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Cincidda C, Pizzoli SFM, Oliveri S, Guiddi P, Pravettoni G. Toward a new personalized psycho-social approach for the support of prostate cancer and their caregivers dyads: a pilot study. Front Med (Lausanne) 2024; 11:1356385. [PMID: 38646557 PMCID: PMC11027503 DOI: 10.3389/fmed.2024.1356385] [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: 12/15/2023] [Accepted: 03/11/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction Prostate cancer patients (PCP) often struggle with a significant emotional, physical, and social burden during the care-flow pathway. Noteworthy, PCP should not be considered a standalone patient, but someone who is connected with a relevant social environment and that is usually supported by a beloved one, the caregiver. The involvement of the caregivers through the care pathway might bring significant benefits both on the psychological and the treatment and decision-making side. The present pilot study aimed at preliminarily assessing quantitatively the psychological impact of a prostate cancer diagnosis on the degree of agreement of PCPs and their caregivers on medical decisions, coping resources and psychological distress levels. Methods 16 PCP and their caregivers were enrolled in the study and fulfilled a battery of standardized questionnaires. Results Results showed low concordance in decision making styles and preferences in patients and their caregivers and that the dyads showed similar depression symptoms levels. Relevant features of the psychological needs of the analyzed dyads, such as need for information and support, also emerged. Conclusion On the basis of these preliminary results, guidelines for the construction of tailored brief psychological support interventions for PCP dyads are provided.
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Affiliation(s)
- Clizia Cincidda
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | | | - Serena Oliveri
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
- “Aldo Ravelli” Center for Neurotechnology and Brain Therapeutics, Department of Health Science, DISS, University of Milan, Milan, Italy
- Neurological Clinic, ASST-Santi Paolo e Carlo, Milan, Italy
| | - Paolo Guiddi
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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2
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Nash AL, Bloom DL, Chapman BM, Wheeler SB, McGuire KP, Lee CN, Weinfurt K, Rosenstein DL, Plichta JK, Vann JCJ, Hwang ES. Contralateral Prophylactic Mastectomy Decision-Making: The Partners' Perspective. Ann Surg Oncol 2023; 30:6268-6274. [PMID: 37573282 DOI: 10.1245/s10434-023-14022-0] [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: 04/26/2023] [Accepted: 07/14/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND The rate of contralateral prophylactic mastectomy (CPM) continues to rise despite no improvement in survival, an increased risk of surgical complications, and negative effects on quality of life. This study explored the experiences of the partners of women who undergo CPM. METHODS This study was part of an investigation into the factors motivating women with early-stage unilateral breast cancer and low genetic risk to opt for contralateral prophylactic mastectomy (CPM). Participating women were asked for permission to invite their partners to take part in interviews. In-depth interviews with partners were conducted using a semi-structured topic guide. A thematic analysis of the data was performed RESULTS: Of 35 partners, all men, 15 agreed to be interviewed. Most perceived their role to be strong and logical. Some hoped their wives would choose a bilateral mastectomy. All felt strongly that the final decision was up to their partners. The partners often framed the decision for CPM as one of life or death. Thus, any aesthetic effects were unimportant by comparison. The male partners had difficulty grasping the physical and emotional changes inherent in mastectomy, which made communicating about sexuality and intimacy very challenging for the couples. In the early recovery period, some noted the stress of managing home life. CONCLUSIONS The experiences of the male partners provide insight into how couples navigate complex treatment decision-making, both together and separately. There may be a benefit to including partners in pre- and post-surgical counseling to mitigate miscommunication regarding the expected oncologic and emotional outcomes related to CPM.
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Affiliation(s)
- Amanda L Nash
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA.
| | - Diane L Bloom
- Department of Health Policy and Management, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Brittany M Chapman
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Kandace P McGuire
- Department of Surgery, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Clara N Lee
- Division of Health Services Management and Policy, Department of Plastic and Reconstructive Surgery, OSU Comprehensive Cancer Center, College of Medicine, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Kevin Weinfurt
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Donald L Rosenstein
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Julie C Jacobson Vann
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
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Ozdemir S, Ng S, Chaudhry I, Teo I, Malhotra C, Finkelstein EA. Caregiver-Reported Roles in Treatment Decision Making in Advanced Cancer and Associated Caregiving Burden and Psychological Distress: A Longitudinal Study. Med Decis Making 2023; 43:191-202. [PMID: 36113405 DOI: 10.1177/0272989x221125408] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To longitudinally examine caregiver-reported treatment decision-making roles and to investigate the associations of these roles with caregiver burden, caregiving esteem, caregiver anxiety, and depression. METHODS 281 caregivers of patients with stage IV solid cancers were recruited from outpatient clinics in Singapore. Caregivers were eligible if they were aged ≥21 y, primary informal caregiver, and involved in treatment decision making. We used 3 y of longitudinal data. The decision-making roles were grouped into 4 categories: no family involvement, patient/physician-led, joint, and family-led/alone decision making. Mixed-effects linear regressions were used to assess associations between decision-making roles and caregiver outcomes. RESULTS On average, 72% of caregivers reported family involvement in decision making. Compared with baseline, a higher proportion of caregivers at the 36-mo follow-up reported no family involvement (from 23% to 34%, P = 0.05) and patient/physician-led decision making (from 22% to 34%, P = 0.02), while a lower proportion reported family-led/alone (from 19% to 7%, P = 0.01) decision making. Compared with family-led/alone decision making, caregivers reporting no family involvement reported lower impact on finances (-0.15 [-0.28, -0.01], P = 0.03) while caregivers who reported patient/physician-led decision making reported lower impact on schedule and health (-0.12 [-0.20, -0.03], P = 0.01), and finances (-0.15 [-0.28, -0.03], P = 0.02), and lower anxiety (-0.69 [-1.17, -0.22], P < 0.01), and depressive symptoms (-0.69 [-1.12, -0.26], P < 0.01). Caregivers who reported joint decision making reported higher caregiving esteem (0.07 [0.01, 0.14], P = 0.02). CONCLUSIONS Higher family involvement in decision making was associated with higher caregiver burden and psychological distress. Help should be given so that family caregivers can support patient decision-making in a meaningful way. HIGHLIGHTS Compared with baseline, a lower proportion of caregivers at the 36-mo follow-up reported family-led or family-alone decision making, and a higher proportion of caregivers reported patient-led or physician-led decision making.Higher levels of family involvement in decision making were associated with burdens on caregivers' daily life, health, and finances and increased caregiver anxiety and depression.Support must be given so that family members can contribute to making medical decisions in a rewarding manner.
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Affiliation(s)
- Semra Ozdemir
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.,Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Sean Ng
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.,Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Isha Chaudhry
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.,Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Irene Teo
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.,Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore.,National Cancer Centre Singapore, Singapore
| | - Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.,Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Eric Andrew Finkelstein
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore.,Duke Global Health Institute, Duke University, Durham, NC, USA
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- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.,Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
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Development of a Patient Decision Aid to Support Shared Decision Making for Patients with Recurrent High-Grade Glioma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127396. [PMID: 35742644 PMCID: PMC9223526 DOI: 10.3390/ijerph19127396] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 12/21/2022]
Abstract
When high-grade gliomas recur, patients, their families, and clinicians face difficult medical decisions. There is no curable treatment, and the treatment options all come with a risk of complications and adverse effects. The patients are often cognitively affected, and they need tailored decision support. The objective of this study was to develop a patient decision aid (PtDA) targeted at patients with recurrent high-grade gliomas. Based on existing knowledge and the International Patient Decision Aids Standards, the PtDA was developed through an iterative process. The PtDA was alpha-tested by potential users to assess its acceptability and usability. The development team comprised three clinicians, two patients, two family members, and a researcher. The fifth version of the PtDA was submitted to the alpha test. Eleven patients, nine family members, and eleven clinicians assessed the PtDA and found it acceptable. Three changes were made during the alpha test. Most participants perceived the PtDA to prepare patients for decision making and improve consultations. The involvement of potential users was emphasized during the development and alpha test process. The PtDA was assessed as useful and acceptable by patients, family members, and clinicians in the decision-making situation of recurrent high-grade glioma.
