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Natvik E, Lavik KO, Ogden J, Strømmen M, Moltu C. The patient-practitioner interaction in post bariatric surgery consultations: an interpersonal process recall study. Disabil Rehabil 2023; 45:4440-4449. [PMID: 36484620 DOI: 10.1080/09638288.2022.2152876] [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: 06/10/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE The patient-practitioner relationship is fundamental to rehabilitation practice and patients' health and wellbeing. Dissonance between patients who have had bariatric surgery and health care practitioners about what supportive care and good outcomes are can undermine care. To address the mechanisms of this process, we conducted an Interpersonal Process Recall study. MATERIALS AND METHODS We interviewed patients (11), video recorded consultations (10), conducted video-assisted individual interviews with patients (10) and practitioners (11) and a dyadic data analysis. RESULTS We identified relational states and shifts in the clinical encounter 2-3 years post-surgery, described in themes: a) Playing by the Book - Making it Easier for Each Other, b) Down the Blind Alley - Giving up on Each Other, and c) Opposite Poles - Towards and Away from Each Other. CONCLUSIONS The post-surgery consultations facilitated responsibility for health and self-care but did not invite dialogues about the psychosocial burdens of living with obesity and undergoing bariatric surgery. Patients and practitioners tried to avoid creating conflict, which in turn seemed to foster distance, rather than human connection. This limits the encounter's benefit to both parties, leaving them frustrated and less willing to either meet again or take any gains into their future lives.IMPLICATIONS FOR REHABILITATIONIllness evokes feelings of stress and uncertainty and is experienced very differently from the perspective of patients and health care practitioners (HCPs), who encounter each other in a field fraught with tension.Bodily changes and difficult emotions related to food and eating are to be expected when undergoing bariatric surgery, and to explicitly "notice, name and validate" emotions can promote the patient's capacity to sustain self-care, lifestyle change, weight loss and health gains.Making interpersonal connection and interaction between patient and HCP the centre of bariatric aftercare can enhance engagement in and outcomes of the post-surgery clinical encounter.
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Affiliation(s)
- Eli Natvik
- The Centre for Health Research, District General Hospital of Førde, Førde, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
| | - Kristina Osland Lavik
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
| | - Jane Ogden
- Department of Psychology, University of Surrey, Guildford, England
| | - Magnus Strømmen
- Centre for Obesity Research, Clinic of Surgery, St. Olavs University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Christian Moltu
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
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Kelly J, Menon V, O'Neill F, Elliot L, Combe E, Drinkwater W, Abbott S, Hayee B. UK cost-effectiveness analysis of endoscopic sleeve gastroplasty versus lifestyle modification alone for adults with class II obesity. Int J Obes (Lond) 2023; 47:1161-1170. [PMID: 37674032 PMCID: PMC10599990 DOI: 10.1038/s41366-023-01374-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/08/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Endoscopic sleeve gastroplasty (ESG) is a minimally invasive procedure that has been demonstrated in the MERIT randomised, controlled trial to result in substantial and durable additional weight loss in adults with obesity compared with lifestyle modification (LM) alone. We sought to conduct the first cost-effectiveness analysis of ESG versus LM alone in adults with class II obesity (BMI 35.0-39.9 kg/m2) from a national healthcare system perspective in England based on results from this study. METHODS A 6-state Markov model was developed comprising 5 BMI-based health states and an absorbing death state. Baseline characteristics, utilities, and transition probabilities were informed by patient-level data from the subset of patients with class II obesity in MERIT. Adverse events (AEs) were based on the MERIT safety population. Mortality was estimated by applying BMI-specific hazard ratios from the published literature to UK general population mortality rates. Utilities for the healthy weight and overweight health states were informed from the literature; disutility associated with increasing BMI in the class I-III obesity health states was estimated using MERIT utility data. Disutility due to AEs and the prevalence of obesity-related comorbidities were based on the literature. Costs included intervention costs, AE costs, and comorbidity costs. RESULTS ESG resulted in higher overall costs than LM alone but led to an increase in quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) for ESG vs LM alone was £2453/QALY gained. ESG was consistently cost effective across a wide range of sensitivity analyses, with no ICER estimate exceeding £10,000/QALY gained. In probabilistic sensitivity analysis, the mean ICER was £2502/QALY gained and ESG remained cost effective in 98.25% of iterations at a willingness-to-pay threshold of £20,000/QALY. CONCLUSION Our study indicates that ESG is highly cost effective versus LM alone for the treatment of adults with class II obesity in England.
