilisation of different cultural meanings of the disease and femininity, negotiating senses for biomedical entities. The study results from a qualitative research of ethnographic inspiration that interviewed women undergoing treatment from breast cancer during 2015. It draws on the accounts to discuss the interaction of society with biomedical entities for the significance of cancer in Brazil between the 1990s and 2010s.
Collapse
Affiliation(s)
- Carlos Barradas
- Pesquisador júnior, Centro de Estudos Sociais / Universidade de Coimbra . Coimbra - Portugal
| | - Luiz Antonio Teixeira
- Professor, Faculdade de Medicina / Universidade Estácio de Sá . Rio de Janeiro - RJ - Brasil
| | - Luiz Alves Araújo Neto
- Pós-doutorando, Programa de Pós-graduação em História das Ciências e da Saúde / Fiocruz . Rio de Janeiro - RJ - Brasil
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Kirby E, Kenny K, Broom A, Lwin Z. Chronicity in/and cancer: a qualitative interview study of health professionals, patients, and family carers. CRITICAL PUBLIC HEALTH 2022. [DOI: 10.1080/09581596.2022.2035319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Emma Kirby
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Katherine Kenny
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, University of Sydney, Sydney, Australia
| | - Alex Broom
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, University of Sydney, Sydney, Australia
| | - Zarnie Lwin
- Cancer Care Services, Royal Brisbane and Women’s Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| |
Collapse
|
10
|
Page A, Broom A, Kenny K, Lwin Z, Wakefield CE, Itchins M, Khasraw M. Experiencing the SARS-CoV-2 Pandemic Whilst Living With Cancer. QUALITATIVE HEALTH RESEARCH 2022; 32:426-439. [PMID: 35068285 DOI: 10.1177/10497323211057082] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The SARS-CoV-2 pandemic has resulted in considerable consequences for many cancer patients, exacerbating pre-existing systemic health system limitations as well as creating new challenges. From socially distanced clinics and the widespread introduction of telehealth, to the halting of clinical trials and the reassessment of what constitutes "essential" treatment, care in oncology has abruptly changed. There is currently limited analysis of cancer patients' experiences of the pandemic and its impacts on illness, wellness, and everyday life. Through semi-structured interviews with 54 people living with cancer during the 2020 phase of the SARS-CoV-2 pandemic in Australia, we explore how patients experience illness and care in reflecting upon a range of pandemic challenges, including delay, distance, and vulnerability. We find that in some cases, these pandemic conditions redefined the meaning of essential cancer care, reconfigured expectations around clinical trials, constructed new affective distances, and amplified dread and fear for people living with cancer.
Collapse
Affiliation(s)
- Alexander Page
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, 4334The University of Sydney, Sydney, NSW, Australia
| | - Alex Broom
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, 4334The University of Sydney, Sydney, NSW, Australia
| | - Katherine Kenny
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, 4334The University of Sydney, Sydney, NSW, Australia
| | - Zarnie Lwin
- Metro North Hospital and Health Service, 3883Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Claire E Wakefield
- Kids Cancer Centre, 63623Sydney Children's Hospital, Sydney, NSW, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, 63623Sydney Children's Hospital, Sydney, NSW, Australia
| | - Malinda Itchins
- Northern Cancer Institute, 94750North Shore Private Hospital, Sydney, NSW, Australia
| | | |
Collapse
|
11
|
Greco C, Arteaga I, Fabian-Therond C, Llewellyn H, Swallow J, Viney W. Cancer, COVID-19, and the need for critique. Wellcome Open Res 2021; 5:280. [PMID: 33521331 PMCID: PMC7839273 DOI: 10.12688/wellcomeopenres.16404.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 12/05/2022] Open
Abstract
In this open letter we examine the implications of the coronavirus disease 2019 (COVID-19) pandemic for cancer research and care from the point of view of the social studies of science, technology, and medicine. We discuss how the pandemic has disrupted several aspects of cancer care, underscoring the fragmentation of institutional arrangements, the malleable priorities in cancer research, and the changing promises of therapeutic innovation. We argue for the critical relevance of qualitative social sciences in cancer research during the pandemic despite the difficulties of immersive kinds of fieldwork. Social science research can help understand the ongoing, situated and lived impact of the pandemic, as well as fully underline its socially stratified consequences. We outline the risk that limiting and prioritising research activities according to their immediate clinical outcomes might have in the relational and longitudinal understanding of cancer practices in the UK. Finally, we alert against potential distortions that a "covidization" of cancer research might entail, arguing for the need to maintain a critical point of view on the pandemic.