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Ferrer RA, Ellis EM, Orehek E, Klein WMP. Fear increases likelihood of seeking decisional support from others when making decisions involving ambiguity. JOURNAL OF BEHAVIORAL DECISION MAKING 2021. [DOI: 10.1002/bdm.2266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Rebecca A. Ferrer
- Basic Biobehavioral and Psychological Sciences Branch National Cancer Institute Rockville Maryland USA
| | - Erin M. Ellis
- Basic Biobehavioral and Psychological Sciences Branch National Cancer Institute Rockville Maryland USA
| | - Edward Orehek
- Department of Psychology San Diego State University San Diego California USA
| | - William M. P. Klein
- Behavioral Research Program, National Cancer Institute Rockville Maryland USA
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Owens OL, Dawson RM, Thomas T. Development of the Prostate Cancer Treatment Decision Framework: A Context-Specific Expansion of the Risk-as-Feelings Hypothesis. Cancer Nurs 2021; 44:E467-E475. [PMID: 33332918 PMCID: PMC8609530 DOI: 10.1097/ncc.0000000000000918] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Over the past 2 decades, numerous decision-making interventions have been developed to guide the prostate cancer (PrCA) treatment choices of patients and families. These interventions are often supported by economic decision frameworks, which do not account for the role of emotions in treatment decisions. In some instances, emotion-driven decisions can override an individual's cognitive evaluation of a decision, leading to unfavorable outcomes such as decision regret. OBJECTIVES To produce a Prostate Cancer Treatment Decision Framework based on the Risk-as-Feelings Hypothesis. METHODS The authors reviewed seminal research in emotion and decision-making in an effort to create a context-specific decision framework. RESULTS Five variables, not germane to the Risk-as-Feelings Hypothesis, play prominent roles in PrCA decision-making including age, spirituality, family support, healthcare provider communication, and perception of treatment outcomes. While family support only affects decision outcomes by influencing emotion and cognitive evaluation of a PrCA decision, age, spirituality, and healthcare provider communication can have direct effects on an individual's perception of treatment outcomes. CONCLUSIONS The Prostate Cancer Treatment Decision Framework combines new variables with older models to explain the PrCA treatment decision-making process and elucidate relationships affecting treatment outcomes and survivors' perceptions of these outcomes. The core premise of this model can be applied to other high-risk health decisions. IMPLICATIONS FOR PRACTICE Healthcare providers have the greatest influence on PrCA treatment decision-making. Using a shared decision-making approach, providers should take into account a patient's personal characteristics and values, in addition to clinical presentation, to help patients with treatment decisions.
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Affiliation(s)
- Otis L Owens
- Author Affiliations: College of Social Work (Dr Owens) and College of Nursing (Dr Dawson), University of South Carolina, Columbia; and Department of Health Sciences, College of Health and Behavioral Studies, James Madison University, Harrisonburg, Virginia (Dr Thomas)
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Ihrig A, Hanslmeier T, Grüllich C, Zschäbitz S, Huber J, Greinacher A, Sauer C, Friederich HC, Maatouk I. Couples coping with advanced prostate cancer: An explorative study on treatment decision making, mental deterioration, partnership, and psychological burden. Urol Oncol 2021; 40:58.e17-58.e25. [PMID: 34400064 DOI: 10.1016/j.urolonc.2021.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the role of spouses and the relevance of quality of life (QoL) and life expectancy (LE) in the treatment decision-making process of patients with advanced prostate cancer (CaP). We also addressed the role of possible mental deterioration, partnership quality, QoL, distress, anxiety, and depression in patients and their spouses. METHODS AND MATERIAL This was a cross-sectional non-interventional explorative study. We administered questionnaires to 96 patients with advanced CaPand their spouses. Both patients and their spouses were asked about the influence of the spouses on treatment decision making, if they prefer quality of life or life expectancy as main goal of treatment and the perceived deterioration of the patients' mental abilities. Additional questionnaires were used to assess medical history, partnership, global quality of life, distress, depression, and anxiety. We performed statistical tests to compare patients with spouses and correlations to detect associations between variables. RESULTS The spouses (65 ± 9 years) were significantly younger than the patients (69 ± 9 years). Ninety-five percent of the patients and 91% of the spouses reported that the spouses were involved in making treatment decisions. There was a high similarity within couples with regard to their preference for QoL or LE during treatment. Between couples, this preference differed markedly. Emotional control and motivation were the areas most commonly reported to have deteriorated among patients' mental abilities. The quality of the partnership was rated as being higher than average by both partners. Among the spouses, the quality of partnership correlated significantly with the preference for LE with regard to treatment decision making. Patients and spouses reported high psychological burdens in all areas, with higher levels of distress and anxiety in spouses (P< 0.01). Reduced quality of life and greater distress, depression, and anxiety were significantly correlated with the amount of deterioration of the patients' mental abilities. CONCLUSIONS Spouses of patients with advanced CaP seem to respond to different aspects of the disease by adjusting both their involvement in treatment decision making and their preferred goal of treatment. Due to mental deterioration in the patients and pronounced anxiety in their spouses, we suggest that it is important for the attending physician to provide detailed information and support to both partners. Overall, the high-stress situation seems to affect both partners to similar degrees.
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Affiliation(s)
- Andreas Ihrig
- Division of Psycho-oncology, Department of General Internal and Psychosomatic Medicine, University Hospital Heidelberg, Germany.
| | - Tobias Hanslmeier
- Division of Psycho-oncology, Department of General Internal and Psychosomatic Medicine, University Hospital Heidelberg, Germany
| | - Carsten Grüllich
- Department of Medical Oncology, National Centre for Tumour Diseases (NCT), University Hospital Heidelberg, Germany; Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Germany
| | - Stefanie Zschäbitz
- Department of Medical Oncology, National Centre for Tumour Diseases (NCT), University Hospital Heidelberg, Germany
| | - Johannes Huber
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Germany
| | - Anja Greinacher
- Division of Psycho-oncology, Department of General Internal and Psychosomatic Medicine, University Hospital Heidelberg, Germany
| | - Christina Sauer
- Division of Psycho-oncology, Department of General Internal and Psychosomatic Medicine, University Hospital Heidelberg, Germany; Psycho-oncology Service, National Centre for Tumour Diseases (NCT), University Hospital Heidelberg, Germany
| | - Hans-Christoph Friederich
- Division of Psycho-oncology, Department of General Internal and Psychosomatic Medicine, University Hospital Heidelberg, Germany
| | - Imad Maatouk
- Division of Psycho-oncology, Department of General Internal and Psychosomatic Medicine, University Hospital Heidelberg, Germany; Psycho-oncology Service, National Centre for Tumour Diseases (NCT), University Hospital Heidelberg, Germany; Section of Psychosomatic Medicine, Psychotherapy and Psychooncology, Department of Internal Medicine II, Julius-Maximilian University Wuerzburg, Wuerzburg, Germany
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8
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Allen Searson N, Balneaves LG, Thorne SE, Gotay C, Truant TLO, Porcino A, Kelly MT. The Effect of a Complementary Therapy Education Seminar on Support Persons of Individuals with Cancer. J Altern Complement Med 2021; 27:365-372. [PMID: 33601933 DOI: 10.1089/acm.2020.0443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Objectives: Complementary therapy (CT) use is prevalent among individuals living with cancer, who often consult family and friends (i.e., support persons) in making decisions about CT. This study examines the effect of an education seminar for adult cancer patients and support persons on the support persons' use, knowledge, and decision-making processes related to CT. Design: A patient education seminar that included support persons was developed and evaluated as part of a CT decision support research program. Survey data were collected before and after the education seminar to examine its impact on support persons' knowledge and use of CT, as well as their engagement in the CT decision-making process. Setting: The study was conducted in Western Canada. Subjects: 62 adult support persons. Interventions: Participants attended a 4-h CT education seminar at one in four provincial cancer centers. The seminar provided recommendations regarding how to make informed decisions about CT, where to find credible information, and key issues to consider to avoid potential risks of CT use. The evidence related to popular CT was also reviewed. Outcome Measures: The primary outcome was support persons' CT knowledge. Secondary outcomes included CT use, information-seeking behavior, decision self-efficacy, decision conflict, and distress. Results: A significant increase in support persons' CT knowledge was observed, as well as improved confidence in CT decision making. There was no significant difference in participants' CT use following the education seminar. Most indicated they would continue to locate information about CT using the Internet. A significant decrease in support persons' decisional conflict was reported; however, there were no significant change in distress related to CT decision making. Conclusions: This study demonstrates the importance of including support persons in patient education related to CT and the positive impact on their knowledge and treatment decision-making processes. No significant change in CT use, information seeking behavior and distress related to CT decisions, however, was observed in the study.