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Affiliation(s)
- Jamie Kelly
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Vinod Menon
- University Hospitals Coventry & Warwickshire NHS Foundation Trust, Coventry, UK
- University of Warwick, Coventry, UK
| | | | | | | | | | - Sally Abbott
- University Hospitals Coventry & Warwickshire NHS Foundation Trust, Coventry, UK
- Research Centre for Healthcare and Communities, Institute of Health and Wellbeing, Coventry University, Coventry, UK
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McAloon T, Coates V, Fitzsimons D. Duty of care trumps utilitarianism in multi-professional obesity management decisions. Nurs Ethics 2022; 29:1401-1414. [PMID: 35623624 PMCID: PMC9527366 DOI: 10.1177/09697330221075764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Escalating levels of obesity place enormous and growing demands on Health
care provision in the (U.K.) United Kingdom. Resources are limited with
increasing and competing demands upon them. Ethical considerations underpin
clinical decision making generally, but there is limited evidence regarding
the relationship between these variables particularly in terms of treating
individuals with obesity. Research aim To investigate the views of National Health Service (NHS) clinicians on
navigating the ethical challenges and decision making associated with
obesity management in adults with chronic illness. Research design A cross-sectional, multi-site survey distributed electronically. Participants A consensus sample of nurses, doctors, dietitians and final year students in
two NHS Trusts and two Universities. Ethical considerations Ethical and governance approvals obtained from a National Ethics Committee
(11NIR035), two universities and two teaching hospitals. Results Of the total (n = 395) participants, the majority were
nurses (48%), female (79%) and qualified clinicians (59%). Participants
strongly considered the individual to have primary responsibility for a
healthy weight and an obligation to attempt to maintain that healthy weight
if they wish to access NHS care. Yet two thirds would not withhold treatment
for patients with obesity. Discussion While clinicians were clear about patient responsibility and obligations, the
majority prioritised their duty of care and would not invoke a utilitarian
approach to decision making. This may reflect awareness of obesity as a
multi-faceted entity, with responsibility for support and management shared
amongst society in general. Conclusions The attitudes of this sample of clinicians complemented the concept of the
health service as being built on a principle of community, with each treated
according to their need. However limited resources challenge the concept of
needs-based decisions consequently societal engagement is necessary to agree
a pragmatic way forward.
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Affiliation(s)
- Toni McAloon
- Department of Nursing, 42259Ulster University - Jordanstown Campus, Newtownabbey, UK
| | - Vivien Coates
- Department of Nursing, 2596Ulster University - Coleraine Campus, Coleraine, UK
| | - Donna Fitzsimons
- Department of Nursing, 1596Queen's University Belfast, Belfast, UK
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Traina G, Feiring E. Priority setting and personal health responsibility: an analysis of Norwegian key policy documents. JOURNAL OF MEDICAL ETHICS 2022; 48:39-45. [PMID: 32122963 PMCID: PMC8717478 DOI: 10.1136/medethics-2019-105612] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 02/11/2020] [Accepted: 02/17/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND The idea that individuals are responsible for their health has been the focus of debate in the theoretical literature and in its concrete application to healthcare policy in many countries. Controversies persist regarding the form, substance and fairness of allocating health responsibility to the individual, particularly in universal, need-based healthcare systems. OBJECTIVE To examine how personal health responsibility has been framed and rationalised in Norwegian key policy documents on priority setting. METHODS Documents issued or published by the Ministry of Health and Care Services between 1987 and 2018 were thematically analysed (n=14). We developed a predefined conceptual framework that guided the analysis. The framework included: (1) the subject and object of responsibility, (2) the level of conceptual abstraction, (3) temporality, (4) normative justificatory arguments and (5) objections to the application of personal health responsibility. RESULTS As an additional criterion, personal health responsibility has been interpreted as relevant if: (A) the patient's harmful behaviour is repeated after receiving treatment (retrospectively), and if (B) the success of the treatment is conditional on the patient's behavioural change (prospectively). When discussed as a retrospective criterion, considerations of reciprocal fairness have been dominant. When discussed as a prospective criterion, the expected benefit of treatment justified its relevance. CONCLUSION Personal health responsibility appears to challenge core values of equality, inclusion and solidarity in the Norwegian context and has been repeatedly rejected as a necessary criterion for priority setting. However, the responsibility criterion seems to have some relevance in particular priority setting decisions.