Collapse
Affiliation(s)
- Cinzia Greco
- Centre for the History of Science Technology and Medicine (CHSTM), University of Manchester, Manchester, M13 9PL, UK
| | - Ignacia Arteaga
- Department of Social Anthropology, University of Cambridge, Cambridge, CB2 3RF, UK
| | | | - Henry Llewellyn
- UCL Division of Psychiatry, University College London, London, W1T 7NF, UK
| | - Julia Swallow
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, EH8 9LD, UK
| | - William Viney
- Department of Anthropology, Goldsmiths, University of London, London, SE14 6NW, UK
| |
Collapse
|
12
|
Jellema P, Annemans M, Heylighen A. Re-grounding the concept of liminality by foregrounding spatial aspects in experiences of cancer care. Health Place 2021; 70:102582. [PMID: 34000604 DOI: 10.1016/j.healthplace.2021.102582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/12/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
Liminality captures the passing stages in transitioning from one sociocultural status to another. As its spatial dimension remains under-examined, we analyse this in experiences of people affected by cancer. We review liminality in cancer-related literature and juxtapose this with empirical material. Analysing interview data (with eight patients) and participant-made photos highlights why places may be experienced differently throughout a period of illness and how places of diagnosis and care 'stretch' across locations. We conclude that exploring liminality's spatial dimension has implications for people 'living beyond' cancer, advances sociological understandings of (cancer) illness, and may inform healthcare facility design.
Collapse
Affiliation(s)
| | - Margo Annemans
- KU Leuven, Dept. of Architecture, Research[x]Design, Belgium
| | - Ann Heylighen
- KU Leuven, Dept. of Architecture, Research[x]Design, Belgium
| |
Collapse
|
13
|
|
14
|
Holmberg C. Experiencing Cancer. An Ethnographic Study on Illness and Disease. Recent Results Cancer Res 2021; 218:245-257. [PMID: 34019173 DOI: 10.1007/978-3-030-63749-1_16] [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] [Indexed: 06/12/2023]
Abstract
Cancer is seen as a 'dread disease' with a long and powerful history that remains resistant to defeat. It is a byword for suffering, pain and death. An unprecedented level of research spending and biomedical engagement offering new treatment options and hopes for a cure goes hand in hand with patient-led movements disseminating widespread public narratives of hope and survivorship. A key paradigm in these public narratives of hope and cure has been early detection of disease, with breast cancer, as the most frequent cancer among women, at the forefront of early detection campaigns. This chapter investigates the experiences behind the public face of breast cancer. It interrogates what it means to have breast cancer in the light of heroic stories of survivorship and fight using the theoretical concepts of illness-the subjective experience of feeling unwell-and disease-bodily pathologies that are identified through biomedical diagnostic technologies. With early detection becoming the primary mode of practice in breast cancer, illness has to be re-conceptualized. If a woman is to undergo treatment after a diagnosis of asymptomatic disease-without symptoms being present in her lifeworld-she has to cognitively understand the severity of the disease, and assume that she would die without treatment. The absence of bodily experiences of symptoms is irrelevant: it is the provision of information through which illness can manifest. The shock of diagnosis, as so often illustrated in cancer narratives, is therefore necessary in order to transform disease into an illness trajectory associated with biomedical treatment. The particular illness experiencehas profound and long-lasting consequences for a woman's life. Understanding the suffering associated with such disease conceptions as a necessary part of the illness experience could help us to improve health care services for those afflicted.