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Affiliation(s)
| | | | - Sally E Thorne
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Carolyn Gotay
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Tracy L O Truant
- School of Nursing, University of British Columbia, Vancouver, Canada
| | | | - Mary T Kelly
- School of Nursing, University of British Columbia, Vancouver, Canada
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Rance S, Westlake D, Brant H, Holme I, Endacott R, Pinkney J, Byng R. Admission Decision-Making in Hospital Emergency Departments: The Role of the Accompanying Person. Glob Qual Nurs Res 2020; 7:2333393620930024. [PMID: 32596418 PMCID: PMC7303774 DOI: 10.1177/2333393620930024] [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: 08/02/2019] [Revised: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 11/15/2022] Open
Abstract
In resource-stretched emergency departments, people accompanying patients
play key roles in patients’ care. This article presents analysis of
the ways health professionals and accompanying persons talked about
admission decisions and caring roles. The authors used an ethnographic
case study design involving participant observation and
semi-structured interviews with 13 patients, 17 accompanying persons
and 26 health care professionals in four National Health Service
hospitals in south-west England. Focused analysis of interactional
data revealed that professionals’ standardization of the patient–carer
relationship contrasted with accompanying persons’ varied connections
with patients. Accompanying persons could directly or obliquely
express willingness, ambivalence and resistance to supporting
patients’ care. The drive to avoid admissions can lead health
professionals to deploy conversational skills to enlist accompanying
persons for discharge care without exploring the meanings of their
particular relationship with the patients. Taking a
relationship-centered approach could improve the attention to
accompanying persons as co-producers of health care and participants
in decision-making.
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Affiliation(s)
| | | | - Heather Brant
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | | | - Ruth Endacott
- University of Plymouth, Plymouth, United Kingdom.,Monash University, Frankston, Victoria, Australia
| | | | - Richard Byng
- University of Plymouth, Plymouth, United Kingdom
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10
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Buller AM, Pichon M, McAlpine A, Cislaghi B, Heise L, Meiksin R. Systematic review of social norms, attitudes, and factual beliefs linked to the sexual exploitation of children and adolescents. CHILD ABUSE & NEGLECT 2020; 104:104471. [PMID: 32371213 DOI: 10.1016/j.chiabu.2020.104471] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 02/28/2020] [Accepted: 03/18/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Despite growing interest in the role of social norms in perpetuating the harmful practice of sexual exploitation of children and adolescents (SECA), little is known about the state of the literature on this issue. OBJECTIVE This systematic review aims to summarize what associated norms, attitudes and factual beliefs have been identified by the SECA literature worldwide. METHODS Multiple database searches were conducted using controlled vocabulary and keywords referring to SECA. RESULTS Our searches identified 3690 unique references. After applying our exclusion criteria, 49 studies, including over 14,000 participants from 37 countries and most world regions, were included. Across studies we identified six injunctive norms perpetuating SECA: owning goods as a social status marker ; being sexually active; exchanging sex for favors; contributing financially to the household; stigma and discrimination against young people who experienced SECA; and lack of social sanctions for SECA perpetrators. These norms were supported by enhanced tolerance of SECA when it involved older or more physically developed adolescents and when it occurred in poverty-affected contexts. Beliefs around markers that denote adolescents' readiness for sex; men's entitlement to sex; and the perceived benefits of intergenerational relationships, also contributed to the maintenance and reproduction of SECA. Findings from all regions suggested that marginalized young people are particularly vulnerable to SECA. CONCLUSIONS Interventions to reduce SECA must consider individual, social, and structural factors and how they interrelate. Context-specific social norms interventions are needed to address harmful norms, promote protective norms, and improve services for those who have experienced SECA.
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Affiliation(s)
- Ana Maria Buller
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, Kings Cross, London, WC1H 9SH, United Kingdom.
| | - Marjorie Pichon
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, Kings Cross, London, WC1H 9SH, United Kingdom.
| | - Alys McAlpine
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, Kings Cross, London, WC1H 9SH, United Kingdom.
| | - Beniamino Cislaghi
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, Kings Cross, London, WC1H 9SH, United Kingdom.
| | - Lori Heise
- Johns Hopkins Bloomberg School of Public Health, 615N. Wolfe Street, Room E4644, Baltimore, MA, 21205, USA.
| | - Rebecca Meiksin
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, Kings Cross, London, WC1H 9SH, United Kingdom.
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11
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Park S, Khan N, Stevenson F, Malpass A. Patient and Public Involvement (PPI) in evidence synthesis: how the PatMed study approached embedding audience responses into the expression of a meta-ethnography. BMC Med Res Methodol 2020; 20:29. [PMID: 32041523 PMCID: PMC7011428 DOI: 10.1186/s12874-020-0918-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 01/31/2020] [Indexed: 11/17/2022] Open
Abstract
Background Patient and public involvement (PPI) has become enshrined as an important pillar of health services empirical research, including PPI roles during stages of research development and analysis and co-design approaches. Whilst user participation has been central to qualitative evidence synthesis (QES) for decades, as seen in the Cochrane consumer network and guidelines, meta-ethnography has been slow to incorporate user participation and published examples of this occurring within meta-ethnography are sparse. In this paper, drawing upon our own experience of conducting a meta-ethnography, we focus on what it means in practice to ‘express a synthesis’ (stage 7). We suggest the methodological importance of ‘expression’ in Noblit and Hare’s seven stage process (Noblit, GW and Hare, RD. Meta-ethnography: synthesizing qualitative studies, 1988) has been overlooked, and in particular, opportunities for PPI user participation within it. Methods Meta-ethnography comprises a seven-stage process of evidence synthesis. Noblit and Hare describe the final 7th stage of the meta-ethnography process as ‘expression of synthesis’, emphasizing co-construction of findings with the audience. In a previous study we conducted a meta-ethnography exploring patient and student experience of medical education within primary care contexts. We subsequently presented and discussed initial meta-ethnography findings with PPI (students and patients) in focus groups and interviews. We transcribed patient and student PPI interpretations of synthesis findings. As a research team, we then translated these into our existing meta-ethnography findings. Results We describe, with examples, the process of involving PPI in stage 7 of meta-ethnography and discuss three methodological implications of incorporating PPI within an interpretative approach to QES: (1) we reflect on the construct hierarchy of user participants’ interpretations and consider whether incorporating these additional 1st order, 2nd level constructs implies an additional logic of 3rd order 2nd level constructs of the QES team; (2) we discuss the link between PPI user participation and what Noblit and Hare may have meant by ideas of ‘expression’ and ‘audience’ as integral to stage 7; and (3) we link PPI user participation to Noblit and Hare’s underlying theory of social explanation, i.e. how expression of the synthesis is underpinned by ideas of translation and that the synthesis must be ‘translated in the audience’s (user participants) particular language’. Conclusions The paper aims to complement recent attempts in the literature to refine and improve guidance on conducting a meta-ethnography, highlighting opportunities for PPI user participation in the processes of interpretation, translation and expression. We discuss the implications of user participation in meta-ethnography on ideas of ‘generalisability’.
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Affiliation(s)
- S Park
- Research Department of Primary Care and Population Health (PCPH), UCL Medical School, Royal Free Campus, Rowland Hill St., London, NW3 2PY, UK.
| | - N Khan
- Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK
| | - F Stevenson
- Research Department of Primary Care and Population Health (PCPH), UCL Medical School, Royal Free Campus, Rowland Hill St., London, NW3 2PY, UK
| | - A Malpass
- Centre for Academic Primary Care, Population Health Sciences, School of Social and Community Medicine, University of Bristol, Office 1.03b, Canynge Hall, 39, Whatley Rd, Bristol, BS8 2PS, UK
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Skea ZC, Newlands R, Gillies K. Exploring non-retention in clinical trials: a meta-ethnographic synthesis of studies reporting participant reasons for drop out. BMJ Open 2019; 9:e021959. [PMID: 31164359 PMCID: PMC6561611 DOI: 10.1136/bmjopen-2018-021959] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/23/2019] [Accepted: 04/23/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To undertake a meta-ethnographic synthesis of findings from primary studies reporting qualitative data that have explored participant-reported factors influencing non-retention within a clinical trial context. DESIGN A systematic search and meta-ethnography was conducted for published papers (from 1946 to July 2018) that contained qualitative data from trial non-retainers. PARTICIPANTS We identified 11 studies reporting qualitative data from 13 trials. The studies were undertaken between 2008 and 2018. Each study included between 3 and 40 people who had dropped out from a trial, with findings from 168 people in total reported across the papers. RESULTS Emergent from our synthesis was the significance of trial non-retainers' perceptions around the personal 'fit' of key aspects of the trial with their personal beliefs, preferences, capabilities or life circumstances. These related to their own health state; preferences for receiving trial 'care'; individual capabilities; beliefs about or experiences of trial medication and considerations whether trial participation could be accommodated into their broader lives. All these factors raise important issues around the extent to which initial decisions to participate were fully informed. CONCLUSIONS To improve retention in clinical trials, researchers should work to reduce the burden on trial participants both through the design of the intervention itself as well as through simplified data collection processes. Providing more detail on the nature of the trial interventions and what can be expected by 'participation' at the consenting stage may prove helpful in order to manage expectations.