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Affiliation(s)
- Gloria Traina
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Eli Feiring
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
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Dieteren CM, Reckers-Droog VT, Schrama S, de Boer D, van Exel J. Viewpoints among experts and the public in the Netherlands on including a lifestyle criterion in the healthcare priority setting. Health Expect 2021; 25:333-344. [PMID: 34845790 PMCID: PMC8849370 DOI: 10.1111/hex.13385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/10/2021] [Accepted: 10/01/2021] [Indexed: 11/28/2022] Open
Abstract
Context It remains unclear whether there would be societal support for a lifestyle criterion for the healthcare priority setting. This study examines the viewpoints of experts in healthcare and the public regarding support for a lifestyle‐related decision criterion, relative to support for the currently applied criteria, in the healthcare priority setting in the Netherlands. Methods We conducted a Q methodology study in samples of experts in healthcare (n = 37) and the public (n = 44). Participants (total sample N = 81) ranked 34 statements that reflected currently applied decision criteria as well as a lifestyle criterion for setting priorities in healthcare. The ranking data were subjected to principal component analysis, followed by oblimin rotation, to identify clusters of participants with similar viewpoints. Findings We identified four viewpoints. Participants with Viewpoint 1 believe that treatments that have been proven to be effective should be reimbursed. Those with Viewpoint 2 believe that life is precious and every effort should be made to save a life, even when treatment still results in a very poor state of health. Those with Viewpoint 3 accept government intervention in unhealthy lifestyles and believe that individual responsibility should be taken into account in reimbursement decisions. Participants with Viewpoint 4 attribute importance to the cost‐effectiveness of treatments; however, when priorities have to be set, treatment effects are considered most important. All viewpoints were supported by a mix of public and experts, but Viewpoint 1 was mostly supported by experts and the other viewpoints were mostly supported by members of the public. Conclusions This study identified four distinct viewpoints on the healthcare priority setting in the Netherlands, each supported by a mix of experts and members of the public. There seems to be some, but limited, support for a lifestyle criterion—in particular, among members of the public. Experts seem to favour the decision criteria that are currently applied. The diversity in views deserves attention when policymakers want to adhere to societal preferences and increase policy acceptance.
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Affiliation(s)
- Charlotte M Dieteren
- Department of Health Economics, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Vivian T Reckers-Droog
- Department of Health Economics, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Sara Schrama
- Department of Health Economics, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Dynothra de Boer
- Department of Health Economics, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Job van Exel
- Department of Health Economics, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands
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6
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Atoofi MK, Qorbani M, Asayesh H, Rezaei N, Moghaddam SS, Djalalinia S. Obesity researches in youth: A scientometrics study in Middle East countries. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2021; 26:54. [PMID: 34729062 PMCID: PMC8506246 DOI: 10.4103/jrms.jrms_415_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 06/21/2020] [Accepted: 02/11/2021] [Indexed: 11/04/2022]
Abstract
Background The alarming trends of obesity/overweight in youth have been interested policy makers and other stakeholders to exact follow and analysis of related scientific evidence. The present paper quantify the trends of outputs of youth obesity/overweight researches in Middle East countries. Materials and Methods The Scopus database systematically searched as the most comprehensive multidisciplinary database, for all related obesity/overweight that focused on youth age groups concerns, from 2000 to 2017. These scientometrics analysis included the trends of scientific products, citations, and other scientometric index in Middle East countries. Results During 2000-2017, in the field of youth obesity, 2350 papers published (0.40% of total 591,105 indexed paper of this region) by Middle East countries. In this regard, Iran with 574 publication (24.43%) had the first rank. After that Turkey and Saudi Arabia, respectively, with 489 (20.81%) and 313 (13.32%) papers, had the next ranks. Over 18-year period, based on the findings all of Eastern Mediterranean countries follow the progressive plans for topics related to youth obesity. Between them, Iran and Turkey have significant growth rates (0.77% and 0.40%, respectively). Scientometric indicators such as "number of published papers," "number of citations" confirmed that during the 2000-2017 the P-trends of total number of related published papers and the correspond citations, in region countries, were significant (2168 papers and 34,132 citations, P < 0.001). Conclusion Most of countries at global and regional levels follow ascending trends in publications and citations in obesity/overweight fields. Iran's position has grown significantly among them. Maintaining and promoting this position requires careful planning and special attention. The findings also could be used for better health policy and complementary researches.