Collapse
Affiliation(s)
- Christine Holmberg
- Medical School Brandenburg Theodor Fontane, Institute of Social Medicine and Epidemiology, Hochstrasse 15, 14770, Brandenburg/Havel, Germany.
| |
Collapse
|
15
|
Waltz M, Prince AER, O’Daniel JM, Foreman AKM, Powell BC, Berg JS. Referencing BRCA in hereditary cancer risk discussions: In search of an anchor in a sea of uncertainty. J Genet Couns 2020; 29:949-959. [PMID: 31967382 PMCID: PMC7374021 DOI: 10.1002/jgc4.1219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 01/03/2020] [Accepted: 01/03/2020] [Indexed: 01/14/2023]
Abstract
As panel testing and exome sequencing are increasingly incorporated into clinical care, clinicians must grapple with how to communicate the risks and treatment decisions surrounding breast cancer genes beyond BRCA1 and BRCA2. In this paper, we examine clinicians' practice of employing BRCA1 and BRCA2 to help contextualize less certain genetic information regarding cancer risk and the possible implications of this practice for patients within the context of an exome sequencing study, NCGENES. We audio-recorded return of results appointments for 14 women who participated in NCGENES, previously had breast cancer, and were suspected of having a hereditary cancer predisposition. These patients were also interviewed four weeks later regarding their understanding of their results. We found that BRCA1 and BRCA2 were held as the gold standard, where clinicians compared what is known about BRCA to the limited understanding of other breast cancer-related genes. BRCA1 and BRCA2 were used as anchors to shape patients' understandings of genetic knowledge, risk, and management, illustrating how the information clinicians provide to patients may work as an external anchor. Yet, presenting BRCA1 and BRCA2 as a means of scientific reassurance can run the risk of patients conflating knowledge about certainty of risk with degree of risk after receiving a result for a moderate penetrance gene. This can be further complicated by misperceptions of the precision of cancer predictability attributed to these or other described 'cancer genes' in public media.
Collapse
Affiliation(s)
- Margaret Waltz
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Julianne M. O’Daniel
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ann Katherine M. Foreman
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bradford C. Powell
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jonathan S. Berg
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
16
|
Greco C, Arteaga I, Fabian-Therond C, Llewellyn H, Swallow J, Viney W. Cancer, COVID-19, and the need for critique. Wellcome Open Res 2020; 5:280. [PMID: 33521331 PMCID: PMC7839273 DOI: 10.12688/wellcomeopenres.16404.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 09/21/2023] Open
Abstract
In this open letter we examine the implications of the coronavirus disease 2019 (COVID-19) pandemic for cancer research and care from the point of view of the social studies of science, technology, and medicine. We discuss how the pandemic has disrupted several aspects of cancer care, underscoring the fragmentation of institutional arrangements, the malleable priorities in cancer research, and the changing promises of therapeutic innovation. We argue for the critical relevance of qualitative social sciences in cancer research during the pandemic despite the difficulties of immersive kinds of fieldwork. Social science research can help understand the ongoing, situated and lived impact of the pandemic, as well as fully underline its socially stratified consequences. We outline the risk that limiting and prioritising research activities according to their immediate clinical outcomes might have in the relational and longitudinal understanding of cancer practices in the UK. Finally, we alert against potential distortions that a "covidization" of cancer research might entail, arguing for the need to maintain a critical point of view on the pandemic.