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Affiliation(s)
- Zoë C Skea
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Wagland R, Nayoan J, Matheson L, Rivas C, Brett J, Downing A, Wilding S, Butcher H, Gavin A, Glaser AW, Watson E. 'Very difficult for an ordinary guy': Factors influencing the quality of treatment decision-making amongst men diagnosed with localised and locally advanced prostate cancer: Findings from a UK-wide mixed methods study. PATIENT EDUCATION AND COUNSELING 2019; 102:797-803. [PMID: 30527732 DOI: 10.1016/j.pec.2018.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/19/2018] [Accepted: 12/02/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To explore experiences of treatment decision-making (TDM) amongst men diagnosed with stage 1-3 prostate cancer. METHODS Mixed-methods study incorporating UK-wide cross-sectional postal survey of men 18-42 months post-diagnosis and semi-structured interviews with a subsample (n = 97), including men who received both radical treatments and active surveillance. Interview data was analysed using a Framework approach. RESULTS Within the context of TDM, 'drivers' included men's intra-personal preferences for decision-making responsibility or clinical direction, relative treatment intrusiveness or desire for excision, and work, personal and social life priorities; 'facilitators' were inter-personal mechanisms such as information and communication with clinicians to enact, but also sometimes challenge drivers. Drivers and facilitators can conflict, challenging patient empowerment. Men frequently undertook greater TDM responsibility than desired, without clinical recommendations; others received conflicting recommendations. Information on potential side-effects was often reportedly inadequate. Unchallenged preferences, absence of clinical recommendations and inadequate preparation for side-effects sometimes led to decision regret. CONCLUSIONS Men are not empowered when expected to take more TDM responsibility than desired, when provided with conflicting recommendations, or when their potentially inappropriate preferences are unchallenged. PRACTICE IMPLICATIONS TDM should involve men exercising preferences and priorities in discussion with clinicians. Clinicians should ensure patients do not receive conflicting recommendations.
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Affiliation(s)
- Richard Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK.
| | - Johana Nayoan
- Health Psychology Research Group, University College London, UK
| | - Lauren Matheson
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Carol Rivas
- Social Science Research Unit, University College London (UCL), London, UK
| | - Jo Brett
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Amy Downing
- Leeds Institute of Medical Research at St James's, University of Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Sarah Wilding
- Leeds Institute of Medical Research at St James's, University of Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Hugh Butcher
- Yorkshire Cancer Patient Forum, c/o Strategic Clinical Network and Senate, Yorkshire and The Humber, Harrogate, UK
| | - Anna Gavin
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Adam W Glaser
- Leeds Institute of Medical Research at St James's, University of Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Eila Watson
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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Holland P, Clayton S. Navigating employment retention with a chronic health condition: a meta-ethnography of the employment experiences of people with musculoskeletal disorders in the UK. Disabil Rehabil 2019; 42:1071-1086. [DOI: 10.1080/09638288.2018.1519041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Paula Holland
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
- Arthritis Research UK-MRC Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Stephen Clayton
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK
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Gray TF, Nolan MT, Clayman ML, Wenzel JA. The decision partner in healthcare decision-making: A concept analysis. Int J Nurs Stud 2019; 92:79-89. [PMID: 30743199 DOI: 10.1016/j.ijnurstu.2019.01.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/08/2019] [Accepted: 01/14/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND The decision partner concept emerged to describe someone who contributes to healthcare decision-making with a patient. There is a need for greater precision and consensus surrounding its conceptual definition and use in broader populations. OBJECTIVE To define and describe the decision partner concept within the context of healthcare decision-making. DESIGN A concept analysis. DATA SOURCES We searched the following databases for articles published between 1990-2017: PsychINFO, PubMed, Embase, and CINAHL. We included qualitative, quantitative, or mixed methods studies that used the term decision partner in the context of healthcare decision-making. METHODS We applied the Walker and Avant method to identify the antecedents, attributes, related concepts, consequences, and empirical referents of the concept, with major themes identified. RESULTS From the 112 articles included in this concept analysis, 6 defining attributes of decision partner were identified: (1) has a relationship with the patient, (2) demonstrates a willingness to participate in decision-making, (3) articulates a clear understanding of both the patient's health condition and the decisions that must be made, (4) demonstrates decision-making self-efficacy; (5) exemplifies an emotional capacity to participate in decision-making, and (6) willing to fulfill several supportive roles including patient advocate and the "hub of information". CONCLUSIONS A unifying definition and discussion of the decision partner concept has been developed. Our findings: (1) offer insights into refining the concept across various diseases and healthcare encounters, (2) contribute to developing theoretical models and empirical research to refine antecedents, attributes, consequences, (3) serve as a foundation to develop instruments to measure the concept and (4) highlight the need to design interventions that include and support decision partners in healthcare decision-making.
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Affiliation(s)
- Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States.
| | - Marie T Nolan
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States; Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, United States
| | - Marla L Clayman
- American Institutes for Research, Chicago, IL, United States
| | - Jennifer A Wenzel
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Collaço N, Rivas C, Matheson L, Nayoan J, Wagland R, Alexis O, Gavin A, Glaser A, Watson E. Prostate cancer and the impact on couples: a qualitative metasynthesis. Support Care Cancer 2018; 26:1703-1713. [PMID: 29511952 DOI: 10.1007/s00520-018-4134-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 02/25/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE To review and interpret existing qualitative literature on the experiences of couples affected by prostate cancer (PCa). METHODS A metasynthesis was carried out which included a systematic search of seven databases between 2000 and 2016. A modified version of Noblit and Hare's meta-ethnographic approach was used to synthesise qualitative study findings and inform overarching interpretations. RESULTS Thirty-seven studies focusing on the experiences of men with PCa and their partner dyad were included producing seven interconnected constructs. The construct accepting change vs seeking continuity reflects the range of ways individuals within the dyad and couples adjust to the diagnosis. Cultivating connection vs disengaging illustrates how couples seek to manage the impact of PCa and its treatment on their relationship, which may lead to a threatened identity, including sexual insecurities. Shielding me, you and us reflects the ways in which couples strive to protect themselves as individuals and/or each other from the impact of PCa. Being a partner and its challenges highlights the responsibilities partners assume and the impact of their supporting role. Yet, partners sometimes report feeling unsupported and side-lined both by the man they are caring for and by healthcare professionals. Couples often recognise the value of facing PCa together. CONCLUSIONS PCa affects both members of the dyad as individuals, as well as the couple's relationship. How best to support couples and how to overcome difficulties in expressing their concerns to one another requires further consideration. Healthcare professionals should endeavour to employ a couple-focused approach where appropriate.
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Affiliation(s)
- Nicole Collaço
- Faculty of Health and Life Sciences, Oxford Brookes University, Jack Straws Lane, Oxford, OX3 0FL, UK.
| | - Carol Rivas
- Faculty of Health Sciences, University of Southampton, S017 1BJ, Southampton, UK
| | - Lauren Matheson
- Faculty of Health and Life Sciences, Oxford Brookes University, Jack Straws Lane, Oxford, OX3 0FL, UK
| | - Johana Nayoan
- Faculty of Health Sciences, University of Southampton, S017 1BJ, Southampton, UK
| | - Richard Wagland
- Faculty of Health Sciences, University of Southampton, S017 1BJ, Southampton, UK
| | - Obrey Alexis
- Faculty of Health and Life Sciences, Oxford Brookes University, Jack Straws Lane, Oxford, OX3 0FL, UK
| | - Anna Gavin
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Public Health, Queen's University, Belfast, BT12 6BA, UK
| | - Adam Glaser
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, Worsley Building, Leeds, LS2 9NL, UK
| | - Eila Watson
- Faculty of Health and Life Sciences, Oxford Brookes University, Jack Straws Lane, Oxford, OX3 0FL, UK
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Lamore K, Montalescot L, Untas A. Treatment decision-making in chronic diseases: What are the family members' roles, needs and attitudes? A systematic review. PATIENT EDUCATION AND COUNSELING 2017; 100:2172-2181. [PMID: 28838630 DOI: 10.1016/j.pec.2017.08.003] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/31/2017] [Accepted: 08/02/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This systematic review aims to examine the roles of family members (FMs) in treatment decision-making for adult patients without cognitive or psychiatric disorders affecting their ability to participate in decision-making. METHODOLOGY A comprehensive, systematic search of the Cochrane Library, PsycINFO, PubMed and ScienceDirect databases, with relevant keywords, was conducted. Two authors evaluated the eligibility of the studies independently, then cross-checked for accuracy. The quality of included studies were assessed using standardized criteria. RESULTS Out of the 12.137 studies identified, 40 were included. Results highlighted the different roles and influences FMs have in the decision-making process. Moreover, several factors ranging from personal to cultural and family-related factors influence their level of involvement. Regardless of the illness, some similarities in family influence exist (e.g., social support). However, the type of family involvement varies according to the illness, the treatment choice and the patients' culture. CONCLUSION FMs have an important role in the decision-making process. In fact, the final decision is often made by the patients after consulting their families. FMs can support both patients and medical teams, and thus facilitate the process. PRACTICE IMPLICATIONS Physicians should include FMs in treatment decision-making when the patients and their FMs wish to be included.
