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Browne K, England A, Young R, Moore N, Kjelle E, Owen A, McEntee MF. Radiographers' perceptions of the experiences of patients with dementia attending the radiology department. J Med Imaging Radiat Sci 2024; 55:189-196. [PMID: 38350753 DOI: 10.1016/j.jmir.2024.01.003] [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: 07/31/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Patients with dementia frequently present to the Radiology Department. However, stigmas have been recorded amongst radiographers surrounding imaging persons with dementia (PwD). This study aimed to investigate the impact of PwD attending the Radiology Department for imaging and the resultant effects to all patients, radiographers, and the Department from the perspectives of the examining radiographer. METHODS A paper-based questionnaire of radiographers' perceptions and experiences of individual examinations 'termed an interaction form' was created and made available in a public hospital in Ireland for a period of eight weeks. Radiographers completed the interaction form collecting data regarding individual imaging examinations of PwD. The form comprised sixteen closed and one open-ended question on the radiographers' individual perspectives of PwDs' abilities and distress levels, carers and comforters and their role in the examination, what the radiographer found helpful in the interaction, and any adverse events. Data were analysed using a combination of descriptive analysis and thematic content analysis. RESULTS Thirty-three interaction forms were completed by the participating radiographers. The modality most commonly represented in the survey was general X-ray (58%). Radiographers reported 84% of examinations for PwD required extra time, with 27% of examinations required repeat imaging and 69% of patients appeared distressed. A carer helped facilitate the completion of 77% of examinations. Qualitative data indicated that distractive and communicative techniques were used by radiographers to make the patient feel more comfortable and help with examination success. CONCLUSION PwD often require more time for radiological examinations, they often need repeat imaging and re-scheduling of an examination at a more appropriate time. These factors need to be considered when scheduling and performing radiological examinations. Patient distress was frequently encountered, this area may benefit from further research and dedicated practitioner training which could help drive improvements in patient experience.
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Affiliation(s)
- Katie Browne
- Discipline of Medical Imaging & Radiation Therapy, School of Medicine, Brookfield Health Sciences Complex, University College Cork, Ireland
| | - Andrew England
- Discipline of Medical Imaging & Radiation Therapy, School of Medicine, Brookfield Health Sciences Complex, University College Cork, Ireland.
| | - Rena Young
- Discipline of Medical Imaging & Radiation Therapy, School of Medicine, Brookfield Health Sciences Complex, University College Cork, Ireland
| | - Niamh Moore
- Discipline of Medical Imaging & Radiation Therapy, School of Medicine, Brookfield Health Sciences Complex, University College Cork, Ireland
| | - Elin Kjelle
- Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway, Norway
| | - Andrew Owen
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Mark F McEntee
- Discipline of Medical Imaging & Radiation Therapy, School of Medicine, Brookfield Health Sciences Complex, University College Cork, Ireland
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Farrington N, Richardson A, Bridges J. 'A real fine balancing act': A secondary qualitative analysis of power imbalance in comorbid cancer and dementia in an outpatient treatment setting. J Adv Nurs 2023. [PMID: 36929372 DOI: 10.1111/jan.15629] [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: 10/17/2022] [Revised: 02/07/2023] [Accepted: 02/22/2023] [Indexed: 03/18/2023]
Abstract
AIMS Studies of health services reveal a focus on provision of scheduled care at the expense of patient need, placing the health service in a position of power and the patient as passive recipient. This secondary qualitative analysis of a focused ethnography draws on the Foucauldian concept of power as pervasive and relational, to examine how an imbalance of power is manifested in situations where people with both cancer and dementia are being treated for cancer. DESIGN Secondary qualitative analysis of a focused ethnographic study. DATA SOURCES In the original study, qualitative data were gathered from observation and interviews with people with cancer and dementia (n = 2), caregivers (n = 7) and staff (n = 20). The study was conducted in the outpatient departments of two teaching hospitals in England between January 2019 and July 2021. Data from all sources were analysed for this secondary analysis using constant comparison. RESULTS The principal theme was balance, encapsulating the competing priorities involved in delivering cancer treatment. There was tension between maintaining safety and ensuring an individual's right to treatment, and difficulty reconciling the needs of the system with the needs of individuals. CONCLUSION The pervasive nature of power can be harnessed to enhance the agency of people with cancer and dementia by incorporating principles of shared decision making. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE We recommend incorporating the principles of personalized care to achieve more equitable power relations, reduce health inequalities and ensure that cancer treatment offered to people with dementia is safe and appropriate. REPORTING METHOD EQUATOR (COREQ) guidelines have been used for reporting. PATIENT OR PUBLIC CONTRIBUTION Patients and the public were involved in designing the original research questions and the study protocol including documentation such as interview topic guides and participant information sheets.