Collapse
Affiliation(s)
- Cinzia Greco
- Centre for the History of Science Technology and Medicine (CHSTM), University of Manchester, Manchester, M13 9PL, UK
| | - Ignacia Arteaga
- Department of Social Anthropology, University of Cambridge, Cambridge, CB2 3RF, UK
| | | | - Henry Llewellyn
- UCL Division of Psychiatry, University College London, London, W1T 7NF, UK
| | - Julia Swallow
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, EH8 9LD, UK
| | - William Viney
- Department of Anthropology, Goldsmiths, University of London, London, SE14 6NW, UK
| |
Collapse
|
17
|
Sritharan J, Luo Y, Harris MA. Trends in participation rates in case–control studies of occupational risk factors 1991–2017. Occup Environ Med 2020; 77:659-665. [DOI: 10.1136/oemed-2019-106200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 05/01/2020] [Accepted: 05/15/2020] [Indexed: 11/03/2022]
Abstract
ObjectiveDeclining participation has been observed in previous epidemiological studies, could occupational risk factor epidemiology be particularly vulnerable to this trend? The objective of this study was to assess trends of participation rates in occupational case-control studies.MethodsFive prominent occupational and epidemiological journals were pre-selected and all articles published between 1991 and 2017 were screened for case-control studies of occupational risk factors for chronic disease outcomes. The primary independent variable was median year of data collection, while the primary outcome variable was reported participation rate. We conducted linear regression, adjusting for study characteristics that included study gender mix, location of recruitment, disease outcome, and data collection method.ResultsA total of 180 studies published in the five journals were included in the final analysis. The mean participation was higher for cases (78.9%) than for controls (71.5%). In linear regression, a significant trend of decreasing participation was observed for both cases with a percent change of −0.50 per year (95% CI −0.75 to −0.25) for cases and a percent change of −0.95 per year (95% CI −1.23 to −0.67) for controls. After adjustment for study gender mix, location, disease outcome, and data collection method, the trend remained statistically significant for both case and control groups.ConclusionDeclining participation rates in case-control studies of occupational risk factors may reflect an overall decline of participation in population-based samples. Lower participation rates introduce the potential for bias and may deter future population-based studies of occupational risk factors.
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Holmberg S. Stable, fragile and recreated - a qualitative study of agency in everyday life with breast and prostate cancer. Int J Qual Stud Health Well-being 2020; 14:1690391. [PMID: 31746274 PMCID: PMC6882442 DOI: 10.1080/17482631.2019.1690391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose: This study aims to explore how agency is constructed in everyday life with cancer in relation to daily activities and habits. Agency is approached as a key element of daily life existence, and it is constructed in terms of "acting in the world", self-behaviour, changing routines, identity expectations and life course.Methods: The study is based on a social constructionist approach and the data of 32 participants were gathered through a public call for narratives on "everyday life with breast and prostate cancer" in Finland in 2009. The analysis was conducted by utilizing a discursive research approach and coding.Results: Three categories of agency were identified: stable-where agency continues fluently after cancer; fragile-where the ability to take care of daily activities has deteriorated; and recreated-where living with cancer adapts or creates a new basis for daily living.Conclusions: The findings of the study suggest that everyday life activities and habits define and (de)construct agency, and that these constructions are tightly linked to the ill person's overall life situation, physical abilities and cultural context. Having cancer can create new challenges to agency in daily life but does not suppress agency.
Collapse
Affiliation(s)
- Suvi Holmberg
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| |
Collapse
|
20
|
Jenniches I, Lemmen C, Cwik JC, Kusch M, Labouvie H, Scholten N, Gerlach A, Stock S, Samel C, Hagemeier A, Hellmich M, Haas P, Hallek M, Pfaff H, Dresen A. Evaluation of a complex integrated, cross-sectoral psycho-oncological care program (isPO): a mixed-methods study protocol. BMJ Open 2020; 10:e034141. [PMID: 32156765 PMCID: PMC7064131 DOI: 10.1136/bmjopen-2019-034141] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION International standards of care require the complete integration of psycho-oncological care into biomedical cancer treatment. The structured integrated, cross-sectoral psycho-oncological programme 'isPO' is aiming to ensure a provision of care in inpatient and outpatient settings according to a stepped-care approach. Up to now, psycho-oncological care is missing regulated and standardised processes to demonstrate the effectiveness. This study protocol describes the process and outcome evaluation that is conducted, along with the isPO study. The programme evaluation is aiming to proof effectiveness, explain potential discrepancies between expected and observed outcomes. Additionally, provide insight into the implementation process, as well as contextual factors that might promote or inhibit the dissemination and implementation of the stepped care programme will be gained. In addition to these measures, a cost-consequence analysis will provide further evidence aimed at integrating psycho-oncological care into primary healthcare. METHODS AND ANALYSIS The evaluation concept is based on a tripartite strategy consisting of a prospective, formative and summative evaluation. To capture all determinants, a concurrent mixed-method design is applied comprising qualitative (interviews and focus groups) and quantitative (standardised questionnaires) surveys of patients and healthcare providers. In addition, analysis of the psycho-oncological care data (isPO care data) and statutory health insurance claims data will be conducted. Primary and secondary data will complement one another (data linkage) to obtain a more comprehensive picture of the effectiveness and implementation of the complex intervention within the isPO study. ETHICS AND DISSEMINATION The study has been approved by the ethics committee of the Medical Faculty of the University of Cologne. For all collected data, the relevant national and European data protection regulations will be considered. All personal identifiers (eg, name, date of birth) will be pseudonymised. Dissemination strategies include annual reports as well as quality workshops for the organisations, the presentation of results in publications and on conferences, and public relations. TRIAL REGISTRATION NUMBER DRKS00015326; Pre-results.