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Affiliation(s)
- Kristopher Lamore
- Laboratory of Psychopathology and Health Processes (EA 4057), University of Paris Descartes, Sorbonne Paris Cité, 71, Avenue Edouard-Vaillant, 92100, Boulogne-Billancourt, France.
| | - Lucile Montalescot
- Laboratory of Psychopathology and Health Processes (EA 4057), University of Paris Descartes, Sorbonne Paris Cité, 71, Avenue Edouard-Vaillant, 92100, Boulogne-Billancourt, France.
| | - Aurélie Untas
- Laboratory of Psychopathology and Health Processes (EA 4057), University of Paris Descartes, Sorbonne Paris Cité, 71, Avenue Edouard-Vaillant, 92100, Boulogne-Billancourt, France.
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18
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Le YCL, McFall SL, Byrd TL, Volk RJ, Cantor SB, Kuban DA, Mullen PD. Is "Active Surveillance" an Acceptable Alternative?: A Qualitative Study of Couples' Decision Making about Early-Stage, Localized Prostate Cancer. Narrat Inq Bioeth 2017; 6:51-61. [PMID: 27346824 DOI: 10.1353/nib.2016.0006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The objective of our study was to describe decision making by men and their partners regarding active surveillance (AS) or treatment for early-stage, localized prostate cancer. Fifteen couples were recruited from a cancer center multispecialty clinic, which gave full information about all options, including AS. Data were collected via individual, semi-structured telephone interviews. Most patients were white, non-Hispanic, had private insurance, had completed at least some college, and were aged 49-72 years. Ten chose AS. All partners were female, and couples reported strong marital satisfaction and cohesion. All couples described similar sequences of a highly emotional initial reaction and desire to be rid of the cancer, information seeking, and decision making. The choice of AS was built on a nuanced evaluation of the man's condition in which the couple differentiated prostate cancer from other cancers and early stage from later stages, wanted to avoid/delay side effects, and trusted the AS protocol to identify negative changes in time for successful treatment. Treated couples continued to want immediate treatment to remove the cancer. We concluded that having a partner's support for AS may help a man feel more comfortable with choosing and adhering to AS. Using decision aids that address both a man's and his partner's concerns regarding AS may increase its acceptability. Our research shows that some patients want to and do involve their partners in the decision-making process. Ethical issues are related to the tension between desire for partner involvement and the importance of the patient as autonomous decision-maker. The extended period of decision making, particularly for AS, is also an ethical issue that requires additional support for patients and couples in the making of fully informed choices that includes AS.
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Hamilton JG, Lillie SE, Alden DL, Scherer L, Oser M, Rini C, Tanaka M, Baleix J, Brewster M, Craddock Lee S, Goldstein MK, Jacobson RM, Myers RE, Zikmund-Fisher BJ, Waters EA. What is a good medical decision? A research agenda guided by perspectives from multiple stakeholders. J Behav Med 2017; 40:52-68. [PMID: 27566316 PMCID: PMC5296255 DOI: 10.1007/s10865-016-9785-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 08/10/2016] [Indexed: 12/12/2022]
Abstract
Informed and shared decision making are critical aspects of patient-centered care, which has contributed to an emphasis on decision support interventions to promote good medical decision making. However, researchers and healthcare providers have not reached a consensus on what defines a good decision, nor how to evaluate it. This position paper, informed by conference sessions featuring diverse stakeholders held at the 2015 Society of Behavioral Medicine and Society for Medical Decision Making annual meetings, describes key concepts that influence the decision making process itself and that may change what it means to make a good decision: interpersonal factors, structural constraints, affective influences, and values clarification methods. This paper also proposes specific research questions within each of these priority areas, with the goal of moving medical decision making research to a more comprehensive definition of a good medical decision, and enhancing the ability to measure and improve the decision making process.
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Affiliation(s)
- Jada G Hamilton
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sarah E Lillie
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Dana L Alden
- Shidler College of Business, University of Hawaii, Honolulu, HI, USA
| | - Laura Scherer
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Megan Oser
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christine Rini
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Miho Tanaka
- Health Services Research and Development Service, Department of Veterans Affairs, Washington, DC, USA
| | - John Baleix
- Hawaii Medical Service Association, BCBS of Hawaii, Honolulu, HI, USA
| | | | - Simon Craddock Lee
- Department of Clinical Sciences and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mary K Goldstein
- Geriatric Research Education and Clinical Center (GRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Medicine, Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | - Robert M Jacobson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ronald E Myers
- Department of Medical Oncology, Sidney Kimmel Medical Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Erika A Waters
- Division of Public Health Sciences, Department of Surgery, Washington University, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO, 63110, USA.
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Zanchetta MS, Cognet M, Lam-Kin-Teng MR, Dumitriu ME, Renaud L, Rhéaume J. From early detection to rehabilitation in the community: reading beyond the blog testimonies of survivors' quality of life and prostate cancer representation. Health Qual Life Outcomes 2016; 14:171. [PMID: 27986091 PMCID: PMC5162078 DOI: 10.1186/s12955-016-0568-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/29/2016] [Indexed: 11/20/2022] Open
Abstract
Background Survivors’ testimonies can reveal much about men’s experiences of prostate cancer and impacts on their quality of life (QOL) during the clinical trajectory of the disease. These survivors’ shared thoughts and views were hypothesized to reflect salient features of their lived social representation of prostate cancer. Context We explored the content of testimonies posted by men to a public blog hosted by a French national prostate cancer patients’ association. The study question, “What do French bloggers’ testimonies reveal about their lived experiences with prostate cancer, especially regarding their quality of life in community settings, that underpin their social representation of prostate cancer?” guided the exploration and analysis of the textual data. The aims were to better understand men’s experiences and predominant thoughts and views, to elucidate patients’ behaviours, and to enlighten medical policy and practice. Purpose Explore issues of QOL as reported by French prostate cancer survivors in a public blog by: (a) identifying the salient aspects and issues of the experience of living with prostate cancer from the perspective of survivors; and (b) analyzing the content in the posted testimonies regarding perceived and lived impacts of prostate cancer on QOL. Methods A critical ethnographic study guided the selection of textual data from 196 male bloggers’ testimonies about prostate cancer posted in the period from 2008 to 2013. Media content analysis method was undertaken on blog testimonies, framed by a multidimensional conceptual framework of QOL. Results Testimonies focused mainly on medical care and rehabilitation, recovery, health education and self-care, as well as on a global vision of prostate cancer and its impacts on personal views of manhood and masculinity. The language used indicated that political, educative and compassionate discourses were intertwined to create a complex representation of the experience and effects of prostate cancer; this multi-faceted representation can inform the public and professional debate about men’s capacity to provide emotional support and problem-solve within a community of interest. Conclusion Findings, while based on data limited to mostly one-time entries to a French blog, contribute to understanding a unique, collective expression of men’s lived experiences of prostate cancer. These anonymous survivors shared their varied reactions, ways of coping, and thoughts on needed change.