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Affiliation(s)
- Mehrdad Kazemzadeh Atoofi
- Spiritual Health Research Center, School of Behavioral Sciences and Mental Health, Tehran Psychiatric Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Hamid Asayesh
- Department of Medical Emergencies, Qom University of Medical Sciences, Qom, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Djalalinia
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
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7
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Recommending no further treatment: Gatekeeping work of generalists at a Japanese university hospital. Soc Sci Med 2021; 290:113891. [DOI: 10.1016/j.socscimed.2021.113891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 11/20/2022]
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8
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Traina G, Feiring E. 'There is no such thing as getting sick justly or unjustly' - a qualitative study of clinicians' beliefs on the relevance of personal responsibility as a basis for health prioritisation. BMC Health Serv Res 2020; 20:497. [PMID: 32493300 PMCID: PMC7268691 DOI: 10.1186/s12913-020-05364-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 05/25/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Concerns have been raised regarding the reasonableness of using personal health responsibility as a principle or criterion for setting priorities in healthcare. While this debate continues, little is known about clinicians' views on the role of patient responsibility in clinical contexts. This paper contributes to the knowledge on the empirical relevance of personal responsibility for priority setting at the clinical level. METHODS A qualitative study of Norwegian clinicians (n = 15) was designed, using semi-structured interviews with vignettes to elicit beliefs on the relevance of personal responsibility as a basis for health prioritisation. Sampling was undertaken purposefully. The interviews were conducted in three hospital trusts in South-Eastern Norway between May 2018 and February 2019 and were analysed with conceptually driven thematic analysis. RESULTS The findings suggest that clinicians endorsed a general principle of personal health responsibility but were reluctant to introduce personal health responsibility as a formal priority setting criterion. Five main objections were cited, relating to avoidability, causality, harshness, intrusiveness, and inequity. Still, both retrospective and prospective attributions of personal responsibility were perceived as relevant in specific clinical settings. The most prominent argument in favour of personal health responsibility was grounded in the idea that holding patients responsible for their conduct would contribute to the efficient use of healthcare resources. Other arguments included fairness to others, desert and autonomy, but such standpoints were controversial and held only marginal relevance. CONCLUSIONS Our study provides important novel insights into the clinicians' beliefs about personal health responsibility improving the empirical knowledge concerning its fairness and potential applications to healthcare prioritisation. These findings suggest that although personal health responsibility would be difficult to implement as a steering criterion within the main priority setting framework, there might be clinical contexts where it could figure in prioritisation practices. Additional research on personal health responsibility would benefit from considering the multiple clinical encounters that shape doctor-patient relationships and that create the information basis for eligibility and prioritisation for treatment.
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Affiliation(s)
- Gloria Traina
- Department of Health Management and Health Economics, University of Oslo, Post box 1089 Blindern, 0317, Oslo, Norway.
| | - Eli Feiring
- Department of Health Management and Health Economics, University of Oslo, Post box 1089 Blindern, 0317, Oslo, Norway
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Abstract
Overweight and obesity are known risk factors for the development of lymphoedema, and are also well-recognised factors complicating the management of lymphoedema. However, a degree of uncertainty remains regarding the way in which obesity impacts upon the condition, and there is little detail about the practical application of weight management strategies in the population with lymphoedema. This article provides the background for ongoing research into the association between lymphoedema management and obesity. It is hoped that this research will provide important insights into the long-term management of lymphoedema.