Collapse
Affiliation(s)
- Imke Jenniches
- IMVR - Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | - Clarissa Lemmen
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne, Cologne, Germany
| | | | - Michael Kusch
- Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Hildegard Labouvie
- Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Nadine Scholten
- IMVR - Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | | | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne, Cologne, Germany
| | - Christina Samel
- Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
| | - Anna Hagemeier
- Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
| | - Peter Haas
- Department of Computer Science (Medical Informatics), University of Applied Sciences and Arts Dortmund, Dortmund, Germany
| | - Michael Hallek
- Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Holger Pfaff
- IMVR - Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | - Antje Dresen
- IMVR - Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| |
Collapse
|
21
|
Pedersen KZ, Roelsgaard Obling A. 'It's all about time': Temporal effects of cancer pathway introduction in treatment and care. Soc Sci Med 2020; 246:112786. [PMID: 31981926 DOI: 10.1016/j.socscimed.2020.112786] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 12/20/2019] [Accepted: 01/03/2020] [Indexed: 12/11/2022]
Abstract
In the last decades, increased focus on time optimisation in healthcare services has led to introduction of new standardising technologies that alter the temporal structures of treatment-trajectories and work-practices. This paper presents a qualitative study of the temporal effects of introducing cancer pathways at a university hospital and a cancer rehabilitation centre in Denmark. Building analytically on a combination of Eviatar Zerubavel's and Norbert Elias's sociological studies on time, we show how the introduction of pathways has intensified the separation of cancer treatment and psychosocial support into two decoupled but mutually interdependent temporal orders. We furthermore demonstrate how pathway introduction has increased the focus on time as an overarching quality standard for treatment and care across organisational boundaries. Based on this analysis, we suggest that to understand current standardisation and optimisation processes and their unintended organisational effects, temporality should be treated as a research object of its own. Rather than analytically pre-empting temporal dichotomies or a priori assigning normativity to particular temporal structures, we call for thorough empirical investigation of temporal patterns in and between healthcare organisations.
Collapse
Affiliation(s)
- Kirstine Zinck Pedersen
- Department of Organization, Copenhagen Business School, Kilen, 3. Sal, 3.93, Kilevej 14A, DK-2000, Frederiksberg, Denmark.