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Affiliation(s)
- Margareth Santos Zanchetta
- Ryerson University- Faculty of Community Services, Daphne Cockwell School of Nursing, 350 Victoria St. office POD 470C, Toronto, ON, M5B 2K3, Canada.
| | - Marguerite Cognet
- Université Denis Diderot- UFR Sciences sociales, Unité de recherche Migrations et Sociétés, Paris, France
| | - Mary Rachel Lam-Kin-Teng
- Ryerson University- Faculty of Community Services, Daphne Cockwell School of Nursing, 350 Victoria St. office POD 470C, Toronto, ON, M5B 2K3, Canada
| | - Marie Elisabeth Dumitriu
- Ryerson University- Faculty of Community Services, Daphne Cockwell School of Nursing, 350 Victoria St. office POD 470C, Toronto, ON, M5B 2K3, Canada
| | - Lise Renaud
- Université du Québec à Montréal, CSSS de la Montagne, Ministère de la santé et des services sociaux du Québec, Montréal, Québec, Canada
| | - Jacques Rhéaume
- CSSS de la Montagne, Ministère de la santé et des services sociaux du Québec, Montréal, Québec, Canada
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Jordan J, Rose L, Dainty KN, Noyes J, Blackwood B. Factors that impact on the use of mechanical ventilation weaning protocols in critically ill adults and children: a qualitative evidence-synthesis. Cochrane Database Syst Rev 2016; 10:CD011812. [PMID: 27699783 PMCID: PMC6458040 DOI: 10.1002/14651858.cd011812.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Prolonged mechanical ventilation is associated with a longer intensive care unit (ICU) length of stay and higher mortality. Consequently, methods to improve ventilator weaning processes have been sought. Two recent Cochrane systematic reviews in ICU adult and paediatric populations concluded that protocols can be effective in reducing the duration of mechanical ventilation, but there was significant heterogeneity in study findings. Growing awareness of the benefits of understanding the contextual factors impacting on effectiveness has encouraged the integration of qualitative evidence syntheses with effectiveness reviews, which has delivered important insights into the reasons underpinning (differential) effectiveness of healthcare interventions. OBJECTIVES 1. To locate, appraise and synthesize qualitative evidence concerning the barriers and facilitators of the use of protocols for weaning critically-ill adults and children from mechanical ventilation;2. To integrate this synthesis with two Cochrane effectiveness reviews of protocolized weaning to help explain observed heterogeneity by identifying contextual factors that impact on the use of protocols for weaning critically-ill adults and children from mechanical ventilation;3. To use the integrated body of evidence to suggest the circumstances in which weaning protocols are most likely to be used. SEARCH METHODS We used a range of search terms identified with the help of the SPICE (Setting, Perspective, Intervention, Comparison, Evaluation) mnemonic. Where available, we used appropriate methodological filters for specific databases. We searched the following databases: Ovid MEDLINE, Embase, OVID, PsycINFO, CINAHL Plus, EBSCOHost, Web of Science Core Collection, ASSIA, IBSS, Sociological Abstracts, ProQuest and LILACS on the 26th February 2015. In addition, we searched: the grey literature; the websites of professional associations for relevant publications; and the reference lists of all publications reviewed. We also contacted authors of the trials included in the effectiveness reviews as well as of studies (potentially) included in the qualitative synthesis, conducted citation searches of the publications reporting these studies, and contacted content experts.We reran the search on 3rd July 2016 and found three studies, which are awaiting classification. SELECTION CRITERIA We included qualitative studies that described: the circumstances in which protocols are designed, implemented or used, or both, and the views and experiences of healthcare professionals either involved in the design, implementation or use of weaning protocols or involved in the weaning of critically-ill adults and children from mechanical ventilation not using protocols. We included studies that: reflected on any aspect of the use of protocols, explored contextual factors relevant to the development, implementation or use of weaning protocols, and reported contextual phenomena and outcomes identified as relevant to the effectiveness of protocolized weaning from mechanical ventilation. DATA COLLECTION AND ANALYSIS At each stage, two review authors undertook designated tasks, with the results shared amongst the wider team for discussion and final development. We independently reviewed all retrieved titles, abstracts and full papers for inclusion, and independently extracted selected data from included studies. We used the findings of the included studies to develop a new set of analytic themes focused on the barriers and facilitators to the use of protocols, and further refined them to produce a set of summary statements. We used the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) framework to arrive at a final assessment of the overall confidence of the evidence used in the synthesis. We included all studies but undertook two sensitivity analyses to determine how the removal of certain bodies of evidence impacted on the content and confidence of the synthesis. We deployed a logic model to integrate the findings of the qualitative evidence synthesis with those of the Cochrane effectiveness reviews. MAIN RESULTS We included 11 studies in our synthesis, involving 267 participants (one study did not report the number of participants). Five more studies are awaiting classification and will be dealt with when we update the review.The quality of the evidence was mixed; of the 35 summary statements, we assessed 17 as 'low', 13 as 'moderate' and five as 'high' confidence. Our synthesis produced nine analytical themes, which report potential barriers and facilitators to the use of protocols. The themes are: the need for continual staff training and development; clinical experience as this promotes felt and perceived competence and confidence to wean; the vulnerability of weaning to disparate interprofessional working; an understanding of protocols as militating against a necessary proactivity in clinical practice; perceived nursing scope of practice and professional risk; ICU structure and processes of care; the ability of protocols to act as a prompt for shared care and consistency in weaning practice; maximizing the use of protocols through visibility and ease of implementation; and the ability of protocols to act as a framework for communication with parents. AUTHORS' CONCLUSIONS There is a clear need for weaning protocols to take account of the social and cultural environment in which they are to be implemented. Irrespective of its inherent strengths, a protocol will not be used if it does not accommodate these complexities. In terms of protocol development, comprehensive interprofessional input will help to ensure broad-based understanding and a sense of 'ownership'. In terms of implementation, all relevant ICU staff will benefit from general weaning as well as protocol-specific training; not only will this help secure a relevant clinical knowledge base and operational understanding, but will also demonstrate to others that this knowledge and understanding is in place. In order to maximize relevance and acceptability, protocols should be designed with the patient profile and requirements of the target ICU in mind. Predictably, an under-resourced ICU will impact adversely on protocol implementation, as staff will prioritize management of acutely deteriorating and critically-ill patients.
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Affiliation(s)
- Joanne Jordan
- Ulster UniversitySchool of NursingShore RoadNewtownabbeyNorthern IrelandUKBT37 OQB
| | - Louise Rose
- Sunnybrook Health Sciences Centre and Sunnybrook Research InstituteDepartment of Critical Care MedicineTorontoCanada
| | - Katie N Dainty
- St. Michael's HospitalLi Ka Shing Knowledge InstituteTorontoONCanada
| | - Jane Noyes
- Bangor UniversityCentre for Health‐Related Research, Fron HeulogBangorWalesUKLL57 2EF
| | - Bronagh Blackwood
- Queen's University BelfastCentre for Experimental Medicine, School of Medicine, Dentistry and Biomedical SciencesWellcome‐Wolfson Building97 Lisburn RoadBelfastNorthern IrelandUKBT9 7LB
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Symes Y, Song L, Heineman RG, Barbosa BD, Tatum K, Greene G, Weaver M, Chen RC. Involvement in Decision Making and Satisfaction With Treatment Among Partners of Patients With Newly Diagnosed Localized Prostate Cancer. Oncol Nurs Forum 2016; 42:672-9. [PMID: 26488835 DOI: 10.1188/15.onf.672-679] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine partner involvement in treatment decision making for localized prostate cancer, congruence between partner involvement and patient preference, reasons for partner noninvolvement, and partner satisfaction with patient treatment
. DESIGN Cross-sectional exploratory study. SETTING 100 counties in North Carolina. SAMPLE 281 partners of men with newly diagnosed localized prostate cancer. METHODS Participants completed a phone survey. Logistic regression analyses were used. MAIN RESEARCH VARIABLES Partners' involvement in treatment decision making, partner satisfaction with treatment, activities of partner involvement, and reasons for noninvolvement. FINDINGS Of the 228 partners (81%) related to decision making, 205 (73%) were very satisfied with the treatment the patients received, and partner involvement was congruent with patient preference in 242 partners (86%). Partners reported several reasons for noninvolvement. CONCLUSIONS Most partners engaged in multiple activities during treatment decision making for localized prostate cancer and were satisfied with the patient's treatment. Partner involvement was mostly congruent with patient preference. IMPLICATIONS FOR NURSING Partners' active involvement in treatment decision making for localized prostate cancer (e.g., being involved in patients' conversations with doctors) should be encouraged and facilitated for those who prefer this type of decision making.