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Affiliation(s)
- Debbie Provan
- Regional Lead for Living With and Beyond Cancer, West of Scotland Cancer Network, Glasgow
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10
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Traina G, Martinussen PE, Feiring E. Being Healthy, Being Sick, Being Responsible: Attitudes towards Responsibility for Health in a Public Healthcare System. Public Health Ethics 2019; 12:145-157. [PMID: 31384303 PMCID: PMC6655377 DOI: 10.1093/phe/phz009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Lifestyle-induced diseases are becoming a burden on healthcare, actualizing the discussion on health responsibilities. Using data from the National Association for Heart and Lung Diseases (LHL)’s 2015 Health Survey (N = 2689), this study examined the public’s attitudes towards personal and social health responsibility in a Norwegian population. The questionnaires covered self-reported health and lifestyle, attitudes towards personal responsibility and the authorities’ responsibility for promoting health, resource-prioritisation and socio-demographic characteristics. Block-wise multiple linear regression assessed the association between attitudes towards health responsibilities and individual lifestyle, political orientation and health condition. We found a moderate support for social responsibility across political views. Respondents reporting unhealthier eating habits, smokers and physically inactive were less supportive of health promotion policies (including information, health incentives, prevention and regulations). The idea that individuals are responsible for taking care of their health was widely accepted as an abstract ideal. Yet, only a third of the respondents agreed with introducing higher co-payments for treatment of ‘self-inflicted’ conditions and levels of support were patterned by health-related behaviour and left-right political orientation. Our study suggests that a significant support for social responsibility does not exclude a strong support for personal health responsibility. However, conditional access to healthcare based on personal lifestyle is still controversial.
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Affiliation(s)
- Gloria Traina
- Department of Health Management and Health Economics, University of Oslo
| | - Pål E Martinussen
- Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU)
| | - Eli Feiring
- Department of Health Management and Health Economics, University of Oslo
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11
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Blackburn M, Stathi A. Moral discourse in general practitioners' accounts of obesity communication. Soc Sci Med 2019; 230:166-173. [PMID: 31030008 DOI: 10.1016/j.socscimed.2019.03.032] [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: 12/14/2017] [Revised: 02/23/2019] [Accepted: 03/21/2019] [Indexed: 10/27/2022]
Abstract
Obesity is not addressed with a large proportion of patients presenting in general practice. An increasing body of evidence suggests that health professionals view body weight as a sensitive topic to include in routine consultations and face barriers in initiating weight loss discussions. This study examined the discursive power relations that shape how general practitioners (GPs) understand and talk about obesity using a novel methodology to elicit responses from GPs about raising the topic of weight. Twenty GPs from the South West of England reflected upon novel trigger films simulating doctor-patient interactions, in which a doctor either acknowledged or ignored their patient's body weight. Underpinned by a discourse analytic approach, our findings suggest that GPs both reproduce and resist moral discourse surrounding body weight. They construct obesity as an individual behavioural problem whilst simultaneously drawing on socio-cultural discourse which positions body weight as central to social identity, situating obesity within a context of stigma and positioning patients as powerless to lose weight. Our findings highlight a need for increased reflexivity about competing discursive frameworks at play during medical consultations about obesity, which we suggest, contribute to increased tension and powerlessness for GPs. Trigger films are an innovative method to elicit information and discuss competing discourses.
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Affiliation(s)
- Maxine Blackburn
- University of Bath, Department for Health, Bath, BA2 7AY, UK; University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh, EH8 9AG, UK.
| | - Afroditi Stathi
- University of Bath, Department for Health, Bath, BA2 7AY, UK; University of Birmingham, School of Sport, Exercise and Rehabilitation Sciences, Birmingham, B15 2TT, UK.