| | | |
Collapse
|
22
|
Jellema P, Annemans M, Heylighen A. Foregrounding the built environment in the experience of cancer care: A qualitative study of autobiographical cancer narratives. Eur J Cancer Care (Engl) 2019; 28:e13156. [PMID: 31436912 DOI: 10.1111/ecc.13156] [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: 10/04/2018] [Revised: 04/25/2019] [Accepted: 08/01/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND For cancer patients, exposure to cancer care facilities entails confrontation in multiple ways. The value ascribed to these places grows over time and can be expected to affect the experience of care. OBJECTIVE The purpose of this study was to foreground the role of the built environment in this experience. METHODS This qualitative study is based on seven autobiographical narratives written by cancer patients being treated in Belgium or in neighbouring countries. RESULTS The thematic analysis of these accounts raises awareness of architecture's role in the experience of cancer patients. Their radius of action is typified by the contrasting adventurous undertakings and shrinking lifeworlds. The built environment furthermore provides leads to metaphors for patients to reformulate their experiences of illness and care. CONCLUSIONS Deterritorialised landscapes of cancer care include multiple, geographically dispersed places of care, rather than a single prominent care facility. Simultaneously, exposure to buildings where formal cancer care takes place is intense and meaningful. Metaphors are linked to the built environment and can be seen, through their use in the narratives, to support coping. Further research could look into the potential of metaphors to enhance understanding between stakeholders collaborating around design for cancer care.
Collapse
Affiliation(s)
- Pleuntje Jellema
- Department of Architecture, Research Design, KU Leuven, Leuven, Belgium
| | - Margo Annemans
- Department of Architecture, Research Design, KU Leuven, Leuven, Belgium
| | - Ann Heylighen
- Department of Architecture, Research Design, KU Leuven, Leuven, Belgium
| |
Collapse
|
23
|
Macdonald S, Conway E, Bikker A, Browne S, Robb K, Campbell C, Steele RJ, Weller D, Macleod U. Making sense of bodily sensations: Do shared cancer narratives influence symptom appraisal? Soc Sci Med 2019; 223:31-39. [PMID: 30703697 DOI: 10.1016/j.socscimed.2018.12.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 12/04/2018] [Accepted: 12/23/2018] [Indexed: 01/22/2023]
Abstract
Though new or altered bodily sensations are a common occurrence they rarely transition to biomedically defined symptoms. When they do, sensations are subject to an appraisal process that can culminate in help-seeking. The transition has particular relevance for cancer diagnoses. Studies of 'symptom appraisal' in cancer patients typically conclude that failure to regard sensations as serious or 'symptom misattribution' results in lengthier help-seeking intervals. Though multiple influences on appraisal processes are acknowledged, including the socio-cultural context, detailed description and analyses of how socio-cultural factors shape appraisal is lacking. In this paper we explore one substantial component of the sociocultural context, namely, publicly recognised shared cancer narratives, and their impact on appraisal. We undertook a secondary analysis of 24 interviews with Scottish colorectal cancer patients originally completed in 2006-2007. Our analysis showed that fear, death and severity dominated cancer narratives and were frequently restated throughout interviews. Yet, early bodily changes were often mild and vague, were commonly experienced in the context of 'feeling well' and failed to match preconceived ideas of what cancer 'feels like'. Moreover, few perceived themselves to be 'at risk' of cancer and diagnoses were characterised as 'shocking' events. Participants engaged in self-monitoring strategies and severe or painful changes prompted help-seeking. Far from misattributing symptoms, responses to bodily changes were sensible and measured; responses are particularly apt in relation to current policy rhetoric, which urges measured use of services. Our findings have resonance across healthcare settings as patients are required to negotiate a narrow and challenging space when making decisions to seek help. There is a pressing need for a more realistic approach to symptom appraisal in order to reduce help-seeking intervals. Future awareness campaigns should emphasise the importance of vague/minor bodily changes although this will necessitate discussions with health professionals on referral thresholds to achieve earlier detection.
Collapse
Affiliation(s)
- Sara Macdonald
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK.