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Affiliation(s)
- Yael Symes
- University of North Carolina at Chapel Hill
| | - Lixin Song
- School of Nursing, University of North Carolina, Chapel Hill, NC
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Rivas C, Matheson L, Nayoan J, Glaser A, Gavin A, Wright P, Wagland R, Watson E. Ethnicity and the prostate cancer experience: a qualitative metasynthesis. Psychooncology 2016; 25:1147-1156. [PMID: 27416079 PMCID: PMC5096040 DOI: 10.1002/pon.4222] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 07/10/2016] [Accepted: 07/11/2016] [Indexed: 12/29/2022]
Abstract
Objectives To summarize black and minority ethnic (BME) patients' and partners experiences of prostate cancer by examining the findings of existing qualitative studies. Methods We undertook a systematic metasynthesis of qualitative studies using a modified version of Noblit and Hare's “meta‐ethnography” approach, with a 2000‐2015 search of 7 databases. Results Thirteen studies of men from US and UK BME groups were included. We explored constructs with BME‐specific features. Health care provider relationships, formation of a spiritual alliance with God (which enhanced the participants' feeling of empowerment and ability to cope with the cancer), and living on for others (generally to increase cancer awareness), often connected to spiritual regrowth, were the 3 constructs most commonly reported. A magnified effect from erectile dysfunction was also common. Initially, this affected men's disclosure to others about their cancer and their sexual problems, but eventually men responded by shifting their conceptualizations of masculinity to sustain self and social identities. There was also evidence of inequality resulting from financial constraints and adversity that necessitated resilience in coping. Conclusions The prostate cancer experience of BME men and their partners is affected by a complex intersection of ethnicity with other factors. Health care services should acknowledge this. If providers recognize the men's felt masculinities, social identities, and spiritual beliefs and their shifting nature, services could be improved, with community as well as individual benefits. More studies are needed in diverse ethnic groups.
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Affiliation(s)
- Carol Rivas
- Faculty of Health Sciences, University of Southampton, Southampton, UK.
| | - Lauren Matheson
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Johana Nayoan
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Adam Glaser
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Anna Gavin
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Penny Wright
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Richard Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Eila Watson
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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Jordan J, Rose L, Dainty KN, Noyes J, Blackwood B. Factors that impact on the use of mechanical ventilation weaning protocols in critically ill adults and children: a qualitative evidence-synthesis. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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McCaughan E, McKenna S, McSorley O, Parahoo K. The experience and perceptions of men with prostate cancer and their partners of the CONNECT psychosocial intervention: a qualitative exploration. J Adv Nurs 2015; 71:1871-82. [PMID: 25818026 DOI: 10.1111/jan.12648] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2015] [Indexed: 11/30/2022]
Abstract
AIM To explore the experience of prostate cancer survivors and their partners of the CONNECT psychosocial intervention. BACKGROUND There is a scarcity of evidence relating to interventions to help men and their partners cope with the after affects of prostate cancer treatment. DESIGN This study employed a qualitative design for in depth exploration through couple interviews. The addition of a short process evaluation questionnaire was used to supplement the qualitative data. METHODS Semi-structured interviews were conducted between January 2012-October 2012 with a purposive sample of 11 couple dyads who had participated in the CONNECT intervention. Data were analysed using inductive content analysis. Simple descriptive statistics were used to analyse the findings from the questionnaire data. RESULTS Couples perceived benefits of participating in the intervention to include: opportunities to share experiences, gain validation, obtain information and engage in couple care. The expertise of the professional facilitator and group dynamics were highlighted as factors influencing the success of the intervention. Potential areas for improvement of the intervention were identified as being: further development of the sexual dysfunction component; incorporation of a partner specific session to better address their needs; determination of optimal delivery format and timing; and further tailoring of the components of the intervention. CONCLUSION Although there were areas that could be further improved, this psychosocial intervention was valued by the participants. The insight gained from this qualitative exploration can be used to make the necessary changes before the intervention can be tested in a large randomised controlled trial.
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Affiliation(s)
- Eilis McCaughan
- Institute of Nursing and Health Research, University of Ulster, Coleraine, UK
| | - Suzanne McKenna
- Institute of Nursing and Health Research, University of Ulster, Coleraine, UK
| | - Oonagh McSorley
- Institute of Nursing and Health Research, University of Ulster, Coleraine, UK
| | - Kader Parahoo
- Institute of Nursing and Health Research, University of Ulster, Coleraine, UK
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Bobridge A, Bond MJ, Marshall V, Paterson J. An investigation of the support needs of men and partners throughout the prostate cancer journey. Psychooncology 2014; 24:341-7. [PMID: 25116753 DOI: 10.1002/pon.3655] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 07/23/2014] [Accepted: 07/26/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Prostate cancer is one of the mostly commonly diagnosed cancers in men. Unfortunately, the treatment for this cancer can have a number of negative side effects, both for the man himself and his partner. This study investigated the support needs of both men and partners throughout the prostate cancer journey and how this journey may be optimally managed. METHODS Thirty-one men who had undergone prostate cancer treatment within the last 6 years and 31 partners answered a questionnaire, which explored support care issues as identified in the literature and from focus groups. RESULTS Men and partners were moderately satisfied with information given regarding diagnosis, treatment and side effects, but partners were more satisfied with information relating to the particular chosen treatment. Men's understanding of their chosen treatment's potential side effects was significantly different from their understanding of diagnosis, cancer outcome, treatment options and selected treatment. Timing of information delivery was preferred by men at diagnosis, whereas partners preferred after the diagnosis. Men wanted more time to think about the diagnosis and treatment, whereas partners wanted an opportunity to discuss the diagnosis. The management of common side effects such as emotional changes, incontinence and erectile dysfunction was rated as 'somewhat' satisfactory. CONCLUSION Men and partners may have different educational and supportive needs throughout the prostate cancer journey that require attention and tailored management.
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Affiliation(s)
- A Bobridge
- School of Nursing and Midwifery, Flinders University & Repatriation General Hospital, South Australia, Australia
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Sher T, Braun L, Domas A, Bellg A, Baucom DH, Houle TT. The partners for life program: a couples approach to cardiac risk reduction. FAMILY PROCESS 2014; 53:131-49. [PMID: 24495204 PMCID: PMC3959575 DOI: 10.1111/famp.12061] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Morbidity and mortality are reliably lower for the married compared with the unmarried across a variety of illnesses. What is less well understood is how a couple uses their relationship for recommended lifestyle changes associated with decreased risk for illness. Partners for Life compared a patient and partner approach to behavior change with a patient only approach on such factors as exercise, nutrition, and medication adherence. Ninety-three patients and their spouses/partners consented to participate (26% of those eligible) and were randomized into either the individual or couples condition. However, only 80 couples, distributed across conditions, contributed data to the analyses, due to missing data and missing data points. For exercise, there was a significant effect of couples treatment on the increase in activity and a significant effect of couples treatment on the acceleration of treatment over time. In addition, there was an interaction between marital satisfaction and treatment condition such that patients who reported higher levels of marital distress in the individuals condition did not maintain their physical activity gains by the end of treatment, while both distressed and nondistressed patients in the couples treatment exhibited accelerating gains throughout treatment. In terms of medication adherence, patients in the couples treatment exhibited virtually no change in medication adherence over time, while patients in the individuals treatment showed a 9% relative decrease across time. There were no condition or time effects for nutritional outcomes. Finally, there was an interaction between baseline marital satisfaction and treatment condition such that patients in the individuals condition who reported lower levels of initial marital satisfaction showed deterioration in marital satisfaction, while non satisfied patients in the couples treatment showed improvement over time.