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Affiliation(s)
- Naomi Farrington
- Clinical Academic Facility, University Hospital Southampton NHSFT & University of Southampton, Southampton, UK
| | - Alison Richardson
- Clinical Academic Facility, University Hospital Southampton NHSFT & University of Southampton, Southampton, UK.,University of Southampton, Faculty of Health Sciences, Southampton, UK
| | - Jackie Bridges
- University of Southampton, Faculty of Health Sciences, Southampton, UK
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Ashley L, Surr C, Kelley R, Price M, Griffiths AW, Fowler NR, Giza DE, Neal RD, Martin C, Hopkinson JB, O'Donovan A, Dale W, Koczwara B, Spencer K, Wyld L. Cancer care for people with dementia: Literature overview and recommendations for practice and research. CA Cancer J Clin 2022; 73:320-338. [PMID: 36512303 DOI: 10.3322/caac.21767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/02/2022] [Accepted: 11/01/2022] [Indexed: 12/14/2022] Open
Abstract
As many countries experience population aging, patients with cancer are becoming older and have more preexisting comorbidities, which include prevalent, age-related, chronic conditions such as dementia. People living with dementia (PLWD) are vulnerable to health disparities, and dementia has high potential to complicate and adversely affect care and outcomes across the cancer trajectory. This report offers an overview of dementia and its prevalence among patients with cancer and a summary of the research literature examining cancer care for PLWD. The reviewed research indicates that PLWD are more likely to have cancer diagnosed at an advanced stage, receive no or less extensive cancer treatment, and have poorer survival after a cancer diagnosis. These cancer disparities do not necessarily signify inappropriately later diagnosis or lower treatment of people with dementia as a group, and they are arguably less feasible and appropriate targets for care optimization. The reviewed research indicates that PLWD also have an increased risk of cancer-related emergency presentations, lower quality processes of cancer-related decision making, accessibility-related barriers to cancer investigations and treatment, higher experienced treatment burden and higher caregiver burden for families, and undertreated cancer-related pain. The authors propose that optimal cancer care for PLWD should focus on proactively minimizing these risk areas and thus must be highly person-centered, with holistic decision making, individualized reasonable adjustments to practice, and strong inclusion and support of family carers. Comprehensive recommendations are made for clinical practice and future research to help clinicians and providers deliver best and equitable cancer care for PLWD and their families.
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Affiliation(s)
- Laura Ashley
- School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Claire Surr
- Centre for Dementia Research, Leeds Beckett University, Leeds, UK
| | - Rachael Kelley
- Centre for Dementia Research, Leeds Beckett University, Leeds, UK
| | - Mollie Price
- School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
| | | | - Nicole R Fowler
- Indiana University Center for Aging Research at Regenstrief Institute, Indianapolis, Indiana, USA
| | - Dana E Giza
- Joan and Stanford Alexander Division of Geriatric and Palliative Medicine, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Richard D Neal
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Charlene Martin
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | - Anita O'Donovan
- Applied Radiation Therapy Trinity (ARTT), Discipline of Radiation Therapy, School of Medicine, Trinity St. James's Cancer Institute, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - William Dale
- Center for Cancer and Aging, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Bogda Koczwara
- Department of Medical Oncology, Flinders Medical Centre & Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | | | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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