| | - Elaine Conway
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Annemieke Bikker
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Susan Browne
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Kathryn Robb
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Christine Campbell
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Robert Jc Steele
- Medical Research Institute, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - David Weller
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Una Macleod
- Hull York Medical School, University of Hull, Hull, HU6 7RX, UK
| |
Collapse
|
24
|
Ramírez AS, Arellano Carmona K. Beyond fatalism: Information overload as a mechanism to understand health disparities. Soc Sci Med 2018; 219:11-18. [PMID: 30342382 PMCID: PMC6240483 DOI: 10.1016/j.socscimed.2018.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 10/03/2018] [Accepted: 10/12/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Fatalism - beliefs about the causes and controllability of disease - has been negatively associated with prevention behaviors. Fatalism has been suggested as a mechanism for health disparities because ethnic minorities are especially likely to hold fatalistic beliefs. However, the construct has been criticized: Fatalism fails to account for structural barriers to health faced by vulnerable populations that also score highly on measures of fatalism. Another critique suggests that operationalizations of fatalism expose communication failures: "Fatalism" rather reflects information overload from an environment riddled with misinformation and contradictions. This study aimed to expand understanding of one mechanism through which communication may contribute to disparities by considering the context of nutrition among bicultural Latinas, who face increased risk from dietary acculturation. METHOD Mixed-methods (semi-structured in-depth interview, survey) with Mexican-American women ages 18-29 (n = 24) in rural California. RESULTS Contrary to previous studies, the majority of this sample of Mexican-American women did not endorse fatalistic beliefs; most demonstrated clear understanding of the link between diet and risk of diseases: Diabetes and heart disease were understood to result from behaviors within one's control. Yet despite articulating links between diet and disease, participants felt overloaded and confused about conflicting information from public and interpersonal sources. Moreover, despite reporting feeling inundated with information, participants noted critical information gaps, distinguishing between information available and information needed. CONCLUSIONS We found minimal support for fatalistic beliefs among a sample of Mexican-American women, but considerable information overload and confusion, together with a desire for specific knowledge and skills. Results extend understanding of how communication may influence disparities: Information overload may be conflated with fatalism, challenging the notion that fatalism is a cultural belief. Moreover, inequalities in access to and ability to process information compound overload effects. We discuss opportunities to improve the clarity of communication about nutrition science and dietary recommendations.
Collapse
Affiliation(s)
- A Susana Ramírez
- School of Social Sciences, Humanities, and Arts, University of California, Merced 5200 North Lake Road, Merced, CA, 95343, USA.
| | - Kimberly Arellano Carmona
- School of Social Sciences, Humanities, and Arts, University of California, Merced 5200 North Lake Road, Merced, CA, 95343, USA.
| |
Collapse
|
25
|
Russell RD, Black LJ, Sherriff JL, Begley A. Dietary responses to a multiple sclerosis diagnosis: a qualitative study. Eur J Clin Nutr 2018; 73:601-608. [PMID: 29941913 DOI: 10.1038/s41430-018-0252-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 06/07/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND/OBJECTIVES Multiple sclerosis (MS) is an immune-mediated disease with no known cure and insufficient evidence to support a special therapeutic diet to alter symptom management or disease progression. Several studies have reported dietary changes made by people with MS, but there has been limited investigation into experiences surrounding diet in those recently diagnosed. This study explored responses to diet after a recent diagnosis of MS in people living in Western Australia. SUBJECTS/METHODS Eleven adults with MS (mean time since diagnosis 8 months) participated in semi-structured interviews focusing on responses to diet since MS diagnosis. Interviews were transcribed, coded and analysed using grounded theory principles. RESULTS Three theme responses emerged; (1) the perceived incompatibility of lack of/or generalised dietary advice with disease seriousness at the time of diagnosis; (2) extensive personal research and information seeking with difficulty judging credibility, and (3) self-experimentation with diet to either control MS symptoms or to cure MS. CONCLUSIONS Given the seriousness of the disease, there is a perceived gap in dietary information provided at the time of diagnosis. Healthcare professionals should address concerns with alternative therapeutic diets advertised to treat or cure MS, and clearly convey the reasoning for the general healthy dietary recommendations. This would better align advice with the perceptions about the role of diet in MS, assist people with MS in need of information and minimise dietary self-experimentation. Future research should explore the importance of diet for those who have had MS for a longer period of time.
Collapse
Affiliation(s)
| | - Lucinda J Black
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Jill L Sherriff
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Andrea Begley
- School of Public Health, Curtin University, Perth, WA, Australia.
| |
Collapse
|