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Affiliation(s)
- Tamara Sher
- The Family Institute at Northwestern University, Evanston, IL
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Toye F, Seers K, Allcock N, Briggs M, Carr E, Andrews J, Barker K. A meta-ethnography of patients’ experience of chronic non-malignant musculoskeletal pain. HEALTH SERVICES AND DELIVERY RESEARCH 2013. [DOI: 10.3310/hsdr01120] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BackgroundThe alleviation of pain is a key aim of health care yet pain can often remain a puzzle as it is not always explained by a specific pathology. Musculoskeletal (MSK) pain is one of the most predominant kinds of chronic pain and its prevalence is increasing. One of the aims of qualitative research in health care is to understand the experience of illness, and make sense of the complex processes involved. However, the proliferation of qualitative studies can make it difficult to use this knowledge. There has been no attempt to systematically review and integrate the findings of qualitative research in order to increase our understanding of chronic MSK pain. A synthesis of qualitative research would help us to understand what it is like to have chronic MSK pain. Specifically, it would help us understand peoples' experience of health care with the aim of improving it.AimThe aim of this study was to increase our understanding of patients’ experience of chronic non-malignant MSK pain; utilise existing research knowledge to improve understanding and, thus, best practice in patient care; and contribute to the development of methods for qualitative research synthesis.MethodsWe used the methods of meta-ethnography, which aim to develop concepts that help us to understand a particular experience, by synthesising research findings. We searched six electronic bibliographic databases (including MEDLINE, EMBASE and PsycINFO) and included studies up until the final search in February 2012. We also hand-searched particular journals known to report qualitative studies and searched reference lists of all relevant qualitative studies for further potential studies. We appraised each study to decide whether or not to include it. The full texts of 321 potentially relevant studies were screened, of which 77 qualitative studies that explored adults’ experience of chronic non-malignant MSK pain were included. Twenty-eight of these studies explored the experience of fibromyalgia.ResultsOur findings revealed the new concept of an adversarial struggle that explains the experience of people with chronic MSK pain. This included the struggle to affirm self and construct self over time; find an explanation for pain; negotiate the health-care system while feeling compelled to stay in it; be valued and believed; and find the right balance between sick/well and hiding/showing pain. In spite of this struggle, our model showed that some people were able to move forward alongside their pain by listening to their body rather than fighting it; letting go of the old self and finding a new self; becoming part of a community and not feeling like the only one; telling others about pain and redefining relationships; realising that pain is here to stay rather than focusing on diagnosis and cure; and becoming the expert and making choices. We offer unique methodological innovations for meta-ethnography, which allowed us to develop a conceptual model that is grounded in 77 original studies. In particular, we describe a collaborative approach to interpreting the primary studies.ConclusionOur model helps us to understand the experience of people with chronic MSK pain as a constant adversarial struggle. This may distinguish it from other types of pain. This study opens up possibilities for therapies that aim to help a person to move forward alongside pain. Our findings call on us to challenge some of the cultural notions about illness, in particular the expectation of achieving a diagnosis and cure. Cultural expectations are deep-rooted and can deeply affect the experience of pain. We therefore should incorporate cultural categories into our understanding of pain. Not feeling believed can have an impact on a person’s participation in everyday life. The qualitative studies in this meta-ethnography revealed that people with chronic MSK pain still do not feel believed. This has clear implications for clinical practice. Our model suggests that central to the relationship between patient and practitioner is the recognition of the patient as a person whose life has been deeply changed by pain. Listening to a person’s narratives can help us to understand the impact of pain. Our model suggests that feeling valued is not simply an adjunct to the therapy, but central to it. Further conceptual syntheses would help us make qualitative research accessible to a wider relevant audience. Further primary qualitative research focusing on reconciling acceptance with moving forward with pain might help us to further understand the experience of pain. Our study highlights the need for research to explore educational strategies aimed at improving patients’ and clinicians’ experience of care.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- F Toye
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - K Seers
- Royal College of Nursing Research Institute, School of Health and Social Studies, University of Warwick, Warwick, UK
| | - N Allcock
- Faculty of Medicine and Health Sciences, School of Nursing, Midwifery and Physiotherapy, University of Nottingham, Nottingham, UK
| | - M Briggs
- Institute of Health and Wellbeing, Leeds Metropolitan University, Leeds, UK
| | - E Carr
- Faculty of Nursing, University of Calgary, Alberta, Canada
| | - J Andrews
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - K Barker
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Walker LM, Tran S, Wassersug RJ, Thomas B, Robinson JW. Patients and partners lack knowledge of androgen deprivation therapy side effects. Urol Oncol 2013; 31:1098-105. [DOI: 10.1016/j.urolonc.2011.12.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 11/23/2011] [Accepted: 12/20/2011] [Indexed: 10/14/2022]
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Ehrich K, Cowie L, Sandall J. Expect the unexpected: patients' and families' expectations and experiences of new clinical procedures. Health Expect 2013; 18:918-28. [PMID: 23614706 DOI: 10.1111/hex.12065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Early stage clinical innovation often occurs 'under the radar' of governance systems for established procedures. Previously impossible or unavailable techniques still being developed involve additional uncertainty and unknown risks and benefits compared with standard procedures. Patient and family expectations, perceptions and experiences of these new procedures and their possible impacts on aspects of patient safety are under-researched. OBJECTIVE To explore patient and family expectations and experiences of undergoing new clinical procedures. SETTING A large UK Hospital NHS Foundation Trust with a range of clinically innovative specialties. METHODS We interviewed 15 patients who received new clinical procedures in a variety of medical and surgical specialties. Qualitative interviews were used to facilitate in-depth exploration of patient and family views and experiences. Topics included patient and family access to and expectations of the procedure, informed decision making regarding acceptance of new procedures and post-procedure experiences. RESULTS Some patients sought out specific interventions, while others accepted new treatment options that clinicians proposed. Most participants reported that explanations about the procedure and risks were clear, and there were opportunities to ask questions prior to the procedure. Most participants also regarded their procedures as successful. However, post-procedure information follow-up was often reported as lacking and some outcomes were considerably problematic and raised patient safety issues. DISCUSSION The importance of patients' and family views in evaluating health care are increasingly recognized. We discuss the implications of our findings for informed decision making and post-intervention follow-up.
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Affiliation(s)
- Kathryn Ehrich
- Women's Health Academic Centre, King's College London, UK
| | - Luke Cowie
- Institute of Primary Care & Public Health, Cardiff University School of Medicine, Cardiff, UK
| | - Jane Sandall
- Women's Health, Division of Women's Health, King's College London, Women's Health Academic Centre, King's Health Partners, North Wing, St. Thomas' Hospital, London, UK
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Cook C, Fay S, Rockwood K. A meta-ethnography of paid dementia care workers' perspectives on their jobs. Can Geriatr J 2012; 15:127-36. [PMID: 23259026 PMCID: PMC3516355 DOI: 10.5770/cgj.15.37] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background While much work has been to evaluate paid workers’ perspectives on the care they provide dementia patients, there is no evidence of any systematic review of this topic. Methods We conducted a meta-ethnography of the topic “paid dementia care workers’ perspectives on their jobs.” Multiple databases were searched for qualitative work that reported on workers’ opinions and perspectives on their jobs in dementia care, including all settings and types of jobs. A final group of 34 articles were included, and their themes and constructs synthesized using a meta-ethnographic approach developed by Noblit and Hare. Results Five overarching themes uncovered: approach to care, education and training, emotional impact of the work, organizational factors, and relationships on the job. We also describe how the themes are related to each other. Conclusions Interplay of the theme areas shows the importance of dementia- specific education and training in terms of the approach to care and emotional impact of the work. Closing the gap between policy and practice is critical, but achieving this will require that attention be paid to dementia-specific education for all workers, including care leaders.
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Affiliation(s)
- Cheryl Cook
- Department of Medicine, Division of Geriatric Medicine, Dalhousie University/Capital District Health Authority, Halifax, NS
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Li C, Zeliadt SB, Hall IJ, Smith JL, Ekwueme DU, Moinpour CM, Penson DF, Thompson IM, Keane TE, Ramsey SD. Willingness to pay for prostate cancer treatment among patients and their family members at 1 year after diagnosis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2012; 15:716-23. [PMID: 22867781 DOI: 10.1016/j.jval.2012.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 02/06/2012] [Accepted: 03/01/2012] [Indexed: 05/12/2023]
Abstract
OBJECTIVES To explore an alternative approach to quantifying the burden of side effects at 1 year after treatment for prostate cancer among both patients and their partners. METHODS We analyzed data from 75 couples in the Family and Cancer Therapy Selection study. Paired patients and family members were independently asked about their willingness to pay (WTP) for a hypothetical new treatment that cures prostate cancer without side effects if they could reconsider their treatment decision by indicating the maximum amount they would be willing to pay given 11 separate "bids" ranging from $0 to $1500 per month. Descriptive and regression analyses were conducted for patients and family members controlling for sociodemographic characteristics and health status; Spearman correlations were also examined. RESULTS Among 75 couples analyzed, the income-adjusted mean WTP estimates per month were $400.8 (standard error [SE] $54.3) for patients and $650.2 (SE 72.2) for family members. The WTP between patients and family members was correlated (Pearson ρ 0.30; P = 0.01). After adjusting for covariates, the adjusted mean WTP per month was $588.1 (SE 65.77) for patients and $819.4 (SE 74.33) for family members. Wanting to avoid side effects at baseline predicted higher WTP for patients (P = 0.010). Experiencing sexual side effects was predictive of higher WTP for family members (P = 0.047). CONCLUSIONS Fairly high WTP amounts for a hypothetical treatment without side effects suggests that patients and their partners are experiencing important burdens 1 year after treatment. The higher amounts partners are willing to pay and the correlation with sexual side effects suggest that they are perceptive of significant treatment burdens.
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Affiliation(s)
- Chunyu Li
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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