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12
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Schnoor J, Braehler E, Heyde CE. Did we learn the lesson after 60 years of Management by Objectives? A survey among former physician executives in German hospitals. Work 2019; 62:353-359. [PMID: 30829645 DOI: 10.3233/wor-192869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Management by Objectives (MbO) has been shown to establish efficient team work in both industry and medicine. Its most important prerequisite for success is target agreements between managers and medical professionals on equal footing. In medicine, lump-sum financing urges the delivery of a health care service with minimal effort. Consequently, daily clinical life changed, with economic goals seeming to become priority over medical principles. OBJECTIVE To determine how well MbO can still be practiced in hospitals with lumped treatment prices. METHODS We used an anonymized questionnaire for already retired physician executives who completed their active leadership positions between 2010 and 2015 in Saxony (Germany). We asked various type of target agreements that had been used in order to achieve medical or economic targets. RESULTS AND CONCLUSIONS Out of 111 former executives, the questionnaires of 25 respondents could be analysed. Eight respondents confirmed target agreements that were mostly set by managing directors. If used, most targets had not been adapted to the infrastructure and personnel strength, nor were they coordinated with neighbouring departments. Four respondents received financial incentives. Most medical executives were unsatisfied and preferred to abandon further goal setting. Due to the low number of cases, the representativeness of the study is limited. Nevertheless, it might be questioned if a flat-rate remuneration system facilitates the change into an authoritarian leadership concept.
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Affiliation(s)
- Joerg Schnoor
- Department of Anaesthesiology and Intensive Care Medicine, COLLM KLINIK OSCHATZ, Oschatz, Germany
| | - Elmar Braehler
- Department of Psychology and Sociology, University Hospital Leipzig, Leipzig, Germany
| | - Christoph-E Heyde
- Department of Orthopaedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
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13
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Phelan SM. An update on research examining the implications of stigma for access to and utilization of bariatric surgery. Curr Opin Endocrinol Diabetes Obes 2018; 25:321-325. [PMID: 30048259 DOI: 10.1097/med.0000000000000431] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW To summarize recent literature examining the relationship between stigma and utilization of surgical treatments for obesity. RECENT FINDINGS The stigma of obesity and stigma associated with surgical treatments for obesity can affect both healthcare providers' recommendations of these options and patients' likelihood of considering and choosing these treatments. Presurgical requirements of healthcare and insurance organizations and a lack of postsurgical support reflect the stigmatizing attitudes that bariatric/metabolic surgery is an 'easy fix' and 'last resort' for patients too undisciplined to lose weight in other ways. SUMMARY Here we review the literature published in the last year that addresses the implications of stigma for the utilization and outcomes of surgical treatments for obesity.
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Affiliation(s)
- Sean M Phelan
- Division of Healthcare Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
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14
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Owen-Smith A, Coast J, Donovan JL. Self-responsibility, rationing and treatment decision making - managing moral narratives alongside fiscal reality in the obesity surgery clinic. Health Expect 2018; 21:606-614. [PMID: 29349856 PMCID: PMC5980582 DOI: 10.1111/hex.12651] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2017] [Indexed: 11/26/2022] Open
Abstract
Background Addressing the prevalence of severe obesity and its concomitant morbidities is widely acknowledged as one of the most pressing global health priorities. Nevertheless, a paucity of effective interventions and universal pressure on health‐care budgets means that access to obesity treatments is often limited. Although health‐care rationing can be conceived as a socially constructed process, little is known about how decisions emerge within the context of face‐to‐face doctor–patient interactions. Methods In this study, we used in‐depth interviews and clinic observations to investigate clinicians’ (n = 11) and patients’ (n = 22) experiences of the rationing of obesity surgery and to examine how broader cultural assumptions around personal responsibility for health emerged in the context of clinical interactions. Results Patients and clinicians worked within similar frameworks when it came to self‐responsibility for health and the appropriateness of providing publicly‐funded weight loss surgery. Issues around personal accountability dominated consultations, and patients were expected to provide narratives of the development of their obesity and to account for the failure of previous interventions. Clinicians faced the added pressure of having to prioritise a limited number of patients for surgery, which was predominantly managed through mandating pre‐referral weight loss targets. Discussion Although clinicians sought to maintain an empathic attitude towards individual patients, in practice they were conflicted by their responsibility to ration health‐care resources and tended to rely on entrenched models of behaviour change to allocate treatment. As a result, the content of consultations was mostly focused on issues of personal responsibility, reflecting wider stigmatized attitudes towards extreme obesity.
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Affiliation(s)
- Amanda Owen-Smith
- School of Social and Community Medicine, University of Bristol, Bristol, UK.,National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Trust, Bristol, UK
| | - Joanna Coast
- School of Social and Community Medicine, University of Bristol, Bristol, UK.,National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Trust, Bristol, UK
| | - Jenny L Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, UK.,National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Trust, Bristol, UK
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